Association of Serum Parathyroid Hormone Levels With All-Cause and Cause-Specific Mortality Among U.S. Adults

ObjectiveTo examine whether parathyroid hormone (PTH) is associated with mortality among U.S. adults.MethodsThis study included 8286 U.S. adults aged ≥20 years with a measurement of serum intact PTH from the National Health and Nutrition Examination Survey 2003-2006 linked to national mortality data through 2015. Multivariable Cox proportional hazard regression models were employed to estimate the adjusted hazard ratio (aHR) of all-cause and cause-specific (cardiovascular and cancer) mortality according to intact PTH levels (low or low-normal, <38; middle-normal, 38-56; high-normal, 57-74; high, >74 pg/mL). We also stratified the analyses by serum albumin-adjusted calcium and 25-hydroxy vitamin D (25OHD) levels.ResultsDuring a median follow-up of 10.1 years, the mean age was 49 years, and 48% were men. After adjusting for potential confounders, both the high-normal and high PTH groups showed higher risks of all-cause mortality than the low or low-normal PTH group (high-normal PTH, aHR, 1.28; 95% confidence interval [CI], 1.10-1.48; high PTH, aHR, 1.42; 95% CI, 1.19-1.69]. When stratified by calcium and 25OHD levels, the association between high PTH and mortality was also found among participants with albumin-adjusted calcium levels of ≥9.6 mg/dL (aHR, 1.53; 95% CI, 1.17-2.01) and those with 25OHD levels of ≥20 ng/mL (aHR, 1.46, 95% CI, 1.17-1.82). We found no evidence of the increased cause-specific mortality risks in the high PTH group.ConclusionHigher PTH levels were associated with an increased risk of all-cause mortality, particularly among participants with albumin-adjusted calcium levels of ≥9.6 mg/dL or 25OHD levels of ≥20 ng/mL.     

Water and Food Consumption Patterns of U.S. Adults from 1999 to 2001

Objective: High water consumption has been proposed as an aid to weight control and as a means of reducing the energy density of the diet. This study examines the relationship between water consumption and other drinking and eating patterns. Research Methods and Procedures: The National Health and Nutrition Examination Survey 1999 to 2001, with responses from 4755 individuals ≥18 years of age, provides the data for this cross‐sectional analysis. A cluster analysis was performed using z‐scores of specific food and beverage consumption to examine patterns. A multinomial logit analysis was used to examine sociodemographic characteristics of each dietary pattern and to examine the effects of water consumption on the likelihood of consuming a non–dairy caloric beverage. All results were weighted to be nationally representative and controlled for design effects. Results: Within the sample, 87% consumed water, with an average daily consumption of 51.9 oz (1.53 liters) per consumer. Water consumers drank fewer soft/fruit drinks and consumed 194 fewer calories per day. Water consumers (potentially a self‐selected sample) consumed more fruits, vegetables, and low‐ and medium‐fat dairy products. Four distinct unhealthy dietary patterns were found that included little or no water consumption. Older and more educated persons used healthier food patterns. Mexican dietary patterns were much healthier than dietary patterns of blacks. Discussion: Water consumption potentially is a dietary component to be promoted, but much more must be understood about its role in a healthy diet. Because high water consumption is linked with healthier eating patterns—patterns more likely to be followed by higher‐educated, older adults—the target of water promotion and healthy diet options should focus on younger and less educated adults.     

Inference Based on Kernel Estimates of the Relative Risk Function in Geographical Epidemiology

Kernel smoothing is a popular approach to estimating relative risk surfaces from data on the locations of cases and controls in geographical epidemiology. The interpretation of such surfaces is facilitated by plotting of tolerance contours which highlight areas where the risk is sufficiently high to reject the null hypothesis of unit relative risk. Previously it has been recommended that these tolerance intervals be calculated using Monte Carlo randomization tests. We examine a computationally cheap alternative whereby the tolerance intervals are derived from asymptotic theory. We also examine the performance of global tests of hetereogeneous risk employing statistics based on kernel risk surfaces, paying particular attention to the choice of smoothing parameters on test power (© 2009 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Relative influence of variables at multiple spatial scales on stream macroinvertebrates in the Northern Lakes and Forest ecoregion, U.S.A.

