Background To compare estimated 10-year and 30-year cardiovascular risk in primary care patients with and without serious mental illness (SMI; bipolar disorder, schizophrenia, or schizoaffective ...disorder). Methods and Results All patients aged 18 to 75 years with a primary care visit in January 2016 to September 2018 were included and were grouped into those with and without SMI using diagnosis codes. Ten-year cardiovascular risk was estimated using atherosclerotic cardiovascular disease scores for patients aged 40 to 75 years without cardiovascular disease; 30-year cardiovascular risk was estimated using Framingham risk scores for patients aged 18 to 59 years without cardiovascular disease. Demographic, vital sign, medication, diagnosis, and health insurance data were collected from the electronic health record by a clinical decision support system. Descriptive statistics examined unadjusted differences, while general linear models examined differences for continuous variables and logistic regression models for categorical variables. Models were then adjusted for age, sex, race, ethnicity, and insurance type. A total of 11 333 patients with SMI and 579 924 patients without SMI were included. After covariate adjustment, 10-year cardiovascular risk was significantly higher in patients with SMI (mean, 9.44%; 95% CI, 9.29%-9.60%) compared with patients without SMI (mean, 7.99%; 95% CI, 7.97-8.02). Similarly, 30-year cardiovascular risk was significantly higher in those with SMI (25% of patients with SMI in the highest-risk group compared with 11% of patients without SMI;
<0.001). The individual cardiovascular risk factors contributing most to increased risk for those with SMI were elevated body mass index and smoking. Among SMI subtypes, patients with bipolar disorder had the highest 10-year cardiovascular risk, while patients with schizoaffective disorder had the highest 30-year cardiovascular risk. Conclusions The significantly increased cardiovascular risk associated with SMI is evident even in young adults. This suggests the importance of addressing uncontrolled major cardiovascular risk factors in those with SMI at as early an age as possible. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02451670.
Abstract Purpose We wanted to assess the impact of an electronic health record-based diabetes clinical decision support system on control of hemoglobin A1c (glycated hemoglobin), blood pressure, and ...low-density lipoprotein (LDL) cholesterol levels in adults with diabetes. Methods We conducted a clinic-randomized trial conducted from October 2006 to May 2007 in Minnesota. Included were 11 clinics with 41 consenting primary care physicians and the physicians' 2,556 patients with diabetes. Patients were randomized either to receive or not to receive an electronic health record (EHR)-based clinical decision support system designed to improve care for those patients whose hemoglobin A1c , blood pressure, or LDL cholesterol levels were higher than goal at any office visit. Analysis used general and generalized linear mixed models with repeated time measurements to accommodate the nested data structure. Results The intervention group physicians used the EHR-based decision support system at 62.6% of all office visits made by adults with diabetes. The intervention group diabetes patients had significantly better hemoglobin A1c (intervention effect −0.26%; 95% confidence interval, −0.06% to −0.47%; P = .01), and better maintenance of systolic blood pressure control (80.2% vs 75.1%, P = .03) and borderline better maintenance of diastolic blood pressure control (85.6% vs 81.7%, P = .07), but not improved low-density lipoprotein cholesterol levels (P = .62) than patients of physicians randomized to the control arm of the study. Among intervention group physicians, 94% were satisfied or very satisfied with the intervention, and moderate use of the support system persisted for more than 1 year after feedback and incentives to encourage its use were discontinued. Conclusions EHR-based diabetes clinical decision support significantly improved glucose control and some aspects of blood pressure control in adults with type 2 diabetes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The increasing analytical speed of mass-spectrometry imaging (MSI) has led to growing interest in the medical field. Acute kidney injury is a severe disease with high morbidity and mortality. No ...reliable cut-offs are known to estimate the severity of acute kidney injury. Thus, there is a need for new tools to rapidly and accurately assess acute ischemia, which is of clinical importance in intensive care and in kidney transplantation. We investigated the value of MSI to assess acute ischemic kidney tissue in a porcine model. A perfusion model was developed where paired kidneys received warm (severe) or cold (minor) ischemia (n = 8 per group). First, ischemic tissue damage was systematically assessed by two blinded pathologists. Second, MALDI-MSI of kidney tissues was performed to study the spatial distributions and compositions of lipids in the tissues. Histopathological examination revealed no significant difference between kidneys, whereas MALDI-MSI was capable of a detailed discrimination of severe and mild ischemia by differential expression of characteristic lipid-degradation products throughout the tissue within 2 h. In particular, lysolipids, including lysocardiolipins, lysophosphatidylcholines, and lysophosphatidylinositol, were dramatically elevated after severe ischemia. This study demonstrates the significant potential of MSI to differentiate and identify molecular patterns of early ischemic injury in a clinically acceptable time frame. The observed changes highlight the underlying biochemical processes of acute ischemic kidney injury and provide a molecular classification tool that can be deployed in assessment of acute ischemic kidney injury.
