IMPORTANCE Retinal telescreening for evaluation of diabetic retinopathy (DR) in the primary care setting may be useful in reaching rural and underserved patients.OBJECTIVES To evaluate telemedicine retinal screenings for patients with type 1 or 2 diabetes and identify factors for ophthalmology referral in the North Carolina Diabetic Retinopathy Telemedicine Network. DESIGN, SETTING, AND PARTICIPANTSA preimplementation and postimplementation evaluation was conducted from January 6, 2014, to November 1, 2015, at 5 primary care clinics serving rural and underserved populations in North Carolina among 1787 adult patients with type 1 or 2 diabetes who received primary care at the clinics and obtained retinal telescreening to determine the presence and severity of DR. A total of 1661 patients with complete data were included in the statistical analysis.INTERVENTION Nonmydriatic fundus photography with remote interpretation by an expert. MAIN OUTCOMES AND MEASURESNumber of patients recruited, level of detected DR, change in rates of screening, rate of ophthalmology referral, percentage of completed referrals, and patient characteristics associated with varying levels of DR. RESULTSOf the 1661 patients (1041 women and 620 men; mean [SD] age, 55.4 [12.7] years), 1323 patients (79.7%) had no DR, 183 patients (11.0%) had DR without a need for an ophthalmology referral, and 155 patients (9.3%) had DR with a need for an ophthalmology referral. The mean rate of screening for DR before implementation of the program was 25.6% (1512 of 5905), which increased to 40.4% (1884 of 4664) after implementation. A total of 93 referred patients (60.0%) completed an ophthalmology referral visit within the study period. Older patients (odds ratio [OR], 1.28; 95% CI, 1.11-1.48) and African American patients (OR, 1.84; 95% CI, 1.24-2.73) or other racial/ethnic minorities (OR, 2.19; 95% CI, 1.16-4.11) had greater odds of requiring an ophthalmology referral compared with white and/or younger patients. Patients with higher hemoglobin A 1c levels (OR, 1.19 per unit change; 95% CI, 1.13-1.25 per unit change) and longer duration of diabetes (OR, 1.76 per decade; 95% CI, 1.53-2.02 per decade) had greater odds of DR requiring an ophthalmology referral. History of stroke (OR, 1.65; 95% CI, 1.10-2.48) and kidney disease (OR, 1.59; 95% CI, 1.10-2.31) were strongly associated with DR and ophthalmology referral. CONCLUSIONS AND RELEVANCEWhen implemented in the primary care setting, retinal telescreening increased the rate of evaluation for DR for patients in rural and underserved settings. This strategy may also increase access to care for minorities and patients with DR requiring treatment.

We study the nonparametric least squares estimator (LSE) of a multivariate convex regression function. The LSE, given as the solution to a quadratic program with O(n 2 ) linear constraints (n being the sample size), is difficult to compute for large problems. Exploiting problem specific structure, we propose a scalable algorithmic framework based on the augmented Lagrangian method to compute the LSE. We develop a novel approach to obtain smooth convex approximations to the fitted (piecewise affine) convex LSE and provide formal bounds on the quality of approximation. When the number of samples is not too large compared to the dimension of the predictor, we propose a regularization scheme -Lipschitz convex regression -where we constrain the norm of the subgradients, and study the rates of convergence of the obtained LSE. Our algorithmic framework is simple and flexible and can be easily adapted to * 1 arXiv:1509.08165v1 [stat.CO] 28 Sep 2015 handle variants: estimation of a non-decreasing/non-increasing convex/concave (with or without a Lipschitz bound) function. We perform numerical studies illustrating the scalability of the proposed algorithm.

Objectives. To examine the characteristics and temporal trends of yoga, tai chi, and qigong (YTQ) use among US adults. Methods. Using the 2002, 2007, 2012, and 2017 National Health Interview Surveys, we examined the prevalence, patterns, and predicting factors of YTQ use by Taylor series linear regression, the Wald F χ2 test, and multivariable logistic regression models (n = 116 404). Results. YTQ use increased from 5.8% in 2002 to 14.5% in 2017 (P ≤ .001). Only 6.6% of YTQ users were referred by their medical doctors, and approximately one third disclosed their use of YTQ to medical professionals. Reasons for using YTQ included (1) YTQ was beneficial, (2) YTQ focused on the whole person, and (3) YTQ was natural. Acute and chronic pain, arthritis, and depression were the top 3 medical conditions for which people used YTQ the most. Conclusions. YTQ use is increasing substantially, mainly because of its natural and holistic healing approach toward health and chronic diseases. Future studies aiming to explore how to best integrate YTQ into the current health care system are warranted.

