Depression, loneliness, and lower social activity as partial mediators of the association between visual impairment and cognitive decline.

OBJECTIVES: Sensory impairment is a hypothesized risk factor for cognitive decline; however, the psychosocial pathways are not well understood. We evaluated whether the association between visual impairment (VI) and cognitive decline was partially mediated via depressive symptoms, loneliness, or social activity. METHODS: We used data from 2601 older adults enrolled in the Memory and Aging Project in 1997 and the Minority Aging Research Study in 2004 with neuropsychological tests across five domains measured annually for up to 16 years. VI was assessed with the Rosenbaum Pocket Vision Screener. Depressive symptoms, loneliness, and social activity were self-reported using validated scales. We used structural equation models to estimate the associations of VI with baseline and change in cognitive function, directly and indirectly through each mediator (depressive symptoms, loneliness, and social activity). We evaluated mediation via "psychological distress" using a latent variable combining depressive symptoms and loneliness. RESULTS: The association between VI and global cognitive decline was mediated via lower social activity (indirect effect) [95% confidence interval (CI)] of linear slope: -0.025 (-0.048, -0.011), via loneliness (-0.011 [95% CI: -0.028, -0.002]), and via psychological distress (-0.017 [95% CI: -0.042, -0.003]). We did not find sufficient evidence for mediation via depressive symptoms alone. CONCLUSIONS: The harmful effect of VI on cognitive decline may be partially mediated through loneliness and lower social activity.

Racial, Ethnic, and Socioeconomic Disparities in COVID-19 Pandemic Worries.

BACKGROUND: Racial, ethnic, and socioeconomic health disparities became evident during the COVID-19 pandemic. This study explores whether these disparities extend to the content of worries. METHODS: We surveyed 1,222 participants from three metropolitan New York City (NYC) based cohorts through telephone interviews conducted from March to September 2020. Worries were assessed using 37 dichotomous questionnaire items, and exploratory factor analysis derived ten categories of worry. Factor scores were analyzed in generalized linear mixed models to examine their associations with race/ethnicity and household income, adjusting for covariates. RESULTS: The most prevalent worry items pertained to U.S. and world politics, American values, health concerns, and return to normalcy. Higher household income was associated with lower worry about economic needs, job/employment, and violence/victimization, while violence/victimization worries were strongly associated with Asian, Hispanic, Black, and multiracial or other race/ethnicity. CONCLUSIONS: During early COVID-19, lower-income and minoritized race and ethnic groups were disproportionately affected by economic and violence/victimization worries, while other worries showed minor variations by income or race/ethnicity.

HIV status and substance use disorder treatment need and utilization among adults in the United States, 2015-2019: Implications for healthcare service provision and integration.

INTRODUCTION: Substance use disorders (SUD) are associated with HIV acquisition and care disruptions. Most research focuses on clinical samples; however, we used a nationally representative, community-based sample to estimate SUD treatment need and utilization by HIV status. METHODS: We included participants from the 2015-2019 National Survey on Drug Use and Health aged 18 and older who met past-year DSM-IV SUD criteria (n = 22,166). Participants self-reported whether a healthcare professional ever told them they had HIV or AIDS [i.e., people with HIV (PWH), non-PWH, HIV status unknown]. Outcomes included past-year: 1) any SUD treatment use; 2) any specialty SUD treatment use; and 3) perceived SUD treatment need. Survey weighted multivariable logistic regression models estimated the likelihood of each outcome by HIV status, adjusting for age, sex, race/ethnicity, education, survey year, health insurance status, and household income. RESULTS: Overall, 0.5 % were PWH and 0.8 % had an HIV unknown status. Any past-year SUD treatment utilization was low across all groups (10.3 % non-PWH, 24.2 % PWH, and 17.3 % HIV status unknown respondents). Specialty SUD treatment utilization was reported by 7.2 % of non-PWH, 17.8 % PWH, and 10.9 % HIV status unknown respondents. Perceived treatment need was reported by 4.9 % of non-PWH, 12.4 % of PWH, and 3.7 % of HIV status unknown respondents. In adjusted models, PWH were more likely than non-PWH to report any past-year SUD treatment utilization (aOR = 2.06; 95 % CI = 1.08-3.94) or past-year specialty SUD treatment utilization (aOR = 2.07; 95 % CI = 1.07-4.01). Among those with a drug use disorder other than cannabis, respondents with HIV-unknown status were less likely than HIV-negative individuals to report past-year perceived treatment need (aOR = 0.39; 95 % CI = 0.20-0.77). CONCLUSIONS: Despite high SUD treatment need among PWH, more than three quarters of PWH with SUD reported no past-year treatment. Compared to non-PWH, PWH had higher treatment utilization and higher specialty treatment utilization, but SUD treatment was low across all groups. As SUD is associated with adverse HIV outcomes, our findings highlight the need for the integration of SUD treatment with HIV testing and care. Increasing access to SUD treatment could help reduce negative SUD-related outcomes along the HIV care continuum.

