ACA-Mandated Elimination of Cost Sharing for Preventive Screening has had Limited Early Impact

Did the Affordable Care Act’s elimination of cost sharing for preventive services increase rates of colonoscopy and mammography screening? Early results say no

The desolation of Smaug : the human-driven decline of the Sungazer lizard (Smaug giganteus)

The Sungazer (Smaug giganteus) is a threatened lizard species endemic to the Highveld grasslands of South Africa. The species faces risks from habitat loss and fragmentation, and illegal harvesting for traditional medicine and the pet trade. Despite these threats, the current conservation status of the species was poorly validated. We visited 79 Sungazer populations recorded in 1978 to assess population change since the initial surveys, and surveyed an additional 164 sites to better define the distribution and estimate the current population size. We interrogated all known historical trade data of the species. One-third of Sungazer populations have been extirpated over the past 37 years. The distribution includes two allopatric populations, with the smaller Mpumalanga population experiencing a significantly higher decline. The species has an extent of occurrence (EOO) of 34 500 km2, and an area of occupancy (AOO) of 1149 km2. The interpreted distribution is 17 978 km2, and just under 60% remains untransformed grassland. We estimate a population size of 677 000 mature individuals, down 48% from the estimated historical population, prior to commercial agricultural development. A total of 1194 live Sungazers were exported under permit from South Africa between 1985 and 2014, with a significant increase in numbers exported over the last decade. Without any evidence of captive breeding, we believe that these animals are all wild-caught. Based on the AOO, level of decline, fragmentation within the distribution and suspected level of exploitation, we recommend classification of the species as Vulnerable under IUCN Red List Criteria A2acd and B2ab(ii–v). The establishment of a protected area network, genetic research and further investigations into the pet and traditional medicine trades are urgently needed.The Rufford Foundation (grant number 10843-1), SANBI’s Threatened Species Programme, National Research Foundation, Endangered Wildlife Trust, University of the Witwatersrand, The Alexander Herp Lab and Tshwane University of Technology provided funding, equipment and vehicles to S.P. for this project.http://www.elsevier.de/jnc2018-04-30Genetic

Unlocking the diagnostic power of plasma extracellular vesicle miR-200 family in pancreatic ductal adenocarcinoma

Background: Distinguishing benign from malignant pancreaticobiliary disease is challenging because of the absence of reliable biomarkers. Circulating extracellular vesicles (EVs) have emerged as functional mediators between cells. Their cargos, including microRNAs (miRNAs), are increasingly acknowledged as an important source of potential biomarkers. This multicentric, prospective study aimed to establish a diagnostic plasma EV-derived miRNA signature to discriminate pancreatic ductal adenocarcinoma (PDAC) from benign pancreaticobiliary disease. Methods: Plasma EVs were isolated using size exclusion chromatography (SEC) and characterised using nanoparticle tracking analysis, electron microscopy and Western blotting. EV-RNAs underwent small RNA sequencing to discover differentially expressed markers for PDAC (n = 10 benign vs. 10 PDAC). Candidate EV-miRNAs were then validated in a cohort of 61 patients (n = 31 benign vs. 30 PDAC) by RT-qPCR. Logistic regression and optimal thresholds (Youden Index) were used to develop an EV-miR-200 family model to detect cancer. This model was tested in an independent cohort of 95 patients (n = 30 benign, 33 PDAC, and 32 cholangiocarcinoma). Results: Small RNA sequencing and RT-qPCR showed that EV-miR-200 family members were significantly overexpressed in PDAC vs. benign disease. Combined expression of the EV-miR-200 family showed an AUC of 0.823. In an independent validation cohort, application of this model showed a sensitivity, specificity and AUC of 100%, 88%, and 0.97, respectively, for diagnosing PDAC. Conclusions: This is the first study to validate plasma EV-miR-200 members as a clinically-useful diagnostic biomarker for PDAC. Further validation in larger cohorts and clinical trials is essential. These findings also suggest the potential utility in monitoring response and/or recurrence. Graphical Abstract

Prospective Monitoring Reveals Dynamic Levels of T Cell Immunity to Mycobacterium Tuberculosis in HIV Infected Individuals

