Reconsidering low-dose aspirin therapy for cardiovascular disease: a study protocol for physician and patient behavioral change

<p>Abstract</p> <p>Background</p> <p>There are often disparities between current evidence and current practice. Decreasing the gap between desired practice outcomes and observed practice outcomes in the healthcare system is not always easy. Stopping previously recommended or variably recommended interventions may be even harder to achieve than increasing the use of a desired but under-performed activity. For over a decade, aspirin has been prescribed for primary prevention of cardiovascular disease and for patients with the coronary artery disease risk equivalents; yet, there is no substantial evidence of an appropriate risk-benefit ratio to support this practice. This paper describes the protocol of a randomized trial being conducted in six primary care practices in the Denver metropolitan area to examine the effectiveness of three interventional strategies to change physician behavior regarding prescription of low-dose aspirin.</p> <p>Methods</p> <p>All practices received academic detailing, one arm received clinician reminders to reconsider aspirin, a second arm received both clinician and patient messages to reconsider aspirin. The intervention will run for 15 to 18 months. Data collected at baseline and for outcomes from an electronic health record will be used to assess pre- and post-interventional prescribing, as well as to explore any inappropriate decrease in aspirin use by patients with known cardiovascular disease.</p> <p>Discussion</p> <p>This study was designed to investigate effective methods of changing physician behavior to decrease the use of aspirin for primary cardiovascular disease prevention. The results of this study will contribute to the small pool of knowledge currently available on the topic of ceasing previously supported practices.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01247454">NCT01247454</a></p

Magnetoelastic coupling in Fe100−xGex single crystals with 4

In this paper we examine the elastic (c′ and c44) and magnetostrictive (λ100 and λ111) behaviors of Fe100−xGex for 4\u3cx\u3c18, quantities used further to find the fundamental magnetoelastic coupling constants b1 and b2 at room temperature. The x dependence ofb1 and b2 for Fe100−xGex is contrasted to those of Fe100−xGax and Fe100−xAlx. While the rhombohedral shear elastic constant c44 is almost insensitive to the type and amount of solute, the tetragonal shear constant c′ shows a pronounced and rapid softening with increasing x for all three alloys but with different decreasing slopes. Similarly, while the rhombohedral magnetostriction λ111 behavior is analogous for all three alloy systems, showing a sign change from negative to positive at the onset of chemical order, the tetragonal magnetostriction λ100 behavior differs. For the Ga and Al alloys, λ100 maintains positive values over the entire x range, both curves showing large peak values, whereasλ100 of Fe100−xGex exhibits a moderate positive peak followed by a negative dip, both of comparable magnitude. Finally the tetragonal coupling constant −b1 of Fe–Ge shows a marked, sharp decrease as chemical order occurs at x ∼ 12 at. % Ge. The decline continues until the ordered D03 phase is fully established at x ∼ 18 at. % Ge. The peak value of |b1| for Fe–Ge is approximately half of those for Fe–Ga and Fe–Al. This smaller value of |b1|, obtained for the higher electron concentration Ge alloy, is consistent with predictions based on band structure calculations. The rhombohedral coupling constant−b2 shows a consistent sign change at the occurrence of chemical ordering in both Fe–Ga and Fe–Ge

A metaproteomic approach to study human-microbial ecosystems at the mucosal luminal interface

Aberrant interactions between the host and the intestinal bacteria are thought to contribute to the pathogenesis of many digestive diseases. However, studying the complex ecosystem at the human mucosal-luminal interface (MLI) is challenging and requires an integrative systems biology approach. Therefore, we developed a novel method integrating lavage sampling of the human mucosal surface, high-throughput proteomics, and a unique suite of bioinformatic and statistical analyses. Shotgun proteomic analysis of secreted proteins recovered from the MLI confirmed the presence of both human and bacterial components. To profile the MLI metaproteome, we collected 205 mucosal lavage samples from 38 healthy subjects, and subjected them to high-throughput proteomics. The spectral data were subjected to a rigorous data processing pipeline to optimize suitability for quantitation and analysis, and then were evaluated using a set of biostatistical tools. Compared to the mucosal transcriptome, the MLI metaproteome was enriched for extracellular proteins involved in response to stimulus and immune system processes. Analysis of the metaproteome revealed significant individual-related as well as anatomic region-related (biogeographic) features. Quantitative shotgun proteomics established the identity and confirmed the biogeographic association of 49 proteins (including 3 functional protein networks) demarcating the proximal and distal colon. This robust and integrated proteomic approach is thus effective for identifying functional features of the human mucosal ecosystem, and a fresh understanding of the basic biology and disease processes at the MLI. © 2011 Li et al

A Report of Florida’s Cancer History, Risk Factors, and Screening Behaviors: Data from the National Health Interview Survey

