Interobserver agreement on definition of the target volume in stereotactic radiotherapy for pancreatic adenocarcinoma using different imaging modalities.

PURPOSE: The aim of this study was to evaluate interobserver agreement (IOA) on target volume definition for pancreatic cancer (PACA) within the Radiosurgery and Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (DEGRO) and to identify the influence of imaging modalities on the definition of the target volumes. METHODS: Two cases of locally advanced PACA and one local recurrence were selected from a large SBRT database. Delineation was based on either a planning 4D CT with or without (w/wo) IV contrast, w/wo PET/CT, and w/wo diagnostic MRI. Novel compared to other studies, a combination of four metrics was used to integrate several aspects of target volume segmentation: the Dice coefficient (DSC), the Hausdorff distance (HD), the probabilistic distance (PBD), and the volumetric similarity (VS). RESULTS: For all three GTVs, the median DSC was 0.75 (range 0.17-0.95), the median HD 15 (range 3.22-67.11) mm, the median PBD 0.33 (range 0.06-4.86), and the median VS was 0.88 (range 0.31-1). For ITVs and PTVs the results were similar. When comparing the imaging modalities for delineation, the best agreement for the GTV was achieved using PET/CT, and for the ITV and PTV using 4D PET/CT, in treatment position with abdominal compression. CONCLUSION: Overall, there was good GTV agreement (DSC). Combined metrics appeared to allow a more valid detection of interobserver variation. For SBRT, either 4D PET/CT or 3D PET/CT in treatment position with abdominal compression leads to better agreement and should be considered as a very useful imaging modality for the definition of treatment volumes in pancreatic SBRT. Contouring does not appear to be the weakest link in the treatment planning chain of SBRT for PACA.

A quantitative global review of species population monitoring.

Species monitoring, defined here as the repeated, systematic collection of data to detect long-term changes in the populations of wild species, is a vital component of conservation practice and policy. We created a database of nearly 1200 schemes, ranging in start date from 1800 to 2018, to review spatial, temporal, taxonomic, and methodological patterns in global species monitoring. We identified monitoring schemes through standardized web searches, an online survey of stakeholders, in-depth national searches in a sample of countries, and a review of global biodiversity databases. We estimated the total global number of monitoring schemes operating at 3300-15,000. Since 2000, there has been a sharp increase in the number of new schemes being initiated in lower- and middle-income countries and in megadiverse countries, but a decrease in high-income countries. The total number of monitoring schemes in a country and its per capita gross domestic product were strongly, positively correlated. Schemes that were active in 2018 had been running for an average of 21 years in high-income countries, compared with 13 years in middle-income countries and 10 years in low-income countries. In high-income countries, over one-half of monitoring schemes received government funding, but this was less than one-quarter in low-income countries. Data collection was undertaken partly or wholly by volunteers in 37% of schemes, and such schemes covered significantly more sites and species than those undertaken by professionals alone. Birds were by far the most widely monitored taxonomic group, accounting for around half of all schemes, but this bias declined over time. Monitoring in most taxonomic groups remains sparse and uncoordinated, and most of the data generated are elusive and unlikely to feed into wider biodiversity conservation processes. These shortcomings could be addressed by, for example, creating an open global meta-database of biodiversity monitoring schemes and enhancing capacity for species monitoring in countries with high biodiversity. Article impact statement: Species population monitoring for conservation purposes remains strongly biased toward a few vertebrate taxa in wealthier countries.

