DIABETES PREVENTION AND CARDIOVASCULAR RISK REDUCTION IN PRIMARY CARE PRACTICEIN PRIMARY CARE PRACTICE

Despite extensive research demonstrating that moderate lifestyle changes can reduce risk for Type 2 diabetes and cardiovascular disease these two chronic conditions continue to account for an overwhelming amount of morbidity and mortality worldwide. Translation of successful prevention and risk reduction research into "real world" settings faces many challenges, while strategies for implementation are lacking. For many reasons, the primary care practice venue provides an ideal environment for provision of prevention services on a permanent basis. The dissertation consists of three related projects; the first two examined the main components of diabetes prevention and cardiovascular disease risk reduction while the third investigated the relationship between perception of disease risk and lifestyle intervention performance. Because current practices of prevention screening are often haphazard and tend to overlook those in greatest need, the first project focused on risk identification through prevention screening in a systematic manner. Feasibility in the primary care practice setting as well as differences between those invited to attend prevention screening and those not invited was examined.The second project investigated the effectiveness and feasibility of provision of a lifestyle change intervention in a primary care practice setting. The successful lifestyle intervention utilized in the Diabetes Prevention Program was modified for delivery in a group rather than individual setting. The effectiveness of the intervention was evaluated through risk assessment measures collected before and after participation in the intervention. Finally, motivation for making lifestyle changes remains a mystery and varies considerably from one individual to another. It has been hypothesized that perceived risk, i.e., the probability of developing a disease or condition may influence an individual's health behavior. Utilizing a modified version of the Risk Perception Survey for Developing Diabetes (RPS-DD) the final project examined baseline differences in responses as well as the relationship between perception of risk and subsequent performance in the group lifestyle intervention. Differences in risk perception before and after participation were also examined. The projects are significant from a public health perspective in that they seek to begin to establish a foundation for implementation of diabetes prevention and cardiovascular risk reduction for the general population

Cost-Effectiveness Analysis of Efforts to Reduce Risk of Type 2 Diabetes and Cardiovascular Disease in Southwestern Pennsylvania, 2005-2007

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938403/pdf/PCD75A109.pd

Physics Design of the National High-power Advanced Torus Experiment

Moving beyond ITER toward a demonstration power reactor (Demo) will require the integration of stable high fusion gain in steady-state, advanced methods for dissipating very high divertor heat-fluxes, and adherence to strict limits on in-vessel tritium retention. While ITER will clearly address the issue of high fusion gain, and new and planned long-pulse experiments (EAST, JT60-SA, KSTAR, SST-1) will collectively address stable steady-state highperformance operation, none of these devices will adequately address the integrated heat-flux, tritium retention, and plasma performance requirements needed for extrapolation to Demo. Expressing power exhaust requirements in terms of Pheat/R, future ARIES reactors are projected to operate with 60-200MW/m, a Component Test Facility (CTF) or Fusion Development Facility (FDF) for nuclear component testing (NCT) with 40-50MW/m, and ITER 20-25MW/m. However, new and planned long-pulse experiments are currently projected to operate at values of Pheat/R no more than 16MW/m. Furthermore, none of the existing or planned experiments are capable of operating with very high temperature first-wall (Twall = 600-1000C) which may be critical for understanding and ultimately minimizing tritium retention with a reactor-relevant metallic first-wall. The considerable gap between present and near-term experiments and the performance needed for NCT and Demo motivates the development of the concept for a new experiment — the National High-power advanced-Torus eXperiment (NHTX) — whose mission is to study the integration of a fusion-relevant plasma-material interface with stable steady-state high-performance plasma operation

Iliotibial band release as an adjunct to the surgical management of patellar stress fracture in the athlete: a case report and review of the literature

Stress fracture of the patella is rare. In this report, a case of patellar stress fracture occurring in an amateur athlete is presented, and an operative adjunct to the surgical management of this condition is proposed

Sgs1 and Exo1 Redundantly Inhibit Break-Induced Replication and De Novo Telomere Addition at Broken Chromosome Ends

