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Cropland fallowing is choosing not to plant a crop during a season when a crop is normally planted. It is an important component of many crop rotations and can improve soil moisture and health. Knowing which fields are fallow is critical to assess crop productivity and crop water productivity, needed for food security assessments. The annual spatial extent of cropland fallows is poorly understood within the United States (U.S.). The U.S. Department of Agriculture Cropland Data Layer does provide cropland fallow areas; however, at a significantly lower confidence than their cropland classes. This study developed a methodology to map cropland fallows within the Northern Great Plains region of the U.S. using an easily implementable decision tree algorithm leveraging training and validation data from wet (2019), normal (2015), and dry (2017) precipitation years to account for climatic variability. The decision trees automated cropland fallow algorithm (ACFA) was coded on a cloud platform utilizing remotely sensed, time-series data from the years 2010-2019 to separate cropland fallows from other land cover/land use classes. Overall accuracies varied between 96%-98%. Producer's and user's accuracies of cropland fallow class varied between 70-87%. [ABSTRACT FROM AUTHOR]

Aims: To test separatel the efficacy of a web‐based and a peer‐based brief intervention (BI), compared with an expanded usual care control (EUC) group, among military reserve component members using alcohoI in a hazardous and harmful manner. Design: In the randomized controlled trial, participants were assigned to: [1] web‐based BI with web‐based boosters (BI + web), [2] web‐based BI with peer‐based boosters (BI + peer) or [3] enhanced usual care (EUC). Setting: Michigan, USA. Participants: A total of 739 Michigan Army National Guard members who reported recent hazardous alcohol use; 84% were male, the mean age was 28 years. Intervention: The BI consisted of an interactive program guided by a personally selected avatar. Boosters were delivered either on the web or personally by a trained veteran peer. A pamphlet, given to all participants, included information on hazardous alcohol use and military‐specific community resources and served as the EUC condition. Measurements The primary outcome measure was binge drinking episodes in the past 30 days, measured at 12 months after the BI. Findings All randomized participants were included in the outcome analyses. In adjusted analyses, BI + peer [beta = −0.43, 95% confidence interval (CI) = −0.56 to −0.31, P < 0.001] and BI + web (beta = −0.34, 95% CI = −0.46 to −0.23, P < 0.001) reduced binge drinking compared with EUC. Conclusion: This satudy was a web‐based brief intervention for hazardous alcohol use, with either web‐ or peer‐based boosters, reduced binge alcohol use among Army National Guard members. [ABSTRACT FROM AUTHOR]

Campbell poses the paradox that although the United States was born with "the most pronounced antistatist ideology in the modern world" and successive generations were "schooled in the principles of limited government", public authorities at every level repeatedly deployed and enhanced their powers (2, 122). The U.S. Constitution reserved many powers to the states, and Campbell narrates and enumerates in detail how the states continually exercised and expanded their authority in response to unexpected crises and burgeoning problems. Much of the power of Campbell's account lies in his careful, systematic explanation of the "contextual influences" that created the conditions for state-building (7). [Extracted from the article]

Purpose: The National Guard provides critical support both domestically and abroad with soldiers dispersed throughout America and spanning the urban‐rural continuum. To determine if location‐specific interventions may be needed, we compared the prevalence and severity of cannabis and alcohol use among National Guard members across localities. Methods: Michigan National Guard members were enrolled (N = 2,746) during drill weekends as part of a larger randomized behavioral trial. Cannabis (ASSIST; prevalence = 5%) and alcohol use (AUDIT; prevalence = 82%) were compared using hurdle regression models across locality status after adjusting for covariates. Findings: Prevalence of cannabis and alcohol use was predicted by locality (adjusted odds ratio [AOR] = 0.913, 95% CI: 0.838‐0.986, P =.029; AOR = 0.963, 95% CI: 0.929‐0.998, P =.038, respectively), with more use in urban localities. Neither severity of cannabis nor alcohol use was predicted by locality status. Conclusions: Prevalence of cannabis and alcohol use in the National Guard is differentially elevated across localities with higher prevalence in more central, densely populated areas. Findings may inform future work considering accessibility and utilization of prevention and treatment services for Guard members across the urban‐rural continuum. [ABSTRACT FROM AUTHOR]

Objective Adults with serious mental illness are at increased risk for diabetes mellitus and diabetes-related complications. This article classifies subgroups among people with serious mental illness and comorbid diabetes with respect to functional status and examines differences among those groups. Methods This analysis used a baseline sample of 157 adults with serious mental illness and diabetes mellitus enrolled in a National Institute of Health-funded research study. Latent profile analysis was used to distinguish health status profiles and investigate how these subgroups differed across assessment domains. Results Participants with depression, schizophrenia, and bipolar disorder (n = 157) were included in the study. Mean age was 52.9 years (standard deviation = 9.8), and 62 (40%) were African American. From the latent profile analysis, a three-class model appeared to provide the best fit. Class 1 (34.9%) had a very low functional health status approximately two standard deviations below the general population mean. Class 2 (43.7%) had a low functional status approximately one standard deviation below the general mean. Class 3 (21.4%) had moderate functional status with scores near population mean. Groups differed on measures of personal characteristics, clinical status and symptom severity, self-care behaviors, and environmental characteristics. Conclusions Although individuals with schizophrenia generally have poor prognosis once they develop diabetes, latent profile analysis identified distinct health status subgroups. Although all three groups demonstrated illness burden, the pattern of differences between these groups across measures may suggest the need for different interventions for highly diverse adults who received care within safety-net primary care. [ABSTRACT FROM AUTHOR]

