The extent to which socioeconomic disadvantages and inadequate health care access account for the disproportionately elevated mortality hazard observed in African American compared with white ...American patients with breast cancer is poorly defined.
We identified 20 studies reported between January 1980 and June 2005 that provided survival analyses in patients with breast cancer after adjusting for ethnicity and some measurement of socioeconomic status. These studies also adjusted for age and stage of disease at time of diagnosis.
The pooled outcome data yielded estimates for the mortality hazard in 14,013 African American and 76,111 white American patients with breast cancer. Studies varied in their methods for assigning socioeconomic status, with most relying on area-wide measures such as census tract and census block data. The combined analysis (adjusted for age, stage, and socioeconomic status) revealed that African American ethnicity was associated with a statistically significant excess mortality risk in overall survival (mortality hazard, 1.27; 95% CI, 1.18 to 1.38) and in breast cancer-specific survival (mortality hazard, 1.19; 95% CI, 1.10 to 1.29).
Our pooled analysis demonstrated that African American ethnicity is a significant and independent predictor of poor outcome from breast cancer, even after accounting for socioeconomic status by conventional measures. These findings support the need for further investigation of the biologic, genetic, and sociocultural factors that may influence survival in African American patients with breast cancer.
We employ shotgun proteomics and data-independent acquisition (DIA) mass spectrometry to analyze cerebrospinal fluid longitudinally collected from 14 amyotrophic lateral sclerosis (ALS) patients (8 ...males and 6 females). We perform three main analyses of these data: (1) examine the intra- and inter-patient protein variability in CSF; (2) explore the association of inflammation with rate of disease progression; and (3) develop a mixed-effects model to best explain the decrease in ALS-Functional Rating Scale (ALS-FRS) score. Overall, the CSF protein abundances are tightly regulated with the intra-individual variability contributing just 4% to the overall variance. In four patients, a moderately significant correlation (
p
< 0.1) was observed between inflammation and rate of disease progression. Using a least absolute shrinkage and selection operator (LASSO) variable selection, we selected 55 viable peptides for mathematical modeling via a linear mixed-effects regression. We then employed forward selection to generate a final model by minimizing Akaike’s information criterion (AIC). The final model utilized changes in abundance from 28 peptides as fixed effects to model progression of the disease in these patients. These peptides were from proteins involved in stress response and innate immunity.
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•The fluorescent sensor displayed no emission in near neutral poly(methacrylic acid), PMAA, solution.•Hg2+ ions selectively turned on the sensor’s charge shift state (CSH) ...emission.•The emission of dye/PMAA/Hg2+ mixture is affected by pH, polymer size and temperature.•The sensor showed satisfactory percent recovery for spiked Hg2+ ions in real water samples.
The conformational change of poly (methacrylic acid) (PMAA) at various pH values is well studied; however, the application of PMAA in the field of analytical chemistry has been very limited. This investigation takes advantage of the conformational change of PMAA at various pH levels and the conformational change induced by metal ions. By adjusting the pH, thiophene-phenylanilide-acridinium molecules can serve as turn-on sensors for Hg2+ ions. In pH 7.4 buffer with PMAA molecules, the sensor is selectively turned on by Hg2+ ions to display strong charge shift state (CSH) emission at 560 nm. The intensity shows linear response to the concentration of Hg2+ ions between 0.020 mM and 0.151 mM with a detection limit in nanomolar range. The photophysical properties of sensor molecules in PMAA/mercury (II) mixture at near neutral pH are comparable to those in PMAA solution in acidic condition without mercury (II) ions. The effect of pH, temperature, polymer size, and polymer concentration on emission intensity were investigated. The sensor showed excellent percent recovery (98.4 % to 103 %) of spiked mercury (II) ions in real water samples. The sensing mechanism is likely through intrachain and interchain coordination of mercury (II) ions with the carboxyl groups on the side chain of PMAA to induce an extended coil conformation of PMAA. Calculations support the conclusion that the size and geometry of the binding sites formed inside PMAA are suitable to incorporate sensor molecules and enhance the charge shift state emission of sensor molecules.
The size of offshore wind turbines over the next decade is expected to continually increase due to reduced balance of station costs per MW and also the higher wind energy at increased altitudes that ...can lead to higher capacity factors. However, there are challenges that may limit the degree of upscaling which is possible. In this paper, a two-bladed downwind turbine system is upscaled from 13.2 MW to 25 MW, by redesigning aerodynamics, structures, and controls. In particular, three 25 MW rotors have been developed: V1 is the upscaled model, V2 is a partial redesigned model, and V3 is a fully redesigned model. Despite their radically large sizes, it is found that these 25 MW turbine rotors satisfy this limited set of design drivers at the rated condition and that larger blade lengths are possible with cone-wise load-alignment. In addition, flapwise morphing (varying the cone angle with a wind-speed schedule) is investigated in terms of minimizing mean and fluctuating root bending loads using steady inflow proxies for the maximum and damage equivalent load moments. The resulting series of 25 MW rotors, which are the largest ever designed, can be a useful baseline for further development and assessment.
