Variations in Cholesterol Management Practices of U.S. Physicians

AbstractObjectives. This study sought to evaluate national cholesterol management practices of U.S. physicians.Background. Past studies show that nonclinical factors affect physician practices. We tested the hypothesis that physician and patient characteristics influence cholesterol management.Methods. We used a stratified, random sample of 2,332 office-based physicians providing 56,215 visits to adults in the 1991–1992 National Ambulatory Medical Care Surveys. We investigated physicians’ reporting of cholesterol-related screening, counseling or medications during office visits and used multiple logistic regression to assess independent predictors.Results. An estimated 1.12 billion adult office visits occurred in 1991 and 1992 (95% confidence interval 1.06 to 1.18 billion). For the 1.03 billion visits by patients without reported hyperlipidemia, cholesterol screening (2.8% of visits) and counseling (1.2%) were not frequent. The likelihood of screening increased with older age, cardiovascular disease risk factors, white race and private insurance. We estimate that only 1 in 12 adults received cholesterol screening annually. In the 85 million visits by patients with hyperlipidemia, cholesterol testing was reported in 22.9%, cholesterol counseling in 34.4% and lipid-lowering medications in 23.1%. Testing was more likely in diabetic and nonobese patients. Counseling was more likely with younger age, cardiovascular disease and private insurance. Medications use was associated with cardiovascular disease, Northeast region of the United States, nonobese patients and visits to internists. Physician practices did not differ by patient gender.Conclusions. Although clinical conditions strongly influence cholesterol management, the appropriateness of variations noted by payment source, geographic region and physician specialty deserve further evaluation. These variations and the low estimated volume of services suggest that physicians have not fully adopted recommended cholesterol management practices.(J Am Coll Cardiol 1997;29:139–46)

Prototype finline-coupled TES bolometers for CLOVER

CLOVER is an experiment which aims to detect the signature of gravitational waves from inflation by measuring the B-mode polarization of the cosmic microwave background. CLOVER consists of three telescopes operating at 97, 150, and 220 GHz. The 97-GHz telescope has 160 feedhorns in its focal plane while the 150 and 220-GHz telescopes have 256 horns each. The horns are arranged in a hexagonal array and feed a polarimeter which uses finline-coupled TES bolometers as detectors. To detect the two polarizations the 97-GHz telescope has 320 detectors while the 150 and 220-GHz telescopes have 512 detectors each. To achieve the target NEPs (1.5, 2.5, and 4.5x10^-17 W/rtHz) the detectors are cooled to 100 mK for the 97 and 150-GHz polarimeters and 230 mK for the 220-GHz polarimeter. Each detector is fabricated as a single chip to ensure a 100% operational focal plane. The detectors are contained in linear modules made of copper which form split-block waveguides. The detector modules contain 16 or 20 detectors each for compatibility with the hexagonal arrays of horns in the telescopes' focal planes. Each detector module contains a time-division SQUID multiplexer to read out the detectors. Further amplification of the multiplexed signals is provided by SQUID series arrays. The first prototype detectors for CLOVER operate with a bath temperature of 230 mK and are used to validate the detector design as well as the polarimeter technology. We describe the design of the CLOVER detectors, detector blocks, and readout, and present preliminary measurements of the prototype detectors performance.Comment: 4 pages, 6 figures; to appear in the Proceedings of the 17th International Symposium on Space Terahertz Technology, held 10-12 May 2006 in Pari

Quantum Computation with Quantum Dots

We propose a new implementation of a universal set of one- and two-qubit gates for quantum computation using the spin states of coupled single-electron quantum dots. Desired operations are effected by the gating of the tunneling barrier between neighboring dots. Several measures of the gate quality are computed within a newly derived spin master equation incorporating decoherence caused by a prototypical magnetic environment. Dot-array experiments which would provide an initial demonstration of the desired non-equilibrium spin dynamics are proposed.Comment: 12 pages, Latex, 2 ps figures. v2: 20 pages (very minor corrections, substantial expansion), submitted to Phys. Rev.