Objective Serious mental illness and type II diabetes mellitus have a high comorbidity, and both have a higher prevalence of anxiety disorders compared to the general population. Targeted Training in Illness Management is a group-based self-management training approach which targets serious mental illness and type II diabetes mellitus concurrently. This analysis examines data from a randomized controlled trial of Targeted Training in Illness Management intervention to examine the impact of comorbid anxiety on baseline psychiatric symptomatology and diabetic control, and on longitudinal treatment outcomes. Methods We conducted secondary analyses on data from a prospective, 60-week, randomized controlled trial testing Targeted Training in Illness Management versus treatment as usual in 200 individuals with serious mental illness and diabetes. Primary outcomes included measures related to serious mental illness symptoms, functional status, general health status, and diabetes control. Measures were compared between those participants with anxiety disorders versus those without anxiety at baseline as well as over time using linear mixed effects analyses. Results Forty seven percent of the participants had one or more anxiety disorders. At baseline, those with an anxiety diagnosis had higher illness severity, depressive, and other psychiatric symptomatology and disability. Diabetic control (HbA1c) was not significantly different at baseline. In the longitudinal analyses, no significant mean slope differences over time (group-by-time interaction effect) between those with anxiety diagnoses and those without in treatment as usual group were found for primary outcomes. Within the Targeted Training in Illness Management arm, those with anxiety disorders had significantly greater improvement in mental health functioning. Those with anxiety comorbidity in the Targeted Training in Illness Management group demonstrated significantly lower HbA1c levels compared to no anxiety comorbidity and also demonstrated a greater improvement in HbA1c over the first 30 weeks compared to those without anxiety comorbidity. Conclusion Comorbid anxiety in serious mental illness and type II diabetes mellitus population is associated with increased psychiatric symptomatology and greater disability. Individuals from this population appear to experience greater improvement in functioning from baseline with the Targeted Training in Illness Management intervention. Anxiety comorbidity in the serious mental illness and type II diabetes mellitus population does not appear to have a negative impact on diabetic control. These complex relationships need further study. Clinical Trials Registration ClinicalTrials.gov: Improving outcomes for individuals with serious mental illness and diabetes (NCT01410357). [ABSTRACT FROM AUTHOR]

Obesity during human pregnancy predisposes offspring to obesity and cardiovascular disease in postnatal life. In a sheep model of maternal overnutrition/obesity we have previously reported myocardial inflammation and fibrosis, as well as cardiac dysfunction in late term fetuses, in association with chronically elevated blood cortisol. Significant research has suggested a link between elevated glucocorticoid exposure in utero and hypertension and cardiovascular disease postnatally. Here we examined the effects of maternal obesity on myocardial inflammation and fibrosis of their adult offspring. Adult male offspring from control (CON) mothers fed 100% of National Research Council (NRC) recommendations (n = 6) and male offspring from obese mothers (MO) fed 150% NRC (n = 6), were put on a 12-week ad libitum feeding challenge then necropsied. At necropsy, plasma cortisol and left and right ventricular thickness were markedly increased (P<0.05) in adult male MO offspring. Myocardial collagen content and collagen-crosslinking were greater (P<0.05) in MO offspring compared to CON offspring in association with increased mRNA and protein expression of glucocorticoid receptors (GR). No group difference was found in myocardial mineralocorticoids receptor (MR) protein expression. Further, mRNA expression for the proinflammatory cytokines: cluster of differentiation (CD)-68, transforming growth factor (TGF)-β1, and tumor necrosis factor (TNF)-α were increased (P < 0.05), and protein expression of CD-68, TGF-β1, and TNF-α tended to increase (P<0.10) in MO vs. CON offspring. These data provide evidence for MO-induced programming of elevated plasma cortisol and myocardial inflammation and fibrosis in adult offspring potentially through increased GR. [ABSTRACT FROM AUTHOR]

Objectives: We assessed characteristics that may predict outpatient appointment attendance in outpatient medical clinics among patients comorbid for serious mental illness (SMI) and type 2 diabetes (DM). Methods: Baseline covariate data from 200 individuals with SMI-DM enrolled in a randomized controlled trial (RCT) were used to examine characteristics associated with electronic health record-identified clinic appointment attendance using a generalized estimating equations approach. The analyses evaluated the relationship between clinic attendance and potentially modifiable factors including disease knowledge, selfefficacy, social support, physical health, and mental health, as well as demographic information. Results: Demographic and mental health characteristics were most associated with clinic attendance in adults with SMI-DM. Physical health was not associated with clinic attendance. Conclusions: Information on clinical and demographic characteristics and factors potentially modifiable by psychological interventions may be useful in improving adherence to treatment among SMI-DM patients. It is our hope that clinicians and researchers will use these results to help tailor adherence-facilitating interventions among people at particular risk for poor engagement in care. [ABSTRACT FROM AUTHOR]

Objectives: A 60-week randomized controlled trial assessed the effects of targeted training in illness management (TTIM) versus treatment as usual among 200 individuals with serious mental illness and diabetes mellitus.Methods: The study used the Clinical Global Impression (CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Brief Psychiatric Rating Scale (BPRS) to assess psychiatric symptoms; the Global Assessment of Functioning (GAF) and the Sheehan Disability Scale (SDS) to assess functioning; the 36-Item Short-Form Health Survey (SF-36) to assess general health, and serum glycosylated hemoglobin (HbA1c) to assess diabetes control.Results: Participants' mean±SD age was 52.7±9.5 years, and 54% were African American. They were diagnosed as having depression (48%), schizophrenia (25%), and bipolar disorder (28%). At baseline, depression severity was substantial but psychosis severity was modest. At 60 weeks, there was greater improvement among TTIM participants versus treatment-as-usual recipients on the CGI (p<.001), the MADRS (p=.016), and the GAF (p=.003). Diabetes knowledge was significantly improved among TTIM participants but not in the treatment-as-usual group. In post hoc analyses among participants whose HbA1c levels at baseline met recommendations set by the American Diabetes Association for persons with high comorbidity (53%), TTIM participants had minimal change in HbA1c over the 60-week follow-up, whereas HbA1c levels worsened in the treatment-as-usual group.Conclusions: TTIM was associated with improved psychiatric symptoms, functioning, and diabetes knowledge compared with treatment as usual. Among participants with better diabetes control at baseline, TTIM participants had better diabetes control at 60 weeks compared with recipients of treatment as usual. [ABSTRACT FROM AUTHOR]

Objective: Care for people with serious mental illness and diabetes is complicated by clinical heterogeneity. This cross-sectional analysis of 200 individuals with comorbid serious mental illness and diabetes explored differentiation between patient subgroups that were characterized on the basis of selected dimensions within a biopsychosocial framework.Methods: Relationships between self-efficacy, treatment expectation, social support, and depression were first assessed via bivariate Spearman correlations among 200 individuals participating in a randomized controlled trial who had diabetes along with major depression, bipolar disorder, or schizophrenia. Next, latent profile analyses were conducted to determine underlying subgroups on the basis of these variables. The resultant groups were compared on diabetes control, function, and symptoms.Results: Two subgroups emerged. One had more severe psychiatric symptoms, low scores on other psychosocial variables, and worse diabetes control. The other had low levels of psychiatric symptoms, better scores on other variables, and better diabetes control.Conclusions: Symptom presentation and internal and external resources appeared to be related to diabetes control for people with comorbid diabetes and serious mental illness. Care approaches need to go beyond standard education and consider biopsychosocial variables. [ABSTRACT FROM AUTHOR]

What will it take to get Americans to do something about political corruption? I mean the deep corruption of politics and policy now caused by massive campaign contributions, by lobbyists who bundle those contributions for political candidates and then influence the policy decisions of elected officials, by the revolving door between public office and lucrative private employment, and—through all these instruments and more—by the influence of wealthy individuals and interests over the agencies and institutions of government. Some people say this is just American politics as usual: money is inevitable in public life, and anyway it's all perfectly legal. Sadly, those who say this are, at this moment, winning the argument. Writing for the Supreme Court majority in Citizens United v. Federal Election Commission (2010), Justice Anthony Kennedy opined, “It is well understood that a substantial and legitimate reason, if not the only reason, to cast a vote for, or to make a contribution to, one candidate over another is that the candidate will respond by producing those political outcomes the supporter favors. Democracy is premised on responsiveness.” Cementing the case, says the Court, is the First Amendment, which protects political speech and political dollars. [ABSTRACT FROM PUBLISHER]

