Absolute Magnitude Of Change Research Articles

Age-Related Differences in Utilization of Allogeneic HCT for Acute Myeloid Leukemia in California: Results of a Population-Based, Novel Linked Dataset

Background: Acute myeloid leukemia (AML) predominantly affects older adults (median age at diagnosis is 67yrs), and often requires allogeneic hematopoietic cell transplantation (alloHCT) for cure. According to the Center for International Blood and Marrow Transplant Research (CIBMTR), beginning in 2001, the largest growth in alloHCT for malignant diseases occurred in patients ≥65yrs. However, whether this is due to expanded utilization of alloHCT for newly diagnosed AML is unclear. Using a novel linked dataset, we examined patients with newly diagnosed AML in California to assess population-based alloHCT utilization over time and factors associated with receipt of alloHCT across age groups. Methods: Data obtained from a linkage between the CIBMTR database, California Cancer Registry (CCR) and Patient Discharge Data (PDD) included adolescents and young adults (AYA, 15-39y), adults (40-64y) and older adults (65-79y) with AML diagnosed between 2001-2016. Patients who received no induction chemotherapy, those who received autologous HCT, or had unspecified HCT type were excluded. Multivariable Fine-Gray regression analyses accounting for the competing risk of death were modeled separately across age cohorts. Results: 7,925 patients with newly diagnosed AML were included. AYAs comprised 15% of the cohort compared with adults (41%), and older adults (43%). Within the adult and older adult cohorts, the majority were non-Hispanic White, while 41% of the AYAs were Hispanic. Most AYA and adult patients had private health insurance; most older adults received Medicare. More AYAs (25%) had the lowest neighborhood SES relative to adults (15%) and older adults (14%). Approximately 30-40% of adults and older adults had 3+ comorbidities (using Elixhauser Comorbidity Index). Within each age cohort, approximately 25% of patients lived >50 miles from a transplant center. Examination of alloHCT utilization over time demonstrated that the use of alloHCT has increased within each age cohort (Figure 1). Although utilization among older adult patients increased from 2% to 13% at 2 years post AML diagnosis, the absolute magnitude of change was lowest in this age group and remains far lower than AYA and adult patients. Multivariable models (Figure 2) demonstrate that patient-level variables associated with alloHCT utilization also vary by age group. For AYAs, alloHCT utilization was lower for low and middle neighborhood SES (vs. high), uninsured and those covered by County/Public Health Service (vs. private insurance); and utilization was higher for males and more recent year of diagnosis. For adults, alloHCT utilization was lower for patients with increased age, male sex, non-Hispanic Black or Asian race/ethnicity (vs. non-Hispanic White), unmarried status (vs. married), low and middle SES, uninsured, Medicaid, Medicare, and County/Public Health Service, and 1-2 or ≥3 comorbidities (vs none); utilization was higher for more recent diagnosis year and patients living <50 miles distance from a transplant center (vs. 100+ miles). For older adults, utilization decreased with increasing age and was lower among Asian and unmarried patients, whereas more recent diagnosis year was associated with higher utilization. Conclusions:Using a novel population-based linked database encompassing >99% of newly diagnosed AML patients in California, we found that alloHCT utilization increased in all age cohorts over time; however, fewer than 14% of older adults who received leukemia induction ultimately received alloHCT even in the most recent era studied. As potential patient-level barriers to alloHCT differ across age groups, studies should explore further modifiable age-related factors and develop age-specific interventions to mitigate barriers to alloHCT utilization.

The association of bispectral index values and metrics of cerebral perfusion during cardiopulmonary bypass

