Search

As resilience and adaptation considerations become mainstreamed into public policy, there is an overarching desire to measure and quantify metrics and indicators that seek to evaluate the efficiency, effectiveness, and justness associated with outcomes of such processes. While much research has sought to develop specific indicators that may serve as proxies for these considerations, less research has focused on those normative aspects of indicator design that support a variety of goals associated with the accuracy, reproducibility, proxy value and multi-stakeholder translation of indicators, among various other goals and values. This perspective article sets forth a range of potential considerations that may be useful for those who seek to design and develop novel resilience and adaptation indicators ("RAIs"). These considerations are explored through a range of hypothetical examples that may be applicable to coastal communities that seek to address the practical challenges facing the design, execution, management and modification of RAIs., Competing Interests: Disclosure statement No potential conflict of interest was reported by the authors.

Despite historical emphasis on "specific" learning disabilities (SLDs), academic skills are strongly correlated across the curriculum. Thus, one can ask how specific SLDs truly are. To answer this question, we used bifactor models to identify variance shared across academic domains (academic g ), as well as variance unique to reading, mathematics, and writing. Participants were 686 children ages 8 to 16. Although the sample was overselected for learning disabilities, we intentionally included children across the full range of individual differences in this study in response to growing recognition that a dimensional, quantitative view of SLD is more accurate than a categorical view. Confirmatory factor analysis identified five academic domains (basic reading, reading comprehension, basic math, math problem-solving, and written expression); spelling clustered with basic reading and not writing. In the bifactor model, all measures loaded significantly on academic g . Basic reading and mathematics maintained variance distinct from academic g , consistent with the notion of SLDs in these domains. Writing did not maintain specific variance apart from academic g , and evidence for reading comprehension-specific variance was mixed. Academic g was strongly correlated with cognitive g ( r = .72) but not identical to it. Implications for SLD diagnosis are discussed.

This article provides a perspective on the reciprocal relationships between public and private sector resilience planning activities and the ongoing COVID responses in the U.S. Through the lens of the built environment, this article provides selected insights into how various disaster, organizational, and engineering resilience activities have likely positively shaped COVID responses within the healthcare sector. These positive influences are contextualized within extensive efforts within public health and healthcare management to calibrate community resilience frameworks and practices for utilization in everything from advancing community health to the continuity of facilities operations. Thereafter, the article shifts focus to speculate on how ongoing experiences under COVID might yield positive impacts for future resilience designs, plans and policies within housing and the built environment. Through this perspective, the article hopes to explore those often overlooked aspects of the physical and social parameters of the built environment that may be understood as providing opportunities to inform future disaster, public health, and climate change preparations and responses., Competing Interests: Conflict of interestThe author declares that they have no conflicts of interest., (© Springer Science+Business Media, LLC, part of Springer Nature 2020.)

Current definitions of specific learning disability (SLD) identify a heterogeneous population that includes individuals with weaknesses in reading, math, or writing, and these academic difficulties often co-occur in many of the same individuals. The Colorado Learning Disabilities Research Center (CLDRC) is an interdisciplinary, multisite research program that uses converging levels of analysis to understand the genetic and environmental etiology, neuropsychology, and developmental outcomes of SLDs in reading (RD), math (MD), and writing (WD), along with the comorbidity between these SLDs and other developmental disorders. The latest results from the CLDRC twin study suggest that shared genetic influences contribute to the significant covariance between all aspects of reading (word reading, reading fluency, and reading comprehension) and math (calculations, math fluency, and word problems), and distinct genetic or environmental influences also contribute to weaknesses in each specific academic domain. RD and MD are associated with a range of negative outcomes on both concurrent measures and measures of functional outcomes completed 5 years after the twins were first assessed. Over the next several years the CLDRC will continue to expand on this work by administering a comprehensive test battery that includes measures of all dimensions of academic achievement that are described in current definitions of SLD and incorporating these measures in new neuroimaging and molecular genetic studies., (© 2019 Wiley Periodicals, Inc.)

