The Impact of Cardiovascular Disease Risk Factors on Late Graft Outcome Disparities in Adult African American Kidney Transplant Recipients

Introduction: Although outcome disparities for non-Hispanic Black (NHB) kidney transplant recipients are well known and documented, there is paucity in the data assessing the impact of cardiovascular disease (CVD) risk factors and risk control on racial disparities in kidney transplantation. Methods: Longitudinal study of a national cohort of veteran kidney recipients transplanted between Jan 2001 and Dec 2007 (follow up through Dec 2010) with the aim of determining the prevalence and impact of CVD risk factor and control, compared between NHB and non-Hispanic White (NHW) recipients, on death-censored graft loss (DCGL), overall graft loss and mortality. Data included comprehensive baseline characteristics acquired through the USRDS with detailed follow up clinical, laboratory and medication regimen information acquired through linkage to the VA electronic health records. Analyses were conducted using sequential multivariable modeling (Cox regression), incorporating blocks of variables into iterative nested models. Results: 3,139 patients with complete data were included (2,095 NHW [66.7%] and 1,044 NHBs [33.3%]). At five years post-transplant, NHBs had a higher prevalence of hypertension (100% vs. 99.2%, p\u3c0.01) and post-transplant diabetes (58.9% vs. 53.3%, p\u3c0.01) with reduced control of hypertension (BP \u3c140/90, 60% vs. 69% p\u3c0.01), diabetes (A1c \u3c7%, 35% vs. 47%, p\u3c0.01) and LDL (\u3c100 mg/dL, 55% vs. 61%, p\u3c0.01), when compared to NHWs. Adherence to several medication classes used to manage CVD risk factors was significantly lower in NHBs, as compared to NHWs. The unadjusted risk of DCGL was two-fold higher in NHBs, when compared to NHWs (HR 2.00, 95% CI 1.61-2.49). After adjustment for recipient sociodemographics, donor criteria, transplant characteristics, CVD risk factors and control and post-transplant events, the adjusted independent risk of DCGL was substantially reduced (HR 1.49, 1.11-1.99). CVD risk factors and risk control reduced the influence of NHB race on DCGL by 8.7-17.5%. Similar trends were noted for the outcomes of overall graft loss and mortality and were consistent in multiple sensitivity analyses. Conclusion: These results demonstrate that NHB kidney transplant recipients have substantially higher rates of CVD risk factors and reduced CVD risk control, as compared to NHWs. These issues may be partly related to medication non-adherence and meaningfully contribute to disparities for graft outcomes within NHBs

Pumpkin and Winter Squash Weed Control

There are at least three major species differences among the pumpkins and winter squashes. And, their response to herbicides differ, so it is important to know which types are sensitive to a particular herbicide to avoid crop injury. The major jack o’lantern pumpkin belongs to Cucurbita pepo (as does summer squash, acorn squash, and gourds), butternut wintersquash is a member of C. moschata, and the buttercups and hubbards belong to C. maxima. The primary preemergence herbicides used are Curbit, Command, Sandea, and Strategy. Curbit and Command control a number of broadleaves and grasses, and Sandea has both pre and postemergence activity on many broadleaves. Strategy, a premix of Curbit and Command, is labeled for all the vine crops, including jack-o-lanterns. All of the vine crops are somewhat sensitive to Sandea, so careful use is recommended. Squash in the C. maxima species tend to be more sensitive to Sandea than other types

Pancreas Transplantation: Personal Factors Associated with Good and Poor Post-Transplant Adaptive Response