Objective While previous work has demonstrated elevation of both comorbid anxiety disorders and diabetes mellitus type II in individuals with serious mental illness, little is known regarding the impact of comorbid anxiety on diabetes mellitus type II outcomes in serious mental illness populations. We analyzed baseline data from patients with serious mental illness and diabetes mellitus type II to examine relationships between comorbid anxiety, glucose control as measured by hemoglobin A1c score, and overall illness burden. Methods Using baseline data from an ongoing prospective treatment study involving 157 individuals with serious mental illness and diabetes mellitus type II, we compared individuals with and without a comorbid anxiety disorder and compared hemoglobin A1c levels between these groups to assess the relationship between anxiety and management of diabetes mellitus type II. We conducted a similar analysis using cumulative number of anxiety diagnoses as a proxy for anxiety load. Finally, we searched for associations between anxiety and overall medical illness burden as measured by Charlson score. Results Anxiety disorders were seen in 33.1% (N = 52) of individuals with serious mental illness and diabetes mellitus type II and were associated with increased severity of depressive symptoms and decreased function. Hemoglobin A1c levels were not significantly different in those with or without anxiety, and having multiple anxiety disorders was not associated with differences in diabetes mellitus type II control. However, depressive symptoms were significantly associated with higher hemoglobin A1c levels. Neither comorbid anxiety nor anxiety load was significantly associated with overall medical burden. Conclusion One in three people with serious mental illness and diabetes mellitus type II had anxiety. Depressive symptoms were significantly associated with Hb1Ac levels while anxiety symptoms had no relation to hemoglobin A1c; this is consistent with previously published work. More studies are needed to better understand the relationship between depression, anxiety, and health management in people with serious mental illness and diabetes mellitus type II. [ABSTRACT FROM AUTHOR]

Maternal obesity (MO) has harmful effects on both fetal development and subsequent offspring health. We previously demonstrated that MO enhances collagen accumulation in fetal skeletal muscle, but its impact on mature offspring muscle collagen accumulation is unknown. Ewes were fed either a control diet (Con, fed 100% of NRC nutrient recommendations) or obesogenic diet (OB, fed 150% of NRC nutrient recommendations) from 60 days before conception to birth. All ewes received the Con diet during lactation. Male offspring were euthanized at 2.5 years (mean) and the left Longissimus dorsi (LD) muscle and semitendinosus (ST) muscle were sampled. Collagen concentration increased by 37.8±19.0% (P<0.05) in LD and 31.2616.0% (P<0.05) in ST muscle of OB compared to Con offspring muscle. Mature collagen cross-linking (pyridinoline concentration) was increased for 22.3±7.4% and 36.3±9.9% (P<0.05) in LD and ST muscle of OB group respectively. Expression of lysyl oxidase, lysyl hydroxylase-2b (LH2b) and prolyl 4-hydroxylase (P4HA) was higher in OB LD and ST muscle. In addition, the expression of metalloproteinases (MMPs) was lower but tissue inhibitor of metalloproteinases (TIMPs) was higher in OB offspring muscle, indicating reduced collagen remodeling. MO enhanced collagen content and cross-linking in offspring muscle, which might be partially due to reduced collagen remodeling. Our observation that the collagen content and cross-linking are enhanced in MO offspring muscle is significant, because fibrosis is known to impair muscle functions and is a hallmark of muscle aging. [ABSTRACT FROM AUTHOR]

Maternal obesity (MO) has harmful effects on both fetal development and subsequent offspring health. The impact of MO on fetal myocardium development has received little attention. Fibrogenesis is regulated by the transforming growth factor-β (TGF-β)/p38 signaling pathway. Using the well-established model of MO in pregnant sheep, we evaluated the effect of MO on TGF-β/p38 and collagen accumulation in fetal myocardiurn. Nonpregnant ewes were assigned to a control diet [Con, fed 100% of National Research Council (NRC) nutrient recommendations or obesogenic diet (OB, fed 150% of NRC recommendations) from 60 days before conception. Fetal ventricular muscle was sampled at 75 and 135 days of gestation (dG). At 75 dG, the expression of precursor TGF-β was 39.9 ± 9.9% higher (P < 0.05) in OB than Con fetal myocardium, consistent with the higher content of phosphorylated Smad3 in OB myocardium. The phosphorylation of p38 tended to be higher in OB myocardium. (P 0.08). In addition, enhanced Smad complexes were bound to Smad-binding elements in 75 dG OB fetal myocardium measured by DNA mobility shift assay (130.2 ± 26.0% higher, P < 0.05). Similar elevation of TGF-β signaling was observed in OB fetal myocardium at 135 dG. Total collagen concentration in OB was greater than Con fetal myocardium (2.42 ± 0.16 vs. 1.87 ± 0.04%, P < 0.05). Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-3 were higher in the Con group compared with OB sheep (43.86 ± 16.01 and 37.23 ± 7.97% respectively, P < 0.05). In summary, MO results in greater fetal heart connective tissue accumulation associated with an unregulated TGF-β/p38 sig- naling pathway at late gestation; such changes would be expected to negatively impact offspring heart function. [ABSTRACT FROM AUTHOR]

