Exam Year Research Articles

Exposure to Fine Particulate Matter and Incidence of Coronary Events: The Mediation Effect by Atherosclerotic Progression

Background/Aim: Epidemiological evidence on the mechanisms for association between long-term exposure to fine particulate matters (PM2.5) and coronary events is limited. We investigated the role of atherosclerotic progression, as potential mediator, in the association between PM2.5 and incidence of coronary events. Methods: In a study of 294 Chinese patients with stable angina, we repeatedly measured coronary plaque phenotypes on computed tomography angiography, including coronary artery calcium (CAC), total, calcified and non-calcified plaque volumes between 2009 and 2014 and followed their incident events until 2016. Annual average PM2.5 concentrations were estimated by a satellite-based exposure model and were aggregated to the year of the follow-up exam and the incident events at the participants’ home. We conducted Cox analysis to estimate effect of PM2.5 exposure on incident events and used mixed effect model to assess relationships between PM2.5 and progression of atherosclerosis. Mediation analysis was applied to evaluate mediated effects by the atherosclerotic markers. Results: Patients were on average 53 year’s old with 15% experienced incident events. CAC increased by 20.3±3.5 Agataton units per year, and total plaque volumes by 28.0±8.9 mm3 per year. For each 20 PM2.5 μg/m3 increase, CAC progressed by 7.7 Agataton units per year (95%CI: 2.3-13.2) and total plaque volumes increased by 20.3 mm3 per year (1.7-39.0), adjusting for risk factors. Using mediation analysis, we observed a positive direct effect of PM2.5 on incidence of coronary events (HR=1.20, 95%CI: 1.08-1.32) and an indirect effect mediated by increased total plaque volumes (HR=1.06, 95%CI: 1.01-1.13) accounting for 25.5% of the total effect. The proportion mediated through CAC progression accounting for 18.8%. No associations were observed between PM2.5 and other plaque phenotypes. Conclusion: This study provided insight of evidence on the role of atherosclerotic progression in association between ambient PM2.5 and coronary events in a susceptible population.

Low- and moderate- levels of arsenic exposure in young adulthood and incidence of chronic kidney disease: Findings from the CARDIA Trace Element Study

BackgroundIt is unclear whether arsenic exerts adverse health effects on the kidney at low- and moderate- levels of exposure. We prospectively examined toenail arsenic concentrations measured during young adulthood in relation to incidence of chronic kidney disease (CKD) in midlife. MethodsA total of 3768 participants (53 % female and 48 % blacks) in the Coronary Artery Risk Development in Young Adults (CARDIA) study were included. Arsenic concentration in toenail clippings was assessed by using inductively coupled plasma mass spectrometry at CARDIA exam year 2. Incident CKD was identified if having estimated glomerular filtration rate <60 mL/min per 1.73 m² or albuminuria >30 mg/g. The association between toenail arsenic levels and CKD incidence over a mean of 24 years of follow-up was examined using multivariable-adjusted Cox proportional hazards models. ResultsAfter controlling for potential confounders, including demographics, socioeconomics, lifestyle factors, clinical measurements of blood pressure, lipids, and glucose, and medical history, arsenic exposure measured in toenails was not associated with CKD incidence (quintile 5 versus quintile 1: hazard ratio = 1.04, 95 % confidence interval = 0.78–1.40, P for trend = 0.38). ConclusionThis longitudinal study does not support the hypothesis that low- and moderate- levels of arsenic exposure are associated with elevated incidence of CKD in the US general population. Further studies are need to investigate species of arsenic biomarkers in relation to nephrotoxicity.

Magnesium Intake Is Inversely Associated with the Risk of Non-Alcoholic Fatty Liver Disease Among American Young adults

