The Y-Band at 1.035 um: Photometric Calibration and the Dwarf Stellar/Sub-Stellar Color Sequence

We define and characterize a photometric bandpass (called "Y") that is centered at 1.035 um, in between the traditionally classified ``optical'' and ``infrared'' spectral regimes. We present Y magnitudes and Y-H and Y-K colors for a sample consisting mostly of photometric and spectral standards, spanning the spectral type range sdO to T5V. Deep molecular absorption features in the near-infrared spectra of extremely cool objects are such that the Y-H and Y-K colors grow rapidly with advancing spectral type especially from late M through mid L, substantially more rapidly than J-H or H-K which span a smaller total dynamic range. Consistent with other near-infrared colors, however, Y-H and Y-K colors turn blueward in the L6-L8 temperature range with later T-type objects having colors similar to those of warmer M and L stars. Use of the Y-band filter is nonetheless promising for easy identification of low-mass stars and brown dwarfs, especially at young ages. The slope of the interstellar reddening vector within this filter is A_Y = 0.38 x A_V. Reddening moves stars nearly along the YHK dwarf color sequence making it more difficult to distinguish unambiguously very low mass candidate brown dwarf objects from higher mass stars seen, e.g. through the galactic plane or towards star-forming regions. Other diagrams involving the Y-band may be somewhat more discriminating.Comment: accepted at PAS

Unsupervised machine learning of integrated health and social care data from the Macmillan Improving the Cancer Journey service in Glasgow

Background: Improving the Cancer Journey (ICJ) was launched in 2014 by Glasgow City Council and Macmillan Cancer Support. As part of routine service, data is collected on ICJ users including demographic and health information, results from holistic needs assessments and quality of life scores as measured by EQ-5D health status. There is also data on the number and type of referrals made and feedback from users on the overall service. By applying artificial intelligence and interactive visualization technologies to this data, we seek to improve service provision and optimize resource allocation.Method: An unsupervised machine-learning algorithm was deployed to cluster the data. The classical k-means algorithm was extended with the k-modes technique for categorical data, and the gap heuristic automatically identified the number of clusters. The resulting clusters are used to summarize complex data sets and produce three-dimensional visualizations of the data landscape. Furthermore, the traits of new ICJ clients are predicted by approximately matching their details to the nearest existing cluster center.Results: Cross-validation showed the model’s effectiveness over a wide range of traits. For example, the model can predict marital status, employment status and housing type with an accuracy between 2.4 to 4.8 times greater than random selection. One of the most interesting preliminary findings is that area deprivation (measured through Scottish Index of Multiple Deprivation-SIMD) is a better predictor of an ICJ client’s needs than primary diagnosis (cancer type).Conclusion: A key strength of this system is its ability to rapidly ingest new data on its own and derive new predictions from those data. This means the model can guide service provision by forecasting demand based on actual or hypothesized data. The aim is to provide intelligent person-centered recommendations. The machine-learning model described here is part of a prototype software tool currently under development for use by the cancer support community.Disclosure: Funded by Macmillan Cancer Support</p

Randomised double blind placebo controlled trial investigating the effect of calcium and vitamin D supplementation on bone mineral density and bone metabolism in adult patients with cystic fibrosis

AbstractBackgroundLow bone mineral density (BMD) is prevalent in adults with cystic fibrosis and might be related to calcium and vitamin D malabsorption from the gastrointestinal tract. The aim of this study was to investigate the effect of calcium and vitamin D supplementation on BMD and bone metabolism in these subjects.MethodsPatients were invited to participate if they had a BMD Z score of −1 or less in the lumbar spine, proximal femur or distal forearm. Patients were randomised to receive calcium 1 g+vitamin D 800 IU or placebo daily, in addition to their regular vitamin D supplements (900 IU/day). BMD and bone biochemical markers were measured before and after 1 year of treatment.ResultsAfter 12 months, the treatment group (n=15) showed a reduced rate of bone loss compared with the control group (n=15) in the lumbar spine (mean difference 1.9% [CI −0.9% to 4.6%]), total hip (mean difference 0.7% [CI −2.2% to 3.5%]) and distal forearm (mean difference 1.7% [CI −2.2% to 5.5%]), but these changes did not reach statistical significance. There was also a trend towards a reduction in bone turnover in the treatment group.ConclusionsCalcium and vitamin D supplementation reduced the rate of bone turnover and bone loss in adult patients with cystic fibrosis, but these changes did not reach statistical significance. These data suggest that a longer term trial of this simple intervention would be justified

Proteomic profiling of urinary proteins in renal cancer by surface enhanced laser desorption ionisation (SELDI) and neural-network analysis: Identification of key issues affecting potential clinical utility.