Study objectiveLow bispectral index (BIS) values have been associated with adverse postoperative outcomes. However, trials of optimizing BIS by titrating anesthetic administration have reported conflicting results. One potential explanation is that cerebral perfusion may also affect BIS, but the extent of this relationship is not clear. Therefore, we examined whether BIS would be associated with cerebral perfusion during cardiopulmonary bypass, when anesthetic concentration was constant. DesignObservational cohort study. SettingCardiac operating room. PatientsSeventy-nine patients with cardiopulmonary bypass surgery were included. MeasurementsContinuous BIS, mean arterial blood pressure (MAP), cerebral blood flow velocity (CBFV), and regional cerebral oxygen saturation (rSO2) were monitored, with analysis during a period of constant anesthetic. Mean flow index (Mx) was calculated as Pearson correlation between MAP and CBFV. The lower limit of autoregulation (LLA) was identified as the MAP value at which Mx increased >0.4 with decreasing blood pressure. Postoperative delirium was assessed using the 3D-Confusion Assessment Method. ResultsMean BIS was lower during periods of MAP < LLA compared with BIS when MAP>LLA (mean 49.35 ± 10.40 vs. 50.72 ± 10.04, p = 0.002, mean difference = 1.38 [standard error: 0.42]). There was a dose response effect, with the BIS proportionately decreasing as MAP decreased below LLA (β = 0.15, 95% CI for the average slope across all patients 0.07 to 0.23, p < 0.001). In contrast, BIS was relatively unchanged when MAP was above LLA (β = 0.03, 95% CI for the average slope across all patients −0.02 to 0.09, p = 0.22). Additionally, increasing CBFV and rSO2 were associated with increasing BIS. Patients with postoperative delirium had lower mean BIS and higher percentage of time duration with BIS <45 compared to patients without delirium. ConclusionsThere was an association of BIS and metrics of cerebral perfusion during a period of constant anesthetic administration, but the absolute magnitude of change in BIS as MAP decreased below the LLA was small.

A-67 Where the Test of Premorbid Functioning (TOPF) Goes, the Hopkins Adult Reading Test (HART) may (not) Follow

Abstract Objective To determine if significant differences exist in estimates of premorbid intellectual functioning between the Test of Premorbid Functioning (TOPF) and Hopkins Adult Reading Test (HART) in a diverse sample of U.S. Veterans. Method Retrospective analysis of data obtained for routine clinical purposes. 102 Veterans (16% female), predominantly self-identified as African American (53.9%), with an average age of 61.79 years (SD = 13.29, range = 21-90 years) and an average education level of 14.45 years (SD = 2.73, range = 9-20 years); 48% received a neurocognitive diagnosis and 72.5% a psychiatric diagnosis. TOPF and HART standard scores and demographically predicted IQ scores were compared in terms of their linear relationship, absolute agreement, absolute magnitude of change, and discrepancy scores, including the degree to which discrepancy was affected by specific demographic factors. Results Despite strong Pearson correlations, concordance correlation coefficients (CCC) showed poor strength of agreement. Root-mean-squared differences (RMSD) was 10.284 (SD = 5.903) between standard scores and 9.948 (SD = 8.183) between predicted IQ scores. Discrepancy scores indicated 41.2% (46.1% for predicted IQ) performed equally well, with 58.8% (53.9%) performing significantly better on one measure than the other. Demographic comparisons for predicted IQ found those who performed better on the HART were older and those who performed better on the TOPF had more years of education. Conclusions The TOPF and HART have a strong linear relationship but insufficient agreement when differences in mean and standard deviation are taken into consideration. Estimates are inconsistent and not interchangeable, especially among older individuals and those with more education.

Widespread population decline in South America correlates with mid-Holocene climate change

Quantifying the impacts of climate change on prehistoric demography is crucial for understanding the adaptive pathways taken by human populations. Archaeologists across South America have pointed to patterns of regional abandonment during the Middle Holocene (8200 to 4200 cal BP) as evidence of sensitivity to shifts in hydroclimate over this period. We develop a unified approach to investigate demography and climate in South America and aim to clarify the extent to which evidence of local anthropic responses can be generalised to large-scale trends. We achieve this by integrating archaeological radiocarbon data and palaeoclimatic time series to show that population decline occurred coeval with the transition to the initial mid-Holocene across South America. Through the analysis of radiocarbon dates with Monte Carlo methods, we find multiple, sustained phases of downturn associated to periods of high climatic variability. A likely driver of the duration and severity of demographic turnover is the frequency of exceptional climatic events, rather than the absolute magnitude of change. Unpredictable levels of tropical precipitation had sustained negative impacts on pre-Columbian populations lasting until at least 6000 cal BP, after which recovery is evident. Our results support the inference that a demographic regime shift in the second half of the Middle Holocene were coeval with cultural practices surrounding Neotropical plant management and early cultivation, possibly acting as buffers when the wild resource base was in flux.