Abstract Objectives To examine magnesium (Mg) intake from diet and supplements during young adulthood in relation to risk of non-alcoholic fatty liver disease (NAFLD) in midlife. Methods A total of 2712 black and white American adults aged 18 to 30 years were recruited in the Coronary Artery Risk Development in Young Adult (CARDIA) study in 1985–1986 (baseline) with 8 additional examinations during 25 years thereafter. Mg intake was assessed at baseline and exam years 7 and 20 using the CARDIA diet history questionnaires. Computed tomography (CT) scanning was performed at exam year 25 (2010–2011) to ascertain NAFLD cases, which was defined as liver attenuation (LA) ≤51 Hounsfield units after exclusion for other causes of liver fat. Logistic regression was used to examine the association between cumulative average Mg intake and the risk of NAFLD. Results At exam year 25, 638 NAFLD cases were documented. An inverse association between total Mg intake (from diet and supplements) and NAFLD risk was observed after adjustment sociodemographics, major lifestyle factors, dietary quality, and clinical measurements (body mass index, blood pressure, lipid profiles, and fasting insulin). Compared with participants in the lowest quintile of Mg intake, those in the highest quintile had a 54% lower risk of NAFLD [multivariable-adjusted odds ratio = 0.46, 95% confidence interval = (0.25, 0.87), P for trend = 0.0498]. Consistently, there was an inverse association between whole grain consumption (a major food source of magnesium) and NAFLD risk. Conclusions This study suggests that higher intake of Mg throughout adulthood is associated with a lower risk of NAFLD in middle age. Funding Sources The Coronary Artery Risk Development in Young Adults Study is supported by grants from the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham, Northwestern University, University of Minnesota, and Kaiser Foundation Research Institute.This study is also partially supported by the NIH grants and NHLBI.

A Plant-Centered Diet and Onset of Chronic Kidney Disease in 20 Years of Follow-Up: Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Cohort

Abstract Objectives Chronic kidney disease (CKD) is an increasing health problem in young adults and may be associated with dietary patterns. We examined the association of a plant-centered diet with incident moderate-to-very high risk CKD in young adults who were initially free of CKD. Methods We followed 3026 community-based participants (Black and White men and women) from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort (1985–86 to 2015–16). Diet was assessed by an interviewer-administered diet history at exam years (Y) 0, 7, and 20. Higher plant-centered diet quality was judged by higher cumulative average value of the A Priori Diet Quality Score (APDQS, range 0–132), a hypothesis-driven index based on 46 food groups. A higher APDQS is characterized by high consumption of nutritionally rich plant foods and limited meat, added sugars, and other less nutritious foods. Kidney status, assessed at 5-year intervals from Y10 to Y30, was based on estimated glomerular filtration rate (eGFR) using CKD-EPI creatinine equation and spot urine albumin-to-creatinine ratio (ACR). CKD diagnosis included new onset of micro- or macro-albuminuria (ACR ≥30 mg/g), eGFR &amp;lt;60 mL/min/1.73m,2, or (hospitalized or fatal) end stage renal disease. Prevalent CKD cases throughout Y10 were excluded. Proportional hazards regression estimated the association of time-varying cumulative average APDQS with incident CKD, adjusted for age, sex, race, education, energy intake, % energy from protein, physical activity, and smoking. Results Mean Y10 age was 35.1 y (±3.6 y) and mean cumulative average APDQS was 65.0 (±11.4). We identified 358 incident CKD cases (59 of whom were severe cases) during mean follow-up of 17.7 years (±4.4) after Y10. Eating a plant-centered, high quality diet was associated with a lower risk of incident CKD. In multivariable analysis, participants in the highest quintile of the APDQS had 37% (95% confidence interval: 0.41–0.97) lower risk of CKD as compared with those in the lowest quintile of the APDQS. For each 11-point increment in APDQS, there was 15% lower risk of CKD (0.74–0.97). The association remained similar after further adjustment for prevalent cases of hypertension and diabetes. Conclusions A plant-centered, high quality diet was associated with a lower risk of developing CKD. Funding Sources CARDIA and MnDRIVE (University of Minnesota).

Magnesium intake is inversely associated with risk of obesity in a 30-year prospective follow-up study among American young adults.

Although laboratory studies suggest a potential role of magnesium (Mg) in weight regulation, human studies relating Mg intake to body weight are limited. This study sought to prospectively examine the association between Mg intake and incidence of obesity and related anthropometric and biochemical indicators. The Coronary Artery Risk Development in Young Adults (CARDIA) study recruited 5115 American young adults, aged 18-30years, at baseline in 1985-6, and re-examined them in eight follow-ups. Incident obesity was defined as body mass index (BMI) ≥ 30kg/m2. Dietary Mg intake was collected using the CARDIA Diet History at baseline and exam years 7 and 20. During the 30-year follow-up, 1675 incident cases of obesity were identified. After adjustment for potential confounders, Mg intake was inversely associated with incidence of obesity. The multivariable-adjusted hazard ratios (95% confidence interval) from quintile 1 (Q1) (lowest intake group) to quintile 5 (Q5) (highest intake group) were 1 (referent), 0.86 (0.74, 1.00), 0.83 (0.71, 0.97), 0.55 (0.46, 0.66), and 0.49 (0.40, 0.60); P for trend < 0.01. Consistently, Mg intake was inversely associated with the levels of BMI, triceps skinfold, suprailiac skinfold, subscapular skinfold, fasting insulin, and C-reactive protein. The observed associations were not materially modified by age, sex, race, or BMI at baseline. In addition, the intakes of foods rich in Mg, including whole grains, nuts and seeds, legumes, and dark-green vegetables, were associated with lower incidence of obesity. This longitudinal study suggests that Mg intake is inversely associated with incidence of obesity.

