Greater Relative Increases Research Articles

Estimating the ratio of fatal to non-fatal overdoses involving all drugs, all opioids, synthetic opioids, heroin or stimulants, USA, 2010–2020

IntroductionUS drug overdose deaths are at historic levels. For every fatal drug overdose, there are many more non-fatal; however, minimal nationally representative data exist on trends in the ratio of...

Improving Racial and Ethnic Disparities in Outpatient Anterior Cervical Discectomy and Fusion Driven by Increasing Utilization of Ambulatory Surgical Centers in New York State.

Retrospective cohort study. The purpose of this study was to assess trends in disparities in utilization of hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for outpatient ACDF (OP-ACDF) between White, Black, Hispanic, and Asian/Pacific Islander patients from 2015 to 2018 in New York State. Racial and ethnic disparities within the field of spine surgery have been thoroughly documented. To date, it remains unknown how these disparities have evolved in the outpatient setting alongside the rapid emergence of ASCs and whether restrictive patterns of access to these outpatient centers exist by race and ethnicity. We conducted a retrospective review from 2015 to 2018 using the Healthcare Cost and Utilization Project (HCUP) New York State Ambulatory Database. Differences in utilization rates for OP-ACDF were assessed and trended over time by race and ethnicity for both HOPDs and freestanding ASCs. Poisson regression was used to evaluate the association between utilization rates for OP-ACDF and race/ethnicity. Between 2015 and 2018, Black, Hispanic, and Asian patients were less likely to undergo OP-ACDF compared with White patients in New York State. However, the magnitude of these disparities lessened over time, as Black, Hispanic, and Asian patients had greater relative increases in utilization of HOPDs and ASCs for ACDF when compared with White patients ( Ptrend <0.001). The magnitude of the increase in freestanding ASC utilization was such that minority patients had higher ACDF utilization rates in freestanding ASCs by 2018 ( P <0.001). We found evidence of improving racial disparities in the relative utilization of outpatient ACDF in New York State. The increase in access to outpatient ACDF appeared to be driven by an increasing number of patients undergoing ACDF in freestanding ASCs in large metropolitan areas. These improving disparities are encouraging and contrast previously documented inequalities in inpatient spine surgery. III.

Resistance training intervention performed with different muscle action durations influences the maximal dynamic strength without promoting joint-angle specific strength gains

ABSTRACT The present study investigated the effect of 10-week matched (range of motion, volume, intensity, rest, and repetition duration) training protocols with varying muscle action duration (MAD) on maximal voluntary isometric contraction (MVIC) test at eight different knee angles and one-repetition maximum (1RM) test after in seated knee extensor machine. Forty women were allocated into one control and three training groups with varying MAD: 5C1E (5s concentric action [CON] and 1s eccentric action [ECC]), 3C3E (3s CON and 3s ECC), and 1C5E (1s CON and 5s ECC). All training groups (5C1E, 3C3E, and 1C5E) showed a greater relative response in 1RM performance than the control group (0.1 ± 3.5%, p ≤ 0.05). The 1C5E group presented greater relative increases in the 1RM performance (22.1 ± 11.6%) compared to 5C1E (13.6 ± 9.2%; p ≤ 0.05) and 3C3E (14.1 ± 5.5%, p ≤ 0.05) groups. The training groups increased the MVIC performance more than the control group (p ≤ 0.05), although there were no significant differences between the training groups. This study demonstrated that isoinertial resistance training protocols with shorter CON MAD showed greater maximum dynamic strength performance response than matched training protocols with other MAD configurations. However, the configuration of MAD did not induce angle-specificity to increase the maximum isometric strength.

Comparative Economic Outcomes in Patients with Focal Seizure Initiating First-Line Eslicarbazepine Acetate Monotherapy versus Generic Antiseizure Drugs.