Stability of Graphene/Nafion Composite in PEM FC Electrodes.

Ensuring the stable operation of proton exchange membrane fuel cells is conducive to their real-world application. A promising direction for stabilizing electrodes is the stabilization of the ionomer via the formation of surface compounds with graphene. A comprehensive study of the (electrochemical, chemical, and thermal) stability of composites for fuel cell electrodes containing a modifying additive of few-layer graphene was carried out. Electrochemical stability was studied by cycling the potential on a disk electrode for 5000 cycles. Chemical stability was assessed via the resistance of the composites to H2O2 treatment using ion-selective potentiometry. Thermal stability was studied using differential thermal analysis. Composites were characterized by UV-Vis spectroscopy, Raman spectroscopy, EDX, and SEM. It was shown that graphene inhibits Nafion degradation when exposed to heat. Contrariwise, Nafion is corrosive to graphene. During electrochemical and chemical exposure, the determining change for carbon-rich composites is the carbon loss (oxidation) of the carbon material. In the case of carbon-poor composites, the removal of fluorine and sulfur from the Nafion polymer with their partial replacement by oxygen prevails. In all cases, the F/S ratio is stable. The dispersity of Nafion in a sample affects its chemical stability more than the G/Nafion ratio does.

Time-lagged associations between two adverse childhood experiences and later-life cognitive function through educational attainment and stroke.

OBJECTIVE: Adverse childhood experiences (ACEs) have been associated with worse cognitive health in older adulthood. This study aimed to extend findings on the specificity, persistence, and pathways of associations between two ACEs and cognition by using a comprehensive neuropsychological battery and a time-lagged mediation design. METHOD: Participants were 3304 older adults in the Health and Retirement Study Harmonized Cognitive Assessment Protocol. Participants retrospectively reported whether they were exposed to parental substance abuse or experienced parental physical abuse before age 18. Factor scores derived from a battery of 13 neuropsychological tests indexed cognitive domains of episodic memory, executive functioning, processing speed, language, and visuospatial function. Structural equation models examined self-reported years of education and stroke as mediators, controlling for sociodemographics and childhood socioeconomic status. RESULTS: Parental substance abuse in childhood was associated with worse later-life cognitive function across all domains, in part via pathways involving educational attainment and stroke. Parental physical abuse was associated with worse cognitive outcomes via stroke independent of education. CONCLUSIONS: This national longitudinal study in the United States provides evidence for broad and persistent indirect associations between two ACEs and cognitive aging via differential pathways involving educational attainment and stroke. Future research should examine additional ACEs and mechanisms as well as moderators of these associations to better understand points of intervention.

Specific Mass Activity and Surface Activity of Platinum Electrically Connected with CNTs in the Oxygen Reduction Reaction.

This paper presents a study of the platinum activity in the ORR in a hydrogen polymer electrolyte membrane fuel cell with electrodes containing multi-walled CNTs in a wide range of compositions and conditions. The data of the comparative analysis of the platinum activity on a fraction of Nafion in the electrode, the composition of the oxidizing agent (oxygen, air), pressure, and temperature are provided. The reasons for the dependence of the platinum surface activity on the component composition of the electrode are considered. Specific mass activity and surface activity of platinum in the ORR in MEA with the electrodes with CNTs depend on the ionomer/platinum ratio. Both dependences have a maximum at the level of the 25% Nafion fraction. The maximum appears as a result of an optimal structure formation, which ensures the fullest use of the platinum surface and minimal concentration overvoltages. Specific mass activity and surface activity of platinum for the sample with 34% CNTs at T = 60 °C and excessive pressure of p = 2 atm amount to 0.46 A/mg and 0.72 mA/cm2, respectively.

