New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Comprehensive reform for student success

Comprend des références bibliographiques et un index.1. The Need for Comprehensive Reform: From Access to Completion Thomas Bailey The introduction to the special issue discusses the current challenges facing community colleges and describes why reform must be comprehensive if challenges are to be solved.2. Using Research and Evaluation to Support Comprehensive Reform Thomas Brock, Alexander K. Mayer, Elizabeth Zachry Rutschow Two comprehensive community college reform initiatives—Achieving the Dream and Completion by Design—encouraged colleges to use research and data to guide improvements that would lead to better student outcomes. The initiatives shed light on the opportunities and challenges of data-driven reform and underscore how evaluation methods may be used to support comprehensive reform efforts.3. The Redesign of Developmental Education in Virginia Nikki Edgecombe Developmental education reforms must, by definition, focus on students’ early college careers. Perhaps as a result, past efforts have not generated large and enduring positive effects. This chapter provides an overview of a comprehensive developmental education redesign in Virginia. It describes its planning and early implementation, presents preliminary descriptive findings on its outcomes, and highlights considerations for systems pursuing comprehensive efforts to more effectively assess and remediate academic underpreparedness.4. Addressing College Readiness Gaps at the College Door Elizabeth Friedmann, Michal Kurlaender, Alice van Ommeren California’s Early Assessment Program provides high school students with early signals about their college readiness in order to improve their skills in the 12th grade year and reduce the need for developmental course taking in college. The program affords an opportunity to describe how comprehensive efforts to adopt this program may have improved alignment between K–12 and community colleges, reduced developmental course taking across California’s community colleges, and facilitated tracking students from K–12 into college.5. Transforming the Community College Student Experience Through Comprehensive, Technology-Mediated Advising Shanna Smith Jaggars, Melinda Mechur Karp Seeking radically improved completion rates, colleges are increasingly turning to technology as a reform tool. Many, however, struggle to leverage technology in ways that lead to large-scale comprehensive change. Case study data on the use of “e-advising” systems in several community colleges help build an understanding of what happens when colleges implement technology to help transform academic advising.6. Using Career Pathways to Guide Students Through Programs of Study Debra D. Bragg, Marianne Krismer Pathways and programs of study provide an increasingly important perspective on college credentialing, completion, and employment. This chapter discusses their nature, structure, and centrality in a competency-based core curriculum developed under the Health Professions Pathways (H2P) consortium funded by Round 1 of the U.S. Department of Labor’s Trade Adjustment Assistance Community College and Career Training grants.7. Leveraging Technology to Create a Student Focused Environment Linda M. Thor, Joseph Moreau Community college educators recognize the need to improve online learner retention and success, which is significantly lower than in traditional face-to-face courses. Yet colleges continue to fail to coordinate with other institutions or to leverage shareable resources. The Online Education Initiative in the California Community Colleges, drawing on experiences of online pioneer Rio Salado College, illustrates how to enhance system efficiency and student success in online learning through coordination and collaboration.8. Competency-Based Programs as a Lever for Reforming Core Areas Jointly Ann E. Person, Nancy Thibeault Sinclair Community College’s efforts to adapt and adopt competencybased models in information technology programs provides an example of how colleges might improve student success in college and careers and transform the way the college creates and maintains career-relevant curricula.9. Using Data for Continuous Program Improvement Nan L. Maxwell, Ann E. Person Although community colleges operate in a constantly changing environment that requires up-to-date program learning goals that meet stakeholder needs, they often do not have the capacity to assess their programs within a continuous improvement framework. This chapter discusses challenges to using data in a continuous improvement framework and describes the approaches some community colleges have used to overcome those challenges.10. Implementing Comprehensive Reform: Implications for Practice Karen Stout Community colleges face challenges and practical impediments when implementing comprehensive reform. To drive reform, Montgomery County Community College developed a blended framework from Achieving the Dream and the American Association of Community Colleges. Although the result was unscaled improvements in the short term, the experience increased understanding of why comprehensive reform remains a challenge and how committed leadership is imperative for its success

Pairing QuantiFERON Gold In-Tube with Opt-Out HIV Testing in a Tuberculosis Contact Investigation in the Southeastern United States

Knowing one's HIV status is particularly important in the setting of recent tuberculosis (TB) exposure. Blood tests for assessment of tuberculosis infection, such as the QuantiFERON Gold in-tube test (QFT; Cellestis Limited, Carnegie, Victoria, Australia), offer the possibility of simultaneous screening for TB and HIV with a single blood draw. We performed a cross-sectional analysis of all contacts to a highly infectious TB case in a large meatpacking factory. Twenty-two percent were foreign-born and 73% were black. Contacts were tested with both tuberculin skin testing (TST) and QFT. HIV testing was offered on an opt-out basis. Persons with TST ≥10 mm, positive QFT, and/or positive HIV test were offered latent TB treatment. Three hundred twenty-six contacts were screened: TST results were available for 266 people and an additional 24 reported a prior positive TST for a total of 290 persons with any TST result (89.0%). Adequate QFT specimens were obtained for 312 (95.7%) of persons. Thirty-two persons had QFT results but did not return for TST reading. Twenty-two percent met the criteria for latent TB infection. Eighty–eight percent accepted HIV testing. Two (0.7%) were HIV seropositive; both individuals were already aware of their HIV status, but one had stopped care a year previously. None of the HIV-seropositive persons had latent TB, but all were offered latent TB treatment per standard guidelines. This demonstrates that opt-out HIV testing combined with QFT in a large TB contact investigation was feasible and useful. HIV testing was also widely accepted. Pairing QFT with opt-out HIV testing should be strongly considered when possible

Using marketing science to understand contraceptive demand in high‐fertility Niger

Global initiatives aim to add 120 million new family planning (FP) users by 2020; however supply‐side interventions may be reaching the limits of their effectiveness in some settings. Our case study in Niger used demand analysis techniques from marketing science. We performed a representative survey (N = 2,004) on women's FP knowledge, attitudes, needs, and behaviors, then used latent class analysis to produce a segmentation of women based on their responses. We found that Nigerien women's demand for modern FP methods was low, with majorities aware of modern methods but much smaller proportions considering use, trying modern methods, or using one consistently. We identified five subgroups of women with distinct, internally coherent profiles regarding FP needs, attitudes, and usage patterns, who faced different barriers to adopting or using modern FP. Serving subgroups of women based on needs, values, and underlying beliefs may help more effectively drive a shift in FP behavior