Determinants Of Decline Research Articles

Determinants of a decline in a nutrition risk measure differ by baseline high nutrition risk status: targeting nutrition risk screening for frailty prevention in the Canadian Longitudinal Study on Aging (CLSA)

ObjectivesNutrition risk is a key component of frailty and screening, and treatment of nutrition risk is part of frailty management. This study identified the determinants of a 3-year decline in nutrition risk (measured by SCREEN-8) for older adults stratified by risk status at baseline.MethodsSecondary data analysis of the comprehensive cohort sample of the Canadian Longitudinal Study on Aging (CLSA) (n = 5031) with complete data for covariates at baseline and 3-year follow-up. Using a conceptual model to define covariates, determinants of a change in nutrition risk score as measured by SCREEN-8 (lower score indicates greater risk) were identified for those not at risk at baseline and those at high risk at baseline using multivariable regression.ResultsModels stratified by baseline nutrition risk were significant. Notable factors associated with a decrease in SCREEN-8 for those not at risk at baseline were mental health diagnoses (− 0.83; CI [− 1.44, −0.22]), living alone at follow-up (− 1.98; CI [− 3.40, −0.56]), and lack of dental care at both timepoints (− 0.91; CI [− 1.62, −0.20]) and at follow-up only (− 1.32; CI [− 2.45, −0.19]). For those at high nutrition risk at baseline, decline in activities of daily living (− 2.56; CI [− 4.36, −0.77]) and low chair-rise scores (− 1.98; CI [− 3.33, − 0.63]) were associated with lower SCREEN-8 scores at follow-up.ConclusionDeterminants of change in SCREEN-8 scores are different for those with no risk and those who are already at high risk, suggesting targeted approaches are needed for screening and treatment of nutrition risk in primary care.

Trends in Vitamin D Status Around the World.

ABSTRACTVitamin D status varies across all continents and countries. Vitamin D status usually is adequate in Latin America and Australia, but in contrast it is very low in the Middle East and some countries in Asia. Trends in vitamin D status, whether it improves or declines over the years, carry important messages. Trends usually are small, but can be predictors and indicators of general health. Vitamin D status has improved in the older population in the United States, and improvement relates to dairy use and vitamin D supplements. To the contrary, vitamin D status has declined in the Inuit population of Canada due to a change from a traditional fish diet to a Western diet. A large improvement was seen in Finland after mandatory fortification of dairy products was introduced. Determinants of decline are less sun exposure, increased use of sunscreen, increase of body mass index (BMI), less physical activity, and poor socioeconomic status. Determinants of increase are food fortification with vitamin D and vitamin D supplements. Food fortification can lead to a population‐wide increase in vitamin D status as shown by the Finnish example. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Are Self-Efficacy and Perceived Environmental Characteristics Determinants of Decline in Physical Activity Time?

This study analyzed whether self-efficacy (SE) and perceived environmental characteristics (EC) are determinants of the decline in physical activity (PA) time in adolescents. This used longitudinal observational approach, with 4 years of data collection, involving 355 adolescents (57.7% girls and 42.3% boys), average age of 11.8 years (0.1y), from João Pessoa, Paraiba, Brazil. SE and EC were measured by scales and PA by a questionnaire. Ordinal logistic regression was used to associate SE and EC with a decline in PA. There was a linear trend toward a decrease in average PA duration (58.3 [13.7]min/wk/y) and a rise in average access to places for PA (point per year) (0.6 [0.1]), urban safety (0.2 [0.1]), and traffic safety scores (0.5 [0.1]). The results of multivariable analysis indicated that SE and EC were not associated with the decline in PA. There was a decline in PA time, and SE and perceived EC were not determinants of this decline.

Production of definitive data from Indonesian geomagnetic observatories

Abstract. Measurement of the geomagnetic field in Indonesia is undertaken by the Meteorological, Climatological, and Geophysical Agency (BMKG). Routine activities at each observatory include the determination of declination, inclination, and total field using absolute and variation measurements. The oldest observatory is Tangerang (TNG), started in 1957, followed by Tuntungan (TUN) in 1980, Tondano (TND) in 1990, Pelabuhan Ratu (PLR) and Kupang (KPG) in 2000, and Jayapura (JAY) in 2012. One of the main obligations of a geomagnetic observatory is to produce final versions of data, released as definitive data, for each year and make them widely available both for scientific and non-scientific purposes, for example to the World Data Centre of Geomagnetism (WDC-G). Unfortunately, some Indonesian geomagnetic observatories do not share their data with the WDC-G and often have difficulty in producing definitive data. In addition, some more basic problems still exist, such as low-quality data due to anthropogenic or instrumental noise, a lack of data-processing knowledge, and limited observer training. In this study, we report on the production of definitive data from Indonesian observatories, and some recommendations are provided about how to improve the data quality. These methods and approaches are applicable to other institutes seeking to enhance their data quality and scientific utility, for example in main field modelling or space weather monitoring. The definitive data from the years 2010 to 2018 are now available in the WDC-G.

A cross-sectional study of factors determining empathy levels among undergraduate medical students of a medical college in Northern Telangana

Background: The development of an ideal doctor-patient relationship requires empathy. Empathetic conversation aids in the formation of an open and trusting equation between doctor and patient. Furthermore, this leads to accurate diagnoses and more compliance to the advised treatment. In this manner, empathy helps in overall recovery of the patient and improves global functioning and generalised well-being. This study aims to make note of the fluctuation in empathy levels during medical education. Studies done in various countries have found factors such as curriculum, clinical rotations timing and gender to progressively influences empathy levels in students throughout their medical training. The recent trend of violence against healthcare professionals in India calls for an urgent action into the gap between doctors and patients communication. Empathy towards patients and attendants will reduce such untoward events. In this current context, we should improve empathy levels among the training doctors. As a first step, we should assess various factors affecting empathy among health care professionals. Method: This cross sectional study was done among undergraduates of a rural medical college in Northern Telangana during the time period of October to December 2019. Their empathy levels were assessed using Jefferson’s Scale for Empathy- Student version (JSE-S). Result: Of the 470 students surveyed, 227 were males and 243 females. Female students were having higher empathy among first year and second years (p<0.001). Empathy levels seem to decline from first year to second year following which the mean empathy remains similar throughout the remaining years in students of both sexes. There is no significant relation between mean empathy scores and choice of future speciality (p>0.05). Conclusion: Female undergraduate students are found to be more empathetic than their male counterparts. A fall in empathy scores from the first to second year of MBBS is seen, which is when students enter their clinical rotations. Targeted intervention at this time may go a long way in the creation of a new generation of more empathetic physicians. Hence, there is a need for evaluation of teaching and learning techniques in medical education. Further, there is a call for more research into the determinants of decline in empathy amongst medical professionals.

Growth differentiation factor-15 and fibroblast growth factor-23 are associated with mortality in type 2 diabetes - An observational follow-up study.

ObjectivesTwo biomarkers, growth differentiation factor 15 (GDF-15) and fibroblast growth factor 23 (FGF-23)), reflecting different aspects of renal pathophysiology, were evaluated as determinants of decline in estimated glomerular filtration rate (eGFR), incident cardiovascular disease (CVD) and all-cause mortality in patients with type 2 diabetes (T2D) and microalbuminuria, but without clinical cardiac disease.Materials and methodsProspective study including 200 T2D patients. The predefined endpoint of chronic kidney disease (CKD) progression: A decline in eGFR of >30% at any time point during follow-up. Hazard ratios (HR) are provided per 1 SD increment of log2-transformed values.ResultsMean (± SD) age was 59 ± 9 years, eGFR 91.1 ± 18.3 ml/min/1.73m2 and median (IQR) UAER 103 (39–230) mg/24-h. During a median 6.1 years follow-up, 40 incident CVD events, 26 deaths and 42 patients reached the CKD endpoint after median 4.9 years. Higher GDF-15 was a determinant of decline in eGFR >30% and all-cause mortality in adjusted models (HR 1.7 (1.1–2.5); p = 0.018 and HR 1.9 (1.2–2.9); p = 0.003, respectively). Adding GDF-15 to traditional risk factors improved risk prediction of decline in renal function (relative integrated discrimination improvement (rIDI) = 30%; p = 0.037). Higher FGF-23 was associated with all-cause mortality in adjusted models (HR 1.6 (1.1–2.2); p = 0.011) with a rIDI of 30% (p = 0.024).ConclusionsIn patients with T2D and microalbuminuria, higher GDF-15 and FGF-23 were independently associated with all-cause mortality and higher GDF-15 improved risk prediction of decline in kidney function and higher FGF-23 of all-cause mortality, beyond traditional risk factors, but not independently of GDF-15.