Total Ankle Arthroplasty and Ankle Arthrodesis Utilization: An American Board of Orthopaedic Surgery (ABOS) Part II Database Study

Category:Ankle, Ankle ArthritisIntroduction/Purpose:Total ankle arthroplasty (TAA) utilization has increased over the last 20 years, while ankle arthrodesis (AAD) utilization has remained constant. However, annual hospital procedure volume for TAA and AAD remains low, with 50% of hospitals performing a median of =5 cases per year. Practicing in a low-volume setting may have implications for technical performance and patient outcomes, especially amongst early-career surgeons. The purpose of this study was to examine trends in utilization of TAA and AAD in ABOS part-II candidates while considering the influence of fellowship training status on treatment of end-stage ankle arthritis.Methods:The American Board of Orthopedic Surgery (ABOS) Part II database was queried to identify all candidates who performed =1 TAA or AAD from exam years 2009-2018. Candidates were categorized by exam year and by self-reported fellowship training status. Descriptive statistical methods were used to report procedure volumes. Trends in utilization of TAA and AAD were examined using log-modified regression analyses.Results:From 2009-2018, there was no significant change in the utilization of TAA or AAD amongst all candidates (p=0.92, p=0.20) (Table 1). Candidates reporting a foot and ankle (FA) fellowship trended towards increased utilization of TAA relative to AAD versus non-FA fellowship candidates, but this failed to reach statistical significance (p=0.06). The utilization of arthroscopic AAD increased over time (p<0.01) amongst all candidates. There was no difference in the rates of utilization of open versus arthroscopic AAD amongst FA trained candidates. High-volume (=5 TAA) candidates represented 10.5% of all candidates performing TAA, and accounted for 34.2% of all TAAs performed over the study period.Conclusion:Utilization of TAA and AAD did not change over the study period, and the number of these procedures performed by early-career surgeons remains low. The majority of both procedures are performed by FA trained surgeons with relatively low practice volumes. There was a trend toward increased TAA utilization relative to AAD utilization in FA trained surgeons, but this did not reach statistical significance. The findings in this study may have implications for technical performance impacting patient outcomes and may guide potential changes in training curricula.

The Association of Cardiorespiratory Fitness and Ideal Cardiovascular Health in the Aerobics Center Longitudinal Study.

This study examined the cross-sectional and longitudinal associations of cardiorespiratory fitness (CRF) and ideal cardiovascular health (CVH). CRF and the 7 CVH components were measured in 11,590 (8865 males; 2725 females) adults at baseline and in 2532 (2160 males; 372 females) adults with at least one follow-up examination from the Aerobics Center Longitudinal Study. Ideal CVH score was calculated as a composite of 7 measures, each scored 0 to 2. CVH groups were based on participant point score: ≤7 (poor), 8 to 11 (intermediate), and 12 to 14 (ideal). Analyses included general linear, logistic regression, and linear mixed models. At baseline, participants in the high CRF category had 21% and 45% higher mean CVH scores than those in the moderate and poor CRF categories (P < .001). The adjusted odds (95% confidence interval) of being in the poor CVH group at baseline were 4.9 (4.4-5.4) and 16.9 (14.3-19.9) times greater for individuals with moderate and low CRF, respectively, compared with those with high CRF (P < .001). Longitudinal analysis found that for every 1-minute increase in treadmill time, CVH score increased by 0.23 units (P < .001) independent of age, sex, exam number, and exam year. Higher CRF is associated with better CVH profiles, and improving CRF over time is independently associated with greater improvements in CVH.

