How did the offshore oil industry develop the means to image the seafloor with photographic precision? What are the stakes of producing images through processes that simultaneously produce carcasses? ...This essay addresses these questions by charting the ambivalent history of reflection seismology from the 1940s to the present day. In the postwar era, when offshore drilling was just emerging, companies like Union Oil, Shell Oil, Macco Corporation, and affiliated researchers were key actors in the development of offshore prospecting techniques. From wire sounding technologies like the soundfish to modern airgun surveys, the hunt for energy resources paved the way for high-resolution imaging of the ocean floor, despite devastating ecological casualties. Drawing from sound studies scholarship in addition to interviews and oceanographic records, this essay focuses on how petroleum surveys have affected the material space of their interventions. In particular, I theorize the survey as a distinct framework for knowledge that privileges comprehensive and continuous information feeds. I contend that the repeated bias toward frictionless signal in combination with discourses of energy security has obscured and even justified the harmful ecological impacts of reflection seismology on ocean environments. Ultimately, I argue that rather than starting with the visual abstractions of survey maps and seismic images, attention must be returned to the violent sonic “bangs” of surveying—a recurring event that is inseparable from the nonhuman and environmental agencies, casualties, and affects that co-constitute the media-making process.
Aim: Management of older PWT2D in LTC is challenging due to comorbidity, functional dependence, and hypoglycemia risk, and is further complicated by nurse shortages. This cross-sectional survey ...emailed to LTC nurses assessed perceived nursing burden associated with complex insulin regimens (basal-bolus BB, sliding scale insulin SSI) vs FRCs.
Methods: The survey comprised 3 hypothetical cases of PWT2D receiving BB, SSI, or FRC. Perceived burden was assessed using the unweighted NASA-Task Load Index (TLX). Responses for the 6 TLX subscales (mental, physical, and temporal demand; effort, frustration, performance) and perceived frequency of fingerstick use were summarized descriptively.
Results: 10,982 nurses received the survey. Of the 250 who qualified (administered BB/SSI/FRC in past 90 days), 87% were female, 51% were ≥45 y, 49% had ≥11 y experience in LTC. TLX scores (max 20 higher = worse) were lower for FRCs vs BB or SSI (Table). Nurses perceived FRCs to require fewer fingersticks vs BB or SSI (Table).
Conclusions: FRCs were perceived to reduce nursing burden and fingerstick use compared with complex insulin regimens. These findings, coupled with the lower hypoglycemia risk for FRCs vs complex insulin regimens reported in clinical trials suggest that use of FRCs in LTC has potential to reduce nursing workload.
Disclosure
H. E. Davidson: Research Support; Sanofi-Aventis U. S. A. Nelson: Research Support; Sanofi-Aventis U. S. L. F. Han: Research Support; Sanofi-Aventis U. S. M. Lamantia: Research Support; Sanofi-Aventis U. S. K. Desai: Employee; Sanofi. X. Li: Employee; Sanofi-Aventis U. S. T. A. Dex: Employee; Sanofi-Aventis U. S., Stock/Shareholder; Pfizer Inc., Viatris Inc., Teva Pharmaceutical Industries Ltd. J. F. Vance: None. K. Overbeck: None.
Funding
Sanofi
Snacking outside main meals may contribute to the high intakes of discretionary foods (i.e., unhealthful foods) among young adults. This study assessed the snacking behaviours of Australian young ...adults including the contribution of snacking to energy and nutrient intakes, the main foods consumed, and portion sizes. A secondary analysis of the MYMeals study of adults aged 18–30 years who consumed at least one snack food during the recording period (n = 889) was conducted. All food consumed over 3 consecutive days was recorded using a purpose-designed smartphone app. Snack foods contributed 13.2% of energy, 23.4% of total sugars, and 16.2% of saturated fat. Females consumed more energy (13.8% vs. 12.2%, p = 0.007) and total sugars (25.8% vs. 20.8%, p = 0.009), from snacking than males. Fruit (20.2%), chocolate (9.9%), cake-type desserts (8.4%), sweet biscuits (6.1%), and ice-cream-type desserts (5.6%) were the most frequently consumed snacks by young adults. The median portion sizes for the top five snack foods consumed were fruit—106 g (IQR: 73), chocolate—26 g (IQR: 36), cake—95 g (IQR: 88), sweet biscuits—26 g (IQR: 29), and ice cream—75 g (IQR: 42). The current findings may inform population-wide strategies to encourage healthful snacks such as fruit, inform portion control by individuals, and persuade the food industry to reduce the serving size of discretionary snack foods such as cake.
