A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

PubMed

Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Ben Romdhane, Habiba; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

2014-01-01

Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

PubMed Central

Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Romdhane, Habiba Ben; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

2014-01-01

Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives. PMID:24409297

Cost-Effectiveness of a Specialized Oral Nutritional Supplementation for Malnourished Older Adult Patients in Spain

PubMed Central

Martínez Llinàs, Diana; Goates, Scott; Sanz Barriuso, Rebeca; Sanz-Paris, Alejandro

2018-01-01

Malnutrition has been related to prolonged hospital stays, and to increases in readmission and mortality rates. In the NOURISH (Nutrition effect On Unplanned Readmissions and Survival in Hospitalized patients) study, administering a high protein oral nutritional supplement (ONS) containing beta-hydroxy-beta-methylbutyrate (HP-HMB) to hospitalised older adult patients led to a significant improvement in survival compared with a placebo treatment. The aim of this study was to determine whether HP-HMB would be cost-effective in Spain. We performed a cost-effectiveness analysis from the perspective of the Spanish National Health System using time horizons of 90 days, 180 days, 1 year, 2 years, 5 years and lifetime. The difference in cost between patients treated with HP-HMB and placebo was €332.75. With the 90 days time horizon, the difference in life years gained (LYG) between both groups was 0.0096, resulting in an incremental cost-effectiveness ratio (ICER) of €34,700.62/LYG. With time horizons of 180 days, 1 year, 2 years, 5 years and lifetime, the respective ICERs were €13,711.68, €3377.96, €2253.32, €1127.34 and €563.84/LYG. This analysis suggests that administering HP-HMB to older adult patients admitted to Spanish hospitals during hospitalisation and after discharge could be a cost-effective intervention that would improve survival with a reduced marginal cost. PMID:29470402

Cost-effectiveness of rituximab as maintenance treatment for relapsed follicular lymphoma: results of a population-based study.

PubMed

Blommestein, Hedwig M; Issa, Djamila E; Pompen, Marjolein; Ten Hoor, Gerhard; Hogendoorn, Mels; Joosten, Peter; Zweegman, Sonja; Huijgens, Peter C; Uyl-de Groot, Carin A

2014-01-01

On the basis of two population-based registries, our study aims to calculate the real-world cost-effectiveness of rituximab maintenance compared with observation in relapsed or refractory follicular lymphoma patients who responded to second-line chemotherapy. Data were obtained from the EORTC20981 trial, the Netherlands Cancer Registry and two population-based registries. A Markov model was developed to calculate cost per life year gained (LYG) and quality-adjusted life years (QALYs) for three scenarios. Our real-world patients were (62 years) 6 to 7 years older and had higher complete response rates to second-line chemotherapy than the trial population. Differences between the real-world rituximab and observation group were observed for second-line chemotherapy and disease progression. Groups were more balanced after using propensity matching. Relying entirely on updated trial results (scenario1) in combination with local cost data resulted in ratios of €11,259 per LYG and €12,655 per QALY. For scenario2, consisting of trial efficacy and matched real-world costs, ratios of €21,202 per LYG and €23,821 per QALY were calculated. Using real-world matched evidence (scenario3) for both effectiveness and costs showed ratios of €10,591 per LYG and €11,245 per QALY. Although differences in real-world and trial population were found, using real-world data as well as results from long-term trial follow-up showed favourable ICERs for rituximab maintenance. Nevertheless, results showed that caution is required with data synthesis, interpretation and generalisability of results. As different scenarios provide answers to different questions, we recommend healthcare decision-makers to recognise the importance of calculating several cost-effectiveness scenarios. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Cost-effectiveness analysis of ledipasvir/sofosbuvir in patients with chronic hepatitis C: Treatment of patients with absence or mild fibrosis compared to patients with advanced fibrosis.

PubMed

Buti, M; Domínguez-Hernández, R; Oyagüez, I; Casado, M A; Esteban, R

2017-09-01

To evaluate the cost-effectiveness of ledipasvir/sofosbuvir (LDV/SOF) in treatment-naïve patients with chronic hepatitis C (CHC) genotype 1 (GT1) in the absence or mild fibrosis (F0-F1) versus advanced fibrosis (F2-F4), from the perspective of the Spanish Health System. A Markov model was developed to simulate disease progression, estimating costs and outcomes [life years gained (LYG) and quality-adjusted life years (QALY)] derived from starting with LDV/SOF in patients with F0-F1 compared with F2-F4. Therapy duration was 8 weeks in noncirrhotic patients with viral load <6 million IU/mL and 12 weeks in the remaining patients. Sustained virologic response rates were obtained from real-world cohort studies. Transition probabilities, utilities and direct costs were obtained from the literature. A 3% annual discount rate was applied to costs and outcomes. Sensitivity analyses were performed. LDV/SOF in F0-F1 patients was a dominant strategy, being more effective (19.85 LYG and 19.80 QALY) than beginning treatment in F2-F4 patients (18.63 LYG and 16.25 QALY), generating savings of €9228 per patient (€3661 due to disease management and monitoring). In a cohort of 1000 patients, LDV/SOF in F0-F1 patients decreased the number of cases of decompensated cirrhosis (93%), hepatocellular carcinoma (97%) and liver-related deaths (95%) and prevented 6 liver transplants compared to initiating LDV/SOF in F2-F4 patients. In CHC treatment-naïve GT1 patients, starting treatment with LDV/SOF in patients with F0-F1 compared to those with F2-F4 increases effectiveness by 1.22 LYG and 3.55 QALY gained and reduces disease burden and it is associated with cost savings. © 2017 John Wiley & Sons Ltd.

Comparing effectiveness of mass media campaigns with price reductions targeting fruit and vegetable intake on US cardiovascular disease mortality and race disparities.

PubMed

Pearson-Stuttard, Jonathan; Bandosz, Piotr; Rehm, Colin D; Afshin, Ashkan; Peñalvo, Jose L; Whitsel, Laurie; Danaei, Goodarz; Micha, Renata; Gaziano, Tom; Lloyd-Williams, Ffion; Capewell, Simon; Mozaffarian, Dariush; O'Flaherty, Martin

2017-07-01

Background: A low intake of fruits and vegetables (F&Vs) is a major risk factor for cardiovascular disease (CVD) in the United States. Both mass media campaigns (MMCs) and economic incentives may increase F&V consumption. Few data exist on their comparative effectiveness. Objective: We estimated CVD mortality reductions potentially achievable by price reductions and MMC interventions targeting F&V intake in the US population. Design: We developed a US IMPACT Food Policy Model to compare 3 policies targeting F&V intake across US adults from 2015 to 2030: national MMCs and national F&V price reductions of 10% and 30%. We accounted for differences in baseline diets, CVD rates, MMC coverage, MMC duration, and declining effects over time. Outcomes included cumulative CVD (coronary heart disease and stroke) deaths prevented or postponed and life-years gained (LYGs) over the study period, stratified by age, sex, and race. Results: A 1-y MMC in 2015 would increase the average national F&V consumption by 7% for 1 y and prevent ∼18,600 CVD deaths (95% CI: 17,600, 19,500), gaining ∼280,100 LYGs by 2030. With a 15-y MMC, increased F&V consumption would be sustained, yielding a 3-fold larger reduction (56,100; 95% CI: 52,400, 57,700) in CVD deaths. In comparison, a 10% decrease in F&V prices would increase F&V consumption by ∼14%. This would prevent ∼153,300 deaths (95% CI: 146,400, 159,200), gaining ∼2.51 million LYGs. For a 30% price decrease, resulting in a 42% increase in F&V consumption, corresponding values would be 451,900 CVD deaths prevented or postponed (95% CI: 433,100, 467,500) and 7.3 million LYGs gained. Effects were similar by sex, with a smaller proportional effect and larger absolute effects at older ages. A 1-y MMC would be 35% less effective in preventing CVD deaths in non-Hispanic blacks than in whites. In comparison, price-reduction policies would have equitable proportional effects. Conclusion: Both national MMCs and price-reduction policies

Cost-effectiveness of bedaquiline in MDR and XDR tuberculosis in Italy

PubMed Central

Codecasa, Luigi R.; Toumi, Mondher; D’Ausilio, Anna; Aiello, Andrea; Damele, Francesco; Termini, Roberta; Uglietti, Alessia; Hettle, Robert; Graziano, Giorgio; De Lorenzo, Saverio

2017-01-01

ABSTRACT Objective: To evaluate the cost-effectiveness of bedaquiline plus background drug regimens (BR) for multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in Italy. Methods: A Markov model was adapted to the Italian setting to estimate the incremental cost-effectiveness ratio (ICER) of bedaquiline plus BR (BBR) versus BR in the treatment of MDR-TB and XDR-TB over 10 years, from both the National Health Service (NHS) and societal perspective. Cost-effectiveness was evaluated in terms of life-years gained (LYG). Clinical data were sourced from trials; resource consumption for compared treatments was modelled according to advice from an expert clinicians panel. NHS tariffs for inpatient and outpatient resource consumption were retrieved from published Italian sources. Drug costs were provided by reference centres for disease treatment in Italy. A 3% annual discount was applied to both cost and effectiveness. Deterministic and probabilistic sensitivity analyses were conducted. Results: Over 10 years, BBR vs. BR alone is cost-effective, with ICERs of €16,639/LYG and €4081/LYG for the NHS and society, respectively. The sensitivity analyses confirmed the robustness of the results from both considered perspectives. Conclusion: In Italy, BBR vs. BR alone has proven to be cost-effective in the treatment of MDR-TB and XDR-TB under a range of scenarios. PMID:28265350

Cost-effectiveness of extended-release niacin/laropiprant added to a stable simvastatin dose in secondary prevention patients not at cholesterol goal in Germany.

PubMed

Michailov, Galin V; Davies, Glenn M; Krobot, Karl J

2012-06-01

Coronary heart disease (CHD) remains the leading cause of death in Germany despite statin use to reduce low-density lipoprotein cholesterol (LDL-C) levels; improving lipids beyond LDL-C may further reduce cardiovascular risk. A fixed-dose combination of extended-release niacin (ERN) with laropiprant (LRPT) provides comprehensive lipid management. We adapted a decision-analytic model to evaluate the economic value (incremental cost-effectiveness ratio [ICER] in terms of costs per life-years gained [LYG]) of ERN/LRPT 2 g over a lifetime in secondary prevention patients in a German setting. Two scenarios were modelled: (1) ERN/LRPT 2 g added to simvastatin 40 mg in patients not at LDL-C goal with simvastatin 40 mg; (2) adding ERN/LRPT 2 g compared with titration to simvastatin 40 mg in patients not at LDL-C goal with simvastatin 20 mg. In both scenarios, adding ERN/LRPT was cost-effective relative to simvastatin monotherapy at a commonly accepted threshold of €30,000 per LYG; ICERs for ERN/LRPT were €13,331 per LYG in scenario 1 and €17,684 per LYG in scenario 2. Subgroup analyses showed that ERN/LRPT was cost-effective in patients with or without diabetes, patients aged ≤ 65 or >65 years and patients with low baseline high-density lipoprotein cholesterol levels; ICERs ranged from €10,342 to €15,579 in scenario 1, and from €14,081 to €20,462 in scenario 2. In conclusion, comprehensive lipid management with ERN/LRPT 2 g is cost-effective in secondary prevention patients in Germany who have not achieved LDL-C goal with simvastatin monotherapy.

Pharmacoeconomic analysis of consolidation therapy with pemetrexed after first-line chemotherapy for non-small cell lung cancer.

PubMed

Tsuchiya, Takanori; Fukuda, Takashi; Furuiye, Masashi; Kawabuchi, Koichi

2011-12-01

Prolongation of progression-free survival and overall survival have been reported with consolidation therapy after first-line chemotherapy in non-small cell lung cancer, but only a few pharmacoeconomic analyses have been performed. We performed a pharmacoeconomic analysis to assess the cost-effectiveness of consolidation therapy with pemetrexed compared with non-consolidation therapy. We developed a Markov model to evaluate the incremental cost-effectiveness ratio (ICER) of consolidation therapy with pemetrexed compared with non-consolidation therapy based on previous reports. We analyzed all histology groups together, and individually analyzed non-squamous cell carcinoma, in which pemetrexed has been shown to be more effective, and squamous cell carcinoma, in which pemetrexed has been shown to be less effective. We conducted a Monte-Carlo simulation to assess the uncertainty for our analysis model and the willingness to pay using thresholds. The ICER for consolidation therapy with pemetrexed was about US$ 109,024/life years gained (LYG) (JPY 12.5 million/LYG) and US$ 203,022/quality-adjusted life years (QALY) (JPY 23.3 million/QALY) for all histology. For non-squamous cell carcinoma, respective values were US$ 80,563/LYG (JPY 9.3 million/LYG) and US$ 150,115/QALY (JPY 17.3 million/QALY). Both % of probability at a threshold of JPY 5.0 million (US$ 43,478) for all histology and non-squamous cell carcinoma were less than 0.1%. This result indicates that it is difficult to use consolidation therapy as the standard of care in Japan while being covered by general medical insurance. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Applying a private sector capitation model to the management of type 2 diabetes in the South African public sector: a cost-effectiveness analysis.

PubMed

Volmink, Heinrich C; Bertram, Melanie Y; Jina, Ruxana; Wade, Alisha N; Hofman, Karen J

2014-09-30

Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector. Cost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing. Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years - 113 994 years). Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.

Cost-effectiveness analysis of ibrutinib in patients with Waldenström macroglobulinemia in Italy.

PubMed

Aiello, Andrea; D'Ausilio, Anna; Lo Muto, Roberta; Randon, Francesca; Laurenti, Luca

2017-01-01

Background and Objective: Ibrutinib has recently been approved in Europe for Waldenström Macroglobulinemia (WM) in symptomatic patients who have received at least one prior therapy, or in first-line treatment for patients unsuitable for chemo-immunotherapy. The aim of the study is to estimate the incremental cost-effectiveness ratio (ICER) of ibrutinib in relapse/refractory WM, compared with the Italian current therapeutic pathways (CTP). Methods: A Markov model was adapted for Italy considering the National Health System perspective. Input data from literature as well as global trials were used. The percentage use of therapies, and healthcare resources consumption were estimated according to expert panel advice. Drugs ex-factory prices and national tariffs were used for estimating costs. The model had a 15-year time horizon, with a 3.0% discount rate for both clinical and economic data. Deterministic and probabilistic sensitivity analyses were performed to test the results strength. Results: Ibrutinib resulted in increased Life Years Gained (LYGs) and increased costs compared to CTP, with an ICER of €52,698/LYG. Sensitivity analyses confirmed the results of the BaseCase. Specifically, in the probabilistic analysis, at a willingness to pay threshold of €60,000/LYG ibrutinib was cost-effective in 84% of simulations. Conclusions: Ibrutinib has demonstrated a positive cost-effectiveness profile in Italy.

Gain monitoring of telescope array photomultiplier cameras for the first 4 years of operation

NASA Astrophysics Data System (ADS)

Shin, B. K.; Tokuno, H.; Tsunesada, Y.; Abu-Zayyad, T.; Aida, R.; Allen, M.; Anderson, R.; Azuma, R.; Barcikowski, E.; Belz, J. W.; Bergman, D. R.; Blake, S. A.; Cady, R.; Cheon, B. G.; Chiba, J.; Chikawa, M.; Cho, E. J.; Cho, W. R.; Fujii, H.; Fujii, T.; Fukuda, T.; Fukushima, M.; Hanlon, W.; Hayashi, K.; Hayashi, Y.; Hayashida, N.; Hibino, K.; Hiyama, K.; Honda, K.; Iguchi, T.; Ikeda, D.; Ikuta, K.; Inoue, N.; Ishii, T.; Ishimori, R.; Ivanov, D.; Iwamoto, S.; Jui, C. C. H.; Kadota, K.; Kakimoto, F.; Kalashev, O.; Kanbe, T.; Kasahara, K.; Kawai, H.; Kawakami, S.; Kawana, S.; Kido, E.; Kim, H. B.; Kim, H. K.; Kim, J. H.; Kim, J. H.; Kitamoto, K.; Kitamura, S.; Kitamura, Y.; Kobayashi, K.; Kobayashi, Y.; Kondo, Y.; Kuramoto, K.; Kuzmin, V.; Kwon, Y. J.; Lim, S. I.; Machida, S.; Martens, K.; Martineau, J.; Matsuda, T.; Matsuura, T.; Matsuyama, T.; Matthews, J. N.; Myers, I.; Minamino, M.; Miyata, K.; Murano, Y.; Nagasawa, K.; Nagataki, S.; Nakamura, T.; Nam, S. W.; Nonaka, T.; Ogio, S.; Ohnishi, M.; Ohoka, H.; Oki, K.; Oku, D.; Okuda, T.; Oshima, A.; Ozawa, S.; Park, I. H.; Pshirkov, M. S.; Rodriguez, D. C.; Roh, S. Y.; Rubtsov, G.; Ryu, D.; Sagawa, H.; Sakurai, N.; Sampson, A. L.; Scott, L. M.; Shah, P. D.; Shibata, F.; Shibata, T.; Shimodaira, H.; Shin, J. I.; Shirahama, T.; Smith, J. D.; Sokolsky, P.; Sonley, T. J.; Springer, R. W.; Stokes, B. T.; Stratton, S. R.; Stroman, T.; Suzuki, S.; Takahashi, Y.; Takeda, M.; Taketa, A.; Takita, M.; Tameda, Y.; Tanaka, H.; Tanaka, K.; Tanaka, M.; Thomas, S. B.; Thomson, G. B.; Tinyakov, P.; Tkachev, I.; Tomida, T.; Troitsky, S.; Tsutsumi, K.; Tsuyuguchi, Y.; Uchihori, Y.; Udo, S.; Ukai, H.; Vasiloff, G.; Wada, Y.; Wong, T.; Wood, M.; Yamakawa, Y.; Yamane, R.; Yamaoka, H.; Yamazaki, K.; Yang, J.; Yoneda, Y.; Yoshida, S.; Yoshii, H.; Zhou, X.; Zollinger, R.; Zundel, Z.

2014-12-01

The stability of the gain of the photomultiplier (PMT) camera for the Fluorescence Detector (FD) of the Telescope Array experiment was monitored using an 241Am loaded scintillator pulsers (YAP) and a diffused xenon flasher (TXF) for a selected set of 35 PMT-readout channels. From the monitoring of YAP pulses over four years of FD operation, we found slow monotonic drifts of PMT gains at a rate of -1.7 +1.7%/year. An average of the PMT gains over the 35 channels stayed nearly constant with a rate of change measured at -0.01±0.31(stat)±0.21(sys)%/year. No systematic decrease of the PMT gain caused by the night sky background was observed. Monitoring by the TXF also tracked the PMT gain drift of the YAP at 0.88±0.14(stat)%/year.

Cost-effectiveness of everolimus vs sunitinib in treating patients with advanced, progressive pancreatic neuroendocrine tumors in the United States.

PubMed

Casciano, Roman; Chulikavit, Maruit; Perrin, Allison; Liu, Zhimei; Wang, Xufang; Garrison, Louis P

2012-01-01

Everolimus (Afinitor) and sunitinib (Sutent) were recently approved to treat patients with advanced, progressive pancreatic neuroendocrine tumors (pNETs). (Afinitor is a registered trademark of Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; Sutent is a registered trademark of Pfizer Inc., New York, NY, USA.) This analysis examined the projected cost-effectiveness of everolimus vs sunitinib in this setting from a US payer perspective. A semi-Markov model was developed to simulate a cohort of patients with advanced, progressive pNET and to estimate the cost per life-year gained (LYG) and per quality-adjusted life-year (QALY) gained when treating with everolimus vs sunitinib. Efficacy data were based on a weight-adjusted indirect comparison of the agents using phase 3 trial data. Model health states included: stable disease with no adverse events, stable disease with adverse events, disease progression, and death. Therapy costs were based on wholesale acquisition cost. Other costs such as physician visits, tests, hospitalizations, and adverse event costs were obtained from literature and/or primary research. Utility inputs were based on primary research. Sensitivity analyses were conducted to test the model's robustness. In the base-case analysis, everolimus was associated with an incremental 0.448 LYG (0.304 QALYs) at an incremental cost of $12,673, resulting in an incremental cost-effectiveness ratio (ICER) of $28,281/LYG ($41,702/QALY gained). The ICER fell within the cost per QALY range for many widely used oncology drugs. Sensitivity analyses demonstrated that, overall, there is a trend that everolimus is cost-effective compared to sunitinib in this setting. Results of the indirect analysis were not statistically significant (p > 0.05). Assumptions that treatment patterns are the same across therapies may not represent real-world practice. While the analysis is limited by its reliance on an indirect comparison of two phase 3 studies, everolimus is

Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases.

PubMed

Cadier, Benjamin; Durand-Zaleski, Isabelle; Thomas, Daniel; Chevreul, Karine

2016-01-01

In France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis. We performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of €50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15-75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was €3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -€736 to €15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than €11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from €15 million to €215 million at the five-year horizon for an initial cessation treatment cost of €125 million to €421 million. The results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings.

Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases

PubMed Central

Cadier, Benjamin; Durand-Zaleski, Isabelle; Thomas, Daniel; Chevreul, Karine

2016-01-01

Context In France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis. Methods and Findings We performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of €50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15–75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was €3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -€736 to €15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than €11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from €15 million to €215 million at the five-year horizon for an initial cessation treatment cost of €125 million to €421 million. Conclusion The results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings. PMID:26909802

Using Survival Analysis to Improve Estimates of Life Year Gains in Policy Evaluations.

PubMed

Meacock, Rachel; Sutton, Matt; Kristensen, Søren Rud; Harrison, Mark

2017-05-01

Policy evaluations taking a lifetime horizon have converted estimated changes in short-term mortality to expected life year gains using general population life expectancy. However, the life expectancy of the affected patients may differ from the general population. In trials, survival models are commonly used to extrapolate life year gains. The objective was to demonstrate the feasibility and materiality of using parametric survival models to extrapolate future survival in health care policy evaluations. We used our previous cost-effectiveness analysis of a pay-for-performance program as a motivating example. We first used the cohort of patients admitted prior to the program to compare 3 methods for estimating remaining life expectancy. We then used a difference-in-differences framework to estimate the life year gains associated with the program using general population life expectancy and survival models. Patient-level data from Hospital Episode Statistics was utilized for patients admitted to hospitals in England for pneumonia between 1 April 2007 and 31 March 2008 and between 1 April 2009 and 31 March 2010, and linked to death records for the period from 1 April 2007 to 31 March 2011. In our cohort of patients, using parametric survival models rather than general population life expectancy figures reduced the estimated mean life years remaining by 30% (9.19 v. 13.15 years, respectively). However, the estimated mean life year gains associated with the program are larger using survival models (0.380 years) compared to using general population life expectancy (0.154 years). Using general population life expectancy to estimate the impact of health care policies can overestimate life expectancy but underestimate the impact of policies on life year gains. Using a longer follow-up period improved the accuracy of estimated survival and program impact considerably.

Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia.

PubMed

Pignone, Michael P; Flitcroft, Kathy L; Howard, Kirsten; Trevena, Lyndal J; Salkeld, Glenn P; St John, D James B

2011-02-21

To examine the costs and cost-effectiveness of full implementation of biennial bowel cancer screening for Australian residents aged 50-74 years. Identification of existing economic models from 1993 to 2010 through searches of PubMed and economic analysis databases, and by seeking expert advice; and additional modelling to determine the costs and cost-effectiveness of full implementation of biennial faecal occult blood test screening for the five million adults in Australia aged 50-74 years. Estimated number of deaths from bowel cancer prevented, costs, and cost-effectiveness (cost per life-year gained [LYG]) of biennial bowel cancer screening. We identified six relevant economic analyses, all of which found colorectal cancer (CRC) screening to be very cost-effective, with costs per LYG under $55,000 per year in 2010 Australian dollars. Based on our additional modelling, we conservatively estimate that full implementation of biennial screening for people aged 50-74 years would have gross costs of $150 million, reduce CRC mortality by 15%-25%, prevent 300-500 deaths from bowel cancer, and save 3600-6000 life-years annually, for an undiscounted cost per LYG of $25,000-$41,667, compared with no screening, and not taking cost savings as a result of treatment into consideration. The additional expenditure required, after accounting for reductions in CRC incidence, savings in CRC treatment costs, and existing ad-hoc colonoscopy use, is likely to be less than $50 million annually. Full implementation of biennial faecal occult blood test screening in Australia can reduce bowel cancer mortality, and is an efficient use of health resources that would require modest additional government investment.

Socioeconomic position in childhood and adulthood and weight gain over 34 years: the Alameda County Study.

PubMed

Baltrus, Peter Thomas; Everson-Rose, Susan A; Lynch, John W; Raghunathan, Trivellore E; Kaplan, George A

2007-08-01

Socioeconomic position (SEP) has been shown to be related to obesity and weight gain, especially among women. It is unclear how different measures of socioeconomic position may impact weight gain over long periods of time, and whether the effect of different measures vary by gender and age group. We examined the effect of childhood socioeconomic position, education, occupation, and log household income on a measure of weight gain using individual growth mixed regression models and Alameda County Study data collected over thirty four years(1965-1999). Analyses were performed in four groups stratified by gender and age at baseline: women, 17-30 years (n = 945) and 31-40 years (n = 712); men, 17-30 years (n = 766) and 31-40 years (n = 608). Low childhood SEP was associated with increased weight gain among women 17-30 (0.13 kg/year, p < 0.001). Low educational status was associated with increased weight gain among women 17-30 (0.14 kg/year, p = 0.030), 31-40 (0.14 kg/year, p = 0.014), and men 17-30 (0.20 kg/year, p = 0.001). Log household income was inversely associated with weight gain among men 31-40 (-0.10 kg/yr, p = 0.16). Long-term weight gain in adulthood is associated with childhood SEP and education in women and education and income in men.

Cost-effectiveness of different strategies to prevent breast and ovarian cancer in German women with a BRCA 1 or 2 mutation.

PubMed

Müller, Dirk; Danner, Marion; Rhiem, Kerstin; Stollenwerk, Björn; Engel, Christoph; Rasche, Linda; Borsi, Lisa; Schmutzler, Rita; Stock, Stephanie

2018-04-01

Women with a BRCA1 or BRCA2 mutation are at increased risk of developing breast and/or ovarian cancer. This economic modeling study evaluated different preventive interventions for 30-year-old women with a confirmed BRCA (1 or 2) mutation. A Markov model was developed to estimate the costs and benefits [i.e., quality-adjusted life years (QALYs), and life years gained (LYG)] associated with prophylactic bilateral mastectomy (BM), prophylactic bilateral salpingo-oophorectomy (BSO), BM plus BSO, BM plus BSO at age 40, and intensified surveillance. Relevant input data was obtained from a large German database including 5902 women with BRCA 1 or 2, and from the literature. The analysis was performed from the German Statutory Health Insurance (SHI) perspective. In order to assess the robustness of the results, deterministic and probabilistic sensitivity analyses were performed. With costs of €29,434 and a gain in QALYs of 17.7 (LYG 19.9), BM plus BSO at age 30 was less expensive and more effective than the other strategies, followed by BM plus BSO at age 40. Women who were offered the surveillance strategy had the highest costs at the lowest gain in QALYs/LYS. In the probabilistic sensitivity analysis, the probability of cost-saving was 57% for BM plus BSO. At a WTP of 10,000 € per QALY, the probability of the intervention being cost-effective was 80%. From the SHI perspective, undergoing BM plus immediate BSO should be recommended to BRCA 1 or 2 mutation carriers due to its favorable comparative cost-effectiveness.

[What is an efficient health technology in Spain?].

PubMed

Sacristán, J A; Oliva, J; Del Llano, J; Prieto, L; Pinto, J L

2002-01-01

Despite the growing recognition of the potential applications of cost-effectiveness assessments, a criterion to establish what is an efficient health technology does not exist in Spain. The objective of this work is to describe the limits and the criteria used in Spain to recommend the adoption of health interventions. A review of the economic evaluations of health technologies published in Spain from 1990 to 2001 was conducted. Complete economic assessments in which the cost-effectiveness ratio was expressed as cost per life-year gained (LYG), cost per quality-adjusted-life-year (QALY) or cost per saved live were selected. Those interventions in which the authors established recommendations (adoption or rejection) and the criteria used were analyzed. Twenty (20%) of the 100 complete economic evaluations fulfilled the selection criteria. In16 studies, the results were expressed as cost per LYG, in 6 studies as cost per QALY and in 1 as cost per saved live. A total of 82 health interventions were assessed and some kind of recommendation was established in 44 of them. All technologies with a cost-effectiveness ratio lower than 30,000 euros (5 million pesetas) per LYG were recommended for adoption by the authors. Up to that limit there was no a clear tendency. Although the results must be interpreted with much precaution, given the limitations of the study, the limits of cost-effectiveness presented in this work could be a first reference to which would be an efficient health intervention in Spain.

Chocolate-candy consumption and three-year weight gain among postmenopausal U.S. women

PubMed Central

Greenberg, James A.; Manson, JoAnn E.; Buijsse, Brian; Wang, Lu; Allison, Matthew A.; Neuhouser, Marian L.; Tinker, Lesley; Waring, Molly E.; Isasi, Carmen R.; Martin, Lisa W.; Thomson, Cynthia A.

2014-01-01

OBJECTIVE To test the hypothesis that greater chocolate-candy intake is associated with more weight gain in postmenopausal women. DESIGN AND METHODS Prospective cohort study involving 107,243 post-menopausal American women aged 50–79 years (mean=60.7) at enrolment in the Women’s Health Initiative (WHI), with three-year follow up. Chocolate-candy consumption was assessed by food frequency questionnaire and body weight was measured. Linear mixed models, adjusted for demographic, socio-economic, anthropomorphic and behavioral variables, were used to test our main hypotheses. RESULTS Compared to women who ate a 1 oz (~28 g) serving of chocolate candy <1 per month, those who ate this amount 1 per month to <1 per week, 1 per week to < 3 per week and ≥3 per week showed greater three-year prospective weight gains (kg) of 0.76 (95% CI: 0.66, 0.85), 0.95 (0.84, 1.06) and 1.40 (1.27, 1.53), respectively, (p for linear trend<0.0001). Each additional 1 oz/day was associated with a greater three-year weight gain (kg) of 0.92 (0.80, 1.05). The weight gain in each chocolate-candy intake level increased as BMI increased above the normal range (18.5–25 kg/m2), and as age decreased. CONCLUSIONS Greater chocolate-candy intake was associated with greater prospective weight gain in this cohort of post-menopausal women. PMID:25644711

Chocolate-candy consumption and 3-year weight gain among postmenopausal U.S. women.

PubMed

Greenberg, James A; Manson, JoAnn E; Buijsse, Brian; Wang, Lu; Allison, Matthew A; Neuhouser, Marian L; Tinker, Lesley; Waring, Molly E; Isasi, Carmen R; Martin, Lisa W; Thomson, Cynthia A

2015-03-01

To test the hypothesis that greater chocolate-candy intake is associated with more weight gain in postmenopausal women. A prospective cohort study involved 107,243 postmenopausal American women aged 50-79 years (mean = 60.7) at enrollment in the Women's Health Initiative, with 3-year follow-up. Chocolate-candy consumption was assessed by food frequency questionnaire, and body weight was measured. Linear mixed models, adjusted for demographic, socio economic, anthropomorphic, and behavioral variables, were used to test our main hypotheses. Compared with women who ate a 1 oz (∼28 g) serving of chocolate candy <1 per month, those who ate this amount 1 per month to <1 per week, 1 per week to < 3 per week and ≥3 per week showed greater 3-year prospective weight gains (kg) of 0.76 (95% CI: 0.66, 0.85), 0.95 (0.84, 1.06), and 1.40 (1.27, 1.53), respectively, (P for linear trend<0.0001). Each additional 1 oz/day was associated with a greater 3-year weight gain (kg) of 0.92 (0.80, 1.05). The weight gain in each chocolate-candy intake level increased as BMI increased above the normal range (18.5-25 kg/m(2)), and was inversely associated with age. Greater chocolate-candy intake was associated with greater prospective weight gain in this cohort of postmenopausal women. © 2015 The Obesity Society.

The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria.

PubMed

Schiller-Fruehwirth, Irmgard; Jahn, Beate; Einzinger, Patrick; Zauner, Günther; Urach, Christoph; Siebert, Uwe

2017-09-01

In 2014, Austrian health authorities implemented an organized breast cancer screening program. Until then, there has been a long-standing tradition of opportunistic screening. To evaluate the cost-effectiveness of organized screening compared with opportunistic screening, as well as to identify factors influencing the clinical and economic outcomes. We developed and validated an individual-level state-transition model and assessed the health outcomes and costs of organized and opportunistic screening for 40-year-old asymptomatic women. The base-case analysis compared a scenario involving organized biennial screening with a scenario reflecting opportunistic screening practice for an average-risk woman aged 45 to 69 years. We applied an annual discount rate of 3% and estimated the incremental cost-effectiveness ratio in terms of the cost (2012 euros) per life-year gained (LYG) from a health care perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. Compared with opportunistic screening, an organized program yielded on average additional 0.0118 undiscounted life-years (i.e., 4.3 days) and cost savings of €41 per woman. In the base-case analysis, the incremental cost-effectiveness ratio of organized screening was approximately €20,000 per LYG compared with no screening. Assuming a willingness-to-pay threshold of €50,000 per LYG, there was a 70% probability that organized screening would be considered cost-effective. The attendance rate, but not the test accuracy of mammography, was an influential factor for the cost-effectiveness. The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of screening women with familial risk for breast cancer with magnetic resonance imaging.

PubMed

Saadatmand, Sepideh; Tilanus-Linthorst, Madeleine M A; Rutgers, Emiel J T; Hoogerbrugge, Nicoline; Oosterwijk, Jan C; Tollenaar, Rob A E M; Hooning, Maartje; Loo, Claudette E; Obdeijn, Inge-Marie; Heijnsdijk, Eveline A M; de Koning, Harry J

2013-09-04

To reduce mortality, women with a family history of breast cancer are often screened with mammography before age 50 years. Additional magnetic resonance imaging (MRI) improves sensitivity and is cost-effective for BRCA1/2 mutation carriers. However, for women with a family history without a proven mutation, cost-effectiveness is unclear. We evaluated data of the largest prospective MRI screening study (MRISC). Between 1999 and 2007, 1597 women (8370 woman-years at risk) aged 25 to 70 years with an estimated cumulative lifetime risk of 15% to 50% for breast cancer were screened with clinical breast examination every 6 months and with annual mammography and MRI. We calculated the cost per detected and treated breast cancer. After incorporating MRISC data into a microsimulation screening analysis model (MISCAN), different schemes were evaluated, and cost per life-year gained (LYG) was estimated in comparison with the Dutch nationwide breast cancer screening program (biennial mammography from age 50 to 75 years). All statistical tests were two-sided. Forty-seven breast cancers (9 ductal carcinoma in situ) were detected. Screening with additional MRI costs $123 672 (€93 639) per detected breast cancer. In increasing age-cohorts, costs per detected and treated breast cancer decreased, but, unexpectedly, the percentage of MRI-only detected cancers increased. Screening under the MRISC-scheme from age 35 to 50 years was estimated to reduce breast cancer mortality by 25% at $134 932 (€102 164) per LYG (3.5% discounting) compared with 17% mortality reduction at $54 665 (€41 390) per LYG with mammography only. Screening with MRI may improve survival for women with familial risk for breast cancer but is expensive, especially in the youngest age categories.

Years of life gained due to leisure-time physical activity in the U.S.

PubMed

Janssen, Ian; Carson, Valerie; Lee, I-Min; Katzmarzyk, Peter T; Blair, Steven N

2013-01-01

Physical inactivity is an important modifiable risk factor for noncommunicable disease. The degree to which physical activity affects the life expectancy of Americans is unknown. This study estimated the potential years of life gained due to leisure-time physical activity in the U.S. Data from the National Health and Nutrition Examination Survey (2007-2010); National Health Interview Study mortality linkage (1990-2006); and U.S. Life Tables (2006) were used to estimate and compare life expectancy at each age of adult life for inactive (no moderate to vigorous physical activity); somewhat-active (some moderate to vigorous activity but <500 MET minutes/week); and active (≥ 500 MET minutes/week of moderate to vigorous activity) adults. Analyses were conducted in 2012. Somewhat-active and active non-Hispanic white men had a life expectancy at age 20 years that was ~2.4 years longer than that for the inactive men; this life expectancy advantage was 1.2 years at age 80 years. Similar observations were made in non-Hispanic white women, with a higher life expectancy within the active category of 3.0 years at age 20 years and 1.6 years at age 80 years. In non-Hispanic black women, as many as 5.5 potential years of life were gained due to physical activity. Significant increases in longevity were also observed within somewhat-active and active non-Hispanic black men; however, among Hispanics the years-of-life-gained estimates were not significantly different from 0 years gained. Leisure-time physical activity is associated with increases in longevity. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Does psychosocial stress explain socioeconomic inequities in 9-year weight gain among young women?

PubMed

Ball, Kylie; Schoenaker, Danielle A J M; Mishra, Gita D

2017-06-01

This study investigated the contribution of psychosocial stress to mediating inequities in weight gain by educational status in a large cohort of young Australian women over a 9-year follow-up. This observational cohort study used survey data drawn from 4,806 women, aged 22 to 27 years at baseline (2000), participating in the Australian Longitudinal Study on Women's Health, who reported their education level (2000), perceived stress (2003), and weight (2003 and 2012). Using a causal inference framework based on counterfactuals for mediation analysis, we fitted linear or logistic regression models to examine the total effect, decomposed into natural direct and indirect effects via perceived stress, of education level (highest qualification completed: up to year 12/trade or diploma vs. university) on weight change. Women with lower education gained more weight over 9 years (6.1 kg, standard deviation [SD] 9.5) than women with higher education (3.8 kg, SD 7.7; P < 0.0001) and were more likely to be very or extremely stressed. The higher weight gain associated with low education was not mediated through perceived stress (per SD increase, percent mediated: 1.0%). Education-based inequities in weight gain over time were not attributable to greater psychosocial stress among women with lower education levels. © 2017 The Obesity Society.

Years of Life Gained Due to Leisure-Time Physical Activity in the United States

PubMed Central

Janssen, Ian; Carson, Valerie; Lee, I-Min; Katzmarzyk, Peter T.; Blair, Steven N.

2013-01-01

Background Physical inactivity is an important modifiable risk factor for non-communicable disease. The degree to which physical activity affects the life expectancy of Americans is unknown. This study estimated the potential years of life gained due to leisure-time physical activity across the adult lifespan in the United States. Methods Data from the National Health and Nutrition Examination Survey (2007–2010), National Health Interview Study mortality linkage (1990–2006), and US Life Tables (2006) were used to estimate and compare life expectancy at each age of adult life for inactive (no moderate-to-vigorous physical activity), somewhat active (some moderate-to-vigorous activity but <500 metabolic equivalent min/week) and active (≥500 metabolic equivalent min/week of moderate-to-vigorous activity) adults. Analyses were conducted in 2012. Results Somewhat active and active non-Hispanic white men had a life expectancy at age 20 that was around 2.4 years longer than the inactive men; this life expectancy advantage was 1.2 years at age 80. Similar observations were made in non-Hispanic white women, with a higher life expectancy within the active category of 3.0 years at age 20 and 1.6 years at age 80. In non-Hispanic black women, as many as 5.5 potential years of life were gained due to physical activity. Significant increases in longevity were also observed within somewhat active and active non-Hispanic black men; however, among Hispanics the years of life gained estimates were more variable and not significantly different from 0 years gained. Conclusions Leisure-time physical activity is associated with increases in longevity in the United States. PMID:23253646

Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina.

PubMed

Urueña, Analía; Pippo, Tomás; Betelu, María Sol; Virgilio, Federico; Giglio, Norberto; Gentile, Angela; Jimenez, Salvador García; Jáuregui, Bárbara; Clark, Andrew D; Diosque, Máximo; Vizzotti, Carla

2011-07-12

Since the 10-valent pneumococcal conjugate vaccine (PCV-10) and 13-valent pneumococcal conjugate vaccine (PCV-13) were recently licensed for use in Argentina, both vaccines were evaluated to estimate the costs, health benefits and cost-effectiveness of adding a PCV to the routine child immunization schedule. The integrated TRIVAC vaccine cost-effectiveness model from Pan American Health Organization's ProVac Initiative (Version 1.0.65) was used to assess the health outcomes of 20 successive cohorts from birth to 5 years of age. PCV-10 and PCV-13 were each compared to a scenario assuming no PCV vaccination. A 3+1 (three doses+booster) schedule and a vaccination price of US$ 20.75 per dose was assumed in the base case for both vaccines. Introduction of PCV-13 rather than PCV-10 would increase the number of life years gained (LYG) by at least 10%. The number of LYG (and LYG after adjustment for DALY morbidity weights) was 56,882 (64,252) for PCV-10 compared to 65,038 (71,628) for PCV-13. From the health system perspective, the cost per DALY averted was US$ 8973 and US$ 10,948 for PCV-10 and PCV-13 respectively, and US$ 8546 and US$ 10,510 respectively, after incorporating costs saved by households. When PCV13 was compared to PCV10 directly, the additional benefits of PCV-13 was conferred at a cost of US$ 28,147 per DALY averted. Cost-effectiveness was influenced mainly by vaccine price, serotype replacement, pneumonia mortality and discount rate. Routine vaccination against S. pneumoniae in Argentina would be cost-effective with either PCV-10 or PCV-13. PCV-13, with higher coverage of local serotypes, would prevent more cases of pneumonia, invasive pneumococcal disease, sequelae and deaths with a higher number of LYG and DALYs averted, but PCV-10, due its higher impact in the prevention of AOM, would save more costs to the healthcare system. Copyright © 2011 Elsevier Ltd. All rights reserved.

The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline.

PubMed

Peterse, Elisabeth F P; Meester, Reinier G S; Siegel, Rebecca L; Chen, Jennifer C; Dwyer, Andrea; Ahnen, Dennis J; Smith, Robert A; Zauber, Ann G; Lansdorp-Vogelaar, Iris

2018-05-30

In 2016, the Microsimulation Screening Analysis-Colon (MISCAN-Colon) model was used to inform the US Preventive Services Task Force colorectal cancer (CRC) screening guidelines. In this study, 1 of 2 microsimulation analyses to inform the update of the American Cancer Society CRC screening guideline, the authors re-evaluated the optimal screening strategies in light of the increase in CRC diagnosed in young adults. The authors adjusted the MISCAN-Colon model to reflect the higher CRC incidence in young adults, who were assumed to carry forward escalated disease risk as they age. Life-years gained (LYG; benefit), the number of colonoscopies (COL; burden) and the ratios of incremental burden to benefit (efficiency ratio [ER] = ΔCOL/ΔLYG) were projected for different screening strategies. Strategies differed with respect to test modality, ages to start (40 years, 45 years, and 50 years) and ages to stop (75 years, 80 years, and 85 years) screening, and screening intervals (depending on screening modality). The authors then determined the model-recommended strategies in a similar way as was done for the US Preventive Services Task Force, using ER thresholds in accordance with the previously accepted ER of 39. Because of the higher CRC incidence, model-predicted LYG from screening increased compared with the previous analyses. Consequently, the balance of burden to benefit of screening improved and now 10-yearly colonoscopy screening starting at age 45 years resulted in an ER of 32. Other recommended strategies included fecal immunochemical testing annually, flexible sigmoidoscopy screening every 5 years, and computed tomographic colonography every 5 years. This decision-analysis suggests that in light of the increase in CRC incidence among young adults, screening may be offered earlier than has previously been recommended. Cancer 2018. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. © 2018 The Authors

Percutaneous cryoablation of metastatic renal cell carcinoma for local tumor control: feasibility, outcomes, and estimated cost-effectiveness for palliation.

PubMed

Bang, Hyun J; Littrup, Peter J; Goodrich, Dylan J; Currier, Brandt P; Aoun, Hussein D; Heilbrun, Lance K; Vaishampayan, Ulka; Adam, Barbara; Goodman, Allen C

2012-06-01

To assess complications, local tumor recurrences, overall survival (OS), and estimates of cost-effectiveness for multisite cryoablation (MCA) of oligometastatic renal cell carcinoma (RCC). A total of 60 computed tomography- and/or ultrasound-guided percutaneous MCA procedures were performed on 72 tumors in 27 patients (three women and 24 men). Average patient age was 63 years. Tumor location was grouped according to common metastatic sites. Established surgical selection criteria graded patient status. Median OS was determined by Kaplan-Meier method and defined life-years gained (LYGs). Estimates of MCA costs per LYG were compared with established values for systemic therapies. Total number of tumors and cryoablation procedures for each anatomic site are as follows: nephrectomy bed, 11 and 11; adrenal gland, nine and eight; paraaortic, seven and six; lung, 14 and 13; bone, 13 and 13; superficial, 12 and nine; intraperitoneal, five and three; and liver, one and one. A mean of 2.2 procedures per patient were performed, with a median clinical follow-up of 16 months. Major complication and local recurrence rates were 2% (one of 60) and 3% (two of 72), respectively. No patients were graded as having good surgical risk, but median OS was 2.69 years, with an estimated 5-year survival rate of 27%. Cryoablation remained cost-effective with or without the presence of systemic therapies according to historical cost comparisons, with an adjunctive cost-effectiveness ratio of $28,312-$59,554 per LYG. MCA was associated with very low morbidity and local tumor recurrence rates for all anatomic sites, with apparent increased OS. Even as an adjunct to systemic therapies, MCA appeared cost-effective for palliation of oligometastatic RCC. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

Hepatic Resection for Colorectal Liver Metastases: A Cost-Effectiveness Analysis

PubMed Central

Beard, Stephen M.; Holmes, Michael; Price, Charles; Majeed, Ali W.

2000-01-01

Objective To analyze the cost-effectiveness of resection for liver metastases compared with standard nonsurgical cytotoxic treatment. Summary Background Data The efficacy of hepatic resection for metastases from colorectal cancer has been debated, despite reported 5-year survival rates of 20% to 40%. Resection is confined to specialized centers and is not widely available, perhaps because of lack of appropriate expertise, resources, or awareness of its efficacy. The cost-effectiveness of resection is important from the perspective of managed care in the United States and for the commissioning of health services in the United Kingdom. Methods A simple decision-based model was developed to evaluate the marginal costs and health benefits of hepatic resection. Estimates of resectability for liver metastases were taken from UK-reported case series data. The results of 100 hepatic resections conducted in Sheffield from 1997 to 1999 were used for the cost calculation of liver resection. Survival data from published series of resections were compiled to estimate the incremental cost per life-year gained (LYG) because of the short period of follow-up in the Sheffield series. Results Hepatic resection for colorectal liver metastases provides an estimated marginal benefit of 1.6 life-years (undiscounted) at a marginal cost of £6,742. If 17% of patients have only palliative resections, the overall cost per LYG is approximately £5,236 (£5,985 with discounted benefits). If potential benefits are extended to include 20-year survival rates, these figures fall to approximately £1,821 (£2,793 with discounted benefits). Further univariate sensitivity analysis of key model parameters showed the cost per LYG to be consistently less than £15,000. Conclusion In this model, hepatic resection appears highly cost-effective compared with nonsurgical treatments for colorectal-related liver metastases. PMID:11088071

Cost-Effectiveness of Early Infant HIV Diagnosis of HIV-Exposed Infants and Immediate Antiretroviral Therapy in HIV-Infected Children under 24 Months in Thailand

PubMed Central

Collins, Intira Jeannie; Cairns, John; Ngo-Giang-Huong, Nicole; Sirirungsi, Wasna; Leechanachai, Pranee; Le Coeur, Sophie; Samleerat, Tanawan; Kamonpakorn, Nareerat; Mekmullica, Jutarat; Jourdain, Gonzague; Lallemant, Marc

2014-01-01

Background HIV-infected infants have high risk of death in the first two years of life if untreated. WHO guidelines recommend early infant HIV diagnosis (EID) of all HIV-exposed infants and immediate antiretroviral therapy (ART) in HIV-infected children under 24-months. We assessed the cost-effectiveness of this strategy in HIV-exposed non-breastfed children in Thailand. Methods A decision analytic model of HIV diagnosis and disease progression compared: EID using DNA PCR with immediate ART (Early-Early); or EID with deferred ART based on immune/clinical criteria (Early-Late); vs. clinical/serology based diagnosis and deferred ART (Reference). The model was populated with survival and cost data from a Thai observational cohort and the literature. Incremental cost-effectiveness ratio per life-year gained (LYG) was compared against the Reference strategy. Costs and outcomes were discounted at 3%. Results Mean discounted life expectancy of HIV-infected children increased from 13.3 years in the Reference strategy to 14.3 in the Early-Late and 17.8 years in Early-Early strategies. The mean discounted lifetime cost was $17,335, $22,583 and $29,108, respectively. The cost-effectiveness ratio of Early-Late and Early-Early strategies was $5,149 and $2,615 per LYG, respectively as compared to the Reference strategy. The Early-Early strategy was most cost-effective at approximately half the domestic product per capita per LYG ($4,420 in Thailand 2011). The results were robust in deterministic and probabilistic sensitivity analyses including varying perinatal transmission rates. Conclusion In Thailand, EID and immediate ART would lead to major survival benefits and is cost- effective. These findings strongly support the adoption of WHO recommendations as routine care. PMID:24632750

Weight gain in the first two years of life, asthma and atopy: the SCAALA cohort study.

PubMed

Matos, Sheila M A; Jesus, Sandra R; Saldiva, Silvia R D M; Prado, Matildes S; D'Innocenzo, Silvana; Assis, Ana M O; Rodrigues, Laura C; Alcantara-Neves, Neuza M; Cruz, Alvaro A; Simões, Silvia de Magalhães; Fiaccone, Rosemeire L; Barreto, Maurício L

2014-11-01

To evaluate the association between weight gain in the first two years of life and the occurrence of wheezing, asthma, serum IgE, skin reactivity and pulmonary function. Cohort study. The metropolitan region of Salvador, Bahia, Brazil. The association was studied between 1997 and 2005 in 669 children up to 11 years of age. Data were collected on asthma and risk factors, both current factors and those present in the first years of life. Weight gain was considered fast when the Z-score was >0·67. Poisson regression was used in the multivariate statistical analysis. Wheezing was reported in 25·6 % of the children. Weight gain was considered fast (Z-score >0·67) in 29·6 % of the children and slow (Z-score <-0·67) in 13·9 %. Children in the slow weight gain group had 36 % fewer symptoms of asthma (prevalence ratio = 0·65; 95 % CI 0·42, 0·99). Slower weight gain in the early years of life may constitute a protective factor against symptoms of asthma. The relevance of this finding for public health is not yet certain, since it is known that children with slow and fast weight gain may be more likely to develop adverse health consequences related to both these situations.

Predicting the "Freshman 15": Environmental and Psychological Predictors of Weight Gain in First-Year University Students

ERIC Educational Resources Information Center

Vella-Zarb, Rachel A.; Elgar, Frank J.

2010-01-01

Objectives: (1) To investigate weight gain in first-year university students; and (2) to examine whether environmental and psychological factors, specifically accommodation and stress, predict weight gain. Methods: Eighty-four first-year university students (77 per cent female) were weighed and completed the Perceived Stress Scale (Cohen, Kamarck…

Economic evaluation of first-line and maintenance treatments for advanced non-small cell lung cancer: a systematic review.

PubMed

Chouaïd, Christos; Crequit, Perinne; Borget, Isabelle; Vergnenegre, Alain

2015-01-01

During these last years, there have been an increased number of new drugs for non-small cell lung cancer (NSCLC), with a growing financial effect on patients and society. The purpose of this article was to review the economics of first-line and maintenance NSCLC treatments. We reviewed economic analyses of NSCLC therapies published between 2004 and 2014. In first-line settings, in unselected patients with advanced NSCLC, the cisplatin gemcitabine doublet appears to be cost-saving compared with other platinum doublets. In patients with nonsquamous NSCLC, the incremental cost-effectiveness ratios (ICERs) per life-year gained (LYG) were $83,537, $178,613, and more than $300,000 for cisplatin-pemetrexed compared with, respectively, cisplatin-gemcitabine, cisplatin-carboplatin-paclitaxel, and carboplatin-paclitaxel-bevacizumab. For all primary chemotherapy agents, use of carboplatin is associated with slightly higher costs than cisplatin. In all the analysis, bevacizumab had an ICER greater than $150,000 per quality-adjusted life-year (QALY). In epidermal growth factor receptor mutated advanced NSCLC, compared with carboplatin-paclitaxel doublet, targeted therapy based on testing available tissue yielded an ICER of $110,644 per QALY, and the rebiopsy strategy yielded an ICER of $122,219 per QALY. Compared with the triplet carboplatin-paclitaxel-bevacizumab, testing and rebiopsy strategies had ICERs of $25,547 and $44,036 per QALY, respectively. In an indirect comparison, ICERs per LYG and QALY of erlotinib versus gefitinib were $39,431 and $62,419, respectively. In anaplastic lymphoma kinase-positive nonsquamous advanced NSCLC, the ICER of first-line crizotinib compared with that of chemotherapy was $255,970 per QALY. For maintenance therapy, gefitinib had an ICER of $19,214 per QALY, erlotinib had an ICER of $127,343 per LYG, and pemetrexed had an ICER varying between $183,589 and $205,597 per LYG. Most recent NSCLC strategies are based on apparently no cost

Educational mobility and weight gain over 13 years in a longitudinal study of young women.

PubMed

Holowko, Natalie; Jones, Mark; Tooth, Leigh; Koupil, Ilona; Mishra, Gita

2014-11-25

Limited evidence exists about the role of education and own educational mobility on body weight trajectory. A better understanding of how education influences long term weight gain can help us to design more effective health policies. Using random effects models, the association between i) highest education (n = 10 018) and ii) educational mobility over a 9 year period (n = 9 907) and weight gain was analysed using five waves of data (over 13 years) from the Australian Longitudinal Study on Women's Health 1973-78 cohort (from 18-23 years to 31-36 years). Highest educational attainment was inversely associated with weight at baseline and weight gain over 13 years. Compared to high educated women, those with a low (12 years or less) or intermediate (trade/certificate/diploma) education, respectively, weighed an additional 2.6 kg (95% CI:1.9 to 3.1) and 2.5 kg (95% CI:1.9 to 3.3) at baseline and gained an additional 3.9 kg (95% CI:2.6 to 5.2) and 3.1 kg (95% CI:2.6 to 3.9) over 13 years. Compared to women who remained with a low education, women with the greatest educational mobility had similar baseline weight to the women who already had a high education at baseline (2.7 kg lighter (95% CI:-3.7 to -1.8) and 2.7 kg lighter (95% CI:-3.4 to -1.9), respectively) and similarly favourable weight gain (gaining 3.1 kg less (95% CI:-4.0 to -2.21) and 4.2 kg less (95% CI:-4.8 to -3.4) over the 13 years, respectively). While educational attainment by mid-thirties was positively associated with better weight management, women's weight was already different in young adult age, before their highest education was achieved. These findings highlight a potential role of early life factors and personality traits which may influence both education and weight outcomes.

Economic evaluation of everolimus versus sorafenib for the treatment of metastatic renal cell carcinoma after failure of first-line sunitinib.

PubMed

Casciano, Roman; Chulikavit, Maruit; Di Lorenzo, Giuseppe; Liu, Zhimei; Baladi, Jean-Francois; Wang, Xufang; Robertson, Justin; Garrison, Lou

2011-01-01

A recent indirect comparison study showed that sunitinib-refractory metastatic renal cell carcinoma (mRCC) patients treated with everolimus are expected to have improved overall survival outcomes compared to patients treated with sorafenib. This analysis examines the likely cost-effectiveness of everolimus versus sorafenib in this setting from a US payer perspective. A Markov model was developed to simulate a cohort of sunitinib-refractory mRCC patients and to estimate the cost per incremental life-years gained (LYG) and quality-adjusted life-years (QALYs) gained. Markov states included are stable disease without adverse events, stable disease with adverse events, disease progression, and death. Transition probabilities were estimated using a subset of the RECORD-1 patient population receiving everolimus after sunitinib, and a comparable population receiving sorafenib in a single-arm phase II study. Costs of antitumor therapies were based on wholesale acquisition cost. Health state costs accounted for physician visits, tests, adverse events, postprogression therapy, and end-of-life care. The model extrapolated beyond the trial time horizon for up to 6 years based on published trial data. Deterministic and probabilistic sensitivity analyses were conducted. The estimated gain over sorafenib treatment was 1.273 LYs (0.916 QALYs) at an incremental cost of $81,643. The deterministic analysis resulted in an incremental cost-effectiveness ratio (ICER) of $64,155/LYG ($89,160/QALY). The probabilistic sensitivity analysis demonstrated that results were highly consistent across simulations. As the ICER fell within the cost per QALY range for many other widely used oncology medicines, everolimus is projected to be a cost-effective treatment relative to sorafenib for sunitinib-refractory mRCC. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of one versus two sample faecal immunochemical testing for colorectal cancer screening.

PubMed

Goede, S Lucas; van Roon, Aafke H C; Reijerink, Jacqueline C I Y; van Vuuren, Anneke J; Lansdorp-Vogelaar, Iris; Habbema, J Dik F; Kuipers, Ernst J; van Leerdam, Monique E; van Ballegooijen, Marjolein

2013-05-01

The sensitivity and specificity of a single faecal immunochemical test (FIT) are limited. The performance of FIT screening can be improved by increasing the screening frequency or by providing more than one sample in each screening round. This study aimed to evaluate if two-sample FIT screening is cost-effective compared with one-sample FIT. The MISCAN-colon microsimulation model was used to estimate costs and benefits of strategies with either one or two-sample FIT screening. The FIT cut-off level varied between 50 and 200 ng haemoglobin/ml, and the screening schedule was varied with respect to age range and interval. In addition, different definitions for positivity of the two-sample FIT were considered: at least one positive sample, two positive samples, or the mean of both samples being positive. Within an exemplary screening strategy, biennial FIT from the age of 55-75 years, one-sample FIT provided 76.0-97.0 life-years gained (LYG) per 1000 individuals, at a cost of € 259,000-264,000 (range reflects different FIT cut-off levels). Two-sample FIT screening with at least one sample being positive provided 7.3-12.4 additional LYG compared with one-sample FIT at an extra cost of € 50,000-59,000. However, when all screening intervals and age ranges were considered, intensifying screening with one-sample FIT provided equal or more LYG at lower costs compared with two-sample FIT. If attendance to screening does not differ between strategies it is recommended to increase the number of screening rounds with one-sample FIT screening, before considering increasing the number of FIT samples provided per screening round.

Switching gains and health plan price elasticities: 20 years of managed competition reforms in The Netherlands.

PubMed

Douven, Rudy; Katona, Katalin; T Schut, Frederik; Shestalova, Victoria

2017-11-01

In this paper we estimate health plan price elasticities and financial switching gains for consumers over a 20-year period in which managed competition was introduced in the Dutch health insurance market. The period is characterized by a major health insurance reform in 2006 to provide health insurers with more incentives and tools to compete, and to provide consumers with a more differentiated choice of products. Prior to the reform, in the period 1995-2005, we find a low number of switchers, between 2 and 4% a year, modest average total switching gains of 2 million euros per year and short-term health plan price elasticities ranging from -0.1 to -0.4. The major reform in 2006 resulted in an all-time high switching rate of 18%, total switching gains of 130 million euros, and a high short-term price elasticity of -5.7. During 2007-2015 switching rates returned to lower levels, between 4 and 8% per year, with total switching gains in the order of 40 million euros per year on average. Total switching gains could have been 10 times higher if all consumers had switched to one of the cheapest plans. We find short-term price elasticities ranging between -0.9 and -2.2. Our estimations suggest substantial consumer inertia throughout the entire period, as we find degrees of choice persistence ranging from about 0.8 to 0.9.

Cost-effectiveness of rosuvastatin 20 mg for the prevention of cardiovascular morbidity and mortality: a Swedish economic evaluation of the JUPITER trial.

PubMed

Ohsfeldt, Robert L; Olsson, Anders G; Jensen, Marie M; Gandhi, Sanjay K; Paulsson, Thomas

2012-01-01

This study estimated the long-term health outcomes, healthcare costs, and cost-effectiveness of rosuvastatin 20 mg therapy in primary prevention of major cardiovascular disease (CVD) in a Swedish population. Based on data from the JUPITER trial, long-term CVD outcomes with rosuvastatin vs no active treatment were estimated for patients with an elevated baseline CVD risk (Framingham CVD score >20%, sub-population of JUPITER population) and for a population similar to the total JUPITER population. Using a decision-analytic model, trial CVD event rates were combined with epidemiological and cost data specific for Sweden. First and subsequent CVD events and death were estimated over a lifetime perspective. The observed relative risk reduction was extrapolated beyond the trial duration. Incremental effectiveness was measured as life-years gained (LYG) and quality-adjusted life-years (QALYs) gained. Treating 100,000 patients with rosuvastatin 20 mg was estimated to avoid 14,692 CVD events over the lifetime (8021 non-fatal MIs, 3228 non-fatal strokes, and 4924 CVD deaths) compared to placebo. This translated into an estimated gain of 42,122 QALYs and 36,865 total life years (LYG). Rosuvastatin was both more effective and less costly over a lifetime perspective, and rosuvastatin is subsequently a dominant alternative compared to no treatment in the assessed population. Using the overall JUPITER population, rosuvastatin was dominant for the lifetime horizon. In the sensitivity analysis, rosuvastatin was the dominant treatment strategy over a 20-year time horizon, and cost-effective with an incremental cost-effectiveness ratio (cost per QALY) of SEK 1783 over a 10-year time horizon. Some model inputs were derived from literature or other data sources, but uncertainty was controlled by sensitivity analyses. Results indicate that rosuvastatin 20 mg treatment is a cost-effective option vs no-treatment in patients with Framingham CVD risk >20% in Sweden and might even be

Cost-effectiveness analysis of combination antifungal therapy with voriconazole and anidulafungin versus voriconazole monotherapy for primary treatment of invasive aspergillosis in Spain

PubMed Central

Grau, Santiago; Azanza, Jose Ramon; Ruiz, Isabel; Vallejo, Carlos; Mensa, Josep; Maertens, Johan; Heinz, Werner J; Barrueta, Jon Andoni; Peral, Carmen; Mesa, Francisco Jesús; Barrado, Miguel; Charbonneau, Claudie; Rubio-Rodríguez, Darío; Rubio-Terrés, Carlos

2017-01-01

Objective According to a recent randomized, double-blind clinical trial comparing the combination of voriconazole and anidulafungin (VOR+ANI) with VOR monotherapy for invasive aspergillosis (IA) in patients with hematologic disease or with hematopoietic stem cell transplant, mortality was lower after 6 weeks with VOR+ANI than with VOR monotherapy in a post hoc analysis of patients with galactomannan-based IA. The objective of this study was to compare the cost-effectiveness of VOR+ANI with VOR, from the perspective of hospitals in the Spanish National Health System. Methods An economic model with deterministic and probabilistic analyses was used to determine costs per life-year gained (LYG) for VOR+ANI versus VOR in patients with galactomannan-based IA. Mortality, adverse event rates, and life expectancy were obtained from clinical trial data. The costs (in 2015 euros [€]) of the drugs and the adverse event-related costs were obtained from Spanish sources. A Tornado plot and a Monte Carlo simulation (1,000 iterations) were used to assess uncertainty of all model variables. Results According to the deterministic analysis, for each patient treated with VOR+ANI compared with VOR monotherapy, there would be a total of 0.348 LYG (2.529 vs 2.181 years, respectively) at an incremental cost of €5,493 (€17,902 vs €12,409, respectively). Consequently, the additional cost per LYG with VOR+ANI compared with VOR would be €15,785. Deterministic sensitivity analyses confirmed the robustness of these findings. In the probabilistic analysis, the cost per LYG with VOR+ANI was €15,774 (95% confidence interval: €15,763–16,692). The probability of VOR+ANI being cost-effective compared with VOR was estimated at 82.5% and 91.9%, based on local cost-effectiveness thresholds of €30,000 and €45,000, respectively. Conclusion According to the present economic study, combination therapy with VOR+ANI is cost-effective as primary therapy of IA in galactomannan

The cost-effectiveness of screening for hereditary hemochromatosis in Germany: a remodeling study.

PubMed

Rogowski, Wolf H

2009-01-01

Genetic tests for hereditary hemochromatosis (HH) are currently included in the German ambulatory care reimbursement scheme but only for symptomatic individuals and the offspring of HH patients. This study synthesizes the most current evidence to examine whether screening in the broader population is cost-effective and to identify the best choice of initial and follow-up screening tests. A probabilistic decision-analytic model was constructed to calculate cost per life year gained (LYG) for HH screening among male Caucasians aged 30. Three strategies were considered in both the general population and male offspring of HH patients: phenotypic (transferrin saturation, TS), genotypic (C282Y mutation), and sequential (genotype if TS is elevated) screening. The incremental cost-effectiveness of sequential screening among male offspring, sequential population-wide screening, and genotypic screening is 41000, 124000, and 161000 Eero/LYG, respectively. All other strategies were subject to simple or extended dominance. The results are subject to high uncertainty. The most influential parameters in the deterministic one-way sensitivity analysis are discounting of life years gained and the adherence of patients to preventive phlebotomy. The current German policy of only screening at-risk individuals is consistent with health economic decision making based on typically accepted thresholds. However, conducting the DNA test after the first elevated TS result is more cost-effective than waiting for a second TS result as recommended by the German guidelines. Further empirical work regarding adherence to long-term prevention recommendations and explicit and well-justified guidance for the choice of discount rates in German economic evaluation are needed.

Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients: a cost-effectiveness analysis.

PubMed

Oostdijk, Evelien A N; de Wit, G A; Bakker, Marina; de Smet, Anne Marie G A; Bonten, M J M

2013-03-05

To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs). A post hoc analysis of a previously performed cluster-randomised trial (NEJM 2009;360:20). 13 Dutch ICUs. Patients with ICU-stay of >48 h that received SDD (n=2045), SOD (n=1904) or SC (n=1990). SDD or SOD. Effects were based on hospital survival, expressed as crude Life Years Gained (cLYG). The incremental cost-effectiveness ratio (ICER) was calculated, with corresponding cost acceptability curves. Sensitivity analyses were performed for discount rates, costs of SDD, SOD and mechanical ventilation. Total costs per patient were €41 941 for SC (95% CI €40 184 to €43 698), €40 433 for SOD (95% CI €38 838 to €42 029) and €41 183 for SOD (95% CI €39 408 to €42 958). SOD and SDD resulted in crude LYG of +0.04 and +0.25, respectively, as compared with SC, implying that both SDD and SOD are dominant (ie, cheaper and more beneficial) over SC. In cost-effectiveness acceptability curves probabilities for cost-effectiveness, compared with standard care, ranged from 89% to 93% for SOD and from 63% to 72% for SDD, for acceptable costs for 1 LYG ranging from €0 to €20 000. Sensitivity analysis for mechanical ventilation and discount rates did not change interpretation. Yet, if costs of the topical component of SDD and SOD would increase 40-fold to €400/day and €40/day (maximum values based on free market prices in 2012), the estimated ICER as compared with SC for SDD would be €21 590 per LYG. SOD would remain cost-saving. SDD and SOD were both effective and cost-saving in Dutch ICUs.

Paclitaxel: a pharmacoeconomic review of its use in the treatment of ovarian cancer.

PubMed

Young, M; Plosker, G L

2001-01-01

Paclitaxel belongs to the group of antitumour agents called the taxanes. Its efficacy in advanced ovarian cancer has been established in large, randomised phase III clinical trials. When used in combination with cisplatin for first-line treatment of advanced ovarian cancer, it is superior to cyclophosphamide/cisplatin, with gains in median survival of around 1 year. Paclitaxel plus carboplatin has similar efficacy to paclitaxel plus cisplatin. There is now consensus that paclitaxel plus either carboplatin or cisplatin is the recommended first-line therapy for patients with advanced ovarian cancer. The particular combination employed may vary between institutions and geographical regions, although paclitaxel plus carboplatin is generally better tolerated (i.e. lower incidence of non-haematological adverse events) than paclitaxel plus cisplatin and is widely used in many countries. Paclitaxel is also used as monotherapy in second-line (salvage) treatment of ovarian cancer. Pharmacoeconomic analyses performed to date have primarily focused on first-line therapy comparing the combination of paclitaxel/cisplatin with cyclophosphamide/cisplatin. All studies incorporated clinical outcomes data, most commonly from the Gynecologic Oncology Group (GOG) 111 trial, showing a survival advantage for paclitaxel/cisplatin. These studies report incremental cost-effectiveness ratios (ICERs) ranging from $US 6395 per additional life-year gained (LYG) in Spain (1995/96 values) to $US 44,690 per additional progression-free LYG in France (year of costs not reported). Five studies were based in the US and Canada and these reported very similar ICERs of $US 13,135 (year of costs not reported) to $US 25,131 (1993 costs) per additional LYG. In all of these studies the incremental costs of paclitaxel/cisplatin therapy fall well within the commonly cited threshold limit of $US 50,000 for new therapies and compare well with incremental costs reported for other oncological and life

The Complete Remission of Acquired Immunodeficiency Syndrome-associated Isolated Central Nervous System Lymphomatoid Granulomatosis: A Case Report and Review of the Literature.

PubMed

Kano, Yasuhiro; Kodaira, Minori; Ushiki, Atsuhito; Kosaka, Makoto; Yamada, Mitsunori; Shingu, Kunihiko; Nishihara, Hiroshi; Hanaoka, Masayuki; Sekijima, Yoshiki

2017-09-15

A 49-year-old man presented with gradually progressive aphasia one month after being diagnosed with acquired immunodeficiency syndrome (AIDS). Brain magnetic resonance imaging showed multiple brain lesions with punctate and linear enhancement. A polymerase chain reaction detected Epstein-Barr virus (EBV) in the patient's cerebrospinal fluid. A diagnosis of isolated central nervous system lymphomatoid granulomatosis (CNS-LYG) was made based on the brain biopsy findings. The complete remission of CNS-LYG was achieved by anti-retroviral therapy (ART) alone. In the present case, the development of AIDS-associated CNS-LYG was considered to have been initiated by the reactivation of EBV in the CNS under immunosuppressive conditions. The patient's condition improved with the reconstitution of the patient's immune system.

The Complete Remission of Acquired Immunodeficiency Syndrome-associated Isolated Central Nervous System Lymphomatoid Granulomatosis: A Case Report and Review of the Literature

PubMed Central

Kano, Yasuhiro; Kodaira, Minori; Ushiki, Atsuhito; Kosaka, Makoto; Yamada, Mitsunori; Shingu, Kunihiko; Nishihara, Hiroshi; Hanaoka, Masayuki; Sekijima, Yoshiki

2017-01-01

A 49-year-old man presented with gradually progressive aphasia one month after being diagnosed with acquired immunodeficiency syndrome (AIDS). Brain magnetic resonance imaging showed multiple brain lesions with punctate and linear enhancement. A polymerase chain reaction detected Epstein-Barr virus (EBV) in the patient's cerebrospinal fluid. A diagnosis of isolated central nervous system lymphomatoid granulomatosis (CNS-LYG) was made based on the brain biopsy findings. The complete remission of CNS-LYG was achieved by anti-retroviral therapy (ART) alone. In the present case, the development of AIDS-associated CNS-LYG was considered to have been initiated by the reactivation of EBV in the CNS under immunosuppressive conditions. The patient's condition improved with the reconstitution of the patient's immune system. PMID:28824078

A Cost-Utility Analysis of Prostate Cancer Screening in Australia.

PubMed

Keller, Andrew; Gericke, Christian; Whitty, Jennifer A; Yaxley, John; Kua, Boon; Coughlin, Geoff; Gianduzzo, Troy

2017-02-01

The Göteborg randomised population-based prostate cancer screening trial demonstrated that prostate-specific antigen (PSA)-based screening reduces prostate cancer deaths compared with an age-matched control group. Utilising the prostate cancer detection rates from this study, we investigated the clinical and cost effectiveness of a similar PSA-based screening strategy for an Australian population of men aged 50-69 years. A decision model that incorporated Markov processes was developed from a health system perspective. The base-case scenario compared a population-based screening programme with current opportunistic screening practices. Costs, utility values, treatment patterns and background mortality rates were derived from Australian data. All costs were adjusted to reflect July 2015 Australian dollars (A$). An alternative scenario compared systematic with opportunistic screening but with optimisation of active surveillance (AS) uptake in both groups. A discount rate of 5 % for costs and benefits was utilised. Univariate and probabilistic sensitivity analyses were performed to assess the effect of variable uncertainty on model outcomes. Our model very closely replicated the number of deaths from both prostate cancer and background mortality in the Göteborg study. The incremental cost per quality-adjusted life-year (QALY) for PSA screening was A$147,528. However, for years of life gained (LYGs), PSA-based screening (A$45,890/LYG) appeared more favourable. Our alternative scenario with optimised AS improved cost utility to A$45,881/QALY, with screening becoming cost effective at a 92 % AS uptake rate. Both modelled scenarios were most sensitive to the utility of patients before and after intervention, and the discount rate used. PSA-based screening is not cost effective compared with Australia's assumed willingness-to-pay threshold of A$50,000/QALY. It appears more cost effective if LYGs are used as the relevant outcome, and is more cost effective than the

Cost-effectiveness analysis of entecavir versus lamivudine in the first-line treatment of Australian patients with chronic hepatitis B.

PubMed

Arnold, Elizabeth; Yuan, Yong; Iloeje, Uchenna; Cook, Greg

2008-01-01

Chronic hepatitis B (CHB) virus infection is a major global healthcare problem. The recent introduction of entecavir in Australia for the treatment of CHB patients in the naive treatment setting has triggered significant optimism with regards to improved clinical outcomes for CHB patients. To estimate, from an Australian healthcare perspective, the cost effectiveness of entecavir 0.5 mg/day versus lamivudine 100 mg/day in the treatment of CHB patients naive to nucleos(t)ide therapy. A cost-utility analysis to project the clinical and economic outcomes associated with CHB disease and treatment was conducted by developing two decision-tree models specific to hepatitis B e antigen-positive (HBeAg+ve) and HBeAg-ve CHB patient subsets. This analysis was constructed using the Australian payer perspective of direct costs and outcomes, with indirect medical costs and lost productivity not being included. The study population comprised a hypothetical cohort of 1000 antiviral treatment-naive CHB patients who received either entecavir 0.5 mg/day or lamivudine 100 mg/day at model entry. The population of patients used in this analysis was representative of those patients likely to receive initial antiviral therapy in clinical practice in Australia. The long-term cost effectiveness of entecavir compared with lamivudine in the first-line treatment of CHB patients was expressed as an incremental cost per life-year gained (LYG) or QALY gained. Results revealed that the availability of entecavir 0.5 mg/day as part of the Australian hepatologist's treatment armamentarium should result in significantly lower future rates of compensated cirrhosis (CC), decompensated cirrhosis (DC), and hepatocellular carcinoma (HCC) events (i.e. 54 fewer cases of CC, seven fewer cases of DC, and 20 fewer cases of HCC over the model's timeframe for HBeAg+ve CHB patients, and 69 fewer cases of CC, eight fewer cases of DC and 25 fewer cases of HCC over the model's timeframe for HBeAg-ve CHB patients

Oral Lactobacillus Counts Predict Weight Gain Susceptibility: A 6-Year Follow-Up Study

PubMed Central

Rosing, Johanne Aviaja; Walker, Karen Christina; Jensen, Benjamin A.H.; Heitmann, Berit L.

2017-01-01

Background Recent studies have shown an association between weight change and the makeup of the intestinal microbiota in humans. Specifically, Lactobacillus, a part of the entire gastrointestinal tract's microbiota, has been shown to contribute to weight regulation. Aim We examined the association between the level of oral Lactobacillus and the subsequent 6-year weight change in a healthy population of 322 Danish adults aged 35–65 years at baseline. Design Prospective observational study. Results In unadjusted analysis the level of oral Lactobacillus was inversely associated with subsequent 6-year change in BMI. A statistically significant interaction between the baseline level of oral Lactobacillus and the consumption of complex carbohydrates was found, e.g. high oral Lactobacillus count predicted weight loss for those with a low intake of complex carbohydrates, while a medium intake of complex carbohydrates predicted diminished weight gain. A closer examination of these relations showed that BMI change and Lactobacillus level was unrelated for those with high complex carbohydrate consumption. Conclusion A high level of oral Lactobacillus seems related to weight loss among those with medium and low intakes of complex carbohydrates. Absence, or a low level of oral Lactobacillus, may potentially be a novel marker to identify those at increased risk of weight gain. PMID:29020671

Oral Lactobacillus Counts Predict Weight Gain Susceptibility: A 6-Year Follow-Up Study.

PubMed

Rosing, Johanne Aviaja; Walker, Karen Christina; Jensen, Benjamin A H; Heitmann, Berit L

2017-01-01

Recent studies have shown an association between weight change and the makeup of the intestinal microbiota in humans. Specifically, Lactobacillus, a part of the entire gastrointestinal tract's microbiota, has been shown to contribute to weight regulation. We examined the association between the level of oral Lactobacillus and the subsequent 6-year weight change in a healthy population of 322 Danish adults aged 35-65 years at baseline. Prospective observational study. In unadjusted analysis the level of oral Lactobacillus was inversely associated with subsequent 6-year change in BMI. A statistically significant interaction between the baseline level of oral Lactobacillus and the consumption of complex carbohydrates was found, e.g. high oral Lactobacillus count predicted weight loss for those with a low intake of complex carbohydrates, while a medium intake of complex carbohydrates predicted diminished weight gain. A closer examination of these relations showed that BMI change and Lactobacillus level was unrelated for those with high complex carbohydrate consumption. A high level of oral Lactobacillus seems related to weight loss among those with medium and low intakes of complex carbohydrates. Absence, or a low level of oral Lactobacillus, may potentially be a novel marker to identify those at increased risk of weight gain. © 2017 The Author(s) Published by S. Karger GmbH, Freiburg.

[Cost-effectiveness analysis of apixaban versus acetylsalicylic acid in the prevention of stroke in patients with non-valvular atrial fibrillation in Spain].

PubMed

Escolar-Albaladejo, Ginés; Barón-Esquivias, Gonzalo; Zamorano, José Luis; Betegón-Nicolás, Lourdes; Canal-Fontcuberta, Cristina; de Salas-Cansado, Marina; Rubio-Rodríguez, Darío; Rubio-Terrés, Carlos

2016-01-01

To assess the cost-effectiveness of apixaban versus acetylsalicylic acid (ASA) in stroke prevention in patients with non-valvular atrial fibrillation (NVAF) with contraindications of vitamin K antagonists in Spain. A Markov model was adapted, simulating the patient's lifetime. The safety and efficacy of the drugs were obtained from AVERROES clinical trial. The analysis was done from the Spanish National Health System (NHS) and societal perspective. The cost of drugs was calculated according to the recommended doses. The cost of NVAF complications and disease management was obtained from Spanish sources. In a cohort of 1,000 patients with NVAF, during their lifetime numerous complications could be avoided with apixaban versus ASA (48 ischemic strokes, 10 systemic embolism and 53 related deaths). In each patient treated with apixaban more life-years (0.303 LYG) and more quality-adjusted life-years (0.277 QALYs) could be gained. Apixaban would generate more costs per patient for the NHS (€1,742 per patient) but savings would result from the social perspective (€2,887 saved per patient). The cost per LYG and QALY gained would be of €5,749 and €6,289 for the NHS. Apixaban would be dominant (more effective with less costs than ASA) from the societal perspective. The results were stable in both deterministic and probabilistic sensitivity analyses. According to this model, when costs and estimated lifetime outcomes achieved with apixaban are compared with those of ASA, apixaban was assessed to be a cost-effective treatment for the prevention of stroke in patients with NVAF in Spain. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

[Cost-effectiveness Analysis of Panitumumab Plus mFOLFOX6 Compared to Bevacizumab Plus mFOLFOX6 for First-line Treatment of Patients with Wild-type RAS Metastatic Colorectal Cancer--Czech Republic Model Adaptation].

PubMed

Fínek, J; Skoupá, J; Jandová, P

2015-01-01

Pharmacoeconomic assessments are a part of the decision process not only during reimbursement setting, but in clinical practice as well. The presented cost-effectiveness analysis assesses panitumumab+mFOLFOX6 vs. bevacizumab+mFOLFOX6 in 1st line treatment of patients with wildtype RAS metastatic colorectal cancer (mCRC) in the Czech environment. The adaptation of a Markov model considers the healthcare perspective; clinical data (efficacy, healthcare utilization and adverse events) are derived from a head-to-head comparison (PEAK study). Health states included in the model: progression free on treatment, progression (with/ without active treatment), resection of metastases, disease-free after successful resection and death. Actual reimbursement levels were used to estimate costs, published literature to estimate duration of 2nd line treatment. The analysis assumes a lifetime horizon; uncertainty was limited by performing one-way and probabilistic sensitivity analyses. Analysis outcomes are life-years gained (LYG) and quality-adjusted life-years (QALYs). Panitumumab+mFOLFOX6 is more effective and more costly in 1st line patients with wildtype RAS mCRC. Incremental costs per QALY are 837,270 CZK, per LYG 615,022 CZK; however, below the willingness-to-pay threshold applied in the Czech Republic. Panitumumab+mFOLFOX6 is cost-effective in 1st line treatment of patients with wildtype RAS mCRC compared to bevacizumab+mFOLFOX6 in the Czech setting.

77 FR 15361 - Gainful Employment Reporting Deadline Date for the 2011-2012 Award Year

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-15

... student assistance programs authorized under title IV of the Higher Education Act of 1965, as amended (HEA... Federal Direct Loan, Teacher Education Assistance for College and Higher Education Grant, and Iraq and... DEPARTMENT OF EDUCATION Gainful Employment Reporting Deadline Date for the 2011-2012 Award Year...

Body mass index gain between ages 20-40 years and lifestyle characteristics of men at ages 40-60 years: The Adventist Health Study-2

PubMed Central

Japas, Claudio; Knutsen, Synnøve; Dehom, Salem; Dos Santos, Hildemar; Tonstad, Serena

2014-01-01

Background Obesity increases risk of premature disease, and may be associated with unfavorable lifestyle changes that add to risk. This study analyzed the association of midlife BMI change with current lifestyle patterns among multiethnic men. Methods Men aged 40-60 years (n=9864) retrospectively reported body weight between ages 20-40 years and current dietary, TV, physical activity and sleep practices in the Adventist Health Study II, a study of church-goers in the US and Canada. In multivariate logistic regression analysis, odds ratios for BMI gain were calculated for each lifestyle practice controlling for sociodemographic and other lifestyle factors and current BMI. Results Men with median or higher BMI gain (2.79 kg/m2) between ages 20-40 years were more likely to consume a non-vegetarian diet, and engage in excessive TV watching and little physical activity and had a shorter sleep duration compared to men with BMI gain below the median (all p<0.001). In multivariate logistic analysis current BMI was significantly associated with all lifestyle factors in multivariate analyses (all p≤0.005). BMI gain was associated with lower odds of vegetarian diet (odds ratio [OR] 0.939; 95% confidence interval [CI] 0.921-0.957) and of physical activity ≥150 minutes/week (OR 0.979, 95% CI 0.960-0.999). Conclusions These findings imply that diet and less physical activity are associated with both gained and attained BMI, while inactivity (TV watching) and short sleep duration correlated only with attained BMI. Unhealthy lifestyle may add risk to that associated with BMI. Longitudinal and intervention studies are needed to infer causal relationships. PMID:25434910

Cost-effectiveness analysis of pneumococcal polysaccharide vaccination from age 60 in São Paulo State, Brazil.

PubMed

Neto, Joao Tonolio; de Araujo, Gabriela Tannus Branco; Gagliardi, Anna; Pinho, Amanda; Durand, Laure; Fonseca, Marcelo

2011-10-01

Vaccination of adults aged 60 years and older against Streptococcus pneumonia is not recommended in Brazil. The 23-valent polysaccharide pneumococcal vaccine (PPV23) is only available for institutionalized persons or with underlying diseases despite the substantial medical and economic burden related to pneumococcal infections in adults over than 59 years. The study aimed at evaluating the cost effectiveness of implementing a large PPV program in this population. This analysis was performed using a static decision tree model. Demographic and epidemiological data were obtained from Brazilian official sources and international literature. Economic data were obtained from a study performed in 2007 in a public and a private hospital located in Sao Paulo. Vaccination was assumed to protect for 5 years with 60% effectiveness against bacteremic pneumococcal pneumonia (BPP) and 21% effectiveness against non bacteremic pneumococcal pneumonia (NBPP). Deterministic and sensitivity analyses were performed. The pneumococcal polysaccharide vaccination saved 5,218 life year gained (LYG). The vaccination program was found to be cost effective in the social security and public health care perspectives with a mean incremental cost-effectiveness ratio of R$10,887 and R$8,281 per LYG respectively. Results were sensitive to the vaccine effectiveness against NBPP, the incidence and case-fatality rate of NBPP. From a societal perspective, PPV23 program for adults 60 and older was found to be cost-saving. Pneumococcal polysaccharide vaccination is clinically and economically favored over the present vaccination strategy, in which persons aged over 59 years in Sao Paulo, have not been vaccinated.

Mifamurtide for high-grade, resectable, nonmetastatic osteosarcoma following surgical resection: a cost-effectiveness analysis.

PubMed

Johal, Sukhvinder; Ralston, Stephen; Knight, Christopher

2013-12-01

Mifamurtide is an immune macrophage stimulant that when added to standard chemotherapy has demonstrated survival benefit for newly diagnosed osteosarcoma. The objectives of this study were to investigate the cost-effectiveness of adding mifamurtide to standard three- or four-agent chemotherapy for high-grade, resectable, nonmetastatic osteosarcoma following surgical resection and the issues of obtaining robust cost-effectiveness estimates for ultra-orphan drugs, given the shortage of data. An economic evaluation was conducted from the perspective of the UK's National Health Service as part of the manufacturer's submission to the National Institute for Health and Care Excellence. The disease process was simplified to a transition through a series of health states, modeled by using a Markov approach. Data to inform the model were derived from patient-level data of Study INT-0133, published literature, and expert opinion. The final efficacy measure was life-years gained (LYG), and utilities were used to obtain quality-adjusted life-years (QALYs). For a 60-year time frame and a discount rate of 3.5% for outcomes, patients receiving mifamurtide benefited from an average additional 1.57 years of life and 1.34 QALYs, compared with patients receiving chemotherapy alone, giving an incremental cost-effectiveness ratio (ICER) of £58,737 per LYG and £68,734 per QALY. Because treatment effects were both substantial in restoring health and sustained over a very long period, the National Institute for Health and Care Excellence changed its guidance to allow a discount of 1.5% for outcomes to be applied in these special circumstances. By using this discount factor, it was found that patients receiving mifamurtide had an average additional 2.58 years of life and 2.20 QALYs compared with patients receiving chemotherapy alone, resulting in an ICER of £35,765 per LYG and £41,933 per QALY. Mifamurtide's ICER is cost-effective compared with that of other orphan and ultra

Rapid Infancy Weight Gain and 7- to 9-year Childhood Obesity Risk: A Prospective Cohort Study in Rural Western China.

PubMed

Zhou, Jing; Dang, Shaonong; Zeng, Lingxia; Gao, Wenlong; Wang, Duolao; Li, Qiang; Jiang, Wenhui; Pei, Leilei; Li, Chao; Yan, Hong

2016-04-01

Obesity is increasing in developing countries. This study aimed to identify the association between rapid infancy weight gain and obesity risk among early school-age children. A total of 581 singletons (349 boys, 232 girls) whose mothers participated in an antenatal multiple micronutrient supplement trial in rural western China were followed from birth to between 7 and 9 years of age. Height and weight were measured at birth, 1.5 years, and between 7 and 9 years. At the 7- to 9-year time point, body composition was determined using bioelectrical impedance analysis. Multilevel mixed analysis was used to test the associations between rapid weight gain in infancy (from birth to age 1.5 years) and body size and composition or overweight/obesity among early school-age children. Overall, 31.2% (181 of 581) of the infants showed a weight-for-age Z score gain greater than 0.67 between birth and 1.5 years, indicating rapid weight gain. Approximately 5.7% (33 of 579) of the subjects were overweight (BMI-for-age Z scores [BAZ] >1 and ≤2) or obese (BAZ >2). Rapid infancy weight gain was associated with a higher BAZ (P < 0.001), mid-upper arm circumferences (P < 0.001), percentage body fat (P < 0.001), and fat mass index (P < 0.001) at 7 to 9 years of age after adjusting for biological and social economic factors, genetic factors, and perinatal and postnatal factors. These associations appeared to be independent of gender, economic status at early school age, and maternal nutritional status at enrollment. Rapid growers may have approximately 3 times the risk of being overweight/obese during the early school-age years (odds ratio = 2.94, 95% CI: 1.17-7.43, P = 0.022). Rapid infancy weight gain is a risk factor for being overweight/obesity among early school-age children in rural western China. We propose that social and biological determinants, such as economic status, physical activity, and feeding practice, should be targeted to prevent obesity.

School Year Versus Summer Differences in Child Weight Gain: A Narrative Review

PubMed Central

O'Connor, Teresia; Johnston, Craig; Hughes, Sheryl; Moreno, Jennette; Chen, Tzu-An; Meltzer, Lisa; Baranowski, Janice

2014-01-01

Abstract The causes of the current high prevalence of overweight and obesity among children are not clearly known. Schools have been implicated in the causal chain to high child obesity prevalence. Recent studies have compared school year versus summertime changes (herein called seasonal differences) in child adiposity or related phenomena. The most common seasonal pattern in six longitudinal descriptive studies was that overweight and obese children experienced accelerated gain in weight or some BMI indicator during the summer, whereas healthy weight children gained less or not at all. Four physical activity (PA) intervention studies demonstrated that school year fitness improvements were lost during the summer. One study showed that PA declined across the summer. Another study provided conflicting results of lower total energy expenditure in the summer, but no seasonal difference in total energy expenditure after adjusting for fat-free mass. This pattern of fairly rapid seasonal differences suggests that PA is the primary factor contributing to seasonal differences in weight or BMI, but the documented seasonal pattern in PA (i.e., higher in summer) does not support this relationship. Sleep duration has also been inversely related to child adiposity. Seasonal patterns in adiposity, PA, and sleep need to be clearly established separately for overweight and healthy weight children in further longitudinal research to provide a clear focus for national policy. PMID:24367922

School year versus summer differences in child weight gain: a narrative review.

PubMed

Baranowski, Tom; O'Connor, Teresia; Johnston, Craig; Hughes, Sheryl; Moreno, Jennette; Chen, Tzu-An; Meltzer, Lisa; Baranowski, Janice

2014-02-01

The causes of the current high prevalence of overweight and obesity among children are not clearly known. Schools have been implicated in the causal chain to high child obesity prevalence. Recent studies have compared school year versus summertime changes (herein called seasonal differences) in child adiposity or related phenomena. The most common seasonal pattern in six longitudinal descriptive studies was that overweight and obese children experienced accelerated gain in weight or some BMI indicator during the summer, whereas healthy weight children gained less or not at all. Four physical activity (PA) intervention studies demonstrated that school year fitness improvements were lost during the summer. One study showed that PA declined across the summer. Another study provided conflicting results of lower total energy expenditure in the summer, but no seasonal difference in total energy expenditure after adjusting for fat-free mass. This pattern of fairly rapid seasonal differences suggests that PA is the primary factor contributing to seasonal differences in weight or BMI, but the documented seasonal pattern in PA (i.e., higher in summer) does not support this relationship. Sleep duration has also been inversely related to child adiposity. Seasonal patterns in adiposity, PA, and sleep need to be clearly established separately for overweight and healthy weight children in further longitudinal research to provide a clear focus for national policy.

Weight gain during the first year of life in relation to maternal smoking and breast feeding in Norway.

PubMed Central

Nafstad, P; Jaakkola, J J; Hagen, J A; Pedersen, B S; Qvigstad, E; Botten, G; Kongerud, J

1997-01-01

OBJECTIVE: To assess the weight gain during the first year of life in relation to maternal smoking during pregnancy and the duration of breastfeeding. DESIGN: This was a one year cohort study. SETTING: The city of Oslo, Norway. PARTICIPANTS: Altogether 3020 children born in Oslo in 1992-93. Children were divided into three groups as follows: 2208 born to non-smoking mothers, 451 to mothers who were light smokers (< 10 cigarettes per day), and 261 to mothers who were heavy smokers (> or = 10 cigarettes per day). MAIN RESULTS: The mean birth weights were 3616 g, 3526 g, and 3382 g and 1 year body weights were 10,056 g (gain 6440 g per year), 10,141 g (6615 g), and 10,158 g (6776 g) in children of non-smoking and light and heavy smoking mothers respectively. Cox regression analysis showed that children of heavy smokers were 2.0 (95% confidence interval, 1.7, 2.3) times and children of light smokers 1.3 (1.2, 1.5) times more likely to have stopped breast feeding during their first year of life compared with children whose mothers were non-smokers. Linear regression analysis, adjusting for confounders, showed that weight gain was slower in breast fed children than in those who were not breast fed (-38 g (-50, -27) per month of breast feeding). Compared with children of non-smokers, the adjusted weight gain was 147 g (40, 255) per year greater in children of light smokers and 184 g (44, 324) per year in children of heavy smokers. CONCLUSION: Children catch up any losses in birth weight due to maternal smoking, but some of the catch up effect is caused by a shorter duration of breast feeding in children of smoking mothers. PMID:9229054

Gestational weight gain and predicted changes in offspring anthropometrics between early infancy and 3 years.

PubMed

Deierlein, A L; Siega-Riz, A M; Herring, A H; Adair, L S; Daniels, J L

2012-04-01

To determine how gestational weight gain (GWG), categorized using the 2009 Institute of Medicine recommendations, relates to changes in offspring weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length z-scores (WLZ) between early infancy and 3 years. Women with singleton infants were recruited from the third cohort of the Pregnancy, Infection, and Nutrition Study (2001-2005). Term infants with at least one weight or length measurement during the study period were included (n = 476). Multivariable linear mixed effects regression models estimated longitudinal changes in WAZ, LAZ and WLZ associated with GWG. In early infancy, compared with infants of women with adequate weight gain, those of women with excessive weight gains had higher WAZ, LAZ and WLZ. Excessive GWG ≥ 200% of the recommended amount was associated with faster rates of change in WAZ and LAZ and noticeably higher predicted mean WAZ and WLZ that persisted across the study period. GWG is associated with significant differences in offspring anthropometrics in early infancy that persisted to 3 years of age. More longitudinal studies that utilize maternal and paediatric body composition measures are necessary to understand the nature of this association. © 2012 The Authors. Pediatric Obesity © 2012 International Association for the Study of Obesity.

Cost effectiveness of prostacyclins in pulmonary arterial hypertension.

PubMed

Roman, Antonio; Barberà, Joan A; Escribano, Pilar; Sala, Maria L; Febrer, Laia; Oyagüez, Itziar; Sabater, Eliazar; Casado, Miguel A

2012-05-01

Pulmonary arterial hypertension (PAH) is considered an orphan disease. Prostacyclins are the keystone for PAH treatment. Choosing between the three available prostacyclin therapies could be complicated because there are no comparison studies, so the final decision must be driven by factors such as efficacy, administration route, safety profile and economic aspects. This study provides a cost-effectiveness and cost-utility comparison of initiating prostacyclin therapy with three different treatment alternatives (inhaled iloprost [ILO], intravenous epoprostenol [EPO] and subcutaneous treprostinil [TRE]) for patients with PAH. The goal of this work is to help physicians with their therapeutic decision-making. A Markov model was built to simulate a patient cohort with class III PAH according to the classification of the New York Heart Association (NYHA). Four health states corresponding with the NYHA classes plus death were allowed for patients in the model. Changing the treatment was possible when patients worsened from functional class III to IV. The time horizon was 3 years, allowing patients to transition between health states on a 12-week cycle basis. The study perspective was that of the National Health System (NHS) [only direct medical costs were included]. Unitary costs were obtained from the Drug Catalogue and e-Salud Database in 2009 and are given in euros (€). Data on health resources and treatment pathways were informed by a four-member expert panel. Efficacy was obtained from pivotal clinical trials of ILO, EPO and TRE, the latter used in Spain as a foreign medication. Utilities for each health state were obtained from the literature. The final efficacy measure was life-years gained (LYG), and utilities were used to obtain quality-adjusted life-years (QALYs). Costs and effects were discounted at a 3% rate. To check for the robustness of the results, sensitivity analyses were performed. At the end of the 3 years, in the base case of the deterministic

Weight Gain Reduction Among 2-Year College Students: The CHOICES RCT

PubMed Central

Lytle, Leslie A.; Laska, Melissa N.; Linde, Jennifer A.; Moe, Stacey G.; Nanney, Marilyn S.; Hannan, Peter J.; Erickson, Darin J.

2016-01-01

Introduction The young adult years have been recognized as an influential period for excess weight gain. Non-traditional students and those attending 2-year community colleges are at particularly high risk for a range of adverse weight-related outcomes. Design Choosing Healthy Options in College Environments and Settings was an RCT with students randomly assigned into a control or intervention condition after baseline assessment. The study was designed to evaluate if a 24-month weight gain prevention intervention reduces the expected increase in BMI and overweight prevalence in young adults attending 2-year colleges. Two cohorts were recruited, corresponding to the fall and spring semesters. Data collection occurred at four time points for each cohort, with baseline occurring in fall 2011 for Cohort 1 and spring 2012 for Cohort 2. The 24-month follow-up occurred in fall 2013 for Cohort 1 and spring 2014 for Cohort 2. Data analysis occurred in 2015–2016. Setting/participants This research was conducted with 441 students from three community colleges in Minnesota. Intervention The 24-month intervention began with a 1-credit college course on healthy weight behaviors. A social networking and social support website was introduced as part of the course and participation encouraged for the duration of the trial. Main outcome measures Changes in BMI, weight, body fat percentage, waist circumference, and weight status were assessed. Results Retention of the cohorts at 24 months was 83.4%. There was not a statistically significant difference in BMI between conditions at the end of the trial. However, there was a statically significant difference in the prevalence of overweight/obesity between treatment conditions at 24 months. Also, participants randomized to the intervention who were overweight or obese at baseline were more than three times as likely to transition to a healthy weight by the end of the trial as compared with control students. Conclusions The intervention

CREATE Two-Year/Four-Year Faculty Workshops: A Focus on Practice, Reflection, and Novel Curricular Design Leads to Diverse Gains for Faculty at Two-Year and Four-Year Institutions †

PubMed Central

Hoskins, Sally G.; Gottesman, Alan J.; Kenyon, Kristy L.

2017-01-01

Improving STEM education through the propagation of highly effective teaching strategies is a major goal of national reform movements. CREATE (Consider, Read, Elucidate the hypotheses, Analyze and interpret the data, and Think of the next Experiment) is a transformative teaching and learning strategy grounded in evidence-based science pedagogy. CREATE courses promote both cognitive (e.g., critical thinking) and affective (e.g., attitudinal and epistemological) student gains in diverse settings. In this study, we look more deeply into the faculty development workshop used to disseminate CREATE pedagogy to instructors at two-year and four-year institutions. We hypothesized that an immersive experience would positively shift faculty participants’ views on teaching/learning, build their understanding of CREATE pedagogy and develop their confidence for course implementation. Internal and external assessments indicate that faculty participants did achieve gains within the timeframe of the CREATE workshop. We discuss the workshop training outcomes in the context of designing effective dissemination models for innovative practices. PMID:29854053

The association between sleep duration and weight gain in adults: a 6-year prospective study from the Quebec Family Study.

PubMed

Chaput, Jean-Philippe; Després, Jean-Pierre; Bouchard, Claude; Tremblay, Angelo

2008-04-01

To investigate the relationship between sleep duration and subsequent body weight and fat gain. Six-year longitudinal study. Community setting. Two hundred seventy-six adults aged 21 to 64 years from the Quebec Family Study. More than half of the sample is drawn from families with at least 1 parent and 1 offspring with a body mass index of 32 kg/m2 or higher. Body composition measurements and self-reported sleep duration were determined. Changes in adiposity indices were compared between short- (5-6 hours), average- (7-8 hours), and long- (9-10 hours) duration sleeper groups. After adjustment for age, sex, and baseline body mass index, short-duration sleepers gained 1.98 kg (95% confidence interval: 1.16-2.82) more and long-duration sleepers gained 1.58 kg (95% CI: 1.02-2.56) more than did average-duration sleepers over 6 years. Short- and long-duration sleepers were 35% and 25% more likely to experience a 5-kg weight gain, respectively, as compared with average-duration sleepers over 6 years. The risk of developing obesity was elevated for short- and long-duration sleepers as compared with average-duration sleepers, with 27% and 21% increases in risk, respectively. These associations remained significant after inclusion of important covariates and were not affected by adjustment for energy intake and physical activity participation. This study provides evidence that both short and long sleeping times predict an increased risk of future body weight and fat gain in adults. Hence, these results emphasize the need to add sleep duration to the panel of determinants that contribute to weight gain and obesity.

Postoperative weight gain during the first year after kidney, liver, heart, and lung transplant: a prospective study.

PubMed

Kugler, Christiane; Einhorn, Ina; Gottlieb, Jens; Warnecke, Gregor; Schwarz, Anke; Barg-Hock, Hannelore; Bara, Christoph; Haller, Hermann; Haverich, Axel

2015-03-01

Studies of all types of organ transplant recipients have suggested that weight gain, expressed as an increase in body mass index (BMI), after transplant is common. To describe weight gain during the first year after transplant and to determine risk factors associated with weight gain with particular attention to type of transplant. A prospective study of 502 consecutive organ transplant recipients (261 kidney, 73 liver, 29 heart, 139 lung) to identify patterns of BMI change. Measurements were made during regular outpatient clinical visits at 2, 6, and 12 months after transplant. Data were retrieved from patients' charts and correlated with maintenance corticosteroid doses. Overall, mean BMI (SD; range) was 23.9 (4.5; 13.6-44.1) at 2 months and increased to 25.4 (4.0; 13.0-42.2) by the end of the first postoperative year. BMI levels organized by World Health Organization categories showed a trend toward overweight/obesity in kidney (53.4%), liver (51.5%), heart (51.7%), and lung (33.1%) patients by 12 months after transplant. BMI changed significantly (P= .05) for all organ types and between all assessment points, except in kidney recipients. Maintenance corticosteroid doses were not a predictor of BMI at 12 months after transplant for most patients. Weight gain was common among patients undergoing kidney, liver, heart, and lung transplant; however, many showed BMI values close to normality at the end of the first year after transplant. In most cases, increased BMI levels were related to obesity before transplant and not to maintenance corticosteroid therapy.

76 FR 46282 - Gainful Employment Reporting Date for the 2010-2011 Award Year and Continued Collection of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-02

... Federal Direct Loan, Teacher Education Assistance for College and Higher Education Grant, and Iraq and... IV of the Higher Education Act of 1965, as amended (HEA), for the 2010-2011 award year. The Secretary... DEPARTMENT OF EDUCATION Gainful Employment Reporting Date for the 2010-2011 Award Year and...

Associations of Linear Growth and Relative Weight Gain in Early Life with Human Capital at 30 Years of Age.

PubMed

Horta, Bernardo Lessa; Victora, Cesar G; de Mola, Christian Loret; Quevedo, Luciana; Pinheiro, Ricardo Tavares; Gigante, Denise P; Motta, Janaina Vieira Dos Santos; Barros, Fernando C

2017-03-01

To assess the associations of birthweight, nutritional status and growth in childhood with IQ, years of schooling, and monthly income at 30 years of age. In 1982, the 5 maternity hospitals in Pelotas, Brazil, were visited daily and 5914 live births were identified. At 30 years of age, 3701 subjects were interviewed. IQ, years of schooling, and income were measured. On average, their IQ was 98 points, they had 11.4 years of schooling, and the mean income was 1593 reais. After controlling for several confounders, birthweight and attained weight and length/height for age at 2 and 4 years of age were associated positively with IQ, years of years of schooling, and income, except for the association between length at 2 years of age and income. Conditional growth analyses were used to disentangle linear growth from relative weight gain. Conditional length at 2 years of age ≥1 SD score above the expected value, compared with ≥1 SD below the expected, was associated with an increase in IQ (4.28 points; 95% CI, 2.66-5.90), years of schooling (1.58 years; 95% CI, 1.08-2.08), and monthly income (303 Brazilian reais; 95% CI, 44-563). Relative weight gain, above what would be expected from linear growth, was not associated with the outcomes. In a middle-income setting, promotion of linear growth in the first 1000 days of life is likely to increase adult IQ, years of schooling, and income. Weight gain in excess of what is expected from linear growth does not seem to improve human capital. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Cost effectiveness of full coverage of the medical management of smoking cessation in France.

PubMed

Chevreul, Karine; Cadier, Benjamin; Durand-Zaleski, Isabelle; Chan, Elis; Thomas, Daniel

2014-05-01

To estimate the incremental cost effectiveness of full coverage of the medical management of smoking cessation from the perspective of statutory health insurance (SHI) in France. Cost-effectiveness analysis based on a Markov state-transition decision analytic model was used to compare full SHI coverage of smoking cessation and actual coverage based on an annual €50 lump sum per insured person among current French smokers aged 15-75 years. We used a scenario approach to take into account the many different behaviours of smokers and the likely variability of SHI policy choices in terms of participation rate and number and frequency of attempts covered. Drug treatments for smoking cessation combined with six medical consultations including individual counselling. The cost effectiveness of full coverage was expressed by the incremental cost-effectiveness ratio (ICER) in 2009 euros per life-year gained (LYG) at the lifetime horizon. The cost effectiveness per LYG for smokers ranged from €1786 to €2012, with an average value of €1911. The minimum value was very close to the maximum value with a difference of only €226. The cost-effectiveness ratio was only minimally sensitive to the participation rate, the number of attempts covered and the cessation rate. Compared to other health measures in primary and secondary prevention of cardiovascular disease already covered by SHI, full coverage of smoking cessation is the most cost-effective approach.

Effect of the INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 Year

PubMed Central

Savage, Jennifer S.; Birch, Leann L.; Marini, Michele; Anzman-Frasca, Stephanie; Paul, Ian M.

2016-01-01

IMPORTANCE Rapid infant weight gain is associated with later obesity, but interventions to prevent rapid infant growth and reduce risk for overweight status in infancy are lacking. OBJECTIVE To examine the effect of a responsive parenting (RP) intervention on infant weight gain between birth and 28 weeks and overweight status at age 1 year. DESIGN, SETTING, AND PARTICIPANTS The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is an ongoing randomized clinical trial comparing an RP intervention designed to prevent childhood obesity with a safety control. The study includes primiparous mother-newborn dyads (n = 291) and was conducted at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, in addition to home visits. Enrollment was initiated in January 2012, and evaluable population analyses for this study were conducted between April 2015 and November 2015. INTERVENTIONS At 2 weeks post partum, initial intervention materials appropriate to the assigned treatment group were mailed to the participant’s home. Research nurses conducted home visits at 3 weeks, 16 weeks, 28 weeks, and 40 weeks, and a research center visit occurred at 1 year. The Intervention Nurses Start Infants Growing on Healthy Trajectories curriculum included messages about infant feeding, sleep hygiene, active social play, emotion regulation, and growth record education. The control group received a developmentally appropriate home safety intervention also delivered by nurse home visitors. MAIN OUTCOMES AND MEASURES Conditional weight gain from birth to 28 weeks was calculated. General linear models examined intervention effect on conditional weight gain. The intervention’s effect on infant weight-for-length percentiles was tested using analysis of variance. Logistic regression compared the odds of overweight status (weight for length ≥95th percentile) at 1 year as a function of conditional weight gain. RESULTS Of the mothers included in the

Weight-Gain Reduction Among 2-Year College Students: The CHOICES RCT.

PubMed

Lytle, Leslie A; Laska, Melissa N; Linde, Jennifer A; Moe, Stacey G; Nanney, Marilyn S; Hannan, Peter J; Erickson, Darin J

2017-02-01

The young adult years have been recognized as an influential period for excess weight gain. Non-traditional students and those attending 2-year community colleges are at particularly high risk for a range of adverse weight-related outcomes. Choosing Healthy Options in College Environments and Settings was an RCT with students randomly assigned into a control or intervention condition after baseline assessment. The study was designed to evaluate if a 24-month weight-gain prevention intervention reduces the expected increase in BMI and overweight prevalence in young adults attending 2-year colleges. Two cohorts were recruited, corresponding to the fall and spring semesters. Data collection occurred at four time points for each cohort, with baseline occurring in fall 2011 for Cohort 1 and spring 2012 for Cohort 2. The 24-month follow-up occurred in fall 2013 for Cohort 1 and spring 2014 for Cohort 2. Data analysis occurred in 2015-2016. This research was conducted with 441 students from three community colleges in Minnesota. The 24-month intervention began with a 1-credit college course on healthy weight behaviors. A social networking and social support website was introduced as part of the course and participation encouraged for the duration of the trial. Changes in BMI, weight, body fat percentage, waist circumference, and weight status were assessed. Retention of the cohorts at 24 months was 83.4%. There was not a statistically significant difference in BMI between conditions at the end of the trial. However, there was a statically significant difference in the prevalence of overweight/obesity between treatment conditions at 24 months. Also, participants randomized to the intervention who were overweight or obese at baseline were more than three times as likely to transition to a healthy weight by the end of the trial as compared with control students. The intervention was not successful in achieving BMI differences between treatment groups. However, an 8

A Study of the Competency of Third Year Medical Students to Interpret Biochemically Based Clinical Scenarios Using Knowledge and Skills Gained in Year 1 and 2

ERIC Educational Resources Information Center

Gowda, Veena Bhaskar S.; Nagaiah, Bhaskar Hebbani; Sengodan, Bharathi

2016-01-01

Medical students build clinical knowledge on the grounds of previously obtained basic knowledge. The study aimed to evaluate the competency of third year medical students to interpret biochemically based clinical scenarios using knowledge and skills gained during year 1 and 2 of undergraduate medical training. Study was conducted on year 3 MBBS…

Children's Readiness Gains in Publically Funded, Community-Based Pre-Kindergarten Programs for 4 Year Olds and Preschool for 3 Year Olds

ERIC Educational Resources Information Center

Goldstein, Peggy; Warde, Beverly; Peluso, Paul

2013-01-01

Background: Many states provide public funding to facilitate school readiness for community-based pre-K and preschool programs for 4 year old children and "at risk" 3 year old children. Little research exists on the school readiness gains of children participating in these "garden variety" community-based programs. Objective:…

Weight six years after childbirth: a follow-up of obese women in a weight-gain restriction programmme.

PubMed

Claesson, Ing-Marie; Josefsson, Ann; Sydsjö, Gunilla

2014-05-01

to compare weight development in an intervention group and a control group, six years after participation in a gestational weight-gain restriction programme. follow-up of a prospective intervention study. antenatal care clinics. a total of 129 women (88.4%) from the original intervention group and 166 women (88.8%) from the original control group. the women answered a study specific questionnaire, covering socio-demographic data and health- and weight status. after adjusting for socio-demographic factors, the mean weight was lower (4.1kg) among the women in the intervention group, compared to the controls (p=0.028). Furthermore, the mean weight change, e.g. the weight at the six year assessment compared with the weight at the start of the intervention at the first antenatal care visit, was greater in the intervention group than in the control group. The women in the intervention group had a larger mean weight change (-5.2kg), e.g. weighed less than the women in the control group (-1.9kg) (p=0.046). Mean weight change expressed in 5kg classes also showed a significant difference between the two groups (p=0.030). the results indicate that attending a gestational weight-gain-restriction programme can have a positive effect on weight up to six years after the intervention. a restrictive gestational weight gain can result in a positive weight development during the first years after childbirth. It might provide both short- and long term medical health benefits for the mother as well as the child. Copyright © 2013 Elsevier Ltd. All rights reserved.

Determinants of Weight Gain during the First Two Years of Life—The GECKO Drenthe Birth Cohort

PubMed Central

Küpers, Leanne K.; L’Abée, Carianne; Bocca, Gianni; Stolk, Ronald P.; Sauer, Pieter J. J.; Corpeleijn, Eva

2015-01-01

Objectives To explain weight gain patterns in the first two years of life, we compared the predictive values of potential risk factors individually and within four different domains: prenatal, nutrition, lifestyle and socioeconomic factors. Methods In a Dutch population-based birth cohort, length and weight were measured in 2475 infants at 1, 6, 12 and 24 months. Factors that might influence weight gain (e.g. birth weight, parental BMI, breastfeeding, hours of sleep and maternal education) were retrieved from health care files and parental questionnaires. Factors were compared with linear regression to best explain differences in weight gain, defined as changes in Z-score of weight-for-age and weight-for-length over 1–6, 6–12 and 12–24 months. In a two-step approach, factors were first studied individually for their association with growth velocity, followed by a comparison of the explained variance of the four domains. Results Birth weight and type of feeding were most importantly related to weight gain in the first six months. Breastfeeding versus formula feeding showed distinct growth patterns in the first six months, but not thereafter. From six months onwards, the ability to explain differences in weight gain decreased substantially (from R2 total = 38.7% to R2 total<7%). Conclusion Birth weight and breast feeding were most important to explain early weight gain, especially in the first six months of life. After the first six months of life other yet undetermined factors start to play a role. PMID:26192417

Effect of obesity on cost per quality-adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology.

PubMed

Chotai, Silky; Sielatycki, J Alex; Parker, Scott L; Sivaganesan, Ahilan; Kay, Harrison L; Stonko, David P; Wick, Joseph B; McGirt, Matthew J; Devin, Clinton J

2016-11-01

Obese patients have greater comorbidities along with higher risk of complications and greater costs after spine surgery, which may result in increased cost and lower quality of life compared with their non-obese counterparts. The aim of the present study was to determine cost-utility following anterior cervical discectomy and fusion (ACDF) in obese patients. This study analyzed prospectively collected data. Patients undergoing elective ACDF for degenerative cervical pathology at a single academic institution were included in the study. Cost and quality-adjusted life years (QALYs) were the outcome measures. One- and two-year medical resource utilization, missed work, and health state values (QALYs) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost (direct+indirect) was used to compute cost per QALY gained. Patients were defined as obese for body mass index (BMI) ≥35 based on the WHO definition of class II obesity. A subgroup analysis was conducted in morbidly obese patients (BMI≥40). There were significant improvements in pain (neck pain or arm pain), disability (Neck Disability Index), and quality of life (EuroQol-5D and Short Form-12) at 2 years after surgery (p<.001). There was no significant difference in post-discharge health-care resource utilization, direct cost, indirect cost, and total cost between obese and non-obese patients at postoperative 1-year and 2-year follow-up. Mean 2-year direct cost for obese patients was $19,225±$8,065 and $17,635±$6,413 for non-obese patients (p=.14). There was no significant difference in the mean total 2-year cost between obese ($23,144±$9,216) and non-obese ($22,183±$10,564) patients (p=.48). Obese patients had a lower mean cumulative gain in QALYs versus non-obese patients at 2-years (0.34 vs. 0.42, p=.32). Two-year

Long-Term Cost-Effectiveness of Insulin Glargine Versus Neutral Protamine Hagedorn Insulin for Type 2 Diabetes in Thailand.

PubMed

Permsuwan, Unchalee; Chaiyakunapruk, Nathorn; Dilokthornsakul, Piyameth; Thavorn, Kednapa; Saokaew, Surasak

2016-06-01

Even though Insulin glargine (IGlar) has been available and used in other countries for more than a decade, it has not been adopted into Thai national formulary. This study aimed to evaluate the long-term cost effectiveness of IGlar versus neutral protamine Hagedorn (NPH) insulin in type 2 diabetes from the perspective of Thai Health Care System. A validated computer simulation model (the IMS CORE Diabetes Model) was used to estimate the long-term projection of costs and clinical outcomes. The model was populated with published characteristics of Thai patients with type 2 diabetes. Baseline risk factors were obtained from Thai cohort studies, while relative risk reduction was derived from a meta-analysis study conducted by the Canadian Agency for Drugs and Technology in Health. Only direct costs were taken into account. Costs of diabetes management and complications were obtained from hospital databases in Thailand. Both costs and outcomes were discounted at 3 % per annum and presented in US dollars in terms of 2014 dollar value. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were also performed. IGlar is associated with a slight gain in quality-adjusted life years (0.488 QALYs), an additional life expectancy (0.677 life years), and an incremental cost of THB119,543 (US$3522.19) compared with NPH insulin. The ICERs were THB244,915/QALY (US$7216.12/QALY) and THB176,525/life-year gained (LYG) (US$5201.09/LYG). The ICER was sensitive to discount rates and IGlar cost. At the acceptable willingness to pay of THB160,000/QALY (US$4714.20/QALY), the probability that IGlar was cost effective was less than 20 %. Compared to treatment with NPH insulin, treatment with IGlar in type 2 diabetes patients who had uncontrolled blood glucose with oral anti-diabetic drugs did not represent good value for money at the acceptable threshold in Thailand.

Gestational weight gain and predicted changes in offspring anthropometrics between early infancy and 3 years

PubMed Central

Deierlein, Andrea L.; Siega-Riz, Anna Maria; Herring, Amy H.; Adair, Linda S.; Daniels, Julie L.

2011-01-01

Objective To determine how gestational weight gain (GWG), categorized using the 2009 Institute of Medicine recommendations, relates to changes in offspring weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length z-scores (WLZ) between early infancy and 3 years. Methods Women with singleton infants were recruited from the third cohort of the Pregnancy, Infection, and Nutrition Study (2001-2005). Term infants with at least one weight or length measurement during the study period were included (n=476). Multivariable linear mixed effects regression models estimated longitudinal changes in WAZ, LAZ, and WLZ associated with GWG. Results In early infancy, compared to infants of women with adequate weight gain, those of women with excessive weight gains had higher WAZ, LAZ, and WLZ. Excessive GWG≥200% of the recommended amount was associated with faster rates of change in WAZ and LAZ and noticeably higher predicted mean WAZ and WLZ that persisted across the study period. Conclusions GWG represents a modifiable behavioral factor that is associated with offspring anthropometric outcomes. More longitudinal studies that utilize maternal and pediatric body composition measures are necessary to understand the nature of this association. PMID:22434753

α1-Proteinase inhibitor (human) in the treatment of hereditary emphysema secondary to α1-antitrypsin deficiency: number and costs of years of life gained.

PubMed

Sclar, David Alexander; Evans, Marc A; Robison, Linda M; Skaer, Tracy L

2012-05-01

α(1)-Antitrypsin deficiency (α-ATD) is a disorder inherited in an autosomal recessive pattern, with co-dominant alleles known as the protease inhibitor system (Pi). The main function of α(1)-antitrypsin (α-AT) is to protect the lungs against a powerful elastase released from neutrophil leucocytes. α-ATD typically presents with a serum α-AT level of <50 mg/dL. In severe α-ATD, phenotype PiZZ, protection of the lungs is compromised, leading to an accelerated decline in forced expiratory volume in 1 second (FEV(1)). As a result, a patient may develop pulmonary emphysema of the panacinar type at a young age (third to fourth decades of life), with cigarette smoking being the most significant additional risk factor. It has been shown that weekly or monthly infusion of human α-AT is effective in raising serum α-AT levels to desired levels (>80 mg/dL), with few, if any, adverse effects. The present study was designed to discern the number of years of life gained, and the expense per year of life gained, associated with use of α-AT augmentation therapy (α(1)-proteinase inhibitor [human]), relative to 'no therapeutic intervention' in persons with α-ATD. Monte Carlo simulation (MCS) was used to: (i) estimate the number of years of life gained; and (ii) estimate the health service expenditures per year of life gained for persons receiving, or not receiving, α-AT augmentation therapy. MCS afforded a decision-analytical framework parameterized with both stochastic (random) and deterministic (fixed) components, and yielded a fiscal risk-profile for each simulated cohort of interest (eight total: by sex, smoking status [non-smoker; or past use (smoker)]; and use of α-AT augmentation therapy). The stochastic components employed in the present inquiry were: (i) age-specific body weight, and height; (ii) age-specific mortality; and (iii) the probability distribution for receipt of a lung transplant, as a function of FEV(1). The deterministic components employed in

Weight gain following treatment of hyperthyroidism.

PubMed

Dale, J; Daykin, J; Holder, R; Sheppard, M C; Franklyn, J A

2001-08-01

Patients frequently express concern that treating hyperthyroidism will lead to excessive weight gain. This study aimed to determine the extent of, and risk factors for, weight gain in an unselected group of hyperthyroid patients. We investigated 162 consecutive hyperthyroid patients followed for at least 6 months. Height, weight, clinical features, biochemistry and management were recorded at each clinic visit. Documented weight gain was 5.42 +/- 0.46 kg (mean +/- SE) and increase in BMI was 8.49 +/- 0.71%, over a mean 24.2 +/- 1.6 months. Pre-existing obesity, Graves' disease causing hyperthyroidism, weight loss before presentation and length of follow-up each independently predicted weight gain. Patients treated with thionamides or radioiodine gained a similar amount of weight (thionamides, n = 87, 5.16 +/- 0.63 kg vs. radioiodine, n = 62, 4.75 +/- 0.57 kg, P = 0.645), but patients who underwent thyroidectomy (n = 13) gained more weight (10.27 +/- 2.56 kg vs. others, P = 0.007). Development of hypothyroidism (even transiently) was associated with weight gain (never hypothyroid, n = 102, 4.57 +/- 0.52 kg, transiently hypothyroid, n = 29, 5.37 +/- 0.85 kg, on T4, n = 31, 8.06 +/- 1.42 kg, P = 0.014). This difference remained after correcting for length of follow-up. In the whole cohort, weight increased by 3.95 +/- 0.40 kg at 1 year (n = 144) to 9.91 +/- 1.62 kg after 4 years (n = 27) (P = 0.008), representing a mean weight gain of 3.66 +/- 0.44 kg/year. We have demonstrated marked weight gain after treatment of hyperthyroidism. Pre-existing obesity, a diagnosis of Graves' disease and prior weight loss independently predicted weight gain and weight continued to rise with time. Patients who became hypothyroid, despite T4 replacement, gained most weight.

Relative Influence of Socioeconomic, Psychological and Sensory Characteristics, Physical Activity and Diet on 5-Year Weight Gain in French Adults

PubMed Central

Castetbon, Katia; Hanafi, Mohamed; Deglaire, Amélie; Schlich, Pascal; Péneau, Sandrine; Méjean, Caroline

2017-01-01

Individual characteristics, dietary intake and physical activity influence weight status; however, the contribution of each factor to weight change has not been studied. The objective was to confirm a conceptual framework by simultaneously assessing the relative influence of socioeconomic, psychological and sensory characteristics, physical activity, and dietary intake on five-year weight gain in French adults. Individual characteristics, physical activity, and dietary data were assessed at baseline in 8014 participants in the NutriNet-Santé cohort. Self-reported anthropometric data were collected at baseline and five years later. Structural equation models, stratified by baseline body mass index (BMI), were used to perform analyses. Dietary restraint was a direct predictor of weight gain, with a stronger effect than age or intake of energy-dense foods, both in non-overweight and overweight participants. In non-overweight individuals only, intake of nutrient-dense foods and physical activity were inversely associated with weight gain. Regarding dietary intake, fat liking was the most important predictor of nutrient-dense food intake and was also related to energy-dense food intake. In these models, dietary restraint appears to be a direct predictor of weight gain and fat liking is a strong determinant of dietary intake. The influence of dietary restraint on weight gain, not explained by diet, warrants further investigation. PMID:29143765

Outrunning major weight gain: a prospective study of 8,340consistent runners during 7 years of follow-up

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

Williams, Paul T.

2006-01-06

Background: Body weight increases with aging. Short-term,longitudinal exercise training studies suggest that increasing exerciseproduces acute weight loss, but it is not clear if the maintenance oflong-term, vigorous exercise attenuates age-related weight gain inproportion to the exercise dose. Methods: Prospective study of 6,119 maleand 2,221 female runners whose running distance changed less than 5 km/wkbetween their baseline and follow-up survey 7 years later. Results: Onaverage, men who ran modest (0-24 km/wk), intermediate (24-48 km/wk) orprolonged distances (>_48 km/wk) all gained weight throughage 64,however, those who ran ?48 km/wk had one-half the average annual weightgain of those who ran<24 km/wk. Age-related weightmore » gain, and itsreduction by running, were both greater in younger than older men. Incontrast, men s gain in waist circumference with age, and its reductionby running, were the same in older and younger men. Women increased theirbody weight and waist and hip circumferences over time, regardless ofage, which was also reduced in proportion to running distance. In bothsexes, running did not attenuate weight gain uniformly, but ratherdisproportionately prevented more extreme increases. Conclusion: Men andwomen who remain vigorously active gain less weight as they age and thereduction is in proportion to the exercise dose.« less

Cohort study examining the association between vegetable consumption and weight gain in a single year among Japanese employees at a manufacturing company.

PubMed

Sawada, Kimi; Murayama, Nobuko; Takemi, Yukari; Ishida, Hiromi

2015-01-01

Overweight and obesity increase the risk of hypertension, type 2 diabetes, and other metabolic disorders and are increasing in Japan, particularly among men. Several prospective studies have suggested that high vegetable intake is inversely associated with weight gain. Here, the association between vegetable consumption and weight gain in a group of food manufacturing workers over the course of one year was investigated. The study was a one-year cohort study of the nutrition and lifestyle survey. The study population consisted of 900 and 910 Japanese employees (aged 19-60 years) from a manufacturing company located in Musashino City, Tokyo, Japan, that were administered the same validated brief self-administered diet history and dietary lifestyle questionnaire in 2006 and 2007, respectively. Clinical examinations of body weight were also performed to assess changes in weight. We analyzed participants who responded in both 2006 and 2007 (n=478). Risk of weight gain of more than 3 kg was significantly lower in the group consuming the most vegetables than in the group consuming the least, and this difference remained significant after adjustment for baseline age, sex, and consumption of other foods (p for trend=0.028). Weight gain was inversely associated with high consumption of vegetables. Encouraging Japanese employees to consume more vegetables may be an important strategy in controlling weight gain and preventing metabolic syndrome.

Propionibacterium acnes overabundance and natural killer group 2 member D system activation in corpus-dominant lymphocytic gastritis.

PubMed

Montalban-Arques, Ana; Wurm, Philipp; Trajanoski, Slave; Schauer, Silvia; Kienesberger, Sabine; Halwachs, Bettina; Högenauer, Christoph; Langner, Cord; Gorkiewicz, Gregor

2016-12-01

Corpus-dominant lymphocytic gastritis (LyG) is characterized by CD8 + T-cell infiltration of the stomach epithelium by a so far uncharacterized mechanism. Although Helicobacter pylori is typically undetectable in LyG, patients respond to H. pylori antibiotic eradication therapy, suggesting a non-H. pylori microbial trigger for the disease. Comparative microbiota analysis of specimens from LyG, H. pylori gastritis and healthy controls precluded involvement of H. pylori in LyG but identified Propionibacterium acnes as a possible disease trigger. In addition, the natural killer group 2 member D (NKG2D) system and the proinflammatory cytokine interleukin (IL)-15 are significantly upregulated in the gastric mucosa of LyG patients, and gastric epithelial cells respond to microbe-derived stimuli, including live P. acnes and the microbial products short-chain fatty acids, with induction of NKG2D ligands. In contrast, H. pylori infection does not activate or even repress NKG2D ligands. Together, our findings identify P. acnes as a possible causative agent for LyG, which is dependent on the NKG2D system and IL-15 activation. © 2016 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland. © 2016 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

Erlotinib or best supportive care for third-line treatment of advanced non-small-cell lung cancer: a real-world cost-effectiveness analysis.

PubMed

Cromwell, Ian; van der Hoek, Kimberly; Malfair Taylor, Suzanne C; Melosky, Barbara; Peacock, Stuart

2012-06-01

Erlotinib has been approved as a third-line treatment for advanced non-small-cell lung cancer (NSCLC) in British Columbia (BC). A cost-effectiveness analysis was conducted to compare costs and effectiveness in patients who received third-line erlotinib to those in a historical patient cohort that would have been eligible had erlotinib been available. In a population of patients who have been treated with drugs for advanced NSCLC, overall survival (OS), progression-to-death survival (PTD) and probability of survival one year after end of second-line (1YS) were determined using a Kaplan-Meier survival analysis. Costs were collected retrospectively from the perspective of the BC health care system. Incremental mean OS was 90 days (0.25 LYG), and incremental mean cost was $11,102 (CDN 2009), resulting in a mean ICER of $36,838/LYG. Univariate sensitivity analysis yielded ICERs ranging from $21,300 to $51,700/LYG. Our analysis suggests that erlotinib may be an effective and cost-effective third-line treatment for advanced NSCLC compared to best supportive care. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Accelerated weight gain among children during summer versus school year and related racial/ethnic disparities: a systematic review.

PubMed

Franckle, Rebecca; Adler, Rachel; Davison, Kirsten

2014-06-12

The objective of this study was to compile and summarize research examining variations in weight gain among students during the summer in comparison to the school year, with a focus on racial/ethnic disparities and students who are at risk of overweight. A systematic search of PubMed and Embase was conducted. Reference lists of identified articles and Google Scholar were also reviewed. Studies that assessed summer weight gain in school children were included. Inclusion criteria were: 1) a focus on children and adolescents aged 5 to 17 attending school; 2) a measured body composition before and after the summer vacation; 3) English-language articles; and 4) publication in a peer-reviewed journal since January 1, 1990. Data were extracted from selected studies in the following categories: study purpose, setting, study design, population, sample size, data collection method, and findings. Seven eligible studies were included in the review. Six of the 7 studies reported accelerated summer weight gain for at least a portion of the study population, with an effect of summer on weight gain identified for the following subgroups: black, Hispanic, and overweight children and adolescents. There may be a trend in increased rate of weight gain during summer school vacation, particularly for high-risk groups, including certain racial/ethnic populations and overweight children and adolescents. Potential solutions for the problem of accelerated summer weight gain include greater access to recreational facilities, physical activity programming, and summer food programs. Further research in this area is needed as summer weight gain may exacerbate existing health disparities.