Monitoring of latent Mycobacterium tuberculosis infection may prevent disease. We tested an ESAT-6 and CFP-10-specific IFN-γ Elispot assay (RD1-Elispot) on 163 HIV-infected individuals living in a TB-endemic setting. An RD1-Elispot was performed every 3 months for a period of 3–21 months. 62% of RD1-Elispot negative individuals were positive by cultured Elispot. Fluctuations in T cell response were observed with rates of change ranging from −150 to +153 spot-forming cells (SFC)/200,000 PBMC in a 3-month period. To validate these responses we used an RD1-specific real time quantitative PCR assay for monokine-induced by IFN-γ (MIG) and IFN-γ inducible protein-10 (IP10) (MIG: r = 0.6527, p = 0.0114; IP-10: r = 0.6967, p = 0.0056; IP-10+MIG: r = 0.7055, p = 0.0048). During follow-up 30 individuals were placed on ARVs and 4 progressed to active TB. Fluctuations in SFC did not correlate with CD4 count, viral load, treatment initiation, or progression to active TB. The RD1-Elispot appears to have limited value in this setting

Does Humeral Component Version Affect Range of Motion and Clinical Outcomes in Reverse Total Shoulder Arthroplasty? A Systematic Review

Background: Prosthesis selection, design, and placement in reverse total shoulder arthroplasty (RTSA) affect post-operative results. The aim of this systematic review was to evaluate the influence of the humeral stem version and prosthesis design (inlay vs. onlay) on shoulder function following RTSA. Methods: A systematic review of the literature on post-operative range of motion (ROM) and functional scores following RTSA with specifically known humeral stem implantations was performed using MEDLINE, Pubmed, and Embase databases, and the Cochrane Library. Functional scores included were Constant scores (CSs) and/or American Shoulder and Elbow Surgeons (ASES) scores. The patients were organised into three separate groups based on the implanted version of their humeral stem: (1) less than 20° of retroversion, (2) 20° of retroversion, and (3) greater than 20° of retroversion. Results: Data from 14 studies and a total of 1221 shoulders were eligible for analysis. Patients with a humeral stem implanted at 20° of retroversion had similar post-operative mean ASES (75.8 points) and absolute CS (68.1 points) compared to the group with humeral stems implanted at less than 20° of retroversion (76 points and 62.5 points; p = 0.956 and p = 0.153) and those implanted at more than 20° of retroversion (73.3 points; p = 0.682). Subjects with humeral stem retroversion at greater than 20° tended towards greater active forward elevation and external rotation compared with the group at 20° of retroversion (p = 0.462) and those with less than 20° of retroversion (p = 0.192). Patients with an onlay-type RTSA showed statistically significantly higher mean post-operative internal rotation compared to patients with inlay-type RTSA designs (p = 0.048). Other functional scores and forward elevation results favoured the onlay-types, but greater external rotation was seen in inlay-type RTSA designs (p = 0.382). Conclusions: Humeral stem implantation in RTSA at 20° of retroversion and greater appears to be associated with higher post-operative outcome scores and a greater range of motion when compared with a retroversion of less than 20°. Within these studies, onlay-type RTSA designs were associated with greater forward elevation but less external rotation when compared to inlay-type designs. However, none of the differences in outcome scores and range of motion between the humeral version groups were statistically significant

A Highly Linear Dual Stage Amplifier with Beyond 1.75 THz Gain-Bandwidth-Product

This work reports a multi-purpose highly linear ultra-wideband amplifier with a gain bandwidth product (GBP) of 1.75 THz, the highest reported in any MMIC process. A transimpedance amplifier is cascaded with a distributed amplifier, emulating a receiver subsystem. Using a diamond heat spreader, to dissipate heat from transistors, the cascaded amplification subsystem can achieve very high OIP3 from 20 to 24 dBm when measured between 5 to 65 GHz. A small signal average gain of 24 dB is observed over a frequency range exceeding the maximum measurable bandwidth from DC to 110 GHz. Compared with other ultra-wideband MMIC amplifiers beyond 110 GHz bandwidth, the circuit offers a unique combination of high linearity (OIP3) and high gain. As a result, the cascaded amplifier is suitable for applications in optical-electrical converters, spectroscopy and ultrawideband measurement systems in the sub-THz frequency range