Maternal obesity (MO) is increasing at an alarming rate. The objective of this study was to evaluate the effect of MO on fibrogenesis in fetal skeletal muscle during maturation in late gestation. Nonpregnant ewes were assigned to a control diet (Con; fed 100% of NRC nutrient recommendations, n = 6) or obesogenic diet COB: fed 150% of NRC recommendations, n = 6) from 60 days before conception, and fetal semitendenosus (St) muscle was sampled at 135 days of gestation (term 148 days). Total concentration and area of collagen in cross-sections of muscle increased by 27.0 ± 6.0 (P < 0.05) and 105.1 ± 5.9% (P = 0.05) in OB compared with Con fetuses. The expression of precursor TGF-β was 177.3 ± 47.6% higher, and concentration of phospho-p38 74.7 ± 23.6% was higher (P < 0.05) in OB than in CON fetal muscle. Increases of 327.9 ± 168.0 (P < 0.05) and 188.9 ± 82.1% (P < 0.05), respectively, were observed for mRNA expression of Smad7 and fibronectin in OB compared with Con muscles. In addition, enzymes involved in collagen synthesis, including lysyl oxidase, lysyl hydroxylase 2b, and prolyl 4-hydroxylase-α1. were increased by 350.2 ± 90.0 (P < 0.05), 236.5 ± 25.2 (P < 0.05), and 82.0 ± 36.2% (P = 0.05). respectively, in OB muscle. In conclusion, MO-enhanced fibrogenesis in fetal muscle in late gestation was associated with upregulation of the TGF-β/p38 signaling pathway. Enhanced fibrogenesis at such an early stage of development is expected to negatively affect the properties of offspring muscle because muscle fibrosis is a hallmark of aging. [ABSTRACT FROM AUTHOR]

Objectives: To examine management strategies and goals reported by people diagnosed with chronic hepatitis C. Methods: We analyzed data from semistructured interviews (N=42) and from electronic sources [illness narratives (N=79) and Internet threaded discussions (N=264)]. Line-by-line coding, comparisons, and team discussions generated catalogs of lay management strategies and goals. We analyzed code-based files to identify informants' selection of specific strategies for each goal. Results: We classified lay management strategies into 3 categories: medical self-care, behavior change, and coping. These strategies were used selectively In addressing multiple goals, categorized as fighting the virus, strengthening the body, and managing consequences. Conclusions: Results underscore the diversity of strategies for living with a disease characterized by uncertain prognosis and variable expression of symptoms. [ABSTRACT FROM AUTHOR]

Most studies of decisions to curtail alcohol consumption reflect experiences of abusing drinkers. An exploratory sequential research design is used to explore the applicability of this research to the experience of nonabusing drinkers advised to curtail alcohol consumption after a hepatitis C diagnosis. A qualitative component identified 17 new decision factors not reflected in an inventory of factors based on synthesis of existing scales. Qualitative data were triangulated by supplementing semistructured interviews with Internet postings. A quantitative component estimated prevalence and association with current drinking of these new decision factors. Patients who quit drinking tended to attribute postdiagnosis drinking to occasional triggers, whereas patients who were still drinking were more likely to endorse rationales not tied to specific triggers. [ABSTRACT FROM PUBLISHER]

Background: Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C(HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not bea problem in the absence of their HCV diagnosis.Objective: This study explores what healthcare providers advise their HCV patients who are drinking alcohol at nonharmful levels about alcohol use and what these patients actually hear.Design: We conducted separate focus groups and interviews about alcohol use and HCV with nonharmful drinkers with HCV (N=50) and healthcare providers (N=14) at a metropolitan teaching hospital. All focus groups and interviews were audio-taped, transcribed, and analyzed using NVivo, a qualitative data management and analysis program.Results: We found similar themes about HCV and alcohol consumption (stop completely, occasional drink is ok, cut down, and provision of mixed/ambiguous messages), reported by both providers and patients.Patient respondents who reported hearing “stop completely”were more likely to have had their last medical visit at the gastroenterology (GI) clinic as opposed to the internal medicine (IM) clinic. Furthermore, IM providers were more likely to give their recommendations in“medical language” than were GI providers.Conclusions: To make the best health-related decisions about their disease, HCV patients need consistent information about alcohol consumption. Departments of Internal Medicine can increase provider knowledge about HCV and alcohol use by providing more education and training on HCV. [ABSTRACT FROM AUTHOR]

Background: Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C (HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not be a problem in the absence of their HCV diagnosis.Objective: This study explores what healthcare providers advise their HCV patients who are drinking alcohol at nonharmful levels about alcohol use and what these patients actually hear.Design: We conducted separate focus groups and interviews about alcohol use and HCV with nonharmful drinkers with HCV (N = 50) and healthcare providers (N = 14) at a metropolitan teaching hospital. All focus groups and interviews were audio-taped, transcribed, and analyzed using NVivo, a qualitative data management and analysis program.Results: We found similar themes about HCV and alcohol consumption (stop completely, occasional drink is ok, cut down, and provision of mixed/ambiguous messages), reported by both providers and patients. Patient respondents who reported hearing "stop completely" were more likely to have had their last medical visit at the gastroenterology (GI) clinic as opposed to the internal medicine (IM) clinic. Furthermore, IM providers were more likely to give their recommendations in "medical language" than were GI providers.Conclusions: To make the best health-related decisions about their disease, HCV patients need consistent information about alcohol consumption. Departments of Internal Medicine can increase provider knowledge about HCV and alcohol use by providing more education and training on HCV. [ABSTRACT FROM AUTHOR]

