Receipt of Guideline-Concordant Care Among Older Women With Stage I-III Breast Cancer: A Population-Based Study

Background: This study examined receipt of guideline-concordant care (GCC) according to evidence-based treatment guidelines and quality measures and specific types of treatment among older women with breast cancer. Patients and Methods: A total of 142,433 patients aged ≥66 years diagnosed with stage I–III breast cancer between 2007 and 2011 were identified in the SEER-Medicare linked database. Algorithms considering cancer characteristics and the appropriate course of care as per guidelines versus actual care received determined receipt of GCC. Multivariable logistic regression estimated the likelihood of GCC and specific types of treatment for women aged ≥75 versus 66 to 74 years. Results: Overall, 39.7% of patients received GCC. Patients diagnosed at stage II or III, with certain preexisting conditions, and of nonwhite race were less likely to receive GCC. Patients with hormone-negative tumors, higher grade tumors, and greater access to oncology care resources were more likely to receive GCC. Patients aged ≥75 years were approximately 40% less likely to receive GCC or adjuvant endocrine therapy, 78% less likely to have any surgery, 61% less likely to have chemotherapy, and about half as likely to have radiation therapy than those aged 66 to 74 years. Conclusions: Fewer than half of older women with breast cancer received GCC, with the lowest rates observed among the oldest age groups, racial/ethnic minorities, and women with later-stage cancers. However, patients with more aggressive tumor characteristics and greater access to oncology resources were more likely to receive GCC. Considering that older women have the highest incidence of breast cancer and that many are diagnosed at stages requiring more aggressive treatment, efforts to increase rates of earlier stage diagnosis and the development of less toxic treatments could help improve GCC and survival while preserving quality of life

Fusarium biocontrol: antagonism and mycotoxin elimination by lactic acid bacteria

Mycotoxins produced by Fusarium species are secondary metabolites with low molecular weight formed by filamentous fungi generally resistant to different environmental factors and, therefore, undergo slow degradation. Contamination by Fusarium mycotoxins in cereals and millets is the foremost quality challenge the food and feed industry faces across the globe. Several types of chemical preservatives are employed in the mitigation process of these mycotoxins, and they help in long-term storage; however, chemical preservatives can be used only to some extent, so the complete elimination of toxins from foods is still a herculean task. The growing demand for green-labeled food drives to evade the use of chemicals in the production processes is getting much demand. Thus, the biocontrol of food toxins is important in the developing food sector. Fusarium mycotoxins are world-spread contaminants naturally occurring in commodities, food, and feed. The major mycotoxins Fusarium species produce are deoxynivalenol, fumonisins, zearalenone, and T2/HT2 toxins. Lactic acid bacteria (LAB), generally regarded as safe (GRAS), is a well-explored bacterial community in food preparations and preservation for ages. Recent research suggests that LAB are the best choice for extenuating Fusarium mycotoxins. Apart from Fusarium mycotoxins, this review focuses on the latest studies on the mechanisms of how LAB effectively detoxify and remove these mycotoxins through their various bioactive molecules and background information of these molecules

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Making a Case for Employing a Societal Perspective in the Evaluation of Medicaid Prescription Drug Interventions

The choice of a perspective is among the most critical influences of the potential outcome of an economic evaluation, since it determines whose interest is relevant in any given analysis. For publicly funded programmes such as Medicaid, and now Medicare, it is important that economic evaluations are undertaken from a societal perspective because such evaluations inform decisions about allocation of healthcare resources. It has been argued that approaches other than the societal perspective selectively include specific costs, while ignoring other costs that are very much more `real', and hence lack theoretical foundation in welfare economics. In view of the importance of perspectives in economic evaluations, this paper reviews 25 existing reports of economic evaluations of interventions involving prescription drugs in the Medicaid programme to examine the perspectives employed in such evaluations, based on the specific cost and benefit measurements. No explicit statement of the perspective employed was included in any of the articles selected for this review. Based on an analysis of the cost measures, none of the studies were found to have adopted a societal perspective in their evaluation. Most studies were from the perspective of Medicaid as the payer and as such did not include costs and benefits from outside the Medicaid system. Ten of the identified evaluations of interventions focused just on costs related to prescription drugs. Six studies included an evaluation of the impact of the intervention on overall programme costs along with the costs of prescription drugs. The nine remaining evaluations employed a broader approach to include related effects of the drug-benefit intervention on costs and utilization of other healthcare services such as physician, outpatient and inpatient services. This review emphasizes the importance of a societal approach in evaluating the effects of interventions in Medicaid and other publicly funded drug benefit programmes. Existing evaluations fall short of employing such a broad perspective. This, along with the limitations in design and data, make findings from these studies less reliable than should be used to make major decisions regarding allocation of tax dollars. While methodological challenges to such an approach are valid and understandable, there is an increasing need to attempt evaluations of cost-containment strategies from a broad-based societal perspective to ensure continuity and sustainability of publicly funded drug benefit programmes such as Medicaid and Medicare.Drug-utilisation, Formularies, Healthcare-expenditure

