The Marginal Cost of Frailty Among Medicare Patients on Hemodialysis.

Introduction:Dialysis patients incur disproportionately high costs compared with other Medicare beneficiaries. Care for frail individuals may be even more costly. We examined the extent to which frailty contributes to higher costs among dialysis patients. Methods:We used ACTIVE/ADIPOSE (A Cohort to Investigate the Value of Exercise/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESRD) enrollees (adult hemodialysis patients evaluated from June 2009 to August 2011) in a retrospective cohort analysis. Individuals using Medicare as the primary payer were included. Fried's frailty phenotype was evaluated at baseline, 12, and 24 months. Costs were derived from linkage with the US Renal Data System (USRDS) and Medicare claims data. We used generalized estimating equations (GEEs) incorporating time-updated frailty and costs to evaluate adjusted point estimates and the marginal cost associated with being frail. We also investigated if frail patients who died during the study incurred higher costs than those who survived. Results:Among 771 enrollees in ACTIVE/ADIPOSE, 425 met inclusion criteria. Mean age was 56 ± 13 years, body mass index (BMI) 29.2 ± 7.1 kg/m2, 42.4% were women, and 29.0% were frail at baseline. Over a mean follow-up of 2.3 years, frail individuals incurred 22% (95% confidence interval [CI] 9.6%-35.8%) higher costs compared with nonfrail individuals ($87,600 per patient per year [pppy], 95$71,800 pppy, 95% CI 64,800-79,600), the difference was driven primarily by higher inpatient expenditures. The difference between frail and nonfrail patients' inpatient expenditures was even more pronounced among those who died during the study compared with those who survived. Conclusions:Frail dialysis patients incur a significantly higher cost relative to their nonfrail counterparts, primarily driven by higher inpatient costs. Frail patients near end of life incur even higher costs

Membranoproliferative glomerulonephritis in patients with chronic venous catheters: a case report and literature review.

Chronic indwelling catheters have been reported to be associated with membranoproliferative glomerulonephritis (MPGN) via the activation of the classical complement pathway in association with bacterial infections such as coagulase negative staphylococcus. We herein provide supporting evidence for the direct causal relationship between chronic catheter infections and MPGN via a case of recurrent MPGN associated with recurrent catheter infections used for total parenteral nutrition (TPN) in a man with short gut syndrome. We also present a literature review of similar cases and identify common clinical manifestations that may serve to aid clinicians in the early identification of MPGN associated with infected central venous catheterization or vice versa. The importance of routine monitoring of kidney function and urinalysis among patients with chronic central venous catheterization is highlighted as kidney injury may herald or coincide with overtly infected chronic indwelling central venous catheters

A database management capability for Ada

The data requirements of mission critical defense systems have been increasing dramatically. Command and control, intelligence, logistics, and even weapons systems are being required to integrate, process, and share ever increasing volumes of information. To meet this need, systems are now being specified that incorporate data base management subsystems for handling storage and retrieval of information. It is expected that a large number of the next generation of mission critical systems will contain embedded data base management systems. Since the use of Ada has been mandated for most of these systems, it is important to address the issues of providing data base management capabilities that can be closely coupled with Ada. A comprehensive distributed data base management project has been investigated. The key deliverables of this project are three closely related prototype systems implemented in Ada. These three systems are discussed

Rewriting magnetic phase change memory by laser heating

Magnetic phase change memory (MAG PCM) consists of bits with different magnetic permeability values. The bits are read by measuring their effect on a magnetic probe field. Previously low permeability crystalline bits had been written in high permeability amorphous films of Metglas via laser heating. Here data is presented showing that by applying short laser pulses with the appropriate power to previously crystallized regions they can first be vitrified and then again crystallized. Thus, MAG PCM is rewriteable. Technical issues in processing the bits are discussed and results on thermal modeling are presented

Divergent Exercise Outcomes of Self-Objectification in Young Adults

Self-objectification occurs through the internalization of unrealistic social standards of attractiveness which leads to excessive valuing of one’s physical features over functionality. Previous studies have associated self-objectification with a host of negative consequences including two opposing exercise-related outcomes, public exercise avoidance and exercise dependence. The main purpose of the present study was to examine whether social appearance anxiety and upward appearance comparison were the underlying mechanisms that explained the relationship between self-objectification and public exercise avoidance and exercise dependence, respectively. In addition, I wanted to explore if loneliness had a moderating effect on the path from self-objectification and these variables. Previous literature associated salient exercise-related factors – exercise participation, exercise location, presence of exercise partner, exercise frequency and duration, and motivation for exercise – with the variables of interest stated above and warranted further investigation. Therefore, the current study was divided into two major parts. The first focused on determining significant differences on mean self-objectification, loneliness, social appearance anxiety, upward appearance comparison, public exercise avoidance, and exercise dependence scores across exercise-related factors through ANCOVAs. The second tested two moderated mediation models whereby social appearance anxiety mediated the relationship between self-objectification and public exercise avoidance and upward appearance comparison mediated the relationship between self-objectification and exercise dependence with loneliness as a moderator. The models were analyzed via the PROCESS macro (Hayes, 2018) in SPSS version 27. Gender and body mass index (BMI) were used as covariates in all analyses. Three hundred eligible participants, 72 men (age = 20.57, SD = 3.13) and 229 women (age = 19.54, SD = 2.24), were recruited to answer an online survey. Results demonstrated that individuals not currently exercising, in general, reported greater negative outcomes related to self-objectification, loneliness, social appearance anxiety, and public exercise avoidance. Other significant differences were elaborated upon in the study. In addition, loneliness was not a significant moderator in the models. However, social appearance anxiety and upward appearance comparison fully mediated the relationship between self-objectification and public exercise avoidance and exercise dependence, respectively. These findings identified key mechanisms that predict unhealthy exercise behavior in self-objectified young adults and can inform intervention efforts

