How effective are dietary interventions in lowering lipids in adults with dyslipidemia?

Diets lower in fat, higher in soy protein, or higher in fiber reduce serum total cholesterol, low-density lipoprotein (LDL), and triglycerides. More restrictive low-fat diets also lower high-density lipoprotein (HDL), while soy protein increases HDL. Average decreases in LDL range from 6.96 to 25.14 mg/dL, depending on the particular intervention and participants' baseline characteristics (strength of recommendation [SOR]: C, based on meta-analyses of randomized controlled trials [RCTs] measuring intermediate endpoints)

Adjudication of Federal Causes of Action in State Court

The first section of this article considers the power of state courts to hear federal cases. Since it is now well established that state courts have the constitutional power to adjudicate federal causes of action if Congress so desires, the significant questions concern the method by which the judiciary is to decipher congressional intent. Although the courts have no difficulty where Congress has explicitly addressed the issue of state court jurisdiction, problems do arise in situations where Congress has remained silent on the question. The first section critically examines the traditional criteria employed by the courts for determining congressional intent in the face of congressional silence and then suggests a substantial alteration in the judiciary\u27s approach to the matter. The second section of the article considers the obligation of state courts to hear federal cases. After first evaluating constitutional questions surrounding such an obligation, this section wilI also examine difficult questions involving congressional intent-specifically, the circumstances under which Congress\u27 silence is intended to permit state courts to avoid hearing federal cases

Angiotensin blockade for diabetes: Monitor microalbuminuria?

No studies address whether continued screening for microalbuminuria once a patient is taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-2 receptor blocker (ARB) improves outcomes. Indirect evidence and expert opinion suggest that it may be beneficial to continue microalbuminuria surveillance to assess response to therapy and monitor disease progression (strength of recommendation: C, based on expert opinion)

Which tests are the most useful for diagnosing PID?

No single test has adequate sensitivity and specificity to reliably identify pelvic inflammatory disease (PID) and thus help to spare women serious sequelae, including infertility (strength of recommendation [SOR]: B, based on systematic reviews of cohort studies and individual cohort studies)

Impact Of Electrical Noise On The Torsional Response Of VFD Compressor Trains

LectureThe popularity of VFD motors in compressor trains has increased in recent years. Increased process flexibility is a primary consideration for implementation of VFD systems. However, this comes at a cost of increased mechanical and electrical complexity. Problems rarely experienced with single speed motors have become more likely with VFD's. These include impacts on the torsional behavior leading to component failure and extended downtimes. VFD's can excite the torsional system in several ways. This paper examines the impact of white noise on the torsional response of VFD compressor trains and contrasts it against the response to single frequency harmonic excitation. The characteristics of white noise, noise modeling characteristics for torsional response, and noise generation techniques are examined. Generation of a frequency banded noise signal is presented using a commonly used math modeling code. Two case studies are presented representing VFD compressor trains found in the LNG industry. Both experienced torsional problems related to the VFD and, in one case, led to a coupling failure and release of parts from the train. In the examination of these trains, a single frequency harmonic (SFH) sweep and banded Gaussian white noise (GWN) encompassing the dynamic response envelop of the 1st TNF, are used as inputs to the torsional analysis

miR-196b target screen reveals mechanisms maintaining leukemia stemness with therapeutic potential.

We have shown that antagomiR inhibition of miRNA miR-21 and miR-196b activity is sufficient to ablate MLL-AF9 leukemia stem cells (LSC) in vivo. Here, we used an shRNA screening approach to mimic miRNA activity on experimentally verified miR-196b targets to identify functionally important and therapeutically relevant pathways downstream of oncogenic miRNA in MLL-r AML. We found Cdkn1b (p27Kip1) is a direct miR-196b target whose repression enhanced an embryonic stem cell–like signature associated with decreased leukemia latency and increased numbers of leukemia stem cells in vivo. Conversely, elevation of p27Kip1 significantly reduced MLL-r leukemia self-renewal, promoted monocytic differentiation of leukemic blasts, and induced cell death. Antagonism of miR-196b activity or pharmacologic inhibition of the Cks1-Skp2–containing SCF E3-ubiquitin ligase complex increased p27Kip1 and inhibited human AML growth. This work illustrates that understanding oncogenic miRNA target pathways can identify actionable targets in leukemia

