Practice-Level Variation in Outpatient Cardiac Care and Association With Outcomes.

BACKGROUND: Utilization of cardiac services varies across regions and hospitals, yet little is known regarding variation in the intensity of outpatient cardiac care across cardiology physician practices or the association with clinical endpoints, an area of potential importance to promote efficient care. METHODS AND RESULTS: We included 7 160 732 Medicare beneficiaries who received services from 5635 cardiology practices in 2012. Beneficiaries were assigned to practices providing the plurality of office visits, and practices were ranked and assigned to quartiles using the ratio of observed to predicted annual payments per beneficiary for common cardiac services (outpatient intensity index). The median (interquartile range) outpatient intensity index was 1.00 (0.81-1.24). Mean payments for beneficiaries attributed to practices in the highest (Q4) and lowest (Q1) quartile of outpatient intensity were: all cardiac payments (Q4 $1272 vs Q1 $581; ratio, 2.2); cardiac catheterization (Q4 $215 vs Q1 $64; ratio, 3.4); myocardial perfusion imaging (Q4 $253 vs Q1 $83; ratio, 3.0); and electrophysiology device procedures (Q4 $353 vs Q1 $142; ratio, 2.5). The adjusted odds ratios (95% CI) for 1 incremental quartile of outpatient intensity for each outcome was: cardiac surgical/procedural hospitalization (1.09 [1.09, 1.10]); cardiac medical hospitalization (1.00 [0.99, 1.00]); noncardiac hospitalization (0.99 [0.99, 0.99]); and death at 1 year (1.00 [0.99, 1.00]). CONCLUSION: Substantial variation in the intensity of outpatient care exists at the cardiology practice level, and higher intensity is not associated with reduced mortality or hospitalizations. Outpatient cardiac care is a potentially important target for efforts to improve efficiency in the Medicare population.

Implementation of cognitive mapping, spatial representation and wayfinding behaviours of people within evacuation modelling tools

Within the building evacuation context, wayfinding describes the process in which an individual located within an arbitrarily complex enclosure attempts to find a path which leads them to relative safety, usually the exterior of the enclosure. Within most evacuation modelling tools, wayfinding is completely ignored; agents are either assigned the shortest distance path or use a potential field to find the shortest path to the exits. In this paper a novel wayfinding technique that attempts to represent the manner in which people wayfind within structures is introduced and demonstrated through two examples. The first step is to encode the spatial information of the enclosure in terms of a graph. The second step is to apply search algorithms to the graph to find possible routes to the destination and assign a cost to the routes based on their personal route preferences such as "least time" or "least distance" or a combination of criteria. The third step is the route execution and refinement. In this step, the agent moves along the chosen route and reassesses the route at regular intervals and may decide to take an alternative path if the agent determines that an alternate route is more favourable e.g. initial path is highly congested or is blocked due to fire.

Spatial, seasonal and long-term fluctuations of plankton in relation to hydroclimatic features in the English Channel, Celtic Sea and Bay of Biscay

Plankton collected by the Continuous Plankton Recorder (CPR) survey were investigated for the English Channel, Celtic Sea and Bay of Biscay from 1979 to 1995. The main goal was to study the relationship between climate and plankton and to understand the factors influencing it. In order to take into account the spatial and temporal structure of biological data, a three-mode principal component analysis (PCA) was developed. It not only identified 5 zones characterised by their similar biological composition and by the seasonal and inter-annual evolution of the plankton, it also made species associations based on their location and year-to-year change. The studied species have stronger year-to-year fluctuations in abundance over the English Channel and Celtic Sea than the species offshore in the Bay of Biscay. The changes in abundance of plankton in the English Channel are negatively related to inter-annual changes of climatic conditions from December to March (North Atlantic Oscillation [NAO] index and air temperature). Thus, the negative relationship shown by Fromentin and Planque (1996; Mar Ecol Prog Ser 134:111-118) between year-to-year changes of Calanus finmarchicus abundance in the northern North Atlantic and North Sea and NAO was also found for the most abundant copepods in the Channel. However, the hypothesis proposed to explain the plankton/NAO relationship is different for this region and a new hypothesis is proposed. In the Celtic Sea, a relationship between the planktonic assemblage and the air temperature was detected, but it is weaker than for the English Channel. No relationship was found for the Bay of Biscay. Thus, the local physical environment and the biological composition of these zones appear to modify the relationship between winter climatic conditions and the year-to-year fluctuations of the studied planktonic species. This shows, therefore, that the relationship between climate and plankton is difficult to generalise.