•Two-bladed downwind turbine system rated at 25 MW is upscaled and designed.•The 25 MW models are developed with aerodynamics, structural, and control redesign.•They satisfy the design requirements to operate at high coning angles in simulations.•Morphing is firstly considered in terms of a detailed flapwise and edgewise loads.•Blade segmentation and outboard pitching may be the key at this extreme-scale.
Background
Most health literacy measures require in-person administration or rely upon self-report.
Objective
We sought to develop and test the feasibility of a brief, objective health literacy ...measure that could be deployed via text messaging or online survey.
Design
Participants were recruited from ongoing NIH studies to complete a phone interview and online survey to test candidate items. Psychometric analyses included parallel analysis for dimensionality and item response theory. After 9 months, participants were randomized to receive the final instrument via text messaging or online survey.
Participants
Three hundred six English and Spanish-speaking adults with ≥ 1 chronic condition
Main Measures
Thirty-three candidate items for the new measure and patient-reported physical function, anxiety, depression, and medication adherence. All participants previously completed the Newest Vital Sign (NVS) in parent NIH studies.
Key Results
Participants were older (average 67 years), 69.6% were female, 44.3% were low income, and 22.0% had a high school level of education or less. Candidate items loaded onto a single factor (RMSEA: 0.04, CFI: 0.99, TLI: 0.98, all loadings >.59). Six items were chosen for the final measure, named the HL6. Items demonstrated acceptable internal consistency (
α
=0.73) and did not display differential item functioning by language. Higher HL6 scores were significantly associated with greater educational attainment (
r
=0.41), higher NVS scores (
r
=0.55), greater physical functioning (
r
=0.26), fewer depressive symptoms (
r
=−0.20), fewer anxiety symptoms (
r
=−0.15), and fewer barriers to medication adherence (
r
=−0.30; all
p
<.01). In feasibility testing, 75.2% of participants in the text messaging arm completed the HL6 versus 66.2% in the online survey arm (
p
=0.09). Socioeconomic disparities in completion were more common in the online survey arm.
Conclusions
The HL6 demonstrates adequate reliability and validity in both English and Spanish. This performance-based assessment can be administered remotely using commonly available technologies with fewer logistical challenges than assessments requiring in-person administration.
•CIND may be more prevalent than expected in diverse, primary care settings.•CIND is associated with reduced ability to independently self-manage health.•Self-care difficulty may be an indirect means ...of detecting early cognitive changes.•Targeting self-care may be a practical approach to manage health in CIND adults.
To determine the prevalence of cognitive impairment no dementia (CIND) among a diverse, community-based population, and establish associations between CIND and health literacy, chronic disease self-management and functional health status.
863 primary care adults without dementia aged 55–74. Adjusted logistic and linear regressions were used to assess associations between CIND (None, Mild, Moderate/Severe) and outcomes.
36 % participants exhibited CIND. It was strongly associated with limited health literacy (Newest Vital Signs: Mild OR 3.25; 95 % CI 1.93, 5.49, Moderate/Severe OR 6.45; 95 % CI 3.16, 13.2; Test of Functional Health Literacy in Adults: Mild OR 3.46; 95 % CI 2.08, 5.75, Moderate/Severe OR 8.82; 95 % CI 4.87, 16.0; all p’s < 0.001) and poor chronic disease self-management (Mild B = −11.2; 95 % CI −13.5, -8.90, Moderate/Severe CI B = −21.0; 95 % CI −23.6, −18.4; both p’s < 0.001). Associations between CIND and functional health status were non-significant.
CIND was prevalent in this cohort, and strongly associated with requisite skills for managing everyday health needs.
Attention to subtle declines in chronic disease self-care may assist with CIND identification and care management within this population. When CIND is observed, clinicians should also expect and address difficulties with self-management.
Donation after circulatory death (DCD) donors offer the ability to expand the lung donor pool and ex vivo lung perfusion (EVLP) further contributes to this ability by allowing for additional ...evaluation and resuscitation of these extended criteria donors. We sought to determine the outcomes of recipients receiving organs from DCD EVLP donors in a multicenter setting.
