Association between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies

Background: The prevalence of class III obesity (body mass index [BMI]≥40 kg/m2) has increased dramatically in several countries and currently affects 6% of adults in the US, with uncertain impact on the risks of illness and death. Using data from a large pooled study, we evaluated the risk of death, overall and due to a wide range of causes, and years of life expectancy lost associated with class III obesity. Methods and Findings: In a pooled analysis of 20 prospective studies from the United States, Sweden, and Australia, we estimated sex- and age-adjusted total and cause-specific mortality rates (deaths per 100,000 persons per year) and multivariable-adjusted hazard ratios for adults, aged 19–83 y at baseline, classified as obese class III (BMI 40.0–59.9 kg/m2) compared with those classified as normal weight (BMI 18.5–24.9 kg/m2). Participants reporting ever smoking cigarettes or a history of chronic disease (heart disease, cancer, stroke, or emphysema) on baseline questionnaires were excluded. Among 9,564 class III obesity participants, mortality rates were 856.0 in men and 663.0 in women during the study period (1976–2009). Among 304,011 normal-weight participants, rates were 346.7 and 280.5 in men and women, respectively. Deaths from heart disease contributed largely to the excess rates in the class III obesity group (rate differences = 238.9 and 132.8 in men and women, respectively), followed by deaths from cancer (rate differences = 36.7 and 62.3 in men and women, respectively) and diabetes (rate differences = 51.2 and 29.2 in men and women, respectively). Within the class III obesity range, multivariable-adjusted hazard ratios for total deaths and deaths due to heart disease, cancer, diabetes, nephritis/nephrotic syndrome/nephrosis, chronic lower respiratory disease, and influenza/pneumonia increased with increasing BMI. Compared with normal-weight BMI, a BMI of 40–44.9, 45–49.9, 50–54.9, and 55–59.9 kg/m2 was associated with an estimated 6.5 (95% CI: 5.7–7.3), 8.9 (95% CI: 7.4–10.4), 9.8 (95% CI: 7.4–12.2), and 13.7 (95% CI: 10.5–16.9) y of life lost. A limitation was that BMI was mainly ascertained by self-report. Conclusions: Class III obesity is associated with substantially elevated rates of total mortality, with most of the excess deaths due to heart disease, cancer, and diabetes, and major reductions in life expectancy compared with normal weight. Please see later in the article for the Editors' Summar

Using decision analysis to support proactive management of emerging infectious wildlife diseases

Despite calls for improved responses to emerging infectious diseases in wildlife, management is seldom considered until a disease has been detected in affected populations. Reactive approaches may limit the potential for control and increase total response costs. An alternative, proactive management framework can identify immediate actions that reduce future impacts even before a disease is detected, and plan subsequent actions that are conditional on disease emergence. We identify four main obstacles to developing proactive management strategies for the newly discovered salamander pathogen Batrachochytrium salamandrivorans (Bsal). Given that uncertainty is a hallmark of wildlife disease management and that associated decisions are often complicated by multiple competing objectives, we advocate using decision analysis to create and evaluate trade-offs between proactive (pre-emergence) and reactive (post-emergence) management options. Policy makers and natural resource agency personnel can apply principles from decision analysis to improve strategies for countering emerging infectious diseases

THE HOT-JUPITER KEPLER-17b: DISCOVERY, OBLIQUITY FROM STROBOSCOPIC STARSPOTS, AND ATMOSPHERIC CHARACTERIZATION

This paper reports the discovery and characterization of the transiting hot giant exoplanet Kepler-17b. The planet has an orbital period of 1.486 days, and radial velocity measurements from the Hobby–Eberly Telescope show a Doppler signal of 419.5+13.3−15.6 m s−1. From a transit-based estimate of the host star's mean density, combined with an estimate of the stellar effective temperature Teff = 5630 ± 100 from high-resolution spectra, we infer a stellar host mass of 1.06 ± 0.07 M☉ and a stellar radius of 1.02 ± 0.03 R☉. We estimate the planet mass and radius to be MP = 2.45 ± 0.11 MJ and RP = 1.31 ± 0.02 RJ. The host star is active, with dark spots that are frequently occulted by the planet. The continuous monitoring of the star reveals a stellar rotation period of 11.89 days, eight times the planet's orbital period; this period ratio produces stroboscopic effects on the occulted starspots. The temporal pattern of these spot-crossing events shows that the planet's orbit is prograde and the star's obliquity is smaller than 15°. We detected planetary occultations of Kepler-17b with both the Kepler and Spitzer Space Telescopes. We use these observations to constrain the eccentricity, e, and find that it is consistent with a circular orbit (e < 0.011). The brightness temperatures of the planet's infrared bandpasses are T3.6 μm = 1880  ±  100 K and T4.5 μm = 1770 ± 150 K. We measure the optical geometric albedo Ag in the Kepler bandpass and find Ag = 0.10 ± 0.02. The observations are best described by atmospheric models for which most of the incident energy is re-radiated away from the day side

Inflammatory and haematological markers in the maternal, umbilical cord and infant circulation in histological chorioamnionitis

