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To determine if financially motivated therapy in Skilled Nursing Facilities (SNFs) is associated with patient outcomes. Cohort study using 2018 Medicare administrative data. 13,949 SNFs in the United States. 934,677 Medicare Part A patients admitted to SNF for post-acute rehabilitation (N=934,677). The primary independent variable was an indicator of financially motivated therapy, separate from intensive therapy, known as thresholding, defined as when SNFs provide 10 or fewer minutes of therapy above weekly reimbursement thresholds. Dichotomous indicators of successful discharge to the community vs institution and functional improvement on measures of transfers, ambulation, or locomotion. Mixed effects models estimated relations between thresholding and community discharge and functional improvement, adjusted for therapy intensity, patient, and facility characteristics. Sensitivity analyses estimated associations between thresholding and outcomes when patients were stratified by therapy volume. Thresholding was associated with a small positive effect on functional improvement (odds ratio 1.07; 95% CI 1.06-1.09) and community discharge (odds ratio 1.03, 95% CI 1.02-1.05). Effect sizes for functional improvement were consistent across patients receiving different volumes of therapy. However, effect sizes for community discharge were largest for patients in low-volume therapy groups (odds ratio 1.27, 95% CI 1.18-1.35). Patients who experienced thresholding during post-acute SNF stays were slightly more likely to improve in function and successfully discharge to the community, especially for patients receiving lower volumes of therapy. While thresholding is an inefficient and financially motivated practice, results suggest that even small amounts of extra therapy time may have contributed positively to outcomes for patients receiving lower-volume therapy. As therapy volumes decline in SNFs, these results emphasize the importance of Medicare payment policy designed to promote, not disincentivize, potentially beneficial rehabilitation services for patients. [ABSTRACT FROM AUTHOR]

The metabolism of different cells within the same microenvironment can differ and dictate physiological or pathological adaptions. Current single-cell analysis methods of metabolism are not label-free. The study introduces a label-free, live-cell analysis method assessing endogenous fluorescence of NAD(P)H and FAD in surface-stained cells by flow cytometry. OxPhos inhibition, mitochondrial uncoupling, glucose exposure, genetic inactivation of glucose uptake and mitochondrial respiration alter the optical redox ratios of FAD and NAD(P)H as measured by flow cytometry. Those alterations correlate strongly with measurements obtained by extracellular flux analysis. Consequently, metabolically distinct live B-cell populations can be resolved, showing that human memory B-cells from peripheral blood exhibit a higher glycolytic flexibility than naïve B cells. Moreover, the comparison of blood-derived B- and T-lymphocytes from healthy donors and rheumatoid arthritis patients unleashes rheumatoid arthritis-associated metabolic traits in human naïve and memory B-lymphocytes. Taken together, these data show that the optical redox ratio can depict metabolic differences in distinct cell populations by flow cytometry. • Real-time simultaneous metabolic analysis of different cell populations. • Label-free detection of the optical redox ratio of FAD/NADH fluorescence via flow cytometry. • Correlation with Seahorse extracellular flux analysis and enzymatic NAD(P)H detection. • Applicable to human T cell lymphoma, primary mouse and human lymphocytes. • Distinction of naïve and memory B cell populations in healthy and inflamed background. [ABSTRACT FROM AUTHOR]

This study investigates the performance of geometrically defined dimple and groove textures in the turning of Al2024. On-machine testing using combinations of periodic SEM imaging and cutting force capture were used for wear assessments of the textured surfaces and to provide input data for tribology testing. Tribometer investigations were conducted to determine the influences of surface textures on elastohydrodynamic lubrication, influenced by tool-chip contact pressure and entrainment area. The study has shown that both dimple and groove textures can reduce surface friction by influencing mixed and hydrodynamic contact, resulting in reductions of cutting forces. [ABSTRACT FROM AUTHOR]

• Surgical site infections produce no long-term differences in quality of life. • Surgical site infections associated with roughly $21,000 cost increase per case. • Surgical site infections render lumbar decompression cost ineffective. Surgical site infections (SSI) following spine procedures are serious and costly complications that may reduce patient quality of life (QOL). Deep SSIs may also extend hospitalizations and require surgical debridement or antibiotic therapy, increasing costs to both patients and the healthcare system. Here we sought to evaluate the effect of deep SSI on care cost and QOL outcomes in patients undergoing posterior lumbar decompression and fusion. To do so we performed a retrospective study of patients undergoing lumbar decompression and fusion between 2008 and 2012. Patients experiencing postoperative deep SSI were matched to controls not experiencing a deep SSI. Included patients had prospectively-gathered QOL outcome measures collected preoperatively and at 6 months postoperatively. Health resource utilization was recorded from patient electronic medical records over the 6-month follow-up. Direct costs were estimated using Medicare national payment amounts. Indirect costs were based on missed work days and patient income. We found both cohorts experienced significant improvements in QOL scores following surgery, and there were no significant differences between the cohorts. The average total cost was significantly higher in the infected cohort compared to controls ($37,009 vs. $16,227; p < 0.0001). Compared to controls, patients experiencing deep SSI had greater costs in each of the following categories: hospitalizations (p < 0.01), office visits (p = 0.03), imaging (p < 0.01), and medications (p < 0.01). Among those experiencing deep SSI, there are significant increases in costs, with minimal long-term impact on QOL outcomes as compared with controls at the six-month follow-up. [ABSTRACT FROM AUTHOR]

