Comparisons for body mass index and body fat percent among Puerto Ricans, blacks, whites and Asians living in the New York City area

The latest data (NHANES III) from the National Center for Health Statistics (NCHS) show that the black population has the highest proportion of overweight among all adult populations in the United States. The present study compared the body mass index (BMI) and body fat percent from dual-photon absorptiometry in 1,324 healthy adults aged 18 to 107 years recruited from four ethnic groups in the New York City area; 523 whites, 280 blacks, 267 Asians and 254 Puerto Ricans. Puerto Ricans had the largest BMI and the largest percent of subjects with body weight more than 120% of their ideal weight, and the largest fat percent of the four ethnic groups: 76% of Puerto Rican males had fat percent above the median value for white males (fat percent = 19.6%) and 95% of Puerto Rican females had fat percent above the median for white females (fat percent = 30.8%). Asians had the smallest BMI, but 63% of them had fat percent above the median values for whites in each gender. Puerto Ricans also had the largest waist-to-hip ratios among the four ethnic groups. In blacks, the percent of subjects with fat percent larger than the median for whites was slightly smaller than that for Puerto Ricans, 64% and 82% of males and females respectively. These results differ from the latest NCHS data and show that Puerto Ricans in this sample are heavier and fatter than blacks.

The Southeastern Aerosol Research and Characterization (SEARCH) study: temporal trends in gas and PM concentrations and composition, 1999-2010

The SEARCH study began in mid 1998 with a focus on particulate matter and gases in the southeastern United States. Eight monitoring sites, comprising four urban/nonurban pairs, are located inland and along the coast of the Gulf of Mexico. Downward trends in ambient carbon monoxide (CO), sulfur dioxide (SO2), and oxidized nitrogen species (NOy) concentrations averaged 1.2 +/- 0.4 to 9.7 +/- 1.8% per year from 1999 to 2010, qualitatively proportional to decreases of 4.7 to 7.9% per year in anthropogenic emissions of CO, SO2, and oxides of nitrogen (NOx) in the SEARCH region. Downward trends in mean annual sulfate (SO4) concentrations ranged from 3.7 +/- 1.1 to 6.2 +/- 1.1% per year approximately linear with, but not 1:1 proportional to, the 7.9 +/- 1.1% per year reduction in SO2 emissions from 1999 to 2010. The 95th percentile of the March-October peak daily 8-hr ozone (O3 concentrations decreased by 1.1 +/- 0.4 to 2.4 +/- 0.6 ppbv per year (1.5 +/- 0.6 to 3.1 +/- 0.8% per year); O3 precursor emissions of NOx and volatile organic compounds (VOC) decreased at rates of 4.7 and 3.3% per year, respectively. Ambient particulate nitrate (NO3) concentrations decreased by 0.6 +/- 1.2 to 5.8 +/- 0.9% per year modulated in comparison with mean annual ambient NOy concentration decreases ranging from 6.0 +/- 0.9 to 9.0 +/- 1.3% per year. Mean annual organic matter (OM) and elemental carbon (EC) concentrations declined by 3.3 +/- 0.8 to 6.5 +/- 0.3 and 3.2 +/- 1.4 to 7.8 +/- 0.7% per year. The analysis demonstrates major improvements in air quality in the Southeast from 1999 to 2010. Meteorological variations and incompletely quantified uncertainties for emission changes create difficulty in establishing unambiguous quantitative relationships between emission reductions and ambient air quality.

IMPLICATIONS

Emissions and secondary pollutants show complex relationships that depend on year-to-year variations in dispersion and atmospheric chemistry. The observed response of 03 to NOx and VOC emissions in the Southeast implies that continuing reductions of precursor emissions, probably achieved through vehicle fleet turnover and emission control measures, will be needed to attain the National Ambient Air Quality Standard for O3. Reductions in fine particle concentrations have resulted from reductions of primary PM, especially EC and a portion of OM, and from reduction of gas precursors known to form particles, especially SO4 from SO2. Continued reduction of PM2.5 mass concentrations will require attention to organic constituents, which may be complicated by potentially unmanageable biogenic species present in the Southeast.

