Antidepressant Medication Use and Its Association With Cardiovascular Disease and All-Cause Mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

PubMed

Hansen, Richard A; Khodneva, Yulia; Glasser, Stephen P; Qian, Jingjing; Redmond, Nicole; Safford, Monika M

2016-04-01

Mixed evidence suggests that second-generation antidepressants may increase the risk of cardiovascular and cerebrovascular events. To assess whether antidepressant use is associated with acute coronary heart disease (CHD), stroke, cardiovascular disease (CVD) death, and all-cause mortality. Secondary analyses of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study were conducted. Use of selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, bupropion, nefazodone, and trazodone was measured during the baseline (2003-2007) in-home visit. Outcomes of CHD, stroke, CVD death, and all-cause mortality were assessed every 6 months and adjudicated by medical record review. Cox proportional hazards time-to-event analysis followed patients until their first event on or before December 31, 2011, iteratively adjusting for covariates. Among 29 616 participants, 3458 (11.7%) used an antidepressant of interest. Intermediate models adjusting for everything but physical and mental health found an increased risk of acute CHD (hazard ratio [HR] = 1.21; 95% CI = 1.04-1.41), stroke (HR = 1.28; 95% CI = 1.02-1.60), CVD death (HR = 1.29; 95% CI = 1.09-1.53), and all-cause mortality (HR = 1.27; 95% CI = 1.15-1.41) for antidepressant users. Risk estimates trended in this direction for all outcomes in the fully adjusted model but only remained statistically associated with increased risk of all-cause mortality (HR = 1.12; 95% CI = 1.01-1.24). This risk was attenuated in sensitivity analyses censoring follow-up time at 2 years (HR = 1.37; 95% CI = 1.11-1.68). In fully adjusted models, antidepressant use was associated with a small increase in all-cause mortality. © The Author(s) 2016.

Impact of particulate air pollution on quality-adjusted life expectancy in Canada.

PubMed

Coyle, Douglas; Stieb, Dave; Burnett, Richard T; DeCivita, Paul; Krewski, Daniel; Chen, Yue; Thun, Michael J

Air pollution and premature death are important public health concerns. Analyses have repeatedly demonstrated that airborne particles are associated with increased mortality and estimates have been used to forecast the impact on life expectancy. In this analysis, we draw upon data from the American Cancer Society (ACS) cohort and literature on utility-based measures of quality of life in relation to health status to more fully quantify the effects of air pollution on mortality in terms of quality-adjusted life expectancy. The analysis was conducted within a decision analytic model using Monte Carlo simulation techniques. Outcomes were estimated based on projections of the Canadian population. A one-unit reduction in sulfate air pollution would yield a mean annual increase in Quality-Adjusted Life Years (QALYs) of 20,960, with gains being greater for individuals with lower educational status and for males compared to females. This suggests that the impact of reductions in sulfate air pollution on quality-adjusted life expectancy is substantial. Interpretation of the results is unclear. However, the potential gains in QALYs from reduced air pollutants can be contrasted to the costs of policies to bring about such reductions. Based on a tentative threshold for the value of health benefits, analysis suggests that an investment in Canada of over 1 billion dollars per annum would be an efficient use of resources if it could be demonstrated that this would reduce sulfate concentrations in ambient air by 1 microg/m(3). Further analysis can assess the efficiency of targeting such initiatives to communities that are most likely to benefit.

Impact of vitamin D on the hospitalization rate of Crohn's disease patients seen at a tertiary care center

PubMed Central

Venkata, Krishna V R; Arora, Sumant S; Xie, Feng-Long; Malik, Talha A

2017-01-01

AIM To study the association between vitamin D level and hospitalization rate in Crohn’s disease (CD) patients. METHODS We designed a retrospective cohort study using adult patients (> 19 years) with CD followed for at least one year at our inflammatory bowel disease center. Vitamin D levels were divided into: low mean vitamin D level (< 30 ng/mL) vs appropriate mean vitamin D level (30-100 ng/mL). Generalized Poisson Regression Models (GPR) for Rate Data were used to estimate partially adjusted and fully adjusted incidence rate ratios (IRR) of hospitalization among CD patients. We also examined IRRs for vitamin D level as a continuous variable. RESULTS Of the 880 CD patients, 196 patients with vitamin D level during the observation period were included. Partially adjusted model demonstrated that CD patients with a low mean vitamin D level were almost twice more likely to be admitted (IRR = 1.76, 95%CI: 1.38-2.24) compared to those with an appropriate vitamin D level. The fully adjusted model confirmed this association (IRR = 1.44, 95%CI: 1.11-1.87). Partially adjusted model with vitamin D level as a continuous variable demonstrated, higher mean vitamin D level was associated with a 3% lower likelihood of admission with every unit (ng/mL) rise in mean vitamin D level (IRR = 0.97, 95%CI: 0.96-0.98). The fully adjusted model confirmed this association (IRR = 0.98, 95%CI: 0.97-0.99). CONCLUSION Normal or adequate vitamin D stores may be protective in the clinical course of CD. However, this role needs to be further characterized and understood. PMID:28465638

N-Terminal Pro-B Type Natriuretic Peptide is Associated with Mild Cognitive Impairment in the General Population.

PubMed

Kara, Kaffer; Mahabadi, Amir Abbas; Weimar, Christian; Winkler, Angela; Neumann, Till; Kälsch, Hagen; Dragano, Nico; Moebus, Susanne; Erbel, Raimund; Jöckel, Karl-Heinz; Jokisch, Martha

2017-01-01

N-terminal pro-B type natriuretic peptide (NT-proBNP) is a marker of cardiac stress and is linked with silent cardiac diseases. While associations of cognitive impairment with manifest cardiovascular diseases are established, data on whether subclinical elevation of NT-proBNP levels below clinically established threshold of heart failure is related with cognitive functioning, especially mild cognitive impairment (MCI), is rare. Aim of the present study was to investigate the cross-sectional association of NT-proBNP levels and MCI in a population-based study sample without heart failure. We used data from the second examination of the population based Heinz-Nixdorf-Recall-Study. Subjects with overt coronary heart disease and subjects with NT-proBNP levels indicating potential heart failure (NT-proBNP≥300 pg/ml) were excluded from this analysis. Participants performed a validated brief cognitive assessment and were classified either as MCI [subtypes: amnestic-MCI (aMCI), non-amnestic-MCI (naMCI)], or cognitively-normal. We included 419 participants with MCI (63.1±7.4 y; 47% men; aMCI n = 209; naMCI n = 210) and 1,206 cognitively normal participants (62.42±7.1 y; 48% men). NT-proBNP-levels≥125 pg/ml compared to <125 pg/ml were associated with MCI in fully adjusted models (OR 1.65 (1.23;2.23) in the total sample, 1.73 (1.09;2.74) in men and 1.63(1.10;2.41) in women). For aMCI, the fully adjusted OR was 1.53 (1.04;2.25) and for naMCI, the fully adjusted OR was 1.34 (1.09; 166) in the total sample. Within normal ranges and without manifest heart failure, higher NT-proBNPlevels are associated with MCI and both MCI subtypes independent of traditional cardiovascular risk factors and sociodemographic parameters.

Does high intelligence improve prognosis? The association of intelligence with recurrence and mortality among Swedish men with coronary heart disease.

PubMed

Sörberg Wallin, Alma; Falkstedt, Daniel; Allebeck, Peter; Melin, Bo; Janszky, Imre; Hemmingsson, Tomas

2015-04-01

Lower intelligence early in life is associated with increased risks for coronary heart disease (CHD) and mortality. Intelligence level might affect compliance to treatment but its prognostic importance in patients with CHD is unknown. A cohort of 1923 Swedish men with a measure of intelligence from mandatory military conscription in 1969-1970 at age 18-20, who were diagnosed with CHD 1991-2007, were followed to the end of 2008. recurrent CHD event. Secondary outcome: case fatality from the first event, cardiovascular and all-cause mortality. National registers provided information on CHD events, comorbidity, mortality and socioeconomic factors. The fully adjusted HRs for recurrent CHD for medium and low intelligence, compared with high intelligence, were 0.98, (95% CIs 0.83 to 1.16) and 1.09 (0.89 to 1.34), respectively. The risks were increased for cardiovascular and all-cause mortality with lower intelligence, but were attenuated in the fully adjusted models (fully adjusted HRs for cardiovascular mortality 1.92 (0.94 to 3.94) and 1.98 (0.89 to 4.37), respectively; for all-cause mortality 1.63 (1.00 to 2.65) and 1.62 (0.94 to 2.78), respectively). There was no increased risk for case-fatality at the first event (fully adjusted ORs 1.06 (0.73 to 1.55) and 0.97 (0.62 to 1.50), respectively). Although we found lower intelligence to be associated with increased mortality in middle-aged men with CHD, there was no evidence for its possible effect on recurrence in CHD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Exemplar-Based Image and Video Stylization Using Fully Convolutional Semantic Features.

PubMed

Zhu, Feida; Yan, Zhicheng; Bu, Jiajun; Yu, Yizhou

2017-05-10

Color and tone stylization in images and videos strives to enhance unique themes with artistic color and tone adjustments. It has a broad range of applications from professional image postprocessing to photo sharing over social networks. Mainstream photo enhancement softwares, such as Adobe Lightroom and Instagram, provide users with predefined styles, which are often hand-crafted through a trial-and-error process. Such photo adjustment tools lack a semantic understanding of image contents and the resulting global color transform limits the range of artistic styles it can represent. On the other hand, stylistic enhancement needs to apply distinct adjustments to various semantic regions. Such an ability enables a broader range of visual styles. In this paper, we first propose a novel deep learning architecture for exemplar-based image stylization, which learns local enhancement styles from image pairs. Our deep learning architecture consists of fully convolutional networks (FCNs) for automatic semantics-aware feature extraction and fully connected neural layers for adjustment prediction. Image stylization can be efficiently accomplished with a single forward pass through our deep network. To extend our deep network from image stylization to video stylization, we exploit temporal superpixels (TSPs) to facilitate the transfer of artistic styles from image exemplars to videos. Experiments on a number of datasets for image stylization as well as a diverse set of video clips demonstrate the effectiveness of our deep learning architecture.

Development of solid tunable optics for ultra-miniature imaging systems

NASA Astrophysics Data System (ADS)

Yongchao, Zou

This thesis focuses on the optimal design, fabrication and testing of solid tunable optics and exploring their applications in miniature imaging systems. It starts with the numerical modelling of such lenses, followed by the optimum design method and alignment tolerance analysis. A miniature solid tunable lens driven by a piezo actuator is then developed. To solve the problem of limited maximum optical power and tuning range in conventional lens designs, a novel multi-element solid tunable lens is proposed and developed. Inspired by the Alvarez principle, a novel miniature solid tunable dual-focus lens, which is designed using freeform surfaces and driven by one micro-electro-mechanical-systems (MEMS) rotary actuator, is demonstrated. To explore the applications of these miniature solid tunable lenses, a miniature adjustable-focus endoscope and one compact adjustable-focus camera module are developed. The adjustable-focus capability of these two miniature imaging systems is fully proved by electrically focusing targets placed at different positions.

Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: A cross-sectional and prospective study

PubMed Central

Gavrieli, Anna; Farr, Olivia M; Davis, Cynthia R; Crowell, Judith A; Mantzoros, Christos S.

2015-01-01

Background Early life adversity (ELA) and post-traumatic stress disorder (PTSD) are associated with poorer psychological and physical health. Potential underlying mechanisms and mediators remain to be elucidated, and the lifestyle habits and characteristics of individuals with ELA and/or PTSD have not been fully explored. We investigated whether the presence of ELA and/or PTSD are associated with nutrition, physical activity, resting and sleeping and smoking. Methods A cross-sectional sample of 151 males and females (age: 45.6±3.5 y, BMI: 30.0±7.1kg/m2) underwent anthropometric measurements, as well as detailed questionnaires for dietary assessment, physical activity, resting and sleeping, smoking habits and psychosocial assessments. A prospective follow-up visit of 49 individuals was performed 2.5 years later and the same outcomes were assessed. ELA and PTSD were evaluated as predictors, in addition to a variable assessing the combined presence/severity of ELA–PTSD. Data were analyzed using analysis of covariance after adjusting for several socioeconomic, psychosocial and anthropometric characteristics. Results Individuals with higher ELA or PTSD severity were found to have a poorer diet quality (DASH score: p=0.006 and p=0.003, respectively; aHEI-2010 score: ELA p=0.009), including further consumption of trans fatty acids (ELA p=0.003); the differences were significantly attenuated null after adjusting mainly for education or income and/or race. Further, individuals with higher ELA severity reported less hours of resting and sleeping (p=0.043) compared to those with zero/lower ELA severity, and the difference remained significant in the fully adjusted model indicating independence from potential confounders. When ELA and PTSD were combined, an additive effect was observed on resting and sleeping (p=0.001); results remained significant in the fully adjusted model. They also consumed more energy from trans fatty acids (p=0.017) tended to smoke more (p=0.008), and have less physical activity (PTSD p=0.024) compared to those with no or lower ELA and PTSD severity. Adjustments for sociodemographic factors and/or BMI rendered results of the above life style parameters non-significant. The analysis of the prospective data showed similar trends to the cross-sectional analysis, further supporting the conclusions, although statistical significance of results was lower due to the lower number of participants. Conclusion Fewer hours of resting and sleeping and poorer diet quality are linked to ELA and/or PTSD, indicating that these pathways might underlie the development of several metabolic abnormalities in individuals with ELA and/or PTSD. Differences in terms of diet quality are significantly attenuated by race and/or education and/or income, whereas differences in other lifestyle habits of individuals with and without ELA and/or PTSD, such as physical activity, are mostly explained by confounding sociodemographic variables and/or body mass index. PMID:26404481

Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: A cross-sectional and prospective study.

PubMed

Gavrieli, Anna; Farr, Olivia M; Davis, Cynthia R; Crowell, Judith A; Mantzoros, Christos S

2015-11-01

Early life adversity (ELA) and post-traumatic stress disorder (PTSD) are associated with poorer psychological and physical health. Potential underlying mechanisms and mediators remain to be elucidated, and the lifestyle habits and characteristics of individuals with ELA and/or PTSD have not been fully explored. We investigated whether the presence of ELA and/or PTSD are associated with nutrition, physical activity, resting and sleeping and smoking. A cross-sectional sample of 151 males and females (age: 45.6±3.5 years, BMI: 30.0±7.1 kg/m(2)) underwent anthropometric measurements, as well as detailed questionnaires for dietary assessment, physical activity, resting and sleeping, smoking habits and psychosocial assessments. A prospective follow-up visit of 49 individuals was performed 2.5 years later and the same outcomes were assessed. ELA and PTSD were evaluated as predictors, in addition to a variable assessing the combined presence/severity of ELA-PTSD. Data were analyzed using analysis of covariance after adjusting for several socioeconomic, psychosocial and anthropometric characteristics. Individuals with higher ELA or PTSD severity were found to have a poorer diet quality (DASH score: p=0.006 and p=0.003, respectively; aHEI-2010 score: ELA p=0.009), including further consumption of trans fatty acids (ELA p=0.003); the differences were significantly attenuated null after adjusting mainly for education or income and/or race. Further, individuals with higher ELA severity reported less hours of resting and sleeping (p=0.043) compared to those with zero/lower ELA severity, and the difference remained significant in the fully adjusted model indicating independence from potential confounders. When ELA and PTSD were combined, an additive effect was observed on resting and sleeping (p=0.001); results remained significant in the fully adjusted model. They also consumed more energy from trans fatty acids (p=0.017) tended to smoke more (p=0.008), and have less physical activity (PTSD p=0.024) compared to those with no or lower ELA and PTSD severity. Adjustments for sociodemographic factors and/or BMI rendered results of the above lifestyle parameters non-significant. The analysis of the prospective data showed similar trends to the cross-sectional analysis, further supporting the conclusions, although statistical significance of results was lower due to the lower number of participants. Fewer hours of resting and sleeping and poorer diet quality are linked to ELA and/or PTSD, indicating that these pathways might underlie the development of several metabolic abnormalities in individuals with ELA and/or PTSD. Differences in terms of diet quality are significantly attenuated by race and/or education and/or income, whereas differences in other lifestyle habits of individuals with and without ELA and/or PTSD, such as physical activity, are mostly explained by confounding sociodemographic variables and/or body mass index. Copyright © 2015 Elsevier Inc. All rights reserved.

HIV-Related Sexual Risk among African American Men Preceding Incarceration: Associations with Support from Significant Others, Family, and Friends.

PubMed

Coatsworth, Ashley M; Scheidell, Joy D; Wohl, David A; Whitehead, Nicole E; Golin, Carol E; Judon-Monk, Selena; Khan, Maria R

2017-02-01

We evaluated the association between social support received from significant others, family, and friends and HIV-related sexual risk behaviors among African American men involved in the criminal justice system. Project DISRUPT is a cohort study among African American men released from prison in North Carolina (N = 189). During the baseline (in-prison) survey, we assessed the amount of support men perceived they had received from significant others, family, and friends. We measured associations between low support from each source (

Psychosocial working conditions and sickness absence in a general population: a cohort study of 21,834 workers in Norway (The HUNT Study).

PubMed

Strømholm, Tonje; Pape, Kristine; Ose, Solveig Osborg; Krokstad, Steinar; Bjørngaard, Johan Håkon

2015-04-01

To examine the associations between psychosocial working conditions and sickness absence. Data for 21,834 employed adults from the Nord-Trøndelag Health Study (HUNT) were linked to the sickness benefit register and sickness absence during 1 year after survey participation was analyzed with logistic regression. A one unit change on a 0 to 3 self-reported job demand scale was associated with a fully adjusted 24% and 25% increased odds of sickness absence in men and women, respectively. A one unit change on a 0 to 3 scale for self-reported support at work was associated with a fully adjusted 13% and 17% reduced odds of sickness absence in men and women, respectively. The results of this study indicate that demands, and to some extent support, at work might influence sickness absence-also when adjusting for a detailed categorization of occupations.

Personal resilience, cognitive appraisals, and coping: an integrative model of adjustment to abortion.

PubMed

Major, B; Richards, C; Cooper, M L; Cozzarelli, C; Zubek, J

1998-03-01

We hypothesized that the effects of personality (self-esteem, control, and optimism) on postabortion adaptation (distress, well-being, and decision satisfaction) would be fully mediated by preabortion cognitive appraisals (stress appraisals and self-efficacy appraisals) and postabortion coping. We further proposed that the effects of preabortion appraisals on adaptation would be fully mediated by postabortion coping. Results of a longitudinal study of 527 women who had first-trimester abortions supported our hypotheses. Women with more resilient personalities appraised their abortion as less stressful and had higher self-efficacy for coping with the abortion. More positive appraisals predicted greater acceptance/reframing coping and lesser avoidance/denial, venting, support seeking, and religious coping. Acceptance-reframing predicted better adjustment on all measures, whereas avoidance-denial and venting related to poorer adjustment on all measures. Greater support seeking was associated with reduced distress, and greater religious coping was associated with less decision satisfaction.

Estradiol and Inflammatory Markers in Older Men

PubMed Central

Maggio, Marcello; Ceda, Gian Paolo; Lauretani, Fulvio; Bandinelli, Stefania; Metter, E. Jeffrey; Artoni, Andrea; Gatti, Elisa; Ruggiero, Carmelinda; Guralnik, Jack M.; Valenti, Giorgio; Ling, Shari M.; Basaria, Shehzad; Ferrucci, Luigi

2009-01-01

Background: Aging is characterized by a mild proinflammatory state. In older men, low testosterone levels have been associated with increasing levels of proinflammatory cytokines. It is still unclear whether estradiol (E2), which generally has biological activities complementary to testosterone, affects inflammation. Methods: We analyzed data obtained from 399 men aged 65–95 yr enrolled in the Invecchiare in Chianti study with complete data on body mass index (BMI), serum E2, testosterone, IL-6, soluble IL-6 receptor, TNF-α, IL-1 receptor antagonist, and C-reactive protein. The relationship between E2 and inflammatory markers was examined using multivariate linear models adjusted for age, BMI, smoking, physical activity, chronic disease, and total testosterone. Results: In age-adjusted analysis, log (E2) was positively associated with log (IL-6) (r = 0.19; P = 0.047), and the relationship was statistically significant (P = 0.032) after adjustments for age, BMI, smoking, physical activity, chronic disease, and serum testosterone levels. Log (E2) was not significantly associated with log (C-reactive protein), log (soluble IL-6 receptor), or log (TNF-α) in both age-adjusted and fully adjusted analyses. Conclusions: In older men, E2 is weakly positively associated with IL-6, independent of testosterone and other confounders including BMI. PMID:19050054

Dietary patterns and chronic kidney disease: a cross-sectional association in the Irish Nun Eye Study.

PubMed

Paterson, Euan N; Neville, Charlotte E; Silvestri, Giuliana; Montgomery, Shannon; Moore, Evelyn; Silvestri, Vittorio; Cardwell, Christopher R; MacGillivray, Tom J; Maxwell, Alexander P; Woodside, Jayne V; McKay, Gareth J

2018-04-27

Associations between dietary patterns and chronic kidney disease are not well established, especially in European populations. We conducted a cross-sectional study of 1033 older Irish women (age range 56-100 years) with a restricted lifestyle. Dietary intake was assessed using a food frequency questionnaire. Renal function was determined by estimated glomerular filtration rate. Two dietary patterns were identified within the study population using factor analysis. A significant negative association was found between unhealthy dietary pattern adherence and renal function in both unadjusted and adjusted models controlling for potential confounding variables (p for trend <0.001), with a mean difference in estimated glomerular filtration rate of -6 ml/min/1.73 m 2 between those in the highest fifth of adherence to the unhealthy dietary pattern compared to the lowest, in the fully adjusted model. Chronic kidney disease risk was significantly greater for the highest fifth, compared to the lowest fifth of unhealthy dietary pattern adherence in adjusted models (adjusted odds ratio = 2.62, p < 0.001). Adherence to the healthy dietary pattern was not associated with renal function or chronic kidney disease in adjusted models. In this cohort, an unhealthy dietary pattern was associated with lower renal function and greater prevalence of chronic kidney disease.

Design and Analysis of a Novel Fully Decoupled Tri-axis Linear Vibratory Gyroscope with Matched Modes.

PubMed

Xia, Dunzhu; Kong, Lun; Gao, Haiyu

2015-07-13

We present in this paper a novel fully decoupled silicon micromachined tri-axis linear vibratory gyroscope. The proposed gyroscope structure is highly symmetrical and can be limited to an area of about 8.5 mm × 8.5 mm. It can differentially detect three axes' angular velocities at the same time. By elaborately arranging different beams, anchors and sensing frames, the drive and sense modes are fully decoupled from each other. Moreover, the quadrature error correction and frequency tuning functions are taken into consideration in the structure design for all the sense modes. Since there exists an unwanted in-plane rotational mode, theoretical analysis is implemented to eliminate it. To accelerate the mode matching process, the particle swam optimization (PSO) algorithm is adopted and a frequency split of 149 Hz is first achieved by this method. Then, after two steps of manual adjustment of the springs' dimensions, the frequency gap is further decreased to 3 Hz. With the help of the finite element method (FEM) software ANSYS, the natural frequencies of drive, yaw, and pitch/roll modes are found to be 14,017 Hz, 14,018 Hz and 14,020 Hz, respectively. The cross-axis effect and scale factor of each mode are also simulated. All the simulation results are in good accordance with the theoretical analysis, which means the design is effective and worthy of further investigation on the integration of tri-axis accelerometers on the same single chip to form an inertial measurement unit.

Improved protein hydrogen/deuterium exchange mass spectrometry platform with fully automated data processing.

PubMed

Zhang, Zhongqi; Zhang, Aming; Xiao, Gang

2012-06-05

Protein hydrogen/deuterium exchange (HDX) followed by protease digestion and mass spectrometric (MS) analysis is accepted as a standard method for studying protein conformation and conformational dynamics. In this article, an improved HDX MS platform with fully automated data processing is described. The platform significantly reduces systematic and random errors in the measurement by introducing two types of corrections in HDX data analysis. First, a mixture of short peptides with fast HDX rates is introduced as internal standards to adjust the variations in the extent of back exchange from run to run. Second, a designed unique peptide (PPPI) with slow intrinsic HDX rate is employed as another internal standard to reflect the possible differences in protein intrinsic HDX rates when protein conformations at different solution conditions are compared. HDX data processing is achieved with a comprehensive HDX model to simulate the deuterium labeling and back exchange process. The HDX model is implemented into the in-house developed software MassAnalyzer and enables fully unattended analysis of the entire protein HDX MS data set starting from ion detection and peptide identification to final processed HDX output, typically within 1 day. The final output of the automated data processing is a set (or the average) of the most possible protection factors for each backbone amide hydrogen. The utility of the HDX MS platform is demonstrated by exploring the conformational transition of a monoclonal antibody by increasing concentrations of guanidine.

Birth by Caesarean Section and the Risk of Adult Psychosis: A Population-Based Cohort Study.

PubMed

O'Neill, Sinéad M; Curran, Eileen A; Dalman, Christina; Kenny, Louise C; Kearney, Patricia M; Clarke, Gerard; Cryan, John F; Dinan, Timothy G; Khashan, Ali S

2016-05-01

Despite the biological plausibility of an association between obstetric mode of delivery and psychosis in later life, studies to date have been inconclusive. We assessed the association between mode of delivery and later onset of psychosis in the offspring. A population-based cohort including data from the Swedish National Registers was used. All singleton live births between 1982 and 1995 were identified (n= 1,345,210) and followed-up to diagnosis at age 16 or later. Mode of delivery was categorized as: unassisted vaginal delivery (VD), assisted VD, elective Caesarean section (CS) (before onset of labor), and emergency CS (after onset of labor). Outcomes included any psychosis; nonaffective psychoses (including schizophrenia only) and affective psychoses (including bipolar disorder only and depression with psychosis only). Cox regression analysis was used reporting partially and fully adjusted hazard ratios (HR) with 95% confidence intervals (CI). Sibling-matched Cox regression was performed to adjust for familial confounding factors. In the fully adjusted analyses, elective CS was significantly associated with any psychosis (HR 1.13, 95% CI 1.03, 1.24). Similar findings were found for nonaffective psychoses (HR 1.13, 95% CI 0.99, 1.29) and affective psychoses (HR 1.17, 95% CI 1.05, 1.31) (χ(2)for heterogeneityP= .69). In the sibling-matched Cox regression, this association disappeared (HR 1.03, 95% CI 0.78, 1.37). No association was found between assisted VD or emergency CS and psychosis. This study found that elective CS is associated with an increase in offspring psychosis. However, the association did not persist in the sibling-matched analysis, implying the association is likely due to familial confounding by unmeasured factors such as genetics or environment. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

U.S. Movements of Crude Oil By Rail

EIA Publications

2017-01-01

U.S. Movements of Crude Oil By Rail includes new data on crude oil transported by railroad. This product will fully integrate EIA's petroleum supply and disposition data along with pipeline, tanker, and barge data. Fully incorporating crude-by-rail movements improves EIA's regional petroleum balances by reducing regional crude oil adjustments (unaccounted for crude oil).

Post-project geomorphic assessment of a large process-based river restoration project

USGS Publications Warehouse

Erwin, Susannah O.; Schmidt, John C.; Allred, Tyler M.

2016-01-01

This study describes channel changes following completion of the Provo River Restoration Project (PRRP), the largest stream restoration project in Utah and one of the largest projects in the United States in which a gravel-bed river was fully reconstructed. We summarize project objectives and the design process, and we analyze monitoring data collected during the first 7 years after project completion. Post-project channel adjustment during the study period included two phases: (i) an initial phase of rapid, but small-scale, adjustment during the first years after stream flow was introduced to the newly constructed channel and (ii) a subsequent period of more gradual topographic adjustment and channel migration. Analysis of aerial imagery and ground-survey data demonstrate that the channel has been more dynamic in the downstream 4 km where a local source contributes a significant annual supply of bed material. Here, the channel migrates and exhibits channel adjustments that are more consistent with project objectives. The upstream 12 km of the PRRP are sediment starved, the channel has been laterally stable, and this condition may not be consistent with large-scale project objectives.

Antidepressant Medication Use and its Association with Cardiovascular Disease and All-Cause Mortality in the Reasons for Geographic and Ethnic Differences in Stroke (REGARDS) Study

PubMed Central

Hansen, Richard A.; Khodneva, Yulia; Glasser, Stephen P.; Qian, Jingjing; Redmond, Nicole; Safford, Monika M.

2018-01-01

Background Mixed evidence suggests second-generation antidepressants may increase risk of cardiovascular and cerebrovascular events. Objective Assess whether antidepressant use is associated with acute coronary heart disease, stroke, cardiovascular disease death, and all-cause mortality. Methods Secondary analyses of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study were conducted. Use of selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, bupropion, nefazodone, and trazodone was measured during the baseline (2003-2007) in-home visit. Outcomes of coronary heart disease, stroke, cardiovascular disease death, and all-cause mortality were assessed every 6 months and adjudicated by medical record review. Cox proportional hazards time-to-event analysis followed patients until their first event on or before December 31, 2011, iteratively adjusting for covariates. Results Among 29,616 participants, 3,458 (11.7%) used an antidepressant of interest. Intermediate models adjusting for everything but physical and mental health found an increased risk of acute coronary heart disease (Hazard Ratio=1.21; 95% CI 1.04-1.41), stroke (Hazard Ratio=1.28; 95% CI 1.02-1.60), cardiovascular disease death (Hazard Ratio =1.29; 95% CI 1.09-1.53), and all-cause mortality (Hazard Ratio=1.27; 95% CI 1.15-1.41) for antidepressant users. Risk estimates trended in this direction for all outcomes in the fully adjusted model, but only remained statistically associated with increased risk of all-cause mortality (Hazard Ratio=1.12; 95% CI 1.01-1.24). This risk was attenuated in sensitivity analyses censoring follow-up time at 2-years (Hazard Ratio=1.37; 95% CI 1.11-1.68). Conclusions In fully adjusted models antidepressant use was associated with a small increase in all-cause mortality. PMID:26783360

Weekly lottery sales volume and suicide numbers: a time series analysis on national data from Taiwan.

PubMed

Chen, Vincent Chin-Hung; Stewart, Robert; Lee, Charles Tzu-Chi

2012-07-01

To investigate the association between weekly lottery sales and number of suicide deaths in Taiwan. All suicides aged 15+ years during 2004-2006 in Taiwan were included. Poisson autoregression time series models investigated associations of weekly numbers with contemporaneous and recent sales from two national lotteries in operation. Adjustments were made for seasonal fluctuation, temperature, monthly unemployment and autocorrelation. In fully adjusted models, suicide deaths were negatively correlated with sales of tickets for a low-prize, low-cost lottery system. However, they were correlated positively with recent sales for a higher-cost, larger-prize system. Both correlations were stronger for male than female suicide numbers but differed in terms of age groups most strongly implicated. Associations between lottery sales and suicide numbers differed according to the nature of the lottery. A low-prize, low-publicity system appeared to be more benign than a high-prize, high-publicity one.

Gravity-driven pH adjustment for site-specific protein pKa measurement by solution-state NMR

NASA Astrophysics Data System (ADS)

Li, Wei

2017-12-01

To automate pH adjustment in site-specific protein pKa measurement by solution-state NMR, I present a funnel with two caps for the standard 5 mm NMR tube. The novelty of this simple-to-build and inexpensive apparatus is that it allows automatic gravity-driven pH adjustment within the magnet, and consequently results in a fully automated NMR-monitored pH titration without any hardware modification on the NMR spectrometer.

An investigation of Forex market efficiency based on detrended fluctuation analysis: A case study for Iran

NASA Astrophysics Data System (ADS)

Abounoori, Esmaiel; Shahrazi, Mahdi; Rasekhi, Saeed

2012-06-01

The efficient market hypothesis (EMH) states that asset prices fully reflect all available information. As a result, speculators cannot predict the future behavior of asset prices and earn excess profits at least after adjusting for risk. Although initial tests of the EMH were performed on stock market data, the EMH was soon applied to other markets including foreign exchange (FX). This study uses the detrended fluctuation analysis (DFA) technique to test 01:12:2005-18:04:2010 Iranian Rial/US Dollar exchange rate time series data to see if it can be explained by the weak form of the EMH. Moreover, to determine changes in the degree of inefficiency over time, the whole period has been divided into four subperiods. The study shows that the Iranian Forex market (the Rial/Dollar case) is weak-form inefficient over the whole period and in each of the subperiods. However, the degree of inefficiency is not constant over time. The findings suggest that profitable risk-adjusted trades could be made using past data.

Job strain as a risk factor for the onset of type 2 diabetes mellitus: findings from the MONICA/KORA Augsburg cohort study.

PubMed

Huth, Cornelia; Thorand, Barbara; Baumert, Jens; Kruse, Johannes; Emeny, Rebecca Thwing; Schneider, Andrea; Meisinger, Christa; Ladwig, Karl-Heinz

2014-09-01

To examine whether job strain is associated with an increased risk of subsequent Type 2 diabetes mellitus (T2DM) development in a population-based study of men and women. Data were derived from the prospective MONICA/KORA Augsburg study. We investigated 5337 working participants aged 29 to 66 years without diabetes at one of the three baseline surveys. Job strain was measured by the Karasek job content questionnaire. High job strain was defined by the quadrant approach, where high job demands combined with low job control were classified as high job strain. Continuous job strain (quotient of job demands divided by job control) was additionally analyzed as sensitivity analysis. Hazard ratios (HRs) were estimated using multivariable Cox proportional hazards models with adjustment for age, sex, survey, socioeconomic and life-style variables, parental history of diabetes, and body mass index. During a median follow-up of 12.7 years, 291 incident cases of T2DM were observed. The participants with high job strain at baseline had a 45% higher fully adjusted risk to develop T2DM than did those with low job strain (HR = 1.45 [95% confidence interval = 1.00-2.10], p = .048). On the continuous scale, more severe job strain in the magnitude of 1 standard deviation corresponded to a 12% increased fully adjusted T2DM risk (HR = 1.12 [95% confidence interval = 1.00-1.25], p = .045). Men and women who experience high job strain are at higher risk for developing T2DM independently of traditional risk factors. Preventive strategies to combat the globally increasing T2DM epidemic should take into consideration the adverse effects of high strain in the work environment.

Preterm birth, age at school entry and educational performance.

PubMed

Odd, David; Evans, David; Emond, Alan

2013-01-01

To investigate if the lack of gestational age correction may explain some of the school failure seen in ex-preterm infants. A cohort study based on the Avon Longitudinal Study of Parents and Children (ALSPAC). The primary outcome was a low Key Stage 1 score (KS1) score at age 7 or having special educational needs (SEN). Exposure groups were defined as preterm (<37 weeks gestation, n = 722) or term (37-42 weeks, n = 11,268). Conditional regression models were derived, matching preterm to term infants on date of birth (DOB), expected date of delivery (EDD) or expected date of delivery and year of school entry. Multiple imputation was used to account for missing covariate data. When matching for DOB, infants born preterm had an increased odds of a low KS1 score (OR 1.73 (1.45-2.06)) and this association persisted after adjusting for potential confounders (OR 1.57 (1.25-1.97)). The association persisted in the analysis matching for EDD (fully adjusted OR 1.53 (1.21-1.94)) but attenuated substantially after additionally restricting to those infants who entered school at the same time as the control infants (fully adjusted OR 1.25 (0.98-1.60)). A compatible reduction in the population attributable risk fraction was seen from 4.60% to 2.12%, and year of school entry appeared to modify the association between gestational age and the risk of a poor KS1 score (p = 0.029). This study provides evidence that the school year placement and assessment of ex-preterm infants based on their actual birthday (rather than their EDD) may increase their risk of learning difficulties with corresponding school failure.

Social determinants of denture/bridge use: Japan gerontological evaluation study project cross-sectional study in older Japanese.

PubMed

Yamamoto, Tatsuo; Kondo, Katsunori; Aida, Jun; Suzuki, Kayo; Misawa, Jimpei; Nakade, Miyo; Fuchida, Shinya; Hirata, Yukio

2014-06-03

Studies suggest that using a denture/bridge may prevent disability in older people. However, not all older people with few remaining teeth use a denture/bridge. This cross-sectional study aimed to examine the social determinants which promote denture/bridge use among older Japanese. A total of 54,388 (25,630 males and 28,758 females) community-dwelling individuals aged 65 or over, living independently, able to perform daily activities, and with 19 or fewer teeth. The dependent variable was denture/bridge use. Socio-demographics, number of teeth, present illness, social participation, social support, and social networks were used as individual-level independent variables. Data for social capital were aggregated and used as local district (n = 561 for males, n = 562 for females) -level independent variables. Number of dentists working in hospitals/clinics per population and population density were used as municipality (n = 28) -level independent variables. Three-level multilevel Poisson regression analysis was performed for each sex. High equivalent income, low number of teeth, present illness, and living in a municipality with high population density were significantly associated with denture/bridge use in both sexes in the fully adjusted models (p < 0.05). Denture/bridge use was significantly associated with high educational attainment in males and participating in social groups in females in the fully adjusted model (p < 0.05). No significant associations were observed between denture/bridge use and social capital. Denture/bridge use was significantly associated with high economic status and present illness in both sexes, high educational attainment in males, and participation in social groups in females among community-dwelling older Japanese after adjusting for possible confounders.

Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis.

PubMed

Der, Geoff; Batty, G David; Deary, Ian J

2006-11-04

To assess the importance of maternal intelligence, and the effect of controlling for it and other important confounders, in the link between breast feeding and children's intelligence. Examination of the effect of breast feeding on cognitive ability and the impact of a range of potential confounders, in particular maternal IQ, within a national database. Additional analyses compared pairs of siblings from the sample who were and were not breast fed. The results are considered in the context of other studies that have also controlled for parental intelligence via meta-analysis. 1979 US national longitudinal survey of youth. Data on 5475 children, the offspring of 3161 mothers in the longitudinal survey. IQ in children measured by Peabody individual achievement test. The mother's IQ was more highly predictive of breastfeeding status than were her race, education, age, poverty status, smoking, the home environment, or the child's birth weight or birth order. One standard deviation advantage in maternal IQ more than doubled the odds of breast feeding. Before adjustment, breast feeding was associated with an increase of around 4 points in mental ability. Adjustment for maternal intelligence accounted for most of this effect. When fully adjusted for a range of relevant confounders, the effect was small (0.52) and non-significant (95% confidence interval -0.19 to 1.23). The results of the sibling comparisons and meta-analysis corroborated these findings. Breast feeding has little or no effect on intelligence in children. While breast feeding has many advantages for the child and mother, enhancement of the child's intelligence is unlikely to be among them.

Adjustable lead glass shielding device for use with an over-the-table x-ray tube.

PubMed

Eubig, C; Groves, B M; Davey, G

1978-12-01

Sources of scattered radiation exposure to personnel from a ceiling-mounted x-ray tube were examined at the side of cardiac catheterization patients. A fully adjustable mounting for a lead glass shield was designed to afford maximum radiation protection to the attending physician's head and neck area, while minimizing interference with the procedure.

25 CFR 39.807 - How will the Student Unit Value be adjusted annually?

Code of Federal Regulations, 2011 CFR

2011-04-01

... Labor. (b) If the student unit value amount is not fully funded, the schools will receive their pro rata... 25 Indians 1 2011-04-01 2011-04-01 false How will the Student Unit Value be adjusted annually? 39.807 Section 39.807 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN...

Flow adjustment inside large finite-size wind farms approaching the infinite wind farm regime

NASA Astrophysics Data System (ADS)

Wu, Ka Ling; Porté-Agel, Fernando

2017-04-01

Due to the increasing number and the growing size of wind farms, the distance among them continues to decrease. Thus, it is necessary to understand how these large finite-size wind farms and their wakes could interfere the atmospheric boundary layer (ABL) dynamics and adjacent wind farms. Fully-developed flow inside wind farms has been extensively studied through numerical simulations of infinite wind farms. The transportation of momentum and energy is only vertical and the advection of them is neglected in these infinite wind farms. However, less attention has been paid to examine the length of wind farms required to reach such asymptotic regime and the ABL dynamics in the leading and trailing edges of the large finite-size wind farms. Large eddy simulations are performed in this study to investigate the flow adjustment inside large finite-size wind farms in conventionally-neutral boundary layer with the effect of Coriolis force and free-atmosphere stratification from 1 to 5 K/km. For the large finite-size wind farms considered in the present work, when the potential temperature lapse rate is 5 K/km, the wind farms exceed the height of the ABL by two orders of magnitude for the incoming flow inside the farms to approach the fully-developed regime. An entrance fetch of approximately 40 times of the ABL height is also required for such flow adjustment. At the fully-developed flow regime of the large finite-size wind farms, the flow characteristics match those of infinite wind farms even though they have different adjustment length scales. The role of advection at the entrance and exit regions of the large finite-size wind farms is also examined. The interaction between the internal boundary layer developed above the large finite-size wind farms and the ABL under different potential temperature lapse rates are compared. It is shown that the potential temperature lapse rate plays a role in whether the flow inside the large finite-size wind farms adjusts to the fully-developed flow regime. The flow characteristics of the wake of these large finite-size wind farms are reported to forecast the effect of large finite-size wind farms on adjacent wind farms. A power deficit as large as 8% is found at a distance of 10 km downwind from the large finite-size wind farms.

Tobacco smoking and alcohol drinking at diagnosis of head and neck cancer and all-cause mortality: Results from head and neck 5000, a prospective observational cohort of people with head and neck cancer.

PubMed

Beynon, Rhona A; Lang, Samantha; Schimansky, Sarah; Penfold, Christopher M; Waylen, Andrea; Thomas, Steven J; Pawlita, Michael; Tim Waterboer; Martin, Richard M; May, Margaret; Ness, Andy R

2018-04-01

Tobacco smoking and alcohol consumption are well-established risk factors for head and neck cancer. The prognostic role of smoking and alcohol intake at diagnosis have been less well studied. We analysed 1,393 people prospectively enrolled into the Head and Neck 5000 study (oral cavity cancer, n=403; oropharyngeal cancer, n=660; laryngeal cancer, n=330) and followed up for a median of 3.5 years. The primary outcome was all-cause mortality. We used Cox proportional hazard models to derive minimally adjusted (age and gender) and fully adjusted (age, gender, ethnicity, stage, comorbidity, body mass index, HPV status, treatment, education, deprivation index, income, marital status, and either smoking or alcohol use) mortality hazard ratios (HR) for the effects of smoking status and alcohol intake at diagnosis. Models were stratified by cancer site, stage and HPV status. The fully-adjusted HR for current versus never-smokers was 1.7 overall (95% confidence interval [CI] 1.1, 2.6). In stratified analyses, associations of smoking with mortality were observed for oropharyngeal and laryngeal cancers (fully adjusted HRs for current smokers: 1.8 (95% CI=0.9, 3.40 and 2.3 (95% CI=0.8, 6.4)). We found no evidence that people who drank hazardous to harmful amounts of alcohol at diagnosis had a higher mortality risk compared to non-drinkers (HR=1.2 (95% CI=0.9, 1.6)). There was no strong evidence that HPV status or tumour stage modified the association of smoking with survival. Smoking status at the time of a head and neck cancer diagnosis influenced all-cause mortality in models adjusted for important prognostic factors. © 2018 The Authors International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

SHBG, sex hormones, and inflammatory markers in older women.

PubMed

Maggio, Marcello; Ceda, Gian Paolo; Lauretani, Fulvio; Bandinelli, Stefania; Corsi, Anna Maria; Giallauria, Francesco; Guralnik, Jack M; Zuliani, Giovanni; Cattabiani, Chiara; Parrino, Stefano; Ablondi, Fabrizio; Dall'aglio, Elisabetta; Ceresini, Graziano; Basaria, Shehzad; Ferrucci, Luigi

2011-04-01

In premenopausal and older women, high testosterone and estradiol (E2) and low SHBG levels are associated with insulin resistance and diabetes, conditions characterized by low-grade inflammation. The aim of the study was to examine the relationship between SHBG, total testosterone, total E2, and inflammatory markers in older women. We conducted a retrospective cross-sectional study of 433 women at least 65 yr old from the InCHIANTI Study, Italy, who were not on hormone replacement therapy or recently hospitalized and who had complete data on SHBG, testosterone, E2, C-reactive protein (CRP), IL-6, soluble IL-6 receptor (sIL-6r), and TNF-α. Relationships between sex hormones and inflammatory markers were examined by multivariate linear regression analyses adjusted for age, body mass index, smoking, insulin, physical activity, and chronic disease. In fully adjusted analyses, SHBG was negatively associated with CRP (P = 0.007), IL-6 (P = 0.008), and sIL-6r (P = 0.02). In addition, testosterone was positively associated with CRP (P = 0.006), IL-6 (P = 0.001), and TNF-α (P = 0.0002). The negative relationship between testosterone and sIL-6r in an age-adjusted model (P = 0.02) was no longer significant in a fully adjusted model (P = 0.12). E2 was positively associated with CRP (P = 0.002) but not with IL-6 in fully adjusted models. In a final model including E2, testosterone, and SHBG, and all the confounders previously considered, SHBG (0.23 ± 0.08; P = 0.006) and E2 (0.21 ± 0.08; P = 0.007), but not testosterone (P = 0.21), were still significantly associated with CRP. In late postmenopausal women not on hormone replacement therapy, SHBG and E2 are, respectively, negative and positive, independent and significant correlates of a proinflammatory state.

SHBG, Sex Hormones, and Inflammatory Markers in Older Women

PubMed Central

Ceda, Gian Paolo; Lauretani, Fulvio; Bandinelli, Stefania; Corsi, Anna Maria; Giallauria, Francesco; Guralnik, Jack M.; Zuliani, Giovanni; Cattabiani, Chiara; Parrino, Stefano; Ablondi, Fabrizio; Dall'Aglio, Elisabetta; Ceresini, Graziano; Basaria, Shehzad; Ferrucci, Luigi

2011-01-01

Context: In premenopausal and older women, high testosterone and estradiol (E2) and low SHBG levels are associated with insulin resistance and diabetes, conditions characterized by low-grade inflammation. Objective: The aim of the study was to examine the relationship between SHBG, total testosterone, total E2, and inflammatory markers in older women. Design and Patients: We conducted a retrospective cross-sectional study of 433 women at least 65 yr old from the InCHIANTI Study, Italy, who were not on hormone replacement therapy or recently hospitalized and who had complete data on SHBG, testosterone, E2, C-reactive protein (CRP), IL-6, soluble IL-6 receptor (sIL-6r), and TNF-α. Relationships between sex hormones and inflammatory markers were examined by multivariate linear regression analyses adjusted for age, body mass index, smoking, insulin, physical activity, and chronic disease. Results: In fully adjusted analyses, SHBG was negatively associated with CRP (P = 0.007), IL-6 (P = 0.008), and sIL-6r (P = 0.02). In addition, testosterone was positively associated with CRP (P = 0.006), IL-6 (P = 0.001), and TNF-α (P = 0.0002). The negative relationship between testosterone and sIL-6r in an age-adjusted model (P = 0.02) was no longer significant in a fully adjusted model (P = 0.12). E2 was positively associated with CRP (P = 0.002) but not with IL-6 in fully adjusted models. In a final model including E2, testosterone, and SHBG, and all the confounders previously considered, SHBG (0.23 ± 0.08; P = 0.006) and E2 (0.21 ± 0.08; P = 0.007), but not testosterone (P = 0.21), were still significantly associated with CRP. Conclusion: In late postmenopausal women not on hormone replacement therapy, SHBG and E2 are, respectively, negative and positive, independent and significant correlates of a proinflammatory state. PMID:21239514

Supermarket and fast-food outlet exposure in Copenhagen: associations with socio-economic and demographic characteristics.

PubMed

Svastisalee, Chalida M; Nordahl, Helene; Glümer, Charlotte; Holstein, Bjørn E; Powell, Lisa M; Due, Pernille

2011-09-01

To investigate whether exposure to fast-food outlets and supermarkets is socio-economically patterned in the city of Copenhagen. The study was based on a cross-sectional multivariate approach to examine the association between the number of fast-food outlets and supermarkets and neighbourhood-level socio-economic indicators. Food business addresses were obtained from commercial and public business locators and geocoded using a geographic information system for all neighbourhoods in the city of Copenhagen (n 400). The regression of counts of fast-food outlets and supermarkets v. indicators of socio-economic status (percentage of recent immigrants, percentage without a high-school diploma, percentage of the population under 35 years of age and average household income in Euros) was performed using negative binomial analysis. Copenhagen, Denmark. The unit of analysis was neighbourhood (n 400). In the fully adjusted models, income was not a significant predictor for supermarket exposure. However, neighbourhoods with low and mid-low income were associated with significantly fewer fast-food outlets. Using backwise deletion from the fully adjusted models, low income remained significantly associated with fast-food outlet exposure (rate ratio = 0·66-0·80) in the final model. In the city of Copenhagen, there was no evidence of spatial patterning of supermarkets by income. However, we detected a trend in the exposure to fast-food outlets, such that neighbourhoods in the lowest income quartile had fewer fast-food outlets than higher-income neighbourhoods. These findings have similarities with studies conducted in the UK, but not in the USA. The results suggest there may be socio-economic factors other than income associated with food exposure in Europe.

Individual and crossover effects of stress on adjustment in medical student marriages.

PubMed

Katz, J; Monnier, J; Libet, J; Shaw, D; Beach, S R

2000-07-01

High-stress individuals may benefit from social support, although their support providers may be adversely affected via stress crossover effects. Individual and crossover effects of perceived stress within medical student marriages (n = 30) were investigated. Perceived spousal support was positively associated with individuals' own marital and emotional adjustment, attenuating stress effects. With regard to crossover effects, medical students' perceived stress was significantly associated with their spouses' emotional adjustment. Further, medical students' own emotional adjustment fully mediated this crossover effect. Results suggest that the contagion of negative affect may serve as a key mechanism through which stress crossover effects operate in marriage.

Dental caries experience, rather than toothbrushing, influences the incidence of dental caries in young Japanese adults.

PubMed

Sonoda, C; Ebisawa, M; Nakashima, H; Sakurai, Y

2017-06-01

A dose-response relationship between toothbrushing frequency and the incidence of dental caries has not been confirmed. Furthermore, no longitudinal study about this relationship has considered dental caries experience at baseline, which is an important factor influencing the frequency of future caries. To elucidate the association between the incidence of dental caries and toothbrushing frequency after adjusting for dental caries experience at baseline in a Japanese population. The 92 recruits of the Japan Maritime Self-Defense Force in Kure, Japan, in 2011 were followed up for 3 years. They underwent oral examination at the annual checkups and answered questions about toothbrushing frequency. The multiple logistic regression analysis was used to analyze the incidence of dental caries and to identify independent effects of toothbrushing frequency and dental caries experience at baseline. Furthermore, the relative importance of the incidence of dental caries was investigated among other independent variables using the partial adjusted R² score. Logistic regression analysis showed that toothbrushing frequency alone did not influence the increment in decayed, missing, and filled teeth (DMFT). However, DMFT at baseline alone was associated with the increment in DMFT (crude odds ratio, OR, 1.20, 95% confidence interval, CI, 1.08,1.33). In the fully adjusted model, only DMFT at baseline was associated with the increment in DMFT (adjusted OR 1.23, 95%CI 1.09,1.38). After three years, the incidence of dental caries in young adult Japanese males was influenced by DMFT at baseline, rather than toothbrushing frequency. Copyright© 2017 Dennis Barber Ltd.

Associations between maternal experiences of racism and early child health and development: findings from the UK Millennium Cohort Study.

PubMed

Kelly, Yvonne; Becares, Laia; Nazroo, James

2013-01-01

Emerging evidence suggests that experienced racism might help explain observed ethnic inequalities in early child health and development. There are few studies outside the US context and none that consider mothers' experiences of racism in relation to a range of early childhood health and developmental markers. The authors used cross-sectional data from the UK Millennium Cohort Study on 2136 mothers and their 5-year-old children from ethnic minority groups. Measures of racism tapped two dimensions of mothers' experience: perceived frequency of racist attacks in residential area and interpersonal racism. Markers of child health and development were obesity; socioemotional difficulties; cognitive: verbal, non-verbal and spatial ability test scores. There was a suggestion that the mothers' experience of interpersonal racism was associated with an increased risk of obesity ('received insults' OR=1.47; 'treated unfairly' OR=1.57; 'disrespectful treatment by shop staff' OR=1.55), but all CIs crossed 1.0, and size estimates were attenuated on further statistical adjustment. Perception of racism in the residential area was associated with socioemotional difficulties (fully adjusted coefficient=1.40, SE=0.47) and spatial abilities (fully adjusted coefficient=-1.99, SE=0.93) but not with verbal or non-verbal ability scores. Maternal experiences of racist insults were associated with non-verbal ability scores (fully adjusted coefficient=-1.70, SE=0.88). The results suggest that mothers' experienced racism is linked to markers of early child health and development. Interventions that aim to improve early child development and address ethnic health inequalities need to incorporate approaches to tackling racism at all levels of society.

Associations of Cannabis and Cigarette Use with Depression and Anxiety at Age 18: Findings from the Avon Longitudinal Study of Parents and Children

PubMed Central

Gage, Suzanne H.; Hickman, Matthew; Heron, Jon; Munafò, Marcus R.; Lewis, Glyn; Macleod, John; Zammit, Stanley

2015-01-01

Introduction Substance use is associated with common mental health disorders, but the causal effect of specific substances is uncertain. We investigate whether adolescent cannabis and cigarette use is associated with incident depression and anxiety, while attempting to account for confounding and reverse causation. Methods We used data from ALSPAC, a UK birth cohort study, to investigate associations between cannabis or cigarettes (measured at age 16) and depression or anxiety (measured at age 18), before and after adjustment for pre-birth, childhood and adolescent confounders. Our imputed sample size was 4561 participants. Results Both cannabis (unadjusted OR 1.50, 95% CI 1.26, 1.80) and cigarette use (OR 1.37, 95% CI 1.16, 1.61) increased the odds of developing depression. Adjustment for pre-birth and childhood confounders partly attenuated these relationships though strong evidence of association persisted for cannabis use. There was weak evidence of association for cannabis (fully adjusted OR 1.30, 95% CI 0.98, 1.72) and insufficient evidence for association for cigarette use (fully adjusted OR = 0.97, 95% CI 0.75, 1.24) after mutually adjusting for each other, or for alcohol or other substance use. Neither cannabis nor cigarette use were associated with anxiety after adjustment for pre-birth and childhood confounders. Conclusions Whilst evidence of association between cannabis use and depression persisted after adjusting for pre-term and childhood confounders, our results highlight the difficulties in trying to estimate and interpret independent effects of cannabis and tobacco on psychopathology. Complementary methods are required to robustly examine effects of cannabis and tobacco on psychopathology. PMID:25875443

Conflict and disfluency as aversive signals: context-specific processing adjustments are modulated by affective location associations.

PubMed

Dreisbach, Gesine; Reindl, Anna-Lena; Fischer, Rico

2018-03-01

Context-specific processing adjustments are one signature feature of flexible human action control. However, up to now the precise mechanisms underlying these adjustments are not fully understood. Here it is argued that aversive signals produced by conflict- or disfluency-experience originally motivate such context-specific processing adjustments. We tested whether the efficiency of the aversive conflict signal for control adaptation depends on the affective nature of the context it is presented in. In two experiments, high vs. low proportions of aversive signals (Experiment 1: conflict trials; Experiment 2: disfluent trials) were presented either above or below the screen center. This location manipulation was motivated by existing evidence that verticality is generally associated with affective valence with up being positive and down being negative. From there it was hypothesized that the aversive signals would lose their trigger function for processing adjustments when presented at the lower (i.e., more negative) location. This should then result in a reduced context-specific proportion effect when the high proportion of aversive signals was presented at the lower location. Results fully confirmed the predictions. In both experiments, the location-specific proportion effects were only present when the high proportion of aversive signals occurred at the more positive location above but were reduced (Experiment 1) or even eliminated (Experiment 2) when the high proportion occurred at the more negative location below. This interaction of processing adjustments with affective background contexts can thus be taken as further hint for an affective origin of control adaptations.

Performance of the Defense Acquisition System, 2015 Annual report

DTIC Science & Technology

2015-09-16

Planned Total (From Start to Completion) Quantity-Adjusted Unit -Procurement Recurring-Flyaway Funding (1999–2014) NOTE: This measures biennial...PAUC is a different funding measure define by statute (10 United States Code [U.S.C.], sections 2430a and 2432) consisting of the total acquisition... measures that (unlike PAUC and APUC) are fully adjusted for any changes in procurement quantity. These results help compare procurement unit costs

Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis.

PubMed

Hertel, Nadine; Kotchie, Robert W; Samyshkin, Yevgeniy; Radford, Matthew; Humphreys, Samantha; Jameson, Kevin

2012-01-01

Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD), despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting. A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta agonist (LABA), an inhaled corticosteroid (ICS), and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS) perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis. Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained). The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13,764/QALY gained. The relative rate ratio of exacerbations was identified as the primary driver of cost-effectiveness. The treatment algorithm recommended in UK clinical practice represents a cost-effective approach for the management of COPD. The addition of roflumilast to the standard of care regimens is a clinical and cost-effective treatment option for patients with severe COPD, who continue to exacerbate despite existing bronchodilator therapy.

Impact of policy changes on infant feeding decisions among low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.

PubMed

Whaley, Shannon E; Koleilat, Maria; Whaley, Mike; Gomez, Judy; Meehan, Karen; Saluja, Kiran

2012-12-01

We present infant feeding data before and after the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package change that supported and incentivized breastfeeding. We describe the key role of California WIC staff in supporting these policy changes. We analyzed WIC data on more than 180,000 infants in Southern California. We employed the analysis of variance and Tukey (honestly significant difference) tests to compare issuance rates of postpartum and infant food packages before and after the changes. We used analysis of covariance to adjust for poverty status changes as a potential confounder. Issuance rates of the "fully breastfeeding" package at infant WIC enrollment increased by 86% with the package changes. Rates also increased significantly for 2- and 6-month-old infants. Issuance rates of packages that included formula decreased significantly. All outcomes remained highly significant in the adjusted model. Policy changes, training of front-line WIC staff, and participant education influenced issuance rates of WIC food packages. In California, the issuance rates of packages that include formula have significantly decreased and the rate for those that include no formula has significantly increased.

Scalable, Lightweight, Integrated and Quick-to-Assemble (SLIQ) Hyperdrives for Functional Circuit Dissection.

PubMed

Liang, Li; Oline, Stefan N; Kirk, Justin C; Schmitt, Lukas Ian; Komorowski, Robert W; Remondes, Miguel; Halassa, Michael M

2017-01-01

Independently adjustable multielectrode arrays are routinely used to interrogate neuronal circuit function, enabling chronic in vivo monitoring of neuronal ensembles in freely behaving animals at a single-cell, single spike resolution. Despite the importance of this approach, its widespread use is limited by highly specialized design and fabrication methods. To address this, we have developed a Scalable, Lightweight, Integrated and Quick-to-assemble multielectrode array platform. This platform additionally integrates optical fibers with independently adjustable electrodes to allow simultaneous single unit recordings and circuit-specific optogenetic targeting and/or manipulation. In current designs, the fully assembled platforms are scalable from 2 to 32 microdrives, and yet range 1-3 g, light enough for small animals. Here, we describe the design process starting from intent in computer-aided design, parameter testing through finite element analysis and experimental means, and implementation of various applications across mice and rats. Combined, our methods may expand the utility of multielectrode recordings and their continued integration with other tools enabling functional dissection of intact neural circuits.

Parenting Influences on Latino Children’s Social Competence in the First Grade: Parental Depression and Parent Involvement at Home and School

PubMed Central

Valdez, Carmen R.; Shewakramani, Vansa; Goldberg, Simon; Padilla, Brian

2013-01-01

Although it is widely accepted that parental depression is associated with problems with children’s socioemotional adjustment, the pathways by which parental depression influences children’s adjustment, particularly in low-income Latino children are not fully understood. In our investigation of 1,462 low-income Latino children in the first grade and their Spanish- and English-dominant parents, a factor analysis revealed three main pathways of possible influence of parent involvement in children’s social development: emotional involvement and educational involvement at home and at school. The findings from multigroup structural equation modeling revealed that whereas the first two pathways mediated the effect of parental depression on child social competence for Spanish-dominant parents, only emotional involvement explained parental depression effects for English-dominant parents. Parent educational involvement at school did not mediate parental depression effects for either Spanish- or English-dominant Latino parents. Discussion and implications of findings with respect to research, practice, and policy with Latinos follow. PMID:23325021

Parenting influences on Latino children's social competence in the first grade: parental depression and parent involvement at home and school.

PubMed

Valdez, Carmen R; Shewakramani, Vansa; Goldberg, Simon; Padilla, Brian

2013-10-01

Although it is widely accepted that parental depression is associated with problems with children's socioemotional adjustment, the pathways by which parental depression influences children's adjustment, particularly in low-income Latino children are not fully understood. In our investigation of 1,462 low-income Latino children in the first grade and their Spanish- and English-dominant parents, a factor analysis revealed three main pathways of possible influence of parent involvement in children's social development: emotional involvement and educational involvement at home and at school. The findings from multigroup structural equation modeling revealed that whereas the first two pathways mediated the effect of parental depression on child social competence for Spanish-dominant parents, only emotional involvement explained parental depression effects for English-dominant parents. Parent educational involvement at school did not mediate parental depression effects for either Spanish- or English-dominant Latino parents. Discussion and implications of findings with respect to research, practice, and policy with Latinos follow.

Food insecurity and socio-demographic characteristics in two UK ethnic groups: an analysis of women in the Born in Bradford cohort.

PubMed

Power, Madeleine; Uphoff, Eleonora P; Stewart-Knox, Barbara; Small, Neil; Doherty, Bob; Pickett, Kate E

2018-03-01

The use of foodbanks has risen sharply in the UK; however, the epidemiology of UK food insecurity is undeveloped. This study contributes to the field by analysing socio-demographic risk factors for food insecurity in a female, ethnically diverse population. Data from the Born in Bradford (BiB) cohort were matched with data on food insecurity from the nested BiB1000 study (N = 1280). Logistic regression was used to model food insecurity in relation to ethnicity and socio-demographic factors. Food insecurity, reported by 13.98% of the sample, was more likely among White British than Pakistani women (crude Odds Ratio (OR) 1.94, 95% CI: 1.37; 2.74, adjusted OR 2.37, 95% CI: 1.57; 3.59). In fully adjusted analyses, food insecurity was associated with a range of socio-economic measures, particularly the receipt of mean-tested benefits (adjusted OR 2.11, 95% CI: 1.41; 3.15) and perception of financial insecurity (adjusted OR 8.91, 95% CI: 4.14; 19.16 for finding it difficult/very difficult compared to living comfortably). The finding that food insecurity prevalence may be higher than previously thought and that food insecurity is highly associated with socio-economic status, notably benefit receipt, is a cause for concern necessitating an urgent policy response.

A Fully Conserved Minimal Adjustment Scheme with (T, S) Coherency for Stabilization of Hydrographic Profiles

DTIC Science & Technology

2012-12-01

positive definite approximation of the Hessian is updated according to the modified Broyden–Fletcher–Goldfarb– Shanno method (Powell 1978). 3. Data Evident...averaged observational hydrographic data . This method adjusts the temperature and salinity profiles fDTk,DSk,k5 1, 2, . . . ,Kg simultaneously and...in data assimilations since it does not simply reject profiles with static instability. This method edits the profiles with the inequality constraint

Do pregnancy characteristics contribute to rising childhood cancer incidence rates in the United States?

PubMed

Kehm, Rebecca D; Osypuk, Theresa L; Poynter, Jenny N; Vock, David M; Spector, Logan G

2018-03-01

Since 1975, childhood cancer incidence rates have gradually increased in the United States; however, few studies have conducted analyses across time to unpack this temporal rise. The aim of this study was to test the hypothesis that increasing cancer incidence rates are due to secular trends in pregnancy characteristics that are established risk factors for childhood cancer incidence including older maternal age, higher birthweight, and lower birth order. We also considered temporal trends in sociodemographic characteristics including race/ethnicity and poverty. We conducted a time series county-level ecologic analysis using linked population-based data from Surveillance, Epidemiology, and End Results cancer registries (1975-2013), birth data from the National Center for Health Statistics (1970-2013), and sociodemographic data from the US Census (1970-2010). We estimated unadjusted and adjusted average annual percent changes (AAPCs) in incidence of combined (all diagnoses) and individual types of cancer among children, ages 0-4 years, from Poisson mixed models. There was a statistically significant unadjusted temporal rise in incidence of combined childhood cancers (AAPC = 0.71%; 95% CI = 0.55-0.86), acute lymphoblastic leukemia (0.78%; 0.49-1.07), acute myeloid leukemia (1.86%; 1.13-2.59), central nervous system tumors (1.31%; 0.94-1.67), and hepatoblastoma (2.70%; 1.68-3.72). Adjustment for county-level maternal age reduced estimated AAPCs between 8% (hepatoblastoma) and 55% (combined). However, adjustment for other county characteristics did not attenuate AAPCs, and AAPCs remained significantly above 0% in models fully adjusted for county-level characteristics. Although rising maternal age may account for some of the increase in childhood cancer incidence over time, other factors, not considered in this analysis, may also contribute to temporal trends. © 2017 Wiley Periodicals, Inc.

A cost-utility analysis of transcatheter versus surgical aortic valve replacement for the treatment of aortic stenosis in the population with intermediate surgical risk.

PubMed

Tam, Derrick Y; Hughes, Avery; Fremes, Stephen E; Youn, Saerom; Hancock-Howard, Rebecca L; Coyte, Peter C; Wijeysundera, Harindra C

2018-05-01

Although transcatheter aortic valve implantation has been shown to be noninferior to surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk, the cost-effectiveness of this strategy in this population is unknown. Our objective was to conduct a cost-utility analysis comparing transcatheter aortic valve implantation with surgical aortic valve replacement in the population with intermediate risk severe aortic stenosis. A fully probabilistic Markov model with 30-day cycles was constructed from the Canadian third-party payer's perspective to estimate the difference in cost and effectiveness (measured as quality-adjusted life years) of transcatheter aortic valve implantation versus surgical aortic valve replacement for intermediate-risk patients over a lifetime time horizon, discounted at 1.5% per annum. Clinical trial data from The Placement of Aortic Transcatheter Valve 2 informed the efficacy inputs. Costs (adjusted to 2016 Canadian dollars) were obtained from the Canadian Institute of Health Information and the Ontario Schedule of Benefits. Incremental cost-effectiveness ratios were calculated. In the base-case analysis, total lifetime costs for transcatheter aortic valve implantation were $10,548 higher than surgical aortic valve replacement but added 0.23 quality-adjusted life years, for an incremental cost-effectiveness ratio of $46,083/quality-adjusted life-years gained. Deterministic 1-way analyses showed that the incremental cost-effectiveness ratio was sensitive to rates of complications and cost of the transcatheter aortic valve implantation prosthesis. There was moderate-to-high parameter uncertainty; transcatheter aortic valve implantation was the preferred option in only 52.7% and 55.4% of the simulations at a $50,000 and $100,000 per quality-adjusted life years willingness-to-pay thresholds, respectively. On the basis of current evidence, transcatheter aortic valve implantation may be cost-effective for the treatment of severe aortic stenosis in patients with intermediate surgical risk. There remains moderate-to-high uncertainty surrounding the base-case incremental cost-effectiveness ratio. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Clinical consequences of chemotherapy dose reduction in obese patients with stage III colon cancer: A retrospective analysis from the PETACC 3 study.

PubMed

Stocker, Gertraud; Hacker, Ulrich T; Fiteni, Frédéric; John Mahachie, Jestinah; Roth, Arnaud D; Van Cutsem, Eric; Peeters, Marc; Lordick, Florian; Mauer, Murielle

2018-06-12

Dose reduction in obese cancer patients has been replaced by fully weight-based dosing recommendations. No data, however, are available on the effects of dose reduction in obese stage III colon cancer patients undergoing adjuvant chemotherapy. Survival outcomes and toxicity data of obese (body mass index [BMI] ≥30 kg/m 2 ), stage III colon cancer patients treated within the phase III PETACC 3 trial comparing leucovorin, 5-FU (LV5FU2) with LV5FU2 plus irinotecan were analysed retrospectively according to chemotherapy dosing at first infusion (i.e. fully weight-based dosed - versus dose-reduced group). Multivariate analyses on relapse free survival (RFS) and overall survival (OS) were conducted to adjust for baseline prognostic factors using Cox regression model. 13.4% (280 of 2094 patients) had a BMI ≥ 30 kg/m 2 , and 5.3% had both a BMI ≥ 30 kg/m 2 and a body surface area (BSA) ≥2 m 2 . Dose reductions occurred in 16.1% of patients with a BMI ≥ 30 kg/m 2 and 32.4% with BMI ≥ 30 kg/m 2 and BSA ≥ 2 m 2 , respectively. In patients with BMI ≥ 30 kg/m 2 , multivariate analysis demonstrated a trend towards better RFS in the fully dosed compared to the dose-reduced group (Hazard ratio (HR): 0.69, 95% CI: 0.43-1.09; p = 0.11); however, there was no statistically significant difference in OS. In patients with BMI ≥ 30 kg/m 2 and BSA ≥ 2 m 2 , multivariate analysis demonstrated better RFS in fully dosed compared with dose-reduced patients (HR: 0.48, 95% CI: 0.27-0.85; p = 0.01) and a strong trend towards better OS (HR: 0.53, 95% CI: 0.28-1.01; p = 0.052). This group comprised predominantly of men. Data support the recommendation of using fully dosed chemotherapy for the adjuvant treatment in obese patients with colon cancer. Copyright © 2018 Elsevier Ltd. All rights reserved.

Heart failure in women and men during acute coronary syndrome and long-term cardiovascular mortality (the ABC-3* Study on Heart Disease) (*Adria, Bassano, Conegliano, and Padova Hospitals).

PubMed

Berton, Giuseppe; Cordiano, Rocco; Cavuto, Fiorella; Bagato, Francesco; Pellegrinet, Marco; Cati, Arianna

2016-10-01

We investigated the gender-based differences in the association between heart failure (HF) during acute coronary syndrome (ACS) and post-discharge, long-term cardiovascular (CV) mortality. The present study included 557 patients enrolled in three intensive coronary care units and discharged alive. HF during ACS was evaluated by Killip class and left ventricular ejection fraction (LVEF). Interaction between gender and HF after 15years of follow up was studied using Cox models including a formal interaction term. Median age was 67 (interquartile range [IQR], 59-75) years, 29% were females, 37% had non-ST elevation myocardial infarction and 32% Killip class>1, and median LVEF was 53% (IQR 46-61). All but five patients were followed up to 15years, representing 5332 person-years. Of these, 40.2% died of CV-related causes. Crude CV mortality rate was higher among women (52.2%) than men (35.3%; P<0.0001). At a univariable level, a negative interaction between female gender and Killip class for CV mortality was found [hazard ratio (HR)=0.51 (0.34-0.77), P=0.002]. In five multivariable models after controlling for age, main CV risk factors, clinical features, post-discharge medical treatment, and mechanical coronary reperfusion, the interaction was significant across all models [HR=0.63 (0.42-0.95), P=0.02 in the fully adjusted model]. LVEF showed no significant hazard associated with female gender on univariable analysis [HR=1.4 (0.9-0.2.0), P=0.11] but did so in all adjusted models [HR=1.7 (1.2-2.5), P=0.005 in the fully adjusted model]. Gender is a consistent, independent effect modifier in the association between HF and long-term CV mortality after ACS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Linkage Analysis of Urine Arsenic Species Patterns in the Strong Heart Family Study

PubMed Central

Gribble, Matthew O.; Voruganti, Venkata Saroja; Cole, Shelley A.; Haack, Karin; Balakrishnan, Poojitha; Laston, Sandra L.; Tellez-Plaza, Maria; Francesconi, Kevin A.; Goessler, Walter; Umans, Jason G.; Thomas, Duncan C.; Gilliland, Frank; North, Kari E.; Franceschini, Nora; Navas-Acien, Ana

2015-01-01

Arsenic toxicokinetics are important for disease risks in exposed populations, but genetic determinants are not fully understood. We examined urine arsenic species patterns measured by HPLC-ICPMS among 2189 Strong Heart Study participants 18 years of age and older with data on ∼400 genome-wide microsatellite markers spaced ∼10 cM and arsenic speciation (683 participants from Arizona, 684 from Oklahoma, and 822 from North and South Dakota). We logit-transformed % arsenic species (% inorganic arsenic, %MMA, and %DMA) and also conducted principal component analyses of the logit % arsenic species. We used inverse-normalized residuals from multivariable-adjusted polygenic heritability analysis for multipoint variance components linkage analysis. We also examined the contribution of polymorphisms in the arsenic metabolism gene AS3MT via conditional linkage analysis. We localized a quantitative trait locus (QTL) on chromosome 10 (LOD 4.12 for %MMA, 4.65 for %DMA, and 4.84 for the first principal component of logit % arsenic species). This peak was partially but not fully explained by measured AS3MT variants. We also localized a QTL for the second principal component of logit % arsenic species on chromosome 5 (LOD 4.21) that was not evident from considering % arsenic species individually. Some other loci were suggestive or significant for 1 geographical area but not overall across all areas, indicating possible locus heterogeneity. This genome-wide linkage scan suggests genetic determinants of arsenic toxicokinetics to be identified by future fine-mapping, and illustrates the utility of principal component analysis as a novel approach that considers % arsenic species jointly. PMID:26209557

First results of the Nordic and Baltic GNSS Analysis Centre

NASA Astrophysics Data System (ADS)

Lahtinen, Sonja; Pasi, Häkli; Jivall, Lotti; Kempe, Christina; Kollo, Karin; Kosenko, Ksenija; Pihlak, Priit; Prizginiene, Dalia; Tangen, Oddvar; Weber, Mette; Paršeliūnas, Eimuntas; Baniulis, Rimvydas; Galinauskas, Karolis

2018-03-01

The Nordic Geodetic Commission (NKG) has launched a joint NKG GNSS Analysis Centre that aims to routinely produce high qualityGNSS solutions for the common needs of the NKG and the Nordic and Baltic countries. A consistent and densified velocity field is needed for the constraining of the gla-cial isostatic adjustment (GIA) modelling that is a key component of maintaining the national reference frame realisations in the area. We described the methods of the NKG GNSS Analysis Centre including the defined processing setup for the local analysis centres (LAC) and for the combination centres.We analysed the results of the first 2.5 years (2014.5-2016). The results showed that different subnets were consistent with the combined solution within 1-2 mm level. We observed the so called network effect affecting our reference frame alignment. However, the accuracy of the reference frame alignment was on a few millimetre level in the area of the main interest (Nordic and Baltic Countries). TheNKGGNSS AC was declared fully operational in April 2017.

Modest Associations Between Electronic Health Record Use and Acute Myocardial Infarction Quality of Care and Outcomes: Results From the National Cardiovascular Data Registry.

PubMed

Enriquez, Jonathan R; de Lemos, James A; Parikh, Shailja V; Simon, DaJuanicia N; Thomas, Laine E; Wang, Tracy Y; Chan, Paul S; Spertus, John A; Das, Sandeep R

2015-11-01

In 2009, national legislation promoted wide-spread adoption of electronic health records (EHRs) across US hospitals; however, the association of EHR use with quality of care and outcomes after acute myocardial infarction (AMI) remains unclear. Data on EHR use were collected from the American Hospital Association Annual Surveys (2007-2010) and data on AMI care and outcomes from the National Cardiovascular Data Registry Acute Coronary Treatment and Interventions Outcomes Network Registry-Get With The Guidelines. Comparisons were made between patients treated at hospitals with fully implemented EHR (n=43 527), partially implemented EHR (n=72 029), and no EHR (n=9270). Overall EHR use increased from 82.1% (183/223) hospitals in 2007 to 99.3% (275/277) hospitals in 2010. Patients treated at hospitals with fully implemented EHRs had fewer heparin overdosing errors (45.7% versus 72.8%; P<0.01) and a higher likelihood of guideline-recommended care (adjusted odds ratio, 1.40 [confidence interval, 1.07-1.84]) compared with patients treated at hospitals with no EHR. In non-ST-segment-elevation AMI, fully implemented EHR use was associated with lower risk of major bleeding (adjusted odds ratio, 0.78 [confidence interval, 0.67-0.91]) and mortality (adjusted odds ratio, 0.82 [confidence interval, 0.69-0.97]) compared with no EHR. In ST-segment-elevation MI, outcomes did not significantly differ by EHR status. EHR use has risen to high levels among hospitals in the National Cardiovascular Data Registry. EHR use was associated with less frequent heparin overdosing and modestly greater adherence to acute MI guideline-recommended therapies. In non-ST-segment-elevation MI, slightly lower adjusted risk of major bleeding and mortality were seen in hospitals implemented with full EHRs; however, in ST-segment-elevation MI, differences in outcomes were not seen. © 2015 American Heart Association, Inc.

Impact of control for air pollution and respiratory epidemics on the estimated associations of temperature and daily mortality.

PubMed

O'Neill, Marie S; Hajat, Shakoor; Zanobetti, Antonella; Ramirez-Aguilar, Matiana; Schwartz, Joel

2005-11-01

We assessed the influence of control for air pollution and respiratory epidemics on associations between apparent temperature (AT) and daily mortality in Mexico City and Monterrey. Poisson regressions were fit to mortality among all ages, children (ages 0-14 years) and the elderly (ages >or=65 years). Predictors included mean daily AT, season, day of week and public holidays for the base model. Respiratory epidemics and air pollution (particulate matter <10 microm in aerodynamic diameter and O3) were added singly and then jointly for a fully adjusted model. Percent changes in mortality were calculated for days of relatively extreme temperatures [cold (10-11 degrees C) for both cities and heat (35-36 degrees C) for Monterrey], compared to days at the overall mean temperature in each city (15 degrees C in Mexico City, 25 degrees C in Monterrey). In Mexico City, total mortality increased 12.4% [95% confidence interval (CI) 10.5%, 14.5%] on cold days (fully adjusted). Among children, the adjusted association was similar [10.9% (95% CI: 5.4%, 16.7%)], but without control for pollution and epidemics, was nearly twice as large [19.7% (95% CI: 13.9%, 25.9)]. In Monterrey, the fully adjusted heat effect for all deaths was 18.7% (95% CI: 11.7%, 26.1%), a third lower than the unadjusted estimate; the heat effect was lower among children [5.5% (95% CI: -10.1%, 23.8%)]. Cold had a similar effect on all-age mortality as in Mexico City [11.7% (95% CI: 3.7%, 20.3%)]. Responses of the elderly differed little from all-ages responses in both cities. Associations between weather and health persisted even with control for air pollution and respiratory epidemics in two Mexican cities, but risk assessments and climate change adaptation programs are best informed by analyses that account for these potential confounders.

Impact of control for air pollution and respiratory epidemics on the estimated associations of temperature and daily mortality

NASA Astrophysics Data System (ADS)

O'Neill, Marie S.; Hajat, Shakoor; Zanobetti, Antonella; Ramirez-Aguilar, Matiana; Schwartz, Joel

2005-11-01

We assessed the influence of control for air pollution and respiratory epidemics on associations between apparent temperature (AT) and daily mortality in Mexico City and Monterrey. Poisson regressions were fit to mortality among all ages, children (ages 0 14 years) and the elderly (ages ≥65 years). Predictors included mean daily AT, season, day of week and public holidays for the base model. Respiratory epidemics and air pollution (particulate matter <10 μm in aerodynamic diameter and O3) were added singly and then jointly for a fully adjusted model. Percent changes in mortality were calculated for days of relatively extreme temperatures [cold (10 11°C) for both cities and heat (35 36°C) for Monterrey], compared to days at the overall mean temperature in each city (15°C in Mexico City, 25°C in Monterrey). In Mexico City, total mortality increased 12.4% [95% confidence interval (CI) 10.5%, 14.5%] on cold days (fully adjusted). Among children, the adjusted association was similar [10.9% (95% CI: 5.4%, 16.7%)], but without control for pollution and epidemics, was nearly twice as large [19.7% (95% CI: 13.9%, 25.9)]. In Monterrey, the fully adjusted heat effect for all deaths was 18.7% (95% CI: 11.7%, 26.1%), a third lower than the unadjusted estimate; the heat effect was lower among children [5.5% (95% CI: -10.1%, 23.8%)]. Cold had a similar effect on all-age mortality as in Mexico City [11.7% (95% CI: 3.7%, 20.3%)]. Responses of the elderly differed little from all-ages responses in both cities. Associations between weather and health persisted even with control for air pollution and respiratory epidemics in two Mexican cities, but risk assessments and climate change adaptation programs are best informed by analyses that account for these potential confounders.

Dietary inflammatory index and risk of lung cancer and other respiratory conditions among heavy smokers in the COSMOS screening study.

PubMed

Maisonneuve, Patrick; Shivappa, Nitin; Hébert, James R; Bellomi, Massimo; Rampinelli, Cristiano; Bertolotti, Raffaella; Spaggiari, Lorenzo; Palli, Domenico; Veronesi, Giulia; Gnagnarella, Patrizia

2016-04-01

To test whether the inflammatory potential of diet, as measured using the dietary inflammatory index (DII), is associated with risk of lung cancer or other respiratory conditions and to compare results obtained with those based on the aMED score, an established dietary index that measures adherence to the traditional Mediterranean diet. In 4336 heavy smokers enrolled in a prospective, non-randomized lung cancer screening program, we measured participants' diets at baseline using a self-administered food frequency questionnaire from which dietary scores were calculated. Cox proportional hazards and logistic regression models were used to assess association between the dietary indices and lung cancer diagnosed during annual screening, and other respiratory outcomes that were recorded at baseline, respectively. In multivariable analysis, adjusted for baseline lung cancer risk (estimated from age, sex, smoking history, and asbestos exposure) and total energy, both DII and aMED scores were associated with dyspnoea (p trend = 0.046 and 0.02, respectively) and radiological evidence of emphysema (p trend = 0.0002 and 0.02). After mutual adjustment of the two dietary scores, only the association between DII and radiological evidence of emphysema (Q4 vs. Q1, OR 1.30, 95 % CI 1.01-1.67, p trend = 0.012) remained statistically significant. At univariate analysis, both DII and aMED were associated with lung cancer risk, but in fully adjusted multivariate analysis, only the association with aMED remained statistically significant (p trend = 0.04). Among heavy smokers, a pro-inflammatory diet, as indicated by increasing DII score, is associated with dyspnoea and radiological evidence of emphysema. A traditional Mediterranean diet, which is associated with a lower DII, may lower lung cancer risk.

Dietary inflammatory index and risk of lung cancer and other respiratory conditions among heavy smokers in the COSMOS screening study

PubMed Central

Shivappa, Nitin; Hébert, James R.; Bellomi, Massimo; Rampinelli, Cristiano; Bertolotti, Raffaella; Spaggiari, Lorenzo; Palli, Domenico; Veronesi, Giulia; Gnagnarella, Patrizia

2016-01-01

Purpose To test whether the inflammatory potential of diet, as measured using the dietary inflammatory index (DII), is associated with risk of lung cancer or other respiratory conditions and to compare results obtained with those based on the aMED score, an established dietary index that measures adherence to the traditional Mediterranean diet. Methods In 4336 heavy smokers enrolled in a prospective, non-randomized lung cancer screening program, we measured participants’ diets at baseline using a self-administered food frequency questionnaire from which dietary scores were calculated. Cox proportional hazards and logistic regression models were used to assess association between the dietary indices and lung cancer diagnosed during annual screening, and other respiratory outcomes that were recorded at baseline, respectively. Results In multivariable analysis, adjusted for baseline lung cancer risk (estimated from age, sex, smoking history, and asbestos exposure) and total energy, both DII and aMED scores were associated with dyspnoea (p trend = 0.046 and 0.02, respectively) and radiological evidence of emphysema (p trend = 0.0002 and 0.02). After mutual adjustment of the two dietary scores, only the association between DII and radiological evidence of emphysema (Q4 vs. Q1, OR 1.30, 95 % CI 1.01–1.67, p trend = 0.012) remained statistically significant. At univariate analysis, both DII and aMED were associated with lung cancer risk, but in fully adjusted multivariate analysis, only the association with aMED remained statistically significant (p trend = 0.04). Conclusions Among heavy smokers, a pro-inflammatory diet, as indicated by increasing DII score, is associated with dyspnoea and radiological evidence of emphysema. A traditional Mediterranean diet, which is associated with a lower DII, may lower lung cancer risk. PMID:25953452

Improved Statistics for Genome-Wide Interaction Analysis

PubMed Central

Ueki, Masao; Cordell, Heather J.