The diagnosis of gastric premalignant conditions (GPCs) relies on endoscopy with mucosal sampling. We hypothesized that the endoscopist biopsy rate (EBR) might constitute a quality indicator for EGD, and we have analyzed its association with GPC detection and the rate of missed gastric cancers (GCs). We analyzed EGD databases from 2 high-volume outpatient units. EBR values, defined as the proportion of EGDs with ≥1 biopsy to all examinations were calculated for each endoscopist in Unit A (derivation cohort) and divided by the quartile values into 4 groups. Detection of GPC was calculated for each group and compared using multivariate clustered logistic regression models. Unit B database was used for validation. All patients were followed in the Cancer Registry for missed GCs diagnosed between 1 month and 3 years after EGDs with negative results. Sixteen endoscopists in Unit A performed 17,490 EGDs of which 15,340 (87.7%) were analyzed. EBR quartile values were 22.4% to 36.7% (low EBR), 36.8% to 43.7% (moderate), 43.8% to 51.6% (high), and 51.7% and 65.8% (very-high); median value 43.8%. The odds ratios for the moderate, high, and very-high EBR groups of detecting GPC were 1.6 (95% confidence interval [CI], 1.3-1.9), 2.0 (95% CI, 1.7-2.4), and 2.5 (95% CI, 2.1-2.9), respectively, compared with the low EBR group (P <.001). This association was confirmed with the same thresholds in the validation cohort. Endoscopists with higher EBR (≥43.8%) had a lower risk of missed cancer compared with those in the lower EBR group (odds ratio, 0.44; 95% CI, 0.20-1.00; P =.049). The EBR parameter is highly variable among endoscopists and is associated with efficacy in GPC detection and the rate of missed GCs. [ABSTRACT FROM AUTHOR]

Abstract Objective Structurally-improved GIP analogs were developed to determine precisely whether GIP receptor (GIPR) agonism or antagonism lowers body weight in obese mice. Methods A series of peptide-based GIP analogs, including structurally diverse agonists and a long-acting antagonist, were generated and characterized in vitro using functional assays in cell systems overexpressing human and mouse derived receptors. These analogs were characterized in vivo in DIO mice following acute dosing for effects on glycemic control, and following chronic dosing for effects on body weight and food intake. Pair-feeding studies and indirect calorimetry were used to survey the mechanism for body weight lowering. Congenital Gipr−/− and Glp1r−/− DIO mice were used to investigate the selectivity of the agonists and to ascribe the pharmacology to effects mediated by the GIPR. Results Non-acylated, Aib2 substituted analogs derived from human GIP sequence showed full in vitro potency at human GIPR and subtly reduced in vitro potency at mouse GIPR without cross-reactivity at GLP-1R. These GIPR agonists lowered acute blood glucose in wild-type and Glp1r−/− mice, and this effect was absent in Gipr−/− mice, which confirmed selectivity towards GIPR. Chronic treatment of DIO mice resulted in modest yet consistent, dose-dependent decreased body weight across many studies with diverse analogs. The mechanism for body weight lowering is due to reductions in food intake, not energy expenditure, as suggested by pair-feeding studies and indirect calorimetry assessment. The weight lowering effect was preserved in DIO Glp-1r−/− mice and absent in DIO Gipr −/− mice. The body weight lowering efficacy of GIPR agonists was enhanced with analogs that exhibit higher mouse GIPR potency, with increased frequency of administration, and with fatty-acylated peptides of extended duration of action. Additionally, a fatty-acylated, N-terminally truncated GIP analog was shown to have high in vitro antagonism potency for human and mouse GIPR without cross-reactive activity at mouse GLP-1R or mouse glucagon receptor (GcgR). This acylated antagonist sufficiently inhibited the acute effects of GIP to improve glucose tolerance in DIO mice. Chronic treatment of DIO mice with high doses of this acylated GIPR antagonist did not result in body weight change. Further, co-treatment of this acylated GIPR antagonist with liraglutide, an acylated GLP-1R agonist, to DIO mice did not result in increased body weight lowering relative to liraglutide-treated mice. Enhanced body weight lowering in DIO mice was evident however following co-treatment of long-acting selective individual agonists for GLP-1R and GIPR, consistent with previous data. Conclusions We conclude that peptide-based GIPR agonists, not peptide-based GIPR antagonists, that are suitably optimized for receptor selectivity, cross-species activity, and duration of action consistently lower body weight in DIO mice, although with moderate efficacy relative to GLP-1R agonists. These preclinical rodent pharmacology results, in accordance with recent clinical results, provide definitive proof that systemic GIPR agonism, not antagonism, is beneficial for body weight loss. Highlights • Structurally-refined and diverse GIP receptor agonists consistently lower body weight in DIO mice. • Body weight lowering of GIP receptor agonists is maintained in GLP-1R−/− mice yet abolished in GIPR−/− mice. • GIP receptor agonism promotes body weight lowering via food intake mechanism. • A fully potent long-acting GIP receptor antagonist does not lower body weight in DIO mice. [ABSTRACT FROM AUTHOR]