Una Revisión Global Cuantitativa del Monitoreo Poblacional de Especies Resumen El monitoreo de especies, definido aquí como la recolección sistemática y repetida de datos para detectar cambios a largo plazo en las poblaciones de las especies silvestres, es un componente vital de la práctica y las políticas de la conservación. Generamos una base de datos de casi 1,200 esquemas, con un rango de fecha de inicio desde 1800 hasta 2018, para revisar los patrones espaciales, temporales, taxonómicos y metodológicos en el monitoreo global de especies. Identificamos los esquemas de monitoreo por medio de búsquedas estandarizadas en línea, una encuesta digital realizada a los actores, búsquedas a profundidad en una muestra de países y en una revisión global de las bases de datos sobre la biodiversidad. Estimamos el número total mundial de esquemas funcionales de monitoreo entre 3,300 y 15,000. Desde el 2000, ha habido un fuerte aumento en el número de esquemas nuevos que han iniciado en países de bajo o mediano ingreso y en países megadiversos, pero una disminución en los países de alto ingreso. El número total de esquemas de monitoreo en un país y su producto interno bruto per cápita tuvieron una correlación sólida y positiva. Los esquemas que estaban activos en 2018 lo habían estado en un promedio de 21 años en los países de alto ingreso, comparado con un promedio de 13 años en los países de mediano ingreso y de 10 años en los países de bajo ingreso. En los países de alto ingreso, más de la mitad de los esquemas de monitoreo recibieron financiamiento del gobierno, comparado con menos de un cuarto de los esquemas en los países de bajo ingreso. La recolección de datos se realizó parcial o totalmente por voluntarios en 37% de los esquemas, y dichos esquemas cubrieron significativamente más sitios y especies que aquellos realizados sólo por profesionales. Las aves fueron por mucho el grupo taxonómico más monitoreado, comprendiendo casi la mitad de todos los esquemas, pero este sesgo declinó con el tiempo. El monitoreo en la mayoría de los grupos taxonómicos todavía es disperso y descoordinado, y la mayoría de los datos generados son vagos y tienen poca probabilidad de alimentar procesos más amplios de conservación de biodiversidad. Estas deficiencias podrían abordarse, por ejemplo, creando una meta-base de datos globales abiertos de los esquemas de monitoreo de la biodiversidad y mejorando la capacidad para el monitoreo de especies en los países con alta biodiversidad.

Development of an ultrasound-capable phantom with patient-specific 3D-printed vascular anatomy to simulate peripheral endovascular interventions.

PURPOSE: Today, ultrasound-guided peripheral endovascular interventions have the potential to be an alternative to conventional interventions that are still X-ray and contrast agent based. For the further development of this approach, a research environment is needed that represents the individual patient-specific endovascular properties as realistically as possible. Aim of the project was the construction of a phantom that combines ultrasound capabilities and the possibility to simulate peripheral endovascular interventions. MATERIAL AND METHODS: We designed a modular ultrasound-capable phantom with exchangeable patient specific vascular anatomy. For the manufacturing of the vascular pathologies, we used 3D printing technology. Subsequently, we evaluated the constructed simulator with regards to its application for endovascular development projects. RESULTS: We developed an ultrasound-capable phantom with an exchangeable 3D-printed segment of the femoral artery. This modality allows the study of several patient-specific 3D-printed pathologies. Compared to the flow properties of a human artery (male; age 28) the phantom shows realistic flow properties in the duplex ultrasound image. We proved the feasibility of the simulator by performing an ultrasound-guided endovascular procedure. Overall, the simulator showed realistic intervention conditions. CONCLUSIONS: With the help of the constructed simulator, new endovascular procedures and navigation systems, such as ultrasound-guided peripheral vascular interventions, can be further developed. Additionally, in our opinion, the use of such simulators can also reduce the need for animal experiments.

Assessment of treatment patterns associated with injectable disease-modifying therapy among relapsing-remitting multiple sclerosis patients.

BACKGROUND: Availability of oral disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS) may affect injectable DMT (iDMT) treatment patterns. OBJECTIVE: The objective of this paper is to evaluate iDMT persistency, reasons for persistency lapses, and outcomes among newly diagnosed RRMS patients. METHODS: Medical records of 300 RRMS patients initiated on iDMT between 2008 and 2013 were abstracted from 18 US-based neurology clinics. Eligible patients had ≥3 visits: pre-iDMT initiation, iDMT initiation (index), and ≥1 visit within 24 months post-index. MS-related symptoms, relapses, iDMT treatment patterns (i.e. persistency, discontinuation, switching, and restart), and reasons for non-persistency were tracked for 24 months. RESULTS: At 24 months, iDMT persistency was 61.0%; 28.0% of patients switched to another DMT, 8.0% discontinued, and 3.0% stopped and restarted the same iDMT. The most commonly identified reasons for non-persistency were perceived lack of efficacy (22.2%), adverse events (18.8%), and fear of needles/self-injecting (9.4%). At 24 months, 38.0% of patients had experienced a relapse and 11.0% had changes in MRI lesion counts. Patients without MS-related symptoms at index reported increases in the incidence of these symptoms at 24 months. CONCLUSIONS: Non-persistency with iDMT remains an issue in the oral DMT age. Many patients still experienced relapses and disease progression, and should consider switching to more effective therapies.