Downsizing and Supersizing: How Changes in Product Attributes Influence Consumer Preferences

ABSTRACTThis paper investigates how changing the value of one attribute while keeping other attributes constant influences consumers' judgments and behaviors. We find that in two options, a proportionally equal change in one attribute tilts people's preference toward the option with higher (or lower) absolute magnitude of change when the change is desirable (or undesirable). We propose that when individuals face an attribute change, they use a deliberative and effortful response, known as System 2, to detect the change. However, they rely less on this system to evaluate the changed options. Instead, a more automatic System 1 processing influences their decision by making them apply the bigger‐is‐better heuristic (bigger‐is‐worse for an undesirable change) to prefer the option with the highest (lowest) absolute magnitude of change. Six studies demonstrate this phenomenon in both lab and real settings and support our hypothesis. Copyright © 2013 John Wiley &amp; Sons, Ltd.

PWE-028 Significantly Improved Abdominal Pain (AP) with Linaclotide (LIN) vs Placebo (PBO) in Patients (PTS) with Irritable Bowel Syndrome (IBS) Regardless of Baseline Pain Severity in 2 Phase 3 Trials

IntroductionLIN, a 14-amino-acid, minimally absorbed, guanylate cyclase C agonist (GCCA), significantly improved abdominal and bowel symptoms in 2 Phase 3 IBS with constipation (IBS-C) trials. Previous IBS trials of other...

Analysis of fossil testate amoebae in Selisoo Bog, Estonia: local variability and implications for palaeoecological reconstructions in peatlands

Niinemets, E., Pensa, M. & Charman, D. J. 2010: Analysis of fossil testate amoebae in Selisoo Bog, Estonia: local variability and implications for palaeoecological reconstructions in peatlands. Boreas, 10.1111/j.1502-3885.2010.00188.x. ISSN 0300-9483. Local variability in decadal water-table changes on an ombrotrophic peatland was explored using testate amoebae analysis of near-surface peats in an Estonian raised bog. The distribution of testate amoebae assemblages was studied along the gradient from hummock to hollow in the upper 30-cm layer of peat. As expected, testate amoebae assemblages in different micro-ecotypes from hummock to hollow, even as close as 10 m apart, are distinctly different. Past water-table change was reconstructed by applying a transfer function based on modern samples from throughout Europe. Results show a decline in water level from the mid-late 20th century on Selisoo bog in all profiles from the different micro-ecotypes. However, the absolute water-table depths and amplitudes of fluctuations vary between reconstructions from different sampling micro-ecotypes. Cores were correlated using changes in non-mire pollen concentrations down-core, but it was not possible to correlate minor changes in water-table owing to non-contiguous sampling and variable accumulation rates. We conclude that different microtopes show the same decadal trends in relative water-table change but that the absolute magnitude of change may be more variable locally. It is important that reconstructed palaeohydrological changes in bogs consider changes in bog micro-ecotypes, and their variation over time, as this may alter the sensitivity of an individual record to drivers such as climate change. Comparison and compilation of data from parallel cores from different micro-ecotypes and/or different sites are likely to provide more robust reconstructions.

Indication of antagonistic interaction between climate change and erosion on plant species richness and soil properties in semiarid Mediterranean ecosystems

AbstractWe analyzed the consequences of climate change and the increase in soil erosion, as well as their interaction on plant and soil properties in semiarid Mediterranean shrublands in Eastern Spain. Current models on drivers of biodiversity change predict an additive or synergistic interaction between drivers that will increase the negative effects of each one. We used a climatic gradient that reproduces the predicted climate changes in temperature and precipitation for the next 40 years of the wettest and coldest end of the gradient; we also compared flat areas with 20° steep hillslopes. We found that plant species richness and plant cover are negatively affected by climate change and soil erosion, which in turn negatively affects soil resistance to erosion, nutrient content and water holding capacity. We also found that plant species diversity correlates weakly with plant cover but strongly with soil properties related to fertility, water holding capacity and resistance to erosion. Conversely, these soil properties correlate weaker with plant species cover. The joint effect of climate change and soil erosion on plant species richness and soil characteristics is antagonistic. That is, the absolute magnitude of change is smaller than the sum of both effects. However, there is no interaction between climate change and soil erosion on plant cover and their effects fit the additive model. The differences in the interaction model between plant cover and species richness supports the view that several soil properties are more linked to the effect that particular plant species have on soil processes than to the quantity and quality of the plant cover and biomass they support. Our findings suggest that plant species richness is a better indicator than plant cover of ecosystems services related with soil development and protection to erosion in semiarid Mediterranean climates.

