Using Graphic Elicitation to Explore Community College Transfer Student Identity, Development, and Engagement

The focus of this paper is to illustrate the use of graphic elicitation, in the form of a relational map, to explore community college transfer student (CCTS) identity, development, and engagement at four-year institutions. Using graphic elicitation illuminated aspects of CCTSs that they may not have been able to otherwise verbalize, and was used in combination with interview questions designed to capture participants\u27 development and engagement, investigating how they made meaning of their institutional experiences. A constructivist grounded theory approach was applied, given the lack of available literature pertaining to CCTSs in these areas. This paper draws upon and contributes to the current graphic elicitation literature and provides a detailed outline of the study’s research design and thorough justification of the use of a relational map. The interview questions and relational maps worked in tandem to uncover theoretical themes that contributed to findings. The study\u27s methodological approach, design using graphic elicitation, and limitations are discussed in addition to potential future research using graphic elicitation techniques

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Attachment goes to court: child protection and custody issues

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child’s need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration

Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine

This consensus statement is an update of the 2010 American College of Sports Medicine position stand on exercise and type 2 diabetes. Since then, a substantial amount of research on select topics in exercise in individuals of various ages with type 2 diabetes has been published while diabetes prevalence has continued to expand worldwide. This consensus statement provides a brief summary of the current evidence and extends and updates the prior recommendations. The document has been expanded to include physical activity, a broader, more comprehensive definition of human movement than planned exercise, and reducing sedentary time. Various types of physical activity enhance health and glycemic management in people with type 2 diabetes, including flexibility and balance exercise, and the importance of each recommended type or mode are discussed. In general, the 2018 Physical Activity Guidelines for Americans apply to all individuals with type 2 diabetes, with a few exceptions and modifications. People with type 2 diabetes should engage in physical activity regularly and be encouraged to reduce sedentary time and break up sitting time with frequent activity breaks. Any activities undertaken with acute and chronic health complications related to diabetes may require accommodations to ensure safe and effective participation. Other topics addressed are exercise timing to maximize its glucose-lowering effects and barriers to and inequities in physical activity adoption and maintenance

Sertoli cell modulates MAA-induced apoptosis of germ cells throughout voltage-operated calcium channels

Spontaneous cell death by apoptosis--occurring during normal spermatogenesis in mammals--is a prominent event, which results in the loss of up to 75% of the potential number of mature spermatozoa. In the rat testis, the most conspicuous dying cells are pachytene spermatocytes, which are also the primary target of the apoptosis experimentally induced by methoxyacetic acid (MAA). In this paper, we have used clusterin expression as an indicator of germ cell apoptosis in rat seminiferous tubules treated with MAA in the presence or in the absence of voltage-operated calcium channels (VOCCs) inhibitors. We performed both a qualitative analysis of clusterin expression by immunofluorescence experiments and a quantitative analysis of apoptosis by in situ end labeling of apoptotic germ cells followed by flow cytometry. The results obtained demonstrate that Sertoli cells, the somatic component of the seminiferous epithelium, which control male germ cell differentiation, also modulate MAA-induced apoptosis of germ cells throughout voltage-operated calcium channels

Epidemiologic trends and treatment survival benefits in a US cohort of patients with primary biliary cholangitis (PBC).

Background and aims: We used data from the Fibrotic Liver Disease (FOLD) Consortium — an established PBC cohort of over 4000 PBC cases drawn from 14.5 million patientts — to study trends in PBC prevalence and incidence, and risk of all‐cause mortality, among PBC patients under routine care in the US. Methods: Annual percentage change (APC) in PBC incidence and prevalence was estimated with join‐ point Poisson regression. Differences associated with race, age, and gender were calculated with rate ratios (RR). Risk of all‐cause mortality was estimated using Cox regression with adjustment for patient characteristics and treatment with ursodeoxycholic acid (UDCA). Propensity scores were used to adjust for treatment selection bias. Analyses were adjusted by study site. Results: Mean age of diagnosis in our racially‐diverse cohort of 3488 PBC patients (21% Hispanic; 8% African American; 7% Asian American) was 59 years. Mean follow‐up was 5 years. 70% received UDCA treatment. From 2006–2014, PBC prevalence increased from 21.7 to 39.2 per 100,000 persons. Adjusted APC (aAPC) differed by age, ranging from 3.0–7.5% (p\u3c0.05). Incidence was 3.7 per 100,000 person‐years in 2006, and 3.4 in 2014, with no trend detected (p=0.09). Across time, the ratio of prevalence (3.8:1) and incidence (3.2:1) between women and men was consistent African Americans had lower prevalence (0.8:1) and incidence (0.6:1) than Whites. In adjusted analyses (Fig), men, patients with elevated ALP, those with a AST/ALT ratio \u3e1.1 (a marker of cirrhosis), and UDCA‐untreated patients were at higher risk of mortality (p\u3c0.05). Specifically, UDCA treatment reduced risk of mortality (adjusted hazard ratio [aHR]=0.52 [0.5–0.6]); AST/ALT ratio \u3e1.1 increased risk of mortality (aHR=2.6 [2.3–2.9]) Conclusions: In US patients under routine clinical care, PBC prevalence rose while incidence remained steady between 2006–2014. Elevated AST/ALT ratios were associated with increased all‐cause mortality; UDCA treatment reduced all‐cause mortality