In budding yeast, an HO endonuclease-inducible double-strand break (DSB) is efficiently repaired by several homologous recombination (HR) pathways. In contrast to gene conversion (GC), where both ends of the DSB can recombine with the same template, break-induced replication (BIR) occurs when only the centromere-proximal end of the DSB can locate homologous sequences. Whereas GC results in a small patch of new DNA synthesis, BIR leads to a nonreciprocal translocation. The requirements for completing BIR are significantly different from those of GC, but both processes require 5′ to 3′ resection of DSB ends to create single-stranded DNA that leads to formation of a Rad51 filament required to initiate HR. Resection proceeds by two pathways dependent on Exo1 or the BLM homolog, Sgs1. We report that Exo1 and Sgs1 each inhibit BIR but have little effect on GC, while overexpression of either protein severely inhibits BIR. In contrast, overexpression of Rad51 markedly increases the efficiency of BIR, again with little effect on GC. In sgs1Δ exo1Δ strains, where there is little 5′ to 3′ resection, the level of BIR is not different from either single mutant; surprisingly, there is a two-fold increase in cell viability after HO induction whereby 40% of all cells survive by formation of a new telomere within a few kb of the site of DNA cleavage. De novo telomere addition is rare in wild-type, sgs1Δ, or exo1Δ cells. In sgs1Δ exo1Δ, repair by GC is severely inhibited, but cell viaiblity remains high because of new telomere formation. These data suggest that the extensive 5′ to 3′ resection that occurs before the initiation of new DNA synthesis in BIR may prevent efficient maintenance of a Rad51 filament near the DSB end. The severe constraint on 5′ to 3′ resection, which also abrogates activation of the Mec1-dependent DNA damage checkpoint, permits an unprecedented level of new telomere addition

Common genetic variants in the CLDN2 and PRSS1-PRSS2 loci alter risk for alcohol-related and sporadic pancreatitis

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR, and SPINK1 variants were associated with pancreatitis risk. We now report two significant genome-wide associations identified and replicated at PRSS1-PRSS2 (1×10-12) and x-linked CLDN2 (p < 1×10-21) through a two-stage genome-wide study (Stage 1, 676 cases and 4507 controls; Stage 2, 910 cases and 4170 controls). The PRSS1 variant affects susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous (or hemizygous male) CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men – male hemizygous frequency is 0.26, female homozygote is 0.07

The Zwicky Transient Facility: System Overview, Performance, and First Results

The Zwicky Transient Facility (ZTF) is a new optical time-domain survey that uses the Palomar 48 inch Schmidt telescope. A custom-built wide-field camera provides a 47 deg 2 field of view and 8 s readout time, yielding more than an order of magnitude improvement in survey speed relative to its predecessor survey, the Palomar Transient Factory. We describe the design and implementation of the camera and observing system. The ZTF data system at the Infrared Processing and Analysis Center provides near-real-time reduction to identify moving and varying objects. We outline the analysis pipelines, data products, and associated archive. Finally, we present on-sky performance analysis and first scientific results from commissioning and the early survey. ZTF’s public alert stream will serve as a useful precursor for that of the Large Synoptic Survey Telescope

The Zwicky Transient Facility: Science Objectives

The Zwicky Transient Facility (ZTF), a public–private enterprise, is a new time-domain survey employing a dedicated camera on the Palomar 48-inch Schmidt telescope with a 47 deg2 field of view and an 8 second readout time. It is well positioned in the development of time-domain astronomy, offering operations at 10% of the scale and style of the Large Synoptic Survey Telescope (LSST) with a single 1-m class survey telescope. The public surveys will cover the observable northern sky every three nights in g and r filters and the visible Galactic plane every night in g and r. Alerts generated by these surveys are sent in real time to brokers. A consortium of universities that provided funding (“partnership”) are undertaking several boutique surveys. The combination of these surveys producing one million alerts per night allows for exploration of transient and variable astrophysical phenomena brighter than r∼20.5 on timescales of minutes to years. We describe the primary science objectives driving ZTF, including the physics of supernovae and relativistic explosions, multi-messenger astrophysics, supernova cosmology, active galactic nuclei, and tidal disruption events, stellar variability, and solar system objects. © 2019. The Astronomical Society of the Pacific

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR