Difference In Attrition Rates Research Articles

Where Are They Now? Attrition Rates of Emergency Medicine Residency Graduates by Gender

Prior studies examined the retention of women emergency physicians through residency training, but their career paths on completing residency are less well understood. Our primary objective was to identify a difference in attrition rates between binary genders of practicing clinical emergency physicians within 10 to 30 years after residency graduation. Our secondary aims investigated gender differences in geographic practice location, academic, and community practice. We hypothesized that women emergency physicians have higher rates of attrition from clinical practice than men. In this cohort study, we tracked employment over 10 to 30 years of graduates from allopathic emergency medicine residency programs established before 2005 and those who graduated before 2010. We obtained graduate lists from 21 residency programs representing geographically diverse training programs in the United States. We utilized public databases to investigate current licensure, board certification, practice location, and occupation for graduates more than 10 years after residency graduation. Physicians who do not practice clinically in emergency medicine or an emergency medicine subspecialty were placed in the "attrition" category. "Not available" was defined as those individuals who did not have adequate information available online. We analyzed differences in attrition of women and men emergency physicians in clinical practice in 2020. We also noted whether they worked in an academic or community setting and assessed their geographic clinical practice region. We identified a total of 4,170 graduates. Of those, 445 (10.6%) were excluded because of insufficient information. Of the 3,725 emergency medicine residency graduates, 71% were men. The attrition rate from clinical emergency medicine for men was 5.3% (95% confidence interval, 4.4% to 6.1%) and the attrition rate for women was 5.8% (95% confidence interval, 4.4% to 7.2%). The difference between the 2 proportions was -0.005 (95% confidence interval, -0.02 to 0.01). There were no gender differences in geographic location or practice type. We did not observe differences in attrition rates by gender in our sample from 21 programs over a 30-year period. The findings from this cohort are disparate from reports of recent emergency medicine graduates and identifying reasons for attrition of emergency physicians will be important to understanding the workforce needs of the future.

Feedback based on health advice via tracing bracelet and smartphone in the management of blood pressure among hypertensive patients: A community-based RCT trial in Chongqing, China.

Lifestyle interventions have been recognized as a line of treatment for noncommunicable diseases. This study aimed to evaluate a bespoke mHealth approach to deliver personalized feedback to improve blood pressure and weight for hypertensive patients in community settings. A total of 307 participants, 50 from each community, were expected to be in the intervention or control group. A professional health facilitator was assigned for each of the 6 communities. The primary outcomes of the study are the reduction in blood pressure and weight at baseline and postintervention. Of 307 recruited, 192 participants (62.5%) completed the study (intervention: 104 and control: 88). There was no difference in attrition rates between the 2 groups (33.5% vs 41.9%, P = .291). After 6 month of intensive feedback intervention through the mHealth approach, patients had better blood pressure (133.4 ± 15.3 vs 139.7 ± 16.0) compared with control. People who were adherent to the intervention demonstrated a clinical benefit in weight and blood pressure.

0286 Presence and Potential Impact of Demographically Based Attrition in Pediatric Sleep Manipulation Research

Abstract Introduction Pediatric sleep manipulation studies have mostly enrolled youth from dominant-culture, higher-income families. Studies with more diverse samples have been underpowered to detect differential attrition and demographic effect moderators. Here we pool data from two adolescent sleep manipulation protocols in a Midwest US city to better examine demographic differences in attrition rates and effect sizes. Methods Samples were pooled from studies detailed in Beebe et al. (2017; SLEEP, zsw035) and Duraccio et al. (2021; JSR, e13054). Both involved a sleep stabilization week, followed by 5-night periods of sleep restriction (6.5 hours/night in bed) and healthy sleep (9.5-10 hours/night in bed) in randomized counterbalanced order. Primary caregivers and 14-17 year-old adolescents each completed attention and sleepiness questionnaires for both conditions. Here we compare adolescents who were caregiver-identified as Black vs. White, the two largest local racial groups. Caregivers also reported their own education, family income, and household structure (single- vs. two-parent). Non-parametric tests looked for differential attrition and MANCOVA tested for racial differences in effects. Results Of the 257 initially enrolled, Black adolescents and those from households with one parent, lower income, or lower caregiver education were differentially lost to attrition (all p<.001), even though the racial makeup of the final sample approximated the regional population (36% Black, 64% White). In the final sample, Black and White youth were equally able to change their sleep (p>.90). Manipulation effects were significantly smaller for Black than White adolescents for inattention (self-report p=.026; parent-report p=.017) and sleepiness (self-report p=.002, parent-report p<.001), but these differential effects were non-significant after controlling for family income, household structure, and caregiver education (p>.05). Conclusion Even when a final study sample seemingly approximates the diversity of the local population, differential attrition may affect results. In this case, it superficially appeared that being in a non-dominant group (self-identified Black) was protective against the impact of short sleep. However, this effect disappeared after controlling for demographic risk factors. Participation in sleep manipulation studies can be challenging, so families facing higher burdens may need more support; otherwise, only the most resilient of those families may succeed, which could distort findings. Support (If Any) NIH (R01HL120879, R01HL092149)