IMPORTANCE Only about half of patients with high blood pressure (BP) in the United States have their BP controlled. Practical, robust, and sustainable models are needed to improve BP control in ...patients with uncontrolled hypertension. OBJECTIVES To determine whether an intervention combining home BP telemonitoring with pharmacist case management improves BP control compared with usual care and to determine whether BP control is maintained after the intervention is stopped. DESIGN, SETTING, AND PATIENTS A cluster randomized clinical trial of 450 adults with uncontrolled BP recruited from 14 692 patients with electronic medical records across 16 primary care clinics in an integrated health system in Minneapolis-St Paul, Minnesota, with 12 months of intervention and 6 months of postintervention follow-up. INTERVENTIONS Eight clinics were randomized to provide usual care to patients (n = 222) and 8 clinics were randomized to provide a telemonitoring intervention (n = 228). Intervention patients received home BP telemonitors and transmitted BP data to pharmacists who adjusted antihypertensive therapy accordingly. MAIN OUTCOMES AND MEASURES Control of systolic BP to less than 140 mm Hg and diastolic BP to less than 90 mm Hg (<130/80 mm Hg in patients with diabetes or chronic kidney disease) at 6 and 12 months. Secondary outcomes were change in BP, patient satisfaction, and BP control at 18 months (6 months after intervention stopped). RESULTS At baseline, enrollees were 45% women, 82% white, mean (SD) age was 61.1 (12.0) years, and mean systolic BP was 148 mm Hg and diastolic BP was 85 mm Hg. Blood pressure was controlled at both 6 and 12 months in 57.2% (95% CI, 44.8% to 68.7%) of patients in the telemonitoring intervention group vs 30.0% (95% CI, 23.2% to 37.8%) of patients in the usual care group (P = .001). At 18 months (6 months of postintervention follow-up), BP was controlled in 71.8% (95% CI, 65.0% to 77.8%) of patients in the telemonitoring intervention group vs 57.1% (95% CI, 51.5% to 62.6%) of patients in the usual care group (P = .003). Compared with the usual care group, systolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months (−10.7 mm Hg 95% CI, −14.3 to −7.3 mm Hg; P<.001), at 12 months (−9.7 mm Hg 95% CI, −13.4 to −6.0 mm Hg; P<.001), and at 18 months (−6.6 mm Hg 95% CI, −10.7 to −2.5 mm Hg; P = .004). Compared with the usual care group, diastolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months (−6.0 mm Hg 95% CI, −8.6 to −3.4 mm Hg; P<.001), at 12 months (−5.1 mm Hg 95% CI, −7.4 to −2.8 mm Hg; P<.001), and at 18 months (−3.0 mm Hg 95% CI, −6.3 to 0.3 mm Hg; P = .07). CONCLUSIONS AND RELEVANCE Home BP telemonitoring and pharmacist case management achieved better BP control compared with usual care during 12 months of intervention that persisted during 6 months of postintervention follow-up. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00781365
The assessment of gaze behaviour is essential for understanding the psychology of communication. Mobile eye-tracking glasses are useful to measure gaze behaviour during dynamic interactions. ...Eye-tracking data can be analysed by using manually annotated areas-of-interest. Computer vision algorithms may alternatively be used to reduce the amount of manual effort, but also the subjectivity and complexity of these analyses. Using additional re-identification (Re-ID) algorithms, different participants in the interaction can be distinguished. The aim of this study was to compare the results of manual annotation of mobile eye-tracking data with the results of a computer vision algorithm. We selected the first minute of seven randomly selected eye-tracking videos of consultations between physicians and patients in a Dutch Internal Medicine out-patient clinic. Three human annotators and a computer vision algorithm annotated mobile eye-tracking data, after which interrater reliability was assessed between the areas-of-interest annotated by the annotators and the computer vision algorithm. Additionally, we explored interrater reliability when using lengthy videos and different area-of-interest shapes. In total, we analysed more than 65 min of eye-tracking videos manually and with the algorithm. Overall, the absolute normalized difference between the manual and the algorithm annotations of face-gaze was less than 2%. Our results show high interrater agreements between human annotators and the algorithm with Cohen’s kappa ranging from 0.85 to 0.98. We conclude that computer vision algorithms produce comparable results to those of human annotators. Analyses by the algorithm are not subject to annotator fatigue or subjectivity and can therefore advance eye-tracking analyses.
