Racial Disparities in Cardiovascular Risk Associated With Body Mass Index in Men and Women: A Subject-Level Meta-Analysis

Introduction The prevalence of obesity is increasing in all segments of the population. While excess body mass is associated with increased disease risks, the magnitude of the risks are unclear from existing studies. In this dissertation we examine the association between BMI and cardiovascular outcomes, CHD, stroke and CVD mortality and blood pressure in four gender-race subgroups. Methods This study uses Black Pooling Project data which includes subject level data on 27,691 men and women and 450,962 person-years of follow-up. Analysis includes linear regression and Cox Proportional Hazard models and is gender-race specific. Subject-level meta-analysis is used to obtain overall estimates of effect. Results: As a group, blacks have a higher adjusted mean systolic blood pressure than whites and are classified as hypertensive at all BMI categories whereas in whites blood pressure did not reach the hypertensive range until a BMI of at least 31 kg/m2. The age adjusted rise in blood pressure for a BMI increase of25-30 kg/m2, is greater for white than black women (5.9±0.2 vs. 4.4±0.5 p=0.005) and for white than black men (6.0±0.3 vs. 4.3±0.7 p=0.03). The adjusted relative risks for CHD, stroke and CVD mortality is significant for obesity in whites but not in blacks. In obese whites, the relative risk for C\lD mortality is (1.59[l.20-2.09]) in women (1.21 [1.04-1.41]) in women \u3e60 years. There are no such significant associations for black women. Conclusions Obesity has a greater impact on blood pressure and CHD, stroke and CVD mortality in whites than blacks. While obesity prevention and treatment are recommended for all, these findings suggest that these efforts will have a greater impact on lowering blood pressure and reducing cardiovascular mortality in whites than blacks

Controlling the Internet

How can libraries provide Internet access and still maintain the control necessary to prevent abuse? Nearly all libraries that offer Internet access have some kind of Internet use policy, but their policies may differ greatly. Some are highly regulated, some lenient, and some change from day to day to cover situations as they occur. A few academic libraries have use policies that are set by their computing facilities

A Retrospective Database Analysis of Neonatal Morbidities to Evaluate a Composite Endpoint for Use in Preterm Labor Clinical Trials

Objective To propose and assess a composite endpoint (CE) of neonatal benefit based on neonatal mortality and morbidities by gestational age (GA) for use in preterm labor clinical trials. Study Design A descriptive, retrospective analysis of the Medical University of South Carolina Perinatal Information System database was conducted. Neonatal morbidities were assessed for inclusion in the CE based on clinical significance/risk of childhood neurodevelopmental impairment, frequency, and association with GA in a mother– neonate linked cohort, comprising women with uncomplicated singleton pregnancies delivered at !24 weeks’ GA. Results Among 17,912 mother–neonate pairs, neonates were at a risk of numerous severe but infrequent morbidities. Clinically important, predominantly rare events were combined into a CE comprising neonatal mortality and morbidities, which decreased in frequency with increasing GA. The highest CE frequency occurred at \u3c31 weeks. High frequency of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis drove the CE. Median length of hospital stay was longer at all GAs in those with the CE compared with those without. Conclusions Descriptive epidemiological assessment and clinical input were used to develop a CE to measure neonatal benefit, comprising clinically meaningful outcomes. These empirical data and CE allowed trials investigating tocolytics to be sized appropriately

Differences in Cardiovascular Disease Mortality Associated With Body Mass Between Black and White Persons

We analyzed cardiovascular disease mortality risks associated with obesity using participant-level meta-analysis of data from the Black Pooling Project for Black and White individuals. The adjusted relative risks (ARRs) were stronger among White participants than among Black participants for coronary heart disease AAR=1.21 (95% confidence interval [CI]=1.07, 1.36) versus 0.87 (95% CI=0.69, 1.09), respectively, and cardiovascular disease ARR=1.18 (95% CI=1.07, 1.29) versus 0.91 (95% CI=0.77, 1.05), repectively. The results suggest that obesity is an independent risk factor in White people, and additional study of body size and disease progression is necessary in the assessment of racial disparities

A Retrospective Database Analysis of Neonatal Morbidities to Evaluate a Composite Endpoint for Use in Preterm Labor Clinical Trials

Objective  To propose and assess a composite endpoint (CE) of neonatal benefit based on neonatal mortality and morbidities by gestational age (GA) for use in preterm labor clinical trials. Study Design  A descriptive, retrospective analysis of the Medical University of South Carolina Perinatal Information System database was conducted. Neonatal morbidities were assessed for inclusion in the CE based on clinical significance/risk of childhood neurodevelopmental impairment, frequency, and association with GA in a mother–neonate linked cohort, comprising women with uncomplicated singleton pregnancies delivered at ≥24 weeks\u27 GA. Results  Among 17,912 mother–neonate pairs, neonates were at a risk of numerous severe but infrequent morbidities. Clinically important, predominantly rare events were combined into a CE comprising neonatal mortality and morbidities, which decreased in frequency with increasing GA. The highest CE frequency occurred at syndrome, bronchopulmonary dysplasia, and sepsis drove the CE. Median length of hospital stay was longer at all GAs in those with the CE compared with those without. Conclusions  Descriptive epidemiological assessment and clinical input were used to develop a CE to measure neonatal benefit, comprising clinically meaningful outcomes. These empirical data and CE allowed trials investigating tocolytics to be sized appropriately

Time-based and event-based prospective memory in autism spectrum disorder: The roles of executive function, theory of mind, and time-estimation

Prospective memory (remembering to carry out an action in the future) has been studied relatively little in ASD. We explored time-based (carry out an action at a pre-specified time) and event-based (carry out an action upon the occurrence of a pre-specified event) prospective memory, as well as possible cognitive correlates, among 21 intellectually high-functioning children with ASD, and 21 age- and IQ-matched neurotypical comparison children. We found impaired time-based, but undiminished event-based, prospective memory among children with ASD. In the ASD group, time-based prospective memory performance was associated significantly with diminished theory of mind, but not with diminished cognitive flexibility. There was no evidence that time-estimation ability contributed to time-based prospective memory impairment in ASD

The personalization of care services and the early impact on staff activity patterns

- Summary: This study examines the early impact on care coordinators’ (care managers’) work activity patterns of implementing the current personalization agenda within English local authorities. The Individual Budget (IB) pilots operated between 2005 and 2007 and provided a basis for personalization that, ultimately, sought to give personal care budgets to every eligible service user in England. Of particular interest was how the pilots impacted upon the roles, responsibilities and activity of care coordinators, who are expected to play a key role in this transformation of social care. A selfadministered diary schedule was completed by 249 care coordinators, including teams directly involved in delivering IBs and a comparative sample of teams not involved in the pilots. These data were supplemented by semi-structured interviews with 48 care coordinators and 43 team managers. - Findings: The study found that on most measures there were no differences in working patterns between care managers with and without IB holders on their caseload. However, the results do show that – contrary to expectations – more time was spent assessing needs, and that more time generally was required to conduct support planning activities. - Application: The findings are necessarily dependent upon the early experiences of the pilot phase of IBs. As personal budgets are rolled out across all eligible service users, it will be interesting to examine whether the time-use of frontline staff, and indeed the wider organization, structure and function of local authority frontline teams, changes further