The classification of endometrial stromal sarcoma (ESS) has been refined and aided by the discovery of various recurrent gene translocations. Low‐grade ESS (LG‐ESS) is most commonly characterized by ...JAZF1‐SUZ12 fusions followed by rearrangements involving PHD finger protein‐1 (PHF1) and multiple fusion partners, including JAZF1, EPC1, EPC2, and MEAF6. In the present study, integrating anchored polymerase chain reaction and paired‐end next‐generation ribonucleic acid sequencing, we identified the presence of a novel malignant brain tumor domain‐containing 1 (MBTD1)‐PHF1 gene fusion in a case of LG‐ESS. MBTD1 belongs to the Polycomb gene group, and its fusion with PHF1 is predicted to mediate tumorigenesis through aberrant transcriptional repression. Histology and immunohistochemical studies demonstrated conventional morphology for LG‐ESS and clinical follow‐up showed no progression of disease after 6 months. These findings help expand the current knowledge on the spectrum of gene rearrangements in the diagnosis of ESS.
Influenza severity increases and vaccine effectiveness decreases with age. High-dose influenza vaccine (HD) with quadruple the antigen of standard-dose (SD) vaccine is more efficacious in ...community-dwelling persons 65 years and older. We evaluated the feasibility of recruiting and randomizing Medicare certified nursing homes (NHs) for a pragmatic cluster-randomized trial comparing HD vs. SD (NCT1720277). Residents were long-stay and at least 65 years old. NH leadership agreed to standard of care random assignment with HD (Fluzone® High-Dose) or SD (Fluzone®) influenza vaccine for their facility for the 2012-2013 influenza season. We used Minimum Data Set (MDS) 3.0 and Vital Status records for pre-specified clinical outcomes: 1) all-cause hospitalization, 2) NH mortality, and 3) functional decline. Intent-to-treat analyses were performed at the resident-level using Cox proportional hazards, multivariable Poisson, and logistic regression models accounting for clustering by facility. We randomized 39 NHs (19 SD and 20 HD), coordinated vaccine delivery, implemented web-based data collection, and accessed MDS data, demonstrating feasibility. There were 2,957 eligible residents (SD 1496; HD 1461); characteristics were similar between groups. A total of 301 (20.1%) of SD and 197 (13.5%) of HD allocated residents were ever hospitalized, (adjusted relative risk 0.680; 95% CI: 0.537, 0.862; p = 0.001). NH mortality was 274 (18.3%) SD vs. 249 (17.1%) HD, adjusted relative risk 0.834; 95% CI: 0.678, 1.027; p = 0.087). There were no differences in decline in functional status (13.4 vs. 13.8%, adjusted relative risk 0.994; 95% CI: 0.774,1.278; p = 0.965). We demonstrate that a pragmatic large-scale trial is feasible in a NH setting.
The objective of this study was to describe antihypertensive medication use, determine what effects comorbid illness has on prescribing of commonly used antihypertensive medications, and explore how ...treatment affected selected clinical and functional outcomes in US nursing home residents.
Cross-sectional observational study using data from the 2004 National Nursing Home Survey, a nationally representative sample of US nursing home residents.
More than one half, 53.8%, of all residents had hypertension as a primary admission or current diagnosis. A large majority (84%) of residents with the diagnosis of hypertension were receiving at least one legend medication indicated for hypertension. The most common selection of pharmacologic agent was monotherapy with diuretics in 11% of all residents receiving antihypertensive medications. Hypertensive residents with a diagnosis of arrhythmia (odds ratio OR = 1.19, 95% confidence interval CI = 1.02-1.38), stroke (OR = 1.18, 95% CI = 1.05-1.34), or heart failure (OR = 1.17, 95% CI = 1.04-1.32) were more likely to be receiving a beta blocker. Those with diabetes (OR = 0.86, 95% CI = 0.77-0.96), depression (OR = 0.78, 95% CI = 0.70-0.87), constipation (OR = 0.72, 95% CI = 0.61-0.84), or asthma (OR = 0.51, 95% CI = 0.34-0.74) were less likely to be receiving a beta blocker. Hospital admission was less likely (OR = 0.50, 95% CI = 0.36-0.69) when residents were taking any commonly used antihypertensive medication (diuretics, beta blockers, angiotensin-converting enzyme/angiotensin receptor blockers ACE/ARBs, calcium channel blockers, or alpha-blockers) but significantly more likely when therapy included a beta blocker (OR = 1.45, 95% CI = 1.18 - 1.78). Beta blockers were associated with an increased likelihood of falls (OR = 1.14, 95% CI = 1.04-1.27) and a decreased likelihood of constipation (OR 0.72, 95% CI = 0.61-0.84). Beta blockers were associated with a decreased likelihood of depression (OR 0.83, 95% CI = 0.74-0.92) as was the use of any commonly used antihypertensive (OR = 0.76, 95% CI = 0.63-0.90).