Collagen accumulates disproportionately in cardiac remodeling induced by hypertension and associated with advancing age. Spironolactone (Spiro), an aldosterone antagonist, attenuates the accumulation of collagen induced by hypertension. It was hypothesized that Spiro would attenuate the age-associated increase in percent collagen in the heart. Female Fisher 344 rats at 3 months (Y), 12 months (M), and 21 months (O) of age were treated with Spiro (30 mg/kg/d) or vehicle (Veh) for 2 months, yielding six groups: Y-Veh, Y-Spiro, M-Veh, M-Spiro, O-Veh, and O-Spiro. Hearts were harvested for immunoblotting, RNA blotting, and biochemical analysis. Percent collagen in the left ventricle and septum was greatest in the oldest rats. Spiro did not significantly attenuate the age-associated increase in collagen fraction or the age-associated increases in expression of atrial natriuretic factor and β-myosin heavy chain messenger RNA. Chronic aldosterone antagonism does not attenuate the age-associated increase in collagen fraction in the female Fisher 344 rat heart. [ABSTRACT FROM AUTHOR]

Aims: Little is known about how non-problematic drinkers respond to advice to reduce alcohol consumption as part of disease management. In this article, we examine patient reports of drinking behaviour after being diagnosed with chronic hepatitis C, a condition for which alcohol consumption is contraindicated. Methods: In this qualitative study, we analyzed transcripts of semi-structured interviews with hepatitis C virus+ (HCV+) patients whose level of alcohol consumption would not be considered problematic in the absence of their diagnosis. Results: Most respondents reported some instances of adherence, but only half adhered to the advice to limit drinking consistently over time. Respondents who did not stop drinking often modified their behaviour by changing the type of alcohol consumed or limiting drinking to particular occasions. Conclusion: Most informants understood the risks of drinking after HCV infection, particularly in the presence of symptoms, with the onset of complications, or when undergoing treatment. But some believed they could monitor their bodies for evidence of disease progression or that drinking was acceptable during early, asymptomatic stages of infection. Our results also identified situations in which patients need support in adhering to intentions not to drink, including social pressures, stressful situations, or environmental triggers. [ABSTRACT FROM AUTHOR]

We report a genome-wide survey of early responses of the mouse heart transcriptome to acute myocardial infarction (AMI). For three regions of the left ventricle (LV), namely, ischemic/infarcted tissue (IF), the surviving LV free wall (FW), and the interventricular septum (IVS), 36,899 transcripts were assayed at six time points from 15 min to 48 h post-AMI in both AMI and sham surgery mice. For each transcript, temporal expression patterns were systematically compared between AMI and sham groups, which identified 515 AMI-responsive genes in IF tissue, 35 in the FW, 7 in the IVS, with three genes induced in all three regions. Using the literature, we assigned functional annotations to all 519 nonredundant AMI-induced genes and present two testable models for central signaling pathways induced early post-AMI. First, the early induction of 15 genes involved in assembly and activation of the activator protein-1 (AP-1) family of transcription factors implicates AP-1 as a dominant regulator of earliest post-ischemic molecular events. Second, dramatic increases in transcripts for arginase 1 (ARG1), the enzymes of polyamine biosynthesis, and protein inhibitor of nitric oxide synthase (NOS) activity indicate that NO production may be regulated, in part, by inhibition of NOS and coordinate depletion of the NOS substrate, L-arginine. ARG1 was the single-most highly induced transcript in the database (121-fold in IF region) and its induction in heart has not been previously reported. [ABSTRACT FROM AUTHOR]

This study examined the long-term relationship of changes in the motivation to remedy alcohol abuse to alcohol use severity among patients with a dual diagnosis of substance abuse disorder and severe and persistent mental illness. Linear regression analyses showed that patients who increasingly recognized alcohol use problems over a 9-month period exhibited signify- scantly greater alcohol use severity at 9 months and a significant increase in alcohol use severity over time. Moreover, patients who became increasingly determined to take actions against alcohol use over a 9-month period exhibited significantly lower alcohol use severity at 9 months and a significant decrease in alcohol use severity over time. The findings support Prochaska et al.'s transtheoretical model of the motivation for change. They suggest that the recognition of alcohol use problems comes along with learning adverse consequences of alcohol use and that increased determination to take actions is critical to the long-term behavioral changes in alcohol use. [ABSTRACT FROM AUTHOR]