• 1 We used 94 sites within the Northern Lakes and Forests ecoregion spanning Minnesota, Wisconsin and Michigan to identify environmental variables at the catchment, reach and riparian scales that influence stream macroinvertebrates. Redundancy analyses (RDA) found significantly influential variables within each scale and compared their relative importance in structuring macroinvertebrate assemblages.
• 2 Environmental variables included landcover, geology and groundwater delivery estimates at the catchment scale, water chemistry, channel morphology and stream habitat at the reach scale, and landcover influences at three distances perpendicular to the stream at the riparian scale. Macroinvertebrate responses were characterised with 22 assemblage attributes, and the relative abundance and presence/absence of 66 taxa.
• 3 Each scale defined macroinvertebrates along an erosional to depositional gradient. Wisconsin's macroinvertebrate index of biotic integrity, Ephemeroptera–Plecoptera–Trichoptera taxa and erosional taxa corresponded with forest streams, whereas organic pollution tolerant, Chironomidae and depositional taxa corresponded with wetland streams. Reach scale analyses defined the gradient similarly as dissolved oxygen and wide, shallow channels (erosional) opposed instream macrophytes and pool habitats (depositional). Riparian forests within 30 m of the stream coincided with an erosional assemblage and biotic integrity.
• 4 Next, we combined all significant environmental variables across scales to compare the relative influence of each spatial scale on macroinvertebrates. Partial RDA procedures described how much of the explained variance was attributable to each spatial scale and each interrelated scale combination.
• 5 Our results appeared consistent with the concept of hierarchical functioning of scale in which large‐scale variables restrict the potential for macroinvertebrate traits or taxa at smaller spatial scales. Catchment and reach variables were equally influential in defining assemblage attributes, whereas the reach scale was more influential in determining relative abundance and presence/absence.
• 6 Ultimately, comprehending the relative influence of catchment and reach scale properties in structuring stream biota will assist prioritising the scale at which to rehabilitate, manage and derive policies for stream ecosystem integrity.

     

Work-Related and Non-Work-Related Injury Deaths in the U.S.: A Comparative Study

This study assesses the percentage of traumatic fatalities attributable to work-related causes in the US, by cause of death and population demographics. The 1993-1998 Vital Statistics Mortality data from the National Center for Health Statistics were used. There were 848,945 traumatic fatalities (E800-E999) among the general population 16 years or older in the US during this time; of these, 32,044 were work-related accounting for 3.8% of all the fatalities. The work-related percentage varied from 62.7% for machine-related deaths to 0.7% for suicides, from 4.9% for males to 1.0% for females, from 9.8% in Alaska to 1.5% in Arizona, from 4.2% for decedents with 1 to 4 year college educations to 2.9% for decedents with high school or less, from 4.4% for races other than white and black to 2.6% for black. Mean age-at-death was 42 years for work-related vs. 48 years for non-work-related fatalities. This difference is more pronounced for deaths from falls (45 years vs. 78 years). Conversely, victims of work-related homicide were older than non-work-related (41 years vs. 33 years). A more complete understanding of the burden of traumatic fatalities attributable to work-related causes requires consideration of the total work-related percentage, causes of death, and population demographics.     

Estimating the Circadian Rhythm in the Risk of Occupational Injuries and Accidents

The authors recently published a prototypic Risk Index (RI) to estimate the risk of critical errors associated with shift systems. This RI was based on published trends in the relative risk of injuries and accidents, and a simple additive model was proposed to estimate the risk for a given shift system. However, extending the RI to irregular work schedules requires an estimation of the phase and amplitude of the circadian rhythm in risk. This paper integrates the published evidence on three independent sources of data that allow such estimations to be made: the trend in risk over a 24 h day, over the course of the night shift, and across the three different (8 h) shifts. Despite potential confounders, maximum risk (i.e., acrophase=peak time) estimates across these three trends showed a remarkable consistency, with all three estimates occurring at about midnight, although the amplitude estimates varied considerably. The best estimate of the amplitude of the circadian rhythm in risk would appear to be that based on trend over the three (8 h) shifts, as this trend is the least confounded. The estimated acrophase (peak time) in risk appeared earlier than would be predicted from consideration of the circadian rhythm in alertness, fatigue, or performance on simple interpolated tasks, such as reaction time or performance on the Psychomotor Vigilance Test.     

Making sense of parameter estimation and model simulation in bioprocesses

Most articles that report fitted parameters for kinetic models do not include meaningful statistical information. This study demonstrates the importance of reporting a complete statistical analysis and shows a methodology to perform it, using functionalities implemented in computational tools. As an example, alginate production is studied in a batch stirred-tank fermenter and modeled using the kinetic model proposed by Klimek and Ollis (1980). The model parameters and their 95% confidence intervals are estimated by nonlinear regression. The significance of the parameters value is checked using a hypothesis test. The uncertainty of the parameters is propagated to the output model variables through prediction intervals, showing that the kinetic model of Klimek and Ollis (1980) can simulate with high certainty the dynamic of the alginate production process. Finally, the results obtained in other studies are compared to show how the lack of statistical analysis can hold back a deeper understanding about bioprocesses.     