Thermal Stabilization of Nafion with Nanocarbon Materials.

The stability of Nafion-carbon composites is important for the efficient functioning of fuel cells. The thermal decomposition of Nafion, nanostructured carbon materials, such as multi-walled carbon nanotubes, graphene-like materials, and their composites, have been studied using constant heating rate thermogravimetry in air. Materials were characterized by quantitative and qualitative analysis methods, such as thermogravimetry, X-ray photoelectron spectroscopy, scanning, and transmission electron microscopy with field emission. In Nafion-carbon composites, an increase in the thermal stability of the Nafion polymer is observed due to the formation of surface compounds at the Nafion-carbon interface. In this case, the degree of stabilization is affected by both the component composition of the composite and the structure of the nanocarbon material. The greatest effect was obtained in the case of using thermally expanded graphite (few-layer graphene). Nafion is distributed to a greater extent over the surface of the carbon material due to its high structural accessibility. The most thermally stable composite is Nafion-graphene in a mass ratio of components 1:4 with one stage Nafion degradation at 422 °C, whereas the degradation of pristine Nafion occurs in three stages at 341, 413, and 430 °C. The dependences of thermal stability and features of thermal degradation on the composition and structure of composites are discussed.

Toward On-Chip Multisensor Arrays for Selective Methanol and Ethanol Detection at Room Temperature: Capitalizing the Graphene Carbonylation.

The artificial olfaction units (or e-noses) capable of room-temperature operation are highly demanded to meet the requests of society in numerous vital applications and developing Internet-of-Things. Derivatized 2D crystals are considered as sensing elements of choice in this regard, unlocking the potential of the advanced e-nose technologies limited by the current semiconductor technologies. Herein, we consider fabrication and gas-sensing properties of On-chip multisensor arrays based on a hole-matrixed carbonylated (C-ny) graphene film with a gradually changed thickness and concentration of ketone groups of up to 12.5 at.%. The enhanced chemiresistive response of C-ny graphene toward methanol and ethanol, of hundred ppm concentration when mixing with air to match permissible exposure OSHA limits, at room-temperature operation is signified. Following thorough characterization via core-level techniques and density functional theory, the predominant role of the C-ny graphene-perforated structure and abundance of ketone groups in advancing the chemiresistive effect is established. Advancing practice applications, selective discrimination of the studied alcohols is approached by linear discriminant analysis employing a multisensor array's vector signal, and the fabricated chip's long-term performance is shown.

Features of the Degradation of the Proton-Conducting Polymer Nafion in Highly Porous Electrodes of PEM Fuel Cells.

The stability of new membrane-electrode assemblies of a proton-exchange membrane fuel cell with highly porous electrodes and low Pt loading, based on the proton-conducting polymer Nafion, was characterized in conditions of electrochemical aging. A comprehensive study of the effect of the microstructure on the evolution of the electrochemical characteristics of the new assemblies was obtained by voltammetry, electrochemical impedance spectroscopy, X-ray powder diffraction, and scanning electron microscopy. Because high (>70%) porosity provides intensive mass transfer inside an electrode, structural-modifying additives-long carbon nanotubes-were introduced into the new electrodes. PEM fuel cells with electrodes of a conventional composition without carbon nanotubes were used for comparison. The aging of the samples was carried out according to the standard accelerated method in accordance with the DOE (Department of Energy) protocols. The results show two fundamental differences between the degradation of highly porous electrodes and traditional ones: 1. in highly porous electrodes, the size of Pt nanoparticles increases to a lesser extent due to recrystallization; 2. a more intense "washout" of Nafion and an increase in ionic resistance occur in highly porous electrodes. Mechanisms of the evolution of the characteristics of structurally modified electrodes under electrochemical aging are proposed.