A screen for dominant modifiers of the irreC-rst cell death phenotype in the developing Drosophila retina

Programmed cell death (PCD) in the Drosophila retina requires activity of the irregular chiasmC-roughest (irreC-rst) gene. Loss-of-function mutations in irreC-rst block PCD during retinal development and lead to a rough eye phenotype in the adult. To identify genes that interact with irreC-rst and may be involved in PCD, we conducted a genetic screen for dominant enhancers and suppressors of the adult rough eye phenotype. We screened 150,000 mutagenized flies and recovered 170 dominant modifiers that localized primarily to the second and third chromosomes. At least two allelic groups correspond to previously identified death regulators, Delta and dRas1. Examination of retinae from homozygous viable mutants indicated two major phenotypic classes. One class exhibited pleiotropic defects while the other class exhibited defects specific to the cell population that normally undergoes PCD.

Getting there from here: evidentiary quandaries of the US outcomes movement

The US outcomes movement assumes, and sometimes argues, the primacy for medical practice of probabilistic knowledge derived from methodologically rigorous statistical studies. 'Evidence-based medicine,' then, is considered a course of clinical medicine prescribed by such research. Implementation of evidence-based medicine as recently been uneven in the US, manifesting not only the expected 'obstacles to implementation' but several theoretical weakness of the applied science model of medical care. Outcomes researchers claim to provide certainty - certainty of what is probable, as it turns out - in a world of clinical uncertainty. This paper argues that outcomes research actually exacerbates the inferential uncertainty of practising physicians who would use knowledge for practice. Two quandaries are discussed: whether to privilege rigorous or relevant research, and whether to privilege universal or local knowledge. In each case, the logic of 'evidence-based medicine' is insufficient to resolve the quandary and would seem to support conflicting resolutions. Recent developments in US health policy are cited as manifestations of these quandaries. Finally, the reader is asked not to disregard the political implications of the outcomes movement.

Psychotherapy with older adults

The scope of need and possible benefit of psychosocial interventions in late life far exceeds the scientific evidence of efficacy. Most studies have been conducted in academic settings with self-selected, relatively independent older adults for whom measures of benefit were narrowly defined. In reviewing the existing literature concerning individual, group, and couples therapies in the geriatric population, we find that with appropriate adaptations for medical comorbidity, cognitive and sensory impairment, caregiver inclusion, and realistic modification of treatment goals, psychotherapeutic endeavors with the senior patient can prove to be highly successful.

The Southeastern Aerosol Research and Characterization (SEARCH) study: spatial variations and chemical climatology, 1999-2010

The Southeastern Aerosol Research and Characterization (SEARCH) study, which has been in continuous operation from 1999 to 2012, was implemented to investigate regional and urban air pollution in the southeastern United States. With complementary data from other networks, the SEARCH measurements provide key knowledge about long-term urban/nonurban pollution contrasts and regional climatology affecting inland locations and sites along the Gulf of Mexico coastline. Analytical approaches ranging from comparisons of mean concentrations to the application of air mass trajectories and principal component analysis provide insight into local and area-wide pollution. Gases (carbon monoxide, sulfur dioxide, nitrogen oxides, ozone, and ammonia), fine particle mass concentration, and fine particle species concentrations (including sulfate, elementary carbon, and organic carbon) are affected by a combination of regional conditions and local emission sources. Urban concentrations in excess of regional baselines and intraurban variations of concentrations depend on source proximity, topography, and local meteorological processes. Regional-scale pollution events (95th percentile concentrations) involving more than 6 of the 8 SEARCH sites are rare (< 2% of days), while subregional events affecting 4-6 sites occur on approximately 10% of days. Regional and subregional events are characterized by widely coincident elevated concentrations of ozone, sulfate, and particulate organic carbon, driven by persistent synoptic-scale air mass stagnation and higher temperatures that favor formation of secondary species, mainly in the summer months. The meteorological conditions associated with regional stagnation do not favor long-range transport of polluted air masses during episodes. Regional and subregional pollution events frequently terminate with southward and eastward penetration of frontal systems, which may initially reduce air pollutant concentrations more inland than along the Gulf Coast.

IMPLICATIONS

Regional distribution of emission sources and synoptic-scale meteorological influences favoring stagnation lead to high regionwide pollution levels. The regional influence is greatest with secondary species, including ozone (03) particulate sulfate (SO4), and particulate organic matter, some of which is produced by atmospheric oxidation of volatile organic compounds (VOCs) from vegetation and anthropogenic sources. Other species, many of which are from primary emissions, are more influenced by local sources, especially within the Atlanta, GA, and Birmingham, AL, metropolitan areas. Limited measurements of modern and fossil total carbon point to the importance of biological and biogenic emissions in the Southeast.