ObjectiveTo examine the association between initiating first-line (1L) monotherapy with eslicarbazepine acetate (ESL) vs a generic antiseizure drug (ASD) and healthcare resource utilization (HCRU) and charges in adults with treated focal seizures (FS).MethodsThis was a retrospective analysis of Symphony Health’s Integrated Dataverse® open-source claims data. Two cohorts were identified as having initiated 1L monotherapy with ESL or literature-defined generic ASDs. Linear regression models with person fixed effects and inverse probability treatment weights assessed the relative additional changes in HCRU and charges among patients who received ESL compared to generic ASD.ResultsA total of 250 and 43,220 patients initiated ESL (48.3 years; 57.2% female) or a generic ASD (54.5 years; 58.1% female), respectively. Compared to patients initiating a generic ASD, patients treated with ESL had additional reductions of 11.8 percentage points in the likelihood of any all-cause outpatient visits (P<0.001), 7.4 percentage points in the likelihood of any emergency department (ED) visits (P=0.013), and 22.7 percentage points in the likelihood of any FS-related outpatient visits (P<0.001). Patients initiating ESL had greater reductions in mean charges for all-cause medical ($2620; P=0.002), outpatient ($1995; P=0.005), and non-FS-related medical ($2708; P<0.001) services. Patients initiating ESL had greater relative increases in mean total prescription ($1368; P<0.001) and ASD-related prescription ($1636; P<0.001) charges, but greater relative reductions in non-ASD prescription ($269; P=0.032) charges. The increases in prescription charges were of a lower magnitude than the decreases in medical charges.ConclusionInitiation of ESL as 1L monotherapy was associated with statistically significantly greater reductions in any use of several all-cause and FS-related services, number of visits, and charges compared to initiation of a generic ASD as 1L monotherapy in patients with FS. Initiation of a generic ASD as 1L monotherapy was associated with significantly smaller increases in total prescription charges and ASD-related prescription charges.

Potential of soil cover with plastic film for the setting of sweet orange orchards

Abstract Soil cover with plastic film is a practice used to optimize the agronomic performance of different crops, but its behavior in the citrus growing conditions of Brazil remains unknown. Five experiments in commercial orchards located in the state of São Paulo, in rainfed or irrigated systems, were carried out to evaluate the effect of soil cover with plastic film (white/black or silver/black color) on the vegetative growth and initial production of sweet orange trees up to 3.5 years after planting. In each location and experiment, completely randomized design was used, with four to ten replicates and five to twelve useful trees per plot. Considering the set of results, soil cover with plastic film increased the average canopy volume by 27% and the average production per tree by 33% compared to control trees without plastic cover. The positive effect of plastic cover was observed until the third year of its application, gradually decreasing with its degradation. In general, greater relative increases were observed in variables evaluated with the use of plastic cover in rainfed experiments than irrigated ones, while the effect of white/black either silver/black films was similar.

Soil respiration in a tropical montane grassland ecosystem is largely heterotroph-driven and increases under simulated warming

Soil respiration, a major source of atmospheric carbon (C), can feed into climate warming, which in turn can amplify soil CO2 efflux by affecting respiration by plant roots, arbuscular mycorrhizal fungi (AMF) and other heterotrophic organisms. Although tropical ecosystems contribute >60% of the global soil CO2 efflux, there is currently a dearth of data on tropical soil respiration responses to increasing temperature. Here we report a simulated warming and soil respiration partitioning experiment in tropical montane grasslands in the Western Ghats in southern India. The study aimed to (a) evaluate soil respiration responses to warming, (b) assess the relative contributions of autotrophic and heterotrophic components to soil respiration, and (c) assess the roles of soil temperature and soil moisture in influencing soil respiration in this system. Soil respiration was tightly coupled with instantaneous soil moisture availability in both the warmed and control plots, with CO2 efflux levels peaking during the wet season. Soil warming by ˜1.4 °C nearly doubled soil respiration from 0.62 g CO2 m−2 hr−1 under ambient conditions to 1.16 g CO2 m−2 hr−1 under warmed conditions. Warming effects on soil CO2 efflux were dependent on water availability, with greater relative increases in soil respiration observed under conditions of low (with a minimum of 2.6%), compared to high (with a maximum of 64.3%), soil moisture. Heterotrophs contributed to the majority of soil CO2 efflux, with respiration remaining unchanged when roots and/or AMF hyphae were excluded as the partitioning treatments were statistically indistinguishable. Overall, our results indicate that future warming is likely to substantially increase the largely heterotroph-driven soil C fluxes in this tropical montane grassland ecosystem.

Accessing social media: Help or hindrance for people with social anxiety?

