Low density lipoprotein cholesterol control status among Canadians at risk for cardiovascular disease: findings from the Canadian Primary Care Sentinel Surveillance Network Database

Background To determine the prevalence of uncontrolled LDL-C in patients with high cardiovascular disease (CVD) risks across Canada and to examine its related factors. Methods Non-pregnant adults >20 years-old, who had a lipid test completed between January 1, 2009 and December 31, 2011 and were included in the Canadian Primary Care Surveillance Network (CPCSSN) database were studied. The Framingham-Risk-Score was calculated to determine the risk levels. A serum LDL-C level of >2.0 mmol/L was considered as being poorly controlled. Patients with a previous record of a cerebrovascular accident, peripheral artery disease, or an ischemic heart disease were regarded as those under secondary prevention. Logistic regression modeling was performed to examine the factors associated with the LDL-C control. Results A total of 6,405 high-risk patients were included in the study and, of this population, 68 % had a suboptimal LDL-C, which was significantly associated with the female gender (OR: 3.26; 95 % CI: 2.63–4.05, p < 0.0001) and no medication therapy (OR: 6.31, 95 % CI: 5.21–7.65, p < 0.0001). Those with comorbidities of diabetes, hypertension, obesity, and smokers had a better LDL-C control. Rural residents (OR: 0.64, 95 % CI: 0.52–0.78, p < 0.0001), and those under secondary prevention (OR: 0.42; 95 % CI: 0.35–0.51, p < 0.0001), were also more likely to have a better LDL-C control. Conclusion A high proportion of high-cardiac risk patients in Canadian primary care settings have suboptimal LDL-C control. A lack of medication therapy appears to be the major contributing factor to this situation

Effects of Changing Climate Extremes and Vegetation Phenology on Wildlife Associated with Grasslands in the Southwestern United States

Assessments of the potential responses of animal species to climate change often rely on correlations between long-term average temperature or precipitation and species\u27 occurrence or abundance. Such assessments do not account for the potential predictive capacity of either climate extremes and variability or the indirect effects of climate as mediated by plant phenology. By contrast, we projected responses of wildlife in desert grasslands of the southwestern United States to future climate means, extremes, and variability and changes in the timing and magnitude of primary productivity. We used historical climate data and remotely sensed phenology metrics to develop predictive models of climate-phenology relations and to project phenology given anticipated future climate. We used wildlife survey data to develop models of wildlife-climate and wildlife-phenology relations. Then, on the basis of the modeled relations between climate and phenology variables, and expectations of future climate change, we projected the occurrence or density of four species of management interest associated with these grasslands: Gambel\u27s Quail (Callipepla gambelii), Scaled Quail (Callipepla squamat), Gunnison\u27s prairie dog (Cynomys gunnisoni), and American pronghorn (Antilocapra americana). Our results illustrated that climate extremes and plant phenology may contribute more to projecting wildlife responses to climate change than climate means. Monthly climate extremes and phenology variables were influential predictors of population measures of all four species. For three species, models that included climate extremes as predictors outperformed models that did not include extremes. The most important predictors, and months in which the predictors were most relevant to wildlife occurrence or density, varied among species. Our results highlighted that spatial and temporal variability in climate, phenology, and population measures may limit the utility of climate averages-based bioclimatic niche models for informing wildlife management actions, and may suggest priorities for sustained data collection and continued analysis

Measurement of Cosmic-ray Electrons at TeV Energies by VERITAS

Cosmic-ray electrons and positrons (CREs) at GeV-TeV energies are a unique probe of our local Galactic neighborhood. CREs lose energy rapidly via synchrotron radiation and inverse-Compton scattering processes while propagating within the Galaxy and these losses limit their propagation distance. For electrons with TeV energies, the limit is on the order of a kiloparsec. Within that distance there are only a few known astrophysical objects capable of accelerating electrons to such high energies. It is also possible that the CREs are the products of the annihilation or decay of heavy dark matter (DM) particles. VERITAS, an array of imaging air Cherenkov telescopes in southern Arizona, USA, is primarily utilized for gamma-ray astronomy, but also simultaneously collects CREs during all observations. We describe our methods of identifying CREs in VERITAS data and present an energy spectrum, extending from 300 GeV to 5 TeV, obtained from approximately 300 hours of observations. A single power-law fit is ruled out in VERITAS data. We find that the spectrum of CREs is consistent with a broken power law, with a break energy at 710 $\pm$ 40$_{stat}$ $\pm$ 140$_{syst}$ GeV.Comment: 17 pages, 2 figures, accepted for publication in PR

Signaling in Secret: Pay-for-Performance and the Incentive and Sorting Effects of Pay Secrecy

Key Findings: Pay secrecy adversely impacts individual task performance because it weakens the perception that an increase in performance will be accompanied by increase in pay; Pay secrecy is associated with a decrease in employee performance and retention in pay-for-performance systems, which measure performance using relative (i.e., peer-ranked) criteria rather than an absolute scale (see Figure 2 on page 5); High performing employees tend to be most sensitive to negative pay-for- performance perceptions; There are many signals embedded within HR policies and practices, which can influence employees’ perception of workplace uncertainty/inequity and impact their performance and turnover intentions; and When pay transparency is impractical, organizations may benefit from introducing partial pay openness to mitigate these effects on employee performance and retention