Engineering the Structural and Electronic Phases of MoTe2 through W Substitution.

MoTe2 is an exfoliable transition metal dichalcogenide (TMD) that crystallizes in three symmetries: the semiconducting trigonal-prismatic 2H- or α-phase, the semimetallic and monoclinic 1T'- or ß-phase, and the semimetallic orthorhombic γ-structure. The 2H-phase displays a band gap of ∼1 eV making it appealing for flexible and transparent optoelectronics. The γ-phase is predicted to possess unique topological properties that might lead to topologically protected nondissipative transport channels. Recently, it was argued that it is possible to locally induce phase-transformations in TMDs, through chemical doping, local heating, or electric-field to achieve ohmic contacts or to induce useful functionalities such as electronic phase-change memory elements. The combination of semiconducting and topological elements based upon the same compound might produce a new generation of high performance, low dissipation optoelectronic elements. Here, we show that it is possible to engineer the phases of MoTe2 through W substitution by unveiling the phase-diagram of the Mo1-xWxTe2 solid solution, which displays a semiconducting to semimetallic transition as a function of x. We find that a small critical W concentration xc ∼ 8% stabilizes the γ-phase at room temperature. This suggests that crystals with x close to xc might be particularly susceptible to phase transformations induced by an external perturbation, for example, an electric field. Photoemission spectroscopy, indicates that the γ-phase possesses a Fermi surface akin to that of WTe2.

Prediction of individual prosthesis size for valve-sparing aortic root reconstruction based on geometric features.

Valve-sparing aortic root reconstruction is an up- and-coming approach for patients suffering from aortic valve insufficiencies which promises to significantly reduce complications. However, the success of the treatment strongly depends on the challenging task of choosing the correct size of the prosthesis, for which, up to now, surgeons solely have to rely on their experience. Here, we present a novel machine learning based approach, which might make it possible to predict the size of the prosthesis from pre-operatively acquired ultrasound images. We utilize support vector regression to train a prediction model on three geometric features extracted from the ultrasound data. In order to evaluate the accuracy and robustness of our approach we created a large data base of porcine aortic root geometries in a healthy state and an artificially dilated state. Our results indicate that prediction of correct prosthesis sizes is feasible. Furthermore, they suggest that it is crucial that the training data set faithfully represents the diversity of aortic root geometries.

Application of the ASVCP guidelines for the establishment of haematologic and biochemical reference intervals in Icelandic horses in Austria.

BACKGROUND: Despite the increasing popularity of Icelandic horses, published reference intervals (RIs) in this breed are rare. Due to their isolation and their small gene pool, alterations in some variables are likely and some possible breed-specific peculiarities have been described. The purpose of the present study was the establishment of comprehensive RIs in Icelandic horses according to recently published guidelines. In a prospective observational study, blood samples were collected from the jugular vein of 142 Icelandic horses into EDTA and serum tubes. Reference intervals were established for haematologic and biochemical analytes on the Advia 2120i™ and the Dimension ExL™ by established methods. RIs were defined as central 95 % intervals bounded by the 2.5th and 97.5th percentiles with their 90 % confidence intervals, calculated according to recently published ASVCP guidelines. An inhouse-developed quality control system using observed total allowable error was used for the surveillance of the internal quality control preceding the measurements. RESULTS: The RIs were as follows: haematocrit: 0.29-0.39, RBC: 5.79-8.63 T/l, haemoglobin: 102.0-142.3 g/l, MCV: 42-51 fl, platelets: 146-263 G/l, WBC: 4.13-8.57 G/l, segs: 1.98-4.73 G/l, lymphocytes: 1.25-3.49 G/l, monocytes: 0.06-0.31 G/l, eosinophils: 0.04-0.50 G/l, glucose: 4.0-5.7 mmol/l, urea: 3.2-6.4 mmol/l, creatinine: 79.6-141.4 µmol/l, total protein: 54.4-72.9 g/l, albumin: 27.7-36.8 g/l, total bilirubin: 8.1-21.1 µmol/l, triglycerides: 0.03-0.44 mmol/l, cholesterol: 1.75-2.90 mmol/l, ALP: 1.35-3.55 µkat/l, AST: 4.52-8.80 µkat/l, GLDH: 0.0-0.18 µkat/l, GGT: 0.11-0.39 µkat/l, CK: 2.53-6.52 µkat/l, LDH: 3.32-7.95 µkat/l, iron: 16.4-39.9 µmol/l, calcium: 2.69-3.19 mmol/l, phosphate: 0.5-1.3 mmol/l, magnesium: 0.6-0.9 mmol/l, sodium: 134-141 mmol/l, potassium: 3.6-4.7 mmol/l, chloride: 100-105 mmol/l. CONCLUSIONS: Reference intervals of several haematologic and biochemical analytes differed from the transferred historical reference intervals applied to equine samples in the authors' laboratory. These might be of clinical importance in some analytes such as creatine kinase.