Epidemiologic trends and treatment survival benefits in a US cohort of patients with primary biliary cholangitis (PBC).

Background and aims: We used data from the Fibrotic Liver Disease (FOLD) Consortium — an established PBC cohort of over 4000 PBC cases drawn from 14.5 million patientts — to study trends in PBC prevalence and incidence, and risk of all‐cause mortality, among PBC patients under routine care in the US. Methods: Annual percentage change (APC) in PBC incidence and prevalence was estimated with join‐ point Poisson regression. Differences associated with race, age, and gender were calculated with rate ratios (RR). Risk of all‐cause mortality was estimated using Cox regression with adjustment for patient characteristics and treatment with ursodeoxycholic acid (UDCA). Propensity scores were used to adjust for treatment selection bias. Analyses were adjusted by study site. Results: Mean age of diagnosis in our racially‐diverse cohort of 3488 PBC patients (21% Hispanic; 8% African American; 7% Asian American) was 59 years. Mean follow‐up was 5 years. 70% received UDCA treatment. From 2006–2014, PBC prevalence increased from 21.7 to 39.2 per 100,000 persons. Adjusted APC (aAPC) differed by age, ranging from 3.0–7.5% (p\u3c0.05). Incidence was 3.7 per 100,000 person‐years in 2006, and 3.4 in 2014, with no trend detected (p=0.09). Across time, the ratio of prevalence (3.8:1) and incidence (3.2:1) between women and men was consistent African Americans had lower prevalence (0.8:1) and incidence (0.6:1) than Whites. In adjusted analyses (Fig), men, patients with elevated ALP, those with a AST/ALT ratio \u3e1.1 (a marker of cirrhosis), and UDCA‐untreated patients were at higher risk of mortality (p\u3c0.05). Specifically, UDCA treatment reduced risk of mortality (adjusted hazard ratio [aHR]=0.52 [0.5–0.6]); AST/ALT ratio \u3e1.1 increased risk of mortality (aHR=2.6 [2.3–2.9]) Conclusions: In US patients under routine clinical care, PBC prevalence rose while incidence remained steady between 2006–2014. Elevated AST/ALT ratios were associated with increased all‐cause mortality; UDCA treatment reduced all‐cause mortality

Serum bilirubin within normal range is associated with an increasing risk of mortality in patients with primary biliary cholangitis regardless of ursodeoxycholic acid treatment. Hepatology 2018; 68:31A-32A.