BACKGROUND: The relationship between histological chorioamnionitis and haematological and biochemical markers in mothers and infants at delivery, and in infants postnatally, is incompletely characterised. These markers are widely used in the diagnosis of maternal and neonatal infection. Our objective was to investigate the effects of histological chorioamnionitis (HCA) on haematological and biochemical inflammatory markers in mothers and infants at delivery, and in infants post-delivery. METHODS: Two hundred and forty seven mothers, delivering 325 infants, were recruited at the only tertiary perinatal centre in Western Australia. Placentae were assessed for evidence of HCA using a semi-quantitative scoring system. Maternal high sensitivity C-reactive protein (hsCRP), procalcitonin, and umbilical cord hsCRP, procalcitonin, white cell count and absolute neutrophil count were measured at delivery. In infants where sepsis was clinically suspected, postnatal CRP, white cell count and absolute neutrophil count were measured up to 48 hours of age. The effect of HCA on maternal, cord and neonatal markers was evaluated by multivariable regression analysis. RESULTS: The median gestational age was 34 weeks and HCA was present in 26 of 247 (10.5%) placentae. Mothers whose pregnancies were complicated by HCA had higher hsCRP (median 26 (range 2-107) versus 5.6 (0-108) mg/L; P&lt;0.001). Histological chorioamnionitis was associated with higher umbilical cord hsCRP (75(th) percentile 2.91 mg/L (range 0-63.9) versus 75(th) percentile 0 mg/L (0-45.6); P&lt;0.001) and procalcitonin (median 0.293 (range 0.05-27.37) versus median 0.064 (range 0.01-5.24) ug/L; P&lt;0.001), with a sustained increase in neonatal absolute neutrophil count (median 4.5 (0.1-26.4)x10(9)/L versus 3.0 (0.1-17.8)x10(9)/L), and CRP up to 48 hours post-partum (median 10 versus 6.5 mg/L) (P&lt;0.05 for each). CONCLUSION: Histological chorioamnionitis is associated with modest systemic inflammation in maternal and cord blood. These systemic changes may increase postnatally, potentially undermining their utility in the diagnosis of early-onset neonatal infection

Millennials in the Workplace: A Communication Perspective on Millennials’ Organizational Relationships and Performance

Stereotypes about Millennials, born between 1979 and 1994, depict them as self-centered, unmotivated, disrespectful, and disloyal, contributing to widespread concern about how communication with Millennials will affect organizations and how they will develop relationships with other organizational members. We review these purported characteristics, as well as Millennials’ more positive qualities—they work well in teams, are motivated to have an impact on their organizations, favor open and frequent communication with their supervisors, and are at ease with communication technologies. We discuss Millennials’ communicated values and expectations and their potential effect on coworkers, as well as how workplace interaction may change Millennials

Nitazoxanide Stimulates Autophagy and Inhibits mTORC1 Signaling and Intracellular Proliferation of Mycobacterium tuberculosis

Tuberculosis, caused by Mycobacterium tuberculosis infection, is a major cause of morbidity and mortality in the world today. M. tuberculosis hijacks the phagosome-lysosome trafficking pathway to escape clearance from infected macrophages. There is increasing evidence that manipulation of autophagy, a regulated catabolic trafficking pathway, can enhance killing of M. tuberculosis. Therefore, pharmacological agents that induce autophagy could be important in combating tuberculosis. We report that the antiprotozoal drug nitazoxanide and its active metabolite tizoxanide strongly stimulate autophagy and inhibit signaling by mTORC1, a major negative regulator of autophagy. Analysis of 16 nitazoxanide analogues reveals similar strict structural requirements for activity in autophagosome induction, EGFP-LC3 processing and mTORC1 inhibition. Nitazoxanide can inhibit M. tuberculosis proliferation in vitro. Here we show that it inhibits M. tuberculosis proliferation more potently in infected human THP-1 cells and peripheral monocytes. We identify the human quinone oxidoreductase NQO1 as a nitazoxanide target and propose, based on experiments with cells expressing NQO1 or not, that NQO1 inhibition is partly responsible for mTORC1 inhibition and enhanced autophagy. The dual action of nitazoxanide on both the bacterium and the host cell response to infection may lead to improved tuberculosis treatment

A TESS Dress Rehearsal: Planetary Candidates and Variables from K2 Campaign 17

We produce light curves for all ∼34,000 targets observed with K2 in Campaign 17 (C17), identifying planet candidates, eclipsing binaries, and other periodic variables. The forward-facing direction of the C17 field means follow-up can begin immediately now that the campaign has concluded and interesting targets have been identified. The C17 field has a large overlap with C6, so this latest campaign also offers an infrequent opportunity to study a large number of targets already observed in a previous K2 campaign. The timing of the C17 data release, shortly before science operations begin with the Transiting Exoplanet Survey Satellite (TESS), also lets us exercise some of the tools and methods developed for identification and dissemination of planet candidates from TESS. We find excellent agreement between these results and those identified using only K2-based tools. Among our planet candidates are several planet candidates with sizes <4 R ⊕ and orbiting stars with Kp ≲ 10 (indicating good RV targets of the sort TESS hopes to find) and a Jupiter-sized single-transit event around a star already hosting a 6 day planet candidate