ANALYSING SOCIAL NEEDS AND SATISFACTORY LEVEL ON LIBRARY AND INFORMATION MANAGEMENT RECRUITMENT AT A MEKONG DELTA UNIVERSITY

This study presents social needs and satisfactory level on Library and Information Management recruitment and enrollment at Can Tho University, Vietnam from 2005 to 2018. The study used a quantitative approach and drew on secondary data provided by the Department of Academic Affairs through 14 years of university entrance exams and admission. Findings reveal that Can Tho University met 40% of the societal demands in the entrance examination period (2005-1014) and only 30.2% at the admission phase (2015-2018). In the years 2006-2008, provinces such as Ca Mau, Hau Giang, and Vinh Long had a higher rate of successful candidates than that in other provinces in the Mekong Delta region and the number of female candidates was always at a much higher level than male candidates. Findings are necessary for the enrollment of Library and Information Management at Can Tho University and for other universities in terms of input evaluation. Implications are also presented with regard to making changes in admission quota.

Body Mass Index and Risk of Intestinal Metaplasia: A Cohort Study.

We examined the association between body mass index (BMI) and development of endoscopic intestinal metaplasia. This retrospective cohort study included 142,832 Korean adults free of endoscopic intestinal metaplasia and atrophic gastritis who underwent upper endoscopy at baseline and subsequent visits and were followed for up to 5 years. A parametric proportional hazards model was used to estimate the adjusted HR with 95% confidence interval (CI) for incident intestinal metaplasia. In more than 444,719.1 person-years of follow-up, 2,281 participants developed endoscopic intestinal metaplasia (incidence rate, 5.1 per 1,000 person-years). Increased BMI categories were associated with increased risk of new-onset intestinal metaplasia in a dose-response manner. After adjustment for age, sex, center, year of screening exam, smoking status, alcohol intake, exercise, total calorie intake, history of diabetes and hypertension, and history of Helicobacter pylori infection, the multivariable adjusted HRs (95% CIs) for incident intestinal metaplasia comparing BMIs of <18.5, 23-24.9, 25.0-29.9, and >30 kg/m2 with a BMI of 18.5-22.9 kg/m2 were 0.84 (0.64-1.09), 1.03 (0.93-1.16), 1.07 (0.96-1.20), and 1.48 (1.20-1.83), respectively. These associations did not differ by clinically relevant subgroups. Risk of endoscopic atrophic gastritis also increased as the baseline BMI category increased. In a large cohort of Korean men and women, obesity was independently associated with increased incidence of endoscopic atrophic gastritis and intestinal metaplasia. Excessive adiposity appears to play a role in development of stomach precursor lesions of stomach cancer, requiring further studies to determine whether strategies to reduce obesity will also help reduce precancerous lesions and, in turn, gastric cancer.

Self-rated health and the risk of incident type 2 diabetes mellitus: A cohort study

We aimed to evaluate the association between self-rated health (SRH) and the risk of incident type 2 diabetes mellitus (T2D). This cohort study consisted of 250,805 Korean men and women without T2D at baseline. SRH was assessed at baseline with a self-administered structured questionnaire. Incident T2D was defined as fasting serum glucose ≥126 mg/dL, HbA1C ≥6.5%, or use of medication for T2D during follow-up. After adjustment for possible confounders including age, center, year of screening exam, smoking status, alcohol intake, physical activity, education level, total calorie intake, body mass index, sleep duration, depressive symptoms, family history of diabetes, history of hypertension, and history of cardiovascular disease, the multivariable-adjusted hazard ratios (95% confidence intervals) for incident T2D comparing good, fair, and poor or very poor SRH to very good SRH were 1.20 (0.98–1.48), 1.63 (1.33–1.98), and 1.83 (1.47–2.27), respectively. These associations were consistently observed in clinically relevant subgroups. Fair or poorer SRH was independently and positively associated with the development of T2D in a large-scale cohort study of apparently healthy Korean adults, indicating that SRH is a predictor of metabolic health. Physicians involved in diabetes screening and management should routinely consider SRH when evaluating T2D risk as well as overall health.

Effects of seafood consumption and toenail mercury and selenium levels on cognitive function among American adults: 25 y of follow up.