Multivariate respiratory motion prediction.

In extracranial robotic radiotherapy, tumour motion is compensated by tracking external and internal surrogates. To compensate system specific time delays, time series prediction of the external optical surrogates is used. We investigate whether the prediction accuracy can be increased by expanding the current clinical setup by an accelerometer, a strain belt and a flow sensor. Four previously published prediction algorithms are adapted to multivariate inputs-normalized least mean squares (nLMS), wavelet-based least mean squares (wLMS), support vector regression (SVR) and relevance vector machines (RVM)-and evaluated for three different prediction horizons. The measurement involves 18 subjects and consists of two phases, focusing on long term trends (M1) and breathing artefacts (M2). To select the most relevant and least redundant sensors, a sequential forward selection (SFS) method is proposed. Using a multivariate setting, the results show that the clinically used nLMS algorithm is susceptible to large outliers. In the case of irregular breathing (M2), the mean root mean square error (RMSE) of a univariate nLMS algorithm is 0.66 mm and can be decreased to 0.46 mm by a multivariate RVM model (best algorithm on average). To investigate the full potential of this approach, the optimal sensor combination was also estimated on the complete test set. The results indicate that a further decrease in RMSE is possible for RVM (to 0.42 mm). This motivates further research about sensor selection methods. Besides the optical surrogates, the sensors most frequently selected by the algorithms are the accelerometer and the strain belt. These sensors could be easily integrated in the current clinical setup and would allow a more precise motion compensation.

A 'waterfall' transfer-based workflow for improved quality of tissue microarray construction and processing in breast cancer research.

A major focus in cancer research is the identification of biomarkers for early diagnosis, therapy prediction and prognosis. Hereby, validation of target proteins on clinical samples is of high importance. Tissue microarrays (TMAs) represent an essential advancement for high-throughput analysis by assembling large numbers of tissue cores with high efficacy and comparability. However, limitations along TMA construction and processing exist. In our presented study, we had to overcome several obstacles in the construction and processing of high-density breast cancer TMAs to ensure good quality sections for further research. Exemplarily, 406 breast tissue cores from formalin-fixed and paraffin embedded samples of 245 patients were placed onto three recipient paraffin blocks. Sectioning was performed using a rotary microtome with a "waterfall" automated transfer system. Sections were stained by immunohistochemistry and immunofluorescence for nine proteins. The number and quality of cores after sectioning and staining was counted manually for each marker. In total, 97.1 % of all cores were available after sectioning, while further 96 % of the remaining cores were evaluable after staining. Thereby, normal tissue cores were more often lost compared to tumor tissue cores. Our workflow provides a robust method for manufacturing high-density breast cancer TMAs for subsequent IHC or IF staining without significant sample loss.

[Loss of appetite, night sweats, eczema, and axillary and inguinal lymph node swelling in a 28-year-old man]. / Inappetenz, Nachtschweiß, chronisches Ekzem und inguinale sowie axilläre Lymphknotenpakete bei einem 28-jährigen Patienten.

