A randomized controlled trial of a physician-directed treatment program for low-income patients with high blood cholesterol: the Southeast Cholesterol Project

OBJECTIVE: To assess the effectiveness of a cholesterol-lowering intervention designed to facilitate the management of hypercholesterolemia by primary care clinicians. DESIGN: Randomized controlled trial, with randomization of clinician-patient groups. SETTING: Twenty-one community and rural health centers in North Carolina and Virginia. PARTICIPANTS: Primary care clinicians (n = 42, 71% physicians) and the patients they enrolled with high cholesterol (n = 372). Twenty-two clinicians were randomized to give the special intervention (184 patients) and 20 to give usual care (188 patients). Two thirds of participating patients were women, 40% were African American, and 11% were Native American. INTERVENTION: A 90-minute tutorial to train clinicians how to use a structured assessment and treatment program (Food for Heart Program) consisting of a brief dietary assessment and three 5- to 10-minute dietary counseling sessions given by the primary care clinician, referral to a local dietitian if the low-density lipoprotein cholesterol (LDL-C) remained elevated at 4-month follow-up, and a prompt for the clinician to consider lipid-lowering medication based on the LDL-C at 7-month follow-up. MAIN OUTCOME MEASURES: Changes in total and LDL cholesterol at 4-month follow-up and averaged over a 1-year follow-up period (4-, 7-, and 12-month follow-up). RESULTS: At 4-month follow-up, total cholesterol decreased 0.33 mmol/L (12.6 mg/dL) in the intervention group and 0.21 mmol/L (8.3 mg/dL) in the control group: the difference was 0.11 mmol/L (4.2 mg/dL) (90% confidence interval [CI], -0.02 to 0.24 mmol/L [-0.7 to 9.1 mg/dL]). The average reduction during the 1-year follow-up period was 0.09 mmol/L (3.6 mg/dL) greater in the intervention group (90% CI, -0.01 to 0.19 mmol/L [-0.3 to 7.5 mg/dL]). Eight percent of intervention patients were taking lipid-lowering medication at follow-up visits compared with 15% of control patients. In a subgroup analysis restricted to the 89% of returnees who were not taking lipid-lowering medication, the reduction in total cholesterol at 4-month follow-up was 0.14 mmol/L (5.5 mg/dL) greater in the intervention group (95% CI, 0.01 to 0.28 mmol/L [0.3 to 10.7 mg/dL]); averaged over 1 year, it was 0.14 mmol/L (5.3 mg/dL) greater (95% CI, 0.03 to 0.24 mmol/L [1.2 to 9.4 mg/dL]). Changes in LDL-C were similar. CONCLUSIONS: Total cholesterol and LDL-C decreased more in the intervention group than in the control group. Overall, the difference in lipid reduction between groups was modest and of borderline statistical significance; among participants who did not take lipid-lowering medication during follow-up, the difference in lipid reduction between groups was larger. We conclude that primary care clinicians can be trained to give a cholesterol-lowering intervention to low-income patients that results in modest, short-term reductions in total cholesterol and LDL-C

The vertebrate fauna of the Upper Permian of Niger. IV. Nigerpeton ricqlesi (Temnospondyli: Cochleosauridae), and the Edopoid Colonization of Gondwana

We describe the edopoid temnospondyl Nigerpeton ricqlesi from the Upper Permian Moradi Formation of northern Niger on the basis of two partial skulls and tentatively associated postcranial material. This crocodile-like taxon displays several edopoid characters states such as a long prenarial region with enlarged premaxillae, elongated vomers, large, posteriorly tapering choanae, and a jugal that broadens anteriorly. Nigerpeton possesses a unique carnivorous dentition. It is autapomorphic in its possession of an extremely elongate snout bearing a maxillary bulge that accommodates three hypertrophied caniniform teeth, inner premaxillary tusks, and anterior paired fenestrae, which pierce the skull roof. In addition, both the maxilla and dentary tooth rows show the sporadic appearance of ‘doubled’ tooth positions. The lateral-line system is present at the adult stage, which suggests an aquatic habitat for this taxon. A phylogenetic analysis of Edopoidea and its relatives places Nigerpeton as the sister taxon to the Permo-Carboniferous genus Chenoprosopus from the U.S.A. As with other members of the Moradi tetrapod fauna, the discovery of Nigerpeton strengthens support for the hypothesis that West Africa hosted an endemic fauna at the close of the Paleozoic Era. Biogeographically, we propose that Late Carboniferous and Permian edopoids were geographically widespread and that they twice crossed the Central Pangean mountain chain (between Laurussia and Gondwana) during their evolution. This distribution was later fragmented with the onset of Late Permian climatic warming

Threshold criterion for wetting at the triple point

Grand canonical simulations are used to calculate adsorption isotherms of various classical gases on alkali metal and Mg surfaces. Ab initio adsorption potentials and Lennard-Jones gas-gas interactions are used. Depending on the system, the resulting behavior can be nonwetting for all temperatures studied, complete wetting, or (in the intermediate case) exhibit a wetting transition. An unusual variety of wetting transitions at the triple point is found in the case of a specific adsorption potential of intermediate strength. The general threshold for wetting near the triple point is found to be close to that predicted with a heuristic model of Cheng et al. This same conclusion was drawn in a recent experimental and simulation study of Ar on CO_2 by Mistura et al. These results imply that a dimensionless wetting parameter w is useful for predicting whether wetting behavior is present at and above the triple temperature. The nonwetting/wetting crossover value found here is w circa 3.3.Comment: 15 pages, 8 figure

