Making the 1,000-Ship Navy a Reality Stubbs, Bruce B
Proceedings - United States Naval Institute,
01/2007, Letnik:
133, Številka:
1
Magazine Article, Trade Publication Article
Discusses the value of the US Coast Guard Given to the US Navy's initiative to build the 1,000-Ship Navy, a global maritime security network. Attention is given to the Coast Guard's capabilities, ...acceptable presence, & interagency expertise. In addition, the post-9/11 shift from "safety first" to "security first" is addressed. Challenges to providing such Coast Guard capabilities to the military are considered. Adapted from the source document.
Abstract Objective Exercise has established efficacy in improving depressive symptoms. Dropouts from randomized controlled trials (RCT’s) pose a threat to the validity of this evidence base, with ...dropout rates varying across studies. We conducted a systematic review and meta-analysis to investigate the prevalence and predictors of dropout rates among adults with depression participating in exercise RCT’s. Method Three authors identified RCT’s from a recent Cochrane review and conducted updated searches of major electronic databases from 01/2013 to 08/2015. We included RCT’s of exercise interventions in people with depression (including major depressive disorder (MDD) and depressive symptoms) that reported dropout rates. A random effects meta-analysis and meta regression were conducted. Results Overall, 40 RCT’s were included reporting dropout rates across 52 exercise interventions including 1720 people with depression (49.1 years (range=19–76 years), 72% female (range=0–100)). The trim and fill adjusted prevalence of dropout across all studies was 18.1% (95%CI=15.0–21.8%) and 17.2% (95%CI=13.5–21.7, N =31) in MDD only. In MDD participants, higher baseline depressive symptoms ( β= 0.0409, 95%CI=0.0809–0.0009, P =0.04) predicted greater dropout, whilst supervised interventions delivered by physiotherapists ( β =−1.2029, 95%CI=−2.0967 to −0.3091, p =0.008) and exercise physiologists ( β= −1.3396, 95%CI=−2.4478 to −0.2313, p =0.01) predicted lower dropout. A comparative meta-analysis ( N =29) established dropout was lower in exercise than control conditions (OR=0.642, 95%CI=0.43–0.95, p =0.02). Conclusions Exercise is well tolerated by people with depression and drop out in RCT’s is lower than control conditions. Thus, exercise is a feasible treatment, in particular when delivered by healthcare professionals with specific training in exercise prescription.
The EML4-ALK fusion oncogene represents a novel molecular target in a small subset of non-small-cell lung cancers (NSCLC). To aid in identification and treatment of these patients, we examined the ...clinical characteristics and treatment outcomes of patients who had NSCLC with and without EML4-ALK.
Patients with NSCLC were selected for genetic screening on the basis of two or more of the following characteristics: female sex, Asian ethnicity, never/light smoking history, and adenocarcinoma histology. EML4-ALK was identified by using fluorescent in situ hybridization for ALK rearrangements and was confirmed by immunohistochemistry for ALK expression. EGFR and KRAS mutations were determined by DNA sequencing.
Of 141 tumors screened, 19 (13%) were EML4-ALK mutant, 31 (22%) were EGFR mutant, and 91 (65%) were wild type (WT/WT) for both ALK and EGFR. Compared with the EGFR mutant and WT/WT cohorts, patients with EML4-ALK mutant tumors were significantly younger (P < .001 and P = .005) and were more likely to be men (P = .036 and P = .039). Patients with EML4-ALK-positive tumors, like patients who harbored EGFR mutations, also were more likely to be never/light smokers compared with patients in the WT/WT cohort (P < .001). Eighteen of the 19 EML4-ALK tumors were adenocarcinomas, predominantly the signet ring cell subtype. Among patients with metastatic disease, EML4-ALK positivity was associated with resistance to EGFR tyrosine kinase inhibitors (TKIs). Patients in the EML4-ALK cohort and the WT/WT cohort showed similar response rates to platinum-based combination chemotherapy and no difference in overall survival.
EML4-ALK defines a molecular subset of NSCLC with distinct clinical characteristics. Patients who harbor this mutation do not benefit from EGFR TKIs and should be directed to trials of ALK-targeted agents.
Reducing human immunodeficiency viruses (HIV) and acquired immune deficiency syndrome (AIDS) racial/ethnic disparities in the Deep South has been a critical objective of the U.S. National HIV/AIDS ...Strategy. This finding, originally published in 2010 by the Office of National AIDS Policy, serves as a complement to the Health and Human Resources and Services Administration's Ending the HIV Epidemic (EtHE): A Plan for America. The EtHE plan, released in 2019, emphasizes community stakeholder involvement to achieve the planning goals of decreasing new HIV infections in key U.S. geographic areas. According to the plan, an important stakeholder is faith leaders, especially around stigma reduction. This paper focuses on a community-academic research partnership's exploration of southern Black faith leaders' teaching perspectives regarding HIV prevention, sexuality, and sexual health in predominantly Black congregations in Memphis, Tennessee. The partnership conducted four focus groups using a semi-structured discussion interview. Any adult faith leader involved in ministry work in a predominantly Black church was eligible to participate in the discussion. A total of 26 faith leaders with a mean age of 54, representing four Christian denominations, consented to participate in the study. Emerging themes included: (1) restriction of scripture to teach prevention and address sexuality, (2) role of secrecy and silence in living with HIV, and (3) impact of the stigma of HIV and sexuality. Findings may inform nationwide jurisdictional implementation plans, particularly for faith-based interventions in southern churches working toward ending the HIV epidemic.
