The Pine Needle, vol. 2, no. 3

Libraries and archives collect materials from different cultures and time periods to preserve and make available the historical record. As a result, materials such as those presented here may reflect sexist, misogynistic, abusive, racist, or discriminatory attitudes or actions that some may find disturbing, harmful, or difficult to view. Both a humor and literary magazine, The Pine Needle was a University of Maine student-produced periodical that began publication in the fall of 1946, the first post-World War II semester that saw GIs returning to campus. In the late 1940s, The Needle continued emphasizing alcohol and tobacco use as well as the sexualization of co-eds with the addition of lampooning women who were influenced to mimic Hollywood pin-ups, as well as those who rejected sexual advances. The March 1948 issue features a pen and ink illustration by Lloyd Shapleigh depicting former, Liberal Vice President Henry A. Wallace looming over the Union building as a crowd of students with signs protest

Perceived Quality of Care and Lifestyle Counseling Among Patients With Heart Disease

Background: To examine patients' perceived quality of care and reported receipt of information on diet and exercise related to cardiovascular disease prevention. Methods: Patients admitted with acute coronary syndromes or elective cardiac catheterization were eligible for enrollment. Baseline medical information was collected through medical-record review. Patients completed surveys at the time of hospitalization that included items on perceived quality of care and whether they had received information from a healthcare provider on diet and exercise as related to their heart. Perceived quality of care was grouped into 3 categories: (1) poor to fair, (2) good, and (3) very good to excellent. Results: Among the 182 cardiac patients who completed the survey, those who reported poor to fair quality of care were more likely to report that they had received no advice regarding diet as compared with those who perceived their quality of care as good or very good to excellent (61%, 59%, and 26%, respectively, P < 0.0001). A similar pattern was observed for exercise (71%, 74%, and 36%, respectively, P < 0.0001). Conclusions: Patients with low perceived quality of care were less likely to have discussed diet and exercise habits with healthcare providers. Improving receipt of lifestyle counseling is warranted given the central role that diet and exercise play in secondary prevention. Copyright © 2010 Wiley Periodicals, Inc. Dr. Jackson receives support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (K23 HL073310-01). The authors have no other funding, financial relationships, or conflicts of interest to disclose.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78479/1/20839_ftp.pd

The Pine Needle, February 1947

Libraries and archives collect materials from different cultures and time periods to preserve and make available the historical record. As a result, materials such as those presented here may reflect sexist, misogynistic, abusive, racist, or discriminatory attitudes or actions that some may find disturbing, harmful, or difficult to view. Both a humor and literary magazine, The Pine Needle was a University of Maine student-produced periodical that began publication in the fall of 1946, the first post-World War II semester that saw GIs returning to campus. The Needle reflected an edginess and rebellion not found in previous UMaine student publications. While past student publications relied on euphemisms for alcohol and dating on campus, The Needle overtly sexualized co-eds and discussed the use of drugs, tobacco, and alcohol by students. Cover art for this issue is an unsigned pen-and-ink illustration produced by a member of The Needle\u27s art staff. It depicts the five members of the editorial staff gathered around a wood coffin labeled, The Needle. Included in this issue is a piece about former History Professor C. Dewitt Hardy II\u27s (1911-1992), term paper assignment entitled, Social Problems in My Home Town. The work mentions the birth of Hardy\u27s son and future artist, Clarion Dewitt Hardy III (1940-2017)

Patient-Related Diet and Exercise Counseling: Do Providers’ Own Lifestyle Habits Matter?

The goal of this research was to evaluate the personal health behaviors of physicians in training and attending physicians in association with patient-related lifestyle counseling. Physicians at a major teaching hospital were surveyed regarding their personal lifestyle behavior, perceived confidence, and frequency of counseling patients regarding lifestyle behaviors. One hundred eighty-three total responses were received. Trainees were more likely to consume fast food and less likely to consume fruits and vegetables than attendings. Attending physicians were more likely to exercise 4 or more days per week and more than 150 minutes per week. Attending physicians were more likely to counsel their patients regarding a healthy diet (70.7% vs 36.3%, P150 minutes per week, being overweight, and reported adequate training in counseling. Only adequate training in counseling was a predictor of strong self-efficacy for counseling in diet. Many physicians lack confidence in their ability to counsel patients regarding lifestyle. Personal behaviors including regular exercise and better training in counseling techniques may improve patient counseling. Prev Cardiol. 2010;13:180–185. © 2010 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79167/1/j.1751-7141.2010.00079.x.pd

Healthcare Cost Impact of Continued Anticoagulation with Rivaroxaban versus Aspirin for Prevention of Recurrent Symptomatic Venous Thromboembolism in the EINSTEIN-CHOICE Trial Population