A bayesian multilevel modeling approach for data query in wireless sensor networks

In power-limited Wireless Sensor Network (WSN), it is important to reduce the communication load in order to achieve energy savings. This paper applies a novel statistic method to estimate the parameters based on the realtime data measured by local sensors. Instead of transmitting large real-time data, we proposed to transmit the small amount of dynamic parameters by exploiting both temporal and spatial correlation within and between sensor clusters. The temporal correlation is built on the level-1 Bayesian model at each sensor to predict local readings. Each local sensor transmits their local parameters learned from historical measurement data to their cluster heads which account for the spatial correlation and summarize the regional parameters based on level-2 Bayesian model. Finally, the cluster heads transmit the regional parameters to the sink node. By utilizing this statistical method, the sink node can predict the sensor measurements within a specified period without directly communicating with local sensors. We show that this approach can dramatically reduce the amount of communication load in data query applications and achieve significant energy savings

Banking from Leeds, not London: regional strategy and structure at the Yorkshire Bank, 1859–1952

Industrial philanthropist Edward Akroyd created the Yorkshire Penny Savings Bank in 1859. Despite competition from the Post Office Savings Bank after 1861 and a serious reserve problem in 1911, it sustained his overall strategy to become a successful regional bank. Using archival and contemporary sources to build on recent scholarship illustrating how savings banks were integrated into local economies and the complementary roles of philanthropy and paternalism, we analyse an English regional bank's strategy, including an assessment of strategic innovation, ownership changes and management structure. This will demonstrate that the founder's vision continued, even though the 1911 crisis radically altered both strategy and structure

A new approach to constructing models of electron diffusion by EMIC waves in the radiation belts

Electromagnetic Ion Cyclotron (EMIC) waves play an important role in relativistic electron losses in the radiation belts through diffusion via resonant wave‐particle interactions. We present a new approach for calculating bounce and drift‐averaged EMIC electron diffusion coefficients. We calculate bounce‐averaged diffusion coefficients, using quasi‐linear theory, for each individual CRRES EMIC wave observation using fitted wave properties, the plasma density and the background magnetic field. These calculations are then combined into bounce‐averaged diffusion coefficients. The resulting coefficients therefore capture the combined effects of individual spectra and plasma properties as opposed to previous approaches that use average spectral and plasma properties, resulting in diffusion over a wider range of energies and pitch‐angles. These calculations, and their role in radiation belt simulations, are then compared against existing diffusion models. The new diffusion coefficients are found to significantly improve the agreement between the calculated decay of relativistic electrons and Van Allen Probes data

Perspectives on tracking data reuse across biodata resources.

Data reuse is a common and vital practice in molecular biology and enables the knowledge gathered over recent decades to drive discovery and innovation in the life sciences. Much of this knowledge has been collated into molecular biology databases, such as UniProtKB, and these resources derive enormous value from sharing data among themselves. However, quantifying and documenting this kind of data reuse remains a challenge. The article reports on a one-day virtual workshop hosted by the UniProt Consortium in March 2023, attended by representatives from biodata resources, experts in data management, and NIH program managers. Workshop discussions focused on strategies for tracking data reuse, best practices for reusing data, and the challenges associated with data reuse and tracking. Surveys and discussions showed that data reuse is widespread, but critical information for reproducibility is sometimes lacking. Challenges include costs of tracking data reuse, tensions between tracking data and open sharing, restrictive licenses, and difficulties in tracking commercial data use. Recommendations that emerged from the discussion include: development of standardized formats for documenting data reuse, education about the obstacles posed by restrictive licenses, and continued recognition by funding agencies that data management is a critical activity that requires dedicated resources. Summaries of survey results are available at: https://docs.google.com/forms/d/1j-VU2ifEKb9C-sW6l3ATB79dgHdRk5v_lESv2hawnso/viewanalytics (survey of data providers) and https://docs.google.com/forms/d/18WbJFutUd7qiZoEzbOytFYXSfWFT61hVce0vjvIwIjk/viewanalytics (survey of users)

Phase diagram for a class of spin-half Heisenberg models interpolating between the square-lattice, the triangular-lattice and the linear chain limits

We study the spin-half Heisenberg models on an anisotropic two-dimensional lattice which interpolates between the square-lattice at one end, a set of decoupled spin-chains on the other end, and the triangular-lattice Heisenberg model in between. By series expansions around two different dimer ground states and around various commensurate and incommensurate magnetically ordered states, we establish the phase diagram for this model of a frustrated antiferromagnet. We find a particularly rich phase diagram due to the interplay of magnetic frustration, quantum fluctuations and varying dimensionality. There is a large region of the usual 2-sublattice Ne\'el phase, a 3-sublattice phase for the triangular-lattice model, a region of incommensurate magnetic order around the triangular-lattice model, and regions in parameter space where there is no magnetic order. We find that the incommensurate ordering wavevector is in general altered from its classical value by quantum fluctuations. The regime of weakly coupled chains is particularly interesting and appears to be nearly critical.Comment: RevTeX, 15 figure