A 28-year-old man presented with loss of appetite, night sweats, eczema, and axillary and inguinal lymph node swelling. The tentative diagnosis of malignant lymphoma was made. To confirm the diagnosis, extirpation of a lymph node and a skin biopsy were performed. Systemic treatment with methylprednisolone resulted in an improvement of eczema and lymph node swelling. Because of the histological findings and clinical course, we diagnosed dermatopathic lymphadenopathy, also known as Pautrier-Woringer syndrome.

Evaluating and comparing algorithms for respiratory motion prediction.

In robotic radiosurgery, it is necessary to compensate for systematic latencies arising from target tracking and mechanical constraints. This compensation is usually achieved by means of an algorithm which computes the future target position. In most scientific works on respiratory motion prediction, only one or two algorithms are evaluated on a limited amount of very short motion traces. The purpose of this work is to gain more insight into the real world capabilities of respiratory motion prediction methods by evaluating many algorithms on an unprecedented amount of data. We have evaluated six algorithms, the normalized least mean squares (nLMS), recursive least squares (RLS), multi-step linear methods (MULIN), wavelet-based multiscale autoregression (wLMS), extended Kalman filtering, and ε-support vector regression (SVRpred) methods, on an extensive database of 304 respiratory motion traces. The traces were collected during treatment with the CyberKnife (Accuray, Inc., Sunnyvale, CA, USA) and feature an average length of 71 min. Evaluation was done using a graphical prediction toolkit, which is available to the general public, as is the data we used. The experiments show that the nLMS algorithm-which is one of the algorithms currently used in the CyberKnife-is outperformed by all other methods. This is especially true in the case of the wLMS, the SVRpred, and the MULIN algorithms, which perform much better. The nLMS algorithm produces a relative root mean square (RMS) error of 75% or less (i.e., a reduction in error of 25% or more when compared to not doing prediction) in only 38% of the test cases, whereas the MULIN and SVRpred methods reach this level in more than 77%, the wLMS algorithm in more than 84% of the test cases. Our work shows that the wLMS algorithm is the most accurate algorithm and does not require parameter tuning, making it an ideal candidate for clinical implementation. Additionally, we have seen that the structure of a patient's respiratory motion trace has strong influence on the outcome of prediction. Further work is needed to determine a priori the suitability of an individual's respiratory behaviour to motion prediction.

Mortality in preterm infants with respiratory distress syndrome treated with poractant alfa, calfactant or beractant: a retrospective study.

OBJECTIVE: The objective of this study is to compare all-cause in-hospital mortality in preterm infants with respiratory distress syndrome (RDS) treated with poractant alfa, calfactant or beractant. STUDY DESIGN: A retrospective cohort study of 14 173 preterm infants with RDS, treated with one of three surfactants between 2005 and 2009, using the Premier Database was done. Multilevel, multivariable logistic regression modeling, adjusting for patient- and hospital-level factors was performed. RESULT: Calfactant treatment was associated with a 49.6% greater likelihood of death than poractant alfa (odds ratio (OR): 1.496, 95% confidence interval (CI): 1.014-2.209, P=0.043). Beractant treatment was associated with a non-significant 37% increase in mortality, compared with poractant alfa (OR: 1.370, 95% CI: 0.996-1.885, P=0.053). No differences in mortality were observed between calfactant and beractant treatment (OR: 1.092, 95% CI: 0.765-1.559, P=0.626). CONCLUSION: Poractant alfa treatment for RDS was associated with a significantly reduced likelihood of death when compared with calfactant and a trend toward reduced mortality when compared with beractant.

Leaching of pharmaceuticals and personal care products in turfgrass soils during recycled water irrigation.