Background Using data from the Reduced-dosed Rivaroxaban in the Long-term Prevention of Recurrent Symptomatic Venous Thromboembolism (EINSTEIN-CHOICE) trial, this study assessed cost impact of continued anticoagulation therapy with rivaroxaban vs. aspirin. Methods Total healthcare costs (2016USD) associated with rivaroxaban and aspirin were calculated as the sum of clinical event costs and drug costs from a US managed care perspective. Clinical event costs were calculated by multiplying event rate by cost of care. One-year Kaplan-Meier clinical event rates for recurrent pulmonary embolism, recurrent deep-vein thrombosis, all-cause mortality, and bleeding were obtained from EINSTEIN-CHOICE. Cost of care was determined by literature review. Drug costs were the product of drug price (wholesale acquisition cost) and treatment duration. A one-way sensitivity analysis was conducted. Results Rivaroxaban users had lower per patient per month (PPPM) clinical event costs compared with aspirin users ($123,$ 243, and $381 for rivaroxaban 10mg, rivaroxaban 20mg, and aspirin, respectively). However, vs. aspirin, PPPM total healthcare costs were$24 higher for rivaroxaban 10mg treated patients ($143 higher for rivaroxaban 20mg) due to higher cost of rivaroxaban. With a 15$19 lower total healthcare cost. Conclusions Continued therapy with rivaroxaban 10mg and 20mg vs. aspirin was associated with lower clinical event costs but higher total healthcare costs; with a 15% drug discount rivaroxaban 10mg had lower total healthcare costs than aspirin

Sex-Based Differences in Outcomes Following Peripheral Artery Revascularization: Insights From VOYAGER PAD.

Background Despite high female prevalence of peripheral artery disease (PAD), little is known about sex-based outcomes after lower extremity revascularization (LER) for symptomatic PAD. The effects of rivaroxaban according to sex following LER have not been fully reported. Methods and Results In VOYAGER PAD (Vascular Outcomes Study of ASA [acetylsalicylic acid] Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for Peripheral Artery Disease), low-dose rivaroxaban versus placebo on a background of aspirin reduced the composite primary efficacy outcome of cardiovascular and limb events in patients with PAD undergoing LER. Unplanned index limb revascularization was prespecified and prospectively ascertained. The primary safety outcome was Thrombolysis in Myocardial Infarction major bleeding. Analyses of outcomes and treatment effects by sex were performed using Cox proportional hazards models. Among 6564 randomly assigned patients followed for a median of 28 months, 1704 (26.0%) were women. Among patients administered placebo, women were at similar risk for the primary efficacy outcome (hazard ratio [HR], 0.90; [95% CI, 0.74-1.09]; P=0.29) as men, while female sex was associated with a trend toward higher risk of unplanned index limb revascularization (HR, 1.18; [95% CI, 1.00-1.40]; P=0.0499). Irrespective of sex, effects of rivaroxaban were consistent for the primary efficacy outcome (P-interaction=0.22), unplanned index limb revascularization (P-interaction=0.64), and bleeding (P-interaction=0.61). Women were more likely than men to discontinue study treatment (HR, 1.13; [95% CI, 1.03-1.25]; P=0.0099). Conclusions Among >1700 women with PAD undergoing LER, women and men were at similar risk for the primary outcome, but a trend for greater risk of unplanned index limb revascularization among women was observed. Effects of rivaroxaban were consistent by sex, though women more often discontinued treatment. Better understanding of sex-based outcomes and treatment adherence following LER is needed. Registration URL: http://clinicaltrials.gov; Unique identifier: NCT02504216

Rivaroxaban or Aspirin for extended treatment of venous thromboembolism

Background: although many patients with venous thromboembolism require extended treatment, it is uncertain whether it is better to use full- or lower-intensity anticoagulation therapy or aspirin. Methods: in this randomized, double-blind, phase 3 study, we assigned 3396 patients with venous thromboembolism to receive either once-daily rivaroxaban (at doses of 20 mg or 10 mg) or 100 mg of aspirin. All the study patients had completed 6 to 12 months of anticoagulation therapy and were in equipoise regarding the need for continued anticoagulation. Study drugs were administered for up to 12 months. The primary efficacy outcome was symptomatic recurrent fatal or nonfatal venous thromboembolism, and the principal safety outcome was major bleeding. Results: a total of 3365 patients were included in the intention-to-treat analyses (median treatment duration, 351 days). The primary efficacy outcome occurred in 17 of 1107 patients (1.5%) receiving 20 mg of rivaroxaban and in 13 of 1127 patients (1.2%) receiving 10 mg of rivaroxaban, as compared with 50 of 1131 patients (4.4%) receiving aspirin (hazard ratio for 20 mg of rivaroxaban vs. aspirin, 0.34; 95% confidence interval [CI], 0.20 to 0.59; hazard ratio for 10 mg of rivaroxaban vs. aspirin, 0.26; 95% CI, 0.14 to 0.47; P<0.001 for both comparisons). Rates of major bleeding were 0.5% in the group receiving 20 mg of rivaroxaban, 0.4% in the group receiving 10 mg of rivaroxaban, and 0.3% in the aspirin group; the rates of clinically relevant nonmajor bleeding were 2.7%, 2.0%, and 1.8%, respectively. The incidence of adverse events was similar in all three groups. Conclusions: among patients with venous thromboembolism in equipoise for continued anticoagulation, the risk of a recurrent event was significantly lower with rivaroxaban at either a treatment dose (20 mg) or a prophylactic dose (10 mg) than with aspirin, without a significant increase in bleeding rates. (Funded by Bayer Pharmaceuticals; EINSTEIN CHOICE ClinicalTrials.gov number, NCT02064439)