Abstract Exercise has established efficacy as an antidepressant in people with depression. However, few meta-analyses have assessed the effects of exercise across different domains of Quality of Life ...(QoL) in people with depression. Furthermore, there has been no previous meta-analysis of control group response in relation to QoL in exercise trials for depression. Randomized Clinical Trials(RCTs) were initially identified from a Cochrane review, and those including QoL assessments were included in the analysis. Search of major electronic databases were conducted to identify RCTs that compared the exercise effects on QoL versus control condition in people with depression. A random effects meta-analysis was employed to evaluate the Standardized Mean Difference (SMD). Six RCTs were included. Exercise significantly improved physical and psychological domains and overall QoL. Effects on social relationship and environment domains were not significant. No significant control group response was found for any domain or overall QoL. Exercise can be considered as a therapeutic strategy to improve physical and psychological domains and overall QoL of people with depression, with no effect evident across the social and environmental domains. The lack of improvement among control groups reinforces the role of exercise as a treatment for depression with benefits to QoL.
After 11 September 2001, maritime homeland security requirements intensified sharply. With the greater need for port and cargo security, plus safeguarding the territorial sea, exclusive economic ...zones, and marine transportation system, the Coast Guard found itself spread more thinly than ever.
Abstract Objective Cardiorespiratory fitness (CRF) is an independent predictor of cardiovascular disease and all-cause mortality. CRF improves in response to exercise interventions, yet the ...effectiveness of such interventions to improve CRF among people with depression is unclear. We conducted a systematic review and meta-analysis to evaluate whether CRF improves in people with depression in exercise randomized control trials (RCTs). Method Three authors identified RCTs from a recent Cochrane review and conducted updated searches of major electronic databases. We included RCTs of exercise interventions in people with depression (including major depressive disorder (MDD) and above-threshold depressive symptoms) that reported CRF (defined as predicted maximal oxygen uptake (VO2 max predicted) or peak oxygen uptake (VO2 peak)) versus a control condition. A random effects meta-analysis was conducted. Results Seven unique RCTs including 8 aerobic exercise interventions for depression were eligible, including 293 people allocated to exercise (mean age=40.3 years, range=27.2–64.7years and 35–100% female) and 205 allocated to control conditions. Across all studies exercise results in a significant increase in CRF ( g =0.64, 95%CI=0.32–0.96, p <0.001) equating to a mean increase of 3.05 ml/kg/min. Results remained significant when restricted to MDD only ( N =5, g =0.41, 95%CI=0.18–0.64, p <0.001) and in high quality studies ( N =5, g =0.60, 95%CI=0.19–1.00, p =0.004). Conclusions People with depression can achieve clinically relevant improvements in CRF in response to exercise interventions. Targeting ‘fitness’ rather than ‘fatness’ may be another feasible intervention strategy in this population.
IMPORTANCE: Sex is a variable that is poorly controlled for in clinical research. OBJECTIVES: To determine if sex bias exists in human surgical clinical research, to determine if data are reported ...and analyzed using sex as an independent variable, and to identify specialties in which the greatest and least sex biases exist. DESIGN, SETTING, AND PARTICIPANTS: For this bibliometric analysis, data were abstracted from 1303 original peer-reviewed articles published from January 1, 2011, through December 31, 2012, in 5 surgery journals. MAIN OUTCOMES AND MEASURES: Study type, location, number and sex of participants, degree of sex matching of included participants, and inclusion of sex-based reporting, statistical analysis, and discussion of data. RESULTS: Of 2347 articles reviewed, 1668 (71.1%) included human participants. After excluding 365 articles, 1303 remained: 17 (1.3%) included males only, 41 (3.1%) included females only, 1020 (78.3%) included males and females, and 225 (17.3%) did not document the sex of the participants. Although female participants represent more than 50% (n = 57 688 606) of the total number (115 377 213) included, considerable variability existed with the number of male (46 111 818), female (58 805 665), and unspecified (10 459 730) participants included among the journals, between US domestic and international studies, and between single vs multicenter studies. For articles included in the study, 38.1% (497 of 1303) reported these data by sex, 33.2% (432 of 1303) analyzed these data by sex, and 22.9% (299 of 1303) included a discussion of sex-based results. Sex matching of the included participants in the research overall was poor, with 45.2% (589 of 1303) of the studies matching the inclusion of both sexes by 50%. During analysis of the different surgical specialties, a wide variation in sex-based inclusion, matching, and data reporting existed, with colorectal surgery having the best matching of male and female participants and cardiac surgery having the worst. CONCLUSIONS AND RELEVANCE: Sex bias exists in human surgical clinical research. Few studies included men and women equally, less than one-third performed data analysis by sex, and there was wide variation in inclusion and matching of the sexes among the specialties and the journals reviewed. Because clinical research is the foundation for evidence-based medicine, it is imperative that this disparity be addressed so that therapies benefit both sexes.
Forty years ago, Apollo astronauts placed the first of several retroreflector arrays on the lunar surface. Their continued usefulness for laser ranging might suggest that the lunar environment does ...not damage optical devices. However, new laser ranging data reveal that the efficiency of the three Apollo reflector arrays is now diminished by a factor of 10 at all lunar phases and by an additional factor of 10 when the lunar phase is near full Moon. These deficits did not exist in the earliest years of lunar ranging, indicating that the lunar environment damages optical equipment on the timescale of decades. Dust or abrasion on the front faces of the corner-cube prisms may be responsible, reducing their reflectivity and degrading their thermal performance when exposed to face-on sunlight at full Moon. These mechanisms can be tested using laboratory simulations and must be understood before designing equipment destined for the Moon.
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