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Background: Identifying risk factors for advanced colorectal adenomas may aid in colorectal cancer (CRC) screening, especially in light of the American College of Gastroenterology's recent guidelines, emphasizing cancer prevention through identification and removal of advanced adenomas. Smoking is an important risk factor for advanced adenomas but there is little data regarding levels of exposure for genders.Methods: The aim of this study was to use an existing database to examine the genders separately with respect to exposure level and anatomic location of advanced adenomas. Our database was designed to study smoking in an asymptomatic, screening population. Data included demographics, family history of CRC, smoking exposure (pack-years and years smoked), alcohol, diabetes, medications, exercise and dietary history. We excluded patients with a first degree relative with CRC.Results: Compared to non-smokers, female smokers had an increased risk for advanced adenomas with an exposure of 10-30 pack-years (adjusted odds ratio [AOR] = 4.11; 95% confidence interval [CI], 1.88-9.01) as well as for ≥30 pack-years (AOR = 2.54; 95% CI, 1.08-5.96) while men had an increased risk with smoking ≥30 pack-years (AOR = 3.10; 95% CI, 1.71-5.65). An increased association with smoking was observed for proximal advanced adenomas (AOR = 4.06; 95% CI, 1.62-10.19) and large hyperplastic polyps in women.Conclusions: Women smokers had an increased risk for advanced adenomas at a lower exposure level and had a greater risk for proximal lesions. These findings may have an impact on CRC screening for women. [ABSTRACT FROM AUTHOR]

Rationale: Most trainees in combined pulmonary and critical care medicine fellowship programs complete in-service training examinations (ITEs) that test knowledge in both disciplines. Whether ITE scores predict performance on the American Board of Internal Medicine Pulmonary Disease Certification Examination and Critical Care Medicine Certification Examination is unknown.Objectives: To determine whether pulmonary and critical care medicine ITE scores predict performance on subspecialty board certification examinations independently of trainee demographics, program director competency ratings, fellowship program characteristics, and prior medical knowledge assessments.Methods: First- and second-year fellows who were enrolled in the study between 2008 and 2012 completed a questionnaire encompassing demographics and fellowship training characteristics. These data and ITE scores were matched to fellows' subsequent scores on subspecialty certification examinations, program director ratings, and previous scores on their American Board of Internal Medicine Internal Medicine Certification Examination. Multiple linear regression and logistic regression were used to identify independent predictors of subspecialty certification examination scores and likelihood of passing the examinations, respectively.Measurements and Main Results: Of eligible fellows, 82.4% enrolled in the study. The ITE score for second-year fellows was matched to their certification examination scores, which yielded 1,484 physicians for pulmonary disease and 1,331 for critical care medicine. Second-year fellows' ITE scores (β = 0.24, P < 0.001) and Internal Medicine Certification Examination scores (β = 0.49, P < 0.001) were the strongest predictors of Pulmonary Disease Certification Examination scores, and were the only significant predictors of passing the examination (ITE odds ratio, 1.12 [95% confidence interval, 1.07-1.16]; Internal Medicine Certification Examination odds ratio, 1.01 [95% confidence interval, 1.01-1.02]). Similar results were obtained for predicting Critical Care Medicine Certification Examination scores and for passing the examination. The predictive value of ITE scores among first-year fellows on the subspecialty certification examinations was comparable to second-year fellows' ITE scores.Conclusions: The Pulmonary and Critical Care Medicine ITE score is an independent, and stronger, predictor of subspecialty certification examination performance than fellow demographics, program director competency ratings, and fellowship characteristics. These findings support the use of the ITE to identify the learning needs of fellows as they work toward subspecialty board certification. [ABSTRACT FROM AUTHOR]

The article discusses the constitutionality of warrantless wiretapping surveillance by the National Security Agency on U.S. citizens. The wiretapping program existed weeks after the September 11, 2001 attacks, on the justification that Congress authorized the president to warrantless wiretap U.S. citizens, and that the president had inherent authority as commander-in-chief. But it is argued that Congress did not expressly authorize the president to do wireless wiretapping and neither has he such inherent authority.

Presents a regional overview of the Central Yupik, the Yukon-Kuskokwim Delta, Northern Bristol Bay and Nunivak Island. Basis for grouping the three islands; Cultural history; Expansion of coastal residents onto the delta; Effect of technological innovation and population growth.