Functional decline in older patients with cancer receiving chemotherapy: A multicenter prospective study.

This study aims to evaluate the evolution of functional status (FS) 2 to 3months after initiation of chemotherapy, to identify factors associated with functional decline during chemotherapy treatment and to investigate the prognostic value of functional decline for overall survival (OS). Patients ≥70years with a malignant tumor were included when chemotherapy was initiated. All patients underwent a geriatric assessment (GA) including FS measured by Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). FS of patients was followed by repeating ADL and IADL to identify functional decline. From 10/2009 until 07/2011, 439 patients were included. At follow-up, ADL and IADL data were available for 387 patients. Functional decline in ADL and IADL was observed in 19.9% and 41.3% of the patients respectively. In multivariable logistic regression analysis, baseline factors associated with decline in ADL are abnormal nutritional status (OR:2.02) and IADL dependency (OR:1.76). Oncological setting (disease progression/relapse vs new diagnosis) (OR:0.59) is the only determinant of decline in IADL. Functional decline in ADL is strongly prognostic for OS (logrank p-value<.0001; Wilcoxon p-value<.0001) with HR 2.34 and functional decline in IADL is also prognostic for OS but less prominent with HR 1.25. Functional decline occurs in about a third of older patients with cancer receiving chemotherapy and is associated with GA components. It strongly predicts survival, the most prominent for ADL. This knowledge can be used to identify older persons with cancer receiving chemotherapy eligible for interventions to prevent functional decline.

Determinants of decline in glomerular filtration rate in nonproteinuric subjects with or without diabetes and hypertension.

This study investigated whether the slope of estimated GFR is different between nonproteinuric subjects with and without diabetes, and what clinical factors are associated with the GFR slope. An observational cohort study was performed in 923 subjects, and the predictive value of baseline variables on the GFR slope was investigated. On the basis of the median 3-yr follow-up and 7 measurements of GFR, GFR slope (%/yr, median and interquartile range) was significantly larger in subjects with diabetes (-2.39 (-4.86 to 0.15), n=729) than in those without diabetes (-1.02 (-4.28 to 1.37), n=194), and this difference remained significant with or without presence of hypertension. After adjustments for confounding factors, predictors of GFR decline were found to be baseline high values of glycosylated hemoglobin A1C(HbA1C), GFR, systolic blood pressure, and low plasma total protein in subjects with diabetes, whereas only the latter two were significant in subjects without diabetes. In subjects with diabetes, the high GFR was accounted for by high HbA1C at baseline, and the predictors of GFR decline differed between those with and without hypertension, or with high and low baseline GFR. Any combination of the predictors showed increased risk for GFR decline. GFR slope is substantially affected by multiple factors at various stages. The degree of chronic hyperglycemia is likely to play a crucial role in elevating GFR and accelerating the decline in patients with type 2 diabetes even from the normoalbuminuric stage.

Change in serum albumin and subsequent decline in functional status in older persons

This study examines whether a three-year change in serum albumin concentration is associated with subsequent decline in functional status in older persons. A total of 588 participants from the Longitudinal Aging Study Amsterdam aged 65-85 years were followed for six years. The three-year change in serum albumin was classified in four groups: chronic low (< or =43 g/L at both time points), decrease (decrease of 2.4% or more) from normal to low, decrease but still normal, and stable normal albumin (reference group). During the subsequent three years, absolute change and a decline of one standard deviation or more (termed substantial decline) in functional status was assessed. Functional status was measured in two ways: using performance tests and self-reported functional ability. Substantial decline in functional performance and functional ability was observed in 243 persons (41.3%) and 133 persons (22.6%), respectively. After adjustment for baseline functional status and potential confounders, chronic low albumin and a decrease from normal to low albumin were associated with a greater absolute decline in functional performance and in self-reported functional ability. Using the outcome substantial decline in functional status, only decrease to low serum albumin was associated with decline in functional ability [odds ratio (OR)=1.97; one-sided 95% Confidence Limit (CL)=1.09]. This study indicates that chronic low serum albumin is a determinant of decline in functional status. However, a decrease in serum albumin from normal to low levels but within the normal range was a stronger determinant of future decline in functional status. Change in serum albumin level within the normal range measured between two points in time may be used as a general marker of future functional decline.