Recent advances in proteomic profiling technologies, such as surface enhanced laser desorption ionization mass spectrometry, have allowed preliminary profiling and identification of tumor markers in biological fluids in several cancer types and establishment of clinically useful diagnostic computational models. There are currently no routinely used circulating tumor markers for renal cancer, which is often detected incidentally and is frequently advanced at the time of presentation with over half of patients having local or distant tumor spread. We have investigated the clinical utility of surface enhanced laser desorption ionization profiling of urine samples in conjunction with neural-network analysis to either detect renal cancer or to identify proteins of potential use as markers, using samples from a total of 218 individuals, and examined critical technical factors affecting the potential utility of this approach. Samples from patients before undergoing nephrectomy for clear cell renal cell carcinoma (RCC; n 48), normal volunteers (n 38), and outpatients attending with benign diseases of the urogenital tract (n 20) were used to successfully train neural-network models based on either presence/absence of peaks or peak intensity values, resulting in sensitivity and specificity values of 98.3–100%. Using an initial “blind” group of samples from 12 patients with RCC, 11 healthy controls, and 9 patients with benign diseases to test the models, sensitivities and specificities of 81.8–83.3% were achieved. The robustness of the approach was subsequently evaluated with a group of 80 samples analyzed “blind” 10 months later, (36 patients with RCC, 31 healthy volunteers, and 13 patients with benign urological conditions). However, sensitivities and specificities declined markedly, ranging from 41.0% to 76.6%. Possible contributing factors including sample stability, changing laser performance, and chip variability were examined, which may be important for the long-term robustness of such approaches, and this study highlights the need for rigorous evaluation of such factors in future studies

Denosumab, raloxifene, romosozumab and teriparatide to prevent osteoporotic fragility fractures: a systematic review and economic evaluation

Background Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture. Objectives The objectives were to evaluate the clinical effectiveness, safety and cost-effectiveness of non-bisphosphonates {denosumab [Prolia®; Amgen Inc., Thousand Oaks, CA, USA], raloxifene [Evista®; Daiichi Sankyo Company, Ltd, Tokyo, Japan], romosozumab [Evenity®; Union Chimique Belge (UCB) S.A. (Brussels, Belgium) and Amgen Inc.] and teriparatide [Forsteo®; Eli Lilly and Company, Indianapolis, IN, USA]}, compared with each other, bisphosphonates or no treatment, for the prevention of fragility fracture. Data sources For the clinical effectiveness review, nine electronic databases (including MEDLINE, EMBASE and the World Health Organization International Clinical Trials Registry Platform) were searched up to July 2018. Review methods A systematic review and network meta-analysis of fracture and femoral neck bone mineral density were conducted. A review of published economic analyses was undertaken and a model previously used to evaluate bisphosphonates was adapted. Discrete event simulation was used to estimate lifetime costs and quality-adjusted life-years for a simulated cohort of patients with heterogeneous characteristics. This was done for each non-bisphosphonate treatment, a strategy of no treatment, and the five bisphosphonate treatments previously evaluated. The model was populated with effectiveness evidence from the systematic review and network meta-analysis. All other parameters were estimated from published sources. An NHS and Personal Social Services perspective was taken, and costs and benefits were discounted at 3.5% per annum. Fracture risk was estimated from patient characteristics using the QFracture® (QFracture-2012 open source revision 38, Clinrisk Ltd, Leeds, UK) and FRAX® (web version 3.9, University of Sheffield, Sheffield, UK) tools. The relationship between fracture risk and incremental net monetary benefit was estimated using non-parametric regression. A probabilistic sensitivity analysis and scenario analyses were used to assess uncertainty. Results Fifty-two randomised controlled trials of non-bisphosphonates were included in the clinical effectiveness systematic review and an additional 51 randomised controlled trials of bisphosphonates were included in the network meta-analysis. All treatments had beneficial effects compared with placebo for vertebral, non-vertebral and hip fractures, with hazard ratios varying from 0.23 to 0.94, depending on treatment and fracture type. The effects on vertebral fractures and the percentage change in bone mineral density were statistically significant for all treatments. The rate of serious adverse events varied across trials (0–33%), with most between-group differences not being statistically significant for comparisons with placebo/no active treatment, non-bisphosphonates or bisphosphonates. The incremental cost-effectiveness ratios were > £20,000 per quality-adjusted life-year for all non-bisphosphonate interventions compared with no treatment across the range of QFracture and FRAX scores expected in the population eligible for fracture risk assessment. The incremental cost-effectiveness ratio for denosumab may fall below £30,000 per quality-adjusted life-year at very high levels of risk or for high-risk patients with specific characteristics. Raloxifene was dominated by no treatment (resulted in fewer quality-adjusted life-years) in most risk categories. Limitations The incremental cost-effectiveness ratios are uncertain for very high-risk patients. Conclusions Non-bisphosphonates are effective in preventing fragility fractures, but the incremental cost-effectiveness ratios are generally greater than the commonly applied threshold of £20,000–30,000 per quality-adjusted life-year. Study registration This study is registered as PROSPERO CRD42018107651. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 29. See the NIHR Journals Library website for further project information