Accelerated Weight Gain Among Children During Summer Versus School Year and Related Racial/Ethnic Disparities: A Systematic Review

PubMed Central

Adler, Rachel; Davison, Kirsten

2014-01-01

Introduction The objective of this study was to compile and summarize research examining variations in weight gain among students during the summer in comparison to the school year, with a focus on racial/ethnic disparities and students who are at risk of overweight. Methods A systematic search of PubMed and Embase was conducted. Reference lists of identified articles and Google Scholar were also reviewed. Studies that assessed summer weight gain in school children were included. Inclusion criteria were: 1) a focus on children and adolescents aged 5 to 17 attending school; 2) a measured body composition before and after the summer vacation; 3) English-language articles; and 4) publication in a peer-reviewed journal since January 1, 1990. Data were extracted from selected studies in the following categories: study purpose, setting, study design, population, sample size, data collection method, and findings. Results Seven eligible studies were included in the review. Six of the 7 studies reported accelerated summer weight gain for at least a portion of the study population, with an effect of summer on weight gain identified for the following subgroups: black, Hispanic, and overweight children and adolescents. Conclusion There may be a trend in increased rate of weight gain during summer school vacation, particularly for high-risk groups, including certain racial/ethnic populations and overweight children and adolescents. Potential solutions for the problem of accelerated summer weight gain include greater access to recreational facilities, physical activity programming, and summer food programs. Further research in this area is needed as summer weight gain may exacerbate existing health disparities. PMID:24921899

Eating style, overeating and weight gain. A prospective 2-year follow-up study in a representative Dutch sample.

PubMed

van Strien, Tatjana; Herman, C Peter; Verheijden, Marieke W

2012-12-01

This study examined which individuals are particularly at risk for developing overweight and whether there are behavioral lifestyle factors that may attenuate this susceptibility. A prospective study with a 2-year follow-up was conducted in a sample representative of the general population of The Netherlands (n=590). Body mass change (self-reported) was assessed in relation to overeating and change in physical activity (both self-reported), dietary restraint, emotional eating, and external eating, as assessed by the Dutch Eating Behavior Questionnaire. There was a consistent main (suppressive) effect of increased physical activity on BMI change. Only emotional eating and external eating moderated the relation between overeating and body mass change. However, the interaction effect of external eating became borderline significant with Yes or No meaningful weight gain (weight gain >3%) as dependent variable. It was concluded that whilst increasing physical activity may attenuate weight gain, particularly high emotional eaters seem at risk for developing overweight, because overconsumption seems to be more strongly related to weight gain in people with high degrees of emotional eating. Copyright © 2012 Elsevier Ltd. All rights reserved.

A Cost-Utility and Cost-Effectiveness Analysis of Different Oral Antiviral Medications in Patients With HBeAg-Negative Chronic Hepatitis B in Iran: An Economic Microsimulation Decision Model.

PubMed

Keshavarz, Khosro; Kebriaeezadeh, Abbas; Alavian, Seyed Moayed; Akbari Sari, Ali; Rezaei Hemami, Mohsen; Lotfi, Farhad; Hashemi Meshkini, Amir; Javanbakht, Mehdi; Keshvari, Maryam; Nikfar, Shekoufeh

2016-09-01

Although hepatitis B infection is the major cause of chronic liver disease in Iran, no studies have employed economic evaluations of the medications used to treat Iranian patients with chronic hepatitis B (CHB). Therefore, the cost-effectiveness of the different treatment options for this disease in Iran is unknown. The aim of this study was to compare the cost utility and cost-effectiveness of medication strategies tailored to local conditions in patients with HB e antigen (HBeAg)-negative CHB infection in Iran. An economic evaluation of the cost utility of the following five oral medication strategies was conducted: adefovir (ADV), lamivudine (LAM), ADV + LAM, entecavir (ETV), and tenofovir (TDF). A Markov microsimulation model was used to estimate the clinical and economic outcomes over the course of the patient's lifetime and based on a societal perspective. Medical and nonmedical direct costs and indirect costs were included in the study and life-years gained (LYG) and quality-adjusted life-years (QALY) were determined as measures of effectiveness. The results are presented in terms of the incremental cost-effectiveness ratio (ICER) per QALY or LYG. The model consisted of nine stages of the disease. The transition probabilities for the movement between the different stages were based on clinical evidence and international expert opinion. A probabilistic sensitivity analysis (PSA) was used to measure the effects of uncertainty in the model parameters. The results revealed that the TDF treatment strategy was more effective and less costly than the other options. In addition, TDF had the highest QALY and LYG in the HBeAg-negative CHB patients, with 13.58 and 21.26 (discounted) in all comparisons. The PSA proved the robustness of the model results. The cost-effectiveness acceptability curves showed that TDF was the most cost-effective treatment in 59% - 78% of the simulations of HBeAg-negative patients, with WTP thresholds less than $14010 (maximum WTP per QALY

The reductions in monetary cost and gains in productivity with methadone maintenance treatment: one year follow-up.

PubMed

Hsiao, Chih Yin; Chen, Kao Chin; Lee, Lan-Ting; Tsai, Hsin Chun; Chang, Wei Hung; Lee, I Hui; Chen, Po See; Lu, Ru-Band; Yang, Yen Kuang

2015-02-28

While methadone maintenance treatment (MMT) is beneficial for heroin dependence, there is little information regarding the reductions in monetary cost and gains in productivity following MMT. The aim of this study was to evaluate the changes in the monetary cost of heroin addiction and productivity after one year of MMT. Twenty-nine participants from an MMT clinic were included. The monetary cost, productivity, quality of life (QOL) and mental health status were assessed at both baseline and one year follow-up. The average annual total cost was approximately US$26,485 (1.43 GDP per capita in 2010) at baseline, and decreased by 59.3% to US$10,784 (0.58 GDP) at follow-up. The mean number of months of unemployment dropped from 6.03 to 2.79, the mean income increased to exceed the basic salary, but only reached 45.3% of the national average monthly earnings. The participants׳ mental health improved, but their QOL scores did not increase significantly. After one year of MMT, the monetary cost of heroin addiction fell, both the productivity and mental health of the participants׳ improved, but limited gains were seen with regard to their QOL. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Effects of having a baby on weight gain.

PubMed

Brown, Wendy J; Hockey, Richard; Dobson, Annette J

2010-02-01

Women often blame weight gain in early adulthood on having a baby. The aim was to estimate the weight gain attributable to having a baby, after disentangling the effects of other factors that influence weight change at this life stage. A longitudinal study of a randomly selected cohort of 6458 Australian women, aged 18-23 years in 1996, was conducted. Self-report mailed surveys were completed in 1996, 2000, 2003, and 2006, and data were analyzed in 2008. On average, women gained weight at the rate of 0.93% per year (95% CI=0.89, 0.98) or 605 g/year (95% CI=580, 635) for a 65-kg woman. Over the 10-year study period, partnered women with one baby gained almost 4 kg more, and those with a partner but no baby gained 1.8 kg more, than unpartnered childless women (after adjustment for other significant factors: initial BMI and age; physical activity, sitting time, energy intake (2003); education level, hours in paid work, and smoking). Having a baby has a marked effect on 10-year weight gain, but there is also an effect attributable to getting married or living with a partner. Social and lifestyle as well as energy balance variables should be considered when developing strategies to prevent weight gain in young adult women. Copyright 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Years of disability-adjusted life gained as a result of thrombolytic therapy for acute ischemic stroke.

PubMed

Hong, Keun-Sik; Saver, Jeffrey L

2010-03-01

Disability-adjusted life year (DALY) metric reflects years of healthy life lost because of living with disability and years of life lost because of premature mortality. Widely used in epidemiological analyses, DALY has not been applied to acute stroke trials. From previous studies, we derived, for each modified Rankin Scale level, disability weights, disability-linked mortality hazard ratios, and age-specific life expectancies. We then analyzed patient level data from the 2 publicly available National Institute of Neurological Disorders and Stroke (NINDS) recombinant tissue plasminogen activator trials. For each subject, we abstracted age, treatment assignment, and 3-month modified Rankin Scale outcome and calculated the DALYs lost resulting from the qualifying stroke. The disability-linked hazard ratios for premature annual mortality for a modified Rankin Scale score of 0 to 5 were 1.53, 1.52, 2.17, 3.18, 4.55, and 6.55, respectively. In the NINDS recombinant tissue plasminogen activator trials, DALYs (mean+/-SE) lost as a result of the qualifying stroke were substantially less with recombinant tissue plasminogen activator than with placebo (4.64+/-0.17 versus 5.91+/-0.21; P<0.0001), a finding that remained robust after adjustment for baseline prognostic factors. When DALYs gained were apportioned to the 29% of patients experiencing any benefit from lytic therapy, each patient gained an average of 4.4 DALYs. DALY analysis showed greater power than dichotomized modified Rankin Scale analysis in discriminating treatment effects overall and in patients >or=70 years of age. For patients who benefit from treatment, <3-hour thrombolytic therapy adds the equivalent of 4.4 years of healthy life, free of disability. The DALY metric provides a continuous scale that increases statistical power, is intuitively understandable, and is applicable to a wide range of conditions and treatments.

Treatment of type 2 diabetes with saxagliptin: a pharmacoeconomic evaluation in Argentina.

PubMed

Elgart, Jorge F; Caporale, Joaquin E; Gonzalez, Lorena; Aiello, Eleonora; Waschbusch, Maximiliano; Gagliardino, Juan J

2013-04-27

The increasing prevalence of diabetes and its inadequate management results in a heavy burden of the disease for the patients, the health and the productive system and the overall community. Consequently, it is necessary to have new effective drugs to treat people with diabetes to decrease such burden. DPP-4 inhibitors can help to cope with this demand, but its usage is challenged by its apparent high cost. The aim of the current study was to compare a simulated cost-effectiveness ratio of metformin (MET) plus one drug of the DPP-4 inhibitors family, saxagliptin (SAXA) or sulfonylurea (SU) treatment during a 20-year period, from the perspective of the social security system, in a cohort of people with Type 2 diabetes (T2DM) who did not attain glycosylated hemoglobin treatment target values only with MET. A discrete event simulation model (Cardiff diabetes model) based on UKPDS 68 was used to simulate disease progression and to estimate the economic and health treatment consequences in people with T2DM. The clinical efficacy parameters for SAXA administration were obtained from the literature; local standard costs were considered for drug acquisition, adverse events (AEs), and micro/macrovascular complications. Costs were expressed in US dollars (2009) with an annual 3.5% discount and a 20-year time horizon. The SAXA + MET treated group had a lower number of non-fatal events than the SU + MET treated group. The model also predicted a lower number of fatal macrovascular events for the SAXA + MET group (149.6 vs. 152.8). The total cost of the SAXA + MET cohort was 15% higher than that of the SU + MET cohort. Treatment with SAXA + MET resulted in a higher number of quality-adjusted life years (QALYs) (9.54 vs. 9.32) and life-years gained (LYGs) (20.84 vs. 20.76) compared to those treated with SU + MET. The incremental cost per QALY and LYG gained was $7,374 and $20,490, respectively. According to the criteria proposed by the Commission on Macroeconomics and Health, the

Treatment of type 2 diabetes with saxagliptin: a pharmacoeconomic evaluation in Argentina

PubMed Central

2013-01-01

Background The increasing prevalence of diabetes and its inadequate management results in a heavy burden of the disease for the patients, the health and the productive system and the overall community. Consequently, it is necessary to have new effective drugs to treat people with diabetes to decrease such burden. DPP-4 inhibitors can help to cope with this demand, but its usage is challenged by its apparent high cost. The aim of the current study was to compare a simulated cost-effectiveness ratio of metformin (MET) plus one drug of the DPP-4 inhibitors family, saxagliptin (SAXA) or sulfonylurea (SU) treatment during a 20-year period, from the perspective of the social security system, in a cohort of people with Type 2 diabetes (T2DM) who did not attain glycosylated hemoglobin treatment target values only with MET. Methods A discrete event simulation model (Cardiff diabetes model) based on UKPDS 68 was used to simulate disease progression and to estimate the economic and health treatment consequences in people with T2DM. The clinical efficacy parameters for SAXA administration were obtained from the literature; local standard costs were considered for drug acquisition, adverse events (AEs), and micro/macrovascular complications. Costs were expressed in US dollars (2009) with an annual 3.5% discount and a 20-year time horizon. Results The SAXA + MET treated group had a lower number of non-fatal events than the SU + MET treated group. The model also predicted a lower number of fatal macrovascular events for the SAXA + MET group (149.6 vs. 152.8). The total cost of the SAXA + MET cohort was 15% higher than that of the SU + MET cohort. Treatment with SAXA + MET resulted in a higher number of quality-adjusted life years (QALYs) (9.54 vs. 9.32) and life-years gained (LYGs) (20.84 vs. 20.76) compared to those treated with SU + MET. The incremental cost per QALY and LYG gained was $7,374 and $20,490, respectively. Conclusions According to the criteria proposed by the

Successful management with CHOP for pulmonary lymphomatoid granulomatosis in a dog.

PubMed

Hatoya, Singo; Kumagai, Daijiro; Takeda, Seiko; Yamamoto, Emi; Nakanishi, Masako; Kuwamura, Mitsuru; Sugiura, Kikuya; Sasai, Hiroshi; Yamate, Jyoji; Inaba, Toshio

2011-04-01

A 3-year-old, spayed female miniature dachshund was presented for vomiting and anorexia. Thoracic radiographs and CT scan revealed abnormal pulmonary opacities at bilateral caudal lobe. Cytological analysis of the pulmonary mass revealed the presence of large lymphohistiocytic cells and small lymphocytes with occasional neutrophils and plasma cells. An open lung biopsy was performed and a diagnosis of pulmonary lymphomatoid granulomatosis (LYG) was made. The dog was administered CHOP based therapy (modified UW-25), and it survived for 1,022 days after admission. Immunohistochemistry revealed pulmonary lesions consisted of many CD79a positive B cells aggregation and proliferation with prominent angiocentric pattern. This was the first case of canine pulmonary LYG managed by CHOP chemotherapy.

Personality type influence the gestational weight gain.

PubMed

Franik, Grzegorz; Lipka, Nela; Kopyto, Katarzyna; Kopocińska, Joanna; Owczarek, Aleksander; Sikora, Jerzy; Madej, Paweł; Chudek, Jerzy; Olszanecka-Glinianowicz, Magdalena

2017-08-01

Pregnancy is frequently followed by the development of obesity. Aside from psychological factors, hormonal changes influence weight gain in pregnant women. We attempted to assess the potential association between personality type and the extent of gestational weight gain. The study group involved 773 women after term delivery (age 26.3 ± 3.9 years, body mass before pregnancy 61.2 ± 11.1 kg). Weight gain during pregnancy was calculated by using self-reported body mass prior to and during the 38th week of pregnancy. Personality type was assessed using the Polish version of the Framingham Type A Behavior Patterns Questionnaire (adapted by Juczynski). Two hundred forty-six (31.8%) study subjects represented type A personalities, 272 (35.2%) type B and 255 (33.0%) an indirect type. Gestational weight gain was related to the behavior patterns questionnaire score and age. In women <30 years with type A personality, the weight gain was higher than in women with type B behavior of the same age. In women >30, the gestational weight gain was larger for type B personalities. Type A personality and increased urgency in younger pregnant women increases the risk of developing obesity during pregnancy in women below 30 years old. A higher level of competitiveness demonstrates a risk factor of excessive weight gain during pregnancy regardless of age.

Effect of the INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 Year: A Randomized Clinical Trial.

PubMed

Savage, Jennifer S; Birch, Leann L; Marini, Michele; Anzman-Frasca, Stephanie; Paul, Ian M

2016-08-01

Rapid infant weight gain is associated with later obesity, but interventions to prevent rapid infant growth and reduce risk for overweight status in infancy are lacking. To examine the effect of a responsive parenting (RP) intervention on infant weight gain between birth and 28 weeks and overweight status at age 1 year. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is an ongoing randomized clinical trial comparing an RP intervention designed to prevent childhood obesity with a safety control. The study includes primiparous mother-newborn dyads (n = 291) and was conducted at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, in addition to home visits. Enrollment was initiated in January 2012, and evaluable population analyses for this study were conducted between April 2015 and November 2015. At 2 weeks post partum, initial intervention materials appropriate to the assigned treatment group were mailed to the participant's home. Research nurses conducted home visits at 3 weeks, 16 weeks, 28 weeks, and 40 weeks, and a research center visit occurred at 1 year. The Intervention Nurses Start Infants Growing on Healthy Trajectories curriculum included messages about infant feeding, sleep hygiene, active social play, emotion regulation, and growth record education. The control group received a developmentally appropriate home safety intervention also delivered by nurse home visitors. Conditional weight gain from birth to 28 weeks was calculated. General linear models examined intervention effect on conditional weight gain. The intervention's effect on infant weight-for-length percentiles was tested using analysis of variance. Logistic regression compared the odds of overweight status (weight for length ≥95th percentile) at 1 year as a function of conditional weight gain. Of the mothers included in the study, 246 were white (88%), 260 were non-Hispanic (93%), 210 were married (75%), and 201 were working full

Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

PubMed Central

Li, Rui; Zhang, Ping; Barker, Lawrence E.; Chowdhury, Farah M.; Zhang, Xuanping

2010-01-01

OBJECTIVE To synthesize the cost-effectiveness (CE) of interventions to prevent and control diabetes, its complications, and comorbidities. RESEARCH DESIGN AND METHODS We conducted a systematic review of literature on the CE of diabetes interventions recommended by the American Diabetes Association (ADA) and published between January 1985 and May 2008. We categorized the strength of evidence about the CE of an intervention as strong, supportive, or uncertain. CEs were classified as cost saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). The CE classification of an intervention was reported separately by country setting (U.S. or other developed countries) if CE varied by where the intervention was implemented. Costs were measured in 2007 U.S. dollars. RESULTS Fifty-six studies from 20 countries met the inclusion criteria. A large majority of the ADA recommended interventions are cost-effective. We found strong evidence to classify the following interventions as cost saving or very cost-effective: (I) Cost saving— 1) ACE inhibitor (ACEI) therapy for intensive hypertension control compared with standard hypertension control; 2) ACEI or angiotensin receptor blocker (ARB) therapy to prevent end-stage renal disease (ESRD) compared with no ACEI or ARB treatment; 3) early irbesartan therapy (at the microalbuminuria stage) to prevent ESRD compared with later treatment (at the macroalbuminuria stage); 4) comprehensive foot care to prevent ulcers compared with usual care; 5) multi-component interventions for diabetic risk factor control and early detection of complications compared with conventional insulin therapy for persons with type 1 diabetes; and 6) multi-component interventions for diabetic risk factor control

A pharmaco-economic analysis of second-line treatment with imatinib or sunitinib in patients with advanced gastrointestinal stromal tumours.

PubMed

Contreras-Hernández, I; Mould-Quevedo, J F; Silva, A; Salinas-Escudero, G; Villasís-Keever, M A; Granados-García, V; Dávila-Loaiza, G; Petersen, J A; Garduño-Espinosa, J

2008-06-03

Second-line treatments recommended by the National Cancer Center Network to manage advanced-stage gastrointestinal stromal tumours (GIST) were evaluated to determine the cost and cost-effectiveness of each intervention in the Mexican insurance system, the Instituto Mexicano del Seguro Social (IMSS). Treatments examined over a 5-year temporal horizon to estimate long-term costs included 800 mg day(-1) of imatinib mesylate, 50 mg day(-1) of sunitinib malate (administered in a 4 week on/2 week rest schedule), and palliative care. The mean cost (MC), cost-effectiveness, and benefit of each intervention were compared to determine the best GIST treatment from the institutional perspective of the IMSS. As sunitinib was not reimbursed at the time of the study, a Markov model and sensitivity analysis were conducted to predict the MC and likelihood of reimbursement. Patients taking 800 mg day(-1) of imatinib had the highest MC (+/-s.d.) of treatment at $35,225.61 USD (+/-1253.65 USD); while sunitinib incurred a median MC of $17,805.87 USD (+/-694.83 USD); and palliative care had the least MC over treatment duration as the cost was $2071.86 USD (+/-472.88 USD). In comparison to palliative care, sunitinib is cost-effective for 38.9% of patients; however, sunitinib delivered the greatest survival benefit as 5.64 progression-free months (PFM) and 1.4 life-years gained (LYG) were obtained in the economic model. Conversely, patients on imatinib and palliative care saw a lower PFM of 5.28 months and 2.58 months and also fewer LYG (only 1.31 and 1.08 years, respectively). Therefore, economic modeling predicts that reimbursing sunitinib over high dose imatinib in the second-line GIST indication would deliver cost savings to the IMSS and greater survival benefits to patients.

A pharmaco-economic analysis of second-line treatment with imatinib or sunitinib in patients with advanced gastrointestinal stromal tumours

PubMed Central

Contreras-Hernández, I; Mould-Quevedo, J F; Silva, A; Salinas-Escudero, G; Villasís-Keever, M A; Granados-García, V; Dávila-Loaiza, G; Petersen, J A; Garduño-Espinosa, J

2008-01-01

Second-line treatments recommended by the National Cancer Center Network to manage advanced-stage gastrointestinal stromal tumours (GIST) were evaluated to determine the cost and cost-effectiveness of each intervention in the Mexican insurance system, the Instituto Mexicano del Seguro Social (IMSS). Treatments examined over a 5-year temporal horizon to estimate long-term costs included 800 mg day−1 of imatinib mesylate, 50 mg day−1 of sunitinib malate (administered in a 4 week on/2 week rest schedule), and palliative care. The mean cost (MC), cost-effectiveness, and benefit of each intervention were compared to determine the best GIST treatment from the institutional perspective of the IMSS. As sunitinib was not reimbursed at the time of the study, a Markov model and sensitivity analysis were conducted to predict the MC and likelihood of reimbursement. Patients taking 800 mg day−1 of imatinib had the highest MC (±s.d.) of treatment at $35 225.61 USD (±1253.65 USD); while sunitinib incurred a median MC of $17 805.87 USD (±694.83 USD); and palliative care had the least MC over treatment duration as the cost was $2071.86 USD (±472.88 USD). In comparison to palliative care, sunitinib is cost-effective for 38.9% of patients; however, sunitinib delivered the greatest survival benefit as 5.64 progression-free months (PFM) and 1.4 life-years gained (LYG) were obtained in the economic model. Conversely, patients on imatinib and palliative care saw a lower PFM of 5.28 months and 2.58 months and also fewer LYG (only 1.31 and 1.08 years, respectively). Therefore, economic modeling predicts that reimbursing sunitinib over high dose imatinib in the second-line GIST indication would deliver cost savings to the IMSS and greater survival benefits to patients. PMID:18506179

Weight Gain and Somatization are Associated With the Onset of Gastroesophageal Reflux Diseases: Results of Two 5-year Follow-up Studies.

PubMed

Barcelo, Marta; Alvarez Sanchez, Angel; Garcia Sanchez, Raquel; Diaz-Rubio, Manuel; Rey, Enrique

2016-03-01

Although 2% to 4% of the population develop gastroesophageal reflux disease (GERD) annually, factors associated with the onset of GERD are scarcely known. To assess whether such factors include weight gain and psychological distress. Two cohorts (first: N=222; second N=754) drawn from 2 case-control studies were followed up for around 5 years. In 2004, all participants were directly interviewed using a validated questionnaire to collect data on body weight, height, GERD symptoms, and psychological distress. In 2009 to 2010, these same participants were again interviewed using the same methodology. The response rate was 83.3% in cohort 1 and 39.1% in cohort 2, after a follow-up of 4.3±0.7 and 5.6±0.3 years, respectively. The multivariate analysis showed only weight gain and psychological distress as being independently associated with the onset of GERD in both cohorts. Weight gain per kilogram showed an adjusted odds ratio (OR) of 1.21 (1.01-1.44) in the first cohort, and a gain of 5 kg or more showed an adjusted OR of 4.65 (1.72-12.53) in the second. Somatization scores showed an adjusted OR of 1.09 (1.04-1.15) in the first cohort (measured as Minnesota Multiphasic Personality Inventory 2 hypochondriasis score) and 2.88 (1.04-8.02) in the second (measured as psychosomatic symptoms score). Body mass index on attaining overweight or obese status was associated with the onset of GERD in the unadjusted but not in the adjusted analysis. Weight gain and somatization are the main factors associated with the onset of GERD. The association between GERD and obesity is just the ultimate consequence of gaining weight.

Systematic review and quality assessment of cost-effectiveness analysis of pharmaceutical therapies for advanced colorectal cancer.

PubMed

Leung, Henry W C; Chan, Agnes L F; Leung, Matthew S H; Lu, Chin-Li

2013-04-01

To systematically review and assess the quality of cost-effectiveness analyses (CEAs) of pharmaceutical therapies for metastatic colorectal cancer (mCRC). The MEDLINE, EMBASE, Cochrane, and EconLit databases were searched for the Medical Subject Headings or text key words quality-adjusted, QALY, life-year gained (LYG), and cost-effectiveness (January 1, 1999-December 31, 2009). Original CEAs of mCRC pharmacotherapy published in English were included. CEAs that measured health effects in units other than quality-adjusted life years or LYG and letters to the editor, case reports, posters, and editorials were excluded. Each article was independently assessed by 2 trained reviewers according to a quality checklist created by the Panel on Cost-Effectiveness in Health and Medicine. Twenty-four CEA studies pertaining to pharmaceutical therapies for mCRC were identified. All studies showed a wide variation in methodologic approaches, which resulted in a different range of incremental cost-effectiveness ratios reported for each regimen. We found common methodologic flaws in a significant number of CEA studies, including lack of clear description for critique of data quality; lack of method for adjusting costs for inflation and methods for obtaining expert judgment; no results of model validation; wide differences in the types of perspective, time horizon, study design, cost categories, and effect outcomes; and no quality assessment of data (cost and effectiveness) for the interventions evaluation. This study has shown a wide variation in the methodology and quality of cost-effectiveness analysis for mCRC. Improving quality and harmonization of CEA for cancer treatment is needed. Further study is suggested to assess the quality of CEA methodology outside the mCRC disease state.

Gestational weight gain and the risk of offspring obesity at 10 and 16 years: a prospective cohort study in low-income women.

PubMed

Diesel, J C; Eckhardt, C L; Day, N L; Brooks, M M; Arslanian, S A; Bodnar, L M

2015-09-01

To study the association between gestational weight gain (GWG) and offspring obesity risk at ages chosen to approximate prepuberty (10 years) and postpuberty (16 years). Prospective pregnancy cohort. Pittsburgh, PA, USA. Low-income pregnant women (n = 514) receiving prenatal care at an obstetric residency clinic and their singleton offspring. Gestational weight gain was classified based on maternal GWG-for-gestational-age Z-score charts and was modelled using flexible spline terms in modified multivariable Poisson regression models. Obesity at 10 or 16 years, defined as body mass index (BMI) Z-scores ≥95th centile of the 2000 CDC references, based on measured height and weight. The prevalence of offspring obesity was 20% at 10 years and 22% at 16 years. In the overall sample, the risk of offspring obesity at 10 and 16 years increased when GWG exceeded a GWG Z-score of 0 SD (equivalent to 30 kg at 40 weeks); but for gains below a Z-score of 0 SD there was no relationship with child obesity risk. The association between GWG and offspring obesity varied by prepregnancy BMI. Among mothers with a pregravid BMI <25 kg/m(2) , the risk of offspring obesity increased when GWG Z-score exceeded 0 SD, yet among overweight women (BMI ≥25 kg/m(2) ), there was no association between GWG Z-scores and offspring obesity risk. Among lean women, higher GWG may have lasting effects on offspring obesity risk. © 2015 Royal College of Obstetricians and Gynaecologists.

Sustaining Student Gains from Online On-Demand Professional Development

ERIC Educational Resources Information Center

Shaha, Steven H.; Glassett, Kelly; Copas, Aimee

2015-01-01

A multi-State, quasi-experimental study was conducted as a longitudinal, two-year follow-up of participation in an online, on-demand professional development (PD) program. The purpose was to ascertain whether student gains were sustained in a second year of PD participation. Data verified gains in Year 1 versus Pre-PD baseline, with continued…

Clinical attachment level gain and three-year maintenance of a maxillary incisor with 100% bone loss: A case report.

PubMed

Tirone, Federico; Salzano, Stefano

2016-01-01

This case report discusses a patient suffering from chronic periodontal disease and diagnosed with a hopeless central incisor. The intention was to show the possibility of gaining new clinical attachment via regenerative surgery in a tooth with 100% bone loss around the root. Treatment of hopeless and questionable teeth in periodontal patients has become an ideological matter. On the one hand, dental implants have proved to be a reliable solution to replace lost teeth; on the other hand, newly emerging evidence suggests that successful periodontal treatment of teeth diagnosed as hopeless is possible. Here we describe surgical, orthodontic, and restorative treatments that led to clinical attachment gain and achieved clinical success over a three-year follow-up period.

[Body weight gain after radioiodine therapy in hyperthyroidism].

PubMed

Scheidhauer, K; Odatzidu, L; Kiencke, P; Schicha, H

2002-02-01

Analysis and follow up of body weight after radioiodine therapy (RITh) of hyperthyroidism, since excessive weight gain is a common complaint among these patients. Therapy and body weight related data of 100 consecutive RITh-patients were retrospectively analysed from the time before up to three years after RITh. All patients suffered from hyperthyroidism (Graves' disease or autonomy), but were adjusted to euthyroid levels after RITh. Patients' data were compared to a control group of 48 euthyroid patients out of the same ambulance and during the same time scale. All patients (RITh and controls) gained weight over the time. There was no statistically significant difference in BMI development over three years between RITh-patients and controls (5.5% resp. 4.9% increase). In the first year after RITh, weight gain of the RITh patients was higher indeed, but lower in the follow up, resulting in the same range of weight gain after three years as the controls. Besides that women showed a slightly higher increase of BMI than men, and so did younger patients compared to elder as well as patients with overweight already before RITh. An initially distinct increase of body weight after RITh of hyperthyroidism is mainly a compensation of pretherapeutic weight loss due to hyperthyroidism. Presupposing adequate euthyroid adjustment of thyroid metabolism after therapy, RITh is not responsible for later weight gain and adipositas.

Numerical simulations of the impact of hydraulic anisotropy and anthropogenic activities on the complex hydrogeological system of the Lower Yarmouk Gorge

NASA Astrophysics Data System (ADS)

Tzoufka, Kalliopi; Siebert, Christian; Rödiger, Tino; Inbar, Nimrod; Shalev, Eyal; Möller, Peter; Raggad, Marwan; Rosenthal, Eliahu; Magri, Fabien

2017-04-01

Transient numerical simulations of coupled fluid flow and heat transport processes were conducted, to investigate (i) the impact of hydraulic anisotropy on a complex hydrogeological system and (ii) the anomalous geothermal gradient in the Upper Cretaceous (A7/B2) aquifer of the Lower Yarmouk Gorge (LYG). The N-S directed geological profile starts on the basalt-covered Golan Heights, crosses the LYG and ends at the Jordanian Ajloun Plateau. Heated fresh groundwaters ascend within the LYG from the confined A7/B2 limestone aquifer through artesian Meizar wells and artesian Muhkeibeh well field. A hydrogeological study based on high frequency water-table measurements at the Meizar wells suggested strong impact of abstraction at the Mukheibeh wells on the hydraulic head distribution north of the LYG (Shalev et al., 2015). Contrastingly, hydrochemical investigations conducted in the area concluded that recharge areas of the A7/B2 aquifer are: (i) the foothills of Mountain Hermon, (ii) the Ajloun Plateau and (iii) the Syrian Hauran Plateau, indicating the presence of a zone of high-hydraulic anisotropy along the main LYG axis. Due to this still debatable hydraulic feature, flow along the LYG principle axis is enhanced whilst flow perpendicular to it is constrained (Siebert et al., 2014). In agreement, transient simulations based on a NW-SE profile supported further the hypothesis of a structural feature existent (Magri et al., 2015). The modeled profile cross-cuts the heterogeneous zone and hence the heterogeneity was implemented as an impermeable zone by employing the Equivalent Porous Media approach. Initial 2D models managed to successfully reproduce the natural hydraulic head and temperature distributions. In subsequent simulations, by implementing Meizar abstraction rates, results revealed that mixed convection explains the anomalous temperature gradient in the area as temperature patterns of these simulations are in accordance with a temperature-depth borehole

Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial.

PubMed

Gæde, Peter; Oellgaard, Jens; Carstensen, Bendix; Rossing, Peter; Lund-Andersen, Henrik; Parving, Hans-Henrik; Pedersen, Oluf

2016-11-01

The aim of this work was to study the potential long-term impact of a 7.8 years intensified, multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria in terms of gained years of life and years free from incident cardiovascular disease. The original intervention (mean treatment duration 7.8 years) involved 160 patients with type 2 diabetes and microalbuminuria who were randomly assigned (using sealed envelopes) to receive either conventional therapy or intensified, multifactorial treatment including both behavioural and pharmacological approaches. After 7.8 years the study continued as an observational follow-up with all patients receiving treatment as for the original intensive-therapy group. The primary endpoint of this follow-up 21.2 years after intervention start was difference in median survival time between the original treatment groups with and without incident cardiovascular disease. Non-fatal endpoints and causes of death were adjudicated by an external endpoint committee blinded for treatment allocation. Thirty-eight intensive-therapy patients vs 55 conventional-therapy patients died during follow-up (HR 0.55 [95% CI 0.36, 0.83], p = 0.005). The patients in the intensive-therapy group survived for a median of 7.9 years longer than the conventional-therapy group patients. Median time before first cardiovascular event after randomisation was 8.1 years longer in the intensive-therapy group (p = 0.001). The hazard for all microvascular complications was decreased in the intensive-therapy group in the range 0.52 to 0.67, except for peripheral neuropathy (HR 1.12). At 21.2 years of follow-up of 7.8 years of intensified, multifactorial, target-driven treatment of type 2 diabetes with microalbuminuria, we demonstrate a median of 7.9 years of gain of life. The increase in lifespan is matched by time free from incident cardiovascular disease. ClinicalTrials.gov registration no. NCT00320008. The study was funded by

Cost-effectiveness analysis of salt reduction policies to reduce coronary heart disease in Syria, 2010-2020.

PubMed

Wilcox, Meredith L; Mason, Helen; Fouad, Fouad M; Rastam, Samer; al Ali, Radwan; Page, Timothy F; Capewell, Simon; O'Flaherty, Martin; Maziak, Wasim

2015-01-01

This study presents a cost-effectiveness analysis of salt reduction policies to lower coronary heart disease in Syria. Costs and benefits of a health promotion campaign about salt reduction (HP); labeling of salt content on packaged foods (L); reformulation of salt content within packaged foods (R); and combinations of the three were estimated over a 10-year time frame. Policies were deemed cost-effective if their cost-effectiveness ratios were below the region's established threshold of $38,997 purchasing power parity (PPP). Sensitivity analysis was conducted to account for the uncertainty in the reduction of salt intake. HP, L, and R+HP+L were cost-saving using the best estimates. The remaining policies were cost-effective (CERs: R=$5,453 PPP/LYG; R+HP=$2,201 PPP/LYG; R+L=$2,125 PPP/LYG). R+HP+L provided the largest benefit with net savings using the best and maximum estimates, while R+L was cost-effective with the lowest marginal cost using the minimum estimates. This study demonstrated that all policies were cost-saving or cost effective, with the combination of reformulation plus labeling and a comprehensive policy involving all three approaches being the most promising salt reduction strategies to reduce CHD mortality in Syria.

Estimating the impact of the US President's Emergency Plan for AIDS Relief on HIV treatment and prevention programmes in Africa.

PubMed

Heaton, Laura M; Bouey, Paul D; Fu, Joe; Stover, John; Fowler, Timothy B; Lyerla, Rob; Mahy, Mary

2015-12-01

Since 2004, the US President's Emergency Plan for AIDS Relief (PEPFAR) has supported the tremendous scale-up of HIV prevention, care and treatment services, primarily in sub-Saharan Africa. We evaluate the impact of antiretroviral treatment (ART), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC) programmes on survival, mortality, new infections and the number of orphans from 2004 to 2013 in 16 PEPFAR countries in Africa. PEPFAR indicators tracking the number of persons receiving ART for their own health, ART regimens for PMTCT and biomedical prevention of HIV through VMMC were collected across 16 PEPFAR countries. To estimate the impact of PEPFAR programmes for ART, PMTCT and VMMC, we compared the current scenario of PEPFAR-supported interventions to a counterfactual scenario without PEPFAR, and assessed the number of life years gained (LYG), number of orphans averted and HIV infections averted. Mathematical modelling was conducted using the SPECTRUM modelling suite V.5.03. From 2004 to 2013, PEPFAR programmes provided support for a cumulative number of 24 565 127 adults and children on ART, 4 154 878 medical male circumcisions, and ART for PMTCT among 4 154 478 pregnant women in 16 PEPFAR countries. Based on findings from the model, these efforts have helped avert 2.9 million HIV infections in the same period. During 2004-2013, PEPFAR ART programmes alone helped avert almost 9 million orphans in 16 PEPFAR countries and resulted in 11.6 million LYG. Modelling results suggest that the rapid scale-up of PEPFAR-funded ART, PMTCT and VMMC programmes in Africa during 2004-2013 led to substantially fewer new HIV infections and orphaned children during that time and longer lives among people living with HIV. Our estimates do not account for the impact of the PEPFAR-funded non-biomedical interventions such as behavioural and structural interventions included in the comprehensive HIV prevention, care and treatment

Cutaneous lymphomatoid granulomatosis: correlation of clinical and biologic features.

PubMed

Beaty, M W; Toro, J; Sorbara, L; Stern, J B; Pittaluga, S; Raffeld, M; Wilson, W H; Jaffe, E S

2001-09-01

Lymphomatoid granulomatosis (LYG) is a rare angiocentric and angiodestructive Epstein-Barr virus-associated B-cell lymphoproliferative disorder (EBV-BLPD), varying widely from an indolent process to an aggressive large cell lymphoma. The skin is the extrapulmonary organ most commonly involved in LYG. We studied 32 skin lesions from 20 patients with known pulmonary LYG, using immunohistochemistry, in situ hybridization for EBV, and polymerase chain reaction for the presence of antigen receptor gene rearrangements (IgH and TCR) to better define both the clinicopathologic spectrum and pathogenesis of the cutaneous lesions. We describe two distinct patterns of cutaneous involvement. Multiple erythematous dermal papules and/or subcutaneous nodules, with or without ulceration, were present in 17 patients (85%). These lesions demonstrate a marked angiocentric lymphohistiocytic infiltrate, composed predominantly of CD4-positive T-cells, with a high propensity for involving the subcutaneous tissues, and exhibiting angiodestruction, necrosis, and cytologic atypia. EBV-positive B-cells were detected in the nodules from five patients; clonal immunoglobulin heavy chain gene (IgH) rearrangements were detected by polymerase chain reaction in two patients. Multiple indurated, erythematous to white plaques were present in three patients (15%). The plaque lesions were negative for EBV and clonal IgH gene rearrangements in all cases studied. The clinical course of overall disease was variable, ranging from spontaneous regression without treatment (1 of 13; 7%), resolution with chemo/immunomodulatory therapy (8 of 13; 62%), and progression (4 of 13; 31%). The clinical and histopathologic features of cutaneous LYG are extremely diverse. However, the majority (85%) of the cutaneous lesions mirrors to some extent LYG in the lung, although EBV+ cells are less frequently identified. This subset of cases shows the histopathologic triad of angiodestruction with associated necrosis

Cost-effectiveness analysis of sensor-augmented pump therapy with low glucose-suspend in patients with type 1 diabetes mellitus and high risk of hypoglycemia in Spain.

PubMed

Conget, Ignacio; Martín-Vaquero, Pilar; Roze, Stéphane; Elías, Isabel; Pineda, Cristina; Álvarez, María; Delbaere, Alexis; Ampudia-Blasco, Francisco Javier

2018-05-19

To compare the cost-effectiveness of sensor-augmented pump therapy (SAP) [continuous subcutaneous insulin infusion (CSII) plus real-time continuous glucose monitoring (RT-CGM)] with low glucose suspend (MiniMed™ Veo™) and CSII alone in patients with type 1 diabetes mellitus (T1DM) at high risk of hypoglycemia in Spain. The IQVIA CORE Diabetes Model was used to estimate healthcare outcomes as life-years gained (LYGs) and quality-adjusted life years (QALYs), and to project lifetime costs. Information about efficacy, resource utilization, and unit costs (€2016) was taken from published sources and validated by an expert panel. Analyses were performed from both the Spanish National Health System (NHS) perspective and the societal perspective. From the NHS perspective, SAP with low glucose suspend was associated to a €47,665 increase in direct healthcare costs and to increases of 0.19 LYGs and 1.88 QALYs, both discounted, which resulted in an incremental cost-effectiveness ratio (ICER) of €25,394/QALY. From the societal perspective, SAP with low glucose suspend increased total costs (including direct and indirect healthcare costs) by €41,036, with a resultant ICER of €21,862/QALY. Considering the willingness-to-pay threshold of €30,000/QALY in Spain, SAP with low glucose suspend represents a cost-effective option from both the NHS and societal perspectives. Sensitivity analyses confirmed the robustness of the model. From both the Spanish NHS perspective and the societal perspective, SAP with low glucose suspend is a cost-effective option for the treatment of T1DM patients at high risk of hypoglycemia. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

[Cost-effectiveness analysis of sofosbuvir, peginterferon and ribavirin in patients with chronic hepatitis C: Early treatment in the initial stage of fibrosis vs. delayed treatment in advanced fibrosis].

PubMed

Buti, María; Domínguez-Hernández, Raquel; Oyagüez, Itziar; Casado, Miguel Ángel

2016-01-01

Cost-effectiveness analysis of sofosbuvir combined with peginterferon alpha-2a and ribavirin (SOF/Peg-IFN/RBV) in early versus advanced fibrosis in previously untreated patients with chronic hepatitis C genotype 1 (CHC-GT1), from the perspective of the Spanish National Health System (NHS). A Markov model was developed to compare lifetime costs and outcomes (life years gained [LYGs] and quality-adjusted life years [QALYs]) of 2 treatment strategies: SOF/Peg-IFN/RBV administered during early fibrosis (mild-moderate fibrosis; F2-F3) or advanced fibrosis (cirrhosis; F4). Efficacy (sustained virologic response), annual transition probabilities, disease management costs and utilities were obtained from the literature. Costs and outcomes were discounted annually at 3%. Direct costs were considered, expressed in Euros (€, 2014). Probabilistic sensitivity analysis (PSA) was also performed. SOF/Peg-IFN/RBV therapy at F2-F3 was more effective (19.12 LYGs and 14.14 QALYs) compared to F4. In a cohort of 1,000 patients, SOF/Peg-IFN/RBV prevented 66 cases of decompensated cirrhosis, 60 hepatocellular carcinomas and 4 liver transplantations compared with therapy in advanced fibrosis. The total lifetime cost of early therapy (€43,263) was less than the cost of treatment in the advanced stage (€49,018). Early therapy was a dominant strategy, more effective and less costly in all simulations. In the PSA analysis, administration of SOF/PEG-IFN/RBV at F2-F3 was dominant in all simulations. Starting SOF/Peg-IFN/RBV therapy at F2-F3, compared with therapy at F4, reduced the incidence of liver disease complications and was associated with cost savings for the Spanish NHS in CHC-GT1 patients. Copyright © 2016 Elsevier España, S.L.U. y AEEH y AEG. All rights reserved.

Examining Year-Long Leadership Gains in FFA Members by Prior FFA Involvement, Class Year, and Gender

ERIC Educational Resources Information Center

Rosch, David; Simonsen, Jon C.; Velez, Jonathan J.

2015-01-01

Students (N = 160) in three diverse FFA chapters were surveyed in early fall, midwinter, and late spring in regard to their leadership skills, confidence in leading, and motivation to engage in leadership-oriented behaviors. The results indicated small-to-moderate gains in transformational leadership skill and a marginally significant…

Active tectonics at the Lower Yarmouk Gorge?

NASA Astrophysics Data System (ADS)

Inbar, Nimrod; Raggad, Marwan; Siebert, Christian; Möller, Peter; Rödiger, Tino; Rosenthal, Eliyaho; Guttman, Josseph; Magri, Fabien

2017-04-01

The Lower Yarmouk Gorge (LYG) extends on the eastern margin of the Jordan Rift Valley (JRV) adjacent to the Kinneret basin which makes part in the chain of pull-apart basins along the Dead Sea Transform (DST). The LYG is bounded to the south by the Ajloun Plateau (northern Jordan) and to the north by the Golan Heights (Israel). It acts as the outflow of the Yarmouk drainage basin into the Jordan River a few kilometers south of Lake Tiberias. Although topographically the Golan Heights and the Ajloun seem to be different provinces separated by the LYG, the northern Ajloun and southern Golan form the southern flank of a major synclinal structure. Morphologically, the LYG resembles the Sheikh-Ali strike-slip fault and other NE-SW striking faults related to the DST. However, the existence of faulting along that line is debatable. As the gorge serves also as state boundary, no seismic lines cross the LYG. Quaternary landslides, mostly on the southern flank of the LYG cover possible surface evidence of faulting although Quaternary basalts located at the gorge path may indicate possible vertical pathways. Moreover, hydrological studies (Siebert et al., 2014, Goretzki et al., 2016) show that permeability anisotropy along the LYG line allows heated groundwater to emerge along the gorge with temperatures rising up to 60°C. The presented study uses well data from northern Jordan and southern Golan Heights as well as seismic data from the southern Golan Heights to bridge over the information gap. Based on the available information we present our hypothesis on the geology of the LYG aiming to contribute to the discussion regarding active tectonics at the Lower Yarmouk Gorge. Our preliminary results show that a major fault along the gorge path is dubious however, perpendicular faulting is more likely to occur. We expect the results of current research to contribute to the understanding of the local complex geohydrological system. Furthermore, results are expected to deepen our

Excess pregnancy weight gain and long-term obesity: one decade later.

PubMed

Rooney, Brenda L; Schauberger, Charles W

2002-08-01

To estimate the impact of excess pregnancy weight gain and failure to lose weight by 6 months postpartum on excess weight 8-10 years later. Seven hundred ninety-five women were observed through pregnancy and 6 months postpartum to examine factors that affect weight loss. Weight was recorded 10 years later through a medical record review to examine the impact of retained weight on long-term obesity. Overall weight change at last follow-up and body mass index (BMI) were examined by pregnancy weight gain appropriateness according to the Institute of Medicine guidelines for weight gain during pregnancy. Of the original cohort, 540 women had a documented weight beyond 5 years (mean = 8.5 years). The average weight gain from prepregnancy to follow-up was 6.3 kg. There was no difference in weight gain by prepregnancy BMI. Women who gained less than the recommended amount during their pregnancy were 4.1 kg heavier at follow-up, those gaining the recommended amount were 6.5 kg heavier, and those gaining more than recommended were 8.4 kg heavier (P =.01). Women who lost all pregnancy weight by 6 months postpartum were 2.4 kg heavier at follow-up than women with retained weight, who weighed 8.3 kg more at follow-up (P =.01). Women who breast-fed and women who participated in aerobic exercise also had significantly lower weight gains. Excess weight gain and failure to lose weight after pregnancy are important and identifiable predictors of long-term obesity. Breast-feeding and exercise may be beneficial to control long-term weight.

CMOST: an open-source framework for the microsimulation of colorectal cancer screening strategies.

PubMed

Prakash, Meher K; Lang, Brian; Heinrich, Henriette; Valli, Piero V; Bauerfeind, Peter; Sonnenberg, Amnon; Beerenwinkel, Niko; Misselwitz, Benjamin

2017-06-05

Colorectal cancer (CRC) is a leading cause of cancer-related mortality. CRC incidence and mortality can be reduced by several screening strategies, including colonoscopy, but randomized CRC prevention trials face significant obstacles such as the need for large study populations with long follow-up. Therefore, CRC screening strategies will likely be designed and optimized based on computer simulations. Several computational microsimulation tools have been reported for estimating efficiency and cost-effectiveness of CRC prevention. However, none of these tools is publicly available. There is a need for an open source framework to answer practical questions including testing of new screening interventions and adapting findings to local conditions. We developed and implemented a new microsimulation model, Colon Modeling Open Source Tool (CMOST), for modeling the natural history of CRC, simulating the effects of CRC screening interventions, and calculating the resulting costs. CMOST facilitates automated parameter calibration against epidemiological adenoma prevalence and CRC incidence data. Predictions of CMOST were highly similar compared to a large endoscopic CRC prevention study as well as predictions of existing microsimulation models. We applied CMOST to calculate the optimal timing of a screening colonoscopy. CRC incidence and mortality are reduced most efficiently by a colonoscopy between the ages of 56 and 59; while discounted life years gained (LYG) is maximal at 49-50 years. With a dwell time of 13 years, the most cost-effective screening is at 59 years, at $17,211 discounted USD per LYG. While cost-efficiency varied according to dwell time it did not influence the optimal time point of screening interventions within the tested range. Predictions of CMOST are highly similar compared to a randomized CRC prevention trial as well as those of other microsimulation tools. This open source tool will enable health-economics analyses in for various countries

Parent-Reported Patterns of Loss and Gain in Communication in 1- to 2-Year-Old Children Are Not Unique to Autism Spectrum Disorder

ERIC Educational Resources Information Center

Brignell, Amanda; Williams, Katrina; Prior, Margot; Donath, Susan; Reilly, Sheena; Bavin, Edith L.; Eadie, Patricia; Morgan, Angela T.

2017-01-01

We compared loss and gain in communication from 1 to 2 years in children later diagnosed with autism spectrum disorder (n = 41), language impairment (n = 110) and in children with typical language development at 7 years (n = 831). Participants were selected from a prospective population cohort study of child language (the Early Language in…

Assessing the Real-World Cost-Effectiveness of Adjuvant Trastuzumab in HER-2/neu Positive Breast Cancer

PubMed Central

Hedden, Lindsay; O'Reilly, Susan; Lohrisch, Caroline; Chia, Stephen; Speers, Caroline; Kovacic, Laurel; Taylor, Suzanne

2012-01-01

Background. Among women with surgically removed, high-risk HER-2/neu-positive breast cancer, trastuzumab has demonstrated significant improvements in disease-free and overall survival. The objective of this study is to evaluate the cost-effectiveness of the currently recommended 12-month adjuvant protocol of trastuzumab using a Markov modeling approach and real-world cost data. Methods. A 10-health-state Markov model tracked patients' quarterly transitions between health states in the local and advanced states of breast cancer. Clinical data were obtained from the joint analysis of the National Surgical Adjuvant Breast and Bowel Project and North Central Cancer Treatment Group, as well as from the metastatic study conducted by Norum et al. Clinical outcomes were adjusted for quality of life using utility estimates published in a systematic review. Real cost data were obtained from the British Columbia Cancer Agency and were evaluated from a payer perspective. Costs and utilities were discounted at 5% per year, respectively, for a 28-year time horizon. Results. In the base case analysis, treatment with a 12-month adjuvant trastuzumab regimen resulted in a gain of 1.38 quality-adjusted life years or 1.17 life years gained at a cost of $18,133 per patient. Thus, the cost per QALY gained for the base case is $13,095. Cost per LYG is $15,492. Conclusions. Over the long term, treatment of HER-2/neu mutation positive breast cancer with a 12-month protocol of trastuzumab in the adjuvant setting is predicted to be cost-effective in a Canadian context. PMID:22302231

Can LENR Energy Gains Exceed 1000?

NASA Astrophysics Data System (ADS)

Nagel, David J.

2011-03-01

Energy gain is defined as the energy realized from reactions divided by the energy required to produce those reactions. Low Energy Nuclear Reactions (LENR) have already been measured to significantly exceed the energy gain of 10 projected from ITER,possibly 15 years from now. Electrochemical experiments using the Pd-D system have shown energy gains exceeding 10. Gas phase experiments with the Ni-H system were reported to yield energy gains of over 100. Neither of these reports has been adequately verified or reproduced. However, the question in the title still deserves consideration. If, as thought by many, it is possible to trigger nuclear reactions that yield MeV energies with chemical energies of the order of eV, then the most optimistic expectation is that LENR gains could approach one million. Hence, the very tentative answer to the question above is yes. However, if LENR could be initiated with some energy cost, and then continue to ``burn,'' very high energy gains might be realized. Consider a match and a pile of dry logs. The phenomenon termed ``heat after death'' will be examined to see if it might be the initial evidence for nuclear ``burning.''

Childhood Weight Gain and Thyroid Autoimmunity at Age 60–64 Years: The 1946 British Birth Cohort Study

PubMed Central

Kuh, Diana; Pierce, Mary; Franklyn, Jayne A.

2013-01-01

Background: Complex bidirectional relationships have been described between body weight, thyroid function, and risk of thyroid disorders, including thyroid autoimmunity. We used a life-course approach to examine the potential association of childhood or adult body weight with the risk of thyroid autoimmunity and other thyroid disorders at age 60–64 years in a large population-based birth cohort study. Methods: In the UK Medical Research Council 1946 British Birth Cohort study, at age 60–64 years, 1277 women and 1185 men (78% of the target sample) responded to a postal questionnaire, which included questions on thyroid disease and thyroid medication. Circulating antithyroid peroxidase antibodies, free T4, and TSH concentrations were measured in 1057 women and 997 men at a subsequent clinic visit. Birth weight was recorded, and height and weight were measured at ages 2, 4, 6, 7, 11, 15 years and also repeatedly in adulthood. Results: At age 60–64 years, 10.9% of women (139 of 1277) and 2.3% of men (27 of 1185) reported they were taking T4, and 11.5% of women (122 of 1057) and 3.3% of men (33 of 997) had positive anti-TPO antibodies (>100 IU/mL), consistent with thyroid autoimmunity. Among women, both T4 use and positive anti-TPO antibodies at age 60–64 years were positively associated with childhood body weight, childhood overweight, and adult body mass index. Childhood weight gain between 0 and 14 years of age was positively associated with later T4 use (odds ratio 1.21, 95% confidence interval 1.03–1.42) and positive anti-TPO antibodies (1.21, 1.00–1.47). Women who were overweight or obese at age 14 years (127 of 972) had a higher risk of later positive anti-TPO antibodies (2.05, 1.12–3.76). In men and women without any thyroid disorders, serum free T4 concentrations were inversely associated with concurrent body mass index (P = .002). Conclusions: Childhood weight gain and childhood overweight conferred an increased susceptibility to later

Determining productivity gains from herbaceous vegetation management with 'age-shift' calculations

Treesearch

David B. South; James H. Miller; Mark O. Kimberley; Curtis L. Vanderschaaf

2006-01-01

Gains in stand volume that result from competition control and fertilization are sometimes reported as 'percentage gains'. Because percentage gains arithmetically decline over time asstand volume increases, plantation managers have difficultyin using percentage gains to project growth and revenues. The 'age-shift' method quantifies the year...

Participation in a Year-Long CURE Embedded into Major Core Genetics and Cellular and Molecular Biology Laboratory Courses Results in Gains in Foundational Biological Concepts and Experimental Design Skills by Novice Undergraduate Researchers†

PubMed Central

Peteroy-Kelly, Marcy A.; Marcello, Matthew R.; Crispo, Erika; Buraei, Zafir; Strahs, Daniel; Isaacson, Marisa; Jaworski, Leslie; Lopatto, David; Zuzga, David

2017-01-01

This two-year study describes the assessment of student learning gains arising from participation in a year-long curriculum consisting of a classroom undergraduate research experience (CURE) embedded into second-year, major core Genetics and Cellular and Molecular Biology (CMB) laboratory courses. For the first course in our CURE, students used micro-array or RNAseq analyses to identify genes important for environmental stress responses by Saccharomyces cerevisiae. The students were tasked with creating overexpressing mutants of their genes and designing their own original experiments to investigate the functions of those genes using the overexpression and null mutants in the second CURE course. In order to evaluate student learning gains, we employed three validated concept inventories in a pretest/posttest format and compared gains on the posttest versus the pretest with student laboratory final grades. Our results demonstrated that there was a significant correlation between students earning lower grades in the Genetics laboratory for both years of this study and gains on the Genetics Concept Assessment (GCA). We also demonstrated a correlation between students earning lower grades in the Genetics laboratory and gains on the Introductory Molecular and Cell Biology Assessment (IMCA) for year 1 of the study. Students furthermore demonstrated significant gains in identifying the variable properties of experimental subjects when assessed using the Rubric for Experimental (RED) design tool. Results from the administration of the CURE survey support these findings. Our results suggest that a year-long CURE enables lower performing students to experience greater gains in their foundational skills for success in the STEM disciplines. PMID:28904646

Participation in a Year-Long CURE Embedded into Major Core Genetics and Cellular and Molecular Biology Laboratory Courses Results in Gains in Foundational Biological Concepts and Experimental Design Skills by Novice Undergraduate Researchers.

PubMed

Peteroy-Kelly, Marcy A; Marcello, Matthew R; Crispo, Erika; Buraei, Zafir; Strahs, Daniel; Isaacson, Marisa; Jaworski, Leslie; Lopatto, David; Zuzga, David

2017-01-01

This two-year study describes the assessment of student learning gains arising from participation in a year-long curriculum consisting of a classroom undergraduate research experience (CURE) embedded into second-year, major core Genetics and Cellular and Molecular Biology (CMB) laboratory courses. For the first course in our CURE, students used micro-array or RNAseq analyses to identify genes important for environmental stress responses by Saccharomyces cerevisiae . The students were tasked with creating overexpressing mutants of their genes and designing their own original experiments to investigate the functions of those genes using the overexpression and null mutants in the second CURE course. In order to evaluate student learning gains, we employed three validated concept inventories in a pretest/posttest format and compared gains on the posttest versus the pretest with student laboratory final grades. Our results demonstrated that there was a significant correlation between students earning lower grades in the Genetics laboratory for both years of this study and gains on the Genetics Concept Assessment (GCA). We also demonstrated a correlation between students earning lower grades in the Genetics laboratory and gains on the Introductory Molecular and Cell Biology Assessment (IMCA) for year 1 of the study. Students furthermore demonstrated significant gains in identifying the variable properties of experimental subjects when assessed using the Rubric for Experimental (RED) design tool. Results from the administration of the CURE survey support these findings. Our results suggest that a year-long CURE enables lower performing students to experience greater gains in their foundational skills for success in the STEM disciplines.

Cross-cultural comparisons of delay discounting of gain and loss.

PubMed

Ishii, Keiko; Gang, Lili; Takahashi, Taiki

2016-11-01

People generally tend to discount future outcomes in favor of smaller but immediate gains (i.e., delay discounting). The present research examined cultural similarities and differences in delay discounting of gain and loss between Chinese and Japanese, based on a q-exponential model of intertemporal choice. Using a hypothetical situation, we asked 65 Japanese participants and 51 Chinese participants to choose between receiving (or paying) a different amount of money immediately or with a specified delay (1 week, 2 weeks, 1 month, 6 months, 1 year, 5 years, and 25 years). For each delay, participants completed a series of 40 binary choices for gain or loss. Regardless of cultures, the q-exponential model was the optimal model. Both impulsivity and time-inconsistency were higher for future gains than for future losses. In addition to the cultural similarities, Chinese participants discounted future gains and losses more steeply than did Japanese. In contrast, Japanese participants were more time-inconsistent in delay discounting than were Chinese, suggesting that the reduction in their subjective value depended relatively on delay.

Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units.

PubMed

Ruiz-Ramos, Jesus; Frasquet, Juan; Romá, Eva; Poveda-Andres, Jose Luis; Salavert-Leti, Miguel; Castellanos, Alvaro; Ramirez, Paula

2017-06-01

To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.

Rapid Weight Gain in Pediatric Refugees after US Immigration.

PubMed

Olson, Brad G; Kurland, Yonatan; Rosenbaum, Paula F; Hobart, Travis R

2017-04-01

Prior studies of immigrants to the United States show significant weight gain after 10 years of US residence. Pediatric refugees are a vulnerable population whose post-immigration weight trajectory has not been studied. We examined the longitudinal weight trajectory of 1067 pediatric refugees seen in a single university based refugee health program between the dates of September 3, 2012 and September 3, 2014 to determine how quickly significant weight gain occurs post-arrival. The most recent BMI was abstracted from the electronic health record and charts reviewed to obtain serial BMI measurements in 3 year increments after the date of US arrival. The mean arrival BMI percentile for all refugees was 47th percentile. This increased significantly to the 63rd percentile within 3 years of US arrival (p < 0.01). This rapid increase was largely attributable to African and South and Southeast Asian refugees. The overall prevalence of age and sex adjusted obesity rose from 7.4 % at arrival to 18.3 % within 9 years of US immigration exceeding the pediatric US national obesity prevalence of 16.9 %. Pediatric refugees are at increased risk of rapid weight gain after US immigration. Targeted interventions focused on prevention of weight gain in specific populations are warranted.

Cost-effectiveness of dronedarone and standard of care compared with standard of care alone: US results of an ATHENA lifetime model.

PubMed

Reynolds, Matthew R; Nilsson, Jonas; Akerborg, Orjan; Jhaveri, Mehul; Lindgren, Peter

2013-01-01

The first antiarrhythmic drug to demonstrate a reduced rate of cardiovascular hospitalization in atrial fibrillation/flutter (AF/AFL) patients was dronedarone in a placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation/atrial flutter (ATHENA trial). The potential cost-effectiveness of dronedarone in this patient population has not been reported in a US context. This study assesses the cost-effectiveness of dronedarone from a US health care payers' perspective. ATHENA patient data were applied to a patient-level health state transition model. Probabilities of health state transitions were derived from ATHENA and published data. Associated costs used in the model (2010 values) were obtained from published sources when trial data were not available. The base-case model assumed that patients were treated with dronedarone for the duration of ATHENA (mean 21 months) and were followed over a lifetime. Cost-effectiveness, from the payers' perspective, was determined using a Monte Carlo microsimulation (1 million fictitious patients). Dronedarone plus standard care provided 0.13 life years gained (LYG), and 0.11 quality-adjusted life years (QALYs), over standard care alone; cost/QALY was $19,520 and cost/LYG was $16,930. Compared to lower risk patients, patients at higher risk of stroke (Congestive heart failure, history of Hypertension, Age ≥ 75 years, Diabetes mellitus, and past history of Stroke or transient ischemic attack (CHADS(2)) scores 3-6 versus 0) had a lower cost/QALY ($9580-$16,000 versus $26,450). Cost/QALY was highest in scenarios assuming lifetime dronedarone therapy, no cardiovascular mortality benefit, no cost associated with AF/AFL recurrence on standard care, and when discounting of 5% was compared with 0%. By extrapolating the results of a large, multicenter, randomized clinical trial (ATHENA

Weight gain and reduced energy expenditure in low-income Brazilian women living in slums: a 4-year follow-up study.

PubMed

Florêncio, Telma M M T; Bueno, Nassib B; Clemente, Ana P G; Albuquerque, Fabiana C A; Britto, Revilane P A; Ferriolli, Eduardo; Sawaya, Ana L

2015-08-14

The present study aimed to investigate the possible changes in anthropometric and biochemical parameters in low-income women living in the outskirts of Maceió (northeast Brazil), and to explore the possible role of dietary intake and physical activity in these changes. A prospective longitudinal study was conducted in a cohort of mothers of malnourished children who attended the Center for Nutritional Recovery and Education, an outreach programme of the Federal University of Alagoas. Socio-economic, anthropometric, biochemical and dietary intake data were assessed at baseline and after a follow-up period of 4 years. Energy expenditure (using doubly labelled water) and physical activity (using triaxial accelerometers) were assessed only in a subgroup of women after 4 years. A total of eighty-five women were assessed. Participants showed an altered biochemical profile, increased systolic blood pressure, decreased thyroid hormone levels, and body-weight gain. However, dietary intakes of the participants did not include large quantities of highly processed and high-glycaemic index foods. The energy intake of the participants did not differ from their total energy expenditure (7990.3 (7173.7-8806.8) v. 8798.1 (8169.0-9432.4) kJ, respectively; P= 0.084). Multivariate analyses showed a significant effect of time spent watching television (β = 0.639 (0.003 to 1.275); P= 0.048) and dietary diversity score (β = -1.039 ( -2.010 to -0.067); P = 0.036) on weight gain. The present study indicates that poor women, who are mothers of malnourished children and have a reasonably balanced dietary intake, exhibit weight gain and are at risk of developing chronic diseases.