Despite increasing use of social media and the potential benefits for people with social anxiety (SA) disorder, little is known about the online experience of people with SA. Our study aimed to investigate the occurrence of cognitive and behavioral processes during a series of online and off-line Facebook (FB)-based tasks among individuals with high and low levels of SA. Sixty-one undergraduates with low or high SA were asked to use FB in a laboratory setting, to make an FB post, and to imagine three ambiguous FB scenarios. Participants with high SA reported higher anxiety throughout the study with an interaction effect, indicating greater relative increases in anxiety for those with high SA over low SA across tasks. The high SA group were more likely to negatively interpret the ambiguous FB scenarios than the low SA group. They also reported using more safety-seeking behaviors and having more negative thoughts. The findings suggest that the cognitive and behavioral processes that characterize socially anxious face-to-face interaction are also evident in online communication. Suggestions are made for the clinical implications of such findings.

Early and Long-term Undernutrition in Female Rats Exacerbates the Metabolic Risk Associated with Nutritional Rehabilitation

Human studies have suggested that early undernutrition increases the risk of obesity, thereby explaining the increase in overweight among individuals from developing countries who have been undernourished as children. However, this conclusion is controversial, given that other studies do not concur. This study sought to determine whether rehabilitation after undernutrition increases the risk of obesity and metabolic disorders. We employed a published experimental food-restriction model. Wistar female rats subjected to severe food restriction since fetal stage and controls were transferred to a moderately high-fat diet (cafeteria) provided at 70 days of life to 6.5 months. Another group of undernourished rats were rehabilitated with chow. The energy intake of undernourished animals transferred to cafeteria formula exceeded that of the controls under this regime and was probably driven by hypothalamic disorders in insulin and leptin signal transduction. The cafeteria diet resulted in greater relative increases in both fat and lean body mass in the undernourished rats when compared with controls, enabling the former group to completely catch up in length and body mass index. White adipose tissues of undernourished rats transferred to the high-lipid regime developed a browning which, probably, contributed to avoid the obesigenic effect observed in controls. Nevertheless, the restricted group rehabilitated with cafeteria formula had greater accretion of visceral than subcutaneous fat, showed increased signs of macrophage infiltration and inflammation in visceral pad, dyslipidemia, and ectopic fat accumulation. The data indicate that early long-term undernutrition is associated with increased susceptibility to the harmful effects of nutritional rehabilitation, without causing obesity.

Increasing minimum daily temperatures are associated with enhanced pesticide use in cultivated soybean along a latitudinal gradient in the mid-western United States.

Assessments of climate change and food security often do not consider changes to crop production as a function of altered pest pressures. Evaluation of potential changes may be difficult, in part, because management practices are routinely utilized in situ to minimize pest injury. If so, then such practices, should, in theory, also change with climate, although this has never been quantified. Chemical (pesticide) applications remain the primary means of managing pests in industrialized countries. While a wide range of climate variables can influence chemical use, minimum daily temperature (lowest 24 h recorded temperature in a given year) can be associated with the distribution and thermal survival of many agricultural pests in temperate regions. The current study quantifies average pesticide applications since 1999 for commercial soybean grown over a 2100 km North-South latitudinal transect for seven states that varied in minimum daily temperature (1999–2013) from −28.6°C (Minnesota) to −5.1°C (Louisiana). Although soybean yields (per hectare) did not vary by state, total pesticide applications (kg of active ingredient, ai, per hectare) increased from 4.3 to 6.5 over this temperature range. Significant correlations were observed between minimum daily temperatures and kg of ai for all pesticide classes. This suggested that minimum daily temperature could serve as a proxy for pesticide application. Longer term temperature data (1977–2013) indicated greater relative increases in minimum daily temperatures for northern relative to southern states. Using these longer-term trends to determine short-term projections of pesticide use (to 2023) showed a greater comparative increase in herbicide use for soybean in northern; but a greater increase in insecticide and fungicide use for southern states in a warmer climate. Overall, these data suggest that increases in pesticide application rates may be a means to maintain soybean production in response to rising minimum daily temperatures and potential increases in pest pressures.