Background: A rise in bilirubin indicates worsening liver function in patients with primary biliary cholangitis (PBC). Recent reports have suggested that total bilirubin above 0.7 mg/dL may be linked to increased risk for liver transplantation and mortality. The Fibrotic Liver Disease Consortium analyzed the impact of bilirubin as well as race, gender, and ursodeoxycholic acid (UDCA) treatment on risk of all-cause mortality in patients from 11 US health systems. Methods: Data were collected from “index date” (the latest among PBC diagnosis date, UDCA initiation date, or 1/1/2006) through 12/31/2016. Bilirubin was categorized as \u3e2, 2-\u3e1.5, 1.5-\u3e1.0, 1.0-\u3e0.7, 0.7-\u3e0.4, and ≤0.4 mg/dL. Inverse Probability of Treatment Weighting (IPTW) was used to adjust for UDCA selection bias. Cox regression (univariate, including variableby-UDCA interactions, followed by multivariate) was used to estimate the impact of risk factors on mortality. Results: Among 4243 patients (8% African American, 7% Asian American/ Pacific Islander (AAPI), 21% Hispanic), 25% died after index date through 2016. Variables retained in the final multivariate model included age at index, Hispanic ethnicity, baseline bilirubin, alkaline phosphatase, and interactions of UDCA with 4 variables (race, gender, AST/ALT\u3e1.1, and albumin). Among UDCA-treated patients, African Americans had significantly lower mortality than Whites (adjusted Hazard Ratio [aHR]=0.72, 95%CI 0.55-0.93); among untreated patients, this relationship was reversed (aHR=1.96, 95%CI 1.50-2.57). Bilirubin level was strongly and positively associated with increasing mortality; compared to patients with low-normal bilirubin (≤0.4 mg/dL), those in the midnormal (0.7-\u3e0.4) or high-normal (1.0-\u3e0.7) ranges had significantly higher mortality (Figure). Mortality was higher among men, Hispanics, and patients with hypoalbuminemia. After IPTW, UDCA treatment was associated with reduced mortality in all categories except in White women with AST/ALT\u3e1.1 and hypoalbuminemia. Conclusion: UDCA treatment was associated with reduced mortality across most patient groups. Regardless of UDCA treatment, high-normal bilirubin (1.0-\u3e0.7 mg/dL) was associated with twice the risk of death compared to bilirubin ≤0.4 mg/dL. The divergent mortality rates observed between African Americans and Whites regarding UDCA treatment are novel and require further research. Our results suggest that, even within the normal range, higher serum bilirubin levels are associated with increased mortality among PBC patients. (Table Presented)

Serum bilirubin within normal range is associated with an increasing risk of mortality in patients with primary biliary cholangitis regardless of ursodeoxycholic acid treatment.

Background: A rise in bilirubin indicates worsening liver function in patients with primary biliary cholangitis (PBC). Recent reports have suggested that total bilirubin above 0.7 mg/dL may be linked to increased risk for liver transplantation and mortality. The Fibrotic Liver Disease Consortium analyzed the impact of bilirubin as well as race, gender, and ursodeoxycholic acid (UDCA) treatment on risk of all‐cause mortality in patients from 11 US health systems. Methods: Data were collected from “index date” (the latest among PBC diagnosis date, UDCA initiation date, or 1/1/2006) through 12/31/2016. Bilirubin was categorized as \u3e2, 2–\u3e1.5, 1.5–\u3e1.0, 1.0–\u3e0.7, 0.7–\u3e0.4, and ≤0.4 mg/dL. Inverse Probability of Treatment Weighting (IPTW) was used to adjust for UDCA selection bias. Cox regression (univariate, including variable‐by‐UDCA interactions, followed by multivariate) was used to estimate the impact of risk factors on mortality. Results: Among 4243 patients (8% African American, 7% Asian American/ Pacific Islander (AAPI), 21% Hispanic), 25% died after index date through 2016. Variables retained in the final multivariate model included age at index, Hispanic ethnicity, baseline bilirubin, alkaline phosphatase, and interactions of UDCA with 4 variables (race, gender, AST/ALT\u3e1.1, and albumin). Among UDCA‐treated patients, African Americans had significantly lower mortality than Whites (adjusted Hazard Ratio [aHR]=0.72, 95%CI 0.55–0.93); among untreated patients, this relationship was reversed (aHR=1.96, 95%CI 1.50–2.57). Bilirubin level was strongly and positively associated with increasing mortality; compared to patients with low‐normal bilirubin (≤0.4 mg/dL), those in the mid‐normal (0.7–\u3e0.4) or high‐normal (1.0–\u3e0.7) ranges had significantly higher mortality (Figure). Mortality was higher among men, Hispanics, and patients with hypoalbuminemia. After IPTW, UDCA treatment was associated with reduced mortality in all categories except in White women with AST/ALT\u3e1.1 and hypoalbuminemia. Conclusion: UDCA treatment was associated with reduced mortality across most patient groups. Regardless of UDCA treatment, high‐normal bilirubin (1.0–\u3e0.7 mg/dL) was associated with twice the risk of death compared to bilirubin ≤0.4 mg/dL. The divergent mortality rates observed between African Americans and Whites regarding UDCA treatment are novel and require further research. Our results suggest that, even within the normal range, higher serum bilirubin levels are associated with increased mortality among PBC patients