The aim of this study was to examine the longitudinal association between seafood and intake of long-chain ω-3 polyunsaturated fatty acids (LCω-3 PUFA) and cognitive function and to explore the possible effect modifications owing to mercury (Hg) and selenium (Se) levels. Participants (N = 3231) from the CARDIA (Coronary Artery Risk Development in Young Adults) study underwent baseline examination and were reexamined in eight follow-up visits. Diet was assessed at baseline and in exam years 7 and 20. Toenail Hg and Se were measured at exam year 2. Cognitive function was measured at exam year 25 using three tests: Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and the Stroop test. The general linear regression model was used to examine cumulative average intakes of LCω-3 PUFA and seafood in relation to the cognitive test scores; and to explore the possible effect modifications caused by Hg and Se. LCω-3 PUFA intake was significantly associated with better performance in the DSST test (quintile 5 versus quintile 1; mean difference = 1.74; 95% confidence interval, 0.19-3.29; Ptrend, 0.048]), but not in the RAVLT and Stroop tests. Similar results were observed for intakes of eicosapentaenoic acid, docosahexaenoic acid, and non-fried seafood. The observed associations were more pronounced in participants with body mass index ≥25 kg/m2, but not significantly modified by toenail Hg or Se. This longitudinal study supported the hypothesis that LCω-3 PUFA or non-fried seafood intake is associated with better cognitive performance in psychomotor speed among US adults, especially those who are overweight or obese.

Cystic fibrosis is associated with an increased risk of Barrett's esophagus

BackgroundCystic fibrosis (CF) patients have increased risks of gastrointestinal cancers, including esophageal adenocarcinoma. Gastroesophageal reflux disease (GERD) is highly prevalent in CF and manifests at early ages. CF patients may be at increased risk for long-term sequelae of chronic GERD, including Barrett's esophagus (BE). We aimed to assess whether patients with CF have an increased risk of BE or related neoplasia. MethodsA matched cohort study was performed of adults with and without CF who had undergone upper endoscopy. Non-CF patients were matched in a 4:1 ratio by age, sex, year of exam, and endoscopist. Odds ratios were calculated for the association between CF and BE or related neoplasia, and multivariable logistic regression modeling was performed to adjust for matching variables and additional potential confounders. Results122 CF patients underwent endoscopy, and 488 matched controls were identified. Seven (5.7%) CF patients had BE or related neoplasia, including one GE junction adenocarcinoma. Mean age of affected CF patients was 36.0, and 85.7% had a prior solid organ transplant. The odds of BE was significantly increased in CF patients (OR 2.91, 95% CI 1.08–7.81). The risk remained significantly increased in a multivariable model including matching variables (OR 3.32, 95% CI 1.19–9.22) and in a parsimonious model (OR 2.99, 95% CI 1.06–8.42). ConclusionsAdults with CF have a 3-fold increased risk of BE or related neoplasia and appears to develop at younger ages. Consideration should be given to screening for BE in select CF patients, especially those who have undergone solid organ transplantation.

Chronic hepatitis B virus infection and risk of dyslipidaemia: A cohort study

Hepatitis B virus (HBV) infection has been associated with a decreased prevalence of dyslipidaemia in cross-sectional studies, but cohort studies are limited. We investigated the longitudinal effects of chronic HBV infection on the development of dyslipidaemia. We performed a cohort study of 62287 non-cirrhotic adult men and women free of dyslipidaemia who underwent serologic testing for hepatitis B surface antigen (HBsAg) and were followed annually or biennially for an average of 4.46years. A parametric proportional hazard model was used to estimate the adjusted hazard ratio with 95% confidence interval (CI) for incident dyslipidaemia according to HBsAg seropositivity status. We identified 12331 incident cases of hypercholesterolaemia during 278004.4 person-years of follow-up (incident rate 44.4 per 1000 person-years). In models adjusted for age, sex, body mass index, year of screening exam, smoking status, alcohol intake, regular exercise and education level, the adjusted hazard ratios (95% CIs) for incident hypercholesterolaemia, high LDL cholesterolaemia; hypertriglyceridaemia, high non-HDL cholesterolaemia and low HDL cholesterolaemia comparing HBsAg-positive to HBsAg-negative participants was 0.71 (0.64-0.79), 0.83 (0.78-0.89), 0.61 (0.54-0.70), 0.69 (0.63-0.75) and 1.10 (0.98-1.24), respectively. An inverse association between HBsAg positivity and incident high apolipoprotein B were also identified, with a corresponding a hazard ratio of 0.63 (0.55-0.72). In a large cohort of apparently healthy Korean adults, HBsAg seropositivity was associated with lower risk of development of dyslipidaemia, suggesting a role of HBV infection in lipid metabolism.