Letter of Apology for Falsification of Data

To the editor : Re: Poehlman ET, Goran MJ, Gardner AW, Ades PA, Arcerio PJ, Katzman-Rooks SN, Montgomery SM, Toth MJ, and Sutherland PT. Determinants of decline in resting metabolic rate in aging females. Am J Physiol Endocrinol Metab 264: E450–E455, 1993. In the referenced paper, we reported

Biological Aspects of Conformal Therapy

Both conformal and intensity-modulated radiation therapy have great potential to further increase tumor control rates and decrease morbidity. A homogeneous escalation of 'biological' dose within a tumor should increase the likelihood of local cure, especially within the mid-range (e.g. 15% to 80%) of tumor control rates, and conversely, a lower control rate should follow a homogeneously reduced dose. However, when the dose to critical normal tissues is tightly constrained, the dose distributions within the treatment volume may necessarily be heterogeneous, and the effect on tumor control probability will depend upon the magnitude of over- or underdosage, and on the proportions of the tumor clonogen population receiving higher or lower than the nominal dose. Dose-volume histograms provide a measure of heterogeneity of dose within the planned treatment volume, but tumor control probability is also influenced by other variables, e.g. inherent tumor clonogen radiosensitivity and growth rates during a course of treatment, alpha/beta ratios, oxygenation and clonogen density throughout the target volume. Heterogeneity in these factors introduces heterogeneity in tumor responses and a less steep change in tumor control probability with change in dose, reducing the gains or losses that would be predicted to result from heterogeneity of dose. Similarly, modeling the effect of inhomogeneous dose distributions on estimates of probability of complications in normal tissues is hindered by uncertainty of estimates for alpha/beta ratios, especially for late-responding tissues, and lack of data on volume effects. Although the effects of dose inhomogeneity cannot be presented with sufficiently reliable quantitation to be directly applicable to dose prescriptions in radiation therapy, the relative influences of heterogeneities in dose and volume can be modeled to provide a framework for clinical decision-making. The magnitude of a dose reduction is the major determinant of decline in tumor control probability. A large dose reduction to even a small volume of tumor can profoundly decrease tumor control probability. Conversely, the most rapid improvement in tumor control probability occurs the closer to 100% the amount of tumor exposed to an increased dose. Escalation of dose is of little value unless it is distributed through most of the tumor: even very large increases in dose to small volumes are of little benefit.

A CCD system for reading circles in wide-angle astrometry

A CCD circle reading system developed for the USNO (Flagstaff) transit telescope is described. Circle readings are needed for the determination of declinations in wide-angle astrometry. The detectros are commercially available Philips CCD-TV imaging cameras, which can produce digital images every 1/15 of a second. The positions of division marks on the circle are determined by fitting a function to their profiles. This reading system is very accurate (± 0.007 arcsec), fast, and extremely reliable. Also, since the digital output is two-dimensional, the radial positions of division marks on a circle can also be determined, but with lower accuracy (± 1.2 μm)

The Application of Radio Interferometers in Astrometry

AbstractAn account is given of the recent precision measurements of position of radio sources by VLBI and especially phase-stable interferometer systems of the 5 km radio telescope in Cambridge.A brief description of the 5 km. telescope is given as well as some of the remarkably accurate determinations of declination and right ascension of radio sources related to the PK4 catalogue. The monitoring of UT1 with high accuracy has also been achieved with the 5 km telescope.Some prospects of even better accuracies with phase-stable interferometers – and VLBI techniques are also presented.

The one‐hundred‐and‐tenth anniversary (1938) of the Kazan Magnetic Observatory

Kazan is one of the places on the Earth where regular magnetic observations began a long time ago. The first observations of declination were made here by Shopp in 1761. The declination at that time was westerly and amounted to 2° 25′. Later determinations of declination were made in 1805 by Schubert.