To date, no study has assessed the degree of similarity between left ventricular (LV) reverse remodeling and atrophic remodeling. Stable LV hypertrophy was induced by creation of an arteriovenous fistula (AVF) in Lewis rats (32 days). LV unloading was induced by heterotopic transplantation of normal (NL-HT) and/or hypertrophic (AVF-HT) hearts (7 days). We compared indexes of remodeling in AVF, NL-HT, and AVF-HT groups with those of normal controls. LV unloading induced decreases in cardiomyocyte size in NL-HT and AVF-HT hearts. NL-HT and AVF-HT LV were both characterized by relative increases in collagen concentration that were largely a reflection of decreases in myocyte volume. NL-HT and AVF-HT LV were associated with similar increases in matrix metalloproteinase (MMP-2 and -9) zymographic activity, without change in the abundance of the tissue inhibitors of the MMPs. In contrast, AVF-HT, but not NL-HT, was associated with a dramatic increase in collagen cross-linking. Our findings suggest an overall similarity in the response of the normal and hypertrophic LV to surgical unloading. However, the dramatic increase in collagen cross-linking after just 1 wk of unloading suggests a potential difference in the dynamics of collagen metabolism between the two models. Further studies will be required to determine the precise molecular mechanisms responsible for these differences in extracellular matrix regulation. However, with respect to these and related issues, heterotopic transplantation of hypertrophied hearts will be a useful small animal model for defining mechanisms of myocyte-matrix interactions during decreased loading conditions. [ABSTRACT FROM AUTHOR]

Examines the temporal relationship between two types of messenger RNA (mRNA) for the principal fibrillar procollagens and subsequent collagen accretion, cross-linking and decorin expression in the left-ventricle postmyocardial infarction. Comparison between heart weight/body weight of infarcted group and control group; Characteristics of procollagen mRNA; Lack of of decorin antibody cross-reactivity with other muscle proteins.

The purpose of this study was to compare the independent and interactive effects of age and exercise training on selected parameters of the right ventricle (RV), left ventricular septum (LVS) and left ventricular free-wall (LVFW) extracellular matrix. Specifically, we evaluated collagen and collagen crosslinking (hydroxylysylpyridinoline, HP) concentrations in the myocardial extracellular matrix in young adult, Y (5.5 months) and old, O (25.5 months) male Fischer 344 rats. Rats were assigned to either a sedentary control (YC, OC) or an exercise training group (YT, OT). Rats were trained for 45 min/day, 5 days/week, for 10 weeks at ≅70% of maximal oxygen consumption. Following the training regimen, rats were sacrificed and their hearts were dissected into the RV, LVS and LVFW. Training resulted in a significant hypertrophy of the left ventricle (LV) but not RV relative to body weight. In young rats, collagen concentration was significantly higher (P<0.01) in RV compared to LVS, but not LVFW. With aging, collagen concentration increased significantly (P<0.05) in both ventricles, but more so in LV than RV so that differences in percent collagen observed between chambers in both YC and YT rats no longer existed in OC and OT animals. This aging effect was attenuated by training in the LVS but not the LVFW, so that collagen concentration, while higher in this region of the LV in OT compared to YT rats, was also lower than that seen in the LVS of OC rats. HP crosslink concentration in the LVS and LVFW, but not the RV of OC rats was significantly elevated above corresponding values seen in YC rats (P<0.05 or greater). In YT rats, training had no effect on HP crosslinking concentration in any of the three regions of the heart. However, in OT rats, training completely prevented the age-associated increase in crosslinking seen in both the LVS and LVFW of OC animals. These findings illustrate the different responses of the RV, LVS and LVFW extracellular matrix components, collagen and HP crosslinking, to both aging and training in the rodent. [ABSTRACT FROM AUTHOR]

The impact of the change in level of hostility and aggression on subsequent substance abuse (drug, alcohol, or combined) recovery was investigated. One hundred and thirty-two dually diagnosed veterans completed an inpatient treatment programme at a large DVA Medical Centre. Results showed significant decreases in addiction severity over 3 month and 12 month following-up. At 3 months, pretreatment severity was predictive of drug, alcohol, and drug/alcohol severity whereas change in hostility and aggression scores were not. At 12 months, however, pretreatment severity was predictive only of drug severity whereas change in hostility and aggression were predictive of alcohol and combined drug/alcohol severity. Implications for changes in substance abuse correlates over time are discussed. [ABSTRACT FROM AUTHOR]

Discusses the issues involved in the German film 'BeFreier und Befreite' directed by Helke Sander. Overview of the film; Use of montage, irony and reflexivity; Controversy over historical contextualizations.