KARAKTERISTIK BUTIR SOAL TRY OUT UJIAN NASIONAL SMA MATA PELAJARAN MATEMATIKA Se-KOTA MATARAM DENGAN MENGGUNAKAN PROGRAM ITEMAN

The purpose of this research was to know how characteristic items of Try Out National Exam Year 2010/2011 at Senior High School on Mathematics Subject in Mataram City that analyzed by using Iteman Program. The characteristic in question was whether the item can be used or not based on the difficulty level of the item, the difference in power, and the functioning of the answer option. The research method used was descriptive. Techniques of collecting data in the form of documents. Source of data in the form of answer sheet of computer package 61 of Try Out National Exam Year 2010/2011 at Senior High School on Mathematics Subject in Mataram City. Aspects analyzed by using this Iteman Program include the level of difficulty item, different power, and the function of whether or not the answer choice. Based on the results of Item of Analysis Try Out National Examination of School Year 2010/2011 Senior High School on Mathematics Subjects in Mataram City by using Iteman Program, it can be concluded that for the level of difficulty Package 61 was classified. Different power for package 61 has a good category. For the reliability of having a high category and a matter of Try Out Package 61 there are 23 problems received with the improvement of 4, 5, 8, 9, 14, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30, 31, 32, 34, 35, 36, and 40. Improvements need to be made on the less functioning effluent. There are 15 accepted questions: 1, 2, 3, 7, 10, 11, 12, 13, 15, 27, 29, 33, 37, 38, and 39. And there are 2 rejected questions 6 and 25.

Abstract 033: Associations of Smoke-Free Policies With Blood Pressure Changes in the Coronary Artery Risk Development in Young Adults Study

Introduction: Laws banning smoking in indoor public places have been associated with reductions in second-hand smoke exposure and cardiovascular disease among non-smokers. Second-hand smoke exposure has been associated with hypertension in prior studies. However, it is unknown whether smoke-free policies are associated with changes in blood pressure. Hypothesis: We tested the hypothesis that living in an area with a smoke-free policy banning smoking in restaurants, bars, and/or other workplaces is associated with reductions in systolic and diastolic blood pressure among non-smokers. Methods: Longitudinal data from 2,896 non-smoking participants of the Coronary Artery Risk Development in Young Adults (CARDIA) Study (aged 18-30 at enrollment, 1985-2011, 14,193 person-exam-years) were linked to state, county, and local 100% smoke-free policies in bars, restaurants, and/or non-hospitality workplaces based on participants’ census tract of residence at each exam. Fixed-effects linear regression estimated associations of each type of smoke-free policy (restaurant, bar, workplace) with within-person changes in systolic and diastolic blood pressure (SBP and DBP). Models adjusted for time-varying covariates: exam year (categorical), socio-demographic (education, income, marital status), health-related (body mass index, total physical activity, alcohol use), and policy (state cigarette tax, self-reported ban on smoking in their workplace) covariates, and interactions of baseline covariates (age, sex, race, field center) with exam year to account for differences in blood pressure patterns that were associated with these characteristics (p&lt;0.05 for all interactions). Blood pressure values were adjusted to reflect antihypertensive medication use (+10 mmHg for SBP, +5 mmHg for DBP for those on medication). Results: At baseline, mean SBP was 110.5 mmHg and mean DBP was 69.3 mmHg. By year 25, a majority of participants were exposed to smoke-free policies in restaurants (1,759 of 2,264, 78%), bars (1,536 of 2,264, 68%), and other workplaces (1,518 of 2,264, 67%). Smoke-free policies were associated with within-person reductions in SBP and DBP in fully adjusted models (expressed as average change between exams in mmHg). Mean reductions in SBP were -0.77 (95% CI: -1.51, -0.02) for restaurant policies, -0.73 (95% CI: -1.54, 0.08) for bar policies, and -0.79 (95% CI: -1.51, -0.08) for workplace policies. Mean reductions in DBP were -0.67 (95% CI: -1.27, -0.06) for restaurant policies, -0.54 (95% CI: -1.20, 0.11) for bar policies, and -0.86 (95% CI: -1.44, -0.28) for workplace policies. Conclusions: Smoke-free policies in restaurants and other workplace are associated with within-person reductions in systolic and diastolic blood pressure among non-smokers. These results suggest an additional health benefit of these policies beyond those previously described in the literature.

