Associations of Rheumatoid Arthritis and Depressive Symptoms Over Time: Are There Differences by Education, Race/Ethnicity, and Gender?

Objective. To examine associations between changes in rheumatoid arthritis (RA) symptoms and depressive symptoms adjusted for other time-varying characteristics, and to test if these associations differed by education, race/ethnicity, or gender. Methods. Data from the 1988–1998 US National Rheumatoid Arthritis Study were analyzed (n = 854). Time-varying covariates included year of the study, pain, functional ability, household work disability, parental status, marital status, employment status, and social support. The time-invariant covariates included years since diagnosis, education, race/ ethnicity, and gender. Multivariate multilevel-model analyses were used to estimate associations within people over time. Results. Patients with RA experience considerable change in depressive symptoms, pain, functional disability, and household work disability over the study period. Depressive symptoms were driven more by differences between people compared to changes within people over time. Findings show that patients experienced increases in depressive symptoms over the study period. The rate of change in depressive symptoms did not differ by education, race/ethnicity, or gender. Times of worse pain, functional disability, and household disability were associated with worse depressive symptoms. The association of functional disability and depressive symptoms was stronger for men than women. Conclusion. Increases in pain and disability were associated with worse depressive symptoms, adjusted for covariates. It is important to monitor and treat both mental and physical health symptoms. Future research efforts should focus on collecting data reflecting the educational, gender, and racial/ethnic diversity of individuals with RA

The role of leadership in implementing lean manufacturing

It is widely accepted that for the successful implementation of lean manufacturing, the senior management commitment is of great importance. However, the lean journey is usually a long one, and eventually management commitment creeps. Furthermore, the involvement of employees in daily improvements is also critical for the success of implementation. Lean leadership can be considered as a way of sustaining and improving the employee performance in lean production systems. In the present study, a thorough literature review is presented focusing in reviewing the principles of lean leadership and the practices that can lead in improving the employee performance. Furthermore, the characteristics and qualities of lean leader are discussed Paper originally presented at Manufacturing Systems 4.0 – Proceedings of the 50th CIRP Conference on Manufacturing Systems, held 3 – 5 May, 2017, Taichung City, Taiwan

Statistics for Fission-Track Thermochronology

This chapter introduces statistical tools to extract geologically meaningful information from fission-track (FT) data using both the external detector and LA-ICP-MS methods. The spontaneous fission of 238U is a Poisson process resulting in large single-grain age uncertainties. To overcome this imprecision, it is nearly always necessary to analyse multiple grains per sample. The degree to which the analytical uncertainties can explain the observed scatter of the single-grain data can be visually assessed on a radial plot and objectively quantified by a chi-square test. For sufficiently low values of the chi-square statistic (or sufficiently high p values), the pooled age of all the grains gives a suitable description of the underlying ‘true’ age population. Samples may fail the chi-square test for several reasons. A first possibility is that the true age population does not consist of a single discrete age component, but is characterised by a continuous range of ages. In this case, a ‘random effects’ model can constrain the true age distribution using two parameters: the ‘central age’ and the ‘(over)dispersion’. A second reason why FT data sets might fail the chi-square test is if they are underlain by multimodal age distributions. Such distributions may consist of discrete age components, continuous age distributions, or a combination of the two. Formalised statistical tests such as chi-square can be useful in preventing overfitting of relatively small data sets. However, they should be used with caution when applied to large data sets (including length measurements) which generate sufficient statistical ‘power’ to reject any simple yet geologically plausible hypothesis

Tibetan Fraternal Polyandry: A Review of its Advantages and Breakdown

The fraternal polyandry marriage relationship of Tibet is widely consideredto be a means of preventing the division of a family\u27s resources among its male heirs. As a family resource preservation strategy, Tibetan polyandry accomplishes the same goal of the European stem family system, but in a very different way. Researchers have suggested that polyandry developed in Tibet, because it provides a household with enough male laborers to fully exploit the marginal agricultural lands in the Himalayas, that it serves as a means of population control, or that it serves as a way of reducing tax obligations to feudal Tibetan lords. A more convincing explanation why Tibetan polyandry is practiced is provided by Nancy E. Levine. She claims that polyandry provides a household with a large labor force, enabling the family to pursue simultaneous and extensive involvement in the three different sectors of the Tibetan economy: agriculture, herding, and trading (1988). Since Tibetan polyandry provides such important economic advantages to households, one can assume that the reasons for the dissolution of polyandrous marriages are largely for individual interests. Levine (1981) and Melvyn C. Goldstein (1981) find that the breakup of polyandrous marriages is usually caused by the younger brothers of the household, because of unhappiness with their spouse, their lower reproductive success than older brothers, a desire for personal autonomy, and difficulty in maintaining a large household. Goldstein (1981) also finds that brothers are more likely to leave polyandrous marriages when unexpected economic opportunities arise