Research support of the WETNET Program

This study examines various aspects of the Microwave Vegetation Index (MVI). MVI is a derived signal created by differencing the spectral response of the 37 GHz horizontally and vertically polarized passive microwave signals. The microwave signal employed to derive this index is thought to be primarily influenced by vegetation structure, vegetation growth, standing water, and precipitation. The state of California is the study site for this research. Imagery from the Special Sensor Microwave/Imager (SSM/I) is used for the creation of MVI datasets analyzed in this research. The object of this research is to determine whether MVI corresponds with some quantifiable vegetation parameter (such as vegetation density) or whether the index is more affected by known biogeophysical parameters such antecedent precipitation. A secondary question associated with the above is whether the vegetation attributes that MVI is employed to determine can be more easily and accurately evaluated by other remote sensing means. An important associated question to be addressed in the study is the effect of different multi-temporal composting techniques on the derived MVI dataset. This work advances our understanding of the fundamental nature of MVI by studying vegetation as a mixture of structural types, such as forest and grassland. The study further advances our understanding by creating multitemporal precipitation datasets to compare the affects of precipitation upon MVI. This work will help to lay the groundwork for the use of passive microwave spectral information either as an adjunct to visible and near infrared imagery in areas where that is feasible or for the use of passive microwave alone in areas of moderate cloud coverage. In this research, an MVI dataset, spanning the period February 15, 1989 through April 25, 1990, has been created using National Aeronautic and Space Administration (NASA) supplied brightness temperature data. Information from the DMSP satellite 37 GHz wavelength SSM/I sensor in both horizontal and vertical polarization has been processed using the MVI algorithm. In conjunction with the MVI algorithm a multitemporal compositing technique was used to create datasets that correspond to 14 day periods. In this technical report, Section Two contains background information on the State of California and the three MVI study sites. Section Three describes the methods used to create the MVI and independent variables datasets. Section Four presents the results of the experiment. Section Five summarizes and concludes the work

Novel lung imaging biomarkers and skin gene expression subsetting in dasatinib treatment of systemic sclerosis-associated interstitial lung disease.

BackgroundThere are no effective treatments or validated clinical response markers in systemic sclerosis (SSc). We assessed imaging biomarkers and performed gene expression profiling in a single-arm open-label clinical trial of tyrosine kinase inhibitor dasatinib in patients with SSc-associated interstitial lung disease (SSc-ILD).MethodsPrimary objectives were safety and pharmacokinetics. Secondary outcomes included clinical assessments, quantitative high-resolution computed tomography (HRCT) of the chest, serum biomarker assays and skin biopsy-based gene expression subset assignments. Clinical response was defined as decrease of >5 or >20% from baseline in the modified Rodnan Skin Score (MRSS). Pulmonary function was assessed at baseline and day 169.ResultsDasatinib was well-tolerated in 31 patients receiving drug for a median of nine months. No significant changes in clinical assessments or serum biomarkers were seen at six months. By quantitative HRCT, 65% of patients showed no progression of lung fibrosis, and 39% showed no progression of total ILD. Among 12 subjects with available baseline and post-treatment skin biopsies, three were improvers and nine were non-improvers. Improvers mapped to the fibroproliferative or normal-like subsets, while seven out of nine non-improvers were in the inflammatory subset (p = 0.0455). Improvers showed stability in forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), while both measures showed a decline in non-improvers (p = 0.1289 and p = 0.0195, respectively). Inflammatory gene expression subset was associated with higher baseline HRCT score (p = 0.0556). Non-improvers showed significant increase in lung fibrosis (p = 0.0313).ConclusionsIn patients with SSc-ILD dasatinib treatment was associated with acceptable safety profile but no significant clinical efficacy. Patients in the inflammatory gene expression subset showed increase in skin fibrosis, decreasing pulmonary function and worsening lung fibrosis during the study. These findings suggest that target tissue-specific gene expression analyses can help match patients and therapeutic interventions in heterogeneous diseases such as SSc, and quantitative HRCT is useful for assessing clinical outcomes.Trial registrationClinicaltrials.gov NCT00764309