Magnetic work of the United States Coast and Geodetic Survey, April 1937 to March 1938

Magnetic surveys—Observations for magnetic declination were made at 141 stations in Alaska, California, Connecticut, Florida, Massachusetts, Montana, New York, Oregon, Texas, Vermont, Virginia, and Washington by officers of the Bureau. Massachusetts Geodetic Survey, working under the Works Progress Administration, occupied 19 stations in Massachusetts and Rhode Island. Complete observations for declination, horizontal intensity, and dip were made by Bureau personnel at 12 stations in California, Kansas, Louisiana, Missouri, Nevada, North Carolina, Oklahoma, and Texas. Dip, only, was observed at one station in California. A large number of observations for declination and two ship‐surveys were made offshore around San Clemente Island, California. Four determinations of declination were made in a non‐magnetic whaleboat in the Gulf of Mexico, using a standard ship's compass and azimuth circle.

Reports of geomagnetic and electric work of organizations and individual investigators in the United States, 1930–31

Reports from about twenty individuals and organizations engaged in some phase of geomagnetic or geoelectric investigations have been received in response to the request of the Secretary of the Section. These interesting reports are given in full following these few notes which indicate the general scope of the investigations reported.Magnetic surveys and observatories—The Carnegie Institution of Washington and the Coast and Geodetic Survey have reported separately on their activities in these fields as they are the principal organizations in the United States compiling data for determining secular variation or obtaining registrations of daily changes in the magnetic and electric elements. Some magnetic observations are obtained by the Hydrographic Office in connection with local surveys, and plans for the investigation of the anomaly in the Gulf of Panama are reported. A magnetograph is operated at Mount Wilson for the study of correlations of magnetic and solar activity. In Canada, the Dominion Observatory reports 47 repeat‐stations reoccupied during 1930 as a part of a comprehensive scheme to reoccupy about 200 stations distributed over the entire country. The Topographical Survey of Canada also reports activity especially in the determination of declination, having made 28,000 precise determinations since the beginning of the work in 1880. Many of the stations are marked as “Repeat‐stations.” Both organizations maintain standard corrections to their instruments by comparison with the standards at the Observatory of the Meteorological Service at Agincourt, and, in addition, a complete intercomparison of the instruments of the Dominion Observatory was made in March 1931 at Washington with the standards of the Department of Terrestrial Magnetism of the Carnegie Institution of Washington.

Comparison Between the Use of Fixed and Movable Circles, in the Determination of Declinations by Meridian Circle

Comparison Between the Use of Fixed and Movable Circles, in the Determination of Declinations by Meridian Circle

A New Magnetic Survey of France 1

THE first systematic series of magnetic observations made in France was undertaken by Lamont, who in 1856 and 1857 determined the absolute value of the different elements at forty-four stations. The results are contained in his “Untersuchungen über die Richtung und Stärke der Erdmagnetismus an Verschiedenen Puncten des Südwestlichen Europa,” and are reduced to three mean epochs: declination to March 1854; horizontal component to June 1848; and dip to the August of the same year. In 1868 and 1869 the Rev. Father Perry made a second series of observations of the intensity and direction of the earth's magnetic force at thirty-three stations in France (Phil. Trans., vols. clx. and clxii.). Determinations of declination have also been made at about twenty stations by MM. Marié-Davy and Descroix in 1875; and declination, dip, and intensity have been observed by M. de Bernardières at various points along the Mediterranean littoral. These observations comprised all that was known respecting the distribution of the magnetic elements and rate of secular change in France prior to the appearance of the important work which forms the subject of this notice.

I. A magnetic survey of the fortieth parallel in North America between the Atlantic Ocean and the Great Salt Lake, Utah

This communication contains the results of a series of observations of the three magnetic elements—dip, intensity, and declination—made along the 40th parallel in North America between the Atlantic Ocean and Salt Lake City. Magnetic observations have been made, with more or less assiduity, at different places in the eastern States for many years past; but of the immense tract of country lying between the Mississippi and the Pacific Ocean there is only a single determination of one of the three elements indicated on Sir Edward Sabine’s maps, viz., a determination of declination at Salt Lake City. A series of observations was made some years since by United States’ officers along the Mexican frontier, and a similar series was carried out by the English and American officers employed on the North American Boundary Commission. The present set of observations was made, therefore, along 'the district which lies midway between the line of observations already run along the northern and southern boundaries of the United States' territory.