Chronic Overlapping Pain Conditions and Long-Term Opioid Treatment

OBJECTIVES: One in 5 people in the United States lives with chronic pain. Many patients with chronic pain experience a subset of specific co-occurring pain conditions that may share a common pain mechanism and that have been designated as chronic overlapping pain conditions (COPCs). Little is known about chronic opioid prescribing patterns among patients with COPCs in primary care settings, especially among socioeconomically vulnerable patients. This study aims to evaluate opioid prescribing among patients with COPCs in US community health centers and to identify individual COPCs and their combinations that are associated with long-term opioid treatment (LOT). STUDY DESIGN: Retrospective cohort study. METHODS: We conducted analyses of more than 1 million patients 18 years and older based on electronic health record data from 449 US community health centers across 17 states between January 1, 2009, and December 31, 2018. Logistic regression models were used to assess the relationship between COPCs and LOT. RESULTS: Individuals with COPCs were prescribed LOT 4 times more often than individuals without a COPC (16.9% vs 4.0%). The presence of chronic low back pain, migraine headache, fibromyalgia, or irritable bowel syndrome combined with any of the other COPCs increased the odds of LOT prescribing compared with the presence of a single COPC. CONCLUSIONS: Although LOT prescribing has declined over time, it remains relatively high among patients with certain COPCs and for those with multiple COPCs. These study findings suggest target populations for future interventions to manage chronic pain among socioeconomically vulnerable patients

A Census of the Young Cluster IC 348

We present a new census of the stellar and substellar members of the young cluster IC 348. We have obtained images at I and Z for a 42'x28' field encompassing the cluster and have combined these measurements with previous optical and near-infrared photometry. From spectroscopy of candidate cluster members appearing in these data, we have identified 122 new members, 15 of which have spectral types of M6.5-M9, corresponding to masses of 0.08-0.015 M_sun by recent evolutionary models. The latest census for IC 348 now contains a total of 288 members, 23 of which are later than M6 and thus are likely to be brown dwarfs. From an extinction-limited sample of members (A_V<=4) for a 16'x14' field centered on the cluster, we construct an IMF that is unbiased in mass and nearly complete for M/M_sun>=0.03 (<=M8). In logarithmic units where the Salpeter slope is 1.35, the mass function for IC 348 rises from high masses down to a solar mass, rises more slowly down to a maximum at 0.1-0.2 M_sun, and then declines into the substellar regime. In comparison, the similarly-derived IMF for Taurus from Briceno et al. and Luhman et al. rises quickly to a peak near 0.8 M_sun and steadily declines to lower masses. The distinctive shapes of the IMFs in IC 348 and Taurus are reflected in the distributions of spectral types, which peak at M5 and K7, respectively. These data provide compelling, model-independent evidence for a significant variation of the IMF with star-forming conditions.Comment: 47 pages, 14 figures, 3rd para of 4.5.3 has been added, this is final version in press at ApJ, also found at http://cfa-www.harvard.edu/sfgroup/preprints.htm

An exploration of the influences on under-representation of male pre-registration nursing students

Background:- Worldwide, men are under-represented in the nursing profession. In Scotland less than 10% of pre-registration nursing students are male. Reasons for this imbalance need to be understood. Objectives:- To explore the views of male pre-registration nursing students, nursing lecturers and school teachers about this imbalance. Design:- Mixed methods study using focus groups and online survey. Settings:- Focus groups in four locations across Scotland. Online survey sent to teachers across Scotland. Participants and methods:- Eight focus groups with 33 male nursing students; four focus groups with 21 university and college nursing lecturers; 46 school teachers returned the online survey. Results:- Although nursing was considered a worthwhile career with job stability and many opportunities, it was also viewed as not being a career for men. Assumptions about the profession and femininity were challenging for men and use of the term ‘male nurse’ was felt to be anomalous. In some circumstances the provision of intimate care to particular patient groups caused difficulty. Positive encouragement from others, a positive role model or knowledge of nursing from significant others could be helpful. However concerns about low earning potential and negative media publicity about the NHS could be a disincentive. Being mature and having resilience were important to cope with being a male nursing student in a mainly female workplace. Some more ‘technical’ specialties were felt to be more attractive to men. Conclusions:- Nursing is viewed as a worthwhile career choice for men, but the gendered assumptions about the feminine nature of nursing can be a deterrent