Hypertension is prevalent in US nursing home residents and most residents with that diagnosis (84%) are being treated with antihypertensive medication. Through examination of the National Nursing Home Survey database, associations between the use of selected antihypertensive medication, comorbid illness, and specified outcomes were observed.
Background:
Influenza, the most important viral infection affecting older adults, produces a substantial burden in health care costs, morbidity, and mortality. Influenza vaccination remains the ...mainstay in prevention and is associated with reduced rates of hospitalization, stroke, heart attack, and death in non-institutional older adult populations. Influenza vaccination produces considerably lower antibody response in the elderly compared to young adults. Four-fold higher vaccine antigen (high-dose) than in the standard adult vaccine (standard-dose) elicits higher serum antibody levels and antibody response in ambulatory elderly.
Purpose:
To describe the design considerations of a large clinical trial of high-dose compared to standard-dose influenza vaccine in nursing homes and baseline characteristics of participating nursing homes and long-stay (more than 90 days) residents over 65 years of age.
Methods:
The high-dose influenza vaccine intervention trial is multifacility, cluster randomized controlled trial with a 2×2 factorial design that compares hospitalization rates, mortality, and functional decline among long-stay nursing home residents in facilities randomized to receive high-dose versus standard-dose influenza vaccine and also randomized with or without free staff vaccines provided by study organizers. Enrollment focused on nursing homes with a large long-stay resident population over 65 years of age. The primary outcome is the resident-level incidence of hospitalization with a primary diagnosis of pulmonary and influenza-like illness, based upon Medicare inpatient hospitalization claims. Secondary outcomes are all-cause mortality based upon the vital status indicator in the Medicare Vital Status file, all-cause hospitalization directly from the nursing home Minimum Data Set discharge records, and the probability of declining at least 4 points on the 28-point Activities of Daily Living Scale.
Results:
Between February and September 2013, the high-dose influenza vaccine trial recruited and randomized 823 nursing homes. The analysis sample includes 53,035 long-stay nursing home residents over 65 years of age, representing 57.7% of the participating facilities’ population. Residents are mainly women (72.2%), white (75.5%), with a mean age of 83 years. Common conditions include hypertension (79.2%), depression (55.1%), and diabetes mellitus (34.4%). The prevalence of circulatory and pulmonary disorders includes heart failure (20.5%), stroke (20.1%), and asthma/chronic obstructive pulmonary disease (20.2%).
Conclusions:
This high-dose influenza vaccine trial uniquely offers a paradigm for future studies of clinical and programmatic interventions within the framework of efforts designed to test the impact of changes in usual treatment practices adopted by health care systems.
Trial registration:
NCT01815268
•Cowden syndrome results in an increased risk of developing breast, thyroid, and endometrial carcinoma, and benign hamartomas.•Phyllodes tumor is a rare fibroepithelial tumor that accounts for less ...than 1% of all breast tumors.•Phyllodes tumors can rarely arise in the anogenital region, as mammary-type glands can be found in this region.•We describe the case of a vulvar Phyllodes tumor that developed in a patient with Cowden syndrome.•This is the first time a vulvar PT has been described in association with Cowden syndrome.
Cowden syndrome is a rare hereditary cancer syndrome characterized by a germline PTEN mutation which results in an increased risk of developing breast, thyroid, and endometrial carcinoma, as well as widespread benign hamartomas. Phyllodes tumor (PT) is a rare fibroepithelial tumor that accounts for less than 1% of all breast tumors. As mammary-type glands can be found in the anogenital region, PTs can rarely arise in this location. We describe the presentation, workup and management of a PT of the vulva that developed in a patient with Cowden syndrome. This report represents the first time a vulvar PT has been described in association with Cowden syndrome and should be considered in the differential diagnosis of a slow-growing vulvar mass.
Immune responses to influenza vaccines decline with age, reducing clinical effectiveness. We compared the effect of the more immunogenic high-dose trivalent influenza vaccine with a standard-dose ...vaccine to identify the effect on reducing hospital admissions of nursing home residents in the USA.
