Hemoglobin A1c Levels Modify Associations between Dietary Acid Load and Breast Cancer Recurrence.

BackgroundMetabolic acidosis promotes cancer metastasis. No prospective studies have examined the association between dietary acid load and breast cancer recurrence among breast cancer survivors, who are susceptible to metabolic acidosis. Hyperglycemia promotes cancer progression and acid formation; however, researchers have not examined whether hyperglycemia can modify the association between dietary acid load and breast cancer recurrence.MethodsWe studied 3081 early-stage breast cancer survivors enrolled in the Women's Healthy Eating and Living study who provided dietary information through 24-h recalls at baseline and during follow-up and had measurements of hemoglobin A1c (HbA1c) at baseline. We assessed dietary acid load using two common dietary acid load scores, potential renal acid load (PRAL) score and net endogenous acid production (NEAP) score.ResultsAfter an average of 7.3 years of follow-up, dietary acid load was positively associated with recurrence when baseline HbA1c levels were ≥ 5.6% (median level) and ≥5.7% (pre-diabetic cut-point). In the stratum with HbA1c ≥ 5.6%, comparing the highest to the lowest quartile of dietary acid load, the multivariable-adjusted hazard ratio was 2.15 (95% confidence interval [CI] 1.34-3.48) for PRAL and was 2.31 (95% CI 1.42-3.74) for NEAP. No associations were observed in the stratum with HbA1c levels were <5.6%. P-values for interactions were 0.01 for PRAL and 0.05 for NEAP.ConclusionsOur study demonstrated for the first time that even at or above normal to high HbA1c levels, dietary acid load was associated with increased risk of breast cancer recurrence among breast cancer survivors.ImpactsOur study provides strong evidence for developing specific dietary acid load guidelines based on HbA1c levels

Associations between Dietary Acid Load and Biomarkers of Inflammation and Hyperglycemia in Breast Cancer Survivors.

Metabolic acidosis can lead to inflammation, tissue damage, and cancer metastasis. Dietary acid load contributes to metabolic acidosis if endogenous acid-base balance is not properly regulated. Breast cancer survivors have reduced capacities to adjust their acid-base balance; yet, the associations between dietary acid load and inflammation and hyperglycemia have not been examined among them. We analyzed data collected from 3042 breast cancer survivors enrolled in the Women's Healthy Eating and Living (WHEL) Study who had provided detailed dietary intakes and measurements of plasma C-reactive protein (CRP) and hemoglobin A1c (HbA1c). Using a cross-sectional design, we found positive associations between dietary acid load and plasma CRP and HbA1c. In the multivariable-adjusted models, compared to women with the lowest quartile, the intakes of dietary acid load among women with the highest quartile showed 30-33% increases of CRP and 6-9% increases of HbA1c. Our study is the first to demonstrate positive associations between dietary acid load and CRP and HbA1c in breast cancer survivors. Our study identifies a novel dietary factor that may lead to inflammation and hyperglycemia, both of which are strong risk factors for breast cancer recurrence and comorbidities

Extending The Technology Acceptance Model: Policy Acceptance Model (PAM)

Many have studied the process of acceptance and adoption of new ideas and technologies as they are introduced into society. While several models have been used to assess various influencing factors, the Technology Acceptance Model (TAM) is one that is most widely accepted. This model examines people’s acceptance of new technologies based on variables that directly correlate to how the end user views the product. This paper introduces the Policy Acceptance Model (PAM), an expansion of TAM, which is designed for the analysis and evaluation of acceptance of new policy implementation. PAM includes the traditional constructs of TAM and adds the variables of age and ethnicity. The model is experimentally assessed using a survey of people’s attitudes toward the upcoming health care reform from 72 survey respondents. The aim is that the theory behind this model can be used as a framework that will be applicable to studies looking at the introduction of any new or modified policies.

Reynolds number influences in aeronautics

Reynolds number, a measure of the ratio of inertia to viscous forces, is a fundamental similarity parameter for fluid flows and therefore, would be expected to have a major influence in aerodynamics and aeronautics. Reynolds number influences are generally large, but monatomic, for attached laminar (continuum) flow; however, laminar flows are easily separated, inducing even stronger, non-monatomic, Reynolds number sensitivities. Probably the strongest Reynolds number influences occur in connection with transitional flow behavior. Transition can take place over a tremendous Reynolds number range, from the order of 20 x 10(exp 3) for 2-D free shear layers up to the order of 100 x 10(exp 6) for hypersonic boundary layers. This variability in transition behavior is especially important for complex configurations where various vehicle and flow field elements can undergo transition at various Reynolds numbers, causing often surprising changes in aerodynamics characteristics over wide ranges in Reynolds number. This is further compounded by the vast parameterization associated with transition, in that any parameter which influences mean viscous flow development (e.g., pressure gradient, flow curvature, wall temperature, Mach number, sweep, roughness, flow chemistry, shock interactions, etc.), and incident disturbance fields (acoustics, vorticity, particulates, temperature spottiness, even electro static discharges) can alter transition locations to first order. The usual method of dealing with the transition problem is to trip the flow in the generally lower Reynolds number wind tunnel to simulate the flight turbulent behavior. However, this is not wholly satisfactory as it results in incorrectly scaled viscous region thicknesses and cannot be utilized at all for applications such as turbine blades and helicopter rotors, nacelles, leading edge and nose regions, and High Altitude Long Endurance and hypersonic airbreathers where the transitional flow is an innately critical portion of the problem

