Secular and Longitudinal Trends in Body Weight in a Large Population of Veterans, 2000-2014

INTRODUCTION: The prevalence of obesity is increasing in the United States and globally, and impacts many aspects of health. To understand the contribution of body weight to chronic diseases such as diabetes, it is necessary to characterize secular and longitudinal weight trends prior to evaluating the weight effects that may result from medical interventions. The cross-sectional National Health and Nutrition Examination Survey (NHANES) indicates that mean body weight in the adult population increased from 152 lb (69 kg) to 181 lb (82 kg) between 1959 and 2008. However, there are no previously published studies on secular or longitudinal weight trends in a veteran population. OBJECTIVES: The purpose of this study is to describe secular and longitudinal trends in body weight for a large population of male and female individuals with and without diabetes in the Veterans Administration (VA) healthcare system, the largest integrated healthcare system in the United States. METHODS: Retrospective observational analysis of data from VA facilities throughout the United States, in patients who had at least 4 outpatient visits within any consecutive 4-year interval during 2000–2014. The dataset included men and women with and without type 2 diabetes. The primary outcomes were longitudinal trends in body weight stratified by birth cohort, sex, and diabetes status. RESULTS: A total of 4,680,735 unique patients, 1,666,346 with diabetes, were included in the analysis. Regressions were performed on the patient-level data and segmented by birth cohort. A total of 176,034,543 weight observations were included in the analysis, with a median of 15 to 36 weight observations per patient in individuals without diabetes, and a median of 22 to 49 weight observations in individuals with diabetes across birth cohorts. In the year 2000, the y-intercept for the regression equations indicated a mean body weight for men without diabetes of 188 lb (85 kg), for women without diabetes of 166 lb (75 kg), for men with diabetes of 213 lb (97 kg), and for women with diabetes of 195 lb (88 kg). Secular trends in body weight during the study period had median linear increases of 0.53 lb/y (0.24 kg/y) in men with diabetes, 0.50 lb/y (0.23 kg/y) in women with diabetes, 0.53 lb/y (0.24 kg/y) in men without diabetes, and 0.86 lb/y (0.39 kg/y) among women without diabetes, respectively. In cohorts born before 1940, body weight decreased. In the cohorts born between 1940-1949, body weight was stable. In all cohorts born after 1950, body weight increased. Across birth cohorts, the rate of weight increase accelerated from older to younger groups, with higher rates in the groups with diabetes than in the groups without diabetes: β2 = 0.0260 lb2/y (0.01179 kg2/y) in men without diabetes, 0.0398 lb2/y (0.01805 kg2/y) in men with diabetes, 0.0127 lb2/y (0.00576 kg2/y) in women without diabetes, and 0.0895 lb2/y (0.04060 kg2/y) in women with diabetes. CONCLUSIONS: This is the first report of secular and longitudinal weight trends in a large, contemporary veteran population that includes both men and women. Consistent with findings from the Normative Aging Study, a longitudinal study of male veterans from the northeastern United States, weight changes varied from decreases among the oldest birth cohorts to increases in the youngest birth cohorts. Secular changes in body weight by birth cohort were consistent with the patterns reported in the Global Burden of Disease Study. The rate of weight change is accelerated in all younger birth cohorts relative to all older birth cohorts, with the highest rates in women with diabetes. Further analyses of this dataset are recommended to elucidate clinical characteristics associated with longitudinal weight change among individuals with and without diabetes in the veteran population

Alien Registration- Walker, Margery J. (Brunswick, Cumberland County)

https://digitalmaine.com/alien_docs/31785/thumbnail.jp

Mortgage Interest Deduction

Reviews the mortgage interest deduction's fiscal costs, its limitations in subsidizing homeownership, and alternatives. Analyzes the estimated effects of eliminating it, replacing it with alternative tax credits, and limiting the deduction to 28 percent

An Ecological Model for Counselor Pedagogy Incorporating Service Learning

This pilot study examined how one Graduate Counseling Program initiated improvements in counselor training pedagogy through incorporating a service-learning project with computer technology into an entry-level course for graduate students.  The service learning experience was designed to advance university and community collaboration and teach students about social justice and advocacy in the field of mental health.  Students were placed in several agencies that represented grossly underserved populations.  A holistic approach incorporating both qualitative and quantitative procedures was utilized for the analysis of this study.  The authors developed a non-standardized questionnaire containing specific questions pooled from the CACREP guidelines for counselor training

Impact of student choice on academic performance:cross-sectional and longitudinal observations of a student cohort