Direct Effect of Life-Course Socioeconomic Status on Late-Life Cognition and Cognitive Decline in the Rush Memory and Aging Project.

The role of socioeconomic status (SES) across the life course in late-life cognition is unclear. We tested the hypotheses that: 1) High SES in childhood, young adulthood, midlife, and late life have independent causal effects on higher cognition level and slower cognitive decline; 2) Compared with stable low SES (referent), stable high SES has the largest estimated effect for higher cognition level and slower decline among life-course SES combinations. The Rush Memory and Aging Project enrolled 1,940 dementia-free older adults in northeastern Illinois (1997-2018). We used inverse probability-weighted marginal structural models to estimate the joint and independent effect of each life-course SES on global and domain-specific cognition. A total of 1,746 participants had, on average, 6 years of follow-up. High SES at each life-course stage starting in young adulthood had a protective estimated effect on global and domain-specific cognition intercepts. Compared with consistently low SES, consistently high SES (ß = 0.64, 95% confidence interval: 0.48, 0.93) and high SES beyond childhood (ß = 0.64, 95% confidence interval: 0.47, 0.83) had the largest benefit for global cognition intercepts. None of the life-course SES measures influenced rate of global or domain-specific decline. Additional understanding of life-course SES components influencing cognitive level is warranted.

New Generation of Compositional Aquivion®-Type Membranes with Nanodiamonds for Hydrogen Fuel Cells: Design and Performance.

Compositional proton-conducting membranes based on perfluorinated Aquivion®-type copolymers modified by detonation nanodiamonds (DND) with positively charged surfaces were prepared to improve the performance of hydrogen fuel cells. Small-angle neutron scattering (SANS) experiments demonstrated the fine structure in such membranes filled with DND (0-5 wt.%), where the conducting channels typical for Aquivion® membranes are mostly preserved while DND particles (4-5 nm in size) decorated the polymer domains on a submicron scale, according to scanning electron microscopy (SEM) data. With the increase in DND content (0, 0.5, and 2.6 wt.%) the thermogravimetric analysis, potentiometry, potentiodynamic, and potentiotatic curves showed a stabilizing effect of the DNDs on the operational characteristics of the membranes. Membrane-electrode assemblies (MEA), working in the O2/H2 system with the membranes of different compositions, demonstrated improved functional properties of the modified membranes, such as larger operational stability, lower proton resistance, and higher current densities at elevated temperatures in the extended temperature range (22-120 °C) compared to pure membranes without additives.

Disparities in substance use disorder treatment use and perceived need by sexual identity and gender among adults in the United States.

BACKGROUND: Substance use disorder (SUD) treatment use is low in the United States. We assessed differences in treatment use and perceived need by sexual identity (i.e., lesbian, gay, bisexual, heterosexual) and gender among adults with a past-year SUD. METHODS: We pooled data from the 2015-2019 National Survey on Drug Use and Health for adults (18+) who met past-year DSM-IV SUD criteria and self-reported sexual identity (n = 21,926). Weighted multivariable logistic regressions estimated odds of past-year: 1) any SUD treatment; 2) specialty SUD treatment; 3) perceived SUD treatment need by sexual identity, stratified by gender and adjusted for socio-demographics. RESULTS: Any past-year SUD treatment use was low among adult men (heterosexual [10.4 %], gay [15.5 %], and bisexual [7.1 %]) and women (heterosexual [9.9 %], gay/lesbian [11.9 %], and bisexual [13.2 %]). Patterns were similar for specialty SUD treatment and perceived treatment need. Adjusted odds of any SUD treatment use were higher among gay men (aOR = 1.65 [95 % Confidence Interval 1.10-2.46]) and bisexual women (aOR = 1.31 [1.01-1.69]) than their heterosexual peers. Compared to their heterosexual counterparts, adjusted odds of perceived SUD treatment need were higher among bisexual women (aOR = 1.65 [1.22-2.25]), gay men (aOR = 1.76 [1.09-2.84]), and bisexual men (aOR = 2.39 [1.35-4.24]). CONCLUSIONS: Most adults with SUD did not receive treatment. Gay men and bisexual women were more likely to receive treatment and reported higher perceived SUD treatment need than heterosexual peers. Facilitating treatment access and engagement is needed to reduce unmet needs among marginalized people who perceive SUD treatment need.