At the Madeleine Borg Child Guidance Institute, New York City, 227 families were treated In a short term program with contact limited to a maximum of twelve anions. Data are presented on numerous variables related to improvement in both the child and his parents. The results Indicate that, with selected cases, this is an efficacious type of Intervention that yields durable benefits. [ABSTRACT FROM AUTHOR]

This article focuses on the establishment of the journal "Hollywood Quarterly" as further evidence of Hollywood's search for maturity. The synthesis of the more formal educative forces and the magical techniques of Hollywood finds material expression in the new Hollywood Quarterly. Sponsored jointly by the University of California, Berkeley, and the Hollywood Writers Mobilization, this journal is an exploratory venture in a new held of non-commercial periodical publishing. This cooperation between the university scholars and the mass media creative workers has been fundamental in the activities of the Hollywood Writers Mobilization, and is the basis of the co-sponsorship of the Hollywood Quarterly by the University of California and the Mobilization. The establishment of this journal is a recognition of the increasing area of interest common to education and such agencies of mass communication as motion pictures, radio and television. Creative workers in Hollywood were drawn together by a common realization that talent must serve more than its own immediate interests. This was the genesis of the Hollywood Writers Mobilization, which has become a kind of center of cultural gravity in the film capital.

Focuses on the devaluation and subsequent repudiation of the first federal currency, the paper dollars issued by the Continental Congress in the United States. Depreciation of the currency; Reaction of American citizens to the repudiation of the currency.

Discusses some observations and conclusions relative to the mind's dedication to survival, a central theoretical concept in the Erhard Seminars Training in the U.S. Details on the terminology used; Types of mental activities; Definition of the mind.

Background: The incidence of alcoholic liver disease (ALD) has increased, causing it to become a primary indication for liver transplantation in the United States. We hypothesized an association between alcohol taxation and prevalence of ALD.Methods: We conducted a retrospective study of united network for organ sharing (UNOS) waitlist additions for liver transplantation between January 2007 and December 2016. We also analyzed the average excise tax (2007-2016) for beer, wine, and spirits in listing states of liver transplant waitlist additions (LTWA).Results: There were 104 805 adult UNOS LTWA with assigned diagnoses, an annual increase from 22% to 28%. There were 24 316 LTWA with ALD diagnosis. The mean value for beer tax was significantly lower for ALD patients than for non-ALD patients across all age groups (P < .001). The analysis demonstrated significantly more ALD in waitlisted patients 35-54 years of age (30%), compared with 18-34 years (10%) and ≥55 years (20%), P < .001. The data confirmed significantly more ALD Medicaid patients in the 35-54 year age group (28%) compared with other age groups, P < .001.Discussion: Our research demonstrated an association between lower beer tax and higher ALD prevalence across all age groups. We found a larger percentage of middle-aged (35-54 years) Medicaid patients listed with ALD. These findings raise the need for further investigation of a potential public health concern for an association between ALD and beer tax, especially for middle-aged patients of lower socioeconomic status. [ABSTRACT FROM AUTHOR]

Purpose. The question of whether publication of selected clinical trials is temporally followed by changes in prescribing of adjunctive lipid-lowering medications was evaluated. Methods. In this retrospective preanalysis and postanalysis, Veterans Health Administration (VHA) patients 18 years or older who received a new or renewed order for any lipid-lowering medication between April 2, 2004, and September 2, 2014, were included. This period was chosen based on the publication dates of three trials investigating the efficacy of nonstatin medications: Simvastatin with or without Ezetimibe in Familial Hypercholesterolemia (ENHANCE, April 3, 2008), Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus (ACCORD Lipid, March 14, 2010), and Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy (AIM-HIGH, December 15, 2011). Annual prescribing rates for ezetimibe, fibrates, and niacin were analyzed for 4 years before and after the ENHANCE, ACCORD, and AIM-HIGH trial publication dates, respectively (3 years for niacin in AIM-HIGH) and reported as percent of patients in the cohort. Results. Among patients receiving lipid-lowering medications, relatively low overall prescribing rates were observed for all three target medications. Prescribing rates for each medication decreased after its respective trial publication, with ezetimibe having the greatest change. Conclusion. Prescribing of ibrates, niacin, and ezetimibe in the VHA system decreased after the publication of landmark trials assessing their addition to a statin, consistent with the recommendations in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline, which did not encourage routine use of adjunctive therapies to lower the risk of cardiovascular disease. [ABSTRACT FROM AUTHOR]