Skinfold thicknesses in a national probability sample of U.S. males and females aged 6 through 17 years

Cycles II and III of the Health Examination Survey included measurements of the skinfolds of over 14,000 individuals 6 through 17 years of age, statistically weighted to provide an accurate national probability sample. Analyses of the triceps and subscapular skinfolds of Negroes and whites are reported here, utilizing the median in preference to the mean. Females of either racial group have thicker skinfolds at all ages studied. Whites have greater median triceps thicknesses than Negroes of the same sex and age, but there are no differences between the two racial groups in the subscapular. Since, between all but one pair of adjacent ages in males, from 12 years on, the median triceps fold decreases, but the estimated cross-sectional are of fat increases, it is strongly recommended that reductions in triceps thickness not be automatically interpreted as meaning a loss of subcutaneous fat. Since greater skewness is found in the subscapular distributions in whites, but not in the triceps, it is suggested that racial differences in triceps thickness at these ages occurs from the operation of hereditary factors, while differences in the subscapular skinfold arise from environmental causes.     

Trends in the Association between Obesity and Socioeconomic Status in U.S. Adults: 1971 to 2000

Objective: To study the secular trends in the disparity of obesity across socioeconomic status (SES) groups among U.S. adults. Research Methods and Procedures: We used national representative data collected in the National Health and Nutrition Examination Surveys conducted in 1971 to 1974, 1976 to 1980, 1988 to 1994, and 1999 to 2000 from 28, 543 adults 20 to 60 years old. Obesity was defined based on BMI calculated using measured weight and height. Trends in the relationship between obesity and education levels were analyzed controlling for age, gender, and ethnicity. Results: The disparity in obesity across SES (less than high school, high school, and college or above to indicate low, medium, and high SES, respectively) has decreased over the past 3 decades. In National Health and Nutrition Examination Surveys I (1971 to 1974), there was as much as a 50% relative difference in the obesity prevalence across the three groups, but by 1999 to 2000, it decreased to 14%. This trend was more pronounced in women. The trends of diminishing disparities in obesity were also revealed by our logistic and linear regression analyses. The odds ratio converged to 1 from the 1970s to 2000. In most sociodemographic groups, the relationship between BMI and SES (coefficients) has been weakened over time. Discussion: The association between SES and obesity has been weakened over the past 3 decades, when the prevalence of obesity increased dramatically. There are considerable variations in the changes in the associations across gender and ethnic groups. Our findings suggest that individual characteristics are not likely the main cause of the current obesity epidemic in the U.S., whereas social‐environmental factors play an important role. Strategies for obesity prevention and management should target all SES groups from a societal perspective.     

An Evaluation of Risk Drivers from a Sample of Risk Assessments Conducted for the U.S. Army

We evaluate risk drivers at selected U.S. Army installations by developing a database containing contaminant-pathway-receptor combinations that exceed regulatory thresholds for ecological (toxicity quotient greater than one), human health cancer risk (predicted incremental lifetime cancer risk greater than one in ten thousand), and noncancer human health (hazard index greater than one). We compare the risk drivers from the database to reported corrective action objectives from available decision documents. For noncancer hazards, explosives (particularly in ground water) dominate the reported exceedances of regulatory thresholds in the database. PAHs in home-grown produce show the highest number of exceedances of regulatory thresholds for cancer risk. For ecological risks, PAHs in both terrestrial and aquatic environments dominate the exceedances of regulatory thresholds. All available cleanup levels were derived based on human health exposures rather than ecological exposures, except for one site. In general, ecological risks were considered to be “more uncertain,” and that was used as a basis for not relying on backcalculated target levels on the basis of ecological risk. The reverse was true for human health risks: the “conservative” assumptions incorporated into the modeling provided the justification for backcalculating health-protective target levels.     