Comparative validation of the IPAQ and the 7-Day PAR among women diagnosed with breast cancer

BACKGROUND: The criterion-related validity and measurement bias of the long form of the International Physical Activity Questionnaire (IPAQ) was compared to the 7-Day Physical Activity Recall (PAR). METHODS: Participants were women who have been diagnosed with breast cancer and enrolled in the ongoing Women's Healthy Eating and Living Study. Women (N = 159, average age 57 years) wore an accelerometer for one week and then completed the IPAQ or the PAR. RESULTS: The validity correlation of the PAR was significantly higher (p < 0.001) than the IPAQ (0.73 vs. 0.33, respectively). The PAR and IPAQ overestimated total physical activity by 13% vs. 247%, respectively. The PAR had better sensitivity (p = 0.14) and specificity (p < .01) than the IPAQ (100% vs. 71% and 84% vs. 59%, respectively) in predicting attainment of the ACSM physical activity guideline. CONCLUSION: The PAR was superior to the IPAQ in terms of validity, measurement bias, and screening statistics

Improved Bias Correction Techniques for Hydrological Simulations of Climate Change

Global climate model (GCM) output typically needs to be bias corrected before it can be used for climate change impact studies. Three existing bias correction methods, and a new one developed here, are applied to daily maximum temperature and precipitation from 21 GCMs to investigate how different methods alter the climate change signal of the GCM. The quantile mapping (QM) and cumulative distribution function transform (CDF-t) bias correction methods can significantly alter the GCM’s mean climate change signal, with differences of up to 2°C and 30% points for monthly mean temperature and precipitation, respectively. Equidistant quantile matching (EDCDFm) bias correction preserves GCM changes in mean daily maximum temperature but not precipitation. An extension to EDCDFm termed PresRat is introduced, which generally preserves the GCM changes in mean precipitation. Another problem is that GCMs can have difficulty simulating variance as a function of frequency. To address this, a frequency-dependent bias correction method is introduced that is twice as effective as standard bias correction in reducing errors in the models’ simulation of variance as a function of frequency, and it does so without making any locations worse, unlike standard bias correction. Last, a preconditioning technique is introduced that improves the simulation of the annual cycle while still allowing the bias correction to take account of an entire season’s values at once

The Missing Heritability in T1D and Potential New Targets for Prevention

Type 1 diabetes (T1D) is a T cell-mediated disease. It is strongly associated with susceptibility haplotypes within the major histocompatibility complex, but this association accounts for an estimated 50% of susceptibility. Other studies have identified as many as 50 additional susceptibility loci, but the effect of most is very modest (odds ratio (OR) 5) and that deletion of V beta 13+ T cells prevents diabetes. A role for the TCR is also suspected in NOD mice, but TCR regions have not been associated with human T1D. To investigate this disparity, we tested the hypothesis in silico that previous studies of human T1D genetics were underpowered to detect MHC-contingent TCR susceptibility. We show that stratifying by MHC markedly increases statistical power to detect potential TCR susceptibility alleles. We suggest that the TCR regions are viable candidates for T1D susceptibility genes, could account for missing heritability, and could be targets for prevention

Novel patient-centered approach to facilitate same-day discharge in patients undergoing elective percutaneous coronary intervention

Background Same‐day discharge ( SDD ) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low‐risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a “patient‐centered” protocol based on risk of complications at Barnes‐Jewish Hospital. Methods and Results Our objectives were as follows: (1) to evaluate time trends in SDD ; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD ( NSDD ); and (3) to compare SDD eligibility by our patient‐centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient‐centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes‐Jewish Hospital's National Cardiovascular Data Registry Cath PCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% ( P &lt;0.001), independent of radial access. Although SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD . Propensity score–adjusted costs were 7331 lower/ SDD patient ( P <0.001), saving an estimated 1.8 million annually. Only 16 patients (6.95%) met the eligibility for SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient‐centered approach markedly increased SDD eligibility. Conclusions With a patient‐centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient‐centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention. </jats:sec