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Healthy Lifestyle Interventions to Combat Noncommunicable Disease-A Novel Nonhierarchical Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascu - Mayo Clinic proceedings
Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.Copyright Â© 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascu - European heart journal
Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.Â© 2015 Mayo Foundation for Medical Education and Research, and the European Society of Cardiology. This article is being published concurrently in Mayo Clinic Proceedings . The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.  Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, Kaminsky L, Williams M, Hivert M-F, Franklin NC, Myers J, Dengel D, Lloyd-Jones DM, Pinto FJ, Cosentino F, Halle M, Gielen S, Dendale P, Niebauer J, Pelliccia A, Giannuzzi P, Corra U, Piepoli MF, Guthrie G, Shurney D. Healthy Lifestyle Interventions to Combat Noncommunicable Diseased - A Novel Nonhierarchical Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Mayo Clinic Proceedings 2015; DOI: 10.1016/j.mayocp.2015.05.001 [In Press].
Comparison of breast specific gamma imaging and molecular breast tomosynthesis in breast cancer detection: Evaluation in phantoms. - Medical physics
Breast specific gamma imaging or molecular breast imaging (BSGI) obtains 2D images of (99m)Tc sestamibi distribution in the breast. Molecular breast tomosynthesis (MBT) maps the tracer distribution in 3D by acquiring multiple projections over a limited angular range. Here, the authors compare the performance of the two technologies in terms of spatial resolution, lesion contrast, and contrast-to-noise ratio (CNR) in phantom studies under conditions of clinically relevant sestamibi dose and imaging time.The systems tested were a Dilon 6800 and a MBT prototype developed at the University of Virginia. Both systems comprise a pixelated sodium iodide scintillator, an array of position sensitive photomultipliers, and a parallel hole collimator. The active areas and energy resolution of the systems are similar. System sensitivity, spatial resolution, lesion contrast, and CNR were measured using a Petri dish, a point source phantom, and a breast phantom containing simulated lesions at two depths, respectively. A single BSGI projection was acquired. Five MBT projections were acquired over Â±20Â°. For both modalities, the total scan count density was comparable to that observed for each in typical 10 min human scans following injection of 22 mCi (814 MBq) of (99m)Tc-sestamibi. To assess the impact of reducing the tracer dose, the pixel counts of projection images were later binomially subsampled by a factor of 2 to give images corresponding to an injected activity of approximately 11 mCi (407 MBq). Both unprocessed (pixelated) BSGI projections and interpolated (smoothed) BSGI images displayed by default on the Dilon 6800 workstation were analyzed. Volumetric images were reconstructed from the MBT projections using a maximum likelihood expectation maximization algorithm and extracted slices were analyzed.Over a depth range of 1.5-7.5 cm, BSGI spatial resolution was 5.6-11.5 mm in unprocessed projections and 5.7-12.0 mm in interpolated images. Over the same range, the in-slice MBT spatial resolution was 6.7-9.4 mm. Lesion contrast was significantly improved with MBT relative to BSGI for five out of eight lesions imaged at either the 22 mCi or the 11 mCi dose level (p < 0.05). At both dose levels, significant improvements in CNR with MBT were also found for five out of eight lesions (9.8, 7.8, 6.2 mm lesions at water depth of 1.7 cm and 9.8, 7.8 mm lesions at water depth of 4.5 cm, p < 0.05). The 6.2 and 4.9 mm lesions located at 4.5 cm below the water surface were not visible in either modality at either activity level.Under conditions of equal dose, imaging time and similar detectors, compared to BSGI, MBT provided higher lesion contrast, higher CNR, and spatial resolution that was less depth dependent.
Flexible Coding of Task Rules in Frontoparietal Cortex: An Adaptive System for Flexible Cognitive Control. - Journal of cognitive neuroscience
How do our brains achieve the cognitive control that is required for flexible behavior? Several models of cognitive control propose a role for frontoparietal cortex in the structure and representation of task sets or rules. For behavior to be flexible, however, the system must also rapidly reorganize as mental focus changes. Here we used multivoxel pattern analysis of fMRI data to demonstrate adaptive reorganization of frontoparietal activity patterns following a change in the complexity of the task rules. When task rules were relatively simple, frontoparietal cortex did not hold detectable information about these rules. In contrast, when the rules were more complex, frontoparietal cortex showed clear and decodable rule discrimination. Our data demonstrate that frontoparietal activity adjusts to task complexity, with better discrimination of rules that are behaviorally more confusable. The change in coding was specific to the rule element of the task and was not mirrored in more specialized cortex (early visual cortex) where coding was independent of difficulty. In line with an adaptive view of frontoparietal function, the data suggest a system that rapidly reconfigures in accordance with the difficulty of a behavioral task. This system may provide a neural basis for the flexible control of human behavior.