An important beneficial reuse of treated wastewater (recycled water) in arid and semiarid regions is landscape irrigation. However, the environmental fate, especially groundwater contamination potential, of trace contaminants such as pharmaceuticals and personal care products (PPCPs) is a significant concern that can hinder the acceptance and adoption of such reuses. In this study, we irrigated mature turfgrass plots with nonspiked tertiary treated wastewater for over 6 mo at 100 or 130% of the reference evapotranspiration rate (ETo) and collected leachate water at the 90-cm depth on a weekly basis. In the recycled water, all 14 target PPCPs were consistently found, and the mean levels of atenolol, gemfibrozil, meprobamate, carbamazepine, and sulfamethoxazole were above 100 ng L. However, only five compounds were detected in the leachate at trace levels. Trimethoprim and primidone were frequently found, whereas the detection of sulfamethoxazole, meprobamate and carbamazepine was less frequent (<50%). When detected, the overall mean concentration in the leachate was 10.2 ng L for trimethoprim, 7.1 ng L for primidone, and 2.9 to 12.4 ng L for carbamazepine, sulfamethoxazole, and meprobamate. The majority of the target PPCPs were completely removed. Given that the irrigation rates were higher than normal, this study clearly demonstrated the efficacy of turfgrass systems in attenuating PPCPs during recycled water irrigation. However, it is also apparent that some PPCPs are more susceptible to leaching than others, and these PPCPs thus merit further research attention.

Evaluation of the fibrinogen antigenic turbidimetric assay as a screening method for measurement of fibrinogen concentration in dogs.

BACKGROUND: A novel method for the rapid detection of fibrinogen concentration in human plasma, the fibrinogen antigenic turbidimetric assay (FIATA), is based on the precipitation of fibrinogen by vancomycin and a resultant change in optical density. OBJECTIVE: The objectives of this study were to evaluate the FIATA method for: (1) measuring fibrinogen concentration in canine plasma using specimens collected in citrate, EDTA, and heparin, (2) species-specific calibration requirements, and (3) applicability for automation. METHODS: Standard curves were generated with both human and canine fibrinogen standards in the FIATA, and a reference interval for fibrinogen concentration was established using citrated plasma from healthy dogs (n = 127). Using specimens collected from this population, results using the FIATA were compared with a modified thermoprecipitation method, and 24 of the FIATA samples were used for comparison with a particle-enhanced turbidometric fibrinogen assay. The FIATA was also applied to an automated chemistry analyzer using citrated plasma. Fibrinogen concentration was measured in EDTA and heparinized plasma in the manual FIATA. Standards, methods, and anticoagulants were compared, and correlation among these variables was evaluated. RESULTS: Significant differences between FIATA results using human and canine standards and the manual and automated methods were not found. For EDTA plasma, fibrinogen concentrations were not identical, but were similar, to those for citrated plasma; heparinized plasma was not suitable for measurement. Correlation between the thermoprecipitation method and FIATA was weak. The reference interval for fibrinogen as measured by the FIATA using citrated plasma was 103-456 mg/dL. CONCLUSIONS: The FIATA can be used as a screening method to measure fibrinogen concentration in citrated or EDTA plasma from dogs.

[Geriatric multimorbidity in claims data - part 2 : diagnoses of hospitals and diagnoses from physicians in the ambulatory setting]. / Geriatrietypische Multimorbidität im Spiegel von Routinedaten - Teil 2 : Ambulante und stationäre Diagnosen bei geriatrisch versorgten und pflegebedürftigen Versicherten.