Complexity versus certainty in understanding species’ declines

Aim Our understanding of and ability to predict species declines is limited, despite decades of study. We sought to expand our understanding of species declines within a regional landscape by testing models using both traditional hypotheses and those derived from a complex adaptive systems approach. Location Our study area was the dry mixed grassland of south-eastern Alberta, Canada, one of the largest remnants of native grassland in North America, and the adjacent grassland in Saskatchewan. Methods We used the breeding birds of the grassland to test the relationship between species declines and a suite of traits associated with decline (such as size, specialization and rarity, as well as distance to edge of a discontinuity, and edge of geographic range) in a stepwise regression with AICc values and bootstrapping via model averaging, followed by a refit procedure to obtain model-averaged parameter estimates. We used both provincial government and Breeding Bird Survey (BBS) classifications of decline. We also modelled degree of decline in the Alberta and Saskatchewan grasslands, which differ in amount of habitat remaining, to test whether severity of decline was explained by the same traits as species decline/not- decline. Results We found that the model for government-defined decline fulfilled government expectations that species’ extinction risk is a function of being large, specialized, rare and carnivorous, whereas the model for BBS-defined decline suggested that the biological reality of decline is more complex, requiring the need to explicitly model scale-specific patterns. Furthermore, species decline/ not- decline was explained by different traits than those that fit degree of decline, though complex systems- derived traits featured in both sets of models. Main conclusions Traditional approaches to predict species declines (e.g. government processes or IUCN Red Lists), may be too simplistic and may therefore misguide management and conservation. Using complex systems approaches that account for scale-specific patterns and processes have the potential to overcome these limitations

Efficacy of aerobic exercise and a prudent diet for improving selected lipids and lipoproteins in adults: a meta-analysis of randomized controlled trials

Background Studies addressing the effects of aerobic exercise and a prudent diet on lipid and lipoprotein concentrations in adults have reached conflicting conclusions. The purpose of this study was to determine the effects of aerobic exercise combined with a prudent diet on lipid and lipoprotein concentrations in adults. Methods Studies were located by searching nine electronic databases, cross-referencing, and expert review. Two independent reviewers selected studies that met the following criteria: (1) randomized controlled trials, (2) aerobic exercise combined with diet recommendations (saturated/trans fat intake less than 10% of total calories and cholesterol less than 300 mg/day and/or fiber intake ≥25 g/day in women and ≥35 grams per day in men), (3) intervention ≥4 weeks, (4) humans ≥18 years of age, (5) published studies, including dissertations and Master\u27s theses, (6) studies published in any language, (7) studies published between January 1, 1955 and May 1, 2009, (8) assessment of one or more of the following lipid and lipoprotein concentrations: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), ratio of TC to HDL-C, non-HDL-C, low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). Two reviewers independently extracted all data. Random-effects models that account for heterogeneity and 95% confidence intervals were used to pool findings. Results Of the 1,401 citations reviewed, six studies representing 16 groups (8 intervention, 8 control) and up to 559 men and women (282 intervention, 277 control) met the criteria for analysis. Statistically significant intervention minus control reductions were found for TC (-15.5 mg/dl, 95% CI, -20.3 to -10.7), TC:HDL-C (-0.4 mg/dl, 95% CI, -0.7 to -0.2), LDL-C (-9.2 mg/dl, 95% CI, -12.7 to -5.8) and TG (-10.6 mg/dl, 95% CI, -17.2 to -4.0) but not HDL-C (-0.5 mg/dl, 95% CI, -4.0 to 3.1). Changes were equivalent to reductions of 7.5%, 6.6%, 7.2% and 18.2% respectively, for TC, TC:HDL-C, LDL-C and TG. Because of missing variance statistics, non-HDL-C was excluded. Conclusions Aerobic exercise combined with a prudent diet is highly efficacious for improving TC, TC:HDL-C, LDL-C and TG, but not HDL-C concentrations, in adults. However, additional studies are needed, including effectiveness studies using intention-to-treat analysis