2012-01-01

Recently, Wu and colleagues [1] proposed two novel statistics for genome-wide interaction analysis using case/control or case-only data. In computer simulations, their proposed case/control statistic outperformed competing approaches, including the fast-epistasis option in PLINK and logistic regression analysis under the correct model; however, reasons for its superior performance were not fully explored. Here we investigate the theoretical properties and performance of Wu et al.'s proposed statistics and explain why, in some circumstances, they outperform competing approaches. Unfortunately, we find minor errors in the formulae for their statistics, resulting in tests that have higher than nominal type 1 error. We also find minor errors in PLINK's fast-epistasis and case-only statistics, although theory and simulations suggest that these errors have only negligible effect on type 1 error. We propose adjusted versions of all four statistics that, both theoretically and in computer simulations, maintain correct type 1 error rates under the null hypothesis. We also investigate statistics based on correlation coefficients that maintain similar control of type 1 error. Although designed to test specifically for interaction, we show that some of these previously-proposed statistics can, in fact, be sensitive to main effects at one or both loci, particularly in the presence of linkage disequilibrium. We propose two new “joint effects” statistics that, provided the disease is rare, are sensitive only to genuine interaction effects. In computer simulations we find, in most situations considered, that highest power is achieved by analysis under the correct genetic model. Such an analysis is unachievable in practice, as we do not know this model. However, generally high power over a wide range of scenarios is exhibited by our joint effects and adjusted Wu statistics. We recommend use of these alternative or adjusted statistics and urge caution when using Wu et al.'s originally-proposed statistics, on account of the inflated error rate that can result. PMID:22496670

Perceived discrimination and mental health disorders: The South African Stress and Health study

PubMed Central

Moomal, Hashim; Jackson, Pamela B; Stein, Dan J; Herman, Allen; Myer, Landon; Seedat, Soraya; Madela-Mntla, Edith; Williams, David R

2011-01-01

Objectives To describe the demographic correlates of perceived discrimination and explore the association between perceived discrimination and psychiatric disorders. Design A national household survey was conducted between 2002 and 2004 using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate diagnoses of psychiatric disorders. Additional instruments provided data on perceived discrimination and related variables. Setting A nationally representative sample of adults in South Africa. Subjects 4 351 individuals aged 18 years and older. Outcomes 12-month and lifetime mood, anxiety and substance use disorders. Results In the multivariate analyses, acute and chronic racial discrimination were associated with an elevated risk of any 12-month DSM-IV disorder when adjusted for socio-demographic factors, but this association was no longer statistically significant when adjusted for other sources of social stress. In fully adjusted models, acute racial discrimination was associated with an elevated risk of lifetime substance use disorders. Acute and chronic non-racial discrimination were associated with an elevated risk of 12-month and lifetime rates of any disorder, even after adjustment for other stressors and potentially confounding psychological factors. The association of chronic non-racial discrimination and 12-month and lifetime disorder was evident across mood, anxiety, and substance use disorders in the fully adjusted models. Conclusion The risk of psychiatric disorders is elevated among persons who report experiences of discrimination. These associations are more robust for chronic than for acute discrimination and for non-racial than for racial discrimination. Perceived discrimination constitutes an important stressor that should be taken into account in the aetiology of psychiatric disorders. PMID:19588802

Automatic classification of seismic events within a regional seismograph network

NASA Astrophysics Data System (ADS)

Tiira, Timo; Kortström, Jari; Uski, Marja

2015-04-01

A fully automatic method for seismic event classification within a sparse regional seismograph network is presented. The tool is based on a supervised pattern recognition technique, Support Vector Machine (SVM), trained here to distinguish weak local earthquakes from a bulk of human-made or spurious seismic events. The classification rules rely on differences in signal energy distribution between natural and artificial seismic sources. Seismic records are divided into four windows, P, P coda, S, and S coda. For each signal window STA is computed in 20 narrow frequency bands between 1 and 41 Hz. The 80 discrimination parameters are used as a training data for the SVM. The SVM models are calculated for 19 on-line seismic stations in Finland. The event data are compiled mainly from fully automatic event solutions that are manually classified after automatic location process. The station-specific SVM training events include 11-302 positive (earthquake) and 227-1048 negative (non-earthquake) examples. The best voting rules for combining results from different stations are determined during an independent testing period. Finally, the network processing rules are applied to an independent evaluation period comprising 4681 fully automatic event determinations, of which 98 % have been manually identified as explosions or noise and 2 % as earthquakes. The SVM method correctly identifies 94 % of the non-earthquakes and all the earthquakes. The results imply that the SVM tool can identify and filter out blasts and spurious events from fully automatic event solutions with a high level of confidence. The tool helps to reduce work-load in manual seismic analysis by leaving only ~5 % of the automatic event determinations, i.e. the probable earthquakes for more detailed seismological analysis. The approach presented is easy to adjust to requirements of a denser or wider high-frequency network, once enough training examples for building a station-specific data set are available.

External adjustment sensitivity analysis for unmeasured confounding: an application to coronary stent outcomes, Pennsylvania 2004-2008.

PubMed

Huesch, Marco D

2013-06-01

Assessing the real-world comparative effectiveness of common interventions is challenged by unmeasured confounding. To determine whether the mortality benefit shown for drug-eluting stents (DES) over bare metal stents (BMS) in observational studies persists after controls for/tests for confounding. Retrospective observational study involving 38,019 patients, 65 years or older admitted for an index percutaneous coronary intervention receiving DES or BMS in Pennsylvania in 2004-2005 followed up for death through 3 years. Analysis was at the patient level. Mortality was analyzed with Cox proportional hazards models allowing for stratification by disease severity or DES use propensity, accounting for clustering of patients. Instrumental variables analysis used lagged physician stent usage to proxy for the focal stent type decision. A method originating in work by Cornfield and others in 1954 and popularized by Greenland in 1996 was used to assess robustness to confounding. DES was associated with a significantly lower adjusted risk of death at 3 years in Cox and in instrumented analyses. An implausibly strong hypothetical unobserved confounder would be required to fully explain these results. Confounding by indication can bias observational studies. No strong evidence of such selection biases was found in the reduced risk of death among elderly patients receiving DES instead of BMS in a Pennsylvanian state-wide population. © Health Research and Educational Trust.

Improved sampling and analysis of images in corneal confocal microscopy.

PubMed

Schaldemose, E L; Fontain, F I; Karlsson, P; Nyengaard, J R

2017-10-01

Corneal confocal microscopy (CCM) is a noninvasive clinical method to analyse and quantify corneal nerve fibres in vivo. Although the CCM technique is in constant progress, there are methodological limitations in terms of sampling of images and objectivity of the nerve quantification. The aim of this study was to present a randomized sampling method of the CCM images and to develop an adjusted area-dependent image analysis. Furthermore, a manual nerve fibre analysis method was compared to a fully automated method. 23 idiopathic small-fibre neuropathy patients were investigated using CCM. Corneal nerve fibre length density (CNFL) and corneal nerve fibre branch density (CNBD) were determined in both a manual and automatic manner. Differences in CNFL and CNBD between (1) the randomized and the most common sampling method, (2) the adjusted and the unadjusted area and (3) the manual and automated quantification method were investigated. The CNFL values were significantly lower when using the randomized sampling method compared to the most common method (p = 0.01). There was not a statistical significant difference in the CNBD values between the randomized and the most common sampling method (p = 0.85). CNFL and CNBD values were increased when using the adjusted area compared to the standard area. Additionally, the study found a significant increase in the CNFL and CNBD values when using the manual method compared to the automatic method (p ≤ 0.001). The study demonstrated a significant difference in the CNFL values between the randomized and common sampling method indicating the importance of clear guidelines for the image sampling. The increase in CNFL and CNBD values when using the adjusted cornea area is not surprising. The observed increases in both CNFL and CNBD values when using the manual method of nerve quantification compared to the automatic method are consistent with earlier findings. This study underlines the importance of improving the analysis of the CCM images in order to obtain more objective corneal nerve fibre measurements. © 2017 The Authors Journal of Microscopy © 2017 Royal Microscopical Society.

Improvement to Airport Throughput Using Intelligent Arrival Scheduling and an Expanded Planning Horizon

NASA Technical Reports Server (NTRS)

Glaab, Patricia C.

2012-01-01

The first phase of this study investigated the amount of time a flight can be delayed or expedited within the Terminal Airspace using only speed changes. The Arrival Capacity Calculator analysis tool was used to predict the time adjustment envelope for standard descent arrivals and then for CDA arrivals. Results ranged from 0.77 to 5.38 minutes. STAR routes were configured for the ACES simulation, and a validation of the ACC results was conducted comparing the maximum predicted time adjustments to those seen in ACES. The final phase investigated full runway-to-runway trajectories using ACES. The radial distance used by the arrival scheduler was incrementally increased from 50 to 150 nautical miles (nmi). The increased Planning Horizon radii allowed the arrival scheduler to arrange, path stretch, and speed-adjust flights to more fully load the arrival stream. The average throughput for the high volume portion of the day increased from 30 aircraft per runway for the 50 nmi radius to 40 aircraft per runway for the 150 nmi radius for a traffic set representative of high volume 2018. The recommended radius for the arrival scheduler s Planning Horizon was found to be 130 nmi, which allowed more than 95% loading of the arrival stream.

Death spiral or euthanasia? The demise of generous group health insurance coverage.

PubMed

Pauly, Mark V; Mitchell, Olivia S; Zeng, Yuhui

Employers must determine the types of health care plans to offer and also set employee premiums for each plan provided. Depending on the structure of the employee share of premiums across different health insurance plans, the incentives to choose one plan over another are altered. If employees know premiums do not fully reflect the risk differences among workers, such pricing can give rise to a so-called "death spiral" due to adverse selection. This paper uses longitudinal information from a natural experiment in the management of health benefits for a large employer to explore the impact of moving from a fixed-dollar contribution policy to a partially risk-adjusted employer contribution policy. Our results show that implementing a significant risk adjustment had no discernable effect on adverse selection against the most generous indemnity insurance policy. This stands in stark contrast to previous studies, which have tended to estimate large impacts attributed to selection when employers move to a fixed-dollar policy from one with some risk adjustment. Further analysis suggests that previous studies, which appeared to detect plans in the throes of a death spiral, may instead have been reflecting an inexorable movement away from a non-preferred product, one that would have been inefficient for nearly all workers even in the absence of adverse selection.

Prevalence and correlates of street racing among Ontario high school students.

PubMed

Vingilis, Evelyn; Smart, Reginald G; Mann, Robert E; Paglia-Boak, Angela; Stoduto, Gina; Adlaf, Edward M

2011-10-01

This study examined the prevalence and correlates of street racing among adolescents derived from the 2009 Ontario Student Drug Use and Health Survey (OSDUHS), an epidemiological survey of students in Ontario, Canada. The key response variable, self-reported street racing in past year, was examined in relation to grade level, rural/urban, school marks, cannabis use, drinking and driving, cannabis use and driving, and property, physical, drugs, and weapons delinquencies. All survey estimates were weighted, and variance and statistical tests were corrected for the complex sampling design. Of the 3053 9th- to 12th-graders (66% response rate), 5.6 percent of high-schoolers (an estimated 42,000 in the province) and (20.4% of grade 11 and 12 students with an advanced-level or full license) reported driving a car, truck, or sport utility vehicle (SUV) in a street race in the 12 months before the survey. Logistic regression analysis of the advanced-level or fully licensed students in grades 11 and 12 found that males compared to females and students in grade 11 compared to students in grade 12 had significantly higher adjusted odds of street racing. Supportive of problem behavior theory, students who reported property and drug delinquencies compared to students not engaging in these delinquencies also had significantly higher adjusted odds of street racing. This first population-based study in North America suggested that the prevalence of street racing at 1 in 5 of advanced or fully licensed high-schoolers in grades 11 and 12 poses significant public health concerns, especially related to the potential for unintentional injury.

Is there a relationship between patient beliefs or communication about generic drugs and medication utilization?

PubMed

Shrank, William H; Cadarette, Suzanne M; Cox, Emily; Fischer, Michael A; Mehta, Jyotsna; Brookhart, Alan M; Avorn, Jerry; Choudhry, Niteesh K

2009-03-01

Insurers and policymakers strive to stimulate more cost-effective prescribing and, increasingly, are educating beneficiaries about generics. To evaluate the relationship between patient beliefs and communication about generic drugs and actual drug use. We performed a national mailed survey of a random sample of 2500 commercially-insured adults. Patient responses were linked to pharmacy claims data to assess actual generic medication use. We used factor analysis to develop 5 multi-item scales from patient survey responses that measured: (1) general preferences for generics, (2) generic safety/effectiveness, (3) generic cost/value, (4) comfort with generic substitution, and (5) communication with providers about generics. The relationship between each scale and the proportion of prescriptions filled for generics was assessed using linear regression, controlling for demographic, health, and insurance characteristics. Separate models were created for each scale and then all 5 scales were included simultaneously in a fully-adjusted model. The usable response rate was 48%. When evaluated independently, a 1 SD increase in each of the 5 scales was associated with a 3.1% to 6.3% increase in generic drug use (P < 0.05 for each). In the fully adjusted model, only 2 scales were significantly associated with generic drug use: comfort with generic substitution (P = 0.021) and communication with providers about generic drugs (P = 0.012). Generic drug use is most closely associated with the 2 actionable items we evaluated: communication with providers about generics and comfort with generic substitution. Educational campaigns that focus on these 2 domains may be most effective at influencing generic drug use.

Making pro formas perform.

PubMed

Bryan, Stephen; Lilien, Steven

2003-10-01

Regulators are trying to clear up the muddle created by earnings-report adjustments called "pro formas" that companies issue. Constraining such reporting, as the regulators seem bent on doing, isn't the solution. Firms should increase alternative reporting--and fully account for their accounting.

Posttraumatic Stress Disorder Symptoms, Relationship Adjustment, and Relationship Aggression in a Sample of Female Flood Victims

PubMed Central

Monson, Candice M.; Schumm, Jeremiah A.; Watkins, Laura E.; Panuzio, Jillian; Resick, Patricia A.

2010-01-01

This study tested a model examining the interrelationships among posttraumatic stress disorder (PTSD) symptoms, intimate relationship adjustment, and intimate relationship aggression in a sample of 205 adult female flood victims. At the bivariate level, higher PTSD symptoms were associated with higher physical and psychological aggression victimization, poorer relationship adjustment, and higher physical and psychological aggression perpetration. Results from structural equation modeling (SEM) analyses indicated that relationship aggression victimization influenced aggression perpetration directly, and in the case of physical aggression, indirectly through its relationship with PTSD symptoms and relationship adjustment. The influence of PTSD symptoms on physical aggression perpetration was fully explained by poorer relationship adjustment. These findings extend prior work from other traumatized populations documenting associations between variables reflecting PTSD symptomatology and indices of relationship functioning, and indicate a need for further investigation in this area of inquiry. PMID:21057584

The association of parental education with childhood undernutrition in low- and middle-income countries: comparing the role of paternal and maternal education.

PubMed

Vollmer, Sebastian; Bommer, Christian; Krishna, Aditi; Harttgen, Kenneth; Subramanian, S V

2017-02-01

Most existing research on the association of parental education with childhood undernutrition focuses on maternal education and often ignores paternal education. We systematically investigate differences in maternal and paternal education and their association with childhood undernutrition. One hundred and eighty Demographic and Health Surveys from 62 countries performed between 1990 and 2014 were analysed. We used linear-probability models to predict childhood undernutrition prevalences, measured as stunting, underweight and wasting, for all combinations of maternal and paternal attainment in school. Models were adjusted for demographic and socio-economic covariates for the child, mother and household, country-level fixed effects and clustering. Additional specifications adjust for local area characteristics instead of country fixed effects. Both higher maternal and paternal education levels are associated with lower childhood undernutrition. In regressions adjusted for child age and sex as well as country-level fixed effects, the association is stronger for maternal education than for paternal education when their combined level of education is held constant. In the fully adjusted models, the observed differences in predicted undernutrition prevalences are strongly attenuated, suggesting a similar importance of maternal and paternal education. These findings are confirmed by the analysis of composite schooling indicators. We find that paternal education is similarly important for reducing childhood undernutrition as maternal education and should therefore receive increased attention in the literature. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

The association of parental education with childhood undernutrition in low- and middle-income countries: comparing the role of paternal and maternal education

PubMed Central

Vollmer, Sebastian; Bommer, Christian; Krishna, Aditi; Harttgen, Kenneth; Subramanian, SV

2017-01-01

Abstract Background: Most existing research on the association of parental education with childhood undernutrition focuses on maternal education and often ignores paternal education. We systematically investigate differences in maternal and paternal education and their association with childhood undernutrition. Methods: One hundred and eighty Demographic and Health Surveys from 62 countries performed between 1990 and 2014 were analysed. We used linear-probability models to predict childhood undernutrition prevalences, measured as stunting, underweight and wasting, for all combinations of maternal and paternal attainment in school. Models were adjusted for demographic and socio-economic covariates for the child, mother and household, country-level fixed effects and clustering. Additional specifications adjust for local area characteristics instead of country fixed effects. Results: Both higher maternal and paternal education levels are associated with lower childhood undernutrition. In regressions adjusted for child age and sex as well as country-level fixed effects, the association is stronger for maternal education than for paternal education when their combined level of education is held constant. In the fully adjusted models, the observed differences in predicted undernutrition prevalences are strongly attenuated, suggesting a similar importance of maternal and paternal education. These findings are confirmed by the analysis of composite schooling indicators. Conclusions: We find that paternal education is similarly important for reducing childhood undernutrition as maternal education and should therefore receive increased attention in the literature. PMID:27501820

Short-term blood pressure variability over 24 h and target organ damage in middle-aged men and women.

PubMed

Madden, J M; O'Flynn, A M; Dolan, E; Fitzgerald, A P; Kearney, P M

2015-12-01

Blood pressure variability (BPV) has been associated with cardiovascular events; however, the prognostic significance of short-term BPV remains uncertain. As uncertainty also remains as to which measure of variability most accurately describes short-term BPV, this study explores different indices and investigates their relationship with subclinical target organ damage (TOD). We used data from the Mitchelstown Study, a cross-sectional study of Irish adults aged 47-73 years (n=2047). A subsample (1207) underwent 24-h ambulatory BP monitoring (ABPM). As measures of short-term BPV, we estimated the s.d., weighted s.d. (wSD), coefficient of variation (CV) and average real variability (ARV). TOD was documented by microalbuminuria and electrocardiogram (ECG) left ventricular hypertrophy (LVH). There was no association found between any measure of BPV and LVH in both unadjusted and fully adjusted logistic regression models. Similar analysis found that ARV (24 h, day and night), s.d. (day and night) and wSD were all univariately associated with microalbuminuria and remained associated after adjustment for age, gender, smoking, body mass index (BMI), diabetes and antihypertensive treatment. However, when the models were further adjusted for the mean BP the association did not persist for all indices. Our findings illustrate choosing the appropriate summary measure, which accurately captures that short-term BPV is difficult. Despite discrepancies in values between the different measures, there was no association between any indexes of variability with TOD measures after adjustment for the mean BP.

Impact of Policy Changes on Infant Feeding Decisions Among Low-Income Women Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

PubMed Central

Koleilat, Maria; Whaley, Mike; Gomez, Judy; Meehan, Karen; Saluja, Kiran

2012-01-01

Objectives. We present infant feeding data before and after the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package change that supported and incentivized breastfeeding. We describe the key role of California WIC staff in supporting these policy changes. Methods. We analyzed WIC data on more than 180 000 infants in Southern California. We employed the analysis of variance and Tukey (honestly significant difference) tests to compare issuance rates of postpartum and infant food packages before and after the changes. We used analysis of covariance to adjust for poverty status changes as a potential confounder. Results. Issuance rates of the “fully breastfeeding” package at infant WIC enrollment increased by 86% with the package changes. Rates also increased significantly for 2- and 6-month-old infants. Issuance rates of packages that included formula decreased significantly. All outcomes remained highly significant in the adjusted model. Conclusions. Policy changes, training of front-line WIC staff, and participant education influenced issuance rates of WIC food packages. In California, the issuance rates of packages that include formula have significantly decreased and the rate for those that include no formula has significantly increased. PMID:23078467

Predictors of Vaccination in India for Children Aged 12-36 Months.

PubMed

Shrivastwa, Nijika; Gillespie, Brenda W; Kolenic, Giselle E; Lepkowski, James M; Boulton, Matthew L

2015-12-01

India has one of the lowest immunization rates worldwide despite a longstanding Universal Immunization Program (UIP) that provides free childhood vaccines. This study characterizes the predictors for under- and non-vaccination among Indian children aged 12-36 months. This study utilized District Level Household and Facility Survey Data, 2008 (DLHS3), from India. DLHS3 is a nationally representative sample collected from December 2007 through December 2008; this analysis was conducted during 2014. Children's vaccination status was categorized as fully, under-, and non-vaccinated based on whether children received all, some, or none of the UIP-recommended vaccines (one dose each of bacillus Calmette-Guérin and measles, and three doses of diphtheria-pertussis-tetanus). A multinomial logistic regression model estimated the odds of under-vaccination compared with full vaccination, and odds of non-vaccination compared with full vaccination. Analytic predictors included socioeconomic, cultural, household, maternal, and childhood characteristics. The analysis included 108,057 children; the estimated proportions of fully, under-, and non-vaccinated children were 57%, 31%, and 12%, respectively. After adjusting for state of residence, age, gender, household wealth, and maternal education, additional significant predictors of children's vaccination status were religion, caste, place of delivery, number of antenatal care visits, and maternal tetanus vaccination, all of which demonstrated large effect sizes. India's immunization coverage remained low in 2008, with just slightly more than half of all children aged 12-36 months fully vaccinated with UIP-recommended vaccines. A better understanding of the predictors for vaccination can help shape interventions to reduce disparities in full vaccination among children of differing demographic/cultural groups. Copyright © 2015 by American Journal of Preventive Medicine and Elsevier Ltd. Published by Elsevier Inc. All rights reserved.

Predictors of vaccination in India for children aged 12-36 months.

PubMed

Shrivastwa, Nijika; Gillespie, Brenda W; Kolenic, Giselle E; Lepkowski, James M; Boulton, Matthew L

2015-11-27

India has one of the lowest immunization rates worldwide despite a longstanding Universal Immunization Program (UIP) that provides free childhood vaccines. This study characterizes the predictors for under- and non-vaccination among Indian children aged 12-36 months. This study utilized District Level Household and Facility Survey Data, 2008 (DLHS3), from India. DLHS3 is a nationally representative sample collected from December 2007 through December 2008; this analysis was conducted during 2014. Children's vaccination status was categorized as fully, under-, and non-vaccinated based on whether children received all, some, or none of the UIP-recommended vaccines (one dose each of bacillus Calmette-Guérin and measles, and three doses of diphtheria-pertussis-tetanus). A multinomial logistic regression model estimated the odds of undervaccination compared with full vaccination, and odds of non-vaccination compared with full vaccination. Analytic predictors included socioeconomic, cultural, household, maternal, and childhood characteristics. The analysis included 108,057 children; the estimated proportions of fully, under-, and non-vaccinated children were 57%, 31%, and 12%, respectively. After adjusting for state of residence, age, gender, household wealth, and maternal education, additional significant predictors of children's vaccination status were religion, caste, place of delivery, number of antenatal care visits, and maternal tetanus vaccination, all of which demonstrated large effect sizes. India's immunization coverage remained low in 2008, with just slightly more than half of all children aged 12-36 months fully vaccinated with UIP-recommended vaccines. A better understanding of the predictors for vaccination can help shape interventions to reduce disparities in full vaccination among children of differing demographic/cultural groups. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Empirical Reference Distributions for Networks of Different Size

PubMed Central

Smith, Anna; Calder, Catherine A.; Browning, Christopher R.

2016-01-01

Network analysis has become an increasingly prevalent research tool across a vast range of scientific fields. Here, we focus on the particular issue of comparing network statistics, i.e. graph-level measures of network structural features, across multiple networks that differ in size. Although “normalized” versions of some network statistics exist, we demonstrate via simulation why direct comparison is often inappropriate. We consider normalizing network statistics relative to a simple fully parameterized reference distribution and demonstrate via simulation how this is an improvement over direct comparison, but still sometimes problematic. We propose a new adjustment method based on a reference distribution constructed as a mixture model of random graphs which reflect the dependence structure exhibited in the observed networks. We show that using simple Bernoulli models as mixture components in this reference distribution can provide adjusted network statistics that are relatively comparable across different network sizes but still describe interesting features of networks, and that this can be accomplished at relatively low computational expense. Finally, we apply this methodology to a collection of ecological networks derived from the Los Angeles Family and Neighborhood Survey activity location data. PMID:27721556

Bias analysis applied to Agricultural Health Study publications to estimate non-random sources of uncertainty.

PubMed

Lash, Timothy L

2007-11-26

The associations of pesticide exposure with disease outcomes are estimated without the benefit of a randomized design. For this reason and others, these studies are susceptible to systematic errors. I analyzed studies of the associations between alachlor and glyphosate exposure and cancer incidence, both derived from the Agricultural Health Study cohort, to quantify the bias and uncertainty potentially attributable to systematic error. For each study, I identified the prominent result and important sources of systematic error that might affect it. I assigned probability distributions to the bias parameters that allow quantification of the bias, drew a value at random from each assigned distribution, and calculated the estimate of effect adjusted for the biases. By repeating the draw and adjustment process over multiple iterations, I generated a frequency distribution of adjusted results, from which I obtained a point estimate and simulation interval. These methods were applied without access to the primary record-level dataset. The conventional estimates of effect associating alachlor and glyphosate exposure with cancer incidence were likely biased away from the null and understated the uncertainty by quantifying only random error. For example, the conventional p-value for a test of trend in the alachlor study equaled 0.02, whereas fewer than 20% of the bias analysis iterations yielded a p-value of 0.02 or lower. Similarly, the conventional fully-adjusted result associating glyphosate exposure with multiple myleoma equaled 2.6 with 95% confidence interval of 0.7 to 9.4. The frequency distribution generated by the bias analysis yielded a median hazard ratio equal to 1.5 with 95% simulation interval of 0.4 to 8.9, which was 66% wider than the conventional interval. Bias analysis provides a more complete picture of true uncertainty than conventional frequentist statistical analysis accompanied by a qualitative description of study limitations. The latter approach is likely to lead to overconfidence regarding the potential for causal associations, whereas the former safeguards against such overinterpretations. Furthermore, such analyses, once programmed, allow rapid implementation of alternative assignments of probability distributions to the bias parameters, so elevate the plane of discussion regarding study bias from characterizing studies as "valid" or "invalid" to a critical and quantitative discussion of sources of uncertainty.

Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics.

PubMed

May, Margaret T; Hogg, Robert S; Justice, Amy C; Shepherd, Bryan E; Costagliola, Dominique; Ledergerber, Bruno; Thiébaut, Rodolphe; Gill, M John; Kirk, Ole; van Sighem, Ard; Saag, Michael S; Navarro, Gemma; Sobrino-Vegas, Paz; Lampe, Fiona; Ingle, Suzanne; Guest, Jodie L; Crane, Heidi M; D'Arminio Monforte, Antonella; Vehreschild, Jörg J; Sterne, Jonathan A C

2012-12-01

HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.

American Indians, substance use, and sexual behavior: do predictors of sexually transmitted infections explain the race gap among young adults?

PubMed

Eitle, David; Greene, Kaylin; Eitle, Tamela McNulty

2015-02-01

In this study, we examined whether substance use and risky sexual behaviors predicted sexually transmitted infections (STIs) among American Indian (AI) and white young adults. Furthermore, we explored whether these factors explained the race disparity in STIs. We conducted a cross-sectional analysis of wave 3 of the National Longitudinal Study of Adolescent Health collected in 2001 to 2002. Young adult participants (aged 18-26 years) provided urine specimens that were tested for chlamydia, gonorrhea, and trichomoniasis infection. Estimates of the association between AI with any STI were adjusted for sexual and other risk behavior correlates using multivariate regression techniques. Nine percent of AIs (n = 367) and 3.6% of whites (n = 7813) tested positive for an STI. Race differences were found for substance use (injection drug use, 3.1% AI vs. 1.3% white; alcohol use frequency, 2.01% AI vs. 2.5% white; binge drinking frequency, 1.25% AI vs. 1.53% white). Among sexually active respondents, AIs were more likely to have paid for sex (9%) than whites (3%). After adjustment, early sexual initiation (adjusted odds ratio, 1.69; 95% confidence interval, 1.19-2.41), no condom use at last sex (adjusted odds ratio, 1.47; 95% confidence interval, 1.08-2.01), and AI race (adjusted odds ratio, 2.45; 95% confidence interval 1.46-4.11) were significantly associated with having an STI. Individual-level sexual and other risk behaviors do not fully explain disparities in STIs among AIs compared with white young adults. Further examination of network and community factors is needed to explain these disparities.

Unemployment and disability pension--an 18-year follow-up study of a 40-year-old population in a Norwegian county.

PubMed

Støver, Morten; Pape, Kristine; Johnsen, Roar; Fleten, Nils; Sund, Erik R; Claussen, Bjørgulf; Bjørngaard, Johan H

2012-02-28

This study explored the association of unemployment and an increased risk of receiving disability pension, and the possibility that this risk is attributed to municipality-specific characteristics. A cohort of 7,985 40-42 year olds was followed for 18 years in national registers, identifying new episodes of unemployment and cases of disability pension. The association between an unemployment period and disability pension in the subsequent year was estimated using discrete time multilevel logistic regressions and clustering individuals by municipality. The association between unemployment and disability pension was adjusted for age in the follow up-period, sex, baseline health status, health behaviour and education level. A conditional intra-class correlation coefficient (ICC) was estimated as a measure of inter-municipality variance. In the follow-up period, 2784 (35%) of the participants were granted disability pension. The crude odds ratio for receiving disability pension after unemployment (adjusted for age in follow-up period and sex only) was 1.42 (95% CI 1.1-1.8). Adjusting for baseline health indicators reduced the odds ratio of unemployment to 1.33 (CI 1.1-1.7). A fully adjusted model, including education level, further reduced the odds ratio of unemployment to 1.25 (CI 1.00-1.6). The ICC of the municipality level was approximately 2%. Becoming unemployed increased the risk of receiving subsequent disability pension. However, adjusting for baseline health status, health behaviour and education attenuated this impact considerably. The multilevel analysis indicated that a minor, yet statistically significant, proportion of the risk of disability pension can be attributed to the municipality of residence.

Unemployment and disability pension-an 18-year follow-up study of a 40-year-old population in a Norwegian county

PubMed Central

2012-01-01

Background This study explored the association of unemployment and an increased risk of receiving disability pension, and the possibility that this risk is attributed to municipality-specific characteristics. Methods A cohort of 7,985 40-42 year olds was followed for 18 years in national registers, identifying new episodes of unemployment and cases of disability pension. The association between an unemployment period and disability pension in the subsequent year was estimated using discrete time multilevel logistic regressions and clustering individuals by municipality. The association between unemployment and disability pension was adjusted for age in the follow up-period, sex, baseline health status, health behaviour and education level. A conditional intra-class correlation coefficient (ICC) was estimated as a measure of inter-municipality variance. Results In the follow-up period, 2784 (35%) of the participants were granted disability pension. The crude odds ratio for receiving disability pension after unemployment (adjusted for age in follow-up period and sex only) was 1.42 (95% CI 1.1-1.8). Adjusting for baseline health indicators reduced the odds ratio of unemployment to 1.33 (CI 1.1-1.7). A fully adjusted model, including education level, further reduced the odds ratio of unemployment to 1.25 (CI 1.00-1.6). The ICC of the municipality level was approximately 2%. Conclusions Becoming unemployed increased the risk of receiving subsequent disability pension. However, adjusting for baseline health status, health behaviour and education attenuated this impact considerably. The multilevel analysis indicated that a minor, yet statistically significant, proportion of the risk of disability pension can be attributed to the municipality of residence. PMID:22369630

Reproductive Factors and Incidence of Heart Failure Hospitalization in the Women’s Health Initiative

PubMed Central

Hall, Philip S.; Nah, Gregory; Howard, Barbara V.; Lewis, Cora E.; Allison, Matthew A.; Sarto, Gloria E.; Waring, Molly E.; Jacobson, Lisette T.; Manson, JoAnn E.; Klein, Liviu; Parikh, Nisha I.

2017-01-01

BACKGROUND Reproductive factors reflective of endogenous sex hormone exposure might have an effect on cardiac remodeling and the development of heart failure (HF). OBJECTIVES This study examined the association between key reproductive factors and the incidence of HF. METHODS Women from a cohort of the Women’s Health Initiative were systematically evaluated for the incidence of HF hospitalization from study enrollment through 2014. Reproductive factors (number of live births, age at first pregnancy, and total reproductive duration [time from menarche to menopause]) were self-reported at study baseline in 1993 to 1998. We employed Cox proportional hazards regression analysis in age- and multivariable-adjusted models. RESULTS Among 28,516 women, with an average age of 62.7 ± 7.1 years at baseline, 1,494 (5.2%) had an adjudicated incident HF hospitalization during an average follow-up of 13.1 years. After adjusting for covariates, total reproductive duration in years was inversely associated with incident HF: hazard ratios (HRs) of 0.99 per year (95% confidence interval [CI]: 0.98 to 0.99 per year) and 0.95 per 5 years (95% CI: 0.91 to 0.99 per 5 years). Conversely, early age at first pregnancy and nulliparity were significantly associated with incident HF in age-adjusted models, but not after multivariable adjustment. Notably, nulliparity was associated with incident HF with preserved ejection fraction in the fully adjusted model (HR: 2.75; 95% CI: 1.16 to 6.52). CONCLUSIONS In postmenopausal women, shorter total reproductive duration was associated with higher risk of incident HF, and nulliparity was associated with higher risk for incident HF with preserved ejection fraction. Whether exposure to endogenous sex hormones underlies this relationship should be investigated in future studies. PMID:28521890

Feasibility study for the quantitative assessment of mineral resources in asteroids

USGS Publications Warehouse

Keszthelyi, Laszlo; Hagerty, Justin; Bowers, Amanda; Ellefsen, Karl; Ridley, Ian; King, Trude; Trilling, David; Moskovitz, Nicholas; Grundy, Will

2017-04-21

This study was undertaken to determine if the U.S. Geological Survey’s process for conducting mineral resource assessments on Earth can be applied to asteroids. Successful completion of the assessment, using water and iron resources to test the workflow, has resulted in identification of the minimal adjustments required to conduct full resource assessments beyond Earth. We also identify the types of future studies that would greatly reduce uncertainties in an actual future assessment. Whereas this is a feasibility study and does not include a complete and robust analysis of uncertainty, it is clear that the water and metal resources in near-Earth asteroids are sufficient to support humanity should it become a fully space-faring species.

i3Drive, a 3D interactive driving simulator.

PubMed

Ambroz, Miha; Prebil, Ivan

2010-01-01

i3Drive, a wheeled-vehicle simulator, can accurately simulate vehicles of various configurations with up to eight wheels in real time on a desktop PC. It presents the vehicle dynamics as an interactive animation in a virtual 3D environment. The application is fully GUI-controlled, giving users an easy overview of the simulation parameters and letting them adjust those parameters interactively. It models all relevant vehicle systems, including the mechanical models of the suspension, power train, and braking and steering systems. The simulation results generally correspond well with actual measurements, making the system useful for studying vehicle performance in various driving scenarios. i3Drive is thus a worthy complement to other, more complex tools for vehicle-dynamics simulation and analysis.

Functional Limitations and Nativity Status among Older Arab, Asian, Black, Hispanic, and White Americans

PubMed Central

Dallo, Florence J.; Booza, Jason; Nguyen, Norma D.

2013-01-01

Background To examine the association between nativity status (foreign and US-born) by race/ethnicity (Arab, Asian, black, Hispanic, white) on having a functional limitation. Methods We used American Community Survey data (2001-2007; n=1,964,777; 65+ years) and estimated odds ratios (95% confidence intervals). Results In the crude model, foreign-born Blacks, Hispanics and Arabs were more likely, while Asians were less likely to report having a functional limitation compared to white. In the fully adjusted model, Blacks, Hispanics, and Asians were less likely, while Arabs were more likely to report having a functional limitation. In both the crude and fully adjusted models, US-born Blacks and Hispanics were more likely, while Asians and Arabs were less likely to report having a functional limitation compared to whites. Discussion Policies and programs tailored to foreign-born Arab Americans may help prevent or delay the onset of disability, especially when initiated shortly after their arrival to the US. PMID:24165988

Preliminary evaluation of the publicly available Laboratory for Breast Radiodensity Assessment (LIBRA) software tool: comparison of fully automated area and volumetric density measures in a case-control study with digital mammography.

PubMed

Keller, Brad M; Chen, Jinbo; Daye, Dania; Conant, Emily F; Kontos, Despina

2015-08-25

Breast density, commonly quantified as the percentage of mammographically dense tissue area, is a strong breast cancer risk factor. We investigated associations between breast cancer and fully automated measures of breast density made by a new publicly available software tool, the Laboratory for Individualized Breast Radiodensity Assessment (LIBRA). Digital mammograms from 106 invasive breast cancer cases and 318 age-matched controls were retrospectively analyzed. Density estimates acquired by LIBRA were compared with commercially available software and standard Breast Imaging-Reporting and Data System (BI-RADS) density estimates. Associations between the different density measures and breast cancer were evaluated by using logistic regression after adjustment for Gail risk factors and body mass index (BMI). Area under the curve (AUC) of the receiver operating characteristic (ROC) was used to assess discriminatory capacity, and odds ratios (ORs) for each density measure are provided. All automated density measures had a significant association with breast cancer (OR = 1.47-2.23, AUC = 0.59-0.71, P < 0.01) which was strengthened after adjustment for Gail risk factors and BMI (OR = 1.96-2.64, AUC = 0.82-0.85, P < 0.001). In multivariable analysis, absolute dense area (OR = 1.84, P < 0.001) and absolute dense volume (OR = 1.67, P = 0.003) were jointly associated with breast cancer (AUC = 0.77, P < 0.01), having a larger discriminatory capacity than models considering the Gail risk factors alone (AUC = 0.64, P < 0.001) or the Gail risk factors plus standard area percent density (AUC = 0.68, P = 0.01). After BMI was further adjusted for, absolute dense area retained significance (OR = 2.18, P < 0.001) and volume percent density approached significance (OR = 1.47, P = 0.06). This combined area-volume density model also had a significantly (P < 0.001) improved discriminatory capacity (AUC = 0.86) relative to a model considering the Gail risk factors plus BMI (AUC = 0.80). Our study suggests that new automated density measures may ultimately augment the current standard breast cancer risk factors. In addition, the ability to fully automate density estimation with digital mammography, particularly through the use of publically available breast density estimation software, could accelerate the translation of density reporting in routine breast cancer screening and surveillance protocols and facilitate broader research into the use of breast density as a risk factor for breast cancer.

Self-enhancement among high-exposure survivors of the September 11th terrorist attack: resilience or social maladjustment?

PubMed

Bonanno, George A; Rennicke, Courtney; Dekel, Sharon

2005-06-01

The authors examined self-enhancing bias as a predictor of adjustment among individuals in or near the World Trade Center during the September 11, 2001, terrorist attacks. Resilience was defined from categorical and continuous analyses of both participant self-report and friend and relative ratings of adjustment. Self-enhancement was associated with a resilient outcome, ratings of better adjustment prior to September 11th, greater positive affect, and reduced perceptions of social constraints. Additional analyses indicated that self-enhancers' reduced symptom levels were fully mediated by their low perceived social constraints. However, consistent with previous evidence suggesting a social cost to self-enhancement, at 18 months post-September 11th, self-enhancers' friends and relatives also rated them as decreasing in social adjustment and as being less honest.

Friend affiliations and school adjustment among Mexican-American adolescents: the moderating role of peer and parent support.

PubMed

Espinoza, Guadalupe; Gillen-O'Neel, Cari; Gonzales, Nancy A; Fuligni, Andrew J

2014-12-01

Studies examining friendships among Mexican-American adolescents have largely focused on their potentially negative influence. The current study examined the extent to which deviant and achievement-oriented friend affiliations are associated with Mexican-American adolescents' school adjustment and also tested whether support from friends and parents moderates these associations. High school students (N = 412; 49 % male) completed questionnaires and daily diaries; primary caregivers also completed a questionnaire. Although results revealed few direct associations between friend affiliations and school adjustment, several moderations emerged. In general, the influence of friends' affiliation was strongest when support from friends was high and parental support was low. The findings suggest that only examining links between friend affiliations and school outcomes does not fully capture how friends promote or hinder school adjustment.

Friend Affiliations and School Adjustment Among Mexican-American Adolescents: The Moderating Role of Peer and Parent Support

PubMed Central

Gillen-O’Neel, Cari; Gonzales, Nancy A.; Fuligni, Andrew J.

2014-01-01

Studies examining friendships among Mexican-American adolescents have largely focused on their potentially negative influence. The current study examined the extent to which deviant and achievement-oriented friend affiliations are associated with Mexican-American adolescents’ school adjustment and also tested whether support from friends and parents moderates these associations. High school students (N = 412; 49 % male) completed questionnaires and daily diaries; primary caregivers also completed a questionnaire. Although results revealed few direct associations between friend affiliations and school adjustment, several moderations emerged. In general, the influence of friends’ affiliation was strongest when support from friends was high and parental support was low. The findings suggest that only examining links between friend affiliations and school outcomes does not fully capture how friends promote or hinder school adjustment. PMID:24096530

Bone health and risk factors of cardiovascular disease--a cross-sectional study in healthy young adults.

PubMed

Pirilä, Satu; Taskinen, Mervi; Turanlahti, Maila; Kajosaari, Merja; Mäkitie, Outi; Saarinen-Pihkala, Ulla M; Viljakainen, Heli

2014-01-01

Both osteoporosis and cardiovascular disease (CVD) are diseases that comprise a growing medical and economic burden in ageing populations. They share many risk factors, including ageing, low physical activity, and possibly overweight. We aimed to study associations between individual risk factors for CVD and bone mineral density (BMD) and turnover markers (BTMs) in apparently healthy cohort. A cross-sectional assessment of 155 healthy 32-year-old adults (74 males) was performed for skeletal status, CVD risk factors and lifestyle factors. We analysed serum osteocalcin, procollagen I aminoterminal propeptide (P1NP), collagen I carboxy-terminal telopeptide (ICTP) and urine collagen I aminoterminal telopeptide (U-NTX), as well as serum insulin, plasma glucose, triglyceride and HDL-cholesterol levels. BMD, fat and lean mass were assessed using DXA scanning. Associations were tested with partial correlations in crude and adjusted models. Bone status was compared between men with or without metabolic syndrome (defined according to the NCEP-ATPIII criteria) with multivariate analysis. Osteocalcin and P1NP correlated inversely with insulin (R = -0.243, P = 0.003 and R = -0.187, P = 0.021) and glucose (R = -0.213, P = 0.009 and R = -0.190, P = 0.019), but after controlling for fat mass and lifestyle factors, the associations attenuated with insulin (R = -0.162, P = 0.053 and R = -0.093, P = 0.266) and with glucose (R = -0.099, P = 0.240 and R = -0.133, P = 0.110), respectively. Whole body BMD associated inversely only with triglycerides in fully adjusted model. In men with metabolic syndrome, whole body BMD, osteocalcin and P1NP were lower compared to healthy men, but these findings disappeared in fully adjusted model. In young adults, inverse associations between BTM/BMD and risk factors of CVD appeared in crude models, but after adjusting for fat mass, no association continued to be present. In addition to fat mass, lifestyle factors, especially physical activity, modified the associations between CVD and bone characteristics. Prospective studies are needed to specify the role of mediators and lifestyle factors in the prevention of CVD and osteoporosis.

Development and Evaluation of an Automated Machine Learning Algorithm for In-Hospital Mortality Risk Adjustment Among Critical Care Patients.

PubMed

Delahanty, Ryan J; Kaufman, David; Jones, Spencer S

2018-06-01

Risk adjustment algorithms for ICU mortality are necessary for measuring and improving ICU performance. Existing risk adjustment algorithms are not widely adopted. Key barriers to adoption include licensing and implementation costs as well as labor costs associated with human-intensive data collection. Widespread adoption of electronic health records makes automated risk adjustment feasible. Using modern machine learning methods and open source tools, we developed and evaluated a retrospective risk adjustment algorithm for in-hospital mortality among ICU patients. The Risk of Inpatient Death score can be fully automated and is reliant upon data elements that are generated in the course of usual hospital processes. One hundred thirty-one ICUs in 53 hospitals operated by Tenet Healthcare. A cohort of 237,173 ICU patients discharged between January 2014 and December 2016. The data were randomly split into training (36 hospitals), and validation (17 hospitals) data sets. Feature selection and model training were carried out using the training set while the discrimination, calibration, and accuracy of the model were assessed in the validation data set. Model discrimination was evaluated based on the area under receiver operating characteristic curve; accuracy and calibration were assessed via adjusted Brier scores and visual analysis of calibration curves. Seventeen features, including a mix of clinical and administrative data elements, were retained in the final model. The Risk of Inpatient Death score demonstrated excellent discrimination (area under receiver operating characteristic curve = 0.94) and calibration (adjusted Brier score = 52.8%) in the validation dataset; these results compare favorably to the published performance statistics for the most commonly used mortality risk adjustment algorithms. Low adoption of ICU mortality risk adjustment algorithms impedes progress toward increasing the value of the healthcare delivered in ICUs. The Risk of Inpatient Death score has many attractive attributes that address the key barriers to adoption of ICU risk adjustment algorithms and performs comparably to existing human-intensive algorithms. Automated risk adjustment algorithms have the potential to obviate known barriers to adoption such as cost-prohibitive licensing fees and significant direct labor costs. Further evaluation is needed to ensure that the level of performance observed in this study could be achieved at independent sites.

Twins' risk of childhood asthma mediated by gestational age and birthweight.

PubMed

Ullemar, V; Lundholm, C; Almqvist, C

2015-08-01

Children born with low gestational age (GA) or low birthweight (BW) are at increased risk of asthma. Twins as compared to singletons are on average more likely to be born with lower GA and BW and have been hypothesized to comprise a high-risk population for asthma. Many previous studies have not accounted for potential confounders or mediators. To investigate the association between twinship and childhood asthma or early life wheeze and identify potential mediators, such as GA/BW. The study population consisted of two cohorts including all children born in Sweden from 1 January 1993 to 1 June 2001 (n = 756,363 singletons, n = 22,478 twins) and 1 July 2005 to 31 December 2009 (n = 456,239 singletons, n = 12,872 twins). Asthma was defined using validated register-based outcomes of diagnosis or medication. The data were analysed using logistic (older cohort) and Cox regression (younger cohort). Adjusted models incorporated potential confounding or mediating factors including gestational age and birthweight. In the younger cohort, the crude hazard ratio (HR) of asthma medication after 1.5 years of age was 1.12 (95% CI 1.01-1.23), and fully adjusted HR was 0.80, 95% CI 0.72-0.89. Crude HR of asthma diagnosis in the same age group was 1.14 (95% CI 0.99-1.30), fully adjusted 0.78 (0.68-0.98). Adjusted analyses in the older group yielded similar results. Twins were at significantly higher unadjusted risk of asthma or early life wheeze compared to singletons in the younger, but not in the older cohort. Associations attenuated following adjustment for GA/BW, suggesting that GA/BW mediates the effect of twinship on asthma risk. After adjustments, twins were at lower risk of asthma outcomes, possibly due to unmeasured confounding. © 2015 John Wiley & Sons Ltd.

Immunodeficiency, AIDS-related pneumonia, and risk of lung cancer among HIV-infected individuals.

PubMed

Marcus, Julia L; Leyden, Wendy A; Chao, Chun R; Horberg, Michael A; Klein, Daniel B; Quesenberry, Charles P; Towner, William J; Silverberg, Michael J

2017-04-24

The objective is to clarify the role of immunodeficiency and pneumonia in elevated lung cancer risk among HIV-infected individuals. Cohort study of HIV-infected and HIV-uninfected adults in a large integrated healthcare system in California during 1996-2011. We used Poisson models to obtain rate ratios for lung cancer associated with HIV infection, overall and stratified by recent CD4 cells/μl (HIV-uninfected as reference group), with χ tests for trends across CD4 strata. Fully adjusted models included demographics, cancer risk factors (smoking, drug/alcohol abuse, overweight/obesity), and prior pneumonia. Among 24 768 HIV-infected and 257 600 HIV-uninfected individuals, the lung cancer rate per 100 000 person-years was 66 (n = 80 events) for HIV-infected and 33 (n = 506 events) for HIV-uninfected individuals [rate ratio 2.0, 95% confidence interval (CI): 1.7-2.2]. Overall, HIV-infected individuals were at increased risk of lung cancer after adjustment for demographics and cancer risk factors (rate ratio 1.4, 95% CI: 1.1-1.7), but not after additional adjustment for pneumonia (rate ratio 1.2, 95% CI: 0.9-1.6). Lower CD4 cell counts were associated with higher risk of lung cancer in unadjusted and demographics-adjusted models (P < 0.001 for all), but this trend did not remain after adjustment for cancer risk factors and pneumonia. Compared with HIV-uninfected individuals, HIV-infected individuals with CD4 less than 200 cells/μl were not at increased risk of lung cancer in fully adjusted models. The increased lung cancer risk among HIV patients is attributable to differences in demographics, risk factors such as smoking, and history of pneumonia. Immunodeficiency does not appear to have an independent effect on lung cancer risk.

HbA1c is significantly associated with arterial stiffness but not with carotid atherosclerosis in a community-based population without type 2 diabetes: The Dong-gu study.

PubMed

Lee, Young-Hoon; Shin, Min-Ho; Choi, Jin-Su; Rhee, Jung-Ae; Nam, Hae-Sung; Jeong, Seul-Ki; Park, Kyeong-Soo; Ryu, So-Yeon; Choi, Seong-Woo; Kim, Bok-Hee; Oh, Gyung-Jae; Kweon, Sun-Seog

2016-04-01

We examined the associations between HbA1c levels and various atherosclerotic vascular parameters among adults without diabetes from the general population. A total of 6500 community-dwelling adults, who were free of type 2 diabetes and ≥50 years of age, were included. High-resolution B-mode ultrasound was used to evaluate carotid artery structure, including intima-media thickness (IMT), plaque, and luminal diameter. Brachial-ankle pulse wave velocity (baPWV), which is a useful indicator of systemic arterial stiffness, was determined using an automatic waveform analysis device. No significant associations were observed between HbA1c, carotid IMT, plaque, or luminal diameter in a fully adjusted model. However, the odds ratio (95% confidence interval) for high baPWV (defined as the highest quartile) increased by 1.43 (1.19-1.71) per 1% HbA1c increase after adjusting for conventional risk factors in a multivariate logistic regression analysis. In addition, HbA1c was independently associated with baPWV in a multivariate linear regression analysis. High-normal HbA1c level was independently associated with arterial stiffness, but not with carotid atherosclerotic parameters, in the general population without diabetes. Our results suggest that the functional atherosclerotic process may already be accelerated according to HbA1c level, even at a level below the diagnostic threshold for diabetes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Intensity-Duration-Frequency curves from remote sensing datasets: direct comparison of weather radar and CMORPH over the Eastern Mediterranean

NASA Astrophysics Data System (ADS)

Morin, Efrat; Marra, Francesco; Peleg, Nadav; Mei, Yiwen; Anagnostou, Emmanouil N.

2017-04-01

Rainfall frequency analysis is used to quantify the probability of occurrence of extreme rainfall and is traditionally based on rain gauge records. The limited spatial coverage of rain gauges is insufficient to sample the spatiotemporal variability of extreme rainfall and to provide the areal information required by management and design applications. Conversely, remote sensing instruments, even if quantitative uncertain, offer coverage and spatiotemporal detail that allow overcoming these issues. In recent years, remote sensing datasets began to be used for frequency analyses, taking advantage of increased record lengths and quantitative adjustments of the data. However, the studies so far made use of concepts and techniques developed for rain gauge (i.e. point or multiple-point) data and have been validated by comparison with gauge-derived analyses. These procedures add further sources of uncertainty and prevent from isolating between data and methodological uncertainties and from fully exploiting the available information. In this study, we step out of the gauge-centered concept presenting a direct comparison between at-site Intensity-Duration-Frequency (IDF) curves derived from different remote sensing datasets on corresponding spatial scales, temporal resolutions and records. We analyzed 16 years of homogeneously corrected and gauge-adjusted C-Band weather radar estimates, high-resolution CMORPH and gauge-adjusted high-resolution CMORPH over the Eastern Mediterranean. Results of this study include: (a) good spatial correlation between radar and satellite IDFs ( 0.7 for 2-5 years return period); (b) consistent correlation and dispersion in the raw and gauge adjusted CMORPH; (c) bias is almost uniform with return period for 12-24 h durations; (d) radar identifies thicker tail distributions than CMORPH and the tail of the distributions depends on the spatial and temporal scales. These results demonstrate the potential of remote sensing datasets for rainfall frequency analysis for management (e.g. warning and early-warning systems) and design (e.g. sewer design, large scale drainage planning)

Physical activity increases survival after heart valve surgery.

PubMed

Lund, K; Sibilitz, K L; Berg, S K; Thygesen, L C; Taylor, R S; Zwisler, A D

2016-09-01

Increased physical activity predicts survival and reduces risk of readmission in patients with coronary heart disease. However, few data show how physical activity is associated with survival and readmission after heart valve surgery. Objective were to assess the association between physical activity levels 6-12 months after heart valve surgery and (1) survival, (2) hospital readmission 18-24 months after surgery and (3) participation in exercise-based cardiac rehabilitation. Prospective cohort study with registry data from The CopenHeart survey, The Danish National Patient Register and The Danish Civil Registration System of 742 eligible patients. Physical activity was quantified with the International Physical Activity Questionnaire and analysed using Kaplan-Meier analysis and Cox regression and logistic regression methods. Patients with a moderate to high physical activity level had a reduced risk of mortality (3 deaths in 289 patients, 1%) compared with those with a low physical activity level (13 deaths in 235 patients, 5.5%) with a fully adjusted HR of 0.19 (95% CI 0.05 to 0.70). In contrast, physical activity level was not associated with the risk of hospital readmission. Patients who participated in exercise-based cardiac rehabilitation (n=297) were more likely than the non-participants (n=200) to have a moderate or high physical activity level than a low physical activity level (fully adjusted OR: 1.52, 95% CI 1.03 to 2.24). Moderate to high levels of physical activity after heart valve surgery are positively associated with higher survival rates and participation in cardiac rehabilitation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Is There a Relationship Between Patient Beliefs or Communication About Generic Drugs and Medication Utilization?

PubMed Central

Shrank, William H.; Cadarette, Suzanne M.; Cox, Emily; Fischer, Michael A.; Mehta, Jyotsna; Brookhart, Alan M.; Avorn, Jerry; Choudhry, Niteesh K.

2009-01-01

Background Insurers and policymakers strive to stimulate more cost-effective prescribing and, increasingly, are educating beneficiaries about generics. Objectives To evaluate the relationship between patient beliefs and communication about generic drugs and actual drug use. Research Design and Subjects We performed a national mailed survey of a random sample of 2500 commercially-insured adults. Patient responses were linked to pharmacy claims data to assess actual generic medication use. Measures We used factor analysis to develop 5 multi-item scales from patient survey responses that measured: (1) general preferences for generics, (2) generic safety/effectiveness, (3) generic cost/value, (4) comfort with generic substitution, and (5) communication with providers about generics. The relationship between each scale and the proportion of prescriptions filled for generics was assessed using linear regression, controlling for demographic, health, and insurance characteristics. Separate models were created for each scale and then all 5 scales were included simultaneously in a fully-adjusted model. Results The usable response rate was 48%. When evaluated independently, a 1 SD increase in each of the 5 scales was associated with a 3.1% to 6.3% increase in generic drug use (P < 0.05 for each). In the fully adjusted model, only 2 scales were significantly associated with generic drug use: comfort with generic substitution (P = 0.021) and communication with providers about generic drugs (P = 0.012). Conclusions Generic drug use is most closely associated with the 2 actionable items we evaluated: communication with providers about generics and comfort with generic substitution. Educational campaigns that focus on these 2 domains may be most effective at influencing generic drug use. PMID:19194329

The association between obesity and self-reported sinus infection in non-smoking adults: a cross-sectional study.

PubMed

Christensen, R A G; Raiber, L; Macpherson, A K; Kuk, J L

2016-12-01

The aim of this article was to examine the associations between having had a sinus infection (SI) and BMI and physical activity (PA), diet quality, stress and/or sleep. A total of 2915 adults from the National Health and Nutrition Examination Survey 2005-2006 were examined. Logistic regression analysis was used to examine the association between having had an SI with BMI and PA, diet quality, stress or sleep. As these factors are known to influence one another, a fully adjusted model with PA, diet quality, stress and sleep was also constructed to examine their independent associations with having had an SI. Overall, 15.5 ± 1.2% of the population report having had an SI in the past year. In all models, individuals with obesity were approximately twice as likely to have had an SI compared to those of normal weight (P < 0.05). While PA and diet quality were not significantly associated with having had an SI (P > 0.05), individuals with stress and sleep troubles were also twice as likely to have had an SI (P < 0.05) independent of BMI. In the fully adjusted model, only the associations for BMI and sleep troubles remained significant (P < 0.05). Results from this study suggest that obesity and sleep troubles, but not PA, quality of diet and stress, are associated with having had an SI. As interactions exist between obesity, immune system factors and exposure to infectious disease(s), more research is necessary to understand the directionality of these relationships. © 2016 World Obesity Federation.

Associations of lifetime walking and weight bearing exercise with accelerometer-measured high impact physical activity in later life.

PubMed

Elhakeem, Ahmed; Hannam, Kimberly; Deere, Kevin C; Hartley, April; Clark, Emma M; Moss, Charlotte; Edwards, Mark H; Dennison, Elaine; Gaysin, Tim; Kuh, Diana; Wong, Andrew; Fox, Kenneth R; Cooper, Cyrus; Cooper, Rachel; Tobias, Jon H

2017-12-01

High impact physical activity (PA) is thought to benefit bone. We examined associations of lifetime walking and weight bearing exercise with accelerometer-measured high impact and overall PA in later life. Data were from 848 participants (66.2% female, mean age = 72.4 years) from the Cohort for Skeletal Health in Bristol and Avon, Hertfordshire Cohort Study and MRC National Survey of Health and Development. Acceleration peaks from seven-day hip-worn accelerometer recordings were used to derive counts of high impact and overall PA. Walking and weight bearing exercise up to age 18, between 18-29, 30-49 and since age 50 were recalled using questionnaires. Responses in each age category were dichotomised and cumulative scores derived. Linear regression was used for analysis. Greater lifetime walking was related to higher overall, but not high impact PA, whereas greater lifetime weight bearing exercise was related to higher overall and high impact PA. For example, fully-adjusted differences in log-overall and log-high impact PA respectively for highest versus lowest lifetime scores were: walking [0.224 (0.087, 0.362) and 0.239 (- 0.058, 0.536)], and weight bearing exercise [0.754 (0.432, 1.076) and 0.587 (0.270, 0.904)]. For both walking and weight bearing exercise, associations were strongest in the 'since age 50' category. Those reporting the most walking and weight bearing exercise since age 50 had highest overall and high impact PA, e.g. fully-adjusted difference in log-high impact PA versus least walking and weight bearing exercise = 0.588 (0.226, 0.951). Promoting walking and weight bearing exercise from midlife may help increase potentially osteogenic PA levels in later life.

Relationship of Having Hobbies and a Purpose in Life With Mortality, Activities of Daily Living, and Instrumental Activities of Daily Living Among Community-Dwelling Elderly Adults

PubMed Central

Tomioka, Kimiko; Kurumatani, Norio; Hosoi, Hiroshi

2016-01-01

Background This study’s aim was to clarify the relationship of having hobbies and a purpose in life (PIL; in Japanese, ikigai) with mortality and a decline in the activities of daily living (ADL) and instrumental ADL (IADL) among the community-dwelling elderly. Methods Prospective observational data from residents aged ≥65 years who were at increased risk for death (n = 1853) and developing a decline in ADL (n = 1254) and IADL (n = 1162) were analyzed. Cox proportional hazard models were used for mortality analysis of data from February 2011 to November 2014. ADL and IADL were evaluated using the Barthel Index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, respectively. ADL and IADL were assessed at baseline and follow-up and were evaluated using logistic regression models. Fully adjusted models included terms for age, gender, BMI, income, alcohol intake, smoking history, number of chronic diseases, cognitive function, and depression. Results During the follow-up of eligible participants, 248 had died, 119 saw a decline in ADL, and 178 saw a decline in IADL. In fully adjusted models, having neither hobbies nor PIL was significantly associated with an increased risk of mortality (hazard ratio 2.08; 95% confidence interval [CI], 1.47–2.94), decline in ADL (odds ratio 2.74; 95% CI, 1.44–5.21), and decline in IADL (odds ratio 1.89; 95% CI, 1.01–3.55) compared to having both hobbies and PIL. Conclusions Although effect modifications by cognitive functioning and depression cannot be ruled out, our findings suggest that having hobbies and PIL may extend not only longevity, but also healthy life expectancy among community-dwelling older adults. PMID:26947954

Relationship of Having Hobbies and a Purpose in Life With Mortality, Activities of Daily Living, and Instrumental Activities of Daily Living Among Community-Dwelling Elderly Adults.

PubMed

Tomioka, Kimiko; Kurumatani, Norio; Hosoi, Hiroshi

2016-07-05

This study's aim was to clarify the relationship of having hobbies and a purpose in life (PIL; in Japanese, ikigai) with mortality and a decline in the activities of daily living (ADL) and instrumental ADL (IADL) among the community-dwelling elderly. Prospective observational data from residents aged ≥65 years who were at increased risk for death (n = 1853) and developing a decline in ADL (n = 1254) and IADL (n = 1162) were analyzed. Cox proportional hazard models were used for mortality analysis of data from February 2011 to November 2014. ADL and IADL were evaluated using the Barthel Index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, respectively. ADL and IADL were assessed at baseline and follow-up and were evaluated using logistic regression models. Fully adjusted models included terms for age, gender, BMI, income, alcohol intake, smoking history, number of chronic diseases, cognitive function, and depression. During the follow-up of eligible participants, 248 had died, 119 saw a decline in ADL, and 178 saw a decline in IADL. In fully adjusted models, having neither hobbies nor PIL was significantly associated with an increased risk of mortality (hazard ratio 2.08; 95% confidence interval [CI], 1.47-2.94), decline in ADL (odds ratio 2.74; 95% CI, 1.44-5.21), and decline in IADL (odds ratio 1.89; 95% CI, 1.01-3.55) compared to having both hobbies and PIL. Although effect modifications by cognitive functioning and depression cannot be ruled out, our findings suggest that having hobbies and PIL may extend not only longevity, but also healthy life expectancy among community-dwelling older adults.

Ethnic Differences in Mammographic Densities: An Asian Cross-Sectional Study

PubMed Central

Mariapun, Shivaani; Li, Jingmei; Yip, Cheng Har; Taib, Nur Aishah Mohd; Teo, Soo-Hwang

2015-01-01

Background Mammographic density is a strong risk factor for breast cancer and is highly variable, but, to date, few studies have examined density in Asian women, particularly those in low and middle-income Asian countries where genetic and lifestyle determinants may be significantly different. Methods A total of 1,240 women who attended an opportunistic mammogram screening programme were eligible for analysis. Mammographic density was estimated using a fully-automated thresholding method and differences across ethnic groups were examined using linear regression in 205 randomly selected Chinese women, 138 Malay and 199 Indian women. Results Percent density was significantly higher in Chinese women (28.5%; 95% CI 27.0%, 30.0%) compared to Malay (24.2%; 95% CI 22.5%, 26.0%) and Indian (24.3%; 95% CI 22.8%, 25.7%) women (p<0.001), after adjustment for age, BMI, menopausal status, parity and age at first full term pregnancy. Correspondingly, adjusted nondense area was significantly lower in Chinese (72.2cm2; 95% CI 67.9cm2, 76.5cm2) women compared to Malay (92.1cm2; 95% CI 86.9cm2, 97.2cm2) and Indian (97.7cm2; 95% CI 93.4cm2, 101.9cm2) women (p<0.001), but dense area did not differ across the three ethnic groups. Conclusions Our study shows that higher percent density and lower nondense area reflect the higher incidence of breast cancer in Chinese compared to Malay and Indian women in Malaysia. Known lifestyle determinants of mammographic density do not fully account for the ethnic variations observed in mammographic density in this Asian cohort. PMID:25659139

Ethnic differences in mammographic densities: an Asian cross-sectional study.

PubMed

Mariapun, Shivaani; Li, Jingmei; Yip, Cheng Har; Taib, Nur Aishah Mohd; Teo, Soo-Hwang

2015-01-01

Mammographic density is a strong risk factor for breast cancer and is highly variable, but, to date, few studies have examined density in Asian women, particularly those in low and middle-income Asian countries where genetic and lifestyle determinants may be significantly different. A total of 1,240 women who attended an opportunistic mammogram screening programme were eligible for analysis. Mammographic density was estimated using a fully-automated thresholding method and differences across ethnic groups were examined using linear regression in 205 randomly selected Chinese women, 138 Malay and 199 Indian women. Percent density was significantly higher in Chinese women (28.5%; 95% CI 27.0%, 30.0%) compared to Malay (24.2%; 95% CI 22.5%, 26.0%) and Indian (24.3%; 95% CI 22.8%, 25.7%) women (p<0.001), after adjustment for age, BMI, menopausal status, parity and age at first full term pregnancy. Correspondingly, adjusted nondense area was significantly lower in Chinese (72.2cm2; 95% CI 67.9cm2, 76.5cm2) women compared to Malay (92.1cm2; 95% CI 86.9cm2, 97.2cm2) and Indian (97.7cm2; 95% CI 93.4cm2, 101.9cm2) women (p<0.001), but dense area did not differ across the three ethnic groups. Our study shows that higher percent density and lower nondense area reflect the higher incidence of breast cancer in Chinese compared to Malay and Indian women in Malaysia. Known lifestyle determinants of mammographic density do not fully account for the ethnic variations observed in mammographic density in this Asian cohort.

Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage.

PubMed

Liotta, Eric M; Prabhakaran, Shyam; Sangha, Rajbeer S; Bush, Robin A; Long, Alan E; Trevick, Stephen A; Potts, Matthew B; Jahromi, Babak S; Kim, Minjee; Manno, Edward M; Sorond, Farzaneh A; Naidech, Andrew M; Maas, Matthew B

2017-08-22

We tested the hypothesis that admission serum magnesium levels are associated with hematoma volume, hematoma growth, and functional outcomes in patients with intracerebral hemorrhage (ICH). Patients presenting with spontaneous ICH were enrolled in an observational cohort study that prospectively collected demographic, clinical, laboratory, radiographic, and outcome data. We performed univariate and adjusted multivariate analyses to assess for associations between serum magnesium levels and initial hematoma volume, final hematoma volume, and in-hospital hematoma growth as radiographic measures of hemostasis, and functional outcome measured by the modified Rankin Scale (mRS) at 3 months. We included 290 patients for analysis. Admission serum magnesium was 2.0 ± 0.3 mg/dL. Lower admission magnesium levels were associated with larger initial hematoma volumes on univariate ( p = 0.02), parsimoniously adjusted ( p = 0.002), and fully adjusted models ( p = 0.006), as well as greater hematoma growth ( p = 0.004, p = 0.005, and p = 0.008, respectively) and larger final hematoma volumes ( p = 0.02, p = 0.001, and p = 0.002, respectively). Lower admission magnesium level was associated with worse functional outcomes at 3 months (i.e., higher mRS; odds ratio 0.14, 95% confidence interval 0.03-0.64, p = 0.011) after adjustment for age, admission Glasgow Coma Scale score, initial hematoma volume, time from symptom onset to initial CT, and hematoma growth, with evidence that the effect of magnesium is mediated through hematoma growth. These data support the hypothesis that magnesium exerts a clinically meaningful influence on hemostasis in patients with ICH. © 2017 American Academy of Neurology.

Twenty-four-hour respiratory quotient: the role of diet and familial resemblance.

PubMed

Toubro, S; Sørensen, T I; Hindsberger, C; Christensen, N J; Astrup, A

1998-08-01

Body weight and obesity show familial resemblance that could be the result of familial correlation of fat oxidation, low levels of which have been implicated in the etiology of weight gain and obesity. We studied the familial correlation of both 24-h respiratory quotient (RQ), an index of the ratio of fat to carbohydrate oxidation, and the possible influence of dietary macronutrient composition expressed by the food quotient (FQ), i.e. the theoretical RQ produced by the diet. We measured the habitual FQ of the 7 days diet by weighed food records, followed by measurement of 24-h RQ in respiration chambers in 71 healthy Caucasian siblings from 31 families. After adjustment for age, gender, and 24-h energy balance, 24-h RQ correlated in families as indicated by an intraclass correlation coefficient (r(i)) of 0.31 (P = 0.03). FQ, adjusted for age and gender, was also a familial trait for the two days immediately preceding diet (r(i) = 0.32, P < 0.01). The familial effect on 24-h RQ, adjusted for age, gender, and 24-h energy balance, remained after adjustment for the FQ of the two days preceding diet (r(i) = 0.27, P < 0.05) and was reduced but not abolished after further adjustment for fasting plasma insulin plus free fatty acids (r(i) = 0.24, P < 0.09). By a correlation analysis aimed at separating familial and individual nonfamilial factors influencing both 24-h RQ and FQ, we found a great but insignificant familial (etaF = 0.49, P < 0.18) and a somewhat lower, but significant individual nonfamilial correlation (etaNF = 0.35, P < 0.03). We conclude that substrate oxidation rates measured by RQ exhibit familial correlation after proper adjustment for confounders such as energy balance, gender, and age, and that this effect could not be fully explained by preceding diet composition, fasting plasma insulin, and free fatty acids. Further RQ and the habitual dietary composition shared familial and nonfamilial factors.

Influence of turbulence, orientation, and site configuration on the response of buildings to extreme wind.

PubMed

Aly, Aly Mousaad

2014-01-01

Atmospheric turbulence results from the vertical movement of air, together with flow disturbances around surface obstacles which make low- and moderate-level winds extremely irregular. Recent advancements in wind engineering have led to the construction of new facilities for testing residential homes at relatively high Reynolds numbers. However, the generation of a fully developed turbulence in these facilities is challenging. The author proposed techniques for the testing of residential buildings and architectural features in flows that lack fully developed turbulence. While these methods are effective for small structures, the extension of the approach for large and flexible structures is not possible yet. The purpose of this study is to investigate the role of turbulence in the response of tall buildings to extreme winds. In addition, the paper presents a detailed analysis to investigate the influence of upstream terrain conditions, wind direction angle (orientation), and the interference effect from the surrounding on the response of high-rise buildings. The methodology presented can be followed to help decision makers to choose among innovative solutions like aerodynamic mitigation, structural member size adjustment, and/or damping enhancement, with an objective to improve the resiliency and the serviceability of buildings.

Influence of Turbulence, Orientation, and Site Configuration on the Response of Buildings to Extreme Wind

PubMed Central

2014-01-01

Atmospheric turbulence results from the vertical movement of air, together with flow disturbances around surface obstacles which make low- and moderate-level winds extremely irregular. Recent advancements in wind engineering have led to the construction of new facilities for testing residential homes at relatively high Reynolds numbers. However, the generation of a fully developed turbulence in these facilities is challenging. The author proposed techniques for the testing of residential buildings and architectural features in flows that lack fully developed turbulence. While these methods are effective for small structures, the extension of the approach for large and flexible structures is not possible yet. The purpose of this study is to investigate the role of turbulence in the response of tall buildings to extreme winds. In addition, the paper presents a detailed analysis to investigate the influence of upstream terrain conditions, wind direction angle (orientation), and the interference effect from the surrounding on the response of high-rise buildings. The methodology presented can be followed to help decision makers to choose among innovative solutions like aerodynamic mitigation, structural member size adjustment, and/or damping enhancement, with an objective to improve the resiliency and the serviceability of buildings. PMID:24701140

Africans Away from Home.

ERIC Educational Resources Information Center

Clarke, John Henrik

Africans who were brought across the Atlantic as slaves never fully adjusted to slavery or accepted its inevitability. Resistance began on board the slave ships, where many jumped overboard or committed suicide. African slaves in South America led the first revolts against tyranny in the New World. The first slave revolt in the Caribbean occurred…

75 FR 35447 - Buy American Exception Under the American Recovery and Reinvestment Act of 2009; Nationwide...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-22

... Reinvestment and Recovery Act of 2009 (Recovery Act) to EERE-funded projects for non-residential programmable...[hyphen]residential programmable thermostats; commercial scale fully-automatic wood pellet boiler systems...) Programmable Thermostats--Includes devices that permit adjustment of heating or air-conditioning operations...

Tobacco smoking is associated with psychotic experiences in the general population of South London.

PubMed

Bhavsar, V; Jauhar, S; Murray, R M; Hotopf, M; Hatch, S L; McNeill, A; Boydell, J; MacCabe, J H

2018-01-01

The association between cigarette smoking and psychosis remains unexplained, but could relate to causal effects in both directions, confounding by socioeconomic factors, such as ethnicity, or use of other substances, including cannabis. Few studies have evaluated the association between cigarettes and psychotic experiences (PEs) in diverse, inner-city populations, or relationships with number of cigarettes consumed. We assessed associations and dose-response relationships between cigarette smoking and PEs in a cross-sectional survey of household residents (n = 1680) in South East London, using logistic regression to adjust for cannabis use, other illicit substances, and socioeconomic factors, including ethnicity. We found association between any PEs and daily cigarette smoking, which remained following adjustment for age, gender, ethnicity, cannabis and use of illicit stimulant drugs (fully adjusted odds ratio 1.47, 95% confidence interval 1.01-2.15). Fully adjusted estimates for the association, and with number of PEs, increased with number of cigarettes smoked daily, implying a dose-response effect (p = 0.001 and <0.001, respectively). Odds of reporting any PEs in ex-smokers were similar to never-smokers. In this diverse epidemiological sample, association between smoking and PEs was not explained by confounders such as cannabis or illicit drugs. Daily cigarette consumption showed a dose-response relationship with the odds of reporting PEs, and of reporting a greater number of PEs. There was no difference in odds of reporting PEs between ex-smokers and never-smokers, raising the possibility that the increase in PEs associated with smoking may be reversible.

Circulating SFRP5 levels are elevated in drug-naïve recently diagnosed type 2 diabetic patients as compared with prediabetic subjects and controls.

PubMed

Canivell, Silvia; Rebuffat, Sandra; Ruano, Elena G; Kostov, Belchin; Sisó-Almirall, Antoni; Novials, Anna; Ceriello, Antonio; Gomis, Ramon

2015-02-01

Secreted frizzled-related protein 5 (SFRP5) has been linked to obesity. Results are conflicting regarding its association with type 2 diabetes (T2D) in humans. We aimed to investigate circulating SFRP5 in prediabetes and T2D and its potential association with parameters of insulin resistance and beta-cell function. We studied 70 drug-naïve T2D patients, 70 prediabetic subjects and 70 controls. All subjects were body mass index matched to the T2D patients and overweight or obese. SFRP5, hormones and cytokines levels were measured by ELISA. Serum SFRP5 levels were elevated in T2D patients as compared with prediabetic subjects (median 15.6, interquartile range [9-24.5] ng/mL vs 9.8 [5-14.2] ng/mL, p < 0.001, respectively) and controls (15.6 [9-24.5] ng/mL vs 10.4 [6.7-16.6] ng/mL, P < 0.001, respectively). No differences were found in serum SFRP5 levels between prediabetic subjects and controls (9.8 [5-14.2] ng/mL vs 10.4 [6.7-16.6] ng/mL, p = 0.472, respectively). After adjusting for potential confounders (age, gender, body mass index, triglycerides, high-density lipoprotein cholesterol and blood pressure), T2D was still associated with higher values of SFRP5 as compared with prediabetes in multinomial logistic regression analysis (fully adjusted odds ratio 3.50, 95% confidence interval 1.40-8.79, p = 0.008). The association was more subtle when comparing T2D with normal glucose tolerance state (fully adjusted odds ratio 2.18, 95% confidence interval 0.91-5.21, p = 0.078). Circulating SFRP5 levels were independently associated with T2D as compared with prediabetes and normal glucose tolerance state. Copyright © 2014 John Wiley & Sons, Ltd.

Racial and ethnic differences in contraceptive use among women who desire no future children, 2006-2010 National Survey of Family Growth.

PubMed

Grady, Cynthia D; Dehlendorf, Christine; Cohen, Elan D; Schwarz, E Bimla; Borrero, Sonya

2015-07-01

To evaluate racial/ethnic differences in contraceptive use among women who do not desire future pregnancy. We used the 2006-2010 National Survey of Family Growth to examine the associations between race/ethnicity and 1) use of any contraceptive method at last heterosexual intercourse and 2) effectiveness of contraceptive method used among women who stated that they did not desire any (more) children. We conducted multivariable logistic regression to assess the independent effect of race/ethnicity on these outcomes, adjusting for socio-demographic factors, reproductive characteristics, and indicators of healthcare access and utilization. The study sample consisted of 2900 women, aged 15-44 years. The vast majority of women (91.2%) used contraception at last sex, although this varied significantly by race/ethnicity (p<.01). In the fully adjusted model controlling for demographic and reproductive characteristics as well as healthcare access, compared to whites, black women were significantly less likely to use any contraception at last sex (OR: 0.43; 95% CI: 0.27-0.73), while there was no significant difference for Hispanic women (OR: 0.95; 95% CI: 0.52-1.72). Among women who used a method at last sex, the type of contraceptive method varied significantly by race/ethnicity in bivariate analysis (p<.01), although most women (59%) used a highly effective method. In the fully adjusted model, racial/ethnic differences were no longer significant. In this nationally representative cohort of women who report that they do not desire (more) children, black women were significantly less likely than white women to use any contraception at last intercourse; this difference did not appear to be due to differential access to health care. Significant racial/ethnic differences exist in contraceptive use among women who have completed childbearing, which do not appear to be explained by differential socioeconomic status, reproductive characteristics or utilization of healthcare. Other factors, including social mobility and locus of reproductive control, that may contribute to these variations should be further explored. Published by Elsevier Inc.

Preterm Birth, Age at School Entry and Long Term Educational Achievement.

PubMed

Odd, David; Evans, David; Emond, Alan

2016-01-01

To investigate if the detrimental impact of year of entering education in preterm infants persists into adolescence. Preterm infants are often enrolled in school a year earlier than would be expected if this decision is based on their actual date of birth rather than their due date. Initially these infants appear to do disproportionately worse than those who do not 'skip' a year. However, it is unclear if this effect remains as the infants grow, to have an important effect on long term achievements in education. A cohort study, drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC). The exposure measurement was gestational age (defined as preterm (<37 weeks gestation) or term (37-42 weeks)). The primary outcome was a low score at the Key Stage 4 (KS4) educational assessment or receiving special educational needs support (both at age 16). We derived conditional regression models matching preterm to term infants on their date of birth (DOB), their expected date of delivery (EDD), or their expected date of delivery and year of school entry. After matching for DOB, preterm infants had an increased odds of SEN (OR 1.57 (1.33-1.86)) and the association remained after adjusting for potential confounders (OR 1.39 (1.14-1.68)). The association remained in the analysis matching for EDD (fully adjusted OR 1.43 (1.17-1.74)) but attenuated after restricting to those infants who were enrolled in school in the same year as the control infants (fully adjusted OR 1.21 (0.97-1.52)). There was less evidence for an impact of prematurity on the KS4 score (Matched for DOB; OR 1.10 (0.91 to 1.34), matched for EDD OR 1.17 (0.96 to 1.42) and EDD and same year of schooling, OR 1.00 (0.80 to 1.26)). This modifiable effect of going to school a year earlier than predicted by their due date appears to have measurable consequences for ex-preterm infants in adolescence and is likely to limit adulthood opportunities.

Pulmonary function and adverse cardiovascular outcomes: Can cardiac function explain the link?

PubMed

Burroughs Peña, Melissa S; Dunning, Allison; Schulte, Phillip J; Durheim, Michael T; Kussin, Peter; Checkley, William; Velazquez, Eric J

2016-12-01

The complex interaction between pulmonary function, cardiac function and adverse cardiovascular events has only been partially described. We sought to describe the association between pulmonary function with left heart structure and function, all-cause mortality and incident cardiovascular hospitalization. This study is a retrospective analysis of patients evaluated in a single tertiary care medical center. We used multivariable linear regression analyses to examine the relationship between FVC and FEV1 with left ventricular ejection fraction (LVEF), left ventricular internal dimension in systole and diastole (LVIDS, LVIDD) and left atrial diameter, adjusting for baseline characteristics, right ventricular function and lung hyperinflation. We also used Cox proportional hazards models to examine the relationship between FVC and FEV1 with all-cause mortality and cardiac hospitalization. A total of 1807 patients were included in this analysis with a median age of 61 years and 50% were female. Decreased FVC and FEV1 were both associated with decreased LVEF. In individuals with FVC less than 2.75 L, decreased FVC was associated with increased all-cause mortality after adjusting for left and right heart echocardiographic variables (hazard ratio [HR] 0.49, 95% CI 0.29, 0.82, respectively). Decreased FVC was associated with increased cardiac hospitalization after adjusting for left heart size (HR 0.80, 95% CI 0.67, 0.96), even in patients with normal LVEF (HR 0.75, 95% CI 0.57, 0.97). In a tertiary care center reduced pulmonary function was associated with adverse cardiovascular events, a relationship that is not fully explained by left heart remodeling or right heart dysfunction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparing the risks of hospitalized heart failure associated with glinide, sulfonylurea, and acarbose use in type 2 diabetes: A nationwide study.

PubMed

Lee, Yen-Chieh; Chang, Chia-Hsuin; Dong, Yaa-Hui; Lin, Jou-Wei; Wu, Li-Chiu; Hwang, Jing-Shiang; Chuang, Lee-Ming

2017-02-01

Increasing evidence suggests that certain newer anti-diabetic drugs are associated with an increased risk of hospitalized heart failure (HHF). However, the potential risks associated with the use of sulfonylurea and glinide have not been carefully evaluated. A retrospective cohort study using the Taiwan National Health Insurance claims database was conducted to examine the risks of HHF among newly diagnosed type 2 diabetic patients who initiated glinide, sulfonylurea, or acarbose therapy during 2006-2012. The outcome of interest was hospitalization due to heart failure after treatment initiation, defined by ICD-9-CM code. A Cox proportional hazard regression model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) using acarbose as the reference group. A total of 25,638 glinide, 272,140 sulfonylurea, and 29,376 acarbose initiators were included in the analysis. Patients who initiated glinide had the highest crude HHF incidence. In the analysis adjusted for baseline differences, a significantly higher risk of HHF was found for glinide (adjusted HR, 1.53; 95% CI, 1.24-1.88), but not for sulfonylurea (adjusted HR, 0.94; 95% CI, 0.80-1.11), as compared with acarbose. The elevated risk remained consistent across different subgroups of patients as well as several sensitivity analyses including exploring the impact of potential unmeasured confounding. These findings indicated that, as compared with acarbose, glinide may be associated with a higher risk of HHF for type 2 diabetic patients. Further researchis needed to fully evaluate the risks and benefits of glinide therapy relative to other oral anti-diabetic agents. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Increased risk of lung cancer in individuals with a family history of the disease: A pooled analysis from the International Lung Cancer Consortium

PubMed Central

Coté, Michele L.; Liu, Mei; Bonassi, Stefano; Neri, Monica; Schwartz, Ann G.; Christiani, David C.; Spitz, Margaret R.; Muscat, Joshua E.; Rennert, Gad; Aben, Katja K.; Andrew, Angeline S.; Bencko, Vladimir; Bickeböller, Heike; Boffetta, Paolo; Brennan, Paul; Brenner, Hermann; Duell, Eric J.; Fabianova, Eleonora; Field, John K.; Foretova, Lenka; Friis, Søren; Harris, Curtis C.; Holcatova, Ivana; Hong, Yun-Chul; Isla, Dolores; Janout, Vladimir; Kiemeney, Lambertus A.; Kiyohara, Chikako; Lan, Qing; Lazarus, Philip; Lissowska, Jolanta; Marchand, Loic Le; Mates, Dana; Matsuo, Keitaro; Mayordomo, Jose I.; McLaughlin, John R.; Morgenstern, Hal; Müeller, Heiko; Orlow, Irene; Park, Bernard J.; Pinchev, Mila; Raji, Olaide Y.; Rennert, Hedy S.; Rudnai, Peter; Seow, Adeline; Stucker, Isabelle; Szeszenia-Dabrowska, Neonila; Teare, M. Dawn; Tjønnelan, Anne; Ugolini, Donatella; van der Heijden, Henricus F.M.; Wichmann, Erich; Wiencke, John K.; Woll, Penella J.; Yang, Ping; Zaridze, David; Zhang, Zuo-Feng; Etzel, Carol J.; Hung, Rayjean J.

2012-01-01

Background and Methods Familial aggregation of lung cancer exists after accounting for cigarette smoking. However, the extent to which family history affects risk by smoking status, histology, relative type and ethnicity is not well described. This pooled analysis included 24 case-control studies in the International Lung Cancer Consortium. Each study collected age of onset/interview, gender, race/ethnicity, cigarette smoking, histology and first-degree family history of lung cancer. Data from 24,380 lung cancer cases and 23,305 healthy controls were analyzed. Unconditional logistic regression models and generalized estimating equations were used to estimate odds ratios and 95% confidence intervals. Results Individuals with a first-degree relative with lung cancer had a 1.51-fold increase in risk of lung cancer, after adjustment for smoking and other potential confounders(95% CI: 1.39, 1.63). The association was strongest for those with a family history in a sibling, after adjustment (OR=1.82, 95% CI: 1.62, 2.05). No modifying effect by histologic type was found. Never smokers showed a lower association with positive familial history of lung cancer (OR=1.25, 95% CI: 1.03, 1.52), slightly stronger for those with an affected sibling (OR=1.44, 95% CI: 1.07, 1.93), after adjustment. Conclusions The increased risk among never smokers and similar magnitudes of the effect of family history on lung cancer risk across histological types suggests familial aggregation of lung cancer is independent of those associated with cigarette smoking. While the role of genetic variation in the etiology of lung cancer remains to be fully characterized, family history assessment is immediately available and those with a positive history represent a higher risk group. PMID:22436981

Demographically Corrected Normative Standards for the Spanish Language Version of the NIH Toolbox Cognition Battery.

