How should a DEXA scan be used to evaluate bisphosphonate therapy for osteoporosis?

If bone density is evaluated after initiating bisphosphonate drug therapy, it should be tested no earlier than 2 years (strength of recommendation [SOR]: B, based on case series of dual energy x-ray absorptiometry [DEXA] scanning precision and bisphosphonate efficacy). Currently no prospective, randomized trials investigate the impact of bone density follow-up testing on osteoporotic patients receiving bisphosphonate therapy

Climate Science Special Report: Fourth National Climate Assessment (NCA4), Volume I

New observations and new research have increased our understanding of past, current, and future climate change since the Third U.S. National Climate Assessment (NCA3) was published in May 2014. This Climate Science Special Report (CSSR) is designed to capture that new information and build on the existing body of science in order to summarize the current state of knowledge and provide the scientific foundation for the Fourth National Climate Assessment (NCA4)

Observations: Atmosphere and Surface.

The evidence of climate change from observations of the atmosphere and surface has grown significantly during recent years. At the same time new improved ways of characterizing and quantifying uncertainty have highlighted the challenges that remain for developing long-term global and regional climate quality data records. A number of changes in the astmopshere are evaluated and quantified for the IPCC AR5 WG1 reportJRC.H.4-Monitoring Agricultural Resource

Observations: Atmosphere and Surface

Executive SummaryThe evidence of climate change from observations of the atmosphere and surface has grown significantly during recent years. At the same time new improved ways of characterizing and quantifying uncertainty have highlighted the challenges that remain for developing long-term global and regional climate quality data records. Currently, the observations of the atmosphere and surface indicate the following changes:Atmospheric CompositionIt is certain that atmospheric burdens of the well-mixed greenhouse gases (GHGs) targeted by the Kyoto Protocol increased from 2005 to 2011. The atmospheric abundance of carbon dioxide (CO2) was 390.5 ppm (390.3 to 390.7) in 2011; this is 40% greater than in 1750. Atmospheric nitrous oxide (N2O) was 324.2 ppb (324.0 to 324.4) in 2011 and has increased by 20% since 1750. Average annual increases in CO2 and N2O from 2005 to 2011 are comparable to those observed from 1996 to 2005. Atmospheric methane (CH4) was 1803.2 ppb (1801.2 to 1805.2) in 2011; this is 150% greater than before 1750. CH4 began increasing in 2007 after remaining nearly constant from 1999 to 2006. Hydrofluorocarbons (HFCs), perfluorocarbons (PFCs), and sulphur hexafluoride (SF6) all continue to increase relatively rapidly, but their contributions to radiative forcing are less than 1% of the total by well-mixed GHGs

Methods and initial findings from the Durham Diabetes Coalition: Integrating geospatial health technology and community interventions to reduce death and disability

Objective: The Durham Diabetes Coalition (DDC) was established in response to escalating rates of disability and death related to type 2 diabetes mellitus, particularly among racial/ethnic minorities and persons of low socioeconomic status in Durham County, North Carolina. We describe a community-based demonstration project, informed by a geographic health information system (GHIS), that aims to improve health and healthcare delivery for Durham County residents with diabetes. Materials and Methods: A prospective, population-based study is assessing a community intervention that leverages a GHIS to inform community-based diabetes care programs. The GHIS integrates clinical, social, and environmental data to identify, stratify by risk, and assist selection of interventions at the individual, neighborhood, and population levels. Results: The DDC is using a multifaceted approach facilitated by GHIS to identify the specific risk profiles of patients and neighborhoods across Durham County. A total of 22,982 patients with diabetes in Durham County were identified using a computable phenotype. These patients tended to be older, female, African American, and not covered by private health insurance, compared with the 166,041 persons without diabetes. Predictive models inform decision-making to facilitate care and track outcomes. Interventions include: 1) neighborhood interventions to improve the context of care; 2) intensive team-based care for persons in the top decile of risk for death or hospitalization within the coming year; 3) low-intensity telephone coaching to improve adherence to evidence-based treatments; 4) county-wide communication strategies; and 5) systematic quality improvement in clinical care. Conclusions: To improve health outcomes and reduce costs associated with type 2 diabetes, the DDC is matching resources with the specific needs of individuals and communities based on their risk characteristics

Climate Science Special Report: Fourth National Climate Assessment (NCA4), Volume I

The article of record as published may be found at https://doi.org/10.7930

Reproduction and transplantation: report on the AST Consensus Conference on Reproductive Issues and Transplantation.

It has been almost 50 years since the first child was born to a female transplant recipient. Since that time pregnancy has become common after transplantation, but physicians have been left to rely on case reports, small series and data from voluntary registries to guide the care of their patients. Many uncertainties exist including the risks that pregnancy presents to the graft, the patient herself, and the long-term risks to the fetus. It is also unclear how to best modify immunosuppressive agents or treat rejection during pregnancy, especially in light of newer agents available where pregnancy safety has not been established. To begin to address uncertainties and define clinical practice guidelines for the transplant physician and obstetrical caregivers, a consensus conference was held in Bethesda, Md. The conferees summarized both what is known and important gaps in our knowledge. They also identified key areas of agreement, and posed a number of critical questions, the resolution of which is necessary in order to establish evidence-based guidelines. The manuscript summarizes the deliberations and conclusions of the conference as well as specific recommendations based on current knowledge in the field