To target populations at greatest risk ofdeveloping cancer, it is vital to understand the patterns ofrisk factors and screening behaviors along with cancer surveillance data. This study provides data on the prevalence of self-reported cancer history, can- cer risk factors, and cancer screening behaviors in Florida and compares them to rates in the rest ofthe U.S. Data were ob- tained from the National Health Interview Survey (NHIS), an annual, cross-sectional household survey of the U.S. civilian non-institutionalized population. We analyzed pooled data from the 2000 and 2005 Cancer Control Modules. Compared to the rest ofthe U.S., Floridians reported a lower prevalence ofcurrent smoking, risky drinking, and obesity, and a greater pre- valence ofProstate Specific Antigen (PSA) testing. However, Floridians reported a greater prevalence ofcancer history and a lower prevalence of physical activity, concern for sun protection, lifetime colorectal cancer screening, lifetime breast exam, life- time mammography screening, and lifetime and past year Pap test. The data indicate that Florida lags behind the rest of the U.S. in several areas, particularly cancer screening, and falls short ofthe Healthy People 2020 objectives for health behaviors and screening. These results provide information for key stakeholders and public health policy makers to effectively target Flor- ida residents at greatest risk for cancer and those not receiving recommended cancer screenings. This study also represents a model ofvaluable state-level evaluations that can be conducted using NHIS data. These types ofanalyses can provide a great- er understanding of state-level variations and lead to more effective public health interventions aimed at reducing cancer bur- den

Trends in smokeless tobacco use in the us workforce: 1987-2005

The primary aim was to examine whether increasing workplace smoking restrictions have led to an increase in smokeless tobacco use among US workers. Smokeless tobacco exposure increases the risk of oral cavity, esophageal, and pancreatic cancers, and stroke. The prevalence of smokeless tobacco use decreased from 1987-2000, except among men 25-44. While smokeless tobacco use has declined in the general population, it may be that the prevalence of smokeless tobacco use has increased among workers due to workplace smoking restrictions, which have been shown to have increased over the years. Using the most current nationally representative National Health Interview Survey (NHIS) data, we examined whether increasing workplace smoking restrictions have led to an increase in smokeless tobacco use among US workers (n = 125,838). There were no significant changes in smokeless tobacco use prevalence from 1987-2005 (pooled prevalence = 3.53%); rates also were lower in smoke free workplaces. Worker groups with high rates of smokeless tobacco use included farm workers (10.51%) and blue collar workers (7.26%). Results indicate that smokeless tobacco prevention strategies targeting particular worker groups are warranted

Effect of childhood victimization on occupational prestige and income trajectories

Background Violence toward children (childhood victimization) is a major public health problem, with long-term consequences on economic well-being. The purpose of this study was to determine whether childhood victimization affects occupational prestige and income in young adulthood. We hypothesized that young adults who experienced more childhood victimizations would have less prestigious jobs and lower incomes relative to those with no victimization history. We also explored the pathways in which childhood victimization mediates the relationships between background variables, such as parent’s educational impact on the socioeconomic transition into adulthood. Methods A nationally representative sample of 8,901 young adults aged 18–28 surveyed between 1999–2009 from the National Longitudinal Survey of Youth 1997 (NLSY) were analyzed. Covariate-adjusted multivariate linear regression and path models were used to estimate the effects of victimization and covariates on income and prestige levels and on income and prestige trajectories. After each participant turned 18, their annual 2002 Census job code was assigned a yearly prestige score based on the 1989 General Social Survey, and their annual income was calculated via self-reports. Occupational prestige and annual income are time-varying variables measured from 1999–2009. Victimization effects were tested for moderation by sex, race, and ethnicity in the multivariate models. Results Approximately half of our sample reported at least one instance of childhood victimization before the age of 18. Major findings include 1) childhood victimization resulted in slower income and prestige growth over time, and 2) mediation analyses suggested that this slower prestige and earnings arose because victims did not get the same amount of education as non-victims. Conclusions Results indicated that the consequences of victimization negatively affected economic success throughout young adulthood, primarily by slowing the growth in prosperity due to lower education levels

Arthritis, Occupational Class, and the Aging US Workforce

Objectives. The working poor sometimes delay retirement to survive. However, their higher risk of disease and disability threatens both their financial survival and their ability to work through the retirement years. We used the burden of disease attributable to arthritis by occupational class to illustrate the challenges faced by the older poor. Methods. We merged data from the National Health Interview Survey, Medical Expenditure Panel Survey, and the National Death Index into a single database. We then calculated and compared age- and occupational class–specific quality-adjusted life years (QALYs) between workers with and without arthritis by using unabridged life tables. Results. White-collar workers have a higher overall health-related quality of life than do other workers, and suffer fewer QALYs lost to arthritis at all ages. For instance, whereas 65-year-old white-collar workers without arthritis look forward to 17 QALYs of future life, blue-collar workers with arthritis experience only 11, and are much less likely to remain in the workforce than are those in service, farming, or white-collar jobs. Conclusions. To meet the needs of the aging workforce, more extensive health and disability insurance will be needed

Single-Electron Spectroscopy

Contains research goals and objectives, reports on four research projects and a list of publications.David and Lucille Packard FoundationJoint Services Electronics Program Grant DAAH04-95-1-0038U.S. Navy - Office of Naval Research Grant N00014-93-1-0633National Science Foundation Young Investigator Awar