PubMed

Casaletto, Kaitlin B; Umlauf, Anya; Marquine, Maria; Beaumont, Jennifer L; Mungas, Daniel; Gershon, Richard; Slotkin, Jerry; Akshoomoff, Natacha; Heaton, Robert K

2016-03-01

Hispanics are the fastest growing ethnicity in the United States, yet there are limited well-validated neuropsychological tools in Spanish, and an even greater paucity of normative standards representing this population. The Spanish NIH Toolbox Cognition Battery (NIHTB-CB) is a novel neurocognitive screener; however, the original norms were developed combining Spanish- and English-versions of the battery. We developed normative standards for the Spanish NIHTB-CB, fully adjusting for demographic variables and based entirely on a Spanish-speaking sample. A total of 408 Spanish-speaking neurologically healthy adults (ages 18-85 years) and 496 children (ages 3-7 years) completed the NIH Toolbox norming project. We developed three types of scores: uncorrected based on the entire Spanish-speaking cohort, age-corrected, and fully demographically corrected (age, education, sex) scores for each of the seven NIHTB-CB tests and three composites (Fluid, Crystallized, Total Composites). Corrected scores were developed using polynomial regression models. Demographic factors demonstrated medium-to-large effects on uncorrected NIHTB-CB scores in a pattern that differed from that observed on the English NIHTB-CB. For example, in Spanish-speaking adults, education was more strongly associated with Fluid scores, but showed the strongest association with Crystallized scores among English-speaking adults. Demographic factors were no longer associated with fully corrected scores. The original norms were not successful in eliminating demographic effects, overestimating children's performances, and underestimating adults' performances on the Spanish NIHTB-CB. The disparate pattern of demographic associations on the Spanish versus English NIHTB-CB supports the need for distinct normative standards developed separately for each population. Fully adjusted scores presented here will aid in more accurately characterizing acquired brain dysfunction among U.S. Spanish-speakers.

Solid Cancer Incidence among the Life Span Study of Atomic Bomb Survivors: 1958-2009.

PubMed

Grant, Eric J; Brenner, Alina; Sugiyama, Hiromi; Sakata, Ritsu; Sadakane, Atsuko; Utada, Mai; Cahoon, Elizabeth K; Milder, Caitlin M; Soda, Midori; Cullings, Harry M; Preston, Dale L; Mabuchi, Kiyohiko; Ozasa, Kotaro

2017-05-01

This is the third analysis of solid cancer incidence among the Life Span Study (LSS) cohort of atomic bomb survivors in Hiroshima and Nagasaki, adding eleven years of follow-up data since the previously reported analysis. For this analysis, several changes and improvements were implemented, including updated dose estimates (DS02R1) and adjustment for smoking. Here, we focus on all solid cancers in aggregate. The eligible cohort included 105,444 subjects who were alive and had no known history of cancer at the start of follow-up. A total of 80,205 subjects had individual dose estimates and 25,239 were not in either city at the time of the bombings. The follow-up period was 1958-2009, providing 3,079,484 person-years of follow-up. Cases were identified by linkage with population-based Hiroshima and Nagasaki Cancer Registries. Poisson regression methods were used to elucidate the nature of the radiation-associated risks per Gy of weighted absorbed colon dose using both excess relative risk (ERR) and excess absolute risk (EAR) models adjusted for smoking. Risk estimates were reported for a person exposed at age 30 years with attained age of 70 years. In this study, 22,538 incident first primary solid cancer cases were identified, of which 992 were associated with radiation exposure. There were 5,918 cases (26%) that occurred in the 11 years (1999-2009) since the previously reported study. For females, the dose response was consistent with linearity with an estimated ERR of 0.64 per Gy (95% CI: 0.52 to 0.77). For males, significant upward curvature over the full dose range as well as restricted dose ranges was observed and therefore, a linear-quadratic model was used, which resulted in an ERR of 0.20 (95% CI: 0.12 to 0.28) at 1 Gy and an ERR of 0.010 (95% CI: -0.0003 to 0.021) at 0.1 Gy. The shape of the ERR dose response was significantly different among males and females (P = 0.02). While there was a significant decrease in the ERR with increasing attained age, this decrease was more rapid in males compared to females. The lowest dose range that showed a statistically significant dose response using the sex-averaged, linear ERR model was 0-100 mGy (P = 0.038). In conclusion, this analysis demonstrates that solid cancer risks remain elevated more than 60 years after exposure. Sex-averaged upward curvature was observed in the dose response independent of adjustment for smoking. Findings from the current analysis regarding the dose-response shape were not fully consistent with those previously reported, raising unresolved questions. At this time, uncertainties in the shape of the dose response preclude definitive conclusions to confidently guide radiation protection policies. Upcoming results from a series of analyses focusing on the radiation risks for specific organs or organ families, as well as continued follow-up are needed to fully understand the nature of radiation-related cancer risk and its public health significance. Data and analysis scripts are available for download at: http://www.rerf.or.jp .

Digital resolver for helicopter model blade motion analysis

NASA Technical Reports Server (NTRS)

Daniels, T. S.; Berry, J. D.; Park, S.

1992-01-01

The paper reports the development and initial testing of a digital resolver to replace existing analog signal processing instrumentation. Radiometers, mounted directly on one of the fully articulated blades, are electrically connected through a slip ring to analog signal processing circuitry. The measured signals are periodic with azimuth angle and are resolved into harmonic components, with 0 deg over the tail. The periodic nature of the helicopter blade motion restricts the frequency content of each flapping and yaw signal to the fundamental and harmonics of the rotor rotational frequency. A minicomputer is employed to collect these data and then plot them graphically in real time. With this and other information generated by the instrumentation, a helicopter test pilot can then adjust the helicopter model's controls to achieve the desired aerodynamic test conditions.

Antibody Levels to Persistent Pathogens and Incident Stroke in Mexican Americans

PubMed Central

Sealy-Jefferson, Shawnita; Gillespie, Brenda W.; Aiello, Allison E.; Haan, Mary N.; Morgenstern, Lewis B.; Lisabeth, Lynda D.

2013-01-01

Background Persistent pathogens have been proposed as risk factors for stroke; however, the evidence remains inconclusive. Mexican Americans have an increased risk of stroke especially at younger ages, as well as a higher prevalence of infections caused by several persistent pathogens. Methodology/Principal Findings Using data from the Sacramento Area Latino Study on Aging (n = 1621), the authors used discrete-time regression to examine associations between stroke risk and (1) immunoglobulin G antibody levels to Helicobacter pylori (H. pylori), Cytomegalovirus, Varicella Zoster Virus, Toxoplasma gondii and Herpes simplex virus 1, and (2) concurrent exposure to several pathogens (pathogen burden), defined as: (a) summed sero-positivity, (b) number of pathogens eliciting high antibody levels, and (c) average antibody level. Models were adjusted for socio-demographics and stroke risk factors. Antibody levels to H. pylori predicted incident stroke in fully adjusted models (Odds Ratio: 1.58; 95% Confidence Interval: 1.09, 2.28). No significant associations were found between stroke risk and antibody levels to the other four pathogens. No associations were found for pathogen burden and incident stroke in fully adjusted models. Conclusions/Significance Our results suggest that exposure to H. pylori may be a stroke risk factor in Mexican Americans and may contribute to ethnic differences in stroke risk given the increased prevalence of exposure to H. pylori in this population. Future studies are needed to confirm this association. PMID:23799066

Sugar-sweetened beverage consumption and genetic predisposition to obesity in 2 Swedish cohorts.

PubMed

Brunkwall, Louise; Chen, Yan; Hindy, George; Rukh, Gull; Ericson, Ulrika; Barroso, Inês; Johansson, Ingegerd; Franks, Paul W; Orho-Melander, Marju; Renström, Frida

2016-09-01

The consumption of sugar-sweetened beverages (SSBs), which has increased substantially during the last decades, has been associated with obesity and weight gain. Common genetic susceptibility to obesity has been shown to modify the association between SSB intake and obesity risk in 3 prospective cohorts from the United States. We aimed to replicate these findings in 2 large Swedish cohorts. Data were available for 21,824 healthy participants from the Malmö Diet and Cancer study and 4902 healthy participants from the Gene-Lifestyle Interactions and Complex Traits Involved in Elevated Disease Risk Study. Self-reported SSB intake was categorized into 4 levels (seldom, low, medium, and high). Unweighted and weighted genetic risk scores (GRSs) were constructed based on 30 body mass index [(BMI) in kg/m(2)]-associated loci, and effect modification was assessed in linear regression equations by modeling the product and marginal effects of the GRS and SSB intake adjusted for age-, sex-, and cohort-specific covariates, with BMI as the outcome. In a secondary analysis, models were additionally adjusted for putative confounders (total energy intake, alcohol consumption, smoking status, and physical activity). In an inverse variance-weighted fixed-effects meta-analysis, each SSB intake category increment was associated with a 0.18 higher BMI (SE = 0.02; P = 1.7 × 10(-20); n = 26,726). In the fully adjusted model, a nominal significant interaction between SSB intake category and the unweighted GRS was observed (P-interaction = 0.03). Comparing the participants within the top and bottom quartiles of the GRS to each increment in SSB intake was associated with 0.24 (SE = 0.04; P = 2.9 × 10(-8); n = 6766) and 0.15 (SE = 0.04; P = 1.3 × 10(-4); n = 6835) higher BMIs, respectively. The interaction observed in the Swedish cohorts is similar in magnitude to the previous analysis in US cohorts and indicates that the relation of SSB intake and BMI is stronger in people genetically predisposed to obesity.

Intimate Partner Violence and Coparenting across the Transition to Parenthood

ERIC Educational Resources Information Center

Kan, Marni L.; Feinberg, Mark E.; Solmeyer, Anna R.

2012-01-01

Intimate partner violence (IPV) between parents has been linked to negative parenting and child maladjustment, yet the mechanisms underlying this association are not fully understood. Based on a theory that violence among parents disrupts the coparental alliance--which has been linked to parenting quality and child adjustment--the authors examined…

Development of a Medicaid Behavioral Health Case-Mix Model

ERIC Educational Resources Information Center

Robst, John

2009-01-01

Many Medicaid programs have either fully or partially carved out mental health services. The evaluation of carve-out plans requires a case-mix model that accounts for differing health status across Medicaid managed care plans. This article develops a diagnosis-based case-mix adjustment system specific to Medicaid behavioral health care. Several…

Shrimp Tropomyosin Retains Antibody Reactivity after Exposure to Acidic Conditions

USDA-ARS?s Scientific Manuscript database

Although shrimp can be found in certain high acid food matrices, the allergenic capacity of shrimp tropomyosin exposed to low pH condition has not been fully clarified. Thus, a model marinade comprising white vinegar adjusted to different pH was used to determine the effects of acid-induced denatura...

Aortic Valve Calcification and Risk of Stroke: The Rotterdam Study.

PubMed

Bos, Daniel; Bozorgpourniazi, Atefeh; Mutlu, Unal; Kavousi, Maryam; Vernooij, Meike W; Moelker, Adriaan; Franco, Oscar H; Koudstaal, Peter J; Ikram, M Arfan; van der Lugt, Aad

2016-11-01

It remains uncertain whether aortic valve calcification (AVC) is a risk factor for stroke. From the population-based Rotterdam Study, 2471 participants (mean age: 69.6 years; 51.8% women) underwent computed tomography to quantify AVC. We assessed prevalent stroke and continuously monitored the remaining participants for the incidence of stroke. Logistic and Cox regression models were used to investigate associations of AVC with prevalent stroke and risk of incident stroke. AVC was present in 33.1% of people. At baseline, 97 participants had ever suffered a stroke. During 18 665 person-years of follow-up (mean: 7.9 years), 135 people experienced a first-ever stroke. The presence of AVC was not associated with prevalent stroke (fully adjusted odds ratio: 0.97 (95% confidence interval, 0.61-1.53]) or with an increased risk of stroke (fully adjusted hazard ratio: 0.99 (95% confidence interval, 0.69-1.44]). Although AVC is a common finding in middle-aged and elderly community-dwelling people, our results suggest that AVC is not associated with an increased risk of stroke. © 2016 American Heart Association, Inc.

Is Childhood Socioeconomic Status Independently Associated with Adult BMI after Accounting for Adult and Neighborhood Socioeconomic Status?

PubMed Central

2017-01-01

Childhood socioeconomic status (SES) is inversely associated with adult weight in high income countries. Whether the influence of childhood SES on adult weight is best described using a critical period model or an accumulation of risk model is not yet settled. This research tests whether childhood SES is associated with adult BMI and likelihood of obesity independent of adult socioeconomic status and neighborhood characteristics. Data on individual childhood and adult characteristics come from the Health and Retirement Study (N = 13,545). Data on neighborhood characteristics come from the 2000 Decennial Census and American Community Survey (2005–2009). In the fully adjusted models, perceived financial hardship before the age of sixteen and having a father who was unemployed are associated with higher BMI among males and, among females, paternal education remains associated with adult BMI. However, childhood SES is not associated with likelihood of obesity after fully adjusting for adult SES and neighborhood characteristics, suggesting that the direct effects of early childhood SES on BMI are small relative to the other factors associated with obesity in adulthood. PMID:28095430

Development and Validation of a Musculoskeletal Model of the Fully Articulated Thoracolumbar Spine and Rib Cage

PubMed Central

Bruno, Alexander G.; Bouxsein, Mary L.; Anderson, Dennis E.

2015-01-01

We developed and validated a fully articulated model of the thoracolumbar spine in opensim that includes the individual vertebrae, ribs, and sternum. To ensure trunk muscles in the model accurately represent muscles in vivo, we used a novel approach to adjust muscle cross-sectional area (CSA) and position using computed tomography (CT) scans of the trunk sampled from a community-based cohort. Model predictions of vertebral compressive loading and trunk muscle tension were highly correlated to previous in vivo measures of intradiscal pressure (IDP), vertebral loading from telemeterized implants and trunk muscle myoelectric activity recorded by electromyography (EMG). PMID:25901907

CKD and the Risk of Acute, Community-Acquired Infections Among Older People With Diabetes Mellitus: A Retrospective Cohort Study Using Electronic Health Records

PubMed Central

McDonald, Helen I.; Thomas, Sara L.; Millett, Elizabeth R.C.; Nitsch, Dorothea

2015-01-01

Background Hospital admissions for community-acquired infection are increasing rapidly in the United Kingdom, particularly among older individuals, possibly reflecting an increasing prevalence of comorbid conditions such as chronic kidney disease (CKD). This study describes associations between CKD (excluding patients treated by dialysis or transplantation) and community-acquired infection incidence among older people with diabetes mellitus. Study Design Retrospective cohort study using primary care records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics admissions data. Setting & Participants 191,709 patients 65 years or older with diabetes mellitus and no history of renal replacement therapy, United Kingdom, 1997 to 2011. Predictor Estimated glomerular filtration rate (eGFR) and history of proteinuria. Outcomes Incidence of community-acquired lower respiratory tract infections (LRTIs, with pneumonia as a subset) and sepsis, diagnosed in primary or secondary care, excluding hospital admissions from time at risk. Measurements Poisson regression was used to calculate incidence rate ratios (IRRs) adjusted for age, sex, smoking status, comorbid conditions, and characteristics of diabetes. Estimates for associations of eGFR with infection were adjusted for proteinuria, and vice versa. Results Strong graded associations between lower eGFRs and infection were observed. Compared with patients with eGFRs ≥ 60 mL/min/1.73 m2, fully adjusted IRRs for pneumonia among those with eGFRs < 15, 15 to 29, 30 to 44, and 45 to 59 mL/min/1.73 m2 were 3.04 (95% CI, 2.42-3.83), 1.73 (95% CI, 1.57-1.92), 1.19 (95% CI, 1.11-1.28), and 0.95 (95% CI, 0.89-1.01), respectively. Associations between lower eGFRs and sepsis were stronger, with fully adjusted IRRs up to 5.56 (95% CI, 3.90-7.94). Those associations with LRTI were weaker but still clinically relevant at up to 1.47 (95% CI, 1.34-1.62). In fully adjusted models, a history of proteinuria remained an independent marker of increased infection risk for LRTI, pneumonia, and sepsis (IRRs of 1.07 [95% CI, 1.05-1.09], 1.26 [95% CI, 1.19-1.33], and 1.33 [95% CI, 1.20-1.47]). Limitations Patients without creatinine results were excluded. Conclusions Strategies to prevent infection among people with CKD are needed. PMID:25641062

Perceived Devaluation and STI Testing Uptake among a Cohort of Street-Involved Youth in a Canadian Setting.

PubMed

Karamouzian, Mohammad; Shoveller, Jean; Dong, Huiru; Gilbert, Mark; Kerr, Thomas; DeBeck, Kora

2017-10-01

Perceived devaluation has been shown to have adverse effects on the mental and physical health outcomes of people who use drugs. However, the impact of perceived devaluation on sexually transmitted infections (STI) testing uptake among street-involved youth, who face multiple and intersecting stigmas due to their association with drug use and risky sexual practices, has not been fully characterized. Data were obtained between December 2013 and November 2014 from a cohort of street-involved youth who use illicit drugs aged 14-26 in Vancouver, British Columbia. Multivariable generalized estimating equations were constructed to assess the independent relationship between perceived devaluation and STI testing uptake. Among 300 street-involved youth, 87.0% reported a high perceived devaluation score at baseline. In the multivariable analysis, high perceived devaluation was negatively associated with STI testing uptake after adjustment for potential confounders (Adjusted Odds Ratio = 0.38, 95% Confidence Interval 0.15-0.98). Perceived devaluation was high among street-involved youth in our sample and appears to have adverse effects on STI testing uptake. HIV prevention and care programs should be examined and improved to better meet the special needs of street-involved youth in non-stigmatizing ways.

Parental Attachment and Adolescents' Perception of School Alienation: The Mediation Role of Self-Esteem and Adjustment.

PubMed

Kocayörük, Ercan; Şimşek, Ömer Faruk

2016-01-01

The present study examined the relationship between adolescents' attachment to parents and their feelings of alienation in the school context by considering the mediating role of adjustment and self-esteem. It was proposed that the degree of attachment to one's parents was associated with adjustment and self-esteem, which in turn predicted possible school alienation. A total of 227 students completed self-report measures on parental attachment, adjustment, self-esteem, and alienation from school. Results were consistent with the attachment theory and related literature that posits that (a) secure attachment to parents was associated with adjustment and self-esteem, (b) secure attachment to parents was negatively associated with feelings of school alienation, and (c) adjustment and self-esteem were a crucial mediators between attachment to parents and school alienation. In addition to enhanced adjustment, the self-esteem of adolescents may be an additional factor in reducing alienation at school. The results also supported the mediator role of self-esteem in the relationship between attachment to parents and adjustment. Finally, the relationship between self-esteem and school alienation were shown to be fully mediated by adjustment. The results were discussed in the context of responsibilities of teachers and school counselors, which may provide both students and parents with the skills to improve social functioning in the school context.

Obstructive sleep apnea and neurocognitive function in a Hispanic/Latino population.

PubMed

Ramos, Alberto R; Tarraf, Wassim; Rundek, Tatjana; Redline, Susan; Wohlgemuth, William K; Loredo, Jose S; Sacco, Ralph L; Lee, David J; Arens, Raanan; Lazalde, Patricia; Choca, James P; Mosley, Thomas; González, Hector M

2015-01-27

We evaluated the association between obstructive sleep apnea (OSA) and neurocognitive function among community-dwelling Hispanic/Latino individuals in the United States. Cross-sectional analysis of the Hispanic Community Health Study/Study of Latinos middle-aged and older adults, aged 45 to 74 years, with neurocognitive test scores at baseline measurements from 2008 to 2011. Neurocognitive scores were measured using the Word Fluency (WF) Test, the Brief-Spanish English Verbal Learning Test (SEVLT), and the Digit Symbol Substitution (DSS) Test. OSA was defined by the apnea-hypopnea index (AHI). Multivariable linear regression models were fit to evaluate relations between OSA and neurocognitive scores. The analysis consisted of 8,059 participants, mean age of 56 years, 55% women, and 41% with less than high school education. The mean AHI was 9.0 (range 0-142; normal AHI <5/h). There was an association between the AHI and all 4 neurocognitive test scores: Brief-SEVLT-sum (β = -0.022) and -recall (β = -0.010), WF (β = -0.023), and DSS (β = -0.050) at p < 0.01 that was fully attenuated by age. In the fully adjusted regression model, female sex was a moderating factor between the AHI and WF (β = -0.027, p < 0.10), SVELT-sum (β = -0.37), SVELT-recall (β = -0.010), and DSS (β = -0.061) at p < 0.01. OSA was associated with worse neurocognitive function in a representative sample of Hispanic/Latino women in the United States. © 2014 American Academy of Neurology.

Socioeconomic deprivation and the clinical management of self-harm: a small area analysis.

PubMed

Carroll, Robert; Knipe, Duleeka; Moran, Paul; Gunnell, David

2017-12-01

Socioeconomic deprivation is associated with increased rates of self-harm but its association with levels of clinical care has not previously been explored. The aim of the current study was to investigate socioeconomic differences in the clinical management of people who self-harm. Cross-sectional analysis of 3607 people presenting to a large inner-city hospital following self-harm. People living in the least deprived quintile were more likely to receive a psychosocial assessment (most vs. least deprived: 63.51 vs. 70.14%). This effect persisted in our fully adjusted model (OR 1.45, CI 1.15-1.82, p = 0.002). Mediation analysis suggested this association was in large part explained by higher rates of self-discharge in people presenting from areas of higher deprivation. Compared to those from more deprived areas, people from less deprived areas are more likely to receive a psychosocial assessment when presenting to hospital following self-harm. The occurrence of higher rates of self-discharge from emergency departments among those from more deprived areas may explain the association.

Intelligence and socioeconomic position in childhood in relation to frailty and cumulative allostatic load in later life: the Lothian Birth Cohort 1936

PubMed Central

Gale, Catharine R; Booth, Tom; Starr, John M; Deary, Ian J

2016-01-01

Background Information on childhood determinants of frailty or allostatic load in later life is sparse. We investigated whether lower intelligence and greater socioeconomic disadvantage in childhood increased the risk of frailty and higher allostatic load, and explored the mediating roles of adult socioeconomic position, educational attainment and health behaviours. Methods Participants were 876 members of the Lothian Birth Cohort 1936 whose intelligence was assessed at age 11. At age 70, frailty was assessed using the Fried criteria. Measurements were made of fibrinogen, triglyceride, total and high-density lipoprotein cholesterol, albumin, glycated haemoglobin, C reactive protein, body mass index and blood pressure, from which an allostatic load score was calculated. Results In sex-adjusted analyses, lower intelligence and lower social class in childhood were associated with an increased risk of frailty: relative risks (95% CIs) were 1.57 (1.21 to 2.03) for a SD decrease in intelligence and 1.48 (1.12 to 1.96) for a category decrease in social class. In the fully adjusted model, both associations ceased to be significant: relative risks were 1.13 (0.83 to 1.54) and 1.19 (0.86 to 1.61), respectively. Educational attainment had a significant mediating effect. Lower childhood intelligence in childhood, but not social class, was associated with higher allostatic load. The sex-adjusted coefficient for allostatic load for a SD decrease in intelligence was 0.10 (0.07 to 0.14). In the fully adjusted model, this association was attenuated but remained significant (0.05 (0.01 to 0.09)). Conclusions Further research will need to investigate the mechanisms whereby lower childhood intelligence is linked to higher allostatic load in later life. PMID:26700299

Circulating Adipokines and Vascular Function: Cross-Sectional Associations in a Community-Based Cohort.

PubMed

Zachariah, Justin P; Hwang, Susan; Hamburg, Naomi M; Benjamin, Emelia J; Larson, Martin G; Levy, Daniel; Vita, Joseph A; Sullivan, Lisa M; Mitchell, Gary F; Vasan, Ramachandran S

2016-02-01

Adipokines may be potential mediators of the association between excess adiposity and vascular dysfunction. We assessed the cross-sectional associations of circulating adipokines with vascular stiffness in a community-based cohort of younger adults. We related circulating concentrations of leptin and leptin receptor, adiponectin, retinol-binding protein 4, and fatty acid-binding protein 4 to vascular stiffness measured by arterial tonometry in 3505 Framingham Third Generation cohort participants free of cardiovascular disease (mean age 40 years, 53% women). Separate regression models estimated the relations of each adipokine to mean arterial pressure and aortic stiffness, as carotid femoral pulse wave velocity, adjusting for age, sex, smoking, heart rate, height, antihypertensive treatment, total and high-density lipoprotein cholesterol, diabetes mellitus, alcohol consumption, estimated glomerular filtration rate, glucose, and C-reactive protein. Models evaluating aortic stiffness also were adjusted for mean arterial pressure. Mean arterial pressure was positively associated with blood retinol-binding protein 4, fatty acid-binding protein 4, and leptin concentrations (all P<0.001) and inversely with adiponectin (P=0.002). In fully adjusted models, mean arterial pressure was positively associated with retinol-binding protein 4 and leptin receptor levels (P<0.002 both). In fully adjusted models, aortic stiffness was positively associated with fatty acid-binding protein 4 concentrations (P=0.02), but inversely with leptin and leptin receptor levels (P≤0.03 both). In our large community-based sample, circulating concentrations of select adipokines were associated with vascular stiffness measures, consistent with the hypothesis that adipokines may influence vascular function and may contribute to the relation between obesity and hypertension. © 2015 American Heart Association, Inc.

Job strain and resting heart rate: a cross-sectional study in a Swedish random working sample.

PubMed

Eriksson, Peter; Schiöler, Linus; Söderberg, Mia; Rosengren, Annika; Torén, Kjell

2016-03-05

Numerous studies have reported an association between stressing work conditions and cardiovascular disease. However, more evidence is needed, and the etiological mechanisms are unknown. Elevated resting heart rate has emerged as a possible risk factor for cardiovascular disease, but little is known about the relation to work-related stress. This study therefore investigated the association between job strain, job control, and job demands and resting heart rate. We conducted a cross-sectional survey of randomly selected men and women in Västra Götalandsregionen, Sweden (West county of Sweden) (n = 1552). Information about job strain, job demands, job control, heart rate and covariates was collected during the period 2001-2004 as part of the INTERGENE/ADONIX research project. Six different linear regression models were used with adjustments for gender, age, BMI, smoking, education, and physical activity in the fully adjusted model. Job strain was operationalized as the log-transformed ratio of job demands over job control in the statistical analyses. No associations were seen between resting heart rate and job demands. Job strain was associated with elevated resting heart rate in the unadjusted model (linear regression coefficient 1.26, 95 % CI 0.14 to 2.38), but not in any of the extended models. Low job control was associated with elevated resting heart rate after adjustments for gender, age, BMI, and smoking (linear regression coefficient -0.18, 95 % CI -0.30 to -0.02). However, there were no significant associations in the fully adjusted model. Low job control and job strain, but not job demands, were associated with elevated resting heart rate. However, the observed associations were modest and may be explained by confounding effects.

Objective evidence of myocardial ischemia in patients with posttraumatic stress disorder.

PubMed

Turner, Jesse H; Neylan, Thomas C; Schiller, Nelson B; Li, Yongmei; Cohen, Beth E

2013-12-01

Patients with posttraumatic stress disorder (PTSD) are at increased risk for cardiovascular disease (CVD), but few studies have included objective measures of CVD and how PTSD causes CVD remains unknown. We sought to determine the association between PTSD and objectively assessed CVD and examine potential underlying mechanisms. Outpatients from two Veterans Affairs Medical Centers were enrolled from 2008 to 2010. Posttraumatic stress disorder was identified using the Clinician Administered PTSD Scale, and standardized exercise treadmill tests were performed to detect myocardial ischemia. Of the 663 participants with complete data, ischemia was present in 17% of patients with PTSD versus 10% of patients without PTSD (p = .006). The association between PTSD and ischemia remained significant after adjusting for potential confounders (age, sex, prior CVD) and mediators (traditional cardiac risk factors, C-reactive protein, obesity, alcohol use, sleep quality, social support, and depression), adjusted odds ratio (OR) 2.42, 95% confidence interval (CI) 1.39 to 4.22, p = .002. Findings remained significant when those with prior CVD were excluded (fully adjusted OR 2.24, 95% CI 1.20-4.18, p = .01) and when continuous PTSD symptom score was used as the predictor (fully adjusted OR per 10-point change in Clinician Administered PTSD Scale score 1.12, 95% CI 1.03-1.22, p = .01). Posttraumatic stress disorder was associated with ischemic changes on exercise treadmill tests independent of traditional cardiac risk factors, C-reactive protein, and several health behaviors and psychosocial risk factors, suggesting additional mechanisms linking PTSD and ischemia should be explored. The association of PTSD and ischemia among patients without known CVD highlights an opportunity for early interventions to prevent progression of cardiovascular disease. Published by Elsevier Inc on behalf of Society of Biological Psychiatry.

Implementation of DSC model and application for analysis of field pile tests under cyclic loading

NASA Astrophysics Data System (ADS)

Shao, Changming; Desai, Chandra S.

2000-05-01

The disturbed state concept (DSC) model, and a new and simplified procedure for unloading and reloading behavior are implemented in a nonlinear finite element procedure for dynamic analysis for coupled response of saturated porous materials. The DSC model is used to characterize the cyclic behavior of saturated clays and clay-steel interfaces. In the DSC, the relative intact (RI) behavior is characterized by using the hierarchical single surface (HISS) plasticity model; and the fully adjusted (FA) behavior is modeled by using the critical state concept. The DSC model is validated with respect to laboratory triaxial tests for clay and shear tests for clay-steel interfaces. The computer procedure is used to predict field behavior of an instrumented pile subjected to cyclic loading. The predictions provide very good correlation with the field data. They also yield improved results compared to those from a HISS model with anisotropic hardening, partly because the DSC model allows for degradation or softening and interface response.

Risk equalization and voluntary deductibles: a complex interaction.

PubMed

van Kleef, R C; Beck, K; van de Ven, W P M M; van Vliet, R C J A

2008-03-01

The presence of voluntary deductibles in the Swiss and Dutch mandatory health insurance has important implications for the respective risk equalization systems. In a theoretical analysis, we discuss the consequences of equalizing three types of expenditures: the net claims that are reimbursed by the insurer, the out-of-pocket expenditures and the expenditure savings due to moral hazard reduction. Equalizing only the net claims, as done in Switzerland, creates incentives for cream skimming and prevents insurers from incorporating out-of-pocket expenditures and moral hazard reductions into their premium structure. In an empirical analysis, we examine the effect of self-selection and conclude that the Swiss and Dutch risk equalization systems do not fully adjust for differences in health status between those who choose a deductible and those who do not. We discuss how this may lead to incentives for cream skimming and to a reduction of cross-subsidies from healthy to unhealthy individuals compared to a situation without voluntary deductibles.

Quality by Design approach in the development of hydrophilic interaction liquid chromatographic method for the analysis of iohexol and its impurities.

PubMed

Jovanović, Marko; Rakić, Tijana; Tumpa, Anja; Jančić Stojanović, Biljana

2015-06-10

This study presents the development of hydrophilic interaction liquid chromatographic method for the analysis of iohexol, its endo-isomer and three impurities following Quality by Design (QbD) approach. The main objective of the method was to identify the conditions where adequate separation quality in minimal analysis duration could be achieved within a robust region that guarantees the stability of method performance. The relationship between critical process parameters (acetonitrile content in the mobile phase, pH of the water phase and ammonium acetate concentration in the water phase) and critical quality attributes is created applying design of experiments methodology. The defined mathematical models and Monte Carlo simulation are used to evaluate the risk of uncertainty in models prediction and incertitude in adjusting the process parameters and to identify the design space. The borders of the design space are experimentally verified and confirmed that the quality of the method is preserved in this region. Moreover, Plackett-Burman design is applied for experimental robustness testing and method is fully validated to verify the adequacy of selected optimal conditions: the analytical column ZIC HILIC (100 mm × 4.6 mm, 5 μm particle size); mobile phase consisted of acetonitrile-water phase (72 mM ammonium acetate, pH adjusted to 6.5 with glacial acetic acid) (86.7:13.3) v/v; column temperature 25 °C, mobile phase flow rate 1 mL min(-1), wavelength of detection 254 nm. Copyright © 2015 Elsevier B.V. All rights reserved.

Dietary Variety and Decline in Lean Mass and Physical Performance in Community-Dwelling Older Japanese: A 4-year Follow-Up Study.

PubMed

Yokoyama, Y; Nishi, M; Murayama, H; Amano, H; Taniguchi, Y; Nofuji, Y; Narita, M; Matsuo, E; Seino, S; Kawano, Y; Shinkai, S

2017-01-01

To examine associations of dietary variety with changes in lean mass and physical performance during a 4-year period in an elderly Japanese population. Four-year prospective study. The Hatoyama Cohort Study and Kusatsu Longitudinal Study, Japan. 935 community-dwelling Japanese aged 65 years or older. Dietary variety was assessed using a 10-item food frequency questionnaire. Body composition was determined by multifrequency bioelectrical impedance analysis, and physical performance (grip strength and usual gait speed) was measured in surveys at baseline and 4 years later. Longitudinal analysis included only participants who were originally in the upper three quartiles of lean body mass, appendicular lean mass, grip strength, and usual gait speed. The outcome measures were decline in lean body mass, appendicular lean mass, grip strength, and usual gait speed, defined as a decrease to the lowest baseline quartile level at the 4-year follow-up survey. Associations of dietary variety with the outcome measures were examined by logistic regression analysis adjusted for potential confounders. In the fully adjusted model, the odds ratios for decline in grip strength and usual gait speed were 0.43 (95% confidence interval, 0.19-0.99) and 0.43 (confidence interval, 0.19-0.99), respectively, for participants in the highest category of dietary variety score as compared with those in the lowest category. Dietary variety was not significantly associated with changes in lean body mass or appendicular lean mass. Among older adults, greater dietary variety may help maintain physical performance, such as grip strength and usual gait speed, but not lean mass.

Appropriate VTE prophylaxis is associated with lower direct medical costs.

PubMed

Amin, Alpesh; Hussein, Mohamed; Battleman, David; Lin, Jay; Stemkowski, Stephen; Merli, Geno J

2010-11-01

To calculate and compare the direct medical costs of guideline-recommended prophylaxis with prophylaxis that does not fully adhere with guideline recommendations in a large, real-world population. Discharge records were retrieved from the US Premier Perspective™ database (January 2003-December 2003) for patients aged≥40 years with a primary diagnosis of cancer, chronic heart failure, lung disease, or severe infectious disease who received some form of thromboprophylaxis. Univariate analysis and multivariate regression modeling were performed to compare direct medical costs between discharges who received appropriate prophylaxis (correct type, dose, and duration based on sixth edition American College of Chest Physicians [ACCP] recommendations) and partial prophylaxis (not in full accordance with ACCP recommendations). Market segmentation analysis was used to compare costs stratified by hospital and patient characteristics. Of the 683 005 discharges included, 148,171 (21.7%) received appropriate prophylaxis and 534,834 (78.3%) received partial prophylaxis. The total direct unadjusted costs were $15,439 in the appropriate prophylaxis group and $17,763 in the partial prophylaxis group. After adjustment, mean adjusted total costs per discharge were lower for those receiving appropriate prophylaxis ($11,713; 95% confidence interval [CI], $11,675-$11,753) compared with partial prophylaxis ($13,369; 95% CI, $13,332-$13 406; P<0.01). Appropriate prophylaxis appeared to be associated with numerically lower unadjusted costs than partial prophylaxis, regardless of hospital size, rural/urban location, teaching status, and patient age and gender. This large, real-world analysis suggests that appropriate prophylaxis, in adherence with ACCP guidelines, is potentially cost-saving compared with partial prophylaxis in at-risk medical patients.

Family-level Coparenting Processes and Child Gender as Moderators of Family Stress and Toddler Adjustment

PubMed Central

Kolak, Amy M.; Vernon-Feagans, Lynne

2009-01-01

The goal of this multi-method study was to examine how child gender and coparenting processes influence associations between family stress and toddlers’ social adjustment. The participants, 104 dual-earner couples and their 2-year-old children, were videotaped in their home during a freeplay activity. Mothers and fathers completed questionnaires about stress in their roles as partners, workers, and parents and their child’s social–emotional adjustment. Consistent with previous research, higher levels of family stress were associated with poorer adjustment for children. Family harmony, represented by warmth and cooperation, was significantly associated with fewer internalizing problems for children even when family stress was considered. Conversely, coparental banter or ‘playful humour’ between parents moderated the nature of the association between family stress and children’s adjustment. Banter between parents was especially protective for girls suggesting that, even in families with toddler-aged children, gender plays an important role in family-level coparenting processes. Future research needs to consider more fully the impact that child characteristics, such as gender, have on the interplay between the family context and children’s development. PMID:19907670

Family-level Coparenting Processes and Child Gender as Moderators of Family Stress and Toddler Adjustment.

PubMed

Kolak, Amy M; Vernon-Feagans, Lynne

2008-01-01

The goal of this multi-method study was to examine how child gender and coparenting processes influence associations between family stress and toddlers' social adjustment. The participants, 104 dual-earner couples and their 2-year-old children, were videotaped in their home during a freeplay activity. Mothers and fathers completed questionnaires about stress in their roles as partners, workers, and parents and their child's social-emotional adjustment. Consistent with previous research, higher levels of family stress were associated with poorer adjustment for children. Family harmony, represented by warmth and cooperation, was significantly associated with fewer internalizing problems for children even when family stress was considered. Conversely, coparental banter or 'playful humour' between parents moderated the nature of the association between family stress and children's adjustment. Banter between parents was especially protective for girls suggesting that, even in families with toddler-aged children, gender plays an important role in family-level coparenting processes. Future research needs to consider more fully the impact that child characteristics, such as gender, have on the interplay between the family context and children's development.

Family employment and child socioemotional behaviour: longitudinal findings from the UK Millennium Cohort Study

PubMed Central

Hope, Steven; Pearce, Anna; Whitehead, Margaret; Law, Catherine

2014-01-01

Background Levels of paid employment in two parent and lone parent families have increased in the UK but evidence of its impact on child socioemotional behaviour is limited and inconsistent. Methods We conducted a longitudinal analysis using the first four sweeps of the Millennium Cohort Study (9 months, 3 years, 5 years and 7 years) to investigate the influence of family employment trajectories in the early years on socioemotional behaviour at 7 years, unadjusted and adjusted for covariates. In addition, mothers’ employment was investigated separately. Results Children from families where no parent was employed for one or more sweeps were at a greater risk of socioemotional problem behaviour compared with those where a parent was continuously employed, even after adjustment for covariates. Children of mothers who were non-employed for one or more sweeps were at greater risk of problem behaviour compared with mothers who were employed at all sweeps. Adjustment for covariates fully attenuated the excess risk for children whose mothers had moved into employment by the time they were 7 years. In contrast, the elevated risk associated with continuous non-employment and a single transition out of employment was attenuated after adjustment for early covariates, fathers’ employment, household income and mothers’ psychological distress at 7 years, but remained significant. Conclusions Family and mothers’ employment were associated with a lower risk of problem behaviour for children in middle childhood, in part explained by sociodemographic characteristics of families and the apparent psychological and socioeconomic benefits of employment. Results for mothers’ transitions in or out of the labour market suggest that child problem behaviour is influenced by current status, over and above diverse earlier experiences of employment and non-employment. PMID:24889054

Associations of sedentary time patterns and TV viewing time with inflammatory and endothelial function biomarkers in children.

PubMed

Gabel, L; Ridgers, N D; Della Gatta, P A; Arundell, L; Cerin, E; Robinson, S; Daly, R M; Dunstan, D W; Salmon, J

2016-06-01

Investigate associations of TV viewing time and accelerometry-derived sedentary time with inflammatory and endothelial function biomarkers in children. Cross-sectional analysis of 164 7-10-year-old children. TV viewing time was assessed by parental proxy report and total and patterns of sedentary time accumulation (e.g. prolonged bouts) were assessed by accelerometry. C-reactive protein (CRP), homeostasis model assessment of insulin resistance, interleukin-2, -6, -8, -10, tumour necrosis factor alpha, adiponectin, resistin, brain-derived neurotrophic factor, soluble intercellular and vascular adhesion molecule 1, plasminogen activator inhibitor 1 and soluble E-selectin were assessed. Generalised linear models assessed the associations of TV viewing and sedentary time with biomarkers, adjusting for sex, waist circumference, moderate- to vigorous-intensity physical activity and diet density. Each additional h week(-1) of TV viewing was associated with 4.4% (95% CI: 2.1, 6.7) greater CRP and 0.6% (0.2, 1.0) greater sVCAM-1 in the fully adjusted model. The association between frequency and duration of 5-10 min bouts of sedentary time and CRP was positive after adjustment for sex and waist circumference but attenuated after adjustment for diet density. This study suggests that TV viewing was unfavourably associated with several markers of inflammation and endothelial dysfunction. The detrimental association between 5 and 10 min bouts of sedentary time and CRP approached significance, suggesting that further research with a stronger study design (longitudinal and/or experimental) is needed to better understand how the accumulation of sedentary time early in life may influence short and longer term health. © 2015 The Authors. Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity.

Associations of sedentary time patterns and TV viewing time with inflammatory and endothelial function biomarkers in children

PubMed Central

Gabel, L.; Ridgers, N. D.; Della Gatta, P. A.; Arundell, L.; Cerin, E.; Robinson, S.; Daly, R. M.; Dunstan, D. W.

2015-01-01

Summary Objective Investigate associations of TV viewing time and accelerometry‐derived sedentary time with inflammatory and endothelial function biomarkers in children. Methods Cross‐sectional analysis of 164 7–10‐year‐old children. TV viewing time was assessed by parental proxy report and total and patterns of sedentary time accumulation (e.g. prolonged bouts) were assessed by accelerometry. C‐reactive protein (CRP), homeostasis model assessment of insulin resistance, interleukin‐2, ‐6, ‐8, ‐10, tumour necrosis factor alpha, adiponectin, resistin, brain‐derived neurotrophic factor, soluble intercellular and vascular adhesion molecule 1, plasminogen activator inhibitor 1 and soluble E‐selectin were assessed. Generalised linear models assessed the associations of TV viewing and sedentary time with biomarkers, adjusting for sex, waist circumference, moderate‐ to vigorous‐intensity physical activity and diet density. Results Each additional h week−1 of TV viewing was associated with 4.4% (95% CI: 2.1, 6.7) greater CRP and 0.6% (0.2, 1.0) greater sVCAM‐1 in the fully adjusted model. The association between frequency and duration of 5–10 min bouts of sedentary time and CRP was positive after adjustment for sex and waist circumference but attenuated after adjustment for diet density. Conclusions This study suggests that TV viewing was unfavourably associated with several markers of inflammation and endothelial dysfunction. The detrimental association between 5 and 10 min bouts of sedentary time and CRP approached significance, suggesting that further research with a stronger study design (longitudinal and/or experimental) is needed to better understand how the accumulation of sedentary time early in life may influence short and longer term health. PMID:26097139

Psychosocial Factors Are Associated With Blood Pressure Progression Among African Americans in the Jackson Heart Study

PubMed Central

Sims, Mario; Higginbotham, John C.; Crowther, Martha R.; Wyatt, Sharon B.; Musani, Solomon K.; Payne, Thomas J.; Fox, Ervin R.; Parton, Jason M.

2016-01-01

BACKGROUND Research that examines the associations of psychosocial factors with incident hypertension among African Americans (AA) is limited. Using Jackson Heart Study (JHS) data, we examined associations of negative affect and stress with incident hypertension and blood pressure (BP) progression among AA. METHODS Our sample consisted of 1,656 normotensive participants at baseline (2000–2004) (mean age 47±12; 61% women). We investigated associations of negative affect (cynical distrust, anger-in, anger-out, and depressive symptoms) and stress (perceived stress, weekly stress inventory (WSI)-event, WSI-impact, and major life events) with BP progression (an increase by one BP stage as defined by JNC VII) and incident hypertension by examination 2 (2005–2008). Poisson regression analysis was utilized to examine the prevalence ratios (PRs; 95% confidence interval (CI)) of BP tracking and incident hypertension with psychosocial factors, adjusting for baseline age, sex, socioeconomic status (SES), and hypertension risk factors. RESULTS Fifty-six percentage of the sample (922 cases) had BP progression from 2005 to 2008. After adjustment for age, sex, and SES, a high anger-out score was associated with a 20% increased risk of BP progression compared to a low anger-out score (PR 1.20; 95% CI 1.05–1.36). High depressive symptoms score was associated with BP progression in the age, sex, and SES-adjusted model (PR 1.14; 95% CI 1.00–1.30). High WSI-event scores were associated with BP progression in the fully adjusted model (PR 1.21; 95% CI 1.04–1.40). We did not observe significant associations with any of the psychosocial measures and incident hypertension. CONCLUSIONS Psychosocial factors were associated with BP progression, with the strongest evidence for number of stressful events that occurred. PMID:26964661

Menopause and myocardial infarction risk among employed women in relation to work and family psychosocial factors in Lithuania.

PubMed

Malinauskiene, Vilija; Tamosiunas, Abdonas

2010-05-01

To assess the relationship between menopause and age at menopause and the risk of the first non-fatal myocardial infarction taking into account the possible influence of psychosocial job characteristics, marital stress, level of social support, educational level, occupation, age and traditional ischemic heart disease risk factors. Population-based case-control study among 35-61 years old employed women in Kaunas, Lithuania. Totally 122 myocardial infarction cases and 371 controls were interviewed in 2001-2004. The logistic regression analysis was performed. Younger age at menopause (

Association Between Chewing Difficulty and Symptoms of Depression in Adults: Results from the Korea National Health and Nutrition Examination Survey.

PubMed

Shin, Hye-Sun; Ahn, Yong-Soon; Lim, Do-Seon

2016-12-01

To assess the association between chewing difficulty and symptoms of depression in a representative sample of the Korean population. Cross-sectional. Korea National Health and Nutrition Examination Survey (KNHANES). KNHANES participants (N = 5,158). Chewing difficulty was assessed according to the self-reported presence of chewing problems using a structured questionnaire. Symptoms of depression were defined as having feelings of sadness or depression consecutively over 2 weeks during the last 12 months. Multivariable logistic regression analysis was used to determine the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of the associations between chewing difficulty and symptoms of depression, adjusted for age; sex; monthly household income; education; number of teeth; number of decayed, missing, or filled permanent teeth; periodontitis; state of dentition; tooth brushing frequency; regular dental visits; smoking status; alcohol consumption; hypertension; diabetes mellitus; and obesity. The interaction effects between chewing difficulty and confounders were evaluated, and age- and sex-stratified analyses were performed. There was a significant positive association between chewing difficulty and symptoms of depression in the fully adjusted model (AOR = 1.86, 95% CI = 1.48-2.33). The strength of the association was highest in men aged 60 and older (AOR = 3.28, 95% CI = 1.54-7.00). Chewing difficulty was independently associated with symptoms of depression in a representative sample of Korean adults. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Piped water supply interruptions and acute diarrhea among under-five children in Addis Ababa slums, Ethiopia: A matched case-control study.

PubMed

Adane, Metadel; Mengistie, Bezatu; Medhin, Girmay; Kloos, Helmut; Mulat, Worku

2017-01-01

The problem of intermittent piped water supplies that exists in low- and middle-income countries is particularly severe in the slums of sub-Saharan Africa. However, little is known about whether there is deterioration of the microbiological quality of the intermittent piped water supply at a household level and whether it is a factor in reducing or increasing the occurrence of acute diarrhea among under-five children in slums of Addis Ababa. This study aimed to determine the association of intermittent piped water supplies and point-of-use (POU) contamination of household stored water by Escherichia coli (E. coli) with acute diarrhea among under-five children in slums of Addis Ababa. A community-based matched case-control study was conducted from November to December, 2014. Cases were defined as under-five children with acute diarrhea during the two weeks before the survey. Controls were matched by age and neighborhood with cases by individual matching. Data were collected using a pre-tested structured questionnaire and E. coli analysis of water from piped water supplies and household stored water. A five-tube method of Most Probable Number (MPN)/100 ml standard procedure was used for E. coli analysis. Multivariable conditional logistic regression with 95% confidence interval (CI) was used for data analysis by controlling potential confounding effects of selected socio-demographic characteristics. During the two weeks before the survey, 87.9% of case households and 51.0% of control households had an intermittent piped water supply for an average of 4.3 days and 3.9 days, respectively. POU contamination of household stored water by E. coli was found in 83.3% of the case households, and 52.1% of the control households. In a fully adjusted model, a periodically intermittent piped water supply (adjusted matched odds ratio (adjusted mOR) = 4.8; 95% CI: 1.3-17.8), POU water contamination in household stored water by E. coli (adjusted mOR = 3.3; 95% CI: 1.1-10.1), water retrieved from water storage containers using handle-less vessels (adjusted mOR = 16.3; 95% CI: 4.4-60.1), and water retrieved by interchangeably using vessels both with and without handle (adjusted mOR = 5.4; 95% CI: 1.1-29.1) were independently associated with acute diarrhea. We conclude that provision of continuously available piped water supplies and education of caregivers about proper water retrieval methods of household stored water can effectively reduce POU contamination of water at the household level and thereby reduce acute diarrhea among under-five children in slums of Addis Ababa. Promotion of household water treatment is also highly encouraged until the City's water authority is able to deliver continuously available piped water supplies.

A Concept Analysis of Fully Informed: Breastfeeding Promotion

DTIC Science & Technology

2005-12-21

updated breastfeeding policy statement, the American Academy of Pediatrics 3 ( AAP , 2005) identified the compelling advantages of breastfeeding and urged...healthcare 4 professionals to implement principles to promote breastfeeding . The AAP cited obstacles 5 to the initiation and continuation of...Analysis of Fully Informed 2 14 A Concept Analysis of Fully Informed: Breastfeeding Promotion 15 In February 2005, the American Academy of Pediatrics ( AAP

Are British Higher Educational Concerns Different from European Higher Educational Concerns?

ERIC Educational Resources Information Center

Mangset, Marte

2008-01-01

British universities are known among the other Bologna countries not to have adjusted fully to the new common three-tier degree structure. Is it the case that British higher educational concerns are different from Continental concerns? A study of recent developments in two British graduate schools of history shows that a three-tier study structure…

Going It Alone: Comparing Subtypes of Withdrawal on Indices of Adjustment and Maladjustment in Emerging Adulthood

ERIC Educational Resources Information Center

Nelson, Larry J.

2013-01-01

Scholars have distinguished conceptually between multiple forms of social withdrawal among children and adolescents, but this distinction has yet to be investigated fully during emerging adulthood. Therefore, the overarching goal of this study was to employ a person-oriented approach to examine differences between subtypes of withdrawal on…

Effect of innate antiviral glycoproteins in breast milk on seroconversion to rotavirus vaccine (Rotarix) in children in Lusaka, Zambia.

PubMed

Mwila-Kazimbaya, Katayi; Garcia, Miguel Pugliese; Bosomprah, Samuel; Laban, Natasha Makabilo; Chisenga, Caroline Cleopatra; Permar, Sallie Robey; Simuyandi, Michelo; Munsaka, Sody; Chilengi, Roma

2017-01-01

Rotavirus vaccines have been introduced into national immunization programmes to mitigate morbidity and mortality associated rotavirus diarrhoea. Lower vaccine effectiveness has however been noted in low-middle income countries, but little is known about the role of maternal components found in breast milk. This study assessed the effect of lactoferrin, lactadherin, and tenascin-c on rotavirus vaccine seroconversion. This was a retrospective cohort study of 128 infants who had been fully immunized with Rotarix™. Serum samples were collected from the infant at baseline and one month after second rotavirus vaccine dose. Breast milk samples were collected from mothers at baseline. Standard ELISA was used to determine titres of rotavirus-specific immunologlobulin G and A in breast milk and serum as well as concentrations of lactoferrin, lactadherin, and tenascin-c. Poisson regression model with robust standard error was used to estimate the effect of breast milk components on seroconversion. The components were modelled on log base 2 so that the effect would be interpreted as a doubling of the concentration. In a multivariable analysis adjusting for maternal age, maternal HIV status, seropositivity at baseline, sex, age of child at vaccination as well as breast milk IgA and IgG, we found evidence of independent effect of LA (Adjusted IRR = 0.95; 95% CI = 0.91-0.99; P = 0.019) on seroconversion while there was no evidence for TNC (Adjusted IRR = 1.00; 95% CI = 0.85-1.17; P = 0.967) and LF (Adjusted RR = 1.01; 95% CI = 0.96-1.05); P = 0.802). We explored the joint effects of the three components but we found no evidence (Adjusted RR = 0.95; 95% CI = 0.81; P = 0.535). High breast milk concentrations of lactadherin might play a role in infant's failure to seroconvert to rotavirus vaccines. Further research to understand this observed association is an important consideration.

Adult education and child mortality in India: the influence of caste, household wealth, and urbanization.

PubMed

Singh-Manoux, Archana; Dugravot, Aline; Smith, George Davey; Subramanyam, Malavika; Subramanian, S V

2008-03-01

Although socioeconomic position is generally found to be related to health, the associations can be different for different measures of socioeconomic position. We examined the association between adult education and child mortality, and the influence of other socioeconomic markers (caste, household wealth, and urbanization) on this association. Data were drawn from the 1998-1999 Indian National Family Health Survey, conducted in 26 states and comprising 66,367 children age 5 years or under. Adult education, for the head of household and spouse, was categorized into 0, 1-8, and 9 or more years of schooling. We used logistic regression to estimate associations between education and child mortality in analysis adjusted for other socioeconomic markers. Effect modification by caste, household wealth, and urbanization was assessed by fitting an interaction term with education. Compared with those who had no education, 9 or more years of education for the head of household and for the spouse were associated with lower child mortality (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.48-0.62 and OR = 0.44; 95% CI = 0.36-0.54, respectively) in analyses adjusted for age, sex, and state of residence. Further adjustments for caste and urbanization attenuated these associations slightly; when adjustments were made for household wealth the associations were attenuated more substantially. Nevertheless, in fully adjusted models, 9 or more years of education for the head of household (OR = 0.81; 95% CI = 0.70-0.93) and the spouse (OR = 0.75; 95% CI = 0.60-0.94) remained associated with lower child mortality. There was no effect modification of this association by caste, household wealth, and urbanization. Adult education has a protective association with child mortality in India. Caste, household wealth, and urbanization do not modify or completely attenuate this association.

Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study

PubMed Central

2013-01-01

Introduction Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors. The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R. Methods Three hundred and forty-six infected adults (age ≥ 15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analyzed using a multinomial logistic regression model. We also searched for the predictors of CHIKV-specific IgG titres, assessed at the time of a serosurvey, using multiple linear regression analysis. Results Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection. In the final model controlling for gender, the determinants of relapsing RMSP were the age 45-59 years (adjusted OR: 2.9, 95% CI: 1.0, 8.6) or greater or equal than 60 years (adjusted OR: 10.4, 95% CI: 3.5, 31.1), severe rheumatic involvement (fever, at least six joints plus four other symptoms) at presentation (adjusted OR: 3.6, 95% CI: 1.5, 8.2), and CHIKV-specific IgG titres (adjusted OR: 3.2, 95% CI: 1.8, 5.5, per one unit increase). Prognostic factors for lingering RMSP were age 45-59 years (adjusted OR: 6.4, 95% CI: 1.8, 22.1) or greater or equal than 60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial rheumatic involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8) and CHIKV-specific IgG titres (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per one unit increase). CHIKV specific IgG titres were positively correlated with age, female gender and the severity of initial rheumatic symptoms. Conclusions Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R. By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response. PMID:23302155

Correlates of Susceptibility to Scams in Older Adults Without Dementia

PubMed Central

James, Bryan D.; Boyle, Patricia A.; Bennett, David A.

2013-01-01

This study examined correlates of susceptibility to scams in 639 community-dwelling older adults without dementia from a cohort study of aging. Regression models adjusted for age, sex, education, and income were used to examine associations between susceptibility to scams, measured by 5-item self-report measure, and a number of potential correlates. Susceptibility was positively associated with age and negatively associated with income, cognition, psychological well being, social support, and literacy. Fully adjusted models indicated that older age and lower levels of cognitive function, decreased psychological well-being, and lower literacy in particular may be markers of susceptibility to financial victimization in old age. PMID:24499279

The necessity of sociodemographic status adjustment in hospital value rankings for perforated appendicitis in children.

PubMed

Tian, Yao; Sweeney, John F; Wulkan, Mark L; Heiss, Kurt F; Raval, Mehul V

2016-06-01

Hospitals are increasingly focused on demonstration of high-value care for common surgical procedures. Although sociodemographic status (SDS) factors have been tied to various surgical outcomes, the impact of SDS factors on hospital value rankings has not been well explored. Our objective was to examine effects of SDS factors on high-value surgical care at the patient level, and to illustrate the importance of SDS adjustment when evaluating hospital-level performance. Perforated appendicitis hospitalizations were identified from the 2012 Kids' Inpatient Database. The primary outcome of interest was high-value care as defined by evaluation of duration of stay and cost. SDS factors included race, health insurance type, median household income, and patient location. The impact of SDS on high-value care was estimated using regression models after accounting for hospital-level variation. Risk-adjusted value rankings were compared before and after adjustment for SDS. From 9,986 hospitalizations, 998 high-value encounters were identified. African Americans were less likely to experience high-value care compared with white patients after adjusting for all SDS variables. Although private insurance and living in nonmetro counties were associated independently with high-value care, the effects were attenuated in the fully adjusted models. For the 136 hospitals ranked according to risk-adjusted value status, 59 hospitals' rankings improved after adjustment and 53 hospitals' rankings declined. After adjustment for patient and hospital factors, SDS has a small but significant impact on risk-adjusted hospital performance ranking for pediatric appendicitis. Adjustment for SDS should be considered in future comparative performance assessment. Copyright © 2016 Elsevier Inc. All rights reserved.

Lessons learned from whole exome sequencing in multiplex families affected by a complex genetic disorder, intracranial aneurysm.

PubMed

Farlow, Janice L; Lin, Hai; Sauerbeck, Laura; Lai, Dongbing; Koller, Daniel L; Pugh, Elizabeth; Hetrick, Kurt; Ling, Hua; Kleinloog, Rachel; van der Vlies, Pieter; Deelen, Patrick; Swertz, Morris A; Verweij, Bon H; Regli, Luca; Rinkel, Gabriel J E; Ruigrok, Ynte M; Doheny, Kimberly; Liu, Yunlong; Broderick, Joseph; Foroud, Tatiana

2015-01-01

Genetic risk factors for intracranial aneurysm (IA) are not yet fully understood. Genomewide association studies have been successful at identifying common variants; however, the role of rare variation in IA susceptibility has not been fully explored. In this study, we report the use of whole exome sequencing (WES) in seven densely-affected families (45 individuals) recruited as part of the Familial Intracranial Aneurysm study. WES variants were prioritized by functional prediction, frequency, predicted pathogenicity, and segregation within families. Using these criteria, 68 variants in 68 genes were prioritized across the seven families. Of the genes that were expressed in IA tissue, one gene (TMEM132B) was differentially expressed in aneurysmal samples (n=44) as compared to control samples (n=16) (false discovery rate adjusted p-value=0.023). We demonstrate that sequencing of densely affected families permits exploration of the role of rare variants in a relatively common disease such as IA, although there are important study design considerations for applying sequencing to complex disorders. In this study, we explore methods of WES variant prioritization, including the incorporation of unaffected individuals, multipoint linkage analysis, biological pathway information, and transcriptome profiling. Further studies are needed to validate and characterize the set of variants and genes identified in this study.

The Relationship Between Computer Experience and Computerized Cognitive Test Performance Among Older Adults

PubMed Central

2013-01-01

Objective. This study compared the relationship between computer experience and performance on computerized cognitive tests and a traditional paper-and-pencil cognitive test in a sample of older adults (N = 634). Method. Participants completed computer experience and computer attitudes questionnaires, three computerized cognitive tests (Useful Field of View (UFOV) Test, Road Sign Test, and Stroop task) and a paper-and-pencil cognitive measure (Trail Making Test). Multivariate analysis of covariance was used to examine differences in cognitive performance across the four measures between those with and without computer experience after adjusting for confounding variables. Results. Although computer experience had a significant main effect across all cognitive measures, the effect sizes were similar. After controlling for computer attitudes, the relationship between computer experience and UFOV was fully attenuated. Discussion. Findings suggest that computer experience is not uniquely related to performance on computerized cognitive measures compared with paper-and-pencil measures. Because the relationship between computer experience and UFOV was fully attenuated by computer attitudes, this may imply that motivational factors are more influential to UFOV performance than computer experience. Our findings support the hypothesis that computer use is related to cognitive performance, and this relationship is not stronger for computerized cognitive measures. Implications and directions for future research are provided. PMID:22929395

Apertured averaged scintillation of fully and partially coherent Gaussian, annular Gaussian, flat toped and dark hollow beams

NASA Astrophysics Data System (ADS)

Eyyuboğlu, Halil T.

2015-03-01

Apertured averaged scintillation requires the evaluation of rather complicated irradiance covariance function. Here we develop a much simpler numerical method based on our earlier introduced semi-analytic approach. Using this method, we calculate aperture averaged scintillation of fully and partially coherent Gaussian, annular Gaussian flat topped and dark hollow beams. For comparison, the principles of equal source beam power and normalizing the aperture averaged scintillation with respect to received power are applied. Our results indicate that for fully coherent beams, upon adjusting the aperture sizes to capture 10 and 20% of the equal source power, Gaussian beam needs the largest aperture opening, yielding the lowest aperture average scintillation, whilst the opposite occurs for annular Gaussian and dark hollow beams. When assessed on the basis of received power normalized aperture averaged scintillation, fixed propagation distance and aperture size, annular Gaussian and dark hollow beams seem to have the lowest scintillation. Just like the case of point-like scintillation, partially coherent beams will offer less aperture averaged scintillation in comparison to fully coherent beams. But this performance improvement relies on larger aperture openings. Upon normalizing the aperture averaged scintillation with respect to received power, fully coherent beams become more advantageous than partially coherent ones.

Nonlinear static and dynamic analysis of beam structures using fully intrinsic equations

NASA Astrophysics Data System (ADS)

Sotoudeh, Zahra

2011-07-01

Beams are structural members with one dimension much larger than the other two. Examples of beams include propeller blades, helicopter rotor blades, and high aspect-ratio aircraft wings in aerospace engineering; shafts and wind turbine blades in mechanical engineering; towers, highways and bridges in civil engineering; and DNA modeling in biomedical engineering. Beam analysis includes two sets of equations: a generally linear two-dimensional problem over the cross-sectional plane and a nonlinear, global one-dimensional analysis. This research work deals with a relatively new set of equations for one-dimensional beam analysis, namely the so-called fully intrinsic equations. Fully intrinsic equations comprise a set of geometrically exact, nonlinear, first-order partial differential equations that is suitable for analyzing initially curved and twisted anisotropic beams. A fully intrinsic formulation is devoid of displacement and rotation variables, making it especially attractive because of the absence of singularities, infinite-degree nonlinearities, and other undesirable features associated with finite rotation variables. In spite of the advantages of these equations, using them with certain boundary conditions presents significant challenges. This research work will take a broad look at these challenges of modeling various boundary conditions when using the fully intrinsic equations. Hopefully it will clear the path for wider and easier use of the fully intrinsic equations in future research. This work also includes application of fully intrinsic equations in structural analysis of joined-wing aircraft, different rotor blade configuration and LCO analysis of HALE aircraft.

Guillain-Barré Syndrome and Adjuvanted Pandemic Influenza A (H1N1) 2009 Vaccines: A Multinational Self-Controlled Case Series in Europe

PubMed Central

Dieleman, Jeanne P.; Olberg, Henning K.; de Vries, Corinne S.; Sammon, Cormac; Andrews, Nick; Svanström, Henrik; Mølgaard-Nielsen, Ditte; Hviid, Anders; Lapeyre-Mestre, Maryse; Sommet, Agnès; Saussier, Christel; Castot, Anne; Heijbel, Harald; Arnheim-Dahlström, Lisen; Sparen, Par; Mosseveld, Mees; Schuemie, Martijn; van der Maas, Nicoline; Jacobs, Bart C.; Leino, Tuija; Kilpi, Terhi; Storsaeter, Jann; Johansen, Kari; Kramarz, Piotr; Bonhoeffer, Jan; Sturkenboom, Miriam C. J. M.

2014-01-01

Background The risk of Guillain-Barré syndrome (GBS) following the United States' 1976 swine flu vaccination campaign in the USA led to enhanced active surveillance during the pandemic influenza (A(H1N1)pdm09) immunization campaign. This study aimed to estimate the risk of GBS following influenza A(H1N1)pdm09 vaccination. Methods A self-controlled case series (SCCS) analysis was performed in Denmark, Finland, France, Netherlands, Norway, Sweden, and the United Kingdom. Information was collected according to a common protocol and standardised procedures. Cases classified at levels 1–4a of the Brighton Collaboration case definition were included. The risk window was 42 days starting the day after vaccination. Conditional Poisson regression and pooled random effects models estimated adjusted relative incidences (RI). Pseudo likelihood and vaccinated-only methods addressed the potential contraindication for vaccination following GBS. Results Three hundred and three (303) GBS and Miller Fisher syndrome cases were included. Ninety-nine (99) were exposed to A(H1N1)pdm09 vaccination, which was most frequently adjuvanted (Pandemrix and Focetria). The unadjusted pooled RI for A(H1N1)pdm09 vaccination and GBS was 3.5 (95% Confidence Interval (CI): 2.2–5.5), based on all countries. This lowered to 2.0 (95% CI: 1.2–3.1) after adjustment for calendartime and to 1.9 (95% CI: 1.1–3.2) when we accounted for contra-indications. In a subset (Netherlands, Norway, and United Kingdom) we further adjusted for other confounders and there the RI decreased from 1.7 (adjusted for calendar month) to 1.4 (95% CI: 0.7–2.8), which is the main finding. Conclusion This study illustrates the potential of conducting European collaborative vaccine safety studies. The main, fully adjusted analysis, showed that the RI of GBS was not significantly elevated after influenza A(H1N1)pdm09 vaccination (RI = 1.4 (95% CI: 0.7–2.8). Based on the upper limits of the pooled estimate we can rule out with 95% certainty that the number of excess GBS cases after influenza A(H1N1)pdm09 vaccination would be more than 3 per million vaccinated. PMID:24404128

Emotional Intelligence deficits in schizophrenia: The impact of non-social cognition.

PubMed

Frajo-Apor, Beatrice; Pardeller, Silvia; Kemmler, Georg; Welte, Anna-Sophia; Hofer, Alex

2016-04-01

Previous studies using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) revealed significant performance deficits across all areas of Emotional Intelligence (EI) in schizophrenia patients compared to healthy controls. However, none of these studies has investigated a potential influence of non-social cognition on these findings. 56 schizophrenia outpatients and 84 control subjects were investigated using the MSCEIT and the Brief Assessment of Cognition in Schizophrenia (BACS). Analyses of covariance were performed with adjustment for the BACS composite score and education. To investigate this issue in more detail, a mediation analysis was conducted. Patients showed significantly lower EI and non-social cognition levels compared to healthy controls. After adjustment for BACS composite score and education, only the group difference in the "managing emotions" branch and thus in the "strategic" EI part of the MSCEIT remained statistically significant, whereas for all other MSCEIT branches (perceiving, using, understanding emotions) statistical significance was lost. The mediation analysis revealed that the difference between schizophrenia patients and controls regarding the MSCEIT total score was almost fully attributable to the mediating effect of non-social cognition. Our findings suggest that in schizophrenia patients EI is largely influenced by non-social cognitive functioning. Only the "managing emotions" branch was found to be independent of non-social cognition. Consequently, non-social cognitive performance was mainly responsible for the observed differences in EI between schizophrenia patients and controls. This has to be taken into account when interpreting MSCEIT data in this population. Copyright © 2016 Elsevier B.V. All rights reserved.

Partial palivizumab prophylaxis and increased risk of hospitalization due to respiratory syncytial virus in a Medicaid population: a retrospective cohort analysis.

PubMed

Krilov, Leonard R; Masaquel, Anthony S; Weiner, Leonard B; Smith, David M; Wade, Sally W; Mahadevia, Parthiv J

2014-10-13

Infection with respiratory syncytial virus (RSV) is common among young children insured through Medicaid in the United States. Complete and timely dosing with palivizumab is associated with lower risk of RSV-related hospitalizations, but up to 60% of infants who receive palivizumab in Medicaid population do not receive full prophylaxis. The purpose of this study was to evaluate the association of partial palivizumab prophylaxis with the risk of RSV hospitalization among high-risk Medicaid-insured infants. Claims data from 12 states during 6 RSV seasons (October 1st to April 30th in the first year of life in 2003-2009) were analyzed. Inclusion criteria were birth hospital discharge before October 1st, continuous insurance eligibility from birth through April 30th, ≥ one palivizumab administration from August 1st to end of season, and high-risk status (≤34 weeks gestational age or chronic lung disease of prematurity [CLDP] or hemodynamically significant congenital heart disease [CHD]). Fully prophylaxed infants received the first palivizumab dose by November 30th with no gaps >35 days up to the first RSV-related hospitalization or end of follow-up. All other infants were categorized as partially prophylaxed. Of the 8,443 high-risk infants evaluated, 67% (5,615) received partial prophylaxis. Partially prophylaxed infants were more likely to have RSV-related hospitalization than fully prophylaxed infants (11.7% versus 7.9%, p< 0.001). RSV-related hospitalization rates ranged from 8.5% to 24.8% in premature, CHD, and CLDP infants with partial prophylaxis. After adjusting for potential confounders, logistic regression showed that partially prophylaxed infants had a 21% greater odds of hospitalization compared with fully prophylaxed infants (odds ratio 1.21, 95% confidence interval 1.09-1.34). RSV-related hospitalization rates were significantly higher in high-risk Medicaid infants with partial palivizumab prophylaxis compared with fully prophylaxed infants. These findings suggest that reduced and/or delayed dosing is less effective.

Serum lipid level and lifestyles are associated with carotid femoral pulse wave velocity among adults: 4.4-year prospectively longitudinal follow-up of a clinical trial.

PubMed

Zhao, XiaoXiao; Wang, Hongyu; Bo, LiuJin; Zhao, Hongwei; Li, Lihong; Zhou, Yingyan

2018-01-01

Lifestyle modifications are recommended as the initial treatment for high blood pressure. The influence of dyslipidemia might be via moderate arterial stiffness, which results in hypertension and cardiovascular disease. We used data from a subgroup of the lifestyle, level of serum lipids/carotid femoral-pulse wave velocity (CF-PWV) Susceptibility BEST Study, a population-based study of community-dwelling adults aged 45-75 years. The serum lipid level and CF-PWV were measured at baseline, and lifestyle such as smoking status, sleeping habits, and the level of oil or salt intake was determined with the use of a validated questionnaire during follow-up. Arterial stiffness was determined as CF-PWV using an electrocardiogram after a mean follow-up of 4.4 years. Regression coefficients (95% CIs), adjusted for demographics, risk factors, cholesterol, and triglycerides (TGs), were calculated by linear regression. Logistic regression analysis was used to identify the association between the variables with CF-PWV independently. In the results, glucose and total cholesterol (TC) were associated with higher CF-PWV (p = 0.000) and lower-destiny lipoprotein was associated with lower CF-PWV (p = 0.001) after adjustments for age, sex, mean arterial pressure, and heart rate. There were significant associations observed for current salt intake in relation to CF-PWV (p-trend = 0.038) without adjustment. This association was retained after adjustments for covariates and had statistical significance (p-trend = 0.048) in model 3, which adjusted age, sex, baseline CF-PWV, mean arterial pressure, heart rate waist circumference, education, smoking status, physical activity, diabetes mellitus (DM), heart disease, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, TGs, antihypertensive medicine, nitrate medicine, and antiplatelet medicine. Linear regression showed statistically significant associations between LDL and CF-PWV in the fully adjusted models (model 1 p = 0.010, model 2 p = 0.020, model 3 p = 0.017). Logistic regression analysis showed that CF-PWV was independently associated with age (p = 0.000), TC (p = 0.000), TGs (p = 0.000), and homo-cysteine (p = 0.000), and their odds ratios were 0.781, 3.424, 0.075, and 1.046, respectively. Our results showed a positive association between LDL and arterial stiffness, and suggested that less smoking status, sleeping disorder, and salt intake were associated with less arterial stiffness.

Assessing the effects of the Spanish partial smoking ban on cardiovascular and respiratory diseases: methodological issues.

PubMed

Galán, Iñaki; Simón, Lorena; Flores, Víctor; Ortiz, Cristina; Fernández-Cuenca, Rafael; Linares, Cristina; Boldo, Elena; Medrano, María José; Pastor-Barriuso, Roberto

2015-12-01

Recent research has assessed the impact of tobacco laws on cardiovascular and respiratory morbidity. In this study, we also examined whether the association between the implementation of the 2005 Spanish smoking ban and hospital admissions for cardiovascular and respiratory diseases varies according to the adjustment for potential confounders. Ecological time series analysis. Residents of Madrid and Barcelona cities (Spain). Data on daily emergency room admissions for acute myocardial infarction, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), and asthma derived from the 2003-2006 Spanish hospital admissions registry. Changes in admission rates between 2006 and the 2003-2005 period were estimated using additive Poisson models allowing for overdispersion adjusted for secular trend in admission, seasonality, day of the week, temperature, number of flu and acute respiratory infection cases, pollution levels, tobacco consumption prevalence and, for asthma cases, pollen count. In Madrid, fully adjusted models failed to detect significant changes in hospital admission rates for any disease during the study period. In Barcelona, however, hospital admissions decreased by 10.2% (95% CI 3.8% to 16.1%) for cerebrovascular diseases and by 16.0% (95% CI 7.0% to 24.1%) for COPD. Substantial changes in effect estimates were observed on adjustment for linear or quadratic trend. Effect estimates for asthma-related admissions varied substantially when adjusting for pollen count in Madrid, and for seasonality and tobacco consumption in Barcelona. Our results confirm that the potential impact of a smoking ban must be adjusted for the underlying secular trend. In asthma-related admissions, pollen count, seasonality and tobacco consumption must be specified in the model. The substantial variability in effects detected between the two cities of Madrid and Barcelona lends strong support for a nationwide study to assess the overall effect of a smoking ban in Spain and identify the causes of the observed heterogeneity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

EMU helmet mounted display

NASA Technical Reports Server (NTRS)

Marmolejo, Jose (Inventor); Smith, Stephen (Inventor); Plough, Alan (Inventor); Clarke, Robert (Inventor); Mclean, William (Inventor); Fournier, Joseph (Inventor)

1990-01-01

A helmet mounted display device is disclosed for projecting a display on a flat combiner surface located above the line of sight where the display is produced by two independent optical channels with independent LCD image generators. The display has a fully overlapped field of view on the combiner surface and the focus can be adjusted from a near field of four feet to infinity.

26 CFR 1.72-7 - Adjustment in investment where a contract contains a refund feature.

Code of Federal Regulations, 2010 CFR

2010-04-01

... amount to be fully paid by dividing the maximum amount guaranteed as of the annuity starting date by the... $1,200 Number of years for which payment guaranteed ($21,053 divided by $1,200) 17.5 Rounded to... annuitant, N = The guaranteed amount divided by the annual annuity payable to the primary annuitant, rounded...

On the Benefits of Latent Variable Modeling for Norming Scales: The Case of the "Supports Intensity Scale-Children's Version"

ERIC Educational Resources Information Center

Seo, Hyojeong; Little, Todd D.; Shogren, Karrie A.; Lang, Kyle M.

2016-01-01

Structural equation modeling (SEM) is a powerful and flexible analytic tool to model latent constructs and their relations with observed variables and other constructs. SEM applications offer advantages over classical models in dealing with statistical assumptions and in adjusting for measurement error. So far, however, SEM has not been fully used…

Young breast cancer patients' involvement in treatment decisions: the major role played by decision-making about surgery.

PubMed

Seror, Valérie; Cortaredona, Sébastien; Bouhnik, Anne-Deborah; Meresse, Mégane; Cluze, Camille; Viens, Patrice; Rey, Dominique; Peretti-Watel, Patrick

2013-11-01

The objective of this study is to investigate young breast cancer patients' preferred and actual involvement in decision-making about surgery, chemotherapy, and adjuvant endocrine therapy (AET). A total of 442 women aged 18-40 years at the time of the diagnosis participated in the region-wide ELIPPSE40 cohort study (southeastern France). Logistic regression analyses were performed on various factors possibly affecting patients' preferred and perceived involvement in the decisions about their cancer treatment. The women's mean age was 36.8 years at enrollment. Preference for a fully passive role in decision-making was stated by 20.7% of them. It was favored by regular breast surveillance (p = 0.04) and positive experience of being informed about cancer diagnosis (p = 0.02). Patients' preferences were independently associated with their reported involvement in decision-making about surgery (p = 0.01). A fully passive role in decision-making about chemotherapy and AET was more likely to be reported by patients who perceived their involvement in decision-making about surgery as having been fully passive (adjusted odds ratio = 4.8, CI95% [2.7-8.7], and adjusted odds ratio = 9.8, CI95% [3.3-29.2], respectively). This study shows a significant relationship between the use of antidepressants and involvement in decision-making about surgery, and confirms the relationship between impaired quality of life (in the psychological domain) and a fully passive role in decisions about cancer treatment. Patients' involvement in decision-making about chemotherapy and AET was strongly influenced by their experience of decision-making about surgery, regardless of their tumor stage and history of breast or ovarian cancer. When decisions are being made about surgery, special attention should be paid to facilitating breast cancer patients' involvement in the decision-making. Copyright © 2013 John Wiley & Sons, Ltd.

Public reaction to Chikungunya outbreaks in Italy-Insights from an extensive novel data streams-based structural equation modeling analysis.

PubMed

Mahroum, Naim; Adawi, Mohammad; Sharif, Kassem; Waknin, Roy; Mahagna, Hussein; Bisharat, Bishara; Mahamid, Mahmud; Abu-Much, Arsalan; Amital, Howard; Luigi Bragazzi, Nicola; Watad, Abdulla

2018-01-01

The recent outbreak of Chikungunya virus in Italy represents a serious public health concern, which is attracting media coverage and generating public interest in terms of Internet searches and social media interactions. Here, we sought to assess the Chikungunya-related digital behavior and the interplay between epidemiological figures and novel data streams traffic. Reaction to the recent outbreak was analyzed in terms of Google Trends, Google News and Twitter traffic, Wikipedia visits and edits, and PubMed articles, exploiting structural modelling equations. A total of 233,678 page-views and 150 edits on the Italian Wikipedia page, 3,702 tweets, 149 scholarly articles, and 3,073 news articles were retrieved. The relationship between overall Chikungunya cases, as well as autochthonous cases, and tweets production was found to be fully mediated by Chikungunya-related web searches. However, in the allochthonous/imported cases model, tweet production was not found to be significantly mediated by epidemiological figures, with web searches still significantly mediating tweet production. Inconsistent relationships were detected in mediation models involving Wikipedia usage as a mediator variable. Similarly, the effect between news consumption and tweets production was suppressed by the Wikipedia usage. A further inconsistent mediation was found in the case of the effect between Wikipedia usage and tweets production, with web searches as a mediator variable. When adjusting for the Internet penetration index, similar findings could be obtained, with the important exception that in the adjusted model the relationship between GN and Twitter was found to be partially mediated by Wikipedia usage. Furthermore, the link between Wikipedia usage and PubMed/MEDLINE was fully mediated by GN, differently from what was found in the unadjusted model. In conclusion-a significant public reaction to the current Chikungunya outbreak was documented. Health authorities should be aware of this, recognizing the role of new technologies for collecting public concerns and replying to them, disseminating awareness and avoid misleading information.

Public reaction to Chikungunya outbreaks in Italy—Insights from an extensive novel data streams-based structural equation modeling analysis

PubMed Central

Sharif, Kassem; Waknin, Roy; Mahagna, Hussein; Bisharat, Bishara; Mahamid, Mahmud; Abu-Much, Arsalan; Amital, Howard; Luigi Bragazzi, Nicola

2018-01-01

The recent outbreak of Chikungunya virus in Italy represents a serious public health concern, which is attracting media coverage and generating public interest in terms of Internet searches and social media interactions. Here, we sought to assess the Chikungunya-related digital behavior and the interplay between epidemiological figures and novel data streams traffic. Reaction to the recent outbreak was analyzed in terms of Google Trends, Google News and Twitter traffic, Wikipedia visits and edits, and PubMed articles, exploiting structural modelling equations. A total of 233,678 page-views and 150 edits on the Italian Wikipedia page, 3,702 tweets, 149 scholarly articles, and 3,073 news articles were retrieved. The relationship between overall Chikungunya cases, as well as autochthonous cases, and tweets production was found to be fully mediated by Chikungunya-related web searches. However, in the allochthonous/imported cases model, tweet production was not found to be significantly mediated by epidemiological figures, with web searches still significantly mediating tweet production. Inconsistent relationships were detected in mediation models involving Wikipedia usage as a mediator variable. Similarly, the effect between news consumption and tweets production was suppressed by the Wikipedia usage. A further inconsistent mediation was found in the case of the effect between Wikipedia usage and tweets production, with web searches as a mediator variable. When adjusting for the Internet penetration index, similar findings could be obtained, with the important exception that in the adjusted model the relationship between GN and Twitter was found to be partially mediated by Wikipedia usage. Furthermore, the link between Wikipedia usage and PubMed/MEDLINE was fully mediated by GN, differently from what was found in the unadjusted model. In conclusion—a significant public reaction to the current Chikungunya outbreak was documented. Health authorities should be aware of this, recognizing the role of new technologies for collecting public concerns and replying to them, disseminating awareness and avoid misleading information. PMID:29795578

The impacts of climate change on irrigation and crop production in Northeast China and implications for energy use and GHG Emission

NASA Astrophysics Data System (ADS)

Yan, Tingting; Wang, Jinxia; Huang, Jikun; Xie, Wei; Zhu, Tingju

2018-06-01

The water-food-energy-GHG nexus under climate change has been gaining increasing attention from both the research and policy communities, especially over the past several years. However, most existing nexus studies are qualitative and explorative in nature. So far, very few studies provide integrated analysis of this nexus across all the four sectors. The purpose of this paper is to examine this nexus by assessing the effects of climate change on agricultural production through the change in water availability, evaluating the adjustment responses and resulting energy consumption and GHG emission, with the Northeast China as a case study. Based on our simulation results, by 2030, climate change is projected to increase water supply and demand gap for irrigation in Northeast China. Due to the increase in water scarcity, irrigated areas will decrease, and the cropping pattern will be adjusted by increasing maize sown areas and decreasing rice sown areas. As a result, the total output of crops and profits will clearly be reduced. Finally, energy consumption and GHG emission from irrigation will be reduced. This study suggests that climate change impact assessment fully consider the nexus among water, food, energy and GHG; however, more studies need to be conducted in the future.

Associations between sleep disturbances and diabetes mellitus among blacks with metabolic syndrome: Results from the Metabolic Syndrome Outcome Study (MetSO).

PubMed

Ramos, Alberto R; Wallace, Douglas M; Pandi-Perumal, Seithikurippu Ratnas; Williams, Natasha J; Castor, Chimene; Sevick, Mary Ann; Mcfarlane, Samy I; Jean-Louis, Girardin

2015-05-01

The association between sleep disturbances and cardiometabolic diseases has been understudied in blacks with metabolic syndrome. This study is a cross-sectional analysis of the Metabolic Syndrome Outcome Study (MetSO) trial. We assessed insomnia symptoms, sleep duration, and risk for sleep apnea. Multivariate logistic regression models evaluated the association between sleep disturbances with diabetes mellitus (DM) and the combined outcomes of DM and hypertension as well as DM and dyslipidemia. The sample consisted of 1,013 participants, mean age of 62 ± 14 years and 61% female. DM was diagnosed in 60% of the sample. Sleep apnea risk was observed in 48% of the sample, while 10% had insomnia symptoms and 65% reported short sleep duration (< 6 hours). Sleep apnea risk, but not insomnia or sleep duration, was associated with DM (OR 1.66; 95% CI 1.21-2.28), adjusting for age, sex, income, obesity (BMI ≥ 30 kg/m(2)), tobacco use, alcohol use, hypertension, dyslipidemia, and depression. In fully adjusted models, sleep apnea risk was associated with the combined outcome of DM-hypertension (OR 1.95; 95% CI 1.42-2.69), but not with diabetes-dyslipidemia. We observed a strong association between sleep apnea risk and diabetes mellitus among blacks with metabolic syndrome.

Parent’s Socioeconomic Status, Adolescents’ Disposable Income, and Adolescents’ Smoking Status in Massachusetts

PubMed Central

Soteriades, Elpidoforos S.; DiFranza, Joseph R.

2003-01-01

Objectives. This study examined the association between parental socioeconomic status (SES) and adolescent smoking. Methods. We conducted telephone interviews with a probability sample of 1308 Massachusetts adolescents aged 12 to 17 years. We used multiple-variable-adjusted logistic regression models. Results. The risk of adolescent smoking increased by 28% with each step down in parental education and increased by 30% for each step down in parental household income. These associations persisted after adjustment for age, sex, race/ethnicity, and adolescent disposable income. Parental smoking status was a mediator of these associations. Conclusions. Parental SES is inversely associated with adolescent smoking. Parental smoking is a mediator but does not fully explain the association. PMID:12835202

Fine Particulate Matter and Total Mortality in Cancer Prevention Study Cohort Reanalysis.

PubMed

Enstrom, James E

2017-01-01

In 1997 the US Environmental Protection Agency (EPA) established the National Ambient Air Quality Standard (NAAQS) for fine particulate matter (PM 2.5 ), largely because of its positive relationship to total mortality in the 1982 American Cancer Society Cancer Prevention Study (CPS II) cohort. Subsequently, EPA has used this relationship as the primary justification for many costly regulations, most recently the Clean Power Plan. An independent analysis of the CPS II data was conducted in order to test the validity of this relationship. The original CPS II questionnaire data, including 1982 to 1988 mortality follow-up, were analyzed using Cox proportional hazards regression. Results were obtained for 292 277 participants in 85 counties with 1979-1983 EPA Inhalable Particulate Network PM 2.5 measurements, as well as for 212 370 participants in the 50 counties used in the original 1995 analysis. The 1982 to 1988 relative risk (RR) of death from all causes and 95% confidence interval adjusted for age, sex, race, education, and smoking status was 1.023 (0.997-1.049) for a 10 µg/m 3 increase in PM 2.5 in 85 counties and 1.025 (0.990-1.061) in the 50 original counties. The fully adjusted RR was null in the western and eastern portions of the United States, including in areas with somewhat higher PM 2.5 levels, particularly 5 Ohio Valley states and California. No significant relationship between PM 2.5 and total mortality in the CPS II cohort was found when the best available PM 2.5 data were used. The original 1995 analysis found a positive relationship by selective use of CPS II and PM 2.5 data. This independent analysis of underlying data raises serious doubts about the CPS II epidemiologic evidence supporting the PM 2.5 NAAQS. These findings provide strong justification for further independent analysis of the CPS II data.