Abstract P042: Association of Epigenetic Age Acceleration and Adverse Cardiac Mechanics: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Prevalence of diastolic dysfunction increases significantly with aging and becomes more prevalent in middle-age to older adulthood. DNA methylation markers of aging have been identified and integrated into an epigenetic age (EA) score, which has been demonstrated to be associated with cardiovascular morbidity and mortality. Epigenetic age acceleration (EAA) is the residual value of EA methylation markers regressed on chronologic age (CA), and is thus independent of CA. Therefore, we sought to examine the association of a previously identified DNA methylation molecular signature in blood (EAA) with cardiac mechanics. Methods: A subset of participants in the CARDIA cohort (n=1200) randomly selected (balanced on race and sex) underwent genome-wide DNA methylation profiling with the Illumina EPIC array from exam year 15 (2000-01 [age 33-45 years]) for calculation of EA and EAA. Echocardiography was completed at exam year 25 (2010-11 [age 43-55]). We used linear regression to examine the association of EA and EAA with parameters of cardiac mechanics. Models were adjusted for age, race, sex, education, study center, and Y15 cardiovascular risk factors (heart rate, body mass index, hypertension, hyperlipidemia, diabetes, and smoking). Results: Mean age of participant was 45.4±3.5 years, 52% female, and 41% black. DNA methylation markers of aging (EA and EAA) were associated with tissue Doppler measures of diastolic function, but not with parameters of left ventricular structure and systolic function ( Table ). Conclusions: EA and EAA are associated with changes in cardiac structure and function. Abnormalities in cardiac structure and function are an important intermediate phenotype prior to the development of symptomatic heart failure, and additional longitudinal research should examine DNA methylation markers as potential mediator of or novel biomarker for incident heart failure in young to middle-age adults.

Abstract MP26: Obesity is Associated With Accelerated Epigenetic Aging in Midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Obesity is associated with increased risk of cardiovascular and other age-related diseases that may represent accelerated aging. As methylation levels in DNA change with aging, epigenetic age (EA), which integrates whole-genome methylation has emerged as a novel biomarker of aging and has been associated with mortality and age-related morbidity. Epigenetic age acceleration (EAA), is based on the residual value of 353 previously defined methylation markers regressed on chronologic age (CA), and is thus independent of CA. Therefore, we sought to examine the association of obesity and EAA in midlife. Methods: A subset of participants in the CARDIA cohort (n=1200) randomly selected (balanced on race and sex) underwent genome-wide DNA methylation profiling with the Illumina EPIC array from exam year 15 (2000-01 [age 33-45 years]) and 20 (2005-06 [38-50 years] for calculation of EAA. Body mass index (BMI) was measured at Y15 and Y20, respectively. We used linear regression to examine the association of obesity (independent variable) with EAA after adjusting for CA, race, sex, education, study center, smoking status, physical activity, and alcohol intake. Results: Participants were 52% female and 41% black and had mean BMI 28.5±6.2 kg/m 2 at Y15 and 29.2±6.4 kg/m 2 at Y20. At Y15, participants who were obese had 1.04 (0.38) years higher EAA compared to normal BMI participants (p&lt;0.01, Figure) . Similar results were observed at Y20. Results were similar when evaluating the association of BMI continuously with EAA (p&lt;0.05). Conclusions: EAA is a promising molecular biomarker of aging associated with obesity. Changes in DNA methylation may serve as an intermediate phenotype prior to the onset of age-associated pathologies related to obesity.

Collaborative learning with PeerWise

Building effective and supportive communities of practice in an asynchronous environment can enable students to learn from each other at their own convenient times without the need to meeting for discussing concepts. In an undergraduate course with a large amount of content to learn, working collaboratively to answer practice exam questions can help encourage deeper learning and understanding. This project examined whether exam performance can be positively influenced by online collaboration during revision and suggests that the quality of an individual’s contribution has a direct effect on his/her subsequent exam performance. We compared two student cohorts’ exam marks from their previous 3 years of exams with how they performed in Year 4 after using PeerWise (an online repository of multiple-choice questions that are created, answered, rated and discussed by students). In addition, we looked at the quantity and quality of their contribution in PeerWise to evaluate how this affected their fourth year exam performance. We confirmed that exam performance is improved by authoring questions in PeerWise, but found it is further enhanced by replying to, and commenting on, others’ posts as well. Published : 3 January 2018 Citation : Research in Learning Technology 2017, 25 : 1979 - http://dx.doi.org/10.25304/rlt.v25.1979

Living with Chronic Pain and Addiction.