Polygenic Risk, Appetite Traits, and Weight Gain in Middle Childhood

PubMed Central

Steinsbekk, Silje; Belsky, Daniel; Guzey, Ismail Cuneyt; Wardle, Jane; Wichstrøm, Lars

2018-01-01

IMPORTANCE Genome-wide association studies have identified genetic risks for obesity. These genetic risks influence development of obesity partly by accelerating weight gain in childhood. Research is needed to identify mechanisms to inform intervention. Cross-sectional studies suggest appetite traits as a candidate mechanism. Longitudinal studies are needed to test whether appetite traits mediate genetic influences on children’s weight gain. OBJECTIVE To test whether genetic risk for obesity predicts accelerated weight gain in middle childhood (ages 4–8 years) and whether genetic association with accelerated weight gain is mediated by appetite traits. DESIGN, SETTING, AND PARTICIPANTS Longitudinal study of a representative birth cohort at the Trondheim Early Secure Study, Trondheim, Norway, enrolled at age 4 years during 2007 to 2008, with follow-ups at ages 6 and 8 years. Participants were sampled from all children born in 2003 or 2004 who attended regular community health checkups for 4-year-olds (97.2%attendance; 82.0%consent rate, n = 2475). Nine hundred ninety-five children participated at age 4 years, 795 at age 6 years, and 699 at age 8 years. Analyses included 652 children with genotype, adiposity, and appetite data. MAIN OUTCOMES AND MEASURES Outcomes were body mass index and body-fat phenotypes measured from anthropometry (ages 4, 6, and 8 years) and bioelectrical impedance (ages 6 and 8 years). Genetic risk for obesity was measured using a genetic risk score composed of 32 single-nucleotide polymorphisms previously discovered in genome-wide association studies of adult body mass index. Appetite traits were measured at age 6 years with the Children’s Eating Behavior Questionnaire. RESULTS Of the 652 genotyped child participants, 323 (49.5%) were female, 58 (8.9%) were overweight, and 1 (0.2%) was obese. Children at higher genetic risk for obesity had higher baseline body mass index and fat mass compared with lower genetic risk peers, and they gained

26 CFR 1.1374-2 - Net recognized built-in gain.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 11 2010-04-01 2010-04-01 true Net recognized built-in gain. 1.1374-2 Section 1... (CONTINUED) INCOME TAXES Small Business Corporations and Their Shareholders § 1.1374-2 Net recognized built-in gain. (a) In general. An S corporation's net recognized built-in gain for any taxable year is the...

Adequacy of Prenatal Care and Gestational Weight Gain

PubMed Central

Crandell, Jamie L.; Jones-Vessey, Kathleen

2016-01-01

Abstract Background: The goal of prenatal care is to maximize health outcomes for a woman and her fetus. We examined how prenatal care is associated with meeting the 2009 Institute of Medicine (IOM) guidelines for gestational weight gain. Sample: The study used deidentified birth certificate data supplied by the North Carolina State Center for Health Statistics. The sample included 197,354 women (≥18 years) who delivered singleton full-term infants in 2011 and 2012. Methods: A generalized multinomial model was used to identify how adequate prenatal care was associated with the odds of gaining excessive or insufficient weight during pregnancy according to the 2009 IOM guidelines. The model adjusted for prepregnancy body size, sociodemographic factors, and birth weight. Results: A total of 197,354 women (≥18 years) delivered singleton full-term infants. The odds ratio (OR) for excessive weight gain was 2.44 (95% CI 2.37–2.50) in overweight and 2.33 (95% CI 2.27–2.40) in obese women compared with normal weight women. The OR for insufficient weight gain was 1.15 (95% CI 1.09–1.22) for underweight and 1.34 (95% CI 1.30–1.39) for obese women compared with normal weight women. Prenatal care at the inadequate or intermediate levels was associated with insufficient weight gain (OR: 1.32, 95% CI 1.27–1.38; OR: 1.15, 95% CI 1.09–1.21, respectively) compared with adequate prenatal care. Women with inadequate care were less likely to gain excessive weight (OR: 0.88, 95% CI 0.86–0.91). Conclusions: Whereas prenatal care was effective for preventing insufficient weight gain regardless of prepregnancy body size, educational background, and racial/ethnic group, there were no indications that adequate prenatal care was associated with reduced risk for excessive gestational weight gain. Further research is needed to improve prenatal care programs for preventing excess weight gain. PMID:26741198

Food groups and weight gain in Japanese men.

PubMed

Ibe, Y; Takahashi, Y; Sone, H

2014-06-01

Identifying subjects at high risk of weight gain according to consumption of food groups is important for individualizing nutritional education, but prospective studies of this issue have been few. We determined whether intake of specific food groups could predict future weight gain. We evaluated data from health checkups on 1236 Japanese men aged 28 to 87 years in 2005 and 2006. Dietary intake was assessed by a 24-h dietary recall at baseline. Weight change was measured after 1 year. Weight increased in 44.7% (n = 553) of participants. Multivariate regression analysis involving many food groups showed a significant association between sugar intake and weight gain after adjustment for age, body mass index (BMI), total energy intake, alcohol, smoking and regular physical exercise (β = 0.22, P = 0.04). The effect of intake of 'fats and oils' was significant when adjusted for age and BMI, however, it became insignificant after adjustment for age, BMI and total energy intake. Intake of sugar, which was evaluated as a food group, was predictive of subsequent weight gain among Japanese men, even after adjustment for many confounders. This corroborates the evidence so far concerning the links between sugar intake and weight gain. Further long-term research is required to give robust recommendation to the public. © 2014 The Authors. Clinical Obesity © 2014 International Association for the Study of Obesity.

The Relationship of Maternal Prepregnancy Body Mass Index and Pregnancy Weight Gain to Neurocognitive Function at Age 10 Years among Children Born Extremely Preterm.

PubMed

Jensen, Elizabeth T; van der Burg, Jelske W; O'Shea, Thomas M; Joseph, Robert M; Allred, Elizabeth N; Heeren, Tim; Leviton, Alan; Kuban, Karl C K

2017-08-01

To assess the association between maternal prepregnancy body mass index and adequacy of pregnancy weight gain in relation to neurocognitive function in school-aged children born extremely preterm. Study participants were 535 ten-year-old children enrolled previously in the prospective multicenter Extremely Low Gestational Age Newborns cohort study who were products of singleton pregnancies. Soon after delivery, mothers provided information about prepregnancy weight. Prepregnancy body mass index and adequacy of weight gain were characterized based on this information. Children underwent a neurocognitive evaluation at 10 years of age. Maternal prepregnancy obesity was associated with increased odds of a lower score for Differential Ability Scales-II Verbal IQ, for Developmental Neuropsychological Assessment-II measures of processing speed and visual fine motor control, and for Wechsler Individual Achievement Test-III Spelling. Children born to mothers who gained an excessive amount of weight were at increased odds of a low score on the Oral and Written Language Scales Oral Expression assessment. Conversely, children whose mother did not gain an adequate amount of weight were at increased odds of a lower score on the Oral and Written Language Scales Oral Expression and Wechsler Individual Achievement Test-III Word Reading assessments. In this cohort of infants born extremely preterm, maternal obesity was associated with poorer performance on some assessments of neurocognitive function. Our findings are consistent with the observational and experimental literature and suggest that opportunities may exist to mitigate risk through education and behavioral intervention before pregnancy. Copyright © 2017 Elsevier Inc. All rights reserved.

A study of the competency of third year medical students to interpret biochemically based clinical scenarios using knowledge and skills gained in year 1 and 2.

PubMed

Gowda, Veena Bhaskar S; Nagaiah, Bhaskar Hebbani; Sengodan, Bharathi

2016-01-01

Medical students build clinical knowledge on the grounds of previously obtained basic knowledge. The study aimed to evaluate the competency of third year medical students to interpret biochemically based clinical scenarios using knowledge and skills gained during year 1 and 2 of undergraduate medical training. Study was conducted on year 3 MBBS students at AIMST University, Malaysia. Clinical scenarios (25) were constructed and administered to student volunteers, making sure at least one question from each system of year 2 was represented. Feedback was obtained on a five-point Likert scale regarding perception of learning biochemistry in MBBS year 1 versus 2. Mean score of test was 18 (72.11%). Performance was comparatively better in questions related to topics learnt in year 1 and reinforced in year 2 compared to those learnt for first time in year 2. In the feedback obtained, 31% strongly agreed and 56% agreed understanding the subject was helped more by learning biochemistry in year 2 than in year 1. Likewise, 36% strongly agreed and 56% agreed appreciating the importance of biochemistry in patient diagnosis was helped more by learning biochemistry in year 2 than year 1. Thirty one percent strongly agreed and 54% agreed that year 1 biochemistry would have been more relevant if case discussions were done simultaneously. Students retain basic science subjects better and appreciate the importance of basic sciences in patient diagnosis if they are reinforced in the context of clinical situations. © 2016 The International Union of Biochemistry and Molecular Biology.

Employment, work hours and weight gain among middle-aged women.

PubMed

Au, N; Hauck, K; Hollingsworth, B

2013-05-01

To investigate the influence of employment and work hours on weight gain and weight loss among middle-aged women. Quantile regression techniques were used to estimate the influence of employment and hours worked on percentage weight change over 2 years across the entire distribution of weight change in a cohort of middle-aged women. A range of controls was included in the models to isolate the effect of work status. A total of 9276 women aged 45-50 years at baseline who were present in both the 1996 and 1998 surveys of the Australian Longitudinal Study of Women's Health. The women were a representative sample of the Australian population. Being out of the labour force or unemployed was associated with lower weight gain and higher weight loss than being employed. The association was stronger at low to moderate levels of weight gain. Among employed women, working regular (35-40), long (41-48) or very long (49+) hours was associated with increasingly higher levels of weight gain compared with working part-time hours. The association was stronger for women with greater weight gain overall. The association between unemployment and weight change became insignificant when health status was controlled for. Employment was associated with more weight gain and less weight loss. Among the employed, working longer hours was associated with more weight gain, especially at the higher levels of weight gain where the health consequences are more serious. These findings suggest that as women work longer hours they are more likely to make lifestyle choices that are associated with weight gain.

Preventing weight gain in adults: the pound of prevention study.

PubMed Central

Jeffery, R W; French, S A

1999-01-01

OBJECTIVES: This study examined whether weight gain with age could be prevented through the use of a low-intensity intervention. METHODS: Participants, 228 men and 998 women recruited from diverse sources, were randomized to one of the following groups: (1) no-contact control, (2) education through monthly newsletters, or (3) education plus incentives for participation. All participants were weighed and completed questionnaires about behaviors and attitudes related to weight at baseline and annually for 3 years thereafter. RESULTS: Individuals in intervention groups reported favorable changes over time in frequency of weighting and healthy dieting practices relative to those in the control group. These behavior changes were in turn related to a reduced rate of weight gain over time. However, weight gain over 3 years did not differ significantly by treatment group. CONCLUSIONS: This low-intensity educational approach to weight gain prevention sustained interest over a lengthy time period and was associated positively with behavior change, but it was not strong enough to significantly reduce weight gain with age. PMID:10224988

Good maintenance of exercise-induced bone gain with decreased training of female tennis and squash players: a prospective 5-year follow-up study of young and old starters and controls.

PubMed

Kontulainen, S; Kannus, P; Haapasalo, H; Sievänen, H; Pasanen, M; Heinonen, A; Oja, P; Vuori, I

2001-02-01

This prospective 5-year follow-up study of 64 adult female racquet sports players and 27 controls assessed the changes in the playing-to-nonplaying arm bone mineral content (BMC) differences to answer three questions: (1) Are training-induced bone gains lost with decreased training? (2) Is the bone response to decreased training different if the playing career has been started before or at puberty rather than after it? (3) Are the possible bone changes related to the changes in training? The players were divided into two groups according to the starting age of their tennis or squash playing. The mean starting age was 10.5 years (SD, 2.2) among the players who had started training before or at menarche (young starters; n = 36) while 26.4 years (SD, 8.0) among those players who had begun training a minimum of 1 year after menarche (old starters; n = 28). At baseline of the 5-year follow-up, the mean age of the young starters was 21.6 years (SD, 7.6) and that of old starters was 39.4 years (SD, 10.5). During the follow-up, the young starters had reduced the average training frequency from 4.7 times a week (2.7) to 1.4 times a week (1.3) and the old starters from 4.0 times a week (1.4) to 2.0 times a week (1.4), respectively. The 5-year follow-up revealed that despite reduced training the exercise-induced bone gain was well maintained in both groups of players regardless of their clearly different starting age of activity and different amount of exercise-induced bone gain. The gain was still 1.3-2.2 times greater in favor of the young starters (at the follow-up, the dominant-to-nondominant arm BMC difference was 22% [8.4] in the humeral shaft of the young starters versus 10% [3.8] in the old starters, and 3.5% [2.4] in controls). In the players, changes in training were only weakly related to changes in the side-to-side BMC difference (r(s) = 0.05-0.34, all NS), and this was true even among the players who had stopped training completely a minimum 1 year before the

Effects of a Gestational Weight Gain Restriction Program for Obese Pregnant Women: Children's Weight Development during the First Five Years of Life.

PubMed

Claesson, Ing-Marie; Sydsjö, Gunilla; Olhager, Elisabeth; Oldin, Carin; Josefsson, Ann

2016-06-01

Maternal prepregnancy obesity (BMI ≥30 kg/m(2)) and excessive gestational weight gain (GWG) have shown a strong positive association with a higher BMI and risk of obesity in the offspring. The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the children's BMI at 5 years of age and weight-for-length/height (WL/H) development from 2 months of age until 5 years of age. This was a follow-up study of 302 children (137 children in an intervention group and 165 children in a control group) whose mothers participated in a weight gain restriction program during pregnancy. BMI at five years of age did not differ between girls and boys in the intervention and control group. The degree of maternal GWG, <7 kg or ≥7 kg, did not affect the offspring's WL/H. Compared with Swedish reference data, just over half of the children in both the intervention and control group had a BMI within the average range, whereas slightly more than one-third of the children had a higher BMI. Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes, there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group.

[Economic evaluation of an infant immunization program in Mexico, based on 13-valent pneumococcal conjugated vaccines].

PubMed

Muciño-Ortega, Emilio; Mould-Quevedo, Joaquín Federico; Farkouh, Raymond; Strutton, David

2011-01-01

Vaccination is an effective intervention for reduce child morbidity and mortality associated to pneumococcus. The availability of new anti-pneumococcal vaccines makes it necessary to evaluate its potential impact on public health and costs related to their implementation. The aim of this study was to estimate the cost-effectiveness and cost-utility of immunization strategies based on pneumococcal conjugated vaccines (PCV's) currently available in Mexico from a third payer perspective. A decision tree model was developed to assess both, economic and health impact, of anti-pneumococcal vaccination in children <2 years (lifetime time horizon, discount rate: 5% annual). Comparators were: no-vaccination (reference) and strategies based on 7, 10 and 13-valent PCV's. Effectiveness measures were: child deaths avoided, life-years gained (LYG) and quality adjusted life years (QALY's) gained. Effectiveness, utility, local epidemiology and cost of treating pneumococcal diseases were extracted from published sources. Univariate sensitivity analysis were performed. Immunization dominates no-vaccination: strategy based on 13-valent vaccine prevented 16.205 deaths, gained 331.230 LY's and 332.006 QALY's and saved US$1.307/child vaccinated. Strategies based on 7 and 10-valent PCV's prevented 13.806 and 5.589 deaths, gained 282.193 and 114.251 LY's, 282.969 and 114.972 QALY's and saved US$1.084 and US$731/child vaccinated, respectively. These results were robust to variations in herd immunity and lower immunogenicity of 10-valent vaccine. In Mexico, immunization strategies based on 7, 10 and 13-valent PCV's would be cost-saving interventions, however, health outcomes and savings of the strategy based on 13-valent vaccine are greater than those estimated for 7 and 10-valent PCV's. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Proximal Femur Mechanical Adaptation to Weight Gain in Late Adolescence: A Six-Year Longitudinal Study

PubMed Central

Petit, Moira A; Beck, Thomas J; Hughes, Julie M; Lin, Hung-Mo; Bentley, Christy; Lloyd, Tom

2008-01-01

The effect of weight gain in late adolescence on bone is not clear. Young women who consistently gained weight (n = 23) from 17 to 22 yr of age had increased BMD but a lack of subperiosteal expansion compared with stable weight peers (n = 48). Bone strength increased appropriately for lean mass in both groups but decreased relative to body weight in weight gainers, suggesting increased bone fragility in weight gainers. Introduction Weight gain leading to obesity often starts in adolescence, yet little is known about its effects on bone. We used longitudinal data to examine the effects of weight gain in late adolescence (from 17 to 22 yr of age) on proximal femur BMD, geometry, and estimates of bending strength. Materials and Methods Participants were classified as either weight gainers (WG, n = 23) or stable weight (SW, n = 48) using a random coefficients model. Weight gainers had positive increases in weight (p < 0.05) at each clinic visit from age 17 onward. Proximal femur DXA scans (Hologic QDR 2000) taken annually from 17 to 22 yr of age were analyzed for areal BMD (g/cm2), subperiosteal width (cm), and bone cross-sectional area (CSA) at the proximal femoral shaft. Cortical thickness was measured, and section modulus (Z, cm3) was calculated as a measure of bone bending strength. Total body lean (g) and fat (g) mass were measured from DXA total body scans. Results Over ages 17–22, height remained stable in both groups. Weight remained static in the SW group but increased 14% on average in the WG group (p < 0.05). After controlling for age 17 baseline values, WG had higher BMD (+2.6%), thicker cortices (+3.6%), and greater bone CSA (+2.3%). Increased BMD did not translate to greater increases in bone bending strength (Z). The SW group achieved similar gains in Z by greater subperiosteal expansion. Bone strength index (SI = Z/height) normalized for body weight remained constant in the SW group but decreased significantly in the WG group. In contrast, SI

Nintedanib in combination with docetaxel for second-line treatment of advanced non-small-cell lung cancer; GENESIS-SEFH drug evaluation report.

PubMed

Espinosa Bosch, María; Asensi Diez, Rocío; García Agudo, Sara; Clopes Estela, Ana

2016-06-01

Nintedanib is a triple angiokinase inhibitor that has been approved by the European Agency Medicines (EMA) in combination with docetaxel for the treatment of adult patients with locally advanced, metastatic or locally recurrent non small cell lung cancer (NSCLC) of adenocarcinoma tumour histology, after first-line chemotherapy. In LUME-Lung 1 clinical trial, the combination of nintedanib plus docetaxel vs. placebo plus docetaxel improved progression free survival (PFS) in NSCLC patients, and improved overall survival in the population of adenocarcinoma patients, particularly in those with progression within 9 months after first line treatment initiation, median 10.9 months ( [95% CI 8.5-12.6] vs. 7.9 months [6.7-9.1]; HR 0.75 [95% CI 0.60-0.92], p=0.0073). The toxicity profile of the combination included a higher incidence of neutropenia, gastro-intestinal (GI) disorders, and liver enzyme elevations; however, this did not cause a detrimental effect on patient quality of life. According to data from the clinical trial mentioned, the addition of nintedanib to docetaxel would lead to an estimated incremental cost-effectiveness ratio (ICER) per year of life with PFS in the overall population of 134,274.47 € (notified price). In the adenocarcinoma population per each life of year gained (LYG), the ICER of adding nintedanib to docetaxel would be 40,886.14 €; while by implementing a sensitivity analysis with a 25% discount in the drug price, the cost per LYG would be 32,364.05 €, and would place it close to the threshold of cost-effectiveness usually considered acceptable in our setting. In view of efficacy and safety results the proposed positioning is to recommend its inclusion in the Hospital Formulary only for adult patients with metastatic or locally recurrent NSCLC with adenocarcinoma histology after first line chemotherapy, with progression < 9 months from the initiation of first line treatment, taking into account the inclusion and exclusion criteria in the

Health characteristics associated with gaining and losing private and public health insurance: a national study.

PubMed

Jerant, Anthony; Fiscella, Kevin; Franks, Peter

2012-02-01

Millions of Americans lack or lose health insurance annually, yet how health characteristics predict insurance acquisition and loss remains unclear. To examine associations of health characteristics with acquisition and loss of private and public health insurance. Prospective observational analysis of 2000 to 2007 Medical Expenditure Panel Survey data for persons aged 18 to 63 on entry, enrolled for 2 years. We modeled year 2 private and public insurance gain and loss. year 2 insurance status [none (reference), any private insurance, or public insurance] among those uninsured in year 1 (N=13,022), and retaining or losing coverage in year 2 among those privately or publicly insured in year 1 (N=47,239). age, sex, race/ethnicity, education, income, region, urbanity, health status, health conditions, year 1 health expenditures, year 1 and 2 employment status, and (in secondary analyses) skepticism toward medical care and insurance. In adjusted analyses, lower income and education were associated with not gaining and with losing private insurance. Poorer health status was associated with public insurance gain. Smoking and being overweight were associated with not gaining private insurance, and smoking with losing private coverage. Secondary analyses adjusting for medical skepticism yielded similar findings. Social disadvantage and poorer health status are associated with gaining public insurance, whereas social advantage, not smoking, and not being overweight are associated with gaining private insurance, even when adjusting for attitudes toward medical care. Private insurers seem to benefit from relatively low health risk selection.

Results of a Markov model analysis to assess the cost-effectiveness of statin therapy for the primary prevention of cardiovascular disease in Korea: the Korean Individual-Microsimulation Model for Cardiovascular Health Interventions.

PubMed

Kang, Hye-Young; Ko, Su-Kyoung; Liew, Danny

2009-12-01

gained (LYG) (1200 KRW approximately US $1). Based on a willingness-to-pay (WTP) threshold of 30 million KRW per QALY saved, there was a 93.7% probability that statin therapy would be cost-effective. Given a WTP threshold of 20 million KRW per QALY, there was a 53.8% probability of being cost-effective. The probabilities at WTP thresholds of 30 and 20 million KRW per LYG were 62.4% and 25.8%, respectively. Based on this analysis using data from the 2005 KNHNES and the KIMCHI model, statin therapy is likely to be cost-effective for the primary prevention of CVD among Koreans aged > or =45 years. The probability of being cost-effective was greater at a threshold of 30 million KRW per QALY (93.7%) than at 20 million KRW per QALY (53.8%). Copyright 2009 Excerpta Medica Inc. All rights reserved.

Rapid weight gain during infancy and early childhood is related to higher anthropometric measurements in preadolescence.

PubMed

Nanri, H; Shirasawa, T; Ochiai, H; Nomoto, S; Hoshino, H; Kokaze, A

2017-05-01

This study examined the relationship between rapid weight gain during infancy and/or early childhood and anthropometric measurements [body mass index (BMI), percent body fat (%BF), waist circumference (WC) and waist-to-height ratio (WHtR)] in preadolescence by sex. Subjects were fourth-grade school children (aged 9 to 10 years) from elementary schools in Ina-town, Japan, in 2010. Measurements of height, weight, %BF and WC were conducted for each subject. We obtained data on height and weight of subjects at birth, age 1.5 years and age 3 years from the Maternal and Child Health handbook. Rapid weight gain was defined as a change in weight-for-age standard deviation score greater than 0.67 from birth to age 1.5 years (infancy) or from age 1.5 to 3 years (early childhood). All anthropometric variables (BMI, %BF, WC and WHtR) at age 9 to 10 years were significantly higher in the rapid weight gain during both infancy and early childhood period group than in the no rapid weight gain group, regardless of sex. When compared with the no rapid weight gain group, rapid weight gain during early childhood period had significantly higher BMI and WC in boys and BMI, %BF and WC in girls. Compared with the no rapid weight gain group, the rapid weight gain during infancy group had a significantly higher WC in boys and significantly higher BMI and WC in girls. Rapid weight gain during both infancy and early childhood was related to higher anthropometric measurements, including WHtR, among Japanese preadolescents, regardless of sex. This study suggests that rapid weight gain during infancy and early childhood may be a risk factor for general/abdominal obesity later in life. © 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd.

Direct healthcare costs and cost-effectiveness of acute coronary syndrome secondary prevention with ticagrelor compared to clopidogrel: economic evaluation from the public payer's perspective in Poland based on the PLATO trial results.

PubMed

Pawęska, Justyna; Macioch, Tomasz; Perkowski, Piotr; Budaj, Andrzej; Niewada, Maciej

2014-01-01

Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist designed to reduce clinical thrombotic events in patients with acute coronary syndrome (ACS). Compared to clopidogrel, ticagrelor has been proven to significantly reduce the rate of death from vascular causes, myocardial infarction (MI), or stroke without an increase in the rate of overall major bleeding in patients who have an ACS with or without ST-segment elevation (STEMI and NSTEMI) or unstable angina (UA). To evaluate the cost-effectiveness and healthcare costs associated with secondary prevention of ACS using ticagrelor or clopidogrel in patients after STEMI, NSTEMI and UA. An economic model based on results from the PLATO trial was used to evaluate the cost-effectiveness of one-year therapy with ticagrelor or clopidogrel. The structure of the model consisted of two parts, i.e. the decision tree with one-year PLATO results and the Markov model with lifelong estimations, which exceeded PLATO follow-up data. The model was adjusted to Polish settings with country-specific data on death rates in the general population and direct medical costs calculated from the public payer's perspective. Costs were derived from the National Health Fund (NHF) and the Ministry of Health and presented in PLN 2013 values. Annual mean costs of second and subsequent years after stroke or MI were obtained from the literature. Uncertainty of assumed parameters was tested in scenarios and probabilistic sensitivity analyses. The adopted model allowed the estimation of an incremental cost-effectiveness ratio for life years gained (LYG) and an incremental cost-utility ratio for quality adjusted life years (QALY). Total direct medical costs to the public payer at a one year horizon were 2,905 PLN higher with ticagrelor than with clopidogrel. However, mean healthcare costs at a one year horizon (excluding drug costs and concomitant drugs) were 690 PLN higher for patients treated with clopidogrel. In a lifetime horizon

Commuting by car: weight gain among physically active adults.

PubMed

Sugiyama, Takemi; Ding, Ding; Owen, Neville

2013-02-01

Prolonged sitting, including time spent sitting in cars, is detrimentally associated with health outcomes. This study examined whether commuting by car was associated with adults' weight gain over 4 years. Among 822 adult residents of Adelaide, Australia, weight change was ascertained from self-reported weight at baseline (2003-2004) and at follow-up (2007-2008). Using time spent for car commuting and work status at baseline, participants were categorized as non-car commuters, occasional car commuters, and daily car commuters. Multilevel linear regression (conducted in 2012) examined associations of weight change with car-commuting category, adjusting for potential confounding variables, for the whole sample, and among those who were physically inactive or active (≥150 minutes/week) in their leisure time. For the overall sample, adjusted mean weight gain (95% CI) over 4 years was 1.26 (0.64, 1.89) kg for non-car commuters; 1.53 (0.69, 2.37) kg for occasional car commuters; and 2.18 (1.44, 2.92) kg for daily car commuters (p for trend=0.090). Stratified analyses found a stronger association for those with sufficient leisure-time physical activity. For non-car commuters with sufficient leisure-time physical activity, the adjusted mean weight gain was 0.46 (-0.43, 1.35) kg, which was not significantly greater than 0. Over 4 years, those who used cars daily for commuting tended to gain more weight than those who did not commute by car. This relationship was pronounced among those who were physically active during leisure time. Reducing sedentary time may prevent weight gain among physically active adults. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Polygenic Risk, Appetite Traits, and Weight Gain in Middle Childhood: A Longitudinal Study.

PubMed

Steinsbekk, Silje; Belsky, Daniel; Guzey, Ismail Cuneyt; Wardle, Jane; Wichstrøm, Lars

2016-02-01

Genome-wide association studies have identified genetic risks for obesity. These genetic risks influence development of obesity partly by accelerating weight gain in childhood. Research is needed to identify mechanisms to inform intervention. Cross-sectional studies suggest appetite traits as a candidate mechanism. Longitudinal studies are needed to test whether appetite traits mediate genetic influences on children's weight gain. To test whether genetic risk for obesity predicts accelerated weight gain in middle childhood (ages 4-8 years) and whether genetic association with accelerated weight gain is mediated by appetite traits. Longitudinal study of a representative birth cohort at the Trondheim Early Secure Study, Trondheim, Norway, enrolled at age 4 years during 2007 to 2008, with follow-ups at ages 6 and 8 years. Participants were sampled from all children born in 2003 or 2004 who attended regular community health checkups for 4-year-olds (97.2% attendance; 82.0% consent rate, n = 2475). Nine hundred ninety-five children participated at age 4 years, 795 at age 6 years, and 699 at age 8 years. Analyses included 652 children with genotype, adiposity, and appetite data. Outcomes were body mass index and body-fat phenotypes measured from anthropometry (ages 4, 6, and 8 years) and bioelectrical impedance (ages 6 and 8 years). Genetic risk for obesity was measured using a genetic risk score composed of 32 single-nucleotide polymorphisms previously discovered in genome-wide association studies of adult body mass index. Appetite traits were measured at age 6 years with the Children's Eating Behavior Questionnaire. Of the 652 genotyped child participants, 323 (49.5%) were female, 58 (8.9%) were overweight, and 1 (0.2%) was obese. Children at higher genetic risk for obesity had higher baseline body mass index and fat mass compared with lower genetic risk peers, and they gained weight and fat mass more rapidly during follow-up. Each SD increase in genetic risk score was

26 CFR 1.665(g)-1A - Capital gain distribution.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Capital gain distribution. 1.665(g)-1A Section 1.665(g)-1A Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX... Beginning on Or After January 1, 1969 § 1.665(g)-1A Capital gain distribution. For any taxable year of a...

26 CFR 1.665(g)-1A - Capital gain distribution.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Capital gain distribution. 1.665(g)-1A Section 1.665(g)-1A Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX... Beginning on Or After January 1, 1969 § 1.665(g)-1A Capital gain distribution. For any taxable year of a...

26 CFR 1.665(g)-1A - Capital gain distribution.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 8 2012-04-01 2012-04-01 false Capital gain distribution. 1.665(g)-1A Section 1.665(g)-1A Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX... Beginning on Or After January 1, 1969 § 1.665(g)-1A Capital gain distribution. For any taxable year of a...

26 CFR 1.665(g)-1A - Capital gain distribution.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 8 2013-04-01 2013-04-01 false Capital gain distribution. 1.665(g)-1A Section 1.665(g)-1A Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX... Beginning on Or After January 1, 1969 § 1.665(g)-1A Capital gain distribution. For any taxable year of a...

26 CFR 1.665(g)-1A - Capital gain distribution.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Capital gain distribution. 1.665(g)-1A Section 1.665(g)-1A Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX... Or After January 1, 1969 § 1.665(g)-1A Capital gain distribution. For any taxable year of a trust...

Multiple socioeconomic determinants of weight gain: the Helsinki Health Study.

PubMed

Loman, Tina; Lallukka, Tea; Laaksonen, Mikko; Rahkonen, Ossi; Lahelma, Eero

2013-03-22

Socioeconomic differences in weight gain have been found, but several socioeconomic determinants have not been simultaneously studied using a longitudinal design. The aim of this study was to examine multiple socioeconomic determinants of weight gain. Mail surveys were conducted in 2000-2002 among 40 to 60-year old employees of the City of Helsinki, Finland (n = 8,960, response rate 67%). A follow-up survey was conducted among the baseline respondents in 2007 with a mean follow-up of 5 to 7 years (n = 7,332, response rate 83%). The outcome measure was weight gain of 5 kg or more over the follow-up. Socioeconomic position was measured by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Multivariable logistic regression models were fitted adjusting simultaneously for all covariates in the final model. Of women 27% and of men 24% gained 5 kg or more in weight over the follow-up. Among women, after adjusting for age, baseline weight and all socioeconomic determinants, those with basic (OR 1.40 95% CI 1.11-1.76) or intermediate education (OR 1.43 95% CI 1.08-1.90), renters (OR 1.18 95% CI 1.03-1.36) and those with occasional (OR 1.19 95% CI 1.03-1.38) or frequent (OR 1.50 95% CI 1.26-1.79) economic difficulties had increased risk of weight gain. Among men, after full adjustment, having current frequent economic difficulties (OR 1.70 95% CI 1.15-2.49) remained associated with weight gain. Current economic difficulties among both women and men, and among women low education and renting, were associated with weight gain. Prevention of weight gain among ageing people would benefit from focusing in particular on those with economic difficulties.

Determinants of weight gain in the action to control cardiovascular risk in diabetes trial.

PubMed

Fonseca, Vivian; McDuffie, Roberta; Calles, Jorge; Cohen, Robert M; Feeney, Patricia; Feinglos, Mark; Gerstein, Hertzel C; Ismail-Beigi, Faramarz; Morgan, Timothy M; Pop-Busui, Rodica; Riddle, Matthew C

2013-08-01

Identify determinants of weight gain in people with type 2 diabetes mellitus (T2DM) allocated to intensive versus standard glycemic control in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. We studied determinants of weight gain over 2 years in 8,929 participants (4,425 intensive arm and 4,504 standard arm) with T2DM in the ACCORD trial. We used general linear models to examine the association between each baseline characteristic and weight change at the 2-year visit. We fit a linear regression of change in weight and A1C and used general linear models to examine the association between each medication at baseline and weight change at the 2-year visit, stratified by glycemia allocation. There was significantly more weight gain in the intensive glycemia arm of the trial compared with the standard arm (3.0 ± 7.0 vs. 0.3 ± 6.3 kg). On multivariate analysis, younger age, male sex, Asian race, no smoking history, high A1C, baseline BMI of 25-35, high waist circumference, baseline insulin use, and baseline metformin use were independently associated with weight gain over 2 years. Reduction of A1C from baseline was consistently associated with weight gain only when baseline A1C was elevated. Medication usage accounted for <15% of the variability of weight change, with initiation of thiazolidinedione (TZD) use the most prominent factor. Intensive participants who never took insulin or a TZD had an average weight loss of 2.9 kg during the first 2 years of the trial. In contrast, intensive participants who had never previously used insulin or TZD but began this combination after enrolling in the ACCORD trial had a weight gain of 4.6-5.3 kg at 2 years. Weight gain in ACCORD was greater with intensive than with standard treatment and generally associated with reduction of A1C from elevated baseline values. Initiation of TZD and/or insulin therapy was the most important medication-related factor associated with weight gain.

Age differences in gain- and loss-motivated attention.

PubMed

Williams, Ryan S; Biel, Anna Lena; Dyson, Benjamin J; Spaniol, Julia

2017-02-01

Adaptive gain theory (Aston-Jones & Cohen, 2005) suggests that the phasic release of norepinephrine (NE) to cortical areas reflects changes in the utility of ongoing tasks. In the context of aging, this theory raises interesting questions, given that the motivations of older adults differ from those of younger adults. According to socioemotional selectivity theory (Carstensen, Isaacowitz, & Charles, 1999), aging is associated with greater emphasis on emotion-regulation goals, leading older adults to prioritize positive over negative information. This suggests that the phasic release of NE in response to threatening stimuli may be diminished in older adults. In the present study, younger adults (aged 18-34years) and older adults (60-82years) completed the Attention Network Test (ANT), modified to include an incentive manipulation. A behavioral index of attentional alerting served as a marker of phasic arousal. For younger adults, this marker correlated with the effect of both gain and loss incentives on performance. For older adults, in contrast, the correlation between phasic arousal and incentive sensitivity held for gain incentives only. These findings suggest that the enlistment of phasic NE activity may be specific to approach-oriented motivation in older adults. Copyright © 2016. Published by Elsevier Inc.

Importance of early weight changes to predict long-term weight gain during psychotropic drug treatment.

PubMed

Vandenberghe, Frederik; Gholam-Rezaee, Mehdi; Saigí-Morgui, Núria; Delacrétaz, Aurélie; Choong, Eva; Solida-Tozzi, Alessandra; Kolly, Stéphane; Thonney, Jacques; Gallo, Sylfa Fassassi; Hedjal, Ahmed; Ambresin, Anne-Emmanuelle; von Gunten, Armin; Conus, Philippe; Eap, Chin B

2015-11-01

Psychotropic drugs can induce substantial weight gain, particularly during the first 6 months of treatment. The authors aimed to determine the potential predictive power of an early weight gain after the introduction of weight gain-inducing psychotropic drugs on long-term weight gain. Data were obtained from a 1-year longitudinal study ongoing since 2007 including 351 psychiatric (ICD-10) patients, with metabolic parameters monitored (baseline and/or 1, 3, 6, 9, 12 months) and with compliance ascertained. International Diabetes Federation and World Health Organization definitions were used to define metabolic syndrome and obesity, respectively. Prevalences of metabolic syndrome and obesity were 22% and 17%, respectively, at baseline and 32% and 24% after 1 year. Receiver operating characteristic analyses indicated that an early weight gain > 5% after a period of 1 month is the best predictor for important long-term weight gain (≥ 15% after 3 months: sensitivity, 67%; specificity, 88%; ≥ 20% after 12 months: sensitivity, 47%; specificity, 89%). This analysis identified most patients (97% for 3 months, 93% for 12 months) who had weight gain ≤ 5% after 1 month as continuing to have a moderate weight gain after 3 and 12 months. Its predictive power was confirmed by fitting a longitudinal multivariate model (difference between groups in 1 year of 6.4% weight increase as compared to baseline, P = .0001). Following prescription of weight gain-inducing psychotropic drugs, a 5% threshold for weight gain after 1 month should raise clinician concerns about weight-controlling strategies. © Copyright 2015 Physicians Postgraduate Press, Inc.

Developmental gains in visuospatial memory predict gains in mathematics achievement.

PubMed

Li, Yaoran; Geary, David C

2013-01-01

Visuospatial competencies are related to performance in mathematical domains in adulthood, but are not consistently related to mathematics achievement in children. We confirmed the latter for first graders and demonstrated that children who show above average first-to-fifth grade gains in visuospatial memory have an advantage over other children in mathematics. The study involved the assessment of the mathematics and reading achievement of 177 children in kindergarten to fifth grade, inclusive, and their working memory capacity and processing speed in first and fifth grade. Intelligence was assessed in first grade and their second to fourth grade teachers reported on their in-class attentive behavior. Developmental gains in visuospatial memory span (d = 2.4) were larger than gains in the capacity of the central executive (d = 1.6) that in turn were larger than gains in phonological memory span (d = 1.1). First to fifth grade gains in visuospatial memory and in speed of numeral processing predicted end of fifth grade mathematics achievement, as did first grade central executive scores, intelligence, and in-class attentive behavior. The results suggest there are important individual differences in the rate of growth of visuospatial memory during childhood and that these differences become increasingly important for mathematics learning.

Developmental Gains in Visuospatial Memory Predict Gains in Mathematics Achievement

PubMed Central

Li, Yaoran; Geary, David C.

2013-01-01

Visuospatial competencies are related to performance in mathematical domains in adulthood, but are not consistently related to mathematics achievement in children. We confirmed the latter for first graders and demonstrated that children who show above average first-to-fifth grade gains in visuospatial memory have an advantage over other children in mathematics. The study involved the assessment of the mathematics and reading achievement of 177 children in kindergarten to fifth grade, inclusive, and their working memory capacity and processing speed in first and fifth grade. Intelligence was assessed in first grade and their second to fourth grade teachers reported on their in-class attentive behavior. Developmental gains in visuospatial memory span (d = 2.4) were larger than gains in the capacity of the central executive (d = 1.6) that in turn were larger than gains in phonological memory span (d = 1.1). First to fifth grade gains in visuospatial memory and in speed of numeral processing predicted end of fifth grade mathematics achievement, as did first grade central executive scores, intelligence, and in-class attentive behavior. The results suggest there are important individual differences in the rate of growth of visuospatial memory during childhood and that these differences become increasingly important for mathematics learning. PMID:23936154

Obesity, Weight Gain and Risk of Colon Adenomas in Japanese Men

PubMed Central

Handa, Koichi; Hayabuchi, Hitomi; Kiyohara, Chikako; Inoue, Hisako; Marugame, Tomomi; Shinomiya, Sachiko; Hamada, Hiroaki; Onuma, Kazuya; Koga, Hiroko

1999-01-01

Obesity has been related to increased risk of colon cancer or adenomas, but the epidemiologic findings are not entirely consistent. We examined the relation of not only body mass index (BMI) but also waist‐to‐hip ratio (WHR) and weight gain to colon adenoma risk in men who received a preretirement health examination at the Japan Self Defense Forces (SDF) Fukuoka and Kumamoto Hospitals during the period from 995 to 1996. In the series of 803 men at age 47–55 years, 189 cases of colon adenomas and 226 controls with normal total colonoscopy were identified. Weight at 10 years before was ascertained by referring to the recorded data. After allowance for hospital, rank in the SDF, smoking and alcohol use, weight gain over the past 10 years was significantly associated with increased risk of colon adenomas (odds ratio for ≥ 6 kg versus ≤−2 kg = 2.2; 95% confidence interval 1.0–4.8). High BMI and high WHR were each associated with increased risk, but only WHR was related to the risk independently of weight gain. In particular, weight gain accompanied with a high WHR was associated with a significant increase in the risk. Men with high physical activity tended to have lower risk. Associations with obesity‐related variables and physical activity were not materially differential as regards the location and size of adenoma. The findings indicate that weight gain in middle age leading to abdominal obesity increases the risk of colon adenomas, and consequently of colon cancer. PMID:10543250

Realized gains from block-plot coastal Douglas-fir trials in the northern Oregon Cascades

Treesearch

Terrence Z. Ye; Keith J.S. Jayawickrama; J. Bradley St. Clair

2010-01-01

Realized gains for coastal Douglas-fir (Pseudotsuga menziesii var. menziesii) were evaluated using data collected from 15-year-old trees from five field trials planted in large block plots in the northern Oregon Cascades. Three populations with different genetic levels (elite--high predicted gain; intermediate--moderate predicted gain; and an...

Gain weighted eigenspace assignment

NASA Technical Reports Server (NTRS)

Davidson, John B.; Andrisani, Dominick, II

1994-01-01

This report presents the development of the gain weighted eigenspace assignment methodology. This provides a designer with a systematic methodology for trading off eigenvector placement versus gain magnitudes, while still maintaining desired closed-loop eigenvalue locations. This is accomplished by forming a cost function composed of a scalar measure of error between desired and achievable eigenvectors and a scalar measure of gain magnitude, determining analytical expressions for the gradients, and solving for the optimal solution by numerical iteration. For this development the scalar measure of gain magnitude is chosen to be a weighted sum of the squares of all the individual elements of the feedback gain matrix. An example is presented to demonstrate the method. In this example, solutions yielding achievable eigenvectors close to the desired eigenvectors are obtained with significant reductions in gain magnitude compared to a solution obtained using a previously developed eigenspace (eigenstructure) assignment method.

Prospective associations of appetitive traits at 3 and 12 months of age with body mass index and weight gain in the first 2 years of life.

PubMed

Quah, Phaik Ling; Chan, Yiong Huak; Aris, Izzuddin M; Pang, Wei Wei; Toh, Jia Ying; Tint, Mya Thway; Broekman, Birit F P; Saw, Seang Mei; Kwek, Kenneth; Godfrey, Keith M; Gluckman, Peter D; Chong, Yap Seng; Meaney, Michael J; Yap, Fabian K P; van Dam, Rob M; Lee, Yung Seng; Chong, Mary F F

2015-10-12

Appetitive traits in childhood such as food responsiveness and enjoyment of food have been associated with body mass index (BMI) in later childhood. However, data on appetitive traits during infancy in relation to BMI in later childhood are sparse. We aimed to relate appetitive traits in infancy to subsequent BMI and weight gain up to 24 months of age. Data of 210 infants from the Singapore GUSTO mother-offspring cohort was obtained. The Baby Eating Behavior Questionnaire (BEBQ) and the Child Eating Behavior Questionnaire (CEBQ) were administered to mothers when their offspring were aged 3 and 12 months respectively. Height and weight of offspring were measured at ages 3, 6, 9,12,15,18 and 24 months. The association of appetitive traits with both BMI z-score and weight gain were evaluated using multivariate linear regression. Food responsiveness at 3 months was associated with higher BMI from 6 months up to 15 months of age (p < 0.01) and with greater weight gain between 3 and 6 months of age (p = 0.012). Slowness in eating and satiety responsiveness at 3 months was significantly associated with lower BMI at 6 months (p < 0.01) and with less weight gain between 3 to 6 months of age (p = 0.034). None of the appetitive traits at 12 months were significantly associated with BMI or weight gain over any time period. Early assessment of appetitive traits at 3 months of age but not at 12 months of age was associated with BMI and weight gain over the first two years of life. Clinical Trials identifier NCT01174875.

Dietary fat and weight gain among women in the Nurses' Health Study.

PubMed

Field, Alison E; Willett, Walter C; Lissner, Lauren; Colditz, Graham A

2007-04-01

To assess the association of dietary fat and weight gain among adult women and to investigate whether offspring of overweight parents have a greater predisposition to weight gain due to intake of dietary fat. This was an 8-year follow-up of 41,518 women in the Nurses' Health Study (NHS), a population-based, prospective cohort. The women were 41 to 68 years of age, free of cardiovascular disease, cancer, and diabetes in 1986 when "baseline" weight and diet were assessed. Eight years later (1994), changes in weight and dietary intake were assessed. Linear regression models were used to relate change in weight to fat intake and change in fat intake, using the percentage of energy from carbohydrate as the comparison, adjusted for age, BMI in 1986, leisure time physical activity, time spent sitting, percent of calories from protein, and change in percentage of calories from protein. Overall, there was a weak positive association between total fat intake (beta=0.11) and weight gain. Increases in monosaturated and polyunsaturated fat were not associated with weight gain, but increases in animal fat, saturated fat, and trans fat had a positive association with weight change. There was not strong evidence of effect modification by parental weight status (p=0.7 to 0.8 for percentage of calories from total fat, animal fat, and vegetable fat); however, the associations were stronger among the overweight compared with leaner women (p<0.05 for percentage of calories from each type of fat). Among overweight women, for every one percentage increase in percentage of calories from trans fat, women gained an additional 2.3 lb (95% confidence interval, 1.80 to 2.86). Our results show that, overall, percent of calories from fat has only a weak positive association with weight gain; however, percentage of calories from animal, saturated, and trans fat has stronger associations. There was no clear evidence that the diet-weight gain association was stronger among offspring of overweight

Early Weight Gain, Linear Growth, and Mid-Childhood Blood Pressure: A Prospective Study in Project Viva.

PubMed

Perng, Wei; Rifas-Shiman, Sheryl L; Kramer, Michael S; Haugaard, Line K; Oken, Emily; Gillman, Matthew W; Belfort, Mandy B

2016-02-01

In recent years, the prevalence of hypertension and prehypertension increased markedly among children and adolescents, highlighting the importance of identifying determinants of elevated blood pressure early in life. Low birth weight and rapid early childhood weight gain are associated with higher future blood pressure. However, few studies have examined the timing of postnatal weight gain in relation to later blood pressure, and little is known regarding the contribution of linear growth. We studied 957 participants in Project Viva, an ongoing US prebirth cohort. We examined the relations of gains in body mass index z-score and length/height z-score during 4 early life age intervals (birth to 6 months, 6 months to 1 year, 1 to 2 years, and 2 to 3 years) with blood pressure during mid-childhood (6-10 years) and evaluated whether these relations differed by birth size. After accounting for confounders, each additional z-score gain in body mass index during birth to 6 months and 2 to 3 years was associated with 0.81 (0.15, 1.46) and 1.61 (0.33, 2.89) mm Hg higher systolic blood pressure, respectively. Length/height gain was unrelated to mid-childhood blood pressure, and there was no evidence of effect modification by birth size for body mass index or length/height z-score gain. Our findings suggest that more rapid gain in body mass index during the first 6 postnatal months and in the preschool years may lead to higher systolic blood pressure in mid-childhood, regardless of size at birth. Strategies to reduce accrual of excess adiposity during early life may reduce mid-childhood blood pressure, which may also impact adult blood pressure and cardiovascular health. © 2015 American Heart Association, Inc.

Early rapid weight gain and subsequent overweight and obesity in middle childhood in Peru.

PubMed

Penny, Mary E; Jimenez, M Michelle; Marin, R Margot

2016-01-01

Rapid postnatal weight gain is associated with risk of overweight and obesity, but it's unclear whether this holds in populations exposed to concurrent obesogenic risk factors and for children who have been extensively breastfed. This study investigates whether an increase in weight for age from birth to 1 year (infancy) and from 1 to 5 years (early childhood) predicts overweight and obesity, and waist circumference at 8 years, using data from a longitudinal cohort study in Peru. Generalized estimating equations (GEE) models were constructed for overweight and obesity, obesity alone and waist circumference at 8 years versus rapid weight gain in infancy, and early childhood including adjusted models to account for confounders. Rapid weight gain in both periods was associated with double the risk of overweight and obesity, obesity alone at 8 years and increased waist circumference even after controlling for maternal BMI and education level, sex of child, height-for-age at 8 years, consumption of "fast food" and number of days of active exercise. The association was significant, with some differences, for children in both rural and urban environments. Rapid weight gain in infancy and in early childhood in Peru is associated with overweight and obesity at age 8 years even when considering other determinants of childhood obesity.

The Contribution of Schooling to Learning Gains of Pupils in Years 1 to 6

ERIC Educational Resources Information Center

Luyten, Hans; Merrell, Christine; Tymms, Peter

2017-01-01

By means of a regression-discontinuity approach with multiple cut-off points, the effects of age and schooling on learning gains in English primary schools are estimated. The analyses relate to over 3,500 pupils in 20, predominantly independently funded, schools and focus on 4 different learning outcomes. In order to take into account delayed and…

Extensive BMI Gain in Puberty is Associated with Lower Increments in Bone Mineral Density in Estonian Boys with Overweight and Obesity: A 3-Year Longitudinal Study.

PubMed

Mengel, Eva; Tillmann, Vallo; Remmel, Liina; Kool, Pille; Purge, Priit; Lätt, Evelin; Jürimäe, Jaak

2017-08-01

The aim of this 3-year prospective study was to examine changes in bone mineral characteristics during pubertal maturation in boys with different BMI values at the beginning of puberty and with different BMI increments during puberty. 26 boys with overweight and obesity (OWB) and 29 normal weight boys (NWB) were studied yearly for 3 years from the age of 11 years to measure the changes in different bone mineral characteristics. The OWB group was further divided into two subgroups according to extensive or non-extensive BMI increment during 3-year period. OWB had higher (P < 0.01) baseline total body (TB) bone mineral density (BMD), TB bone mineral content (BMC), TB BMC for height, lumbar spine (LS) BMD, and LS BMC compared to NWB. Throughout the study period, OWB gained more TB BMD (P = 0.0001), TB BMC (P = 0.0048), TB BMC for height (P = 0.0124), LS BMD (P = 0.0029), and LS BMC (P = 0.0022) compared to NWB. Also during the study period, TB BMD (P = 0.0065), TB BMC (P = 0.0141), TB BMC for height (P = 0.0199), LS BMD (P = 0.0066), LS apparent volumetric BMD (BMAD) (P = 0.0075), and LS BMC (P = 0.017) increased significantly less in those OWB whose BMI increased more extensively. Extensive BMI gain is associated with lower increments in bone mineral characteristics in boys with overweight and obesity. Unfavorable increment in total body fat mass and percentage during pubertal years could be one reason for that.

Increasing weight-bearing physical activity and calcium-rich foods to promote bone mass gains among 9–11 year old girls: outcomes of the Cal-Girls study

PubMed Central

French, Simone A; Story, Mary; Fulkerson, Jayne A; Himes, John H; Hannan, Peter; Neumark-Sztainer, Dianne; Ensrud, Kristine

2005-01-01

Background A two-year, community-based, group-randomized trial to promote bone mass gains among 9–11 year-old girls through increased intake of calcium-rich foods and weight-bearing physical activity was evaluated. Methods Following baseline data collection, 30 5th-grade Girl Scout troops were randomized to a two-year behavioral intervention program or to a no-treatment control group. Evaluations were conducted at baseline, one year, and two years. Measures included bone mineral content, density, and area (measured by DXA), dietary calcium intake (24-hour recall), and weight-bearing physical activity (physical activity checklist interview). Mixed-model regression was used to evaluate treatment-related changes in bone mineral content (g) for the total body, lumbar spine (L1-L4), proximal femur, one-third distal radius, and femoral neck. Changes in eating and physical activity behavioral outcomes were examined. Results Although the intervention was implemented with high fidelity, no significant intervention effects were observed for total bone mineral content or any specific bone sites. Significant intervention effects were observed for increases in dietary calcium. No significant intervention effects were observed for increases in weight-bearing physical activity. Conclusion Future research needs to identify the optimal dosage of weight-bearing physical activity and calcium-rich dietary behavior change required to maximize bone mass gains in pre-adolescent and adolescent girls. PMID:16029507

Everolimus Is Associated With Less Weight Gain Than Tacrolimus 2 Years After Liver Transplantation: Results of a Randomized Multicenter Study

PubMed Central

Charlton, Michael; Rinella, Mary; Patel, Dharmesh; McCague, Kevin; Heimbach, Julie; Watt, Kymberly

2017-01-01

Background Weight gain early after transplant is a risk factor for posttransplant metabolic syndrome (PTMS), cardiovascular events, and renal insufficiency. The impact of mammalian target of rapamycin inhibition on posttransplant weight gain and the development of PTMS components postliver transplantation were examined in a randomized, controlled study. Methods After a run-in period, patients (N = 719) were randomized at 30 ± 5 days posttransplant in a 1:1:1 ratio to 3 treatment groups: (i) everolimus (EVR) + reduced tacrolimus (TAC) (n = 245); (ii) TAC control (n = 243) or (iii) TAC elimination (n = 231). In this post hoc analysis, weight change at 12 and 24 months was compared between groups. Vital signs, lipids, and laboratory parameters at 12 and 24 months and rates of PTMS were assessed. Results Mean increase in weight from baseline was higher at month 12 in the TAC control arm (8.15 ± 9.27 kg) than in the EVR + reduced TAC (5.88 ± 12.60 kg, P = 0.056) and the TAC elimination arms (4.76 ± 9.94 kg, P = 0.007). At month 24, the TAC control arm displayed a significantly greater weight increase (9.54 ± 10.21 kg) than either the EVR + reduced TAC (6.69 ± 8.37 kg, P = 0.011) or the TAC elimination groups (6.01 ± 9.98 kg, P = 0.024). Rates of PTMS were similar for the EVR + reduced TAC (71.8%), TAC elimination (70.3%) and TAC control (67.4%) arms (P = NS). Conclusions EVR with reduced-exposure TAC attenuated weight gain at 1 and 2 years posttransplant compared with a standard TAC immunosuppression regimen. Rates of PTMS were comparable between EVR-containing and TAC control regimens. PMID:28817434

Magnitude and determinants of inadequate third-trimester weight gain in rural Bangladesh

PubMed Central

Hasan, S. M. Tafsir; Rahman, Sabuktagin; Locks, Lindsey Mina; Rahman, Mizanur; Hore, Samar Kumar; Saqeeb, Kazi Nazmus; Khan, Md. Alfazal

2018-01-01

Objectives The objective of this study was to estimate the magnitude and determinants of inadequate weight gain in the third-trimester among rural women in Matlab, Bangladesh. Methods The study analyzed data on weight gain in the third trimester in 1,883 pregnant women in Matlab, Bangladesh. All these women were admitted to Matlab hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) for childbirth during 2012–2014, and they had singleton live births at term. Data were retrieved from the electronic databases of Matlab Health and Demographic Surveillance System and Matlab hospital. A multivariable logistic regression for inadequate weight gain in the third trimester (≤4 kg) was built with sociodemographic, environmental and maternal factors as predictors. Results One thousand and twenty-six (54%) pregnant women had inadequate weight gain in the third trimester. In the multivariable model, short stature turned out to be the most robust risk factor for inadequate weight gain in the third trimester (OR = 2.5; 95% CI 1.8, 3.5 for short compared to tall women). Pre-third-trimester BMI was inversely associated with insufficient weight gain (OR = 0.96; 95% CI 0.93, 0.99 for 1 unit increase in BMI). Other risk factors for inadequate weight gain in the third trimester were advanced age (OR = 1.9; 95% CI 1.2, 3.1 for ≥35 years compared to ≤19 years), parity (OR = 1.5; 95% CI 1.2, 1.9 for multipara compared to nulliparous women), low socioeconomic status (OR = 1.7; 95% CI 1.2, 2.3 for women in the lowest compared to women in the highest wealth quintile), low level of education (OR = 1.6; 95% CI 1.2, 2.1 for ≤5 years compared to ≥10 years of education), belonging to the Hindu religious community (OR = 1.8; 95% CI 1.3, 2.5), consuming arsenic-contaminated water (OR = 1.4; 95% CI 1.1, 1.9), and conceiving during monsoon or dry season compared to summer (OR = 1.4; 95% CI 1.1, 1.8). Conclusions Among rural Bangladeshi women in Matlab

Courseware Design by College Students: The Educational Gains.

ERIC Educational Resources Information Center

Or-Bach, Rachel

2000-01-01

Describes the experience gained during several years of teaching courses on CBT (computer-based training) design to undergraduate students with varying backgrounds and interests. Discusses the theoretical background for the potential benefits; preparation for lifelong learning; information technology literacy and teaching multimedia development; a…

Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management: Analysis of 479 Patients With Minimum 2-Year Follow-Up.

PubMed

Scheer, Justin K; Hostin, Richard; Robinson, Chessie; Schwab, Frank; Lafage, Virginie; Burton, Douglas C; Hart, Robert A; Kelly, Michael P; Keefe, Malla; Polly, David; Bess, Shay; Shaffrey, Christopher I; Smith, Justin S; Ames, Christopher P

2018-03-01

Retrospective review of prospective multicenter adult spinal deformity (ASD) database. To compare the quality-adjusted life years (QALYs) between operative and nonoperative treatments for ASD patients. Operative management of ASD repeatedly demonstrates improvements in HRQOL over nonoperative treatment. However, little is reported regarding QALY improvements after surgical correction of ASD. Inclusion criteria: ≥18 years, ASD. Health utility values were calculated from SF6D scores and used to calculate QALYs at minimum 2 years from the baseline utility value as well as at 1, 2, and 3 years for the available patients. A 1:1 propensity score matching using six baseline variables was conducted to account for the nonrandom distribution of operative and nonoperative treatments. Four hundred seventy-nine patients were included (OP:258, 70.7%, NONOP:221, 47.1%). One hundred fifty-one (OP:90, NONOP:61) had complete 1, 2, and 3 year data available for QALY trending. Unmatched results are not listed in the abstract. Mean baseline utility scores were statistically similar between the matched groups (OP: 0.609 ± 0.093, NONOP: 0.600 ± 0.091, P = 0.6401) and at 2 year min postop mean OP QALY was greater than NONOP (1.377 ± 0.345 vs. 1.256 ± 0.286, respectively, P < 0.01). For the subanalysis cohort, mean OP QALYs at 1, 2, and 3 years postoperative were all significantly greater than NONOP, P < 0.03 for all (1 yr: 0.651 ± 0.089 vs. 0.61 ± 0.079, 2 yr: 1.29 ± 0.157 vs. 1.189 ± 0.141, and 3 yr: 1.903 ± 0.235 vs. 1.749 ± 0.198, respectively). Matched OP had a larger QALYs gained (from baseline) at 2 year minimum postoperative (0.112 ± 0.243 vs. 0.008 ± 0.195, P < 0.01). For subanalysis of patients with complete 1 to 3 years data, OP had a significantly larger QALYs gained at 1, 2, and 3 years compared with NONOP: 1 year (0.073 ± 0.121 vs. 0.029 ± 0.082, P = 0.0447), 2 years (0.167 ± 0

Associations of neighbourhood walkability indices with weight gain.

PubMed

Koohsari, Mohammad Javad; Oka, Koichiro; Shibata, Ai; Liao, Yung; Hanibuchi, Tomoya; Owen, Neville; Sugiyama, Takemi

2018-04-03

Inconsistent associations of neighbourhood walkability with adults' body weight have been reported. Most studies examining the relationships of walkability and adiposity are cross-sectional in design. We examined the longitudinal relationships of two walkability indices - conventional walkability and space syntax walkability, and their individual components, with weight change among adults over four years. Data were from the Physical Activity in Localities and Community study in Adelaide, Australia. In 2003-2004, 2650 adults living in 154 Census Collection Districts (CCDs) returned baseline questionnaires; in 2007-2008, the follow-up survey was completed by 1098. Participants reported their weight at baseline and at follow-up. Neighbourhood walkability indices were calculated using geographic information systems and space syntax software. Linear marginal models using generalized estimating equations with robust standard errors were fitted to examine associations of the two walkability indices and their individual components with the weight at follow-up, adjusting for baseline weight, socio-demographic variables, and spatial clustering at the level of CCD. The overall mean weight gain over four years was 1.5 kg. The two walkability indices were closely correlated (r = 0.76, p < 0.01). No significant associations were found between the overall neighbourhood walkability indices and weight change. Among walkability components, there was a marginally significant negative association between space syntax measure of street integration and weight change: one standard deviation increment in street integration was associated with 0.31 kg less weight gain (p = 0.09). Using a prospective study design and a novel space-syntax based measure of walkability, we were not able to identify relationships between neighbourhood walkability with weight gain. This is consistent with other inconclusive findings on the built environment and obesity. Research on the built

Is prostate cancer screening cost-effective? A microsimulation model of prostate-specific antigen-based screening for British Columbia, Canada

PubMed Central

Pataky, Reka; Gulati, Roman; Etzioni, Ruth; Black, Peter; Chi, Kim N.; Coldman, Andrew J.; Pickles, Tom; Tyldesley, Scott; Peacock, Stuart

2015-01-01

Prostate-specific antigen (PSA) screening for prostate cancer may reduce mortality, but it incurs considerable risk of overdiagnosis and potential harm to quality of life. Our objective was to evaluate the cost-effectiveness of PSA screening, with and without adjustment for quality of life, for the British Columbia (BC) population. We adapted an existing natural history model using BC incidence, treatment, cost and mortality patterns. The modeled mortality benefit of screening derives from a stage-shift mechanism, assuming mortality reduction consistent with the European Study of Randomized Screening for Prostate Cancer. The model projected outcomes for 40 year-old men under 14 combinations of screening ages and frequencies. Cost and utility estimates were explored with deterministic sensitivity analysis. The incremental cost-effectiveness of regular screening ranged from $36,300/LYG, for screening every four years from ages 55-69, to $588,300/LYG, for screening every two years from ages 40-74. The marginal benefits of increasing screening frequency to two years or starting screening at age 40 were small and came at significant cost. After utility adjustment, all screening strategies resulted in a loss of QALYs; however, this result was very sensitive to utility estimates. Plausible outcomes under a range of screening strategies inform discussion of prostate cancer screening policy in BC and similar jurisdictions. Screening may be cost-effective but the sensitivity of results to utility values suggests individual preferences for quality versus quantity of life should be a key consideration. PMID:24443367

Monitoring the WFC3/UVIS Relative Gain with Internal Flatfields

NASA Astrophysics Data System (ADS)

Fowler, J.; Baggett, S.

2017-03-01

The WFC3/UVIS gain stability has been monitored twice yearly. This project provides a new examination of gain stability, making use of the existing internal flatfield observations taken every three days (for the Bowtie monitor) for a regular look at relative gain stability. Amplifiers are examined for consistency both in comparison to each other and over time, by normalizing the B, C, and D amplifiers to A, and then plotting statistics for each of the three normalized amplifiers with time. We find minimal trends in these statistics, with a 0.02 - 0.2% change in mean amplifier ratio over 7.5 years. The trends in the amplifiers are well-behaved with the exception of the B/A ratio, which shows increased scatter in mean, median, and standard deviation. The cause of the scatter remains unclear though we find it is not dependent upon detector defects, filter features, or shutter effects, and is only observable after pixel flagging (both from the data quality arrays and outlier values) has been applied.

Weight gain and 10-year cardiovascular risk with sustained tobacco abstinence in smokers with serious mental illness: a subgroup analysis of a randomized trial.

PubMed

Thorndike, Anne N; Achtyes, Eric D; Cather, Corinne; Pratt, Sarah; Pachas, Gladys N; Hoeppner, Susanne S; Evins, A Eden

2016-03-01

People with serious mental illness die earlier than those without mental illness, largely from cardiovascular disease due to high rates of smoking and obesity. The objective of this study was to determine whether the metabolic effects of postcessation weight gain among smokers with serious mental illness attenuated the cardiovascular benefit of tobacco abstinence. A subgroup analysis was conducted of 65 outpatient smokers with DSM-IV diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder from 10 community mental health centers in 6 states who enrolled between March 2008-April 2012 and completed a trial of varenicline for tobacco abstinence. The intervention included a 12-week open-label phase with varenicline followed by a 40-week randomized, placebo-controlled phase in 87 participants who achieved 12-week abstinence. Main outcome measures were smoking status and change from baseline in weight and 10-year Framingham cardiovascular risk score at end of intervention (week 52). At week 52, 65 participants completed follow-up (33 abstinent; 32 relapsed). At baseline, the 2 groups did not differ in body mass index (mean = 31 kg/m(2)), blood pressure, serum glucose, or diagnoses of diabetes (31%) and hypertension (34%). Abstinent participants were older and had a higher mean baseline Framingham risk score (14.2% vs 10.3%, P = .002). At week 52, abstinent participants gained more weight than relapsed participants (4.8 vs 1.2 kg, P = .048) and, as a result of quitting smoking, had a greater reduction in Framingham risk score (-7.6% vs 0.0%, P < .001). There was no effect of study drug assignment on weight or Framingham risk score. Sustained tobacco abstinence reduced 10-year cardiovascular risk in outpatients with serious mental illness despite significant postcessation weight gain and high prevalence of obesity, diabetes, and hypertension. Clinicaltrials.gov identifier: NCT00621777. © Copyright 2016 Physicians Postgraduate Press, Inc.

Effects of Device on Video Head Impulse Test (vHIT) Gain.