BACKGROUND: Due to demographics, characteristic multimorbidity in geriatric patients is resulting in increased social, medical, and healthcare challenges. Geriatric multimorbidity (GM) can be defined as the simultaneous occurrence of at least two diseases that require medical care with an interdisciplinary focus on independence in activities of daily living. Typical conditions of GM are, e.g., incontinence, cognitive impairment, frailty, and decubitus. MATERIAL AND METHODS: Part 2 of this study is based on claims data of 240,502 AOK insurants (AOK is one of the major health insurance companies of the German statutory health insurance system) aged ≥ 60 years with at least one admission to a hospital with a geriatric ward. Geriatric conditions (GCs) were ascertained in two ways: diagnoses from physicians in the ambulant care setting and diagnoses in a hospital setting in 2008. A total of 15 GC were assessed using diagnoses based on ICD-10 codes (as per suggestion from scientific geriatric societies). An insurant was defined as a person with GM, if he/she had at least two GCs. RESULTS: The proportion of GCs in ambulant or inpatient diagnoses of 240,502 insurants varied significantly in most cases. For specific GCs, considerably higher proportions of ambulant diagnoses (e.g., pain, impairment of vision, or hearing) or for inpatient diagnoses (e.g., electrolyte or fluid metabolism disorders, malnutrition, incontinence) were identified. Only on rare occasions were small differences observed comparing the proportions of specific GCs in the diagnoses of the two different care sectors. This finding reduces considerably the accordance between the two care sectors with reference to the presence or absence of a GC for ambulant or inpatient diagnoses. The main agreement was with the non-coding of specific GCs, not with ambulant or inpatient diagnoses. Insurants with a geriatric hospital admission or certain care level (level ≥ 1) generally had higher proportions for specific GCs for inpatient and ambulant diagnoses than non-geriatric treated insurants or insurants without a certain care level. Of the geriatric treated insurants and those with certain care levels, 90% were characterized by the presence of GM for both ambulant or inpatient diagnoses. This percentage is remarkably higher than for patients who featured no geriatric treatment or had no certain care level. CONCLUSION: The inclusion of ambulant diagnoses in addition to inpatient diagnosis offers comprehensive possibilities to identify insurants with GM in claims data. The contribution of the diagnoses of both care sectors for the identification of GC and GM varies with regard to attribute and insurant orientation. Furthermore, significant attribute-oriented overlap of insurants claiming geriatric treatments and insurants with certain care levels became visible, which can open new possibilities for simpler identification of a portion of patients with GM.

The androgen receptor CAG repeat polymorphism as a risk factor of low serum testosterone and its cardiometabolic effects in men.

Previous studies reported correlations of CAG repeat length with sex hormone serum concentrations and cardiometabolic risk factors, but were limited by small cross-sectional samples. We used data of 1859 men aged 20-79 years from the population-based Study of Health in Pomerania (SHIP) to investigate the direct and modulating effects of CAG repeat length on androgen action and cardiometabolic risk factors. We performed cross-sectional and longitudinal linear and Poisson regression models adjusted for age, smoking, physical activity, alcohol consumption and body mass index. The CAG repeat length was categorized into quartiles and low total testosterone (TT) defined according to the age-specific (by decades) 10th percentile, respectively. Age-adjusted cross-sectional linear regression models showed a positive association between CAG repeat length and serum testosterone concentrations [ß coefficient for TT, 0.099 (p = 0.028) and for free T, 0.002 (p = 0.001), respectively]. After a 5.0 year median follow-up period, men with CAG repeat length in the lowest quartile had an increased risk of incident low TT concentrations [relative risk (RR), 2.31; 95% confidence interval (CI), 1.18-4.55]. We found no direct association between CAG repeat length and cardiometabolic risk factors in cross-sectional and longitudinal multivariable linear regression analyses; whereas men with longer CAG repeat length and low TT concentrations showed the highest risk of incident MetS (RR, 1.51; 95% CI, 1.05-2.16). CAG repeat length is a risk factor of incident low TT concentrations and a contributing factor of testosterone-related cardiometabolic effects. The added clinical value of a combined assessment of CAG repeat length and serum TT concentrations merits further investigation.

Laboratory assessment of emission reduction strategies for the agricultural fumigants 1,3-dichloropropene and chloropicrin.

With the increased use of the agricultural fumigants 1,3-dichloropropene (1,3-D) and chloropicrin (CP), it is important that strategies to reduce emissions of these fumigant from soil to the air are assessed to protect air quality. Using an established soil column approach, the following emission reduction strategies were compared to a control: (1) spray application of ammonium thiosulfate to the soil surface; (2) deep injection at 46 cm depth; (3) high density polyethylene sealed over the soil surface; (4) virtually impermeable film sealed over the soil surface; and (5) irrigation with ammonium thiosulfate solution. Relative to the control, 1,3-D emissions were reduced by 26.1, 1.0, 0.01, 94.2, and 42.5%, for treatments 1 through 5, respectively. For CP the reductions were 41.6, 23.3, 94.6, 99.9, and 87.5% for treatments 1 through 5, respectively. Virtually impermeable film gave the greatest reductions for both fumigants, while HDPE was very effective only for CP. Despite offering less significant emission reductions, the lower cost alternatives to tarping, particularly irrigation with ATS solution, may offer substantial benefitwhere tarping is not economically viable.