Context. Post-asymptotic giant branch (post-AGB) binaries are surrounded by stable dusty and gaseous disks similar to the ones around young stellar objects. Whereas, significant effort has been spent ...on modeling observations of disks around young stellar objects, the disks around post-AGB binaries have received significantly less attention, even though they pose significant constraints on theories of disk physics and binary evolution. Aims. We want to examine the structure of and phenomena at play in circumbinary disks around post-AGB stars. We continue the analysis of our near-infrared interferometric image of the inner rim of the circumbinary disk around IRAS08544-4431. We want to understand the physics governing this inner disk rim. Methods. We use a radiative transfer model of a dusty disk to reproduce simultaneously the photometry as well as the near-infrared interferometric dataset on IRAS08544-4431. The model assumes hydrostatic equilibrium and takes dust settling self-consistently into account. Results. The best-fit radiative transfer model shows excellent agreement with the spectral energy distribution up to millimeter wavelengths as well as with the PIONIER visibility data. It requires a rounded inner rim structure, starting at a radius of 8.25 au. However, the model does not fully reproduce the detected over-resolved flux nor the azimuthal flux distribution of the inner rim. While the asymmetric inner disk rim structure is likely to be the consequence of disk-binary interactions, the origin of the additional over-resolved flux remains unclear. Conclusions. As in young stellar objects, the disk inner rim of IRAS08544-4431 is ruled by dust sublimation physics. Additional observations are needed to understand the origin of the extended flux and the azimuthal perturbation at the inner rim of the disk.
The WISE view of RV Tauri stars Gezer, I; Van Winckel, H; Bozkurt, Z ...
Monthly notices of the Royal Astronomical Society,
10/2015, Letnik:
453, Številka:
1
Journal Article
Recenzirano
We present a detailed study based on infrared (IR) photometry of all Galactic RV Tauri stars from the General Catalogue of Variable Stars (GCVS). RV Tauri stars are the brightest among the Population ...II Cepheids. They are thought to evolve away from the asymptotic giant branch (AGB) towards the white dwarf domain. IRAS detected several RV Tauri stars because of their large IR excesses and it was found that they occupy a specific region in the 12 − 25, 25 − 60 IRAS two-colour diagram. We used the all sky survey of Wide-field Infrared Survey Explorer to extend these studies and compare the IR properties of all RV Tauri stars in the GCVS with a selected sample of post-AGB objects with the goal to place the RV Tauri pulsators in the context of post-AGB evolution. Moreover, we correlated the IR properties of both the RV Tauri stars and the comparison sample with other observables like binarity and the presence of a photospheric chemical anomaly called depletion. We find that Galactic RV Tauri stars display a range of IR properties and we differentiate between disc sources, objects with no IR excess and objects for which the spectral energy distribution (SED) is uncertain. We obtain a clear correlation between disc sources and binarity. RV Tauri stars with a variable mean magnitude are exclusively found among the disc sources. We also find evidence for disc evolution among the binaries. Furthermore our studies show that the presence of a disc seems to be a necessary but not sufficient condition for the depletion process to become efficient.