Implementation of the National Environmental Policy Act through unique conditions on the Environmental Protection Agency\u27s wastewater treatment construction grants

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Progress in Reducing Tobacco Use Across Nebraska

Tobacco use is the leading cause of preventable death in the United States, causing over 400,000 deaths annually. In Nebraska each year, 2,400 adults die prematurely because of cigarette smoking. It is estimated that 45,000 Nebraskans now under the age of 18 will eventually die prematurely from cigarette smoking. Cigarette smoking is responsible for $419 million of Nebraska\u27s annual health care costs (representing approximately 7 percent of the state\u27s annual health care costs, including 12 percent of Nebraska\u27s annual Medicaid expenditures), and smoking-related mortality results in over$400 million in forgone future earnings in the state per year. In 2000, the Nebraska State Legislature took an important step towards addressing the state\u27s most significant public health problem by enacting Legislative Bill 1436, which appropriated $21 million from the Tobacco Settlement Trust Fund to support statewide tobacco prevention and cessation efforts. This additional funding enabled the Nebraska Health and Human Services System\u27s (NHHSS) existing tobacco program, Tobacco Free Nebraska (TFN), to greatly expand its efforts by establishing a comprehensive statewide tobacco program. The funding marked a turning point for TFN, resulting in the Centers for Disease Control and Prevention citing the program as one of the model tobacco prevention and cessation programs in the nation. In 2002, the State Legislature took another important step towards eliminating tobacco use in Nebraska by passing a 30-cent increase in the state\u27s cigarette tax. TFN’s achievements as a model program have been previously documented in the 2001 and 2002 State Snapshots and through a variety of other reports developed by an independent evaluation team. These reports, including this State Snapshot, provide information on statewide progress in tobacco control efforts to NHHSS, national, state, and local policymakers, and other interested parties. The year 2003 marked another turning point for TFN. In June, the Nebraska State Legislature made an appropriation of$405,000 annually to TFN through Legislative Bill 285A rather than renewing the program\u27s funding at its previous level of $7 million. The new appropriation represents a 94 percent cut in the annual program funding originally provided by LB 1436. Because of this recent budget cut, many components of Nebraska\u27s comprehensive tobacco prevention and cessation program have been scaled down or will soon be eliminated (see below). This places the future of TFN\u27s strong community-based foundation in jeopardy since the program\u27s level of support is well below the annual$13.3 million in funding recommended by the CDC to implement statewide best practices in tobacco control

CdiA Effectors from Uropathogenic Escherichia coli Use Heterotrimeric Osmoporins as Receptors to Recognize Target Bacteria.

Many Gram-negative bacterial pathogens express contact-dependent growth inhibition (CDI) systems that promote cell-cell interaction. CDI+ bacteria express surface CdiA effector proteins, which transfer their C-terminal toxin domains into susceptible target cells upon binding to specific receptors. CDI+ cells also produce immunity proteins that neutralize the toxin domains delivered from neighboring siblings. Here, we show that CdiAEC536 from uropathogenic Escherichia coli 536 (EC536) uses OmpC and OmpF as receptors to recognize target bacteria. E. coli mutants lacking either ompF or ompC are resistant to CDIEC536-mediated growth inhibition, and both porins are required for target-cell adhesion to inhibitors that express CdiAEC536. Experiments with single-chain OmpF fusions indicate that the CdiAEC536 receptor is heterotrimeric OmpC-OmpF. Because the OmpC and OmpF porins are under selective pressure from bacteriophages and host immune systems, their surface-exposed loops vary between E. coli isolates. OmpC polymorphism has a significant impact on CDIEC536 mediated competition, with many E. coli isolates expressing alleles that are not recognized by CdiAEC536. Analyses of recombinant OmpC chimeras suggest that extracellular loops L4 and L5 are important recognition epitopes for CdiAEC536. Loops L4 and L5 also account for much of the sequence variability between E. coli OmpC proteins, raising the possibility that CDI contributes to the selective pressure driving OmpC diversification. We find that the most efficient CdiAEC536 receptors are encoded by isolates that carry the same cdi gene cluster as E. coli 536. Thus, it appears that CdiA effectors often bind preferentially to "self" receptors, thereby promoting interactions between sibling cells. As a consequence, these effector proteins cannot recognize nor suppress the growth of many potential competitors. These findings suggest that self-recognition and kin selection are important functions of CDI