Growth of silver hake within the U.S. continental shelf ecosystem of the northwest Atlantic Ocean

Von Bertalanffy growth parameters were estimated for silver hake Merluccius bilinearis within four regions of the United States continental shelf ecosystem of the northwest Atlantic Ocean during 1975–1980, 1982–1987 and 1988–1992. Differences in silver hake growth were found between the Middle Atlantic and southern Georges Bank regions ( P <0–01) over all three time periods. Growth also differed between northern Georges Bank and the Gulf of Maine ( P <0–01) during 1975–1980 and 1982–1987, and significant differences between southern Georges Bank and northern Georges Bank were found only during 1982–1987. Silver hake in the Gulf of Maine exhibited larger asymptotic sizes, but attained their asymptotic size at slower rates (L₀₀= 47 cm and K =0–33) in comparison to silver hake in the Middle Atlantic ( L₀₀= 43 cm and K =0–51), while growth parameter estimates for silver hake on Georges Bank were intermediate between these. Although significant differences in growth of silver hake between the various regions are consistent with separate stocks in the U.S. continental shelf ecosystem, the growth characteristics from the different regions are inconsistent with the presently assigned stock boundaries. (c) 1996 The Fisheries Society of the British Isles     

Evaluation of Finnish Diabetes Risk Score in Screening Undiagnosed Diabetes and Prediabetes among U.S. Adults by Gender and Race: NHANES 1999-2010

Objective

To evaluate the performance of Finnish Diabetes Risk Score (FINDRISC) in detecting undiagnosed diabetes and prediabetes among U.S. adults by gender and race.

Methods

This cross-sectional analysis included participants (aged ≥20 years) from the National Health and Nutrition Examination Survey (NHANES) 1999–2010. Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve and the optimal cutoff points for identifying undiagnosed diabetes and prediabetes were calculated for FINDRISC by gender and race/ethnicity.

Results

Among the 20,633 adults (≥20 years), 49.8% were women and 53.0% were non-Hispanic White. The prevalence of undiagnosed diabetes and prediabetes was 4.1% and 35.6%, respectively. FINDRISC was positively associated with the prevalence of diabetes (OR = 1.48 for 1 unit increase, p<0.001) and prediabetes (OR = 1.15 for 1 unit increase, p<0.001). The area under ROC for detecting undiagnosed diabetes was 0.75 for total population, 0.74 for men and 0.78 for women (p = 0.04); 0.76 for White, 0.76 for Black and 0.72 for Hispanics (p = 0.03 for White vs. Hispanics). The area under ROC for detecting prediabetes was 0.67 for total population, 0.66 for men and 0.70 for women (p<0.001); 0.68 for White, 0.67 for Black and 0.65 for Hispanics (p<0.001 for White vs. Hispanics). The optimal cutoff point was 10 (sensitivity = 0.75) for men and 12 (sensitivity = 0.72) for women for detecting undiagnosed diabetes; 9 (sensitivity = 0.61) for men and 10 (sensitivity = 0.69) for women for detecting prediabetes.

Conclusions

FINDRISC is a simple and non-invasive screening tool to identify individuals at high risk for diabetes in the U.S. adults.     

从美国 FDA 审评角度探讨新药研发的风险控制

众所周知,新药研发是一个漫长而艰难的过程,投入大,但成功率低。从项目的选择、分子结构最优化、靶点的选择、体外实 验结果与体内反应的一致性、药物安全性、临床试验设计优化以及对新药研发相关法规的理解、与监管部门的有效沟通等诸方面,探讨 对新药研发风险的把控。     

Finite Sample Properties of the Maximum Likelihood Estimator and of Likelihood Ratio Tests in Hidden Markov Models

Hidden Markov models were successfully applied in various fields of time series analysis, especially for analyzing ion channel recordings. The maximum likelihood estimator (MLE) has recently been proven to be asymptotically normally distributed. Here, we investigate finite sample properties of the MLE and of different types of likelihood ratio tests (LRTs) by means of simulation studies. The MLE is shown to reach the asymptotic behavior within sample sizes that are common for various applications. Thus, reliable estimates and confidence intervals can be obtained. We give an approximative scaling function for the estimation error for finite samples, and investigate the power of different LRTs suitable for applications to ion channels, including tests for superimposed hidden Markov processes. Our results are applied to physiological sodium channel data.     

Risk Acceptance in the Furniture Sector: Analysis of Acceptance Level and Relevant Influence Factors

ABSTRACT

Risk acceptance has been broadly discussed in relation to hazardous risk activities and/or technologies. A better understanding of risk acceptance in occupational settings is also important; however, studies on this topic are scarce. It seems important to understand the level of risk that stakeholders consider sufficiently low, how stakeholders form their opinion about risk, and why they adopt a certain attitude toward risk. Accordingly, the aim of this study is to examine risk acceptance in regard to occupational accidents in furniture industries. The safety climate analysis was conducted through the application of the Safety Climate in Wood Industries questionnaire. Judgments about risk acceptance, trust, risk perception, benefit perception, emotions, and moral values were measured. Several models were tested to explain occupational risk acceptance. The results showed that the level of risk acceptance decreased as the risk level increased. High-risk and death scenarios were assessed as unacceptable. Risk perception, emotions, and trust had an important influence on risk acceptance. Safety climate was correlated with risk acceptance and other variables that influence risk acceptance. These results are important for the risk assessment process in terms of defining risk acceptance criteria and strategies to reduce risks.     