Fine Particulate Matter and Total Mortality in Cancer Prevention Study Cohort Reanalysis

PubMed Central

2017-01-01

Background: In 1997 the US Environmental Protection Agency (EPA) established the National Ambient Air Quality Standard (NAAQS) for fine particulate matter (PM2.5), largely because of its positive relationship to total mortality in the 1982 American Cancer Society Cancer Prevention Study (CPS II) cohort. Subsequently, EPA has used this relationship as the primary justification for many costly regulations, most recently the Clean Power Plan. An independent analysis of the CPS II data was conducted in order to test the validity of this relationship. Methods: The original CPS II questionnaire data, including 1982 to 1988 mortality follow-up, were analyzed using Cox proportional hazards regression. Results were obtained for 292 277 participants in 85 counties with 1979-1983 EPA Inhalable Particulate Network PM2.5 measurements, as well as for 212 370 participants in the 50 counties used in the original 1995 analysis. Results: The 1982 to 1988 relative risk (RR) of death from all causes and 95% confidence interval adjusted for age, sex, race, education, and smoking status was 1.023 (0.997-1.049) for a 10 µg/m3 increase in PM2.5 in 85 counties and 1.025 (0.990-1.061) in the 50 original counties. The fully adjusted RR was null in the western and eastern portions of the United States, including in areas with somewhat higher PM2.5 levels, particularly 5 Ohio Valley states and California. Conclusion: No significant relationship between PM2.5 and total mortality in the CPS II cohort was found when the best available PM2.5 data were used. The original 1995 analysis found a positive relationship by selective use of CPS II and PM2.5 data. This independent analysis of underlying data raises serious doubts about the CPS II epidemiologic evidence supporting the PM2.5 NAAQS. These findings provide strong justification for further independent analysis of the CPS II data. PMID:28473741

Relationship between chewing behavior and body weight status in fully dentate healthy adults.

PubMed

Zhu, Yong; Hollis, James H

2015-03-01

Recent research indicates that chewing behavior may influence energy intake and energy expenditure. However, little is known about the relationship between chewing behavior and body weight status. In the present study, 64 fully dentate normal-weight or overweight/obese adults were asked to consume five portions of a test food and the number of chewing cycles, chewing duration before swallowing and chewing rate were measured. Adjusting for age and gender, normal-weight participants used a higher number of chewing cycles (p = 0.003) and a longer chewing duration (p < 0.001) to consume each portion of the food, compared to overweight/obese participants. However, there was no significant difference in their chewing rate (p = 0.597). A statistically significant negative correlation between body mass index and the number of chewing cycles (r = -0.296, p = 0.020) and chewing duration (r = -0.354, p = 0.005) was observed. In conclusion, these results suggest that chewing behavior is associated with body weight status in fully dentate healthy adults.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Agostini, Federica; Abedi, Ali; Suzuki, Yasumitsu

The decomposition of electronic and nuclear motion presented in Abedi et al. [Phys. Rev. Lett. 105, 123002 (2010)] yields a time-dependent potential that drives the nuclear motion and fully accounts for the coupling to the electronic subsystem. Here, we show that propagation of an ensemble of independent classical nuclear trajectories on this exact potential yields dynamics that are essentially indistinguishable from the exact quantum dynamics for a model non-adiabatic charge transfer problem. We point out the importance of step and bump features in the exact potential that are critical in obtaining the correct splitting of the quasiclassical nuclear wave packetmore » in space after it passes through an avoided crossing between two Born-Oppenheimer surfaces and analyze their structure. Finally, an analysis of the exact potentials in the context of trajectory surface hopping is presented, including preliminary investigations of velocity-adjustment and the force-induced decoherence effect.« less

Knowing your face: A componential analysis of self-perceived facial attractiveness.

PubMed

Yoder, Marcel S; Ault, Lara K; Mathews, Maureen A

2017-01-01

Facial attractiveness (FA) is a highly agreed upon and socially important characteristic, but contemporary research has not fully investigated individuals' enhancement of their FA. We used the social relations model (SRM) to analyze data from 187 participants. In face-to-face groups of four, participants rated their own and others' FA. We assessed the degree of FA enhancement using unconfounded measures of both self-insight and social comparison. Results indicated African Americans and men enhanced more than Caucasians and women. Race effects were mediated by psychological adjustment, while gender effects were related to meta-perceptions. Men tended to view themselves through a "frog prince" lens, such that they accurately predicted others' lesser views of them but persisted in overly positive self-perceptions of FA. Findings suggest further consideration of SRM measures, meta-perceptions, and a focus on sample diversity in the study of self-enhancement.

Race, APOL1 Risk, and eGFR Decline in the General Population

PubMed Central

Rebholz, Casey M.; Chen, Yuan; Rawlings, Andreea M.; Estrella, Michelle M.; Selvin, Elizabeth; Appel, Lawrence J.; Tin, Adrienne; Coresh, Josef

2016-01-01

The APOL1 high-risk genotype, present in approximately 13% of blacks in the United States, is a risk factor for kidney function decline in populations with CKD. It is unknown whether genetic screening is indicated in the general population. We evaluated the prognosis of APOL1 high-risk status in participants in the population-based Atherosclerosis Risk in Communities (ARIC) study, including associations with eGFR decline, variability in eGFR decline, and related adverse health events (AKI, ESRD, hypertension, diabetes, cardiovascular disease, pre-ESRD and total hospitalization rate, and mortality). Among 15,140 ARIC participants followed from 1987–1989 (baseline) to 2011–2013, 75.3% were white, 21.5% were black/APOL1 low-risk, and 3.2% were black/APOL1 high-risk. In a demographic-adjusted analysis, blacks had a higher risk for all assessed adverse health events; however, in analyses adjusted for comorbid conditions and socioeconomic status, blacks had a higher risk for hypertension, diabetes, and ESRD only. Among blacks, the APOL1 high-risk genotype associated only with higher risk of ESRD in a fully adjusted analysis. Black race and APOL1 high-risk status were associated with faster eGFR decline (P<0.001 for each). However, we detected substantial overlap among the groups: median (10th–90th percentile) unadjusted eGFR decline was 1.5 (1.0–2.2) ml/min per 1.73 m2 per year for whites, 2.1 (1.4–3.1) ml/min per 1.73 m2 per year for blacks with APOL1 low-risk status, and 2.3 (1.5–3.5) ml/min per 1.73 m2 per year for blacks with APOL1 high-risk status. The high variability in eGFR decline among blacks with and without the APOL1 high-risk genotype suggests that population-based screening is not yet justified. PMID:26966015

Race, APOL1 Risk, and eGFR Decline in the General Population.

PubMed

Grams, Morgan E; Rebholz, Casey M; Chen, Yuan; Rawlings, Andreea M; Estrella, Michelle M; Selvin, Elizabeth; Appel, Lawrence J; Tin, Adrienne; Coresh, Josef

2016-09-01

The APOL1 high-risk genotype, present in approximately 13% of blacks in the United States, is a risk factor for kidney function decline in populations with CKD. It is unknown whether genetic screening is indicated in the general population. We evaluated the prognosis of APOL1 high-risk status in participants in the population-based Atherosclerosis Risk in Communities (ARIC) study, including associations with eGFR decline, variability in eGFR decline, and related adverse health events (AKI, ESRD, hypertension, diabetes, cardiovascular disease, pre-ESRD and total hospitalization rate, and mortality). Among 15,140 ARIC participants followed from 1987-1989 (baseline) to 2011-2013, 75.3% were white, 21.5% were black/APOL1 low-risk, and 3.2% were black/APOL1 high-risk. In a demographic-adjusted analysis, blacks had a higher risk for all assessed adverse health events; however, in analyses adjusted for comorbid conditions and socioeconomic status, blacks had a higher risk for hypertension, diabetes, and ESRD only. Among blacks, the APOL1 high-risk genotype associated only with higher risk of ESRD in a fully adjusted analysis. Black race and APOL1 high-risk status were associated with faster eGFR decline (P<0.001 for each). However, we detected substantial overlap among the groups: median (10th-90th percentile) unadjusted eGFR decline was 1.5 (1.0-2.2) ml/min per 1.73 m(2) per year for whites, 2.1 (1.4-3.1) ml/min per 1.73 m(2) per year for blacks with APOL1 low-risk status, and 2.3 (1.5-3.5) ml/min per 1.73 m(2) per year for blacks with APOL1 high-risk status. The high variability in eGFR decline among blacks with and without the APOL1 high-risk genotype suggests that population-based screening is not yet justified. Copyright © 2016 by the American Society of Nephrology.

Increased risk of lung cancer in individuals with a family history of the disease: a pooled analysis from the International Lung Cancer Consortium.

PubMed

Coté, Michele L; Liu, Mei; Bonassi, Stefano; Neri, Monica; Schwartz, Ann G; Christiani, David C; Spitz, Margaret R; Muscat, Joshua E; Rennert, Gad; Aben, Katja K; Andrew, Angeline S; Bencko, Vladimir; Bickeböller, Heike; Boffetta, Paolo; Brennan, Paul; Brenner, Hermann; Duell, Eric J; Fabianova, Eleonora; Field, John K; Foretova, Lenka; Friis, Søren; Harris, Curtis C; Holcatova, Ivana; Hong, Yun-Chul; Isla, Dolores; Janout, Vladimir; Kiemeney, Lambertus A; Kiyohara, Chikako; Lan, Qing; Lazarus, Philip; Lissowska, Jolanta; Le Marchand, Loic; Mates, Dana; Matsuo, Keitaro; Mayordomo, Jose I; McLaughlin, John R; Morgenstern, Hal; Müeller, Heiko; Orlow, Irene; Park, Bernard J; Pinchev, Mila; Raji, Olaide Y; Rennert, Hedy S; Rudnai, Peter; Seow, Adeline; Stucker, Isabelle; Szeszenia-Dabrowska, Neonila; Dawn Teare, M; Tjønnelan, Anne; Ugolini, Donatella; van der Heijden, Henricus F M; Wichmann, Erich; Wiencke, John K; Woll, Penella J; Yang, Ping; Zaridze, David; Zhang, Zuo-Feng; Etzel, Carol J; Hung, Rayjean J

2012-09-01

Familial aggregation of lung cancer exists after accounting for cigarette smoking. However, the extent to which family history affects risk by smoking status, histology, relative type and ethnicity is not well described. This pooled analysis included 24 case-control studies in the International Lung Cancer Consortium. Each study collected age of onset/interview, gender, race/ethnicity, cigarette smoking, histology and first-degree family history of lung cancer. Data from 24,380 lung cancer cases and 23,305 healthy controls were analysed. Unconditional logistic regression models and generalised estimating equations were used to estimate odds ratios and 95% confidence intervals. Individuals with a first-degree relative with lung cancer had a 1.51-fold increase in the risk of lung cancer, after adjustment for smoking and other potential confounders (95% CI: 1.39, 1.63). The association was strongest for those with a family history in a sibling, after adjustment (odds ratios (OR) = 1.82, 95% CI: 1.62, 2.05). No modifying effect by histologic type was found. Never smokers showed a lower association with positive familial history of lung cancer (OR = 1.25, 95% CI: 1.03, 1.52), slightly stronger for those with an affected sibling (OR = 1.44, 95% CI: 1.07, 1.93), after adjustment. The occurrence of lung cancer among never smokers and similar magnitudes of the effect of family history on lung cancer risk across histological types suggests familial aggregation of lung cancer is independent of those risks associated with cigarette smoking. While the role of genetic variation in the aetiology of lung cancer remains to be fully characterised, family history assessment is immediately available and those with a positive history represent a higher risk group. Copyright © 2012 Elsevier Ltd. All rights reserved.

A spherical aberration-free microscopy system for live brain imaging.

PubMed

Ue, Yoshihiro; Monai, Hiromu; Higuchi, Kaori; Nishiwaki, Daisuke; Tajima, Tetsuya; Okazaki, Kenya; Hama, Hiroshi; Hirase, Hajime; Miyawaki, Atsushi

2018-06-02

The high-resolution in vivo imaging of mouse brain for quantitative analysis of fine structures, such as dendritic spines, requires objectives with high numerical apertures (NAs) and long working distances (WDs). However, this imaging approach is often hampered by spherical aberration (SA) that results from the mismatch of refractive indices in the optical path and becomes more severe with increasing depth of target from the brain surface. Whereas a revolving objective correction collar has been designed to compensate SA, its adjustment requires manual operation and is inevitably accompanied by considerable focal shift, making it difficult to acquire the best image of a given fluorescent object. To solve the problems, we have created an objective-attached device and formulated a fast iterative algorithm for the realization of an automatic SA compensation system. The device coordinates the collar rotation and the Z-position of an objective, enabling correction collar adjustment while stably focusing on a target. The algorithm provides the best adjustment on the basis of the calculated contrast of acquired images. Together, they enable the system to compensate SA at a given depth. As proof of concept, we applied the SA compensation system to in vivo two-photon imaging with a 25 × water-immersion objective (NA, 1.05; WD, 2 mm). It effectively reduced SA regardless of location, allowing quantitative and reproducible analysis of fine structures of YFP-labeled neurons in the mouse cerebral cortical layers. Interestingly, although the cortical structure was optically heterogeneous along the z-axis, the refractive index of each layer could be assessed on the basis of the compensation degree. It was also possible to make fully corrected three-dimensional reconstructions of YFP-labeled neurons in live brain samples. Our SA compensation system, called Deep-C, is expected to bring out the best in all correction-collar-equipped objectives for imaging deep regions of heterogeneous tissues. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Near real-time vaccine safety surveillance with partially accrued data.

PubMed

Greene, Sharon K; Kulldorff, Martin; Yin, Ruihua; Yih, W Katherine; Lieu, Tracy A; Weintraub, Eric S; Lee, Grace M

2011-06-01

The Vaccine Safety Datalink (VSD) Project conducts near real-time vaccine safety surveillance using sequential analytic methods. Timely surveillance is critical in identifying potential safety problems and preventing additional exposure before most vaccines are administered. For vaccines that are administered during a short period, such as influenza vaccines, timeliness can be improved by undertaking analyses while risk windows following vaccination are ongoing and by accommodating predictable and unpredictable data accrual delays. We describe practical solutions to these challenges, which were adopted by the VSD Project during pandemic and seasonal influenza vaccine safety surveillance in 2009/2010. Adjustments were made to two sequential analytic approaches. The Poisson-based approach compared the number of pre-defined adverse events observed following vaccination with the number expected using historical data. The expected number was adjusted for the proportion of the risk window elapsed and the proportion of inpatient data estimated to have accrued. The binomial-based approach used a self-controlled design, comparing the observed numbers of events in risk versus comparison windows. Events were included in analysis only if they occurred during a week that had already passed for both windows. Analyzing data before risk windows fully elapsed improved the timeliness of safety surveillance. Adjustments for data accrual lags were tailored to each data source and avoided biasing analyses away from detecting a potential safety problem, particularly early during surveillance. The timeliness of vaccine and drug safety surveillance can be improved by properly accounting for partially elapsed windows and data accrual delays. Copyright © 2011 John Wiley & Sons, Ltd.

Cost-Effectiveness of Radiofrequency Catheter Ablation Compared with Antiarrhythmic Drug Therapy for Paroxysmal Atrial Fibrillation

PubMed Central

Reynolds, Matthew R.; Zimetbaum, Peter; Josephson, Mark E.; Ellis, Ethan; Danilov, Tatyana; Cohen, David J.

2009-01-01

Background Radiofrequency catheter ablation (RFA) has emerged as an important treatment strategy for AF. The potential cost-effectiveness of RFA for AF, relative to antiarrhythmic drug (AAD) therapy, has not been fully explored from a U.S. perspective. Methods and Results We constructed a Markov disease simulation model for a hypothetical cohort of drug- refractory paroxysmal AF patients managed either with RFA ± AAD or AAD alone. Costs and quality-adjusted life years (QALYs) were projected over 5 years. Model inputs were drawn from published clinical trial and registry data, from new registry and trial data analysis, and from data prospectively collected from AF patients managed with RFA at our institution. We assumed no benefit form ablation on stroke, heart failure or death, but did estimate changes in quality-adjusted life expectancy using data from several AF cohorts. In the base case scenario, cumulative costs with the RFA and AAD strategies were $26,584 and $19,898, respectively. Over 5 years, quality adjusted life expectancy was 3.51 QALYs with RFA, versus 3.38 for the AAD group. The incremental cost-effectiveness ratio for RFA vs. AAD was thus $51,431/QALY. Model results were most sensitive to time horizon, the relative utility weights of successful ablation vs. unsuccessful drug therapy, and to the cost of an ablation procedure. Conclusions RFA ± AAD for symptomatic, drug-refractory paroxysmal AF appears to be reasonably cost-effective compared with AAD therapy alone from the perspective of the US health care system, based on improved quality of life and avoidance of future health care costs. PMID:19808491

A market systems analysis of the U.S. Sport Utility Vehicle market considering frontal crash safety technology and policy.

PubMed

Hoffenson, Steven; Frischknecht, Bart D; Papalambros, Panos Y

2013-01-01

Active safety features and adjustments to the New Car Assessment Program (NCAP) consumer-information crash tests have the potential to decrease the number of serious traffic injuries each year, according to previous studies. However, literature suggests that risk reductions, particularly in the automotive market, are often accompanied by adjusted consumer risk tolerance, and so these potential safety benefits may not be fully realized due to changes in consumer purchasing or driving behavior. This article approaches safety in the new vehicle market, particularly in the Sport Utility Vehicle and Crossover Utility Vehicle segments, from a market systems perspective. Crash statistics and simulations are used to predict the effects of design and policy changes on occupant crash safety, and discrete choice experiments are conducted to estimate the values consumers place on vehicle attributes. These models are combined in a market simulation that forecasts how consumers respond to the available vehicle alternatives, resulting in predictions of the market share of each vehicle and how the change in fleet mixture influences societal outcomes including injuries, fuel consumption, and firm profits. The model is tested for a scenario where active safety features are implemented across the new vehicle fleet and a scenario where the U.S. frontal NCAP test speed is modified. While results exhibit evidence of consumer risk adjustment, they support adding active safety features and lowering the NCAP frontal test speed, as these changes are predicted to improve the welfare of both firms and society. Copyright © 2012 Elsevier Ltd. All rights reserved.

Mortality Differences Between Traditional Medicare and Medicare Advantage: A Risk-Adjusted Assessment Using Claims Data

PubMed Central

Beveridge, Roy A.; Mendes, Sean M.; Caplan, Arial; Rogstad, Teresa L.; Olson, Vanessa; Williams, Meredith C.; McRae, Jacquelyn M.; Vargas, Stefan

2017-01-01

Medicare Advantage (MA) has grown rapidly since the Affordable Care Act; nearly one-third of Medicare beneficiaries now choose MA. An assessment of the comparative value of the 2 options is confounded by an apparent selection bias favoring MA, as reflected in mortality differences. Previous assessments have been hampered by lack of access to claims diagnosis data for the MA population. An indirect comparison of mortality as an outcome variable was conducted by modeling mortality on a traditional fee-for-service (FFS) Medicare data set, applying the model to an MA data set, and then evaluating the ratio of actual-to-predicted mortality in the MA data set. The mortality model adjusted for clinical conditions and demographic factors. Model development considered the effect of potentially greater coding intensity in the MA population. Further analysis calculated ratios for subpopulations. Predicted, risk-adjusted mortality was lower in the MA population than in FFS Medicare. However, the ratio of actual-to-predicted mortality (0.80) suggested that the individuals in the MA data set were less likely to die than would be predicted had those individuals been enrolled in FFS Medicare. Differences between actual and predicted mortality were particularly pronounced in low income (dual eligibility), nonwhite race, high morbidity, and Health Maintenance Organization (HMO) subgroups. After controlling for baseline clinical risk as represented by claims diagnosis data, mortality differences favoring MA over FFS Medicare persisted, particularly in vulnerable subgroups and HMO plans. These findings suggest that differences in morbidity do not fully explain differences in mortality between the 2 programs. PMID:28578605

Sickness absence due to back pain or depressive episode and the risk of all-cause and diagnosis-specific disability pension: A Swedish cohort study of 4,823,069 individuals.

PubMed

Dorner, T E; Alexanderson, K; Svedberg, P; Ropponen, A; Stein, K V; Mittendorfer-Rutz, E

2015-10-01

The aim of this study was to investigate the associations between sickness absence due to back pain or depressive episode with future all-cause and diagnosis-specific disability pension, while adjusting for comorbidity and socio-demographics, for all and stratifying for sex. In total, 4,823,069 individuals aged 16-64 years, living in Sweden at the end of 2004, not on old-age or disability pension in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the study population. Crude and adjusted hazard ratios (HRs) for all-cause and diagnosis-specific disability pension (2006-2010) in relation to diagnosis-specific sickness absence with sickness benefits paid by the Social Insurance Agency were estimated using Cox regression. The HR for all-cause disability pension was 7.52 (7.25-7.52) in individuals with an incident sick-leave spell due to back pain, compared to individuals without sickness absence in 2005 in the fully adjusted (socio-demographics and comorbidity) model. The fully adjusted (multivariate) HRs for diagnosis-specific disability pension were musculoskeletal diagnoses 23.87 (22.75-25.04), mental 2.49 (2.27-2.73) or all other diagnoses, 3.44 (3.17-3.75). In individuals with an incident sick-leave spell due to a depressive episode in 2005, the multivariate adjusted HR for all-cause disability pension was 12.87 (12.42-13.35), while the multivariate HRs for disability pension due to musculoskeletal diagnoses were 4.39 (3.89-4.96), for mental diagnoses 25.32 (24.29-26.38) and for all other somatic diagnoses 3.44 (3.09-3.82). Men who were sickness absent due to a depressive episode had a higher HR for disability pension compared to women. Results indicate that sickness absence due to a depressive episode or back pain is a strong risk factor for a future disability pension due to mental, musculoskeletal or other somatic diagnoses. © 2015 European Pain Federation - EFIC®

Relationships between markers of inflammation and bone density: findings from the Hertfordshire Cohort Study.

PubMed

Fuggle, N R; Westbury, L D; Syddall, H E; Duggal, N A; Shaw, S C; Maslin, K; Dennison, E M; Lord, J; Cooper, C

2018-05-28

Among 365 Hertfordshire Cohort Study participants (aged 59-71 years at baseline), higher adiponectin and adiponectin to leptin ratios were associated with lower baseline lumbar spine and femoral neck bone mineral density (BMD). Lower IL-10 was associated with accelerated decline in lumbar spine BMD. This suggests that bone health can be influenced by changes in immune phenotype and alterations in adipokine homeostasis. The aim of this study was to examine the association between indices of inflammation and BMD in a population-based cohort of older adults in the UK. Analyses were based on a sample of 194 men and 171 women of the Hertfordshire Cohort Study (community-living, older adults). Dual energy X-ray absorptiometry (DXA) was performed at the lumbar spine and proximal femur at baseline and repeated at a median of 4.5 years (inter-quartile range 3.6 to 5.2). Inflammatory markers (CRP, TNF, IL-1β, IL-6, IL-8, IL-10, adiponectin and leptin) were ascertained at baseline using enzyme-linked immunosorbent assay (ELISA) techniques and Bio-Plex Pro Assays. Gender-adjusted linear regression was used to examine the associations between markers of inflammation and outcomes with and without adjustment for anthropometric and lifestyle factors. The mean (SD) ages at baseline were 64.4 (2.5) and 66.5 (2.7) years for men and women respectively. Higher levels of adiponectin and adiponectin to leptin ratios were each associated with lower baseline lumbar spine and femoral neck BMD in gender-adjusted (p < 0.01) and fully adjusted (p < 0.05) analyses. Lower levels of IL-10 and TNF were each associated with accelerated decline in lumbar spine BMD in both gender-adjusted (p ≤ 0.05) and fully adjusted (p < 0.05) analyses. In a cohort of older adults, high levels of adiponectin and adiponectin to leptin ratios were both associated with lower BMD at the lumbar spine and femoral neck at baseline, and lower IL-10 was associated with accelerated decline in BMD at the lumbar spine. This adds weight to the theory that bone health can be influenced by changes in immune phenotype and alterations in adipokine homeostasis.

The State of Preschool 2014: State Preschool Yearbook

ERIC Educational Resources Information Center

Barnett, W. Steven; Carolan, Megan E.; Squires, James H.; Brown, Kirsty Clarke; Horowitz, Michelle

2015-01-01

The 2013-2014 school year offered hope of a recovery for state-funded pre-K after the dismal effects of the recession. State funding for pre-K increased by nearly $120 million in 2013-2014, adjusted for inflation. This is the second year in a row that state pre-K has seen a real funding increase, though programs have yet to fully recover from the…

On the Benefits of Latent Variable Modeling for Norming Scales: The Case of the "Supports Intensity Scale--Children's Version"

ERIC Educational Resources Information Center

Seo, Hyojeong; Little, Todd D.; Shogren, Karrie A.; Lang, Kyle M.

2016-01-01

Structural equation modeling (SEM) is a powerful and flexible analytic tool to model latent constructs and their relations with observed variables and other constructs. SEM applications offer advantages over classical models in dealing with statistical assumptions and in adjusting for measurement error. So far, however, SEM has not been fully used…

Machine learning-based kinetic modeling: a robust and reproducible solution for quantitative analysis of dynamic PET data

NASA Astrophysics Data System (ADS)

Pan, Leyun; Cheng, Caixia; Haberkorn, Uwe; Dimitrakopoulou-Strauss, Antonia

2017-05-01

A variety of compartment models are used for the quantitative analysis of dynamic positron emission tomography (PET) data. Traditionally, these models use an iterative fitting (IF) method to find the least squares between the measured and calculated values over time, which may encounter some problems such as the overfitting of model parameters and a lack of reproducibility, especially when handling noisy data or error data. In this paper, a machine learning (ML) based kinetic modeling method is introduced, which can fully utilize a historical reference database to build a moderate kinetic model directly dealing with noisy data but not trying to smooth the noise in the image. Also, due to the database, the presented method is capable of automatically adjusting the models using a multi-thread grid parameter searching technique. Furthermore, a candidate competition concept is proposed to combine the advantages of the ML and IF modeling methods, which could find a balance between fitting to historical data and to the unseen target curve. The machine learning based method provides a robust and reproducible solution that is user-independent for VOI-based and pixel-wise quantitative analysis of dynamic PET data.

Local Observability Analysis of Star Sensor Installation Errors in a SINS/CNS Integration System for Near-Earth Flight Vehicles.

PubMed

Yang, Yanqiang; Zhang, Chunxi; Lu, Jiazhen

2017-01-16

Strapdown inertial navigation system/celestial navigation system (SINS/CNS) integrated navigation is a fully autonomous and high precision method, which has been widely used to improve the hitting accuracy and quick reaction capability of near-Earth flight vehicles. The installation errors between SINS and star sensors have been one of the main factors that restrict the actual accuracy of SINS/CNS. In this paper, an integration algorithm based on the star vector observations is derived considering the star sensor installation error. Then, the star sensor installation error is accurately estimated based on Kalman Filtering (KF). Meanwhile, a local observability analysis is performed on the rank of observability matrix obtained via linearization observation equation, and the observable conditions are presented and validated. The number of star vectors should be greater than or equal to 2, and the times of posture adjustment also should be greater than or equal to 2. Simulations indicate that the star sensor installation error could be readily observable based on the maneuvering condition; moreover, the attitude errors of SINS are less than 7 arc-seconds. This analysis method and conclusion are useful in the ballistic trajectory design of near-Earth flight vehicles.

Machine learning-based kinetic modeling: a robust and reproducible solution for quantitative analysis of dynamic PET data.

PubMed

Pan, Leyun; Cheng, Caixia; Haberkorn, Uwe; Dimitrakopoulou-Strauss, Antonia

2017-05-07

A variety of compartment models are used for the quantitative analysis of dynamic positron emission tomography (PET) data. Traditionally, these models use an iterative fitting (IF) method to find the least squares between the measured and calculated values over time, which may encounter some problems such as the overfitting of model parameters and a lack of reproducibility, especially when handling noisy data or error data. In this paper, a machine learning (ML) based kinetic modeling method is introduced, which can fully utilize a historical reference database to build a moderate kinetic model directly dealing with noisy data but not trying to smooth the noise in the image. Also, due to the database, the presented method is capable of automatically adjusting the models using a multi-thread grid parameter searching technique. Furthermore, a candidate competition concept is proposed to combine the advantages of the ML and IF modeling methods, which could find a balance between fitting to historical data and to the unseen target curve. The machine learning based method provides a robust and reproducible solution that is user-independent for VOI-based and pixel-wise quantitative analysis of dynamic PET data.

Interparental violence and children's long-term psychosocial adjustment: the mediating role of parenting practices.

PubMed

Gámez-Guadix, Manuel; Almendros, Carmen; Carrobles, José Antonio; Muñoz-Rivas, Marina

2012-03-01

The objectives of this study were: (a) to examine the direct and indirect relationships among witnessing interparental violence, parenting practices, and children's long-term psychosocial adjustment; (b) to analyze the possible gender differences in the relationships specified. The sample consisted of 1295 Spanish university students (M age = 21.21, SD = 4.04). We performed statistical analyses using structural equation modeling. The results showed that witnessing parental violence as a child is related to poor long-term psychosocial adjustment during the child's adult years. Furthermore, we found that parenting practices fully mediated the relation between witnessing interparental violence and the child's long-term adjustment. The multigroup analyses showed that most of the relations among the variables did not differ significantly by gender. However, the relation between harsh discipline and antisocial behavior was stronger for males, whereas the relation between harsh discipline and depressive symptoms was stronger for females. Finally, we discuss the implications of these findings for the clinicians and specialists who plan and develop intervention programs for populations at risk.

Response Monitoring and Adjustment: Differential Relations with Psychopathic Traits

PubMed Central

Bresin, Konrad; Finy, M. Sima; Sprague, Jenessa; Verona, Edelyn

2014-01-01

Studies on the relation between psychopathy and cognitive functioning often show mixed results, partially because different factors of psychopathy have not been considered fully. Based on previous research, we predicted divergent results based on a two-factor model of psychopathy (interpersonal-affective traits and impulsive-antisocial traits). Specifically, we predicted that the unique variance of interpersonal-affective traits would be related to increased monitoring (i.e., error-related negativity) and adjusting to errors (i.e., post-error slowing), whereas impulsive-antisocial traits would be related to reductions in these processes. Three studies using a diverse selection of assessment tools, samples, and methods are presented to identify response monitoring correlates of the two main factors of psychopathy. In Studies 1 (undergraduates), 2 (adolescents), and 3 (offenders), interpersonal-affective traits were related to increased adjustment following errors and, in Study 3, to enhanced monitoring of errors. Impulsive-antisocial traits were not consistently related to error adjustment across the studies, although these traits were related to a deficient monitoring of errors in Study 3. The results may help explain previous mixed findings and advance implications for etiological models of psychopathy. PMID:24933282

The effect of customization and use of a fetal growth standard on the association between birthweight percentile and adverse perinatal outcome.

PubMed

Sovio, Ulla; Smith, Gordon C S

2018-02-01

It has been proposed that correction of offspring weight percentiles (customization) might improve the prediction of adverse pregnancy outcome; however, the approach is not accepted universally. A complication in the interpretation of the data is that the main method for calculation of customized percentiles uses a fetal growth standard, and multiple analyses have compared the results with birthweight-based standards. First, we aimed to determine whether women who deliver small-for-gestational-age infants using a customized standard differed from other women. Second, we aimed to compare the association between birthweight percentile and adverse outcome using 3 different methods for percentile calculation: (1) a noncustomized actual birthweight standard, (2) a noncustomized fetal growth standard, and (3) a fully customized fetal growth standard. We analyzed data from the Pregnancy Outcome Prediction study, a prospective cohort study of nulliparous women who delivered in Cambridge, UK, between 2008 and 2013. We used a composite adverse outcome, namely, perinatal morbidity or preeclampsia. Receiver operating characteristic curve analysis was used to compare the 3 methods of calculating birthweight percentiles in relation to the composite adverse outcome. We confirmed previous observations that delivering an infant who was small for gestational age (<10th percentile) with the use of a fully customized fetal growth standard but who was appropriate for gestational age with the use of a noncustomized actual birthweight standard was associated with higher rates of adverse outcomes. However, we also observed that the mothers of these infants were 3-4 times more likely to be obese and to deliver preterm. When we compared the risk of adverse outcome from logistic regression models that were fitted to the birthweight percentiles that were derived by each of the 3 predefined methods, the areas under the receiver operating characteristic curves were similar for all 3 methods: 0.56 (95% confidence interval, 0.54-0.59) fully customized, 0.56 (95% confidence interval, 0.53-0.59) noncustomized fetal weight standard, and 0.55 (95% confidence interval, 0.53-0.58) noncustomized actual birthweight standard. When we classified the top 5% of predicted risk as high risk, the methods that used a fetal growth standard showed attenuation after adjustment for gestational age, whereas the birthweight standard did not. Further adjustment for the maternal characteristics, which included weight, attenuated the association with the customized standard, but not the other 2 methods. The associations after full adjustment were similar when we compared the 3 approaches. The independent association between birthweight percentile and adverse outcome was similar when we compared actual birthweight standards and fetal growth standards and compared customized and noncustomized standards. Use of fetal weight standards and customized percentiles for maternal characteristics could lead to stronger associations with adverse outcome through confounding by preterm birth and maternal obesity. Copyright © 2017 Elsevier Inc. All rights reserved.

Piped water supply interruptions and acute diarrhea among under-five children in Addis Ababa slums, Ethiopia: A matched case-control study

PubMed Central

Adane, Metadel; Mengistie, Bezatu; Medhin, Girmay; Kloos, Helmut; Mulat, Worku

2017-01-01

Background The problem of intermittent piped water supplies that exists in low- and middle-income countries is particularly severe in the slums of sub-Saharan Africa. However, little is known about whether there is deterioration of the microbiological quality of the intermittent piped water supply at a household level and whether it is a factor in reducing or increasing the occurrence of acute diarrhea among under-five children in slums of Addis Ababa. This study aimed to determine the association of intermittent piped water supplies and point-of-use (POU) contamination of household stored water by Escherichia coli (E. coli) with acute diarrhea among under-five children in slums of Addis Ababa. Methods A community-based matched case-control study was conducted from November to December, 2014. Cases were defined as under-five children with acute diarrhea during the two weeks before the survey. Controls were matched by age and neighborhood with cases by individual matching. Data were collected using a pre-tested structured questionnaire and E. coli analysis of water from piped water supplies and household stored water. A five-tube method of Most Probable Number (MPN)/100 ml standard procedure was used for E. coli analysis. Multivariable conditional logistic regression with 95% confidence interval (CI) was used for data analysis by controlling potential confounding effects of selected socio-demographic characteristics. Main findings During the two weeks before the survey, 87.9% of case households and 51.0% of control households had an intermittent piped water supply for an average of 4.3 days and 3.9 days, respectively. POU contamination of household stored water by E. coli was found in 83.3% of the case households, and 52.1% of the control households. In a fully adjusted model, a periodically intermittent piped water supply (adjusted matched odds ratio (adjusted mOR) = 4.8; 95% CI: 1.3–17.8), POU water contamination in household stored water by E. coli (adjusted mOR = 3.3; 95% CI: 1.1–10.1), water retrieved from water storage containers using handle-less vessels (adjusted mOR = 16.3; 95% CI: 4.4–60.1), and water retrieved by interchangeably using vessels both with and without handle (adjusted mOR = 5.4; 95% CI: 1.1–29.1) were independently associated with acute diarrhea. Conclusion We conclude that provision of continuously available piped water supplies and education of caregivers about proper water retrieval methods of household stored water can effectively reduce POU contamination of water at the household level and thereby reduce acute diarrhea among under-five children in slums of Addis Ababa. Promotion of household water treatment is also highly encouraged until the City’s water authority is able to deliver continuously available piped water supplies. PMID:28723927

Adaptive Data Processing Technique for Lidar-Assisted Control to Bridge the Gap between Lidar Systems and Wind Turbines: Preprint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schlipf, David; Raach, Steffen; Haizmann, Florian

2015-12-14

This paper presents first steps toward an adaptive lidar data processing technique crucial for lidar-assisted control in wind turbines. The prediction time and the quality of the wind preview from lidar measurements depend on several factors and are not constant. If the data processing is not continually adjusted, the benefit of lidar-assisted control cannot be fully exploited, or can even result in harmful control action. An online analysis of the lidar and turbine data are necessary to continually reassess the prediction time and lidar data quality. In this work, a structured process to develop an analysis tool for the predictionmore » time and a new hardware setup for lidar-assisted control are presented. The tool consists of an online estimation of the rotor effective wind speed from lidar and turbine data and the implementation of an online cross correlation to determine the time shift between both signals. Further, initial results from an ongoing campaign in which this system was employed for providing lidar preview for feed-forward pitch control are presented.« less

Intelligence and socioeconomic position in childhood in relation to frailty and cumulative allostatic load in later life: the Lothian Birth Cohort 1936.

PubMed

Gale, Catharine R; Booth, Tom; Starr, John M; Deary, Ian J

2016-06-01

Information on childhood determinants of frailty or allostatic load in later life is sparse. We investigated whether lower intelligence and greater socioeconomic disadvantage in childhood increased the risk of frailty and higher allostatic load, and explored the mediating roles of adult socioeconomic position, educational attainment and health behaviours. Participants were 876 members of the Lothian Birth Cohort 1936 whose intelligence was assessed at age 11. At age 70, frailty was assessed using the Fried criteria. Measurements were made of fibrinogen, triglyceride, total and high-density lipoprotein cholesterol, albumin, glycated haemoglobin, C reactive protein, body mass index and blood pressure, from which an allostatic load score was calculated. In sex-adjusted analyses, lower intelligence and lower social class in childhood were associated with an increased risk of frailty: relative risks (95% CIs) were 1.57 (1.21 to 2.03) for a SD decrease in intelligence and 1.48 (1.12 to 1.96) for a category decrease in social class. In the fully adjusted model, both associations ceased to be significant: relative risks were 1.13 (0.83 to 1.54) and 1.19 (0.86 to 1.61), respectively. Educational attainment had a significant mediating effect. Lower childhood intelligence in childhood, but not social class, was associated with higher allostatic load. The sex-adjusted coefficient for allostatic load for a SD decrease in intelligence was 0.10 (0.07 to 0.14). In the fully adjusted model, this association was attenuated but remained significant (0.05 (0.01 to 0.09)). Further research will need to investigate the mechanisms whereby lower childhood intelligence is linked to higher allostatic load in later life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Correlation of MRI-derived adipose tissue measurements and anthropometric markers with prevalent hypertension in the community.

PubMed

Lorbeer, Roberto; Rospleszcz, Susanne; Schlett, Christopher L; Heber, Sophia D; Machann, Jürgen; Thorand, Barbara; Meisinger, Christa; Heier, Margit; Peters, Annette; Bamberg, Fabian; Lieb, Wolfgang

2018-07-01

To compare the correlations of MRI-derived adipose tissue measurements and anthropometric markers, respectively, with prevalent hypertension in a community-based sample, free of clinical cardiovascular disease. MRI-derived adipose tissue measurements were obtained in 345 participants (143 women; age 39-73 years) of the KORA FF4 survey from Southern Germany using a 3-Tesla machine and included total adipose tissue (TAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SCAT), hepatic fat fraction (HFF), pancreatic fat fraction (PFF) as well as pericardial adipose tissue (PAT). In addition, the anthropometric markers body mass index, waist circumference, hip circumference, waist-hip ratio (WHR) and waist-height ratio (WHtR) as well as blood pressure measurements were obtained. The prevalence of hypertension was 33.6% (women: 28%, men: 38%). VAT and PAT had the highest area under the curve (AUC) values for identifying individuals with prevalent hypertension (AUC: 0.75; 0.73, respectively), whereas WHtR and waist circumference were best performing anthropometric markers (AUC: 0.72; 0.70, respectively). A 1SD increment of TAT was associated with the highest odd for hypertension in the age-adjusted and sex-adjusted model (OR = 2.20, 95% CI 1.67-2.91, P < 0.001) and in the fully adjusted model (OR = 1.97, 95% CI 1.45-2.66, P < 0.001). TAT was the only MRI-derived adipose tissue measurement that was associated with hypertension independently of the best performing anthropometric marker waist circumference in the fully adjusted model (OR = 1.93, 95% CI 1.00-3.72, P = 0.049). MRI-derived adipose tissue measurements perform similarly in identifying prevalent hypertension compared with anthropometric markers. Especially, TAT, VAT and PAT as well as WHtR and waist circumference were highly correlated with prevalent hypertension.

Identifying molecular features for prostate cancer with Gleason 7 based on microarray gene expression profiles.

PubMed

Bălăcescu, Loredana; Bălăcescu, O; Crişan, N; Fetica, B; Petruţ, B; Bungărdean, Cătălina; Rus, Meda; Tudoran, Oana; Meurice, G; Irimie, Al; Dragoş, N; Berindan-Neagoe, Ioana

2011-01-01

Prostate cancer represents the first leading cause of cancer among western male population, with different clinical behavior ranging from indolent to metastatic disease. Although many molecules and deregulated pathways are known, the molecular mechanisms involved in the development of prostate cancer are not fully understood. The aim of this study was to explore the molecular variation underlying the prostate cancer, based on microarray analysis and bioinformatics approaches. Normal and prostate cancer tissues were collected by macrodissection from prostatectomy pieces. All prostate cancer specimens used in our study were Gleason score 7. Gene expression microarray (Agilent Technologies) was used for Whole Human Genome evaluation. The bioinformatics and functional analysis were based on Limma and Ingenuity software. The microarray analysis identified 1119 differentially expressed genes between prostate cancer and normal prostate, which were up- or down-regulated at least 2-fold. P-values were adjusted for multiple testing using Benjamini-Hochberg method with a false discovery rate of 0.01. These genes were analyzed with Ingenuity Pathway Analysis software and were established 23 genetic networks. Our microarray results provide new information regarding the molecular networks in prostate cancer stratified as Gleason 7. These data highlighted gene expression profiles for better understanding of prostate cancer progression.

Untangling the Association Between Migraine, Pain, and Anxiety: Examining Migraine and Generalized Anxiety Disorders in a Canadian Population Based Study.

PubMed

Fuller-Thomson, Esme; Jayanthikumar, Janany; Agbeyaka, Senyo K

2017-03-01

The aims of this study were to investigate: (1) the prevalence and unadjusted and adjusted odds of 12-month generalized anxiety disorder (GAD) among adults with migraine in comparison to those without migraine; (2) If debilitating pain and/or limitations in instrumental activities of daily living (IADLs) are mediators of the migraine-GAD association; and (3) Factors associated with past year GAD among adults with migraine. Secondary data analysis of the nationally representative 2012 Canadian Community Health Survey-Mental Health (CCHS-MS), a population-based survey of community dwellers with a response rate of 68.9%. The first subsample included those with (n = 2232) and without migraine (n = 19,270), and the second subsample was restricted to those with migraine (n = 2232). GAD was based on the WHO-CIDI scale. Fully, 6% of those with migraines had past year GAD in comparison of 2.1% of those without migraine (P < .001). The socio-demographically adjusted odds of past year GAD were two and a half times higher among those with migraine than those without (OR= 2.46; 95% CI = 2.00, 3.02). A path analysis indicated that debilitating pain and limitations in IADLs were mediators in the relationship between migraine and GAD. In the sample restricted to migraineurs, the factors associated with higher odds of 12-month GAD included having a university degree, having low income, being without a confidant, and being male. Generalized anxiety disorder is robustly associated with migraine and targeted outreach and interventions are warranted. © 2016 American Headache Society.

Sarcopenia is an independent risk factor of dysphagia in hospitalized older people.

PubMed

Maeda, Keisuke; Akagi, Junji

2016-04-01

Sarcopenia can cause varying physical function disorders, including dysphagia. Malnutrition, a potential result of dysphagia, can also cause sarcopenia. However, the association between sarcopenia and dysphagia is not fully understood, despite evidence suggesting correlations between deglutition disorders and degenerative loss of muscle mass. The present study investigated the prevalence of dysphagia among patients with sarcopenia, and the association between the two conditions. We included 224 older adults (mean age 82.5 ± 8.4 years; 37.9% men). Individuals who had a stroke or other diseases that could directly cause dysphagia were excluded. Logistic regression analyses were carried out after adjusting for potential causes of sarcopenia, including malnutrition, a low activity of daily living levels and aging, to investigate the relationship between the skeletal muscle index (SMI), prevalence of sarcopenia diagnosed based on a low SMI and grip strength, and swallowing functions. The Mini-Nutritional Assessment short form was used to assess their nutritional status, and the Barthel Index was used to evaluate their activities of daily living. The prevalences of sarcopenia and dysphagia were 76.8% and 30.0%, respectively. Multivariate analysis showed that Barthel Index, SMI and presence of sarcopenia were significant independent factors for the prevalence of dysphagia, after adjusting for sex, age and nutritional status. Furthermore, subgroup analysis showed that SMI in males, and both hand-grip strength and SMI in females were lower in dysphagic subjects than in non-dysphagic subjects (P ≤ 0.01). Sarcopenia was an independent risk factor for dysphagia among older individuals. However, further studies are required to define causality. © 2015 Japan Geriatrics Society.

Fully unsteady subsonic and supersonic potential aerodynamics for complex aircraft configurations with applications to flutter

NASA Technical Reports Server (NTRS)

Tseng, K.; Morino, L.

1975-01-01

A general formulation is presented for the analysis of steady and unsteady, subsonic and supersonic aerodynamics for complex aircraft configurations. The theoretical formulation, the numerical procedure, the description of the program SOUSSA (steady, oscillatory and unsteady, subsonic and supersonic aerodynamics) and numerical results are included. In particular, generalized forces for fully unsteady (complex frequency) aerodynamics for a wing-body configuration, AGARD wing-tail interference in both subsonic and supersonic flows as well as flutter analysis results are included. The theoretical formulation is based upon an integral equation, which includes completely arbitrary motion. Steady and oscillatory aerodynamic flows are considered. Here small-amplitude, fully transient response in the time domain is considered. This yields the aerodynamic transfer function (Laplace transform of the fully unsteady operator) for frequency domain analysis. This is particularly convenient for the linear systems analysis of the whole aircraft.

Job Strain, Health and Sickness Absence: Results from the Hordaland Health Study

PubMed Central

Wang, Min-Jung; Mykletun, Arnstein; Møyner, Ellen Ihlen; Øverland, Simon; Henderson, Max; Stansfeld, Stephen; Hotopf, Matthew; Harvey, Samuel B.

2014-01-01

Objectives While it is generally accepted that high job strain is associated with adverse occupational outcomes, the nature of this relationship and the causal pathways involved are not well elucidated. We aimed to assess the association between job strain and long-term sickness absence (LTSA), and investigate whether any associations could be explained by validated health measures. Methods Data from participants (n = 7346) of the Hordaland Health Study (HUSK), aged 40–47 at baseline, were analyzed using multivariate Cox regression to evaluate the association between job strain and LTSA over one year. Further analyses examined whether mental and physical health mediated any association between job strain and sickness absence. Results A positive association was found between job strain and risk of a LTSA episode, even controlling for confounding factors (HR = 1.64 (1.36–1.98); high job strain exposure accounted for a small proportion of LTSA episodes (population attributable risk 0.068). Further adjustments for physical health and mental health individually attenuated, but could not fully explain the association. In the fully adjusted model, the association between high job strain and LTSA remained significant (HR = 1.30 (1.07–1.59)). Conclusion High job strain increases the risk of LTSA. While our results suggest that one in 15 cases of LTSA could be avoided if high job strain were eliminated, we also provide evidence against simplistic causal models. The impact of job strain on future LTSA could not be fully explained by impaired health at baseline, which suggests that factors besides ill health are important in explaining the link between job strain and sickness absence. PMID:24755878

Portable precision dc voltage-current transfer standard for electrometer calibration

USGS Publications Warehouse

Landis, G.; Godwin, M.

1982-01-01

A circuit design is presented for an instrument providing a highly stable and fully adjustable voltage and current in the range of 0-1.999 V or 0-199.9 mV and 10-11-10-15 A. This instrument is used to verify the calibration and performance of dc and vibrating reed electrometers and chart recorders on mass spectrometers of the USGS Isotope Laboratories in Denver.

High Temperature Catalytically Assisted Combustion.

DTIC Science & Technology

1983-07-31

AUTHOR(S) F.V. Bracco, B.S.H. Royce, C. Bruno, D.A. Santavicca, Y. Stein 16I. SUPPLEMENTARY NOTATION FIELD GROUP - SUB. GR. ’Catalytic Combustion... controlling radial gradients. These functions can be very accurate for fully developed steady flows but require significant adjustments for transient...however, to limit computation costs, the reported solutions were obtained using the quasi -steady gas assumption already employed by T’ien in his one

Mexican-American War

DTIC Science & Technology

2006-01-01

speedily, but to bring all matters in dispute between this Government and Mexico to an early and amicable adjustment; and in this view I shall be prepared... views , though entertained by but few, have been widely and extensively circulated, not only at home, but have been spread throughout Mexico and the whole...President was referred, fully sustained his views of the character of the wrongs which we had suffered from Mexico , and recommended that another demand

Social-emotional competence and early adolescents' peer acceptance in school: Examining the role of afternoon cortisol.

PubMed

Oberle, Eva

2018-01-01

The present study investigated the role of afternoon cortisol in social-emotional competence and peer acceptance in early adolescence. To date, research on basal cortisol activity and social development in childhood and adolescence has predominately focused on understanding maladjustment and dysfunction in development. The degree to which basal cortisol is also involved in positive adjustment and social functioning remains largely unexplored. A total of 154 early adolescents (46% female; Mean age = 11.26; SD = .65) from diverse ethnic backgrounds provided self-reports of perspective taking, peer reports of acceptance by classmates, peer reports of prosocial behaviors, and saliva samples to assess basal cortisol. As expected and in alignment with previous research, afternoon cortisol, perspective taking, prosocial behaviors, and peer acceptance were all positively correlated. Path analyses followed by bootstrapping analyses revealed that the direct path from higher afternoon cortisol to higher levels of prosocial behavior was fully mediated by perspective taking skills. The direct path from higher afternoon cortisol to peer acceptance was fully mediated by perspective taking skills and prosocial behavior. The findings are discussed within the broader context of previous research on cortisol and social adjustment in childhood and early adolescence. The practical relevance of the findings is considered.

Vitamin D levels and menopause-related symptoms.

PubMed

LeBlanc, Erin S; Desai, Manisha; Perrin, Nancy; Wactawski-Wende, Jean; Manson, JoAnn E; Cauley, Jane A; Michael, Yvonne L; Tang, Jean; Womack, Catherine; Song, Yiqing; Johnson, Karen C; O'Sullivan, Mary J; Woods, Nancy; Stefanick, Marcia L

2014-11-01

This study aims to determine whether vitamin D levels are associated with menopause-related symptoms in older women. A randomly selected subset of 1,407 women, among 26,104 potentially eligible participants of the Women's Health Initiative Calcium and Vitamin D trial of postmenopausal women aged 51 to 80 years, had 25-hydroxyvitamin D [25(OH)D] levels measured at the Women's Health Initiative Calcium and Vitamin D trial baseline visit. Information about menopause-related symptoms at baseline was obtained by questionnaire and included overall number of symptoms and composite measures of sleep disturbance, emotional well-being, and energy/fatigue, as well as individual symptoms. After exclusions for missing data, 530 women (mean [SD] age, 66.2 [6.8] y) were included in these analyses. Borderline significant associations between 25(OH)D levels and total number of menopausal symptoms were observed (with P values ranging from 0.05 to 0.06 for fully adjusted models); however, the effect was clinically insignificant and disappeared with correction for multiple testing. No associations between 25(OH)D levels and composite measures of sleep disturbance, emotional well-being, or energy/fatigue were observed (P's > 0.10 for fully adjusted models). There is no evidence for a clinically important association between serum 25(OH)D levels and menopause-related symptoms in postmenopausal women.

Vitamin D levels and menopause-related symptoms

PubMed Central

LeBlanc, Erin S.; Desai, Manisha; Perrin, Nancy; Wactawski-Wende, Jean; Manson, JoAnn E.; Cauley, Jane A.; Michael, Yvonne L.; Tang, Jean; Womack, Catherine; Song, Yiqing; Johnson, Karen C.; O’Sullivan, Mary J.; Woods, Nancy; Stefanick, Marcia L.

2015-01-01

Objective To determine whether vitamin D levels are associated with menopause-related symptoms in older women. Methods A randomly selected subset of 1,407 women, among 26,104 potentially eligible participants of the Women’s Health Initiative Calcium and Vitamin D (CaD) trial of postmenopausal women aged 51-80 years, had 25-hydroxyvitamin D [25(OH)D] levels measured at the CaD trial baseline visit. Information about menopause-related symptoms at baseline was obtained by questionnaire and included overall number of symptoms and composite measures of sleep disturbance, emotional well-being, and energy/fatigue, as well as individual symptoms. After exclusions for missing data, 530 women [mean age 66.2 years (SD 6.8)] were included in these analyses. Results There were borderline significant associations between 25(OH)D levels and total number of menopausal symptoms (p values ranging from 0.05 to 0.06 for fully adjusted models); however, the effect was clinically insignificant and disappeared with correction for multiple testing. There were no associations between 25(OH)D levels and composite measures of sleep disturbance, emotional well-being, or energy/fatigue (p’s > 0.10 for fully adjusted models). Conclusions There was no evidence of a clinically important association between serum 25(OH)D levels and menopause-related symptoms in postmenopausal women. PMID:24736200

Psychosocial Factors Are Associated With Blood Pressure Progression Among African Americans in the Jackson Heart Study.

PubMed

Ford, Cassandra D; Sims, Mario; Higginbotham, John C; Crowther, Martha R; Wyatt, Sharon B; Musani, Solomon K; Payne, Thomas J; Fox, Ervin R; Parton, Jason M

2016-08-01

Research that examines the associations of psychosocial factors with incident hypertension among African Americans (AA) is limited. Using Jackson Heart Study (JHS) data, we examined associations of negative affect and stress with incident hypertension and blood pressure (BP) progression among AA. Our sample consisted of 1,656 normotensive participants at baseline (2000-2004) (mean age 47±12; 61% women). We investigated associations of negative affect (cynical distrust, anger-in, anger-out, and depressive symptoms) and stress (perceived stress, weekly stress inventory (WSI)-event, WSI-impact, and major life events) with BP progression (an increase by one BP stage as defined by JNC VII) and incident hypertension by examination 2 (2005-2008). Poisson regression analysis was utilized to examine the prevalence ratios (PRs; 95% confidence interval (CI)) of BP tracking and incident hypertension with psychosocial factors, adjusting for baseline age, sex, socioeconomic status (SES), and hypertension risk factors. Fifty-six percentage of the sample (922 cases) had BP progression from 2005 to 2008. After adjustment for age, sex, and SES, a high anger-out score was associated with a 20% increased risk of BP progression compared to a low anger-out score (PR 1.20; 95% CI 1.05-1.36). High depressive symptoms score was associated with BP progression in the age, sex, and SES-adjusted model (PR 1.14; 95% CI 1.00-1.30). High WSI-event scores were associated with BP progression in the fully adjusted model (PR 1.21; 95% CI 1.04-1.40). We did not observe significant associations with any of the psychosocial measures and incident hypertension. Psychosocial factors were associated with BP progression, with the strongest evidence for number of stressful events that occurred. © American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Does Walkability Contribute to Geographic Variation in Psychosocial Distress? A Spatial Analysis of 91,142 Members of the 45 and Up Study in Sydney, Australia

PubMed Central

Morgan, Geoffrey G.; Jalaludin, Bin B.; Bauman, Adrian E.

2018-01-01

Walkability describes the capacity of the built environment to promote walking, and has been proposed as a potential focus for community-level mental health planning. We evaluated this possibility by examining the contribution of area-level walkability to variation in psychosocial distress in a population cohort at spatial scales comparable to those used for regional planning in Sydney, Australia. Data on psychosocial distress were analysed for 91,142 respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. We fit conditional auto regression models at the postal area level to obtain smoothed “disease maps” for psychosocial distress, and assess its association with area-level walkability after adjusting for individual- and area-level factors. Prevalence of psychosocial distress was 7.8%; similar for low (7.9%), low-medium (7.9%), medium-high (8.0%), and high (7.4%) walkability areas; and decreased with reducing postal area socioeconomic disadvantage: 12.2% (most), 9.3%, 7.5%, 5.9%, and 4.7% (least). Unadjusted disease maps indicated strong geographic clustering of psychosocial distress with 99.0% of excess prevalence due to unobserved and spatially structured factors, which was reduced to 55.3% in fully adjusted maps. Spatial and unstructured variance decreased by 97.3% and 39.8% after adjusting for individual-level factors, and another 2.3% and 4.2% with the inclusions of area-level factors. Excess prevalence of psychosocial distress in postal areas was attenuated in adjusted models but remained spatially structured. Postal area prevalence of high psychosocial distress is geographically clustered in Sydney, but is unrelated to postal area walkability. Area-level socioeconomic disadvantage makes a small contribution to this spatial structure; however, community-level mental health planning will likely deliver greatest benefits by focusing on individual-level contributors to disease burden and inequality associated with psychosocial distress. PMID:29415461

Does Walkability Contribute to Geographic Variation in Psychosocial Distress? A Spatial Analysis of 91,142 Members of the 45 and Up Study in Sydney, Australia.

PubMed

Mayne, Darren J; Morgan, Geoffrey G; Jalaludin, Bin B; Bauman, Adrian E

2018-02-06

Walkability describes the capacity of the built environment to promote walking, and has been proposed as a potential focus for community-level mental health planning. We evaluated this possibility by examining the contribution of area-level walkability to variation in psychosocial distress in a population cohort at spatial scales comparable to those used for regional planning in Sydney, Australia. Data on psychosocial distress were analysed for 91,142 respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. We fit conditional auto regression models at the postal area level to obtain smoothed "disease maps" for psychosocial distress, and assess its association with area-level walkability after adjusting for individual- and area-level factors. Prevalence of psychosocial distress was 7.8%; similar for low (7.9%), low-medium (7.9%), medium-high (8.0%), and high (7.4%) walkability areas; and decreased with reducing postal area socioeconomic disadvantage: 12.2% (most), 9.3%, 7.5%, 5.9%, and 4.7% (least). Unadjusted disease maps indicated strong geographic clustering of psychosocial distress with 99.0% of excess prevalence due to unobserved and spatially structured factors, which was reduced to 55.3% in fully adjusted maps. Spatial and unstructured variance decreased by 97.3% and 39.8% after adjusting for individual-level factors, and another 2.3% and 4.2% with the inclusions of area-level factors. Excess prevalence of psychosocial distress in postal areas was attenuated in adjusted models but remained spatially structured. Postal area prevalence of high psychosocial distress is geographically clustered in Sydney, but is unrelated to postal area walkability. Area-level socioeconomic disadvantage makes a small contribution to this spatial structure; however, community-level mental health planning will likely deliver greatest benefits by focusing on individual-level contributors to disease burden and inequality associated with psychosocial distress.

Racial disparities in colorectal cancer survival: to what extent are racial disparities explained by differences in treatment, tumor characteristics, or hospital characteristics?

PubMed

White, Arica; Vernon, Sally W; Franzini, Luisa; Du, Xianglin L

2010-10-01

Racial/ethnic differences in colorectal cancer (CRC) survival have been documented throughout the literature. However, the reasons for these disparities are difficult to decipher. The objective of this analysis was to determine the extent to which racial/ethnic disparities in survival are explained by differences in sociodemographics, tumor characteristics, diagnosis, treatment, and hospital characteristics. A cohort of 37,769 Medicare beneficiaries who were diagnosed with American Joint Committee on Cancer stages I, II, and III CRC from 1992 to 2002 and resided in 16 Surveillance, Epidemiology, and End Results (SEER) regions of the United States was identified in the SEER-Medicare linked database. Survival was estimated using the Kaplan-Meier method. Cox proportional hazards modeling was used to estimate hazard ratios (HRs) of mortality and 95% confidence intervals (CIs). Black patients had worse CRC-specific survival than white patients, but the difference was reduced after adjustment (adjusted HR [aHR], 1.24; 95% CI, 1.14-1.35). Asian patients had better survival than white patients after adjusting for covariates (aHR, 0.80; 95% CI, 0.70-0.92) for stages I, II, and III CRC. Relative to Asians, blacks and whites had worse survival after adjustment (blacks: aHR, 1.56; 95% CI, 1.33-1.82; whites: aHR, 1.26; 95% CI, 1.10-1.44). Comorbidities and socioeconomic Status were associated with a reduction in the mortality difference between blacks and whites and blacks and Asians. Comorbidities and SES appeared to be more important factors contributing to poorer survival among black patients relative to white and Asian patients. However, racial/ethnic differences in CRC survival were not fully explained by differences in several factors. Future research should further examine the role of quality of care and the benefits of treatment and post-treatment surveillance in survival disparities. Copyright © 2010 American Cancer Society.

Family employment and child socioemotional behaviour: longitudinal findings from the UK Millennium Cohort Study.

PubMed

Hope, Steven; Pearce, Anna; Whitehead, Margaret; Law, Catherine

2014-10-01

Levels of paid employment in two parent and lone parent families have increased in the UK but evidence of its impact on child socioemotional behaviour is limited and inconsistent. We conducted a longitudinal analysis using the first four sweeps of the Millennium Cohort Study (9 months, 3 years, 5 years and 7 years) to investigate the influence of family employment trajectories in the early years on socioemotional behaviour at 7 years, unadjusted and adjusted for covariates. In addition, mothers' employment was investigated separately. Children from families where no parent was employed for one or more sweeps were at a greater risk of socioemotional problem behaviour compared with those where a parent was continuously employed, even after adjustment for covariates. Children of mothers who were non-employed for one or more sweeps were at greater risk of problem behaviour compared with mothers who were employed at all sweeps. Adjustment for covariates fully attenuated the excess risk for children whose mothers had moved into employment by the time they were 7 years. In contrast, the elevated risk associated with continuous non-employment and a single transition out of employment was attenuated after adjustment for early covariates, fathers' employment, household income and mothers' psychological distress at 7 years, but remained significant. Family and mothers' employment were associated with a lower risk of problem behaviour for children in middle childhood, in part explained by sociodemographic characteristics of families and the apparent psychological and socioeconomic benefits of employment. Results for mothers' transitions in or out of the labour market suggest that child problem behaviour is influenced by current status, over and above diverse earlier experiences of employment and non-employment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Geographical Variation in Diabetes Prevalence and Detection in China: Multilevel Spatial Analysis of 98,058 Adults

PubMed Central

Zhou, Maigeng; Astell-Burt, Thomas; Bi, Yufang; Feng, Xiaoqi; Jiang, Yong; Li, Yichong; Page, Andrew; Wang, Limin; Xu, Yu

2015-01-01

OBJECTIVE To investigate the geographic variation in diabetes prevalence and detection in China. RESEARCH DESIGN AND METHODS Self-report and biomedical data were collected from 98,058 adults aged ≥18 years (90.5% response) from 162 areas spanning mainland China. Diabetes status was assessed using American Diabetes Association criteria. Among those with diabetes, detection was defined by prior diagnosis. Choropleth maps were used to visually assess geographical variation in each outcome at the provincial level. The odds of each outcome were assessed using multilevel logistic regression, with adjustment for person- and area-level characteristics. RESULTS Geographic visualization at the provincial level indicated widespread variation in diabetes prevalence and detection across China. Regional prevalence adjusted for age, sex, and urban/rural socioeconomic circumstances (SECs) ranged from 8.3% (95% CI 7.2%, 9.7%) in the northeast to 12.7% (11.1%, 14.6%) in the north. A clear negative gradient in diabetes prevalence was observed from 13.1% (12.0%, 14.4%) in the urban high-SEC to 8.7% (7.8%, 9.6%) in rural low-SEC counties/districts. Adjusting for health literacy and other person-level characteristics only partially attenuated these geographic variations. Only one-third of participants living with diabetes had been previously diagnosed, but this also varied substantively by geography. Regional detection adjusted for age, sex, and urban/rural SEC, for example, spanned from 40.4% (34.9%, 46.3%) in the north to 15.6% (11.7%, 20.5%) in the southwest. Compared with detection of 40.8% (37.3%, 44.4%) in urban high-SEC counties, detection was poorest among rural low-SEC counties at just 20.5% (17.7%, 23.7%). Person-level characteristics did not fully account for these geographic variations in diabetes detection. CONCLUSIONS Strategies for addressing diabetes risk and improving detection require geographical targeting. PMID:25352654

Fully Burdened Cost of Fuel Using Input-Output Analysis

DTIC Science & Technology

2011-12-01

Distribution Model could be used to replace the current seven-step Fully Burdened Cost of Fuel process with a single step, allowing for less complex and...wide extension of the Bulk Fuels Distribution Model could be used to replace the current seven-step Fully Burdened Cost of Fuel process with a single...ABBREVIATIONS AEM Atlantic, Europe, and the Mediterranean AOAs Analysis of Alternatives DAG Defense Acquisition Guidebook DAU Defense Acquisition University

Application of a Fully Numerical Guidance to Mars Aerocapture

NASA Technical Reports Server (NTRS)

Matz, Daniel A.; Lu, Ping; Mendeck, Gavin F.; Sostaric, Ronald R.

2017-01-01

An advanced guidance algorithm, Fully Numerical Predictor-corrector Aerocapture Guidance (FNPAG), has been developed to perform aerocapture maneuvers in an optimal manner. It is a model-based, numerical guidance that benefits from requiring few adjustments across a variety of different hypersonic vehicle lift-to-drag ratios, ballistic co-efficients, and atmospheric entry conditions. In this paper, FNPAG is first applied to the Mars Rigid Vehicle (MRV) mid lift-to-drag ratio concept. Then the study is generalized to a design map of potential Mars aerocapture missions and vehicles, ranging from the scale and requirements of recent robotic to potential human and precursor missions. The design map results show the versatility of FNPAG and provide insight for the design of Mars aerocapture vehicles and atmospheric entry conditions to achieve desired performance.

The association between smoking and blood pressure in men: a cross-sectional study.

PubMed

Li, Guoju; Wang, Hailing; Wang, Ke; Wang, Wenrui; Dong, Fen; Qian, Yonggang; Gong, Haiying; Hui, Chunxia; Xu, Guodong; Li, Yanlong; Pan, Li; Zhang, Biao; Shan, Guangliang

2017-10-10

Cigarette smoking is a known risk factor for cardiovascular disease (CVD), but the association between smoking and blood pressure is unclear. Thus, the current study examined the association between cigarette smoking and blood pressure in men. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP) were examined using digital blood pressure measuring device, and smoking status was determined with China National Health Survey. The ANCOVA showed that the adjusted DBP and MAP were lower in current smokers versus nonsmokers and the adjusted SBP was lower in current smokers versus former smokers (P < 0.05). Additionally, the adjusted PP tend to be decreased steadily as the pack·years increased in current smokers. In a fully adjusted logistic regression model, former smokers had increased ORs (95% CI) of 1.48 (1.01, 2.18) of hypertension and current smokers had not increased ORs (95% CI) of 0.83 (0.61, 1.12), compared with never smokers. The findings revealed that the adjusted blood pressure were lower in current smokers versus nonsmokers and former smokers. No significant dose-dependent effect of current smoking on blood pressure indices except PP was observed. Smoking cessation was significantly associated with an increased risk of hypertension. However, current smoking was not a risk factor of hypertension.

Can statistic adjustment of OR minimize the potential confounding bias for meta-analysis of case-control study? A secondary data analysis.

PubMed

Liu, Tianyi; Nie, Xiaolu; Wu, Zehao; Zhang, Ying; Feng, Guoshuang; Cai, Siyu; Lv, Yaqi; Peng, Xiaoxia

2017-12-29

Different confounder adjustment strategies were used to estimate odds ratios (ORs) in case-control study, i.e. how many confounders original studies adjusted and what the variables are. This secondary data analysis is aimed to detect whether there are potential biases caused by difference of confounding factor adjustment strategies in case-control study, and whether such bias would impact the summary effect size of meta-analysis. We included all meta-analyses that focused on the association between breast cancer and passive smoking among non-smoking women, as well as each original case-control studies included in these meta-analyses. The relative deviations (RDs) of each original study were calculated to detect how magnitude the adjustment would impact the estimation of ORs, compared with crude ORs. At the same time, a scatter diagram was sketched to describe the distribution of adjusted ORs with different number of adjusted confounders. Substantial inconsistency existed in meta-analysis of case-control studies, which would influence the precision of the summary effect size. First, mixed unadjusted and adjusted ORs were used to combine individual OR in majority of meta-analysis. Second, original studies with different adjustment strategies of confounders were combined, i.e. the number of adjusted confounders and different factors being adjusted in each original study. Third, adjustment did not make the effect size of original studies trend to constringency, which suggested that model fitting might have failed to correct the systematic error caused by confounding. The heterogeneity of confounder adjustment strategies in case-control studies may lead to further bias for summary effect size in meta-analyses, especially for weak or medium associations so that the direction of causal inference would be even reversed. Therefore, further methodological researches are needed, referring to the assessment of confounder adjustment strategies, as well as how to take this kind of bias into consideration when drawing conclusion based on summary estimation of meta-analyses.

Disparities in self-reported diabetes mellitus among Arab, Chaldean, and black Americans in Southeast Michigan.

PubMed

Jamil, Hikmet; Fakhouri, Monty; Dallo, Florence; Templin, Thomas; Khoury, Radwan; Fakhouri, Haifa

2008-10-01

Diabetes mellitus is an important public health problem that disproportionately affects minorities. Using a cross sectional, convenience sample, we estimated the prevalence of self-reported diabetes for Whites (n = 212), Arabs (n = 1,303), Chaldeans (n = 828), and Blacks (n = 789) in southeast Michigan. In addition, using a logistic regression model, we estimated odds ratios and 95% confidence intervals for the association between ethnicity and diabetes before and after adjusting for demographic, socioeconomic status, health care, chronic conditions, and health behavior variables. The overall age- and sex-adjusted prevalence of diabetes was 7.0%. Estimates were highest for Blacks (8.0%) followed by Arabs and Whites (7.0% for each group) and Chaldeans (6.0%). In the fully adjusted model, the association between ethnicity and diabetes was not statistically significant. Future studies should collect more detailed socioeconomic status, acculturation and health behavior information, which are factors that may affect the relationship between race/ethnicity and diabetes.

Executive Functioning and School Adjustment: The Mediational Role of Pre-kindergarten Learning-related Behaviors

PubMed Central

Sasser, Tyler R.; Bierman, Karen L.; Heinrichs, Brenda

2016-01-01

164 four-year-old children (14% Latino American, 30% African American, 56% European American; 57% girls) in 22 Head Start classrooms were followed through third grade. Growth curve models were used to estimate the predictive associations between pre-kindergarten executive function (EF) skills and trajectories of academic skill development (math, literacy, overall academic functioning) and social-emotional adjustment at school (social competence, aggression), controlling for child sex, race, verbal IQ, and pre-kindergarten baseline scores. Direct developmental pathways were examined, along with indirect pathways, in which the association between preschool EF and elementary school adjustment was mediated by classroom learning behaviors. Preschool EF significantly predicted later math skills, academic functioning, and social competence, and marginally predicted later literacy skills. Preschool learning behaviors fully mediated the association between EF and later literacy skills and social competence, but did not mediate associations between EF and later math skills or academic functioning. Implications for developmental theory and early education are discussed. PMID:27231409

Progress in Fully Automated Abdominal CT Interpretation

PubMed Central

Summers, Ronald M.

2016-01-01

OBJECTIVE Automated analysis of abdominal CT has advanced markedly over just the last few years. Fully automated assessment of organs, lymph nodes, adipose tissue, muscle, bowel, spine, and tumors are some examples where tremendous progress has been made. Computer-aided detection of lesions has also improved dramatically. CONCLUSION This article reviews the progress and provides insights into what is in store in the near future for automated analysis for abdominal CT, ultimately leading to fully automated interpretation. PMID:27101207

Risk factors for death from pandemic influenza in 1918–1919: a case–control study

PubMed Central

Summers, Jennifer A; Stanley, James; Baker, Michael G; Wilson, Nick

2014-01-01

Background Despite the persisting threat from future influenza pandemics, much is still unknown about the risk factors for death from such events, and especially for the 1918–1919 influenza pandemic. Methods A case–control study was performed to explore possible risk factors for death from pandemic influenza among New Zealand military personnel in the Northern Hemisphere in 1918–1919 (n = 218 cases, n = 221 controls). Data were compiled from a Roll-of-Honour dataset, a dataset of nearly all military personnel involved in the war and archived individual records. Results In the fully adjusted multivariable model, the following were significantly associated with increased risk of death from pandemic influenza: age (25–29 years), pre-pandemic hospitalisations for a chronic condition (e.g. tuberculosis), relatively early year of military deployment, a relatively short time from enlistment to foreign service, and having a larger chest size (e.g. adjusted odds ratio for 90–99 cm versus <90 cm was 2·45; 95% CI=1·47–4·10). There were no significant associations in the fully adjusted model with military rank, occupational class at enlistment, and rurality at enlistment. Conclusions This is one of the first published case–control studies of mortality risk factors for the 1918–1919 influenza pandemic. Some of the findings are consistent with previous research on risk factors (such as chronic conditions and age groups), but others appear more novel (e.g., larger chest size). As all such historical analyses have limitations, there is a need for additional studies in other settings as archival World War One records become digitalised. PMID:24490663

Lifestyle and emotional well-being in men and women with type 2 diabetes (e-VitaDM-4; ZODIAC-48).

PubMed

Hendriks, Steven H; van Soldt, Evelien G W; van Vugt, Michael; Groenier, Klaas H; Roelofsen, Yvonne; Maas, Angela H E M; Bilo, Henk J G; Kleefstra, Nanne; van Hateren, Kornelis J J

2017-12-01

Whether lifestyle is associated with well-being in patients with type 2 diabetes (T2D) is largely unknown. Uncovering and clarifying associations between these constructs may lead to new strategies for improving both. The aim was to investigate the relationship between lifestyle and well-being, focussing on gender differences. This cross-sectional study included 1085 patients with T2D that participated in the e-Vita part of the Zwolle outpatient diabetes project integrating available care (ZODIAC) study. Patients were included from May 2012 until September 2014 from 52 general practices. Emotional well-being was assessed with the World Health Organization-5 well-being index (WHO-5). Lifestyle information on body mass index, smoking, physical activity and alcohol use was extracted from self-reported questionnaires. Multiple linear regression analyses were used. After adjustment for other lifestyle factors, physical activity, smoking and drinking 22-35 alcohol consumptions per week were associated with the WHO-5 score in men and physical activity and smoking were associated with the WHO-5 score in women. In the fully adjusted analyses for the total study population, physical activity and smoking were still associated with the WHO-5 score (b = 1.1, P < .001 and b =-3.1, P = .018, respectively). In the fully adjusted analyses stratified to gender only physical activity was associated with the WHO-5 score (in men: b =0.8, P = .006, in women: b = 1.4, P = .001). This study shows a negative, non-clinically relevant association between smoking and emotional well-being in the total population with T2D and a positive, non-clinically relevant association between physical activity and emotional well-being in both men and women with T2D.

Intimate personal violence and caregiving: Influences on physical and mental health in middle-aged women.

PubMed

Ferreira, Pablo; Loxton, Deborah; Tooth, Leigh R

2017-08-01

To investigate if women with a history of having experienced intimate partner violence (IPV) who undertook caregiving would experience worse mental and physical health compared to those without caregiving roles. IPV, caregiving history and data on covariates were collected between 1996 and 2010 from 8453 participants in the Australian Longitudinal Study on Women's Health aged between 45 and 65 over the course of the study. Regression analyses were used to analyse the association of IPV and caregiving (categorised as IPV+caregiving, IPV+no caregiving, no IPV+caregiving, no IPV+no caregiving), with and without adjustment for covariates, on mental and physical health-related quality of life (HRQOL), depressive symptoms and perceived stress, measured in 2010. Experiencing IPV and being a caregiver was associated with poor health outcomes on three of the four outcomes (depressive symptoms, OR 2.08, 95% CI 1.58, 2.75; stress, OR 2.11, 95% CI 1.55, 2.87; physical HRQOL β -2.39, 95% CI -3.34, -1.44; all p≤0.001, fully adjusted) compared with not experiencing IPV or caregiving. On these outcomes, IPV and caregiving combined had a stronger association than IPV or caregiving separately. For mental HRQOL, a weaker association was found (OR 1.41 95% CI 1.02, 1.95, fully adjusted, p=0.04). This paper provides evidence for the cumulative health impact of stressful life events, both those that are perpetrated against an individual (violence) and those undertaken with a degree of personal agency (caregiving). The findings underscore the need to understand the drivers of poor health, for clinicians to ask about life circumstances of patients experiencing poor health, and for the provision of referral pathways for complex cases. Copyright © 2017 Elsevier B.V. All rights reserved.

Long-term exposure to residential railway and road traffic noise and risk for diabetes in a Danish cohort.

PubMed

Roswall, Nina; Raaschou-Nielsen, Ole; Jensen, Steen Solvang; Tjønneland, Anne; Sørensen, Mette

2018-01-01

Road traffic noise exposure has been found associated with diabetes incidence. Evidence for an association between railway noise exposure is less clear, as large studies with detailed railway noise modelling are lacking. To investigate the association between residential railway noise and diabetes incidence, and to repeat previous analyses on road traffic noise and diabetes with longer follow-up time. Among 50,534 middle-aged Danes enrolled into the Diet, Cancer and Health cohort from 1993 to 97, we identified 5062 cases of incident diabetes during a median follow-up of 15.5 years. Present and historical residential addresses from 1987 to 2012 were found in national registries, and railway and road traffic noise (L den ) were modelled for all addresses, using the Nordic prediction method. We used Cox proportional hazard models to investigate the association between residential traffic noise over 1 and 5 years before diagnosis, and diabetes incidence. Hazard ratios (HRs) were calculated as crude and adjusted for potential confounders. We found no association between railway noise exposure and diabetes incidence among the 9527 persons exposed, regardless of exposure time-window: HR 0.99 (0.94-1.04) per 10dB for 5-year exposure in fully adjusted models. There was no effect modification by sex, road traffic noise, and education. We confirmed the previously found association between road traffic noise exposure and diabetes including 6 additional years of follow-up: HR 1.08 (1.04-1.13) per 10dB for 5-year exposure in fully adjusted models. The study does not suggest an association between residential railway noise exposure and diabetes incidence, but supports the finding of a direct association with residential road traffic noise. Copyright © 2017 Elsevier Inc. All rights reserved.

Uric acid and endothelial function in elderly community-dwelling subjects.

PubMed

Ticinesi, Andrea; Lauretani, Fulvio; Ceda, Gian Paolo; Ruggiero, Carmelinda; Ferrucci, Luigi; Aloe, Rosalia; Larsson, Anders; Cederholm, Tommy; Lind, Lars; Meschi, Tiziana; Maggio, Marcello

2017-03-01

The role of serum uric acid (SUA), an inflammatory agent and potential mediator of cardiovascular diseases, in endothelial function (EF) has been tested only in middle-aged subjects affected by specific diseases. Our aim was to assess the relationship between SUA and measures of EF in a cohort of elderly community-dwellers. This study involved 424 males and 426 females aged 70years from the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS), having complete data on SUA and EF assessed by flow-mediated vasodilation (FMD) and by intra-arterial infusion of acetylcholine (endothelium-dependent vasodilation, EDV) and sodium nitroprusside (endothelium-independent vasodilation, EIDV). Univariate and multivariate regression models obtained by backward selection from initial fully-adjusted models were built to assess the relationship between SUA and measures of EF in both genders. Cardiovascular risk factors, serum hormonal and metabolic mediators, and body composition were considered as potential confounders. In the univariate model, SUA was inversely associated in both genders with log(EDV) (β±SE males -0.39±0.17, p=0.03; females -0.57±0.19, p=0.003) and log(EIDV) (males -0.23±0.12, p=0.05; females -0.49±0.15, p=0.002), but not with log(FMD). After adjustment for BMI, only the association between SUA and log(EIDV) in females persisted, though attenuated (-0.32±0.16, p=0.049), and was no longer significant in the fully-adjusted multivariate model including waist/hip ratio. In conclusion, in older subjects, especially women, SUA is associated with EF not independently of a list of confounders including BMI and trunk fat mass, suggesting a role as surrogate metabolic marker rather than an active player in EF. Copyright © 2017 Elsevier Inc. All rights reserved.

Uric acid and endothelial function in elderly community-dwelling subjects

PubMed Central

Ticinesi, Andrea; Lauretani, Fulvio; Ceda, Gian Paolo; Ruggiero, Carmelinda; Ferrucci, Luigi; Aloe, Rosalia; Larsson, Anders; Cederholm, Tommy; Lind, Lars; Meschi, Tiziana; Maggio, Marcello

2017-01-01

The role of serum uric acid (SUA), an inflammatory agent and potential mediator of cardiovascular diseases, in endothelial function (EF) has been tested only in middle-aged subjects affected by specific diseases. Our aim was to assess the relationship between SUA and measures of EF in a cohort of elderly community-dwellers. This study involved 424 males and 426 females aged 70 years from the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS), having complete data on SUA and EF assessed by flow-mediated vasodilation (FMD) and by intra-arterial infusion of acetylcholine (endothelium-dependent vasodilation, EDV) and sodium nitroprusside (endothelium-independent vasodilation, EIDV). Univariate and multivariate regression models obtained by backward selection from initial fully-adjusted models were built to assess the relationship between SUA and measures of EF in both genders. Cardiovascular risk factors, serum hormonal and metabolic mediators, and body composition were considered as potential confounders. In the univariate model, SUA was inversely associated in both genders with log(EDV) (β ± SE males −0.39 ± 0.17, p = 0.03; females −0.57 ± 0.19, p = 0.003) and log(EIDV) (males −0.23 ± 0.12, p = 0.05; females −0.49 ± 0.15, p = 0.002), but not with log(FMD). After adjustment for BMI, only the association between SUA and log(EIDV) in females persisted, though attenuated (−0.32 ± 0.16, p = 0.049), and was no longer significant in the fully-adjusted multivariate model including waist/hip ratio. In conclusion, in older subjects, especially women, SUA is associated with EF not independently of a list of confounders including BMI and trunk fat mass, suggesting a role as surrogate metabolic marker rather than an active player in EF. PMID:28057563

Serum Endotoxins and Flagellin and Risk of Colorectal Cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) Cohort

PubMed Central

Kong, So Yeon; Tran, Hao Quang; Gewirtz, Andrew T.; McKeown-Eyssen, Gail; Fedirko, Veronika; Romieu, Isabelle; Tjønneland, Anne; Olsen, Anja; Overvad, Kim; Boutron-Ruault, Marie-Christine; Bastide, Nadia; Affret, Aurélie; Kühn, Tilman; Kaaks, Rudolf; Boeing, Heiner; Aleksandrova, Krasimira; Trichopoulou, Antonia; Kritikou, Maria; Vasilopoulou, Effie; Palli, Domenico; Krogh, Vittorio; Mattiello, Amalia; Tumino, Rosario; Naccarati, Alessio; Bueno-de-Mesquita, H.Bas; Peeters, Petra H.; Weiderpass, Elisabete; Quirós, J. Ramón; Sala, Núria; Sánchez, María-José; Huerta Castaño, José María; Barricarte, Aurelio; Dorronsoro, Miren; Werner, Mårten; Wareham, Nicholas J.; Khaw, Kay-Tee; Bradbury, Kathryn E.; Freisling, Heinz; Stavropoulou, Faidra; Ferrari, Pietro; Gunter, Marc J.; Cross, Amanda J.; Riboli, Elio; Bruce, W. Robert

2017-01-01

Background Chronic inflammation and oxidative stress are thought to be involved in colorectal cancer (CRC) development. These processes may be contributed to by leakage of bacterial products, such as lipopolysaccharide (LPS) and flagellin, across the gut barrier. The objective of this study, nested within a prospective cohort, was to examine associations between circulating LPS and flagellin serum antibody levels and CRC risk. Methods 1,065 incident CRC cases (colon n=667; rectal n=398) were matched (1:1) to control subjects. Serum flagellin- and LPS-specific IgA and IgG levels were quantitated by ELISA. Multivariable conditional logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI), adjusting for multiple relevant confouding factors. Results Overall, elevated anti-LPS and anti-flagellin biomarker levels were not associated with CRC risk. After testing potential interactions by various factors relevant for CRC risk and anti-LPS and anti-flagellin, sex was identified as a statistically significant interaction factor (pinteraction < 0.05 for all the biomarkers). Analyses stratified by sex showed a statistically significant positive CRC risk association for men (fully-adjusted OR for highest vs. lowest quartile for total anti-LPS+flagellin = 1.66; 95% CI, 1.10-2.51; ptrend = 0.049) while a borderline statistically significant inverse association was observed for women (fully-adjusted OR= 0.70; 95%CI, 0.47-1.02; ptrend = 0.18). Conclusion In this prospective study on European populations, we found bacterial exposure levels to be positively associated to CRC risk among men while in women, a possible inverse association may exist. Impact Further studies are warranted to better clarify these preliminary observations. PMID:26823475

Error-related brain activity and error awareness in an error classification paradigm.