Objective: Data from 157 individuals with serious mental illness and comorbid diabetes enrolled in an ongoing treatment study were used to examine clinical correlates of diabetes control. Methods: Factors assessed included depressive symptoms (Montgomery-Asberg Depression Rating Scale), global psychopathology severity (Brief Psychiatric Rating Scale), and glycosylated hemoglobin (HbAlc). a biomarker of diabetes control. Results: Seventy-seven participants had depression, 40 had schizophrenia, and 40 had bipolar disorder. Most were moderately to severely depressed with poor diabetes control. No correlation between diagnosis and diabetes control was found after adjustment for gender, race, health literacy, diabetes duration, and diabetes knowledge. Greater depression severity and longer diabetes duration were related to poorer diabetes control. Lower severity of global psychopathology was related to poorer diabetes control, perhaps because of overall low levels of psychosis and mania. Conclusions: People with serious mental illness and diabetes face multiple challenges, which, along with severe depression, may impede diabetes self-management. [ABSTRACT FROM AUTHOR]

Objective: The study aim was to determine the prevalence of repeated assaults on staff and other patients and characteristics of patients who commit repeated assaults in the Veterans Health Administration of the Department of Veterans Affairs. Methods: Patients in VA medical centers and freestanding outpatient clinics who committed two or more assaults in fiscal years 1995 and 1996 were identified through a survey of facility quality or risk managers. For each repeatedly assaultive patient, structured information, including incident reports, was obtained for all assault occasions. Results: A total of 153 VA facilities responded, for a response rate of 99 percent. The survey identified 8,968 incidents of repeated assault by 2,233 patients, for a mean of 4.02 assaults per patient in the two-year study period. In 92 percent of the incidents, the assaultive patient had a primary or secondary psychiatric diagnosis. The mean age of the repeat assaulters was 62 years. Ninety-eight percent of the repeat assaulters were male, and 76.6 percent were Caucasian. At least 16 percent of the assaulters, 22 percent of the patients assaulted, and 20 percent of the staff assaulted required medical attention for injuries, which, along with the number of lost work days, indicates that repeated assaults are costly. Conclusions: Repeatedly assaultive patients represent major challenges to their own safety as well as to that of other patients and staff. Identifying patients at risk for repeated assaults and developing intervention strategies is critically important for ensuring the provision of health care to the vulnerable population of assaultive patients. [ABSTRACT FROM AUTHOR]

Objective: To more clearly define the scope and impact of violence in health care facilities, national data on assaults in VA medical centers and freestanding clinics were examined. Methods: A survey was distributed to all VA medical centers and freestanding clinics asking for cumulative data for one fiscal year (October 1990 through September 1991). Data were obtained on number, types, and locations of physical assaults and other assaultive behavior; the types of staff assaulted and number of workdays lost due to injuries; diagnoses of perpetrators; recommendations made after the incidents were reviewed; training in prevention and management of assaultive behavior; and the impact of training on rates of assaultive behavior. Results: During the survey year, 24,219 incidents of assaultive behavior were reported by 166 VA facilities; 8,552 incidents involved battery or physical assault. Weapon possession by perpetrators was common (8.5 percent of incidents), and weapons were used in 130 assaults (1.5 percent of assaults). Assaults occurred most frequently in psychiatric units (43.1 percent), followed by long-term-care units (18.5 percent) and admitting or triage areas (13.4 percent). Assault- related injuries were most common among nursing personnel. Perpetrators of assaults were most typically diagnosed as having psychoses, substance use disorders, or dementia. On inpatient psychiatry units, an inverse correlation was found between expenditures on staffing and the frequency of assaultive incidents. Staff training on management of assaultive behavior varied widely. Conclusions: Assaultive behavior is a significant problem for health care workers. Staff in all clinical areas need to be prepared to deal with assaultive patients. More research is needed on staff training and interventions for preventing and limiting assaults. [ABSTRACT FROM AUTHOR]

The human person makes great demands on the physician and calls for unique attention. Hence the doctor-patient relationship calls for the highest ideals of kindness, patience, trustworthiness, generosity and skill. The Catholic physician brings to these demands a specific meaning: ministering to the sick is to see Christ in them and to show Him to them. [ABSTRACT FROM AUTHOR]

Focuses on how business interests corrupted politics in 19th and 20th centuries in the U.S. Changes in the methods of participation in politics; Impact of commercial development on the Republican government; States accused of politico-business corruption; Role of state parties in politico-business corruption.

Presents a study on whether the leucine zipper will induce electrophoretic mobility anomalies without DNA bending. DNA template construction and protein constructs; Circular permutation analyses; Gel electrophoretic affinity studies.

Reports that pre-bending of a promoter sequence enhances the affinity for the TATA-binding factor. Factors determining DNA topology; Importance of DNA topology in control of transcription.

Pathological gamblers entering a comprehensive treatment program were thoroughly assessed before treatment and 6 months after completion of treatment. The reports of gamblers and collateral informants were highly consistent. Follow-up interviews were conducted with 57 of the 66 patients entering treatment. Total abstinence was reported by 56% (N=32) of the patients located for follow-up, and significant improvement on a wide range of measures was documented. The authors feel that the results demonstrate that pathological gambling is a treatable mental disorder. [ABSTRACT FROM AUTHOR]

Reviews early journalistic, episcopal and scholarly reactions to the papal encyclical `Veritatis Splendor.' Critical issues concerning the encyclical; Positive value of the encyclical; Meaning of the object; Ecclesiology.