Objective To signal, FGF19 and FGF21 require co-receptor βKlotho (KLB) to act in concert with FGF receptors, and yet there is appreciable variance in the C-terminal sequences of these two novel metabolic hormones where binding is believed to be primary. We seek to determine the functional consequences for these amino acid differences and determine whether such information can be used to design high potency antagonists and agonists. Methods We employed a functional in vitro assay to identify C-terminal protein fragments capable of fully blocking KLB-mediated FGF19 and 21 receptor signaling. The key residues in each hormone responsible for support full bioactivity were identified through peptide-based Ala-scanning. Chemical optimization of the peptides was employed to increase their antagonistic potency. An optimized sequence as a substituted part of a full length FGF21 was assessed for enhanced FGFR/KLB-mediated agonism using tissue culture and obese mice. Results C-terminal FGF19 and FGF21 peptides of relatively short length were observed to potently inhibit the activity of these two hormones, in vitro and in vivo . These FGFs of different sequence also demonstrated a striking conservation of structural determinants to maintain KLB binding. A single C-terminal amino acid in FGF19 was observed to modulate relative activity through FGFR1 and FGFR4. The substitution of native FGF21 C-terminal sequence with a peptide optimized for the highest antagonistic activity resulted in significantly enhanced FGF potency, as measured by in vitro signaling and improvements in metabolic outcomes in diet-induced obese mice. Conclusions We report here the ability of short C-terminal peptides to bind KLB and function as antagonists of FGF19 and 21 actions. These proteins maintain high conservation of sequence in those residues central to KLB binding. An FGF21 chimeric protein possessing an optimized C-terminal sequence proved to be a super-agonist in delivery of beneficial metabolic effects in obese mice. [ABSTRACT FROM AUTHOR]

Acclimation, adaptation and survival in persistent cold polar environments are complex phenomena associated with myriad molecular, biochemical and physiological mechanisms. The psychrophile, Chlamydomonas priscuii , is endemic to Lake Bonney, Antarctica. Adaptation to its extreme polar environment includes homeoviscous adaptation of membranes, maintenance of energy balance through photostasis and surface area to volume ratio. In addition to these mechanisms, this psychrophile can exist in culture as motile, single cells or as immobile, multicellular palmelloids. Comparative biochemical, physiological, microscopic and spectroscopic analyses of purified single cells and palmelloids indicate that the conversion of single cells to multicellular palmelloids alters the composition and organization of the photosynthetic apparatus. This enhances photoprotection of the photosynthetic apparatus from light and low temperature stress by minimizing potential cellular energy imbalances and safely dissipating excessive excitation energy by nonphotochemical quenching mechanisms. In addition to decreased susceptibility to predation, enhanced photoprotection from photoinhibition associated with palmelloid formation may be a complementary, selective, evolutionary advantage for the induction of multicellularity in green algae. • Adaptation of single cell green algae to polar habitats includes conversion of single cells into multicellular palmelloids. • Environmental conditions signal the conversion of single cells to multicellular palmelloids. • Palmelloid formation reorganizes the photosynthetic apparatus for enhanced photoprotection from stress. • This may be a selective advantage multicellularity in green algae. [ABSTRACT FROM AUTHOR]