Cascade of care for office-based buprenorphine treatment in Bronx community clinics

IntroductionThe cascade of care for opioid use disorder (OUD) has been described at the population level to inform health policy and in health care systems, programs, and communities to guide targeted interventions. Office-based buprenorphine treatment is essential for expanding access to OUD treatment; however, few studies examine the cascade of care specifically for office-based buprenorphine treatment. Our objective was to describe a cascade of care for patients referred for office-based buprenorphine treatment in the primary care setting. MethodsWe conducted a retrospective cohort study of patients with OUD who were referred for office-based buprenorphine treatment within a large, urban health care system between 2018 and 2019. Our primary outcomes included completion of each step of the buprenorphine treatment cascade of care: 1) referred for treatment, 2) scheduled initial visit, 3) completed initial visit, 4) initiated buprenorphine treatment, and 5) retained in treatment at 90 days. We constructed a cascade of care by calculating proportions of patients identified at every step, starting with the total number of patients referred for treatment as the first step. We extracted data from the program's referral database and electronic medical record system. We compared characteristics of patients referred who initiated buprenorphine to those referred who did not initiate buprenorphine treatment using chi-squared tests and t-tests. To account for the hierarchical nature of the data, we conducted a Generalized Estimating Equation (GEE) modeling to test the differences in attrition rates among the steps of the cascade of care. ResultsIn the 24-month period between 2018 and 2019, 226 patients were referred for office-based buprenorphine treatment at Montefiore's Buprenorphine Treatment Network. Patients' mean age at referral was 47 years, and most were male (68.6%), Hispanic (49.6%), and publicly insured (75.7%). Among all patients, 182 (80.5%) were scheduled for an initial visit, 142 (62.8%) completed the initial visit, 134 (59.3%) initiated buprenorphine treatment, and 95 (42.0%) were retained in treatment at 90 days. 37.2% of all patients referred did not complete the initial visit. A GEE model showed that attrition is significantly steeper in the first two steps of the cascade of care, compared to the later three steps (AOR = 1.95, 95% CI = 1.31–2.91, p < 0.05). Compared to referred patients who did not initiate treatment, those referred who initiated treatment were more likely to be using non–prescribed buprenorphine at time of referral (19.4% vs. 5.4%, p < 0.05) and be self-referred (22.4% vs. 9.8%, p < 0.05). ConclusionOur study is the first to describe a cascade of care for office-based buprenorphine treatment in a large health care system. The study observed the steepest attrition in the first two steps of the cascade of care, where more than a third of patients referred did not complete the initial visit. Patients who were self-referred, or using non–prescribed buprenorphine were more likely to initiate treatment. A cascade of care specific for office-based buprenorphine can inform future efforts to improve linkage to care.

Evaluation of the Success of Weight Loss Programs Using the Fit for Performance Curriculum.