PubMed

Di Gregorio, Francesco; Steinhauser, Marco; Maier, Martin E

2016-10-01

Error-related brain activity has been linked to error detection enabling adaptive behavioral adjustments. However, it is still unclear which role error awareness plays in this process. Here, we show that the error-related negativity (Ne/ERN), an event-related potential reflecting early error monitoring, is dissociable from the degree of error awareness. Participants responded to a target while ignoring two different incongruent distractors. After responding, they indicated whether they had committed an error, and if so, whether they had responded to one or to the other distractor. This error classification paradigm allowed distinguishing partially aware errors, (i.e., errors that were noticed but misclassified) and fully aware errors (i.e., errors that were correctly classified). The Ne/ERN was larger for partially aware errors than for fully aware errors. Whereas this speaks against the idea that the Ne/ERN foreshadows the degree of error awareness, it confirms the prediction of a computational model, which relates the Ne/ERN to post-response conflict. This model predicts that stronger distractor processing - a prerequisite of error classification in our paradigm - leads to lower post-response conflict and thus a smaller Ne/ERN. This implies that the relationship between Ne/ERN and error awareness depends on how error awareness is related to response conflict in a specific task. Our results further indicate that the Ne/ERN but not the degree of error awareness determines adaptive performance adjustments. Taken together, we conclude that the Ne/ERN is dissociable from error awareness and foreshadows adaptive performance adjustments. Our results suggest that the relationship between the Ne/ERN and error awareness is correlative and mediated by response conflict. Copyright © 2016 Elsevier Inc. All rights reserved.

A population-based case-control study on statin exposure and risk of acute diverticular disease.

PubMed

Sköldberg, Filip; Svensson, Tobias; Olén, Ola; Hjern, Fredrik; Schmidt, Peter T; Ljung, Rickard

2016-01-01

A reduced risk of perforated diverticular disease among individuals with current statin exposure has been reported. The aim of the present study was to investigate whether statins reduce the risk of acute diverticular disease. A nation-wide population-based case-control study was performed, including 13,127 cases hospitalised during 2006-2010 with a first-time diagnosis of colonic diverticular disease, and 128,442 control subjects (matched for sex, age, county of residence and calendar year). Emergency surgery, assumed to be a proxy for complicated diverticulitis, was performed on 906 of the cases during the index admission, with 8818 matched controls. Statin exposure was classified as "current" or "former" if a statin prescription was last dispensed ≤ 125 days or >125 days before index date, respectively. The association between statin exposure and acute diverticular disease was investigated by conditional logistic regression, including models adjusting for country of birth, educational level, marital status, comorbidities, nonsteroidal anti-inflammatory drug/steroid exposure and healthcare utilisation. A total of 1959 cases (14.9%) and 16,456 controls (12.8%) were current statin users (crude OR 1.23 [95% CI 1.17-1.30]; fully adjusted OR 1.00 [0.94-1.06]). One hundred and thirty-two of the cases subjected to surgery (14.6%), and 1441 of the corresponding controls (16.3%) were current statin users (crude OR 0.89 [95% CI 0.73-1.08]; fully adjusted OR 0.70 [0.55-0.89]). The results do not indicate that statins affect the development of symptomatic diverticular disease in general. However, current statin use was associated with a reduced risk of emergency surgery for diverticular disease.

Family income and youths' symptoms of depression and anxiety: a longitudinal study of the French GAZEL Youth cohort.

PubMed

Melchior, Maria; Chastang, Jean-François; Walburg, Vera; Arseneault, Louise; Galéra, Cédric; Fombonne, Eric

2010-12-01

It is not clear whether socioeconomic inequalities with regard to depression and anxiety are present in adolescence and young adulthood. We tested the hypothesis that in the community, youths growing up in families with low income have elevated rates of such psychological difficulties. We used data from participants of the GAZEL Youth study, a French community-based cohort assessed in 1991 and 1999 (n = 941 youths, 4-18 years of age at baseline). Measures of family income and youths' symptoms of depression and anxiety (assessed using the ASEBA family of instruments) were obtained from parents and youths at study baseline and follow-up. Covariates included family characteristics (parental divorce, parental unemployment or labor force exit, parental health difficulties including psychopathology and the quality of family relations) and youths' characteristics (sex, age, stressful life events, history of internalizing and externalizing problems). Youths from families with low income during the study period had elevated odds of symptoms of depression and anxiety at follow-up (compared to youths from families with intermediate/high income, age-adjusted OR: 1.74, 95% CI 1.17-2.57; fully adjusted OR: 1.94, 95% CI: 1.27-2.97). In particular, the likelihood of psychological difficulties was elevated among youths from families that experienced decreasing and persistently low income over time (fully adjusted ORs, respectively: 2.44, 95% CI 1.24-4.81 and 1. 83, 95% 1.10-3.06). Clinicians need to be aware that youths growing up in low-income families in the community may be at risk of depression and anxiety during the period of transition to adulthood. © 2010 Wiley-Liss, Inc.

Fully Nonlinear Modeling and Analysis of Precision Membranes

NASA Technical Reports Server (NTRS)

Pai, P. Frank; Young, Leyland G.

2003-01-01

High precision membranes are used in many current space applications. This paper presents a fully nonlinear membrane theory with forward and inverse analyses of high precision membrane structures. The fully nonlinear membrane theory is derived from Jaumann strains and stresses, exact coordinate transformations, the concept of local relative displacements, and orthogonal virtual rotations. In this theory, energy and Newtonian formulations are fully correlated, and every structural term can be interpreted in terms of vectors. Fully nonlinear ordinary differential equations (ODES) governing the large static deformations of known axisymmetric membranes under known axisymmetric loading (i.e., forward problems) are presented as first-order ODES, and a method for obtaining numerically exact solutions using the multiple shooting procedure is shown. A method for obtaining the undeformed geometry of any axisymmetric membrane with a known inflated geometry and a known internal pressure (i.e., inverse problems) is also derived. Numerical results from forward analysis are verified using results in the literature, and results from inverse analysis are verified using known exact solutions and solutions from the forward analysis. Results show that the membrane theory and the proposed numerical methods for solving nonlinear forward and inverse membrane problems are accurate.

Differences in chewing behaviors between healthy fully dentate young and older adults assessed by electromyographic recordings.

PubMed

Zhu, Yong; Hollis, James H

2015-01-01

To characterize changes in chewing behaviors associated with healthy aging, 10 young and 10 older fully dentate healthy participants were enrolled in this study. They chewed carrot samples that differed in hardness until their normal swallowing threshold. Their chewing behaviors were assessed using an electromyographic recording device. Adjusting for gender and body mass index, older adults had a higher number of chewing cycles (p = 0.020), a longer chewing duration (p < 0.001), a slower chewing rate (p = 0.002), a greater maximal electromyographic voltage (p = 0.003) and a greater muscle activity (p = 0.002) before they could comfortably swallow the food bolus. A statistically significant main effect of food hardness on the number of chewing cycles, chewing duration, chewing rate and muscle activity was also observed (p < 0.001 for all). These results suggest that reduced mastication efficiency is associated with healthy aging in fully dentate adults. This ingestive behavior may contribute to aging-related reduction in appetite in older adults.

Ethnic Differences in Gestational Weight Gain: A Population-Based Cohort Study in Norway.

PubMed

Kinnunen, Tarja I; Waage, Christin W; Sommer, Christine; Sletner, Line; Raitanen, Jani; Jenum, Anne Karen

2016-07-01

Objectives To explore ethnic differences in gestational weight gain (GWG). Methods This was a population-based cohort study conducted in primary care child health clinics in Groruddalen, Oslo, Norway. Participants were healthy pregnant women (n = 632) categorised to six ethnic groups (43 % were Western European women, the reference group). Body weight was measured at 15 and 28 weeks' gestation on average. Data on pre-pregnancy weight and total GWG until delivery were self-reported. The main method of analysis was linear regression adjusting for age, weeks' gestation, pre-pregnancy body mass index, education and severe nausea. Results No ethnic differences were observed in GWG by 15 weeks' gestation. By 28 weeks' gestation, Eastern European women had gained 2.71 kg (95 % confidence interval, CI 1.10-4.33) and Middle Eastern women 1.32 kg (95 % CI 0.14-2.50) more weight on average than the Western European women in the fully adjusted model. Among Eastern European women, the total adjusted GWG was 3.47 kg (95 % CI 1.33-5.61) above the reference group. Other ethnic groups (South Asian, East Asian and African) did not differ from the reference group. When including non-smokers (n = 522) only, observed between-group differences increased and Middle Eastern women gained more weight than the reference group by all time points. Conclusions Eastern European and Middle Eastern women had higher GWG on average than Western European women, especially among the non-smokers. Although prevention of excessive GWG is important for all pregnant women, these ethnic groups might need special attention during pregnancy.

Longitudinal analysis of relationships between social support and general health in an Australian population cohort of young women.

PubMed

Holden, Libby; Lee, Christina; Hockey, Richard; Ware, Robert S; Dobson, Annette J

2015-02-01

The influence of social support on health and quality of life has been well documented. There is less evidence on whether health status affects social support, and little is known about longitudinal relationships between social support and health in early adulthood. This study investigates these associations using both concurrent and time-lagged measures at 5 time-points over 12 years during early adulthood. A population-based cohort of 9,758 young women from the Australian Longitudinal Study on Women's Health was used. Women were aged 22-27 in 2000 and 35-39 in 2012. The General Health subscale of the SF-36 and the MOS Social Support Survey 6-item Scale were used, with scores standardised to a range of 0-100. Longitudinal tobit models were used, because both social support and general health data were left skewed, with marked ceiling effects. All models were adjusted for status of the outcome of interest at the immediately previous survey. With both concurrent and time-lagged measures, there was a statistically significant difference in mean general health scores across social support quintiles after adjusting for demographic and behavioural covariates: lower general health was associated with lower social support. In reverse, social support mean scores were also significantly different across general health quintiles in both concurrent and time-lagged fully adjusted models. Social support is significantly associated with both current and subsequent general health in early adulthood. The significance of the reverse associations indicates that the two mutually influence each other. This study highlights the importance of social support as a health-related quality of life issue.

Arteriopathy after transarterial chemo-lipiodolization for hepatocellular carcinoma.

PubMed

Matsui, Y; Figi, A; Horikawa, M; Jahangiri Noudeh, Y; Tomozawa, Y; Hashimoto, K; Kaufman, J A; Farsad, K

2017-12-01

The purpose of this study was to investigate the incidence of and the risk factors for arteriopathy in hepatic arteries after transarterial chemo-lipiodolization in patients with hepatocellular carcinoma and the subsequent treatment strategy changes due to arteriopathy. A total of 365 arteries in 167 patients (126 men and 41 women; mean age, 60.4±15.0 [SD] years [range: 18-87 years]) were evaluated for the development of arteriopathy after chemo-lipiodolization with epirubicin- or doxorubicin-Lipiodol ® emulsion. The development of arteriopathy after chemo-lipiodolization was assessed on arteriograms performed during subsequent transarterial treatments. The treatment strategy changes due to arteriopathy, including change in the chemo-lipiodolization method and the application of alternative therapies was also investigated. Univariate and multivariate binary logistic regression models were used to identify risk factors for arteriopathy and subsequent treatment strategy change. One hundred two (27.9%) arteriopathies were detected in 62/167 (37.1%) patients (45 men, 17 women) with a mean age of 63.3±7.1 [SD] years (age range, 50-86 years). The incidence of arteriopathy was highly patient dependent, demonstrating significant correlation in a fully-adjusted multivariate regression model (P<0.0001). Multivariate-adjusted regression analysis with adjustment for the patient effect showed a statistically significant association of super-selective chemo-lipiodolization (P=0.003) with the incidence of arteriopathy. Thirty of the 102 arteriopathies (29.4%) caused a change in treatment strategy. No factors were found to be significantly associated with the treatment strategy change. The incidence of arteriopathy after chemo-lipiodolization is 27.9%. Among them, 29.4% result in a change in treatment strategy. Copyright © 2017 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Association between home food preparation skills and behaviour, and consumption of ultra-processed foods: Cross-sectional analysis of the UK National Diet and nutrition survey (2008-2009).

PubMed

Lam, Matthew Chak Leung; Adams, Jean

2017-05-23

'Ultra-processed foods' (UPF) have been industrially processed and tend to be higher in saturated fat, sodium and sugar than other foods. There is some evidence that consumption of UPF is associated with overweight, obesity and related diseases. In developed countries more than half of dietary energy is attributed to UPF. One reason for reliance on UPF may be poor home food preparation skills or infrequent use of these. This relationship has been previously proposed but not tested. We examined the relationship between home food preparation skills and behaviour and consumption of UPF. We used data from adults in the UK National Diet & Nutrition Survey 2008-09. Home food preparation skills and behaviours of adults (n = 509) were assessed using questions on confidence using eight cooking techniques, confidence cooking 10 foods, ability to prepare a cake or biscuits without help, and whether or not participants prepared a main meal five or more days per week. Individuals' UPF consumption was determined from four-day estimated diet diaries. Associations were adjusted for age, gender, occupational social class and household composition. In fully adjusted models, individuals who were confident with all 10 foods (adjusted beta (95% CI) = -3.76 (-6.02 to -1.50)), able to bake cakes or biscuits without help (-3.87 (-6.62 to -1.12)), and cooked a main meal at least five days a week (-2.84 (-5.43 to -0.24)) consumed a lower percentage of dietary energy from UPF. In UK adults better home food preparation skills and more frequent use of these skills tended to be cross-sectionally associated with lower UPF consumption. Greater encouragement of these skills may help reduce reliance on UPF.

Macronutrient intake as a mediator with FTO to increase body mass index.

PubMed

Hardy, Dale S; Racette, Susan B; Hoelscher, Deanna M

2014-01-01

The fat mass and obesity-associated (FTO) single nucleotide polymorphisms (SNPs; rs1421085, rs17817449, rs9939609, rs8050136) and macronutrient intake (carbohydrate, protein, fat, total calories) are associated with body mass index (BMI). However, the mechanism for this relationship has not been fully elucidated. This study examined whether macronutrient intake mediates the association between FTO SNPs and BMI. Baseline cross-sectional data from the Atherosclerosis Risk in Communities (ARIC) study of whites (n = 10,176) and African Americans (n = 3641) aged 45 to 64 years were analyzed. In linear regression models with BMI as the dependent variable, FTO SNPs were significantly associated with higher BMI after adjusting for covariates. The addition of energy-adjusted macronutrients attenuated the FTO effect estimates, indicating partial mediation. In whites, β ranged from 0.40 (95% confidence interval [CI], 0.20, 0.60) for rs17817449 heterozygous carriers to 0.93 (95% CI, 0.64, 122) for rs8050136 homozygous carriers; for African Americans rs17817449 homozygous carriers β was 0.65 (95% CI, 0.03, 1.27). In models with macronutrient intake as the dependent variable, all FTO SNPs were associated with higher protein intake for homozygous carriers after adjusting for BMI and other covariates. Among whites, β ranged from 1.44 (95% CI, 0.51, 2.37) for rs8050136 to 1.73 (95% CI, 0.85, 2.61) for rs17817449; among African American rs8050136 homozygous carriers β was 2.46 (95% CI, 0.77, 4.14). In mediation analysis, in whites only, FTO high-risk alleles were associated with higher BMI partly through their small effects on carbohydrate and protein intake. These findings suggest that in adults, the relationship between FTO variants and BMI is not primarily through mediation of food intake.

Analysis of the relationships between type 2 diabetes status, glycemic control, and neuroimaging measures in the Diabetes Heart Study Mind.

PubMed

Raffield, Laura M; Cox, Amanda J; Freedman, Barry I; Hugenschmidt, Christina E; Hsu, Fang-Chi; Wagner, Benjamin C; Xu, Jianzhao; Maldjian, Joseph A; Bowden, Donald W

2016-06-01

To examine the relationships between type 2 diabetes (T2D) status, glycemic control, and T2D duration with magnetic resonance imaging (MRI)-derived neuroimaging measures in European Americans from the Diabetes Heart Study (DHS) Mind cohort. Relationships were examined using marginal models with generalized estimating equations in 784 participants from 514 DHS Mind families. Fasting plasma glucose, glycated hemoglobin, and diabetes duration were analyzed in 682 participants with T2D. Models were adjusted for potential confounders, including age, sex, history of cardiovascular disease, smoking, educational attainment, and use of statins or blood pressure medications. Association was tested with gray and white matter volume, white matter lesion volume, gray matter cerebral blood flow, and white and gray matter fractional anisotropy and mean diffusivity. Adjusting for multiple comparisons, T2D status was associated with reduced white matter volume (p = 2.48 × 10(-6)) and reduced gray and white matter fractional anisotropy (p ≤ 0.001) in fully adjusted models, with a trend toward increased white matter lesion volume (p = 0.008) and increased gray and white matter mean diffusivity (p ≤ 0.031). Among T2D-affected participants, neither fasting glucose, glycated hemoglobin, nor diabetes duration were associated with the neuroimaging measures assessed (p > 0.05). While T2D was significantly associated with MRI-derived neuroimaging measures, differences in glycemic control in T2D-affected individuals in the DHS Mind study do not appear to significantly contribute to variation in these measures. This supports the idea that the presence or absence of T2D, not fine gradations of glycemic control, may be more significantly associated with age-related changes in the brain.

Minimal Pleural Effusion in Small Cell Lung Cancer: Proportion, Mechanisms, and Prognostic Effect.

PubMed

Ryu, Jeong-Seon; Lim, Jun Hyeok; Lee, Jeong Min; Kim, Woo Chul; Lee, Kyung-Hee; Memon, Azra; Lee, Seul-Ki; Yi, Bo-Rim; Kim, Hyun-Jung; Hwang, Seung-Sik

2016-02-01

To determine the frequency and investigate possible mechanisms and prognostic relevance of minimal (<10-mm thickness) pleural effusion in patients with small cell lung cancer (SCLC). The single-center retrospective study was approved by the institutional review board of the hospital, and informed consent was waived by the patients. A cohort of 360 consecutive patients diagnosed with SCLC by using histologic analysis was enrolled in this study. Based on the status of pleural effusion on chest computed tomographic (CT) scans at diagnosis, patients were classified into three groups: no pleural effusion, minimal pleural effusion, and malignant pleural effusion. Eighteen variables related to patient, environment, stage, and treatment were included in the final model as potential confounders. Minimal pleural effusion was present in 74 patients (20.6%) and malignant pleural effusion in 83 patients (23.0%). Median survival was significantly different in patients with no, minimal, or malignant pleural effusion (median survival, 11.2, 5.93, and 4.83 months, respectively; P < .001, log-rank test). In the fully adjusted final model, patients with minimal pleural effusion had a significantly increased risk of death compared with those with no pleural effusion (adjusted hazard ratio, 1.454 [95% confidence interval: 1.012, 2.090]; P = .001). The prognostic effect was significant in patients with stage I-III disease (adjusted hazard ratio, 2.751 [95% confidence interval: 1.586, 4.773]; P < .001), but it disappeared in stage IV disease. An indirect mechanism representing mediastinal lymphadenopathy was responsible for the accumulation in all but one patient with minimal pleural effusion. Minimal pleural effusion is a common clinical finding in staging SCLC. Its presence is associated with worse survival in patients and should be considered when CT scans are interpreted. © RSNA, 2015.

Area-Level Deprivation and Overall and Cause-Specific Mortality: 12 Years’ Observation on British Women and Systematic Review of Prospective Studies

PubMed Central

Sánchez-Santos, Maria T.; Mesa-Frias, Marco; Choi, Minkyoung; Nüesch, Eveline; Asunsolo-Del Barco, Angel; Amuzu, Antoinette; Smith, George Davey; Ebrahim, Shah; Prieto-Merino, David; Casas, Juan P.

2013-01-01

Background Prospective studies have suggested a negative impact of area deprivation on overall mortality, but its effect on cause-specific mortality and the mechanisms that account for this association remain unclear. We investigate the association of area deprivation, using Index of Multiple deprivation (IMD), with overall and cause-specific mortality, contextualising findings within a systematic review. Methods And Findings We used data from 4,286 women from the British Women’s Heart Health Study (BWHHS) recruited at 1999-2001 to examine the association of IMD with overall and cause-specific mortality using Cox regression models. One standard deviation (SD) increase in the IMD score had a hazard ratio (HR) of 1.21 (95% CI: 1.13-1.30) for overall mortality after adjustment for age and lifecourse individual deprivation, which was attenuated to 1.15 (95% CI: 1.04-1.26) after further inclusion of mediators (health behaviours, biological factors and use of statins and blood pressure-lowering medications). A more pronounced association was observed for respiratory disease and vascular deaths. The meta-analysis, based on 20 published studies plus the BWHHS (n=21), yielded a summary relative risk (RR) of 1.15 (95% CI: 1.11-1.19) for area deprivation (top [least deprived; reference] vs. bottom tertile) with overall mortality in an age and sex adjusted model, which reduced to 1.06 (95% CI: 1.04-1.08) in a fully adjusted model. Conclusions Health behaviours mediate the association between area deprivation and cause-specific mortality. Efforts to modify health behaviours may be more successful if they are combined with measures that tackle area deprivation. PMID:24086262

What shapes 7-year-olds' subjective well-being? Prospective analysis of early childhood and parenting using the Growing Up in Scotland study.

PubMed

Parkes, Alison; Sweeting, Helen; Wight, Daniel

2016-10-01

Research on predictors of young children's psychosocial well-being currently relies on adult-reported outcomes. This study investigated whether early family circumstances and parenting predict 7-year-olds' subjective well-being. Information on supportive friendships, liking school and life satisfaction was obtained from 7-year-olds in one Growing Up in Scotland birth cohort in 2012-2013 (N = 2869). Mothers provided information on early childhood factors from 10 to 34 months, parenting (dysfunctional parenting, home learning and protectiveness) from 46 to 70 months, and 7-year-olds' adjustment. Multivariable path models explored associations between early childhood factors, parenting and 7-year-olds' subjective well-being. Supplementary analyses compared findings with those for mother-reported adjustment. In a model of early childhood factors, maternal distress predicted less supportive friendships and lower life satisfaction (coefficients -0.12), poverty predicted less supportive friendships (-0.09) and remote location predicted all outcomes (-0.20 to -0.27). In a model with parenting added, dysfunctional parenting predicted all outcomes (-10 to -0.16), home learning predicted liking school (0.11) and life satisfaction (0.08), and protectiveness predicted life satisfaction (0.08). Effects of maternal distress were fully mediated, largely via dysfunctional parenting, while home learning mediated negative effects of low maternal education. Direct effects of poverty and remote location remained. Findings for mother-reported child adjustment were broadly similar. Unique prospective data show parenting and early childhood impact 7-year-olds' subjective well-being. They underline the benefits for children of targeting parental mental health and dysfunctional parenting, and helping parents develop skills to support children at home and school.

Distribution, genetic and cardiovascular determinants of FVIII:c - Data from the population-based Gutenberg Health Study.

PubMed

Hermanns, M Iris; Grossmann, Vera; Spronk, Henri M H; Schulz, Andreas; Jünger, Claus; Laubert-Reh, Dagmar; Mazur, Johanna; Gori, Tommaso; Zeller, Tanja; Pfeiffer, Norbert; Beutel, Manfred; Blankenberg, Stefan; Münzel, Thomas; Lackner, Karl J; Ten Cate-Hoek, Arina J; Ten Cate, Hugo; Wild, Philipp S

2015-01-01

Elevated levels of c are associated with risk for both venous and arterial thromboembolism. However, no population-based study on the sex-specific distribution and reference ranges of plasma c and its cardiovascular determinants is available. c was analyzed in a randomly selected sample of 2533 males and 2440 females from the Gutenberg Health Study in Germany. Multivariable regression analyses for c were performed under adjustment for genetic determinants, cardiovascular risk factors and cardiovascular disease. Females (126.6% (95% CI: 125.2/128)) showed higher c levels than males (121.2% (119.8/122.7)). c levels increased with age in both sexes (ß per decade: 5.67% (4.22/7.13) male, 6.15% (4.72/7.57) female; p<0.001). Sex-specific reference limits and categories indicating the grade of deviation from the reference were calculated, and nomograms for c were created. c was approximately 25% higher in individuals with non-O blood type. Adjusted for sex and age, ABO-blood group accounted for 18.3% of c variation. In multivariable analysis, c was notably positively associated with diabetes mellitus, obesity, hypertension and dyslipidemia and negatively with current smoking. In a fully adjusted multivariable model, the strongest associations observed were of elevated c with diabetes and peripheral artery disease in both sexes and with obesity in males. Effects of SNPs in the vWF, STAB2 and SCARA5 gene were stronger in females than in males. The use of nomograms for valuation of c might be useful to identify high-risk cohorts for thromboembolism. Additionally, the prospective evaluation of c as a risk predictor becomes feasible. Copyright © 2015. Published by Elsevier Ireland Ltd.

Breast-feeding, dietary intakes and their associations with subclinical vitamin A deficiency in children in Anhui Province, China.

PubMed

Zhang, Yewu; Tao, Fangbiao; Yin, Huiping; Zhu, Xiaoming; Ji, Guoping; Kong, Shenghua; Song, Qinhua; Chen, Jianhua; Chu, Chengzhi; Li, Zhu

2007-07-01

This study aimed to explore the associations between breast-feeding, dietary intakes and other related factors and subclinical vitamin A deficiency (SVAD) in children aged 0-5 years in an area in China where mild vitamin A deficiency (VAD) is found. Data were from a population-based cross-sectional study with 1052 children aged 0-5 years. SVAD cases were identified by the indicator of serum retinol

Application of a Novel DCPD Adjustment Method for the J-R Curve Characterization: A study based on ORNL and ASTM Interlaboratory Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Xiang; Sokolov, Mikhail A; Nanstad, Randy K

Material fracture toughness in the fully ductile region can be described by a J-integral vs. crack growth resistance curve (J-R curve). As a conventional J-R curve measurement method, the elastic unloading compliance (EUC) method becomes impractical for elevated temperature testing due to relaxation of the material and friction induced back-up shape of the J-R curve. One alternative solution of J-R curve testing applies the Direct Current Potential Drop (DCPD) technique for measuring crack extension. However, besides crack growth, potential drop can also be influenced by plastic deformation, crack tip blunting, etc., and uncertainties exist in the current DCPD methodology especiallymore » in differentiating potential drop due to stable crack growth and due to material deformation. Thus, using DCPD for J-R curve determination remains a challenging task. In this study, a new adjustment procedure for applying DCPD to derive the J-R curve has been developed for conventional fracture toughness specimens, including compact tension, three-point bend, and disk-shaped compact specimens. Data analysis has been performed on Oak Ridge National Laboratory (ORNL) and American Society for Testing and Materials (ASTM) interlaboratory results covering different specimen thicknesses, test temperatures, and materials, to evaluate the applicability of the new DCPD adjustment procedure for J-R curve characterization. After applying the newly-developed procedure, direct comparison between the DCPD method and the normalization method on the same specimens indicated close agreement for the overall J-R curves, as well as the provisional values of fracture toughness near the onset of ductile crack extension, Jq, and of tearing modulus.« less

Food Security and Cardiovascular Disease Risk Among Adults in the United States: Findings From the National Health and Nutrition Examination Survey, 2003–2008

PubMed Central

2013-01-01

Introduction Little is known about the relationship between food security status and predicted 10-year cardiovascular disease risk. The objective of this study was to examine the associations between food security status and cardiovascular disease risk factors and predicted 10-year risk in a national sample of US adults. Methods A cross-sectional analysis using data from 10,455 adults aged 20 years or older from the National Health and Nutrition Examination Survey 2003–2008 was conducted. Four levels of food security status were defined by using 10 questions. Results Among all participants, 83.9% had full food security, 6.7% had marginal food security, 5.8% had low food security, and 3.6% had very low food security. After adjustment, mean hemoglobin A1c was 0.15% greater and mean concentration of C-reactive protein was 0.8 mg/L greater among participants with very low food security than among those with full food security. The adjusted mean concentration of cotinine among participants with very low food security was almost double that of participants with full food security (112.8 vs 62.0 ng/mL, P < .001). No significant associations between food security status and systolic blood pressure or concentrations of total cholesterol, high-density lipoprotein cholesterol, or non-high-density lipoprotein cholesterol were observed. Participants aged 30 to 59 years with very low food security were more likely to have a predicted 10-year cardiovascular disease risk greater than 20% than fully food secure participants (adjusted prevalence ratio, 2.38; 95% CI, 1.31–4.31). Conclusion Adults aged 30 to 59 years with very low food security showed evidence of increased predicted 10-year cardiovascular disease risk. PMID:24309090

Food security and cardiovascular disease risk among adults in the United States: findings from the National Health and Nutrition Examination Survey, 2003-2008.

PubMed

Ford, Earl S

2013-12-05

Little is known about the relationship between food security status and predicted 10-year cardiovascular disease risk. The objective of this study was to examine the associations between food security status and cardiovascular disease risk factors and predicted 10-year risk in a national sample of US adults. A cross-sectional analysis using data from 10,455 adults aged 20 years or older from the National Health and Nutrition Examination Survey 2003-2008 was conducted. Four levels of food security status were defined by using 10 questions. Among all participants, 83.9% had full food security, 6.7% had marginal food security, 5.8% had low food security, and 3.6% had very low food security. After adjustment, mean hemoglobin A1c was 0.15% greater and mean concentration of C-reactive protein was 0.8 mg/L greater among participants with very low food security than among those with full food security. The adjusted mean concentration of cotinine among participants with very low food security was almost double that of participants with full food security (112.8 vs 62.0 ng/mL, P < .001). No significant associations between food security status and systolic blood pressure or concentrations of total cholesterol, high-density lipoprotein cholesterol, or non-high-density lipoprotein cholesterol were observed. Participants aged 30 to 59 years with very low food security were more likely to have a predicted 10-year cardiovascular disease risk greater than 20% than fully food secure participants (adjusted prevalence ratio, 2.38; 95% CI, 1.31-4.31). Adults aged 30 to 59 years with very low food security showed evidence of increased predicted 10-year cardiovascular disease risk.

Exploratory plasma proteomic analysis in a randomized crossover trial of aspirin among healthy men and women.

PubMed

Wang, Xiaoliang; Shojaie, Ali; Zhang, Yuzheng; Shelley, David; Lampe, Paul D; Levy, Lisa; Peters, Ulrike; Potter, John D; White, Emily; Lampe, Johanna W

2017-01-01

Long-term use of aspirin is associated with lower risk of colorectal cancer and other cancers; however, the mechanism of chemopreventive effect of aspirin is not fully understood. Animal studies suggest that COX-2, NFκB signaling and Wnt/β-catenin pathways may play a role, but no clinical trials have systematically evaluated the biological response to aspirin in healthy humans. Using a high-density antibody array, we assessed the difference in plasma protein levels after 60 days of regular dose aspirin (325 mg/day) compared to placebo in a randomized double-blinded crossover trial of 44 healthy non-smoking men and women, aged 21-45 years. The plasma proteome was analyzed on an antibody microarray with ~3,300 full-length antibodies, printed in triplicate. Moderated paired t-tests were performed on individual antibodies, and gene-set analyses were performed based on KEGG and GO pathways. Among the 3,000 antibodies analyzed, statistically significant differences in plasma protein levels were observed for nine antibodies after adjusting for false discoveries (FDR adjusted p-value<0.1). The most significant protein was succinate dehydrogenase subunit C (SDHC), a key enzyme complex of the mitochondrial tricarboxylic acid (TCA) cycle. The other statistically significant proteins (NR2F1, MSI1, MYH1, FOXO1, KHDRBS3, NFKBIE, LYZ and IKZF1) are involved in multiple pathways, including DNA base-pair repair, inflammation and oncogenic pathways. None of the 258 KEGG and 1,139 GO pathways was found to be statistically significant after FDR adjustment. This study suggests several chemopreventive mechanisms of aspirin in humans, which have previously been reported to play a role in anti- or pro-carcinogenesis in cell systems; however, larger, confirmatory studies are needed.

Diabetes is associated with subclinical functional limitation in nondisabled older individuals: the Health, Aging, and Body Composition study.

PubMed

De Rekeneire, Nathalie; Resnick, Helaine E; Schwartz, Ann V; Shorr, Ronald I; Kuller, Lewis H; Simonsick, Eleanor M; Vellas, Bruno; Harris, Tamara B

2003-12-01

The aim of this study was to examine the role of comorbid conditions and body composition in the association between diabetes and subclinical functional limitation, an indication of early functional decline, in well-functioning older individuals. This was a cross-sectional analysis of 3,075 well-functioning black and white men and women aged 70-79 years, enrolled in the Health, Aging, and Body Composition study. Diabetes was defined by self-report and/or hypoglycemic medication use or fasting glucose >/=126 mg/dl. Subclinical functional limitation was defined using self-report of capacity and objective performance measures. Comorbid conditions were identified by self-reported diagnoses, medication use, and clinical measures. Body composition measures included anthropometry and total fat (dual X-ray absorptiometry). Of 2,926 participants, 1,252 (42.8%) had subclinical functional limitation at baseline. Among 2,370 individuals without diabetes, 40% had subclinical functional limitation, whereas the prevalence was 53% among the 556 diabetic participants with an age/sex/race-adjusted odds ratio (OR) 1.70 (95% CI 1.40-2.06). This association remained significant when adjusted for body composition measures (OR 1.54 [1.26-1.88]), diabetes-related comorbidities, and other potential confounders (OR 1.40 [1.14-1.73]). In the fully adjusted model, consideration of HbA(1c) (< or >/=7%) and diabetes duration showed that poor glycemic control in diabetic individuals explained the association with subclinical functional limitation. In a well-functioning older population, diabetes is associated with early indicators of functional decline, even after accounting for body composition and diabetes-related comorbidities. Poor glycemic control contributes to this relationship. Whether improvement in glycemic control in older people with diabetes would change this association should be tested.

Case complexity scores in congenital heart surgery: a comparative study of the Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system.

PubMed

Al-Radi, Osman O; Harrell, Frank E; Caldarone, Christopher A; McCrindle, Brian W; Jacobs, Jeffrey P; Williams, M Gail; Van Arsdell, Glen S; Williams, William G

2007-04-01

The Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery system were developed by consensus to compare outcomes of congenital cardiac surgery. We compared the predictive value of the 2 systems. Of all index congenital cardiac operations at our institution from 1982 to 2004 (n = 13,675), we were able to assign an Aristotle Basic Complexity score, a Risk Adjustment in Congenital Heart Surgery score, and both scores to 13,138 (96%), 11,533 (84%), and 11,438 (84%) operations, respectively. Models of in-hospital mortality and length of stay were generated for Aristotle Basic Complexity and Risk Adjustment in Congenital Heart Surgery using an identical data set in which both Aristotle Basic Complexity and Risk Adjustment in Congenital Heart Surgery scores were assigned. The likelihood ratio test for nested models and paired concordance statistics were used. After adjustment for year of operation, the odds ratios for Aristotle Basic Complexity score 3 versus 6, 9 versus 6, 12 versus 6, and 15 versus 6 were 0.29, 2.22, 7.62, and 26.54 (P < .0001). Similarly, odds ratios for Risk Adjustment in Congenital Heart Surgery categories 1 versus 2, 3 versus 2, 4 versus 2, and 5/6 versus 2 were 0.23, 1.98, 5.80, and 20.71 (P < .0001). Risk Adjustment in Congenital Heart Surgery added significant predictive value over Aristotle Basic Complexity (likelihood ratio chi2 = 162, P < .0001), whereas Aristotle Basic Complexity contributed much less predictive value over Risk Adjustment in Congenital Heart Surgery (likelihood ratio chi2 = 13.4, P = .009). Neither system fully adjusted for the child's age. The Risk Adjustment in Congenital Heart Surgery scores were more concordant with length of stay compared with Aristotle Basic Complexity scores (P < .0001). The predictive value of Risk Adjustment in Congenital Heart Surgery is higher than that of Aristotle Basic Complexity. The use of Aristotle Basic Complexity or Risk Adjustment in Congenital Heart Surgery as risk stratification and trending tools to monitor outcomes over time and to guide risk-adjusted comparisons may be valuable.

CRASHWORTHY HELICOPTER GUNNER’S SEAT INVESTIGATION

DTIC Science & Technology

1975-01-01

less restrict- ing to gun motion than a fully armored bucket seat. The problem remains in getting the gunners to wear body armor, and this can be... motions . The adjustable seat back accommodates a gun- ner with or without body armor and troops with or without combat packs and equipment. A back flap...Developmental Retractable Monkey Harness Restraint for UH-l 1 1.9 10 Gunner Survival Vest With Body Armor (ISVESTA) Side View . . . . . . . . *. . ... .. 22

Gravitational Force and the Cardiovascular System

NASA Technical Reports Server (NTRS)

Pendergast, D. R.; Olszowka, A. J.; Rokitka, M. A.; Farhi, L. E.

1991-01-01

Cardiovascular responses to changes in gravitational force are considered. Man is ideally suited to his 1-g environment. Although cardiovascular adjustments are required to accommodate to postural changes and exercise, these are fully accomplished for short periods (min). More challenging stresses are those of short-term microgravity (h) and long-term microgravity (days) and of gravitational forces greater than that of Earth. The latter can be simulated in the laboratory and quantitative studies can be conducted.

Analog Delta-Back-Propagation Neural-Network Circuitry

NASA Technical Reports Server (NTRS)

Eberhart, Silvio

1990-01-01

Changes in synapse weights due to circuit drifts suppressed. Proposed fully parallel analog version of electronic neural-network processor based on delta-back-propagation algorithm. Processor able to "learn" when provided with suitable combinations of inputs and enforced outputs. Includes programmable resistive memory elements (corresponding to synapses), conductances (synapse weights) adjusted during learning. Buffer amplifiers, summing circuits, and sample-and-hold circuits arranged in layers of electronic neurons in accordance with delta-back-propagation algorithm.

Acculturation and Psychological Adjustment of Vietnamese Refugees: An Ecological Acculturation Framework.

PubMed

Salo, Corrina D; Birman, Dina

2015-12-01

Acculturation to the culture of the host society as well as to one's heritage culture have been shown to impact immigrants' adjustment during the years following resettlement. While acculturation has been identified as an important factor in adjustment of Vietnamese immigrants (Birman and Tran in Am J Orthopsychiatr 78(1):109-120. doi: 10.1037/0002-9432.78.1.109 , 2008), no clear pattern of findings has emerged and too few studies have employed an ecological approach. The purpose of this paper is to contextualize the study of acculturation and adjustment by taking an ecological approach to exploring these relationships across several life domains, using a bilinear scale, and examining mediators of these relationships for adult Vietnamese refugees (N = 203) in the United States. We call this approach the Ecological Acculturation Framework (EAF). Results of a structural equation model (SEM) showed that job satisfaction fully mediated the relationship between American acculturation and psychological distress, demonstrating that this relationship was specific to an occupational domain. However, while Vietnamese acculturation predicted co-ethnic social support satisfaction, it did not predict reduced psychological distress. Implications for a life domains approach, including domain specificity, are discussed.

A weighted adjustment of a similarity transformation between two point sets containing errors

NASA Astrophysics Data System (ADS)

Marx, C.

2017-10-01

For an adjustment of a similarity transformation, it is often appropriate to consider that both the source and the target coordinates of the transformation are affected by errors. For the least squares adjustment of this problem, a direct solution is possible in the cases of specific-weighing schemas of the coordinates. Such a problem is considered in the present contribution and a direct solution is generally derived for the m-dimensional space. The applied weighing schema allows (fully populated) point-wise weight matrices for the source and target coordinates, both weight matrices have to be proportional to each other. Additionally, the solutions of two borderline cases of this weighting schema are derived, which only consider errors in the source or target coordinates. The investigated solution of the rotation matrix of the adjustment is independent of the scaling between the weight matrices of the source and the target coordinates. The mentioned borderline cases, therefore, have the same solution of the rotation matrix. The direct solution method is successfully tested on an example of a 3D similarity transformation using a comparison with an iterative solution based on the Gauß-Helmert model.

Intimate Partner Violence Is Associated with Suicidality Among Low-Income Postpartum Women.

PubMed

Tabb, Karen M; Huang, Hsiang; Valdovinos, Miriam; Toor, Raman; Ostler, Teresa; Vanderwater, Erin; Wang, Yang; Menezes, Paulo Rossi; Faisal-Cury, Alexandre

2018-02-01

Although intimate partner violence (IPV) during perinatal period is more common than during other maternal health conditions, it receives less attention within research on maternal mortality rates. Given the risks for maternal mortality because of suicidality, the purpose of this investigation is to examine the risk of suicidal ideation (SI) among postpartum women exposed to IPV. In this cross-sectional study, participants were recruited between May 2005 and March 2007 from primary care clinics in São Paulo, Brazil. A total of 701 postpartum women were included in the analysis. Postpartum SI was assessed using the clinical interview schedule-revised. IPV was assessed using a structured questionnaire previously validated in Brazilian populations. Crude and adjusted risk ratios with 95% confidence intervals (95% CI) were estimated using Poisson regression with robust variance to examine the association between IPV and the risk for postpartum SI. The prevalence of postpartum SI was 4%. Among those with postpartum SI, 70% reported IPV during the postpartum period. Compared with non-IPV counterparts, postpartum women who reported IPV had an increased risk for SI (relative risk [RR] 7.25, 95% CI: 3.23-16.27). In the fully adjusted model, the risk for SI remained significantly higher for women who experienced IPV than for those who did not (RR 3.02, 95% CI: 1.29-7.07). Postpartum women exposed to violence had a threefold greater risk of having suicidal thoughts.

Adaptation in conflict: are conflict-triggered control adjustments protected in the presence of motivational distractors?

PubMed

Becker, Daniela; Jostmann, Nils B; Holland, Rob W

2018-06-06

Solving a conflict between two response options in an interference task has been found to increase control in a subsequent conflict situation. The present research examined whether such conflict adaptation persists in the presence of distractors that have motivational relevance and are therefore competing for attentional resources (i.e. they signal opportunities for monetary gains or losses contingent on overall task performance). In an adjusted flanker task, motivational (versus neutral versus no) distractors were presented together with the current trial while the previous trial never included any distractor. Accumulated evidence across three studies showed that motivational distractors reduced the conflict adaptation effect. This was found irrespective of the location at which the distractor occurred (Study 1), and independent of its valence (i.e. reward or loss, Study 2). Study 3 and a merged data analysis ruled out low-level alternative explanations. In line with a dual competition account (Pessoa, L. (2009). How do emotion and motivation direct executive control? Trends in Cognitive Sciences, 13(4), 160-166. doi: 10.1016/j.tics.2009.01.006 ), our results show that conflict adaptation is not fully protected in the presence of motivational distractors. We discuss whether this should be interpreted as a limitation, or as reflecting the flexibility of the control system in dealing with motivationally relevant information.

Childhood risk factors for lifetime bulimic or compulsive eating by age 30 years in a British national birth cohort.

PubMed

Nicholls, D; Statham, R; Costa, S; Micali, N; Viner, R M

2016-10-01

To examine whether previously identified childhood risk factors for bulimia or compulsive eating (BCE) predict self-reported lifetime BCE by age 30 years in a prospective birth cohort. Using data from the 1970 British Cohort Study at birth, 5, and 10 years, associations between 22 putative childhood risk factors and self-reported lifetime BCE at 30 years were examined, adjusting for sex and socioeconomic status. Only female sex (odds ratio (OR): 9.2; 95% confidence interval (CI): 1.9-43.7; p = 0.005), low self-esteem (OR:2.9; 95%CI: 1.1-7.5; p = 0.03) and high maternal education (OR:5.4; 95%CI: 2.0-14.8; p = 0.001) were significantly associated with higher risk of BCE, whereas high SES at 10 years was significantly protective (OR:0.2; 95%CI: 0.1-0.8; p = 0.022) of BCE in fully adjusted multivariable logistic regression analysis. Our findings do not support a strong role for childhood weight status and eating behaviours in the development of bulimia and compulsive eating pathology, rather suggesting a focus on self esteem may have greater relative importance. Findings in relation to maternal education and SES need further exploration. Copyright © 2016 Elsevier Ltd. All rights reserved.

Maternal Visceral Adiposity by Consistency of Lactation

PubMed Central

Catov, Janet; Ness, Roberta; Schwarz, Eleanor Bimla

2013-01-01

The purpose of this study was to examine the assocation between lactation and maternal visceral adiposity among US women who were on average 7 years postpartum. This cross-sectional analysis included 89 women who gave birth between 1997 and 2002, who did not have preeclampsia, prepregnancy hypertension or prepregnancy diabetes, and enrolled in The Women and Infant Study of Healthy Hearts (WISH). Computed tomography was used to assess abdominal adiposity. History of lactation was self-reported. Visceral adiposity was greater by 36.96 cm2 (95% CI: 20.92,53.01) among mothers who never breastfed than mothers who breastfed for ≥3 months after every birth, even after adjustment for age, parity, years since last birth, site, socioeconomic, lifestyle, psychological, and family history variables, early adult BMI, and current BMI. Similarly, in fully adjusted models, mothers who breastfed any of their children for less than 3 months had 20.38 cm2 (95% CI: 2.70, 38.06) greater visceral adiposity than mothers who consistently breastfed all their children for 3 or more months. This study found that 7 years postpartum visceral fat depots are significantly greater among mothers who lactated for less than 3 months after the birth of each of their children. These results provide a potential physiologic basis for prior findings that women who do not consistently breastfeed are at an increased risk of diabetes, cardiovascular disease, and the metabolic syndrome. PMID:21404071

Relationship between Carotenoids, Retinol, and Estradiol Levels in Older Women

PubMed Central

Maggio, Marcello; de Vita, Francesca; Lauretani, Fulvio; Bandinelli, Stefania; Semba, Richard D.; Bartali, Benedetta; Cherubini, Antonio; Cappola, Anne R.; Ceda, Gian Paolo; Ferrucci, Luigi

2015-01-01

Background. In vitro evidence suggests anti-estrogenic properties for retinol and carotenoids, supporting a chemo-preventive role of these phytochemicals in estrogen-dependent cancers. During aging there are significant reductions in retinol and carotenoid concentrations, whereas estradiol levels decline during menopause and progressively increase from the age of 65. We aimed to investigate the hypothesis of a potential relationship between circulating levels of retinol, carotenoids, and estradiol (E2) in a cohort of late post-menopausal women. Methods. We examined 512 women ≥ 65 years from the InCHIANTI study. Retinol, α-caroten, β-caroten, β-criptoxantin, lutein, zeaxanthin, and lycopene levels were assayed at enrollment (1998–2000) by High-Performance Liquid Chromatography. Estradiol and testosterone (T) levels were assessed by Radioimmunometry (RIA) and testosterone-to-estradiol ratio (T/E2), as a proxy of aromatase activity, was also calculated. General linear models adjusted for age (Model 1) and further adjusted for other confounders including Body Mass Index (BMI) BMI, smoking, intake of energy, lipids, and vitamin A; C-Reactive Protein, insulin, total cholesterol, liver function, and testosterone (Model 2) were used to investigate the relationship between retinol, carotenoids, and E2 levels. To address the independent relationship between carotenoids and E2 levels, factors significantly associated with E2 in Model 2 were also included in a fully adjusted Model 3. Results. After adjustment for age, α-carotene (β ± SE = −0.01 ± 0.004, p = 0.02) and β-carotene (β ± SE = −0.07 ± 0.02, p = 0.0007) were significantly and inversely associated with E2 levels. α-Carotene was also significantly and positively associated with T/E2 ratio (β ± SE = 0.07 ± 0.03, p = 0.01). After adjustment for other confounders (Model 2), the inverse relationship between α-carotene (β ± SE = −1.59 ± 0.61, p = 0.01), β-carotene (β ± SE = −0.29 ± 0.08, p = 0.0009), and E2 persisted whereas the relationship between α-carotene and T/E2 ratio was attenuated (β ± SE = 0.22 ± 0.12, p = 0.07). In a fully adjusted model (Model 3), only β-carotene (β ± SE = −0.05 ± 0.02, p = 0.03) was significantly and inversely associated with E2 levels independent of α-carotene. No association was found between retinol, total non-pro-vitamin A carotenoids, lutein, zeaxanthin, and lycopene, and E2 levels. Conclusions: In older women, β-carotene levels are independently and inversely associated with E2. PMID:26251919

Relationship between Carotenoids, Retinol, and Estradiol Levels in Older Women.

PubMed

Maggio, Marcello; de Vita, Francesca; Lauretani, Fulvio; Bandinelli, Stefania; Semba, Richard D; Bartali, Benedetta; Cherubini, Antonio; Cappola, Anne R; Ceda, Gian Paolo; Ferrucci, Luigi

2015-08-05

In vitro evidence suggests anti-estrogenic properties for retinol and carotenoids, supporting a chemo-preventive role of these phytochemicals in estrogen-dependent cancers. During aging there are significant reductions in retinol and carotenoid concentrations, whereas estradiol levels decline during menopause and progressively increase from the age of 65. We aimed to investigate the hypothesis of a potential relationship between circulating levels of retinol, carotenoids, and estradiol (E2) in a cohort of late post-menopausal women. We examined 512 women ≥ 65 years from the InCHIANTI study. Retinol, α-caroten, β-caroten, β-criptoxantin, lutein, zeaxanthin, and lycopene levels were assayed at enrollment (1998-2000) by High-Performance Liquid Chromatography. Estradiol and testosterone (T) levels were assessed by Radioimmunometry (RIA) and testosterone-to-estradiol ratio (T/E2), as a proxy of aromatase activity, was also calculated. General linear models adjusted for age (Model 1) and further adjusted for other confounders including Body Mass Index (BMI) BMI, smoking, intake of energy, lipids, and vitamin A; C-Reactive Protein, insulin, total cholesterol, liver function, and testosterone (Model 2) were used to investigate the relationship between retinol, carotenoids, and E2 levels. To address the independent relationship between carotenoids and E2 levels, factors significantly associated with E2 in Model 2 were also included in a fully adjusted Model 3. After adjustment for age, α-carotene (β ± SE = -0.01 ± 0.004, p = 0.02) and β-carotene (β ± SE = -0.07 ± 0.02, p = 0.0007) were significantly and inversely associated with E2 levels. α-Carotene was also significantly and positively associated with T/E2 ratio (β ± SE = 0.07 ± 0.03, p = 0.01). After adjustment for other confounders (Model 2), the inverse relationship between α-carotene (β ± SE = -1.59 ± 0.61, p = 0.01), β-carotene (β ± SE = -0.29 ± 0.08, p = 0.0009), and E2 persisted whereas the relationship between α-carotene and T/E2 ratio was attenuated (β ± SE = 0.22 ± 0.12, p = 0.07). In a fully adjusted model (Model 3), only β-carotene (β ± SE = -0.05 ± 0.02, p = 0.03) was significantly and inversely associated with E2 levels independent of α-carotene. No association was found between retinol, total non-pro-vitamin A carotenoids, lutein, zeaxanthin, and lycopene, and E2 levels. In older women, β-carotene levels are independently and inversely associated with E2.

Alcohol consumption, mediating biomarkers, and risk of type 2 diabetes among middle-aged women.

PubMed

Beulens, Joline W J; Rimm, Eric B; Hu, Frank B; Hendriks, Henk F J; Mukamal, Kenneth J

2008-10-01

The purpose of this study was to investigate whether adiponectin concentrations and biomarkers of inflammation, endothelial dysfunction, and insulin resistance mediate the association between alcohol consumption and diabetes. In a nested case-control study of 705 women with incident diabetes and 787 matched control subjects, we examined the adjusted relationship between baseline alcohol consumption and risk of diabetes before and after adjustment for markers of inflammation/endothelial dysfunction (C-reactive protein, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, E-selectin, tumor necrosis factor-alpha receptor 2, and interleukin-6), fasting insulin, and adiponectin concentrations. Alcohol consumption was associated with a decreased risk of diabetes (odds ratio per 12.5 g/day increment in alcohol use 0.58; 95% CI 0.49-0.69; P < 0.001). Adjustment for BMI attenuated the association by 25%. None of the markers of inflammation or fasting insulin appeared to account for >2% of the observed relationship. Without adjustment for BMI, these biomarkers individually explained slightly more of the association, but <10% in all cases. Adiponectin accounted for 25% in a fully adjusted model and for 29% without adjustment for BMI. In this population of women, alcohol consumption was inversely associated with risk of type 2 diabetes. Adiponectin appeared to be a mediator of this association, but circulating biomarkers of inflammation, endothelial dysfunction, and fasting insulin did not explain this association. These results suggest that further research is needed into the potentially mediating roles of other biomarkers affected by alcohol consumption.

Atopic dermatitis is not associated with actinic keratosis: cross-sectional results from the Rotterdam study.

PubMed

Hajdarbegovic, E; Blom, H; Verkouteren, J A C; Hofman, A; Hollestein, L M; Nijsten, T

2016-07-01

Epidermal barrier impairment and an altered immune system in atopic dermatitis (AD) may predispose to ultraviolet-induced DNA damage. To study the association between AD and actinic keratosis (AK) in a population-based cross-sectional study. AD was defined by modified criteria of the U.K. working party's diagnostic criteria. AKs were diagnosed by physicians during a full-body skin examination, and keratinocyte cancers were identified via linkage to the national pathology database. The results were analysed in adjusted multivariable and multinomial models. A lower proportion of subjects with AD had AKs than those without AD: 16% vs. 24%, P = 0·002; unadjusted odds ratio (OR) 0·60, 95% confidence interval (CI) 0·42-0·83; adjusted OR 0·74, 95% CI 0·51-1·05; fully adjusted OR 0·69, 95% CI 0·47-1·07. In a multinomial model patients with AD were less likely to have ≥ 10 AKs (adjusted OR 0·28, 95% CI 0·09-0·90). No effect of AD on basal cell carcinoma or squamous cell carcinoma was found: adjusted OR 0·71, 95% CI 0·41-1·24 and adjusted OR 1·54, 95% CI 0·66-3·62, respectively. AD in community-dwelling patients is not associated with AK. © 2016 British Association of Dermatologists.

The contribution of gestational age, area deprivation and mother’s country of birth to ethnic variations in infant mortality in England and Wales: A national cohort study using routinely collected data

PubMed Central

Quigley, Maria A.; Dattani, Nirupa; Gray, Ron; Jayaweera, Hiranthi; Kurinczuk, Jennifer J.; Macfarlane, Alison; Hollowell, Jennifer

2018-01-01

Objectives We aimed to describe ethnic variations in infant mortality and explore the contribution of area deprivation, mother’s country of birth, and prematurity to these variations. Methods We analyzed routine birth and death data on singleton live births (gestational age≥22 weeks) in England and Wales, 2006–2012. Infant mortality by ethnic group was analyzed using logistic regression with adjustment for sociodemographic characteristics and gestational age. Results In the 4,634,932 births analyzed, crude infant mortality rates were higher in Pakistani, Black Caribbean, Black African, and Bangladeshi infants (6.92, 6.00, 5.17 and 4.40 per 1,000 live births, respectively vs. 2.87 in White British infants). Adjustment for maternal sociodemographic characteristics changed the results little. Further adjustment for gestational age strongly attenuated the risk in Black Caribbean (OR 1.02, 95% CI 0.89–1.17) and Black African infants (1.17, 1.06–1.29) but not in Pakistani (2.32, 2.15–2.50), Bangladeshi (1.47, 1.28–1.69), and Indian infants (1.24, 1.11–1.38). Ethnic variations in infant mortality differed significantly between term and preterm infants. At term, South Asian groups had higher risks which cannot be explained by sociodemographic characteristics. In preterm infants, adjustment for degree of prematurity (<28, 28–31, 32–33, 34–36 weeks) fully explained increased risks in Black but not Pakistani and Bangladeshi infants. Sensitivity analyses with further adjustment for small for gestational age, or excluding deaths due to congenital anomalies did not fully explain the excess risk in South Asian groups. Conclusions Higher infant mortality in South Asian and Black infants does not appear to be explained by sociodemographic characteristics. Higher proportions of very premature infants appear to explain increased risks in Black infants but not in South Asian groups. Strategies targeting the prevention and management of preterm birth in Black groups and suboptimal birthweight and modifiable risk factors for congenital anomalies in South Asian groups might help reduce ethnic inequalities in infant mortality. PMID:29649290

Adjustable flow rate controller for polymer solutions

DOEpatents

Jackson, Kenneth M.

1981-01-01

An adjustable device for controlling the flow rate of polymer solutions which results in only little shearing of the polymer molecules, said device comprising an inlet manifold, an outlet manifold, a plurality of tubes capable of providing communication between said inlet and outlet manifolds, said tubes each having an internal diameter that is smaller than that of the inlet manifold and large enough to insure that viscosity of the polymer solution passing through each said tube will not be reduced more than about 25 percent, and a valve associated with each tube, said valve being capable of opening or closing communication in that tube between the inlet and outlet manifolds, each said valve when fully open having a diameter that is substantially at least as great as that of the tube with which it is associated.

Marital conflict, maternal and paternal parenting, and child adjustment: a test of mediation and moderation.

PubMed

Kaczynski, Karen J; Lindahl, Kristin M; Malik, Neena M; Laurenceau, Jean-Philippe

2006-06-01

Parenting was examined as a mediator of associations between marital and child adjustment, and parent gender was examined as a moderator of associations among marital, parental, and child functioning in 226 families with a school-age child (146 boys). Parenting fully mediated associations between marital conflict and child internalizing and externalizing behaviors. Parent gender did not moderate associations when data from the full sample or families with girls only were evaluated. Parent gender did moderate associations when families with boys were evaluated, with the association between marital conflict and parenting stronger for fathers than mothers. A trend suggested fathers' parenting may be more strongly related to internalizing behavior and mothers' parenting may be more strongly related to externalizing behavior in boys. ((c) 2006 APA, all rights reserved).

Maximizing Total QoS-Provisioning of Image Streams with Limited Energy Budget

NASA Astrophysics Data System (ADS)

Lee, Wan Yeon; Kim, Kyong Hoon; Ko, Young Woong

To fully utilize the limited battery energy of mobile electronic devices, we propose an adaptive adjustment method of processing quality for multiple image stream tasks running with widely varying execution times. This adjustment method completes the worst-case executions of the tasks with a given budget of energy, and maximizes the total reward value of processing quality obtained during their executions by exploiting the probability distribution of task execution times. The proposed method derives the maximum reward value for the tasks being executable with arbitrary processing quality, and near maximum value for the tasks being executable with a finite number of processing qualities. Our evaluation on a prototype system shows that the proposed method achieves larger reward values, by up to 57%, than the previous method.

Qualitative and quantitative analysis of mixtures of compounds containing both hydrogen and deuterium

NASA Technical Reports Server (NTRS)

Crespi, H. L.; Harkness, L.; Katz, J. J.; Norman, G.; Saur, W.

1969-01-01

Method allows qualitative and quantitative analysis of mixtures of partially deuterated compounds. Nuclear magnetic resonance spectroscopy determines location and amount of deuterium in organic compounds but not fully deuterated compounds. Mass spectroscopy can detect fully deuterated species but not the location.

A New Wideband, Fully Steerable, Decametric Array at Clark Lake

NASA Technical Reports Server (NTRS)

Erickson, W. C.; Fisher, J. R.

1974-01-01

A fully steerable, decametric array for radio astronomy is under construction at the Clark Lake Radio Observatory near Borrego Springs, California. This array will be a T of 720 conical spiral antennas (teepee-shaped antennas, hence the array is called the TPT), 3.0 km by 1.8 km capable of operating between 15 and 125 MHz. Both its operating frequency and beam position will be adjustable in less than one millisecond, and the TPT will provide a 49-element picture around the central beam position for extended source observations. Considerable experience was gained in the operation of completed portions of the array, and successful operation of the final array is assured. The results are described of the tests which were conducted with the conical spirals, and the planned electronics and data processing systems are described.

MCNP-model for the OAEP Thai Research Reactor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gallmeier, F.X.; Tang, J.S.; Primm, R.T. III

An MCNP input was prepared for the Thai Research Reactor, making extensive use of the MCNP geometry`s lattice feature that allows a flexible and easy rearrangement of the core components and the adjustment of the control elements. The geometry was checked for overdefined or undefined zones by two-dimensional plots of cuts through the core configuration with the MCNP geometry plotting capabilities, and by a three-dimensional view of the core configuration with the SABRINA code. Cross sections were defined for a hypothetical core of 67 standard fuel elements and 38 low-enriched uranium fuel elements--all filled with fresh fuel. Three test calculationsmore » were performed with the MCNP4B-code to obtain the multiplication factor for the cases with control elements fully inserted, fully withdrawn, and at a working position.« less

Sequential planning of flood protection infrastructure under limited historic flood record and climate change uncertainty

NASA Astrophysics Data System (ADS)

Dittes, Beatrice; Špačková, Olga; Straub, Daniel

2017-04-01

Flood protection is often designed to safeguard people and property following regulations and standards, which specify a target design flood protection level, such as the 100-year flood level prescribed in Germany (DWA, 2011). In practice, the magnitude of such an event is only known within a range of uncertainty, which is caused by limited historic records and uncertain climate change impacts, among other factors (Hall & Solomatine, 2008). As more observations and improved climate projections become available in the future, the design flood estimate changes and the capacity of the flood protection may be deemed insufficient at a future point in time. This problem can be mitigated by the implementation of flexible flood protection systems (that can easily be adjusted in the future) and/or by adding an additional reserve to the flood protection, i.e. by applying a safety factor to the design. But how high should such a safety factor be? And how much should the decision maker be willing to pay to make the system flexible, i.e. what is the Value of Flexibility (Špačková & Straub, 2017)? We propose a decision model that identifies cost-optimal decisions on flood protection capacity in the face of uncertainty (Dittes et al. 2017). It considers sequential adjustments of the protection system during its lifetime, taking into account its flexibility. The proposed framework is based on pre-posterior Bayesian decision analysis, using Decision Trees and Markov Decision Processes, and is fully quantitative. It can include a wide range of uncertainty components such as uncertainty associated with limited historic record or uncertain climate or socio-economic change. It is shown that since flexible systems are less costly to adjust when flood estimates are changing, they justify initially lower safety factors. Investigation on the Value of Flexibility (VoF) demonstrates that VoF depends on the type and degree of uncertainty, on the learning effect (i.e. kind and quality of information that we will gather in the future) and on the formulation of the optimization problem (risk-based vs. rule-based approach). The application of the framework is demonstrated on catchments in Germany. References: DWA (Deutsche Vereinigung für Wasserwirtschaft Abwasser und Abfall eV.) 2011. Merkblatt DWA-M 507-1: Deiche an Fließgewässern. (A. Bieberstein, Ed.). Hennef: DWA Deutsche Vereinigung für Wasserwirtschaft, Abwasser und Abfall e. V. Hall, J., & Solomatine, D. 2008. A framework for uncertainty analysis in flood risk management decisions. International Journal of River Basin Management, 6(2), 85-98. http://doi.org/10.1080/15715124.2008.9635339 Špačková, O. & Straub, D. 2017. Long-term adaption decisions via fully and partially observable Markov decision processes. Sustainable and Resilient Infrastructure. In print.

The self-reported health of legal and illegal/irregular immigrants in the Czech Republic.

PubMed

Pikhart, Hynek; Drbohlav, Dusan; Dzurova, Dagmar

2010-10-01

To test whether immigrants with illegal/irregular status have higher odds of poor self-rated health (SRH) than immigrants with legal status, and whether different demographic, socioeconomic and psychosocial factors affect SRH among legal and illegal/irregular immigrants. Analysis is based on data from two questionnaire surveys of 285 Post-Soviet and Vietnamese immigrants (126 legal and 159 illegal/irregular) living and working in the Czech Republic, which were conducted between 2003 and 2006. The risk of poor SRH was estimated by ordered polytomous regression, the dependent variable was SRH, and selected demographic, socioeconomic and psychosocial characteristics entered the analysis as explanatory variables. Odds of poor SRH among illegal immigrants were not statistically significantly higher than among legal migrants in fully adjusted analysis. Females and older immigrants had poorer SRH. Satisfaction with work, and, partly, with housing were found to have a significant role. Educational level and 'social communication' variables did not have an important role in predicting SRH. Inequalities in SRH among legal and illegal immigrants were largely explained by socioeconomic and psychosocial factors in this study. These results should stimulate further research activities that might improve health policy and planning related to immigrants' health in this and other countries in Europe.

Local Observability Analysis of Star Sensor Installation Errors in a SINS/CNS Integration System for Near-Earth Flight Vehicles

PubMed Central

Yang, Yanqiang; Zhang, Chunxi; Lu, Jiazhen

2017-01-01

Strapdown inertial navigation system/celestial navigation system (SINS/CNS) integrated navigation is a fully autonomous and high precision method, which has been widely used to improve the hitting accuracy and quick reaction capability of near-Earth flight vehicles. The installation errors between SINS and star sensors have been one of the main factors that restrict the actual accuracy of SINS/CNS. In this paper, an integration algorithm based on the star vector observations is derived considering the star sensor installation error. Then, the star sensor installation error is accurately estimated based on Kalman Filtering (KF). Meanwhile, a local observability analysis is performed on the rank of observability matrix obtained via linearization observation equation, and the observable conditions are presented and validated. The number of star vectors should be greater than or equal to 2, and the times of posture adjustment also should be greater than or equal to 2. Simulations indicate that the star sensor installation error could be readily observable based on the maneuvering condition; moreover, the attitude errors of SINS are less than 7 arc-seconds. This analysis method and conclusion are useful in the ballistic trajectory design of near-Earth flight vehicles. PMID:28275211

Tolerance of image enhancement brightness and contrast in lateral cephalometric digital radiography for Steiner analysis

NASA Astrophysics Data System (ADS)

Rianti, R. A.; Priaminiarti, M.; Syahraini, S. I.

2017-08-01

Image enhancement brightness and contrast can be adjusted on lateral cephalometric digital radiographs to improve image quality and anatomic landmarks for measurement by Steiner analysis. To determine the limit value for adjustments of image enhancement brightness and contrast in lateral cephalometric digital radiography for Steiner analysis. Image enhancement brightness and contrast were adjusted on 100 lateral cephalometric radiography in 10-point increments (-30, -20, -10, 0, +10, +20, +30). Steiner analysis measurements were then performed by two observers. Reliabilities were tested by the Interclass Correlation Coefficient (ICC) and significance tested by ANOVA or the Kruskal Wallis test. No significant differences were detected in lateral cephalometric analysis measurements following adjustment of the image enhancement brightness and contrast. The limit value of adjustments of the image enhancement brightness and contrast associated with incremental 10-point changes (-30, -20, -10, 0, +10, +20, +30) does not affect the results of Steiner analysis.

The effect of pre-existing malnutrition on pediatric burn mortality in a sub-Saharan African burn unit.

PubMed

Grudziak, Joanna; Snock, Carolyn; Mjuweni, Stephen; Gallaher, Jared; Cairns, Bruce; Charles, Anthony

2017-11-01

Nutritional status predicts burn outcomes in the developed world, but its effect on burn mortality in the developing world has not been widely studied. In sub Saharan Africa, burn is primarily a disease of children, and the majority of children in sub-Saharan Africa are malnourished. We therefore sought to determine the prevalence and effect of malnutrition on burn mortality at our institution. This is a retrospective review of children aged 0-5, with anthropomorphic measurements available, who were admitted to our burn unit from July 2011 to May 2016. Age-adjusted Z scores were calculated for height, weight, weight for height, and mid-upper arm circumference (MUAC). Following bivariate analysis, we used logistic regression to construct a fully adjusted model of predictors of mortality. Of the 1357 admitted patients, 839 (61.2%) were aged 0-5. Of those, 512 (62.9%) had one or more anthropomorphic measurements available, and were included in the analysis. 54% were male, and the median age was 28 months. The median TBSA was 15%, with a majority of burns caused by scalds (77%). Mortality was 16%. Average Z-score for any of the indicators of malnutrition was -1.45±1.66. TBSA (OR: 1.08, 95% CI: 1.06, 1.11), decreasing Z-score (OR: 1.19, 95% CI: 1.00, 1.41), and flame burn (OR: 2.51, 95% CI: 1.40, 4.49) were associated with an increase in mortality. Preexisting malnutrition in burn patients in sub-Saharan Africa increases odds of mortality after controlling for significant covariates. Survival of burn patients in this region will not reach that of the developed world until a strategy of aggressive nutritional support is implemented in this population. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Workplace bullying and post-traumatic stress symptoms among family physicians in Lithuania: an occupation and region specific approach.

PubMed

Malinauskiene, Vilija; Einarsen, Staale

2014-12-01

The study investigated associations between workplace bullying and post-traumatic stress symptoms as compared to and controlled for associations between the latter and other psychosocial stress factors at work and in everyday life. The study employed a representative sample of Lithuanian family physicians, hence investigated a particularly resourceful occupational group in a geographical region earlier found to have a high risk context for exposure to bullying at work. With a response rate of 89.2%, a total of 323 family physicians filled in an anonymous questionnaire on workplace bullying, post-traumatic symptomatology (IES-R), other psychosocial stressors at work and in everyday life, personal health resources (sense of coherence), behavioral characteristics and demographic variables. The statistical software SPSS 14.0, Windows was used in the analysis. Associations were tested using a multivariate logistic regression analysis. A high prevalence of bullying was found among family physicians in Lithuania, with 13% of them experiencing severe workplace bullying and 17.3% experiencing more occasional incidents of bullying. The prevalence of post-traumatic stress symptoms was also high with 15.8% scoring above the standardized cut-off thresholds for post-traumatic stress disorder. The odds ratio (OR) of severe bullying for post-traumatic stress after adjustment for age and gender was 8.05 (95% confidence intervals (CI): 3.80-17.04). In the fully adjusted model it increased to 13.88 (95% CI: 4.68-41.13) indicating cumulative effects of all the investigated stressors. Workplace bullying is particularly prevalent among Lithuanian family physicians, as are the symptoms of post-traumatic distress. Strong associations between post-traumatic stress and exposure to severe bullying indicate that bullying is a significant source of mental health.

Medication persistence and discontinuation of rivaroxaban and dabigatran etexilate among patients with non-valvular atrial fibrillation.

PubMed

Nelson, Winnie W; Song, Xue; Thomson, Erin; Smith, David M; Coleman, Craig I; Damaraju, C V; Schein, Jeffrey R

2015-01-01

To compare real-world persistence and discontinuation among non-valvular atrial fibrillation (NVAF) patients on rivaroxaban and dabigatran in the US. A large nationally representative US claims database was used to conduct a retrospective cohort analysis of patients with NVAF on rivaroxaban or dabigatran between October 2010 and March 2013. The index date was the date of the first prescription of rivaroxaban or dabigatran. All patients had ≥6 months of data prior to the index date and were followed until the earliest of inpatient death, end of continuous enrollment, or end of the study period. Rivaroxaban patients were matched 1:1 with dabigatran patients using the propensity score matching technique. Cox proportional hazards models were employed to estimate the adjusted hazard ratios (aHRs) of non-persistence and discontinuation. Persistence was defined as absence of a refill gap of ≥60 days. Discontinuation was defined as no additional refill for at least 90 days and until the end of follow-up. A total of 30,337 NVAF patients on rivaroxaban or dabigatran met the study criteria. All 7259 rivaroxaban patients were matched 1:1 to dabigatran patients. Compared with dabigatran users, rivaroxaban patients were 11% less likely to become non-persistent with therapy (aHR: 0.89, 95% CI 0.84-0.95) and 29% less likely to discontinue therapy (aHR: 0.71, 95% CI 0.66-0.77). Claims data are subject to miscoding and inaccuracies. Refill data may not fully reflect actual medication taken. Confounding may remain even after propensity score matching and additional adjustments in model. Longer follow-up may produce more precise estimates of persistence and discontinuation. This matched cohort analysis indicated that, compared to dabigatran, rivaroxaban was associated with better persistence and lower rates of discontinuation.

Medication persistence and discontinuation of rivaroxaban versus warfarin among patients with non-valvular atrial fibrillation.

PubMed

Nelson, Winnie W; Song, Xue; Coleman, Craig I; Thomson, Erin; Smith, David M; Damaraju, C V; Schein, Jeffrey R

2014-12-01

To compare real-world persistence and discontinuation among non-valvular atrial fibrillation (NVAF) patients on rivaroxaban and warfarin in the US. A large nationally representative US claims database was used to conduct a retrospective cohort analysis of patients with NVAF treated with rivaroxaban or warfarin from 1 July 2010 through 31 March 2013. Index date was the date of the first prescription of rivaroxaban or warfarin. All patients were followed until the earliest of inpatient death, end of continuous enrollment, or end of study period. Rivaroxaban patients were matched 1:1 by propensity scores. Medication persistence was defined as absence of refill gap of ≥ 60 days. Discontinuation was defined as no additional refill for at least 90 days and until the end of follow-up. Cox proportional hazards models were estimated to examine the adjusted hazard ratios (aHRs) of rivaroxaban vs. warfarin on non-persistence and discontinuation. A total of 32,886 NVAF patients on rivaroxaban or warfarin met the study inclusion criteria. Each of the 7259 rivaroxaban patients identified were matched 1:1 to warfarin patients. Patients on rivaroxaban had a significantly better rate of persistence (aHR: 0.63, 95% CI 0.59-0.68) and lower rate of discontinuation (aHR: 0.54, 95% CI 0.49-0.58) compared to warfarin recipients. Claims data may have contained inaccuracies and miscoding. Confounding may remain even after propensity score matching and additional adjustments in model. Refill data may not fully reflect actual medication use. Longer follow-up may produce more precise estimates of persistence and discontinuation. This matched cohort analysis indicated that rivaroxaban was associated with significantly higher medication persistence and lower discontinuation rates compared to warfarin.

Night shift work and breast cancer risk: what do the meta-analyses tell us?

PubMed

Pahwa, Manisha; Labrèche, France; Demers, Paul A

2018-05-22

Objectives This paper aims to compare results, assess the quality, and discuss the implications of recently published meta-analyses of night shift work and breast cancer risk. Methods A comprehensive search was conducted for meta-analyses published from 2007-2017 that included at least one pooled effect size (ES) for breast cancer associated with any night shift work exposure metric and were accompanied by a systematic literature review. Pooled ES from each meta-analysis were ascertained with a focus on ever/never exposure associations. Assessments of heterogeneity and publication bias were also extracted. The AMSTAR 2 checklist was used to evaluate quality. Results Seven meta-analyses, published from 2013-2016, collectively included 30 cohort and case-control studies spanning 1996-2016. Five meta-analyses reported pooled ES for ever/never night shift work exposure; these ranged from 0.99 [95% confidence interval (CI) 0.95-1.03, N=10 cohort studies) to 1.40 (95% CI 1.13-1.73, N=9 high quality studies). Estimates for duration, frequency, and cumulative night shift work exposure were scant and mostly not statistically significant. Meta-analyses of cohort, Asian, and more fully-adjusted studies generally resulted in lower pooled ES than case-control, European, American, or minimally-adjusted studies. Most reported statistically significant between-study heterogeneity. Publication bias was not evident in any of the meta-analyses. Only one meta-analysis was strong in critical quality domains. Conclusions Fairly consistent elevated pooled ES were found for ever/never night shift work and breast cancer risk, but results for other shift work exposure metrics were inconclusive. Future evaluations of shift work should incorporate high quality meta-analyses that better appraise individual study quality.

The association of subjective orthodontic treatment need with oral health-related quality of life.

PubMed

Kragt, Lea; Jaddoe, Vincent; Wolvius, Eppo; Ongkosuwito, Edwin

2017-08-01

The existing body of evidence reports an inconsistent association between subjective and objective orthodontic treatment need. The concept of oral health-related quality of life (OHRQoL) might help to explain the differences in subjective and objective orthodontic treatment need. Our aim was to investigate the association of subjective orthodontic treatment with OHRQoL in children. This cross-sectional study was embedded in the Generation R Study, a population-based prospective cohort study. OHRQoL and subjective orthodontic treatment need were assessed by parental questionnaires. Questionnaire items were individually compared among children with no, borderline and definite subjective orthodontic need. The association between subjective orthodontic treatment need and OHRQoL was investigated in multivariate regression analysis with weighted least squares. Differences by sex and levels of objective orthodontic treatment need were evaluated. In total, 3774 children were included in the analysis. Children with borderline subjective orthodontic treatment need and those with definite subjective orthodontic treatment need had significantly poorer OHRQoL based on the fully adjusted model (adjusted regression coefficient (aβ)=-0.49, 95% CI: -0.75, -0.30; (aβ)=-1.58, 95% CI: -1.81, -1.58, respectively). The association between subjective orthodontic treatment need and OHRQoL was stronger in girls than in boys and stronger in children with objective orthodontic treatment need than in those with none. Oral health-related quality of life is poorer in children with subjective orthodontic treatment need. This has not been investigated before in such a large-population-based study and clearly offers an explanation for the lack of concurrence between objective and subjective orthodontic treatment need. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis.

PubMed

Haff, Nancy; Patel, Mitesh S; Lim, Raymond; Zhu, Jingsan; Troxel, Andrea B; Asch, David A; Volpp, Kevin G

2015-01-01

To evaluate the use of behavioral economics to design financial incentives to promote health behavior change and to explore associations with demographic characteristics. Studies performed by the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania published between January 2006 and March 2014. Randomized, controlled trials with available participant-level data. Studies that did not use financial incentives to promote health behavior change were excluded. Participant-level data from seven studies were pooled. Meta-analysis on the pooled sample using a random-effects model with interaction terms to examine treatment effects and whether they varied by incentive structure or demographic characteristics. The pooled study sample comprised 1403 participants, of whom 35% were female, 70% were white, 24% were black, and the mean age was 48 years (standard deviation 11.2 years). In the fully adjusted model, participants offered financial incentives had higher odds of behavior change (odds ratio [OR]: 3.96; p < .01) when compared to control. There were no significant interactions between financial incentives and gender, age, race, income, or education. When further adjusting for incentive structure, blacks had higher odds than whites of achieving behavior change (OR: 1.67; p < .05) with a conditional payment. Compared to lower-income participants, higher-income participants had lower odds of behavior change (OR: 0.46; p = .01) with a regret lottery. Financial incentives designed using concepts from behavioral economics were effective for promoting health behavior change. There were no large and consistent relationships between the effectiveness of financial incentives and observable demographic characteristics. Second-order examinations of incentive structure suggest potential relationships among the effectiveness of financial incentives, incentive structure, and the demographic characteristics of race and income.

Associations between social vulnerability, employment conditions and hazardous alcohol consumption in Chile.

PubMed

Ansoleaga, Elisa; Castillo-Carniglia, Alvaro

2013-05-01

Studies from many different countries have found associations between alcohol use, employment and social context. The aim of this study was to investigate associations between hazardous alcohol consumption (HAC), social vulnerability and employment conditions among Chilean adults. A cross-sectional study, involving analysis of the 2008 National Survey on Drugs in Chile, was conducted on 8316 economically active men and women aged between 18 and 65 years, who completed the alcohol section of the survey. The participants were selected randomly and data collected through face-to-face interviews. Multilevel analysis was used to achieve the study's objectives. The Alcohol Use Disorders Identification Test was used to define HAC. There were no significant associations between HAC and employment status or occupational category when controlling for potential confounders. Using the social services sector as a reference, the adjusted odds ratio (95% confidence interval) of HAC was 2.60 (1.96-3.46) for those who worked in construction, 2.03 (1.43-2.89) in mining, 1.74 in agriculture (1.16-2.63) and in industry (1.26-2.39), 1.73 (1.31-2.28) in trade, 1.67 (1.29-2.16) in other services and 1.42 (1.01-2.00) in transport. There was no association between the socioeconomic status of the participant's neighbourhood and HAC in the fully adjusted model. The perception of neighbourhood security (third quartile of insecurity) was associated with HAC (odds ratio 1.22; 95% confidence interval 1.02-1.46). HAC was independently associated with the participant's economic sector and perception of neighbourhood security in Chilean adults. It is important to perform in-depth analyses of contextual effects on individual alcohol consumption. © 2012 Australasian Professional Society on Alcohol and other Drugs.

Association between Vitamin D Genetic Risk Score and Cancer Risk in a Large Cohort of U.S. Women

PubMed Central

Chandler, Paulette D.; Tobias, Deirdre K.; Wang, Lu; Smith-Warner, Stephanie A.; Chasman, Daniel I.; Rose, Lynda; Giovannucci, Edward L.; Buring, Julie E.; Ridker, Paul M.; Cook, Nancy R.; Manson, JoAnn E.; Sesso, Howard D.

2018-01-01

Some observational studies suggest an inverse association between circulating 25-hydroxyvitamin D (25OHD) and cancer incidence and mortality. We conducted a Mendelian randomization analysis of the relationship between a vitamin D genetic risk score (GRS, range 0–10), comprised of five single nucleotide polymorphisms (SNPs) of vitamin D status in the DHCR7, CYP2R1 and GC genes and cancer risk among women. Analysis was performed in the Women’s Genome Health Study (WGHS), including 23,294 women of European ancestry who were cancer-free at baseline and followed for 20 years for incident cancer. In a subgroup of 1782 WGHS participants with 25OHD measures at baseline, the GRS was associated with circulating 25OHD mean (SD) = 67.8 (26.1) nmol/L, 56.9 (18.7) nmol/L in the lowest versus 73.2 (27.9) nmol/L in the highest quintile of the GRS (p trend < 0.0001 across quintiles). However, in age-adjusted Cox proportional hazards models, higher GRS (reflecting higher 25OHD levels) was not associated (cases; Hazard Ratio (HR) (95% Confidence Interval (CI)), p-value) with incident total cancer: (n = 3985; 1.01 (1.00–1.03), p = 0.17), breast (n = 1560; 1.02 (0.99–1.05), p = 0.21), colorectal (n = 329; 1.06 (1.00–1.13), p = 0.07), lung (n = 330; 1.00 (0.94–1.06), p = 0.89) or total cancer death (n = 770; 1.00 (0.96–1.04), p = 0.90). Results were similar in fully-adjusted models. A GRS for higher circulating 25OHD was not associated with cancer incidence or mortality. PMID:29315215

Similar Outcomes for Contact Aspiration and Stent Retriever Use According to the Admission Clot Burden Score in ASTER.

PubMed

Zhu, François; Lapergue, Bertrand; Kyheng, Maéva; Blanc, Raphael; Labreuche, Julien; Ben Machaa, Malek; Duhamel, Alain; Marnat, Gautier; Saleme, Suzana; Costalat, Vincent; Bracard, Serge; Richard, Sébastien; Desal, Hubert; Mazighi, Mikael; Consoli, Arturo; Piotin, Michel; Gory, Benjamin

2018-07-01

The clot burden score (CBS) at admission reliably evaluates the thrombus burden in acute ischemic stroke patients with anterior circulation large vessel occlusion. Mechanical thrombectomy has been diversified, especially with contact aspiration technique, and its efficiency with respect to the thrombus burden is not known. We compared reperfusion, adverse events, neurological recovery, and 90-day functional outcome of stent retriever use versus contact aspiration according to the admission CBS. This is a post hoc analysis of the ASTER (Contact Aspiration Versus Stent Retriever for Successful Revascularization) randomized trial. The primary outcome was successful reperfusion after all procedures, defined as modified Thrombolysis in Cerebral Infarction scores 2b/3. Secondary outcomes were 90-day functional outcome, assessed with the modified Rankin Scale. Safety outcomes included 90-day mortality and any intracerebral hemorrhage. A total of 231 randomized patients were included in this study: 114 patients had a CBS of 0 to 6 and 117 a CBS ≥7 at admission. Successful reperfusion at procedure end was achieved more frequently in patients with CBS ≥7 (88.9%) than patients with a CBS 0 to 6 (81.6%; fully adjusted risk ratio, 1.09; 95% confidence interval, 1.01-1.28). Favorable outcome (modified Rankin Scale score, 0-2) at 90 days was achieved in significantly more patients with CBS ≥7 (61.9%) than in patients with CBS 0 to 6 (41.8%; fully adjusted risk ratio, 1.19; 95% confidence interval, 1.02-1.40). No outcome differences of first-line mechanical thrombectomy strategy (aspiration versus stent) on any angiographic or clinical outcomes were observed between the 2 groups. We also found no evidence of interaction between first-line mechanical thrombectomy strategy and CBS groups regarding safety. First-line mechanical thrombectomy with contact aspiration compared with stent retriever did not result in an increased successful reperfusion rate in acute ischemic stroke patients with large vessel occlusion of the anterior circulation according to the admission CBS. The latter, however, seems to be a reliable prognostic indicator of angiographic and clinical outcome. © 2018 American Heart Association, Inc.

U.S. Africa Policy: Some Possible Course Adjustment

DTIC Science & Technology

1994-08-29

installations on behalf of an African Marxist government. A lot of Angola’s oil was exported to the United States; the U.S. companies involved made money. The...country, with major legitimate social service and infrastructure needs and, probably, very greedy leadership, would be able to forego exportation of its...droughts like the Sahel-and fully capable of feeding its population and producing for agricultural export . It has diamonds for ready cash. The size of

Validation of published Stirling engine design methods using engine characteristics from the literature

NASA Technical Reports Server (NTRS)

Martini, W. R.

1980-01-01

Four fully disclosed reference engines and five design methods are discussed. So far, the agreement between theory and experiment is about as good for the simpler calculation methods as it is for the more complicated methods, that is, within 20%. For the simpler methods, a one number adjustable constant can be used to reduce the error in predicting power output and efficiency over the entire operating map to less than 10%.