PubMed

Janky, Kristen L; Patterson, Jessie N; Shepard, Neil T; Thomas, Megan L A; Honaker, Julie A

2017-10-01

Numerous video head impulse test (vHIT) devices are available commercially; however, gain is not calculated uniformly. An evaluation of these devices/algorithms in healthy controls and patients with vestibular loss is necessary for comparing and synthesizing work that utilizes different devices and gain calculations. Using three commercially available vHIT devices/algorithms, the purpose of the present study was to compare: (1) horizontal canal vHIT gain among devices/algorithms in normal control subjects; (2) the effects of age on vHIT gain for each device/algorithm in normal control subjects; and (3) the clinical performance of horizontal canal vHIT gain between devices/algorithms for differentiating normal versus abnormal vestibular function. Prospective. Sixty-one normal control adult subjects (range 20-78) and eleven adults with unilateral or bilateral vestibular loss (range 32-79). vHIT was administered using three different devices/algorithms, randomized in order, for each subject on the same day: (1) Impulse (Otometrics, Schaumberg, IL; monocular eye recording, right eye only; using area under the curve gain), (2) EyeSeeCam (Interacoustics, Denmark; monocular eye recording, left eye only; using instantaneous gain), and (3) VisualEyes (MicroMedical, Chatham, IL, binocular eye recording; using position gain). There was a significant mean difference in vHIT gain among devices/algorithms for both the normal control and vestibular loss groups. vHIT gain was significantly larger in the ipsilateral direction of the eye used to measure gain; however, in spite of the significant mean differences in vHIT gain among devices/algorithms and the significant directional bias, classification of "normal" versus "abnormal" gain is consistent across all compared devices/algorithms, with the exception of instantaneous gain at 40 msec. There was not an effect of age on vHIT gain up to 78 years regardless of the device/algorithm. These findings support that vHIT gain is

Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life

PubMed Central

Zheng, Yan; Manson, JoAnn E.; Yuan, Changzheng; Liang, Matthew H.; Grodstein, Francine; Stampfer, Meir J.; Willett, Walter C.

2017-01-01

Importance Data describing the effects of weight gain across adulthood on overall health are important for weight control. Objective To examine the association of weight gain from early to middle adulthood with health outcomes later in life. Design, Setting, and Participants Cohort analysis of US women from the Nurses’ Health Study (1976-June 30, 2012) and US men from the Health Professionals Follow-Up Study (1986-January 31, 2012) who recalled weight during early adulthood (at age of 18 years in women; 21 years in men), and reported current weight during middle adulthood (at age of 55 years). Exposures Weight change from early to middle adulthood (age of 18 or 21 years to age of 55 years). Main Outcomes and Measures Beginning at the age of 55 years, participants were followed up to the incident disease outcomes. Cardiovascular disease, cancer, and death were confirmed by medical records or the National Death Index. A composite healthy aging outcome was defined as being free of 11 chronic diseases and major cognitive or physical impairment. Results A total of 92 837 women (97% white; mean [SD] weight gain: 12.6 kg [12.3 kg] over 37 years) and 25 303 men (97% white; mean [SD] weight gain: 9.7 kg [9.7 kg] over 34 years) were included in the analysis. For type 2 diabetes, the adjusted incidence per 100 000 person-years was 207 among women who gained a moderate amount of weight (≥2.5 kg to <10 kg) vs 110 among women who maintained a stable weight (weight loss ≤2.5 kg or gain <2.5 kg) (absolute rate difference [ARD] per 100 000 person-years, 98; 95% CI, 72 to 127) and 258 vs 147, respectively, among men (ARD, 111; 95% CI, 58 to 179); hypertension: 3415 vs 2754 among women (ARD, 662; 95% CI, 545 to 782) and 2861 vs 2366 among men (ARD, 495; 95% CI, 281 to 726); cardiovascular disease: 309 vs 248 among women (ARD, 61; 95% CI, 38 to 87) and 383 vs 340 among men (ARD, 43; 95% CI, −14 to 109); obesity-related cancer: 452 vs 415 among women (ARD, 37; 95% CI, 4

Preschoolers with Autism Spectrum Disorder Followed for 2 Years: Those Who Gained and Those Who Lost the Most in Terms of Adaptive Functioning Outcome

ERIC Educational Resources Information Center

Hedvall, Åsa; Westerlund, Joakim; Fernell, Elisabeth; Norrelgen, Fritjof; Kjellmer, Liselotte; Olsson, Martina Barnevik; Carlsson, Lotta Höglund; Eriksson, Mats A.; Billstedt, Eva; Gillberg, Christopher

2015-01-01

Clinical predictors of 2-year outcome in preschoolers with ASD were studied in a population-based group of very young children with ASD (n = 208). Children who gained the most (n = 30) and lost the most (n = 23), i.e., increased or decreased their adaptive functioning outcome according to the Vineland Composite Score between study entry (T1) and…

TNFα blockade for inflammatory rheumatic diseases is associated with a significant gain in android fat mass and has varying effects on adipokines: a 2-year prospective study.

PubMed

Toussirot, Éric; Mourot, Laurent; Dehecq, Barbara; Wendling, Daniel; Grandclément, Émilie; Dumoulin, Gilles

2014-04-01

To evaluate the long-term consequences of TNFα inhibitors on body composition and fat distribution, as well as changes in serum adipokines in patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS). Eight patients with RA and twelve with AS requiring a TNFα inhibitor were prospectively followed for 2 years. Body composition was evaluated by dual X-ray absorptiometry and included measurements of total fat mass, lean mass, fat in the gynoid and android regions, and visceral fat. Serum leptin, total and high molecular weight (HMW) adiponectin, resistin, and ghrelin were also assessed. There was a significant gain in body mass index (p = 0.05) and a tendency for weight (p = 0.07), android fat (p = 0.07), and visceral fat (p = 0.059) increase in patients with RA, while in AS, total fat mass significantly increased (p = 0.02) with a parallel weight gain (p = 0.07). When examining the whole population of patients, we observed after 2 years a significant increase in body weight (+1.9%; p = 0.003), body mass index (+2.5%; p = 0.004), total fat mass (+11.1%; p = 0.007), and fat in the android region (+18.3%; p = 0.02). There was a substantial, albeit nonsignificant gain in visceral fat (+24.3%; p = 0.088). Lean mass and gynoid fat were not modified. No major changes were observed for serum leptin, total adiponectin, and ghrelin, while HMW adiponectin and the HMW/total adiponectin ratio tended to decrease (-15.2%, p = 0.057 and -9.3%, p = 0.067, respectively). Resistin decreased significantly (-22.4%, p = 0.01). Long-term TNFα inhibition in RA and AS is associated with a significant gain in fat mass, with a shift to the android (visceral) region. This fat redistribution raises questions about its influence on the cardiovascular profile of patients receiving these treatments.

Comparing gains and losses.

PubMed

McGraw, A Peter; Larsen, Jeff T; Kahneman, Daniel; Schkade, David

2010-10-01

Loss aversion in choice is commonly assumed to arise from the anticipation that losses have a greater effect on feelings than gains, but evidence for this assumption in research on judged feelings is mixed. We argue that loss aversion is present in judged feelings when people compare gains and losses and assess them on a common scale. But many situations in which people judge and express their feelings lack these features. When judging their feelings about an outcome, people naturally consider a context of similar outcomes for comparison (e.g., they consider losses against other losses). This process permits gains and losses to be normed separately and produces psychological scale units that may not be the same in size or meaning for gains and losses. Our experiments show loss aversion in judged feelings for tasks that encourage gain-loss comparisons, but not tasks that discourage them, particularly those using bipolar scales.

Excessive weight gain during full breast-feeding.

PubMed

Grunewald, Maria; Hellmuth, Christian; Demmelmair, Hans; Koletzko, Berthold

2014-01-01

Breast-feeding is considered to offer optimal nutrition for healthy infant growth and development. Observational studies have linked breast-feeding to reduced obesity. CASE OBSERVATION: We observed an infant who was born macrosomic (4.56 kg) and showed excessive weight gain markedly exceeding the 97th percentile of weight during full breast-feeding. At the age of 4 months, the weight was greater than 11 kg. Clinical evaluation did not reveal any underlying pathology. After the introduction of complementary feeding and hence reduction of the breast milk intake, the excessive weight gain was attenuated and the slope of the percentile curve paralleled upper percentiles. Since this pattern suggested full breast-feeding as the driver of excessive weight gain, we analyzed the human milk composition at the infant age of 1 year and compared the results with published data on composition at this stage of lactation. The milk contents of lactose, fat, fatty acids, polar lipids, carnitine species, and insulin were similar to the reference data. The adiponectin content was increased. The most remarkable alteration was a high milk protein content (mean 1.25 g/dl, reference 0.8 g/dl). A very high protein supply in infancy has been previously shown to increase plasma concentrations of the growth factors insulin and IGF-1, weight gain, and later obesity. We speculate that interindividual variations in human milk adiponectin and protein contents may contribute to modulation of the growth of fully breast-fed infants and in this case may have contributed to excessive weight gain during full breast-feeding. This hypothesis merits being tested in future cohort studies. © 2014 S. Karger AG, Basel.

Associations between adiposity, hormones, and gains in height, whole-body height-adjusted bone size, and size-adjusted bone mineral content in 8- to 11-year-old children.

PubMed

Dalskov, S; Ritz, C; Larnkjær, A; Damsgaard, C T; Petersen, R A; Sørensen, L B; Ong, K K; Astrup, A; Michaelsen, K F; Mølgaard, C

2016-04-01

We examined fat-independent associations of hormones with height and whole-body bone size and mineral content in 633 school children. IGF-1 and osteocalcin predict growth in height, while fat, osteocalcin, and in girls also, IGF-1 predict growth in bone size. Leptin and ghrelin are inversely associated with bone size in girls. Obesity causes larger bone size and bone mass, but the role of hormones in this up-regulation of bone in obesity is not well elucidated. We examined longitudinal associations between baseline body fat mass (FM), and fat-independent fasting levels of ghrelin, adiponectin, leptin, insulin, insulin-like growth factor-I (IGF-1), osteocalcin, and intact parathyroid hormone, and subsequent changes in height and in whole-body height-adjusted bone area "BAheight" and size-adjusted bone mineral content "BMCsize" in 8- to 11-year-olds. Analyses were carried out separately for boys (n = 325) and girls (n = 308) including data from baseline, 3 and 6 months from OPUS School Meal Study. In both sexes: gain in BAheight was positively associated with baseline FM (≥2.05 cm(2)/kg, both p ≤ 0.003). Furthermore, gain in height was positively associated with baseline IGF-1 (≥0.02 cm/ng/ml, p = 0.001) and osteocalcin (≥0.13 cm/ng/ml, p ≤ 0.009); and gain in BAheight was positively associated with baseline osteocalcin (≥0.35 cm(2)/ng/ml, p ≤ 0.019). In girls only, gain in BAheight was also positively associated with baseline IGF-1 (0.06 cm(2)/ng/ml, p = 0.017) and inversely associated with both baseline ghrelin (-0.01 cm(2)/pg/ml, p = 0.001) and leptin (-1.21 cm(2)/μg/ml, p = 0.005). In boys, gain in BMCsize was positively associated with osteocalcin (0.18 g/ng/ml, p = 0.030). This large longitudinal study suggests that in 8- to 11-year-old children, IGF-1 and osteocalcin predict growth in height, while FM, osteocalcin, and in girls also, IGF-1 predict growth in BAheight. Fat-independent inverse

Obesity, weight gain, and ovarian cancer risk in African American women.

PubMed

Bandera, Elisa V; Qin, Bo; Moorman, Patricia G; Alberg, Anthony J; Barnholtz-Sloan, Jill S; Bondy, Melissa; Cote, Michele L; Funkhouser, Ellen; Peters, Edward S; Schwartz, Ann G; Terry, Paul; Schildkraut, Joellen M

2016-08-01

Although there is growing evidence that higher adiposity increases ovarian cancer risk, little is known about its impact in African American (AA) women, the racial/ethnic group with the highest prevalence of obesity. We evaluated the impact of body mass index (BMI) 1 year before diagnosis and weight gain since age 18 years on ovarian cancer risk in a population-based case-control study in AA women in 11 geographical areas in the US. Cases (n = 492) and age and site matched controls (n = 696) were identified through rapid case ascertainment and random-digit-dialing, respectively. Information was collected on demographic and lifestyle factors, including self-reported height, weight at age 18 and weight 1 year before diagnosis/interview. Multivariable logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential covariates. Obese women had elevated ovarian cancer risk, particularly for BMI ≥ 40 kg/m(2) compared to BMI <25 (OR = 1.72, 95% CI: 1.12-2.66; p for trend: 0.03). There was also a strong association with weight gain since age 18 (OR: 1.52; 95% CI: 1.07-2.16; p for trend: 0.02) comparing the highest to lowest quartile. In stratified analyses by menopausal status, the association with BMI and weight gain was limited to postmenopausal women, with a 15% (95% CI: 1.05-1.23) increase in risk per 5 kg/m(2) of BMI and 6% (95% CI: 1.01-1.10) increase in risk per 5 kg of weight gain. Excluding hormone therapy users essentially did not change results. Obesity and excessive adult weight gain may increase ovarian cancer risk in post-menopausal AA women. © 2016 UICC.

Antipsychotic metabolic effects: weight gain, diabetes mellitus, and lipid abnormalities.

PubMed

McIntyre, R S; McCann, S M; Kennedy, S H

2001-04-01

To review published and nonpublished literature describing changes in weight, glucose homeostasis, and lipid milieu with antipsychotics. A Medline search was completed using the words weight gain, diabetes mellitus, cholesterol, triglycerides, risperidone, clozapine, olanzapine, quetiapine, ziprasidone, predictors, prolactin, obesity, and conventional antipsychotics. Publications, including original articles, review articles, letters to the editor, abstracts or posters presented at professional meetings in the last 4 years, and references from published articles, were collected. Manufacturers, including Eli Lilly Canada Inc, JanssenOrtho Inc, Pfizer Canada Inc, AstraZeneca Inc, and Novartis Pharmaceuticals, were contacted to retrieve additional medical information. The topic of antipsychotic-induced weight gain is understudied, and there are relatively few well-controlled studies. Weight gain as a side effect has been described with both conventional and atypical antipsychotics. Moreover, some atypical antipsychotics are associated with de novo diabetes mellitus and increased serum triglyceride levels. Predictors of weight gain may be age, baseline body mass index, appetite stimulation, previous antipsychotic exposure, and antipsychotic treatment duration. Significant weight gain is reported with the existing atypical antipsychotics. The weight gain described is highly distressing to patients, may reduce treatment adherence, and may increase the relative risk for diabetes mellitus and hypertriglyceridemia. Physicians employing these agents should routinely monitor weight, fasting blood glucose, and lipid profiles.

Active rc filter permits easy trade-off of amplifier gain and sensitivity to gain

NASA Technical Reports Server (NTRS)

Kerwin, W. J.; Shaffer, C. V.

1968-01-01

Passive RC network was designed with zeros of transmission in the right half of the complex frequency plane in the feedback loop of a simple negative-gain amplifier. The proper positioning provides any desired trade-off between amplifier gain and sensitivity to amplifier gain.

Evaluation of bioMérieux's Dissociated Vidas Lyme IgM II and IgG II as a First-Tier Diagnostic Assay for Lyme Disease

PubMed Central

Delorey, Mark J.; Replogle, Adam; Sexton, Christopher; Schriefer, Martin E.

2017-01-01

ABSTRACT The recommended laboratory diagnostic approach for Lyme disease is a standard two-tiered testing (STTT) algorithm where the first tier is typically an enzyme immunoassay (EIA) that if positive or equivocal is reflexed to Western immunoblotting as the second tier. bioMérieux manufactures one of the most commonly used first-tier EIAs in the United States, the combined IgM/IgG Vidas test (LYT). Recently, bioMérieux launched its dissociated first-tier tests, the Vidas Lyme IgM II (LYM) and IgG II (LYG) EIAs, which use purified recombinant test antigens and a different algorithm than STTT. The dissociated LYM/LYG EIAs were evaluated against the combined LYT EIA using samples from 471 well-characterized Lyme patients and controls. Statistical analyses were conducted to assess the performance of these EIAs as first-tier tests and when used in two-tiered algorithms, including a modified two-tiered testing (MTTT) approach where the second-tier test was a C6 EIA. Similar sensitivities and specificities were obtained for the two testing strategies (LYT versus LYM/LYG) when used as first-tier tests (sensitivity, 83 to 85%; specificity, 85 to 88%) with an observed agreement of 80%. Sensitivities of 68 to 69% and 76 to 77% and specificities of 97% and 98 to 99% resulted when the two EIA strategies were followed by Western immunoblotting and when used in an MTTT, respectively. The MTTT approach resulted in significantly higher sensitivities than did STTT. Overall, the LYM/LYG EIAs performed equivalently to the LYT EIA in test-to-test comparisons or as first-tier assays in STTT or MTTT with few exceptions. PMID:28330884

Improved Gain Microstrip Patch Antenna

DTIC Science & Technology

2015-08-06

08-2015 Publication Improved Gain Microstrip Patch Antenna David A. Tonn Naval Under Warfare Center Division, Newport 1176 Howell St., Code 00L...GAIN MICROSTRIP PATCH ANTENNA STATEMENT OF GOVERNMENT INTEREST [0001] The invention described herein may be manufactured and used by or for the...patch antenna having increased gain, and an apparatus for increasing the gain and bandwidth of an existing microstrip patch antenna . (2) Description

The cost-effectiveness of CT-guided sacroiliac joint injections: a measure of QALY gained.

PubMed

Bydon, Mohamad; Macki, Mohamed; De la Garza-Ramos, Rafael; Youssef, Mina; Gokaslan, Ziya L; Meleka, Sherif; Bydon, Ali

2014-10-01

The purpose of this study is to estimate the total cost and the quality of life years (QALY) gained for computer tomography (CT)-guided sacroiliac joint (SIJ) injections. The cost per QALY gained for the procedure is the primary end-point of this study. In our 1-year prospective institutional study, we gathered 30 patients undergoing CT-guided SIJ injections for degenerative changes at the SIJ space. Patient-reported outcomes included both the US population-based EQ-5D (EuroQol) index score and the EQ-visual analog scale (VAS). The EQ-5D is based on mobility, self-care, usual activities, pain/discomfort, and anxiety depression. Utility expenditures were based on hospital charges at our institution. All 30 patients had one pre-injection physician visit followed by 43 initial injections (13 bilateral). Each patient underwent one CT scan, and three patients required additional plain films. In the 1 year following the injections, 26 physician visits were documented. Five patients required repeat CT-guided injections. Total 1-year cost for all 30 patients was $34 874·00. Mean decrease in EQ-VAS was 0·60 (P  =  0·187). The mean 1-year gain of 0·58 EQ-5D QALY reached statistical significance (P < 0·001). The cost per QALY gained by CT-guided sacroiliac injections was $2004·29. In one of the first cost analyses of CT-guided sacroiliac injections, we found that the procedure improves pain and activities of daily living. The cost per QALY gained by CT-guided sacroiliac injections falls well below the threshold cost of 1 QALY, suggesting that the procedure is strongly cost-effective.

Weight Gain: A Possible Side Effect of All Antiretrovirals

PubMed Central

Ricci, Elena; Menzaghi, Barbara; Orofino, Giancarlo; Passerini, Simone; Madeddu, Giordano; Martinelli, Canio Vito; De Socio, Giuseppe Vittorio; Squillace, Nicola; Rusconi, Stefano; Bonfanti, Paolo; Di Biagio, Antonio; Quirino, T; Bonfanti, P; Ricci, E; Bellacosa, C; Maggi, P; Calza, L; Abeli, C; Menzaghi, B; Celesia, B M; Grosso, C; Stagno, A; Vichi, F; Mazzotta, F; Martinelli, C; Penco, G; Cassola, G; Di Biagio, A; Taramasso, L; Nicolini, L A; Dentone, C; Molteni, C; Palvarini, L; Scalzini, A; Carenzi, L; Rizzardini, G; Valsecchi, L; Cordier, L; Rusconi, S; Colombo, V; Galli, M; Franzetti, M; De Socio, G V; Mazzotta, E; Parruti, G; Madeddu, G; Bagella, P; S. Mura, M; Libertone, R; Antinori, A; Di Giambenedetto, S; Orofino, G; Guastavigna, M; Caramell, P

2017-01-01

Abstract Weight gain and body mass index (BMI) increase are central issues in patients living with HIV who need to minimize the risk of metabolic disease. Information collected through the SCOLTA cohort revealed significant 1-year BMI increase in patients treated with dolutegravir (P = .004), raltegravir (P = .0004), elvitegravir (P = .004), darunavir (P = .0006), and rilpivirine (P = .029). BMI gain correlated with low baseline BMI (P = .002) and older age (P = .0007) in Centers for Disease Control and Prevention stages A/B, with lower BMI (P = .005) and CD4+ T-cell count (P = .007) at enrollment in stage C. PMID:29255735

Gestational Weight Gain and Interpregnancy Weight Change in Adolescent Mothers.

PubMed

Whelan, Emily; Armson, B Anthony; Ashley-Martin, Jillian; MacSween, Kayla; Woolcott, Christy

2017-06-01

To examine the association between gestational weight gain (GWG) and interpregnancy weight change (IPWC) in adolescent mothers (younger than 20 years), and to determine if this association differs from adult women (aged 20-35 years). Retrospective cohort study. We included 3055 adolescents and 17,090 adult women with singleton pregnancies recorded in the Nova Scotia Atlee Perinatal Database with a subsequent pregnancy occurring between 2003 and 2014. GWG in the first pregnancy was categorized as below, within, or above the current Institute of Medicine recommendations. IPWC was defined as the difference between the prepregnancy weights of the 2 pregnancies. Analyses were adjusted for parity, body mass index in the first pregnancy, and time between pregnancies. Relative to adolescents with GWG within the recommendations, those who gained below had a 2.7 kg (95% confidence interval [CI], 1.4-3.9) lower mean IPWC whereas those who gained above had a 4.2 kg (95% CI, 3.3-5.1) higher mean IPWC. Smaller differences in IPWC between GWG categories were observed in adult women; relative to those with GWG within the recommendations, adults who gained below had a 1.3 kg (95% CI, 0.9-1.7) lower mean IPWC and those who gained above had a 2.9 kg (95% CI, 2.6-3.2) higher mean IPWC. Mean IPWC differed across GWG categories and the differences were greater in adolescents than in adult women. This difference should be considered when assessing whether specific GWG recommendations are needed for adolescents. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Yoga practice is associated with attenuated weight gain in healthy, middle-aged men and women.

PubMed

Kristal, Alan R; Littman, Alyson J; Benitez, Denise; White, Emily

2005-01-01

Yoga is promoted or weight maintenance, but there is little evidence of its efficacy. To examine whether yoga practice is associated with lower mean 10-year weight gain after age 45. Participants included 15,550 adults, aged 53 to 57 years, recruited to the Vitamin and Lifestyle (VITAL) cohort study between 2000 and 2002. Physical activity (including yoga) during the past 10 years, diet, height, and weight at recruitment and at ages 30 and 45. All measures were based on self-reporting, and past weight was retrospectively ascertained. Multiple regression analyses were used to examined covariate-adjusted associations between yoga practice and weight change from age 45 to recruitment, and polychotomous logistic regression was used to examine associations of yoga practice with the relative odds of weight maintenance (within 5%) and weight loss (> 5%) compared to weight gain. Yoga practice for four or more years was associated with a 3.1-lb lower weight gain among normal weight (BMI < 25) participants [9.5 lbs versus 12.6 Ibs] and an 18.5-lb lower weight gain among overweight participants [-5.0 lbs versus 13.5 Ibs] (both P for trend <.001). Among overweight individuals, 4+ years of yoga practice was associated with a relative odds of 1.85 (95% confidence interval [CI] 0.63-5.42) for weight maintenance (within 5%) and 3.88 (95% Cl 1.30-9.88) for weight loss (> 5%) compared to weight gain (P for trend .026 and .003, respectively). Regular yoga practice was associated with attenuated weight gain, most strongly among individuals who were overweight. Although causal inference from this observational study is not possible, results are consistent with the hypothesis that regular yoga practice can benefit individuals who wish to maintain or lose weight.

26 CFR 1.665(f)-1A - Undistributed capital gain.

Code of Federal Regulations, 2010 CFR

2010-04-01

... TAX (CONTINUED) INCOME TAXES Treatment of Excess Distributions of Trusts Applicable to Taxable Years.... (ii) The amount of taxes imposed on the trust for such year attributable to such gains, as defined in § 1.665(d)-1A, and (iii) In the case of a trust that does not use the alternative method for computing...

Improved knowledge gain and retention for third-year medical students during surgical journal club using basic science review: A pilot study.

PubMed

Williams, Austin D; Mann, Barry D

2017-02-01

As they enter the clinical years, medical students face large adjustments in the acquisition of medical knowledge. We hypothesized that basic science review related to the topic of journal club papers would increase the educational benefit for third-year medical students. Students were randomized either to participation in a review session about basic science related to the journal club paper, or to no review. After one day, and after three months, students were given a 10-question quiz encompassing the basic science and the clinical implications of the paper. Twenty-six of 50 students were randomized to basic science review. These students scored better on both sections of the quiz one day after journal club, but only on basic science questions after three months. Students who participated in basic science review had better knowledge gain and retention. Educational activities building upon foundational knowledge improves learning on clinical rotations. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of Time on Perceived Gains from an Undergraduate Research Program

PubMed Central

Adedokun, Omolola A.; Parker, Loran C.; Childress, Amy; Burgess, Wilella; Adams, Robin; Agnew, Christopher R.; Leary, James; Knapp, Deborah; Shields, Cleveland; Lelievre, Sophie; Teegarden, Dorothy

2014-01-01

The current study examines the trajectories of student perceived gains as a result of time spent in an undergraduate research experience (URE). Data for the study come from a survey administered at three points over a 1-yr period: before participation in the program, at the end of a Summer segment of research, and at the end of the year. Repeated-measures analysis of variance was used to examine the effect of time on perceived gains in student research skills, research confidence, and understanding of research processes. The results suggest that the students experienced different gains/benefits at developmentally different stages of their UREs. Participants reported gains in fewer areas at the end of the Summer segment compared with the end of the yearlong experience, thus supporting the notion that longer UREs offer students more benefit. PMID:24591512

Summary of Pressure Gain Combustion Research at NASA

NASA Technical Reports Server (NTRS)

Perkins, H. Douglas; Paxson, Daniel E.

2018-01-01

NASA has undertaken a systematic exploration of many different facets of pressure gain combustion over the last 25 years in an effort to exploit the inherent thermodynamic advantage of pressure gain combustion over the constant pressure combustion process used in most aerospace propulsion systems. Applications as varied as small-scale UAV's, rotorcraft, subsonic transports, hypersonics and launch vehicles have been considered. In addition to studying pressure gain combustor concepts such as wave rotors, pulse detonation engines, pulsejets, and rotating detonation engines, NASA has studied inlets, nozzles, ejectors and turbines which must also process unsteady flow in an integrated propulsion system. Other design considerations such as acoustic signature, combustor material life and heat transfer that are unique to pressure gain combustors have also been addressed in NASA research projects. In addition to a wide range of experimental studies, a number of computer codes, from 0-D up through 3-D, have been developed or modified to specifically address the analysis of unsteady flow fields. Loss models have also been developed and incorporated into these codes that improve the accuracy of performance predictions and decrease computational time. These codes have been validated numerous times across a broad range of operating conditions, and it has been found that once validated for one particular pressure gain combustion configuration, these codes are readily adaptable to the others. All in all, the documentation of this work has encompassed approximately 170 NASA technical reports, conference papers and journal articles to date. These publications are very briefly summarized herein, providing a single point of reference for all of NASA's pressure gain combustion research efforts. This documentation does not include the significant contributions made by NASA research staff to the programs of other agencies, universities, industrial partners and professional society

Parent-Reported Bullying and Child Weight Gain between Ages 6 and 15.

PubMed

Sutin, Angelina R; Robinson, Eric; Daly, Michael; Terracciano, Antonio

2016-12-01

Childhood bullying has long-term negative mental and physical health correlates, including weight gain and symptoms of depression. The purpose of this research is to examine whether bullying in the first year of school is associated with greater weight gain by early adolescence and whether adolescent depressive symptoms mediate this association. Data were drawn from the Longitudinal Study of Australian Children. Children (N = 3929) were measured every 2 years; BMI and waist circumference were available from ages 4 to 15. Parents reported on bullying at age 6. Children reported on their depressive symptoms at ages 12-13. Participants who weighed in the obese category at age 4 had an over 50% increased risk of being bullied in school at age 6. Being bullied at age 6 was associated with excess weight gain between ages 6 and 15, defined as either BMI or waist circumference. Depressive symptoms at age 12 partially explained the association between bullying and increases in adiposity. None of the associations varied by gender. Similar to other forms of peer victimization, bullying early in school is associated with greater weight gain through early adolescence; depressive symptom is one mechanism that contributes to this association.

Association of gestational weight gain expectations with advice on actual weight gain

USDA-ARS?s Scientific Manuscript database

To examine pregnant women's gestational weight gain expectations/advice from various sources (i.e., self, family/friends, physician) and the impact of these sources of expectations/advice on actual measured gestational weight gain. Pregnant women (n=230, 87.4% Caucasian, second pregnancy) in a cohor...

Weight Gain during Pregnancy

MedlinePlus

... Global Map Premature Birth Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal ... fitness > Weight gain during pregnancy Weight gain during pregnancy E-mail to a friend Please fill in ...

Asthma Triggers: Gain Control

MedlinePlus

... Centers Asthma Contact Us Share Asthma Triggers: Gain Control Breathing Freely: Controlling Asthma Triggers This video features ... Air Quality: Biological Pollutants Help Your Child Gain Control Over Asthma Top of Page Molds About Molds ...

Weight gain in freshman college students and perceived health

PubMed Central

de Vos, Paul; Hanck, Christoph; Neisingh, Marjolein; Prak, Dennis; Groen, Henk; Faas, Marijke M.

2015-01-01

Background We determined body weight increase in first year Dutch college students. We had the objective to determine whether the awareness of the unhealthy lifestyle raised concerns and willingness to change habits. Methods Body weight, heartbeat, BMI, body fat percentages, and blood pressure values were collected from 1095 students. Comprehensive statistical analysis was performed on the data. Results The students had a mean weight gain of 1.1 kg and an average BMI gain of 0.35. Members of a student corps gained significantly more weight (1.6 ± 3.1 kg) than non-members (1.0 ± 2.5 kg), while students who are living independently gained an average of 0.5 kg more than students living with their parents (p < 0.05). Approximately 40% of the students changed their eating patterns and 30.7% of the students consumed more alcohol. Conclusions Students experienced hindrance in physical exercise and mental well-being. Students with a high BMI without irregular eating habits were willing to change their lifestyle. However, students who had irregular lifestyles exhibited the lowest willingness to change their eating behaviors and to lose weight. Our study provides insight into means by which adolescents at high risk for weight gain can be approached to improve experienced quality of life. PMID:26844076

Competence with Fractions Predicts Gains in Mathematics Achievement

PubMed Central

Bailey, Drew H.; Hoard, Mary K.; Nugent, Lara; Geary, David C.

2012-01-01

Competence with fractions predicts later mathematics achievement, but the co-developmental pattern between fractions knowledge and mathematics achievement is not well understood. We assessed this co-development through examination of the cross-lagged relation between a measure of conceptual knowledge of fractions and mathematics achievement in sixth and seventh grade (n = 212). The cross-lagged effects indicated that performance on the sixth grade fractions concepts measure predicted one year gains in mathematics achievement (β = .14, p<.01), controlling for the central executive component of working memory and intelligence, but sixth grade mathematics achievement did not predict gains on the fractions concepts measure (β = .03, p>.50). In a follow-up assessment, we demonstrated that measures of fluency with computational fractions significantly predicted seventh grade mathematics achievement above and beyond the influence of fluency in computational whole number arithmetic, performance on number fluency and number line tasks, and central executive span and intelligence. Results provide empirical support for the hypothesis that competence with fractions underlies, in part, subsequent gains in mathematics achievement. PMID:22832199

Competence with fractions predicts gains in mathematics achievement.

PubMed

Bailey, Drew H; Hoard, Mary K; Nugent, Lara; Geary, David C

2012-11-01

Competence with fractions predicts later mathematics achievement, but the codevelopmental pattern between fractions knowledge and mathematics achievement is not well understood. We assessed this codevelopment through examination of the cross-lagged relation between a measure of conceptual knowledge of fractions and mathematics achievement in sixth and seventh grades (N=212). The cross-lagged effects indicated that performance on the sixth grade fractions concepts measure predicted 1-year gains in mathematics achievement (ß=.14, p<.01), controlling for the central executive component of working memory and intelligence, but sixth grade mathematics achievement did not predict gains on the fractions concepts measure (ß=.03, p>.50). In a follow-up assessment, we demonstrated that measures of fluency with computational fractions significantly predicted seventh grade mathematics achievement above and beyond the influence of fluency in computational whole number arithmetic, performance on number fluency and number line tasks, central executive span, and intelligence. Results provide empirical support for the hypothesis that competence with fractions underlies, in part, subsequent gains in mathematics achievement. Copyright © 2012 Elsevier Inc. All rights reserved.

Water quality in Gaines Creek and Gaines Creek arm of Eufaula Lake, Oklahoma

USGS Publications Warehouse

Kurklin, J.K.

1990-01-01

Based on samples collected from May 1978 to May 1980 and analyzed for major anions, nitrogen, trace elements, phytoplankton, and bacteria, the water in Gaines Creek and the Gaines Creek arm of Eufaula Lake was similar with respect to suitability for municipal use. Water from Gaines Creek had a pH range of 5.7 to 7.6 and a maximum specific conductance of 97 microsiemens per centimeter at 25o Celsius, whereas water from the Gaines Creek arm of Eufaula Lake had a pH range of 6.0 to 9.2 and a maximum specific conductance of 260 microsiemens per centimeter at 25o Celsius. Dissolved oxygen, pH, temperature, and specific conductance values for the lake varied with depth. With the exceptions of cadmium, iron, lead, and manganese, trace-element determinations of samples were within recommended national primary and secondary drinking-water standards. When compared to the National Academy of Sciences water-quality criteria, phytoplankton and bacteria counts exceeded recommendations; however, water from either Gaines Creek or Eufaula Lake could be treated similarly and used as a municipal water supply.

College-Aged Males Experience Attenuated Sweet and Salty Taste with Modest Weight Gain.

PubMed

Noel, Corinna A; Cassano, Patricia A; Dando, Robin

2017-10-01

Background: Human and animal studies report a blunted sense of taste in people who are overweight or obese, with heightened sensitivity also reported after weight loss. However, it is unknown if taste changes concurrently with weight gain. Objective: This study investigated the association of weight gain with changes in suprathreshold taste intensity perception in a free-living population of young adults. Methods: Taste response, anthropometric measures, and diet changes were assessed with a longitudinal study design in first-year college students 3 times throughout the academic year. At baseline, 93 participants (30 males, 63 females) were an average of 18 y old, with a body mass index (in kg/m 2 ) of 21.9. Sweet, umami, salty, sour, and bitter taste intensities were evaluated at 3 concentrations by using the general Labeled Magnitude Scale. Ordinary least-squares regression models assessed the association of weight gain and within-person taste change, adjusting for sex, race, and diet changes. Results: Participants gained an average of 3.9% in weight, ranging from -5.7% to +13.8%. With each 1% increase in body weight, males perceived sweet and salty as less intense, with taste responses decreasing by 11.0% (95% CI: -18.9%, -2.3%; P = 0.015) and 7.5% (95% CI: -13.1%, -1.5%; P = 0.015) from baseline, respectively. Meanwhile, females did not experience this decrement, and even perceived a 6.5% increase (95% CI: 2.6%, 10.5%; P = 0.007) in sour taste with similar amounts of weight gain. Changes in the consumption of meat and other umami-rich foods also negatively correlated with umami taste response (-39.1%; 95% CI: -56.3%, -15.0%; P = 0.004). Conclusions: A modest weight gain is associated with concurrent taste changes in the first year of college, especially in males who experience a decrement in sweet and salty taste. This suggests that young-adult males may be susceptible to taste loss when gaining weight. © 2017 American Society for Nutrition.

Longitudinal associations between key dietary behaviors and weight gain over time: Transitions through the adolescent years

PubMed Central

Laska, Melissa N.; Murray, David M.; Lytle, Leslie A.; Harnack, Lisa J.

2012-01-01

Previous studies have yielded inconsistent results in documenting the association between key dietary factors and adolescent weight change over time. The purpose of this study was to examine the extent to which changes in adolescent sugar-sweetened beverage, diet soda, breakfast and fast food consumption were associated with changes in BMI and percent body fat (PBF), both cross-sectionally and longitudinally. Our sample included 693 Minnesota adolescents followed over two years. Adjusting for physical activity, puberty, race, socio-economic status, age, and total energy intake, cross-sectional findings indicated that for both males and females, diet soda consumption was significantly and positively associated with BMI and PBF, and breakfast intake was significantly and negatively associated with BMI and PBF among girls. In longitudinal analyses, however, there were no significant associations after adjusting for the number of tests performed. This study adds to previous research through its methodological strengths, including adjustment for physical activity and energy intake assessed using state-of-the-art methods (i.e., accelerometers and 24-hour dietary recalls), as well as its evaluation of both BMI and PBF. Additional research is needed to better understand the complex constellation of factors that contribute to adolescent weight gain over time. PMID:21701567

Leading Gainful Employment Metric Reporting

ERIC Educational Resources Information Center

Powers, Kristina; MacPherson, Derek

2016-01-01

This chapter will address the importance of intercampus involvement in reporting of gainful employment student-level data that will be used in the calculation of gainful employment metrics by the U.S. Department of Education. The authors will discuss why building relationships within the institution is critical for effective gainful employment…

Cost-effectiveness analysis of adding a quadrivalent HPV vaccine to the cervical cancer screening programme in Switzerland.

PubMed

Szucs, Thomas D; Largeron, Nathalie; Dedes, Konstantin J; Rafia, Rachid; Bénard, Stève

2008-05-01

Based on positive safety and efficacy data, a quadrivalent Human PapillomaVirus (HPV) vaccine has been approved in Switzerland to prevent HPV types 6, 11, 16 and 18 infections. The objective of this study was to explore the cost-effectiveness of an HPV vaccination in Switzerland. A Markov model of the natural history of HPV infection was adapted to the Swiss context and followed a hypothetical cohort of 41,200 girls aged 11 years over their lifetime. Main epidemiological and economic parameters were extracted from the literature. Two strategies were compared: conventional cytological screening only and HPV vaccination followed by conventional cytological screening. A coverage rate of 80% was used and the vaccine was assumed to provide a lifelong protection. Analyses were performed from the direct health care cost perspective including only direct medical costs. Compared to screening only, adding a quadrivalent HPV vaccine could prevent over lifetime 62% of cervical cancers and related deaths, 19% of Cervical Intraepithelial Neoplasia (CIN 1), 43% of CIN 2, 45% of CIN 3 and 66% of genital warts per cohort. Incremental cost-effectiveness ratios (ICER) were estimated to be CHF 45,008 per Life Year Gained (LYG) and CHF 26,005 per Quality Adjusted Life Year (QALY) gained. Sensitivity analyses demonstrated that the ICER was robust to all parameters, but was most sensitive to the need for a booster and discount rates. Compared to commonly accepted standard thresholds in Europe and other vaccination strategies implemented in Switzerland, adding a quadrivalent HPV vaccine alongside the current cervical cancer screening programme is likely to be cost-effective in Switzerland.

A Randomized Trial Investigating the Effect of a Brief Lifestyle Intervention on Freshman-Year Weight Gain

ERIC Educational Resources Information Center

Middleton, Kathryn R.; Perri, Michael G.

2014-01-01

Objective: The current study was a randomized controlled trial investigating the effect of an innovative, short-term lifestyle intervention on weight gain in female freshman college students. Participants: Ninety-five freshmen were recruited from a large public university in the United States. Methods: Participants completed baseline assessments…

Parent-reported patterns of loss and gain in communication in 1- to 2-year-old children are not unique to autism spectrum disorder.

PubMed

Brignell, Amanda; Williams, Katrina; Prior, Margot; Donath, Susan; Reilly, Sheena; Bavin, Edith L; Eadie, Patricia; Morgan, Angela T

2017-04-01

We compared loss and gain in communication from 1 to 2 years in children later diagnosed with autism spectrum disorder (n = 41), language impairment (n = 110) and in children with typical language development at 7 years (n = 831). Participants were selected from a prospective population cohort study of child language (the Early Language in Victoria Study). Parent-completed communication tools were used. As a group, children with autism spectrum disorder demonstrated slower median skill gain, with an increasing gap between trajectories compared to children with typical development and language impairment. A proportion from all groups lost skills in at least one domain (autism spectrum disorder (41%), language impairment (30%), typical development (26%)), with more children with autism spectrum disorder losing skills in more than one domain (autism spectrum disorder (47%), language impairment (15%, p = 0.0003), typical development (16%, p < 0.001)). Loss was most common for all groups in the domain of 'emotion and eye gaze' but with a higher proportion for children with autism spectrum disorder (27%; language impairment (12%, p = 0.03), typical development (14%, p = 0.03)). A higher proportion of children with autism spectrum disorder also lost skills in gesture (p = 0.01), sounds (p = 0.009) and understanding (p = 0.004) compared to children with typical development but not with language impairment. These findings add to our understanding of early communication development and highlight that loss is not unique to autism spectrum disorder.

Weight-gain misperceptions and the third-person effect in Black and White college-bound females: potential implications for healthy weight management.

PubMed

Webb, Jennifer B; Butler-Ajibade, Phoebe; Robinson, Seronda A; Lee, Shanique J

2013-08-01

Elements of social norm theory and communication theory on the third-person effect may prove useful in efforts to prevent excessive weight gain among emerging adults entering college. The present study explored the associations of race/ethnicity and BMI status with these socio-cognitive factors that may affect first-year weight regulation in a sample of Black (N = 247) and White (N = 94) college-bound females. Participants completed an online survey assessing first-year weight-gain perceived norms along with weight-change expectations and concerns. Results provided evidence of the persistence of the myth of the "Freshman 15", belief in the typicality of gaining weight during the first year of college, and significant concern about first-year weight gain. Initial findings further revealed a robust third-person effect whereby despite nearly 90% of the sample endorsing that first-year weight gain was common, only 12% expected they would experience weight gain. Main effects of race/ethnicity, BMI status, and their interaction further uncovered distinct patterns of findings. Preliminary results highlight the need for college health officials at both predominantly White as well as minority-serving institutions to adequately address the significant concern over first-year weight gain in conjunction with the desire to lose weight expressed by an appreciable number of incoming college females. Findings also advocate the utility of evaluating social norm theory and the third-person perceptual bias in the context of first-year weight gain to potentially enhance the design and effectiveness of healthy weight management initiatives among ethnically-diverse young women entering college. Copyright © 2013 Elsevier Ltd. All rights reserved.

Parent-Reported Bullying and Child Weight Gain between Ages 6 and 15

PubMed Central

Robinson, Eric; Daly, Michael; Terracciano, Antonio

2016-01-01

Abstract Background: Childhood bullying has long-term negative mental and physical health correlates, including weight gain and symptoms of depression. The purpose of this research is to examine whether bullying in the first year of school is associated with greater weight gain by early adolescence and whether adolescent depressive symptoms mediate this association. Methods: Data were drawn from the Longitudinal Study of Australian Children. Children (N = 3929) were measured every 2 years; BMI and waist circumference were available from ages 4 to 15. Parents reported on bullying at age 6. Children reported on their depressive symptoms at ages 12–13. Results: Participants who weighed in the obese category at age 4 had an over 50% increased risk of being bullied in school at age 6. Being bullied at age 6 was associated with excess weight gain between ages 6 and 15, defined as either BMI or waist circumference. Depressive symptoms at age 12 partially explained the association between bullying and increases in adiposity. None of the associations varied by gender. Conclusions: Similar to other forms of peer victimization, bullying early in school is associated with greater weight gain through early adolescence; depressive symptom is one mechanism that contributes to this association. PMID:27710013

Changes in job strain and subsequent weight gain: a longitudinal study, based on the Danish Nurse Cohort.

PubMed

Vesterlund, Gitte Kingo; Keller, Amélie Cléo; Heitmann, Berit Lilienthal

2018-04-01

Obesity as well as job strain is increasing, and job strain might contribute to weight gain. The objective of the current study was to examine associations between longitudinal alterations in the components of job strain and subsequent weight gain. The study was designed as a prospective cohort study with three questionnaire surveys enabling measurement of job-strain alterations over 6 years and subsequent measurements of weight gain after further 10 years of follow-up. ANCOVA and trend analyses were conducted. Job demands were measured as job busyness and speed, and control as amount of influence. Employed nurses in Denmark. We included a sub-sample of 6188 female nurses from the Danish Nurse Cohort, which consisted of the nurses who participated in surveys in 1993, 1999 and 2009. A linear trend in weight gain was seen in nurses who were often busy in 1999 between those who were rarely v. sometimes v. often busy in 1993 (P=0·03), with the largest weight gain in individuals with sustained high busyness in both years. Loss of influence between 1993 and 1999 was associated with larger subsequent weight gain than sustained high influence (P=0·003) or sustained low influence (P=0·02). For speed, no associations were found. Busyness, speed and influence differed in their relationship to subsequent weight gain. A decrease in job influence and a sustained burden of busyness were most strongly related to subsequent weight gain. Focus on job strain reduction and healthy diet is essential for public health.

Frequent self-weighing with electronic graphic feedback to prevent age-related weight gain in young adults

PubMed Central

Bertz, Fredrik; Pacanowski, Carly R.; Levitsky, David A.

2016-01-01

Background Young adults display substantial weight gain. Preventing this age-related weight gain would reduce overweight and obesity. Objective We evaluated an internet based intervention using Internet-connected scales and graphic email feedback; the Caloric Titration Method (CTM), to reduce age-related weight gain over the course of 1 y among first-year college students. Design First-year college students (n=167) were randomized to (CTM) or control (C) group. Both groups were provided Internet-connected scales. CTM group was instructed to weigh daily, view a weight graph emailed to them after weighing, and try to maintain their weight as indicated in the graph. The C group could weigh at any time, but did not receive feedback. At six months and 1 year the C group were notified to provide weights. Intention to treat analysis, using a mixed model adjusted for baseline weight, BMI and gender was used to analyze the effect of the intervention. Results Baseline Body Mass Index was 22.9 ± 3.0 kg/m2. Frequency of self-weighing (median) was 5 times/week in the CTM group, compared to 1 time/week in C (p<0.001). Ninety-five percent of the CTM participants weighed ≥3 times/week, compared to 15% in C group (p<0.001). After 1 year the C group had gained 1.1 ± 4.4 kg whereas the CTM group lost 0.5 ± 3.7 kg, yielding a significant overall time*group interaction (F=3.39, p=0.035). The difference in weight change between the two groups at 1 year was significant (p=0.004). Weight change of the CTM group was not different from zero whereas weight gain in C group was significant. Retention was 81%. Conclusions The internet based frequent self-weighing CTM system was effective in preventing age-related weight gain in young adults over one year and thus offers promise to reduce overweight and obesity. PMID:26414563

Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study

PubMed Central

Booth, Helen P; Gulliford, Martin C

2018-01-01

Abstract Objective To evaluate the long term association between antidepressant prescribing and body weight. Design Population based cohort study. Setting General practices contributing to the UK Clinical Practice Research Datalink, 2004-14. Participants 136 762 men and 157 957 women with three or more records for body mass index (BMI). Main outcome measures The main outcomes were antidepressant prescribing, incidence of ≥5% increase in body weight, and transition to overweight or obesity. Adjusted rate ratios were estimated from a Poisson model adjusting for age, sex, depression recording, comorbidity, coprescribing of antiepileptics or antipsychotics, deprivation, smoking, and advice on diet. Results In the year of study entry, 17 803 (13.0%) men and 35 307 (22.4%) women with a mean age of 51.5 years (SD 16.6 years) were prescribed antidepressants. During 1 836 452 person years of follow-up, the incidence of new episodes of ≥5 weight gain in participants not prescribed antidepressants was 8.1 per 100 person years and in participants prescribed antidepressants was 11.2 per 100 person years (adjusted rate ratio 1.21, 95% confidence interval 1.19 to 1.22, P<0.001). The risk of weight gain remained increased during at least six years of follow-up. In the second year of treatment the number of participants treated with antidepressants for one year for one additional episode of ≥5% weight gain was 27 (95% confidence interval 25 to 29). In people who were initially of normal weight, the adjusted rate ratio for transition to overweight or obesity was 1.29 (1.25 to 1.34); in people who were initially overweight, the adjusted rate ratio for transition to obesity was 1.29 (1.25 to 1.33). Associations may not be causal, and residual confounding might contribute to overestimation of associations. Conclusion Widespread utilisation of antidepressants may be contributing to long term increased risk of weight gain at population level. The potential for weight

Invention and Gain Analysis.

ERIC Educational Resources Information Center

Weber, Robert J.; Dixon, Stacey

1989-01-01

Gain analysis is applied to the invention of the sewing needle as well as different sewing implements and modes of sewing. The analysis includes a two-subject experiment. To validate the generality of gain heuristics and underlying switching processes, the invention of the assembly line is also analyzed. (TJH)

Sequence specific motor performance gains after memory consolidation in children and adolescents.

PubMed

Dorfberger, Shoshi; Adi-Japha, Esther; Karni, Avi

2012-01-01

Memory consolidation for a trained sequence of finger opposition movements, in 9- and 12-year-old children, was recently found to be significantly less susceptible to interference by a subsequent training experience, compared to that of 17-year-olds. It was suggested that, in children, the experience of training on any sequence of finger movements may affect the performance of the sequence elements, component movements, rather than the sequence as a unit; the latter has been implicated in the learning of the task by adults. This hypothesis implied a possible childhood advantage in the ability to transfer the gains from a trained to the reversed, untrained, sequence of movements. Here we report the results of transfer tests undertaken to test this proposal in 9-, 12-, and 17-year-olds after training in the finger-to-thumb opposition sequence (FOS) learning task. Our results show that the performance gains in the trained sequence partially transferred from the left, trained hand, to the untrained hand at 48-hours after a single training session in the three age-groups tested. However, there was very little transfer of the gains from the trained to the untrained, reversed, sequence performed by either hand. The results indicate sequence specific post-training gains in FOS performance, as opposed to a general improvement in performance of the individual, component, movements that comprised both the trained and untrained sequences. These results do not support the proposal that the reduced susceptibility to interference, in children before adolescence, reflects a difference in movement syntax representation after training.

Diet and physical activity as possible mediators of the association between educational attainment and body mass index gain among Australian adults.

PubMed

Gearon, Emma; Peeters, Anna; Ng, Winda; Hodge, Allison; Backholer, Kathryn

2018-04-23

To quantify the mediating role of leisure time physical activity (LTPA) and five dietary behaviours on educational differences in 13-year body mass index (BMI) gain across adulthood. Participants from the Melbourne Collaborative Cohort Study (4791 women; 3103 men) who maintained or gained BMI over 1990-1994 to 2003-2007 and met our inclusion criteria were selected. Education, potential mediators and confounders (age, alcohol, and smoking) were measured at baseline. We conducted sex-specific multiple mediation analyses using MacKinnon's product of coefficients method. A higher educational attainment was associated with a 0.27 kg m -2 (95% CI 0.14, 0.39) lesser 13-year BMI gain among women only. We observed significant indirect effects of educational attainment on 13-year BMI gain through LTPA and nutrient-rich foods (each associated with a higher educational attainment and lesser 13-year BMI gain) and diet soft drink (associated with a lower educational attainment and greater 13-year BMI gain), which mediated 10, 15 and 20% of this relationship, respectively (45% in total). Nutrient-rich foods, LTPA and diet soft drink may represent effective public health targets to reduce inequities in excess weight across adulthood.

The Benefits of Multi-Year Research Experiences: Differences in Novice and Experienced Students’ Reported Gains from Undergraduate Research

PubMed Central

Thiry, Heather; Weston, Timothy J.; Laursen, Sandra L.; Hunter, Anne-Barrie

2012-01-01

This mixed-methods study explores differences in novice and experienced undergraduate students’ perceptions of their cognitive, personal, and professional gains from engaging in scientific research. The study was conducted in four different undergraduate research (UR) programs at two research-extensive universities; three of these programs had a focus on the biosciences. Seventy-three entry-level and experienced student researchers participated in in-depth, semi-structured interviews and completed the quantitative Undergraduate Research Student Self-Assessment (URSSA) instrument. Interviews and surveys assessed students’ developmental outcomes from engaging in UR. Experienced students reported distinct personal, professional, and cognitive outcomes relative to their novice peers, including a more sophisticated understanding of the process of scientific research. Students also described the trajectories by which they developed not only the intellectual skills necessary to advance in science, but also the behaviors and temperament necessary to be a scientist. The findings suggest that students benefit from multi-year UR experiences. Implications for UR program design, advising practices, and funding structures are discussed. PMID:22949423

The potential of imaging techniques as a screening tool for colorectal cancer: a cost-effectiveness analysis.

PubMed

Greuter, Marjolein J E; Berkhof, Johannes; Fijneman, Remond J A; Demirel, Erhan; Lew, Jie-Bin; Meijer, Gerrit A; Stoker, Jaap; Coupé, Veerle M H

2016-07-01

Imaging may be promising for colorectal cancer (CRC) screening, since it has test characteristics comparable with colonoscopy but is less invasive. We aimed to assess the potential of CT colonography (CTC) and MR colonography (MRC) in terms of (cost-effectiveness) using the Adenoma and Serrated pathway to Colorectal CAncer model. We compared several CTC and MRC strategies with 5- or 10-yearly screening intervals with no screening, 10-yearly colonoscopy screening and biennial faecal immunochemical test (FIT) screening. We assumed trial-based participation rates in the base-case analyses and varied the rates in sensitivity analyses. Incremental lifetime costs and health effects were estimated from a healthcare perspective. The health gain of CTC and MRC was similar and ranged from 0.031 to 0.048 life-year gained compared with no screening, for 2-5 screening rounds. Lifetime costs per person for MRC strategies were €60-110 higher than those for CTC strategies with an equal number of screening rounds. All imaging-based strategies were cost-effective compared with no screening. FIT screening was the dominant screening strategy, leading to most LYG and highest cost-savings. Compared with three rounds of colonoscopy screening, CTC with five rounds was found to be cost-effective in an incremental analysis of imaging strategies. Assumptions on screening participation have a major influence on the ordering of strategies in terms of costs and effects. CTC and MRC have potential for CRC screening, compared with no screening and compared with three rounds of 10-yearly colonoscopy screening. When taking FIT screening as the reference, imaging is not cost-effective. Participation is an important driver of effectiveness and cost estimates. This is the first study to assess the cost-effectiveness of MRC screening for CRC.

Do Gains in Test Scores Explain Labor Market Outcomes?

ERIC Educational Resources Information Center

Rose, Heather

2006-01-01

Using data from the National Education Longitudinal Study of 1988, this article investigates whether students who made relatively large test score gains during high school had larger earnings 7 years after high school compared to students whose scores improved little. In models that control for pre-high school test scores, family background, and…

Loop gain stabilizing with an all-digital automatic-gain-control method for high-precision fiber-optic gyroscope.

PubMed

Zheng, Yue; Zhang, Chunxi; Li, Lijing; Song, Lailiang; Chen, Wen

2016-06-10

For a fiber-optic gyroscope (FOG) using electronic dithers to suppress the dead zone, without a fixed loop gain, the deterministic compensation for the dither signals in the control loop of the FOG cannot remain accurate, resulting in the dither residuals in the FOG rotation rate output and the navigation errors in the inertial navigation system. An all-digital automatic-gain-control method for stabilizing the loop gain of the FOG is proposed. By using a perturbation square wave to measure the loop gain of the FOG and adding an automatic gain control loop in the conventional control loop of the FOG, we successfully obtain the actual loop gain and make the loop gain converge to the reference value. The experimental results show that in the case of 20% variation in the loop gain, the dither residuals are successfully eliminated and the standard deviation of the FOG sampling outputs is decreased from 2.00  deg/h to 0.62  deg/h (sampling period 2.5 ms, 10 points smoothing). With this method, the loop gain of the FOG can be stabilized over the operation temperature range and in the long-time application, which provides a solid foundation for the engineering applications of the high-precision FOG.

Working memory plasticity in old age: practice gain, transfer, and maintenance.

PubMed

Li, Shu-Chen; Schmiedek, Florian; Huxhold, Oliver; Röcke, Christina; Smith, Jacqui; Lindenberger, Ulman

2008-12-01

Adult age differences in cognitive plasticity have been studied less often in working memory than in episodic memory. The authors investigated the effects of extensive working memory practice on performance improvement, transfer, and short-term maintenance of practice gains and transfer effects. Adults age 20-30 years and 70-80 years practiced a spatial working memory task with 2 levels of processing demands across 45 days for about 15 min per day. In both age groups and relative to age-matched, no-contact control groups, we found (a) substantial performance gains on the practiced task, (b) near transfer to a more demanding spatial n-back task and to numerical n-back tasks, and (c) 3-month maintenance of practice gains and near transfer effects, with decrements relative to postpractice performance among older but not younger adults. No evidence was found for far transfer to complex span tasks. The authors discuss neuronal mechanisms underlying adult age differences and similarities in patterns of plasticity and conclude that the potential of deliberate working memory practice as a tool for improving cognition in old age merits further exploration. Copyright (c) 2009 APA, all rights reserved.

Impact of increasing tobacco taxes on working-age adults: short-term health gain, health equity and cost savings.

PubMed

Cleghorn, Christine L; Blakely, Tony; Kvizhinadze, Giorgi; van der Deen, Frederieke S; Nghiem, Nhung; Cobiac, Linda J; Wilson, Nick

2017-11-16

The health gains and cost savings from tobacco tax increase peak many decades into the future. Policy-makers may take a shorter-term perspective and be particularly interested in the health of working-age adults (given their role in economic productivity). Therefore, we estimated the impact of tobacco taxes in this population within a 10-year horizon. As per previous modelling work, we used a multistate life table model with 16 tobacco-related diseases in parallel, parameterised with rich national data by sex, age and ethnicity. The intervention modelled was 10% annual increases in tobacco tax from 2011 to 2020 in the New Zealand population (n=4.4 million in 2011). The perspective was that of the health system, and the discount rate used was 3%. For this 10-year time horizon, the total health gain from the tobacco tax in discounted quality-adjusted life years (QALYs) in the 20-65 year age group (age at QALY accrual) was 180 QALYs or 1.6% of the lifetime QALYs gained in this age group (11 300 QALYs). Nevertheless, for this short time horizon: (1) cost savings in this group amounted to NZ$10.6 million (equivalent to US$7.1 million; 95% uncertainty interval: NZ$6.0 million to NZ$17.7 million); and (2) around two-thirds of the QALY gains for all ages occurred in the 20-65 year age group. Focusing on just the preretirement and postretirement ages, the QALY gains in each of the 60-64 and 65-69 year olds were 11.5% and 10.6%, respectively, of the 268 total QALYs gained for all age groups in 2011-2020. The majority of the health benefit over a 10-year horizon from increasing tobacco taxes is accrued in the working-age population (20-65 years). There remains a need for more work on the associated productivity benefits of such health gains. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Alarming weight gain in women of a post-transitional country.

PubMed

Garmendia, Maria L; Alonso, Faustino T; Kain, Juliana; Uauy, Ricardo; Corvalan, Camila

2014-03-01

In post-transitional countries, obesity disproportionally affects women. Longitudinal studies can detect high-risk groups in whom to target actions. We investigated the magnitude and velocity of BMI changes in Chilean women of reproductive age and evaluated whether these trends vary in specific groups. Longitudinal study. We measured weight and height in 2007 (baseline) and again in 2010 (follow-up); we estimated change in BMI (weight/height2) within the 3-year period and assessed its relationship with age, years of education and parity, collected at baseline and follow-up using a questionnaire. Population-based cohort of low- to middle-income Chilean women. Seven hundred and sixty-one women of reproductive age (mean 32·0 (sd 7·0) years), mothers of children who participate in the Growth and Obesity Cohort Study (GOCS). At baseline, 61 % of women had BMI ≥ 25·0 kg/m2. After 3 years, women gained on average 2·6 kg and obesity (BMI ≥ 30·0 kg/m2) increased by 23 % (12 % new obesity cases). Women with normal nutritional status gained more BMI than obese women (1·4 v. 0·6 kg/m2, P < 0·001). An increase in parity was positively associated with BMI change, independently of age, nutritional status and education (P < 0·05). Age and education were not associated with BMI change after controlling for other factors (P > 0·05). In Chile, a post-transitional country, we observed an alarming increase in obesity among women of reproductive age. Our results indicate that in this population actions need to be targeted at all women irrespective of their nutritional status. A key component of these policies should be avoiding excessive weight gain during pregnancy.

Prospective study of dietary energy density and weight gain in a Japanese adult population.

PubMed

Sasaki, K M; Wada, K; Zeredo, J L L; Nagata, C

2017-03-01

High dietary energy density (ED) has been associated with weight gain. However, little is known about the long-term effects of ED on weight changes among free-living subjects, particularly in Japanese and other Asian populations. In this study, we assessed dietary habits and weight changes in participants (5778 males and 7440 females, 35-69 years old) of the Takayama study. ED was estimated using a validated FFQ at baseline only. Information on body weight (BW) was obtained by self-administered questionnaires at baseline and follow-up. Mean BW difference in 9·8 years was 17 (se 4221) g for men and -210 (se 3889) g for women. In men, ED was positively associated with BW at follow-up after controlling for age, BW, height, physical activity score, alcohol consumption, energy intake, years of education at the baseline and change of smoking status during the follow-up. On average, men in the highest quartile of ED (>5·322 kJ/g (>1·272 kcal/g)) gained 138 (se 111) g, whereas men in the lowest ED (<1·057) lost 22 (se 111) g (P for trend=0·01). The association between ED and BW gain was stronger in men with normal weight. In women, the association between ED and weight change was not statistically significant. In conclusion, contrary to some studies that report an association between ED and weight gain in the overweight only, our data suggest that high-ED diets may be associated with weight gain in the lean population as well, at least in male subjects.

Study of gain-coupled distributed feedback laser based on high order surface gain-coupled gratings

NASA Astrophysics Data System (ADS)

Gao, Feng; Qin, Li; Chen, Yongyi; Jia, Peng; Chen, Chao; Cheng, LiWen; Chen, Hong; Liang, Lei; Zeng, Yugang; Zhang, Xing; Wu, Hao; Ning, Yongqiang; Wang, Lijun

2018-03-01

Single-longitudinal-mode, gain-coupled distributed feedback (DFB) lasers based on high order surface gain-coupled gratings are achieved. Periodic surface metal p-contacts with insulated grooves realize gain-coupled mechanism. To enhance gain contrast in the quantum wells without the introduction of effective index-coupled effect, groove length and depth were well designed. Our devices provided a single longitudinal mode with the maximum CW output power up to 48.8 mW/facet at 971.31 nm at 250 mA without facet coating, 3dB linewidth (<3.2 pm) and SMSR (>39 dB). Optical bistable characteristic was observed with a threshold current difference. Experimentally, devices with different cavity lengths were contrasted on power-current and spectrum characteristics. Due to easy fabrication technique and stable performance, it provides a method of fabricating practical gain-coupled distributed feedback lasers for commercial applications.

Gain affected by the interior shape of the ear canal.

PubMed

Yu, Jen-Fang; Chen, Yen-Sheng; Cheng, Wei-De

2011-06-01

This study investigated the correlation of gain distribution and the interior shape of the human external ear canal. Cross-sectional study of gain measurement at the first bend and second bend. Chang Gung Memorial Hospital and Chang Gung University. There were 15 ears in patients aged between 20 and 30 years (8 men/7 women) with normal hearing and middle ears. Stimulus frequencies of 500, 1000, 2000, 3000, and 4000 Hz were based on the standard clinical hearing test. Measurements closer to the tympanic membrane and the positions at the first and second bends were confirmed by using otoscope. Real ear measurement to analyze the canal resonance in human external ears was adopted. This study found that gain at stimulus frequencies of 4000 Hz was affected by the interior shape of the ear canal (P < .005), particularly at the first and second bends, whereas gain was only affected by the length of the ear canal for stimulus frequencies of 2000 Hz (P < .005). This study found that gain was affected not only by the length of the external auditory canal (EAC) but also by the interior shape of the EAC significantly. The findings of this study may have potential clinical applications in canalplasty and congenital aural atresia surgery and may be used to guide surgeries that attempt to reshape the ear canal to achieve more desirable hearing outcomes.

Intentions to Prevent Weight Gain in Older and Younger Adults; The Importance of Perceived Health and Appearance Consequences.