Childhood socioeconomic position and adult mental wellbeing:Evidence from four British birth cohort studies

There is much evidence showing that childhood socioeconomic position is associated with physical health in adulthood; however existing evidence on how early life disadvantage is associated with adult mental wellbeing is inconsistent. This paper investigated whether childhood socioeconomic position (SEP) is associated with adult mental wellbeing and to what extent any association is explained by adult SEP using harmonised data from four British birth cohort studies.The sample comprised 20,717 participants with mental wellbeing data in the Hertfordshire Cohort Study (HCS), the MRC National Survey of Health and Development (NSHD), the National Child Development Study (NCDS), and the British Cohort Study (BCS70). Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) scores at age 73 (HCS), 60-64 (NSHD), 50 (NCDS), or 42 (BCS70) were used. Harmonised socioeconomic position (Registrar General's Social Classification) was ascertained in childhood (age 10/11) and adulthood (age 42/43). Associations between childhood SEP, adult SEP, and wellbeing were tested using linear regression and multi-group structural equation models.More advantaged father's social class was associated with better adult mental wellbeing in the BCS70 and the NCDS. This association was independent of adult SEP in the BCS70 but fully mediated by adult SEP in the NCDS. There was no evidence of an association between father's social class and adult mental wellbeing in the HCS or the NSHD.Socioeconomic conditions in childhood are directly and indirectly, through adult socioeconomic pathways, associated with adult mental wellbeing, but findings from these harmonised data suggest this association may depend on cohort or age

Perceived Barriers to Weight Management in Primary Care—Perspectives of Patients and Providers

BACKGROUND: Despite the consequences of overweight and obesity, effective weight management is not occurring in primary care. OBJECTIVE: To identify beliefs about obesity that act as barriers to weight management in primary care by surveying both patients and providers and comparing their responses. DESIGN: Anonymous, cross-sectional, self-administered survey of patients and providers of a Veteran’s Administration Primary Care Clinic, distributed at the clinic site. SUBJECTS: Forty-eight Internal Medicine providers and 488 patients. MEASUREMENTS: Beliefs, attitudes, and experiences with weight management as well as demographic characteristics were collected through a questionnaire. RESULTS: Providers and patients differed significantly on many beliefs about weight. Providers were more likely than patients to perceive that patients lack self-control to stay on a diet and that fattening food in society and lack of time for exercise were prime factors in weight gain. They also expressed more interest in helping patients with weight management than patients desiring this. Patients were more likely to state that weight problems should be managed on one’s own, talking to a provider is not helpful, providers blame them for their weight problem, and that appointments contain sufficient time for weight discussion. CONCLUSION: Providers and patients emphasize different barriers to weight management. Providers need to be aware of the beliefs that their patients hold to improve weight management discussions and interventions in primary care

Education for sustainable development: A study in adolescent perception changes towards sustainability following a strategic planning-based intervention-the young persons' plan for the planet program

© 2019 by the authors. In 2016, the United Nations (UN) launched the 17 Sustainable Development Goals (SDGs) as a framework for sustainable development and a sustainable future. However, the global challenge has been to engage, connect, and empower communities, particularly young people, to both understand and deliver the 17 SDGs. In this study, we show the benefit of a strategic planning-based experiential learning tool, the Young Persons' Plan for the Planet (YPPP) Program, to improve the underlying competencies of Australian and Mauritian adolescents in increasing understanding and delivering the SDGs. The study was conducted with 300 middle to senior high school students, in 25 schools throughout Australia and Mauritius, over an 18-month period. The intervention included the development of research, strategic planning, management, STEM (Science Technology, Engineering, Maths) and global competency skills in the students, to enable them to build and deliver regional and national SDG plans. Research methods included pre- and post-intervention testing of the attitudes of these students to sustainable development outcomes and compared these attitudes to subsets of scientists and the Australian national population. Our results, from both qualitative and quantitative evidence, demonstrate significant improvements in these adolescents' appreciation of, and attitudes towards, the SDGs and sustainable outcomes, across a range of key parameters. The results from the 76 students who attended the International Conference in Mauritius in December 2018 demonstrate significant improvements in mean levels of understanding, and attitudes of the students towards the SDGs awareness (+85%), understanding/engagement (+75%), motivation (+57%), and action orientation/empowerment (+66%). These changes were tested across a range of socio-demographic, geographic, and cultural parameters, with consistent results. These findings have significant implications for the challenge of sustainable education and achieving community engagement and action towards the SDGs in Australia and Mauritius, particularly for young people. As the intervention can be replicated and scaled, the findings also highlight the opportunity to extend both the research and this type of experiential learning intervention across both broader geographies and other generation and community segments