Notable differences in patient adaptation after pancreas transplant cause some to thrive and return to independent living, while others struggle with emotional and social problems. In order to prepare vulnerable individuals to better cope after transplant, we investigated pre-transplant factors associated with post-transplant adaptive capacity. The pancreas transplant team de ned; good adaptive response (GAR) in patients who were responsible, resourceful, and optimistic. Poor adaptive response (PAR) was associated with patients who tended to complain and were emotionally dependent. METHODS: Experts included 3 nurse coordinators and 3 social workers. A modified Delphi approach was used to achieve consensus on the de nition of GAR and PAR. 200 of the last transplanted pancreas recipients were selected if they: received a pancreas transplant for type 1 DM, with, or without a kidney, and survived a minimum of six months post-transplant. The experts classified cases into GAR and PAR, contextualized by confidence. We completed a chart abstraction of all 200 cases using pre-transplant data and the extracted variables were regressed on the 54 top weighted GAR cases and the top 40 weighted PAR cases. RESULTS: In the final model, past smoker, currently on disability, simultaneous pancreas and kidney (SPK), and less than high school education significantly predicted probability of having a PAR (p<0.05). The model was a well-fitting model with a Hosmer and Lemeshow goodness of t test of (p=0.8250 < 0.05). Given the lack of inclusion of any of the predicted social variables for PAR patients we looked at predictors of GAR. The goodness of fit test was a well-fitting model (p= 0.6294 < 0.05). In addition to pancreas after kidney (PAK) having an odds ratio of 10.39, past smoker was 10.99 and current disability was 5.8. Discussion: The association of PAK with GAR and SPK with PAR suggests a possible effect from prior experience with transplant aiding in coping afterwards. Our findings support the need for a prospective study of coping with pancreas transplant and points to more intensive pre-transplant preparation of recipients, particularly those with lesser education

The Three-Component System

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Evaluation of digital correction techniques for ERTS images

There are no author-identified significant results in this report

General Equilibrium Treatment Effects: A Study of Tuition Policy

This paper defines and estimates general equilibrium treatment effects. The conventional approach in the literature on treatment effects ignores interactions among individuals induced by the policy interventions being studied. Focusing on the impact of tuition policy, and using estimates from our dynamic overlapping generations general equilibrium model of capital and human capital formation, we find that general equilibrium impacts of tuition on college enrollment are an order of magnitude smaller than those reported in the literature on microeconomic treatment effects. The assumptions used to justify the LATE parameter in a partial equilibrium setting do not hold in a general equilibrium setting. Policy changes induce two way flows. We extend the LATE concept to a general equilibrium setting. We present a more comprehensive evaluation to program evaluation by considering both the tax and benefit consequences of the program being evaluated and placing the analysis in a market setting.

High Tunnel Colored Pepper Production in 2008

This report on colored pepper production was originally published in the 2008 Annual Progress Reports for the Horticulture Research Station (ISRF 0008-36)

Force-Time Differences between Ballistic and Non-Ballistic Half-Squats.

The purpose of this study was to examine the force-time differences between concentric-only half-squats (COHS) performed with ballistic (BAL) or non-ballistic (NBAL) intent across a range of loads. Eighteen resistance-trained men performed either BAL or NBAL COHS at 30%, 50%, 70%, and 90% of their one repetition maximum (1RM) COHS. Relative peak force (PF) and relative impulse from 0⁻50 ms (Imp50), 0⁻90 ms (Imp90), 0⁻200 ms (Imp200), and 0⁻250 ms (Imp250) were compared using a series of 2 × 4 (intent × load) repeated measures ANOVAs with Bonferroni post hoc tests. Cohen\u27s d effect sizes were calculated to provide measures of practical significance between the BAL and NBAL COHS and each load. BAL COHS produced statistically greater PF than NBAL COHS at 30% (d = 3.37), 50% (d = 2.88), 70% (d = 2.29), and 90% 1RM (d = 1.19) (all p \u3c 0.001). Statistically significant main effect differences were found between load-averaged BAL and NBAL COHS for Imp90 (p = 0.006, d = 0.25), Imp200 (p = 0.001, d = 0.36), and Imp250 (p \u3c 0.001, d = 0.41), but not for Imp50 (p = 0.018, d = 0.21). Considering the greater PF and impulse observed during the BAL condition, performing COHS with BAL intent may provide a favorable training stimulus compared to COHS performed with NBAL intent

High Tunnel Pole Bean Production in 2008

This report on pole bean production was originally published in the 2008 Annual Progress Reports for the Horticulture Research Station (ISRF 0008-36)

High Tunnel Pepper Production in 2007

This report on pepper production was originally published in the 2007 Annual Progress Reports for the Armstrong Research and Demonstration Farm. Learn more about the Tunnels to Tables project