This was an unplanned post hoc analysis of a multicenter, prospective, nonrandomized trial that took place during 2011 to 2017 with 3 years of follow-up. Patients were placed into 3 groups based off procurement strategy: brain-dead donor (control), brain-dead donor evaluated by EVLP, and DCD donors evaluated by EVLP. The primary outcomes were severe primary graft dysfunction at 72 hours and survival. Secondary outcomes included select perioperative outcomes, and 1-year and 3-years allograft function and quality of life measures.
The DCD EVLP group had significantly higher incidence of severe primary graft dysfunction at 72 hours (P = .03), longer days on mechanical ventilation (P < .001) and in-hospital length of stay (P = .045). Survival at 3 years was 76.5% (95% CI, 69.2%-84.7%) for the control group, 68.3% (95% CI, 58.9%-79.1%) for the brain-dead donor group, and 60.7% (95% CI, 45.1%-81.8%) for the DCD group (P = .36). At 3-year follow-up, presence observed bronchiolitis obliterans syndrome or quality of life metrics did not differ among the groups.
Although DCD EVLP allografts might not be appropriate to transplant in every candidate recipient, the expansion of their use might afford recipients stagnant on the waitlist a viable therapy.
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The quest for reduced levelized cost of energy has driven significant growth in wind turbine size; however, larger rotors face significant technical and logistical challenges. The largest published ...rotor design is 25 MW, and here we consider an even larger 50 MW design with blade length over 250 m. This paper shows that a 50 MW design is indeed possible from a detailed engineering perspective and presents a series of aero-structural blade designs, and critical assessment of technology pathways and challenges for extreme-scale rotors. The 50 MW rotor design begins with Monte Carlo simulations focused on optimizing carbon spar cap and root design. A baseline design resulted in a 250-m blade with mass of 502 tonnes. Subsequently, an aero-structural design and optimization were performed to reduce the blade mass/cost with more than 25% mass reduction and 30% cost reduction by determining optimal blade chord and airfoil thickness for best aero-structural performance.
Patients with tumors adjacent to the optic nerves and chiasm are frequently not candidates for single-fraction stereotactic radiosurgery (SRS) due to concern for radiation-induced optic neuropathy. ...However, these patients have been successfully treated with hypofractionated SRS over 2-5 days, though dose constraints have not yet been well defined. We reviewed the literature on optic tolerance to radiation and constructed a dose-response model for visual pathway tolerance to SRS delivered in 1-5 fractions. We analyzed optic nerve and chiasm dose-volume histogram (DVH) data from perioptic tumors, defined as those within 3 mm of the optic nerves or chiasm, treated with SRS from 2000-2013 at our institution. Tumors with subsequent local progression were excluded from the primary analysis of vision outcome. A total of 262 evaluable cases (26 with malignant and 236 with benign tumors) with visual field and clinical outcomes were analyzed. Median patient follow-up was 37 months (range: 2-142 months). The median number of fractions was 3 (1 fraction n = 47, 2 fraction n = 28, 3 fraction n = 111, 4 fraction n = 10, and 5 fraction n = 66); doses were converted to 3-fraction equivalent doses with the linear quadratic model using α/β = 2 Gy prior to modeling. Optic structure dose parameters analyzed included Dmin , Dmedian , Dmean , Dmax , V 30 Gy , V 25 Gy , V 20 Gy , V 15 Gy , V 10 Gy , V 5 Gy , D50% , D10% , D5% , D1% , D 1 cc , D 0.50 cc , D 0.25 cc , D 0.20 cc , D 0.10 cc , D 0.05 cc , D 0.03 cc . From the plan DVHs, a maximum-likelihood parameter fitting of the probit dose-response model was performed using DVH Evaluator software. The 68% CIs, corresponding to one standard deviation, were calculated using the profile likelihood method. Of the 262 analyzed, 2 (0.8%) patients experienced common terminology criteria for adverse events grade 4 vision loss in one eye, defined as vision of 20/200 or worse in the affected eye. One of these patients had received 2 previous courses of radiotherapy to the optic structures. Both cases were meningiomas treated with 25 Gy in 5 fractions, with a 3-fraction equivalent optic nerve Dmax of 19.2 and 22.2 Gy. Fitting these data to a probit dose-response model enabled risk estimates to be made for these previously unvalidated optic pathway constraints: the Dmax limits of 12 Gy in 1 fraction from QUANTEC, 19.5 Gy in 3 fractions from Timmerman 2008, and 25 Gy in 5 fractions from AAPM Task Group 101 all had less than 1% risk. In 262 patients with perioptic tumors treated with SRS, we found a risk of optic complications of less than 1%. These data support previously unvalidated estimates as safe guidelines, which may in fact underestimate the tolerance of the optic structures, particularly in patients without prior radiation. Further investigation would refine the estimated normal tissue complication probability for SRS near the optic apparatus.
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