Design method of freeform light distribution lens for LED automotive headlamp based on DMD

NASA Astrophysics Data System (ADS)

Ma, Jianshe; Huang, Jianwei; Su, Ping; Cui, Yao

2018-01-01

We propose a new method to design freeform light distribution lens for light-emitting diode (LED) automotive headlamp based on digital micro mirror device (DMD). With the Parallel optical path architecture, the exit pupil of the illuminating system is set in infinity. Thus the principal incident rays of micro lens in DMD is parallel. DMD is made of high speed digital optical reflection array, the function of distribution lens is to distribute the emergent parallel rays from DMD and get a lighting pattern that fully comply with the national regulation GB 25991-2010.We use DLP 4500 to design the light distribution lens, mesh the target plane regulated by the national regulation GB 25991-2010 and correlate the mesh grids with the active mirror array of DLP4500. With the mapping relations and the refraction law, we can build the mathematics model and get the parameters of freeform light distribution lens. Then we import its parameter into the three-dimensional (3D) software CATIA to construct its 3D model. The ray tracing results using Tracepro demonstrate that the Illumination value of target plane is easily adjustable and fully comply with the requirement of the national regulation GB 25991-2010 by adjusting the exit brightness value of DMD. The theoretical optical efficiencies of the light distribution lens designed using this method could be up to 92% without any other auxiliary lens.

Choline in anxiety and depression: the Hordaland Health Study.

PubMed

Bjelland, Ingvar; Tell, Grethe S; Vollset, Stein E; Konstantinova, Svetlana; Ueland, Per M

2009-10-01

Despite its importance in the central nervous system as a precursor for acetylcholine and membrane phosphatidylcholine, the role of choline in mental illness has been little studied. We examined the cross-sectional association between plasma choline concentrations and scores of anxiety and depression symptoms in a general population sample. We studied a subsample (n = 5918) of the Hordaland Health Study, including both sexes and 2 age groups of 46-49 and 70-74 y who had valid information on plasma choline concentrations and symptoms of anxiety and depression measured by the Hospital Anxiety and Depression Scale--the latter 2 as continuous measures and dichotomized at a score > or =8 for both subscales. The lowest choline quintile was significantly associated with high anxiety levels (odds ratio: 1.33; 95% CI: 1.06, 1.69) in the fully adjusted (age group, sex, time since last meal, educational level, and smoking habits) logistic regression model. Also, the trend test in the anxiety model was significant (P = 0.007). In the equivalent fully adjusted linear regression model, a significant inverse association was found between choline quintiles and anxiety levels (standardized regression coefficient = -0.027, P = 0.045). We found no significant associations in the corresponding analyses of the relation between plasma choline and depression symptoms. In this large population-based study, choline concentrations were negatively associated with anxiety symptoms but not with depression symptoms.

Target Uncertainty Mediates Sensorimotor Error Correction

PubMed Central

Vijayakumar, Sethu; Wolpert, Daniel M.

2017-01-01

Human movements are prone to errors that arise from inaccuracies in both our perceptual processing and execution of motor commands. We can reduce such errors by both improving our estimates of the state of the world and through online error correction of the ongoing action. Two prominent frameworks that explain how humans solve these problems are Bayesian estimation and stochastic optimal feedback control. Here we examine the interaction between estimation and control by asking if uncertainty in estimates affects how subjects correct for errors that may arise during the movement. Unbeknownst to participants, we randomly shifted the visual feedback of their finger position as they reached to indicate the center of mass of an object. Even though participants were given ample time to compensate for this perturbation, they only fully corrected for the induced error on trials with low uncertainty about center of mass, with correction only partial in trials involving more uncertainty. The analysis of subjects’ scores revealed that participants corrected for errors just enough to avoid significant decrease in their overall scores, in agreement with the minimal intervention principle of optimal feedback control. We explain this behavior with a term in the loss function that accounts for the additional effort of adjusting one’s response. By suggesting that subjects’ decision uncertainty, as reflected in their posterior distribution, is a major factor in determining how their sensorimotor system responds to error, our findings support theoretical models in which the decision making and control processes are fully integrated. PMID:28129323

Target Uncertainty Mediates Sensorimotor Error Correction.

PubMed

Acerbi, Luigi; Vijayakumar, Sethu; Wolpert, Daniel M

2017-01-01

Human movements are prone to errors that arise from inaccuracies in both our perceptual processing and execution of motor commands. We can reduce such errors by both improving our estimates of the state of the world and through online error correction of the ongoing action. Two prominent frameworks that explain how humans solve these problems are Bayesian estimation and stochastic optimal feedback control. Here we examine the interaction between estimation and control by asking if uncertainty in estimates affects how subjects correct for errors that may arise during the movement. Unbeknownst to participants, we randomly shifted the visual feedback of their finger position as they reached to indicate the center of mass of an object. Even though participants were given ample time to compensate for this perturbation, they only fully corrected for the induced error on trials with low uncertainty about center of mass, with correction only partial in trials involving more uncertainty. The analysis of subjects' scores revealed that participants corrected for errors just enough to avoid significant decrease in their overall scores, in agreement with the minimal intervention principle of optimal feedback control. We explain this behavior with a term in the loss function that accounts for the additional effort of adjusting one's response. By suggesting that subjects' decision uncertainty, as reflected in their posterior distribution, is a major factor in determining how their sensorimotor system responds to error, our findings support theoretical models in which the decision making and control processes are fully integrated.

Estimating conditional proportion curves by regression residuals.

PubMed

Han, Bing; Lim, Nelson

2010-06-15

Researchers often derive a categorical outcome from an observed continuous measurement y. For example, human obesity status can be defined by the body mass index. They proceed to estimate the conditional proportion curve p(x) = P(y

Rate vs. rhythm control and adverse outcomes among European patients with atrial fibrillation.

PubMed

Purmah, Yanish; Proietti, Marco; Laroche, Cecilé; Mazurek, Michal; Tahmatzidis, Dimitrios; Boriani, Giuseppe; Novo, Salvatore; Lip, Gregory Y H

2018-02-01

The impact of rate and rhythm control strategies on outcomes in patients with atrial fibrillation (AF) remains controversial. Our aims were: to report use of rate and rhythm control strategies in European patients from the EURObservational Research Program AF General Pilot Registry. Secondly, to evaluate outcomes according to assigned strategies. Use of pure rate and rhythm control agents was described according to European regions. 1-year follow-up data were reported. Among rate control strategies, beta-blockers were the most commonly used drug. Proportions of patients assigned to rhythm control varied greatly between countries, and amiodarone was the most used rhythm control drug. Of the original 3119 patients, 1036 (33.2%) were assigned to rate control only and 355 (11.4%) to rhythm control only. Patients assigned to a rate control strategy were older (P < 0.0001) and more likely female (P = 0.0266). Patients assigned to a rate control strategy had higher rates for any thrombo-embolic event (P = 0.0245), cardiovascular death (P = 0.0437), and all-cause death (P < 0.0001). Kaplan-Meier analysis showed that rate control strategy was associated with a higher risk for all-cause death (P < 0.001). On Cox regression analysis, rate control strategy was independently associated with all-cause death (P = 0.0256). A propensity matched analysis only found a trend for the association between rate control and all-cause death (P = 0.0664). In a European AF patients' cohort, a pure rate control strategy was associated with a higher risk for adverse events at 1-year follow-up, and partially adjusted analysis suggested that rate control independently increased the risk for all-cause death. A fully adjusted propensity score matched analysis found that this association was no longer statistically significant, suggesting an important role of comorbidities in determining the higher risk for all-cause death. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Determination of the total acidity in soft drinks using potentiometric sequential injection titration.

PubMed

van Staden, J Koos F; Mashamba, M Mulalo G; Stefan, R Raluca I

2002-12-06

A potentiometric SI titration system for the determination of total acidity in soft drinks is proposed. The concept is based on the aspiration of the acid soft drink sample between two base zones into a holding coil with the volume of the first base zone twice to that of the second one and channelled by flow reversal through a reaction coil to a potentiometric sensor. A solution of 0.1 mol l(-1) sodium chloride is used as ionic strength adjustment buffer in the carrier stream. The system has been applied to the analysis of some South African soft drinks having a total acidity level of about 0.2-0.3% (w/v). The method has a sample frequency of 45 samples per h with a linear range of 0.1 and 0.6% (w/v). It is easy to use, fully computerised, and gives the results that are comparable to both automated batch titration and manual titration.

Fast Response of the Tropics to an Abrupt Loss of Arctic Sea Ice via Ocean Dynamics

NASA Astrophysics Data System (ADS)

Wang, Kun; Deser, Clara; Sun, Lantao; Tomas, Robert A.

2018-05-01

The role of ocean dynamics in the transient adjustment of the coupled climate system to an abrupt loss of Arctic sea ice is investigated using experiments with Community Climate System Model version 4 in two configurations: a thermodynamic slab mixed layer ocean and a full-depth ocean that includes both dynamics and thermodynamics. Ocean dynamics produce a distinct sea surface temperature warming maximum in the eastern equatorial Pacific, accompanied by an equatorward intensification of the Intertropical Convergence Zone and Hadley Circulation. These tropical responses are established within 25 years of ice loss and contrast markedly with the quasi-steady antisymmetric coupled response in the slab-ocean configuration. A heat budget analysis reveals the importance of anomalous vertical advection tied to a monotonic temperature increase below 200 m for the equatorial sea surface temperature warming maximum in the fully coupled model. Ocean dynamics also rapidly modify the midlatitude atmospheric response to sea ice loss.

Optimal control of motorsport differentials

NASA Astrophysics Data System (ADS)

Tremlett, A. J.; Massaro, M.; Purdy, D. J.; Velenis, E.; Assadian, F.; Moore, A. P.; Halley, M.

2015-12-01

Modern motorsport limited slip differentials (LSD) have evolved to become highly adjustable, allowing the torque bias that they generate to be tuned in the corner entry, apex and corner exit phases of typical on-track manoeuvres. The task of finding the optimal torque bias profile under such varied vehicle conditions is complex. This paper presents a nonlinear optimal control method which is used to find the minimum time optimal torque bias profile through a lane change manoeuvre. The results are compared to traditional open and fully locked differential strategies, in addition to considering related vehicle stability and agility metrics. An investigation into how the optimal torque bias profile changes with reduced track-tyre friction is also included in the analysis. The optimal LSD profile was shown to give a performance gain over its locked differential counterpart in key areas of the manoeuvre where a quick direction change is required. The methodology proposed can be used to find both optimal passive LSD characteristics and as the basis of a semi-active LSD control algorithm.

Risk factors for acute toxoplasmosis in England and Wales.

PubMed

Said, B; Halsby, K D; O'Connor, C M; Francis, J; Hewitt, K; Verlander, N Q; Guy, E; Morgan, D

2017-01-01

Over 300 cases of acute toxoplasmosis are confirmed by reference testing in England and Wales annually. We conducted a case-control study to identify risk factors for Toxoplasma gondii infection to inform prevention strategies. Twenty-eight cases and 27 seronegative controls participated. We compared their food history and environmental exposures using logistic regression to calculate odds ratios (OR) and 95% confidence intervals in a model controlling for age and sex. Univariable analysis showed that the odds of eating beef (OR 10·7, P < 0·001), poultry (OR 6·4, P = 0·01) or lamb/mutton (OR 4·9, P = 0·01) was higher for cases than controls. After adjustment for potential confounders a strong association between beef and infection remained (OR 5·6, P = 0·01). The small sample size was a significant limitation and larger studies are needed to fully investigate potential risk factors. The study findings emphasize the need to ensure food is thoroughly cooked and handled hygienically, especially for those in vulnerable groups.

Longitudinal distribution of Chironomidae (Diptera) downstream from a dam in a neotropical river.

PubMed

Pinha, G D; Aviz, D; Lopes Filho, D R; Petsch, D K; Marchese, M R; Takeda, A M

2013-08-01

The damming of a river causes dangerous consequences on structure of the environment downstream of the dam, modifying the sediment composition, which impose major adjustments in longitudinal distribution of benthic community. The construction of Engenheiro Sérgio Motta Dam in the Upper Paraná River has caused impacts on the aquatic communities, which are not yet fully known. This work aimed to provide more information about the effects of this impoundment on the structure of Chironomidae larvae assemblage. The analysis of data of physical and chemical variables in relation to biological data of 8 longitudinal sections in the Upper Paraná River showed that composition of Chironomidae larvae of stations near Engenheiro Sérgio Motta Dam differed of the other stations (farther of the Dam). The predominance of coarse sediments at stations upstream and finer sediments further downstream affected the choice of habitat by different morphotypes of Chironomidae and it caused a change in the structure of this assemblage in the longitudinal stretch.

Integration and testing of the DESI spectrograph prototype

NASA Astrophysics Data System (ADS)

Perruchot, S.; Secroun, A.; Blanc, P.-E.; Ronayette, S.; Régal, X.; Castagnoli, G.; Le Van Suu, A.; Ealet, A.; Cuby, J.-G.; Elliot, A.; Honscheid, K.; Jelinsky, P.

2016-08-01

The Dark Energy Spectroscopic Instrument (DESI) is under construction to measure the expansion history of the Universe using the Baryon Acoustic Oscillation probe. The KPNO Mayall telescope will deliver light to 5000 fibers feeding ten broadband spectrographs. A consortium of Aix-Marseille University (AMU) and CNRS laboratories (LAM, OHP and CPPM) together with the WINLIGHT Systems company (Pertuis-France) has committed to integrate and validate the performance requirements of the full spectrographs, equipped with their cryostats, shutters and other mechanisms. An AIT plan has been defined and dedicated test equipment has been designed and implemented. This equipment simulates the fiber input illumination from the telescope, and offers a variety of continuum and line sources. Flux levels are adjustable and can illuminate one or several fibers along the test slit. It is fully remotely controlled and interfaced to the Instrument Control System. Specific analysis tools have also been developed to verify and monitor the performance and stability of the spectrographs. All these developments are described in details.

Fully-coupled analysis of jet mixing problems. Three-dimensional PNS model, SCIP3D

NASA Technical Reports Server (NTRS)

Wolf, D. E.; Sinha, N.; Dash, S. M.

1988-01-01

Numerical procedures formulated for the analysis of 3D jet mixing problems, as incorporated in the computer model, SCIP3D, are described. The overall methodology closely parallels that developed in the earlier 2D axisymmetric jet mixing model, SCIPVIS. SCIP3D integrates the 3D parabolized Navier-Stokes (PNS) jet mixing equations, cast in mapped cartesian or cylindrical coordinates, employing the explicit MacCormack Algorithm. A pressure split variant of this algorithm is employed in subsonic regions with a sublayer approximation utilized for treating the streamwise pressure component. SCIP3D contains both the ks and kW turbulence models, and employs a two component mixture approach to treat jet exhausts of arbitrary composition. Specialized grid procedures are used to adjust the grid growth in accordance with the growth of the jet, including a hybrid cartesian/cylindrical grid procedure for rectangular jets which moves the hybrid coordinate origin towards the flow origin as the jet transitions from a rectangular to circular shape. Numerous calculations are presented for rectangular mixing problems, as well as for a variety of basic unit problems exhibiting overall capabilities of SCIP3D.

Engaging stakeholders for adaptive management using structured decision analysis

USGS Publications Warehouse

Irwin, Elise R.; Kathryn, D.; Kennedy, Mickett

2009-01-01

Adaptive management is different from other types of management in that it includes all stakeholders (versus only policy makers) in the process, uses resource optimization techniques to evaluate competing objectives, and recognizes and attempts to reduce uncertainty inherent in natural resource systems. Management actions are negotiated by stakeholders, monitored results are compared to predictions of how the system should respond, and management strategies are adjusted in a “monitor-compare-adjust” iterative routine. Many adaptive management projects fail because of the lack of stakeholder identification, engagement, and continued involvement. Primary reasons for this vary but are usually related to either stakeholders not having ownership (or representation) in decision processes or disenfranchisement of stakeholders after adaptive management begins. We present an example in which stakeholders participated fully in adaptive management of a southeastern regulated river. Structured decision analysis was used to define management objectives and stakeholder values and to determine initial flow prescriptions. The process was transparent, and the visual nature of the modeling software allowed stakeholders to see how their interests and values were represented in the decision process. The development of a stakeholder governance structure and communication mechanism has been critical to the success of the project.

Initial clinical trial of a closed loop, fully automatic intra-aortic balloon pump.

PubMed

Kantrowitz, A; Freed, P S; Cardona, R R; Gage, K; Marinescu, G N; Westveld, A H; Litch, B; Suzuki, A; Hayakawa, H; Takano, T

1992-01-01

A new generation, closed loop, fully automatic intraaortic balloon pump (CL-IABP) system continuously optimizes diastolic augmentation by adjusting balloon pump parameters beat by beat without operator intervention. In dogs in sinus rhythm and with experimentally induced arrhythmias, the new CL-IABP system provided safe, effective augmentation. To investigate the system's suitability for clinical use, 10 patients meeting standard indications for IABP were studied. The patients were pumped by the fully automatic IABP system for an average of 20 hr (range, 1-48 hr). At start-up, the system optimized pumping parameters within 7-20 sec. Evaluation of 186 recordings made at hourly intervals showed that inflation began within 20 msec of the dicrotic notch 99% of the time. In 100% of the recordings, deflation straddled the first half of ventricular ejection. Peak pressure across the balloon membrane averaged 55 mmHg and, in no case, exceeded 100 mmHg. Examination of the data showed that as soon as the system was actuated it provided consistently beneficial diastolic augmentation without any further operator intervention. Eight patients improved and two died (one of irreversible cardiogenic shock and one of ischemic cardiomyopathy). No complications were attributable to the investigational aspects of the system. A fully automated IABP is feasible in the clinical setting, and it may have advantages relative to current generation IABP systems.

Road traffic noise, air pollution and incident cardiovascular disease: A joint analysis of the HUNT, EPIC-Oxford and UK Biobank cohorts.

PubMed

Cai, Yutong; Hodgson, Susan; Blangiardo, Marta; Gulliver, John; Morley, David; Fecht, Daniela; Vienneau, Danielle; de Hoogh, Kees; Key, Tim; Hveem, Kristian; Elliott, Paul; Hansell, Anna L

2018-05-01

This study aimed to investigate the effects of long-term exposure to road traffic noise and air pollution on incident cardiovascular disease (CVD) in three large cohorts: HUNT, EPIC-Oxford and UK Biobank. In pooled complete-case sample of the three cohorts from Norway and the United Kingdom (N = 355,732), 21,081 incident all CVD cases including 5259 ischemic heart disease (IHD) and 2871 cerebrovascular cases were ascertained between baseline (1993-2010) and end of follow-up (2008-2013) through medical record linkage. Annual mean 24-hour weighted road traffic noise (Lden) and air pollution (particulate matter with aerodynamic diameter ≤ 10 μm [PM10], ≤2.5 μm [PM2.5] and nitrogen dioxide [NO2]) exposure at baseline address was modelled using a simplified version of the Common Noise Assessment Methods in Europe (CNOSSOS-EU) and European-wide Land Use Regression models. Individual-level covariate data were harmonised and physically pooled across the three cohorts. Analysis was via Cox proportional hazard model with mutual adjustments for both noise and air pollution and potential confounders. No significant associations were found between annual mean Lden and incident CVD, IHD or cerebrovascular disease in the overall population except that the association with incident IHD was significant among current-smokers. In the fully adjusted models including adjustment for Lden, an interquartile range (IQR) higher PM10 (4.1 μg/m3) or PM2.5 (1.4 μg/m3) was associated with a 5.8% (95%CI: 2.5%-9.3%) and 3.7% (95%CI: 0.2%-7.4%) higher risk for all incident CVD respectively. No significant associations were found between NO2 and any of the CVD outcomes. We found suggestive evidence of a possible association between road traffic noise and incident IHD, consistent with current literature. Long-term particulate air pollution exposure, even at concentrations below current European air quality standards, was significantly associated with incident CVD. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effect of ionized serum calcium on outcomes in acute kidney injury needing renal replacement therapy: Secondary analysis of the Acute Renal Failure Trial Network Study

PubMed Central

Afshinnia, Farsad; Belanger, Karen; Palevsky, Paul M.; Young, Eric W.

2014-01-01

Background Hypocalcemia is very common in critically ill patients. While the effect of ionized calcium (iCa) on outcome is not well understood, manipulation of iCa in critically ill patients is a common practice. We analyzed all-cause mortality and several secondary outcomes in patients with acute kidney injury (AKI) by categories of serum iCa among participants in the Acute Renal Failure Trial Network (ATN) Study. Methods This is a post hoc secondary analysis of the ATN Study which was not preplanned in the original trial. Risk of mortality and renal recovery by categories of iCa were compared using multiple fixed and adjusted time-varying Cox regression models. Multiple linear regression models were used to explore the impact of baseline iCa on days free from ICU and hospital. Results A total of 685 patients were included in the analysis. Mean age was 60 (SD=15) years. There were 502 male patients (73.3%). Sixty-day all-cause mortality was 57.0%, 54.8%, and 54.4%, in patients with an iCa <1, 1–1.14, and ≥1.15 mmol/L, respectively (P=0.87). Mean of days free from ICU or hospital in all patients and the 28-day renal recovery in survivors to day 28 were not significantly different by categories of iCa. The hazard for death in a fully adjusted time-varying Cox regression survival model was 1.7 (95% CI: 1.3–2.4) comparing iCa <1 to iCa ≥1.15 mmol/L. No outcome was different for levels of iCa >1 mmol/L. Conclusion Severe hypocalcemia with iCa <1 mmol/L independently predicted mortality in patients with AKI needing renal replacement therapy. PMID:23992422

Higher Body Mass Index Is Associated With Greater Proportions of Effector CD8+ T Cells Expressing CD57 in Women Living With HIV.

PubMed

Reid, Michael J A; Baxi, Sanjiv M; Sheira, Lila A; Landay, Alan L; Frongillo, Edward A; Adedimeji, Adebola; Cohen, Mardge H; Wentz, Eryka; Gustafson, Deborah R; Merenstein, Daniel; Hunt, Peter W; Tien, Phyllis C; Weiser, Sheri D

2017-08-15

A low proportion of CD28CD8 T cells that express CD57 is associated with increased mortality in HIV infection. The effect of increasing body mass index (BMI) changes in the proportion of CD57CD28CD8 T cells among HIV-infected individuals on antiretroviral therapy is unknown. In a US cohort of HIV-infected women, we evaluated associations of BMI and waist circumference with 3 distinct CD8 T cell phenotypes: % CD28CD57CD8 T cells, % CD57 of CD28CD8 T cells, and % CD28 of all CD8 T cells. Multivariable linear regression analysis was used to estimate beta coefficients for each of 3 T-cell phenotypes. Covariates included HIV parameters (current and nadir CD4, current viral load), demographics (age, race, income, and study site), and lifestyle (tobacco and alcohol use) factors. Of 225 participants, the median age was 46 years and 50% were obese (BMI >30 m/kg). Greater BMI and waist circumference were both associated with higher % CD28CD57CD8 T cells and % CD57 of all CD28CD8 T cells in multivariable analysis, including adjustment for HIV viral load (all P < 0.05). The association between greater BMI and the overall proportion of CD28 CD8 cells in fully adjusted models (0.078, 95% confidence interval: -0.053 to 0.209) was not significant. In this analysis, greater BMI and waist circumference are associated with greater expression of CD57 on CD28CD8 T cells and a greater proportion of CD57CD28 CD8 T cells. These findings may indicate that increasing BMI is immunologically protective in HIV-infected women. Future research is needed to understand the prognostic importance of these associations on clinical outcomes.

The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members.

PubMed

Helfrich, Christian D; Simonetti, Joseph A; Clinton, Walter L; Wood, Gordon B; Taylor, Leslie; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Fihn, Stephan D; Nelson, Karin M

2017-07-01

Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians. To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams. We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014. Primary care personnel at VA clinics responding to a national survey. Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity). There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition. Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.

Adjusting for multiple prognostic factors in the analysis of randomised trials

PubMed Central

2013-01-01

Background When multiple prognostic factors are adjusted for in the analysis of a randomised trial, it is unclear (1) whether it is necessary to account for each of the strata, formed by all combinations of the prognostic factors (stratified analysis), when randomisation has been balanced within each stratum (stratified randomisation), or whether adjusting for the main effects alone will suffice, and (2) the best method of adjustment in terms of type I error rate and power, irrespective of the randomisation method. Methods We used simulation to (1) determine if a stratified analysis is necessary after stratified randomisation, and (2) to compare different methods of adjustment in terms of power and type I error rate. We considered the following methods of analysis: adjusting for covariates in a regression model, adjusting for each stratum using either fixed or random effects, and Mantel-Haenszel or a stratified Cox model depending on outcome. Results Stratified analysis is required after stratified randomisation to maintain correct type I error rates when (a) there are strong interactions between prognostic factors, and (b) there are approximately equal number of patients in each stratum. However, simulations based on real trial data found that type I error rates were unaffected by the method of analysis (stratified vs unstratified), indicating these conditions were not met in real datasets. Comparison of different analysis methods found that with small sample sizes and a binary or time-to-event outcome, most analysis methods lead to either inflated type I error rates or a reduction in power; the lone exception was a stratified analysis using random effects for strata, which gave nominal type I error rates and adequate power. Conclusions It is unlikely that a stratified analysis is necessary after stratified randomisation except in extreme scenarios. Therefore, the method of analysis (accounting for the strata, or adjusting only for the covariates) will not generally need to depend on the method of randomisation used. Most methods of analysis work well with large sample sizes, however treating strata as random effects should be the analysis method of choice with binary or time-to-event outcomes and a small sample size. PMID:23898993

Systems and methods of varying charged particle beam spot size

DOEpatents

Chen, Yu-Jiuan

2014-09-02

Methods and devices enable shaping of a charged particle beam. A modified dielectric wall accelerator includes a high gradient lens section and a main section. The high gradient lens section can be dynamically adjusted to establish the desired electric fields to minimize undesirable transverse defocusing fields at the entrance to the dielectric wall accelerator. Once a baseline setting with desirable output beam characteristic is established, the output beam can be dynamically modified to vary the output beam characteristics. The output beam can be modified by slightly adjusting the electric fields established across different sections of the modified dielectric wall accelerator. Additional control over the shape of the output beam can be excreted by introducing intentional timing de-synchronization offsets and producing an injected beam that is not fully matched to the entrance of the modified dielectric accelerator.

A new version of JQMD for soft heavy-ion collisions

NASA Astrophysics Data System (ADS)

Mancusi, Davide; Niita, Koji; Sihver, Lembit

The JQMD model (JAERI Quantum Molecular Dynamics) has been successfully used for a long time now to describe many different aspects of nuclear reactions in a unified way. However, in soft, peripheral heavy-ion collisions, the JQMD model shows instabilities and spurious fluctuations that are responsible for an overestimation of few-nucleon-removal cross sections. The reasons of this shortcoming are, firstly, that the JQMD is not fully relativistically covariant, and secondly, that the fermionic nature of the nuclear ground state cannot be faithfully reproduced in a semi-classical framework. We present here R-JQMD, an improved and fully covariant version of JQMD that also features a new ground-state initialisation algorithm for nuclei. The new code is only marginally slower than JQMD and it produces physically sounder results. We also discuss whether R-JQMD can be adjusted to improve JQMD's agreement with measured heavy-ion fragmentation cross sections.

An Integrative, Multi-Scale Computational Model of a Swimming Lamprey Fully Coupled to Its Fluid Environment and Incorporating Proprioceptive Feedback

NASA Astrophysics Data System (ADS)

Hamlet, C. L.; Hoffman, K.; Fauci, L.; Tytell, E.

2016-02-01

The lamprey is a model organism for both neurophysiology and locomotion studies. To study the role of sensory feedback as an organism moves through its environment, a 2D, integrative, multi-scale model of an anguilliform swimmer driven by neural activation from a central pattern generator (CPG) is constructed. The CPG in turn drives muscle kinematics and is fully coupled to the surrounding fluid. The system is numerically evolved in time using an immersed boundary framework producing an emergent swimming mode. Proprioceptive feedback to the CPG based on experimental observations adjust the activation signal as the organism interacts with its environment. Effects on the speed, stability and cost (metabolic work) of swimming due to nonlinear dependencies associated with muscle force development combined with proprioceptive feedback to neural activation are estimated and examined.

Attrition of U.S. military enlistees with waivers for hearing deficiency, 1995-2004.

PubMed

Niebuhr, David W; Li, Yuanzhang; Powers, Timothy E; Krauss, Margot R; Chandler, David; Helfer, Thomas

2007-01-01

Hearing deficiency is the condition for which accession medical waivers are most commonly granted. The retention of individuals entering service with a waiver for hearing deficiency has not been previously studied. Military retention among new enlistees with a medical waiver for hearing deficiency was compared with that among a matched comparison group of fully qualified enlistees. Comparisons according to branch of service over the first 3 years of service were performed with the Kaplan-Meier product-limit method and proportional-hazards model. Army subjects had significantly lower retention rates than did their fully qualified counterparts. In the adjusted model, Army and Navy enlistees with a waiver for hearing deficiency had a significantly lower likelihood of retention than did their matched counterparts. The increased likelihood of medical attrition in enlistees with a waiver for hearing loss provides no evidence to make the hearing accession standard more lenient and validates a selective hearing loss waiver policy.

Fatigue data for polyether ether ketone (PEEK) under fully-reversed cyclic loading

PubMed Central

Shrestha, Rakish; Simsiriwong, Jutima; Shamsaei, Nima

2016-01-01

In this article, the data obtained from the uniaxial fully-reversed fatigue experiments conducted on polyether ether ketone (PEEK), a semi-crystalline thermoplastic, are presented. The tests were performed in either strain-controlled or load-controlled mode under various levels of loading. The data are categorized into four subsets according to the type of tests, including (1) strain-controlled fatigue tests with adjusted frequency to obtain the nominal temperature rise of the specimen surface, (2) strain-controlled fatigue tests with various frequencies, (3) load-controlled fatigue tests without step loadings, and (4) load-controlled fatigue tests with step loadings. Accompanied data for each test include the fatigue life, the maximum (peak) and minimum (valley) stress–strain responses for each cycle, and the hysteresis stress–strain responses for each collected cycle in a logarithmic increment. A brief description of the experimental method is also given. PMID:26937465

Fatigue data for polyether ether ketone (PEEK) under fully-reversed cyclic loading.

PubMed

Shrestha, Rakish; Simsiriwong, Jutima; Shamsaei, Nima

2016-03-01

In this article, the data obtained from the uniaxial fully-reversed fatigue experiments conducted on polyether ether ketone (PEEK), a semi-crystalline thermoplastic, are presented. The tests were performed in either strain-controlled or load-controlled mode under various levels of loading. The data are categorized into four subsets according to the type of tests, including (1) strain-controlled fatigue tests with adjusted frequency to obtain the nominal temperature rise of the specimen surface, (2) strain-controlled fatigue tests with various frequencies, (3) load-controlled fatigue tests without step loadings, and (4) load-controlled fatigue tests with step loadings. Accompanied data for each test include the fatigue life, the maximum (peak) and minimum (valley) stress-strain responses for each cycle, and the hysteresis stress-strain responses for each collected cycle in a logarithmic increment. A brief description of the experimental method is also given.

Quantum Control of Graphene Plasmon Excitation and Propagation at Heaviside Potential Steps.

PubMed

Wang, Dongli; Fan, Xiaodong; Li, Xiaoguang; Dai, Siyuan; Wei, Laiming; Qin, Wei; Wu, Fei; Zhang, Huayang; Qi, Zeming; Zeng, Changgan; Zhang, Zhenyu; Hou, Jianguo

2018-02-14

Quantum mechanical effects of single particles can affect the collective plasmon behaviors substantially. In this work, the quantum control of plasmon excitation and propagation in graphene is demonstrated by adopting the variable quantum transmission of carriers at Heaviside potential steps as a tuning knob. First, the plasmon reflection is revealed to be tunable within a broad range by varying the ratio γ between the carrier energy and potential height, which originates from the quantum mechanical effect of carrier propagation at potential steps. Moreover, the plasmon excitation by free-space photos can be regulated from fully suppressed to fully launched in graphene potential wells also through adjusting γ, which defines the degrees of the carrier confinement in the potential wells. These discovered quantum plasmon effects offer a unified quantum-mechanical solution toward ultimate control of both plasmon launching and propagating, which are indispensable processes in building plasmon circuitry.

Application of Fourier transform midinfrared spectroscopy to the discrimination between Irish artisanal honey and such honey adulterated with various sugar syrups.

PubMed

Kelly, J Daniel; Petisco, Cristina; Downey, Gerard

2006-08-23

A collection of authentic artisanal Irish honeys (n = 580) and certain of these honeys adulterated by fully inverted beet syrup (n = 280), high-fructose corn syrup (n = 160), partial invert cane syrup (n = 120), dextrose syrup (n = 160), and beet sucrose (n = 120) was assembled. All samples were adjusted to 70 degrees Bx and scanned in the midinfrared region (800-4000 cm(-1)) by attenuated total reflectance sample accessory. By use of soft independent modeling of class analogy (SIMCA) and partial least-squares (PLS) classification, authentic honey and honey adulterated by beet sucrose, dextrose syrups, and partial invert corn syrup could be identified with correct classification rates of 96.2%, 97.5%, 95.8%, and 91.7%, respectively. This combination of spectroscopic technique and chemometric methods was not able to unambiguously detect adulteration by high-fructose corn syrup or fully inverted beet syrup.

Formation and adjustment of typhoon-impacted reef islands interpreted from remote imagery: Nadikdik Atoll, Marshall Islands

NASA Astrophysics Data System (ADS)

Ford, Murray R.; Kench, Paul S.

2014-06-01

In 1905, a devastating typhoon hit Nadikdik Atoll (5°54‧ N and 172°09‧ E) in the southern Marshall Islands. Evidence suggests that large sections of reef islands on Nadikdik were overwashed and destroyed. Comparison of aerial photographs taken in 1945 and modern satellite imagery provides a unique record of the geomorphic adjustment of islands after the typhoon. Between 1945 and 2010 the vegetated area of islands on Nadikdik grew from 0.74 to 0.90 km2. Observed changes to Nadikdik reef islands manifested through a range of styles and were largely accretionary. Of note, the formation of a new island was tracked from an embryonic deposit to a fully vegetated and stable island over a 61 year period. Similarly, a number of previously discrete islands have agglomerated and formed a single larger island. These changes were rapid and indicate that reef island formation can occur quickly. Evidence suggests that despite the typhoon occurring over a century ago the geomorphic adjustment of islands is still on-going.

Exploring hotspots of pneumococcal pneumonia and potential impacts of ejecta dust exposure following the Christchurch earthquakes.

PubMed

Pearson, Amber L; Kingham, Simon; Mitchell, Peter; Apparicio, Philippe

2013-12-01

The etiology of pneumococcal pneumonia (PP) is well-known. Yet, some events may increase its incidence. Natural disasters may worsen air quality, a risk factor for PP. We investigated spatial/spatio-temporal clustering of PP pre- and post-earthquakes in Christchurch, New Zealand. The earthquakes resulted in deaths, widespread damage and liquefaction ejecta (a source of air-borne dust). We tested for clusters and associations with ejecta, using 97 cases (diagnosed 10/2008-12/2011), adjusted for age and area-level deprivation. The strongest evidence to support the potential role of ejecta in clusters of PP cases was the: (1) geographic shift in the spatio-temporal cluster after deprivation adjustment to match the post-earthquake clusters and; (2) increased relative risk in the fully-adjusted post-earthquake compared to the pre-earthquake cluster. The application of spatial statistics to study PP and ejecta are novel. Further studies to assess the long-term impacts of ejecta inhalation are recommended particularly in Christchurch, where seismic activity continues. Copyright © 2013 Elsevier Ltd. All rights reserved.

The religiosity as social value hypothesis: A multi-method replication and extension across 65 countries and three levels of spatial aggregation.

PubMed

Gebauer, Jochen E; Sedikides, Constantine; Schönbrodt, Felix D; Bleidorn, Wiebke; Rentfrow, Peter J; Potter, Jeff; Gosling, Samuel D

2017-09-01

Are religious people psychologically better or worse adjusted than their nonreligious counterparts? Hundreds of studies have reported a positive relation between religiosity and psychological adjustment. Recently, however, a comparatively small number of cross-cultural studies has questioned this staple of religiosity research. The latter studies find that religious adjustment benefits are restricted to religious cultures. Gebauer, Sedikides, and Neberich (2012) suggested the religiosity as social value hypothesis (RASV) as one explanation for those cross-cultural differences. RASV states that, in religious cultures, religiosity possesses much social value, and, as such, religious people will feel particularly good about themselves. In secular cultures, however, religiosity possesses limited social value, and, as such, religious people will feel less good about themselves, if at all. Yet, previous evidence has been inconclusive regarding RASV and regarding cross-cultural differences in religious adjustment benefits more generally. To clarify matters, we conducted 3 replication studies. We examined the relation between religiosity and self-esteem (the most direct and appropriate adjustment indicator, according to RASV) in a self-report study across 65 countries (N = 2,195,301), an informant-report study across 36 countries (N = 560,264), and another self-report study across 1,932 urban areas from 243 federal states in 18 countries (N = 1,188,536). Moreover, we scrutinized our results against 7, previously untested, alternative explanations. Our results fully and firmly replicated and extended prior evidence for cross-cultural differences in religious adjustment benefits. These cross-cultural differences were best explained by RASV. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

How firms set prices for medical materials: a multi-country study.

PubMed

Ide, Hiroo; Mollahaliloglu, Salih

2009-09-01

This study presents a comparison of medical material prices, discusses why differences exist, and examines methods for comparing prices. Market prices for drug-eluting stents (DES), non-drug-eluting stents (non-DES), and percutaneous transluminal coronary angioplasty (PTCA) catheters were collected from five countries: the United States, Japan, Korea, Turkey, and Thailand. To compare prices, three adjustment methods were used: currency exchange rates, purchasing power parity (PPP), and gross domestic product (GDP) per capita. The ratios of medical material prices compared with those in the United States were higher in Japan (from 1.4 for DES to 5.0 for PTCA catheters) and Korea (from 1.2 for DES to 4.0 for PTCA catheters), and lower in Turkey (from 0.8 for non-DES to 1.4 for DES) and Thailand (from 0.5 for non-DES to 1.3 for PTCA catheters). The PPP-adjusted ratios changed slightly for Japan, Korea, and Turkey. When the prices were adjusted by GDP per capita, the ratios were much higher. Comparing prices using currency exchange rates or PPP is applicable only between countries with stable economic relations; adjustment by GDP per capita reflects the actual burden. Further study is needed to fully elucidate the factors influencing the global medical material market.

Prospective post traumatic stress disorder symptom trajectories in active duty and separated military personnel

DTIC Science & Technology

2017-01-30

the proportion of active duty service members receiving VA care was restricted to zero. This model included all the covariates of the fully adjusted...assessed remained consistent across participants and timepoints. VA care was assessed from self -report, but could not be verified with VA medical...utility of a self -report version of PRIME-MD: the PHQ primary care study. JAMA J. Am. Med. Assoc. 282, 1737e1744. Spitzer, R.L., Williams, J.B

STS-52 Pilot Baker, in LES/LEH, during JSC WETF bailout exercises

NASA Technical Reports Server (NTRS)

1992-01-01

STS-52 Columbia, Orbiter Vehicle (OV) 102, Pilot Michael A. Baker smiles from under his launch and entry helmet (LEH) and from behind the communications carrier assembly (CCA) microphones as he adjusts his parachute harness. Baker, fully outfitted in a launch and entry suit (LES), prepares for emergency egress (bailout) training exercise in JSC's Weightless Environment Training Facility (WETF) Bldg 29 pool. The WETF's 25-ft deep pool will be used in this simulation of a water landing.

Army Physical Readiness Training

DTIC Science & Technology

2010-03-01

The lower leg pad is adjusted to contact the lower legs just above the ankle , allowing the lower leg to be fully extended, but not locked. The lower...contacts the lower legs just behind the ankles .  The hips, low back, shoulders, and head are firmly against the seat back.  Maintain a natural arch in...count 1 and inhale on count 2. Precautions: Avoid flexing or extending the trunk. Do not allow the ankles to turn in or out. C hapter 6 6-40 T C 3

Rangewide analysis of fungal associations in the fully mycoheterotrophic Corallorhiza striata complex (Orchidaceae) reveals extreme specificity on ectomycorrhizal Tomentella (Thelephoraceae) across North America

Treesearch

Craig F. Barrett; John V. Freudenstein; D. Lee Taylor; Urmas Koljalg

2010-01-01

Fully mycoheterotrophic plants offer a fascinating system for studying phylogenetic associations and dynamics of symbiotic specificity between hosts and parasites. These plants frequently parasitize mutualistic mycorrhizal symbioses between fungi and trees. Corallorhiza striata is a fully mycoheterotrophic, North American orchid distributed from...

A 37-mm Ceramic Gun Nozzle Stress Analysis

DTIC Science & Technology

2006-05-01

Figures iv List of Tables iv 1 . Introduction 1 2. Ceramic Nozzle Structure and Materials 1 3. Sequentially-Coupled and Fully-Coupled Thermal Stress...FEM Analysis 1 4. Ceramic Nozzle Thermal Stress Response 4 5. Ceramic Nozzle Dynamic FEM 7 6. Ceramic Nozzle Dynamic Responses and Discussions 8 7...candidate ceramics and the test fixture model components are listed in table 1 . 3. Sequentially-Coupled and Fully-Coupled Thermal Stress FEM Analysis

Burns to the genitalia, perineum, and buttocks increase the risk of death among U.S. service members sustaining combat-related burns in Iraq and Afghanistan.

PubMed

Clemens, Michael S; Janak, Judson C; Rizzo, Julie A; Graybill, John C; Buehner, Michelle F; Hudak, Steven J; Thompson, Charles K; Chung, Kevin K

2017-08-01

Among service members injured in Iraq and Afghanistan, to determine the risk of mortality associated with combat-related burns to the genitalia, perineum, and buttocks. The prospectively maintained burn registry from the United States Army Institute of Surgical Research was retrospectively reviewed to identify all service members with combat-related burns sustained in Iraq and Afghanistan from March 2003 to October 2013. The two primary risk factors of interest were (1) any burn to the genitals, perineum, and/or buttocks (PB) and (2) burns involving the entire perineal, genital, and buttock region (complete PB). Cox proportional hazard models were used to estimate the risk of mortality for both primary risk factors, and adjusted for severe non-burn-related trauma, percent of burn over total body surface area (TBSA), inhalational injury, time to urinary tract infection, and time to bacteremia. A post-hoc analysis was performed to explore the potential effect modification of TBSA burned on the relationship between PB and mortality. Among the 902 U.S. service members with combat-related burns sustained during the study period, 226 (25.0%) had involvement of the genitalia, perineum, and/or buttocks. Complete PB was associated with a crude risk of mortality (HR: 5.3; 2.9-9.7), but not an adjusted risk (HR=1.8; 0.8-4.0). However, TBSA burned was identified as a potential negative effect modifier. Among patients with burns <60% TBSA, sustaining a complete PB conferred an adjusted risk of death (HR=2.7; 1.1-6.8). Further, patients with a perineal burn had a five-fold increased incidence of bacteremia. In adjusted models, each event of bacteremia increased the risk of mortality by 92% (HR 1.92; 1.39-2.65). Perineal burns were associated with a two-fold increased incidence of severe non-burn related trauma that also doubled mortality risk in adjusted models (HR 2.29; 1.23-4.27). Among those with relatively survivable combat-related burns (<60% TBSA), genital/perineal/buttock involvement increases the risk of death. Bacteremia may account for part of this increased risk, but does not fully explain the independent risk associated with perineal burns. Published by Elsevier Ltd.

History of spontaneous miscarriage and the risk of diabetes mellitus among middle-aged and older Chinese women.

PubMed

Liu, Bingqing; Song, Lulu; Li, Hui; Zheng, Xiaoxuan; Yuan, Jing; Liang, Yuan; Wang, Youjie

2018-06-01

Epidemiological studies of the long-term maternal health outcomes of spontaneous miscarriages have been sparse and inconsistent. The objective of our study is to examine the association between spontaneous miscarriages and diabetes among middle-aged and older Chinese women. A total of 19,539 women from the Dongfeng-Tongji cohort study who completed a questionnaire and had medical examinations performed on were included in the analysis. History of spontaneous miscarriage was obtained by self-reporting in the first follow-up questionnaire interview. The presence of diabetes was determined by a fasting plasma glucose level, self-reported physician diagnosis and use of antidiabetic medication. A series of multivariate logistic regression models were used to calculate the odds ratios and 95% CI across spontaneous miscarriage categories (0, 1, 2, ≥ 3) after adjustment for potential confounding factors. The prevalence rate of diabetes was 18.8% among the participants. In the fully adjusted logistic regression model, women who had 1, 2 or ≥ 3 spontaneous miscarriages had 0.86 times (95% CI 0.68, 1.08), 1.30 times (95% CI 0.82, 2.04) and 2.11 times (95% CI 1.08, 4.11) higher risk of diabetes, respectively, compared with women who had no history of spontaneous miscarriage. There is an increased risk of diabetes among women with a history of a higher number of spontaneous miscarriages. History of multiple spontaneous miscarriages should be taken into consideration when assessing the risk of diabetes.

[Association between preventive care provided in public dental services and caries prevalence].

PubMed

Celeste, Roger Keller; Nadanovsky, Paulo; De Leon, Antonio Ponce

2007-10-01

To assess the association between preventive care provided in public dental services and young people's oral health. Oral health data on 4,033 young people aged 15 to 19 years living in 85 municipalities of the state of Rio Grande do Sul, Southern Brazil, were obtained from the national oral health survey "Saúde Bucal Brasil 2003" for the period 2002-2003. The following variables were studied: age, gender, income, education, time elapsed since last dental visit, reason for dental visit, and water fluoridation. Data on dental care services were obtained from the national database of public health services. Statistical analysis was performed using multilevel logistic regression. Youngsters from the 21 municipalities with the lowest preventive care (scaling + fluoride + sealants) rates per 100 inhabitants were 2.27 (95% CI: 1.45;3.56) more likely to have non-filled dental cavities than those from the 21 municipalities with the highest care rates. After adjustment for a number of individual and contextual factors this likelihood decreased to 1.76 (95% CI: 1.13;2.72). The variance attributable to variables at municipal level was 14.1% for the empty model and decreased to 10.5% for the fully adjusted model. Rio Grande do Sul public dental services may have contributed for the reduction in the number of non-filled cavities in young people. However, it was not possible to detect the impact of this service on total dental caries experience.

The efficacy of the Self-Adjusting File versus WaveOne in removal of root filling residue that remains in oval canals after the use of ProTaper retreatment files: A cone-beam computed tomography study

PubMed Central

Pawar, Ajinkya M; Thakur, Bhagyashree; Metzger, Zvi; Kfir, Anda; Pawar, Mansing

2016-01-01

Aim: The current ex vivo study compared the efficacy of removing root fillings using ProTaper retreatment files followed by either WaveOne reciprocating file or the Self-Adjusting File (SAF). Materials and Methods: Forty maxillary canines with single oval root canal were selected and sectioned to obtain 18-mm root segments. The root canals were instrumented with WaveOne primary files, followed by obturation using warm lateral compaction, and the sealer was allowed to fully set. The teeth were then divided into two equal groups (N = 20). Initial removal of the bulk of root filling material was performed with ProTaper retreatment files, followed by either WaveOne files (Group 1) or SAF (Group 2). Endosolv R was used as a gutta-percha softener. Preoperative and postoperative high-resolution cone-beam computed tomography (CBCT) was used to measure the volume of the root filling residue that was left after the procedure. Statistical analysis was performed using t-test. Results: The mean volume of root filling residue in Group 1 was 9.4 (±0.5) mm3, whereas in Group 2 the residue volume was 2.6 (±0.4) mm3, (P < 0.001; t-test). Conclusions: When SAF was used after ProTaper retreatment files, significantly less root filling residue was left in the canals compared to when WaveOne was used. PMID:26957798

Effects of early age at natural menopause on coronary heart disease and stroke in Chinese women.

PubMed

Shen, Lijun; Song, Lulu; Liu, Bingqing; Li, Hui; Zheng, Xiaoxuan; Zhang, Lina; Yuan, Jing; Liang, Yuan; Wang, Youjie

2017-08-15

Menopause is identified as a risk factor for cardiovascular disease because of the change of estrogen. The objective of the study was to explore the associations between early age at natural menopause (menopause at an age≤45years) and the presence of CHD and stroke. The study subjects were from the first follow-up survey of the Dongfeng-Tongji cohort study. A total of 16,515 postmenopausal women were included for the analysis. Logistic regression models were used to examine the associations between age at natural menopause (≤45, 45-52, >52years) and the presence of CHD and stroke adjusted for sociodemographic characteristics, lifestyle, reproductive history and metabolic factors. In the fully adjusted model, for each 1-year delay in menopausal age, the prevalence of CHD and stroke was reduced by 3% (OR, 0.97; 95% CI, 0.95-0.98) and 5% (OR, 0.95; 95% CI, 0.92-0.98), respectively. Women with early menopause (≤45years) had a higher prevalence of CHD (OR, 1.33; 95% CI, 1.13-1.57) compared with those with menopause at ages 45-52years. Similarly, women with early menopause (≤45years) was associated with higher prevalence of stroke (OR, 1.69; 95% CI, 1.25-2.30) compared with those with menopause at ages 45-52years. Early age at natural menopause is significantly associated with the presence of CHD and stroke among Chinese women. Copyright © 2017. Published by Elsevier B.V.

Covariate Imbalance and Adjustment for Logistic Regression Analysis of Clinical Trial Data

PubMed Central

Ciolino, Jody D.; Martin, Reneé H.; Zhao, Wenle; Jauch, Edward C.; Hill, Michael D.; Palesch, Yuko Y.

2014-01-01

In logistic regression analysis for binary clinical trial data, adjusted treatment effect estimates are often not equivalent to unadjusted estimates in the presence of influential covariates. This paper uses simulation to quantify the benefit of covariate adjustment in logistic regression. However, International Conference on Harmonization guidelines suggest that covariate adjustment be pre-specified. Unplanned adjusted analyses should be considered secondary. Results suggest that that if adjustment is not possible or unplanned in a logistic setting, balance in continuous covariates can alleviate some (but never all) of the shortcomings of unadjusted analyses. The case of log binomial regression is also explored. PMID:24138438

Impact of Learner's Characteristics and Learning Behaviour on Learning Performance during a Fully Online Course

ERIC Educational Resources Information Center

Nakayama, Minoru; Mutsuura, Kouichi; Yamamoto, Hiroh

2014-01-01

A fully online learning environment requires effective learning management in order to promote pro-active education. Since student's notes are a reflection of the progress of their education, analysis of notes taken can be used to track the learning process of students who participate in fully online courses. This paper presents the causal…

Exergy Analysis for Energy Systems

DTIC Science & Technology

2006-09-01

Webb, The effect of viscous dissipation in thermally fully- developed electro-osmotic heat transfer in microchannels, International Journal of Heat...electro-osmotic heat transfer in microchannel, International Journal of Heat & Mass Transfer 46(2003)1359–1369 [19] D. Maynes, B. Webb, Fully...AFRL-VA-WP-TM-2007-3095 EXERGY ANALYSIS FOR ENERGY SYSTEMS Dr. Rama S.R. Gorla Gorla Consultants, Inc. SEPTEMBER 2006 Final

Breastfeeding in Children of Women Taking Antiepileptic Drugs

PubMed Central

Meador, Kimford J.; Baker, Gus A.; Browning, Nancy; Cohen, Morris J.; Bromley, Rebecca L.; Clayton-Smith, Jill; Kalayjian, Laura A.; Kanner, Andres; Liporace, Joyce D.; Pennell, Page B.; Privitera, Michael; Loring, David W.

2014-01-01

IMPORTANCE Breastfeeding is known to have beneficial effects, but concern exists that breastfeeding during maternal antiepileptic drug (AED) therapy may be harmful. We previously noted no adverse effects of breastfeeding associated with AED use on IQ at age 3 years, but IQ at age 6 years is more predictive of school performance and adult abilities. OBJECTIVES To examine the effects of AED exposure via breastfeeding on cognitive functions at age 6 years. DESIGN, SETTING, AND PARTICIPANTS Prospective observational multicenter study of long-term neurodevelopmental effects of AED use. Pregnant women with epilepsy receiving monotherapy (ie, carbamazepine, lamotrigine, phenytoin, or valproate) were enrolled from October 14, 1999, through April 14, 2004, in the United States and the United Kingdom. At age 6 years, 181 children were assessed for whom we had both breastfeeding and IQ data. All mothers in this analysis continued taking the drug after delivery. MAIN OUTCOMES AND MEASURES Differential Ability Scales IQ was the primary outcome. Secondary measures included measures of verbal, nonverbal, memory, and executive functions. For our primary analysis, we used a linear regression model with IQ at age 6 years as the dependent variable, comparing children who breastfed with those who did not. Similar secondary analyses were performed for the other cognitive measures. RESULTS In total, 42.9% of children were breastfed a mean of 7.2 months. Breastfeeding rates and duration did not differ across drug groups. The IQ at age 6 years was related to drug group (P italic> .001 [adjusted IQ worse by 7–13 IQ points for valproate compared to other drugs]), drug dosage (regression coefficient, −0.1; 95% CI, −0.2 to 0.0; P = .01 [higher dosage worse]), maternal IQ (regression coefficient, 0.2; 95% CI, 0.0 to 0.4; P = .01 [higher child IQ with higher maternal IQ]), periconception folate use (adjusted IQ 6 [95% CI, 2–10] points higher for folate, P = .005), and breastfeeding (adjusted IQ 4 [95% CI, 0–8] points higher for breastfeeding, P = .045). For the other cognitive domains, only verbal abilities differed between the breastfed and nonbreastfed groups (adjusted verbal index 4 [95% CI, 0–7] points higher for breastfed children, P = .03). CONCLUSIONS AND RELEVANCE No adverse effects of AED exposure via breast milk were observed at age 6 years, consistent with another recent study at age 3 years. In our study, breastfed children exhibited higher IQ and enhanced verbal abilities. Additional studies are needed to fully delineate the effects of all AEDs. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00021866 PMID:24934501

Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years.

PubMed

Meador, Kimford J; Baker, Gus A; Browning, Nancy; Cohen, Morris J; Bromley, Rebecca L; Clayton-Smith, Jill; Kalayjian, Laura A; Kanner, Andres; Liporace, Joyce D; Pennell, Page B; Privitera, Michael; Loring, David W

2014-08-01

Breastfeeding is known to have beneficial effects, but concern exists that breastfeeding during maternal antiepileptic drug (AED) therapy may be harmful. We previously noted no adverse effects of breastfeeding associated with AED use on IQ at age 3 years, but IQ at age 6 years is more predictive of school performance and adult abilities. To examine the effects of AED exposure via breastfeeding on cognitive functions at age 6 years. Prospective observational multicenter study of long-term neurodevelopmental effects of AED use. Pregnant women with epilepsy receiving monotherapy (ie, carbamazepine, lamotrigine, phenytoin, or valproate) were enrolled from October 14, 1999, through April 14, 2004, in the United States and the United Kingdom. At age 6 years, 181 children were assessed for whom we had both breastfeeding and IQ data. All mothers in this analysis continued taking the drug after delivery. Differential Ability Scales IQ was the primary outcome. Secondary measures included measures of verbal, nonverbal, memory, and executive functions. For our primary analysis, we used a linear regression model with IQ at age 6 years as the dependent variable, comparing children who breastfed with those who did not. Similar secondary analyses were performed for the other cognitive measures. In total, 42.9% of children were breastfed a mean of 7.2 months. Breastfeeding rates and duration did not differ across drug groups. The IQ at age 6 years was related to drug group (P < .001 [adjusted IQ worse by 7-13 IQ points for valproate compared to other drugs]), drug dosage (regression coefficient, -0.1; 95% CI, -0.2 to 0.0; P = .01 [higher dosage worse]), maternal IQ (regression coefficient, 0.2; 95% CI, 0.0 to 0.4; P = .01 [higher child IQ with higher maternal IQ]), periconception folate use (adjusted IQ 6 [95% CI, 2-10] points higher for folate, P = .005), and breastfeeding (adjusted IQ 4 [95% CI, 0-8] points higher for breastfeeding, P = .045). For the other cognitive domains, only verbal abilities differed between the breastfed and nonbreastfed groups (adjusted verbal index 4 [95% CI, 0-7] points higher for breastfed children, P = .03). No adverse effects of AED exposure via breast milk were observed at age 6 years, consistent with another recent study at age 3 years. In our study, breastfed children exhibited higher IQ and enhanced verbal abilities. Additional studies are needed to fully delineate the effects of all AEDs. clinicaltrials.gov Identifier: NCT00021866.

Exploring the Inner Edge of the Habitable Zone with Fully Coupled Oceans

NASA Technical Reports Server (NTRS)

Way, M.J; Del Genio, A.D.; Kelley, M.; Aleinov, I.; Clune, T.

2015-01-01

The role of rotation in planetary atmospheres plays an important role in regulating atmospheric and oceanic heat flow, cloud formation and precipitation. Using the Goddard Institute for Space Studies (GISS) three dimension General Circulation Model (3D-GCM) we demonstrate how varying rotation rate and increasing the incident solar flux on a planet are related to each other and may allow the inner edge of the habitable zone to be much closer than many previous habitable zone studies have indicated. This is shown in particular for fully coupled ocean runs -- some of the first that have been utilized in this context. Results with a 100m mixed layer depth and our fully coupled ocean runs are compared with those of Yang et al. 2014, which demonstrates consistency across models. However, there are clear differences for rotations rates of 1-16x present earth day lengths between the mixed layer and fully couple ocean models, which points to the necessity of using fully coupled oceans whenever possible. The latter was recently demonstrated quite clearly by Hu & Yang 2014 in their aquaworld study with a fully coupled ocean when compared with similar mixed layer ocean studies and by Cullum et al. 2014. Atmospheric constituent amounts were also varied alongside adjustments to cloud parameterizations (results not shown here). While the latter have an effect on what a planet's global mean temperature is once the oceans reach equilibrium they do not qualitatively change the overall relationship between the globally averaged surface temperature and incident solar flux for rotation rates ranging from 1 to 256 times the present Earth day length. At the same time this study demonstrates that given the lack of knowledge about the atmospheric constituents and clouds on exoplanets there is still a large uncertainty as to where a planet will sit in a given star's habitable zone.

Consumption of Yogurt and the Incident Risk of Cardiovascular Disease: A Meta-Analysis of Nine Cohort Studies.

PubMed

Wu, Lei; Sun, Dali

2017-03-22

Previous systematic reviews and meta-analyses have evaluated the association of dairy consumption and the risk of cardiovascular disease (CVD). However, the findings were inconsistent. No quantitative analysis has specifically assessed the effect of yogurt intake on the incident risk of CVD. We searched the PubMed and the Embase databases from inception to 10 January 2017. A generic inverse-variance method was used to pool the fully-adjusted relative risks (RRs) and the corresponding 95% confidence intervals (CIs) with a random-effects model. A generalized least squares trend estimation model was used to calculate the specific slopes in the dose-response analysis. The present systematic review and meta-analysis identified nine prospective cohort articles involving a total of 291,236 participants. Compared with the lowest category, highest category of yogurt consumption was not significantly related with the incident risk of CVD, and the RR (95% CI) was 1.01 (0.95, 1.08) with an evidence of significant heterogeneity (I² = 52%). However, intake of ≥200 g/day yogurt was significantly associated with a lower risk of CVD in the subgroup analysis. There was a trend that a higher level of yogurt consumption was associated with a lower incident risk of CVD in the dose-response analysis. A daily dose of ≥200 g yogurt intake might be associated with a lower incident risk of CVD. Further cohort studies and randomized controlled trials are still demanded to establish and confirm the observed association in populations with different characteristics.

Consumption of Yogurt and the Incident Risk of Cardiovascular Disease: A Meta-Analysis of Nine Cohort Studies

PubMed Central

Wu, Lei; Sun, Dali

2017-01-01

Previous systematic reviews and meta-analyses have evaluated the association of dairy consumption and the risk of cardiovascular disease (CVD). However, the findings were inconsistent. No quantitative analysis has specifically assessed the effect of yogurt intake on the incident risk of CVD. We searched the PubMed and the Embase databases from inception to 10 January 2017. A generic inverse-variance method was used to pool the fully-adjusted relative risks (RRs) and the corresponding 95% confidence intervals (CIs) with a random-effects model. A generalized least squares trend estimation model was used to calculate the specific slopes in the dose-response analysis. The present systematic review and meta-analysis identified nine prospective cohort articles involving a total of 291,236 participants. Compared with the lowest category, highest category of yogurt consumption was not significantly related with the incident risk of CVD, and the RR (95% CI) was 1.01 (0.95, 1.08) with an evidence of significant heterogeneity (I2 = 52%). However, intake of ≥200 g/day yogurt was significantly associated with a lower risk of CVD in the subgroup analysis. There was a trend that a higher level of yogurt consumption was associated with a lower incident risk of CVD in the dose-response analysis. A daily dose of ≥200 g yogurt intake might be associated with a lower incident risk of CVD. Further cohort studies and randomized controlled trials are still demanded to establish and confirm the observed association in populations with different characteristics. PMID:28327514

Serum pentadecanoic acid (15:0), a short-term marker of dairy food intake, is inversely associated with incident type 2 diabetes and its underlying disorders123

PubMed Central

Santaren, Ingrid D; Watkins, Steven M; Liese, Angela D; Wagenknecht, Lynne E; Rewers, Marian J; Haffner, Steven M; Lorenzo, Carlos

2014-01-01

Background: Growing evidence suggests that dairy consumption is associated with lower type 2 diabetes risk. However, observational studies have reported inconsistent results, and few have examined dairy's association with the underlying disorders of insulin resistance and β-cell dysfunction. Objective: We investigated the association of the dairy fatty acid biomarkers pentadecanoic acid (15:0) and trans-palmitoleic acid (trans 16:1n−7) with type 2 diabetes traits by evaluating 1) prospective associations with incident diabetes after 5 y of follow-up and 2) cross-sectional associations with directly measured insulin resistance and β-cell dysfunction. Design: The study analyzed 659 adults without diabetes at baseline from the triethnic multicenter Insulin Resistance Atherosclerosis Study (IRAS). Diabetes status was assessed by using oral-glucose-tolerance tests. Frequently sampled intravenous-glucose-tolerance tests measured insulin sensitivity (SI) and β-cell function [disposition index (DI)]. Serum fatty acids were quantified by using gas chromatography. Logistic and linear regression models were adjusted for demographic, lifestyle, and dietary variables. Results: Serum 15:0 was a significant biomarker for total dairy intake in the IRAS cohort. It was associated with a decreased incident diabetes risk (OR: 0.73, P = 0.02) and was positively associated with log SI (β: 0.84, P = 0.03) and log DI (β: 2.21, P = 0.02) in fully adjusted models. trans 16:1n−7 was a marker of total partially hydrogenated dietary fat intake and was not associated with outcomes in fully adjusted models. Conclusions: Serum 15:0, a marker of short-term intake of this fatty acid, was inversely associated with diabetes risk in this multiethnic cohort. This study may contribute to future recommendations regarding the benefits of dairy products on type 2 diabetes risk. PMID:25411288

Association of urinary melatonin levels and aging-related outcomes in older men.

PubMed

Devore, Elizabeth E; Harrison, Stephanie L; Stone, Katie L; Holton, Kathleen F; Barrett-Connor, Elizabeth; Ancoli-Israel, Sonia; Yaffe, Kristine; Ensrud, Kristine; Cawthon, Peggy M; Redline, Susan; Orwoll, Eric; Schernhammer, Eva S

2016-07-01

Circadian disruptions can contribute to accelerated aging, and the circadian system regulates cognitive and physical functions; therefore, circadian markers (eg, melatonin) may be associated with key aspects of healthy aging and longevity. To evaluate urinary melatonin levels in relation to cognitive function, physical function, and mortality among 2,821 older men in the Osteoporotic Fractures in Men Study DESIGN: Cohort study. In 2003-2005, participants provided first-morning spot urine samples, which were assayed for 6-sulfatoxymelatonin (the primary melatonin metabolite in urine); cognitive and physical function assessments were completed twice, at baseline and an average of 6.5 years later. Participant deaths were confirmed by central review of death certificates over a mean of 9.2 years of follow up. In multivariable-adjusted regression models, we observed a significant trend of better Digit Vigilance Test scores (ie, decreased time to completion) at baseline across increasing melatonin quartiles (p-trend = 0.01); however, mean time-to-completion scores did not significantly differ comparing extreme quartiles (group means: 547.1 seconds (95% CI: 533.6, 560.6) versus 561.3 seconds (95% CI: 547.8, 574.9)), and there were no associations of urinary melatonin levels with other cognitive test scores, or any cognitive change scores over time. Furthermore, melatonin levels were not related to physical function scores (p-trends = 0.4 for walking speed, 0.7 for chair stands, and 0.6 for grip strength in fully-adjusted models) or mortality risk (p-trend = 0.3 in the fully-adjusted model). We found little evidence of associations between urinary melatonin levels and key measures of healthy aging and mortality in this cohort of older men. Further research should explore the relation of melatonin, particularly if assessed earlier in life, and other circadian markers with healthy aging outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

A fully automatic approach to register mobile mapping and airborne imagery to support the correction of platform trajectories in GNSS-denied urban areas

NASA Astrophysics Data System (ADS)

Jende, Phillipp; Nex, Francesco; Gerke, Markus; Vosselman, George

2018-07-01

Mobile Mapping (MM) solutions have become a significant extension to traditional data acquisition methods over the last years. Independently from the sensor carried by a platform, may it be laser scanners or cameras, high-resolution data postings are opposing a poor absolute localisation accuracy in urban areas due to GNSS occlusions and multipath effects. Potentially inaccurate position estimations are propagated by IMUs which are furthermore prone to drift effects. Thus, reliable and accurate absolute positioning on a par with MM's high-quality data remains an open issue. Multiple and diverse approaches have shown promising potential to mitigate GNSS errors in urban areas, but cannot achieve decimetre accuracy, require manual effort, or have limitations with respect to costs and availability. This paper presents a fully automatic approach to support the correction of MM imaging data based on correspondences with airborne nadir images. These correspondences can be employed to correct the MM platform's orientation by an adjustment solution. Unlike MM as such, aerial images do not suffer from GNSS occlusions, and their accuracy is usually verified by employing well-established methods using ground control points. However, a registration between MM and aerial images is a non-standard matching scenario, and requires several strategies to yield reliable and accurate correspondences. Scale, perspective and content strongly vary between both image sources, thus traditional feature matching methods may fail. To this end, the registration process is designed to focus on common and clearly distinguishable elements, such as road markings, manholes, or kerbstones. With a registration accuracy of about 98%, reliable tie information between MM and aerial data can be derived. Even though, the adjustment strategy is not covered in its entirety in this paper, accuracy results after adjustment will be presented. It will be shown that a decimetre accuracy is well achievable in a real data test scenario.

Contribution of health behaviours and clinical factors to socioeconomic differences in frailty among older adults.

PubMed

Soler-Vila, Hosanna; García-Esquinas, Esther; León-Muñoz, Luz Ma; López-García, Esther; Banegas, José R; Rodríguez-Artalejo, Fernando

2016-04-01

To examine the association between socioeconomic status (SES) and risk of frailty, and to assess whether behavioural and clinical factors (BCF) mediate this association. Cohort of 1857 non-institutionalised individuals aged ≥ 60 years recruited in 2008-2010 and followed through 2012. Education, occupation, and BCF were ascertained at baseline, and incident frailty was assessed at follow-up with the Fried frailty criteria. Men showed no differences in frailty risk by education or occupation. Compared with women with university education, the adjusted OR (aOR) adjusted for age and the number of frailty criteria at baseline for incident frailty in women with primary or lower education was 3.02 (95% CI 1.25 to 7.30); once fully adjusted for BCF, the OR was 2.00 (95% CI 0.76 to 5.23). No alcohol intake (vs light-moderate), longer time spent watching TV, less time spent reading, and a higher frequency of obesity, depression and musculoskeletal disease in those with primary or lower education accounted for most of the decline in OR. BCF explained 50.5% of the excess frailty risk associated with lower education. The aOR of frailty incidence for manual versus non-manual occupation was 2.24 (95% CI 1.41 to 3.56) versus a fully aOR of 2.05 (95% CI 1.24 to 3.37). BCF explained 15.3% of the association, with individual mediators being similar to those for education-related differences. A lower education or a manual occupation was associated with higher frailty risk in older women. These associations were partly explained by lower alcohol consumption, higher sedentariness, and higher obesity and chronic disease rates in women with lower SES. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Individual-based versus aggregate meta-analysis in multi-database studies of pregnancy outcomes: the Nordic example of selective serotonin reuptake inhibitors and venlafaxine in pregnancy.

PubMed

Selmer, Randi; Haglund, Bengt; Furu, Kari; Andersen, Morten; Nørgaard, Mette; Zoëga, Helga; Kieler, Helle

2016-10-01

Compare analyses of a pooled data set on the individual level with aggregate meta-analysis in a multi-database study. We reanalysed data on 2.3 million births in a Nordic register based cohort study. We compared estimated odds ratios (OR) for the effect of selective serotonin reuptake inhibitors (SSRI) and venlafaxine use in pregnancy on any cardiovascular birth defect and the rare outcome right ventricular outflow tract obstructions (RVOTO). Common covariates included maternal age, calendar year, birth order, maternal diabetes, and co-medication. Additional covariates were added in analyses with country-optimized adjustment. Country adjusted OR (95%CI) for any cardiovascular birth defect in the individual-based pooled analysis was 1.27 (1.17-1.39), 1.17 (1.07-1.27) adjusted for common covariates and 1.15 (1.05-1.26) adjusted for all covariates. In fixed effects meta-analyses pooled OR was 1.29 (1.19-1.41) based on crude country specific ORs, 1.19 (1.09-1.29) adjusted for common covariates, and 1.16 (1.06-1.27) for country-optimized adjustment. In a random effects model the adjusted OR was 1.07 (0.87-1.32). For RVOTO, OR was 1.48 (1.15-1.89) adjusted for all covariates in the pooled data set, and 1.53 (1.19-1.96) after country-optimized adjustment. Country-specific adjusted analyses at the substance level were not possible for RVOTO. Results of fixed effects meta-analysis and individual-based analyses of a pooled dataset were similar in this study on the association of SSRI/venlafaxine and cardiovascular birth defects. Country-optimized adjustment attenuated the estimates more than adjustment for common covariates only. When data are sparse pooled data on the individual level are needed for adjusted analyses. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Integrated analysis of large space systems

NASA Technical Reports Server (NTRS)

Young, J. P.

1980-01-01

Based on the belief that actual flight hardware development of large space systems will necessitate a formalized method of integrating the various engineering discipline analyses, an efficient highly user oriented software system capable of performing interdisciplinary design analyses with tolerable solution turnaround time is planned Specific analysis capability goals were set forth with initial emphasis given to sequential and quasi-static thermal/structural analysis and fully coupled structural/control system analysis. Subsequently, the IAC would be expanded to include a fully coupled thermal/structural/control system, electromagnetic radiation, and optical performance analyses.

Midlife Physical Activity and Cognition Later in Life: A Prospective Twin Study.

PubMed

Iso-Markku, Paula; Waller, Katja; Vuoksimaa, Eero; Heikkilä, Kauko; Rinne, Juha; Kaprio, Jaakko; Kujala, Urho M

2016-10-18

Physical activity has been associated with a reduced risk of cognitive decline but the nature of this association remains obscure. To study associations between midlife physical activity and cognition in old age for a prospective cohort of Finnish twins. Physical activity in the Finnish Twin Cohort was assessed using questionnaire responses collected in 1975 and 1981. After a mean follow-up of 25.1 years, the subjects' (n = 3050; mean age 74.2; range 66-97) cognition was evaluated with a validated telephone interview. Both participation in vigorous physical activity, and the volume of physical activity, divided into quintiles, were used as predictors of cognitive impairment. Metrics collected by TELE were used to categorize participants as: cognitively impaired, suffering mild cognitive impairment, or cognitively healthy. Participation in vigorous physical activity compared to non-participation for both 1975 and 1981 was associated with a lower risk of cognitive impairment in individual-based analyses (fully adjusted OR 0.50, 95% CI 0.35-0.73). Pairwise analyses yielded similar but statistically non-significant associations. In terms of the volume of physical activity, the most active quintile of individuals (OR 0.69, 95% CI 0.46-1.04) had a reduced risk of cognitive decline compared with the most sedentary quintile in the fully adjusted model although no clear dose-response was found. Vigorous midlife physical activity was associated with less cognitive impairment but without a clear dose-response association between the volume of physical activity and cognition.

Persistent-current magnetizations of Nb3Sn Rutherford cables and extracted strands

NASA Astrophysics Data System (ADS)

Collings, E. W.; Sumption, M. D.; Myers, C. S.; Wang, X.; Dietderich, D. R.; Yagotyntsev, K.; Nijhuis, A.

2017-12-01

The magnetizations of eight high-gradient quadrupole cables designated HQ and QXF and a pair of strands, identical in architecture but with different effective strand diameters extracted from an HQ and a related QXF cable, were measured. In the service of field quality assessment, the cable magnetizations and losses were measured by pickup coil magnetometry at 4.2 K in face-on fields, B m , of ± 400 mT at frequencies, f, of up to 60 mHz. Based on the coupling component of loss, Q coup , the coupling magnetization M coup = Q coup /4B m was derived for a ramp rate of 7.5 mT/s. Persistent current (shielding) magnetization and loss (M sh and Q h,strand ) were measured on short pieces of extracted strand by vibrating sample magnetometry at 4.2 K. Unpenetrated M-B loops to ± 400 mT and fully penetrated loops to ± 14 T were obtained. M coup can be easily controlled and reduced to relatively small values by introducing cores and adjusting the preparation conditions. But in low fields near injection Nb3Sn’s high J c and correspondingly high M sh,cable may call for magnetic compensation to preserve field quality. The suitably adjusted cable and strand fully penetrated M-B loops were in reasonable accord leading to the conclusion that strand magnetization is a useful measure of cable magnetization, and that when suitably manipulated can provide input to magnet field error calculations.

Does admission via an acute medical unit influence hospital mortality? 12 years' experience in a large Dublin hospital.

PubMed

Coary, R; Byrne, D; O'Riordan, D; Conway, R; Cournane, S; Silke, B

2014-01-01

Following an emergency medical admission, patients may be admitted an acute medical assessment unit (AMAU) or directly into a ward. An AMAU provides a structured environment for their initial assessment and treatment. All emergency admissions (66,933 episodes in 36,271 patients) to an Irish hospital over an 12-year period (2002-2013) were studied with 30-day in-hospital mortality as the outcome measure. Univariate Odds Ratios, by initial patient allocation, and the fully adjusted Odds Ratios were calculated, using a validated logistic regression model. Patients, by design, were intended to be admitted initially to the AMAU (<= 5 day stay). Capacity constraints dictated that only 39.8% of patients were so admitted; the remainder bypassed the AMAU to a ward (60.2%). All patients remained under the care of the admitting consultant/team. We computed the risk profile for each group, using a multiple variable validated model of 30-day in-hospital mortality; the model indicated the same risk profile between these groups. The univariate OR of an in-hospital death by day 30 for a patient initially allocated to the AMAU, compared with an initial ward allocation was 0.76 (95% CI: 0.71, 0.82- p<0.001). The fully adjusted risk for patients was 0.67 (95% CI: 0.62, 0.73- p<0.001). Patients, with equivalent mortality risk, allocated initially to AMAU or a more traditional ward, appeared to have substantially different outcomes.

A Closed-Loop Proportional-Integral (PI) Control Software for Fully Mechanically Controlled Automated Electron Microscopic Tomography

DOE Office of Scientific and Technical Information (OSTI.GOV)

REN, GANG; LIU, JINXIN; LI, HONGCHANG

A closed-loop proportional-integral (PI) control software is provided for fully mechanically controlled automated electron microscopic tomography. The software is developed based on Gatan DigitalMicrograph, and is compatible with Zeiss LIBRA 120 transmission electron microscope. However, it can be expanded to other TEM instrument with modification. The software consists of a graphical user interface, a digital PI controller, an image analyzing unit, and other drive units (i.e.: image acquire unit and goniometer drive unit). During a tomography data collection process, the image analyzing unit analyzes both the accumulated shift and defocus value of the latest acquired image, and provides the resultsmore » to the digital PI controller. The digital PI control compares the results with the preset values and determines the optimum adjustments of the goniometer. The goniometer drive unit adjusts the spatial position of the specimen according to the instructions given by the digital PI controller for the next tilt angle and image acquisition. The goniometer drive unit achieves high precision positioning by using a backlash elimination method. The major benefits of the software are: 1) the goniometer drive unit keeps pre-aligned/optimized beam conditions unchanged and achieves position tracking solely through mechanical control; 2) the image analyzing unit relies on only historical data and therefore does not require additional images/exposures; 3) the PI controller enables the system to dynamically track the imaging target with extremely low system error.« less

Relationship Between Meditation Depth and Waking Salivary Alpha-Amylase Secretion Among Long-Term MBSR Instructors.

PubMed

Haslam, Alyson; Wirth, Michael D; Robb, Sara Wagner

2017-08-01

The purpose of this study was to characterize sympathetic activity by using waking salivary alpha-amylase (sAA) concentrations in a group of long-term meditation instructors and to examine the association between meditation (depth, dose and duration) and the waking alpha-amylase response. Salivary alpha-amylase samples were collected (immediately upon waking and at 15-min, 30-min and 45-min intervals after waking) from mindfulness-based stress reduction instructors to determine both the area under the curve and the awakening slope (difference in alpha-amylase concentrations between waking and 30-min post-waking). It was determined through general linear models that neither years of meditation nor meditation dose were associated with the awakening sAA slope, but higher scores for meditation depth (greater depth) was associated with a more negative (or steeper) awakening slope [Quartile (Q)1: -7 versus Q4: -21 U/mL; p = 0.06], in fully adjusted models. Older age (p = 0.04) and a later time of waking (p < 0.01) also were associated with less negative awakening slope values. Smoking was associated with lower area under the curve values (smokers: 1716 U/mL versus nonsmokers: 2107 U/mL; p = 0.05) in fully adjusted models. The results suggest a 'healthy' sAA waking slope among individuals who meditate more deeply. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

PubMed

Savitz, Lucy A; Savitz, Samuel T

2016-01-01

Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided.

Stressed and overworked? A cross-sectional study of the working situation of urban and rural general practitioners in Austria in the framework of the QUALICOPC project

PubMed Central

Hoffmann, Kathryn; Wojczewski, Silvia; George, Aaron; Schäfer, Willemijn L. A.; Maier, Manfred

2015-01-01

Aim To assess the workload of general practitioners (GPs) in Austria, with a focus on identifying the differences between GPs working in urban and rural areas. Methods Within the framework of the Quality and Costs of Primary Care in Europe (QUALICOPC) study, data were collected from a stratified sample of GPs using a standardized questionnaire between November 2011 and May 2012. Data analysis included descriptive statistics and regression analysis. Results The analysis included data from 173 GPs. GPs in rural areas reported an average of 49.3 working hours per week, plus 23.7 on-call duties per 3 months and 26.2 out-of-office care services per week. Compared to GPs working in urban areas, even in the fully adjusted regression model, rural GPs had significantly more working hours (B 7.00; P = 0.002) and on-call duties (B 18.91; P < 0.001). 65.8% of all GPs perceived their level of stress as high and 84.6% felt they were required to do unnecessary administrative work. Conclusion Our findings show a high workload among Austrian GPs, particularly those working in rural areas. Since physicians show a diminishing interest to work as GPs, there is an imperative to improve this situation. PMID:26321030

Retracing Evolution of Red Fluorescence in GFP-Like Proteins from Faviina Corals

PubMed Central

Field, Steven F.; Matz, Mikhail V.

2010-01-01

Proteins of the green fluorescent protein family represent a convenient experimental model to study evolution of novelty at the molecular level. Here, we focus on the origin of Kaede-like red fluorescent proteins characteristic of the corals of the Faviina suborder. We demonstrate, using an original approach involving resurrection and analysis of the library of possible evolutionary intermediates, that it takes on the order of 12 mutations, some of which strongly interact epistatically, to fully recapitulate the evolution of a red fluorescent phenotype from the ancestral green. Five of the identified mutations would not have been found without the help of ancestral reconstruction, because the corresponding site states are shared between extant red and green proteins due to their recent descent from a dual-function common ancestor. Seven of the 12 mutations affect residues that are not in close contact with the chromophore and thus must exert their effect indirectly through adjustments of the overall protein fold; the relevance of these mutations could not have been anticipated from the purely theoretical analysis of the protein's structure. Our results introduce a powerful experimental approach for comparative analysis of functional specificity in protein families even in the cases of pronounced epistasis, provide foundation for the detailed studies of evolutionary trajectories leading to novelty and complexity, and will help rational modification of existing fluorescent labels. PMID:19793832

Power-rate-distortion analysis for wireless video communication under energy constraint

NASA Astrophysics Data System (ADS)

He, Zhihai; Liang, Yongfang; Ahmad, Ishfaq

2004-01-01

In video coding and streaming over wireless communication network, the power-demanding video encoding operates on the mobile devices with limited energy supply. To analyze, control, and optimize the rate-distortion (R-D) behavior of the wireless video communication system under the energy constraint, we need to develop a power-rate-distortion (P-R-D) analysis framework, which extends the traditional R-D analysis by including another dimension, the power consumption. Specifically, in this paper, we analyze the encoding mechanism of typical video encoding systems and develop a parametric video encoding architecture which is fully scalable in computational complexity. Using dynamic voltage scaling (DVS), a hardware technology recently developed in CMOS circuits design, the complexity scalability can be translated into the power consumption scalability of the video encoder. We investigate the rate-distortion behaviors of the complexity control parameters and establish an analytic framework to explore the P-R-D behavior of the video encoding system. Both theoretically and experimentally, we show that, using this P-R-D model, the encoding system is able to automatically adjust its complexity control parameters to match the available energy supply of the mobile device while maximizing the picture quality. The P-R-D model provides a theoretical guideline for system design and performance optimization in wireless video communication under energy constraint, especially over the wireless video sensor network.

Bandwidth tunable amplifier for recording biopotential signals.

PubMed

Hwang, Sungkil; Aninakwa, Kofi; Sonkusale, Sameer

2010-01-01

This paper presents a low noise, low power, bandwidth tunable amplifier for bio-potential signal recording applications. By employing depletion-mode pMOS transistor in diode configuration as a tunable sub pA current source to adjust the resistivity of MOS-Bipolar pseudo-resistor, the bandwidth is adjusted without any need for a separate band-pass filter stage. For high CMRR, PSRR and dynamic range, a fully differential structure is used in the design of the amplifier. The amplifier achieves a midband gain of 39.8dB with a tunable high-pass cutoff frequency ranging from 0.1Hz to 300Hz. The amplifier is fabricated in 0.18εm CMOS process and occupies 0.14mm(2) of chip area. A three electrode ECG measurement is performed using the proposed amplifier to show its feasibility for low power, compact wearable ECG monitoring application.

Does Occupation Explain Gender and Other Differences in Work-Related Eye Injury Hospitalization Rates?

PubMed Central

Smith, Gordon S.; Lincoln, Andrew E.; Wong, Tien Y.; Bell, Nicole S.; Vinger, Paul F.; Amoroso, Paul J.; Lombardi, David A.

2007-01-01

Objective We sought to determine whether demographic differences in eye injury rates persist after adjusting for occupational exposure. Methods On-duty eye injury hospitalizations were linked to occupation among active-duty US Army personnel. Results Eye injury rates were higher for white solidiers, men, and for younger soldiers, even after adjusting for occupational group and specific job titles using multivariate models. Conclusions This finding contrasts with studies of other injuries, suggesting that occupation does not fully account for variations in eye injury risk. Because protective eyewear can prevent most serious eye injuries, we hypothesize that differences in protective eyewear use between men and women may contribute to differences in eye injury rates, although follow-up studies are needed to confirm this. Prevention efforts should consider targeting high-risk demographic groups in addition to high-risk occupations. PMID:15951724

Joint Intelligence Analysis Complex: DOD Needs to Fully Incorporate Best Practices into Future Cost Estimates

DTIC Science & Technology

2016-11-01

Report to Congressional Requesters November 2016 GAO-17-29 United States Government Accountability Office United States Government... Accountability Office Highlights of GAO-17-29, a report to congressional requesters November 2016 JOINT INTELLIGENCE ANALYSIS COMPLEX DOD...of scope, according to DOD and Air Force officials. However, without fully accounting for life- cycle costs, management may have difficulty

Associations between traffic noise, particulate air pollution, hypertension, and isolated systolic hypertension in adults: the KORA study.

PubMed

Babisch, Wolfgang; Wolf, Kathrin; Petz, Markus; Heinrich, Joachim; Cyrys, Josef; Peters, Annette

2014-05-01

Studies on the association between traffic noise and cardiovascular diseases have rarely considered air pollution as a covariate in the analyses. Isolated systolic hypertension has not yet been in the focus of epidemiological noise research. The association between traffic noise (road and rail) and the prevalence of hypertension was assessed in two study populations with a total of 4,166 participants 25-74 years of age. Traffic noise (weighted day-night average noise level; LDN) at the facade of the dwellings was derived from noise maps. Annual average PM2.5 mass concentrations at residential addresses were estimated by land-use regression. Hypertension was assessed by blood pressure readings, self-reported doctor-diagnosed hypertension, and antihypertensive drug intake. In the Greater Augsburg, Germany, study population, traffic noise and air pollution were not associated with hypertension. In the City of Augsburg population (n = 1,893), where the exposure assessment was more detailed, the adjusted odds ratio (OR) for a 10-dB(A) increase in noise was 1.16 (95% CI: 1.00, 1.35), and 1.11 (95% CI: 0.94, 1.30) after additional adjustment for PM2.5. The adjusted OR for a 1-μg/m3 increase in PM2.5 was 1.15 (95% CI: 1.02, 1.30), and 1.11 (95% CI: 0.98, 1.27) after additional adjustment for noise. For isolated systolic hypertension, the fully adjusted OR for noise was 1.43 (95% CI: 1.10, 1.86) and for PM2.5 was 1.08 (95% CI: 0.87, 1.34). Traffic noise and PM2.5 were both associated with a higher prevalence of hypertension. Mutually adjusted associations with hypertension were positive but no longer statistically significant.