Adiposity and hepatic lipid in healthy full-term, breastfed, and formula-fed human infants: a prospective short-term longitudinal cohort study

The effect of mode of infant feeding on adiposity deposition is not fully understood. The objective was to test the hypothesis that differences in total and regional adipose tissue content and intrahepatocellular lipid (IHCL) arise in early infancy between breast- and formula-fed infants and to describe longitudinal changes. This prospective longitudinal cohort study was performed in 2 hospitals in the United Kingdom. Healthy, full-term, appropriate weight-for-gestational age infants were recruited; adipose tissue volume and distribution were directly quantified by using whole-body magnetic resonance imaging; IHCL was assessed by in vivo proton magnetic resonance spectroscopy. Measurements were performed after birth (median age: 13 d) and at 6-12 wk of age. Method of infant feeding was recorded prospectively by using maternally completed feeding diaries. Breastfed was defined as >80% of feeds consisting of breast milk at both points; formula-fed was defined as >80% of feeds consisting of formula milk at both points. Longitudinal results were obtained from 70 infants (36 breastfed, 9 mixed-fed, and 25 formula-fed). No differences were found in total or regional adipose tissue or IHCL between breastfed and formula-fed infants. In pooled analyses including all feeding groups, IHCL and total adipose tissue approximately doubled between birth and 6-12 wk: IHCL after birth (median: 0.949; IQR: 0.521-1.711) and at 6-12 wk (1.828; 1.376-2.697; P < 0.001) and total adipose tissue after birth (0.749 L; 0.620-0.928 L) and at 6-12 wk (1.547 L; 1.332-1.790 L; P < 0.001). Increasing adiposity was characterized by greater relative increases in subcutaneous than in internal adipose tissue depots. No differences were detectable in adipose tissue or IHCL accretion between breastfed and formula-fed infants up to 2 mo. The substantial increase in IHCL seen over this period in both breastfed and formula-fed infants is a novel observation, which suggests that hepatic storage of lipids may be physiologic up to 2 mo. This trial was registered at www.clinicaltrials.gov as NCT02033005.

Transcriptome‐wide RNA sequencing analysis of rat skeletal muscle feed arteries: impact of exercise training in obesity (1106.23)

We employed next generation RNA sequencing (RNA‐Seq) technology to determine the extent to which exercise alters global gene expression in skeletal muscle feed arteries and aortic endothelial cells (AEC) of obese OLETF rats. Transcriptional profiles of the soleus and gasctrocnemius muscle feed arteries (SFA and GFA, respectively) and AEC‐enriched samples from rats that underwent an endurance exercise training program(EndEx; n=12), interval sprint training program (IST; n=12), or remained sedentary (Sed; n=12) were examined. In response to EndEx, there were 39 upregulated and 20 downregulated genes in SFA and 1 upregulated and 1 downregulated gene in GFA (FDR &lt; 10%). In response to IST, there were 305 upregulated and 324 downregulated genes in SFA and 101 upregulated and 66 downregulated genes in GFA, with an overlap of 32 genes between arteries. Furthermore, in AEC, there were 183 up‐regulated and 141 downregulated genes with EndEx and 71 upregulated and 69 downregulated genes with IST, with an overlap of 35 between exercise programs. Only expression of two genes (i.e., Tubb2b and Slc9a3r2) was altered (i.e., increased) by exercise in all three arteries. The finding that both EndEx and IST produced greater transcriptional changes in the SFA compared to the GFA is intriguing when considering the fact that treadmill exercise is associated with greater relative increases in blood flow to the gastrocnemius muscle compared to the soleus muscle.Grant Funding Source: NIH RO1HL036088

Transcriptome-wide RNA sequencing analysis of rat skeletal muscle feed arteries. II. Impact of exercise training in obesity

We employed next-generation RNA sequencing (RNA-Seq) technology to determine the extent to which exercise training alters global gene expression in skeletal muscle feed arteries and aortic endothelial cells of obese Otsuka Long-Evans Tokushima Fatty (OLETF) rats. Transcriptional profiles of the soleus and gastrocnemius muscle feed arteries (SFA and GFA, respectively) and aortic endothelial cell-enriched samples from rats that underwent an endurance exercise training program (EndEx; n = 12) or a interval sprint training program (IST; n = 12) or remained sedentary (Sed; n = 12) were examined. In response to EndEx, there were 39 upregulated (e.g., MANF) and 20 downregulated (e.g., ALOX15) genes in SFA and 1 upregulated (i.e., Wisp2) and 1 downregulated (i.e., Crem) gene in GFA [false discovery rate (FDR) < 10%]. In response to IST, there were 305 upregulated (e.g., MANF, HSPA12B) and 324 downregulated genes in SFA and 101 upregulated and 66 downregulated genes in GFA, with an overlap of 32 genes between arteries. Furthermore, in aortic endothelial cells, there were 183 upregulated (e.g., eNOS, SOD-3) and 141 downregulated (e.g., ATF3, Clec1b, npy, leptin) genes with EndEx and 71 upregulated and 69 downregulated genes with IST, with an overlap of 35 between exercise programs. Expression of only two genes (Tubb2b and Slc9a3r2) was altered (i.e., increased) by exercise in all three arteries. The finding that both EndEx and IST produced greater transcriptional changes in the SFA compared with the GFA is intriguing when considering the fact that treadmill bouts of exercise are associated with greater relative increases in blood flow to the gastrocnemius muscle compared with the soleus muscle.