Overweight and obesity rates continue to rise among U.S. Army soldiers, which impacts their overall readiness status and puts them at greater risk for musculoskeletal injury and development of chronic disease. To address the concern with obesity and ensure that Soldiers are meeting body composition standards, the Army offers Fit for Performance-Weight Loss Strategies curriculum, a program of standardized material on nutrition and physical activity presented over six 1-hour sessions. This study aimed to evaluate the success and attrition of weight loss programs using the Fit for Performance curriculum in an Army setting among TRICARE regions. This retrospective cohort study consolidated data on participants in weight loss programs using the Fit for Performance curriculum. It examines attrition rates, weight loss, change in body mass index (BMI), factors influencing weight loss, and attrition based on geographical location. Statistical analysis was completed using R Core Team software, version 3.6.1, for t-tests, linear regression, and analysis of variance. Significance was set at P ≤ .05. This study was determined to be exempt by the Walter Reed National Military Hospital Institutional Review Board. In total, 8,336 U.S. Army soldiers (80% male, mean age = 26.2 ± 6.9 years) participated in the program. Attrition rates were high (96.4%). Those who attended 4-6 sessions lost significantly more weight than those who attended 1-3 sessions (0.72 kg [1.60lbs], P<.001); however, weight lost was not clinically significant. Sex, age, and number of sessions attended influenced to the amount of weight lost, but only accounted for 4% of the variation. Among TRICARE regions there was a significant difference in attrition rates, with those in the Western (1.2 sessions, P < .001) and Overseas (1.6 sessions, P<.001) regions attending statistically fewer sessions than those in the Eastern region. Consistent attendance in a weight loss program promotes changes in BMI, which may improve the health of the force. However, the factors influencing these changes are unclear. The results indicate opportunities to re-examine current processes and the program elements to encourage increased or complete participation and determine if program element changes are warranted for the Fit for Performance-Weight Loss Strategies Program. Attrition rates were high, indicating opportunities to research reasons for attendance and attrition in the future. Finally, these findings highlight an opportunity for educating the military leadership on the increased success with increased attendance.

Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: A randomized controlled trial.

Forty percent of all general-practitioner appointments are related to mental illness, although less than 35% of individuals have access to therapy and psychological care, indicating a pressing need for accessible and affordable therapy tools. The ubiquity of smartphones offers a delivery platform for such tools. Previous research suggests that gamification-turning intervention content into a game format-could increase engagement with prevention and early-stage mobile interventions. This study aimed to explore the effects of a gamified mobile mental health intervention on improvements in resilience, in comparison with active and inactive control conditions. Differences between conditions on changes in personal growth, anxiety and psychological wellbeing, as well as differences in attrition rates, were also assessed. The eQuoo app was developed and published on all leading mobile platforms. The app educates users about psychological concepts including emotional bids, generalization, and reciprocity through psychoeducation, storytelling, and gamification. In total, 358 participants completed in a 5-week, 3-armed (eQuoo, "treatment as usual" cognitive behavioral therapy journal app, no-intervention waitlist) randomized controlled trial. Relevant scales were administered to all participants on days 1, 17, and 35. Repeated-measures ANOVA revealed statistically significant increases in resilience in the test group compared with both control groups over 5 weeks. The app also significantly increased personal growth, positive relations with others, and anxiety. With 90% adherence, eQuoo retained 21% more participants than the control or waitlist groups. Intervention delivered via eQuoo significantly raised mental well-being and decreased self-reported anxiety while enhancing adherence in comparison with the control conditions. Mobile apps using gamification can be a valuable and effective platform for well-being and mental health interventions and may enhance motivation and reduce attrition. Future research should measure eQuoo's effect on anxiety with a more sensitive tool and examine the impact of eQuoo on a clinical population.

Teaching Political Science Research Methods Across Delivery Modalities: Comparing Outcomes Between Face-to-Face and Distance-Hybrid Courses

What delivery modality is most effective in teaching undergraduate, political science research methods? Using systematically collected data from two academic terms and employing a quasi-experimental design, this paper explores variation in learning outcomes between face-to-face and distance-hybrid course offerings. Variation in the dependent variable is observed through measuring attrition (drop or failure), course performance among those who pass, and course satisfaction. While any evidence of difference in attrition rates is marginal when controlling for sex, age, university experience, a background in similar coursework, or whether the course is taken by a major, there is no evidence that modality predicts performance among those who successfully complete the course. Distance-hybrid learners are less satisfied with the class overall, unless you control for knowledge gains, math anxiety, and especially social presence. Perceptions of a learning community predict satisfaction for learners across both modalities, but when modeled controlling for other subjective outcomes, we predict higher satisfaction for distance learners. This suggests that the best pathway to equalize outcomes across delivery modalities is to work hard to overcome the social presence gap experienced by students learning in a distance-hybrid environment.

