Diagnostic route is associated with care satisfaction independently of tumour stage: Evidence from linked English Cancer Patient Experience Survey and cancer registration data.

BACKGROUND: Whether diagnostic route (e.g. emergency presentation) is associated with cancer care experience independently of tumour stage is unknown. METHODS: We analysed data on 18 590 patients with breast, prostate, colon, lung, and rectal cancers who responded to the 2014 English Cancer Patient Experience Survey, linked to cancer registration data on diagnostic route and tumour stage at diagnosis. We estimated odds ratios (OR) of reporting a negative experience of overall cancer care by tumour stage and diagnostic route (crude and adjusted for patient characteristic and cancer site variables) and examined their interactions with cancer site. RESULTS: After adjustment, the likelihood of reporting a negative experience was highest for emergency presenters and lowest for screening-detected patients with breast, colon, and rectal cancers (OR versus two-week-wait 1.51, 95% confidence interval [CI] 1.24-1.83; 0.88, 95% CI 0.75-1.03, respectively). Patients with the most advanced stage were more likely to report a negative experience (OR stage IV versus I 1.37, 95% CI 1.15-1.62) with little confounding between stage and route, and no evidence for cancer-stage or cancer-route interactions. CONCLUSIONS: Though the extent of disease is strongly associated with ratings of overall cancer care, diagnostic route (particularly emergency presentation or screening detection) exerts important independent effects.This work is supported by Macmillan Cancer Support grant 5995414 for which GAA and GL are joint principal investigators. GL is supported by a Cancer Research UK Advanced Clinician Scientist Fellowship Award (C18081/A18180)

Status of the SIRGAS reference frame: recent developments and new challenges

In accordance with recent developments of the International Association of Geodesy (IAG) and the policies promoted by the Subcommittee on Geodesy of the United Nations Committee of Experts on Global Geospatial Information Management (UN-GGIM), a main goal of the Geodetic Reference System for the Americas (SIRGAS) is the procurement of an integrated regional reference frame. This frame should support the precise determination of geocentric coordinates and also provide a unified physical reference frame for gravimetry, physical heights, and a geoid. The geometric reference frame is determined by a network of about 500 continuously operating GNSS stations, which are routinely processed by ten analysis centers. The GNSS solutions from the analysis centers are used to generate weekly station positions aligned to the International Terrestrial Reference Frame (ITRF) and multi-year (cumulative) reference frame solutions. This processing is also the basis for the generation of precise tropospheric zenith path delays with an hourly sampling rate over the Americas. The reference frame for the determination of physical heights is a regional densification of the International Height Reference Frame (IHRF). Current efforts focus on the estimation and evaluation of potential values obtained from high resolution gravity field modelling, an activity tightly coupled with geoid determination. The gravity reference frame aims to be a regional densification of the International Terrestrial Gravity Reference Frame (ITGRF). Thus, SIRGAS activities are focused on evaluating the quality of existing absolute gravity stations and to identify regional gaps where additional absolute gravity stations are needed. Another main goal of SIRGAS is to promote the use of its geodetic reference frame at the national level and to support capacity building activities in the region. This paper summarizes key milestones in the establishment and maintenance of the SIRGAS reference frame and discusses current efforts and future challenges.Fil: Alves Costa, Sonia M.. Instituto Brasileiro de Geografia E Estatística; BrasilFil: Sanchez, Laura. Technische Universität München; AlemaniaFil: Piñon, Diego. Ministerio de Defensa. Instituto Geografico Nacional; ArgentinaFil: Tarrio Mosquera, Jose A.. Universidad de Santiago de Chile; ChileFil: Guimaraes, Gabriel. Universidade Federal de Uberlandia; BrasilFil: Demian Gomez. Ohio University; Estados UnidosFil: Drewes, Hermann. Deutsches Geodätisches Forschungsinstitut; AlemaniaFil: Mackern Oberti, María Virginia. Universidad Nacional de Cuyo. Facultad de Ingeniería; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Antokoletz, Ezequiel Darío. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: de Matos, Ana C. O.C. Universidade de Sao Paulo; BrasilFil: Blitzkow, Denizar. Universidade de Sao Paulo; Brasi

Forest Health in the Southern Cone of America: State of the Art and Perspectives on Regional Efforts