From 1861 to the 1940s, gold was produced from 64 mining districts in Nova Scotia, where mercury amalgamation was the dominant method for the extraction of gold from ore until the 1880s. As a result, wastes (tailings) from the milling process were contaminated by mercury and were high in naturally occurring arsenic. In 2004 and 2005, sediments, water and mollusc tissues were collected from 29 sampling stations at nine former gold mining areas along the Atlantic coastline and were analysed for arsenic and mercury. The resulting data were compared with environmental quality guidelines. Samples indicated high potential risk of adverse effects in the intertidal environments of Seal Harbour, Wine Harbour and Harrigan Cove. Arsenic in Seal Harbour was bioavailable, resulting in high concentrations of arsenic in soft-shell clam tissues. Mercury concentrations in tissues were below guidelines. This paper presents results of the sampling programs and implications of these findings. [ABSTRACT FROM AUTHOR]

In industrial production, the absence of component markings and unrecognized component failure can result in a lack of protection against product piracy and malfunctions of machinery and installations. A technique for storing data inherently in the subsurface region of the component was developed. Inherently stored data is highly resistant to external stresses and inseparably linked to the component. To evaluate the integrity of highly stressed components, material inherent sensors are induced in the subsurface region of the component to store the loading history. These techniques offer the potential for securely identifying and evaluating the status of components, and thus reducing failure costs. [ABSTRACT FROM AUTHOR]

Background During an ongoing phase II observational study on watch and wait policy in rectal cancer, a substantial number of patients presented residual lesion after radiotherapy with a clinical benign appearance. This article aims to discuss the clinical significance of such findings. Materials and methods Main entry criteria were age ≥70 years and small tumour (≤5 cm and ≤60% of circumferential involvement) located in the low rectum. Patients received chemoradiation (50 Gy, 2 Gy per fraction concomitantly with a 5-Fu bolus and leucovorin) or 5 × 5 Gy if considered unfit for chemotherapy. Patients with clinical complete response (cCR) were observed. Those with persistent tumours underwent transanal endoscopic microsurgery [TEM] if the baseline tumour was ≤3 cm and cN0 or total mesorectal excision. Results The watch and wait procedure was used in 11 out of the total 35 patients (31%) with a cCR; 17 patients (49%) with residual tumours that appeared clinically malignant were referred for TEM or abdominal surgery. In the remaining seven (20%), the residual tumour clinically appeared benign. Of these, there were two invasive cancers, four high-grade dysplasias and one low-grade dysplasia. The five patients with dysplasia, underwent local lesion resection without recurrence within a median of 11 months follow-up. Conclusions The majority of lesions that appeared clinically benign after radio(chemo)therapy were also benign on pathological examination. Thus, local excision of such lesions should be considered. [ABSTRACT FROM AUTHOR]

Explore national geographic differences in unplanned readmission after accounting for patient-level admission factors and area-level post-acute care availability for individuals receiving home health services following stroke or lower-extremity joint replacement (JR). Retrospective cross-sectional analysis of Centers for Medicare & Medicaid Services (CMS) home health claims records and the Outcome and Assessment Information Set (OASIS). Using Rural-Urban Continuum Codes (RUCC) we classified all US counties into metro, metro-adjacent rural, and non-metro-adjacent rural areas and examined the availability of other post-acute care (PAC) provider types (long-term care hospitals, skilled nursing (SNF), and inpatient rehabilitation facilities) in each. We conducted multilevel logistic regressions to show the association between county classification and the odds of an unplanned readmission. We examined acute care discharges to home health agencies. The population included 100% Medicare records from 2013–2015 fee-for-service beneficiaries >65 years. The cohort included 21,395 stroke records and 160,287 JR records. N/A. Odds of an unplanned readmission for individuals who received home health services following stroke or JR. Overall, 11.0% of stroke and 3.4% of JR had an unplanned readmission. For those >65 with JR, unplanned readmissions increased as age (range 2.6–5.4%) and length of stay (2.9–13%) increased. PAC availability other than home health varied across county groups. For metro counties, >50% were SNF-only; only 20% had all PAC provider types, whereas 80% of metro-adjacent rural counties were SNF-only with < 2% with all PAC provider types. Compared to metro areas, residing in a rural area was protective of readmission for those with stroke (metro-adjacent rural OR=0.887 (95CI 0.751–1.047), metro non-adjacent rural OR=0.789 (0.634–0.982). There was no significant effect of rural area on JR unplanned readmission. Residing in rural counties is protective against unplanned readmission following home health services for stroke care. Further research should characterize social and contextual factors in rural areas that contribute to community-dwelling individuals' health. This work was supported by the Agency for Healthcare Research and Quality (AHRQ) R01-HS024711. Authors declare no conflicts. [ABSTRACT FROM AUTHOR]