We did a single-blind, pragmatic, comparative effectiveness, cluster-randomised trial with a 2 × 2 factorial design. Medicare-certified nursing homes in the USA located within 50 miles of a Centers for Disease Control and Prevention influenza reporting city were recruited, so long as the facilities were not located in a hospital, had more than 50 long-stay residents, had less than 20% of the population aged under 65 years, and were not already planning to administer the high-dose influenza vaccine to residents. Enrolled nursing homes were randomised to a facility-wide standard of care for the residents of either high dose or standard dose as the vaccine for the 2013-14 influenza season and half of each group were randomly allocated to free vaccines for staff. Individual residents were included in the analysis group if they were aged 65 years or older and were long-stay residents (ie, had been in the facility 90 days or more before commencing the influenza vaccination programme). The analysts and investigators with access to the raw data were masked to study group by coding the groups until after the analyses were complete. The primary outcome was hospital admissions related to pulmonary and influenza-like illness between Nov 1, 2013, and May 31, 2014, identified from Medicare hospital claims available for residents who were without private health insurance (ie, those who were considered Medicare fee-for-service). We obtained data from the Centers for Medicare & Medicaid Services (CMS) and enrolled facilities. The analyses used marginal Poisson and Cox proportional hazards regression, accounting for clustering of residents within homes, on an intention-to-treat basis, adjusting for facility clustering and prespecified covariates. Safety data were voluntarily reported according to the standard of care. This trial is registered with ClinicalTrials.gov, number NCT01815268.
823 facilities were recruited to the study between March and August, 2013, to participate in the trial, of which 409 facilities were randomised for residents to receive high-dose vaccine, and 414 facilities for residents to receive standard-dose vaccine. The facilities housed 92 269, of whom 75 917 were aged 65 years or older and 53 008 were also long-stay residents, and 38 256 were matched to Medicare hospital claims as of Nov 1, 2013. Staff vaccination rates did not differ between groups, so analyses focused on the high-dose versus standard-dose vaccine comparison. On the basis of Medicare fee-for-service claims, the incidence of respiratory-related hospital admissions was significantly lower in facilities where residents received high-dose influenza vaccines than in those that received standard-dose influenza vaccines (0·185 per 1000 resident-days or 3·4% over 6 months vs 0·211 per 1000 resident-days or 3·9% over 6 months; unadjusted relative risk of 0·888, 95% CI 0·785-1·005, 0=0·061, and adjusted relative risk 0·873, 0·776-0·982, p=0·023).
When compared with standard-dose vaccine, high-dose influenza vaccine can reduce risk of respiratory-related hospital admissions from nursing home residents aged 65 years and older.
Sanofi Pasteur, Swiftwater, PA, USA.
Gene copy number variation (CNV) can arise as a response to selection pressure from the environment. Herbicide is one selective agent targeting and promoting the evolution of resistance in ...agricultural weed populations. In Amaranthus palmeri, CNV of the EPSPS gene, the target of glyphosate herbicide, ranges from 1 to over 160 copies, and is the primary genetic determinant of glyphosate resistance. The amplified copies of EPSPSare found as extrachromosomal circular DNA, which raises questions about the heritability of resistance gene copies. I used 799 F1 progeny from 30 crosses to examine the following: (i) Is there a relationship between EPSPScopy number (CN) of offspring and mean of the parental pair copy number? (ii) Is there variability in the directionality of EPSPSinheritance with increasing mean CN? EPSPSgene CN estimates were obtained by probe-based droplet digital PCR and the copy number estimates were used to perform controlled crosses to create the F1 generation. The results illustrate an overall increase in mean copy number in response to increasing mean EPSPScopies in the parents. I report a significant heritability estimate of EPSPSgene copies between parental pairs and their offspring mean EPSPScopy number, with a threshold point of 48.8 EPSPScopies. The heritability is significantly higher (h2 =0.69) for low to moderate mean copy number plants below this 48.8 copy number threshold, but declines (h2 =0.14) for high mean copy number plants. F1 data revealed progeny means decreasing as parental pair means increase, and minimal relation between the standard deviation of the progeny EPSPScopy number and the difference in parental pair copy number. Positive and negative transgressive segregants were observed, and the tendency to accumulate or lose amplified copies shifted with parental pair mean CN value. These results are discussed in the context of ecological, evolutionary, and genetic factors that may influence EPSPS CN inheritance in A. palmeri.This thesis investigates the properties the extent to which progeny CN is determined by parental CN in a system exhibiting extrachromosomal CNV, contributing to the ongoing effort to understand the evolutionary trajectory of gene copy number inheritance and resistance.
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