Risk of dementia following androgen deprivation therapy for treatment of prostate cancer.

BACKGROUND: Evidence for androgen deprivation therapy (ADT) and risk of dementia is both limited and mixed. We aimed to assess the association between ADT and risk of dementia among men with localized and locally advanced prostate cancer (PCa). METHODS: We conducted a retrospective cohort study using SEER-Medicare-linked data among 100,414 men aged ≥ 66 years and diagnosed with localized and locally advanced PCa (cT1-cT4) between 1992 and 2009. We excluded men with a history of stroke, dementia, or use of psychiatric services. Men were followed until death or administrative end of follow-up at 36 months. Inverse-probability weighted Fine-Gray models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for Alzheimer's, all-cause dementia, and use of psychiatric services by duration of pharmacologic ADT (0, 1-6, and ≥ 7 months). RESULTS: Among 100,414 men with PCa (median age 73 [IQR: 69-77] years; 84% white, 10% black), 38% (n = 37,911) received ADT within 6 months of diagnosis. Receipt of any pharmacologic ADT was associated with a 17% higher risk of all-cause dementia (HR 1.17, 95% CI 1.07-1.27), 23% higher risk of Alzheimer's (HR 1.23, 95% CI 1.11-1.37), and 10% higher risk of psychiatric services use, though the confidence interval included the null (HR 1.10, 95% CI 1.00-1.22). Longer duration of ADT (≥7 months) was associated with a 25% higher risk of all-cause dementia, 34% higher risk of Alzheimer's, and 9% higher risk of psychiatric services, compared with no ADT. CONCLUSIONS: Our study supports an association between pharmacologic ADT and higher risk of all-cause dementia, Alzheimer's, and use of psychiatric services among men with localized and locally advanced PCa.

Recommended Cancer Screening in Accountable Care Organizations: Trends in Colonoscopy and Mammography in the Medicare Shared Savings Program.

PURPOSE: Accountable care organizations (ACOs) are a delivery and payment model designed to encourage integrated, high-value care. We designed a study to test the association between ACOs and two recommended cancer screening tests, colonoscopy for colorectal cancer and mammography for breast cancer. METHODS: Using the random 20% sample of Medicare claims, beneficiaries were attributed to ACO or non-ACO cohorts on the basis of providers' enrollment in the Medicare Shared Savings Program. An inverse probability of treatment weighting was used to balance patient characteristics between ACO and non-ACO cohorts. A propensity score-weighted, difference-in-differences analysis was then performed using the same provider groups in 2010-pre-ACO-as a baseline. A secondary analysis for older-nonrecommended-age ranges was performed. RESULTS: Prevalence of colonoscopy in recommended age ranges in ACOs from 2010 to 2014 increased from 15.3% (95% CI, 14.9% to 15.6%) to 17.9% (95% CI, 17.3% to 18.5%). This differed significantly from the change in non-ACOs (difference in differences, 1.2%; P < .001). Among women in ACOs, mammography prevalence rose from 53.7% (95% CI, 53.0% to 54.4%) to 54.9% (95% CI, 54.2% to 55.7%). In contrast to colonoscopy, the difference in mammography prevalence was not significantly different in ACO versus non-ACOs (difference in differences, 0.49%; P < .13). A similar pattern was also observed in older-nonrecommended-age ranges with significant difference in differences (ACO v non-ACO) in colonoscopy, but not mammography. CONCLUSION: The impact of ACOs on cancer screening varies between screening tests. Our results are consistent with a greater effect of ACOs on high-cost, high-complexity screening services, which may be more sensitive to integrated care delivery models.

Prostate cancer in the medicare shared savings program: are Accountable Care Organizations associated with reduced expenditures for men with prostate cancer?