Does unemployment cause long-term mortality? Selection and causation after the 1992-96 deep Swedish recession.

PubMed

Vågerö, Denny; Garcy, Anthony M

2016-10-01

Mass unemployment in Europe is endemic, especially among the young. Does it cause mortality? We analyzed long-term effects of unemployment occurring during the deep Swedish recession 1992-96. Mortality from all and selected causes was examined in the 6-year period after the recession among those employed in 1990 (3.4 million). Direct health selection was analyzed as risk of unemployment by prior medical history based on all hospitalizations 1981-91. Unemployment effects on mortality were estimated with and without adjustment for prior social characteristics and for prior medical history. A prior circulatory disease history did not predict unemployment; a history of alcohol-related disease or suicide attempts did, in men and women. Unemployment predicted excess male, but not female, mortality from circulatory disease, both ischemic heart disease and stroke, and from all causes combined, after full adjustment. Adjustment for prior social characteristics reduced estimates considerably; additional adjustment for prior medical history did not. Mortality from external and alcohol-related causes was raised in men and women experiencing unemployment, after adjustment for social characteristics and medical history. For the youngest birth cohorts fully adjusted alcohol mortality HRs were substantial (male HR = 4.44; female HR = 5.73). The effect of unemployment on mortality was not uniform across the population; men, those with a low education, low income, unmarried or in urban employment were more vulnerable. Direct selection by medical history explains a modest fraction of any increased mortality risk following unemployment. Mass unemployment imposes long-term mortality risk on a sizeable segment of the population. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association.

Does unemployment cause long-term mortality? Selection and causation after the 1992–96 deep Swedish recession

PubMed Central

Garcy, Anthony M.

2016-01-01

Abstract Background: Mass unemployment in Europe is endemic, especially among the young. Does it cause mortality? Methods: We analyzed long-term effects of unemployment occurring during the deep Swedish recession 1992–96. Mortality from all and selected causes was examined in the 6-year period after the recession among those employed in 1990 (3.4 million). Direct health selection was analyzed as risk of unemployment by prior medical history based on all hospitalizations 1981–91. Unemployment effects on mortality were estimated with and without adjustment for prior social characteristics and for prior medical history. Results: A prior circulatory disease history did not predict unemployment; a history of alcohol-related disease or suicide attempts did, in men and women. Unemployment predicted excess male, but not female, mortality from circulatory disease, both ischemic heart disease and stroke, and from all causes combined, after full adjustment. Adjustment for prior social characteristics reduced estimates considerably; additional adjustment for prior medical history did not. Mortality from external and alcohol-related causes was raised in men and women experiencing unemployment, after adjustment for social characteristics and medical history. For the youngest birth cohorts fully adjusted alcohol mortality HRs were substantial (male HR = 4.44; female HR = 5.73). The effect of unemployment on mortality was not uniform across the population; men, those with a low education, low income, unmarried or in urban employment were more vulnerable. Conclusions: Direct selection by medical history explains a modest fraction of any increased mortality risk following unemployment. Mass unemployment imposes long-term mortality risk on a sizeable segment of the population. PMID:27085193

Fully automated corneal endothelial morphometry of images captured by clinical specular microscopy

NASA Astrophysics Data System (ADS)

Bucht, Curry; Söderberg, Per; Manneberg, Göran

2009-02-01

The corneal endothelium serves as the posterior barrier of the cornea. Factors such as clarity and refractive properties of the cornea are in direct relationship to the quality of the endothelium. The endothelial cell density is considered the most important morphological factor. Morphometry of the corneal endothelium is presently done by semi-automated analysis of pictures captured by a Clinical Specular Microscope (CSM). Because of the occasional need of operator involvement, this process can be tedious, having a negative impact on sampling size. This study was dedicated to the development of fully automated analysis of images of the corneal endothelium, captured by CSM, using Fourier analysis. Software was developed in the mathematical programming language Matlab. Pictures of the corneal endothelium, captured by CSM, were read into the analysis software. The software automatically performed digital enhancement of the images. The digitally enhanced images of the corneal endothelium were transformed, using the fast Fourier transform (FFT). Tools were developed and applied for identification and analysis of relevant characteristics of the Fourier transformed images. The data obtained from each Fourier transformed image was used to calculate the mean cell density of its corresponding corneal endothelium. The calculation was based on well known diffraction theory. Results in form of estimated cell density of the corneal endothelium were obtained, using fully automated analysis software on images captured by CSM. The cell density obtained by the fully automated analysis was compared to the cell density obtained from classical, semi-automated analysis and a relatively large correlation was found.

Predicting survival in heart failure case and control subjects by use of fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics

NASA Technical Reports Server (NTRS)

Ho, K. K.; Moody, G. B.; Peng, C. K.; Mietus, J. E.; Larson, M. G.; Levy, D.; Goldberger, A. L.

1997-01-01

BACKGROUND: Despite much recent interest in quantification of heart rate variability (HRV), the prognostic value of conventional measures of HRV and of newer indices based on nonlinear dynamics is not universally accepted. METHODS AND RESULTS: We have designed algorithms for analyzing ambulatory ECG recordings and measuring HRV without human intervention, using robust methods for obtaining time-domain measures (mean and SD of heart rate), frequency-domain measures (power in the bands of 0.001 to 0.01 Hz [VLF], 0.01 to 0.15 Hz [LF], and 0.15 to 0.5 Hz [HF] and total spectral power [TP] over all three of these bands), and measures based on nonlinear dynamics (approximate entropy [ApEn], a measure of complexity, and detrended fluctuation analysis [DFA], a measure of long-term correlations). The study population consisted of chronic congestive heart failure (CHF) case patients and sex- and age-matched control subjects in the Framingham Heart Study. After exclusion of technically inadequate studies and those with atrial fibrillation, we used these algorithms to study HRV in 2-hour ambulatory ECG recordings of 69 participants (mean age, 71.7+/-8.1 years). By use of separate Cox proportional-hazards models, the conventional measures SD (P<.01), LF (P<.01), VLF (P<.05), and TP (P<.01) and the nonlinear measure DFA (P<.05) were predictors of survival over a mean follow-up period of 1.9 years; other measures, including ApEn (P>.3), were not. In multivariable models, DFA was of borderline predictive significance (P=.06) after adjustment for the diagnosis of CHF and SD. CONCLUSIONS: These results demonstrate that HRV analysis of ambulatory ECG recordings based on fully automated methods can have prognostic value in a population-based study and that nonlinear HRV indices may contribute prognostic value to complement traditional HRV measures.

Numerical simulation and experimentation of adjusting the curvatures of micro-cantilevers using the water-confined laser-generated plasma

NASA Astrophysics Data System (ADS)

Gu, Chunxing; Shen, Zongbao; Liu, Huixia; Li, Pin; Lu, Mengmeng; Zhao, Yinxin; Wang, Xiao

2013-04-01

This paper describes a precise and non-contact adjustment technique using the water-confined laser-generated plasma to adjust the curvature of micro-components (micro-mechanical cantilevers). A series of laser shock micro-adjustment experiments were conducted on 0.4 mm-thick Al samples using pulsed Nd:YAG lasers operating at 1064 nm wavelengths to verify the technical feasibility. Systematic study was carried out in the term of effects of various factors on the adjusting results, including laser energies, laser focus positions, laser shock times and confined regime configuration. The research results have shown that the different bending angles and bending directions can be obtained by changing the laser processing parameters. And, for the adjustment process, the absence of confined regime configuration could also generate suitable bending deformation. But, in the case of larger energy, the final surfaces would have the sign of ablation, hence resulting in poor surface quality. An analysis procedure including dynamic analysis performed by ANSYS/LS-DYNA and static analysis performed by ANSYS is presented in detail to attain the simulation of laser shock micro-adjustment to predict the final bending deformation. The predicted bending profiles is well correlated with the available experimental data, showing the finite element analysis can predict the final curvatures of the micro-cantilevers properly.

Job insecurity and risk of diabetes: a meta-analysis of individual participant data.

PubMed

Ferrie, Jane E; Virtanen, Marianna; Jokela, Markus; Madsen, Ida E H; Heikkilä, Katriina; Alfredsson, Lars; Batty, G David; Bjorner, Jakob B; Borritz, Marianne; Burr, Hermann; Dragano, Nico; Elovainio, Marko; Fransson, Eleonor I; Knutsson, Anders; Koskenvuo, Markku; Koskinen, Aki; Kouvonen, Anne; Kumari, Meena; Nielsen, Martin L; Nordin, Maria; Oksanen, Tuula; Pahkin, Krista; Pejtersen, Jan H; Pentti, Jaana; Salo, Paula; Shipley, Martin J; Suominen, Sakari B; Tabák, Adam; Theorell, Töres; Väänänen, Ari; Vahtera, Jussi; Westerholm, Peter J M; Westerlund, Hugo; Rugulies, Reiner; Nyberg, Solja T; Kivimäki, Mika

2016-12-06

Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes. We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate. The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09-1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01-1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I 2 = 24%, p = 0.2; multivariable-adjusted model: I 2 = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35). Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity. © 2016 Canadian Medical Association or its licensors.

Kinetic performance comparison of fully and superficially porous particles with a particle size of 5 µm: intrinsic evaluation and application to the impurity analysis of griseofulvin.

PubMed

Kahsay, Getu; Broeckhoven, Ken; Adams, Erwin; Desmet, Gert; Cabooter, Deirdre

2014-05-01

After the great commercial success of sub-3 µm superficially porous particles, vendors are now also starting to commercialize 5 µm superficially porous particles, as an alternative to their fully porous counterparts which are routinely used in pharmaceutical analysis. In this study, the performance of 5 µm superficially porous particles was compared to that of fully porous 5 µm particles in terms of efficiency, separation performance and loadability on a conventional HPLC instrument. Van Deemter and kinetic plots were first used to evaluate the efficiency and performance of both particle types using alkylphenones as a test mixture. The van Deemter and kinetic plots showed that the superficially porous particles provide a superior kinetic performance compared to the fully porous particles over the entire relevant range of separation conditions, when both support types were evaluated at the same operating pressure. The same observations were made both for isocratic and gradient analysis. The superior performance was further demonstrated for the separation of a pharmaceutical compound (griseofulvin) and its impurities, where a gain in analysis time of around 2 could be obtained using the superficially porous particles. Finally, both particle types were evaluated in terms of loadability by plotting the resolution of the active pharmaceutical ingredient and its closest impurity as a function of the signal-to-noise ratio obtained for the smallest impurity. It was demonstrated that the superficially porous particles show better separation performance for griseofulvin and its impurities without significantly compromising sensitivity due to loadability issues in comparison with their fully porous counterparts. Moreover these columns can be used on conventional equipment without modifications to obtain a significant improvement in analysis time. Copyright © 2014 Elsevier B.V. All rights reserved.

Deterministic Modeling of the High Temperature Test Reactor with DRAGON-HEXPEDITE

DOE Office of Scientific and Technical Information (OSTI.GOV)

J. Ortensi; M.A. Pope; R.M. Ferrer

2010-10-01

The Idaho National Laboratory (INL) is tasked with the development of reactor physics analysis capability of the Next Generation Nuclear Power (NGNP) project. In order to examine the INL’s current prismatic reactor analysis tools, the project is conducting a benchmark exercise based on modeling the High Temperature Test Reactor (HTTR). This exercise entails the development of a model for the initial criticality, a 19 fuel column thin annular core, and the fully loaded core critical condition with 30 fuel columns. Special emphasis is devoted to physical phenomena and artifacts in HTTR that are similar to phenomena and artifacts in themore » NGNP base design. The DRAGON code is used in this study since it offers significant ease and versatility in modeling prismatic designs. DRAGON can generate transport solutions via Collision Probability (CP), Method of Characteristics (MOC) and Discrete Ordinates (Sn). A fine group cross-section library based on the SHEM 281 energy structure is used in the DRAGON calculations. The results from this study show reasonable agreement in the calculation of the core multiplication factor with the MC methods, but a consistent bias of 2–3% with the experimental values is obtained. This systematic error has also been observed in other HTTR benchmark efforts and is well documented in the literature. The ENDF/B VII graphite and U235 cross sections appear to be the main source of the error. The isothermal temperature coefficients calculated with the fully loaded core configuration agree well with other benchmark participants but are 40% higher than the experimental values. This discrepancy with the measurement partially stems from the fact that during the experiments the control rods were adjusted to maintain criticality, whereas in the model, the rod positions were fixed. In addition, this work includes a brief study of a cross section generation approach that seeks to decouple the domain in order to account for neighbor effects. This spectral interpenetration is a dominant effect in annular HTR physics. This analysis methodology should be further explored in order to reduce the error that is systematically propagated in the traditional generation of cross sections.« less

Insulin resistance is associated with carotid intima-media thickness in non-diabetic subjects. A cross-sectional analysis of the ELSA-Brasil cohort baseline.

PubMed

Santos, Itamar S; Bittencourt, Márcio S; Goulart, Alessandra C; Schmidt, Maria Inês; Diniz, Maria de Fátima H S; Lotufo, Paulo A; Benseñor, Isabela M

2017-05-01

Epidemiological studies have analyzed the association between carotid intima-media thickness (CIMT) and insulin resistance, glucose levels or glycated hemoglobin with mixed results. We aimed to evaluate the association between CIMT and homeostasis model assessment - insulin resistance (HOMA-IR), fasting and post-load plasma glucose and glycated hemoglobin in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline. We included 8028 participants (aged 35-74 years) without diabetes or overt cardiovascular disease who had complete CIMT data at baseline. We built crude and adjusted linear and binary logistic models to evaluate the association between CIMT and (a) HOMA-IR; (b) fasting plasma glucose; (c) post-load plasma glucose; and (d) glycated hemoglobin. We also built post-hoc models, stratified by sex. In the fully-adjusted linear models, only the association between CIMT (in mm) and HOMA-IR remained significant (β = 0.004; 95% confidence interval [95%CI]:0.001 to 0.006). Consistent with these results, only the association between the highest age- sex- and race-specific CIMT quartile and HOMA-IR was significant in the adjusted logistic model (odds ratio [OR]:1.10; 95% CI:1.04-1.17). The association between HOMA-IR and the highest CIMT quartile remained significant in sex-specific analyses (OR:1.10; 95% CI:1.02-1.20 for men and OR:1.10; 95% CI:1.02-1.20 for women). We did not find an independent association between CIMT and glucose or glycated hemoglobin. We found a direct association between HOMA-IR and CIMT in a large sample of non-diabetic participants. Mechanisms unrelated to glucose homeostasis, as a direct effect of insulin on atherosclerosis, or medial hypertrophy, may be involved. Copyright © 2017 Elsevier B.V. All rights reserved.

Fibroblast Growth Factor 23: A Biomarker of Kidney Function Decline.

PubMed

Drew, David A; Katz, Ronit; Kritchevsky, Stephen; Ix, Joachim H; Shlipak, Michael G; Newman, Anne B; Hoofnagle, Andy; Fried, Linda; Sarnak, Mark J; Gutierrez, Orlando M

2018-01-01

Fibroblast growth factor 23 (FGF-23) is a hormone that regulates phosphorus levels and vitamin D metabolism. Previous studies have shown FGF-23 to be a risk factor for incident end-stage renal disease; however, there are less data on the association of FGF-23 with earlier kidney-related outcomes. Serum FGF-23 was assayed using an intact ELISA assay in 2,496 participants of the Healthy Aging and Body Composition Study, a cohort of well-functioning older adults. Kidney function was estimated by assaying cystatin C at baseline and years 3 and 10. The associations between FGF-23 and decline in kidney function (defined by estimated glomerular filtration rate (eGFR) decline ≥30% or ≥3 mL/min/year) and incident chronic kidney disease (CKD; incident eGFR <60 mL/min/1.73 m2 and ≥1 mL/min/year decline) were evaluated. Models were adjusted for demographics, baseline eGFR, urine albumin/creatinine ratio, comorbidity, and serum calcium, phosphorus, 25(OH) vitamin D and parathyroid hormone. The mean (SD) age was 75 (3) years, with 52% female and 38% black. There were 405 persons with 30% decline, 702 with >3 mL/min/year decline, and 536 with incident CKD. In fully adjusted continuous models, doubling of FGF-23 concentrations was not associated with kidney function decline (OR [95% CI] = 0.98 [0.82-1.19] for ≥30% decline and OR 1.17 [95% CI 1.00-1.37] for ≥3 mL/min/year decline), or incident CKD (incident rate ratio [IRR] 1.05 [95% CI 0.91-1.22]). In adjusted quartile analysis, the highest quartile of FGF-23 was significantly associated with incident CKD (IRR 1.27 [95% CI 1.02-1.58] for highest vs. lowest quartile). Higher FGF-23 concentrations were not consistently associated with decline in kidney function or incident CKD in community-dwelling older adults. © 2018 S. Karger AG, Basel.

Underage alcohol drinking and medical services use in Hong Kong: a cross-sectional study

PubMed Central

Wang, Man Ping; Ho, Sai Yin; Lam, Tai Hing

2013-01-01

Objectives To investigate the association of underage alcohol drinking with medical consultation and hospitalisation in Hong Kong. Design Cross-sectional study. Setting Secondary schools in Hong Kong. Participants A total of 33 300 secondary 1 (US grade 7) to secondary 5 students (47.6% boys; mean age 14.6 years, SD 1.6) in 85 randomly selected schools. Outcome measures An anonymous questionnaire was used to obtain information about medical consultation in the past 14 days, hospitalisation in the past 12 months, drinking alcohol, smoking, illicit drug use, physical activity, secondhand smoke exposure, feeling depressed, feeling anxious and sociodemographic characteristics. Drinking alcohol was categorised as non-drinking (reference), <1, 1–2 and 3–7 days/week. Logistic regression yielded adjusted ORs (AORs) of medical consultation and hospitalisation for drinking, adjusting for different potential confounders. Subgroup analysis was conducted among adolescents who did not report feeling anxious or depressed. Results More than one-fourth (27.6%) of adolescents drank alcohol, 15.9% had medical consultation and 5.1% had been hospitalised. In the fully adjusted model, the AORs (95% CI) for medical consultation were 1.14 (1.06 to 1.23) for <1 day/week, 1.30 (1.13 to 1.50) for 1–2 days/week and 1.70 (1.41 to 2.06) for 3–7 days/week of drinking compared with non-drinking (p for trend <0.001). The corresponding AORs (95% CI) for hospitalisation were 1.14 (1.02 to 1.28), 1.68 (1.32 to 2.14) and 2.38 (1.90 to 2.98) (p for trend <0.001). Similar associations were observed among students who did not feel anxious or depressed. Conclusions Alcohol consumption was associated with medical services use in Chinese adolescents. More rigorous alcohol control policies and health promotion programmes are needed to reduce alcohol drinking and related harms in adolescents. PMID:23793697

Association of occupation with prevalent hypertension in an elderly East German population: an exploratory cross-sectional analysis.

PubMed

Schumann, Barbara; Seidler, Andreas; Kluttig, Alexander; Werdan, Karl; Haerting, Johannes; Greiser, Karin Halina

2011-04-01

Hypertension is one of the most relevant risk factors for cardiovascular disease; however, little is known about differences in hypertension by occupation. The aim of this study was to explore the association between occupational group and prevalent hypertension. Cross-sectional data of the CARLA study were used, a representative sample of an East German population aged 45-83. Job titles of the current or last held occupation of 967 men and 808 women were coded using the German classification of occupation. Hypertension was defined as blood pressure of ≥140 mmHg (systolic), ≥90 mmHg (diastolic) or use of antihypertensives. Sex-stratified, age-adjusted prevalence risk ratios (PR) with 95% confidence intervals (CI) were calculated for 31 occupational groups. Hypertension was prevalent in 79% of the population. In men, highest age-adjusted prevalence ratios were observed in metal-processing workers, carpenters/painters, and electricians with PRs of 1.31 (CI 1.04-1.65), 1.28 (CI 1.00-1.64), and 1.21 (0.95-1.53), respectively, compared to office clerks. In women, highest PRs were found in technicians/forewomen, scrutinisers/storekeepers, and food-processing occupations with PR 1.28 (1.09-1.49), 1.23 (0.99-1.51), and 1.22 (1.01-1.48), respectively. Adjustment for education, smoking, body mass index, and current work hours did not fully explain occupational differences. Excluding currently non-working subjects lead to decreased PRs in men and to increased PR in women. Differences in the prevalences of hypertension by occupational group were only partly explained by conventional risk factors and may require workplace interventions targeted at high-risk occupations. Longitudinal data with large cohorts and work-related exposure assessment are needed to confirm a temporal relationship between occupation and incident hypertension.

Oxidative stress, telomere shortening, and DNA methylation in relation to low-to-moderate occupational exposure to welding fumes.

PubMed

Li, Huiqi; Hedmer, Maria; Wojdacz, Tomasz; Hossain, Mohammad Bakhtiar; Lindh, Christian H; Tinnerberg, Håkan; Albin, Maria; Broberg, Karin

2015-10-01

Evidence suggests that exposure to welding fumes is a risk factor for lung cancer. We examined relationships between low-to-moderate occupational exposure to particles from welding fumes and cancer-related biomarkers for oxidative stress, changes in telomere length, and alterations in DNA methylation. We enrolled 101 welders and 127 controls (all currently nonsmoking men) from southern Sweden. We performed personal sampling of respirable dust and measured 8-oxodG concentrations in urine using a simplified liquid chromatography tandem mass spectrometry method. Telomere length in peripheral blood was measured by quantitative polymerase chain reaction. Methylation status of 10 tumor suppressor genes was determined by methylation-sensitive high-resolution melting analysis. All analyses were adjusted for age, body mass index, previous smoking, passive smoking, current residence, and wood burning stove/boiler at home. Welders were exposed to respirable dust at 1.2 mg/m(3) (standard deviation, 3.3 mg/m(3); range, 0.1-19.3), whereas control exposures did not exceed 0.1 mg/m(3) (P < 0.001). Welders and controls did not differ in 8-oxodG levels (β = 1.2, P = 0.17) or relative telomere length (β = -0.053, P = 0.083) in adjusted models. Welders showed higher probability of adenomatous polyposis coli (APC) methylation in the unadjusted model (odds ratio = 14, P = 0.014), but this was not significant in the fully adjusted model (P = 0.052). Every working year as a welder was associated with 0.0066 units shorter telomeres (95% confidence interval -0.013 to -0.00053, P = 0.033). Although there were no clear associations between concentrations of respirable dust and the biomarkers, there were modest signs of associations between oxidative stress, telomere alterations, DNA methylation, and occupational exposure to low-to-moderate levels of particles. © 2015 Wiley Periodicals, Inc.

Association of urinary bisphenol A concentration with medical disorders and laboratory abnormalities in adults.

PubMed

Lang, Iain A; Galloway, Tamara S; Scarlett, Alan; Henley, William E; Depledge, Michael; Wallace, Robert B; Melzer, David

2008-09-17

Bisphenol A (BPA) is widely used in epoxy resins lining food and beverage containers. Evidence of effects in animals has generated concern over low-level chronic exposures in humans. To examine associations between urinary BPA concentrations and adult health status. Cross-sectional analysis of BPA concentrations and health status in the general adult population of the United States, using data from the National Health and Nutrition Examination Survey 2003-2004. Participants were 1455 adults aged 18 through 74 years with measured urinary BPA and urine creatinine concentrations. Regression models were adjusted for age, sex, race/ethnicity, education, income, smoking, body mass index, waist circumference, and urinary creatinine concentration. The sample provided 80% power to detect unadjusted odds ratios (ORs) of 1.4 for diagnoses of 5% prevalence per 1-SD change in BPA concentration, or standardized regression coefficients of 0.075 for liver enzyme concentrations, at a significance level of P < .05. Chronic disease diagnoses plus blood markers of liver function, glucose homeostasis, inflammation, and lipid changes. Higher urinary BPA concentrations were associated with cardiovascular diagnoses in age-, sex-, and fully adjusted models (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.18-1.63; P = .001 with full adjustment). Higher BPA concentrations were also associated with diabetes (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.21-1.60; P < .001) but not with other studied common diseases. In addition, higher BPA concentrations were associated with clinically abnormal concentrations of the liver enzymes gamma-glutamyltransferase (OR per 1-SD increase in BPA concentration, 1.29; 95% CI, 1.14-1.46; P < .001) and alkaline phosphatase (OR per 1-SD increase in BPA concentration, 1.48; 95% CI, 1.18-1.85; P = .002). Higher BPA exposure, reflected in higher urinary concentrations of BPA, may be associated with avoidable morbidity in the community-dwelling adult population.

Increased Risk of Acute Pancreatitis in Patients with Rheumatoid Arthritis: A Population-Based Cohort Study

PubMed Central

Chang, Chi Ching; Chiou, Chi Sheng; Lin, Hsiu Li; Wang, Li Hsuan; Chang, Yu Sheng; Lin, Hsiu-Chen

2015-01-01

The study was conducted to determine whether patients with rheumatoid arthritis (RA) are at increased risk of acute pancreatitis compared with those without RA and to determine if the risk of acute pancreatitis varied by anti-RA drug use. We used the large population-based dataset from the National Health Insurance (NHI) program in Taiwan to conduct a retrospective cohort study. Patients newly diagnosed with RA between 2000 and 2011 were referred to as the RA group. The comparator non-RA group was matched with propensity score, using age and sex, in the same time period. We presented the incidence density by 100,000 person-years. The propensity score and all variables were analyzed in fully adjusted Cox proportional hazard regression. The cumulative incidence of acute pancreatitis was assessed by Kaplan-Meier analysis, with significance based on the log-rank test. From claims data of one million enrollees randomly sampled from the Taiwan NHI database, 29,755 adults with RA were identified and 119,020 non- RA persons were matched as a comparison group. The RA cohort had higher incidence density of acute pancreatitis (185.7 versus 119.0 per 100,000 person-years) than the non-RA cohort. The adjusted hazard ratio (HR) was 1.62 (95% CI [confidence interval] 1.43–1.83) for patients with RA to develop acute pancreatitis. Oral corticosteroid use decreased the risk of acute pancreatitis (adjusted HR 0.83, 95% CI 0.73–0.94) but without a dose-dependent effect. Current use of disease modifying anti-rheumatic drugs or tumor necrosis factor blockers did not decrease the risk of acute pancreatitis. In conclusion, patients with RA are at an elevated risk of acute pancreatitis. Use of oral corticosteroids may reduce the risk of acute pancreatitis. PMID:26262880

Occupational class differences in later life hospital use by women who survived to age 80: the Renfrew and Paisley prospective cohort study.

PubMed

Hart, Carole L; McCartney, Gerry; Watt, Graham C M

2015-05-01

population ageing challenges the sustainability of healthcare provision. to investigate occupational class differences in hospital use in women aged 80+ years. a total of 8,353 female residents, aged 45-64, took part in the Renfrew and Paisley prospective cohort study in 1972-76. Information on general and mental health hospital discharges was provided from computerised linkage with the Scottish Morbidity Records data to 31 December 2012. Numbers of admissions and bed-days after the 80th birthday were calculated for all and specific causes. Rate ratios by occupational class were calculated using negative binomial regression analysis, adjusting for age and a range of risk factors. four thousand and four hundred and seven (56%) women survived to age 80 and had 17,563 general admissions thereafter, with a mean stay of 19.4 days. There were no apparent relationships with occupational class for all general admissions, but lower occupational class was associated with higher rate ratios for coronary heart disease and stroke and lower rate ratios for cancer. Adjustment for risk factors could not fully explain the raised rate ratios. Bed-day use was higher in lower occupational classes, especially for stroke. There were strong associations with mental health admissions, especially dementia. Compared with the highest occupational class, admission rate ratios for dementia were higher for the lowest occupational class (adjusted rate ratio = 2.60, 95% confidence interval 1.79-3.77). in this population, there were no socio-economic gradients seen in hospital utilisation for general admissions in old age. However, occupational class was associated with mental health admissions, coronary heart disease, stroke and cancer. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The role of socio-economic status and perinatal factors in racial disparities in the risk of cerebral palsy.

PubMed

Durkin, Maureen S; Maenner, Matthew J; Benedict, Ruth E; Van Naarden Braun, Kim; Christensen, Deborah; Kirby, Russell S; Wingate, Martha; Yeargin-Allsopp, Marshalyn

2015-09-01

To determine whether racial disparities in cerebral palsy (CP) risk among US children persist after controlling for socio-economic status (SES) (here indicated by maternal education) and perinatal risk factors. A population-based birth cohort study was conducted using the Autism and Developmental Disabilities Monitoring Network surveillance and birth data for 8-year-old children residing in multi-county areas in Alabama, Georgia, Missouri, and Wisconsin between 2002 and 2008. The birth cohort comparison group included 458 027 children and the case group included 1570 children with CP, 1202 with available birth records. χ(2) tests were performed to evaluate associations and logistic regression was used to calculate relative risks (RR) and adjusted odds ratios (OR) with 95% confidence intervals (CI). The risk of spastic CP was more than 50% higher for black versus white children (RR 1.52, 95% CI 1.33-1.73), and this greater risk persisted after adjustment for SES (OR 1.35, 95% CI 1.18-1.55), but not after further adjustment for preterm birth and size for gestational age. The protective effect of maternal education remained after adjustment for race/ethnicity and perinatal factors. Maternal education appears to independently affect CP risk but does not fully explain existing racial disparities in CP prevalence in the US. © 2015 Mac Keith Press.

Ten years on: Is dental general anaesthesia in childhood a risk factor for caries and anxiety?

PubMed Central

Haworth, S.; Dudding, T.; Waylen, A.; Thomas, S. J.; Timpson, N. J.

2017-01-01

Objectives To identify whether dental general anaesthesia (DGA) status is informative in assessing risk of caries or dental anxiety by (a) describing long-term oral health and dental anxiety for people who underwent DGA in childhood and (b) testing whether DGA status in childhood is associated with incident future dental caries or anxiety independently of preconceived risk factors. Design Analysis of prospectively obtained data. Setting An established population based cohort in the UK, the Avon Longitudinal Study of Parents and Children. Participants and methods In total 1,695 participants with dental data in childhood and adolescence were included in analysis. DGA status by age 7 and oral health measures at age 17 were identified from questionnaire data. Main outcome measures Filled or extracted permanent teeth at age 17, Corah Dental Anxiety Scale. Results One hundred and twenty-eight (7.6%) participants underwent DGA in childhood. Individuals who underwent DGA had higher measures of filled or extracted permanent teeth in adolescence (0.36 more affected teeth in fully-adjusted model [95% confidence interval: 0.27, 0.55; P <0.001]). Conclusions DGA in childhood predicts burden of treated caries in adolescence, independently of other risk factors. DGA status may be a clinically useful adjunct in identifying young people at high risk of further disease. PMID:28232699

Metabolic Flux Between Unsaturated and Saturated Fatty Acids is Controlled by the FabA:FabB Ratio in the Fully Reconstituted Fatty Acid Biosynthetic Pathway of E. coli#

PubMed Central

Xiao, Xirui; Yu, Xingye; Khosla, Chaitan

2013-01-01

The entire fatty acid biosynthetic pathway from Escherichia coli, starting from the acetyl-CoA carboxylase, has been reconstituted in vitro from fourteen purified protein components. Radiotracer analysis verified stoichiometric conversion of acetyl-CoA and NAD(P)H into the free fatty acid product, allowing implementation of a facile spectrophotometric assay for kinetic analysis of this multi-enzyme system. At steady state, a maximum turnover rate of 0.5 s−1 was achieved. Under optimal turnover conditions, the predominant products were C16 and C18 saturated as well as monounsaturated fatty acids. The reconstituted system allowed us to quantitatively interrogate the factors that influence metabolic flux toward unsaturated versus saturated fatty acids. In particular, the concentrations of the dehydratase FabA and the β-ketoacyl synthase FabB were found to be crucial for controlling this property. By altering these variables, the percentage of unsaturated fatty acid produced could be adjusted between 10 and 50% without significantly affecting the maximum turnover rate of the pathway. Our reconstituted system provides a powerful tool to understand and engineer rate-limiting and regulatory steps in this complex and practically significant metabolic pathway. PMID:24147979

Impact of glucocerebrosidase mutations on motor and nonmotor complications in Parkinson's disease.

PubMed

Oeda, Tomoko; Umemura, Atsushi; Mori, Yuko; Tomita, Satoshi; Kohsaka, Masayuki; Park, Kwiyoung; Inoue, Kimiko; Fujimura, Harutoshi; Hasegawa, Hiroshi; Sugiyama, Hiroshi; Sawada, Hideyuki

2015-12-01

Homozygous mutations of the glucocerebrosidase gene (GBA) cause Gaucher disease (GD), and heterozygous mutations of GBA are a major risk factor for Parkinson's disease (PD). This study examined the impact of GBA mutations on the longitudinal clinical course of PD patients by retrospective cohort design. GBA-coding regions were fully sequenced in 215 PD patients and GD-associated GBA mutations were identified in 19 (8.8%) PD patients. In a retrospective cohort study, time to develop dementia, psychosis, wearing-off, and dyskinesia were examined. Survival time analysis followed a maximum 12-year observation (median 6.0 years), revealing that PD patients with GD-associated mutations developed dementia and psychosis significantly earlier than those without mutations (p < 0.001 and p = 0.017, respectively). Adjusted hazard ratios of GBA mutations were 8.3 for dementia (p < 0.001) and 3.1 for psychosis (p = 0.002). No statistically significant differences were observed for wearing-off and dyskinesia between the groups. N-isopropyl-p[(123)I] iodoamphetamine single-photon emission tomography pixel-by-pixel analysis revealed that regional cerebral blood flow was reduced in the bilateral parietal cortex, including the precuneus of GD-associated mutant PD patients, compared with matched PD controls without mutations. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Ten years on: Is dental general anaesthesia in childhood a risk factor for caries and anxiety?

PubMed

Haworth, S; Dudding, T; Waylen, A; Thomas, S J; Timpson, N J

2017-02-24

Objectives To identify whether dental general anaesthesia (DGA) status is informative in assessing risk of caries or dental anxiety by (a) describing long-term oral health and dental anxiety for people who underwent DGA in childhood and (b) testing whether DGA status in childhood is associated with incident future dental caries or anxiety independently of preconceived risk factors.Design Analysis of prospectively obtained data.Setting An established population based cohort in the UK, the Avon Longitudinal Study of Parents and Children.Participants and methods In total 1,695 participants with dental data in childhood and adolescence were included in analysis. DGA status by age 7 and oral health measures at age 17 were identified from questionnaire data.Main outcome measures Filled or extracted permanent teeth at age 17, Corah Dental Anxiety Scale.Results One hundred and twenty-eight (7.6%) participants underwent DGA in childhood. Individuals who underwent DGA had higher measures of filled or extracted permanent teeth in adolescence (0.36 more affected teeth in fully-adjusted model [95% confidence interval: 0.27, 0.55; P <0.001]).Conclusions DGA in childhood predicts burden of treated caries in adolescence, independently of other risk factors. DGA status may be a clinically useful adjunct in identifying young people at high risk of further disease.

Internet-based modular program BADI for adjustment disorder: protocol of a randomized controlled trial.

PubMed

Skruibis, Paulius; Eimontas, Jonas; Dovydaitiene, Migle; Mazulyte, Egle; Zelviene, Paulina; Kazlauskas, Evaldas

2016-07-26

Adjustment disorder is one of the most common mental health diagnoses. Still it receives relatively little attention from researchers trying to establish best interventions to treat it. With high prevalence of stressful life events, which might be leading to adjustment disorder, and limited resources of mental health service providers, online interventions could be a very practical way of helping people who have these disorders or are in the risk to develop them. The proposed study protocol is aimed to describe a randomized controlled trial of an internet-based modular intervention for adjustment disorder as it is defined in a proposal for the ICD-11. This study is a two-armed Randomized Controlled Trial (RCT) to examine the effectiveness of a web-based intervention BADI (Brief Adjustment Disorder Intervention) for adjustment disorder symptoms. BADI has four modules: Relaxation, Time management, Mindfulness and Strengthening relationships. It is based on stress and coping research and integrates evidence-based treatment approaches such as Cognitive Behavioural therapy (CBT), mindfulness and body-mind practices, as well as exercises for enhancing social support. Primary outcome of the study are symptoms of adjustment disorder and well-being. Engagement into the program and motivation for change is a secondary outcome. All participants after completing the baseline assessment are randomly assigned to one of the two groups: either to the one in which participant will instantly gain access to the BADI intervention or a group in which participants will be given access to the BADI program after waiting one month. Participants of BADI can choose exercises of the program flexibly. There is no particular order in which the exercises should be completed. Study will provide new insights of modular internet-based interventions efficacy for adjustment disorders. The study will also provide information about the role of motivation and expectancies on engagement in modular internet-based interventions. In case this RCT supports effectiveness of fully automated version of BADI, it could be used very broadly. It could become a cost-effective and accessible intervention for adjustment disorder. The study was retrospectively registered with the Australian and New Zealand Clinical Trials Registry with the registration number ACTRN12616000883415 . Registered 5 July, 2016.

Study of Spiritual Intelligence and Adjustment Among Arts and Science College Students.

PubMed

Devi, R Kalpana; Rajesh, Nakulan V; Devi, M Anisha

2017-06-01

A study to evaluate the relationship between the spiritual intelligence and adjustment among the college students was conducted on a sample of 250 students in six various colleges of Tuticorin district, Tamil Nadu, India. Gender, religion, community, major subject, educational qualification of father and mother, student locality, college type, father and mother's occupation and monthly family income (n = 11 variables) were chosen for the study. Test of significance for spiritual intelligence and adjustment was studied and found them nonsignificant except student locality, found to be significant. Two valid and reliable instruments were used to assess student's spiritual intelligence and adjustment. Correlation and Chi-square analysis using structural equation model were used to analyze these data. Correlation analysis showed significant relationship between the variables among the college students (n = 250). Chi-square analysis of association between adjustments of college students showed that most variables are nonsignificant unlike father's educational qualification and mother's occupation. The results disclosed the significant positive relationship with spiritual intelligence and adjustment among adolescents.

Heat transfer in damaged material

NASA Astrophysics Data System (ADS)

Kruis, J.

2013-10-01

Fully coupled thermo-mechanical analysis of civil engineering problems is studied. The mechanical analysis is based on damage mechanics which is useful for modeling of behaviour of quasi-brittle materials, especially in tension. The damage is assumed to be isotropic. The heat transfer is assumed in the form of heat conduction governed by the Fourier law and heat radiation governed by the Stefan-Boltzmann law. Fully coupled thermo-mechanical problem is formulated.

Trying to understand routine stroke outcome data: the need for adequate casemix adjustment and some practical considerations.

PubMed

Weir, N U; Signorini, D F; Dennis, M S; Murdoch, P S

2000-07-01

To determine how far the difference in published stroke case fatality between the Western General Hospital (WGH), Edinburgh and the Falkirk and District Royal Infirmary (FDRI) for the period 1990-93 can be explained by adjusting more fully for casemix. The cases were ascertained and followed prospectively at the WGH and retrospectively at the FDRI; casemix correction was performed using a validated logistic regression model. The WGH is a teaching hospital and the FDRI a district general hospital. Four hundred and thirty seven patients with a verified acute stroke at the WGH; 471 patients assigned a cerebrovascular disease discharge diagnostic code at the FDRI. Thirty day case fatality. About half of the difference in the two hospitals' published stroke case fatality could be accounted for by variation in measured casemix. The residual difference in adjusted case fatality might have been due to differences in the structure of stroke care or simply to remaining differences in casemix. Full investigation of the cause was prevented by the destruction of the deceased patients records. Comparisons of routinely collected stroke outcomes will remain difficult to interpret unless casemix is properly accounted for and deceased patients' records stored for several years.

Synthetic Geopolymers for Controlled Delivery of Oxycodone: Adjustable and Nanostructured Porosity Enables Tunable and Sustained Drug Release

PubMed Central

Forsgren, Johan; Pedersen, Christian; Strømme, Maria; Engqvist, Håkan

2011-01-01

In this article we for the first time present a fully synthetic mesoporous geopolymer drug carrier for controlled release of opioids. Nanoparticulate precursor powders with different Al/Si-ratios were synthesized by a sol-gel route and used in the preparation of different geopolymers, which could be structurally tailored by adjusting the Al/Si-ratio and the curing temperatures. In particular, it was shown that the pore sizes of the geopolymers decreased with increasing Al/Si ratio and that completely mesoporous geopolymers could be produced from precursor particles with the Al/Si ratio 2∶1. The mesoporosity was shown to be associated with a sustained and linear in vitro release profile of the opioid oxycodone. A clinically relevant release period of about 12 h was obtained by adjusting the size of the pellets. The easily fabricated and tunable geopolymers presented in this study constitute a novel approach in the development of controlled release formulations, not only for opioids, but whenever the clinical indication is best treated with a constant supply of drugs and when the mechanical stability of the delivery vehicle is crucial. PMID:21423616

Designing payment for Collaborative Care for Depression in primary care.

PubMed

Bao, Yuhua; Casalino, Lawrence P; Ettner, Susan L; Bruce, Martha L; Solberg, Leif I; Unützer, Jürgen

2011-10-01

To design a bundled case rate for Collaborative Care for Depression (CCD) that aligns incentives with evidence-based depression care in primary care. A clinical information system used by all care managers in a randomized controlled trial of CCD for older primary care patients. We conducted an empirical investigation of factors accounting for variation in CCD resource use over time and across patients. CCD resource use at the patient-episode and patient-month levels was measured by number of care manager contacts and direct patient contact time and analyzed with count data (Poisson or negative binomial) models. Episode-level resource use varies substantially with patient's time in the program. Monthly use declines sharply in the first 6 months regardless of treatment response or remission status, but it remains stable afterwards. An adjusted episode or monthly case rate design better matches payment with variation in resource use compared with a fixed design. Our findings lend support to an episode payment adjusted by number of months receiving CCD and a monthly payment adjusted by the ordinal month. Nonpayment tools including program certification and performance evaluation and reward systems are needed to fully align incentives. © Health Research and Educational Trust.

Automated Gravimetric Calibration to Optimize the Accuracy and Precision of TECAN Freedom EVO Liquid Handler

PubMed Central

Bessemans, Laurent; Jully, Vanessa; de Raikem, Caroline; Albanese, Mathieu; Moniotte, Nicolas; Silversmet, Pascal; Lemoine, Dominique

2016-01-01

High-throughput screening technologies are increasingly integrated into the formulation development process of biopharmaceuticals. The performance of liquid handling systems is dependent on the ability to deliver accurate and precise volumes of specific reagents to ensure process quality. We have developed an automated gravimetric calibration procedure to adjust the accuracy and evaluate the precision of the TECAN Freedom EVO liquid handling system. Volumes from 3 to 900 µL using calibrated syringes and fixed tips were evaluated with various solutions, including aluminum hydroxide and phosphate adjuvants, β-casein, sucrose, sodium chloride, and phosphate-buffered saline. The methodology to set up liquid class pipetting parameters for each solution was to split the process in three steps: (1) screening of predefined liquid class, including different pipetting parameters; (2) adjustment of accuracy parameters based on a calibration curve; and (3) confirmation of the adjustment. The run of appropriate pipetting scripts, data acquisition, and reports until the creation of a new liquid class in EVOware was fully automated. The calibration and confirmation of the robotic system was simple, efficient, and precise and could accelerate data acquisition for a wide range of biopharmaceutical applications. PMID:26905719

Alternatives for using multivariate regression to adjust prospective payment rates

PubMed Central

Sheingold, Steven H.

1990-01-01

Multivariate regression analysis has been used in structuring three of the adjustments to Medicare's prospective payment rates. Because the indirect-teaching adjustment, the disproportionate-share adjustment, and the adjustment for large cities are responsible for distributing approximately $3 billion in payments each year, the specification of regression models for these adjustments is of critical importance. In this article, the application of regression for adjusting Medicare's prospective rates is discussed, and the implications that differing specifications could have for these adjustments are demonstrated. PMID:10113271

Asymptotic analysis of discrete schemes for non-equilibrium radiation diffusion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cui, Xia, E-mail: cui_xia@iapcm.ac.cn; Yuan, Guang-wei; Shen, Zhi-jun

Motivated by providing well-behaved fully discrete schemes in practice, this paper extends the asymptotic analysis on time integration methods for non-equilibrium radiation diffusion in [2] to space discretizations. Therein studies were carried out on a two-temperature model with Larsen's flux-limited diffusion operator, both the implicitly balanced (IB) and linearly implicit (LI) methods were shown asymptotic-preserving. In this paper, we focus on asymptotic analysis for space discrete schemes in dimensions one and two. First, in construction of the schemes, in contrast to traditional first-order approximations, asymmetric second-order accurate spatial approximations are devised for flux-limiters on boundary, and discrete schemes with second-ordermore » accuracy on global spatial domain are acquired consequently. Then by employing formal asymptotic analysis, the first-order asymptotic-preserving property for these schemes and furthermore for the fully discrete schemes is shown. Finally, with the help of manufactured solutions, numerical tests are performed, which demonstrate quantitatively the fully discrete schemes with IB time evolution indeed have the accuracy and asymptotic convergence as theory predicts, hence are well qualified for both non-equilibrium and equilibrium radiation diffusion. - Highlights: • Provide AP fully discrete schemes for non-equilibrium radiation diffusion. • Propose second order accurate schemes by asymmetric approach for boundary flux-limiter. • Show first order AP property of spatially and fully discrete schemes with IB evolution. • Devise subtle artificial solutions; verify accuracy and AP property quantitatively. • Ideas can be generalized to 3-dimensional problems and higher order implicit schemes.« less

Antidepressant use and mortality in very old people.

PubMed

Boström, Gustaf; Hörnsten, Carl; Brännström, Jon; Conradsson, Mia; Nordström, Peter; Allard, Per; Gustafson, Yngve; Littbrand, Håkan

2016-07-01

Antidepressant treatment may increase the risk of death. The association between antidepressants and mortality has been evaluated in community-dwelling older people, but not in representative samples of very old people, among whom dementia, multimorbidity, and disability are common. Umeå 85+/GERDA study participants (n = 992) aged 85, 90, and ≥95 years were followed for up to five years. Cox proportional hazard regression models were used to analyze mortality risk associated with baseline antidepressant treatment, adjusted for potential confounders. Mean age was 89 years; 27% of participants had dementia, 20% had stroke histories, 29% had heart failure, and 16% used antidepressants. In age- and sex-adjusted analyses, antidepressant use was associated with a 76% increased mortality risk (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.41-2.19). Adding adjustment for Geriatric Depression Scale score, HR was 1.62 (95% CI, 1.29-2.03). The association was not significant when adjusting for additional confounding factors (HR = 1.08; 95% CI, 0.85-1.38). Interaction analyses in the fully adjusted model revealed a significant interaction between sex and antidepressant use (HR: 1.76; 95% CI, 1.05-2.94). Among male and female antidepressant users, the HRs for death were 0.76 (95% CI, 0.47-1.24) and 1.28 (95% CI, 0.97-1.70), respectively. Among very old people, baseline antidepressant treatment does not seem to be independently associated with increased mortality risk. However, the risk may be different in men and women. This difference and the potential risk of initial treatment require further investigation in future cohort studies of very old people.

Creating pharmacy staffing-to-demand models: predictive tools used at two institutions.

PubMed

Krogh, Paul; Ernster, Jason; Knoer, Scott

2012-09-15

The creation and implementation of data-driven staffing-to-demand models at two institutions are described. Predictive workload tools provide a guideline for pharmacy managers to adjust staffing needs based on hospital volume metrics. At Abbott Northwestern Hospital, management worked with the department's staff and labor management committee to clearly outline the productivity monitoring system and the process for reducing hours. Reference charts describing the process for reducing hours and a form to track the hours of involuntary reductions for each employee were created to further enhance communication, explain the rationale behind the new process, and promote transparency. The University of Minnesota Medical Center-Fairview, found a strong correlation between measured pharmacy workload and an adjusted census formula. If the daily census and admission report indicate that the adjusted census will provide enough workload for the fully staffed department, no further action is needed. If the census report indicates the adjusted census is less than the breakeven point, staff members are asked to leave work, either voluntarily or involuntarily. The opposite holds true for days when the adjusted census is higher than the breakeven point, at which time additional staff are required to synchronize worked hours with predicted workload. Successful staffing-to- demand models were implemented in two hospital pharmacies. Financial savings, as indicated by decreased labor costs secondary to reduction of staffed shifts, were approximately $42,000 and $45,500 over a three-month period for Abbott Northwestern Hospital and the University of Minnesota Medical Center-Fairview, respectively. Maintenance of 100% productively allowed the departments to continue to replace vacant positions and avoid permanent staff reductions.

Paternal age at childbirth and eating disorders in offspring.

PubMed

Javaras, K N; Rickert, M E; Thornton, L M; Peat, C M; Baker, J H; Birgegård, A; Norring, C; Landén, M; Almqvist, C; Larsson, H; Lichtenstein, P; Bulik, C M; D'Onofrio, B M

2017-02-01

Advanced paternal age at childbirth is associated with psychiatric disorders in offspring, including schizophrenia, bipolar disorder and autism. However, few studies have investigated paternal age's relationship with eating disorders in offspring. In a large, population-based cohort, we examined the association between paternal age and offspring eating disorders, and whether that association remains after adjustment for potential confounders (e.g. parental education level) that may be related to late/early selection into fatherhood and to eating disorder incidence. Data for 2 276 809 individuals born in Sweden 1979-2001 were extracted from Swedish population and healthcare registers. The authors used Cox proportional hazards models to examine the effect of paternal age on the first incidence of healthcare-recorded anorexia nervosa (AN) and all eating disorders (AED) occurring 1987-2009. Models were adjusted for sex, birth order, maternal age at childbirth, and maternal and paternal covariates including country of birth, highest education level, and lifetime psychiatric and criminal history. Even after adjustment for covariates including maternal age, advanced paternal age was associated with increased risk, and younger paternal age with decreased risk, of AN and AED. For example, the fully adjusted hazard ratio for the 45+ years (v. the 25-29 years) paternal age category was 1.32 [95% confidence interval (CI) 1.14-1.53] for AN and 1.26 (95% CI 1.13-1.40) for AED. In this large, population-based cohort, paternal age at childbirth was positively associated with eating disorders in offspring, even after adjustment for potential confounders. Future research should further explore potential explanations for the association, including de novo mutations in the paternal germline.

Intra-operative adjustment of standard planes in C-arm CT image data.

PubMed

Brehler, Michael; Görres, Joseph; Franke, Jochen; Barth, Karl; Vetter, Sven Y; Grützner, Paul A; Meinzer, Hans-Peter; Wolf, Ivo; Nabers, Diana

2016-03-01

With the help of an intra-operative mobile C-arm CT, medical interventions can be verified and corrected, avoiding the need for a post-operative CT and a second intervention. An exact adjustment of standard plane positions is necessary for the best possible assessment of the anatomical regions of interest but the mobility of the C-arm causes the need for a time-consuming manual adjustment. In this article, we present an automatic plane adjustment at the example of calcaneal fractures. We developed two feature detection methods (2D and pseudo-3D) based on SURF key points and also transferred the SURF approach to 3D. Combined with an atlas-based registration, our algorithm adjusts the standard planes of the calcaneal C-arm images automatically. The robustness of the algorithms is evaluated using a clinical data set. Additionally, we tested the algorithm's performance for two registration approaches, two resolutions of C-arm images and two methods for metal artifact reduction. For the feature extraction, the novel 3D-SURF approach performs best. As expected, a higher resolution ([Formula: see text] voxel) leads also to more robust feature points and is therefore slightly better than the [Formula: see text] voxel images (standard setting of device). Our comparison of two different artifact reduction methods and the complete removal of metal in the images shows that our approach is highly robust against artifacts and the number and position of metal implants. By introducing our fast algorithmic processing pipeline, we developed the first steps for a fully automatic assistance system for the assessment of C-arm CT images.

Qualitative analysis of mycotoxins using micellar electrokinetic capillary chromatography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Holland, R.D.; Sepaniak, M.J.

1993-05-01

Naturally occurring mycotoxins are separated using micellar electrokinetic capillary chromatography. Trends in the retention of these toxins, resulting from changes in mobile-phase composition and pH, are reported and presented as a means of alleviating coelution problems. Two sets of mobile-phase conditions are determined that provide unique separation selectivity. The facile manner by which mobile-phase conditions can be altered, without changes in instrumental configuration, allowed the acquisition of two distinctive, fully resolved chromatograms of 10 mycotoxins in a period of approximately 45 min. By adjusting retention times, using indigenous or added components in mycotoxin samples as normalization standards, it is possiblemore » to obtain coefficients of variation in retention time that average less than 1%. The qualitative capabilities of this methodology are evaluated by separating randomly generated mycotoxin-interferent mixtures. In this study, the utilization of normalized retention times applied to separations obtained with two sets of mobile-phase conditions permitted the identification of all the mycotoxins in five unknown samples without any misidentifications. 24 refs., 3 figs., 2 tabs.« less

Phosphorus and nitrogen fluxes carried by 21 Finnish agricultural rivers in 1985-2006.

PubMed

Ekholm, Petri; Rankinen, Katri; Rita, Hannu; Räike, Antti; Sjöblom, Heidi; Raateland, Arjen; Vesikko, Ljudmila; Cano Bernal, José Enrique; Taskinen, Antti

2015-04-01

The Finnish Agri-Environmental Programme aims to reduce nutrient load to waters. Using national monitoring data, we estimated the agricultural load (incl. natural background) of total phosphorus (TP) and total nitrogen (TN) transported by 21 Finnish rivers to the northern Baltic Sea and analysed the flow-adjusted trends in the loads and concentrations from 1985 to 2006. We also related the loads to spatial and temporal patterns in catchment and agricultural characteristics. Agricultural load of TN increased, especially in the rivers discharging into the Bothnian Bay, while the load of TP decreased in most of the rivers, except those discharging into the Archipelago Sea. The trends may partly be related to a decrease in grassed area (TP, TN) and increased mineralisation (TN), but the available data on catchment and agricultural characteristics did not fully explain the observed pattern. Our study showed that data arising from relatively infrequent monitoring may prove useful for analysing long-term trend. The mutual correlation among the explaining variables hampered the analysis of the load generating factors.

[Research program for the Brazilian Unified Health System (SUS): the contribution to health management and services in Paraiba State, Brazil].

PubMed

Celino, Suely Deysny de Matos; Costa, Gabriela Maria Cavalcanti; França, Inácia Sátiro Xavier de; Araújo, Ednaldo Cavalcante de

2013-01-01

The shared management in health of the Research Program for the Unified Health System (PPSUS) has the purpose of funding research in priority areas for the health of the Brazilian population. The scope of this qualitative study is to understand the researchers' perception of the contribution of research funded by the PPSUS invitations to bid in the State of Paraiba, for resolving the priority health problems of the Paraiba population, for reducing regional inequalities in health and for bolstering the management of SUS. A documentary survey of the bids and final reports of research and a semi-structured interview with 28 coordinators of these studies was conducted. Triangulation strategy of data was used and subsequently subjected to content analysis, which converged with the categories: solving the health problems; reducing regional inequalities; contribution to management. Paraiba state needs adjustments such that the PPSUS can be fully implemented, ensuring that the knowledge generated can be converted into health policies and actions, since the research funded respond to the health needs of the population and difficulties in SUS management.

4D printing smart biomedical scaffolds with novel soybean oil epoxidized acrylate

PubMed Central

Miao, Shida; Zhu, Wei; Castro, Nathan J.; Nowicki, Margaret; Zhou, Xuan; Cui, Haitao; Fisher, John P.; Zhang, Lijie Grace

2016-01-01

Photocurable, biocompatible liquid resins are highly desired for 3D stereolithography based bioprinting. Here we solidified a novel renewable soybean oil epoxidized acrylate, using a 3D laser printing technique, into smart and highly biocompatible scaffolds capable of supporting growth of multipotent human bone marrow mesenchymal stem cells (hMSCs). Porous scaffolds were readily fabricated by simply adjusting the printer infill density; superficial structures of the polymerized soybean oil epoxidized acrylate were significantly affected by laser frequency and printing speed. Shape memory tests confirmed that the scaffold fixed a temporary shape at −18 °C and fully recovered its original shape at human body temperature (37 °C), which indicated the great potential for 4D printing applications. Cytotoxicity analysis proved that the printed scaffolds had significant higher hMSC adhesion and proliferation than traditional polyethylene glycol diacrylate (PEGDA), and had no statistical difference from poly lactic acid (PLA) and polycaprolactone (PCL). This research is believed to significantly advance the development of biomedical scaffolds with renewable plant oils and advanced 3D fabrication techniques. PMID:27251982

Neural Network Assisted Inverse Dynamic Guidance for Terminally Constrained Entry Flight

PubMed Central

Chen, Wanchun

2014-01-01

This paper presents a neural network assisted entry guidance law that is designed by applying Bézier approximation. It is shown that a fully constrained approximation of a reference trajectory can be made by using the Bézier curve. Applying this approximation, an inverse dynamic system for an entry flight is solved to generate guidance command. The guidance solution thus gotten ensures terminal constraints for position, flight path, and azimuth angle. In order to ensure terminal velocity constraint, a prediction of the terminal velocity is required, based on which, the approximated Bézier curve is adjusted. An artificial neural network is used for this prediction of the terminal velocity. The method enables faster implementation in achieving fully constrained entry flight. Results from simulations indicate improved performance of the neural network assisted method. The scheme is expected to have prospect for further research on automated onboard control of terminal velocity for both reentry and terminal guidance laws. PMID:24723821

Fully Solution-Processable Fabrication of Multi-Layered Circuits on a Flexible Substrate Using Laser Processing

PubMed Central

Ji, Seok Young; Choi, Wonsuk; Jeon, Jin-Woo; Chang, Won Seok

2018-01-01

The development of printing technologies has enabled the realization of electric circuit fabrication on a flexible substrate. However, the current technique remains restricted to single-layer patterning. In this paper, we demonstrate a fully solution-processable patterning approach for multi-layer circuits using a combined method of laser sintering and ablation. Selective laser sintering of silver (Ag) nanoparticle-based ink is applied to make conductive patterns on a heat-sensitive substrate and insulating layer. The laser beam path and irradiation fluence are controlled to create circuit patterns for flexible electronics. Microvia drilling using femtosecond laser through the polyvinylphenol-film insulating layer by laser ablation, as well as sequential coating of Ag ink and laser sintering, achieves an interlayer interconnection between multi-layer circuits. The dimension of microvia is determined by a sophisticated adjustment of the laser focal position and intensity. Based on these methods, a flexible electronic circuit with chip-size-package light-emitting diodes was successfully fabricated and demonstrated to have functional operations. PMID:29425144

A neural network with modular hierarchical learning

NASA Technical Reports Server (NTRS)

Baldi, Pierre F. (Inventor); Toomarian, Nikzad (Inventor)

1994-01-01

This invention provides a new hierarchical approach for supervised neural learning of time dependent trajectories. The modular hierarchical methodology leads to architectures which are more structured than fully interconnected networks. The networks utilize a general feedforward flow of information and sparse recurrent connections to achieve dynamic effects. The advantages include the sparsity of units and connections, the modular organization. A further advantage is that the learning is much more circumscribed learning than in fully interconnected systems. The present invention is embodied by a neural network including a plurality of neural modules each having a pre-established performance capability wherein each neural module has an output outputting present results of the performance capability and an input for changing the present results of the performance capabilitiy. For pattern recognition applications, the performance capability may be an oscillation capability producing a repeating wave pattern as the present results. In the preferred embodiment, each of the plurality of neural modules includes a pre-established capability portion and a performance adjustment portion connected to control the pre-established capability portion.

An evaluation of some strategies for vibration control of flexible rotors

NASA Technical Reports Server (NTRS)

Burrows, C. R.

1992-01-01

There is evidence that the reliability of magnetic bearings has achieved an acceptable level in applications when high cost can be tolerated. This acceptability would be enhanced if the inherent capability of magnetic bearings as active control elements were fully used. The technological and commercial promise of magnetic bearings will be fulfilled only if attention is focussed on the control problems associated with their use. The open loop adaptive control algorithm provides an efficient method of controlling the vibration of rotors without the need of a prior knowledge of parameter values. It overcomes the disadvantages normally associated with open loop control while avoiding the problem of instability associated with closed loop control algorithms. The algorithm is conceptually satisfying because it uses the capability of magnetic bearings as fully active vibration control elements rather than limiting them to act as adjustable stiffness and damping elements, as is the case when they are used with local position and velocity feedback.

Association between spending on social protection and tuberculosis burden: a global analysis.

PubMed

Siroka, Andrew; Ponce, Ninez A; Lönnroth, Knut

2016-04-01

The End TB Strategy places great emphasis on increasing social protection and poverty alleviation programmes. However, the role of social protection on controlling tuberculosis has not been examined fully. We analysed the association between social protection spending and tuberculosis prevalence, incidence, and mortality globally. We used publicly available data from WHO's Global Tuberculosis Programme for tuberculosis burden in terms of yearly incidence, prevalence, and mortality per 100,000 people, and social protection data from the International Labour Organization (ILO), expressed as the percentage of national gross domestic product (GDP) spent on social protection programmes (excluding health). Data from ILO were from 146 countries covering the years between 2000 and 2012. We used descriptive assessments to examine levels of social protection and tuberculosis burden for each country, then used these assessments to inform our fully adjusted multivariate regression models. Our models controlled for economic output, adult HIV prevalence, health expenditure, population density, the percentage of foreign-born residents, and the strength of the national tuberculosis treatment programme, and also incorporated a country-level fixed effect to adjust for clustering of datapoints within countries. Overall, social protection spending levels were inversely associated with tuberculosis prevalence, incidence, and mortality. For a country spending 0% of their GDP on social protection, moving to spending 1% of their GDP was associated with a change of -18·33 per 100,000 people (95% CI -32·10 to -4·60; p=0·009) in prevalence, -8·16 per 100,000 people (-16·00 to -0·27; p=0·043) in incidence, and -5·48 per 100,000 people (-9·34 to -1·62; p=0·006) in mortality. This association was mitigated at higher levels of social protection spending, and lost significance when more than 11% of GDP was spent. Our findings suggest that investments in social protection could contribute to a reduced tuberculosis burden, especially in countries that are investing a small proportion of their GDP in this area. However, further research is needed to support these ecological associations. National Institutes of Health National Center for Advancing Translational Science (University of California, Los Angeles [CA, USA] Clinical and Translational Science Institute). Copyright © 2016 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.

Joint Intelligence Analysis Complex: DOD Partially Used Best Practices for Analyzing Alternatives and Should Do So Fully for Future Military Construction Decisions

DTIC Science & Technology

2016-09-01

Military Construction Decisions Report to Congressional Requesters September 2016 GAO-16-853 United States Government Accountability Office...ANALYSIS COMPLEX DOD Partially Used Best Practices for Analyzing Alternatives and Should Do So Fully for Future Military Construction Decisions What...a set of AOA best practices for military construction decisions. Without guidance for using AOA best practices during certain military construction

Spatiotemporal Bayesian analysis of Lyme disease in New York state, 1990-2000.

PubMed

Chen, Haiyan; Stratton, Howard H; Caraco, Thomas B; White, Dennis J

2006-07-01

Mapping ordinarily increases our understanding of nontrivial spatial and temporal heterogeneities in disease rates. However, the large number of parameters required by the corresponding statistical models often complicates detailed analysis. This study investigates the feasibility of a fully Bayesian hierarchical regression approach to the problem and identifies how it outperforms two more popular methods: crude rate estimates (CRE) and empirical Bayes standardization (EBS). In particular, we apply a fully Bayesian approach to the spatiotemporal analysis of Lyme disease incidence in New York state for the period 1990-2000. These results are compared with those obtained by CRE and EBS in Chen et al. (2005). We show that the fully Bayesian regression model not only gives more reliable estimates of disease rates than the other two approaches but also allows for tractable models that can accommodate more numerous sources of variation and unknown parameters.

A balanced perspective: using nonfinancial measures to assess financial performance.

PubMed

Watkins, Ann L

2003-11-01

Assessments of hospitals' financial performance have traditionally been based exclusively on analysis of a concise set of key financial ratios. One study, however, demonstrates that analysis of a hospital's financial condition can be significantly enhanced with the addition of several nonfinancial measures, including case-mix adjusted admissions, case-mix adjusted admissions per full-time equivalent, and case-mix adjusted admissions per beds in service.

Robust and automated three-dimensional segmentation of densely packed cell nuclei in different biological specimens with Lines-of-Sight decomposition.

PubMed

Mathew, B; Schmitz, A; Muñoz-Descalzo, S; Ansari, N; Pampaloni, F; Stelzer, E H K; Fischer, S C

2015-06-08

Due to the large amount of data produced by advanced microscopy, automated image analysis is crucial in modern biology. Most applications require reliable cell nuclei segmentation. However, in many biological specimens cell nuclei are densely packed and appear to touch one another in the images. Therefore, a major difficulty of three-dimensional cell nuclei segmentation is the decomposition of cell nuclei that apparently touch each other. Current methods are highly adapted to a certain biological specimen or a specific microscope. They do not ensure similarly accurate segmentation performance, i.e. their robustness for different datasets is not guaranteed. Hence, these methods require elaborate adjustments to each dataset. We present an advanced three-dimensional cell nuclei segmentation algorithm that is accurate and robust. Our approach combines local adaptive pre-processing with decomposition based on Lines-of-Sight (LoS) to separate apparently touching cell nuclei into approximately convex parts. We demonstrate the superior performance of our algorithm using data from different specimens recorded with different microscopes. The three-dimensional images were recorded with confocal and light sheet-based fluorescence microscopes. The specimens are an early mouse embryo and two different cellular spheroids. We compared the segmentation accuracy of our algorithm with ground truth data for the test images and results from state-of-the-art methods. The analysis shows that our method is accurate throughout all test datasets (mean F-measure: 91%) whereas the other methods each failed for at least one dataset (F-measure≤69%). Furthermore, nuclei volume measurements are improved for LoS decomposition. The state-of-the-art methods required laborious adjustments of parameter values to achieve these results. Our LoS algorithm did not require parameter value adjustments. The accurate performance was achieved with one fixed set of parameter values. We developed a novel and fully automated three-dimensional cell nuclei segmentation method incorporating LoS decomposition. LoS are easily accessible features that ensure correct splitting of apparently touching cell nuclei independent of their shape, size or intensity. Our method showed superior performance compared to state-of-the-art methods, performing accurately for a variety of test images. Hence, our LoS approach can be readily applied to quantitative evaluation in drug testing, developmental and cell biology.

Diabetes, Insulin Resistance, and Dementia Among HIV-1–Infected Patients

PubMed Central

Shikuma, Cecilia M.; Shiramizu, Bruce T.; Williams, Andrew E.; Watters, Michael R.; Poff, Pamela W.; Grove, John S.; Selnes, Ola A.; Sacktor, Ned C.

2006-01-01

Objectives: Metabolic complications have been associated with HIV-1 infection and with long-term use of antiretroviral (ARV) medications. In some studies, such complications have been linked to cardiovascular events, yet limited data exist concerning metabolic complications and dementia. The objective of this study was to examine the relationship between HIV-associated dementia (HAD) and diabetes among patients with HIV-1 infection. Design: Cross-sectional analysis of entry data for a longitudinal cohort study. Methods: A total of 203 participants who were enrolled in the Hawaii Aging with HIV Cohort between October 2001 and November 2003 served as the study population. Research case definitions of HAD were determined in consensus conferences by a panel that included neurologists, neuropsychologists, and a geriatrician. Diabetes was determined by self-report or a fasting glucose level >125 mg/dL. Results: Participants' ages ranged between 20–76 years at enrollment with approximately one-half aged ≥50 years. After adjustment for important covariates including age, education, ethnicity, CD4 lymphocyte count, duration of HIV infection, and protease inhibitor–based ARV therapy, we found a statistically significant association of diabetes with HAD (odds ratio 5.43, 1.66–17.70). A significant association remained after adjustment for other vascular risk factors. Among participants without diabetes, fasting glucose levels were higher with increasing impairment category. Conclusions: Within the Hawaii Aging with HIV Cohort, a longitudinal study enriched with older HIV-1–infected individuals, diabetes is associated with prevalent dementia. This finding is not fully explained by age or coexisting vascular risk factors. Evaluation of underlying mechanisms is warranted. PMID:15608521

Social Norms in the Development of Adolescent Substance Use: A Longitudinal Analysis of the International Youth Development Study

PubMed Central

Eisenberg, Marla E.; Toumbourou, John W.; Catalano, Richard F.; Hemphill, Sheryl A.

2014-01-01

Identifying specific aspects of peer social norms that influence adolescent substance use may assist international prevention efforts. This study examines two aggregated measures of social norms in the school setting and their predictive association with substance (alcohol, tobacco and marijuana) use 2 years later in a large cross-national population-based cohort of adolescents. The primary hypothesis is that in Grade 7 both “injunctive” school norms (where students associate substance use with “coolness”) and “descriptive” norms (where student substance use is common) will predict Grade 9 substance use. Data come from the International Youth Development Study, including 2,248 students (51.2 % female) in the US and Australia attending 121 schools in Grade 7. Independent variables included injunctive norms (aggregating measures of school-wide coolness ratings of each substance use) and descriptive norms (aggregating the prevalence of school substance use) in Grade 7. Dependent variables included binge drinking and current use of alcohol, tobacco and marijuana in Grade 9. Associations between each type of school-wide social norm and substance use behaviors in Grade 9 were tested using multilevel logistic regression, adjusting for covariates. In unadjusted models, both injunctive and descriptive norms each significantly predicted subsequent substance use. In fully adjusted models, injunctive norms were no longer significantly associated with Grade 9 use, but descriptive norms remained significantly associated with tobacco and marijuana use in the expected direction. The findings identify descriptive social norms in the school context as a particularly important area to address in adolescent substance use prevention efforts. PMID:24633850

Apples to apples: the origin and magnitude of differences in asbestos cancer risk estimates derived using varying protocols.

PubMed

Berman, D Wayne

2011-08-01

Given that new protocols for assessing asbestos-related cancer risk have recently been published, questions arise concerning how they compare to the "IRIS" protocol currently used by regulators. The newest protocols incorporate findings from 20 additional years of literature. Thus, differences between the IRIS and newer Berman and Crump protocols are examined to evaluate whether these protocols can be reconciled. Risks estimated by applying these protocols to real exposure data from both laboratory and field studies are also compared to assess the relative health protectiveness of each protocol. The reliability of risks estimated using the two protocols are compared by evaluating the degree with which each potentially reproduces the known epidemiology study risks. Results indicate that the IRIS and Berman and Crump protocols can be reconciled; while environment-specific variation within fiber type is apparently due primarily to size effects (not addressed by IRIS), the 10-fold (average) difference between amphibole asbestos risks estimated using each protocol is attributable to an arbitrary selection of the lowest of available mesothelioma potency factors in the IRIS protocol. Thus, the IRIS protocol may substantially underestimate risk when exposure is primarily to amphibole asbestos. Moreover, while the Berman and Crump protocol is more reliable than the IRIS protocol overall (especially for predicting amphibole risk), evidence is presented suggesting a new fiber-size-related adjustment to the Berman and Crump protocol may ultimately succeed in reconciling the entire epidemiology database. However, additional data need to be developed before the performance of the adjusted protocol can be fully validated. © 2011 Society for Risk Analysis.

Association of white and red meat consumption with general and abdominal obesity: a cross-sectional study among a population of Iranian military families in 2016.

PubMed

Dabbagh-Moghadam, Arasb; Mozaffari-Khosravi, Hassan; Nasiri, Morteza; Miri, Ali; Rahdar, Maliehe; Sadeghi, Omid

2017-12-01

To assess the association of red and white meat consumption with general and abdominal obesity among Iranian military families. In this cross-sectional study, 525 subjects with age range of 19-55 years belong to military families of Army of Islamic Republic of Iran were recruited during 2016. Dietary data were collected using semi-quantitative food-frequency questionnaire. A self-reported questionnaire was used to collect data on demographic characteristics and anthropometric measurements. General obesity was defined as body mass index ≥25 kg/m 2 and abdominal obesity as waist circumference ≥80 cm for women and ≥ 94 cm for men. Finally, we had complete data on 170 subjects for analysis. Mean age of subjects was 33.78 ± 6.48. We found a significant positive association between red meat consumption and abdominal obesity in fully adjusted model, so that subjects in the fourth quartile had 4.51 more odds to be abdominally obese compared with those in the first quartile of red meat consumption (OR 4.51, 95% CI 1.32-15.40). Such relationship was not seen for general obesity. In addition, white meat consumption was not associated with general and abdominal obesity either before or after adjustment for covariates. Red meat consumption was positively associated with abdominal obesity. No significant relationship was found between white meat consumption, and general and abdominal obesity. Therefore, further studies are needed to shed light our findings.

Income, family context and self-regulation in 5-year-old children

PubMed Central

Li, Mengying; Riis, Jenna L.; Ghazarian, Sharon R.; Johnson, Sara B.

2016-01-01

Objective Self-regulation (SR) is a core aspect of child development with enduring effects on health and wellbeing across the lifespan. Early childhood poverty may shape SR development. This study examined the cross-sectional relations among family income, family context and SR in five-year-old children. Method 140 five-year-old children and their mothers participated in the study. Children completed a battery of SR tasks; mothers completed questionnaires. Cognitive and emotional SR composite scores were generated based on a principal component analysis of the SR tasks. SR scores were first regressed on family income (in 10 levels ranging from <5,000 to 150,000+) adjusting for age, sex and race of the child; family context variables were subsequently added to the models. Results Controlling for age, sex and race, each level increase in family income was associated with 0.04 standard deviation (SD) increase in emotional SR (p=0.32) and 0.08 SD increase in cognitive SR (p=0.01). In fully adjusted models, exposure to household instability and experiencing 10 or more negative life events was associated with worse emotional SR; exposure to mother’s depressive symptoms was associated with worse cognitive SR. Higher income buffered children’s SR from some contextual risk factors. Family contextual variables explained 62% of the correlation between higher income and better cognitive SR scores. Conclusions Income-based cognitive SR disparities were associated with family contextual factors. Screening for family adversity in pediatric care and linking families to needed resources may protect children’s developing SR capacities, with benefits to health and well-being. PMID:28092295

Economics of Malignant Gliomas: A Critical Review

PubMed Central

Raizer, Jeffrey J.; Fitzner, Karen A.; Jacobs, Daniel I.; Bennett, Charles L.; Liebling, Dustin B.; Luu, Thanh Ha; Trifilio, Steven M.; Grimm, Sean A.; Fisher, Matthew J.; Haleem, Meraaj S.; Ray, Paul S.; McKoy, Judith M.; DeBoer, Rebecca; Tulas, Katrina-Marie E.; Deeb, Mohammed; McKoy, June M.

2015-01-01

Purpose: Approximately 18,500 persons are diagnosed with malignant glioma in the United States annually. Few studies have investigated the comprehensive economic costs. We reviewed the literature to examine costs to patients with malignant glioma and their families, payers, and society. Methods: A total of 18 fully extracted studies were included. Data were collected on direct and indirect costs, and cost estimates were converted to US dollars using the conversion rate calculated from the study's publication date, and updated to 2011 values after adjustment for inflation. A standardized data abstraction form was used. Data were extracted by one reviewer and checked by another. Results: Before approval of effective chemotherapeutic agents for malignant gliomas, estimated total direct medical costs in the United States for surgery and radiation therapy per patient ranged from $50,600 to $92,700. The addition of temozolomide (TMZ) and bevacizumab to glioblastoma treatment regimens has resulted in increased overall costs for glioma care. Although health care costs are now less front-loaded, they have increased over the course of illness. Analysis using a willingness-to-pay threshold of $50,000 per quality-adjusted life-year suggests that the benefits of TMZ fall on the edge of acceptable therapies. Furthermore, indirect medical costs, such as productivity losses, are not trivial. Conclusion: With increased chemotherapy use for malignant glioma, the paradigm for treatment and associated out-of-pocket and total medical costs continue to evolve. Larger out-of-pocket costs may influence the choice of chemotherapeutic agents, the economic implications of which should be evaluated prospectively. PMID:25466707

Economics of Malignant Gliomas: A Critical Review.

PubMed

Raizer, Jeffrey J; Fitzner, Karen A; Jacobs, Daniel I; Bennett, Charles L; Liebling, Dustin B; Luu, Thanh Ha; Trifilio, Steven M; Grimm, Sean A; Fisher, Matthew J; Haleem, Meraaj S; Ray, Paul S; McKoy, Judith M; DeBoer, Rebecca; Tulas, Katrina-Marie E; Deeb, Mohammed; McKoy, June M

2015-01-01

Approximately 18,500 persons are diagnosed with malignant glioma in the United States annually. Few studies have investigated the comprehensive economic costs. We reviewed the literature to examine costs to patients with malignant glioma and their families, payers, and society. A total of 18 fully extracted studies were included. Data were collected on direct and indirect costs, and cost estimates were converted to US dollars using the conversion rate calculated from the study's publication date, and updated to 2011 values after adjustment for inflation. A standardized data abstraction form was used. Data were extracted by one reviewer and checked by another. Before approval of effective chemotherapeutic agents for malignant gliomas, estimated total direct medical costs in the United States for surgery and radiation therapy per patient ranged from $50,600 to $92,700. The addition of temozolomide (TMZ) and bevacizumab to glioblastoma treatment regimens has resulted in increased overall costs for glioma care. Although health care costs are now less front-loaded, they have increased over the course of illness. Analysis using a willingness-to-pay threshold of $50,000 per quality-adjusted life-year suggests that the benefits of TMZ fall on the edge of acceptable therapies. Furthermore, indirect medical costs, such as productivity losses, are not trivial. With increased chemotherapy use for malignant glioma, the paradigm for treatment and associated out-of-pocket and total medical costs continue to evolve. Larger out-of-pocket costs may influence the choice of chemotherapeutic agents, the economic implications of which should be evaluated prospectively. Copyright © 2015 by American Society of Clinical Oncology.

Evaluation of the Retinal Vasculature in Hypertension and Chronic Kidney Disease in an Elderly Population of Irish Nuns.

PubMed

McGowan, Amy; Silvestri, Giuliana; Moore, Evelyn; Silvestri, Vittorio; Patterson, Christopher C; Maxwell, Alexander P; McKay, Gareth J

2015-01-01

Chronic kidney disease (CKD) and hypertension are global public health problems associated with considerable morbidity, premature mortality and attendant healthcare costs. Previous studies have highlighted that non-invasive examination of the retinal microcirculation can detect microvascular pathology that is associated with systemic disorders of the circulatory system such as hypertension. We examined the associations between retinal vessel caliber (RVC) and fractal dimension (DF), with both hypertension and CKD in elderly Irish nuns. Data from 1233 participants in the cross-sectional observational Irish Nun Eye Study (INES) were assessed from digital photographs with a standardized protocol using computer-assisted software. Multivariate regression analyses were used to assess associations with hypertension and CKD, with adjustment for age, body mass index (BMI), refraction, fellow eye RVC, smoking, alcohol consumption, ischemic heart disease (IHD), cerebrovascular accident (CVA), diabetes and medication use. In total, 1122 (91%) participants (mean age: 76.3 [range: 56-100] years) had gradable retinal images of sufficient quality for blood vessel assessment. Hypertension was significantly associated with a narrower central retinal arteriolar equivalent (CRAE) in a fully adjusted analysis (P = 0.002; effect size = -2.16 μm; 95% confidence intervals [CI]: -3.51, -0.81 μm). No significant associations between other retinal vascular parameters and hypertension or between any retinal vascular parameters and CKD were found. Individuals with hypertension have significantly narrower retinal arterioles which may afford an earlier opportunity for tailored prevention and treatment options to optimize the structure and function of the microvasculature, providing additional clinical utility. No significant associations between retinal vascular parameters and CKD were detected.

Prevalence and associated factors of hepatitis C virus infection among renal disease patients on maintenance hemodialysis in three health centers in Aden, Yemen: a cross sectional study.

PubMed

Aman, Khadija; Al-Dubai, Sami AbdoRadman; Aman, Reema; Hawash, Aamenah; Alshagga, Mustafa; Kassim, Saba

2015-03-01

We aimed to assess the prevalence and factors associated with positive anti-hepatitis C virus (HCV) antibodies among patients on maintenance hemodialysis (HD) in three centers in Aden, Yemen. The data from 219 patients and their records over the period between 2000-2013, was extracted and analyzed. The mean ± SD age of the patients was 47.08 ± 13.9 years; 74.4% of them were married and 14.6% were employed. The prevalence of validated anti-HCV-positive cases was 40.2% (95%CI 33.64%-46.73%). The mean ± SD duration on HD of all the patients was 35.09 ± 38 months. On bivariate analysis, the duration on HD and attending more than one center for HD associated significantly with anti-HCV positivity (P <0.05). On multivariate fully adjusted Poisson regression modelling, controlled for age, Patients attending more than one center and those who underwent HD for longer durations were more likely to be positive for anti- HCV antibodies [P = 0.004, adjusted prevalence rate ratio (APRR) = 1.87, 95% confidence interval (CI): 1.22-2.88; P = 0.0005, APRR = 1.01, 95% CI: 1.00-1.02. In this study sample, the prevalence of HCV was significant. Patients attending more than one center and those who underwent HD for longer durations were found to be more likely to contract HCV. Enhancing existing infection control measures and allocating more resources to HD centers therefore warrants consideration.

Income, Family Context, and Self-Regulation in 5-Year-Old Children.

PubMed

Li, Mengying; Riis, Jenna L; Ghazarian, Sharon R; Johnson, Sara B

Self-regulation (SR) is a core aspect of child development with enduring effects on health and wellbeing across the lifespan. Early childhood poverty may shape SR development. This study examined the cross-sectional relationship among family income, family context, and SR in 5-year-old children. A total of 140 five-year-old children and their mothers participated in the study. Children completed a battery of SR tasks; mothers completed questionnaires. Cognitive and emotional SR composite scores were generated based on a principal component analysis of the SR tasks. The SR scores were first regressed on family income (in 10 levels ranging from <5000 to 150,000+) adjusting for age, sex, and race of the child; family context variables were subsequently added to the models. Controlling for age, sex, and race, each level increase in family income was associated with 0.04 SD increase in emotional SR (p = .32) and 0.08 SD increase in cognitive SR (p = .01). In fully adjusted models, exposure to household instability and experiencing 10 or more negative life events was associated with worse emotional SR; exposure to mother's depressive symptoms was associated with worse cognitive SR. Higher income buffered children's SR from some contextual risk factors. Family contextual variables explained 62% of the correlation between higher income and better cognitive SR scores. Income-based cognitive SR disparities were associated with family contextual factors. Screening for family adversity in pediatric care and linking families to needed resources may protect children's developing SR capacities, with benefits to health and well-being.

Computer-aided system of evaluation for population-based all-in-one service screening (CASE-PASS): from study design to outcome analysis with bias adjustment.

PubMed

Chen, Li-Sheng; Yen, Amy Ming-Fang; Duffy, Stephen W; Tabar, Laszlo; Lin, Wen-Chou; Chen, Hsiu-Hsi

2010-10-01

Population-based routine service screening has gained popularity following an era of randomized controlled trials. The evaluation of these service screening programs is subject to study design, data availability, and the precise data analysis for adjusting bias. We developed a computer-aided system that allows the evaluation of population-based service screening to unify these aspects and facilitate and guide the program assessor to efficiently perform an evaluation. This system underpins two experimental designs: the posttest-only non-equivalent design and the one-group pretest-posttest design and demonstrates the type of data required at both the population and individual levels. Three major analyses were developed that included a cumulative mortality analysis, survival analysis with lead-time adjustment, and self-selection bias adjustment. We used SAS AF software to develop a graphic interface system with a pull-down menu style. We demonstrate the application of this system with data obtained from a Swedish population-based service screen and a population-based randomized controlled trial for the screening of breast, colorectal, and prostate cancer, and one service screening program for cervical cancer with Pap smears. The system provided automated descriptive results based on the various sources of available data and cumulative mortality curves corresponding to the study designs. The comparison of cumulative survival between clinically and screen-detected cases without a lead-time adjustment are also demonstrated. The intention-to-treat and noncompliance analysis with self-selection bias adjustments are also shown to assess the effectiveness of the population-based service screening program. Model validation was composed of a comparison between our adjusted self-selection bias estimates and the empirical results on effectiveness reported in the literature. We demonstrate a computer-aided system allowing the evaluation of population-based service screening programs with an adjustment for self-selection and lead-time bias. This is achieved by providing a tutorial guide from the study design to the data analysis, with bias adjustment. Copyright © 2010 Elsevier Inc. All rights reserved.

Does workplace social capital protect against long-term sickness absence? Linking workplace aggregated social capital to sickness absence registry data.

PubMed

Hansen, Anne-Sophie K; Madsen, Ida E H; Thorsen, Sannie Vester; Melkevik, Ole; Bjørner, Jakob Bue; Andersen, Ingelise; Rugulies, Reiner

2018-05-01

Most previous prospective studies have examined workplace social capital as a resource of the individual. However, literature suggests that social capital is a collective good. In the present study we examined whether a high level of workplace aggregated social capital (WASC) predicts a decreased risk of individual-level long-term sickness absence (LTSA) in Danish private sector employees. A sample of 2043 employees (aged 18-64 years, 38.5% women) from 260 Danish private-sector companies filled in a questionnaire on workplace social capital and covariates. WASC was calculated by assigning the company-averaged social capital score to all employees of each company. We derived LTSA, defined as sickness absence of more than three weeks, from a national register. We examined if WASC predicted employee LTSA using multilevel survival analyses, while excluding participants with LTSA in the three months preceding baseline. We found no statistically significant association in any of the analyses. The hazard ratio for LTSA in the fully adjusted model was 0.93 (95% CI 0.77-1.13) per one standard deviation increase in WASC. When using WASC as a categorical exposure we found a statistically non-significant tendency towards a decreased risk of LTSA in employees with medium WASC (fully adjusted model: HR 0.78 (95% CI 0.48-1.27)). Post hoc analyses with workplace social capital as a resource of the individual showed similar results. WASC did not predict LTSA in this sample of Danish private-sector employees.