Closing the Loop on Cadmium - An Assessment of the Material Cycle of Cadmium in the U.S. (11 pp)

Goal, Scope and Background In this study, the major flows of cadmium in the U.S. economy are quantified and the primary sinks are identified to gauge the need for additional policy to minimize the potential human health and ecosystem risks associated with these flows. Because of the concurrent occurrence of cadmium and zinc in ore, we also consider the relevant portions of the material cycle of zinc. Methods We estimated the flows of cadmium through U.S. manufacturing using a mass balance approach with data provided by the U.S. Geological Survey's Minerals Yearbook. Cadmium emissions factors were created using facility specific information found in the U.S. Toxics Release Inventory and were used to model future losses. Data gaps were filled through review of relevant literature. We modeled the import and sales of nickel-cadmium batteries with rechargeable battery usage trends and estimates of market share by battery chemistry. Results and Conclusion Primary cadmium in the U.S. is almost exclusively produced as a co-product of zinc. Almost all zinc and cadmium mined in the U.S. is exported to foreign smelters as ore concentrate. We estimate that the bulk of cadmium consumed in the U.S. economy (~90%) is imported in the form of nickel-cadmium rechargeable batteries. These batteries can be divided into the larger wet-cells and portable rechargeable batteries (PRB). The collection rate for the recycling of large wet cells was found to be high (80%) while the collection rate for PRBs is low (5-20%). The Rechargeable Battery Recycling Corporation (RBRC) is responsible for the collection of these batteries which are recycled exclusively by the International Materials Reclamation Company (INMETCO). The remaining PRBs are generally disposed of in municipal solid waste (MSW) landfills. This study provides a detailed substance flow analysis of U.S. stocks and flows of cadmium in products, however additional research is needed to better quantify the associated exposures and risks. Recommendation and Perspective Based on our analysis, we make four recommendations. First we suggest that if cadmium is to be used, it should be used in long-lived products that can be easily collected and recycled with minimal losses. Second, continued cadmium use should be coupled with renewed efforts on the part of policy-makers to encourage the collection and recycling of cadmium-bearing products. At present, consumers do not see the environmental cost associated with the proper disposal of the cadmium content of NiCd batteries. Policy options for improving recycling rates include collecting deposits and providing rewards for the return of spent batteries, taxing or otherwise discouraging discarding PRBs in municipal solid waste, and providing incentives for extended producer responsibility. Third, we highlight the importance of the connection between zinc mining and the supply of cadmium in designing an effective policy to manage the risks associated with cadmium. Fourth, we recommend that policy measures be taken to provide the necessary data required to improve our understanding of the flow of cadmium into the U.S. in the form of product imports and the amount of cadmium lost or disposed of by recycling processes.     

Restoring species diversity: assessing capacity in the U.S. native plant industry

Large quantities of diverse and appropriately adapted native plant germplasm are required to facilitate restoration globally, yet shortages can prevent restorations from attaining desired species diversity and structure. An extensive native plant industry has developed in the United States to help meet these demands, yet very little is known about its capacity to support germplasm needs. To better understand current capacity and germplasm availability, we report results of the first comprehensive and quantitative assessment of the native plant industry in the United States, which includes at least 841 vendors nationwide and the species they make available for restoration. We synthesized lists of commercially available species from native plant vendors across the United States and identified gaps in species availability to inform germplasm research, development, and production. Of the approximately 25,000 vascular plant taxa native to the United States, 26% are sold commercially, with growth form, conservation status, distribution, and taxonomy significantly predicting availability. In contrast, only 0.07% of approximately 3,000 native nonvascular taxa are sold commercially. We also investigated how demand for germplasm to support high‐quality restoration efforts is met by vendors in the Midwestern tallgrass prairie region, which has been targeted extensively by restoration efforts for decades. In this well‐developed native plant market, 74% of more than 1,000 target species are commercially available, often from vendors that advertise genetically diverse, locally sourced germplasm. We make recommendations to build on the successes of regional markets like the tallgrass prairie region, and to fill identified gaps, including investing in research to support production, ensuring more consistent and clear demand, and fostering regional collaboration.