Association of the severity of diabetes- related complications with stage of breast cancer at diagnosis among elderly women with pre-existing diabetes

Purpose—This study assessed the association between the severity of diabetes complications using diabetes complications severity index (DCSI) and stage of breast cancer (BC) at diagnosis among elderly women with pre-existing diabetes and incident BC. Methods—Using Surveillance, Epidemiology and End Results-Medicare data, we identified women with incident BC during 2004–2011 and pre-existing diabetes (N = 7729). Chi-square tests were used to test for group differences in stage of BC at diagnosis. Multinomial logistic regression was used to examine the associations between the severity of diabetes complications and stage of BC at diagnosis. Results—Overall, women with a DCSI = 2 and a DCSI ≥ 3 were more likely to be diagnosed at advanced stages as compared to those with no diabetes complications. In full adjusted association (after adding BC screening to the analysis model), the severity of diabetes complications was no longer an independent predictor of advanced stages at diagnosis. However, women with a DCSI = 2 were 26% more likely to be diagnosed at stage I (versus stage 0) of BC at diagnosis as compared to those without diabetes complications (OR 1.26, 95% CI 1.03–1.53). Conclusion—The increased likelihood of having advanced-stage BC at diagnosis associated with severity of diabetes-related complications appears to be mediated by lower rates of breast cancer screening among elderly women with pre-existing diabetes complications. Therefore, reducing disparity in receiving breast cancer screening among elderly women with diabetes may reduce the risk of advanced-stage breast cancer diagnosis

Knowledge transfer and information leakage in protocols

A protocol defines a structured conversation aimed at exchanging information between two or more parties. Complete confidentiality is virtually impossible so long as useful information needs to be transmitted. A more useful approach is to quantify the amount of information that is leaked. Traditionally, information flow in protocols has been analyzed using notions of entropy. We move to a discrete approach where information is measured in terms of propositional facts. We consider protocols involving agents holding numbered cards who exchange information to discover each others’ private hands. We define a transition system that searches the space of all possible announcement sequences made by such a set of agents and tries to identify a subset of announcements that constitutes an informative yet safe protocol

Generic verification of security protocols

Security protocols are notoriously difficult to debug. One approach to the automatic verification of security protocols with a bounded set of agents uses logic programming with analysis and synthesis rules to describe how the attacker gains information and constructs new messages. We propose a generic approach to verifying security protocols in Spin. The dynamic process creation mechanism of Spin is used to nondeterministically create different combinations of role instantiations. We incorporate the synthesis and analysis features of the logic programming approach to describe how the intruder learns information and replays it back into the system. We formulate a generic “loss of secrecy ” property that is flagged whenever the intruder learns private information from an intercepted message. We also describe a simplification of the Dolev-Yao attacker model that suffices to analyze secrecy properties

Optimized OR-Sets without ordering constraints

Eventual consistency is a relaxation of strong consistency that guarantees that if no new updates are made to a replicated data object, then all replicas will converge. The conflict free replicated datatypes (CRDTs) of Shapiro et al. are data structures whose inherent mathematical structure guarantees eventual consistency. We investigate a fundamental CRDT called Observed-Remove Set (OR-Set) that robustly implements sets with distributed add and delete operations. Existing CRDT implementations of OR-Sets either require maintaining a permanent set of “tombstones” for deleted elements, or imposing strong constraints such as causal order on message delivery. We formalize a concurrent specification for OR-Sets without ordering constraints and propose a generalized implementation of OR-sets without tombstones that provably satisfies strong eventual consistency. We introduce Interval Version Vectors to succinctly keep track of distributed time-stamps in systems that allow out-of-order delivery of messages. The space complexity of our generalized implementation is competitive with respect to earlier solutions with causal ordering. We also formulate k-causal delivery, a generalization of causal delivery, that provides better complexity bounds

Resampling Operations as Features for Detecting LSB Replacement and LSB Matching in Color Images

We show that changes to the color distribution statistics induced by resampling operations on color images present useful features for the detection and estimation of embeddings due to LSB steganography. The resampling operations considered in our study are typical operations like zoom-in, zoom-out, rotations and distortions. We show experimental evidence that the features computed from these resampling operations form distinct clusters in pattern space for different levels of embeddings and are amenable to classification using a pattern classifier like SVM. Our method works well not only for LSB Replacement teganography but also for the LSB Matching approach