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Chronic disease collaboratives help practices redesign care delivery. The North Carolina Improving Performance in Practice program provides coaches to guide implementation of 4 key practice changes: registries, planned care templates, protocols, and self-management support. Coaches rate progress using the Key Drivers Implementation Scales (KDIS). This study examines whether higher KDIS scores are associated with improved diabetes outcomes.We analyzed clinical and KDIS data from 42 practices. We modeled whether higher implementation scores at year 1 of participation were associated with improved diabetes measures during year 2. Improvement was defined as an increase in the proportion of patients with hemoglobin A1C values9%, blood pressure values130/80 mmHg, and low-density lipoprotein (LDL) levels100 mg/dL.Statistically significant improvements in the proportion of patients who met the LDL threshold were noted with higher "registry" and "protocol" KDIS scores. For hemoglobin A1C and blood pressure values, none of the odds ratios were statistically significant.Practices that implement key changes may achieve improved patient outcomes in LDL control among their patients with diabetes. Our data confirm the importance of registry implementation and protocol use as key elements of improving patient care. The KDIS tool is a pragmatic option for measuring practice changes that are rooted in the Chronic Care Model.

Reducing anthropogenic greenhouse gas (GHG) emissions in material quantities, globally, is a critical element in limiting the impacts of global warming. GHG emissions associated with energy extraction and use are a major component of any strategy addressing climate change mitigation. Non-emitting options for electrical power and liquid transportation fuels are increasingly considered key components of an energy system with lower overall environmental impacts. Renewable energy technologies (RETs) as well as biofuels technologies have been accelerating rapidly during the past decades, both in technology performance and cost-competitiveness — and they are increasingly gaining market share. These technology options offer many positive attributes, but also have unique cost/benefit trade-offs, such as land-use competition for bioresources and variability for wind and solar electric generation technologies. This paper presents a brief summary of status, recent progress, some technological highlights for RETs and biofuels, and an analysis of critical issues that must be addressed for RETs to meet a greater share of the global energy requirements and lower GHG emissions.

Chronic inflammation is a process where dendritic cells (DCs) are constantly sampling antigen in the skin and migrating to lymph nodes where they induce the activation and proliferation of T cells. The T cells then travel back to the skin where they release cytokines that induce/maintain the inflammatory condition. This process is cyclic and ongoing. We created a differential equations model to reflect the initial stages of the inflammatory process. In particular, we modeled antigen stimulation of DCs in the skin, movement of DCs from the skin to a lymph node, and the subsequent activation of T cells in the lymph node. The model was able to simulate DC and T cell responses to antigen introduction taking place within realistic time scales. The goal of such a preliminary model is simply to be able to capture biologically realistic dynamics. Future models can then build on this preliminary model in directions that can potentially allow not only for model validation, but for predictions and hypothesis testing.

(2006). Yeast through the Ages: a Statistical Analysis of Genetic Changes in Aging Yeast. CHANCE: Vol. 19, Genomics: Special Section on Genomics Statistics, pp. 39-44.

The X chromosome is generally understudied in association studies, in part because the analyst has had limited methodological options. For nuclear-family-based association studies, most current methods extend the transmission disequilibrium test (TDT) to the X chromosome. We present a new method to study association in case-parent triads: the parent-informed likelihood ratio test for the X chromosome (PIX-LRT). Our method enables estimation of relative risks and takes advantage of parental genotype information and the sex of the affected offspring to increase statistical power to detect an effect. Under a parental exchangeability assumption for the X, if case-parent triads are complete, the parents of affected offspring provide an independent replication sample for estimates based on transmission distortion to their affected offspring. For each offspring sex we combine the parent-level and the offspring-level information to form a likelihood ratio test statistic; we then combine the two to form a composite test statistic. Our method can estimate relative risks under different modes of inheritance or a more general co-dominant model. In triads with missing parental genotypes, the method accounts for missingness with the Expectation-Maximization algorithm. We calculate non-centrality parameters to assess the power gain and robustness of our method compared to alternative methods. We apply PIX-LRT to publically available data from an international consortium of genotyped families affected by the birth defect oral cleft and find a strong, internally-replicated signal for a SNP marker related to cleft lip with or without cleft palate.

OBJECTIVE Reduced maternal plasma levels of the peptide vasodilator adrenomedullin have been associated with adverse pregnancy outcomes. We measured the extent to which genetic polymorphisms in the adrenomedullin signaling pathway are associated with birth weight, glycemic regulation, and preeclampsia risk. STUDY DESIGN We genotyped 1,353 women in the Pregnancy, Infection, and Nutrition Postpartum Study for 37 ancestry-informative markers and for single-nucleotide polymorphisms in adrenomedullin (ADM), complement factor H variant (CFH), and calcitonin receptor-like receptor (CALCRL). We used linear and logistic regression to model the association between genotype and birth weight, glucose loading test (GLT) results, preeclampsia, and gestational diabetes (GDM). All models were adjusted for pregravid body mass index, maternal age, and probability of Yoruban ancestry. p values of

PURPOSE This study examined how characteristics of practice leadership affect the change process in a statewide initiative to improve the quality of diabetes and asthma care. METHODS We used a mixed methods approach, involving analyses of existing quality improvement data on 76 practices with at least 1 year of participation and focus groups with clinicians and staff in a 12-practice subsample. Existing data included monthly diabetes or asthma measures (clinical measures) and monthly practice implementation, leadership, and practice engagement scores rated by an external practice coach. RESULTS Of the 76 practices, 51 focused on diabetes and 25 on asthma. In aggregate, 50% to 78% made improvements within in each clinical measure in the fi rst year. The odds of making practice changes were greater for practices with higher leadership scores (odds ratios = 2.41-4.20). Among practices focused on diabetes, those with higher leadership scores had higher odds of perform- ing nephropathy screening (odds ratio = 1.37, 95% CI, 1.08-1.74); no signifi cant associations were seen for the intermediate outcome measures of hemoglobin A1c, blood pressure, and cholesterol. Focus groups revealed the importance of a leader, typically a physician, who believed in the transformation work (ie, a visionary leader) and promoted practice engagement through education and cross-training. Practices with greater change implementation also mentioned the importance of a midlevel operational leader who helped to create and sustain practice changes. This person communicated and interacted well with, and was respected by both clinicians and staff. CONCLUSIONS In the presence of a vision for transformation, operational leaders within practices can facilitate practice changes that are associated with clinical improvement.