Analysis of national trends in neurosurgical resident attrition.

Resident attrition creates a profound burden on trainees and residency programs. This study aims to analyze trends in resident attrition in neurological surgery. This study followed a cohort of 1275 residents who started neurosurgical residency from 2005 to 2010. Data obtained from the American Association of Neurological Surgeons (AANS) included residents who matched in neurosurgery during this time. Residents who did not finish their residency training at the program in which they started were placed into the attrition group. Residents in the attrition group were characterized by one of five outcomes: transferred neurosurgery programs; transferred to a different specialty; left clinical medicine; deceased; or unknown. A thorough internet search was conducted for residents who did not complete their training at their first neurosurgical program. Variables leading to attrition were also analyzed, including age, sex, presence of advanced degree (Ph.D.), postgraduate year (PGY), and geographical region of program. Residents starting neurosurgical residency from 2005 to 2010 had an overall attrition rate of 10.98%. There was no statistically significant difference in attrition rates among the years (p = 0.337). The outcomes for residents in the attrition group were found to be as follows: 33.61% transferred neurosurgical programs, 56.30% transferred to a different medical specialty, 8.40% left clinical medicine, and 1.68% were deceased. It was observed that women had a higher attrition rate (18.50%) than men (10.35%). Most attrition (65.07%) occurred during PGY 1 or 2. The attrition group was also observed to be significantly older at the beginning of residency training, with a mean of 31.69 years of age compared to 29.31 in the nonattrition group (p < 0.001). No significant difference was observed in the attrition rates for residents with a Ph.D. (9.86%) compared to those without a Ph.D. (p = 0.472). A majority of residents in the attrition group pursued training in different medical specialties, most commonly neurology, radiology, and anesthesiology. Factors associated with an increased rate of attrition were older age at the beginning of residency, female sex, and junior resident (PGY-1 to PGY-2). Resident attrition remains a significant problem within neurosurgical training, and future studies should focus on targeted interventions to identify individuals at risk to help them succeed in their medical careers.

Web-Based Educational Seminars Compare Favorably with In-House Seminars for Bariatric Surgery Patients.

Comprehensive preparative patient education is a key element in bariatric patient success. The primary objective of this study was to compare attrition rates, demographics, and surgery outcomes between patients who participated in the online vs in-house preparative seminars. A retrospective chart review was performed involving patients who chose to participate in online vs in-house educational seminar between July of 2014 and December of 2016. The patients were divided into two groups based on their choice of educational seminar and tracked to see how many made it to an initial visit and to surgery. In those who had bariatric surgery, data was collected on age, type of insurance, length of stay (LOS), longest follow-up, and change in body mass index. Total of 1230 patients were included in this study. There was no difference in attrition rate to initial consultation visit (29.1% vs 29.9%), but there was a statistically higher attrition to surgery in the in-house seminar attendees (72.9%) compared to online participants (66.6%, p < 0.05). Between January 2015 and December 2016, 291 patients underwent primary bariatric surgery. The online group was on average 3years younger which was statistically significant. There were no differences in LOS, longest follow-up, and weight loss at 12months between the groups. When comparing attrition rates and bariatric surgery outcomes, no overall difference was noted between patients who received web- or hospital-based preparative education. Bariatric programs should provide access to online seminars to attract younger population and save resources and cost.

Does a Criminal Past Predict Worker Performance? Evidence from One of America’s Largest Employers

This paper is one of the first systematic assessments of ex-felons' workplace performance. Using FOIA-requested data from the Department of Defense, we follow 1.3 million ex-offender and non-offender enlistees in the US military from 2002 to 2009. Those with a felony background show no difference in attrition rates due to poor performance compared to those without criminal records. Moreover, exfelons are promoted more quickly and to higher ranks than other enlistees. At the same time, we find that ex-felons are slightly more likely to commit a legal offense in the military system (5 percent of non-felons compared to 6.6 percent of ex-felons). We also find a higher rate of work-related deaths among the ex-felon sample; closer evaluation of limited data suggests this may be driven by ex-felons being assigned more often to combat positions. Overall, our study shows that the military's criminal history screening process can result in successful employment outcomes for exfelons, at least in terms of job mobility and reliability, to the mutual benefit of employer and employee. An important question arising from this analysis is whether the military's whole person review can apply successfully to the civilian sector.