PubMed

Beeken, Rebecca J; Mahdi, Sundus; Johnson, Fiona; Meisel, Susanne F

2018-01-01

This study investigates whether health and appearance consequences predict intentions to prevent weight gain and whether these relationships differ in younger versus older adults and in men versus women. UK adults aged 18-26 years (younger adults; n = 584) or >45 years (older adults; n = 107) participated in an online survey. Logistic regression assessed associations between intentions to avoid gaining weight and age, gender as well as perceived negative consequences of weight gain for health and appearance. Co-variates were ethnicity, education, weight perception and perceived weight gain vulnerability. Interactions between age, gender and perceived health and appearance consequences of weight gain were also tested. Perceived negative appearance consequences of weight gain predicted weight gain prevention intentions (OR = 9.3, p < 0.001). Health concerns were not a significant predictor of intentions overall but were a strong predictor for older adults (age × health concern interaction: OR = 13.6, p > 0.01). Concerns about feeling unattractive predict intentions to prevent weight gain. However, health consequences of weight gain are only important motivators for older adults. Future research should identify ways to shift the focus of young people from appearance concerns towards the health benefits of maintaining a healthy weight. © 2018 The Author(s) Published by S. Karger GmbH, Freiburg.

Emotional eating as a mediator between depression and weight gain.

PubMed

van Strien, Tatjana; Konttinen, Hanna; Homberg, Judith R; Engels, Rutger C M E; Winkens, Laura H H

2016-05-01

Depression is often associated with weight gain but underlying mechanisms are unclear. This study assessed whether three psychological eating styles (emotional eating, external eating and restrained eating) act as mediators between depression and weight gain. We used structural equation modelling to test the hypothesized mediation models in a sample of 298 fathers and 294 mothers by assessing self-reported eating styles (Dutch Eating Behavior Questionnaire), depressive feelings (Depressive Mood List) and body mass index (BMI) at baseline and BMI after five years. In the model with emotional eating we also assessed the moderation effect of 5-HTTLPR genotype in a sub-sample of 520 Caucasians. All analyses were performed separately for the two sexes. Although the overall effect of depression on weight gain was statistically non-significant in both sexes, there was a causal chain between depression, emotional eating and weight gain in the mothers. Depressive symptoms were related to higher emotional eating and emotional eating predicted greater increases in BMI independently of depression. Moreover, the indirect effect (via emotional eating) of depression on BMI change was significant (Beta = 0.18, P = 0.026). This mediation effect was found to be independent of 5-HTTLPR genotype. No such mediation effect was found for the fathers. Further, external eating and restrained eating did not act as mediators between depression and weight gain in either sex. The finding that emotional eating acted as mediator between depression and weight gain in the mothers suggests that obesity interventions should take emotional eating into account. Copyright © 2016 Elsevier Ltd. All rights reserved.

Improvements in Cardiovascular Risk Factors in Young Adults in a Randomized Trial of Approaches to Weight Gain Prevention

PubMed Central

Wing, Rena R.; Tate, Deborah F.; Garcia, Katelyn R.; Bahnson, Judy; Lewis, Cora E.; Espeland, Mark A.

2017-01-01

Objective Weight gain occurs commonly in young adults and increases cardiovascular (CVD) risk. We previously reported that two self-regulation interventions reduced weight gain relative to control. Here we examine whether these interventions also benefit CVD risk factors. Methods SNAP (Study of Novel Approaches to Weight Gain Prevention) was a randomized trial in 2 academic settings (N=599; 18–35 years; body mass index 21–30 kg/m2) comparing two interventions (Self-Regulation with Small Changes; Self-Regulation with Large Changes) and Control. Small Changes taught participants to make daily small changes (approximately 100 calorie) in intake and activity. Large Changes taught participants to initially lose 5–10 pounds to buffer anticipated weight gains. CVD risk factors were assessed at baseline and 2 years in 471 participants. Results Although Large Changes was associated with more beneficial changes in glucose, insulin, and HOMA-IR than Control, these differences were not significant after adjusting for multiple comparisons or 2-year weight change. Comparison of participants grouped by percent weight change baseline to 2 years showed significant differences for several CVD risk factors, with no interaction with treatment condition. Conclusions Magnitude of weight change, rather than specific weight gain prevention interventions, was related to changes in CVD risk factors in young adults. PMID:28782918

Optimization of control gain by operator adjustment

NASA Technical Reports Server (NTRS)

Kruse, W.; Rothbauer, G.

1973-01-01

An optimal gain was established by measuring errors at 5 discrete control gain settings in an experimental set-up consisting of a 2-dimensional, first-order pursuit tracking task performed by subjects (S's). No significant experience effect on optimum gain setting was found in the first experiment. During the second experiment, in which control gain was continuously adjustable, high experienced S's tended to reach the previously determined optimum gain quite accurately and quickly. Less experienced S's tended to select a marginally optimum gain either below or above the experimentally determined optimum depending on initial control gain setting, although mean settings of both groups were equal. This quick and simple method is recommended for selecting control gains for different control systems and forcing functions.

Optical antenna gain. I - Transmitting antennas

NASA Technical Reports Server (NTRS)

Klein, B. J.; Degnan, J. J.

1974-01-01

The gain of centrally obscured optical transmitting antennas is analyzed in detail. The calculations, resulting in near- and far-field antenna gain patterns, assume a circular antenna illuminated by a laser operating in the TEM-00 mode. A simple polynomial equation is derived for matching the incident source distribution to a general antenna configuration for maximum on-axis gain. An interpretation of the resultant gain curves allows a number of auxiliary design curves to be drawn that display the losses in antenna gain due to pointing errors and the cone angle of the beam in the far field as a function of antenna aperture size and its central obscuration. The results are presented in a series of graphs that allow the rapid and accurate evaluation of the antenna gain which may then be substituted into the conventional range equation.

Preschool Interpersonal Relationships Predict Kindergarten Achievement: Mediated by Gains in Emotion Knowledge

PubMed Central

Torres, Marcela M.; Domitrovich, Celene E.; Bierman, Karen L.

2016-01-01

Using longitudinal data, this study tested a model in which preschool interpersonal relationships promoted kindergarten achievement in a pathway mediated by growth in emotion knowledge. The sample included 164 children attending Head Start (14% Hispanic-American, 30% African-American, 56% Caucasian; 56% girls). Preschool interpersonal relationships were indexed by student-teacher relationship closeness and positive peer interactions. Two measures of emotion knowledge (identifying emotions in photographs, recognizing emotions in stories) were assessed at the start and end of the preschool year. Structural equation models revealed that positive interpersonal relationships (with teachers and peers) predicted gains in emotion knowledge (identification, recognition) during the preschool year. Positive interpersonal relationships in preschool also predicted kindergarten achievement (controlling for initial preschool achievement); however, this association was mediated by gains in emotion knowledge during the preschool year. Implications are discussed for school readiness programs serving economically-disadvantaged children. PMID:27630379

The association between patient participation and functional gain following inpatient rehabilitation.

PubMed

Morghen, Sara; Morandi, Alessandro; Guccione, Andrew A; Bozzini, Michela; Guerini, Fabio; Gatti, Roberto; Del Santo, Francesco; Gentile, Simona; Trabucchi, Marco; Bellelli, Giuseppe

2017-08-01

To evaluate patients' participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training. All patients aged 65 years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors. A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95 % confidence interval 1.19-1.91). This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.

Weight Gain in Children with Cleft Lip and Palate without Use of Palatal Plates

PubMed Central

da Silva Freitas, Renato; Lopes-Grego, Andrey Bernardo; Dietrich, Helena Luiza Douat; Cerchiari, Natacha Regina de Moraes; Nakakogue, Tabatha; Tonocchi, Rita; Gabardo, Juarez; da Silva, Éder David Borges; Forte, Antonio Jorge

2012-01-01

Goals/Background. To evaluate children's growth in the first year of life, who have cleft palate and lip, without the use of palatal plates. Materials/Method. Chart review was conducted, retrospectively, in the Center for Integral Assistance of Cleft Lip and Palate (CAIF), in Brazil, between 2008 and 2009. Results for both genders were compared to the data published by the World Health Organization (WHO) regarding average weight gain in children during their first year of life. Results. Patients with syndromic diagnosis and with cleft classified as preforamen were excluded, resulting in a final number of 112 patients: 56 male and 56 female. Similar patterns were seen comparing the two genders. Although it was observed weight gain below the average until the 11th month in male patients and until 9 months in female patients, both genders remained at the 50th percentile (p50) and improved after the 4th month of age for boys and the 9th month of age for girls. Conclusion. Children with cleft palate weigh less than regular children during their first months of life. At the end of the first year, weight gain is similar comparing normal and affected children. However, factors that optimized weight gain included choosing the best treatment for each case, proper guidance, and multiprofessional integrated care. PMID:23304489

26 CFR 1.857-2 - Real estate investment trust taxable income and net capital gain.

Code of Federal Regulations, 2010 CFR

2010-04-01

... estate investment trust taxable income and net capital gain. (a) Real estate investment trust taxable... paid during the taxable year, and the net capital gain is excluded in computing real estate investment... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Real estate investment trust taxable income and...

Comparing WTP values of different types of QALY gain elicited from the general public.

PubMed

Pennington, Mark; Baker, Rachel; Brouwer, Werner; Mason, Helen; Hansen, Dorte Gyrd; Robinson, Angela; Donaldson, Cam

2015-03-01

The appropriate thresholds for decisions on the cost-effectiveness of medical interventions remain controversial, especially in 'end-of-life' situations. Evidence of the values placed on different types of health gain by the general public is limited. Across nine European countries, 17,657 people were presented with different hypothetical health scenarios each involving a gain of one quality adjusted life year (QALY) and asked about their willingness to pay (WTP) for that gain. The questions included quality of life (QoL) enhancing and life extending health gains, and a scenario where respondents faced imminent, premature death. The mean WTP values for a one-QALY gain composed of QoL improvements were modest (PPP$11,000). When comparing QALY gains obtained in the near future, the valuation of life extension exceeded the valuation of QoL enhancing gains (mean WTP PPP$19,000 for a scenario in which a coma is avoided). The mean WTP values were higher still when respondents faced imminent, premature death (PPP$29,000). Evidence from the largest survey on the value of health gains by the general public indicated a higher value for life extending gains compared with QoL enhancing gains. A further modest premium may be indicated for life extension when facing imminent, premature death. Copyright © 2013 John Wiley & Sons, Ltd.

Brain Gain am Beispiel Österreich

NASA Astrophysics Data System (ADS)

Aschbacher, Christine; Gejguš, Mirko; Sablik, Jozef

2016-06-01

BrainGain is a common trend within the last ten years in Europe and all-over the world. Managers, key players and scientists are allowed to choose wherever they want to work in the world. As there is a lack of qualified individuals for companies and universities, BrainGain has become a necessity, and mostly - the higher educated individuals are moving away according to a better offer elsewhere in the world. Therefore, a lot of expats are moving around with their families. Many times, the lack of integration at the current place, country or city, is the critical success factor for staying or leaving. Furthermore, if the family does not feel happy in the current location, then the manager or scientist will move away or return home and the investment will be lost. Moreover, many students have received a good education in a state university, however afterwards they have not secured a satisfactory job in the country where they have studied, therefore they are moving away to utilise their know-how. Measures to retain the know-how include a common placement and a welcome-culture in the country, and also exchanges on an international level.

Coherent Pump-Probe Interactions and Terahertz Intersubband Gain in Semiconductor Quantum Wells

NASA Technical Reports Server (NTRS)

Liu, Ansheng; Ning, Cun-Zheng

1999-01-01

In recent years there has been considerable interest in intersubband-transition-based infrared semiconductor quantum well (QW) lasers because of their potential applications. In the mid-infrared range, both electrically-injected quantum cascade lasers [1] and optically-pumped multiple QW lasers [2] have been experimentally realized. In these studies, optical gain is due to population inversion between the lasing subbands. It was also proposed that stimulated Raman scattering in QW systems can produce net infrared optical gain [3j. In such a nonlinear optical scheme, the appearance of optical gain that may lead to intersubband Raman lasers does not rely on the population inversion. Since, in tile resonant Raman process (Raman gain is the largest in this case), the pump field induces population redistribution among subbands in the QW s ystem, it seems that a realistic estimate of the optical gain has to include this effect. Perturbative calculations used in the previous work [3] may overestimate the Raman gain. In this paper we present a nonperturbative calculation of terahertz gain of optically-pumped semiconductor step quantum wells. Limiting optical transitions within the conduction band of QW, we solve the pump-field-induced nonequilibrium distribution function for each subband of the QW system from a set of coupled rate equations. Both intrasubband and intersubband relaxation processes in the quantum well system are included. Taking into account the coherent interactions between pump and THz (signal) waves, we we derive the susceptibility of the QW system for the THz field. For a GaAs/AlGaAs step QW, we calculate the Thz gain spectrum for different pump frequencies and intensities. Under moderately strong pumping (approximately 0.3 MW/sq cm), a significant THz gain (approximately 300/m) is predicted. It is also shown that the coherent wave interactions (resonant stimulated Raman processes) contribute significantly to the THz gain.

Comparison of functional gains after arthroscopic rotator cuff repair in patients over 70 years of age versus patients under 50 years of age: a prospective multicenter study.

PubMed

Moraiti, Constantina; Valle, Pablo; Maqdes, Ali; Boughebri, Omar; Dib, Chourky; Giakas, Giannis; Kany, Jean; Elkholti, Kamil; Garret, Jérôme; Katz, Denis; Leclère, Franck Marie; Valenti, Philippe

2015-02-01

satisfied, and only 1 (2.5%) was less satisfied. Rotator cuff tears are characterized by greater retraction in the frontal plane and greater fatty infiltration in patients older than 70 years compared with patients younger than 50 years. After arthroscopic repair, healing is greater for patients younger than 50 years. Functional gain is at least equal between the 2 groups. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Optical antenna gain. III - The effect of secondary element support struts on transmitter gain

NASA Technical Reports Server (NTRS)

Klein, B. J.; Degnan, J. J.

1976-01-01

The effect of a secondary-element spider support structure on optical antenna transmitter gain is analyzed. An expression describing the influence of the struts on the axial gain, in both the near and far fields, is derived as a function of the number of struts and their width. It is found that, for typical systems, the struts degrade the on-axis gain by less than 0.4 dB, and the first side-lobe level is not increased significantly. Contour plots have also been included to show the symmetry of the far-field distributions for three- and four-support members.

High-gain magnetized inertial fusion.

PubMed

Slutz, Stephen A; Vesey, Roger A

2012-01-13

Magnetized inertial fusion (MIF) could substantially ease the difficulty of reaching plasma conditions required for significant fusion yields, but it has been widely accepted that the gain is not sufficient for fusion energy. Numerical simulations are presented showing that high-gain MIF is possible in cylindrical liner implosions based on the MagLIF concept [S. A. Slutz et al Phys. Plasmas 17, 056303 (2010)] with the addition of a cryogenic layer of deuterium-tritium (DT). These simulations show that a burn wave propagates radially from the magnetized hot spot into the surrounding much denser cold DT given sufficient hot-spot areal density. For a drive current of 60 MA the simulated gain exceeds 100, which is more than adequate for fusion energy applications. The simulated gain exceeds 1000 for a drive current of 70 MA.

Body Weight Gain and Hyperphagia After Administration of SGLT-2 Inhibitor: A Case Report.

PubMed

Hamamoto, Hiromi; Noda, Mitsuhiko

2015-12-07

A detailed description is given of a case we encountered in which unexpectedly marked weight gain occurred following a treatment switch from a GLP-1 receptor agonist to an SGLT-2 inhibitor The patient, a 44-year-old man with type 2 diabetes mellitus, had gained about 10 kg in weight in the previous year. Therefore, metformin was replaced with liraglutide to obtain reduction of body weight. Although the patient lost about 8 kg (7%), during the 18-month period on the medication, the weight loss stabilized; therefore, the treatment was again switched to tofogliflozin to obtain further reduction of body weight. However, the patient reported increasing hunger and an exaggerated appetite from week 3 onward after the start of tofogliflozin, and gained about 9 kg in weight within 2 weeks, associated with a tendency towards increased HbA1c; therefore, tofogliflozin was discontinued. Immediate reinstitution of liraglutide resulted in reduction of the increased appetite, weight, and HbA1c level. Caution should be exercised against hyperphagia and weight gain due to hunger that may occur following discontinuation of a GLP-1 receptor agonist and/or initiation of an SGLT-2 inhibitor.

Weight gain in children on oxcarbazepine monotherapy.

PubMed

Garoufi, Anastasia; Vartzelis, George; Tsentidis, Charalambos; Attilakos, Achilleas; Koemtzidou, Evangelia; Kossiva, Lydia; Katsarou, Eustathia; Soldatou, Alexandra

2016-05-01

Studies of the effect of oxcarbazepine (OXC) on body growth of children with epilepsy are rare and their results are controversial. To the contrary, many studies have shown significant weight gain following valproate (VPA) treatment. To prospectively evaluate the effect of OXC monotherapy on growth patterns of children with epilepsy and compare it with the effect of VPA monotherapy. Fifty-nine otherwise healthy children, aged 3.7-15.9 years, with primary generalized, partial or partial with secondary generalization seizure disorder, were included in the study. Twenty six children were placed on OXC and thirty three on VPA monotherapy. Body weight (BW), height and body mass index (BMI) as well as their standard deviation scores (SDS), were evaluated prior to as well as 8 months post initiation of OXC or VPA therapy. Eight months post OXC-treatment, BW, SDS-BW, BMI and SDS-BMI increased significantly. The increase was similar to that observed in the VPA group. An additional 15.4% of children in the OXC group and 21.2% in the VPA group became overweight or obese. The effect of both OXC and VPA therapy on linear growth did not reach statistical significance. Similarly to VPA, OXC monotherapy resulted in a significant weight gain in children with epilepsy. Careful monitoring for excess weight gain along with counseling on adapting a healthy lifestyle should be offered to children on OXC therapy. Copyright © 2016 Elsevier B.V. All rights reserved.

Measuring learning gain: Comparing anatomy drawing screencasts and paper-based resources.

PubMed

Pickering, James D

2017-07-01

The use of technology-enhanced learning (TEL) resources is now a common tool across a variety of healthcare programs. Despite this popular approach to curriculum delivery there remains a paucity in empirical evidence that quantifies the change in learning gain. The aim of the study was to measure the changes in learning gain observed with anatomy drawing screencasts in comparison to a traditional paper-based resource. Learning gain is a widely used term to describe the tangible changes in learning outcomes that have been achieved after a specific intervention. In regard to this study, a cohort of Year 2 medical students voluntarily participated and were randomly assigned to either a screencast or textbook group to compare changes in learning gain across resource type. Using a pre-test/post-test protocol, and a range of statistical analyses, the learning gain was calculated at three test points: immediate post-test, 1-week post-test and 4-week post-test. Results at all test points revealed a significant increase in learning gain and large effect sizes for the screencast group compared to the textbook group. Possible reasons behind the difference in learning gain are explored by comparing the instructional design of both resources. Strengths and weaknesses of the study design are also considered. This work adds to the growing area of research that supports the effective design of TEL resources which are complimentary to the cognitive theory of multimedia learning to achieve both an effective and efficient learning resource for anatomical education. Anat Sci Educ 10: 307-316. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

Determination of the STIS CCD Gain

NASA Astrophysics Data System (ADS)

Riley, Allyssa; Monroe, TalaWanda; Lockwood, Sean

2016-09-01

This report summarizes the analysis and absolute gain results of the STIS Cycle 23 special calibration program 14424 that was designed to measure the gain of amplifiers A, C and D at nominal gain settings of 1 and 4 e-/DN. We used the mean-variance technique and the results indicate a <3.5% change in the gain for amplifier D from when it was originally calculated pre-flight. We compared these values to previous measurements from Cycles 17 through 23. This report outlines the observations, methodology, and results of the mean-variance technique.

Measurement of Antenna Bore-Sight Gain

NASA Technical Reports Server (NTRS)

Fortinberry, Jarrod; Shumpert, Thomas

2016-01-01

The absolute or free-field gain of a simple antenna can be approximated using standard antenna theory formulae or for a more accurate prediction, numerical methods may be employed to solve for antenna parameters including gain. Both of these methods will result in relatively reasonable estimates but in practice antenna gain is usually verified and documented via measurements and calibration. In this paper, a relatively simple and low-cost, yet effective means of determining the bore-sight free-field gain of a VHF/UHF antenna is proposed by using the Brewster angle relationship.

IQ Gains and the Binet Decrements.

ERIC Educational Resources Information Center

Flynn, James R.

1984-01-01

Thorndike's Stanford-Binet data suggest that from 1932 to 1971-72 preschool children enjoyed greater IQ gains than older children, possibly due to the rise of television. Additional analysis indicated that gains were either due to sampling error or totally antedated 1947. Gains of 12 IQ points were found for Americans. (Author/EGS)

The relation between promotional spending on drugs and their therapeutic gain: a cohort analysis

PubMed Central

Lexchin, Joel

2017-01-01

Background: Whether drug promotion helps or hinders appropriate prescribing by physicians is debated. This study examines the most heavily promoted drugs and the therapeutic value of those drugs to help determine whether doctors should be using promotional material to inform themselves about drugs. Methods: Lists were constructed of the 50 most heavily promoted drugs (amount of money spent on journal advertisements and visits by sales representatives) and the 50 top-selling drugs (by dollar value) for 2013, 2014 and 2015. Therapeutic gain was determined by examining ratings from the Patented Medicine Prices Review Board and the French drug bulletin Prescrire International and was categorized as major, moderate or little to none. For each of the 3 years, the number of drugs in the 3 therapeutic categories for drugs in both groups was compared. The amount and proportion of money spent on promotion for drugs in each of the 3 therapeutic categories for the 3 years was also determined. Results: Therapeutic ratings were available for 42 of 79 of the most heavily promoted drugs over the 3 years and for 40 of 61 of the top-selling drugs. Nearly all the money spent on promotion in each of the 3 years went to drugs with little to no therapeutic gain. The distribution of therapeutic gain for drugs in both groups was statistically significantly different only in 2013 (p = 0.04). Interpretation: Most of the money spent on promotion went to drugs that offer little to no therapeutic gain. This result calls into question whether doctors should read journal advertisements or see sales representatives to acquire information about important medical therapies. PMID:28912143

Trends and determinants of weight gains among OECD countries: an ecological study.

PubMed

Nghiem, S; Vu, X-B; Barnett, A

2018-06-01

Obesity has become a global issue with abundant evidence to indicate that the prevalence of obesity in many nations has increased over time. The literature also reports a strong association between obesity and economic development, but the trend that obesity growth rates may converge over time has not been examined. We propose a conceptual framework and conduct an ecological analysis on the relationship between economic development and weight gain. We also test the hypothesis that weight gain converges among countries over time and examine determinants of weight gains. This is a longitudinal study of 34 Organisation for Economic Cooperation and Development (OECD) countries in the years 1980-2008 using publicly available data. We apply a dynamic economic growth model to test the hypothesis that the rate of weight gains across countries may converge over time. We also investigate the determinants of weight gains using a longitudinal regression tree analysis. We do not find evidence that the growth rates of body weight across countries converged for all countries. However, there were groups of countries in which the growth rates of body weight converge, with five groups for males and seven groups for females. The predicted growth rates of body weight peak when gross domestic product (GDP) per capita reaches US$47,000 for males and US$37,000 for females in OECD countries. National levels of consumption of sugar, fat and alcohol were the most important contributors to national weight gains. National weight gains follow an inverse U-shape curve with economic development. Excessive calorie intake is the main contributor to weight gains. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

A weight-gain-for-gestational-age z score chart for the assessment of maternal weight gain in pregnancy.

PubMed

Hutcheon, Jennifer A; Platt, Robert W; Abrams, Barbara; Himes, Katherine P; Simhan, Hyagriv N; Bodnar, Lisa M

2013-05-01

To establish the unbiased relation between maternal weight gain in pregnancy and perinatal health, a classification for maternal weight gain is needed that is uncorrelated with gestational age. The goal of this study was to create a weight-gain-for-gestational-age percentile and z score chart to describe the mean, SD, and selected percentiles of maternal weight gain throughout pregnancy in a contemporary cohort of US women. The study population was drawn from normal-weight women with uncomplicated, singleton pregnancies who delivered at the Magee-Womens Hospital in Pittsburgh, PA, 1998-2008. Analyses were based on a randomly selected subset of 648 women for whom serial prenatal weight measurements were available through medical chart record abstraction (6727 weight measurements). The pattern of maternal weight gain throughout gestation was estimated by using a random-effects regression model. The estimates were used to create a chart with the smoothed means, percentiles, and SDs of gestational weight gain for each week of pregnancy. This chart allows researchers to express total weight gain as an age-standardized z score, which can be used in epidemiologic analyses to study the association between pregnancy weight gain and adverse or physiologic pregnancy outcomes independent of gestational age.

Charge Gain, Voltage Gain, and Node Capacitance of the SAPHIRA Detector Pixel by Pixel

NASA Astrophysics Data System (ADS)

Pastrana, Izabella M.; Hall, Donald N. B.; Baker, Ian M.; Jacobson, Shane M.; Goebel, Sean B.

2018-01-01

The University of Hawai`i Institute for Astronomy has partnered with Leonardo (formerly Selex) in the development of HgCdTe linear mode avalanche photodiode (L-APD) SAPHIRA detectors. The SAPHIRA (Selex Avalanche Photodiode High-speed Infra-Red Array) is ideally suited for photon-starved astronomical observations, particularly near infrared (NIR) adaptive optics (AO) wave-front sensing. I have measured the stability, and linearity with current, of a 1.7-um (10% spectral bandpass) infrared light emitting diode (IR LED) used to illuminate the SAPHIRA and have then utilized this source to determine the charge gain (in e-/ADU), voltage gain (in uV/ADU), and node capacitance (in fF) for each pixel of the 320x256@24um SAPHIRA. These have previously only been averages over some sub-array. Determined from the ratio of the temporal averaged signal level to variance under constant 1.7-um LED illumination, I present the charge gain pixel-by-pixel in a 64x64 sub-array at the center of the active area of the SAPHIRA (analyzed separately as four 32x32 sub-arrays) to be about 1.6 e-/ADU (σ=0.5 e-/ADU). Additionally, the standard technique of varying the pixel reset voltage (PRV) in 10 mV increments and recording output frames for the same 64x64 subarray found the voltage gain per pixel to be about 11.7 uV/ADU (σ=0.2 uV/ADU). Finally, node capacitance was found to be approximately 23 fF (σ=6 fF) utilizing the aforementioned charge and voltage gain measurements. I further discuss the linearity measurements of the 1.7-um LED used in the charge gain characterization procedure.

The impact of overdiagnosis on the selection of efficient lung cancer screening strategies.

PubMed

Han, Summer S; Ten Haaf, Kevin; Hazelton, William D; Munshi, Vidit N; Jeon, Jihyoun; Erdogan, Saadet A; Johanson, Colden; McMahon, Pamela M; Meza, Rafael; Kong, Chung Yin; Feuer, Eric J; de Koning, Harry J; Plevritis, Sylvia K

2017-06-01

The U.S. Preventive Services Task Force (USPSTF) recently updated their national lung screening guidelines and recommended low-dose computed tomography (LDCT) for lung cancer (LC) screening through age 80. However, the risk of overdiagnosis among older populations is a concern. Using four comparative models from the Cancer Intervention and Surveillance Modeling Network, we evaluate the overdiagnosis of the screening program recommended by USPSTF in the U.S. 1950 birth cohort. We estimate the number of LC deaths averted by screening (D) per overdiagnosed case (O), yielding the ratio D/O, to quantify the trade-off between the harms and benefits of LDCT. We analyze 576 hypothetical screening strategies that vary by age, smoking, and screening frequency and evaluate efficient screening strategies that maximize the D/O ratio and other metrics including D and life-years gained (LYG) per overdiagnosed case. The estimated D/O ratio for the USPSTF screening program is 2.85 (model range: 1.5-4.5) in the 1950 birth cohort, implying LDCT can prevent ∼3 LC deaths per overdiagnosed case. This D/O ratio increases by 22% when the program stops screening at an earlier age 75 instead of 80. Efficiency frontier analysis shows that while the most efficient screening strategies that maximize the mortality reduction (D) irrespective of overdiagnosis screen through age 80, screening strategies that stop at age 75 versus 80 produce greater efficiency in increasing life-years gained per overdiagnosed case. Given the risk of overdiagnosis with LC screening, the stopping age of screening merits further consideration when balancing benefits and harms. © 2017 UICC.

Height gain during early childhood is an important predictor of schooling and mathematics ability outcomes.

PubMed

Gandhi, Mihir; Ashorn, Per; Maleta, Kenneth; Teivaanmäki, Tiina; Duan, Xiaolian; Cheung, Yin Bun

2011-08-01

To examine the association between height gain at different stages of early childhood and schooling and cognitive outcomes in 12-year-old Malawian children. A prospective cohort study looking at the growth and development of 325 rural Malawian children. Main outcome measures were highest school grade completed, number of times repeating grades and percentage of correctly answered mathematical questions at 12 years of age. Height-for-age at 1 month and conditional height gain for 6, 18 and 60 months were used as predictors. Ordinal logistic and linear regression analyses were used to estimate the association and adjust for confounder. The conditional height gain during 18-60 months was positively associated with mathematics test results (p=0.003) and negatively associated with number of times repeating grades (p=0.011). It was not significantly associated with highest grade completed (p=0.194) if those who never attended school were included as having completed zero grade, but was positively (p=0.049) associated with this outcome among those who ever attended school. Height gain during the 18-60 months period of age was related to schooling and mathematics ability at age 12 years. The importance of promoting catch-up growth after the period when stunting is common should receive attention. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

Effect of intermittent kangaroo mother care on weight gain of low birth weight neonates with delayed weight gain.

PubMed

Samra, Nashwa M; Taweel, Amal El; Cadwell, Karin

2013-01-01

To evaluate intermittent Kangaroo Mother Care (KMC) with additional opportunities to breastfeed on weight gain of low birth weight (LBW) neonates with delayed weight gain. 40 LBW neonates were followed to see whether KMC with additional opportunities to breastfeed improved weight gain. In the KMC group, the mean age of regaining birth weight was significantly less (15.68 vs. 24.56 days) and the average daily weight gain was significantly higher (22.09 vs. 10.39 g, p < .001) than controls. KMC with additional opportunities to breastfeed was found to be an effective intervention for LBWs with delayed weight gain and should be considered to be an effective strategy.

Gains in Life Expectancy Associated with Higher Education in Men

PubMed Central

Bijwaard, Govert E.; van Poppel, Frans; Ekamper, Peter; Lumey, L. H.

2015-01-01

Background Many studies show large differences in life expectancy across the range of education, intelligence, and socio-economic status. As educational attainment, intelligence, and socio-economic status are highly interrelated, appropriate methods are required to disentangle their separate effects. The aim of this paper is to present a novel method to estimate gains in life expectancy specifically associated with increased education. Our analysis is based on a structural model in which education level, IQ at age 18 and mortality all depend on (latent) intelligence. The model allows for (selective) educational choices based on observed factors and on an unobserved factor capturing intelligence. Our estimates are based on information from health examinations of military conscripts born in 1944–1947 in The Netherlands and their vital status through age 66 (n = 39,798). Results Our empirical results show that men with higher education have lower mortality. Using structural models to account for education choice, the estimated gain in life expectancy for men moving up one educational level ranges from 0.3 to 2 years. The estimated gain in months alive over the observational period ranges from -1.2 to 5.7 months. The selection effect is positive and amounts to a gain of one to two months. Decomposition of the selection effect shows that the gain from selection on (latent) intelligence is larger than the gain from selection on observed factors and amounts to 1.0 to 1.7 additional months alive. Conclusion Our findings confirm the strong selection into education based on socio-economic status and intelligence. They also show significant higher life expectancy among individuals with higher education after the selectivity of education choice has been taken into account. Based on these estimates, it is plausible therefore that increases in education could lead to increases in life expectancy. PMID:26496647

Gains in Life Expectancy Associated with Higher Education in Men.

PubMed

Bijwaard, Govert E; van Poppel, Frans; Ekamper, Peter; Lumey, L H

2015-01-01

Many studies show large differences in life expectancy across the range of education, intelligence, and socio-economic status. As educational attainment, intelligence, and socio-economic status are highly interrelated, appropriate methods are required to disentangle their separate effects. The aim of this paper is to present a novel method to estimate gains in life expectancy specifically associated with increased education. Our analysis is based on a structural model in which education level, IQ at age 18 and mortality all depend on (latent) intelligence. The model allows for (selective) educational choices based on observed factors and on an unobserved factor capturing intelligence. Our estimates are based on information from health examinations of military conscripts born in 1944-1947 in The Netherlands and their vital status through age 66 (n = 39,798). Our empirical results show that men with higher education have lower mortality. Using structural models to account for education choice, the estimated gain in life expectancy for men moving up one educational level ranges from 0.3 to 2 years. The estimated gain in months alive over the observational period ranges from -1.2 to 5.7 months. The selection effect is positive and amounts to a gain of one to two months. Decomposition of the selection effect shows that the gain from selection on (latent) intelligence is larger than the gain from selection on observed factors and amounts to 1.0 to 1.7 additional months alive. Our findings confirm the strong selection into education based on socio-economic status and intelligence. They also show significant higher life expectancy among individuals with higher education after the selectivity of education choice has been taken into account. Based on these estimates, it is plausible therefore that increases in education could lead to increases in life expectancy.

Young Children's Analogical Problem Solving: Gaining Insights from Video Displays

ERIC Educational Resources Information Center

Chen, Zhe; Siegler, Robert S.

2013-01-01

This study examined how toddlers gain insights from source video displays and use the insights to solve analogous problems. Two- to 2.5-year-olds viewed a source video illustrating a problem-solving strategy and then attempted to solve analogous problems. Older but not younger toddlers extracted the problem-solving strategy depicted in the video…

Weight gain after adjuvant chemotherapy in patients with early breast cancer in Istanbul Turkey.

PubMed

Basaran, Gul; Turhal, Nazım Serdar; Cabuk, Devrim; Yurt, Nevin; Yurtseven, Gul; Gumus, Mahmut; Teomete, Mehmet; Dane, Faysal; Yumuk, Perran Fulden

2011-06-01

Weight gain is a well-known and unwanted complication of adjuvant chemotherapy in breast cancer. We observed that the female Turkish cancer patients frequently gain weight with adjuvant treatment of breast cancer and planned to examine the magnitude of this problem in early breast cancer patients treated at our hospital. A total of 176 early breast cancer patients who received their adjuvant systemic therapy in Marmara University Hospital between 2003 and 2007 are included in the study. We recorded their weight before and after chemotherapy and also a year after chemotherapy to find out whether the change with weight is transitory. We have also recorded demographic information, including the educational level, menopausal status, the type of chemotherapy or hormonal treatment administered stage of disease, marital status, occupation and the underlying diseases to analyze the relationship between change in weight and these parameters. Median age of patients was 53 and 72% of patients were postmenopausal. Educational level was equally distributed for primary education (27%), high school (40%), and university (33%). The majority of the patients (76%) was married, had two children (69%) and was housewife (60%). Family history of any cancer was high (32%). Most of the patients had stage II cancer (56%), received anthracyclines+/- taxane based chemotherapy (98%) and had no underlying disease (68%). The majority also did not smoke (73%) or drink alcohol (93%). A total of 67% and 72% patients gained weight upon completion and one year after completion of chemotherapy. Mean weight before the chemotherapy, upon completion of chemotherapy and one year after completion of chemotherapy were 68.9 kg, 70.6 kg (P = 0.000) and 71.9 kg (P = 0.000) respectively. Mean body mass index was 27.1 at baseline, 27.8 upon completion of chemotherapy (P = 0.000) and 28.3 one year after completion of chemotherapy (P = 0.000). Age, menopausal status, multiparity and presence of comorbid diseases

Comparison of Video Head Impulse Test (vHIT) Gains Between Two Commercially Available Devices and by Different Gain Analytical Methods.

PubMed

Lee, Sang Hun; Yoo, Myung Hoon; Park, Jun Woo; Kang, Byung Chul; Yang, Chan Joo; Kang, Woo Suk; Ahn, Joong Ho; Chung, Jong Woo; Park, Hong Ju

2018-06-01

To evaluate whether video head impulse test (vHIT) gains are dependent on the measuring device and method of analysis. Prospective study. vHIT was performed in 25 healthy subjects using two devices simultaneously. vHIT gains were compared between these instruments and using five different methods of comparing position and velocity gains during head movement intervals. The two devices produced different vHIT gain results with the same method of analysis. There were also significant differences in the vHIT gains measured using different analytical methods. The gain analytic method that compares the areas under the velocity curve (AUC) of the head and eye movements during head movements showed lower vHIT gains than a method that compared the peak velocities of the head and eye movements. The former method produced the vHIT gain with the smallest standard deviation among the five procedures tested in this study. vHIT gains differ in normal subjects depending on the device and method of analysis used, suggesting that it is advisable for each device to have its own normal values. Gain calculations that compare the AUC of the head and eye movements during the head movements show the smallest variance.

Tropical forests are a net carbon source based on aboveground measurements of gain and loss

NASA Astrophysics Data System (ADS)

Baccini, A.; Walker, W.; Carvalho, L.; Farina, M.; Sulla-Menashe, D.; Houghton, R. A.

2017-10-01

The carbon balance of tropical ecosystems remains uncertain, with top-down atmospheric studies suggesting an overall sink and bottom-up ecological approaches indicating a modest net source. Here we use 12 years (2003 to 2014) of MODIS pantropical satellite data to quantify net annual changes in the aboveground carbon density of tropical woody live vegetation, providing direct, measurement-based evidence that the world’s tropical forests are a net carbon source of 425.2 ± 92.0 teragrams of carbon per year (Tg C year-1). This net release of carbon consists of losses of 861.7 ± 80.2 Tg C year-1 and gains of 436.5 ± 31.0 Tg C year-1. Gains result from forest growth; losses result from deforestation and from reductions in carbon density within standing forests (degradation or disturbance), with the latter accounting for 68.9% of overall losses.

Controlling gain one photon at a time

PubMed Central

Schwartz, Gregory W; Rieke, Fred

2013-01-01

Adaptation is a salient property of sensory processing. All adaptational or gain control mechanisms face the challenge of obtaining a reliable estimate of the property of the input to be adapted to and obtaining this estimate sufficiently rapidly to be useful. Here, we explore how the primate retina balances the need to change gain rapidly and reliably when photons arrive rarely at individual rod photoreceptors. We find that the weakest backgrounds that decrease the gain of the retinal output signals are similar to those that increase human behavioral threshold, and identify a novel site of gain control in the retinal circuitry. Thus, surprisingly, the gain of retinal signals begins to decrease essentially as soon as background lights are detectable; under these conditions, gain control does not rely on a highly averaged estimate of the photon count, but instead signals from individual photon absorptions trigger changes in gain. DOI: http://dx.doi.org/10.7554/eLife.00467.001 PMID:23682314

Effect of Intermittent Kangaroo Mother Care on Weight Gain of Low Birth Weight Neonates With Delayed Weight Gain

PubMed Central

Samra, Nashwa M.; Taweel, Amal El; Cadwell, Karin

2013-01-01

Objective: To evaluate intermittent Kangaroo Mother Care (KMC) with additional opportunities to breastfeed on weight gain of low birth weight (LBW) neonates with delayed weight gain. Methods: 40 LBW neonates were followed to see whether KMC with additional opportunities to breastfeed improved weight gain. Results: In the KMC group, the mean age of regaining birth weight was significantly less (15.68 vs. 24.56 days) and the average daily weight gain was significantly higher (22.09 vs. 10.39 g, p < .001) than controls. Conclusion: KMC with additional opportunities to breastfeed was found to be an effective intervention for LBWs with delayed weight gain and should be considered to be an effective strategy. PMID:24868132

Energy expenditure, spontaneous physical activity and with weight gain in kidney transplant recipients.

PubMed

Heng, Anne-Elisabeth; Montaurier, Christophe; Cano, Noël; Caillot, Nicolas; Blot, A; Meunier, Nathalie; Pereira, Bruno; Marceau, Geoffroy; Sapin, Vincent; Jouve, Christelle; Boirie, Yves; Deteix, Patrice; Morio, Beatrice

2015-06-01

Alterations in energy metabolism could trigger weight gain after renal transplantation. Nineteen transplanted non-diabetic men, 53 ± 1.6 years old, receiving calcineurin inhibitors but no corticosteroids were studied. They were compared with nine healthy men matched for height, age and lean body mass. Daily energy expenditure and its components (sleeping, basal and absorptive metabolic rates) were analyzed for 24 h in calorimetric chambers and for 4 days in free living conditions using calibrated accelerometry. Other variables known to influence energy expenditure were assessed: body composition, physical activity, 4-day food intake, drug consumption, serum C-reactive protein, interleukin-6, thyroid and parathyroid hormones, and epinephrine. Transplant recipients who gained more than 5% body weight after transplantation (n = 11, +11.0 ± 1.5 kg) were compared with those who did not (n = 8) and with the controls. Weight gain compared with non-weight gain patients and controls exhibited higher fat mass without change in lean body mass. Daily, sleeping and resting energy expenditure adjusted for lean body mass was significantly higher in non-weight gain (167.1 ± 4.2 kJ/kg/lean body mass/24 h, P < 0.05) compared with weight gain patients (147.4 ± 3.6) and controls (146.1 ± 4.6). Weight gain compared with controls and non-weight gain subjects had lower free living physical activity and a higher consumption of antihypertensive drugs and β-blockers. After kidney transplantation, weight gain patients were characterized by lower adjusted energy expenditure, reduced spontaneous physical activity but a more sedentary life style and a trend toward a higher energy intake explaining the reason they gained weight. The nWG KTR had increased resting and sleeping EE which protected them from weight gain. Such hypermetabolism was also observed in 24-h EE measurements. By comparison with the nWG patients, the WG transplant recipients were characterized by higher �

Food availability as a determinant of weight gain among renal transplant recipients.

PubMed

Bloodworth, Robin F; Ward, Kenneth D; Relyea, George E; Cashion, Ann K

2014-06-01

Excessive weight gain is common after renal transplantation, but it is unknown whether environmental factors, such as food availability, contribute to this important clinical problem. We evaluated the effects of food availability (fast food restaurants, convenience stores, and grocery stores within 1, 2, and 3 mile buffers of transplant recipients' residences) on body mass index (BMI) change during the first year post-transplant. Participants (n = 299) resided in Memphis, Tennessee. BMI increased by 1.42 units (p < .001) corresponding to an average weight gain of 9.25 lbs (5.43%) during the first year post-transplant. The number of grocery stores within 1 mile of recipient's residence was associated with an increase in BMI (p < .05), but fast food restaurants and convenience stores were not significantly associated with BMI change. © 2014 Wiley Periodicals, Inc.

Nativity status/length of stay in the US and excessive gestational weight gain in New York City teens, 2008-2010.

PubMed

Huynh, Mary H; Borrell, Luisa N; Chambers, Earle C

2015-02-01

Nativity status/length of stay in the US has been found to be associated with obesity. However, little work has examined the role of nativity status/length of stay in excessive gestational weight gain (EGWG) in adolescents. This study utilized New York City Department of Health and Mental Hygiene birth certificate data in a cross-sectional analysis of 15,715 singleton births to primiparous teen mothers (12-19 years) between 2008 and 2010. Nativity and length of stay in the United States (US) were obtained from birth certificates. EGWG was calculated using weight at delivery and pre-pregnancy weight. Prevalence ratios were calculated through generalized estimating equations to assess the strength of the association between nativity status/length of US residence and EGWG. For US-born teens, 43 % gained more weight than recommended as compared to 32 % for foreign-born teens who have lived in the US for less than 5 years (FB <5 years). Following adjustment for maternal demographics and other factors, US-born teens (adjusted prevalence ratios (APR) (CI) 1.26 [1.18,1.34]), FB 10+ years (APR (CI) 1.17 [1.07,1.28]), and FB 5-10 years (APR (CI) 1.11 [1.01,1.21]) were more likely to have gained weight excessively as compared to FB <5 years. US-born teens and FB teens that have been in the US longer than 5 years are more likely to gain weight excessively during pregnancy as compared to teens with fewer than 5 years in the US. These results identify a critical period when adolescents are in frequent contact with health care providers and can receive counseling regarding healthy weight gain.

Association of gain and loss of weight before and after menopause with risk of postmenopausal breast cancer in the Iowa women's health study.

PubMed

Harvie, Michelle; Howell, Anthony; Vierkant, Robert A; Kumar, Nagi; Cerhan, James R; Kelemen, Linda E; Folsom, Aaron R; Sellers, Thomas A

2005-03-01

Obesity and adult weight gain are well-established risk factors for postmenopausal breast cancer. Although there are a few studies demonstrating the contribution of adult weight gain to breast cancer risk, whether weight gain during a critical time period is specifically associated with risk, or whether subsequent weight loss among women who have gained weight will reduce the excess risk, is not firmly established. We investigated the association of changes in weight (loss or gain in excess of 5% of body weight) using two risk factor models: (a) age 18 to 30 years and age 30 years to menopause and (b) age 30 years to menopause and after the menopause to the baseline study in 1986 on risk of postmenopausal breast cancer in a prospective cohort of 33,660 postmenopausal women in Iowa. Over 15 years of follow-up, 1,987 cases of breast cancer occurred. Data were analyzed using proportional hazards regression models adjusted for established breast cancer risk factors. The most frequently observed pattern of body weight over time was a consistent increase; these women were observed to have the highest rates of breast cancer and served as the reference category for all comparisons. The lowest-risk groups were (a) women who maintained or lost weight from age 18 to 30 years and then lost weight from age 30 years to menopause [risk ratio (RR), 0.36; 95% confidence interval (95% CI), 0.22-0.60] and (b) women who maintained or lost weight from age 30 years to menopause and then lost weight after the menopause (RR, 0.48; 95% CI, 0.22-0.65). Women who gained weight from age 30 years to menopause but then lost weight after the menopause experienced risk reductions (RR, 0.77; 95% CI, 0.64-0.92) although perhaps slightly smaller in magnitude than women who maintained their weight in both time intervals (RR, 0.63; 95% CI, 0.55-0.73). Women who gained weight from age 18 to 30 years and then lost weight from age 30 years to menopause had comparable risk reductions (RR, 0.61; 95% CI, 0

Modification of saccadic gain by reinforcement

PubMed Central

Paeye, Céline; Wallman, Josh

2011-01-01

Control of saccadic gain is often viewed as a simple compensatory process in which gain is adjusted over many trials by the postsaccadic retinal error, thereby maintaining saccadic accuracy. Here, we propose that gain might also be changed by a reinforcement process not requiring a visual error. To test this hypothesis, we used experimental paradigms in which retinal error was removed by extinguishing the target at the start of each saccade and either an auditory tone or the vision of the target on the fovea was provided as reinforcement after those saccades that met an amplitude criterion. These reinforcement procedures caused a progressive change in saccade amplitude in nearly all subjects, although the rate of adaptation differed greatly among subjects. When we reversed the contingencies and reinforced those saccades landing closer to the original target location, saccade gain changed back toward normal gain in most subjects. When subjects had saccades adapted first by reinforcement and a week later by conventional intrasaccadic step adaptation, both paradigms yielded similar degrees of gain changes and similar transfer to new amplitudes and to new starting positions of the target step as well as comparable rates of recovery. We interpret these changes in saccadic gain in the absence of postsaccadic retinal error as showing that saccade adaptation is not controlled by a single error signal. More generally, our findings suggest that normal saccade adaptation might involve general learning mechanisms rather than only specialized mechanisms for motor calibration. PMID:21525366

Low levels of physical activity are associated with dysregulation of energy intake and fat mass gain over 1 year.

PubMed

Shook, Robin P; Hand, Gregory A; Drenowatz, Clemens; Hebert, James R; Paluch, Amanda E; Blundell, John E; Hill, James O; Katzmarzyk, Peter T; Church, Timothy S; Blair, Steven N

2015-12-01

Previous studies suggest that appetite may be dysregulated at low levels of activity, creating an energy imbalance that results in weight gain. The aim was to examine the relation between energy intake, physical activity, appetite, and weight gain during a 1-y follow-up period in a large sample of adults. Participants included 421 individuals (mean ± SD age: 27.6 ± 3.8 y). Measurements included the following: energy intake with the use of interviewer-administered dietary recalls and calculated by using changes in body composition and energy expenditure, moderate-to-vigorous physical activity (MVPA) with the use of an arm-based monitor, body composition with the use of dual-energy X-ray absorptiometry, and questionnaire-derived perceptions of dietary restraint, disinhibition, hunger, and control of eating. Participants were grouped at baseline into quintiles of MVPA (min/d) by sex. Measurements were repeated every 3 mo for 1 y. At baseline, an inverse relation existed between body weight and activity groups, with the least-active group (15.7 ± 9.9 min MVPA/d, 6062 ± 1778 steps/d) having the highest body weight (86.3 ± 13.2 kg) and the most-active group (174.5 ± 60.5 min MVPA/d, 10260 ± 3087 steps/d) having the lowest body weight (67.5 ± 11.0 kg). A positive relation was observed between calculated energy intake and activity group, except in the lowest quintile of activity. The lowest physical activity group reported higher levels of disinhibition (P = 0.07) and cravings for savory foods (P = 0.03) compared with the group with the highest level of physical activity. Over 1 y of follow-up, the lowest activity group gained the largest amount of fat mass (1.7 ± 0.3 kg) after adjustment for change in MVPA and baseline fat mass. The odds of gaining >3% of fat mass were between 1.8 and 3.8 times as high for individuals in the least-active group as for those in the middle activity group. These results suggest that low levels of physical activity are a risk factor

Longitudinal associations between key dietary behaviors and weight gain over time: transitions through the adolescent years.

PubMed

Laska, Melissa N; Murray, David M; Lytle, Leslie A; Harnack, Lisa J

2012-01-01

Previous studies have yielded inconsistent results when documenting the association between key dietary factors and adolescent weight change over time. The purpose of this study was to examine the extent to which changes in adolescent sugar-sweetened beverage (SSB), diet soda, breakfast, and fast-food consumption were associated with changes in BMI and percent body fat (PBF). This study analyzed data from a sample of 693 Minnesota adolescents followed over 2 years. Random coefficient models were used to examine the relationship between dietary intake and BMI and PBF and to separate cross-sectional and longitudinal associations. Adjusting for total physical activity, total energy intake, puberty, race, socioeconomic status, and age, cross-sectional findings indicated that for both males and females, breakfast consumption was significantly and inversely associated with BMI and PBF, and diet soda intake was significantly and positively associated with BMI and PBF among females. In longitudinal analyses, however, there were fewer significant associations. Among males there was evidence of a significant longitudinal association between SSB consumption and PBF; after adjustment for energy intake, an increase of one serving of SSB per day was associated with an increase of 0.7 units of PBF among males. This study adds to previous research through its methodological strengths, including adjustment for physical activity and energy intake assessed using state-of-the-art methods (i.e., accelerometers and 24-h dietary recalls), as well as its evaluation of both BMI and PBF. Additional research is needed to better understand the complex constellation of factors that contribute to adolescent weight gain over time.

Variable gain for a wind turbine pitch control

NASA Technical Reports Server (NTRS)

Seidel, R. C.; Birchenough, A. G.

1981-01-01

The gain variation is made in the software logic of the pitch angle controller. The gain level is changed depending upon the level of power error. The control uses low gain for low pitch activity the majority of the time. If the power exceeds ten percent offset above rated, the gain is increased to a higher gain to more effectively limit power. A variable gain control functioned well in tests on the Mod-0 wind turbine.

Contrast Gain Control in Auditory Cortex

PubMed Central

Rabinowitz, Neil C.; Willmore, Ben D.B.; Schnupp, Jan W.H.; King, Andrew J.

2011-01-01

Summary The auditory system must represent sounds with a wide range of statistical properties. One important property is the spectrotemporal contrast in the acoustic environment: the variation in sound pressure in each frequency band, relative to the mean pressure. We show that neurons in ferret auditory cortex rescale their gain to partially compensate for the spectrotemporal contrast of recent stimulation. When contrast is low, neurons increase their gain, becoming more sensitive to small changes in the stimulus, although the effectiveness of contrast gain control is reduced at low mean levels. Gain is primarily determined by contrast near each neuron's preferred frequency, but there is also a contribution from contrast in more distant frequency bands. Neural responses are modulated by contrast over timescales of ∼100 ms. By using contrast gain control to expand or compress the representation of its inputs, the auditory system may be seeking an efficient coding of natural sounds. PMID:21689603

Rosiglitazone Decreases C-Reactive Protein to a Greater Extent Relative to Glyburide and Metformin Over 4 Years Despite Greater Weight Gain

PubMed Central

Kahn, Steven E.; Haffner, Steven M.; Viberti, Giancarlo; Herman, William H.; Lachin, John M.; Kravitz, Barbara G.; Yu, Dahong; Paul, Gitanjali; Holman, Rury R.; Zinman, Bernard

2010-01-01

OBJECTIVE C-reactive protein (CRP) is closely associated with obesity and cardiovascular disease in both diabetic and nondiabetic populations. In the short term, commonly prescribed antidiabetic agents have different effects on CRP; however, the long-term effects of those agents are unknown. RESEARCH DESIGN AND METHODS In A Diabetes Outcome Progression Trial (ADOPT), we examined the long-term effects of rosiglitazone, glyburide, and metformin on CRP and the relationship among CRP, weight, and glycemic variables in 904 subjects over 4 years. RESULTS Baseline CRP was significantly correlated with homeostasis model assessment of insulin resistance (HOMA-IR), A1C, BMI, waist circumference, and waist-to-hip ratio. CRP reduction was greater in the rosiglitazone group by −47.6% relative to glyburide and by −30.5% relative to metformin at 48 months. Mean weight gain from baseline (at 48 months) was 5.6 kg with rosiglitazone, 1.8 kg with glyburide, and −2.8 kg with metformin. The change in CRP from baseline to 12 months was correlated positively with change in BMI in glyburide (r = 0.18) and metformin (r = 0.20) groups but not in the rosiglitazone (r = −0.05, NS) group. However, there was no longer a significant correlation between change in CRP and change in HOMA-IR, A1C, or waist-to-hip ratio in any of the three treatment groups. CONCLUSIONS Rosiglitazone treatment was associated with durable reductions in CRP independent of changes in insulin sensitivity, A1C, and weight gain. CRP in the glyburide and metformin groups was positively associated with changes in weight, but this was not the case with rosiglitazone. PMID:19808911

Cost-Effectiveness Analysis of Using Loss of Heterozygosity to Manage Premalignant Oral Dysplasia in British Columbia, Canada.

PubMed

Cromwell, Ian; Regier, Dean A; Peacock, Stuart J; Poh, Catherine F

2016-09-01

Management of low-grade oral dysplasias (LGDs) is complicated, as only a small percentage of lesions will progress to invasive disease. The current standard of care requires patients to undergo regular monitoring of their lesions, with intervention occurring as a response to meaningful clinical changes. Recent improvements in molecular technologies and understanding of the biology of LGDs may allow clinicians to manage lesions based on their genome-guided risk. We used a decision-analytic Markov model to estimate the cost-effectiveness of risk-stratified care using a genomic assay. In the experimental arm, patients with LGDs were managed according to their risk profile using the assay, with low- and intermediate-risk patients given longer screening intervals and high-risk patients immediately treated with surgery. Patients in the comparator arm had standard care (biannual follow-up appointments at an oral cancer clinic). Incremental costs and outcomes in life-years gained (LYG) and quality-adjusted life-years (QALY) were calculated based on the results in each arm. The mean cost of assay-guided management was $8,123 (95% confidence interval [CI] $2,973 to $23,062 in 2013 Canadian dollars) less than the cost of standard care. This difference was driven largely by reductions in resource use among people who did not develop cancer. Mean incremental effectiveness was 0.18 LYG (95% CI 0.08 to 0.39) or 0.64 QALY (95% CI 0.46 to 0.89). Sensitivity analysis suggests that these findings are robust to both expected and extreme variation in all parameter values. Use of the assay-guided management strategy costs less and is more effective than standard management of LGDs. The findings of this study strongly suggest that the use of a risk-stratification method such as a genomic assay can result in improved quality-adjusted survival outcomes for patients with low-grade oral dysplasia (LGD). The use of such an assay in this study provides "precision medicine," allowing for a

Computer algorithm for coding gain

NASA Technical Reports Server (NTRS)

Dodd, E. E.

1974-01-01

Development of a computer algorithm for coding gain for use in an automated communications link design system. Using an empirical formula which defines coding gain as used in space communications engineering, an algorithm is constructed on the basis of available performance data for nonsystematic convolutional encoding with soft-decision (eight-level) Viterbi decoding.

Reversal of olanzapine-induced weight gain in a patient with schizophrenia by switching to asenapine: a case report.

PubMed

Okazaki, Kosuke; Yamamuro, Kazuhiko; Kishimoto, Toshifumi

2017-01-01

Antipsychotics are effective for treating schizophrenia, but atypical antipsychotics can cause several adverse side effects including weight gain, hyperprolactinemia, and extrapyramidal symptoms. Moreover, weight gain increases the risk of metabolic diseases. We treated a case of olanzapine-induced weight gain in a 41-year-old man with schizophrenia by switching his medication from olanzapine to asenapine. The weight gain improved after switching the medication, from 80.3 to 75.0 kg, a weight loss of 6.6%, and there was no significant worsening of psychological symptoms or other adverse effects. Asenapine might be effective for treating patients with schizophrenia who experience olanzapine-induced weight gain.

Direct measurements of fluorine atom concentration, gain length and small signal gain in an hydrogen fluoride overtone laser

NASA Astrophysics Data System (ADS)

Wisniewski, Charles F.; Hewett, Kevin B.; Manke, Gerald C., II; Randall Truman, C.; Hager, Gordon D.

2003-03-01

Experimental techniques have been developed to directly measure the concentration of fluorine atoms, the gain length and the small signal gain in a hydrogen fluoride 5 cm slit nozzle laser. A gas phase titration technique was utilized to measure the fluorine atom concentration using HCl as the titrant. The gain length was measured using a pitot probe to locate the interface of the primary flow with the high Mach number shroud flows. A tunable diode laser was utilized to perform small signal gain measurements on HF overtone ( ν=2→0) transitions.

Bilingual Resource Instruction for Development of Gainful Employment Skills. Project BRIDGES, 1987-88.

ERIC Educational Resources Information Center

Berney, Tomi D.; Adelman, Miriam

The Bilingual Resources for Development of Gainful Employment skills (Project BRIDGES) was a federally-funded program in its second year of a 3-year funding cycle. Project BRIDGES aimed at developing the academic and vocational skills of limited-English-proficient (LEP) students who had failed two or more classes and were at risk of dropping out.…

Glucagon-like peptide-1 analogs against antipsychotic-induced weight gain: potential physiological benefits

PubMed Central

2012-01-01

Background Antipsychotic-induced weight gain constitutes a major unresolved clinical problem which may ultimately be associated with reducing life expectancy by 25 years. Overweight is associated with brain deterioration, cognitive decline and poor quality of life, factors which are already compromised in normal weight patients with schizophrenia. Here we outline the current strategies against antipsychotic-induced weight gain, and we describe peripheral and cerebral effects of the gut hormone glucagon-like peptide-1 (GLP-1). Moreover, we account for similarities in brain changes between schizophrenia and overweight patients. Discussion Current interventions against antipsychotic-induced weight gain do not facilitate a substantial and lasting weight loss. GLP-1 analogs used in the treatment of type 2 diabetes are associated with significant and sustained weight loss in overweight patients. Potential effects of treating schizophrenia patients with antipsychotic-induced weight gain with GLP-1 analogs are discussed. Conclusions We propose that adjunctive treatment with GLP-1 analogs may constitute a new avenue to treat and prevent metabolic and cerebral deficiencies in schizophrenia patients with antipsychotic-induced weight gain. Clinical research to support this idea is highly warranted. PMID:22891821

Cost-effectiveness analysis of rotavirus vaccination in Argentina.

PubMed

Urueña, Analía; Pippo, Tomás; Betelu, María Sol; Virgilio, Federico; Hernández, Laura; Giglio, Norberto; Gentile, Ángela; Diosque, Máximo; Vizzotti, Carla

2015-05-07

Rotavirus is a leading cause of severe diarrhea in children under 5. In Argentina, the most affected regions are the Northeast and Northwest, where hospitalizations and deaths are more frequent. This study estimated the cost-effectiveness of adding either of the two licensed rotavirus vaccines to the routine immunization schedule. The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (Version 2.0) was used to assess health benefits, costs savings, life-years gained (LYGs), DALYs averted, and cost/DALY averted of vaccinating 10 successive cohorts, from the health care system and societal perspectives. Two doses of monovalent (RV1) rotavirus vaccine and three doses of pentavalent (RV5) rotavirus vaccine were each compared to a scenario assuming no vaccination. The price/dose was US$ 7.50 and US$ 5.15 for RV1 and RV5, respectively. We ran both a national and sub-national analysis, discounting all costs and benefits 3% annually. Our base case results were compared to a range of alternative univariate and multivariate scenarios. The number of LYGs was 5962 and 6440 for RV1 and RV5, respectively. The cost/DALY averted when compared to no vaccination from the health care system and societal perspective was: US$ 3870 and US$ 1802 for RV1, and US$ 2414 and US$ 358 for RV5, respectively. Equivalent figures for the Northeast were US$ 1470 and US$ 636 for RV1, and US$ 913 and US$ 80 for RV5. Therefore, rotavirus vaccination was more cost-effective in the Northeast compared to the whole country; and, in the Northwest, health service's costs saved outweighed the cost of introducing the vaccine. Vaccination with either vaccine compared to no vaccination was highly cost-effective based on WHO guidelines and Argentina's 2011 per capita GDP of US$ 9090. Key variables influencing results were vaccine efficacy, annual loss of efficacy, relative coverage of deaths, vaccine price, and discount rate. Compared to no

Gain-phase modulation in chirped-pulse amplification

NASA Astrophysics Data System (ADS)

Shen, Yijie; Gao, Gan; Meng, Yuan; Fu, Xing; Gong, Mali

2017-10-01

The cross-modulation between the gain and chirped phase in chirped-pulse amplification (CPA) is theoretically and experimentally demonstrated. We propose a gain-phase coupled nonlinear Schrödinger equation (GPC-NLSE) for solving chirped-pulse propagation in a nonlinear gain medium involved in the gain-phase modulation (GPM) process. With the GPC-NLSE, the space-time-frequency-dependent gain, chirped phase, pulse, and spectrum evolutions can be precisely calculated. Moreover, a short-length high-gain Yb-doped fiber CPA experiment is presented in which a self-steepening distortion of the seed pulse is automatically compensated after amplification. This phenomenon can be explained by the GPM theory whereas conventional models cannot. The experimental results for the temporal and spectral intensities show excellent agreement with our theory. Our GPM theory paves the way for further investigations of the finer structures of the pulse and spectrum in CPA systems.

Maternal weight change between 1 and 2 years postpartum: the importance of 1 year weight retention.

PubMed

Lipsky, Leah M; Strawderman, Myla S; Olson, Christine M

2012-07-01

Pregnancy weight gain may lead to long-term increases in maternal BMI for some women. The objective of this study was to examine maternal body weight change 1y-2y postpartum, and to compare classifications of 2y weight retention with and without accounting for 1y-2y weight gain. Early pregnancy body weight (EPW, first trimester) was measured or imputed, and follow-up measures obtained before delivery, 1 year postpartum (1y) and 2 years postpartum (2y) in an observational cohort study of women seeking prenatal care in several counties in upstate New York (n = 413). Baseline height was measured; demographic and behavioral data were obtained from questionnaires and medical records. Associations of 1y-2y weight change (kg) and 1y-2y weight gain (≥2.25 kg) with anthropometric, socioeconomic, and behavioral variables were evaluated using linear and logistic regressions. While mean ± SE 1y-2y weight change was 0.009 ± 4.6 kg, 1y-2y weight gain (≥2.25 kg) was common (n = 108, 26%). Odds of weight gain 1y-2y were higher for overweight (OR(adj) = 2.63, CI(95%) = 1.43-4.82) and obese (OR(adj) = 2.93, CI(95%) = 1.62-5.27) women than for women with BMI <25. Two year weight retention (2y-EPW ≥2.25 kg) was misclassified in 38% (n = 37) of women when 1y-2y weight gain was ignored. One year weight retention (1YWR) (1y-EPW) was negatively related to 1y-2y weight change (β(adj) ± SE = -0.28 ± 0.04, P < 0.001) and weight gain (≥2.25 kg) (OR(adj) = 0.91, CI(95%) = 0.87-0.95). Relations between 1y weight retention and 1y-2y weight change were attenuated for women with higher early pregnancy BMI. Weight change 1y-2y was predicted primarily by an inverse relation with 1y weight retention. The high frequency of weight gain has important implications for classification of postpartum weight retention.

Maternal Weight Change Between 1 and 2 Years Postpartum: The Importance of 1 Year Weight Retention

PubMed Central

Lipsky, Leah M.; Strawderman, Myla S.; Olson, Christine M.