The plantation and natural forests of South America have been highly impacted by native and exotic pests in recent decades. The interaction of emerging invasive pests, climate change, and timber markets will define the region’s forests, with significant but uncertain ecological changes and economic losses expected. The Southern Cone Forest Health Group (SCFHG), a joint ad hoc initiative run by forest health professionals from Argentina, Brazil, Chile, and Uruguay, aims to strengthen relationships between the forestry industry, stakeholders, academia, and government agencies across the region. Here, we highlight regional strengths, weaknesses, threats, and opportunities to address forest health issues in the region. A regional approach with a strong communication network is relevant for future actions. In the current global scenario of invasive species and climate change, the implementation of practices that incorporate the resilience of forest ecosystems and sustainable management needs to be prioritized in forest policy across the region. Understanding that pests and pathogens do not recognize borders, we call on governments and organizations to support joint actions with agreements and adequate resources to enhance our regional capabilities.Estación Experimental Agropecuaria BarilocheFil: Villacide, Jose Maria. Instituto Nacional de Tecnologia Agropecuaria (INTA). Estacion Experimental Agropecuaria Bariloche. Area de Recursos Forestales. Grupo de Ecologia de Poblaciones de Insectos; ArgentinaFil: Villacide, Jose Maria. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Instituto de Investigaciones Forestales y Agropecuarias Bariloche; ArgentinaFil: Gomez, Demian F. Texas A&M Forest Service; Estados UnidosFil: Perez, Carlos Alberto. Universidad de la República Paysandú. Facultad de Agronomia; UruguayFil: Corley, Juan Carlos. Instituto Nacional de Tecnologia Agropecuaria (INTA). Estacion Experimental Agropecuaria Bariloche. Area de Recursos Forestales. Grupo de Ecologia de Poblaciones de Insectos; ArgentinaFil: Corley, Juan Carlos. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Instituto de Investigaciones Forestales y Agropecuarias Bariloche; ArgentinaFil: Corley, Juan Carlos. Universidad Nacional del Comahue. Centro Regional Universitario Bariloche. Departamento de Ecologia; ArgentinaFil: Ahumada, Rodrigo. Bioforest S.A. División de Silvicultura y Sanidad; ChileFil: Rodrigues Barbosa, Leonardo. Embrapa Florestas. Empresa Brasileira de Pesquisa Agropecuária; BrasilFil: Furtado, Edson Luiz. Universidade Estadual Paulista. Faculdade de Ciências Agronômicas Botucatu. Departamento de Proteção Vegetal; BrasilFil: Gonzalez, Andres. Universidad de la Republica. Facultad de Quimica; UruguayFil: Ramirez, Nazaret. Área Productividad de las Plantaciones. I&D.Montes del Plata; UruguayFil: Balmelli, Gustavo. Instituto Nacional de Investigacion Agropecuaria. Sistema Forestal; UruguayFil: Dias de Souza, Caroline. Instituto de Pesquisas e Estudos Florestais. Programa Cooperativo Sobre Proteção Florestal; BrasilFil: Martinez, Gonzalo. Instituto Nacional de Investigacion Agropecuaria. Sistema Forestal; Urugua

A first worldwide multispecies survey of invasive Mediterranean pine bark beetles (Coleoptera: Curculionidae, Scolytinae)

Several European and Mediterranean species of pine bark beetles (Coleoptera: Curculionidae: Scolytinae) have become established in North America and the southern hemisphere, posing a novel threat to planted and naturally-occurring pine forests. Our objectives were to investigate (1) the occurrence and relative abundance of pine bark beetles in these regions, and (2) the trapping performance of different blends of multispecies lures. In 2016–2017 a network of interception traps was installed in six non-European countries (Argentina, Australia, New Zealand, South Africa, the United States, and Uruguay), and in six European countries (France, Greece, Hungary, Italy, Portugal, and Spain) for comparison. Half of the traps were baited with alpha-pinene and ethanol, and the other half with alpha-pinene, ethanol, and a combination of bark beetle pheromones (ipsdienol, ipsenol, and Z-verbenol). Five Mediterranean scolytine species (Hylurgus ligniperda, Hylastes ater, H. angustatus, Orthotomicus erosus, and O. laricis) were found in non-European countries. Hylurgus ligniperda and Hylastes ater were the most widespread species found in several of the invaded regions, while O. laricis and H. angustatus occurred only in Argentina and South Africa, respectively. Despite large variation among species and countries, most species were trapped with the blend containing bark beetle pheromones, except O. erosus, which was more attracted to alpha-pinene and ethanol alone. This study represents the first step towards the development of an international monitoring protocol based on multi-lure traps for the survey and early-interception of invasive alien bark beetle species.MBIE (New Zealand, contract C04X1104), from PICT 2016-0705 (Argentina), from FCT UID/AGR/00239/2013 (Portugal) and from DOR-UNIPD (Italy).http://link.springer.com/journal/10530hj2021Forestry and Agricultural Biotechnology Institute (FABI)Zoology and Entomolog