Intervention for Feeding Difficulties in Children With a Complex Medical History: A Randomized Clinical Trial.

This study aimed to compare outcomes of different multidisciplinary feeding therapy approaches in children with feeding difficulties. Children aged 2 to 6 years with feeding difficulties and a medically complex history (MC) were recruited. Children with feeding difficulties and a nonmedically complex history (NMC) were included as a comparison group. Participants attended a clinical assessment, and eligible participants were randomized to receive targeted feeding intervention incorporating either operant conditioning or systematic desensitization. Parents could elect to receive intervention in an intensive (10 sessions in a week) or weekly (10 sessions during 10 weeks) format. Both groups received immersive parent training. A review was completed 3 months post-intervention. In total, 98 participants were eligible to participate (MC, n = 43; NMC, n = 55). Data from 20 children from the MC group (47%) and 41 children from the NMC group (75%) were included in the final analysis. Clinically significant improvements were observed following both arms of therapy, consistent with previous research. Parents of children in the MC arm were significantly more likely to elect for intensive intervention than weekly (MC = 12/20, 60%; 12/41, 29%; P = 0.02). Both therapy protocols were considered clinically effective. The difference in attrition rates between the etiological groups suggests primary differences in how service delivery should be managed. Progress for the medically complex child may be slower while medical issues are stabilized, or while the focus for parents shifts to other developmental areas. In planning services for a medically complex group, therefore, it is essential that consideration be given to medical and family needs.

PP.03.21] TELOMERE LENGTH AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE

Objective: Short telomere length (TL) in leukocytes is associated with atherosclerotic cardiovascular disease (ACVD). It is unknown whether this relationship is due to a shorter leukocyte TL (LTL) at birth or, alternatively, to a faster LTL attrition thereafter, before or during ACVD manifestation. To assess the temporal relation of LTL with ACVD, we draw on the following findings: wide LTL variation exists across individuals, but at birth TLs are similar across the individual's somatic tissues. After birth, TL attrition varies in proportion to the replicative activities of tissues. Consequently, skeletal muscle (M), a minimally proliferative tissue, displays a longer TL than LTL, which represents the highly proliferative hematopoietic system. Accordingly, the difference between LTL and MTL and the ratio of (LTL-MTL)/MTL provides additional information on LTL attrition since early life. Design and method: We studied 271 individuals (82 women/189 men) aged 63 ± 14 years (mean ± SD), undergoing surgery. Their TL in leukocytes and in muscle biopsies (obtained during surgery) was measured by Southern blots. We tested the following variables for association with ACVD: LTL, MTL adjusted for muscle biopsy site (MTLA), LTL-MTLA and (LTL-MTLA)/ MTLA. Results: In all subjects, MTLA was longer than LTL and LTL-MTLA difference became wider with age similarly in ACVD patients (15.9 ± 0.5 bp/year; mean ± SE) and controls (14.4 ± 0.3 bp/year). Age- and sex-adjusted LTL (P = 0.005), but not MTLA (P = 0.68), was shorter in patients with ACVD than controls. LTL-MTLA (−272 ± 73 bp) and (LTL-MTLA)/MTLA (−3.2 ± 0.8%) were wider in ACVD than in controls (P = 0.0003 and 0.0001, respectively). Both composite variables that combined LTL and MTL yielded better fitting models than either LTL or MTLA by themselves, and (LTL-MTLA)/MTLA explained ACVD slightly better than LTL-MTLA. Conclusions: This first study applying the “blood-and-muscle” TL model in patients with ACVD shows more pronounced TL attrition in ACVD patients than controls. The difference in attrition rates was not modified by age during adulthood indicating that accelerated attrition in early life is likely to be a major explanation of the shorter LTL in ACVD patients.