OBJECTIVES: To assess whether Medicare expenditures for men with incident prostate cancer, treated in Accountable Care Organizations (ACOs) differ from those of men treated in non-ACOs. METHODS: Using the 20% Medicare sample, total charges for 1 year following an initial diagnosis of prostate cancer were abstracted from Medicare claims. Prostate cancer expenditures were calculated by subtracting total charges from the year prior to diagnosis. Propensity score weighting was used to balance baseline characteristics of men treated in ACOs and non-ACOs, and between treatment modalities (radiation, prostatectomy, and expectant management). A propensity score weighted regression model was then used to estimate mean expenditures for men with prostate cancer treated in ACOs and non ACOs and to test the association between ACO status and costs. RESULTS: We identified 3297 men treated in ACOs for localized prostate cancer versus 24,088 in the non-ACO cohort. The weighted total charges for each treatment modality were $32,358 (radiation), $27,662 (prostatectomy), and $11,134 (expectant management). In our propensity score weighted regression model, the association between charges and ACO status was not significant, nor was the interaction between treatment type and costs. This was true both overall, and in a stratified analysis by treatment type. CONCLUSIONS: There was no significant difference in Medicare spending on prostate cancer care based on provider ACO affiliation, regardless of treatment type. Although the effects of ACOs on clinical care are complex, this study adds to a growing body of evidence suggesting that ACOs fail to achieve significantly lower charges in certain clinical settings.

Simple sediment rheology explains the Ediacara biota preservation.

The soft-bodied Ediacara biota (571-541 million years ago) represents the oldest complex large organisms in the fossil record, providing a bridge between largely microbial ecosystems of the Precambrian and the animal-dominated world of the Phanerozoic, potentially holding clues about the early evolution of Metazoa. However, the nature of most Ediacaran organisms remains unresolved, partly due to their enigmatic non-actualistic preservation. Here, we show that Flinders-style fossilization of Ediacaran organisms was promoted by unusually prolonged conservation of organic matter, coupled with differences in rheological behaviour of the over- and underlying sediments. In contrast with accepted models, cementation of overlying sand was not critical for fossil preservation, which is supported by the absence of cement in unweathered White Sea specimens and observations of soft sediment deformation in South Australian specimens. The rheological model, confirmed by laboratory simulations, implies that Ediacaran fossils do not necessarily reflect the external shape of the organism, but rather the morphology of a soft external or internal organic 'skeleton'. The rheological mechanism provides new constraints on biological interpretations of the Ediacara biota.

Antisocial personality and risks of cause-specific mortality: results from the Epidemiologic Catchment Area study with 27 years of follow-up.

PURPOSE: Little is known about the effect of antisocial personality disorder (ASPD) on the risks of cause-specific mortality in the community. This study aimed to close this gap by evaluating if ASPD increases risks of cause-specific mortality in population-based residential and institutionalized samples with 27 years of follow-up. METHODS: Data were collected in four metropolitan sites as part of the Epidemiologic Catchment Area (ECA) study during 1979-1983. Records were linked to the National Death Index through the end of 2007. Cox proportional hazards models adjusted for propensity weights and sample weights were fitted to estimate the effect of ASPD on the hazard of dying. RESULTS: 420 respondents with ASPD (median survival age 71.0 years) and 15,367 without ASPD (median survival age 84.6 years) were included in this study. Those with ASPD were more likely to die from all causes (HR = 4.46; 95% CI = 2.44-8.16), suicide (HR = 2.81; 95% CI = 1.03-7.65), malignant neoplasms (HR = 4.09; 95% CI = 2.66-6.28), chronic lower respiratory disease (HR = 5.67; 95% CI = 2.92-11.0), and human immunodeficiency virus infection (HR = 8.07; 95% CI = 2.03-32.1), but not from accidents (HR = 0.58; 95% CI = 0.17-1.93) or heart disease (HR = 1.09; 95% CI = 0.43-2.76). CONCLUSIONS: Our findings demonstrate that antisocial personality disorder is a strong predictor of all-cause mortality, and cause-specific mortality. Early identification, treatment, and prevention of ASPD are important public mental health initiatives that could reduce premature mortality among this vulnerable population.

Impact of Accountable Care Organizations on Prostate Cancer Screening and Biopsies in the United States.