The Allan-Herndon-Dudley syndrome (AHDS) is a severe disease caused by dysfunctional central thyroid hormone transport due to functional loss of the monocarboxylate transporter 8 (MCT8). In this study, we assessed whether mice with concomitant deletion of the thyroid hormone transporters Mct8 and the organic anion transporting polypeptide (Oatp1c1) represent a valid preclinical model organism for the AHDS. We generated and metabolically characterized a new CRISPR/Cas9 generated Mct8/Oatp1c1 double-knockout (dKO) mouse line for the clinical features observed in patients with AHDS. We show that Mct8/ Oatp1c1 dKO mice mimic key hallmarks of the AHDS, including decreased life expectancy, central hypothyroidism, peripheral hyperthyroidism, impaired neuronal myelination, impaired motor abilities and enhanced peripheral thyroid hormone action in the liver, adipose tissue, skeletal muscle and bone. We conclude that Mct8/Oatp1c1 dKO mice are a valuable model organism for the preclinical evaluation of drugs designed to treat the AHDS. • Mct8/Oatp1c1 mice represent a valuable model organism for the Allan-Herndon-Dudley Syndrome. • Mct8/Oatp1c1 show central hypothyroidism and peripheral hyperthyroidism. • Mct8/Oatp1c1 show decreased life expectancy. • Mct8/Oatp1c1 show loss of body weight and fat, enhanced bone catabolism and increased T3 action in liver and adipose tissue. • Mct8/Oatp1c1 show severe neuronal hypomyelination and motor impairments. [ABSTRACT FROM AUTHOR]

We present a 15 year institutional analysis of the factors affecting progression free survival (PFS) and overall survival (OS) in patients undergoing attempted resection of adult intramedullary spinal cord ependymomas. Intramedullary spinal cord tumors are rare but important clinical entities, and ependymomas are the most commonly encountered intramedullary tumor. In total, 53 adult patients over the span of 15 years were analyzed for OS, PFS, and the effects of plane of dissection (POD) and gross total resection (GTR) on functional and long term outcomes. The mean age was 45 years and median follow-up was 54 months. The follow-up neurological outcome and modified McCormick scale were used to determine the functional outcome. Kaplan–Meier curves were used to calculate progression and survival. The overall ability to achieve GTR was significantly correlated to identification of an intraoperative POD ( p < 0.001). There was a trend towards increased PFS with the ability to achieve a GTR. There was no significant difference in the pre- and postoperative functional outcome scores. The ability to achieve a GTR is strongly correlated to the identification of a POD in ependymomas. There is a trend towards an increased probability of PFS in intramedullary spinal cord tumors when GTR is achieved. The resection of these tumors is likely to halt, but not reverse, neurological deterioration. [ABSTRACT FROM AUTHOR]

Necrotizing soft-tissue infections are life-threatening infections with significant morbidity and mortality. A 36-year-old female gravida 1 para 1001 with a history of intravenous drug use and homelessness presented to the emergency department for a three-day history of labial pain, swelling, and fevers. A contrast tomography scan revealed necrotizing soft tissue infection of the mons and vulva with subcutaneous gas. Empiric broad-spectrum antibiotics were initiated. She underwent an emergent two-staged surgical debridement and delayed primary closure after 1-month in the hospital. She was discharged to complete a 9 to 12 month course of antibiotics. Multidisciplinary team was central to patient care. Necrotizing soft tissue infections are a diverse group of infections affecting the subcutaneous tissue, muscle, and fascia. Actinomyces is a rare cause and require long-term antibiotics. Early recognition and emergent surgical debridement has been shown to reduce morbidity and mortality. A multidisciplinary approach is critical for proper wound care and healing, pain management, and long-term follow up. Actinomyces-associated vulvar NSTIs are life-threatening infections requiring early surgical debridement, long-term antibiotics, and multidisciplinary approach. • Vulvar necrotizing soft-tissue infection is a life-threatening infection requiring prompt surgical debridement. • A two-staged debridement with a post-operative wound vacuum is an effective treatment strategy. • Actinomyces is a rare cause of necrotizing soft tissue infection and requires long-term antibiotics. • Multidisciplinary care is critical in reducing morbidity. [ABSTRACT FROM AUTHOR]

Nowadays the technological progress of technical products occurs according to the laws of natural selection: new technologies are replacing old ones, winners of the competition are those products that best meet the expectations of society and the requirements of the market. Therefore, using, adapting and modeling of the basic laws of the theory of biological evolution in order to study the evolutionary processes in technical systems are already many years a popular area of research. Modern technical solutions combine the ability to store and transmit information on their technical specifications and accumulated changes from generation to generation. The main research area of the Collaborative Research Centre (CRC) 653 “Gentelligent Components in Their Lifecycle” is the innovative development of smart products in which the genetic and intellectual dimensions are a combination that enables to use the accumulated product life cycle information for the development of subsequent generations adapted to their environment. One of the central questions of the evolution of technical products is how to consider inheritance and the transfer of information. Based on evolutionary mechanisms the definition of technical inheritance as a transfer of assembled and verified information from production and application to the next product generation has been composed. The authors employed the analysis of existing evolutionary theories in biology, evolutionary laws of technical systems and their adaptation as well as the redefining of gentelligent smart products. [ABSTRACT FROM AUTHOR]