Identifying the science and technology dimensions of emerging public policy issues through horizon scanning

Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security.Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security

An integrated framework for sustainable development goals

The United Nations (UN) Rio+20 summit committed nations to develop a set of universal sustainable development goals (SDGs) to build on the millennium development goals (MDGs) set to expire in 2015. Research now indicates that humanity’s impact on Earth’s life support system is so great that further global environmental change risks undermining long-term prosperity and poverty eradication goals. Socioeconomic development and global sustainability are often posed as being in conflict because of trade-offs between a growing world population, as well as higher standards of living, and managing the effects of production and consumption on the global environment. We have established a framework for an evidence-based architecture for new goals and targets. Building on six SDGs, which integrate development and environmental considerations, we developed a comprehensive framework of goals and associated targets, which demonstrate that it is possible, and necessary, to develop integrated targets relating to food, energy, water, and ecosystem services goals; thus providing a neutral evidence-based approach to support SDG target discussions. Global analyses, using an integrated global target equation, are close to providing indicators for these targets. Alongside development-only targets and environment-only targets, these integrated targets would ensure that synergies are maximized and trade-offs are managed in the implementation of SDGs

Scaffold Vaccines for Generating Robust and Tunable Antibody Responses

Traditional bolus vaccines often fail to sustain robust adaptive immune responses, typically requiring multiple booster shots for optimal efficacy. Additionally, these provide few opportunities to control the resulting subclasses of antibodies produced, which can mediate effector functions relevant to distinct disease settings. Here, it is found that three scaffold-based vaccines, fabricated from poly(lactide-co-glycolide) (PLG), mesoporous silica rods, and alginate cryogels, induce robust, long-term antibody responses to a model peptide antigen gonadotropin-releasing hormone with single-shot immunization. Compared to a bolus vaccine, PLG vaccines prolong germinal center formation and T follicular helper cell responses. Altering the presentation and release of the adjuvant (cytosine-guanosine oligodeoxynucleotide, CpG) tunes the resulting IgG subclasses. Further, PLG vaccines elicit strong humoral responses against disease-associated antigens HER2 peptide and pathogenic E. coli, protecting mice against E. coli challenge more effectively than a bolus vaccine. Scaffold-based vaccines may thus enable potent, durable and versatile humoral immune responses against disease

Dynamin impacts homology-directed repair and breast cancer response to chemotherapy

After the initial responsiveness of triple-negative breast cancers (TNBCs) to chemotherapy, they often recur as chemotherapy-resistant tumors, and this has been associated with upregulated homology-directed repair (HDR). Thus, inhibitors of HDR could be a useful adjunct to chemotherapy treatment of these cancers. We performed a high-throughput chemical screen for inhibitors of HDR from which we obtained a number of hits that disrupted microtubule dynamics. We postulated that high levels of the target molecules of our screen in tumors would correlate with poor chemotherapy response. We found that inhibition or knockdown of dynamin 2 (DNM2), known for its role in endocytic cell trafficking and microtubule dynamics, impaired HDR and improved response to chemotherapy of cells and of tumors in mice. In a retrospective analysis, levels of DNM2 at the time of treatment strongly predicted chemotherapy outcome for estrogen receptor-negative and especially for TNBC patients. We propose that DNM2-associated DNA repair enzyme trafficking is important for HDR efficiency and is a powerful predictor of sensitivity to breast cancer chemotherapy and an important target for therapy