Culture and Subjectivity in Neoliberal and postfeminist times

My aim in this paper is to think through a number of issues concerning the relationship between culture and subjectivity. It seems to me that exploring the relationship of changing forms of political organisation, social relations and cultural practices to changing modes and experiences of subjecthood and subjectivity are among the most important and urgent tasks for critical intellectual work. These questions go to the heart of understanding power, ideology and agency and they require research that is interdisciplinary, psychosocial and intersectional. My particular focus in this short article is on the interrelations between changing representational practices in visual culture and changing subjectivity/ies. I argue that neoliberalism and postfeminism are central to understanding contemporary media culture, and I put the case for research which does not retreat from exploring how these broader social/political/economic/cultural discourses and formations may relate to subjectivity

Empowerment/sexism: Figuring female sexual agency in contemporary advertising

This paper argues that there has been a significant shift in advertising representations of women in recent years, such that rather than being presented as passive objects of the male gaze, young women in adverts are now frequently depicted as active, independent and sexually powerful. This analysis examines contemporary constructions of female sexual agency in advertisements examining three recognizable ‘figures’: the young, heterosexually desiring ‘midriff’, the vengeful woman set on punishing her partner or ex partner for his transgressions, and the ‘hot lesbian’, almost always entwined with her beautiful Other or double. Using recent examples of adverts the paper asks how this apparent ‘agency’ and ‘empowerment’ should be understood. Drawing on accounts of the incorporation or recuperation of feminist ideas in advertising the paper takes a critical approach to these representations, examining their exclusions, their constructions of gender relations and heteronormativity, and the way power is figured within them. A feminist poststructuralist approach is used to interrogate the way in which ‘sexual agency’ becomes a form of regulation in these adverts, that requires the re-moulding of feminine subjectivity to fit the current postfeminist, neoliberal moment in which young women should not only be beautiful but sexy, sexually knowledgeable/practised and always ‘up for it’. The paper makes an original contribution to debates about representations of gender in advertising, to poststructuralist analyses about the contemporary operation of power, and to writing about female ‘sexual agency’ by suggesting that ‘voice’ or ‘agency’ may not be the solution to the ‘missing discourse of female desire' but may in fact be a technology of discipline and regulation

Core outcome domains for early-phase clinical trials of sound-, psychology-, and pharmacology-based interventions to manage chronic subjective tinnitus in adults: the COMIT'ID study protocol for using a Delphi process and face-to-face meetings to establish consensus

Background: The reporting of outcomes in clinical trials of subjective tinnitus indicates that many different tinnitus-related complaints are of interest to investigators, from perceptual attributes of the sound (e.g. loudness) to psychosocial impacts (e.g. quality of life). Even when considering one type of intervention strategy for subjective tinnitus, there is no agreement about what is critically important for deciding whether a treatment is effective. The main purpose of this observational study is therefore to develop Core Outcome Domain Sets for the three different intervention strategies (sound, psychological, and pharmacological) for adults with chronic subjective tinnitus that should be measured and reported in every clinical trial of these interventions. Secondary objectives are to identify the strengths and limitations of our study design for recruiting and reducing attrition of participants, and to explore uptake of the core outcomes. Methods: The ‘Core Outcome Measures in Tinnitus: International Delphi’ (COMIT’ID) study will use a mixed methods approach that incorporates input from healthcare users at the pre-Delphi stage, a modified three round Delphi survey and final consensus meetings (one for each intervention). The meetings will generate recommendations by stakeholder representatives on agreed Core Outcome Domain Sets specific to each intervention. A subsequent step will establish a common cross-cutting Core Outcome Domain Set by identifying the common outcome domains included in all three intervention-specific Core Outcome Domain Sets. To address the secondary objectives, we will gather feedback from participants about their experience of taking part in the Delphi process. We aspire to conduct an observational cohort study to evaluate uptake of the core outcomes in published studies at 7 years following core outcome set publication. Discussion: The COMIT’ID study aims to develop a Core Outcome Domain Set that are agreed as critically important for deciding whether a treatment for subjective tinnitus is effective. Such a recommendation would help to standardise future clinical trials worldwide and so we will determine if participation increases use of the core outcome set in the long term. Trial registration: This project has been registered in the database of the Core Outcome Measures in Effectiveness Trials (COMET) initiative

Are We Focused on the Wrong Early Postoperative Quality Metrics? Optimal Realignment Outweighs Perioperative Risk in Adult Spinal Deformity Surgery

BACKGROUND: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications. OBJECTIVE: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. STUDY DESIGN/SETTING: Retrospective cohort study of a prospectively collected multicenter database. METHODS: ASD patients with two-year (2Y) data included. Groups were propensity score matched (PSM) for age, frailty, body mass index (BMI), Charlson Comorbidity Index (CCI), and baseline deformity. Optimal radiographic criteria are defined as meeting low deformity in all three (Scoliosis Research Society) SRS-Schwab parameters or being proportioned in Global Alignment and Proportionality (GAP). Cost-per-QALY was calculated for each time point. Multivariable logistic regression analysis and ANCOVA (analysis of covariance) adjusting for baseline disability and deformity (pelvic incidence (PI), pelvic incidence minus lumbar lordosis (PI-LL)) were used to determine the significance of surgical details, complications, clinical outcomes, and cost-utility. RESULTS: A total of 930 patients were considered. Following PSM, 253 optimal (O) and 253 not optimal (NO) patients were assessed. The O group underwent more invasive procedures and had more levels fused. Analysis of complications by two years showed that the O group suffered less overall major (38% vs. 52%, CONCLUSIONS: Fewer late complications (mechanical and reoperations) are seen in optimally aligned patients, leading to better long-term cost-utility overall. Therefore, the current focus on avoiding short-term complications may be counterproductive, as achieving optimal surgical correction is critical for long-term success