2016-01-01

Pregnancy weight gain may lead to long-term increases in maternal BMI for some women. The objective of this study was to examine maternal body weight change 1y–2y postpartum, and to compare classifications of 2y weight retention with and without accounting for 1y–2y weight gain. Early pregnancy body weight (EPW, first trimester) was measured or imputed, and follow-up measures obtained before delivery, 1 year postpartum (1y) and 2 years postpartum (2y) in an observational cohort study of women seeking prenatal care in several counties in upstate New York (n = 413). Baseline height was measured; demographic and behavioral data were obtained from questionnaires and medical records. Associations of 1y–2y weight change (kg) and 1y–2y weight gain (≥2.25 kg) with anthropometric, socioeconomic, and behavioral variables were evaluated using linear and logistic regressions. While mean ± SE 1y–2y weight change was 0.009 ± 4.6 kg, 1y–2y weight gain (≥2.25 kg) was common (n = 108, 26%). Odds of weight gain 1y–2y were higher for overweight (ORadj = 2.63, CI95% = 1.43–4.82) and obese (ORadj = 2.93, CI95% = 1.62–5.27) women than for women with BMI <25. Two year weight retention (2y–EPW ≥2.25 kg) was misclassified in 38% (n = 37) of women when 1y–2y weight gain was ignored. One year weight retention (1YWR) (1y–EPW) was negatively related to 1y–2y weight change (βadj ± SE = −0.28 ± 0.04, P < 0.001) and weight gain (≥2.25 kg) (ORadj = 0.91, CI95% = 0.87–0.95). Relations between 1y weight retention and 1y–2y weight change were attenuated for women with higher early pregnancy BMI. Weight change 1y–2y was predicted primarily by an inverse relation with 1y weight retention. The high frequency of weight gain has important implications for classification of postpartum weight retention. PMID:22334257

Optimal PID gain schedule for hydrogenerators

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

Orelind, G.; Wozniak, L.; Medanic, J.

1989-09-01

This paper describes the development and testing of a digital gain switching governor for hydrogenerators. Optimal gains were found at different load points by minimizing a quadratic performance criterion prior to controller operating. During operation, the gain sets are switched in depending on the gate position and speed error magnitude. With gain switching operating, the digital governor was shown to have a substantial reduction of noise on the command signal and up to 42% faster responses to power requests. Non-linear control strategies enabled the digital governor to have a 2.5% to 2% reduction in speed overshoot on startups, and anmore » 8% to 1% reduction in undershoot on load rejections as compared to the analog.« less

Sudden Gains During Therapy of Social Phobia

PubMed Central

Hofmann, Stefan G.; Schulz, Stefan M.; Meuret, Alicia E.; Moscovitch, David A.; Suvak, Michael

2007-01-01

The present study investigated the phenomenon of sudden gains in 107 participants with social phobia (social anxiety disorder) who received either cognitive–behavioral group therapy or exposure group therapy without explicit cognitive interventions, which primarily used public speaking situations as exposure tasks. Twenty-two out of 967 session-to-session intervals met criteria for sudden gains, which most frequently occurred in Session 5. Individuals with sudden gains showed similar improvements in the 2 treatment groups. Although cognitive–behavioral therapy was associated with more cognitive changes than exposure therapy, cognitive changes did not precede sudden gains. In general, the results of this study question the clinical significance of sudden gains in social phobia treatment. PMID:16881776

Linear Growth and Fat and Lean Tissue Gain during Childhood: Associations with Cardiometabolic and Cognitive Outcomes in Adolescent Indian Children.

PubMed

Krishnaveni, Ghattu V; Veena, Sargoor R; Srinivasan, Krishnamachari; Osmond, Clive; Fall, Caroline H D

2015-01-01

We aimed to determine how linear growth and fat and lean tissue gain during discrete age periods from birth to adolescence are related to adolescent cardiometabolic risk factors and cognitive ability. Adolescents born to mothers with normal glucose tolerance during pregnancy from an Indian birth cohort (N = 486, age 13.5 years) had detailed anthropometry and measurements of body fat (fat%), fasting plasma glucose, insulin and lipid concentrations, blood pressure and cognitive function. Insulin resistance (HOMA-IR) was calculated. These outcomes were examined in relation to birth measurements and statistically independent measures (conditional SD scores) representing linear growth, and fat and lean tissue gain during birth-1, 1-2, 2-5, 5-9.5 and 9.5-13.5 years in 414 of the children with measurements at all these ages. Birth length and linear growth at all ages were positively associated with current height. Fat gain, particularly during 5-9.5 years was positively associated with fat% at 13.5 years (0.44 SD per SD [99.9% confidence interval: 0.29,0.58]). Greater fat gain during mid-late childhood was associated with higher systolic blood pressure (5-9.5 years: 0.23 SD per SD [0.07,0.40]) and HOMA-IR (5-9.5 years: 0.24 [0.08,0.40], 9.5-13.5 years: 0.22 [0.06,0.38]). Greater infant growth (up to age 2 years) in linear, fat or lean components was unrelated to cardiometabolic risk factors or cognitive function. This study suggests that factors that increase linear, fat and lean growth in infancy have no adverse cardiometabolic effects in this population. Factors that increase fat gain in mid-late childhood may increase cardiometabolic risk, without any benefit to cognitive abilities.

The Economic Gains of Achieving Reduced Alcohol Consumption Targets for Australia

PubMed Central

Magnus, Anne; Cadilhac, Dominique; Sheppard, Lauren; Cumming, Toby; Pearce, Dora; Carter, Rob

2012-01-01

Objectives. To inform prevention policy, we estimated the economic benefits to health, production, and leisure in the 2008 Australian population of a realistic target reduction in per capita annual adult alcohol consumption. Methods. We chose a target of 6.4 liters annually per capita on average. We modeled lifetime health benefits as fewer incident cases of alcohol-related disease, deaths, and disability adjusted life years. We estimated production gains with surveyed participation and absenteeism rates. We valued gains with friction cost and human capital methods. We estimated and valued household production and leisure gains from time-use surveys. Results. A reduction of 3.4 liters of alcohol consumed annually per capita would result in one third fewer incident cases of disease (98 000), deaths (380), working days lost (5 million), days of home-based production lost (54 000), and a A$ 789-million health sector cost reduction. Workforce production had a A$ 427 million gain when we used the friction cost method. By contrast, we estimated a loss of 28 000 leisure days and 1000 additional early retirements. Conclusions. Economic savings and health benefits from reduced alcohol consumption may be substantial—particularly in the health sector with reduced alcohol-related disease and injury. PMID:22594720

Experience gained from treating facial injuries due to civil unrest

PubMed Central

Whitlock, R I H

1981-01-01

During the past 10 years of civil unrest in Northern Ireland a wide variety of facial injuries have been treated at the Royal Victoria Hospital, Belfast. The causes and nature of these injuries are described and the experience gained in their management is reviewed. Imagesp[35]-ap[42]-aFig. 1Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7 PMID:7247260

CONDITIONS FOR CSR MICROBUNCHING GAIN SUPPRESSION

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

Tsai, Cheng Ying; Douglas, David R.; Li, Rui

The coherent synchrotron radiation (CSR) of a high brightness electron beam traversing a series of dipoles, such as transport arcs, may result in phase space degradation. On one hand, the CSR can perturb electron transverse motion in dispersive regions along the beamline, causing emittance growth. On the other hand, the CSR effect on the longitudinal beam dynamics could result in microbunching gain enhancement. For transport arcs, several schemes have been proposed* to suppress the CSR-induced emittance growth. Similarly, several scenarios have been introduced** to suppress CSR-induced microbunching gain, which however mostly aim for linac-based machines. In this paper we trymore » to provide sufficient conditions for suppression of CSR-induced microbunching gain along a transport arc, analogous to*. Several example lattices are presented, with the relevant microbunching analyses carried out by our semi-analytical Vlasov solver***. The simulation results show that lattices satisfying the proposed conditions indeed have microbunching gain suppressed. We expect this analysis can shed light on lattice design approach that could suppress the CSR-induced microbunching gain.« less

Longitudinal weight gain in women identified with polycystic ovary syndrome: results of an observational study in young women.

PubMed

Teede, Helena J; Joham, Anju E; Paul, Eldho; Moran, Lisa J; Loxton, Deborah; Jolley, Damien; Lombard, Catherine

2013-08-01

Polycystic ovary syndrome (PCOS) affects 6-18% of women. The natural history of weight gain in women with PCOS has not been well described. Here we aimed to examine longitudinal weight gain in women with and without PCOS and to assess the association between obesity and PCOS prevalence. The observational study was set in the general community. Participants were women randomly selected from the national health insurance scheme (Medicare) database. Mailed survey data were collected by the Australian Longitudinal Study on Women's Health. Data from respondents to survey 4, aged 28-33 years (2006, n = 9,145) were analyzed. The main outcome measures were PCOS prevalence and body mass index (BMI). Self-reported PCOS prevalence was 5.8% (95% CI: 5.3%-6.4%). Women reporting PCOS had higher weight, mean BMI [2.5 kg/m(2) (95% CI: 1.9-3.1)], and greater 10-year weight gain [2.6 kg (95% CI: 1.2-4.0)]. BMI was the strongest correlate of PCOS status with every BMI increment increasing the risk of reporting PCOS by 9.2% (95% CI: 6%-12%). This community based observational study with longitudinal reporting of weight shows that weight, BMI, and 10-year weight gain were higher in PCOS. We report the novel finding that obesity and greater weight gain are significantly associated with PCOS status. Considering the prevalence, major health and economic burden of PCOS, the increasing weight gain in young women, and established benefits of weight loss, these results have major public health implications. Copyright © 2012 The Obesity Society.

Polyurethane foam pica in a patient with excessive interdialytic weight gain

PubMed Central

Iyasere, Osasuyi; Allington, Ying; Cafferkey, Michele

2010-01-01

Maintaining fluid balance in haemodialysis patients is important because of the adverse effects of excessive interdialytic weight gain. This often requires fluid restriction that patients often struggle with. We report a case of a 31-year-old female diabetic patient on haemodialysis with repeated excessive interdialytic weight gains despite fluid restriction and dry weight adjustment. It was subsequently discovered that she devised an unusual, albeit unsuccessful, strategy of eating the polyurethane foam from her dialysis chair while increasing her fluid intake hoping that it would absorb excess water in the gut! This under-diagnosed phenomenon known as pica has been reported in renal patients with substances such as ice, clay and baking soda. PMID:22767521

Early Gains in Renal Function Following Implantation of HeartMate II Left Ventricular Assist Devices May Not Persist to One Year.

PubMed

Hasin, Tal; Grupper, Avishay; Dillon, John J; Maleszewski, Joseph J; Li, Zhuo; Topilsky, Yan; Frantz, Robert P; Edwards, Brooks S; Pereira, Naveen L; Maltais, Simon; Stulak, John M; Joyce, Lyle; Daly, Richard; Park, Soon J; Kushwaha, Sudhir S

Renal function improves early after left ventricular assist device (LVAD) implantation but later decline has been observed. We sought to determine the occurrence and evaluate possible causes for this decline. In 62 consecutive patients with HeartMateII LVAD with available calculated glomerular filtration rate (GFR, ml/min/1.73 m) 1 year after implant, GFR was assessed repeatedly and possible predictors for decline from 3 to 12 months were investigated. Post-mortem renal specimens for patients supported with an LVAD were evaluated. GFR 54.5 ± 19.5 at admission increased to 66.4 ± 22.3 preoperatively and to 79.2 ± 30.1 ~1 month after implantation. Subsequently at ~3 months GFR declined to 74.7 ± 25.4, at ~6 months to 68.8 ± 23.1, and ~1 year after implant to 63.9 ± 17.7. Glomerular filtration rate at 1 year was significantly lower (p < 0.0001, p < 0.0001, p = 0.005) than GFR 1, 3, and 6 months after implant. Early rise in GFR after surgery was not associated with late decline. Shorter bypass time (β = -0.09, p = 0.048) and higher albumin 3 months after LVAD (β = 14.4, p = 0.025) were significantly associated with less later decline in GFR. Arteriosclerosis was identified in autopsy renal specimens. In conclusion, early gains in renal function after LVAD implant are not sustained in many patients. Patient, device, and operative factors may influence long-term renal function in these patients.

Impact of Age and Race on Outcomes of a Program to Prevent Excess Weight Gain and Disordered Eating in Adolescent Girls.

PubMed

Burke, Natasha L; Shomaker, Lauren B; Brady, Sheila; Reynolds, James C; Young, Jami F; Wilfley, Denise E; Sbrocco, Tracy; Stephens, Mark; Olsen, Cara H; Yanovski, Jack A; Tanofsky-Kraff, Marian

2017-08-28

Interpersonal psychotherapy (IPT) prevents weight gain and reduces loss-of-control (LOC)-eating in adults. However, IPT was not superior to health-education (HE) for preventing excess weight gain and reducing LOC-eating over 1-year in adolescent girls at risk for excess weight gain and eating disorders. Limited data suggest that older and non-White youth may be especially responsive to IPT. In secondary analyses, we examined if age or race moderated weight and LOC-eating outcomes. The 113 participants (12-17 years; 56.6% White) from the original trial were re-contacted 3 years later for assessment. At baseline and follow-up visits through 3 years, we assessed BMI, adiposity by dual energy X-ray absorptiometry, and LOC-eating presence. In linear mixed models, baseline age moderated 3-year BMI outcome; older girls in IPT had the lowest 3-year BMI gain compared to younger girls in IPT and all girls in HE, p = 0.04. A similar pattern was observed for adiposity. Race moderated 3-year LOC-eating; non-White girls in IPT were most likely to abstain from LOC-eating at 3 years compared to all other girls, p = 0.04. This hypothesis-generating analysis suggests future studies should determine if IPT is especially efficacious at reducing LOC-eating in older, non-White adolescents.

Weight gain - unintentional

MedlinePlus

... Cushing syndrome Underactive thyroid, or low thyroid (hypothyroidism) Polycystic ovary syndrome Menopause Pregnancy Bloating, or swelling due to a buildup of fluid in the tissues can cause weight gain. This may be due to menstruation, heart ...

Is Weight Gain after Smoking Cessation Inevitable?

ERIC Educational Resources Information Center

Talcott, Gerald W.; And Others

1995-01-01

Studied weight gain after smoking cessation in a naturalistic setting where all smokers quit and risk factors for postcessation weight gain were modified. Results showed no significant weight changes for smokers who quit. Suggests that an intensive program featuring dietary guidelines and increased physical activity can attenuate weight gain. (RJM)

Approximate reversibility in the context of entropy gain, information gain, and complete positivity

NASA Astrophysics Data System (ADS)

Buscemi, Francesco; Das, Siddhartha; Wilde, Mark M.

2016-06-01

There are several inequalities in physics which limit how well we can process physical systems to achieve some intended goal, including the second law of thermodynamics, entropy bounds in quantum information theory, and the uncertainty principle of quantum mechanics. Recent results provide physically meaningful enhancements of these limiting statements, determining how well one can attempt to reverse an irreversible process. In this paper, we apply and extend these results to give strong enhancements to several entropy inequalities, having to do with entropy gain, information gain, entropic disturbance, and complete positivity of open quantum systems dynamics. Our first result is a remainder term for the entropy gain of a quantum channel. This result implies that a small increase in entropy under the action of a subunital channel is a witness to the fact that the channel's adjoint can be used as a recovery map to undo the action of the original channel. We apply this result to pure-loss, quantum-limited amplifier, and phase-insensitive quantum Gaussian channels, showing how a quantum-limited amplifier can serve as a recovery from a pure-loss channel and vice versa. Our second result regards the information gain of a quantum measurement, both without and with quantum side information. We find here that a small information gain implies that it is possible to undo the action of the original measurement if it is efficient. The result also has operational ramifications for the information-theoretic tasks known as measurement compression without and with quantum side information. Our third result shows that the loss of Holevo information caused by the action of a noisy channel on an input ensemble of quantum states is small if and only if the noise can be approximately corrected on average. We finally establish that the reduced dynamics of a system-environment interaction are approximately completely positive and trace preserving if and only if the data processing

Body weight gain induced by a newer antipsychotic agent reversed as negative symptoms improved.

PubMed

Koga, M; Nakayama, K

2005-07-01

We describe a patient in whom improvement in negative symptoms contributed to early weight loss and subsequent long-term improvement in weight management. Case report. A 26-year-old woman with schizophrenia gained 7 kg over the course of 1 year after starting treatment with olanzapine. However, as negative symptoms gradually improved with treatment, she became motivated to diet and exercise regularly. She quickly lost 9 kg and subsequently maintained optimal weight (55 kg; body mass index, 24.1 kg/m(2) ). Important strategies for minimizing weight gain in patients taking antipsychotic agents include improving negative symptoms of avolition and apathy, regular monitoring of body weight and potential medical consequences of overweight and obesity, and educating the patient about the importance of diet and regular exercise.

Development of the Exercise Motives and Gains Inventory

ERIC Educational Resources Information Center

Strömmer, Sofia T.; Ingledew, David K.; Markland, David

2015-01-01

There are existing measures of exercise motives (what people want from exercise), but corresponding measures of gains (what people get) are needed, because motives and gains could influence each other and together influence other variables. An exercise motives and gains inventory (EMGI) was developed by creating gains scales to complement existing…

Nicotine Replacement: Effects on Postcessation Weight Gain.

ERIC Educational Resources Information Center

Gross, Janet; And Others

1989-01-01

Examined nicotine replacement effects on postcessation weight gain in smoking cessation volunteers. Randomly assigned abstinent subjects to active nicotine or placebo gum conditions for 10 weeks. Analyses revealed strong evidence for gum effect on weight gain, with active gum users gaining mean total of 3.8 pounds compared with 7.8 pounds for…

Influence of Maturation Stage on Agility Performance Gains After Plyometric Training: A Systematic Review and Meta-analysis.

PubMed

Asadi, Abbas; Arazi, Hamid; Ramirez-Campillo, Rodrigo; Moran, Jason; Izquierdo, Mikel

2017-09-01

Asadi, A, Arazi, H, Ramirez-Campillo, R, Moran, J, and Izquierdo, M. Influence of maturation stage on agility performance gains after plyometric training: a systematic review and meta-analysis. J Strength Cond Res 31(9): 2609-2617, 2017-Although plyometric training (PT) improves change of direction (COD) ability, the influence of age on COD gains after PT is unclear. Therefore, the aim of this systematic review was to identify the age-related pattern of improvement in COD ability after PT in youths. A computerized search within 6 databases was performed, selecting studies based on specific inclusion criteria: experimental trials published in English-language journals, PT focused on the lower-body, COD ability measurements reported before and after training, and male participants aged 10 to 18 years. Sixteen articles with a total of 30 effect sizes (ESs) in the experimental groups and 13 ESs in the control groups were included. For the analyses, subjects were categorized into 3 age groups: 10-12.9 years of age (PRE), 13-15.9 years of age (MID), and 16-18 years of age (POST). Independent of age, PT improved COD ability in youths (ES = 0.86, time gains [TG = -0.61]). However, a tendency toward greater COD ability gains was observed in older subjects (MID, ES = 0.95; POST, ES = 0.99) compared with younger subjects (PRE, ES = 0.68). Pearson product-moment correlation (r) indicated that 2-weekly sessions of PT-induced meaningful COD ability gains (for ES, r = 0.436; for TG, r = -0.624). A positive relationship was found between training intensity and ES (r = 0.493). In conclusion, PT improves COD ability in youths, with meaningfully greater effects in older youths. Two PT sessions per week, with 1,400 moderate-intensity jumps for 7 weeks, seems to be an adequate dose.

Insulin detemir attenuates food intake, body weight gain and fat mass gain in diet-induced obese Sprague-Dawley rats.

PubMed

Rojas, J M; Printz, R L; Niswender, K D

2011-07-04

Initiation and intensification of insulin therapy commonly causes weight gain, a barrier to therapy. A contrasting body of evidence indicates that insulin functions as an adiposity negative feedback signal and reduces food intake, weight gain and adiposity via action in the central nervous system. Basal insulin analogs, detemir (Det) and glargine (Glar), have been associated with less hypoglycemia compared with neutral protamine hagedorn insulin, and Det with less weight gain, especially in patients with higher body mass index (BMI). We sought to determine whether insulin therapy per se causes body weight and fat mass gain when delivered via a clinically relevant subcutaneous (SC) route in the absence of hypoglycemia and glycosuria in non-diabetic lean and diet-induced obese rats. Rats were exposed to either a low-fat diet (LFD; 13.5% fat) or high-fat diet (HFD; 60% fat), and received Det (0.5 U kg(-1)), Glar (0.2 U kg(-1)) or vehicle (Veh) SC once daily for 4 weeks. These dosages of insulin were equipotent in rats with respect to blood-glucose concentration and did not induce hypoglycemia. As predicted by current models of energy homeostasis, neither insulin Det nor Glar therapy affected food intake and weight gain in LFD rats. Det treatment significantly attenuated food intake, body weight gain and fat mass gain relative to the Glar and Veh in high-fat fed animals, mirroring observations in humans. That neither insulin group gained excess weight, suggests weight gain with SC basal insulin therapy may not be inevitable. Our data further suggest that Det possesses a unique property to attenuate the development of obesity associated with a HFD.

Early weight gain predicts outcome in two treatments for adolescent anorexia nervosa.

PubMed

Le Grange, Daniel; Accurso, Erin C; Lock, James; Agras, Stewart; Bryson, Susan W

2014-03-01

Determine whether early weight gain predicts full remission at end-of-treatment (EOT) and follow-up in two different treatments for adolescent anorexia nervosa (AN), and to track the rate of weight gain throughout treatment and follow-up. Participants were 121 adolescents with AN (mean age = 14.4 years, SD = 1.6), from a two-site (Chicago and Stanford) randomized controlled trial. Adolescents were randomly assigned to family-based treatment (FBT) (n = 61) or individual adolescent focused therapy (AFT) (n = 60). Treatment response was assessed using percent of expected body weight (EBW) and the global score on the Eating Disorder Examination (EDE). Full remission was defined as having achieved ≥95% EBW and within one standard deviation of the community norms of the EDE. Full remission was assessed at EOT as well as 12-month follow-up. Receiver operating characteristic analyses showed that the earliest predictor of remission at EOT was a gain of 5.8 pounds (2.65 kg) by session 3 in FBT (area under the curve (AUC) = 0.670; p = .043), and a gain of 7.1 pounds (3.20 kg) by session 4 in AFT (AUC = 0.754, p = .014). Early weight gain did not predict remission at follow-up for either treatment. A survival analysis showed that weight was marginally superior in FBT as opposed to AFT (Wald chi-square = 3.692, df = 1, p = .055). Adolescents with AN who receive either FBT or AFT, and show early weight gain, are likely to remit at EOT. However, FBT is superior to AFT in terms of weight gain throughout treatment and follow-up. Copyright © 2013 Wiley Periodicals, Inc.

The Physics of Advanced High-Gain Targets for Inertial Fusion Energy

NASA Astrophysics Data System (ADS)

Perkins, L. John

2010-11-01

In ca. 2011-2012, the National Ignition Facility is poised to demonstrate fusion ignition and gain in the laboratory for the first time. This key milestone in the development of inertial confinement fusion (ICF) can be expected to engender interest in the development of inertial fusion energy (IFE) and expanded efforts on a number of advanced targets that may achieve high fusion energy gain at lower driver energies. In this tutorial talk, we will discuss the physics underlying ICF ignition and thermonuclear burn, examine the requirements for high gain, and outline candidate R&D programs that will be required to assess the performance of these target concepts under various driver systems including lasers, heavy-ions and pulsed power. Such target concepts include those operating by fast ignition, shock ignition, impact ignition, dual-density, magnetically-insulated, one- and two-sided drive, etc., some of which may have potential to burn advanced, non-DT fusion fuels. We will then delineate the role of such targets in their application to the production of high average fusion power. Here, systems studies of IFE economics suggest that we should strive for target fusion gains of around 100 at drive energies of 1MJ, together with corresponding rep-rates of up to 10Hz and driver electrical efficiencies around 15%. In future years, there may be exciting opportunities to study such ``innovative confinement concepts'' with prospects of fielding them on facilities such as NIF to obtain high fusion energy gains on a single shot basis.

Biologic Agents Are Associated with Excessive Weight Gain in Children with Inflammatory Bowel Disease.

PubMed

Haas, Leonard; Chevalier, Rachel; Major, Brittny T; Enders, Felicity; Kumar, Seema; Tung, Jeanne

2017-11-01

Children with active inflammatory bowel disease (IBD) are frequently underweight. Anti-tumor necrosis factor (anti-TNF) agents may induce remission and restore growth. However, its use in other autoimmune diseases has been associated with excess weight gain. Our aim was to examine whether children with IBD could experience excess weight gain. A centralized diagnostic index identified pediatric IBD patients evaluated at our institution who received anti-TNF therapy for at least 1 year between August 1998 and December 2013. Anthropometric data were collected at time of anti-TNF initiation and annually. Excess weight gain was defined as ΔBMI SDS (standard deviation score) where patients were (1) reclassified from "normal" to "overweight/obese," (2) "overweight" to "obese," or (2) a final BMI SDS >0 and ΔSDS >0.5. During the study period, 268 children received anti-TNF therapy. Of these, 69 had sufficient follow-up for a median of 29.3 months. Median age at first anti-TNF dose was 12.8 years. At baseline, mean weight SDS was -0.7 (SD 1.4), while mean BMI SDS was -0.6 (1.3). Using baseline BMI SDS, 11.6% were overweight/obese. At last follow-up (LFU), however, the mean ΔBMI SDS was 0.50 (p < 0.0001). However, 10 (17%) patients had excess weight gain at LFU; 3 patients were reclassified from "normal" to "obese," and 7 had a final BMI SDS >0 and ΔSDS >0.5. Pediatric patients with IBD may experience excess weight gain when treated with anti-TNF agents. Monitoring for this side effect is warranted.

How should gestational weight gain be assessed? A comparison of existing methods and a novel method, area under the weight gain curve

PubMed Central

Kleinman, Ken P; Oken, Emily; Radesky, Jenny S; Rich-Edwards, Janet W; Peterson, Karen E; Gillman, Matthew W

2007-01-01

Background Gestational weight gain is important to assess for epidemiological and public health purposes: it is correlated with infant growth and may be related to maternal outcomes such as reproductive health and chronic disease risk. Methods commonly used to assess weight gain incorporate assumptions that are usually not borne out, such as a linear weight gain, or do not account for differential length of gestation. Methods We introduce a novel method to assess gestational weight gain, the area under the weight gain curve. This is easily interpretable as the additional pound-days carried due to pregnancy and avoids many flaws in alternative assessments. We compare the performance of the simple difference, weekly gain, Institute of Medicine categories and the area under the weight gain curve in predicting birthweight and maternal weight retention at 6, 12, 24 and 36 months post-partum. The analytic sample comprises 2016 participants in Project Viva, an observational prospective cohort study of pregnant women in Massachusetts. Results For birthweight outcomes, none of the weight gain measures is a meaningfully superior predictor. For 6-month postpartum weight retention the simple difference is superior, while for 12-, 24- and 36-month weight retention the area under the weight gain curve is superior. Conclusions These findings are plausible biologically: the same amount of weight gained early vs later in the pregnancy may reflect increased maternal fat stores. The timing of weight gain is reflected best in the area under the weight gain curve. Different methods of measuring gestational weight gain may be appropriate depending on the context. PMID:17715174

Coverage Gains After the Affordable Care Act Among the Uninsured in Minnesota.

PubMed

Call, Kathleen Thiede; Lukanen, Elizabeth; Spencer, Donna; Alarcón, Giovann; Kemmick Pintor, Jessie; Baines Simon, Alisha; Gildemeister, Stefan

2015-11-01

We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesota's insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future.

Low levels of physical activity are associated with dysregulation of energy intake and fat mass gain over 1 year12

PubMed Central

Shook, Robin P; Hand, Gregory A; Drenowatz, Clemens; Hebert, James R; Paluch, Amanda E; Blundell, John E; Hill, James O; Katzmarzyk, Peter T; Church, Timothy S; Blair, Steven N

2015-01-01

Background: Previous studies suggest that appetite may be dysregulated at low levels of activity, creating an energy imbalance that results in weight gain. Objective: The aim was to examine the relation between energy intake, physical activity, appetite, and weight gain during a 1-y follow-up period in a large sample of adults. Design: Participants included 421 individuals (mean ± SD age: 27.6 ± 3.8 y). Measurements included the following: energy intake with the use of interviewer-administered dietary recalls and calculated by using changes in body composition and energy expenditure, moderate-to-vigorous physical activity (MVPA) with the use of an arm-based monitor, body composition with the use of dual-energy X-ray absorptiometry, and questionnaire-derived perceptions of dietary restraint, disinhibition, hunger, and control of eating. Participants were grouped at baseline into quintiles of MVPA (min/d) by sex. Measurements were repeated every 3 mo for 1 y. Results: At baseline, an inverse relation existed between body weight and activity groups, with the least-active group (15.7 ± 9.9 min MVPA/d, 6062 ± 1778 steps/d) having the highest body weight (86.3 ± 13.2 kg) and the most-active group (174.5 ± 60.5 min MVPA/d, 10260 ± 3087 steps/d) having the lowest body weight (67.5 ± 11.0 kg). A positive relation was observed between calculated energy intake and activity group, except in the lowest quintile of activity. The lowest physical activity group reported higher levels of disinhibition (P = 0.07) and cravings for savory foods (P = 0.03) compared with the group with the highest level of physical activity. Over 1 y of follow-up, the lowest activity group gained the largest amount of fat mass (1.7 ± 0.3 kg) after adjustment for change in MVPA and baseline fat mass. The odds of gaining >3% of fat mass were between 1.8 and 3.8 times as high for individuals in the least-active group as for those in the middle activity group. Conclusions: These results suggest

Compensatory Prekindergarteners' I.Q. Gain Correlated with Third Grade Reading Achievement.

ERIC Educational Resources Information Center

Archer, Philip D.; Sewall, Michael B.

The purpose of this study was to investigate the correlation between gain on the Stanford-Binet Intelligence Test (S-B) in compensatory prekindergarten programs, and scores on the New York State Pupil Evaluation Program (PEP), Reading Section, over three years later. Four hundred and five subjects showed a correlation of 0.42 for the pre-post S-B…

Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis

PubMed Central

2012-01-01

Background The General Medical Services primary care contract for the United Kingdom financially rewards performance in 19 clinical areas, through the Quality and Outcomes Framework. Little is known about how best to determine the size of financial incentives in pay for performance schemes. Our aim was to test the hypothesis that performance indicators with larger population health benefits receive larger financial incentives. Methods We performed cross sectional analyses to quantify associations between the size of financial incentives and expected health gain in the 2004 and 2006 versions of the Quality and Outcomes Framework. We used non-parametric two-sided Spearman rank correlation tests. Health gain was measured in expected lives saved in one year and in quality adjusted life years. For each quality indicator in an average sized general practice we tested for associations first, between the marginal increase in payment and the health gain resulting from a one percent point improvement in performance and second, between total payment and the health gain at the performance threshold for maximum payment. Results Evidence for lives saved or quality adjusted life years gained was found for 28 indicators accounting for 41% of the total incentive payments. No statistically significant associations were found between the expected health gain and incentive gained from a marginal 1% increase in performance in either the 2004 or 2006 version of the Quality and Outcomes Framework. In addition no associations were found between the size of financial payment for achievement of an indicator and the expected health gain at the performance threshold for maximum payment measured in lives saved or quality adjusted life years. Conclusions In this subgroup of indicators the financial incentives were not aligned to maximise health gain. This disconnection between incentive and expected health gain risks supporting clinical activities that are only marginally effective, at the

IQ Gains in Argentina between 1964 and 1998

ERIC Educational Resources Information Center

Flynn, James R.; Rossi-Case, Lilia

2012-01-01

The literature on IQ gains in Latin America is sparse. We estimate gains on Raven's Progressive Matrices in the city of La Plata (Argentina) between 1964 and 1998. The gains are robust at the top of the curve as well as at the bottom. Therefore, they are contrary to the hypothesis that nutrition played a major role in recent Argentine IQ gains.…

Tropical forests are a net carbon source based on aboveground measurements of gain and loss.

PubMed

Baccini, A; Walker, W; Carvalho, L; Farina, M; Sulla-Menashe, D; Houghton, R A

2017-10-13

The carbon balance of tropical ecosystems remains uncertain, with top-down atmospheric studies suggesting an overall sink and bottom-up ecological approaches indicating a modest net source. Here we use 12 years (2003 to 2014) of MODIS pantropical satellite data to quantify net annual changes in the aboveground carbon density of tropical woody live vegetation, providing direct, measurement-based evidence that the world's tropical forests are a net carbon source of 425.2 ± 92.0 teragrams of carbon per year (Tg C year -1 ). This net release of carbon consists of losses of 861.7 ± 80.2 Tg C year -1 and gains of 436.5 ± 31.0 Tg C year -1 Gains result from forest growth; losses result from deforestation and from reductions in carbon density within standing forests (degradation or disturbance), with the latter accounting for 68.9% of overall losses. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

Loss restlessness and gain calmness: durable effects of losses and gains on choice switching.

PubMed

Yechiam, Eldad; Zahavi, Gal; Arditi, Eli

2015-08-01

While the traditional conceptualization of the effect of losses focuses on bias in the subjective weight of losses compared with respective gains, some accounts suggest more global task-related effects of losses. Based on a recent attentional theory, we predicted a positive after-effect of losses on choice switching in later tasks. In two experimental studies, we found increased choice switching rates in tasks with losses compared to tasks with no losses. Additionally, this heightened shifting behavior was maintained in subsequent tasks that do not include losses, a phenomenon we refer to as "loss restlessness." Conversely, gains were found to have an opposite "calming" effect on choice switching. Surprisingly, the loss restlessness phenomenon was observed following an all-losses payoff regime but not after a task with symmetric mixed gains and losses. This suggests that the unresolved mental account following an all-losses regime increases search behavior. Potential implications to macro level phenomena, such as the leverage effect, are discussed.

Modeling health gains and cost savings for ten dietary salt reduction targets.

PubMed

Wilson, Nick; Nghiem, Nhung; Eyles, Helen; Mhurchu, Cliona Ni; Shields, Emma; Cobiac, Linda J; Cleghorn, Christine L; Blakely, Tony

2016-04-26

Dietary salt reduction is included in the top five priority actions for non-communicable disease control internationally. We therefore aimed to identify health gain and cost impacts of achieving a national target for sodium reduction, along with component targets in different food groups. We used an established dietary sodium intervention model to study 10 interventions to achieve sodium reduction targets. The 2011 New Zealand (NZ) adult population (2.3 million aged 35+ years) was simulated over the remainder of their lifetime in a Markov model with a 3 % discount rate. Achieving an overall 35 % reduction in dietary salt intake via implementation of mandatory maximum levels of sodium in packaged foods along with reduced sodium from fast foods/restaurant food and discretionary intake (the "full target"), was estimated to gain 235,000 QALYs over the lifetime of the cohort (95 % uncertainty interval [UI]: 176,000 to 298,000). For specific target components the range was from 122,000 QALYs gained (for the packaged foods target) down to the snack foods target (6100 QALYs; and representing a 34-48 % sodium reduction in such products). All ten target interventions studied were cost-saving, with the greatest costs saved for the mandatory "full target" at NZ$1260 million (US$820 million). There were relatively greater health gains per adult for men and for Māori (indigenous population). This work provides modeling-level evidence that achieving dietary sodium reduction targets (including specific food category targets) could generate large health gains and cost savings for a national health sector. Demographic groups with the highest cardiovascular disease rates stand to gain most, assisting in reducing health inequalities between sex and ethnic groups.

Association of mGFR of the Remaining Kidney Divided by Its Volume before Donation with Functional Gain in mGFR among Living Kidney Donors.

PubMed

Courbebaisse, Marie; Gaillard, François; Tissier, Anne-Marie; Fournier, Catherine; Le Nestour, Alexis; Corréas, Jean-Michel; Slimani-Thevenet, Hind; Martinez, Frank; Léon, Carine; Eladari, Dominique; Timsit, Marc-Olivier; Otal, Philippe; Hignette, Chantal; Friedlander, Gérard; Méjean, Arnaud; Houillier, Pascal; Kamar, Nassim; Legendre, Christophe

2016-08-08

The predictors of long-term renal function in living kidney donors are currently discussed. Our objectives were to describe the predictors of functional gain of the remaining kidney after kidney donation. We hypothesized that GFR of the remaining kidney divided by volume of this kidney (rk-GFR/vol) would reflect the density of functional nephrons and be inversely associated with functional gain of the remaining kidney. We conducted a prospective monocentric study including 63 living donors (26 men; 50.3±11.8 years old) who had been evaluated for (51)Cr-EDTA and measured GFR, split renal function by scintigraphy before donation (between 2004 and 2009), and measured GFR at 5.7±0.5 years after donation. For 52 donors, volume of the remaining kidney (measured and estimated with the ellipsoid formula using renal computed tomography scannography) was determined before donation. We tested our hypothesis in an external validation cohort of 39 living donors (13 men; 51.0±9.4 years old) from another single center during the same time period. For the main cohort, the mean measured GFR was 97.6±13.0 ml/min per 1.73 m(2) before donation and 63.8±9.4 ml/min per 1.73 m(2) at 5 years. Functional gain averaged 16.2±7.2 ml/min per 1.73 m(2) (+35.3%±16.7%). Multivariate analysis showed that age, body mass index, and rk-GFR/vol at donation were negatively correlated with functional gain and had strong predictive power of the 5-year functional gain (adjusted 5-year functional gain for age: -0.4 [95% confidence interval (95% CI), -0.5 to -0.1]; body mass index: -0.3 [95% CI, -0.6 to -0.1]; rk-GFR/vol: -55.1 [95% CI, -92.3 to -17.9]). We tested this model in the external validation cohort (adjusted 5-year functional gain for age: -0.1 [95% CI, -0.5 to 0.3]; body mass index: -0.9 [95% CI, -1.8 to -0.1]; rk-GFR/vol: -97.6 [95% CI, -137.5 to -57.6]) and confirmed that rk-GFR/vol was inversely associated with 5-year functional gain. For given age and body mass index, the long

Weight Gain and Obesity in Infants and Young Children Exposed to Prolonged Antibiotic Prophylaxis.

PubMed

Edmonson, M Bruce; Eickhoff, Jens C

2017-02-01

An association between antibiotic use and excessive weight gain or obesity in healthy infants and young children has been reported, but evidence is inconsistent and based on observational studies of growth in relation to incidental antibiotic exposures. To evaluate whether prolonged antibiotic exposure is associated with weight gain in children participating in a clinical trial of antibiotic prophylaxis to prevent recurrent urinary tract infection. Secondary analysis of data from the Randomized Intervention for Children With Vesicoureteral Reflux Study, a 2-year randomized clinical trial that enrolled participants from 2007 to 2011. All 607 children who were randomized to receive antibiotic (n = 302) or placebo (n = 305) were included. Children with urinary tract anomalies, premature birth, or major comorbidities were excluded from participation. Trimethoprim-sulfamethoxazole or placebo taken orally, once daily, for 2 years. Weight gain as measured by change in weight-for-age z score from baseline to the end-of-study visit at 24 months. Secondary outcomes included weight gain at 6, 12, and 18 months and the prevalence of overweight or obesity at 24 months. Participants had a median age of 12 months (range, 2-71 months) and 558 of 607 (91.9%) were female. Anthropometric data were complete at the 24-month visit for 428 children (214 in the trimethoprim-sulfamethoxazole group and 214 in the placebo group). Weight gain in the trimethoprim-sulfamethoxazole group and the placebo group was similar (mean [SD] change in weight-for-age z score: +0.14 [0.83] and +0.18 [0.85], respectively; difference, -0.04 [95% CI, -0.19 to 0.12]; P = .65). There was no significant difference in weight gain at 6, 12, or 18 months or in the prevalence of overweight or obesity at 24 months (24.8% vs 25.7%; P = .82). Subgroup analyses showed no significant interaction between weight gain effect and age, sex, history of breastfeeding, prior antibiotic use, adherence to study

Gain scheduling - Potential hazards and possible remedies

NASA Technical Reports Server (NTRS)

Shamma, Jeff S.; Athans, Michael

1991-01-01

A common gain scheduling rule-of-thumb is to schedule on a slow variable. In this work, it is shown how current gain scheduling practice is necessarily limited to slow variations in the scheduling variable. These limitations are revealed to be consequences of fundamental control concepts. Furthermore, it is shown how a formulation of the gain scheduling procedure can lead toward ultimately removing these restrictions.

Association between maternal nutritional status of pre pregnancy, gestational weight gain and preterm birth.

PubMed

Xinxo, Sonela; Bimbashi, Astrit; Z Kakarriqi, Eduard; Zaimi, Edmond

2013-01-01

Maternal nutritional status of pre pregnancy and gestational weight gain affects the preterm birth. The association between maternal nutritional status of pre pregnancy and preterm birth appears to be complex and varied by studies from different countries, thus this association between the gestational weight gain and preterm birth is more consolidated. The study aims to determine any association between the pre pregnancy maternal nutritional status, gestational weight gain and the preterm birth rate in the Albanian context. In case control study, we analyzed women who have delivered in obstetric institutions in Tirana during the year 2012. Body mass index and gestational weight gain of 150 women who had a preterm delivery were compared with those of 150 matched control women who had a normal delivery regarding the gestation age. The self-reported pre pregnancy weight, height, gestational weight gain, age, education and parity are collected through a structured questioner. The body mass index and gestational weight gain are categorized based on the Institute of Medicine recommendation. The multiple logistic regression is used to measure the association between the nutritional status of pre pregnancy and gestational weight gain and the preterm birth rate. The women which have a underweight status or obese of pre pregnancy are more likely to have a preterm birth compared to the women of a normal pre-pregnancy nutritional status (respectively OR =2.7 and 4.3 p<0.05). Women who do not reach the recommended gestational weight gain are more likely to have a preterm birth compared to the women which reach this weight (OR=1.8 p< 0.05). Maternal nutritional status and gestational weight gain affects the risk for preterm birth. Pre-pregnancy and gestation nutritional assessments should be part of routine prenatal visits.

Body Weight Gain and Hyperphagia After Administration of SGLT-2 Inhibitor: A Case Report

PubMed Central

Hamamoto, Hiromi; Noda, Mitsuhiko

2015-01-01

Patient: Male, 44 Final Diagnosis: Type 2 diabetes Symptoms: Hunger • increased appetite Medication: GLP-1 receptor agonist • SGLT-2 inhibitor Clinical Procedure: — Specialty: Internal Medicine/Diabetology Objective: Unusual or unexpected effect of treatment Background: A detailed description is given of a case we encountered in which unexpectedly marked weight gain occurred following a treatment switch from a GLP-1 receptor agonist to an SGLT-2 inhibitor. Case Report: The patient, a 44-year-old man with type 2 diabetes mellitus, had gained about 10 kg in weight in the previous year. Therefore, metformin was replaced with liraglutide to obtain reduction of body weight. Although the patient lost about 8 kg (7%), during the 18-month period on the medication, the weight loss stabilized; therefore, the treatment was again switched to tofogliflozin to obtain further reduction of body weight. However, the patient reported increasing hunger and an exaggerated appetite from week 3 onward after the start of tofogliflozin, and gained about 9 kg in weight within 2 weeks, associated with a tendency towards increased HbA1c; therefore, tofogliflozin was discontinued. Immediate reinstitution of liraglutide resulted in reduction of the increased appetite, weight, and HbA1c level. Conclusions: Caution should be exercised against hyperphagia and weight gain due to hunger that may occur following discontinuation of a GLP-1 receptor agonist and/or initiation of an SGLT-2 inhibitor. PMID:26638727

[Antipsychotic-induced weight gain--pharmacogenetic studies].

PubMed

Olajossy-Hilkesberger, Luiza; Godlewska, Beata; Marmurowska-Michałowskal, Halina; Olajossy, Marcin; Landowski, Jerzy

2006-01-01

Drug-naive patients with schizophrenia often present metabolic abnormalities and obesity. Weight gain may be the side effect of treatment with many antipsychotic drugs. Genetic effects, besides many other factors, are known to influence obesity in patients with schizophrenia treated with antipsychotics. Numerous studies of several genes' polymorphisms have been performed. -759C/T polymorphism of 5HT2C gene attracted most attention. In 5 independent studies of this polymorphism the association between T allele with the lower AP-induced weight gain was detected. No associations could be detected between weight gain and other polymorphisms of serotonergic system genes as well as histaminergic system genes. Studies of adrenergic and dopaminergic system have neither produced any unambiguous results. Analysis of the newest candidate genes (SAP-25, leptin gene) confirmed the role of genetic factors in AP-induced weight gain. It is worth emphasising, that the studies have been conducted in relatively small and heterogenic groups and that various treatment strategies were used.

Evaluation of balloon trajectory forecast routines for GAINS

NASA Astrophysics Data System (ADS)

Collander, R.; Girz, C.

The Global Air-ocean IN-situ System (GAINS) is a global observing system designed to augment current environmental observing and monitoring networks. GAINS is a network of long-duration, stratospheric platforms that carry onboard sensors and hundreds of dropsondes to acquire meteorological, air chemistry, and climate data over oceans and in remote land regions of the globe. Although GAINS platforms will include balloons and Remotely Operated Aircraft (ROA), the scope of this paper is limited to balloon-based platforms. A primary goal of GAINS balloon test flights is post-flight recovery of the balloon shell and payload, which requires information on the expected flight path and landing site prior to launch. Software has been developed for the prediction of the balloon trajectory and landing site, with separate versions written to generate predictions based upon rawinsonde data and model output. Balloon positions are calculated in 1-min increments based on wind data from the closest rawinsonde site or model grid point, given a known launch point, ascent and descent rate and flight duration. For short flights (< 6h), rawinsonde winds interpolated to 10-mb levels are used for trajectory calculations. Predictions for flight durations of 6 to 48h are based upon the initialization and 3 h forecast wind fields from NOAA's global aviation- (AVN) and Rapid Update Cycle (RUC) models. Given a limited number of actual balloon launches, trajectories computed from a chronological series of hourly RUC initializations are used as the baseline for comparison purposes. These baseline trajectories are compared to trajectory predictions from the rawinsonde and model-based versions on a monthly and seasonal basis over a 1-year period (January 1 - December 31, 2001) for flight durations of 3h, 6h and 48h. Predicted trajectories diverge from the baseline path, with the divergence increasing with increasing time. We examine the zonal, meridional and net magnitudes of these deviations, and

[Combined influence of preconception body mass index and gestational weight gain on fetal growth].

PubMed

Mardones, Francisco; García-Huidobro, Trinidad; Ralph, Constanza; Farías, Marcelo; Domínguez, Angélica; Rojas, Iván; Urrutia, M Teresa

2011-06-01

The Chilean Ministry of Health has been using standards for nutritional evaluation and weight gain recommendations during pregnancy in the last 25 years. In the meantime new standards have been developed. To study the combined influence of preconception maternal nutritional status and gestational weight gain, using new standards to classify those parameters, on perinatal outcomes. A cohort of 11,465 healthy pregnant women was prospectively followed until term. Their pre-gestational nutritional status was classified using the body mass index cut-offs in use in the United States (USA). Their gestational weight gain was classified using categories proposed in a Danish study. Perinatal outcomes included were risky birth weight, i.e. < 3000 g and ≥ 4000 g, and cesarean delivery. Relative risks for those perinatal outcomes were calculated for all combined categories of pre-gestational nutritional status and gestational weight gain. Relative risks of almost all gestational weight gain results were statistically significant for women having a normal pre-gestational nutritional status meanwhile all of them were not significant for underweight women. Overweight and obese women had similar relative risks values as normal women. However, many of them were not significant, especially in obese women. There is an independent and combined influence of preconception nutritional status and gestational weight gain on perinatal outcomes, when using standards to classify those parameters developed in the USA and Denmark, respectively.

Gain-adaptive vector quantization for medium-rate speech coding

NASA Technical Reports Server (NTRS)

Chen, J.-H.; Gersho, A.

1985-01-01

A class of adaptive vector quantizers (VQs) that can dynamically adjust the 'gain' of codevectors according to the input signal level is introduced. The encoder uses a gain estimator to determine a suitable normalization of each input vector prior to VQ coding. The normalized vectors have reduced dynamic range and can then be more efficiently coded. At the receiver, the VQ decoder output is multiplied by the estimated gain. Both forward and backward adaptation are considered and several different gain estimators are compared and evaluated. An approach to optimizing the design of gain estimators is introduced. Some of the more obvious techniques for achieving gain adaptation are substantially less effective than the use of optimized gain estimators. A novel design technique that is needed to generate the appropriate gain-normalized codebook for the vector quantizer is introduced. Experimental results show that a significant gain in segmental SNR can be obtained over nonadaptive VQ with a negligible increase in complexity.

26 CFR 1.737-1 - Recognition of precontribution gain.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Property A1 and Property A2 is long-term, U.S.-source capital gain or loss. The character of gain on Property A3 is long-term, foreign-source capital gain. B contributes Property B, nondepreciable real... long-term, U.S.-source capital gain ($10,000 gain on Property A1 and $8,000 loss on Property A2) and $1...

Gain and energy storage in holmium YLF

NASA Technical Reports Server (NTRS)

Storm, Mark E.; Deyst, John P.

1991-01-01

It is demonstrated that Q-switched holmium lasers are capable of high-gain and high-energy operation at 300 K. Small-signal gain coefficients of 0.50 and 0.12/cm have been measured in YLF and YAG, respectively. Small-signal gains of 0.50/cm are comparable to those achievable in Nd:YAG and are not typical of low-gain materials. This large gain in the Ho:YLF material is made possible by operating the amplifier in the ground state depletion mode. The amplifier performance data and associated analysis presented demonstrate that efficient energy storage is possible with very high excited state ion densities of the Ho 5I7 upper laser level. This is an important result since upconversion can limit the 5I7 population. Although upconversion was still present in this experiment, it was possible to achieve efficient energy storage, demonstrating that the problem is manageable even at high excitation densities in YLF.

[Atypical antipsychotic-induced weight gain].

PubMed

Godlewska, Beata R; Olajossy-Hilkesberger, Luiza; Marmurowska-Michałowska, Halina; Olajossy, Marcin; Landowski, Jerzy

2006-01-01

Introduction of a new group of antipsychotic drugs, called atypical because of the proprieties differing them from classical neuroleptics, gave hope for the beginning of a new era in treatment of psychoses, including schizophrenia. Different mechanisms of action not only resulted in a broader spectrum of action and high efficacy but also in a relative lack of extrapiramidal symptoms. However, atypical neuroleptics are not totally free from adverse effects. Symptoms such as sedation, metabolic changes and weight gain, often very quick and severe - present also in the case of classical drugs, but put to the background by extrapiramidal symptoms--have become prominent. Weight gain is important both from the clinical and subjective point of view--as associated with serious somatic consequences and as a source of enormous mental distress. These problems are addressed in this review, with the focus on weight gain associated with the use of specific atypical neuroleptics.

High current gain transistor laser

PubMed Central

Liang, Song; Qiao, Lijun; Zhu, Hongliang; Wang, Wei

2016-01-01

A transistor laser (TL), having the structure of a transistor with multi-quantum wells near its base region, bridges the functionality gap between lasers and transistors. However, light emission is produced at the expense of current gain for all the TLs reported up to now, leading to a very low current gain. We propose a novel design of TLs, which have an n-doped InP layer inserted in the emitter ridge. Numerical studies show that a current flow aperture for only holes can be formed in the center of the emitter ridge. As a result, the common emitter current gain can be as large as 143.3, which is over 15 times larger than that of a TL without the aperture. Besides, the effects of nonradiative recombination defects can be reduced greatly because the flow of holes is confined in the center region of the emitter ridge. PMID:27282466

Optimal gains for a single polar orbiting satellite

NASA Technical Reports Server (NTRS)

Banfield, Don; Ingersoll, A. P.; Keppenne, C. L.

1993-01-01

Gains are the spatial weighting of an observation in its neighborhood versus the local values of a model prediction. They are the key to data assimilation, as they are the direct measure of how the data are used to guide the model. As derived in the broad context of data assimilation by Kalman and in the context of meteorology, for example, by Rutherford, the optimal gains are functions of the prediction error covariances between the observation and analysis points. Kalman introduced a very powerful technique that allows one to calculate these optimal gains at the time of each observation. Unfortunately, this technique is both computationally expensive and often numerically unstable for dynamical systems of the magnitude of meteorological models, and thus is unsuited for use in PMIRR data assimilation. However, the optimal gains as calculated by a Kalman filter do reach a steady state for regular observing patterns like that of a satellite. In this steady state, the gains are constants in time, and thus could conceivably be computed off-line. These steady-state Kalman gains (i.e., Wiener gains) would yield optimal performance without the computational burden of true Kalman filtering. We proposed to use this type of constant-in-time Wiener gain for the assimilation of data from PMIRR and Mars Observer.

Psychosocial working conditions and weight gain among employees.

PubMed

Lallukka, T; Laaksonen, M; Martikainen, P; Sarlio-Lähteenkorva, S; Lahelma, E

2005-08-01

To study the associations between psychosocial working conditions and weight gain. Data from postal questionnaires (response rate 67%) sent to 40- to 60-y-old women (n=7093) and men (n=1799) employed by the City of Helsinki in 2000-2002 were analysed. Weight gain during the previous 12 months was the outcome variable in logistic regression analyses. Independent variables included Karasek's job demands and job control, work fatigue, working overtime, work-related mental strain, social support and the work-home interface. The final models were adjusted for age, education, marital status, physical strain and body mass index. In the previous 12 months, 25% of women and 19% of men reported weight gain. Work fatigue and working overtime were associated with weight gain in both sexes. Women who were dissatisfied with combining paid work and family life were more likely to have gained weight. Men with low job demands were less likely to have gained weight. All of these associations were independent of each other. Few work-related factors were associated with weight gain. However, our study suggests that work fatigue and working overtime are potential risk factors for weight gain. These findings need to be confirmed in prospective studies.

A 3-year physical activity intervention program increases the gain in bone mineral and bone width in prepubertal girls but not boys: the prospective copenhagen school child interventions study (CoSCIS).

PubMed

Hasselstrøm, H A; Karlsson, M K; Hansen, S E; Grønfeldt, V; Froberg, K; Andersen, L B

2008-10-01

The aim of this study was to evaluate the effect of increasing the amount of time spent in physical education classes on bone mineral accrual and gain in bone size in prepubertal Danish children. A total of 135 boys and 108 girls, aged 6-8 years, were included in a school-based curriculum intervention program where the usual time spent in physical education classes was doubled to four classes (180 min) per week. The control group comprised age-matched children (62 boys and 76 girls) recruited from a separate community who completed the usual Danish school curriculum of physical activity (90 min/week). Dual-energy X-ray absorptiometry was used to evaluate bone mineral content (BMC; g), bone mineral density (g/cm(2)), and bone width at the calcaneus and distal forearm before and after 3 years of intervention. Anthropometrics and Tanner stages were evaluated on the same occasions. General physical activity was measured with an accelerometer worn for 4 days. In girls, the intervention group had a 12.5% increase (P = 0.04) in distal forearm BMC and a 13.2% increase (P = 0.005) in distal forearm scanned area compared with girls in the control group. No differences were found between the intervention and control groups in boys. Increasing the frequency of physical education classes for prepubertal children is associated with a higher accrual of bone mineral and higher gain in bone size after 3 years in girls but not in boys.

Effects of internal gain assumptions in building energy calculations

NASA Astrophysics Data System (ADS)

Christensen, C.; Perkins, R.

1981-01-01

The utilization of direct solar gains in buildings can be affected by operating profiles, such as schedules for internal gains, thermostat controls, and ventilation rates. Building energy analysis methods use various assumptions about these profiles. The effects of typical internal gain assumptions in energy calculations are described. Heating and cooling loads from simulations using the DOE 2.1 computer code are compared for various internal gain inputs: typical hourly profiles, constant average profiles, and zero gain profiles. Prototype single-family-detached and multifamily-attached residential units are studied with various levels of insulation and infiltration. Small detached commercial buildings and attached zones in large commercial buildings are studied with various levels of internal gains. The results indicate that calculations of annual heating and cooling loads are sensitive to internal gains, but in most cases are relatively insensitive to hourly variations in internal gains.

Correcting the Normalized Gain for Guessing

ERIC Educational Resources Information Center

Stewart, John; Stewart, Gay

2010-01-01

The normalized gain, "g", has been an important tool for the characterization of conceptual improvement in physics courses since its use in Hake's extensive study on conceptual learning in introductory physics. The normalized gain is calculated from the score on a pre-test administered before instruction and a post-test administered…

Nucleus accumbens response to gains in reputation for the self relative to gains for others predicts social media use

PubMed Central

Meshi, Dar; Morawetz, Carmen; Heekeren, Hauke R.

2013-01-01

Our reputation is important to us; we've experienced natural selection to care about our reputation. Recently, the neural processing of gains in reputation (positive social feedback concerning one's character) has been shown to occur in the human ventral striatum. It is still unclear, however, how individual differences in the processing of gains in reputation may lead to individual differences in real-world behavior. For example, in the real-world, one way that people currently maintain their reputation is by using social media websites, like Facebook. Furthermore, Facebook use consists of a social comparison component, where users observe others' behavior and can compare it to their own. Therefore, we hypothesized a relationship between the way the brain processes specifically self-relevant gains in reputation and one's degree of Facebook use. We recorded functional neuroimaging data while participants received gains in reputation, observed the gains in reputation of another person, or received monetary reward. We demonstrate that across participants, when responding to gains in reputation for the self, relative to observing gains for others, reward-related activity in the left nucleus accumbens predicts Facebook use. However, nucleus accumbens activity in response to monetary reward did not predict Facebook use. Finally, a control step-wise regression analysis showed that Facebook use primarily explains our results in the nucleus accumbens. Overall, our results demonstrate how individual sensitivity of the nucleus accumbens to the receipt of self-relevant social information leads to differences in real-world behavior. PMID:24009567

Nucleus accumbens response to gains in reputation for the self relative to gains for others predicts social media use.

PubMed

Meshi, Dar; Morawetz, Carmen; Heekeren, Hauke R

2013-01-01

Our reputation is important to us; we've experienced natural selection to care about our reputation. Recently, the neural processing of gains in reputation (positive social feedback concerning one's character) has been shown to occur in the human ventral striatum. It is still unclear, however, how individual differences in the processing of gains in reputation may lead to individual differences in real-world behavior. For example, in the real-world, one way that people currently maintain their reputation is by using social media websites, like Facebook. Furthermore, Facebook use consists of a social comparison component, where users observe others' behavior and can compare it to their own. Therefore, we hypothesized a relationship between the way the brain processes specifically self-relevant gains in reputation and one's degree of Facebook use. We recorded functional neuroimaging data while participants received gains in reputation, observed the gains in reputation of another person, or received monetary reward. We demonstrate that across participants, when responding to gains in reputation for the self, relative to observing gains for others, reward-related activity in the left nucleus accumbens predicts Facebook use. However, nucleus accumbens activity in response to monetary reward did not predict Facebook use. Finally, a control step-wise regression analysis showed that Facebook use primarily explains our results in the nucleus accumbens. Overall, our results demonstrate how individual sensitivity of the nucleus accumbens to the receipt of self-relevant social information leads to differences in real-world behavior.

20 CFR 220.141 - Substantial gainful activity, defined.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Substantial work activity. Substantial work activity is work activity that involves doing significant physical... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Substantial gainful activity, defined. 220... RETIREMENT ACT DETERMINING DISABILITY Substantial Gainful Activity § 220.141 Substantial gainful activity...

20 CFR 220.141 - Substantial gainful activity, defined.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) Substantial work activity. Substantial work activity is work activity that involves doing significant physical... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Substantial gainful activity, defined. 220... RETIREMENT ACT DETERMINING DISABILITY Substantial Gainful Activity § 220.141 Substantial gainful activity...

Complying with physician gain-sharing restrictions.

PubMed

O'Hare, P K

1998-05-01

Many IDSs are considering implementing gain-sharing programs as a way to motivate their physicians to provide high-quality, cost-effective services. Before embarking on such programs, however, IDSs need to understand the legal requirements associated with such programs to ensure that the gain-sharing arrangement is in compliance with Federal law.

Preterm infant linear growth and adiposity gain: trade-offs for later weight status and intelligence quotient.

PubMed

Belfort, Mandy B; Gillman, Matthew W; Buka, Stephen L; Casey, Patrick H; McCormick, Marie C

2013-12-01

To examine trade-offs between cognitive outcome and overweight/obesity in preterm-born infants at school age and young adulthood in relation to weight gain and linear growth during infancy. We studied 945 participants in the Infant Health and Development Program, an 8-center study of preterm (≤37 weeks gestational age), low birth weight (≤2500 g) infants from birth to age 18 years. Adjusting for maternal and child factors in logistic regression, we estimated the odds of overweight/obesity (body mass index [BMI] ≥85th percentile at age 8 or ≥25 kg/m(2) at age 18) and in separate models, low IQ (<85) per z-score changes in infant length and BMI from term to 4 months, from 4 to 12 months, and from 12 to 18 months. More rapid linear growth from term to 4 months was associated with lower odds of IQ <85 at age 8 years (OR, 0.82; 95% CI, 0.70-0.96), but higher odds of overweight/obesity (OR, 1.27; 95% CI, 1.05-1.53). More rapid BMI gain in all 3 infant time intervals was also associated with higher odds of overweight/obesity, and BMI gain from 4-12 months was associated with lower odds of IQ <85 at age 8. Results at age 18 were similar. In these preterm, low birth weight infants born in the 1980s, faster linear growth soon after term was associated with better cognition, but also with a greater risk of overweight/obesity at age 8 years and 18 years. BMI gain over the entire 18 months after term was associated with later risk of overweight/obesity, with less evidence of a benefit for IQ. Copyright © 2013 Mosby, Inc. All rights reserved.

Radiation hardness of thin Low Gain Avalanche Detectors

NASA Astrophysics Data System (ADS)

Kramberger, G.; Carulla, M.; Cavallaro, E.; Cindro, V.; Flores, D.; Galloway, Z.; Grinstein, S.; Hidalgo, S.; Fadeyev, V.; Lange, J.; Mandić, I.; Medin, G.; Merlos, A.; McKinney-Martinez, F.; Mikuž, M.; Quirion, D.; Pellegrini, G.; Petek, M.; Sadrozinski, H. F.-W.; Seiden, A.; Zavrtanik, M.

2018-05-01

Low Gain Avalanche Detectors (LGAD) are based on a n++-p+-p-p++ structure where an appropriate doping of the multiplication layer (p+) leads to high enough electric fields for impact ionization. Gain factors of few tens in charge significantly improve the resolution of timing measurements, particularly for thin detectors, where the timing performance was shown to be limited by Landau fluctuations. The main obstacle for their operation is the decrease of gain with irradiation, attributed to effective acceptor removal in the gain layer. Sets of thin sensors were produced by two different producers on different substrates, with different gain layer doping profiles and thicknesses (45, 50 and 80 μm). Their performance in terms of gain/collected charge and leakage current was compared before and after irradiation with neutrons and pions up to the equivalent fluences of 5 ṡ 1015 cm-2. Transient Current Technique and charge collection measurements with LHC speed electronics were employed to characterize the detectors. The thin LGAD sensors were shown to perform much better than sensors of standard thickness (∼300 μm) and offer larger charge collection with respect to detectors without gain layer for fluences < 2 ṡ 1015 cm-2. Larger initial gain prolongs the beneficial performance of LGADs. Pions were found to be more damaging than neutrons at the same equivalent fluence, while no significant difference was found between different producers. At very high fluences and bias voltages the gain appears due to deep acceptors in the bulk, hence also in thin standard detectors.

Effect of body image on pregnancy weight gain.

PubMed

Mehta, Ushma J; Siega-Riz, Anna Maria; Herring, Amy H

2011-04-01

The majority of women gain more weight during pregnancy than what is recommended. Since gestational weight gain is related to short and long-term maternal health outcomes, it is important to identify women at greater risk of not adhering to guidelines. The objective of this study was to examine the relationship between body image and gestational weight gain. The Body Image Assessment for Obesity tool was used to measure ideal and current body sizes in 1,192 women participating in the Pregnancy, Infection and Nutrition Study. Descriptive and multivariable techniques were used to assess the effects of ideal body size and discrepancy score (current-ideal body sizes), which reflected the level of body dissatisfaction, on gestational weight gain. Women who preferred to be thinner had increased risk of excessive gain if they started the pregnancy at a BMI ≤26 kg/m(2) but a decreased risk if they were overweight or obese. Comparing those who preferred thin body silhouettes to those who preferred average size silhouettes, low income women had increased risk of inadequate weight gain [RR = 1.76 (1.08, 2.88)] while those with lower education were at risk of excessive gain [RR = 1.11 (1.00, 1.22)]. Our results revealed that body image was associated with gestational weight gain but the relationship is complex. Identifying factors that affect whether certain women are at greater risk of gaining outside of guidelines may improve our ability to decrease pregnancy-related health problems.

Brillouin gain enhancement in nano-scale photonic waveguide

NASA Astrophysics Data System (ADS)

Nouri Jouybari, Soodabeh

2018-05-01

The enhancement of stimulated Brillouin scattering in nano-scale waveguides has a great contribution in the improvement of the photonic devices technology. The key factors in Brillouin gain are the electrostriction force and radiation pressure generated by optical waves in the waveguide. In this article, we have proposed a new scheme of nano-scale waveguide in which the Brillouin gain is considerably improved compared to the previously-reported schemes. The role of radiation pressure in the Brillouin gain was much higher than the role of the electrostriction force. The Brillouin gain strongly depends on the structural parameters of the waveguide and the maximum value of 12127 W-1 m-1 is obtained for the Brillouin gain.