Large-Scale Dissemination of Collaborative Care and Implications for Psychiatry. - Psychiatric services (Washington, D.C.)
The evidence is overwhelming that a collaborative care approach to common mental illnesses is superior to usual care. Why isn't this model widely available? The authors of this column argue that the problem is not a lack of evidence or documentation of a better model, but the need for adoption of implementation science and dissemination knowledge to bring collaborative care into practice. They discuss the challenge of providing mental health care in the United States, the evidence that collaborative care is effective and can play a major role in expanding mental health services, the science of dissemination, six successful large-scale dissemination programs for collaborative care, and the implications of this shift in care delivery for psychiatry and all mental health providers.
Linking nitrogen management, seep chemistry, and stream water quality in two agricultural headwater watersheds. - Journal of environmental quality
Riparian seepage zones in headwater agricultural watersheds represent important sources of nitrate-nitrogen (NO-N) to surface waters, often connecting N-rich groundwater systems to streams. In this study, we examined how NO-N concentrations in seep and stream water were affected by NO-N processing along seep surface flow paths and by upslope applications of N from fertilizers and manures. The research was conducted in two headwater agricultural watersheds, FD36 (40 ha) and RS (45 ha), which are fed, in part, by a shallow fractured aquifer system possessing high (3-16 mg L) NO-N concentrations. Data from in-seep monitoring showed that NO-N concentrations generally decreased downseep (top to bottom), indicating that most seeps retained or removed a fraction of delivered NO-N (16% in FD36 and 1% in RS). Annual mean N applications in upslope fields (as determined by yearly farmer surveys) were highly correlated with seep NO-N concentrations in both watersheds (slope: 0.06; = 0.79; < 0.001). Strong positive relationships also existed between seep and stream NO-N concentrations in FD36 (slope: 1.01; = 0.79; < 0.001) and in RS (slope: 0.64; = 0.80; < 0.001), further indicating that N applications control NO-N concentrations at the watershed scale. Our findings clearly point to NO-N leaching from upslope agricultural fields as the primary driver of NO-N losses from seeps to streams in these watersheds and therefore suggest that appropriate management strategies (cover crops, limiting fall/winter nutrient applications, decision support tools) be targeted in these zones.Copyright Â© by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.
Contributions of systematic tile drainage to watershed-scale phosphorus transport. - Journal of environmental quality
Phosphorus (P) transport from agricultural fields continues to be a focal point for addressing harmful algal blooms and nuisance algae in freshwater systems throughout the world. In humid, poorly drained regions, attention has turned to P delivery through subsurface tile drainage. However, research on the contributions of tile drainage to watershed-scale P losses is limited. The objective of this study was to evaluate long-term P movement through tile drainage and its manifestation at the watershed outlet. Discharge data and associated P concentrations were collected for 8 yr (2005-2012) from six tile drains and from the watershed outlet of a headwater watershed within the Upper Big Walnut Creek watershed in central Ohio. Results showed that tile drainage accounted for 47% of the discharge, 48% of the dissolved P, and 40% of the total P exported from the watershed. Average annual total P loss from the watershed was 0.98 kg ha, and annual total P loss from the six tile drains was 0.48 kg ha. Phosphorus loads in tile and watershed discharge tended to be greater in the winter, spring, and fall, whereas P concentrations were greatest in the summer. Over the 8-yr study, P transported in tile drains represented <2% of typical application rates in this watershed, but >90% of all measured concentrations exceeded recommended levels (0.03 mg L) for minimizing harmful algal blooms and nuisance algae. Thus, the results of this study show that in systematically tile-drained headwater watersheds, the amount of P delivered to surface waters via tile drains cannot be dismissed. Given the amount of P loss relative to typical application rates, development and implementation of best management practices (BMPs) must jointly consider economic and environmental benefits. Specifically, implementation of BMPs should focus on late fall, winter, and early spring seasons when most P loading occurs.Copyright Â© by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.