BACKGROUND: Student choice plays a prominent role in the undergraduate curriculum in many contemporary medical schools. A key unanswered question relates to its impact on academic performance. METHODS: We studied 301 students who were in years 2 and 3 of their medical studies in 2005/06. We investigated the relationship between SSC grade and allocated preference. Separately, we examined the impact of ‘self-proposing’ (students designing and completing their own SSC) on academic performance in other, standard-set, summative assessments throughout the curriculum. The chi-squared test was used to compare academic performance in SSC according to allocated preference. Generalised estimating equations were used to investigate the effect of self-proposing on performance in standard-set examinations. RESULTS: (1) Performance in staff-designed SSC was not related to allocated preference. (2) Performance in year 1 main examination was one of the key predictors of performance in written and OSCE examinations in years 2, 3 and 4 (p<0.001). (3) The higher the score in the year 1 examination, the more likely a student was to self-propose in subsequent years (OR [CI] 1.07 [1.03-1.11], p<0.001). (4) Academic performance of students who self-proposed at least once in years 2 and/or 3 varied according to gender and year of course. CONCLUSION: In this study, no association was observed between allocated preference and SSC grade. The effect of self-proposing on academic performance in standard-set examinations was small. Our findings suggest instead that academically brighter students are more likely to design their own modules. Although student choice may have educational benefits, this report does not provide convincing evidence that it improves academic performance

Oidium longipes, a new powdery mildew fungus on petunia in the USA: A potential threat to ornamental and vegetable solanaceous crops

This is the first North American report of Oidium longipes, an anamorphic powdery mildew species described recently in Europe. It was found on vegetatively propagated petunia grown in a commercial greenhouse in New Jersey, USA, where it caused a rapidly spreading disease. The pathogen might have originated offshore and may have already been distributed in the United States through horticultural trade. During field surveys in Europe, it was found on petunia in Hungary and Austria as well; this is the first report of O. longipes from these two countries. A detailed light microscopy study of American and European specimens of O. longipes, including freshly collected samples and authentic herbarium specimens, revealed that its conidiophore morphology is more variable than illustrated in the original species description or in subsequent works. Microcycle conidiation, a process not yet known to occur in powdery mildews, was repeatedly observed in O. longipes. The rDNA internal transcribed spacer (ITS) sequences were identical in colonies containing different conidiophore types as well as in a total of five specimens collected from petunia in the United States, Austria, Hungary, Germany, and Switzerland. A phylogenetic analysis of the ITS sequences revealed that the closest known relative of O. longipes is O. lycopersici, known to infect tomato only in Australia. Cross-inoculation tests showed that O. longipes from petunia heavily infected tobacco cv. Xanthi, while the tomato and eggplant cultivars tested were moderately susceptible to this pathogen. These results indicate that its spread represents a potential danger to a number of solanaceous crops. Our ad hoc field surveys conducted in 2006 and 2007 did not detect it outside New Jersey in the United States; all the other powdery mildew–infected petunias, collected in New York and Indiana, were infected by Podosphaera xanthii. In Europe, most of the powdery mildew–infected petunias examined in this study were infected by P. xanthii or Golovinomyces orontii. Our multiple inoculation tests revealed that the same petunia plants and even the same leaves can be infected concomitantly by O. longipes, O. neolycopersici, G. orontii, and P. xanthii. Thus, it is at present unclear to what extent O. longipes contributes to the powdery mildew epidemics that develop year after year on solanaceous plants in many parts of the world

Assessment of student competency in a simulated speech-language pathology clinical placement

“This is an Accepted Manuscript of an article published by Taylor & Francis in International Journal of Speech-Language Pathology on 30 August 2013, available online: http://wwww.tandfonline.com/10.3109/17549507.2013.809603.” http://dx.doi.org/10.3109/17549507.2013.809603.Clinical education programs in speech-language pathology enable the transition of students’ knowledge and skills from the classroom to the workplace. Simulated clinical learning experiences provide an opportunity to address the competency development of novice students. This study reports on the validation of an assessment tool designed to evaluate speech-language pathology students’ performance in a simulated clinical placement. The Assessment of Foundation Clinical Skills (AFCS) was designed to link to concepts and content of COMPASS®: Competency Assessment in Speech Pathology, a validated assessment of performance in the workplace. It incorporates units and elements of competency relevant to the placement. The validity of the AFCS was statistically investigated using Rasch analysis. Participants were 18 clinical educators and 130 speech-language pathology students undertaking the placement. Preliminary results support the validity of the AFCS as an assessment of foundation clinical skills of students in this simulated clinical placement. All units of competency and the majority of elements were relevant and representative of these skills. The use of a visual analogue scale which included a pre-Novice level to rate students’ performance on units of competency was supported. This research provides guidance for development of quality assessments of performance in simulated placements

Cholecystokinin receptors in GtoPdb v.2023.1

Cholecystokinin receptors (nomenclature as agreed by the NC-IUPHAR Subcommittee on CCK receptors [90]) are activated by the endogenous peptides cholecystokinin-8 (CCK-8), CCK-33, CCK-58 and gastrin (gastrin-17). There are only two distinct subtypes of CCK receptors, CCK1 and CCK2 receptors [64, 124], with some alternatively spliced forms most often identified in neoplastic cells. The CCK receptor subtypes are distinguished by their peptide selectivity, with the CCK1 receptor requiring the carboxyl-terminal heptapeptide-amide that includes a sulfated tyrosine for high affinity and potency, while the CCK2 receptor requires only the carboxyl-terminal tetrapeptide shared by each CCK and gastrin peptides. These receptors have characteristic and distinct distributions, with both present in both the central nervous system and peripheral tissues