Method and system for edge cladding of laser gain media

DOEpatents

Bayramian, Andrew James; Caird, John Allyn; Schaffers, Kathleen Irene

2014-03-25

A gain medium operable to amplify light at a gain wavelength and having reduced transverse ASE includes an input surface and an output surface opposing the input surface. The gain medium also includes a central region including gain material and extending between the input surface and the output surface along a longitudinal optical axis of the gain medium. The gain medium further includes an edge cladding region surrounding the central region and extending between the input surface and the output surface along the longitudinal optical axis of the gain medium. The edge cladding region includes the gain material and a dopant operable to absorb light at the gain wavelength.

A variable-gain output feedback control design methodology

NASA Technical Reports Server (NTRS)

Halyo, Nesim; Moerder, Daniel D.; Broussard, John R.; Taylor, Deborah B.

1989-01-01

A digital control system design technique is developed in which the control system gain matrix varies with the plant operating point parameters. The design technique is obtained by formulating the problem as an optimal stochastic output feedback control law with variable gains. This approach provides a control theory framework within which the operating range of a control law can be significantly extended. Furthermore, the approach avoids the major shortcomings of the conventional gain-scheduling techniques. The optimal variable gain output feedback control problem is solved by embedding the Multi-Configuration Control (MCC) problem, previously solved at ICS. An algorithm to compute the optimal variable gain output feedback control gain matrices is developed. The algorithm is a modified version of the MCC algorithm improved so as to handle the large dimensionality which arises particularly in variable-gain control problems. The design methodology developed is applied to a reconfigurable aircraft control problem. A variable-gain output feedback control problem was formulated to design a flight control law for an AFTI F-16 aircraft which can automatically reconfigure its control strategy to accommodate failures in the horizontal tail control surface. Simulations of the closed-loop reconfigurable system show that the approach produces a control design which can accommodate such failures with relative ease. The technique can be applied to many other problems including sensor failure accommodation, mode switching control laws and super agility.

Elevated CO2 stimulates marsh elevation gain, counterbalancing sea-level rise

USGS Publications Warehouse

Langley, J.A.; McKee, K.L.; Cahoon, D.R.; Cherry, J.A.; Megonigala, J.P.

2009-01-01

Tidal wetlands experiencing increased rates of sea-level rise (SLR) must increase rates of soil elevation gain to avoid permanent conversion to open water. The maximal rate of SLR that these ecosystems can tolerate depends partly on mineral sediment deposition, but the accumulation of organic matter is equally important for many wetlands. Plant productivity drives organic matter dynamics and is sensitive to global change factors, such as rising atmospheric CO2 concentration. It remains unknown how global change will influence organic mechanisms that determine future tidal wetland viability. Here, we present experimental evidence that plant response to elevated atmospheric [CO2] stimulates biogenic mechanisms of elevation gain in a brackish marsh. Elevated CO2 (ambient + 340 ppm) accelerated soil elevation gain by 3.9 mm yr−1in this 2-year field study, an effect mediated by stimulation of below-ground plant productivity. Further, a companion greenhouse experiment revealed that the CO2 effect was enhanced under salinity and flooding conditions likely to accompany future SLR. Our results indicate that by stimulating biogenic contributions to marsh elevation, increases in the greenhouse gas, CO2, may paradoxically aid some coastal wetlands in counterbalancing rising seas.

Elevated CO2 stimulates marsh elevation gain, counterbalancing sea-level rise.

PubMed

Langley, J Adam; McKee, Karen L; Cahoon, Donald R; Cherry, Julia A; Megonigal, J Patrick

2009-04-14

Tidal wetlands experiencing increased rates of sea-level rise (SLR) must increase rates of soil elevation gain to avoid permanent conversion to open water. The maximal rate of SLR that these ecosystems can tolerate depends partly on mineral sediment deposition, but the accumulation of organic matter is equally important for many wetlands. Plant productivity drives organic matter dynamics and is sensitive to global change factors, such as rising atmospheric CO(2) concentration. It remains unknown how global change will influence organic mechanisms that determine future tidal wetland viability. Here, we present experimental evidence that plant response to elevated atmospheric [CO(2)] stimulates biogenic mechanisms of elevation gain in a brackish marsh. Elevated CO(2) (ambient + 340 ppm) accelerated soil elevation gain by 3.9 mm yr(-1) in this 2-year field study, an effect mediated by stimulation of below-ground plant productivity. Further, a companion greenhouse experiment revealed that the CO(2) effect was enhanced under salinity and flooding conditions likely to accompany future SLR. Our results indicate that by stimulating biogenic contributions to marsh elevation, increases in the greenhouse gas, CO(2), may paradoxically aid some coastal wetlands in counterbalancing rising seas.

Elevated CO2 stimulates marsh elevation gain, counterbalancing sea-level rise

PubMed Central

Langley, J. Adam; McKee, Karen L.; Cahoon, Donald R.; Cherry, Julia A.; Megonigal, J. Patrick

2009-01-01

Tidal wetlands experiencing increased rates of sea-level rise (SLR) must increase rates of soil elevation gain to avoid permanent conversion to open water. The maximal rate of SLR that these ecosystems can tolerate depends partly on mineral sediment deposition, but the accumulation of organic matter is equally important for many wetlands. Plant productivity drives organic matter dynamics and is sensitive to global change factors, such as rising atmospheric CO2 concentration. It remains unknown how global change will influence organic mechanisms that determine future tidal wetland viability. Here, we present experimental evidence that plant response to elevated atmospheric [CO2] stimulates biogenic mechanisms of elevation gain in a brackish marsh. Elevated CO2 (ambient + 340 ppm) accelerated soil elevation gain by 3.9 mm yr−1 in this 2-year field study, an effect mediated by stimulation of below-ground plant productivity. Further, a companion greenhouse experiment revealed that the CO2 effect was enhanced under salinity and flooding conditions likely to accompany future SLR. Our results indicate that by stimulating biogenic contributions to marsh elevation, increases in the greenhouse gas, CO2, may paradoxically aid some coastal wetlands in counterbalancing rising seas. PMID:19325121

[Eating attitudes, attitudes related to weight gain, and body satisfaction of pregnant adolescents].

PubMed

Oliboni, Carolina Marques; Alvarenga, Marle Dos Santos

2015-12-01

To assess attitudes about eating, weight gain and body image of pregnant adolescents. Pregnant adolescents (n=67) were assessed using the Body Image Questionnaire, the Attitude towards Weight Gain during Pregnancy scale (AWGP) and questions about risk behaviors for eating disorders and unhealthy weight control practices. Associations between variables were analyzed by ANOVA, Kruskal-Wallis test, Pearson and Spearman tests. The influence of the independent variables regarding skipping meals, body satisfaction and binge eating was evaluated by logistic regression. The average age of the adolescents was 15.3 years (SD=1.14) and their average gestational age was 21.9 weeks (SD=6.53). The average AWGP score was 52.6 points, indicating a positive attitude towards weight gain, and 82.1% of the pregnant girls were satisfied with their bodies. Obese girls had more body dissatisfaction (p=0.001), and overweight girls thought more about food (p=0.02) and eating (p=0.03). The frequency of reported binge eating was 41.8%, and the frequency of skipping meals was 19%. Regression analysis showed that the current Body Mass Index (p=0.03; OR=1.18) and the importance of body awareness and fitness before pregnancy (p=0.03; OR=4.63) were predictors of skipping meals. Higher socioeconomic level (p=0.04; OR=0.55) and greater concern with weight gain (p=0.03; OR=0.32) predicted binge eating. Even though the majority of the pregnant adolescents had positive attitudes toward weight gain and body satisfaction, those heavier and more concerned with weight gain had a higher risk of unhealthy attitudes, while those of lower social class, less concerned with weight gain and less embarrassed about their bodies during pregnancy, had a lower risk of unhealthy attitudes.

Gestational Weight Gain and Post-Partum Weight Loss Among Young, Low-Income, Ethnic Minority Women

PubMed Central

ROTHBERG, Bonnie E. Gould; MAGRIPLES, Urania; KERSHAW, Trace S.; RISING, Sharon Schindler; ICKOVICS, Jeannette R.

2010-01-01

Objective Document weight change trajectories that lead to gestational weight gain or postpartum weight loss outside clinical recommendations established by Institute of Medicine (IOM). Methods Women aged 14-25 receiving prenatal care and delivering singleton infants at term (N=427). Medical record review and four structured interviews conducted: second and third trimester, 6- and 12-months postpartum. Longitudinal mixed modeling to evaluate weight change trajectories. Results Only 22% of participants gained gestational weight within IOM guidelines. 62% exceeded maximum recommendations -- more common among those overweight/obese (BMI≥25.0; p<0.0001). 52% retained ≥10 pounds one-year postpartum. Increased weight gain and retention documented among smokers and women with pregnancy-induced hypertension; breastfeeding promoted postpartum weight loss (all p<.02). BMI by race interaction suggested healthier outcomes for Latinas (p=0.02). Conclusion Excessive pregnancy weight gain and inadequate postpartum weight loss are highly prevalent among young low-income ethnic minority women. Pregnancy and postpartum are critical junctures for weight management interventions. PMID:20974459

75 FR 58373 - Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR UP)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-24

... DEPARTMENT OF EDUCATION [CFDA No. 84.334A (Partnership grants)] Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR UP) AGENCY: Office of Postsecondary Education, Department of Education. ACTION: Notice of intent to fund down the fiscal year (FY) 2008 grant slate for the GEAR UP...

Impact of Energy Gain and Subsystem Characteristics on Fusion Propulsion Performance Balances

NASA Technical Reports Server (NTRS)

Chakrabarti, Suman; Schmidt, George R.

2000-01-01

Rapid transportation of large payloads and human crews to destinations throughout the solar system will require propulsion systems having not only very high exhaust velocities (I (sub sp) greater than or equal to 10 (exp 4) to 10 (exp 5) sec) but also extremely low mass-power ratios (alpha less than or equal to 10 (exp -1) kg/kW). Such low a are difficult to achieve with power-limited propulsion systems. but may be attainable with fusion and other high I (sub SP) nuclear concepts that produce energy within the propellant. The magnitude of this energy gain is of fundamental importance. It must be large enough to sustain the nuclear process while still providing a high jet power relative to the massive power-intensive subsystems associated with these types of concepts. This paper evaluates the energy gain and mass-power characteristics required for a consistent with 1-year roundtrip planetary missions ranging up to 100 AU. Central to this analysis is an equation for overall system a, which is derived from the power balance of a generalized "gain-limited" propulsion system. Results show that the gain required to achieve alpha approximately 10 (exp -1) kg/kW with foreseeable subsystem technology can vary from 50 to as high as 10,000, which is 2 to 5 orders of magnitude greater than current state-of-the art. However, order of magnitude improvements in propulsion subsystem mass and efficiency could reduce gain requirements to 10 to 1,000 - still a very challenging goal.

Coverage Gains After the Affordable Care Act Among the Uninsured in Minnesota

PubMed Central

Lukanen, Elizabeth; Spencer, Donna; Alarcón, Giovann; Kemmick Pintor, Jessie; Baines Simon, Alisha; Gildemeister, Stefan

2015-01-01

Objectives. We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. Methods. Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. Results. ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesota’s insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. Conclusions. Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future. PMID:26447912

High adherence is necessary to realize health gains from water quality interventions.

PubMed

Brown, Joe; Clasen, Thomas

2012-01-01

Safe drinking water is critical for health. Household water treatment (HWT) has been recommended for improving access to potable water where existing sources are unsafe. Reports of low adherence to HWT may limit the usefulness of this approach, however. We constructed a quantitative microbial risk model to predict gains in health attributable to water quality interventions based on a range of assumptions about pre-treatment water quality; treatment effectiveness in reducing bacteria, viruses, and protozoan parasites; adherence to treatment interventions; volume of water consumed per person per day; and other variables. According to mean estimates, greater than 500 DALYs may be averted per 100,000 person-years with increased access to safe water, assuming moderately poor pre-treatment water quality that is a source of risk and high treatment adherence (>90% of water consumed is treated). A decline in adherence from 100% to 90% reduces predicted health gains by up to 96%, with sharpest declines when pre-treatment water quality is of higher risk. Results suggest that high adherence is essential in order to realize potential health gains from HWT.

Association of mGFR of the Remaining Kidney Divided by Its Volume before Donation with Functional Gain in mGFR among Living Kidney Donors

PubMed Central

Gaillard, François; Tissier, Anne-Marie; Fournier, Catherine; Le Nestour, Alexis; Corréas, Jean-Michel; Slimani-Thevenet, Hind; Martinez, Frank; Léon, Carine; Eladari, Dominique; Timsit, Marc-Olivier; Otal, Philippe; Hignette, Chantal; Friedlander, Gérard; Méjean, Arnaud; Houillier, Pascal; Kamar, Nassim; Legendre, Christophe

2016-01-01

Background and objectives The predictors of long–term renal function in living kidney donors are currently discussed. Our objectives were to describe the predictors of functional gain of the remaining kidney after kidney donation. We hypothesized that GFR of the remaining kidney divided by volume of this kidney (rk-GFR/vol) would reflect the density of functional nephrons and be inversely associated with functional gain of the remaining kidney. Design, setting, participants, & measurements We conducted a prospective monocentric study including 63 living donors (26 men; 50.3±11.8 years old) who had been evaluated for 51Cr-EDTA and measured GFR, split renal function by scintigraphy before donation (between 2004 and 2009), and measured GFR at 5.7±0.5 years after donation. For 52 donors, volume of the remaining kidney (measured and estimated with the ellipsoid formula using renal computed tomography scannography) was determined before donation. We tested our hypothesis in an external validation cohort of 39 living donors (13 men; 51.0±9.4 years old) from another single center during the same time period. Results For the main cohort, the mean measured GFR was 97.6±13.0 ml/min per 1.73 m2 before donation and 63.8±9.4 ml/min per 1.73 m2 at 5 years. Functional gain averaged 16.2±7.2 ml/min per 1.73 m2 (+35.3%±16.7%). Multivariate analysis showed that age, body mass index, and rk-GFR/vol at donation were negatively correlated with functional gain and had strong predictive power of the 5-year functional gain (adjusted 5-year functional gain for age: −0.4 [95% confidence interval (95% CI), −0.5 to −0.1]; body mass index: −0.3 [95% CI, −0.6 to −0.1]; rk-GFR/vol: −55.1 [95% CI, −92.3 to −17.9]). We tested this model in the external validation cohort (adjusted 5-year functional gain for age: −0.1 [95% CI, −0.5 to 0.3]; body mass index: −0.9 [95% CI, −1.8 to −0.1]; rk-GFR/vol: −97.6 [95% CI, −137.5 to −57.6]) and confirmed that rk

Longevity in Slovenia: Past and potential gains in life expectancy by age and causes of death.

PubMed

Lotrič Dolinar, Aleša; Došenović Bonča, Petra; Sambt, Jože

2017-06-01

In Slovenia, longevity is increasing rapidly. From 1997 to 2014, life expectancy at birth increased by 7 and 5 years for men and women, respectively. This paper explores how this gain in life expectancy at birth can be attributed to reduced mortality from five major groups of causes of death by 5-year age groups. It also estimates potential future gains in life expectancy at birth. The importance of the five major causes of death was analysed by cause-elimination life tables. The total elimination of individual causes of death and a partial hypothetical adjustment of mortality to Spanish levels were analysed, along with age and cause decomposition (Pollard). During the 1997-2014 period, the increase in life expectancy at birth was due to lower mortality from circulatory diseases (ages above 60, both genders), as well as from lower mortality from neoplasms (ages above 50 years) and external causes (between 20 and 50 years) for men. However, considering the potential future gains in life expectancy at birth, by far the strongest effect can be attributed to lower mortality due to circulatory diseases for both genders. If Spanish mortality rates were reached, life expectancy at birth would increase by more than 2 years, again mainly because of lower mortality from circulatory diseases in very old ages. Life expectancy analyses can improve evidence-based decision-making and allocation of resources among different prevention programmes and measures for more effective disease management that can also reduce the economic burden of chronic diseases.

24 CFR 3280.506 - Heat loss/heat gain.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 5 2012-04-01 2012-04-01 false Heat loss/heat gain. 3280.506... URBAN DEVELOPMENT MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS Thermal Protection § 3280.506 Heat loss/heat gain. The manufactured home heat loss/heat gain shall be determined by methods outlined in...

24 CFR 3280.506 - Heat loss/heat gain.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 5 2011-04-01 2011-04-01 false Heat loss/heat gain. 3280.506... URBAN DEVELOPMENT MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS Thermal Protection § 3280.506 Heat loss/heat gain. The manufactured home heat loss/heat gain shall be determined by methods outlined in...

24 CFR 3280.506 - Heat loss/heat gain.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Heat loss/heat gain. 3280.506... URBAN DEVELOPMENT MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS Thermal Protection § 3280.506 Heat loss/heat gain. The manufactured home heat loss/heat gain shall be determined by methods outlined in...

24 CFR 3280.506 - Heat loss/heat gain.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 5 2014-04-01 2014-04-01 false Heat loss/heat gain. 3280.506... URBAN DEVELOPMENT MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS Thermal Protection § 3280.506 Heat loss/heat gain. The manufactured home heat loss/heat gain shall be determined by methods outlined in...

24 CFR 3280.506 - Heat loss/heat gain.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 5 2013-04-01 2013-04-01 false Heat loss/heat gain. 3280.506... URBAN DEVELOPMENT MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS Thermal Protection § 3280.506 Heat loss/heat gain. The manufactured home heat loss/heat gain shall be determined by methods outlined in...

Excessive weight gain is associated with an increased risk for pouch failure in patients with restorative proctocolectomy.

PubMed

Wu, Xian-Rui; Zhu, Hong; Kiran, Ravi P; Remzi, Feza H; Shen, Bo

2013-09-01

The aim was to evaluate the impact of weight gain on pouch outcomes after ileostomy closure. Consecutive inflammatory bowel disease patients with ileal pouches followed up at our subspecialty Pouch Center from 2002 to 2011 were studied. The association of excessive weight gain (defined as a 15% increase the index weight) with pouch outcomes were evaluated using univariate and multivariate analyses. A total of 846 patients met inclusion criteria, with 470 (55.6%) being men. The mean age at the diagnosis of inflammatory bowel disease and at pouch surgery was 27.2 ± 11.9 years and 37.8 ± 12.8 years, respectively. Patients with weight gain more likely had mechanical or surgical complications of the pouch (18.4% versus 12.3%, P = 0.049), Crohn's disease of the pouch (30.6% versus 18.5%, P = 0.001), Pouch Center visits (2.0 [1.0-4.0] versus 2.0 [1.0-3.0], P = 0.008), and postoperative pouch-related hospitalization (21.1% versus 10.6%, P < 0.001). After a median follow-up of 9.0 (interquartile range = 4.0-14.0) years, 68 patients (8.0%) developed pouch failure. In the multivariate analysis, excessive weight gain was an independent risk factor for pouch failure with a hazard ratio of 1.69 (95% confidence interval = 1.01-2.84, P = 0.048) after adjusting for preoperative or postoperative use of anti-tumor necrosis factor biologics, postoperative use of immunosuppressants, Crohn's disease of the pouch, mechanical or surgical complications of the pouch, and postoperative pouch-associated hospitalization. Excessive weight gain after closure of the ileostomy is associated with worse pouch outcomes in patients with inflammatory bowel disease. Appropriate weight control may help improve pouch retention.

Optical properties of nanowire metamaterials with gain

NASA Astrophysics Data System (ADS)

Lima, Joaquim; Adam, Jost; Rego, Davi; Esquerre, Vitaly; Bordo, Vladimir

2016-11-01

The transmittance, reflectance and absorption of a nanowire metamaterial with optical gain are numerically simulated and investigated. It is assumed that the metamaterial is represented by aligned silver nanowires embedded into a semiconductor matrix, made of either silicon or gallium phosphide. The gain in the matrix is modeled by adding a negative imaginary part to the dielectric function of the semiconductor. It is found that the optical coefficients of the metamaterial depend on the gain magnitude in a non-trivial way: they can both increase and decrease with gain depending on the lattice constant of the metamaterial. This peculiar behavior is explained by the field redistribution between the lossy metal nanowires and the amplifying matrix material. These findings are significant for a proper design of nanowire metamaterials with low optical losses for diverse applications.

New Discovery About Middle-Age Weight Gain

MedlinePlus

... Middle-Age Weight Gain Follow us Photo: AdobeStock New Discovery About Middle-Age Weight Gain A TEAM ... findings could lead to the development of a new type of weight-loss medication. SOURCE: NIH Research ...

Weight gain in women diagnosed with breast cancer.

PubMed

Demark-Wahnefried, W; Rimer, B K; Winer, E P

1997-05-01

This review of the literature indicates that weight gain is a common observation among women after the diagnosis of breast cancer. Gains in weight range from 0 to 50 lb and are influenced by menopausal status; nodal status; and the type, duration, and intensity of treatment. Weight gain appears to be greater among premenopausal women; among those who are node positive; and among those receiving higher dose, longer duration, and multiagent regimens. Psychosocial research suggests that weight gain has a profoundly negative impact on quality of life in patients with breast cancer. Recent findings also suggest that weight gain during therapy may increase the risk of recurrence and decrease survival. Although weight gain in patients with breast cancer is clinically well appreciated, little research has been conducted to investigate the underlying mechanisms of energy imbalance. Changes in rates of metabolism, physical activity, and dietary intake are all plausible mechanisms and call for more research. Further study will provide valuable insight into the problem of weight gain and encourage effective interventions to improve the quality and quantity of life for the woman with breast cancer. Until more is known, however, dietetics practitioners will have to monitor and work individually with patients with breast cancer and use empirical approaches to achieve the important goal of weight management.

Using tracers to evaluate streamflow gain-loss characteristics of Terror Creek, in the vicinity of a mine-permit area, Delta County, Colorado, water year 2003

USGS Publications Warehouse

Williams, Cory A.; Leib, Kenneth J.

2005-01-01

parametric paired t-test indicates that there is a 2.36-percent probability of observing a sample mean difference of 0.34 cubic foot per second if the population mean is zero. The p-value of 0.125 for the nonparametric exact Wilcoxon signed rank test indicates that there is a 12.5-percent probability of observing a sample mean difference this large if the population mean is zero. The similarity in streamflow gain-loss between measurement sets indicates that the process controlling streamflow may be the same between the two hydrologic conditions evaluated. Gains between measurement locations 4 and 5 may be related to hyporheic flow from tributaries that were dry during the study. No other obvious sources of surface water were identified during the investigation. The cause for the observed streamflow loss between measurement locations 5 and 6 is unknown but may be related to mapped local faulting, 100 years of coal mining in the area, and aquifer recharge.

Gain Shift Corrections at Chi-Nu

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

Brown, Tristan Brooks; Devlin, Matthew James

Ambient conditions have the potential to cause changes in liquid scintillator detector gain that vary with time and temperature. These gain shifts can lead to poor resolution in both energy as well as pulse shape discrimination. In order to correct for these shifts in the Chi-Nu high energy array, a laser system has been developed for calibration of the pulse height signals.

Associations Among Obesity, Acute Weight Gain, and Response to Treatment with Olanzapine in Adolescent Schizophrenia

PubMed Central

Correll, Christoph U.; Tohen, Mauricio; DelBello, Melissa P.; Ganocy, Stephen J.; Findling, Robert L.; Chang, Kiki

2013-01-01

Abstract Objective The purpose of this study was to investigate associations between body weight and illness characteristics, including weight gain and therapeutic efficacy, in adolescents with schizophrenia. Methods Adolescents ages 13–17 years (n=107) with American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) schizophrenia enrolled in a 6 week, double-blind, placebo-controlled trial comparing olanzapine and placebo. Therapeutic response was assessed by the Brief Psychiatric Rating Scale for Children (BPRS-C). Secondary outcomes included the Clinical Global Impressions-Severity (CGI-S) scale and Positive and Negative Syndrome Scale (PANSS). Obesity was defined as sex-/age-adjusted body mass index (BMI)≥95th percentile. Linear regression was used to analyze the relationship between weight gain and psychiatric symptom improvement; logistic regression was conducted to identify predictors of baseline obesity. Results Weight gain was significantly correlated with greater BPRS-C reduction among olanzapine-treated subjects (r=−0.31, p<0.01), whereas a trend was observed among placebo-treated subjects (r=−0.31, p=0.08). However, this relationship became nonsignificant when analyses were controlled for duration of olanzapine treatment (p=0.12), and a treatment by weight gain interaction did not emerge in a repeated-measures mixed model analysis that included time in the study (t=1.27, p=0.21). Additionally, weight gain ≥7% was not significantly associated with response or remission. Among 17 adolescents (16%) with obesity at study entry, obesity was not significantly associated with endpoint BPRS-C illness severity. However, girls (p=0.03), individuals hospitalized within the past year (p=0.02), and those with less severe overall (p=0.03) and negative symptoms (p=0.003) according to the CGI-S and PANSS negative subscale, respectively, were more likely to be obese at baseline. Conclusion Baseline obesity was

Diminished 11β-hydroxysteroid dehydrogenase type 2 activity is associated with decreased weight and weight gain across the first year of life.

PubMed

Rogers, Samantha L; Hughes, Beverly A; Jones, Christopher A; Freedman, Lauren; Smart, Katherine; Taylor, Norman; Stewart, Paul M; Shackleton, Cedric H L; Krone, Nils P; Blissett, Jacqueline; Tomlinson, Jeremy W

2014-05-01

Low birth weight is associated with adverse metabolic outcome in adulthood. Exposure to glucocorticoid (GC) excess in utero is associated with decreased birth weight, but the prospective longitudinal relationship between GC metabolism and growth has not been examined. We have hypothesized that changes in GC metabolism leading to increased availability may impair growth. This was a prospective, longitudinal study with clinical measurements and 24-hour urinary steroid metabolite analysis at 1, 4, 12, 26, and 52 weeks after delivery in mothers and their babies. The study was conducted with observations and samples collected in the volunteers' own homes. Healthy mothers and newborn babies/infants participated in the study. There were no interventions. Urinary steroid metabolite excretion quantified by gas chromatography/mass spectroscopy across the first year of life in relation to change in weight was measured. The total production of the GC metabolites quantified increased across the first year of life. Markers of 11β-hydroxysteroid dehydrogenase type 1 activity increased from the age of 3 months as did those of 5α-reductase activity. After correcting for confounding variables, low markers of 11β-hydroxysteroid dehydrogenase type 2 activity was associated with reduced absolute weight and decreased weight gain over the first year of life. In the mothers, 5α-reductase activity was low at birth and progressively increased to normal over the first 6 months postpartum. Increased GC exposure as a consequence of reduced 11β-hydroxysteroid dehydrogenase type 2 activity is likely to be a critical determinant of growth in early life. This not only highlights the central role of GCs and their metabolism, but also emphasizes the need for detailed longitudinal analyses.

Gains in accuracy from averaging ratings of abnormality

NASA Astrophysics Data System (ADS)

Swensson, Richard G.; King, Jill L.; Gur, David; Good, Walter F.

1999-05-01

Six radiologists used continuous scales to rate 529 chest-film cases for likelihood of five separate types of abnormalities (interstitial disease, nodules, pneumothorax, alveolar infiltrates and rib fractures) in each of six replicated readings, yielding 36 separate ratings of each case for the five abnormalities. Analyses for each type of abnormality estimated the relative gains in accuracy (area below the ROC curve) obtained by averaging the case-ratings across: (1) six independent replications by each reader (30% gain), (2) six different readers within each replication (39% gain) or (3) all 36 readings (58% gain). Although accuracy differed among both readers and abnormalities, ROC curves for the median ratings showed similar relative gains in accuracy. From a latent-variable model for these gains, we estimate that about 51% of a reader's total decision variance consisted of random (within-reader) errors that were uncorrelated between replications, another 14% came from that reader's consistent (but idiosyncratic) responses to different cases, and only about 35% could be attributed to systematic variations among the sampled cases that were consistent across different readers.

Functional Gain After Inpatient Stroke Rehabilitation: Correlates and Impact on Long-Term Survival.

PubMed

Scrutinio, Domenico; Monitillo, Vincenzo; Guida, Pietro; Nardulli, Roberto; Multari, Vincenzo; Monitillo, Francesco; Calabrese, Gianluigi; Fiore, Pietro

2015-10-01

Prediction of functional outcome after stroke rehabilitation (SR) is a growing field of interest. The association between SR and survival still remains elusive. We sought to investigate the factors associated with functional outcome after SR and whether the magnitude of functional improvement achieved with rehabilitation is associated with long-term mortality risk. The study population consisted of 722 patients admitted for SR within 90 days of stroke onset, with an admission functional independence measure (FIM) score of <80 points. We used univariable and multivariable linear regression analyses to assess the association between baseline variables and FIM gain and univariable and multivariable Cox analyses to assess the association of FIM gain with long-term mortality. Age (P<0.001), marital status (P=0.003), time from stroke onset to rehabilitation admission (P<0.001), National Institutes of Health Stroke Scale score at rehabilitation admission (P<0.001), and aphasia (P=0.021) were independently associated with FIM gain. The R2 of the model was 0.275. During a median follow-up of 6.17 years, 36.9% of the patients died. At multivariable Cox analysis, age (P<0.0001), coronary heart disease (P=0.018), atrial fibrillation (P=0.042), total cholesterol (P=0.015), and total FIM gain (P<0.0001) were independently associated with mortality. The adjusted hazard ratio for death significantly decreased across tertiles of increasing FIM gain. Several factors are independently associated with functional gain after SR. Our findings strongly suggest that the magnitude of functional improvement is a powerful predictor of long-term mortality in patients admitted for SR. © 2015 American Heart Association, Inc.

Sudden gains in exposure therapy for obsessive-compulsive disorder.

PubMed

Collins, Lindsey M; Coles, Meredith E

2017-06-01

Prior research in the treatment of depression and anxiety has demonstrated that a sudden reduction in symptoms between two consecutive sessions (sudden gain) is related to lower post-treatment symptom severity (e.g. Hofmann, Schulz, Meuret, Moscovitch, & Suvak, 2006; Tang & DeRubeis, 1999). However, only one study has examined sudden gains in the treatment of obsessive compulsive disorder (OCD). In that study, one-third of the patients with OCD experienced a sudden gain (Aderka et al., 2012). Further, patients who had a sudden gain had lower clinician-rated OCD symptom severity post-treatment (Aderka et al., 2012). In replication, the current study examined the frequency, characteristics, and clinical impact of sudden gains in 27 OCD patients during exposure and response prevention (ERP) therapy. Fifty two percent of patients experienced a sudden gain. The mean magnitude of a sudden gain represented, on average, 61.4% of total symptom reduction. Following treatment, individuals who had experienced a sudden gain were rated as less severe on the clinical global impression scale, but they did not experience a greater reduction in OCD symptoms (pre-to post-treatment) than those without a sudden gain. None of the pre-treatment characteristics tested were found to significantly predict whether a patient would have a sudden gain. Additional research examining predictors of, and patterns of, change in OCD symptoms is warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

Potential gains from hospital mergers in Denmark.

PubMed

Kristensen, Troels; Bogetoft, Peter; Pedersen, Kjeld Moeller

2010-12-01

The Danish hospital sector faces a major rebuilding program to centralize activity in fewer and larger hospitals. We aim to conduct an efficiency analysis of hospitals and to estimate the potential cost savings from the planned hospital mergers. We use Data Envelopment Analysis (DEA) to estimate a cost frontier. Based on this analysis, we calculate an efficiency score for each hospital and estimate the potential gains from the proposed mergers by comparing individual efficiencies with the efficiency of the combined hospitals. Furthermore, we apply a decomposition algorithm to split merger gains into technical efficiency, size (scale) and harmony (mix) gains. The motivation for this decomposition is that some of the apparent merger gains may actually be available with less than a full-scale merger, e.g., by sharing best practices and reallocating certain resources and tasks. Our results suggest that many hospitals are technically inefficient, and the expected "best practice" hospitals are quite efficient. Also, some mergers do not seem to lower costs. This finding indicates that some merged hospitals become too large and therefore experience diseconomies of scale. Other mergers lead to considerable cost reductions; we find potential gains resulting from learning better practices and the exploitation of economies of scope. To ensure robustness, we conduct a sensitivity analysis using two alternative returns-to-scale assumptions and two alternative estimation approaches. We consistently find potential gains from improving the technical efficiency and the exploitation of economies of scope from mergers.

Optomechanical transistor with mechanical gain

NASA Astrophysics Data System (ADS)

Zhang, X. Z.; Tian, Lin; Li, Yong

2018-04-01

We study an optomechanical transistor, where an input field can be transferred and amplified unidirectionally in a cyclic three-mode optomechanical system. In this system, the mechanical resonator is coupled simultaneously to two cavity modes. We show that it only requires a finite mechanical gain to achieve the nonreciprocal amplification. Here the nonreciprocity is caused by the phase difference between the linearized optomechanical couplings that breaks the time-reversal symmetry of this system. The amplification arises from the mechanical gain, which provides an effective phonon bath that pumps the mechanical mode coherently. This effect is analogous to the stimulated emission of atoms, where the probe field can be amplified when its frequency is in resonance with that of the anti-Stokes transition. We show that by choosing optimal parameters, this optomechanical transistor can reach perfect unidirectionality accompanied with strong amplification. In addition, the presence of the mechanical gain can result in ultralong delay in the phase of the probe field, which provides an alternative to controlling light transport in optomechanical systems.

Redesign of a Variable-Gain Output Feedback Longitudinal Controller Flown on the High-Alpha Research Vehicle (HARV)

NASA Technical Reports Server (NTRS)

Ostroff, Aaron J.

1998-01-01

This paper describes a redesigned longitudinal controller that flew on the High-Alpha Research Vehicle (HARV) during calendar years (CY) 1995 and 1996. Linear models are developed for both the modified controller and a baseline controller that was flown in CY 1994. The modified controller was developed with three gain sets for flight evaluation, and several linear analysis results are shown comparing the gain sets. A Neal-Smith flying qualities analysis shows that performance for the low- and medium-gain sets is near the level 1 boundary, depending upon the bandwidth assumed, whereas the high-gain set indicates a sensitivity problem. A newly developed high-alpha Bode envelope criterion indicates that the control system gains may be slightly high, even for the low-gain set. A large motion-base simulator in the United Kingdom was used to evaluate the various controllers. Desired performance, which appeared to be satisfactory for flight, was generally met with both the low- and medium-gain sets. Both the high-gain set and the baseline controller were very sensitive, and it was easy to generate pilot-induced oscillation (PIO) in some of the target-tracking maneuvers. Flight target-tracking results varied from level 1 to level 3 and from no sensitivity to PIO. These results were related to pilot technique and whether actuator rate saturation was encountered.

Measuring Student Learning in Social Statistics: A Pretest-Posttest Study of Knowledge Gain

ERIC Educational Resources Information Center

Delucchi, Michael

2014-01-01

This study used a pretest-posttest design to measure student learning in undergraduate statistics. Data were derived from 185 students enrolled in six different sections of a social statistics course taught over a seven-year period by the same sociology instructor. The pretest-posttest instrument reveals statistically significant gains in…

Symmetric Gain Optoelectronic Mixers for LADAR

DTIC Science & Technology

2008-12-01

photodetector in the receiver is used as an optoelectronic mixer (OEM). Adding gain to the optoelectronic mixer allows the following transimpedance ...output is the low frequency difference signal, several orders of magnitude lower than the LO signal. Therefore, the gain of the transimpedance ... amplifier (TZA) following the photodetector can be increased, improving LADAR range. The metal-semiconductor- metal (MSM) Schottky detector is such a

Gain curves and hydrodynamic modeling for shock ignition

NASA Astrophysics Data System (ADS)

Lafon, M.; Ribeyre, X.; Schurtz, G.

2010-05-01

Ignition of a precompressed thermonuclear fuel by means of a converging shock is now considered as a credible scheme to obtain high gains for inertial fusion energy. This work aims at modeling the successive stages of the fuel time history, from compression to final thermonuclear combustion, in order to provide the gain curves of shock ignition (SI). The leading physical mechanism at work in SI is pressure amplification, at first by spherical convergence, and by collision with the shock reflected at center during the stagnation process. These two effects are analyzed, and ignition conditions are provided as functions of the shock pressure and implosion velocity. Ignition conditions are obtained from a non-isobaric fuel assembly, for which we present a gain model. The corresponding gain curves exhibit a significantly lower ignition threshold and higher target gains than conventional central ignition.

Gestational Weight Gain: Association with Adverse Pregnancy Outcomes.

PubMed

Hannaford, Karen E; Tuuli, Methodius G; Odibo, Linda; Macones, George A; Odibo, Anthony O

2017-01-01

Background  It is unclear how adherence to the Institute of Medicine's (IOM) guidelines for weight gain affects pregnancy outcomes. Objective  We investigated how weight gain outside the IOM's recommendations affects the risks of adverse pregnancy outcomes. Study Design  We performed a secondary analysis of a prospective cohort study including singleton, nonanomalous fetuses. The risks of small for gestational age (SGA), macrosomia, preeclampsia, cesarean delivery, gestational diabetes, or preterm birth were calculated for patients who gained weight below or above the IOM's recommendations based on body mass index category. A time-to-event analysis was performed to account for gestational age at delivery. A Cox proportional model was fit to estimate hazard ratios accounting for possible confounders. Results  Women who gained weight below recommendations were 2.5 times more likely to deliver SGA and twice as likely to deliver preterm. Normal-weight patients who gained below recommendations were 2.5 times more likely to deliver SGA and twice as likely to deliver preterm. Obese patients who gained inadequate weight were 2.5 times more likely to deliver SGA. Conclusion  Among normal-weight patients, adhering to IOM recommendations may prevent growth abnormalities and preterm delivery. Among obese patients, a minimum weight gain requirement may prevent SGA infants. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antidepressants and Weight Gain

MedlinePlus

... 2015;37:46. Blumenthal SR, et al. An electronic health records study of long-term weight gain following antidepressant ... your agreement to the Terms and Conditions and Privacy Policy linked below. Terms and Conditions Privacy Policy ...

Overcoming the Volatility in School-Level Gain Scores: A New Approach to Identifying Value Added with Cross-Sectional Data

ERIC Educational Resources Information Center

Kelly, Sean; Monczunski, Laura

2007-01-01

Traditionally, state accountability systems have measured school-level achievement gains using cross-sectional data, for example, by comparing scores of one year's eighth graders to scores of the next year's eighth graders. This approach produces extremely volatile estimates of value added from year to year. This volatility suggests that the…

Weight gain in Turner Syndrome: association to puberty induction? - longitudinal analysis of KIGS data.

PubMed

Reinehr, Thomas; Lindberg, Anders; Toschke, Christina; Cara, Jose; Chrysis, Dionisis; Camacho-Hübner, Cecilia

2016-07-01

Girls with Turner Syndrome (TS) treated or not treated with growth hormone (GH) are prone to overweight. Therefore, we hypothesize that puberty induction in TS is associated with weight gain. We analyzed weight changes (BMI-SDS) between onset of GH treatment and near adult height (NAH) in 887 girls with TS enrolled in KIGS (Pfizer International Growth Database). Puberty was induced with estrogens in 646 (72·8%) girls with TS. Weight status did not change significantly between GH treatment start and 1 year later (mean difference -0·02 BMI-SDS), but increased significantly (P < 0·001) until NAH (+0·40 BMI-SDS). The BMI-SDS increased +0·21 until start of puberty (P < 0·001). Girls with spontaneous and induced puberty showed similar BMI-SDS changes. Puberty induction at ≥12 years was associated with a significant (P < 0·001) less increase of BMI-SDS (+0·7 BMI-SDS) between baseline and NAH compared to puberty induction at <12 year (+1·0 BMI-SDS). In multiple linear regression analyses changes of BMI-SDS between baseline and NAH were negatively associated with baseline BMI-SDS (P < 0·001), GH doses (P = 0·015), and age at puberty induction (P < 0·001), positively with years on GH treatment (P = 0·004), while duration and dose of estrogens, its route of administration (transdermal/oral), changes of height-SDS, thyroxin and oxandrolone treatment, and karyotype did not correlate significantly to changes of BMI-SDS in this time period. Puberty does not seem to play a major role in weight gain in girls with TS since the majority of the increases in BMI-SDS occurred before puberty. However, late puberty induction seems to decrease the risk of weight gain. © 2016 John Wiley & Sons Ltd.

Sound pressure gain produced by the human middle ear.

PubMed

Kurokawa, H; Goode, R L

1995-10-01

The acoustic function of the middle ear is to match sound passing from the low impedance of air to the high impedance of cochlear fluid. Little information is available on the actual middle ear pressure gain in human beings. This article describes experiments on middle ear pressure gain in six fresh human temporal bones. Stapes footplate displacement and phase were measured with a laser Doppler vibrometer before and after removal of the tympanic membrane, malleus, and incus. Acoustic insulation of the round window with clay was performed. Umbo displacement was also measured before tympanic membrane removal to assess baseline tympanic membrane function. The middle ear has its major gain in the lower frequencies, with a peak near 0.9 kHz. The mean gain was 23.0 dB below 1.0 kHz, the resonant frequency of the middle ear; the mean peak gain was 26.6 dB. Above 1.0 kHz, the second pressure gain decreased at a rate of -8.6 dB/octave, with a mean gain of 6.5 dB at 4.0 kHz. Only a small amount of gain was present above 7.0 kHz. Significant individual differences in pressure gain were found between ears that appeared related to variations in tympanic membrane function and not to variations in cochlear impedance.

How Pregnant African-American Women View Pregnancy Weight Gain

PubMed Central

Groth, Susan W.; Morrison-Beedy, Dianne; Meng, Ying

2012-01-01

Objective To gain insight into how low-income, pregnant African-American women viewed their weight gain while pregnant and how they managed their weight during pregnancy. Design Descriptive study using three focus groups. Setting Women were recruited from urban prenatal care sites and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) services in a medium-sized urban Northeastern city. Participants Twenty-six adult, low-income, pregnant African-American women, aged 18–39; the majority were within the first 20 weeks of pregnancy. Methods Three focus groups were conducted utilizing open-ended questions related to pregnancy weight gain. Content analysis was used to analyze the verbatim transcripts. Analysis focused on meaning, intention and context. Groups were compared and contrasted at the within and between group levels to identify themes. Results Four themes were identified that provided insight into how women viewed their pregnancy weight gain and managed weight gain during pregnancy: (a) pregnancy weight gain: no matter how much means a healthy baby; (b) weight retention: it happens; (c) there is a limit: weight gain impact on appearance; and (d) watching and waiting: plans for controlling weight. Conclusion Low-income African-American women, though cognizant of the likelihood of retention of weight following pregnancy, are not focused on limiting their gestational weight gain. The cultural acceptance of a larger body size along with the belief that gaining more weight is indicative of a healthy infant present challenges for interventions to limit excessive gestational weight gain. PMID:22789036

Welfare Gains from Financial Liberalization

PubMed Central

Townsend, Robert M.; Ueda, Kenichi

2010-01-01

Financial liberalization has been a controversial issue, as empirical evidence for growth enhancing effects is mixed. Here, we find sizable welfare gains from liberalization (cost to repression), though the gain in economic growth is ambiguous. We take the view that financial liberalization is a government policy that alters the path of financial deepening, while financial deepening is endogenously chosen by agents given a policy and occurs in transition towards a distant steady state. This history-dependent view necessitates the use of simulation analysis based on a growth model. Our application is a specific episode: Thailand from 1976 to 1996. PMID:20806055

Body Size, Adult BMI Gain and Endometrial Cancer Risk: The Multiethnic Cohort

PubMed Central

Park, Sungshim Lani; Goodman, Marc T.; Zhang, Zuo-Feng; Kolonel, Laurence N.; Henderson, Brian E.; Setiawan, Veronica Wendy

2009-01-01

The effect of body size and change in BMI on endometrial cancer risk across different racial/ethnic groups has not been studied. We examined the association between body size and endometrial cancer risk and potential effect modification of other risk factors among 50,376 women in the Multiethnic Cohort Study. During 10.3 years of follow-up, 463 endometrial cancer cases were identified. Epidemiologic data were collected from the baseline questionnaire. “BMI change” was defined as the percentage of body mass index change from age 21 to the time of recruitment. Women who were heavier at age 21 or at baseline (weight ≥ 53.5kg or ≥ 63.9 kg, respectively) had an increased endometrial cancer risk compared to the lowest quartile of weight during the respective periods. BMI gain ≥ 35% had a RR of 4.12 (95% CI: 2.69, 6.30) compared to the reference group (−5% ≤ BMI change <+5%). Women who averaged an annual BMI gain ≥ 1% had a >3.20-fold (95% CI: 2.37, 4.33) increased risk compared to women who maintained a stable adult BMI (−0.25 to <+0.25%). The highest risk associated with BMI gain was observed among nulliparous women and postmenopausal women who never used hormone therapy. While African Americans and Whites showed an increase in risk after ≥ 35% BMI gain, Japanese Americans showed an increase in risk with much smaller gain (≥ 5%). In conclusion, adult obesity and increase in adiposity are risk factors for endometrial cancer; and the risk associated with these factors may vary across racial/ethnic groups. PMID:19585578

Antipsychotic induced weight gain in schizophrenia:mechanisms and management.

PubMed

Rege, Sanil

2008-05-01

The aim of the present paper was to describe the mechanisms and management of antipsychotic-induced weight gain in schizophrenia patients. A comprehensive literature review of all available articles on the mechanisms and management of antipsychotic-induced weight gain was done by searching databases PsychINFO and PubMed. A summary of the available guidelines for monitoring of antipsychotic-induced weight gain and metabolic syndrome is also provided. There has been a substantial increase in the number of studies investigating the mechanisms and management of antipsychotic-induced weight gain after 2002. These include advances in the understanding of pharmacogenomics of weight gain and several randomized controlled trials (RCTs) evaluating pharmacological and psychological treatments to promote weight loss. The most effective strategy for prevention of weight gain is the choice of antipsychotic medication with low weight gain potential. In individuals with established weight gain and metabolic issues, switching to an antipsychotic agent with lower weight gain potential and/or lifestyle modifications with physical activity are most effective in promoting weight loss. Pharmacological agents such as orlistat and sibutramine are effective in general obesity but have not been sufficiently evaluated in antipsychotic-induced weight gain. The case to prescribe routine pharmacological treatment to promote weight loss is weak. Long-term, pragmatic studies are required to inform clinical practice. Weight gain in schizophrenia is associated with significant physical and psychological morbidity. Achieving an optimal trade-off between effectiveness and side-effects of antipsychotic agents, although difficult, is achievable. This should be based on three main principles: (i) a shared decision-making model between the patient, clinician and carer(s) when choosing an antipsychotic; (ii) a commitment to baseline and follow-up monitoring with explicit identification of the responsible

Extensive intron gain in the ancestor of placental mammals

PubMed Central

2011-01-01

Background Genome-wide studies of intron dynamics in mammalian orthologous genes have found convincing evidence for loss of introns but very little for intron turnover. Similarly, large-scale analysis of intron dynamics in a few vertebrate genomes has identified only intron losses and no gains, indicating that intron gain is an extremely rare event in vertebrate evolution. These studies suggest that the intron-rich genomes of vertebrates do not allow intron gain. The aim of this study was to search for evidence of de novo intron gain in domesticated genes from an analysis of their exon/intron structures. Results A phylogenomic approach has been used to analyse all domesticated genes in mammals and chordates that originated from the coding parts of transposable elements. Gain of introns in domesticated genes has been reconstructed on well established mammalian, vertebrate and chordate phylogenies, and examined as to where and when the gain events occurred. The locations, sizes and amounts of de novo introns gained in the domesticated genes during the evolution of mammals and chordates has been analyzed. A significant amount of intron gain was found only in domesticated genes of placental mammals, where more than 70 cases were identified. De novo gained introns show clear positional bias, since they are distributed mainly in 5' UTR and coding regions, while 3' UTR introns are very rare. In the coding regions of some domesticated genes up to 8 de novo gained introns have been found. Intron densities in Eutheria-specific domesticated genes and in older domesticated genes that originated early in vertebrates are lower than those for normal mammalian and vertebrate genes. Surprisingly, the majority of intron gains have occurred in the ancestor of placentals. Conclusions This study provides the first evidence for numerous intron gains in the ancestor of placental mammals and demonstrates that adequate taxon sampling is crucial for reconstructing intron evolution. The

Estimating QALY gains in applied studies: a review of cost-utility analyses published in 2010.

PubMed

Wisløff, Torbjørn; Hagen, Gunhild; Hamidi, Vida; Movik, Espen; Klemp, Marianne; Olsen, Jan Abel

2014-04-01

Reimbursement agencies in several countries now require health outcomes to be measured in terms of quality-adjusted life-years (QALYs), leading to an immense increase in publications reporting QALY gains. However, there is a growing concern that the various 'multi-attribute utility' (MAU) instruments designed to measure the Q in the QALY yield disparate values, implying that results from different instruments are incommensurable. By reviewing cost-utility analyses published in 2010, we aim to contribute to improved knowledge on how QALYs are currently calculated in applied analyses; how transparently QALY measurement is presented; and how large the expected incremental QALY gains are. We searched Embase, MEDLINE and NHS EED for all cost-utility analyses published in 2010. All analyses that had estimated QALYs gained from health interventions were included. Of the 370 studies included in this review, 48% were pharmacoeconomic evaluations. Active comparators were used in 71% of studies. The median incremental QALY gain was 0.06, which translates to 3 weeks in best imaginable health. The EQ-5D-3L is the dominant instrument used. However, reporting of how QALY gains are estimated is generally inadequate. In 55% of the studies there was no reference to which MAU instrument or direct valuation method QALY data came from. The methods used for estimating expected QALY gains are not transparently reported in published papers. Given the wide variation in utility scores that different methodologies may assign to an identical health state, it is important for journal editors to require a more transparent way of reporting the estimation of incremental QALY gains.

A generalized predictive model for direct gain

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

Givoni, B.

In the correlational model for direct gain developed by the Los Alamos National Laboratory, a list of constants applicable to different types of buildings or passive solar systems was specified separately for each type. In its original form, the model was applicable only to buildings similar in their heat capacity, type of glazing, or night insulation to the types specified by the model. While maintaining the general form of the predictive equations, the new model, the predictive model for direct gain (PMDG), replaces the constants with functions dependent upon the thermal properties of the building, or the components of themore » solar system, or both. By this transformation, the LANL model for direct gain becomes a generalized one. The new model predicts the performance of buildings heated by direct gain with any heat capacity, glazing, and night insulation as functions of their thermophysical properties and climatic conditions.« less

Microwave gain medium with negative refractive index.

PubMed

Ye, Dexin; Chang, Kihun; Ran, Lixin; Xin, Hao

2014-12-19

Artificial effective media are attractive because of the fantastic applications they may enable, such as super lensing and electromagnetic invisibility. However, the inevitable loss due to their strongly dispersive nature is one of the fundamental challenges preventing such applications from becoming a reality. In this study, we demonstrate an effective gain medium based on negative resistance, to overcompensate the loss of a conventional passive metamaterial, meanwhile keeping its original negative-index property. Energy conservation-based theory, full-wave simulation and experimental measurement show that a fabricated sample consisting of conventional sub-wavelength building blocks with embedded microwave tunnel diodes exhibits a band-limited Lorentzian dispersion simultaneously with a negative refractive index and a net gain. Our work provides experimental evidence to the assertion that a stable net gain in negative-index gain medium is achievable, proposing a potential solution for the critical challenge current metamateiral technology faces in practical applications.

The effects of changing exercise levels on weight and age-relatedweight gain

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

Williams, Paul T.; Wood, Peter D.

2004-06-01

To determine prospectively whether physical activity canprevent age-related weight gain and whether changing levels of activityaffect body weight. DESIGN/SUBJECTS: The study consisted of 8,080 maleand 4,871 female runners who completed two questionnaires an average(+/-standard deviation (s.d.)) of 3.20+/-2.30 and 2.59+/-2.17 yearsapart, respectively, as part of the National Runners' Health Study.RESULTS: Changes in running distance were inversely related to changes inmen's and women's body mass indices (BMIs) (slope+/-standard error(s.e.): -0.015+/-0.001 and -0.009+/-0.001 kg/m(2) per Deltakm/week,respectively), waist circumferences (-0.030+/-0.002 and -0.022+/-0.005 cmper Deltakm/week, respectively) and percent changes in body weight(-0.062+/-0.003 and -0.041+/-0.003 percent per Deltakm/week,respectively, all P<0.0001). The regression slopes were significantlysteepermore » (more negative) in men than women for DeltaBMI and Deltapercentbody weight (P<0.0001). A longer history of running diminishedthe impact of changing running distance on men's weights. When adjustedfor Deltakm/week, years of aging in men and years of aging in women wereassociated with increases of 0.066+/-0.005 and 0.056+/-0.006 kg/m(2) inBMI, respectively, increases of 0.294+/-0.019 and 0.279+/-0.028 percentin Delta percentbody weight, respectively, and increases of 0.203+/-0.016and 0.271+/-0.033 cm in waist circumference, respectively (allP<0.0001). These regression slopes suggest that vigorous exercise mayneed to increase 4.4 km/week annually in men and 6.2 km/week annually inwomen to compensate for the expected gain in weight associated with aging(2.7 and 3.9 km/week annually when correct for the attenuation due tomeasurement error). CONCLUSIONS: Age-related weight gain occurs evenamong the most active individuals when exercise is constant.Theoretically, vigorous exercise must increase significantly with age tocompensate for the expected gain in weight associated withaging.« less

Are You Gainfully Employed? Setting Standards for For-Profit Degrees. Education Sector Reports

ERIC Educational Resources Information Center

Miller, Ben

2010-01-01

For-profit higher education institutions have grown by leaps and bounds in recent years, largely free of federal regulation. That freedom would be significantly curtailed if the gainful employment standard takes effect. Vocational training programs would be judged by the ratio of the debt that graduates assume relative to their current earnings…

Musicianship enhances ipsilateral and contralateral efferent gain control to the cochlea.

PubMed

Bidelman, Gavin M; Schneider, Amy D; Heitzmann, Victoria R; Bhagat, Shaum P

2017-02-01

Human hearing sensitivity is easily compromised with overexposure to excessively loud sounds, leading to permanent hearing damage. Consequently, finding activities and/or experiential factors that distinguish "tender" from "tough" ears (i.e., acoustic vulnerability) would be important for identifying people at higher risk for hearing damage. To regulate sound transmission and protect the inner ear against acoustic trauma, the auditory system modulates gain control to the cochlea via biological feedback of the medial olivocochlear (MOC) efferents, a neuronal pathway linking the lower brainstem and cochlear outer hair cells. We hypothesized that a salient form of auditory experience shown to have pervasive neuroplastic benefits, namely musical training, might act to fortify hearing through tonic engagement of these reflexive pathways. By measuring MOC efferent feedback via otoacoustic emissions (cochlear emitted sounds), we show that dynamic ipsilateral and contralateral cochlear gain control is enhanced in musically-trained individuals. Across all participants, MOC strength was correlated with the years of listeners' training suggested that efferent gain control is experience dependent. Our data provide new evidence that intensive listening experience(s) (e.g., musicianship) can strengthen the ipsi/contralateral MOC efferent system and sound regulation to the inner ear. Implications for reducing acoustic vulnerability to damaging sounds are discussed. Copyright © 2016 Elsevier B.V. All rights reserved.

Gestational weight gain and subsequent postpartum weight loss among young, low-income, ethnic minority women.

PubMed

Gould Rothberg, Bonnie E; Magriples, Urania; Kershaw, Trace S; Rising, Sharon Schindler; Ickovics, Jeannette R

2011-01-01

Document weight change trajectories that lead to gestational weight gain or postpartum weight loss outside clinical recommendations established by the Institute of Medicine. Women aged 14-25 receiving prenatal care and delivering singleton infants at term (n = 427). Medical record review and 4 structured interviews conducted: second and third trimester, 6- and 12-months postpartum. Longitudinal mixed modeling to evaluate weight change trajectories. Only 22% of participants gained gestational weight within Institute of Medicine guidelines. There were 62% that exceeded maximum recommendations-more common among those overweight/obese (body mass index ≥25.0; P < .0001). 52% retained ≥10 lb 1-year postpartum. Increased weight gain and retention documented among smokers and women with pregnancy-induced hypertension; breastfeeding promoted postpartum weight loss (all P < .02). Body mass index by race interaction suggested healthier outcomes for Latinas (P = .02). Excessive pregnancy weight gain and inadequate postpartum weight loss are highly prevalent among young low-income ethnic minority women. Pregnancy and postpartum are critical junctures for weight management interventions. Copyright © 2011 Mosby, Inc. All rights reserved.

Propagating modes in gain-guided optical fibers.

PubMed

Siegman, A E

2003-08-01

Optical fibers in which gain-guiding effects are significant or even dominant compared with conventional index guiding may become of practical interest for future high-power single-mode fiber lasers. I derive the propagation characteristics of symmetrical slab waveguides and cylindrical optical fibers having arbitrary amounts of mixed gain and index guiding, assuming a single uniform transverse profile for both the gain and the refractive-index steps. Optical fibers of this type are best characterized by using a complex-valued v-squared parameter in place of the real-valued v parameter commonly used to describe conventional index-guided optical fibers.

Electrical gain in interband cascade infrared photodetectors

NASA Astrophysics Data System (ADS)

Huang, Wenxiang; Li, Lu; Lei, Lin; Massengale, Jeremy A.; Yang, Rui Q.; Mishima, Tetsuya D.; Santos, Michael B.

2018-03-01

In order to achieve improved understanding and gain insights into the device operation of interband cascade infrared photodetectors (ICIPs) and ultimately to optimize the design, we present a comparative study of five long-wavelength (LW) ICIPs based on a type-II InAs/GaSb superlattice. This study shows how the device responsivity is affected by the individual absorber thicknesses and the number of cascade stages, through the impact of light attenuation. Additionally, this study further validates that the electrical gain universally exists in non-current-matched ICIPs. With multiple cascade stages to suppress noise, these LW ICIPs achieved superior device performance at high temperatures, in terms of Johnson-noise limited detectivities, compared to commercial MCT detectors. Furthermore, a theory is developed to quantitatively describe the electrical gain in ICIPs and our calculations are in good agreement with the experimental results. Based on the theory, the optimal number of stages for maximizing the device detectivity D* is identified with inclusion of the electrical gain. Our calculation shows that this optimal number of stages is relatively large in the presence of the gain and the maximized D* has a relatively weak dependence on the absorber thickness when it is sufficiently thin.

Relationship of pressure to be thin with gains in body weight and fat mass in adolescents.

PubMed

Suelter, C S; Schvey, N; Kelly, N R; Shanks, M; Thompson, K A; Mehari, R; Brady, S; Yanovski, S Z; Melby, C L; Tanofsky-Kraff, M; Yanovski, J A; Shomaker, L B

2018-01-01

Sociocultural pressure to be thin is commonly reported by adolescents; yet, to what extent such pressure is associated with weight gain has not been evaluated longitudinally. Examine whether pressure to be thin was positively associated with weight and fat gain in adolescents. Participants were 196 healthy adolescent (age 15 ± 1 years old) girls (65%) and boys of varying weights (BMI 25 ± 7 kg/m 2 ) studied at baseline and 1-year follow-up. At baseline, adolescents and their mothers reported pressure to be thin by questionnaire. At baseline and follow-up, BMI was calculated, and fat mass was assessed with air displacement plethysmography. Multiple regression was used to examine associations between baseline pressure to be thin and 1-year changes in BMI and fat mass. Accounting for multiple covariates, including baseline BMI or fat, adolescent-reported pressure from parents and peers and mother-reported pressure toward their teen were associated with greater gains in either adolescent BMI or fat (ps < .05). Adolescent weight status was a moderator of multiple effects (ps < .05). Parental and peer pressure to be thin were associated with increases in BMI and fat mass during adolescence, particularly in heavier adolescents. Further research is necessary to clarify how this association operates reciprocally and to identify underlying explanatory mechanisms. © 2016 World Obesity Federation.

Quantifying the mechanisms of domain gain in animal proteins.

PubMed

Buljan, Marija; Frankish, Adam; Bateman, Alex

2010-01-01

Protein domains are protein regions that are shared among different proteins and are frequently functionally and structurally independent from the rest of the protein. Novel domain combinations have a major role in evolutionary innovation. However, the relative contributions of the different molecular mechanisms that underlie domain gains in animals are still unknown. By using animal gene phylogenies we were able to identify a set of high confidence domain gain events and by looking at their coding DNA investigate the causative mechanisms. Here we show that the major mechanism for gains of new domains in metazoan proteins is likely to be gene fusion through joining of exons from adjacent genes, possibly mediated by non-allelic homologous recombination. Retroposition and insertion of exons into ancestral introns through intronic recombination are, in contrast to previous expectations, only minor contributors to domain gains and have accounted for less than 1% and 10% of high confidence domain gain events, respectively. Additionally, exonization of previously non-coding regions appears to be an important mechanism for addition of disordered segments to proteins. We observe that gene duplication has preceded domain gain in at least 80% of the gain events. The interplay of gene duplication and domain gain demonstrates an important mechanism for fast neofunctionalization of genes.

Temporal Gain Correction for X-Ray Calorimeter Spectrometers

NASA Technical Reports Server (NTRS)

Porter, F. S.; Chiao, M. P.; Eckart, M. E.; Fujimoto, R.; Ishisaki, Y.; Kelley, R. L.; Kilbourne, C. A.; Leutenegger, M. A.; McCammon, D.; Mitsuda, K.

2016-01-01

Calorimetric X-ray detectors are very sensitive to their environment. The boundary conditions can have a profound effect on the gain including heat sink temperature, the local radiation temperature, bias, and the temperature of the readout electronics. Any variation in the boundary conditions can cause temporal variations in the gain of the detector and compromise both the energy scale and the resolving power of the spectrometer. Most production X-ray calorimeter spectrometers, both on the ground and in space, have some means of tracking the gain as a function of time, often using a calibration spectral line. For small gain changes, a linear stretch correction is often sufficient. However, the detectors are intrinsically non-linear and often the event analysis, i.e., shaping, optimal filters etc., add additional non-linearity. Thus for large gain variations or when the best possible precision is required, a linear stretch correction is not sufficient. Here, we discuss a new correction technique based on non-linear interpolation of the energy-scale functions. Using Astro-HSXS calibration data, we demonstrate that the correction can recover the X-ray energy to better than 1 part in 104 over the entire spectral band to above 12 keV even for large-scale gain variations. This method will be used to correct any temporal drift of the on-orbit per-pixel gain using on-board calibration sources for the SXS instrument on the Astro-H observatory.

The Second Year Itch: An Examination of Pre-Entry Factors that Contribute to Second-Year College Persistence

ERIC Educational Resources Information Center

Scobie, Nora Allen

2010-01-01

The persistence of second-year college students is gaining attention nationally. Vast resources have been dedicated to the retention of first-year students only to lose them at some point during the second year. Much of the research about the second-year experience is qualitative and focused on institutional inputs. This study examined pre-entry…

Compensated gain control circuit for buck regulator command charge circuit

DOEpatents

Barrett, David M.

1996-01-01

A buck regulator command charge circuit includes a compensated-gain control signal for compensating for changes in the component values in order to achieve optimal voltage regulation. The compensated-gain control circuit includes an automatic-gain control circuit for generating a variable-gain control signal. The automatic-gain control circuit is formed of a precision rectifier circuit, a filter network, an error amplifier, and an integrator circuit.

Fuel Cycle Analysis Framework Base Cases for the IAEA/INPRO GAINS Collaborative Project

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

Brent Dixon

Thirteen countries participated in the Collaborative Project GAINS “Global Architecture of Innovative Nuclear Energy Systems Based on Thermal and Fast Reactors Including a Closed Fuel Cycle”, which was the primary activity within the IAEA/INPRO Program Area B: “Global Vision on Sustainable Nuclear Energy” for the last three years. The overall objective of GAINS was to develop a standard framework for assessing future nuclear energy systems taking into account sustainable development, and to validate results through sample analyses. This paper details the eight scenarios that constitute the GAINS framework base cases for analysis of the transition to future innovative nuclear energymore » systems. The framework base cases provide a reference for users of the framework to start from in developing and assessing their own alternate systems. Each base case is described along with performance results against the GAINS sustainability evaluation metrics. The eight cases include four using a moderate growth projection and four using a high growth projection for global nuclear electricity generation through 2100. The cases are divided into two sets, addressing homogeneous and heterogeneous scenarios developed by GAINS to model global fuel cycle strategies. The heterogeneous world scenario considers three separate nuclear groups based on their fuel cycle strategies, with non-synergistic and synergistic cases. The framework base case analyses results show the impact of these different fuel cycle strategies while providing references for future users of the GAINS framework. A large number of scenario alterations are possible and can be used to assess different strategies, different technologies, and different assumptions about possible futures of nuclear power. Results can be compared to the framework base cases to assess where these alternate cases perform differently versus the sustainability indicators.« less

Pubertal height gain: male-female and interpopulation comparisons.

PubMed

Spencer, Richard P