Enhancement in specific strength of open cell aluminium foams through plasma electrolytic oxidation treatment

Open cell aluminium foams produced by replication have their strength enhanced by ceramic surface layers generated using plasma electrolytic oxidation. The composite materials produced show, in some cases, greater relative increases in strength–weight ratio than those produced by applying other coatings to porous structures; however, the behaviour depends on the characteristics of the layer generated. The most significant increases appear to correlate with conditions that produce more uniform coating thicknesses with depth of penetration into the foam structure.

Lowering the Triglyceride/High-Density Lipoprotein Cholesterol Ratio Is Associated With the Beneficial Impact of Pioglitazone on Progression of Coronary Atherosclerosis in Diabetic Patients: Insights From the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) Study

The purpose of this study was to determine the factors associated with the favorable effect of pioglitazone on atheroma progression. Diabetes mellitus is associated with accelerated coronary atheroma progression. Pioglitazone slowed progression compared with glimepiride in this population. In all, 360 diabetic patients with coronary artery disease were treated with pioglitazone or glimepiride for 18 months in the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) study. Coronary atheroma progression was evaluated by serial intravascular ultrasound. The relationship between changes in biochemical parameters, percent atheroma volume, and total atheroma volume was investigated. Pioglitazone-treated patients demonstrated greater increases in high-density lipoprotein cholesterol (HDL-C) and reductions in glycated hemoglobin, triglycerides, and C-reactive protein. Significant correlations were observed between changes in percent atheroma volume and triglycerides (r = 0.15, p = 0.04), triglyceride/HDL-C ratio (r = 0.16, p = 0.03), and glycated hemoglobin (r = 0.16, p = 0.03) with pioglitazone, and changes in low-density lipoprotein cholesterol (r = -0.15, p = 0.05), apolipoprotein B (r = -0.16, p = 0.04), and apolipoprotein A-I (r = -0.20, p = 0.01) with glimepiride. Substantial atheroma regression, compared to progression, was associated with greater relative increases in HDL-C (14.2% vs. 7.8%, p = 0.04), relative decreases in triglycerides (-13.3% vs. -1.9%, p = 0.045), triglyceride/HDL-C ratio (-22.5 vs. -9.9%, p = 0.05), and decrease in glycated hemoglobin (-0.6% vs. -0.3%, p = 0.01). Multivariable analysis revealed that pioglitazone-induced effects on triglyceride/HDL-C were associated with changes in percent atheroma volume (p = 0.03) and total atheroma volume (p = 0.02). Favorable effects of pioglitazone on the triglyceride/HDL-C ratio correlated with delayed atheroma progression in diabetic patients. This finding highlights the potential importance of targeting atherogenic dyslipidemia in diabetic patients with coronary artery disease.

Development Of A Valid Rowing-Specific VO2max Field Test

Currently, there are no feasible methods for testing aerobic capacity in the field among rowers. PURPOSE: To produce a valid, field-based VO2 test for rowers using minimal equipment. METHODS: Thirty rowers (15 men and 15 women) between the ages of 18 and 26 years were recruited from rowing clubs within the District of Columbia metropolitan area. The test protocol consisted of a maximum of seven 2-min stages on a rowing ergometer, separated by 30 second breaks during which blood lactic acid concentrations were determined. Intensity level started at 200 W for men and 150 W for women, and increased by 50 W with each additional stage. VO2 was determined by sampling expired gas fractions of CO2 and O2 from a mixing chamber (ParvoMedics 2400; Sandy, UT) and athletes were instructed to row to volitional exhaustion. To predict VO2max from the submaximal data, VO2 was regressed on peak heart rate for stages 1-5 in men and stages 1-4 in women. RESULTS: Approximately 80% of the men and 87% of the women achieved a respiratory exchange ratio (RER) of 1.10 or greater and lactic acid concentrations of 8.87±3.8 and 8.40±4.2 mmol·L-1 were achieved for men and women respectively confirming that athletes performed close to maximal effort. Submaximal heart rate was a significant correlate of VO2, but this relation was stronger in men (r=0.73; p<0.0001) than in women (r=0.57; p<0.001). Further, the VO2max values predicted from heart rate data were approximately 23% and 25% lower than what was actually achieved for men and women, respectively, and the correlation between predicted and actual VO2max was only modest in men (r=0.55; p<0.05) and quite negligible in women (r = -0.05; p=0.85). CONCLUSION: Although this field test was adequate in predicting VO2max in men, it performed poorly in women. The 30-sec rests at the end of each stage may have attenuated the strong linear relation often observed between heart rate and VO2. Moreover, women had greater relative increases in intensity with increasing stage compared with men, which may have prematurely shortened their test. Modifications to the testing protocol should produce stronger correlations and a more accurate prediction of VO2max.