This study evaluated the use of the Curaçao criteria for the diagnosis of HHT in the pediatric population with a family history of HHT. In those between the age of 0 and 21 years who meet 1 criterion (unlikely HHT) or 2 criteria (possible HHT), genetic testing is preferred for diagnosis. The Curaçao criteria appear to reliably diagnose HHT in children and adolescents who meet 3 or 4 criteria (definite HHT).

Introduction: Hereditary hemorrhagic telangiectasia (HHT) is characterized by the abnormal development of blood vessels leading to the formation of mucocutaneous telangiectasias and arteriovenous malformations (AVMs) in visceral organs. Anemia is a frequent complication of HHT secondary to blood loss from recurrent epistaxis, gastrointestinal bleeding, or both. The purpose of this study was to determine presence and severity of anemia at initial evaluation for HHT, and identify predictors of anemia. Methods: We conducted a retrospective chart review of HHT patients evaluated at the University of North Carolina HHT Center of Excellence from 2008-2015. Data abstracted from the medical record included diagnosis of anemia, hemoglobin, source of bleeding, HHT genotype, epistaxis severity score (ESS), presence of visceral organ AVMs, history of treatment of AVMs, iron therapy, and need for blood transfusions. All data were collected from the patient's first visit to the HHT center. Source of bleeding was recorded as epistaxis, GI bleeding, or both. Epistaxis severity was determined by the ESS, with a higher score indicating more severe bleeding. GI bleeding had to be confirmed by patient history, presence of bleeding telangiectasias on endoscopy, or ongoing symptoms (bright red or dark stools). Presence of anemia required verification with complete blood count results. Anemia severity was defined as mild if hemoglobin ≥ 10, moderate if 8-10, and severe if <8 g/dl. Screening for visceral organ AVMs was conducted as per the international guidelines for management of HHT. All patients were screened for pulmonary (pAVM) and brain (bAVM) AVMs, and screening for GI and liver (lAVM) AVMs was pursued only in symptomatic patients. Cramer's V and chi squared goodness of fit test determined if overall source or severity was linked to gender, genotype, and AVM location. A test of multinomial proportions determined statistical significance between individual gender, genotype, and AVM location with source and severity. Results: A total of 168 patients were included, of which 84 had documented anemia. In patients with anemia, the majority were female (72%), Caucasian (79%), and had ALK-1 genotype (50%). Mild anemia was most common (52%), followed by moderate (37%), and severe anemia (11%). Neither gender nor genotype was significantly associated with anemia severity. In patients with mild anemia, pAVMs were the most common visceral organ affected (45%), while GI telangiectasias were most common in the severe anemia group (67%). In moderate anemia, there was an equal proportion of GI and pAVM involvement (44%). Overall the presence of AVMs was linked to anemia severity (p-value: 0.0006), but there was no association between individual AVM site and anemia severity. The majority of patients with mild anemia were or had been on oral iron (76%), while patients with moderate (75%) and severe anemia (100%) had or were currently on IV iron replacement. Epistaxis was the most common cause of anemia in the mild and moderate groups (75% and 59% respectively), while both GI bleeding and epistaxis were present in the majority of patients with severe anemia (44%). The mean ESS in patients with mild anemia was 5.18 compared to 6.93 in those with moderate anemia. The ALK-1 genotype was a significant predictor of anemia related to epistaxis. LAVMs also significantly increased the risk for anemia from recurrent epistaxis while GI telangiectasias were associated with anemia from both GI bleeding and epistaxis. Conclusion:Iron deficiency anemia can be associated with significant morbidity. This is the first study to analyze the causes and severity of anemia in HHT patients at the time of initial evaluation to an HHT Center of Excellence. A high prevalence of anemia was found in this HHT population, with 50% of patients having documented anemia. We found that patients with ALK-1 mutations and liver AVMs are more likely to have epistaxis as the source of their anemia. Further, we demonstrate that patients with severe anemia more frequently present with GI AVMs. Understanding disease related predictors of anemia could help identify patients that are at highest risk and thereby facilitate aggressive screening in high-risk groups. Our findings are timely given the increasing awareness of HHT within the hematology community. Disclosures No relevant conflicts of interest to declare.

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