Women in surgery: A longer term follow-up

BackgroundThere are an increasing number of women in surgery. Previously, many questions focused upon their ability to complete surgical training and contribute fully to the surgical workforce. More meaningful information lies in identifying the long-term follow-up of where, and in what specialty, women residents eventually practice. MethodsAll residents entering general surgery training at the University of Louisville between 1996 and 2009 were studied. Comparison between men and women was performed for program completion, length of residency training, and eventual specialty practice. ResultsOne hundred and eight residents entered general surgery residency. Twenty-three (21%) did not complete training. There was no difference in attrition rates between men or women (22% vs. 19%, p = 0.77). Women completing residency were just as likely to practice general surgery (either private or academic practice) as their male counterparts (67% vs. 67% p = 0.96). ConclusionsWomen are a valuable resource in surgery and are able to complete a vigorous residency. Long-term follow-up is crucial and permits us to evaluate this important group of trainees practicing surgery today.

Risking it all for love? Resetting beliefs about HIV risk among low-income South African teens

Research suggests that the much higher HIV prevalence among young women in sub-Saharan Africa than among males of their age cohort is linked to the high prevalence of age-disparate sexual partnerships, and that incorrect beliefs about the relationship between age and HIV-risk are partly responsible. We report the results of an experiment that tests whether a simple, computer-based “HIV risk game” leads to better understanding of the relationship between HIV-risk and age among low-income South African adolescents than a version of the traditional “brochure approach” to dispensing information does. Our results are striking. The randomly assigned treatment group, which receives repeated doses of information about the link between age and HIV-risk as feedback to their own responses to simple questions about relative HIV-risk, is significantly more likely to correctly identify which of a pair of hypothetical men or women of different ages is more likely to have HIV than the control group. Subjects in the treatment group answer, on average, 1.65 times as many questions about HIV risk and age correctly as those in the control group. We also find that subjects’ (particularly female subjects’) beliefs about HIV risk among women are less accurate than their beliefs about HIV risk among men. Finally, a follow-up survey with no significant difference in attrition rates between those in the treatment and control groups, shows substantially higher information retention among treatment subjects than among control subjects.

Nabilone as an adjunctive to gabapentin for multiple sclerosis-induced neuropathic pain: a randomized controlled trial.

Neuropathic pain (NPP) is a chronic syndrome suffered by patients with multiple sclerosis (MS), for which there is no cure. Underlying cellular mechanisms involved in its pathogenesis are multifaceted, presenting significant challenges in its management. A randomized, double-blind, placebo-controlled study involving 15 relapsing-remitting MS patients with MS-induced NPP was conducted to evaluate nabilone combined with gabapentin (GBP). Eligible patients stabilized on GBP (≥1,800 mg/day) with inadequate pain relief were recruited. Nabilone or placebo was titrated over 4 weeks (0.5 mg/week increase) followed by 5-week maintenance of 1 mg oral nabilone (placebo) twice daily. Primary outcomes included two daily patient-reported measures using a 100-mm visual analog scale (VAS), pain intensity (VASpain), and impact of pain on daily activities (VASimpact). Hierarchical regression modeling was conducted on each outcome to determine if within-person pain trajectory differed across study groups, during 63-day follow-up. After adjustment for key patient-level covariates (e.g., age, sex, Expanded Disability Status Scale, duration of MS, baseline pain), a significant group × time(2) interaction term was reported for both the VASpain (P < 0.01) and VASimpact score (P < 0.01), demonstrating the adjusted rate of decrease for both outcomes was statistically greater in nabilone vs placebo study group. No significant difference in attrition rates was noted between treatments. Nabilone was well tolerated, with dizziness/drowsiness most frequently reported. Nabilone as an adjunctive to GBP is an effective, well-tolerated combination for MS-induced NPP. The results of this study identify a novel therapeutic combination for use in this population of patients predisposed to tolerability issues that may otherwise prevent effective pain management.