Discrimination of interaural temporal disparities conveyed by high-frequency sinusoidally amplitude-modulated tones and high-frequency transposed tones: Effects of spectrally flanking noises

Dreyer and Oxenham [(2008). "Effects of level and background noise on interaural time difference discrimination for transposed stimuli," J. Acoust. Soc. Am. 123, EL1-EL7] reported that spectrally flanking noise increased threshold interaural temporal disparities (ITDs) conveyed by high-frequency transposed tones but rendered them indiscriminable when they were conveyed by high-frequency sinusoidally amplitude-modulated (SAM) tones. This study extends those observations and evaluates the role of "off-frequency listening." Threshold ITDs were measured using 4-kHz-centered transposed or SAM tonal "targets." In "baseline" conditions, targets were presented without spectrally flanking noise. Additionally, targets were presented along with continuous diotic broadband Gaussian noise spectrally "notched" between 3.6 and 4.4 kHz. In another condition, only the high-pass segment of the notched noise was continuously present. In the final condition, only the low-pass segment was continuously present. Results indicate that (1) relative to baseline, adding notched noise resulted in similar relative increases of threshold ITDs for both SAM and transposed targets; (2) the presence of the high-pass segment of the notched noise resulted in greater relative increases in threshold ITDs over those obtained in baseline conditions for SAM tones as compared to transposed tones; (3) comparisons among all of the data were consistent with the interpretation that both on-frequency and off-frequency processing of envelope-based ITDs can be disrupted by the presence of a notched noise.

Trends in Overweight and Obesity in Chinese Adults: Between 1991 and 1999–2000

The aim of this study was to evaluate trends in BMI and the prevalence of overweight (BMI > or = 25 kg/m(2)) and obesity (BMI > or = 30 kg/m(2)) between 1991 and 1999-2000 among Chinese adults. In this study, two population-based samples of Chinese adults aged between 45 and 79 years (n = 7,858 during each period), and comparable in the distributions of age, gender, degree of urbanization, and region (North/South) were used. Height and weight were measured using identical procedures at each period, and BMI was calculated as weight (in kilogram) divided by height (in square meter). From 1991 to 1999-2000, the mean BMI increased from 21.8 to 23.4 kg/m(2) among men and from 21.8 to 23.5 kg/m(2) among women (each P < 0.001). Among men, the prevalence of overweight and obesity increased from 9.6 and 0.6%, respectively, in 1991 to 20.0 and 3.0%, respectively, in 1999-2000 (each P < 0.001). Among women, the prevalence of overweight and obesity increased from 14.5 and 1.8%, respectively, in 1991 to 26.5 and 5.2%, respectively, in 1999-2000 (each P < 0.001). The prevalence of overweight and obesity increased in all age groups, in rural and urban areas, and in North and South China, with greater relative increases in obesity among older age groups, South China, and rural areas (P interaction < 0.05). Overweight and obesity increased tremendously during the 1990s in China. These data underscore the need for national programs in weight maintenance and reduction, to prevent obesity-related outcomes in China.