Monitoring residual stress relaxation due to mechanical loading has the capability to retrieve a component's load history. So far, these changes are determined by X-ray diffraction using the sin 2 ψ-method going along with high effort regarding specimen preparation, measurement time and costs. The presented paper evaluates harmonic analysis of eddy current measurements as an alternative technology to determine alterations of a component's subsurface due to fatigue. Transferring this approach to a wide range of machined components and mass production bears the potential to gain access to large databases of service life information, representing an important enabling technology for cyber-physical systems. [ABSTRACT FROM AUTHOR]

Problematic requirements, regarding the assessment of the integrity of highly loaded components require that modern methods be developed to record the component's loading history during its life cycle. New developments are moving towards a continuous monitoring of loading history using sensors as well as towards determing the material's or component's state during its service. This requires integrating the load sensors into the component in order to record the component's loading online. Based on the physical material properties of metastable austenitic steels, a novel design is developed for implementing local, component-inherent load sensors; so-called directionally-sensitive yield-stress sensors. The appropriate strengths and yield stresses, corresponding to the component loading to be monitored, can be specifically set by locally heat treating the selected, cold-worked sensor's region using a fibre-laser. Electromagnetic testing methods, such as eddy current technology and imaging induction thermography are developed to rapidly collect the technical data of such microstructures which possess modified physical material properties. The measuring technology is developed and adapted to the testing task via modelling. FEM computation are also performed both for describing the domain's scope and the eddy current distribution, as well as for simulating the magnetising processes as well as the chronological formation of temperature fields in the component's edge region. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study is to examine the relationships among income, diet, physical activity behaviors and overweight among Russian children during a period of economic upheaval. Subjects include 2151 schoolchildren aged 7–13 derived from cross-sectional waves of the Russia Longitudinal Monitoring Surveys in 1995 and in 2002. Diet was assessed by 24-h recall and physical activity (h/week) and household income by parental questionnaire. Hours spent in vigorous activities were low (1.0–1.5h/week), and time spent in sedentary behaviors increased from 31 to 37h/week between 1995 and 2002. In 1995 there was a direct relationship of income to energy and fat intake, and time spent in vigorous activity, and an inverse relationship of income to h/week spent in moderate activities (such as walking to school). The effect of having low income parents was less in 2002 than in 1995. Overweight prevalence did not differ significantly by income in either year, but there was a significant decline in overweight among high income children. Only hours spent in moderate physical activity was moderately protective against overweight. Income disparities do not explain trends in overweight among Russian children. [Copyright &y& Elsevier]

Abstract: Functionalized fullerenes represent a new class of photosensitizer (PS) that is being investigated for photodynamic therapy (PDT) of various diseases, including cancer. We tested the hypothesis that fullerenes could be used to mediate PDT of intraperitoneal (IP) carcinomatosis in a mouse model. In humans this form of cancer responds poorly to standard treatment and manifests as a thin covering of tumor nodules on intestines and on other abdominal organs. We used a colon adenocarcinoma cell line (CT26) stably expressing luciferase to allow monitoring of IP tumor burden in BALB/c mice by noninvasive real-time optical imaging using a sensitive low-light camera. IP injection of a preparation of N-methylpyrrolidinium-fullerene formulated in Cremophor-EL micelles, followed by white-light illumination delivered through the peritoneal wall (after creation of a skin flap), produced a statistically significant reduction in bioluminescence and a survival advantage in mice. From the Clinical Editor: This team of investigators report on functionalized fullerenes, to be used as photosensitizer for photodynamic therapy and demonstrate the efficacy of this method in an intraperitoneal carcinomatosis mouse model. [Copyright &y& Elsevier]

The surgical management of primary and metastatic spine tumors is an essential treatment modality. Because the most spine tumors are metastatic, surgical management of spine tumors is often palliative. However, when indicated, decompression and stabilization can lead to improved quality of life. There are a variety of primary benign and malignant tumors that can involve the spine, and each has its own general management principles. For all tumor types, the diagnostic evaluation and staging of the tumor are essential to determine appropriate management. Surgical management, when indicated, is either palliative or curative, and the gold standard is en bloc spondylectomy. The upper thoracic spine represents a unique region with anatomical obstacles to adequate access, making complete surgical excision difficult. This region of the spine also has unique biomechanical considerations and requires instrumentation for stabilization. Because of the difficulty in accessing the upper thoracic spine, several different approaches have been developed and modified. The management of upper thoracic spine tumors will be presented here, including a case study involving a primary malignancy involving the T1 vertebral body. [Copyright &y& Elsevier]

