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Introduction 371 I. Cliodynamics and Complexity 377 II. Sociolegal Patterns of Mass Incarceration in the United States 384 A. Historical Prison Trends 384 B. Preparedness of Legal Systems 387 C. [...]

On the third anniversary of the World Health Organization's declaration of a global pandemic, Gen Z's first congressional representative, Maxwell Alejandro Frost, advocated for a reduction in the Pentagon's budget to better serve local communities. This perspective underscores the economic and moral rationale for reallocating national defense funds to communities. The call for defunding the police has gained momentum, paralleling the advocacy for demilitarization. This Article emphasizes the overlooked impact of U.S. military carbon emissions on climate change and advocates for its inclusion in national carbon accounting systems globally. The U.S. Department of Defense has not been transparent about its carbon footprint, excluding significant military emissions from most official reports. Including military carbon emissions in national assessments can strengthen the U.S.'s stance in climate negotiations. Reallocating the Pentagon budget to support climate change initiatives would foster international cooperation and peace. This demilitarization could symbolize the U.S.'s commitment to disarmament, inspiring global stability, and resilience against climate-induced challenges. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to estimate clinical, economic (including productivity), and health‐related quality of life (HRQoL) outcomes and associated individual characteristics among adults with overweight (OW) or obesity in the United States. Methods: This study included adult respondents with body mass index (BMI) ≥18.5 kg/m2 in the 2017–2018 National Health and Nutrition Examination Survey (NHANES) and 2016 Medical Expenditure Panel Survey. Respondents were classified according to BMI. Individual characteristics were described by BMI categories. Multivariable regression models estimated the association between BMI categories and outcomes, adjusting for individual characteristics. Results: Nearly three‐quarters (73.7%) of NHANES participants were OW or obese. Relative to Normal weight (NW), respondents with Class 3 obesity had more obesity‐related complications (2.07 vs. 4.62, p < 0.001). Higher BMI was associated with significantly lower HRQoL, lower productivity, and higher healthcare expenditures as well as more frequent weight loss attempts in the previous 12 months. Weight loss surgery and prescription anti‐obesity medications (AOMs) were used only by a very small proportion of individuals. Despite frequent weight loss attempts, most respondents did not achieve clinically meaningful weight loss. Conclusions: Adults with OW or obesity experienced worse clinical, economic and HRQoL outcomes than those with NW. Better use of evidence‐based obesity treatments, including prescription AOMs, should be considered to achieve more clinically meaningful weight reduction and improved outcomes in individuals with OW or obesity. [ABSTRACT FROM AUTHOR]

Background: Obesity is associated with an increased risk of multiple conditions, ranging from heart disease to cancer. However, there are few predictive models for these outcomes that have been developed specifically for people with overweight/obesity. Objective: To develop predictive models for obesity‐related complications in patients with overweight and obesity. Methods: Electronic health record data of adults with body mass index 25–80 kg/m2 treated in primary care practices between 2000 and 2019 were utilized to develop and evaluate predictive models for nine long‐term clinical outcomes using a) Lasso‐Cox models and b) a machine‐learning method random survival forests (RSF). Models were trained on a training dataset and evaluated on a test dataset over 100 replicates. Parsimonious models of <10 variables were also developed using Lasso‐Cox. Results: Over a median follow‐up of 5.6 years, study outcome incidence in the cohort of 433,272 patients ranged from 1.8% for knee replacement to 11.7% for atherosclerotic cardiovascular disease. Harrell C‐index averaged over replicates ranged from 0.702 for liver outcomes to 0.896 for death for RSF, and from 0.694 for liver outcomes to 0.891 for death for Lasso‐Cox. The Harrell C‐index for parsimonious models ranged from 0.675 for liver outcomes to 0.850 for knee replacement. Conclusions: Predictive modeling can identify patients at high risk of obesity‐related complications. Interpretable Cox models achieve results close to those of machine learning methods and could be helpful for population health management and clinical treatment decisions. [ABSTRACT FROM AUTHOR]

Aim: To assess the effect of tirzepatide on long‐term risk of atherosclerotic cardiovascular disease (ASCVD) among people with obesity or overweight without diabetes from SURMOUNT‐1. Materials and Methods: SURMOUNT‐1, a phase 3 trial, evaluated the efficacy and safety of tirzepatide in adults with body mass index ≥30 or ≥27 kg/m2 and at least one weight‐related complication, excluding diabetes. Participants were randomly assigned to tirzepatide (5/10/15 mg) or placebo. Changes from baseline in cardiometabolic variables were assessed. The predicted 10‐year ASCVD risk scores were calculated (American College of Cardiology/American Heart Association risk engine) at baseline, week 24, and week 72 in SURMOUNT‐1 participants without a history of ASCVD. Percent change in risk scores from baseline to weeks 24 and 72 was compared between tirzepatide and placebo using mixed model for repeated measures analysis. Analyses were also conducted in participants with intermediate to high risk at baseline. Results: Tirzepatide‐treated groups demonstrated reductions in cardiometabolic variables over 72 weeks. In participants without a history of ASCVD (N = 2461), the baseline median risk score was low and did not differ across groups (1.5%–1.6%). Relative change in risk from baseline to week 72 was greater for tirzepatide (−23.5% to −16.4%) than placebo (12.7%; P < 0.001). Relative change among participants with intermediate‐to‐high baseline risk was significantly greater for tirzepatide (P < 0.05). Intermediate‐to‐high‐risk participants demonstrated similar relative change but greater absolute risk reduction compared to the overall population. Conclusion: Tirzepatide treatment significantly reduced the 10‐year predicted risk of ASCVD versus placebo in patients with obesity or overweight without diabetes. [ABSTRACT FROM AUTHOR]