Living with Chronic Pain and Addiction Ken Start I was living a nightmare. A non-stop nightmare that pulled me into a black vortex of a never-ending feeling of hopelessness. This was my life of addiction to opiates. My addiction began with a serious auto accident in 1991. That accident caused a broken back, and the beginning of years of exams, tests, surgeries and medications. Medications that I fell in love with. My first experience with Vicodin brought me an inner pleasure I could not compare to anything else in my life. I became addicted and went from Vicodin to stronger medications in a short period of time. I had a shopping list of opiates I depended on for my existence. My addiction had taken over my life [End Page 198] and I went from a working young father one day to a numb, obsessed addict the next. At 54 years old, I have had 18 back-related surgeries including having stainless steel hardware put into my spine, pain pumps, pain stimulators and several other back surgeries. I have been through eight drug and alcohol related rehabilitation centers all due to my deadly addiction to opiates, drugs and alcohol. Addiction and chronic pain took me to places that were dark, scary and hopeless. My addiction may have started due to the back injury, however I used more and more drugs due to my addiction than the need for pain relief. Opiates may have made the pain a bit better at first, but after a while it did not help much and I was just taking it for my own selfish reasons. After15 years of addiction, my life was saved by medical professionals who cared enough to walk beside me and care enough to hold me accountable for my own destructive behaviors and actions. A local doctor finally sat me down and told me I was an addict. He said that if I didn't make a change, I would not be alive much longer. His recommendation was for me to go to the Mayo Clinic in Rochester, Minnesota to be evaluated for my back and addiction issues. I took the trip the following day and was blessed to be admitted for evaluations. I was seen, evaluated and placed in the Mayo Clinic Pain Rehabilitation Out-Patient Clinic for four weeks. Attending PRC gave me the opportunity to meet others like myself. These were people who lived in chronic pain and had had no success in finding a cure. As I attended this program I learned new techniques on how to live with chronic pain. Techniques such as bio-feedback, relaxation, deep breathing, appropriate exercise, cognitive therapies, sleep hygiene, time control and moderation. I slowly learned how to utilize these techniques in my daily schedule and to depend on new ways to live with the pain. While at Mayo Clinic Pain Rehabilitation Clinic, it was decided that my medications would be decreased and my internal dilaudid pain pump would be turned off. As an addict, this was a terrifying thought. However, after speaking with the medical professionals I had built a trust with, I agreed to go through with their plan. Over the next few days and weeks they turned my pump down until it was completely off and decreased my oral medications to nearly none. This was unchartered ground for me and I began to go through withdrawals. I was very sick due to my body's dependence on these drugs. However, I began to come out of the cloud of withdrawal and feel better. This was the first time I had been nearly drug free in many years and I felt as though I might have a future worth living. Addiction to opiates had taken my life, my family, my friends, my faith, and my happiness. Instead I had been filled with depression, mental pain, suicidal thoughts and idealization, and a darkness I could not escape. Now for the first time in a very long time I had hope and was living life using the techniques I was taught at Mayo Clinic Pain Rehabilitation Clinic. After my four-week stay at PRC, I was referred to the Mayo...

Non-alcoholic fatty liver disease and the development of nephrolithiasis: A cohort study.

BackgroundNon-alcoholic fatty liver disease (NAFLD), a hepatic manifestation or precursor of metabolic syndrome, may increase nephrolithiasis, a renal manifestation of insulin resistance, but the prospective association between NAFLD and incident nephrolithiasis has not been evaluated. We examined the association of NAFLD with the development of nephrolithiasis in a large cohort of Korean men and women.MethodsWe performed a cohort study of 208,578 Korean adults who underwent a health checkup examination between January 2002 and December 2014 and were followed-up annually or biennially through December 2014. NAFLD was defined as the presence of fatty liver in the absence of excessive alcohol use or other identifiable causes. Fatty liver and nephrolithiasis were determined based on ultrasonographic findings. We used a parametric Cox model to estimate the adjusted hazard ratios (HRs) of nephrolithiasis according to the presence of NAFLD.ResultsDuring 1,054,887.6 person-year of follow-up, 16,442 participants developed nephrolithiasis. After adjusting for age, center, year of screening exam, smoking status, alcohol intake, physical activity, education level, body mass index, history of hypertension and diabetes, HOMA-IR, uric acid and C-reactive protein, male participants with NAFLD had a significantly increased risk of nephrolithiasis than those without NAFLD (adjusted HR 1.17, 95% CI 1.06–1.30). However, no association between NAFLD and nephrolithiasis was observed in women (adjusted HR 0.97, 95% CI 0.81–1.16).ConclusionsIn this large cohort study of young and middle-aged Koreans, NAFLD was significantly associated with an increased incidence of nephrolithiasis in men but not in women.