INTRODUCTION: Accountable care organizations are designed to financially incentivize efficiency and reduce low value care. To determine if accountable care organizations have impacted prostate cancer screening patterns, we analyzed trends in prostate specific antigen screening and prostate biopsies by accountable care organization and nonaccountable care organization providers. METHODS: Using a random 20% sample of Medicare claims, we selected men 66 years old or older. In 2014 beneficiaries were attributed to accountable care organization and nonaccountable care organization providers using a modified Medicare Shared Savings Program algorithm. Beneficiaries treated by these same providers in 2010 served as the control population. Inverse probability weighting and difference in differences analyses were used to compare trends in prostate specific antigen screening and prostate biopsies in 2010 and 2014. Analyses were stratified by the age groups 66 to 69 years old and 70 years old or older. RESULTS: Among the beneficiaries treated by accountable care organization and nonaccountable care organization providers, prostate specific antigen screening rates were 62.4% and 60.5% in 2010 vs 55.9% and 54.4% in 2014 in men 66 to 69 years old, respectively (p=0.3). Prostate biopsy rates were 2.5% and 2.3% in 2010 vs 1.7% and 1.6% in 2014, respectively (p=0.6). In men 70 years old or older, prostate specific antigen screening rates were 54.3% and 54.2% in 2010 vs 46.0% and 46.4% in 2014, respectively (p=0.2). Similarly, prostate biopsy rates were 1.8% and 1.7% in 2010 vs 1.1% and 1.1% in 2014, respectively (p=0.7). CONCLUSIONS: Although decreasing the use of low value services is a fundamental goal of accountable care organizations, prostate specific antigen screening and prostate biopsy trends were similar for accountable care organization and nonaccountable care organization providers across all age groups in the study years. This finding suggests that accountable care organization implementation did not have an impact on prostate specific antigen screening or prostate biopsy use.

Liver Disease in Men Undergoing Androgen Deprivation Therapy for Prostate Cancer.

PURPOSE: Androgen deprivation therapy is associated with the development of diabetes and metabolic syndrome. To our knowledge its effect on the development of nonalcoholic fatty liver disease, a condition which frequently co-occurs with metabolic syndrome and other subsequent liver conditions such as liver cirrhosis, hepatic necrosis or any liver disease, has not been investigated. MATERIALS AND METHODS: We identified 82,938 men 66 years old or older who were diagnosed with localized prostate cancer in the SEER (Surveillance, Epidemiology and End Results)-Medicare database from 1992 to 2009. Men with preexisting nonalcoholic fatty liver disease, liver disease, diabetes or metabolic syndrome were excluded from study. Propensity score adjusted, competing risk regression models were created to compare the risk of nonalcoholic fatty liver disease in men who were vs were not treated with androgen deprivation. We also explored the influence of cumulative exposure to androgen deprivation therapy, calculated as monthly equivalent doses of gonadotropin-releasing hormone agonists/antagonists (fewer than 7, 7 to 11 or more than 11 doses). RESULTS: Overall 37.5% of men underwent androgen deprivation therapy. They were more likely to be diagnosed with nonalcoholic fatty liver disease (HR 1.54, 95% CI 1.40-1.68), liver cirrhosis (HR 1.35, 95% CI 1.12-1.60), liver necrosis (HR 1.41, 95% CI 1.15-1.72) and any liver disease (HR 1.47, 95% CI 1.35-1.60). A dose-response relationship was observed between the number of androgen deprivation therapy doses, and nonalcoholic fatty liver disease and any liver disease. CONCLUSIONS: Androgen deprivation therapy in men with prostate cancer is associated with the diagnosis of nonalcoholic fatty liver disease. The usual limitations of an observational study design apply, including possible inaccuracy in defining outcomes in a population based registry.

Molecular fossils from organically preserved Ediacara biota reveal cyanobacterial origin for Beltanelliformis.

The Ediacara biota (~575-541 million years ago) mark the emergence of large, complex organisms in the palaeontological record, preluding the radiation of modern animal phyla. However, their phylogenetic relationships, even at the domain level, remain controversial. We report the discovery of molecular fossils from organically preserved specimens of Beltanelliformis, demonstrating that they represent large spherical colonies of cyanobacteria. The conservation of molecular remains in organically preserved Ediacaran organisms opens a new path for unravelling the natures of the Ediacara biota.