Proapolipoprotein A-I conversion kinetics in vivo in human and in rat

We have determined the turnover rates for proapolipoprotein A-I (proapoA-I) and mature apolipoprotein A-I (apoA-I) in vivo in human and in rat. For the human study, high density lipoprotein (HDL)-associated 125I-labeled proapoA-I (A-I isoform 1) and 131I-labeled mature apoA-I (A-I isoforms 3, 4, and 5) were injected simultaneously into two normal volunteers. Blood samples were obtained serially and HDL proapoA-I and mature apoA-I were separated by isoelectrofocusing for the determination of the associated radioactivity. Residence times of proapoA-I and mature apoA-I were 0.13 and 3.9 days and production rates were 9.0 and 9.3 mg/kg per day, respectively. Analysis of the specific activity curves suggested a complete proapoA-I to mature apoA-I precursor-product relationship. Proprotein conversion was virtually completed in 24 hr. For the rat study, HDL- and lymph chylomicron- (flotation constant Sf greater than 400 S) associated 125I-labeled proapoA-I and 131I-mature apoA-I were injected into fasted rats. Residence times of proapoA-I and mature apoA-I injected in association with HDL were 0.13 and 0.28 day, respectively, and for injection associated with chylomicrons the residence times were 0.08 and 0.26 day. When associated with chylomicrons, proapoA-I was converted more efficiently to the mature form. As in the human study, the results demonstrated a complete proapoA-I to mature apoA-I precursor-product relationship. Our data are consistent with the concepts that (i) conversion to mature apoA-I is the major proapoA-I catabolic fate in plasma; (ii) mature apoA-I is conceivably derived solely from proapoA-I in plasma and proapoA-I is the major apoA-I form secreted in vivo; and (iii) a putative proapoA-I-chylomicron complex is the preferred substrate for the apoA-I propeptidase.

Suicide and aging: international perspectives

From Durkheim to Kraepelin, suicide has been recognized as a social and psychiatric ill. Among clinical scientists in the United States, interest in suicide grew substantially in the 1980's as rates among older adults increased. However, major advances in the science of mental health seem unlikely to reduce the prevalence of suicide as long as case recognition at the community level continues to be problematic. Public policy promoted to reduce social risk factors coupled with greater attention to psychopathology is the logical outgrowth from the most recent data. Differences in suicide rates by nation add weight to the argument.

Origin of apolipoprotein A-I polymorphism in plasma

The origin and the functional significance of apo-A-I polymorphism in man has been investigated. Together with proapo-A-I (identified as A-I1 of the polymorphic series), four other isoforms are found in human plasma, namely A-I2, A-I3, A-I4, and A-I5. A-I3 is the "mature" product of proapo-A-I conversion in plasma. In this study we provide evidence that the other, more acidic, mature apo-A-I isoproteins are derived from A-I3 by a stepwise deamidation process. This conclusion is based on the following observations. 1) Incubation of A-I3 or A-I4, either free or associated with high density lipoprotein, produces a series of more acidic isoproteins corresponding to the sequence found in plasma. The conversion process fits in well with a first order reaction, and A-I3 to A-I4 conversion occurs virtually at the same rate as A-I4 to A-I5 conversion. 2) A-I3 and A-I4 have the same NH2- and C-terminal residues. 3) Formation of apo-A-I acidic isoproteins is accompanied by liberation of ammonia. In order to investigate whether deamidation of apo-A-I results in the production of forms which have different catabolism, a series of turnover studies was carried out in normal volunteers. A-I3 and A-I4 residence times in plasma were, respectively, 3.50 +/- 0.16 and 3.00 +/- 0.10 days (mean +/- S.E.; n = 3). Degradation rate of A-I3 was 8.81 +/- 0.69 mg/kg/day and that of A-I4 was 1.66 +/- 0.15 mg/kg/day (mean +/- S.E.; n = 3). Conversion of A-I3 to A-I4 and A-I4 to A-I5 occurred at the same rate in vivo as that observed in vitro. These results are consistent with the concept that A-I3 is the precursor to the other mature apo-A-I isoforms in plasma. A-I3 is the major isoform through which apo-A-I is eliminated from plasma.

Informal caregiving as state Medicaid expenditure: an only slightly immodest proposal

States and Medicaid recipients would be better off if the federal Medicaid program allowed states to assign a dollar value to some unpaid care friends and family give to Medicaid recipients. The dollar value of this unpaid labor would then be counted as state spending in the calculation of federal match. The proposal, which would ease the pressure on tight state budgets, is entirely compatible with the recent federal-state compromise regarding provider taxes and donations and reinforces an important but overlooked Medicaid policy that cultivates and relies upon households to deliver care.