In order to study the effects of rotating disks in the post-asymptotic giant branch (post-AGB) evolution, we observe a class of binary post-AGB stars that seem to be systematically surrounded by ...equatorial disks and slow outflows. Although the rotating dynamics had only been well identified in three cases, the study of such structures is thought to be fundamental to the understanding of the formation of disks in various phases of the late evolution of binary stars and the ejection of planetary nebulae from evolved stars.
We present ALMA maps of
CO and
CO
=3-2 lines in the source IRAS 08544-4431, which belongs to the above mentioned class of objects. We analyzed the data by means of nebula models, which account for the expectedly composite source and can reproduce the data. From our modeling, we estimated the main nebula parameters, including the structure and dynamics and the density and temperature distributions. We discuss the uncertainties of the derived values and, in particular, their dependence on the distance.
Our observations reveal the presence of an equatorial disk in rotation; a low-velocity outflow is also found, probably formed of gas expelled from the disk. The main characteristics of our observations and modeling of IRAS 08544-4431 are similar to those of better studied objects, confirming our interpretation. The disk rotation indicates a total central mass of about 1.8
, for a distance of 1100 pc. The disk is found to be relatively extended and has a typical diameter of ~ 4 10
cm. The total nebular mass is ~ 2 10
, of which ~ 90% corresponds to the disk. Assuming that the outflow is due to mass loss from the disk, we derive a disk lifetime of ~ 10000 yr. The disk angular momentum is found to be comparable to that of the binary system at present. Assuming that the disk angular momentum was transferred from the binary system, as expected, the high values of the disk angular momentum in this and other similar disks suggest that the size of the stellar orbits has significantly decreased as a consequence of disk formation.
Jonkman, S.N.; Hillen, M.M.; Nicholls, R.J.; Kanning, W., and van Ledden, M., 2013. Costs of adapting coastal defences to sea-level rise—new estimates and their implications. The cost of upgrading ...and raising coastal defences is an important consideration in societal response to sea-level rise. Currently available unit cost estimates have a limited empirical basis. This article presents new information on the unit costs of adapting coastal defences for three specific case studies in low-lying delta regions: The Netherlands, New Orleans, and Vietnam. Typical measures include dikes, flood walls, storm surge barriers, and nourishment. These unit cost estimates are significantly higher than earlier estimates that are still the main source of costs for global vulnerability assessments. Factors affecting these unit costs include local economic factors (material and labour costs), design choices related to the alignment of the system, and the types of measures for implementation of the system in an urban or rural environment. On the basis of an example for a Dutch sea dike, it is shown that the material quantities and associated costs are expected to rise linearly, in the case of depth-limited wave breaking, for the range of sea-level rise rates that are expected in the coming century. However, other factors, such as increasing costs for implementation of wider coastal defences in an urban environment and future changes in material and labour costs, could contribute to a nonlinear increase of the costs. Further collection and analysis of project information for coastal defence projects in other regions is recommended to strengthen the empirical basis of the cost estimates that are used for regional and global assessments.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
In the United States, primary care providers (PCPs) routinely balance acute, chronic, and preventive patient care delivery, including cancer prevention and screening, in time-limited visits. Clinical ...decision support (CDS) may help PCPs prioritize cancer prevention and screening with other patient needs. In a three-arm, pragmatic, clinic-randomized control trial, we are studying cancer prevention CDS in a large, upper Midwestern healthcare system. The web-based, electronic health record (EHR)-linked CDS integrates evidence-based primary and secondary cancer prevention and screening recommendations into an existing cardiovascular risk management CDS system. Our objective with this study was to identify adoption barriers and facilitators before implementation in primary care.
We conducted semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) with 28 key informants employed by the healthcare organization in either leadership roles or the direct provision of clinical care. Transcribed interviews were analyzed using qualitative content analysis.
EHR, CDS workflow, CDS users (providers and patients), training, and organizational barriers and facilitators were identified related to Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals CFIR domains.
Identifying and addressing key informant-identified barriers and facilitators before implementing cancer prevention CDS in primary care may support a successful implementation and sustained use. The CFIR is a useful framework for understanding pre-implementation barriers and facilitators. Based on our findings, the research team developed and instituted specialized training, pilot testing, implementation plans, and post-implementation efforts to maximize identified facilitators and address barriers.
clinicaltrials.gov , NCT02986230 , December 6, 2016.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