Key Points: Question: Does once-weekly subcutaneous tirzepatide with diet and physical activity affect maintenance of body weight reduction in individuals with obesity or overweight? Findings: After 36 weeks of open-label maximum tolerated dose of tirzepatide (10 or 15 mg), adults (n = 670) with obesity or overweight (without diabetes) experienced a mean weight reduction of 20.9%. From randomization (at week 36), those switched to placebo experienced a 14% weight regain and those continuing tirzepatide experienced an additional 5.5% weight reduction during the 52-week double-blind period. Meaning: In participants with obesity/overweight, withdrawing tirzepatide led to substantial regain of lost weight, whereas continued treatment maintained and augmented initial weight reduction. Importance: The effect of continued treatment with tirzepatide on maintaining initial weight reduction is unknown. Objective: To assess the effect of tirzepatide, with diet and physical activity, on the maintenance of weight reduction. Design, Setting, and Participants: This phase 3, randomized withdrawal clinical trial conducted at 70 sites in 4 countries with a 36-week, open-label tirzepatide lead-in period followed by a 52-week, double-blind, placebo-controlled period included adults with a body mass index greater than or equal to 30 or greater than or equal to 27 and a weight-related complication, excluding diabetes. Interventions: Participants (n = 783) enrolled in an open-label lead-in period received once-weekly subcutaneous maximum tolerated dose (10 or 15 mg) of tirzepatide for 36 weeks. At week 36, a total of 670 participants were randomized (1:1) to continue receiving tirzepatide (n = 335) or switch to placebo (n = 335) for 52 weeks. Main Outcomes and Measures: The primary end point was the mean percent change in weight from week 36 (randomization) to week 88. Key secondary end points included the proportion of participants at week 88 who maintained at least 80% of the weight loss during the lead-in period. Results: Participants (n = 670; mean age, 48 years; 473 [71%] women; mean weight, 107.3 kg) who completed the 36-week lead-in period experienced a mean weight reduction of 20.9%. The mean percent weight change from week 36 to week 88 was −5.5% with tirzepatide vs 14.0% with placebo (difference, −19.4% [95% CI, −21.2% to −17.7%]; P <.001). Overall, 300 participants (89.5%) receiving tirzepatide at 88 weeks maintained at least 80% of the weight loss during the lead-in period compared with 16.6% receiving placebo (P <.001). The overall mean weight reduction from week 0 to 88 was 25.3% for tirzepatide and 9.9% for placebo. The most common adverse events were mostly mild to moderate gastrointestinal events, which occurred more commonly with tirzepatide vs placebo. Conclusions and Relevance: In participants with obesity or overweight, withdrawing tirzepatide led to substantial regain of lost weight, whereas continued treatment maintained and augmented initial weight reduction. Trial Registration: ClinicalTrials.gov Identifier: NCT04660643 This randomized clinical trial examines the effect of tirzepatide on the maintenance of weight reduction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the diagnostic accuracy of ultrasonography in detecting choledocholithiasis in obstructive jaundice patients taking magnetic resonance cholangiopancreatography as gold standard. MATERIAL AND METHODS: This Cross-Sectional validation study was conducted at department of Radiology, KRL Hospital, Islamabad from 31st January 2021 to 31st July 2021. A total of 150 patients of both gender presenting with obstructive jaundice were included in the study. The patient underwent directly under a limited sonographic scan covering the area of pancreato-biliary region. The ultrasound was performed by using a curved low frequency probe (2-5 MHz). The pancreato-biliary region was evaluated with grayscale ultrasound. Findings from both ultrasound and MRCP were noted. RESULTS: Age range in this study was from 18 to 70 years with mean age of 42.113 - 7.64 years and mean weight was 80.220 - 6.76 Kg. Ultrasound showed sensitivity of 76.3%, specificity 92.3%, diagnostic accuracy 86%, PPV 86.5% and NPV by 85.7%. CONCLUSION: Ultrasound has a moderate sensitivity, high specificity and a high diagnostic accuracy in diagnosis of obstructive jaundice. [ABSTRACT FROM AUTHOR]