Central Nervous System Dysfunction after Noncardiac Surgery and Anesthesia in the Elderly

Central Nervous System Dysfunction after Noncardiac Surgery and Anesthesia in the Elderly

The Effects of an Acute Bout of Exercise on the Blood Lipids of Male Cigarette Smokers

A single bout of exercise has been shown to positively alter blood lipids in healthy, non-smoking men. However, since cigarette smoking negatively alters blood lipids, the positive effects of exercise on blood lipid has not been documented. PURPOSE: Examine the effects of treadmill walking to expend 600kcal at 65% VO2peak on the blood lipids of male cigarette smokers (≥10 cigarettes/day for ≥6months). METHODS: Five cigarette smokers (SMK) who were 21±2yrs old, 76.9±9.3kg in weight, 1.8±0.1m tall, 14.3±5.1% body fat and had a VO2peak of 44.4±0.9ml/kg/min and five non-smokers (NS) who were 23±2yrs old, 89.5±13.9kg in weight, 1.8±0.1m tall, 19.9±5.2% body fat and had a VO2peak of 42.6±2.0ml/kg/min volunteered for this study. Each subject randomly completed two trials: a no exercise control trial (CON) and a 600kcal treadmill walk at 65% VO2peak (EXER). Body composition was determined with air plethysmography and VO2peak with open-circuit spirometry utilizing the Bruce treadmill protocol. Veni puncture was performed at baseline, 24, and 48hrs post-exercise of each trial for collection of fasting blood for the determination of lipids and LDL particle size. SMK continued to smoke on their regular schedules, but had ≥1 cigarette w/in one hour of each sampling period. RESULTS: There were no group differences in descriptive data. Additionally, there were no differences between baseline CON and EXER data, nor in data over CON trial within each group. There were no differences in total cholesterol (TC), HDL-C, HDL3-C or LDL particle size between groups at baseline EXER. NS had higher HDL2-C (15.0±1.8 vs 7.6±5.3mg/dL) and lower triglycerides (TG; 84.6±10.9 vs 114.0±25.6mg/ dL) as compared to SMK at baseline EXER. HDL-C increased at 24hrs post-exercise by 7.6% (46.0±3.6 to 49.8±3.9mg/dL) in NS, and 10.1% (43.4±5.3 to 48.3±6.1mg/dL) in SMK. HDL2-C increased 18.5% (15.0±1.8 to 18.4±2.6mg/dL) in NS, and 50.0% (7.6±5.3 to 15.2±8.4mg/dL) in SMK. TG decreased at 24hrs post-exercise by 20.0% (84.6±10.9 to 70.5±9.3mg/dL) in NS, and 72% (114.0±25.6 to 66.1±24.0mg/dL) in SMK. There were no differences between NS or SMK in the absolute magnitude of change in HDL-C, HDL2-C and TG over EXER. TC, HDL3-C, nor LDL particle size was altered over EXER. CONCLUSION: An acute bout of walking at 65% VO2peak which expended 600kcal was sufficient to favorably modify HDL-C, HDL2-C and TG in these men, but did not impact TC, HDL3-C, or LDL particle size. These results suggest that the negative effects of cigarette smoking did not interfere with the positive effects of an acute bout of walking on blood lipids.

Instrumental behaviour of albino rats in response to incident x radiation.

Albino rats were placed in shuttle boxes, each containing a black and a white compartment. The apparatus was placed in an X-ray field so that experimental subjects were exposed to continuous low-level radiation during all time spent in the black compartment of the shuttle box. A lead screen effectively shielded the white compartments so that experimental subjects could escape from the radiation by remaining at the white end. Control subjects received no radiation in either compartment. The change in preference for the black compartment differed between the four groups during the course of the radiation exposure. The absolute magnitude of change was inversely related to dose-rate with the group exposed to 1 r per minute showing the greatest decrease. The threshold for appearance of the effect was observed to be a linear function of dose-rate and appeared invariant with respect to total dose within the range of dose-rates employed.