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms

Regional Solid Earth and Ionospheric Responses to Subduction Earthquakes in South America

First, we developed an earthquake location technique using a non-iterative GPS location algorithm known as the Bancroft algorithm. We also proposed the use of an improved quality factor for earthquake hypocenter solutions. This factor is derived from GPS and known as geometric dilution of precision (GDOP). We applied the Bancroft algorithm to ~10 years of earthquake data in the Charlevoix Seismic zone, Canada and found that this location algorithm improves the solutions of hypocenters located in regions with high GDOP. Second, we applied and tested an interpolation technique, called least squares collocation (LSC), to the co-seismic deformation (obtained using GPS) produced by the 2010 Mw 8.8 Maule earthquake. We found that this interpolation technique cannot be used to predict the co-seismic jumps due to the low number of available GPS sites. Third, we used the same method as before to produce a trajectory prediction model (TPM) to estimate the trajectories of passive geodetic benchmarks. This methodology proved to be very useful for engineering and surveying communities dealing with co- and post-seismic deformation in large geodetic networks after great earthquakes. The TPM for Argentina is currently being implemented by the National Geographic Institute of that country. Fourth, we studied the ionospheric response in Antarctica to acoustic waves induced by Rayleigh waves produced by two major seismic events, the 2010 Mw 8.8 Maule earthquake and the 2011 Mw 9.0 Tohoku-Oki earthquake. We found that the geometry of the geomagnetic field at the South Geomagnetic Pole and the low elevation of GPS satellites in Antarctica favor the observation of acoustic wave-plasma coupling in the ionosphere. Fifth and finally, we studied the lithospheric stress guide and far-field co-seismic deformation after a megathrust earthquake. We found that the energy transmitted to the far-field depends on the asthenospheric strength. We also studied the surface deformation as a function of slip source depth, finding that sources within the stress guide are amplified in the far-field as compared to those occurring in the crust. We suggested that the information collected by far-field GPS stations can help reveal lithospheric and asthenospheric structures

The effect of the 2017 solar eclipse in the ionospheric total electron content

Using 15-second RINEX files inside the totality path, I calculated the Total Electron Content (TEC) at each station-satellite pair for each epoch recorded during the day of the 2017 solar eclipse. These calculations result in TEC observations at the ionospheric piercing points (IPP), the intersection of the station-satellite line-of-sight (LOS) and the peak electron density of the ionospheric F layer at a height of ~300 km. Using the estimated TEC at each IPP, I produced a video showing the TEC change during the passage of the umbra and penumbra of the eclipse over North America over a period of one hour. The video shows that as the moon’s shadow passes and the sunlight is blocked, the TEC drops due to the recombination of the ionized particles. More information available at the UNAVCO Google+ webpage: https://plus.google.com/u/0/112042426109504523574/posts/bPJ2f7exmP

Towards Sustainable Forest Management in Central America: Review of Southern Pine Beetle (Dendroctonus frontalis Zimmermann) Outbreaks, Their Causes, and Solutions

Outbreaks of the southern pine beetle (SPB) Dendroctonus frontalis Zimmermann in Central America have had a devastating impact on pine forests. It remains unclear to what extent these outbreaks are caused by the beetle&rsquo;s ecology, climate, and historical management practices. Using research data and experience accumulated in northern latitudes to guide management of forests in Central America is associated with great uncertainty, given the many unique features of the conifer forests in this region. The main recommendation from this review is that Central American bark beetle outbreaks need to be studied locally, and the local climate, biotic elements, and silvicultural history need to be considered. The key to reducing the impacts of SPB in Central America are local research and implementation of proactive management, in order to facilitate the establishment of forests more resilient to increasing environmental and anthropogenic pressures