Phosphorus transport in agricultural subsurface drainage: a review. - Journal of environmental quality
Phosphorus (P) loss from agricultural fields and watersheds has been an important water quality issue for decades because of the critical role P plays in eutrophication. Historically, most research has focused on P losses by surface runoff and erosion because subsurface P losses were often deemed to be negligible. Perceptions of subsurface P transport, however, have evolved, and considerable work has been conducted to better understand the magnitude and importance of subsurface P transport and to identify practices and treatments that decrease subsurface P loads to surface waters. The objectives of this paper were (i) to critically review research on P transport in subsurface drainage, (ii) to determine factors that control P losses, and (iii) to identify gaps in the current scientific understanding of the role of subsurface drainage in P transport. Factors that affect subsurface P transport are discussed within the framework of intensively drained agricultural settings. These factors include soil characteristics (e.g., preferential flow, P sorption capacity, and redox conditions), drainage design (e.g., tile spacing, tile depth, and the installation of surface inlets), prevailing conditions and management (e.g., soil-test P levels, tillage, cropping system, and the source, rate, placement, and timing of P application), and hydrologic and climatic variables (e.g., baseflow, event flow, and seasonal differences). Structural, treatment, and management approaches to mitigate subsurface P transport-such as practices that disconnect flow pathways between surface soils and tile drains, drainage water management, in-stream or end-of-tile treatments, and ditch design and management-are also discussed. The review concludes by identifying gaps in the current understanding of P transport in subsurface drains and suggesting areas where future research is needed.Copyright Â© by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.
The characteristics of patients frequently admitted to academic medical centers in the United States. - Journal of hospital medicine
The recent intense attention to hospital readmissions and their implications for quality, safety, and reimbursement necessitates understanding specific subsets of readmitted patients. Frequently admitted patients, defined as patients who are admitted 5 or more times within 1 year, may have some distinguishing characteristics that require novel solutions.A comprehensive administrative database (University HealthSystem Consortium's Clinical Data Base/Resource Managerâ„¢) was analyzed to identify demographic, social, and clinical characteristics of frequently admitted patients in 101 US academic medical centers.We studied 28,291 frequently admitted patients with 180,185 admissions over a 1-year period (2011-2012). These patients comprise 1.6% of all patients, but account for 8% of all admissions and 7% of direct costs. Their admissions are driven by multiple chronic conditions; compared to other hospitalized patients, they have significantly more comorbidities (an average of 7.1 vs 2.5), and 84% of their admissions are to medical services. A minority, but significantly more than other patients, have comorbidities of psychosis or substance abuse. Moreover, although they are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% vs 21.6%), nearly three-quarters have private or Medicare coverage.Patients who are frequently admitted to US academic medical centers are likely to have multiple complex chronic conditions and may have behavioral comorbidities that mediate their health behaviors, resulting in acute episodes requiring hospitalization. This information can be used to identify solutions for preventing repeat hospitalization for this small group of patients who consume a highly disproportionate share of healthcare resources. Journal of Hospital Medicine 2015. Â© 2015 Society of Hospital Medicine.Â© 2015 Society of Hospital Medicine.
Characteristics of hand involvement in a comparative study of two early RA cohorts from the UK and China. - International journal of rheumatic diseases
To compare the characteristics of early hand involvement in rheumatoid arthritis (RA) using two matched populations, from the UK and China.A cohort comparison study was conducted. Sixty Chinese patients recruited from Shanghai, China were matched on gender and age with 60 patients from a prospective early RA cohort from the UK (SARAH trial). The procedures of data collection in China followed the standard operating procedures employed in the SARAH trial. Outcome measures including Michigan Hand Outcomes Questionnaire (MHQ), medication history and physical assessments were used to assess functional ability and hand impairment.UK patients reported significantly more hand pain (PÂ =Â 0.015), less satisfaction with dominant hand performance (PÂ Â =Â 0.040), more swollen and tender joints (PÂ =Â 0.016 and PÂ =Â 0.001) and greater dexterity of both dominant and non-dominant hands (PÂ <Â 0.001 and PÂ <Â 0.001), while Chinese patients had higher disease activity indicated by erythrocyte sedimentation rate and C-reactive protein, more rheumatoid factor, less satisfaction in both dominant and non-dominant hand appearances (PÂ <Â 0.001 and PÂ <Â 0.001, respectively) and greater dominant hand deformity (PÂ Â =Â 0.003). No statistically significant differences were seen in range of movement and overall hand function as reported by the MHQ.The severity of RA is not milder in China than in the UK and the characteristics of hand involvement tend to be different. Clinicians should consider country-specific differences in managing pain and delivering treatment. It would be helpful for a future study to investigate the RA impact characteristics on a wider range of patients both from within China and from other populations.Â© 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
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