Abstract: Insulin-mediated glucose metabolism was investigated in streptozotocin (STZ)–treated diabetic pigs to explore if the STZ-diabetic pig can be a suitable model for insulin-resistant, type 2 diabetes mellitus. Pigs (∼40 kg) were meal-fed with a low-fat (5%) diet. Hyperinsulinemic (1, 2, and 8 mU kg−1 min−1) clamps and/or 6,6-2H-glucose infusion studies were performed in 36 pigs. Diabetic (slow, 30-minute infusion of 130 mg STZ/kg) vs normal pigs were nonketotic, showed fasting hyperglycemia (21.7 ± 1.1 vs 5.3 ± 0.2 mmol/L), comparable plasma insulin (9 ± 7 vs 5 ± 1 mU/L), and elevated triglyceride concentrations (1.0 ± 0.3 vs 0.2 ± 0.1 mmol/L). After a standard meal, plasma triglycerides, cholesterol, and nonesterified fatty acid concentrations were significantly higher in diabetic vs normal pigs (1.2 ± 0.3 vs 0.3 ± 0.1, 2.3 ± 0.2 vs 1.7 ± 0.1, and 1.5 ± 0.5 vs 0.2 ± 0.1 mmol/L, respectively, P < .05). Fasting whole-body glucose uptake, hepatic glucose production, and urinary glucose excretion were increased (P < .01) in diabetic vs normal pigs (9.1 ± 0.6 vs 4.8 ± 0.4, 11.4 ± 0.6 vs 4.8 ± 0.4, and 2.3 ± 0.2 vs 0.0 ± 0.0 mg kg−1 min−1). During hyperinsulinemic euglycemia (∼6 mmol/L), whole-body glucose uptake was severely reduced (P < .01) and hepatic glucose production was moderately increased (P < .05) in diabetic vs normal pigs (6.7 ± 1.3 vs 21.1 ± 2.2 and 1.7 ± 0.5 vs 0.8 ± 0.3 mg kg−1 min−1) despite plasma insulin concentrations of 45 ± 5 vs 24 ± 5 mU/L, respectively. Metformin vs placebo treatment of diabetic pigs (twice 1.5 g/d) for 2 weeks during isoenergetic feeding (1045 kJ/kg body weight0.75) resulted in a reduction in both fasting and postprandial hyperglycemia (14.7 ± 1.5 vs 19.4 ± 0.6 and 24.9 ± 2.2 vs 35.5 ± 4.9 mmol/L), a reduction in daily urinary glucose excretion (∼250 vs ∼350 g/kg food), and an increase in insulin-stimulated glucose disposal (9.4 ± 2.2 vs 5.8 ± 1.7 mg kg−1 min−1; P < .05), respectively. In conclusion, a slow infusion of STZ (130 mg/kg) in pigs on a low-fat diet induces the characteristic metabolic abnormalities of type 2 diabetes mellitus and its sensitivity to oral metformin therapy. It is therefore a suitable humanoid animal model for studying different aspects of metabolic changes in type 2 diabetes mellitus. Insulin resistance in STZ-diabetic pigs is most likely secondary to hyperglycemia and/or hyperlipidemia and therefore of metabolic origin. [Copyright &y& Elsevier]

Studies carbon pools and ecosystem properties along a latitudinal gradient in northern scots pine forests. Decline in total ecosystems carbon, decomposition rates and litterfall amounts with increase in latitude; Impact of the latitude on plant species richness in the ground flora; Variation in the percentage cover of lower canopy vegetation.

Objective To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely. Design Retrospective analysis. Setting Home health agencies. Participants Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009. Interventions Not applicable. Main Outcome Measures Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge. Results Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13–1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88–.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77–.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18–1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10–1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70–.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03–1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07–1.28). Conclusions As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation. [ABSTRACT FROM AUTHOR]