Blood cell telomere lengths and shortening rates of chimpanzee and human females

Slower rates of aging distinguish humans from our nearest living cousins. Chimpanzees rarely survive their forties while large fractions of women are postmenopausal even in high-mortality hunter-gatherer populations. Cellular and molecular mechanisms for these somatic aging differences remain to be identified, though telomeres might play a role. To find out, we compared telomere lengths across age-matched samples of female chimpanzees and women. We used a monochrome multiplex quantitative polymerase chain reaction to assay canonical telomere repeats in blood cells from captive female chimpanzees (65 individuals; age: 6.2-56.7 years) and compared them to the same measure in human females (43 individuals; age: 7.4-57.3 years). Our samples showed little difference in attrition rates between the species (~0.022 T/S per year for chimpanzees and ~0.012 T/S per year for humans with overlapping 95% confidence intervals), but telomeres were twice as long in chimpanzees as in humans (T/S ratios = 2.70 and 1.26, respectively). Based on the longevity differences, we initially hypothesized that telomere shortening rates would be faster in chimpanzees than in humans. Instead, it is shorter telomere length that appears to be the derived state in humans. This comparison indicates that better characterization of physiological aging in our closest living relatives will be indispensable for understanding the evolution of distinctive human longevity.

Estimating Parents’ Valuations of Class Size Reductions Using Attrition in the Tennessee STAR Experiment

Abstract This study estimates parents’ valuations of small classes by examining the effects of randomly assigned class type on the decision to remove one’s child from the Tennessee Student Teacher Achievement Ratio experiment, using a new hedonic estimation strategy that estimates the cash payment that would be required to generate the same difference in attrition rates as was observed between treatment and control groups. In 2010 dollars, our preferred estimates indicate that parents on the margin of sending their children to private schools valued small classes at $2,000–$18,000 per year relative to a cost of $3,000 per student year.

Patient freedom to choose a weight loss diet in the treatment of overweight and obesity: a randomized dietary intervention in type 2 diabetes and pre-diabetes.

BackgroundOffering the overweight or obese patient the option of choosing from a selection of weight loss diets has not been investigated in type 2 diabetes. The aim of the study was to investigate if the option to choose from, and interchange between a selection of diets (“Choice”), as opposed to being prescribed one set diet (“No Choice”), improves drop out rates and leads to improved weight loss and cardio-metabolic outcomes.MethodsThe study was a 12 month, randomized parallel intervention. A total of 144 volunteers with type 2 diabetes or pre-diabetes and a BMI >27 were randomized to “No Choice” or “Choice”. Those in the No Choice group were placed on a set weight loss diet (CSIRO) with no change permitted. Those in the Choice group could choose from, and interchange between, the CSIRO, South Beach or Mediterranean diets.ResultsThere were no differences in attrition rates or weight loss between the “Choice” and “No Choice”. In a secondary analysis of the intention-to-treat weight loss data with last measured weight carried forward gave a highly significant diet group by time by gender interaction (p = 0.002) with men doing better in the No Choice group overall (maximum difference “No Choice “-2.9 ± 4.6 kg vs. “Choice”-6.2 kg ± 5.3 kg at 6 months) and women doing better in the Choice group overall (maximum difference Choice -3.1 ± 3.7 kg vs. “No Choice” -2.0 kg ± 2.6 kg at 6 months).ConclusionsMen prefer direction in their weight loss advice and do less well with choice. A gender-specific approach is recommended when prescribing weight loss diets.Trial registrationanzctr.org.au ACTRN12612000310864.

Resistance exercise training for fibromyalgia

Resistance exercise training for fibromyalgia

Recruiting and Retaining Indigenous Farmworker Participants

There is limited information on the specific practices used to successfully recruit and retain indigenous and Latino farmworkers in research studies. This article describes the strategies used in a community-based participatory research project with indigenous agricultural workers. Participants were recruited through consulting with indigenous relatives and friends, identifying and meeting with indigenous leaders from hometown associations in countries of origin, and asking current participants to recruit fellow farmworkers. Adjustments were initiated to the second year protocol to enhance recruitment and retention. The difference in attrition rates between years one and two was statistically significant, a difference partially attributed to modifications to recruitment and retention protocol. Findings confirmed that active recruitment techniques and word-of-mouth recruitment were more effective than passive methods. Trust among academic, organization, and community partners, and shared language and culture between those doing the recruitment and the participants, contributed to sustained farmworker participation.