A commentary on the Atlantic meridional overturning circulation stability in climate models

NASA Astrophysics Data System (ADS)

Gent, Peter R.

2018-02-01

The stability of the Atlantic meridional overturning circulation (AMOC) in ocean models depends quite strongly on the model formulation, especially the vertical mixing, and whether it is coupled to an atmosphere model. A hysteresis loop in AMOC strength with respect to freshwater forcing has been found in several intermediate complexity climate models and in one fully coupled climate model that has very coarse resolution. Over 40% of modern climate models are in a bistable AMOC state according to the very frequently used simple stability criterion which is based solely on the sign of the AMOC freshwater transport across 33° S. In a recent freshwater hosing experiment in a climate model with an eddy-permitting ocean component, the change in the gyre freshwater transport across 33° S is larger than the AMOC freshwater transport change. This casts very strong doubt on the usefulness of this simple AMOC stability criterion. If a climate model uses large surface flux adjustments, then these adjustments can interfere with the atmosphere-ocean feedbacks, and strongly change the AMOC stability properties. AMOC can be shut off for many hundreds of years in modern fully coupled climate models if the hosing or carbon dioxide forcing is strong enough. However, in one climate model the AMOC recovers after between 1000 and 1400 years. Recent 1% increasing carbon dioxide runs and RCP8.5 future scenario runs have shown that the AMOC reduction is smaller using an eddy-resolving ocean component than in the comparable standard 1° ocean climate models.

Does breast-feeding in infancy lower blood pressure in childhood? The Avon Longitudinal Study of Parents and Children (ALSPAC).

PubMed

Martin, Richard M; Ness, Andrew R; Gunnell, David; Emmett, Pauline; Davey Smith, George

2004-03-16

Breast-feeding in infancy has been associated with decreased coronary heart disease mortality, but the underlying mechanisms are unclear. We investigated the association of breast-feeding with blood pressure in a contemporary cohort. In a prospective cohort study (ALSPAC, United Kingdom), a total of 7276 singleton, term infants born in 1991 and 1992 were examined at 7.5 years. Complete data were available for 4763 children. The systolic and diastolic blood pressures of breast-fed children were 1.2 mm Hg lower (95% CI, 0.5 to 1.9) and 0.9 mm Hg lower (0.3 to 1.4), respectively, compared with children who were never breast-fed (models controlled for age, sex, room temperature, and field observer). Blood pressure differences were attenuated but remained statistically significant in fully adjusted models controlling for social, economic, maternal, and anthropometric variables (reduction in systolic blood pressure: 0.8 mm Hg [0.1 to 1.5]; reduction in diastolic blood pressure: 0.6 mm Hg [0.1 to 1.0]). Blood pressure differences were similar whether breast-feeding was partial or exclusive. We examined the effect of breast-feeding duration. In fully adjusted models, there was a 0.2-mm Hg reduction (0.0 to 0.3) in systolic pressure for each 3 months of breast-feeding. Breast-feeding is associated with a lowering of later blood pressure in children born at term. If the association is causal, the wider promotion of breast-feeding is a potential component of the public health strategy to reduce population levels of blood pressure.

Does workplace social capital protect against long-term sickness absence? Linking workplace aggregated social capital to sickness absence registry data

PubMed Central

Hansen, Anne-Sophie K.; Madsen, Ida E. H.; Thorsen, Sannie Vester; Melkevik, Ole; Bjørner, Jakob Bue; Andersen, Ingelise; Rugulies, Reiner

2017-01-01

Aims: Most previous prospective studies have examined workplace social capital as a resource of the individual. However, literature suggests that social capital is a collective good. In the present study we examined whether a high level of workplace aggregated social capital (WASC) predicts a decreased risk of individual-level long-term sickness absence (LTSA) in Danish private sector employees. Methods: A sample of 2043 employees (aged 18–64 years, 38.5% women) from 260 Danish private-sector companies filled in a questionnaire on workplace social capital and covariates. WASC was calculated by assigning the company-averaged social capital score to all employees of each company. We derived LTSA, defined as sickness absence of more than three weeks, from a national register. We examined if WASC predicted employee LTSA using multilevel survival analyses, while excluding participants with LTSA in the three months preceding baseline. Results: We found no statistically significant association in any of the analyses. The hazard ratio for LTSA in the fully adjusted model was 0.93 (95% CI 0.77–1.13) per one standard deviation increase in WASC. When using WASC as a categorical exposure we found a statistically non-significant tendency towards a decreased risk of LTSA in employees with medium WASC (fully adjusted model: HR 0.78 (95% CI 0.48–1.27)). Post hoc analyses with workplace social capital as a resource of the individual showed similar results. Conclusions: WASC did not predict LTSA in this sample of Danish private-sector employees. PMID:28784025

Effect of a community intervention programme promoting social interactions on functional disability prevention for older adults: propensity score matching and instrumental variable analyses, JAGES Taketoyo study.

PubMed

Hikichi, Hiroyuki; Kondo, Naoki; Kondo, Katsunori; Aida, Jun; Takeda, Tokunori; Kawachi, Ichiro

2015-09-01

The efficacy of promoting social interactions to improve the health of older adults is not fully established due to residual confounding and selection bias. The government of Taketoyo town, Aichi Prefecture, Japan, developed a resident-centred community intervention programme called 'community salons', providing opportunities for social interactions among local older residents. To evaluate the impact of the programme, we conducted questionnaire surveys for all older residents of Taketoyo. We carried out a baseline survey in July 2006 (prior to the introduction of the programme) and assessed the onset of functional disability during March 2012. We analysed the data of 2421 older people. In addition to the standard Cox proportional hazard regression, we conducted Cox regression with propensity score matching (PSM) and an instrumental variable (IV) analysis, using the number of community salons within a radius of 350 m from the participant's home as an instrument. In the 5 years after the first salon was launched, the salon participants showed a 6.3% lower incidence of functional disability compared with non-participants. Even adjusting for sex, age, equivalent income, educational attainment, higher level activities of daily living and depression, the Cox adjusted HR for becoming disabled was 0.49 (95% CI 0.33 to 0.72). Similar results were observed using PSM (HR 0.52, 95% CI 0.33 to 0.83) and IV-Cox analysis (HR 0.50, 95% CI 0.34 to 0.74). A community health promotion programme focused on increasing social interactions among older adults may be effective in preventing the onset of disability. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Association of Osteopontin, Neopterin, and Myeloperoxidase With Stroke Risk in Patients With Prior Stroke or Transient Ischemic Attacks: Results of an Analysis of 13 Biomarkers From the Stroke Prevention by Aggressive Reduction in Cholesterol Levels Trial.

PubMed

Ganz, Peter; Amarenco, Pierre; Goldstein, Larry B; Sillesen, Henrik; Bao, Weihang; Preston, Gregory M; Welch, K Michael A

2017-12-01

Established risk factors do not fully identify patients at risk for recurrent stroke. The SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) evaluated the effect of atorvastatin on stroke risk in patients with a recent stroke or transient ischemic attack and no known coronary heart disease. This analysis explored the relationships between 13 plasma biomarkers assessed at trial enrollment and the occurrence of outcome strokes. We conducted a case-cohort study of 2176 participants; 562 had outcome strokes and 1614 were selected randomly from those without outcome strokes. Time to stroke was evaluated by Cox proportional hazards models. There was no association between time to stroke and lipoprotein-associated phospholipase A 2 , monocyte chemoattractant protein-1, resistin, matrix metalloproteinase-9, N-terminal fragment of pro-B-type natriuretic peptide, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, or soluble CD40 ligand. In adjusted analyses, osteopontin (hazard ratio per SD change, 1.362; P <0.0001), neopterin (hazard ratio, 1.137; P =0.0107), myeloperoxidase (hazard ratio, 1.177; P =0.0022), and adiponectin (hazard ratio, 1.207; P =0.0013) were independently associated with outcome strokes. After adjustment for the Stroke Prognostic Instrument-II and treatment, osteopontin, neopterin, and myeloperoxidase remained independently associated with outcome strokes. The addition of these 3 biomarkers to Stroke Prognostic Instrument-II increased the area under the receiver operating characteristic curve by 0.023 ( P =0.015) and yielded a continuous net reclassification improvement (29.1%; P <0.0001) and an integrated discrimination improvement (42.3%; P <0.0001). Osteopontin, neopterin, and myeloperoxidase were independently associated with the risk of recurrent stroke and improved risk classification when added to a clinical risk algorithm. URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00147602. © 2017 American Heart Association, Inc.

C-reactive protein and cold-pressor tolerance in the general population: the Tromsø Study.

PubMed

Schistad, Elina Iordanova; Stubhaug, Audun; Furberg, Anne-Sofie; Engdahl, Bo Lars; Nielsen, Christopher Sivert

2017-07-01

The aim of this study was to examine whether increases in severity of subclinical inflammation, measured by high-sensitivity C-reactive protein (hs-CRP), increased experimental pain sensitivity, measured by cold-pressor tolerance, and to test whether this relationship is independent of chronic pain. A large population-based study from 2007 to 2008, the sixth Tromsø Study, provided data from 12,981 participants. For the present analysis, complete data for 10,274 participants (age: median 58 years) were available. The main outcome measure was cold-pressor tolerance, tested by placing the dominant hand in circulating cold water (3°C) for a maximum of 106 seconds. Cox proportional hazard models, treating hand withdrawal during the cold-pressor test as the event and enduring the full test time as censored data, were used to investigate the relationship between hs-CRP levels (≤3 or >3 mg/L) and cold-pressure tolerance. The fully adjusted model was controlled for age, sex, education, body mass index, smoking status, alcohol consumption, emotional distress, statin usage, and self-reported presence of chronic pain. Additional analysis was performed in participants without chronic pain. Higher levels of hs-CRP were negatively related to cold-pressor tolerance (hazard ratio [HR] = 1.24, 95% confidence interval [CI], 1.12-1.37, P < 0.001), adjusted for age and sex. This relationship remained essentially unaltered after controlling for potential confounders (HR = 1.22, 95% CI, 1.09-1.36, P < 0.001), as well as for the presence of chronic pain (HR = 1.22, 95% CI, 1.09-1.36, P < 0.001). The present data show that subclinical inflammation is related to increased pain sensitivity, suggesting a potential role of inflammation in experimental pain which may be of importance for the development of clinical pain.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walsh, Seán, E-mail: walshsharp@gmail.com; Department of Oncology, Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford OX3 7DQ; Roelofs, Erik

Purpose: A fully heterogeneous population averaged mechanistic tumor control probability (TCP) model is appropriate for the analysis of external beam radiotherapy (EBRT). This has been accomplished for EBRT photon treatment of intermediate-risk prostate cancer. Extending the TCP model for low and high-risk patients would be beneficial in terms of overall decision making. Furthermore, different radiation treatment modalities such as protons and carbon-ions are becoming increasingly available. Consequently, there is a need for a complete TCP model. Methods: A TCP model was fitted and validated to a primary endpoint of 5-year biological no evidence of disease clinical outcome data obtained frommore » a review of the literature for low, intermediate, and high-risk prostate cancer patients (5218 patients fitted, 1088 patients validated), treated by photons, protons, or carbon-ions. The review followed the preferred reporting item for systematic reviews and meta-analyses statement. Treatment regimens include standard fractionation and hypofractionation treatments. Residual analysis and goodness of fit statistics were applied. Results: The TCP model achieves a good level of fit overall, linear regression results in a p-value of <0.000 01 with an adjusted-weighted-R{sup 2} value of 0.77 and a weighted root mean squared error (wRMSE) of 1.2%, to the fitted clinical outcome data. Validation of the model utilizing three independent datasets obtained from the literature resulted in an adjusted-weighted-R{sup 2} value of 0.78 and a wRMSE of less than 1.8%, to the validation clinical outcome data. The weighted mean absolute residual across the entire dataset is found to be 5.4%. Conclusions: This TCP model fitted and validated to clinical outcome data, appears to be an appropriate model for the inclusion of all clinical prostate cancer risk categories, and allows evaluation of current EBRT modalities with regard to tumor control prediction.« less

Association of Hemoglobin A1c and Wound Healing in Diabetic Foot Ulcers.

PubMed

Fesseha, Betiel K; Abularrage, Christopher J; Hines, Kathryn F; Sherman, Ronald; Frost, Priscilla; Langan, Susan; Canner, Joseph; Likes, Kendall C; Hosseini, Sayed M; Jack, Gwendolyne; Hicks, Caitlin W; Yalamanchi, Swaytha; Mathioudakis, Nestoras

2018-04-16

This study evaluated the association between hemoglobin A 1c (A1C) and wound outcomes in patients with diabetic foot ulcers (DFUs). We conducted a retrospective analysis of an ongoing prospective, clinic-based study of patients with DFUs treated at an academic institution during a 4.7-year period. Data from 270 participants and 584 wounds were included in the analysis. Cox proportional hazards regression was used to assess the incidence of wound healing at any follow-up time in relation to categories of baseline A1C and the incidence of long-term (≥90 days) wound healing in relation to tertiles of nadir A1C change and mean A1C change from baseline, adjusted for potential confounders. Baseline A1C was not associated with wound healing in univariate or fully adjusted models. Compared with a nadir A1C change from baseline of -0.29 to 0.0 (tertile 2), a nadir A1C change of 0.09 to 2.4 (tertile 3) was positively associated with long-term wound healing in the subset of participants with baseline A1C <7.5% (hazard ratio [HR], 2.07; 95% CI, 1.08-4.00), but no association with wound healing was seen with the mean A1C change from baseline in this group. Neither nadir A1C change nor mean A1C change were associated with long-term wound healing in participants with baseline A1C ≥7.5%. There does not appear to be a clinically meaningful association between baseline or prospective A1C and wound healing in patients with DFUs. The paradoxical finding of accelerated wound healing and increase in A1C in participants with better baseline glycemic control requires confirmation in further studies. © 2018 by the American Diabetes Association.

Determining the full costs of medical education in Thai Binh, Vietnam: a generalizable model.

PubMed

Bicknell, W J; Beggs, A C; Tham, P V

2001-12-01

We summarize a model for determining the full cost of educating a medical student at Thai Binh Medical School in Vietnam. This is the first full-cost analysis of medical education in a low-income country in over 20 years. We emphasize policy implications and the importance of looking at the educational costs and service roles of the major health professions. In Vietnam fully subsidized medical education has given way to a system combining student-paid tuition and fees with decreased government subsidies. Full cost information facilitates resource management, setting tuition charges at a school and adjusting budget allocations between medical schools, teaching hospitals, and health centres. When linked to quality indicators, trends within and useful comparisons between schools are possible. Cost comparisons between different types of providers can assist policy-makers in judging the appropriateness of expenditures per graduate for nursing and allied health education versus physician education. If privatization of medical education is considered, cost analysis allows policy-makers to know the full costs of educating physicians including the subsidies required in clinical settings. Our approach is intuitively simple and provides useful, understandable new information to managers and policy-makers. The full cost per medical graduate in 1997 was 111 462 989 Vietnamese Dong (US$9527). The relative expenditure per Vietnamese physician educated was 2.8 times the expenditure in the United States when adjusted for GNP per capita. Preliminary findings suggest that, within Vietnam, the cost to educate a physician is 14 times the cost of educating a nurse. Given the direct costs of physician education, the lifetime earnings of physicians and the costs that physicians generate for the use of health services and supplies, it is remarkable that so little attention is paid to the costs of educating physicians. Studies of this type can provide the quantitative basis for vital human resource and health services policy considerations.

Pregnancy diet and offspring asthma risk over a 10-year period: the Lifeways Cross Generation Cohort Study, Ireland.

PubMed

Viljoen, Karien; Segurado, Ricardo; O'Brien, John; Murrin, Celine; Mehegan, John; Kelleher, Cecily C

2018-02-20

The association of maternal pregnancy diet with offspring asthma risk have been reported. However, literature on longitudinal patterns of asthma risk relative to intrauterine nutrient exposure is limited. We aimed to establish whether vegetable, oily fish and vitamin D intake during pregnancy are associated with childhood asthma risk over a 10-year period in the Irish Republic. Mother-child pairs (n=897) from the Lifeways prospective birth cohort, with data on nutrient intake during pregnancy and asthma status, respectively, were eligible for inclusion in the analysis. Data on socioeconomic and morbidity indicators over 10 years of follow-up on mothers and the index child were collected through self-administered questionnaires. Asthma status as diagnosed by the general practitioner at any time point over 10 years was related to maternal vegetable, oily fish and vitamin D intake during pregnancy, while adjusting for gestational age, socioeconomic status, smoking at delivery, breast feeding, season of birth and supplement use. Data were modelled with a marginal model on correlated observations over time within individuals. In the fully adjusted model, asthma was inversely associated with higher daily average intake of oily fish (OR 0.23 per serving/day, 95% CI 0.04 to 1.41) and of vegetables (OR 0.96 per serving/day, 95% CI 0.88 to 1.05), but the confidence limits overlapped 1. A higher daily vitamin D intake was associated with reduced odds of asthma (OR 0.93 per μg/day, 95% CI 0.89 to 0.98). This analysis suggests higher daily average intake of vitamin D in pregnancy is associated with asthma risk in offspring over the first 10 years of life. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Dog Ownership and Mortality in England: A Pooled Analysis of Six Population-based Cohorts.

PubMed

Ding, Ding; Bauman, Adrian E; Sherrington, Cathie; McGreevy, Paul D; Edwards, Kate M; Stamatakis, Emmanuel

2018-02-01

Dog ownership may be associated with reduced risk for cardiovascular disease. However, data are scant on the relationship between dog ownership and all-cause and cause-specific mortality risk. Data from six separate cohorts (1995-1997, 2001-2002, 2004) of the Health Survey for England were pooled and analyzed in 2017. Participants were 59,352 adults (mean age 46.5, SD=17.9 years) who consented to be linked to the National Death Registry. Living in a household with a dog was reported at baseline. Outcomes included all-cause and cardiovascular disease mortality (determined using ICD-9 codes 390-459, ICD-10 codes I01-I99). Multilevel Weibull survival analysis was used to examine the associations between dog ownership and mortality, adjusted for various sociodemographic and lifestyle variables. Potential effect modifiers, including age, sex, education, living circumstances, longstanding illness, and prior diagnosis of cardiovascular disease, were also examined. During 679,441 person-years of follow-up (mean 11.5, SD=3.8 years), 8,169 participants died from all causes and 2,451 from cardiovascular disease. In the fully adjusted models, there was no statistically significant association between dog ownership and mortality outcomes (hazard ratio=1.03, 95% CI=0.98, 1.09, for all-cause mortality; and hazard ratio=1.07, 95% CI=0.96, 1.18, for cardiovascular disease mortality) and no significant effect modification. There is no evidence for an association between living in a household with a dog and all-cause or cardiovascular disease mortality in this large sample. These results should be interpreted in light of limitations in the measurement of dog ownership and its complexity in potential long-term health implications. Future studies should measure specific aspects of ownership, such as caring responsibilities and temporality. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Systematic review of statistical approaches to quantify, or correct for, measurement error in a continuous exposure in nutritional epidemiology.

PubMed

Bennett, Derrick A; Landry, Denise; Little, Julian; Minelli, Cosetta

2017-09-19

Several statistical approaches have been proposed to assess and correct for exposure measurement error. We aimed to provide a critical overview of the most common approaches used in nutritional epidemiology. MEDLINE, EMBASE, BIOSIS and CINAHL were searched for reports published in English up to May 2016 in order to ascertain studies that described methods aimed to quantify and/or correct for measurement error for a continuous exposure in nutritional epidemiology using a calibration study. We identified 126 studies, 43 of which described statistical methods and 83 that applied any of these methods to a real dataset. The statistical approaches in the eligible studies were grouped into: a) approaches to quantify the relationship between different dietary assessment instruments and "true intake", which were mostly based on correlation analysis and the method of triads; b) approaches to adjust point and interval estimates of diet-disease associations for measurement error, mostly based on regression calibration analysis and its extensions. Two approaches (multiple imputation and moment reconstruction) were identified that can deal with differential measurement error. For regression calibration, the most common approach to correct for measurement error used in nutritional epidemiology, it is crucial to ensure that its assumptions and requirements are fully met. Analyses that investigate the impact of departures from the classical measurement error model on regression calibration estimates can be helpful to researchers in interpreting their findings. With regard to the possible use of alternative methods when regression calibration is not appropriate, the choice of method should depend on the measurement error model assumed, the availability of suitable calibration study data and the potential for bias due to violation of the classical measurement error model assumptions. On the basis of this review, we provide some practical advice for the use of methods to assess and adjust for measurement error in nutritional epidemiology.

Discriminative capacity of calcaneal quantitative ultrasound and of osteoporosis and fracture risk factors in postmenopausal women with osteoporotic fractures.

PubMed

Hernández, J L; Marin, F; González-Macías, J; Díez-Pérez, A; Vila, J; Giménez, S; Galán, B; Arenas, M S; Suárez, F; Gayola, L; Guillén, G; Sagredo, T; Belenguer, R; Moron, A; Arriaza, E

2004-04-01

Bone fragility fractures constitute the principal complication of osteoporosis. The identification of individuals at high risk of sustaining osteoporotic fractures is important for implementing preventive measures. The purpose of this study is to analyze the discriminative capacity of a series of osteoporosis and fracture risk factors, and of calcaneal quantitative ultrasound (QUS), in a population of postmenopausal women with a history of osteoporotic fracture. A cross-sectional analysis was made of a cohort of 5195 women aged 65 or older (mean +/- SD: 72.3 +/- 5.4 years) seen in 58 primary care centers in Spain. A total of 1042 women (20.1%) presented with a history of osteoporotic fracture. Most fractures (93%) were non-vertebral. Age-adjusted odds ratios corresponding to each decrease in one standard deviation of the different QUS parameters ranged from 1.47 to 1.55 (P < 0.001) for fractures. The age-adjusted multivariate analysis yielded the following risk factors independently associated with a history of osteoporotic fracture: number of fertile years, a family history of fracture, falls in the previous year, a history of chronic obstructive airway disease, the use of antiarrhythmic drugs, and a low value for any of the QUS parameters. The area under the receiver operating characteristic curve of the best model was 0.656. In summary, a series of easily assessable osteoporotic fracture risk factors has been identified. QUS was shown to discriminate between women with and without a history of fracture, and constitutes a useful tool for assessing fracture risk. Various of the vertebral and hip fracture risk factors frequently cited in North American and British populations showed no discriminative capacity in our series--thus suggesting that such factors may not be fully applicable to our population and/or to the predominant type of fractures included in the present study.

ATLAS, an integrated structural analysis and design system. Volume 6: Design module theory

NASA Technical Reports Server (NTRS)

Backman, B. F.

1979-01-01

The automated design theory underlying the operation of the ATLAS Design Module is decribed. The methods, applications and limitations associated with the fully stressed design, the thermal fully stressed design and a regional optimization algorithm are presented. A discussion of the convergence characteristics of the fully stressed design is also included. Derivations and concepts specific to the ATLAS design theory are shown, while conventional terminology and established methods are identified by references.

Cardiac patients' perceptions of neighboring patients' risk: influence on psychological stress in the ED and subsequent posttraumatic stress.

PubMed

Konrad, Beatrice; Hiti, David; Chang, Bernard P; Retuerto, Jessica; Julian, Jacob; Edmondson, Donald

2017-11-06

As many as 12% of acute coronary syndrome (ACS) patients screen positive for post-traumatic stress disorder (PTSD) symptoms due to their cardiac event, and emergency department (ED) factors such as overcrowding have been associated with risk for PTSD. We tested the association of patients' perceptions of their proximity to a critically ill patient during ED evaluation for ACS with development of posttraumatic stress symptoms (PSS) in the month after hospital discharge. Participants were enrolled in the REactions to Acute Care and Hospitalization (REACH) study during evaluation for ACS in an urban ED. Participants reported whether they perceived a patient near them was close to death. They also reported their current fear, concern they may die, perceived control, and feelings of vulnerability on an Emergency Room Perceptions questionnaire. One month later, participants reported on PTSD symptoms specific to the cardiac event and ED hospitalization. Of 763 participants, 12% reported perceiving a nearby patient was likely to die. In a multivariate linear regression model [F(9757) = 19.69, p < .001, R 2 adjusted = .18] with adjustment for age, sex, GRACE cardiac risk score, discharge ACS diagnosis, Charlson comorbidity index, objective ED crowding, and depression symptoms at baseline, perception of a nearby patients' likely death was associated with a 2.33 point (95% CI, 0.60-4.61) increase in 1 month PTSD score. A post hoc mediation analysis with personal threat perceptions [F(10,756) = 25.28, p < .001, R 2 adjusted = .24] showed increased personal threat perceptions during the ED visit, B = 0.71 points on the PCL per point on the personal threat perception questionnaire, β = 0.27, p = .001, fully mediated association of participants' perceptions of nearby patients' likely death with 1-month PTSD score (after adjustment for ED threat perceptions,) B = 0.89 (95% CI, -1.33 to 3.12), β = 0.03, p = .43, accounting for 62% of the adjusted effect and causing the main effect to become statistically nonsignificant. We found patients who perceived a nearby patient was likely to die had significantly greater PTSD symptoms at 1 month. Awareness of this association may be helpful for designing ED patient management procedures to identify and treat patients with an eye to post-ACS psychological care.

A single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure.

PubMed

Wu, Jia-Rong; DeWalt, Darren A; Baker, David W; Schillinger, Dean; Ruo, Bernice; Bibbins-Domingo, Kristen; Macabasco-O'Connell, Aurelia; Holmes, George M; Broucksou, Kimberly A; Erman, Brian; Hawk, Victoria; Cene, Crystal W; Jones, Christine DeLong; Pignone, Michael

2014-09-01

To determine whether a single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure. Poor medication adherence is associated with increased morbidity and mortality. Having a simple means of identifying suboptimal medication adherence could help identify at-risk patients for interventions. We performed a prospective cohort study in 592 participants with heart failure within a four-site randomised trial. Self-report medication adherence was assessed at baseline using a single-item question: 'Over the past seven days, how many times did you miss a dose of any of your heart medication?' Participants who reported no missing doses were defined as fully adherent, and those missing more than one dose were considered less than fully adherent. The primary outcome was combined all-cause hospitalisation or death over one year and the secondary endpoint was heart failure hospitalisation. Outcomes were assessed with blinded chart reviews, and heart failure outcomes were determined by a blinded adjudication committee. We used negative binomial regression to examine the relationship between medication adherence and outcomes. Fifty-two percent of participants were 52% male, mean age was 61 years, and 31% were of New York Heart Association class III/IV at enrolment; 72% of participants reported full adherence to their heart medicine at baseline. Participants with full medication adherence had a lower rate of all-cause hospitalisation and death (0·71 events/year) compared with those with any nonadherence (0·86 events/year): adjusted-for-site incidence rate ratio was 0·83, fully adjusted incidence rate ratio 0·68. Incidence rate ratios were similar for heart failure hospitalisations. A single medication adherence question at baseline predicts hospitalisation and death over one year in heart failure patients. Medication adherence is associated with all-cause and heart failure-related hospitalisation and death in heart failure. It is important for clinicians to assess patients' medication adherence on a regular basis at their clinical follow-ups. © 2013 John Wiley & Sons Ltd.

Adherence to a Mediterranean-style diet and incident fractures: pooled analysis of observational evidence.

PubMed

Kunutsor, Setor K; Laukkanen, Jari A; Whitehouse, Michael R; Blom, Ashley W

2018-06-01

The Mediterranean diet is associated with decreased morbidity and mortality from various chronic diseases. Adherence to a Mediterranean-style diet has been suggested to have protective effects on bone health and decreases the incidence of bone fractures, but the evidence is not clear. We conducted a systematic review and meta-analysis of available observational studies to quantify the association between adherence to a Mediterranean-style diet, as assessed by the Mediterranean Diet Score (MDS), and the risk of fractures in the general population. Relevant studies were identified in a literature search of MEDLINE, EMBASE, Web of Science, and reference lists of relevant studies to October 2016. Relative risks (RRS) with 95% confidence intervals (CIs) were aggregated using random-effects models. Five observational studies with data on 353,076 non-overlapping participants and 33,576 total fractures (including 6,881 hip fractures) were included. The pooled fully adjusted RR (95% CI) for hip fractures per 2-point increment in adherence to the MDS was 0.82 (0.71-0.96). Adherence to the MDS was not associated with the risk of any or total fractures based on pooled analysis of only two studies. Limited observational evidence supports a beneficial effect of adherence to a Mediterranean-style diet on the incidence of hip fractures. Well-designed intervention studies are needed to elucidate the relationship between adherence to a Mediterranean-style diet and the risk of adverse bone health outcomes such as fractures.

Development of a fully automated software system for rapid analysis/processing of the falling weight deflectometer data.

DOT National Transportation Integrated Search

2009-02-01

The Office of Special Investigations at Iowa Department of Transportation (DOT) collects FWD data on regular basis to evaluate pavement structural conditions. The primary objective of this study was to develop a fully-automated software system for ra...

Adjustment of Adaptive Gain with Bounded Linear Stability Analysis to Improve Time-Delay Margin for Metrics-Driven Adaptive Control

NASA Technical Reports Server (NTRS)

Bakhtiari-Nejad, Maryam; Nguyen, Nhan T.; Krishnakumar, Kalmanje Srinvas

2009-01-01

This paper presents the application of Bounded Linear Stability Analysis (BLSA) method for metrics driven adaptive control. The bounded linear stability analysis method is used for analyzing stability of adaptive control models, without linearizing the adaptive laws. Metrics-driven adaptive control introduces a notion that adaptation should be driven by some stability metrics to achieve robustness. By the application of bounded linear stability analysis method the adaptive gain is adjusted during the adaptation in order to meet certain phase margin requirements. Analysis of metrics-driven adaptive control is evaluated for a linear damaged twin-engine generic transport model of aircraft. The analysis shows that the system with the adjusted adaptive gain becomes more robust to unmodeled dynamics or time delay.

Investing in health: is social housing value for money? A cost-utility analysis.

PubMed

Lawson, K D; Kearns, A; Petticrew, M; Fenwick, E A L

2013-10-01

There is a healthy public policy agenda investigating the health impacts of improving living conditions. However, there are few economic evaluations, to date, assessing value for money. We conducted the first cost-effectiveness analysis of a nationwide intervention transferring social and private tenants to new-build social housing, in Scotland. A quasi-experimental prospective study was undertaken involving 205 intervention households and 246 comparison households, over 2 years. A cost-utility analysis assessed the average cost per change in health utility (a single score summarising overall health-related quality of life), generated via the SF-6D algorithm. Construction costs for new builds were included. Analysis was conducted for all households, and by family, adult and elderly households; with estimates adjusted for baseline confounders. Outcomes were annuitised and discounted at 3.5%. The average discounted cost was £18, 708 per household, at a national programme cost of £ 28.4 million. The average change in health utility scores in the intervention group attributable to the intervention were +0.001 for all households, +0.001 for family households, -0.04 for adult households and -0.03 for elderly households. All estimates were statistically insignificant. At face value, the interventions were not value for money in health terms. However, because the policy rationale was the amenity provision of housing for disadvantaged groups, impacts extend beyond health and may be fully realised over the long term. Before making general value-for-money inferences, economic evaluation should attempt to estimate the full social value of interventions, model long-term impacts and explicitly incorporate equity considerations.

A selection model for accounting for publication bias in a full network meta-analysis.

PubMed

Mavridis, Dimitris; Welton, Nicky J; Sutton, Alex; Salanti, Georgia

2014-12-30

Copas and Shi suggested a selection model to explore the potential impact of publication bias via sensitivity analysis based on assumptions for the probability of publication of trials conditional on the precision of their results. Chootrakool et al. extended this model to three-arm trials but did not fully account for the implications of the consistency assumption, and their model is difficult to generalize for complex network structures with more than three treatments. Fitting these selection models within a frequentist setting requires maximization of a complex likelihood function, and identification problems are common. We have previously presented a Bayesian implementation of the selection model when multiple treatments are compared with a common reference treatment. We now present a general model suitable for complex, full network meta-analysis that accounts for consistency when adjusting results for publication bias. We developed a design-by-treatment selection model to describe the mechanism by which studies with different designs (sets of treatments compared in a trial) and precision may be selected for publication. We fit the model in a Bayesian setting because it avoids the numerical problems encountered in the frequentist setting, it is generalizable with respect to the number of treatments and study arms, and it provides a flexible framework for sensitivity analysis using external knowledge. Our model accounts for the additional uncertainty arising from publication bias more successfully compared to the standard Copas model or its previous extensions. We illustrate the methodology using a published triangular network for the failure of vascular graft or arterial patency. Copyright © 2014 John Wiley & Sons, Ltd.

The Integrated Taxonomy of Health Care: Classifying Both Complementary and Biomedical Practices Using a Uniform Classification Protocol

PubMed Central

Porcino, Antony; MacDougall, Colleen

2009-01-01

Background: Since the late 1980s, several taxonomies have been developed to help map and describe the interrelationships of complementary and alternative medicine (CAM) modalities. In these taxonomies, several issues are often incompletely addressed: A simple categorization process that clearly isolates a modality to a single conceptual categoryClear delineation of verticality—that is, a differentiation of scale being observed from individually applied techniques, through modalities (therapies), to whole medical systemsRecognition of CAM as part of the general field of health care Methods: Development of the Integrated Taxonomy of Health Care (ITHC) involved three stages: Development of a precise, uniform health glossaryAnalysis of the extant taxonomiesUse of an iterative process of classifying modalities and medical systems into categories until a failure to singularly classify a modality occurred, requiring a return to the glossary and adjustment of the classifying protocol Results: A full vertical taxonomy was developed that includes and clearly differentiates between techniques, modalities, domains (clusters of similar modalities), systems of health care (coordinated care system involving multiple modalities), and integrative health care. Domains are the classical primary focus of taxonomies. The ITHC has eleven domains: chemical/substance-based work, device-based work, soft tissue–focused manipulation, skeletal manipulation, fitness/movement instruction, mind–body integration/classical somatics work, mental/emotional–based work, bio-energy work based on physical manipulation, bio-energy modulation, spiritual-based work, unique assessments. Modalities are assigned to the domains based on the primary mode of interaction with the client, according the literature of the practitioners. Conclusions: The ITHC has several strengths: little interpretation is used while successfully assigning modalities to single domains; the issue of taxonomic verticality is fully resolved; and the design fully integrates the complementary health care fields of biomedicine and CAM. PMID:21589735

PANDA: a pipeline toolbox for analyzing brain diffusion images.

PubMed

Cui, Zaixu; Zhong, Suyu; Xu, Pengfei; He, Yong; Gong, Gaolang

2013-01-01

Diffusion magnetic resonance imaging (dMRI) is widely used in both scientific research and clinical practice in in-vivo studies of the human brain. While a number of post-processing packages have been developed, fully automated processing of dMRI datasets remains challenging. Here, we developed a MATLAB toolbox named "Pipeline for Analyzing braiN Diffusion imAges" (PANDA) for fully automated processing of brain diffusion images. The processing modules of a few established packages, including FMRIB Software Library (FSL), Pipeline System for Octave and Matlab (PSOM), Diffusion Toolkit and MRIcron, were employed in PANDA. Using any number of raw dMRI datasets from different subjects, in either DICOM or NIfTI format, PANDA can automatically perform a series of steps to process DICOM/NIfTI to diffusion metrics [e.g., fractional anisotropy (FA) and mean diffusivity (MD)] that are ready for statistical analysis at the voxel-level, the atlas-level and the Tract-Based Spatial Statistics (TBSS)-level and can finish the construction of anatomical brain networks for all subjects. In particular, PANDA can process different subjects in parallel, using multiple cores either in a single computer or in a distributed computing environment, thus greatly reducing the time cost when dealing with a large number of datasets. In addition, PANDA has a friendly graphical user interface (GUI), allowing the user to be interactive and to adjust the input/output settings, as well as the processing parameters. As an open-source package, PANDA is freely available at http://www.nitrc.org/projects/panda/. This novel toolbox is expected to substantially simplify the image processing of dMRI datasets and facilitate human structural connectome studies.

PANDA: a pipeline toolbox for analyzing brain diffusion images

PubMed Central

Cui, Zaixu; Zhong, Suyu; Xu, Pengfei; He, Yong; Gong, Gaolang

2013-01-01

Diffusion magnetic resonance imaging (dMRI) is widely used in both scientific research and clinical practice in in-vivo studies of the human brain. While a number of post-processing packages have been developed, fully automated processing of dMRI datasets remains challenging. Here, we developed a MATLAB toolbox named “Pipeline for Analyzing braiN Diffusion imAges” (PANDA) for fully automated processing of brain diffusion images. The processing modules of a few established packages, including FMRIB Software Library (FSL), Pipeline System for Octave and Matlab (PSOM), Diffusion Toolkit and MRIcron, were employed in PANDA. Using any number of raw dMRI datasets from different subjects, in either DICOM or NIfTI format, PANDA can automatically perform a series of steps to process DICOM/NIfTI to diffusion metrics [e.g., fractional anisotropy (FA) and mean diffusivity (MD)] that are ready for statistical analysis at the voxel-level, the atlas-level and the Tract-Based Spatial Statistics (TBSS)-level and can finish the construction of anatomical brain networks for all subjects. In particular, PANDA can process different subjects in parallel, using multiple cores either in a single computer or in a distributed computing environment, thus greatly reducing the time cost when dealing with a large number of datasets. In addition, PANDA has a friendly graphical user interface (GUI), allowing the user to be interactive and to adjust the input/output settings, as well as the processing parameters. As an open-source package, PANDA is freely available at http://www.nitrc.org/projects/panda/. This novel toolbox is expected to substantially simplify the image processing of dMRI datasets and facilitate human structural connectome studies. PMID:23439846

Are integrated HIV services less stigmatizing than stand-alone models of care? A comparative case study from Swaziland

PubMed Central

Church, Kathryn; Wringe, Alison; Fakudze, Phelele; Kikuvi, Joshua; Simelane, Dudu; Mayhew, Susannah H

2013-01-01

Introduction Integrating HIV with primary health services has the potential to reduce HIV-related stigma through delivering care in settings disassociated with HIV. This study investigated the relationship between integrated care and felt stigma. The study design was a comparative case study of four models of HIV care in Swaziland, ranging from fully integrated to fully stand-alone HIV care. Methods An exit survey (N=602) measured differences in felt stigma across model of care; the primary outcome “perception of HIV status exposure through clinic attendance” was analyzed using multivariable logistic regression. In-depth interviews (N=22) explored whether and how measured differences in stigma experiences were related to service integration. Results There were significant differences in perceived status exposure across models of care. After adjustment for potential confounding between sites, those at a partially integrated site and a partially stand-alone site had greater odds of perceived status exposure than those at the fully stand-alone site (aOR 3.33, 95% CI 1.98–5.60; and aOR 11.84, 95% CI 6.89–20.36, respectively). There was no difference between the fully stand-alone and the fully integrated clinic. Qualitative data suggested that many clients at HIV-only sites felt greater confidentiality knowing that those around them were positive, and support was gained from other HIV care clients. Confidentiality was maintained in various ways, even in stand-alone sites, through separate waiting areas for HIV testing and HIV treatment, and careful clinic and room labelling. Conclusions The relationship between model of care and stigma was complex, and the hypothesis that stigma is higher at stand-alone sites did not hold true in this high prevalence setting. Policy-makers should ensure that service integration does not increase stigma, in particular within partially integrated models of care. PMID:23336726

[Pertussis in fully vaccinated infants and children. Are new vaccination strategies required?].

PubMed

Moraga-Llop, Fernando A; Mendoza-Palomar, Natàlia; Muntaner-Alonso, Antoni; Codina-Grau, Gemma; Fàbregas-Martori, Anna; Campins-Martí, Magda

2014-04-01

To analyse the vaccination status of children diagnosed with pertussis and to compare the clinical manifestations of fully vaccinated with unvaccinated, or incompletely-vaccinated, children. The clinical histories and vaccination cards of patients under 16years of age seen in the Emergency Room of the University Hospital Vall d'Hebron, Barcelona (Spain), for pertussis confirmed by a microbiological study were reviewed. The study period lasted from January 1, 2009 to December 31, 2011. Two hundred and twelve cases were studied: 35 in 2009, 28 in 2010 and 149 in 2011. RT-PCR was positive in 210 patients, and 73 had a positive culture. Infants under 6months of age account for 36.8% of all cases. Forty-four patients (21.5%) were not vaccinated. Forty-four (21.5%) children were between 2 and 5months of age and had received 1-2vaccine doses. One hundred and seventeen (57%) children were fully vaccinated; 76.9% (90cases) had received the last dose less than 4years ago. When clinical manifestations of the fully vaccinated patients were compared with those of the non-vaccinated or incompletely-vaccinated children, only cyanosis was found with a higher frequency in the latter group (P<.001). The age-adjusted probability of hospitalisation was significantly associated with non-vaccination (P=.001). The case mortality rate among inpatients was 1.3%. The number of pertussis cases seen in our centre has risen significantly in the last year. More than half (57%) of the patients were fully vaccinated, and 76.9% had received the last dose in the previous 4years. Other vaccination strategies, such as vaccination of adolescents, adults, and pregnant women, as well as a cocoon strategy are required to protect infants under 6months of age. More effective vaccines need to be developed. Copyright © 2012 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Variation in birth outcomes by mother's country of birth among non-Hispanic black women in the United States.

PubMed

Elo, Irma T; Vang, Zoua; Culhane, Jennifer F

2014-12-01

Rates of prematurity (PTB) and small-for-gestational age (SGA) were compared between US-born and foreign-born non-Hispanic black women. Comparisons were also made between Sub-Saharan African-born and Caribbean-born black women and by maternal country of birth within the two regions. Comparisons were adjusted for sociodemographic, health behavioral and medical risk factors available on the birth record. Birth record data (2008) from all states (n = 27) where mother's country of birth was recorded were used. These data comprised 58 % of all singleton births to non-Hispanic black women in that year. Pearson Chi square and logistic regression were used to investigate variation in the rates of PTB and SGA by maternal nativity. Foreign-born non-Hispanic black women had significantly lower rates of PTB (OR 0.727; CI 0. 726, 0.727) and SGA (OR 0.742; CI 0.739-0.745) compared to US-born non-Hispanic black women in a fully adjusted model. Sub-Saharan African-born black women compared to Caribbean-born black women had significantly lower rates of PTB and SGA. Within each region, the rates of PTB and SGA varied by mother's country of birth. These differences could not be explained by adjustment for known risk factors obtained from vital records. Considerable heterogeneity in rates of PTB and SGA among non-Hispanic black women in the US by maternal nativity was documented and remained unexplained after adjustment for known risk factors.

Experimental Study of Combined Forced and Free Laminar Convection in a Vertical Tube

NASA Technical Reports Server (NTRS)

Hallman, Theodore M.

1961-01-01

An apparatus was built to verify an analysis of combined forced and free convection in a vertical tube with uniform wall heat flux and to determine the limits of the analysis. The test section was electrically heated by resistance heating of the tube wall and was instrumented with thermocouples in such a way that detailed thermal entrance heat-transfer coefficients could be obtained for both upflow and downflow and any asymmetry in wall temperature could be detected. The experiments showed that fully developed heat-transfer results, predicted by a previous analysis, were confirmed over the range of Rayleigh numbers investigated. The concept of "locally fully developed" heat transfer was established. This concept involves the assumption that the fully developed heat-transfer analysis can be applied locally even though the Rayleigh number is varying along the tube because of physical-property variations with temperature. Thermal entrance region data were obtained for pure forced convection and for combined forced and free convection. The analysis of laminar pure forced convection in the thermal entrance region conducted by Siegel, Sparrow, and Hallman was experimentally confirmed. A transition to an eddy motion, indicated by a fluctuation in wall temperature was found in many of the upflow runs. A stability correlation was found. The fully developed Nusselt numbers in downflow were below those for pure forced convection but fell about 10 percent above the analytical curve. Quite large circumferential variations in wall temperature were observed in downflow as compaired with those encountered in upflow, and the fully developed Nussalt numbers reported are based on average wall temperatures determined by averaging the readings of two diametrically opposite wall thermocouples at each axial position. With larger heating rates in downflow the wall temperature distributions strongly suggested a cell flow near the bottom. At still larger heating rates the wall temperatures varied in a periodic way.

SU-C-201-04: Quantification of Perfusion Heterogeneity Based On Texture Analysis for Fully Automatic Detection of Ischemic Deficits From Myocardial Perfusion Imaging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fang, Y; Huang, H; Su, T

Purpose: Texture-based quantification of image heterogeneity has been a popular topic for imaging studies in recent years. As previous studies mainly focus on oncological applications, we report our recent efforts of applying such techniques on cardiac perfusion imaging. A fully automated procedure has been developed to perform texture analysis for measuring the image heterogeneity. Clinical data were used to evaluate the preliminary performance of such methods. Methods: Myocardial perfusion images of Thallium-201 scans were collected from 293 patients with suspected coronary artery disease. Each subject underwent a Tl-201 scan and a percutaneous coronary intervention (PCI) within three months. The PCImore » Result was used as the gold standard of coronary ischemia of more than 70% stenosis. Each Tl-201 scan was spatially normalized to an image template for fully automatic segmentation of the LV. The segmented voxel intensities were then carried into the texture analysis with our open-source software Chang Gung Image Texture Analysis toolbox (CGITA). To evaluate the clinical performance of the image heterogeneity for detecting the coronary stenosis, receiver operating characteristic (ROC) analysis was used to compute the overall accuracy, sensitivity and specificity as well as the area under curve (AUC). Those indices were compared to those obtained from the commercially available semi-automatic software QPS. Results: With the fully automatic procedure to quantify heterogeneity from Tl-201 scans, we were able to achieve a good discrimination with good accuracy (74%), sensitivity (73%), specificity (77%) and AUC of 0.82. Such performance is similar to those obtained from the semi-automatic QPS software that gives a sensitivity of 71% and specificity of 77%. Conclusion: Based on fully automatic procedures of data processing, our preliminary data indicate that the image heterogeneity of myocardial perfusion imaging can provide useful information for automatic determination of the myocardial ischemia.« less

Meta-analyzing dependent correlations: an SPSS macro and an R script.

PubMed

Cheung, Shu Fai; Chan, Darius K-S

2014-06-01

The presence of dependent correlation is a common problem in meta-analysis. Cheung and Chan (2004, 2008) have shown that samplewise-adjusted procedures perform better than the more commonly adopted simple within-sample mean procedures. However, samplewise-adjusted procedures have rarely been applied in meta-analytic reviews, probably due to the lack of suitable ready-to-use programs. In this article, we compare the samplewise-adjusted procedures with existing procedures to handle dependent effect sizes, and present the samplewise-adjusted procedures in a way that will make them more accessible to researchers conducting meta-analysis. We also introduce two tools, an SPSS macro and an R script, that researchers can apply to their meta-analyses; these tools are compatible with existing meta-analysis software packages.

Association between Arsenic Exposure from Drinking Water and Longitudinal Change in Blood Pressure among HEALS Cohort Participants.

PubMed

Jiang, Jieying; Liu, Mengling; Parvez, Faruque; Wang, Binhuan; Wu, Fen; Eunus, Mahbub; Bangalore, Sripal; Newman, Jonathan D; Ahmed, Alauddin; Islam, Tariqul; Rakibuz-Zaman, Muhammad; Hasan, Rabiul; Sarwar, Golam; Levy, Diane; Slavkovich, Vesna; Argos, Maria; Scannell Bryan, Molly; Farzan, Shohreh F; Hayes, Richard B; Graziano, Joseph H; Ahsan, Habibul; Chen, Yu

2015-08-01

Cross-sectional studies have shown associations between arsenic exposure and prevalence of high blood pressure; however, studies examining the relationship of arsenic exposure with longitudinal changes in blood pressure are lacking. We evaluated associations of arsenic exposure in relation to longitudinal change in blood pressure in 10,853 participants in the Health Effects of Arsenic Longitudinal Study (HEALS). Arsenic was measured in well water and in urine samples at baseline and in urine samples every 2 years after baseline. Mixed-effect models were used to estimate the association of baseline well and urinary creatinine-adjusted arsenic with annual change in blood pressure during follow-up (median, 6.7 years). In the HEALS population, the median water arsenic concentration at baseline was 62 μg/L. Individuals in the highest quartile of baseline water arsenic or urinary creatinine-adjusted arsenic had a greater annual increase in systolic blood pressure compared with those in the reference group (β = 0.48 mmHg/year; 95% CI: 0.35, 0.61, and β = 0.43 mmHg/year; 95% CI: 0.29, 0.56 for water arsenic and urinary creatinine-adjusted arsenic, respectively) in fully adjusted models. Likewise, individuals in the highest quartile of baseline arsenic exposure had a greater annual increase in diastolic blood pressure for water arsenic and urinary creatinine-adjusted arsenic, (β = 0.39 mmHg/year; 95% CI: 0.30, 0.49, and β = 0.45 mmHg/year; 95% CI: 0.36, 0.55, respectively) compared with those in the lowest quartile. Our findings suggest that long-term arsenic exposure may accelerate age-related increases in blood pressure. These findings may help explain associations between arsenic exposure and cardiovascular disease.

Stroke outcomes measures must be appropriately risk adjusted to ensure quality care of patients: a presidential advisory from the American Heart Association/American Stroke Association.

PubMed

Fonarow, Gregg C; Alberts, Mark J; Broderick, Joseph P; Jauch, Edward C; Kleindorfer, Dawn O; Saver, Jeffrey L; Solis, Penelope; Suter, Robert; Schwamm, Lee H

2014-05-01

Because stroke is among the leading causes of death, disability, hospitalizations, and healthcare expenditures in the United States, there is interest in reporting outcomes for patients hospitalized with acute ischemic stroke. The American Heart Association/American Stroke Association, as part of its commitment to promote high-quality, evidence-based care for cardiovascular and stroke patients, fully supports the development of properly risk-adjusted outcome measures for stroke. To accurately assess and report hospital-level outcomes, adequate risk adjustment for case mix is essential. During the development of the Centers for Medicare & Medicaid Services 30-day stroke mortality and 30-day stroke readmission measures, concerns were expressed that these measures were not adequately designed because they do not include a valid initial stroke severity measure, such as the National Institutes of Health Stroke Scale. These outcome measures, as currently constructed, may be prone to mischaracterizing the quality of stroke care being delivered by hospitals and may ultimately harm acute ischemic stroke patients. This article details (1) why the Centers for Medicare & Medicaid Services acute ischemic stroke outcome measures in their present form may not provide adequate risk adjustment, (2) why the measures as currently designed may lead to inaccurate representation of hospital performance and have the potential for serious unintended consequences, (3) what activities the American Heart Association/American Stroke Association has engaged in to highlight these concerns to the Centers for Medicare & Medicaid Services and other interested parties, and (4) alternative approaches and opportunities that should be considered for more accurately risk-adjusting 30-day outcomes measures in patients with ischemic stroke.

Associations of serum LDL particle concentration with carotid intima-media thickness and coronary artery calcification.

PubMed

Zaid, Maryam; Miura, Katsuyuki; Fujiyoshi, Akira; Abbott, Robert D; Hisamatsu, Takashi; Kadota, Aya; Arima, Hisatomi; Kadowaki, Sayaka; Torii, Sayuki; Miyagawa, Naoko; Suzuki, Sentaro; Takashima, Naoyuki; Ohkubo, Takayoshi; Sekikawa, Akira; Maegawa, Hiroshi; Horie, Minoru; Nakamura, Yasuyuki; Okamura, Tomonori; Ueshima, Hirotsugu

2016-01-01

Low-density lipoprotein particle (LDL-P) has recently been found to be a stronger predictor of cardiovascular disease (CVD) than LDL-cholesterol (LDL-C). Whether LDL-P is associated with subclinical atherosclerosis, independent of LDL-C, as well as other lipid measures has not been fully examined. We aimed to analyze LDL-P associations with measures of subclinical atherosclerosis. We examined 870 Japanese men randomly selected from Kusatsu City, Shiga, Japan, aged 40-79 years from 2006-2008, free of clinical CVD and not using lipid-lowering medication. Cross-sectional associations of lipid measures with carotid intima-media thickness (cIMT) and coronary artery calcification (CAC; >0 Agatston score) were examined. LDL-P was significantly positively associated with cIMT and maintained this association after adjustments for LDL-C and other lipid measures. Although these lipid measures were positively associated with cIMT, model adjustment for LDL-P removed any significant relationships. Higher LDL-P was associated with a significantly higher odds ratio of CAC and further adjustment for LDL-C did not affect this relationship. In contrast, the LDL-C association with CAC was no longer significant after adjustment for LDL-P. Other lipid measures attenuated associations of LDL-P with CAC. Likewise, associations of these measures with CAC were attenuated when model adjustments for LDL-P were made. In a community-based sample of Japanese men, free of clinical CVD, LDL-P was a robust marker for subclinical atherosclerosis, independent of LDL-C and other lipid measures. Associations of LDL-C and other lipid measures with either cIMT or CAC were generally not independent of LDL-P. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Does equality legislation reduce intergroup differences? Religious affiliation, socio-economic status and mortality in Scotland and Northern Ireland: A cohort study of 400,000 people.

PubMed

Wright, David M; Rosato, Michael; Raab, Gillian; Dibben, Chris; Boyle, Paul; O'Reilly, Dermot

2017-05-01

Religion frequently indicates membership of socio-ethnic groups with distinct health behaviours and mortality risk. Determining the extent to which interactions between groups contribute to variation in mortality is often challenging. We compared socio-economic status (SES) and mortality rates of Protestants and Catholics in Scotland and Northern Ireland, regions in which interactions between groups are profoundly different. Crucially, strong equality legislation has been in place for much longer and Catholics form a larger minority in Northern Ireland. Drawing linked Census returns and mortality records of 404,703 people from the Scottish and Northern Ireland Longitudinal Studies, we used Poisson regression to compare religious groups, estimating mortality rates and incidence rate ratios. We fitted age-adjusted and fully adjusted (for education, housing tenure, car access and social class) models. Catholics had lower SES than Protestants in both countries; the differential was larger in Scotland for education, housing tenure and car access but not social class. In Scotland, Catholics had increased age-adjusted mortality risk relative to Protestants but variation among groups was attenuated following adjustment for SES. Those reporting no religious affiliation were at similar mortality risk to Protestants. In Northern Ireland, there was no mortality differential between Catholics and Protestants either before or after adjustment. Men reporting no religious affiliation were at increased mortality risk but this differential was not evident among women. In Scotland, Catholics remained at greater socio-economic disadvantage relative to Protestants than in Northern Ireland and were also at a mortality disadvantage. This may be due to a lack of explicit equality legislation that has decreased inequality by religion in Northern Ireland during recent decades. Copyright © 2017 Elsevier Ltd. All rights reserved.

Neuropathy and presence of emotional distress and depression in longstanding diabetes: Results from the Canadian study of longevity in type 1 diabetes.

PubMed

Bai, Johnny-Wei; Lovblom, Leif E; Cardinez, Marina; Weisman, Alanna; Farooqi, Mohammed A; Halpern, Elise M; Boulet, Genevieve; Eldelekli, Devrim; Lovshin, Julie A; Lytvyn, Yuliya; Keenan, Hillary A; Brent, Michael H; Paul, Narinder; Bril, Vera; Cherney, David Z I; Perkins, Bruce A

2017-08-01

To determine the association of neuropathy and other complications with emotional distress and depression among patients with longstanding type 1 diabetes (T1DM). Canadians with ≥50years of T1DM completed a questionnaire including assessment of distress and depression by the Problem Areas in Diabetes Scale (PAID) and Geriatric Depression Scale (GDS), respectively. Complications were determined using the Michigan Neuropathy Screening Instrument (Questionnaire Component), fundoscopy reports, renal function tests, and self-reported peripheral-(PVD) and cardiovascular (CVD) disease. Associations were analyzed by Poisson regression. Among 323 participants, 137 (42.4%) had neuropathy, 113 (36.5%) nephropathy, 207 (69.5%) retinopathy, 95 (29.4%) CVD, and 31 (9.8%) PVD. The neuropathy subgroup had higher prevalence of distress (13 (9.5%) vs. 6 (3.3%), p=0.029) and depression (34 (24.9%) vs. 12 (6.5%), p<0.001). Adjusting for diabetes complications, neuropathy was associated with higher PAID (adjusted RR 1.44 (95% CI 1.14-1.82), p=0.003) and GDS scores (adjusted RR1.57 (1.18-2.11), p=0.002). Independent of potential confounders, neuropathy remained associated with higher PAID (adjusted RR 1.39 (1.10-1.76), p=0.006) and GDS scores (adjusted RR 1.37 (1.03-1.83), p=0.032). Associations with neuropathy were not fully explained by neuropathic pain. Compared to other complications, neuropathy had the greatest association with distress and depression in longstanding T1DM, independent of pain. Strategies beyond pain management are needed to improve quality of life in diabetic neuropathy. Copyright © 2017. Published by Elsevier Inc.

Dialysate Sodium Concentration and the Association with Interdialytic Weight Gain, Hospitalization, and Mortality

PubMed Central

Hecking, Manfred; Karaboyas, Angelo; Saran, Rajiv; Sen, Ananda; Inaba, Masaaki; Rayner, Hugh; Hörl, Walter H.; Pisoni, Ronald L.; Robinson, Bruce M.; Sunder-Plassmann, Gere; Port, Friedrich K.

2012-01-01

Summary Background and objectives Recommendations to decrease the dialysate sodium (DNa) prescription demand analyses of patient outcomes. We analyzed morbidity and mortality at various levels of DNa, simultaneously accounting for interdialytic weight gain (IDWG) and for the mortality risk associated with lower predialysis serum sodium (SNa) levels. Design, setting, participants, & measurements We used multiply-adjusted linear mixed models to evaluate the magnitude of IDWG and Cox proportional hazards models to assess hospitalizations and deaths in 29,593 patients from the Dialysis Outcomes and Practice Patterns Study with baseline DNa and SNa as predictors, categorized according to lowest to highest levels. Results IDWG increased with higher DNa across all SNa categories, by 0.17% of body weight per 2 mEq/L higher DNa; however, higher DNa was not associated with higher mortality in a fully adjusted model (also adjusted for SNa; hazard ratio [HR]=0.98 per 2 mEq/L higher DNa, 95% confidence interval [CI] 0.95–1.02). Instead, higher DNa was associated with lower hospitalization risk (HR=0.97 per 2 mEq/L higher DNa, 95% CI 0.95–1.00, P=0.04). Additional adjustments for IDWG did not change these results. In sensitivity analyses restricted to study facilities, in which 90%–100% of patients have the same DNa (56%), the adjusted HR for mortality was 0.88 per 2 mEq/L higher DNa (95% CI 0.83–0.94). These analyses represented a pseudo-randomized experiment in which the association between DNa and mortality is unlikely to have been confounded by indication. Conclusions In the absence of randomized prospective studies, the benefit of reducing IDWG by decreasing DNa prescriptions should be carefully weighed against an increased risk for adverse outcomes. PMID:22052942

Carotid arterial wall characteristics are associated with incident ischemic stroke but not coronary heart disease in the ARIC Study

PubMed Central

Yang, Eric Y.; Chambless, Lloyd; Sharrett, A. Richey; Virani, Salim S.; Liu, Xiaoxi; Tang, Zhengzheng; Boerwinkle, Eric; Ballantyne, Christie M.; Nambi, Vijay

2011-01-01

Background and Purpose Ultrasound measurements of arterial stiffness are associated with atherosclerosis risk factors, but limited data exist on their association with incident cardiovascular events. We evaluated the association of carotid ultrasound derived arterial stiffness measures with incident coronary heart disease (CHD) and ischemic stroke in the ARIC study. Methods Carotid arterial strain (CAS) and compliance (AC), distensibility (AD) and stiffness indices (SI), pressure-strain (Ep) and Young’s elastic moduli (YEM) were measured in 10,407 individuals using ultrasound. Hazard ratios for incident CHD (myocardial infarction [MI], fatal CHD, coronary revascularization) and stroke in minimally adjusted (age, sex, center, race) and fully adjusted models (minimally adjusted model + diabetes, height, weight, total cholesterol, high-density lipoprotein cholesterol, tobacco use, systolic blood pressure, antihypertensive medication use, and carotid intima-media thickness (CIMT) were calculated. Results The mean age was 55.3 years. Over a mean follow up of 13.8 years, 1,267 incident CHD and 383 ischemic stroke events occurred. After full adjustment for risk factors and CIMT, all arterial stiffness parameters [CAS HR (95% confidence interval [CI]) =1.14 (1.02, 1.28); AD HR=1.19 (1.02, 1.39); SI HR=1.14 (1.04, 1.25); Ep HR=1.17 (1.06, 1.28); YEM HR=1.13 (1.03, 1.24)], except arterial compliance HR=1.02 (0.90, 1.16), were significantly associated with incident stroke but not with CHD. Conclusions After adjusting for cardiovascular risk factors, ultrasound measures of carotid arterial stiffness are associated with incident ischemic stroke but not incident CHD events, despite that the 2 outcomes sharing similar risk factors. PMID:22033999

Do repeated risk factor measurements influence the impact of education on cardiovascular mortality?

PubMed

Ariansen, Inger; Graff-Iversen, Sidsel; Stigum, Hein; Strand, Bjørn Heine; Wills, Andrew K; Næss, Øyvind

2015-12-01

It has been questioned if the excess cardiovascular disease (CVD) mortality by lower educational level can be fully explained by conventional modifiable CVD risk factors. Our objective was to examine whether repeated measures over time of risk factors (smoking, physical inactivity, blood pressure, total cholesterol and body mass index) explain more of the socioeconomic gradient in CVD mortality than if they are measured only once. A cohort of 34 884 men and women attended all three screenings (1974-1978, 1977-1983 and 1985-1988) in the Norwegian Counties Study and were followed for CVD mortality through 2009 by linkage to the Norwegian Cause of Death Registry. Age-adjusted and sex-adjusted HR of CVD mortality was 2.32 (95% CI 1.93 to 2.80) for basic relative to tertiary educated individuals. The HR was attenuated by 48% (HR 1.54 (1.28 to 1.87)) when adjusted for CVD risk factors measured at baseline and by 56% (HR 1.45 (1.20 to 1.75)) when two repeated measurements ascertained 5 years apart were added to the model. Similarly, absolute risk difference in CVD mortality by education was attenuated by 62% when adjusted for baseline and by 72% when adjusted for repeated measurements of risk factors. In this cohort, repeated measurements of risk factors seemed to explain more of the educational gradient in CVD mortality. This suggests that a substantial part of the excess CVD mortality among those with lower education might be explained by conventional risk factors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Dynamic integral imaging technology for 3D applications (Conference Presentation)

NASA Astrophysics Data System (ADS)

Huang, Yi-Pai; Javidi, Bahram; Martínez-Corral, Manuel; Shieh, Han-Ping D.; Jen, Tai-Hsiang; Hsieh, Po-Yuan; Hassanfiroozi, Amir

2017-05-01

Depth and resolution are always the trade-off in integral imaging technology. With the dynamic adjustable devices, the two factors of integral imaging can be fully compensated with time-multiplexed addressing. Those dynamic devices can be mechanical or electrical driven. In this presentation, we will mainly focused on discussing various Liquid Crystal devices which can change the focal length, scan and shift the image position, or switched in between 2D/3D mode. By using the Liquid Crystal devices, dynamic integral imaging have been successfully applied on 3D Display, capturing, and bio-imaging applications.

Aggregate age-at-marriage patterns from individual mate-search heuristics.

PubMed

Todd, Peter M; Billari, Francesco C; Simão, Jorge

2005-08-01

The distribution of age at first marriage shows well-known strong regularities across many countries and recent historical periods. We accounted for these patterns by developing agent-based models that simulate the aggregate behavior of individuals who are searching for marriage partners. Past models assumed fully rational agents with complete knowledge of the marriage market; our simulated agents used psychologically plausible simple heuristic mate search rules that adjust aspiration levels on the basis of a sequence of encounters with potential partners. Substantial individual variation must be included in the models to account for the demographically observed age-at-marriage patterns.

Effects of alignment layer thickness on the pretilt angle of liquid crystals

NASA Astrophysics Data System (ADS)

Son, Jong-Ho; Zin, Wang-Cheol

2010-12-01

Mixture solutions of vertical- and planar-aligning polyimide precursors were coated on bare glass. The concentrations of the solutions were varied to control the thicknesses of the films. The resulting blend films were baked to induce imidization and then rubbed. The thicknesses (t) of the blend film and of the pure vertical-alignment film affected their surface energies; the pretilt angle can be fully controlled in the range 5.5°≤Θ0≤87° by adjusting t. The surface energy of pure planar-alignment layers was independent of t.

High-power ultrashort fiber laser for solar cells micromachining

NASA Astrophysics Data System (ADS)

Lecourt, J.-B.; Duterte, C.; Liegeois, F.; Lekime, D.; Hernandez, Y.; Giannone, D.

2012-02-01

We report on a high-power ultra-short fiber laser for thin film solar cells micromachining. The laser is based on Chirped Pulse Amplification (CPA) scheme. The pulses are stretched to hundreds of picoseconds prior to amplification and can be compressed down to picosecond at high energy. The repetition rate is adjustable from 100 kHz to 1 MHz and the optical average output power is close to 13 W (before compression). The whole setup is fully fibred, except the compressor achieved with bulk gratings, resulting on a compact and reliable solution for cold ablation.

Behavioral adjustment of siblings of children with autism engaged in applied behavior analysis early intervention programs: the moderating role of social support.

PubMed

Hastings, Richard P

2003-04-01

There have been few studies of the impact of intensive home-based early applied behavior analysis (ABA) intervention for children with autism on family functioning. In the present study, behavioral adjustment was explored in 78 siblings of children with autism on ABA programs. First, mothers' ratings of sibling adjustment were compared to a normative sample. There were no reported increases in behavioral adjustment problems in the present sample. Second, regression analyses revealed that social support functioned as a moderator of the impact of autism severity on sibling adjustment rather than a mediator or compensatory variable. In particular, siblings in families with a less severely autistic child had fewer adjustment problems when more formal social support was also available to the family. The implications of these data for future research and for practice are discussed.

Numerical and experimental analysis of a ducted propeller designed by a fully automated optimization process under open water condition

NASA Astrophysics Data System (ADS)

Yu, Long; Druckenbrod, Markus; Greve, Martin; Wang, Ke-qi; Abdel-Maksoud, Moustafa

2015-10-01

A fully automated optimization process is provided for the design of ducted propellers under open water conditions, including 3D geometry modeling, meshing, optimization algorithm and CFD analysis techniques. The developed process allows the direct integration of a RANSE solver in the design stage. A practical ducted propeller design case study is carried out for validation. Numerical simulations and open water tests are fulfilled and proved that the optimum ducted propeller improves hydrodynamic performance as predicted.

Androgynous, Reconfigurable Closed Loop Feedback Controlled Low Impact Docking System With Load Sensing Electromagnetic Capture Ring

NASA Technical Reports Server (NTRS)

Lewis, James L. (Inventor); Carroll, Monty B. (Inventor); Morales, Ray H. (Inventor); Le, Thang D. (Inventor)

2002-01-01

The present invention relates to a fully androgynous, reconfigurable closed loop feedback controlled low impact docking system with load sensing electromagnetic capture ring. The docking system of the present invention preferably comprises two Docking- assemblies, each docking assembly comprising a load sensing ring having an outer face, one of more electromagnets, one or more load cells coupled to said load sensing ring. The docking assembly further comprises a plurality of actuator arms coupled to said load sensing ring and capable of dynamically adjusting the orientation of said load sensing ring and a reconfigurable closed loop control system capable of analyzing signals originating from said plurality of load cells and of outputting real time control for each of the actuators. The docking assembly of the present invention incorporates an active load sensing system to automatically dynamically adjust the load sensing ring during capture instead of requiring significant force to push and realign the ring.

Dynamic Resource Adjustment to Provide Seamless Streaming Services on Multimedia Mobile Cellular Networks

NASA Astrophysics Data System (ADS)

Lin, Chow-Sing; Yen, Fang-Zhi

With the rapid advances in wireless network communication, multimedia presentation has become more applicable. However, due to the limited wireless network resource and the mobility of Mobile Host (MH), QoS for wireless streaming is much more difficult to maintain. How to decrease Call Dropping Probability (CDP) in multimedia traffic while still keeping acceptable Call Block Probability (CBP) without sacrificing QoS has become an significant issue in providing wireless streaming services. In this paper, we propose a novel Dynamic Resources Adjustment (DRA) algorithm, which can dynamically borrow idle reserved resources in the serving cell or the target cell for handoffing MHs to compensate the shortage of bandwidth in media streaming. The experimental simulation results show that compared with traditional No Reservation (NR), and Resource Reservation in the six neighboring cells (RR-nb), and Resource Reservation in the target cell (RR-t), our proposed DRA algorithm can fully utilize unused reserved resources to effectively decrease the CDP while still keeping acceptable CBP with high bandwidth utilization.

Jeff Greulich, DynCorp life support technician, adjusts a prototype helmet on a NASA Dryden pilot. F

NASA Technical Reports Server (NTRS)

2002-01-01

Jeff Greulich, DynCorp life support technician, adjusts a prototype helmet on pilot Craig Bomben at NASA Dryden Flight Research Center, Edwards, Calif. Built by Gentex Corp., Carbondale, Pa., the helmet was evaluated by five NASA pilots during the summer and fall of 2002. The objective was to obtain data on helmet fit, comfort and functionality. The inner helmet of the modular system is fitted to the individual crewmember. The outer helmet features a fully integrated spectral mounted helmet display and a binocular helmet mounted display. The helmet will be adaptable to all flying platforms. The Dryden evaluation was overseen by the Center's Life Support office. Assessments have taken place during normal proficiency flights and some air-to-air combat maneuvering. Evaluation platforms included the F-18, B-52 and C-12. The prototype helmet is being developed by the Naval Air Science and Technology Office and the Aircrew Systems Program Office, Patuxent River, Md.

Sugar and Type 2 diabetes.

PubMed

Lean, Michael E J; Te Morenga, Lisa

2016-12-01

Consumption of sugar, specifically sugar-sweetened beverages, has been widely held responsible by the media for the global rise in Type 2 diabetes (T2DM). Systematic reviews and dietary guidelines relating dietary sugars to T2DM. Weight gain and T2DM incidence are associated with diet and lifestyle patterns characterized by high consumptions of any sweetened beverages. High sugar intakes impair risk factors for macrovascular complications of T2DM. Much of the association between sugars and T2DM is eliminated by adjusting data for body mass index (BMI). However, BMI adjustment does not fully account for adiposity (r 2 =0.65-0.75). Excess sugar can promote weight gain, thus T2DM, through extra calories, but has no unique diabetogenic effect at physiological levels. Ethical concerns about caffeine added to sweetened beverages, undetectable by consumers, to increase consumption. Evidence needed for limiting dietary sugar below 10% energy intake. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Minimum alcohol pricing policies in practice: A critical examination of implementation in Canada.

PubMed

Thompson, Kara; Stockwell, Tim; Wettlaufer, Ashley; Giesbrecht, Norman; Thomas, Gerald

2017-02-01

There is an interest globally in using Minimum Unit Pricing (MUP) of alcohol to promote public health. Canada is the only country to have both implemented and evaluated some forms of minimum alcohol prices, albeit in ways that fall short of MUP. To inform these international debates, we describe the degree to which minimum alcohol prices in Canada meet recommended criteria for being an effective public health policy. We collected data on the implementation of minimum pricing with respect to (1) breadth of application, (2) indexation to inflation and (3) adjustments for alcohol content. Some jurisdictions have implemented recommended practices with respect to minimum prices; however, the full harm reduction potential of minimum pricing is not fully realised due to incomplete implementation. Key concerns include the following: (1) the exclusion of minimum prices for several beverage categories, (2) minimum prices below the recommended minima and (3) prices are not regularly adjusted for inflation or alcohol content. We provide recommendations for best practices when implementing minimum pricing policy.

Work organization, exposure to workplace hazards and sickness presenteeism in the European employed population.

PubMed

d'Errico, Angelo; Ardito, Chiara; Leombruni, Roberto

2016-01-01

Aim of the study was to identify work organization features and workplace hazards associated with sickness presenteeism (SP) among European workers. The study was conducted on data from the European Working Conditions Survey 2010 and included a study population of 30,279 employees. The relationship between work-related factors and SP was assessed through Poisson multivariate robust regression models, adjusting for significant (P < 0.05) individual and work-related characteristics. SP for at least 2 days in the previous year was reported by 35% of the workers. In fully adjusted model, several psychosocial (decision authority, skill discretion, reward, abuse; psychological, cognitive, and emotional demand), and organizational factors (shift work, working with clients, long work hours) were positively associated with SP, whereas job insecurity and exposure to physical factors (lifting or moving people, vibration) decreased SP risk. Our results support the importance of work-related factors, especially psychosocial exposures and organizational features, in determining workers' SP. © 2015 Wiley Periodicals, Inc.

A unified framework for weighted parametric multiple test procedures.

PubMed

Xi, Dong; Glimm, Ekkehard; Maurer, Willi; Bretz, Frank

2017-09-01

We describe a general framework for weighted parametric multiple test procedures based on the closure principle. We utilize general weighting strategies that can reflect complex study objectives and include many procedures in the literature as special cases. The proposed weighted parametric tests bridge the gap between rejection rules using either adjusted significance levels or adjusted p-values. This connection is made by allowing intersection hypotheses of the underlying closed test procedure to be tested at level smaller than α. This may be also necessary to take certain study situations into account. For such cases we introduce a subclass of exact α-level parametric tests that satisfy the consonance property. When the correlation is known only for certain subsets of the test statistics, a new procedure is proposed to fully utilize this knowledge within each subset. We illustrate the proposed weighted parametric tests using a clinical trial example and conduct a simulation study to investigate its operating characteristics. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Global and physical self-esteem and body dissatisfaction as mediators of the relationship between weight status and being a victim of bullying.

PubMed

Fox, Claire L; Farrow, Claire V

2009-10-01

Research has found evidence of a link between being overweight or obese and bullying/peer victimisation, and also between obesity and adjustment problems such as low self-esteem and body dissatisfaction. Studies have also found that adjustment problems can put children at an increased risk of being bullied over time. However, to date the factors that place overweight or obese children at risk of being bullied have been poorly elucidated. Self-report data were collected from a sample of 11-14 year olds (N=376) about their weight status, about their experiences of three different types of bullying (Verbal, Physical and Social), their global self-worth, self-esteem for physical appearance, and body dissatisfaction. Overweight or obese children reported experiencing significantly more verbal and physical (but not social) bullying than their non-overweight peers. Global self-worth, self-esteem for physical appearance and body dissatisfaction each fully mediated the paths between weight status and being a victim of bullying.

Age, class and race discrimination: their interactions and associations with mental health among Brazilian university students.

PubMed

Bastos, João Luiz; Barros, Aluisio J D; Celeste, Roger Keller; Paradies, Yin; Faerstein, Eduardo

2014-01-01

Although research on discrimination and health has progressed significantly, it has tended to focus on racial discrimination and US populations. This study explored different types of discrimination, their interactions and associations with common mental disorders among Brazilian university students, in Rio de Janeiro in 2010. Associations between discrimination and common mental disorders were examined using multiple logistic regression models, adjusted for confounders. Interactions between discrimination and socio-demographics were tested. Discrimination attributed to age, class and skin color/race were the most frequently reported. In a fully adjusted model, discrimination attributed to skin color/race and class were both independently associated with increased odds of common mental disorders. The simultaneous reporting of skin color/race, class and age discrimination was associated with the highest odds ratio. No significant interactions were found. Skin color/race and class discrimination were important, but their simultaneous reporting, in conjunction with age discrimination, were associated with the highest occurrence of common mental disorders.

Risk of Stroke Among Survivors of the September 11, 2001 World Trade Center Disaster.

PubMed

Yu, Shengchao; Alper, Howard E; Nguyen, Angela-Maithy; Brackbill, Robert M

2018-05-30

The aim of this study was to investigate the association between 9/11-related posttraumatic stress disorder (PTSD), dust cloud exposure, and subsequent development of stroke among 42,527 enrollees in the World Trade Center (WTC) Health Registry. Using four waves of longitudinal data from the WTC Health Registry surveys, we employed Cox proportional hazards regression models to assess the associations. Incidence of stroke was higher among those with PTSD or intense dust cloud exposure than those without, and it was even higher for those who had experienced both. In fully adjusted models, participants with PTSD had an increased risk of developing stroke [adjusted hazards ratio (AHR) 1.69, 95% confidence interval (95% CI) 1.42 to 2.02], as did those with intense dust exposure (AHR 1.29, 95% CI 1.09 to 1.53). We found that individuals with 9/11-related PTSD and/or intense dust exposure may have an increased risk of developing stroke.

Drug use and limited prenatal care: an examination of responsible barriers.

PubMed

Schempf, Ashley H; Strobino, Donna M

2009-04-01

The purpose of this study was to determine sociodemographic, psychosocial, and health belief factors that explain the association between maternal drug use and little or no prenatal care. A cohort of 812 low-income women who delivered at Johns Hopkins Hospital were administered a postpartum survey. Drug use was determined by self-report, medical record, and toxicologic screens. Medical records were abstracted to determine little or no prenatal care, as defined by

Mesh Deformation Based on Fully Stressed Design: The Method and Two-Dimensional Examples

NASA Technical Reports Server (NTRS)

Hsu, Su-Yuen; Chang, Chau-Lyan

2007-01-01

Mesh deformation in response to redefined boundary geometry is a frequently encountered task in shape optimization and analysis of fluid-structure interaction. We propose a simple and concise method for deforming meshes defined with three-node triangular or four-node tetrahedral elements. The mesh deformation method is suitable for large boundary movement. The approach requires two consecutive linear elastic finite-element analyses of an isotropic continuum using a prescribed displacement at the mesh boundaries. The first analysis is performed with homogeneous elastic property and the second with inhomogeneous elastic property. The fully stressed design is employed with a vanishing Poisson s ratio and a proposed form of equivalent strain (modified Tresca equivalent strain) to calculate, from the strain result of the first analysis, the element-specific Young s modulus for the second analysis. The theoretical aspect of the proposed method, its convenient numerical implementation using a typical linear elastic finite-element code in conjunction with very minor extra coding for data processing, and results for examples of large deformation of two-dimensional meshes are presented in this paper. KEY WORDS: Mesh deformation, shape optimization, fluid-structure interaction, fully stressed design, finite-element analysis, linear elasticity, strain failure, equivalent strain, Tresca failure criterion

Ultramap v3 - a Revolution in Aerial Photogrammetry

NASA Astrophysics Data System (ADS)

Reitinger, B.; Sormann, M.; Zebedin, L.; Schachinger, B.; Hoefler, M.; Tomasi, R.; Lamperter, M.; Gruber, B.; Schiester, G.; Kobald, M.; Unger, M.; Klaus, A.; Bernoegger, S.; Karner, K.; Wiechert, A.; Ponticelli, M.; Gruber, M.

2012-07-01

In the last years, Microsoft has driven innovation in the aerial photogrammetry community. Besides the market leading camera technology, UltraMap has grown to an outstanding photogrammetric workflow system which enables users to effectively work with large digital aerial image blocks in a highly automated way. Best example is the project-based color balancing approach which automatically balances images to a homogeneous block. UltraMap V3 continues innovation, and offers a revolution in terms of ortho processing. A fully automated dense matching module strives for high precision digital surface models (DSMs) which are calculated either on CPUs or on GPUs using a distributed processing framework. By applying constrained filtering algorithms, a digital terrain model can be derived which in turn can be used for fully automated traditional ortho texturing. By having the knowledge about the underlying geometry, seamlines can be generated automatically by applying cost functions in order to minimize visual disturbing artifacts. By exploiting the generated DSM information, a DSMOrtho is created using the balanced input images. Again, seamlines are detected automatically resulting in an automatically balanced ortho mosaic. Interactive block-based radiometric adjustments lead to a high quality ortho product based on UltraCam imagery. UltraMap v3 is the first fully integrated and interactive solution for supporting UltraCam images at best in order to deliver DSM and ortho imagery.

Associations Between Vitamin D Levels and Depressive Symptoms in Later Life: Evidence From the English Longitudinal Study of Ageing (ELSA).

PubMed

de Oliveira, Cesar; Hirani, Vasant; Biddulph, Jane P

2017-06-22

A possible role of vitamin D in depression has received considerable attention, especially given the significant disability, mortality, and healthcare costs associated to depression and the high prevalence of vitamin D deficiency. We investigated the cross-sectional associations between serum 25-hydroxyvitamin D (25OHD) levels and depressive symptoms (CES-D) in 5,607 older adults from the English Longitudinal Study of Ageing (ELSA). Overall, there was a significant association between low 25OHD levels and elevated depressive symptoms (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.20-2.07 for the lowest quartile; OR = 1.45, 95% CI = 1.15-1.83 for <30 nmol/L cut-off and OR = 1.34, 95% CI = 1.10-1.62 for the ≤50 nmol/L cut-off) after adjustment for a wide range of covariates of clinical significance. Fully adjusted models showed that women in the lowest (OR = 1.67, 95% CI = 1.20-2.34) and second lowest (OR = 1.68, 95% CI = 1.20-2.35) quartiles of 25OHD as well as those with 25OHD levels <30 nmol/L (OR = 1.40, 95% CI = 1.06-1.86) and ≤50 nmol/L (OR = 1.35, 95% CI = 1.07-1.72) were more likely to report elevated depressive symptoms. For men, however, this association only remained significant for those with 25OHD levels of <30 nmol/L (OR = 1.60, 95% CI = 1.06-2.42) in the fully adjusted models. The independent and inverse association found between low 25OHD levels and elevated depressive symptoms suggests that vitamin D deficiency may be a risk factor for late-life depression, particularly among women. Whether our findings have any clinical meaning or not, additional data are needed from well-designed randomized controlled trials of vitamin D for the prevention and treatment of late-life depression. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America.

CFD determination of flow perturbation boundary conditions for seal rotordynamic modeling

NASA Astrophysics Data System (ADS)

Venkatesan, Ganesh

2002-09-01

A new approach has been developed and utilized to determine the flow field perturbations (i.e. disturbance due to rotor eccentricity and/or motion) upstream of and within a non-contacting seal. The results are proposed for use with bulk-flow perturbation and CFD-perturbation seal rotordynamic models, as well as in fully 3-D CFD models, to specify approximate boundary conditions for the first-order variables at the computational domain inlet. The perturbation quantities were evaluated by subtracting the numerical flow field solutions corresponding to the concentric rotor position from that for an eccentric rotor position. The disturbance pressure quantities predicted from the numerical solutions were validated by comparing with previous pressure measurements. A parametric study was performed to understand the influence of upstream chamber height, seal clearance, shaft speed, whirl speed, zeroth-order streamwise and swirl velocities, and downstream pressure on the distribution of the first-order quantities in the upstream chamber, seal inlet and seal exit regions. Radially bulk-averaged first-order quantities were evaluated in the upstream chamber, as well as at the seal inlet and exit. The results were finally presented in the form of generalized dimensionless boundary condition correlations so that they can be applied to seal rotordynamic models over a wide range of operating conditions and geometries. To examine the effect of the proposed, approximate first-order boundary conditions on the solutions of the fully 3-D CFD rotordynamic models, the first-order boundary condition correlations for the upstream chamber were used to adjust the circumferential distribution of domain inlet values. The benefit of the boundary condition expressions was assessed for two previously measured test cases, one for a gas seal and the other for a liquid seal. For the gas seal case, a significant improvement in the prediction of the cross-coupled stiffness, when including the proposed first-order inlet boundary values, was found. In the case of liquid seals the tangential impedance values obtained with boundary condition adjustments showed a very slight improvement for a range of whirl speeds over those obtained without them. The radial impedance values obtained with the new adjustments showed a significant improvement over those obtained without them.

Adult physical, sexual, and emotional abuse and postpartum depression, a population based, prospective study of 53,065 women in the Norwegian Mother and Child Cohort Study.

PubMed

Sørbø, Marie Flem; Grimstad, Hilde; Bjørngaard, Johan Håkon; Lukasse, Mirjam; Schei, Berit

2014-09-08

Postpartum depression (PPD) has detrimental consequences to the women, their infants and families. The aim of the present study was to assess the association between adult abuse and PPD. This study was based on data from 53,065 pregnant women in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health. Women were recruited through a postal invitation in relation to a routine ultra-sound invitation at week 18 of gestation. Exposure to adult emotional, sexual, physical abuse was based on self-report at week 30, also differentiating if the perpetrator was known or a stranger, and whether the abuse was recent or not (<12 month since abuse). PPD was measured with a four items version of the Edinburgh Postnatal Depression Scale (EDS) at six months postpartum. The associations between different types of adult abuse and PPD were performed with logistic regression, adjusting for age, parity, civil status, education, child abuse, social support, and depression prior to pregnancy. Altogether, 11% had PPD, and 19% had been exposed to adult abuse. Women reporting adult abuse had an 80% increased fully adjusted odds of PPD (OR 1.8 95% CI 1.7-1.9) compared to non-abused women. There was a tendency towards higher odds of PPD for women reporting combinations of adult abuse (emotional, sexual and physical), as compared with those reporting sexual, emotional or physical abuse only. Exposure from known perpetrator was more strongly associated with PPD than exposure from an unknown perpetrator. Compared with women without adult abuse, the fully adjusted odds of PPD was 2.6 (95% CI 2.4-2.9) higher for women with any recent adult abuse and 1.5 (95% CI 1.5-1.7) higher for women with any adult abuse, but not recent. The results from this large prospective population-based cohort study support initiatives aiming to assess and adequately address abuse when counseling and treating women of PPD.