Biomechanics of Massive Rotator Cuff Tears

Some individuals with massive rotator cuff tears maintain active shoulder abduction, and some maintain good postoperative active range of motion despite high rates of repeat tears after repair. We devised a biomechanical rationale for these observations and measured the increases in residual muscle forces necessary to maintain active shoulder motion with rotator cuff tears of various sizes. A custom cadaver shoulder controller utilizing position and orientation closed-loop feedback control was used. Six cadaver glenohumeral joint specimens were tested in open-chain scapular plane abduction with equivalent upper extremity weight. The shoulder controller limited superior translation of the humeral head to 3.0 mm while maintaining neutral axial rotation by automatically controlling individual rotator cuff forces. Three-dimensional position and orientation and rotator cuff and deltoid force vectors were recorded. Specimens were tested with an intact rotator cuff and with 6, 7, and 8-cm tears. All six specimens achieved full abduction with <or=3.0 mm of superior translation of the humeral head for all rotator cuff tear sizes. The effect of rotator cuff tear was significant for all tear sizes (p < 0.01). Compared with the intact condition, the subscapularis force requirements for the 6, 7, and 8-cm tears were increased by 30%, 44%, and 85%, respectively. For the combined infraspinatus and teres minor, the forces were increased by 32%, 45%, and 86%, respectively. The maximum deltoid force for the simulated tear condition never exceeded the deltoid force required at maximum abduction for the intact condition. However, between 10 degrees and 45 degrees of abduction, the average deltoid force requirement increased 22%, 28%, and 45% for the three tear sizes. In the presence of a massive rotator cuff tear, stable glenohumeral abduction without excessive superior humeral head translation requires significantly higher forces in the remaining intact portion of the rotator cuff. These force increases are within the physiologic range of rotator cuff muscles for 6-cm tears and most 7-cm tears. Increases in deltoid force requirements occur in early abduction; however, greater relative increases are required of the rotator cuff, especially in the presence of larger rotator cuff tears.

Psychosocial Factors Predict CD4 and Viral Load Change in Men and Women With Human Immunodeficiency Virus in the Era of Highly Active Antiretroviral Treatment

Most previous longitudinal studies demonstrating relationships between psychosocial variables and human immunodeficiency virus (HIV) disease progression utilized samples of gay men accrued before the era of highly active antiretroviral treatment (HAART), without including viral load (VL) as an indicator of disease progression or assessing the impact of medication adherence. This study sought to determine whether psychosocial variables would predict both CD4 and VL changes in a diverse sample assessed entirely during the era of HAART and accounting for adherence effects. This longitudinal study assessed a multiethnic HIV+ sample (n = 177) of men and women in the midrange of illness (CD4 number between 150 and 500; no previous acquired immunodeficiency syndrome [AIDS]-defining symptom) every 6 months for 2 years. Hierarchical linear modeling was used to model change in CD4 and VL controlling for sociodemographics (age, gender, ethnicity, education) and medical variables (baseline CD4/VL, antiretroviral medications at each time point, adherence). Baseline depression, hopelessness, and education predicted the slope of CD4 and VL. Avoidant coping and life event stress predicted VL change. Cumulative variables produced stronger relationships (depression, avoidant coping, and hopelessness with CD4/VL slope and life events stress with VL slope). High cumulative depression and avoidant coping were associated with approximately twice the rate of decline in CD4 as low scorers and greater relative increases in VL. Social support was not significantly related to CD4 or VL slope. Psychosocial factors contribute significantly to the variance in HIV disease progression (assessed through CD4 number and VL) in a diverse sample, accounting for adherence and do so in the era of HAART.

Comparative Above-Ground Development Rates for Several Annual Grass Weeds and Cereal Grains

Above-ground seedling development was characterized for five annual grass weeds: downy brome, bulbous bluegrass, jointed goatgrass, Italian ryegrass, wild oat; and three cereals: winter wheat, winter barley, and winter triticale in field experiments over two years. The rate of leaf production on the main stem of each species was linearly related to cumulative growing degree days (GDD) since planting. Leaf production rates were faster for bulbous bluegrass, downy brome, Italian ryegrass, wild oat, and barley than for wheat, triticale, and jointed goatgrass. The main stem development stage when individual tillers appeared was similar in all species except under poor seedbed conditions in 1991, in which case lower-node tillers were delayed in the cereals and jointed goatgrass, but not in most of the weed species. Bulbous bluegrass, downy brome, and barley had the same percentage of plants produce the first four primary tillers on the main stem in both years; the other species showed more year-to-year variation. Seedling heights at full emergence were generally greater for large-seeded species. Small-seeded species compared to large-seeded species tended to have greater relative increases in plant height over time. Knowledge of comparative development rates between these weeds and cereals could provide information for development of growth models for each of the species and could also improve understanding of the competitive relationships between grass weeds and cereal grains.