An Exploration of Successful Psychosocial Adjustment to Long-Term In-Centre Haemodialysis

Objectives: Haemodialysis extends life for people with end-stage kidney disease (ESKD) worldwide, but it imposes significant psychosocial burdens and there is little evidence about successful adjustment. This study aimed to improve understanding of successful psychosocial adjustment to in-centre haemodialysis (ICHD; dialysis in a hospital or satellite unit). Methods: Individual semi-structured interviews were conducted with a purposive sample of 18 people with ESKD who had all received in-centre haemodialysis in the UK for at least 90 days in the last two years. An inductive thematic analysis was employed to identify themes from the verbatim interview transcripts. Results: There were four themes: 1) reaching a state of acceptance, which described the importance of accepting the necessity of dialysis; 2) taking an active role in treatment, which described how being actively involved in treatment gave participants greater feelings of autonomy and control; 3) utilising social support networks, which described the benefits of instrumental and emotional support; and 4) building emotional resilience, which described the importance of optimism and positivity. Conclusions: The themes demonstrated elements of successful adjustment that could be targeted by interventions to promote psychological flexibility and positive adjustment among people receiving in-centre haemodialysis worldwide

Feasibility of community-based control of tsetse: A pilot project using Tiny Targets in the Democratic Republic of Congo

Gambianse Human African Trypanosomiasis (g-HAT) is a neglected tropical disease caused by trypanosomes transmitted by tsetse flies. 70%Most (>80%) of the cases in 2019 (604/863) occur in the Democratic Republic of Congo (DRC). and Thea national programme for g-HAT to eliminatione HAT in DRC includes athe large-scale deployment of Tiny Targets which attract and kill tsetse. This intervention is directed by vector-control specialists with small teams, moving in canoes, deploying Tiny Targets along riverbanks where tsetse concentrate. While the targets are deployed in communal areas, and the method is cheap and easy-to-use, local people have little involvement. This study aimed to evaluate if a community-led vector control programme was feasible in the context of DRC’s g-HAT elimination programme

Tectono-metallogenetic evolution of the Fe–Cu deposit of Dominga, northern Chile

The Dominga district in northern Chile (2082 Mt at 23.3 % Fe, 0.07 % Cu) shows a spatial and genetic affinity among distinctive structural elements and Fe–Cu-rich paragenetic mineral assemblages. Deep seated, NE-to-E striking structural elements form a right-lateral duplex-like structural system (early structural system, ESS) that cuts a regionally extensive alteration (stage I) zone. The EES system served as a locus and as path for the emplacement of biotite–magnetite alteration/mineralization (stage IIa) as veins and Fe-bearing layers following altered volcano sedimentary strata. NW-striking actinolite–magnetite hydrothermal breccias, coeval with and part of the ESS, include apatite (stage IIb) crystallized at 127 ± 15 Ma (U–Pb, 2σ). The ESS was also the locus of subsequent alteration/mineralization represented by K-feldspar, epidote, and albite (stage IIIa) and Fe–Cu-rich (vermiculite–anhydrite–chalcopyrite, stage IIIb) mineral associations. Shallowly developed, NNE-striking, left-lateral structural elements defining the El Tofo Structural System (ETSS)—probably part of the Atacama Fault System—clearly crosscut the ESS. Minerals associated with alteration/mineralization stage IIIb also occur as veins and as part of hydrothermal breccias of the ETSS, marking the transition from the ESS to ETSS. Molybdenite associated with alteration/mineralization stage IIIb yielded a Re–Os age of 127.1 ± 0.7 Ma (2σ). Both the ESS and ETSS were cut by left-lateral, NW- to E-striking shallowly developed structural elements (Intermediate Structural System, ISS) on which a hematite–calcite assemblage (stage IV) occurs mostly as infill material of veins and fault veins. The ISS is cut by N-striking, left-lateral, and shallowly developed structural elements (Late Structural System, LSS) showing no evidence of alteration/mineralization. Estimated strain and stress fields indicate an overall NW-trending shortening/compression and NE-trending stretching/tension strike-slip regime probably due to oblique subduction during the Mesozoic. However, the orientations of the stress and strain fields calculated for each structural system suggest a back-and-forth rotation pattern during transition from one structural system to the other—as they change between transtension and transpression—and between alteration/mineralization stages