Spatial Heterogeneity and Genetic Variation in the Copepod Neocalanus Cristatus Along Two Transects in the North Pacific Sampled By the Continuous Plankton Recorder

We present a macrogeographic study of spatial heterogeneity in an important subarctic Pacific copepod and describe the first genetic analysis of population structure using Continuous Plankton Recorder (CPR) samples. Samples of Neocalanus cristatus were collected at a constant depth of similar to 7 m from two CPR tow-routes, (i) an east-west similar to 6500-km transect from Vancouver Island, Canada to Hokkaido Island, Japan, and (ii) a north-south transect of similar to 2250 km from Anchorage, Alaska to Tacoma, Washington. Analysis of these samples revealed three features of the biology of N. cristatus. First, N. cristatus undergoes small-scale diel vertical migration that is larger among stages CV- adult (3-6 times more abundant at 7 m at night), than stages CI-CIV (only 2-4 times higher at night). Secondly, while there were no regions where N. cristatus did not appear, each transect sampled a few large-scale macrogeographic patches. Thirdly, an analysis of molecular variation, using a partial sequence of the N. cristatus cytochrome oxidase I gene, revealed that 7.3% (P < 0.0001) of the total genetic variation among N. cristatus sampled from macrogeographic patches by the CPR could be explained by spatial heterogeneity. We suggest that spatial heterogeneity at macrogeographic scales may be important in plankton evolution.

Spatial patterns and trends in abundance of larval sandeels in the North Sea: 1950-2005

Early recruitment indices based on larval fish data from the Continuous Plankton Recorder (CPR) have the potential to inform stock assessments of Ammodytes marinus in the North Sea. We evaluate whether the CPR data are reliable for sandeel larvae. Spatially, CPR larval data were comparable with catches by dedicated larval samplers (Gulf and bongo nets) during ICES coordinated surveys in 2004 and 2009. ICES data are also used to explore environmental influences on sandeel distributions. Temporally, CPR data correlate with larval data from plankton surveys off Stonehaven (1999–2005), with sandeel 0-group trawl data at the east Fair Isle ground (since 1984), and with recruitment data (since 1983) for the Dogger Banks stock assessment area. Therefore, CPR data may provide an early recruit index of relative abundance for the Dogger Banks assessment area, where the majority of the commercial catch of A. marinus is taken, and the Wee Bankie area that is particularly important for seabird foraging. While warm conditions may stimulate the production of sandeel larvae, their natural mortality is typically greater, in the Dogger Banks and Wadden Sea areas, when the larvae are hatched in warm years and/or with abundant 1-year-old sandeel that are likely to be cannibalistic.

Genomic organization, complex splicing pattern and expression of a human septin gene on chromosome 17q25.3

The Ov/Br septin gene, which is also a fusion partner of MLL in acute myeloid leukaemia, is a member of a family of novel GTP binding proteins that have been implicated in cytokinesis and exocytosis. In this study, we describe the genomic and transcriptional organization of this gene, detailing seventeen exons distributed over 240 kb of sequence. Extensive database analyses identified orthologous rodent cDNAs that corresponded to new, unidentified 5' splice variants of the Ov/Br septin gene, increasing the total number of such variants to six. We report that splicing events, occurring at non-canonical sites within the body of the 3' terminal exon, remove either 1801 bp or 1849 bp of non-coding sequence and facilitate access to a secondary open reading frame of 44 amino acids maintained near the end of the 3' UTR. These events constitute a novel coding arrangement and represent the first report of such a design being implemented by a eukaryotic gene. The various Ov/Br proteins either differ minimally at their amino and carboxy termini or are equivalent to truncated versions of larger isoforms. Northern analysis with an Ov/Br septin 3' UTR probe reveals three transcripts of 4.4, 4 and 3 kb, the latter being restricted to a sub-set of the tissues tested. Investigation of the identified Ov/Br septin isoforms by RT-PCR confirms a complex transcriptional pattern, with several isoforms showing tissue-specific distribution. To date, none of the other human septins have demonstrated such transcriptional complexity.

Effect of chronic angiotensin converting enzyme inhibition on spatial memory and anxiety-like behavours in rats

Angiotensin converting enzyme inhibitors (ACEis) are widely used anti-hypertensive agents that are also reported to have positive effects on mood and cognition. The present study examined the influence of the ACEi, perindopril, on cognitive performance and anxiety measures in rats. Two groups of rats were treated orally for one week with the ACEi, perindopril, at doses of 0.1 and 1.0mg/kg/day. Learning was assessed by the reference memory task in the water maze, comparing treated to control rats. Over five training days both perindopril-treated groups learnt the location of the submerged platform in the water maze task significantly faster than control rats. A 60s probe trial on day 6 showed that the 1.0mg/kg/day group spent significantly longer time in the training quadrant than control rats. This improved performance in the swim maze task was not due to the effect of perindopril on motor activity or the anxiety levels of the rats as perindopril-treated and control animals behaved similarly in activity boxes and on the elevated+maze. These results confirm the anecdotal human studies that ACEis have a positive influence on cognition and provide possibilities for ACEis to be developed into therapies for memory loss.