Objective To characterize rehabilitation service use among community-dwelling older adults in the United States by identifying predictors of rehabilitation utilization, patient-reported functional improvement, and rehabilitation goal attainment. Design Cross-sectional analysis of the 2015 National Health and Aging Trends Study, which used an age-stratified, multistage sampling design and oversampled blacks and the oldest old (≥85y). Setting Standardized, in-person home interviews and physical performance testing. Participants Nationally representative sample of community-dwelling Medicare beneficiaries (N=7487) aged ≥65 years. Interventions Not applicable. Main Outcome Measures Rehabilitation services use (physical therapy, occupational therapy, and speech therapy) across all settings in the last year, patient-reported functional improvement, and patient-reported rehabilitation goal attainment. Results Twenty percent of older adults reported rehabilitation use in the last year. In a multivariable model, rehabilitation use was significantly lower among blacks and higher among those with higher education, chronic medical conditions, pain, history of falls, and severe limitations in physical performance. Overall, 72% reported functional improvement during rehabilitation, and 75% reported meeting their goals by discharge. Improved function was associated with longer duration of rehabilitation. A significantly lower percentage of older adults with bothersome pain and severe physical limitations reported meeting rehabilitation goals. Conclusions Most older adults who received rehabilitation reported functional improvement and meeting rehabilitation goals. However, social disparities were evident with lower rehabilitation utilization among blacks and those with less education. Importantly, functional improvement and goal attainment did not vary by demographics or diagnoses. Longer duration of rehabilitation and improved pain management may be necessary for functional improvement and goal attainment. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine which work-related injuries are the most frequent and costly. Design: Secondary analysis of workers' compensation claims data. Setting: Data were provided by a large, Maryland workers' compensation insurer from 1998 through 2008. Participants: Not applicable. Interventions: None. Main Outcomes Measures: For 45 injury types, the number of claims and compensation amount was calculated for total compensation and for medical and indemnity compensation separately. Results: Back and knee injuries were the most frequently occurring single injury types, whereas heart attack and occupational disease were the most expensive in terms of mean compensation. When taking into account both the frequency and cost of injury (mean cost × number occurrences), back, knee, and shoulder injuries were the most expensive single injury types. Conclusions: Successful prevention and management of back, knee, and shoulder injuries could lead to a substantial reduction in the burden associated with work-related injuries. [Copyright &y& Elsevier]

Background: CD4+ T cells are responsible for the progressive lung damage seen in patients with chronic beryllium disease (CBD), a granulomatous lung disorder in which antigen-specific, TH1-type, cytokine-secreting T cells have been characterized. Compared with those seen in beryllium (Be)–sensitized subjects, increased numbers of Be-responsive T cells are present in the blood of patients with CBD. Objective: The aim of this study was to determine whether the number of Be-specific T cells in blood predicted the development of CBD in a cohort of Be-exposed subjects. Methods: Using IFN-γ ELISpot and proliferation-based assays, we determined the frequency and proliferative capacity of Be-responsive T cells in blood. Results: Compared with the Be lymphocyte proliferation test, which detected an abnormal Be-induced proliferative response in 11 (4.2%) of 260 workers from a Be-machining facility, the IFN-γ ELISpot detected a sensitization rate of 10% (χ2 = 55.7, P < .0001). A significant positive correlation was also noted between the number of Be-responsive CD4+ T cells in the blood and lung tissue of patients with CBD. Importantly, the transition from Be sensitization to CBD was associated with an increased number of antigen-specific T cells in blood. Conclusion: These findings have important implications for Be-induced disease and potentially other immune-mediated disorders, suggesting that the frequency of antigen-specific T cells in blood can serve as a noninvasive biomarker to predict disease development and severity of the Be-specific CD4+ T-cell alveolitis. [ABSTRACT FROM AUTHOR]

A large forested landscape (18 640 ha) located in Michigan's centralUpper Peninsula was examined to estimate current and pre-European mineral soil carbon (C) content. Utilizing current forest stand information and pre-European settlement forest data, a landscape level soil C estimate was made for each time period and the change in soil C over the 150-year interval was quantified. Soil, forest type, and age class information were entered into a geographical information system (GIS); high medium, and low C levels were assigned to soils based on forest type and age class groupings. Using organic matter data from soil surveys of the area, a range of mineral soil C values was determined for each soil mapping unit and vegetation combination, and a percent C value was estimated based on previously assigned C levels. Estimates of average percent C were calculated for both current and pre-European landscapes to be 9.7% and 11.7%, respectively. Overall, there appears to be a decrease in soil C content since European settlement as a result of changes in forest cover and land use. Due to the strong relationship between forest type and soil C content, an increase ofurban/brush areas, and a shift from hemlock and conifer forest typesto hardwoods and mixed pine/hardwood forests since European settlement, there has been a reduction of the average landscape level soil C on a g/m2 basis. The net reduction in mineral soil C content on this landscape is estimated to be approximately 0.3 to 0.8 Tg C(in the upper 10--25 cm of mineral soil) over the 150 years since European settlement of the arca. (c) 1999 Elsevier Science B.V. [ABSTRACT FROM AUTHOR]