Objective To determine whether genetic variants associated with glucose homeostasis are associated with gestational diabetes (GDM). Study Design We genotyped 899 self-identified Caucasian women and 386 self-identified African-American women in the Pregnancy, Infection and Nutrition (PIN) Studies cohorts for 38 single-nucleotide polymorphisms (SNPs) associated with type II diabetes (T2DM) and/or glucose homeostasis in European populations. Results GDM was diagnosed in 56 of 899 (6.2%) Caucasian and 24 of 386 (6.2%) African-American women. Among Caucasian women, GDM was associated with carriage of TCF7L2 rs7901695, MTNR1B rs10830963 and GCKR rs780094 alleles that are associated with T2DM and fasting glucose in nonpregnant populations. Among African-American participants, we found an increased risk among TSPAN8 rs7961581 C allele homozygotes and reduced risk among carriers of the JAZF1 rs864745 T allele. Conclusion We found several SNPs that are associated with GDM risk in the PIN cohorts. Maternal genotyping may identify women at risk for impaired gestational glucose tolerance.

Publisher Summary This chapter examines availability, markets, and the technical potential of renewable energy (RE) resources in meeting energy demand in a redefined energy economy. These new energy challenges include energy security, environmental integrity, climate change, and economic prosperity. It looks at how far renewables have come during the past decades and their potential to provide a larger portion of energy needs in the future. It also examines the current status of renewables capacity as well as technology investment; it includes trends by country and by technology as well as the impact of the global economic situation. Market and technology trends for resources such as hydropower, wind, solar, geothermal, and bioenergy; it also provides market projections are also outlined.

We sought to determine whether genetic variants associated with diabetes and obesity predict gestational weight gain.A total of 960 participants in the Pregnancy, Infection, and Nutrition cohorts were genotyped for 27 single-nucleotide polymorphisms (SNPs) associated with diabetes and obesity.Among Caucasian and African American women (n = 960), KCNQ1 risk allele carriage was directly associated with weight gain (P.01). In Bayesian hierarchical models among Caucasian women (n = 628), we found posterior odds ratios3 for inclusion of TCF2 and THADA SNPs in our models. Among African American women (n = 332), we found associations between risk allele carriage and weight gain for the THADA and INSIG2 SNPs. In Bayesian variable selection models, we found an interaction between the TSPAN8 risk allele and pregravid obesity, with lower weight gain among obese risk allele carriers.We found evidence that diabetes and obesity risk alleles interact with maternal pregravid body mass index to predict gestational weight gain.

The 2008 Washington International Renewable Energy Conference (WIREC) was held in Washington, D.C., from March 4-6, 2008, and involved nearly 9,000 people from 125 countries. The event brought together worldwide leaders in renewable energy (RE) from governments, international organizations, nongovernmental organizations, and the private sector to discuss the role that renewables can play in alleviating poverty, growing economies, and passing on a healthy planet to future generations. The conference concluded with more than 140 governments, international organizations, and private-sector representatives pledging to advance the uptake of renewable energy. The U.S. government authorized the National Renewable Energy Laboratory (NREL) to estimate the carbon dioxide (CO2) savings that would result from the pledges made at the 2008 conference. This report describes the methodology and assumptions used by NREL in quantifying the potential CO2 reductions derived from those pledges.

Yeast replicative aging is a process resembling replicative aging in mammalian cells. During aging, wild-type haploid yeast cells enlarge, become sterile, and undergo nucleolar enlargement and fragmentation; we sought gene expression changes during the time of these phenotypic changes. Gene expression studied via microarrays and quantitative real-time reverse-transcription polymerase chain reaction (qPCR) has shown reproducible, statistically significant changes in messenger RNA (mRNA) of genes at 12 and 18-20 generations. Our findings support previously described changes towards aerobic metabolism, decreased ribosome gene expression, and a partial environmental stress response. Our findings include a pseudostationary phase, downregulation of methylation-related metabolism, increased nucleotide excision repair-related mRNA, and a strong upregulation of many of the regulatory subunits of protein phosphatase I (Glc7). These findings are correlated with aging changes in higher organisms as well as with the known involvement of protein phosphorylation states during yeast aging.

Management of Pregnant and Neonatal Dogs, Cats and Exotic Pets Edited by Cheryl Lopate 336 pages, paperback, £43.99. Wiley-Blackwell. 2012. ISBN 978 0 8138 0793 5 ![Graphic][1] ‘MANAGEMENT of Pregnant and Neonatal Dogs, Cats and Exotic Pets’ aims to appeal to a wide audience, including qualified vets, students and professional breeders. I was therefore concerned that it might struggle to cater for any of these groups by being too technical for breeders or not containing enough valuable information for vets. Although the less academic of breeders may be put off by the use of … [1]: /embed/inline-graphic-1.gif