Although previous research has shown cognitive skills to be important predictors of reading ability in children, the respective roles for genetic and environmental influences on these relations is an open question. The present study explored the genetic and environmental etiologies underlying the relations between selected executive functions and cognitive abilities (working memory, inhibition, processing speed, and naming speed) with 3 components of reading ability (word reading, reading comprehension, and listening comprehension). Twin pairs drawn from the Colorado Front Range (n = 676; 224 monozygotic pairs; 452 dizygotic pairs) between the ages of 8 and 16 (M = 11.11) were assessed on multiple measures of each cognitive and reading-related skill. Each cognitive and reading-related skill was modeled as a latent variable, and behavioral genetic analyses estimated the portions of phenotypic variance on each latent variable due to genetic, shared environmental, and nonshared environmental influences. The covariance between the cognitive skills and reading-related skills was driven primarily by genetic influences. The cognitive skills also shared large amounts of genetic variance, as did the reading-related skills. The common cognitive genetic variance was highly correlated with the common reading genetic variance, suggesting that genetic influences involved in general cognitive processing are also important for reading ability. Skill-specific genetic variance in working memory and processing speed also predicted components of reading ability. Taken together, the present study supports a genetic association between children's cognitive ability and reading ability., ((c) 2016 APA, all rights reserved).)

Fifty-six specific poor reading comprehenders (SPRC) were selected in Grade 4 and retrospectively compared to good comprehenders at preschool (age 5) and at the end of kindergarten, Grade 1, and Grade 2. The results revealed deficits in vocabulary, grammar, verbal memory and early deficits in phonological awareness in most of the SPRC sample, beginning in preschool. The reading comprehension deficits in children with SPRC were not as marked in earlier assessments in Grade 1 and 2, probably because of the greater dependence on word decoding in reading comprehension in the early grades., (© 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

The present study explored the environmental and genetic etiologies of the longitudinal relations between prereading skills and reading and spelling. Twin pairs (n = 489) were assessed before kindergarten (M = 4.9 years), post-first grade (M = 7.4 years), and post-fourth grade (M = 10.4 years). Genetic influences on five prereading skills (print knowledge, rapid naming, phonological awareness, vocabulary, and verbal memory) were primarily responsible for relations with word reading and spelling. However, relations with post-fourth-grade reading comprehension were due to both genetic and shared environmental influences. Genetic and shared environmental influences that were common among the prereading variables covaried with reading and spelling, as did genetic influences unique to verbal memory (only post-fourth-grade comprehension), print knowledge, and rapid naming., (© 2014 The Authors. Child Development © 2014 Society for Research in Child Development, Inc.)

Reading comprehension is a foundational academic skill and significant attention has focused on reading development. This report is the first to examine the stability and change in genetic and environmental influences on reading comprehension across Grades 1 to 6. This developmental range is particularly important because it encompasses the timespan in which most children move from learning how to read to using reading for learning. Longitudinal simplex models were fitted separately for two independent twin samples (N = 706; N = 976). Results suggested that the shared environment contributed to variance in early but not later reading. Instead, stability in reading development was largely mediated by continuous genetic influences. Thus, although reading is clearly a learned skill and the environment remains important for reading development, individual differences in reading comprehension appear to be also influenced by a core of genetic stability that persists through the developmental course of reading.

Modern behavior-genetic studies of twins in the U.S., Australia, Scandinavia, and the U.K. show that genes account for most of the variance in children's reading ability by the end of the first year of formal reading instruction. Strong genetic influence continues across the grades, though the relevant genes vary for reading words and comprehending text, and some of the genetic influence comes through a gene - environment correlation. Strong genetic influences do not diminish the importance of the environment for reading development in the population and for helping struggling readers, but they question setting the same minimal performance criterion for all children.

Studies of poor comprehenders vary in the selection criteria and tests that they use to define poor comprehension. Could these differences play a role in determining findings about poor comprehension? This study assessed the extent to which differences in selection methods affect who gets identified as poor comprehenders, and examined how their cognitive profiles differ. Over 1,500 children, ages 8 - 19, took multiple tests of reading comprehension, listening comprehension, single word reading and nonword reading. Poor comprehension was defined by performing in the low-tail and by discrepancies either with word or nonword reading. Odds of any two selection methods identifying the same individuals were generally low, and depended on type of comprehension test more than modality, as well as selection criteria, and comprehender's age. Poor comprehenders selected by the different methods were found to vary in IQ, working memory, but not attention. The findings show that differences across studies in tests and selection criteria used to define poor comprehension are not insignificant and can have substantial consequences for what is meant by poor comprehension and its associated deficits.

The authors examined the implications of test differences for defining and diagnosing comprehension deficits using reading comprehension tests. They had 995 children complete the Gray Oral Reading Test-3, the Qualitative Reading Inventory-3, the Woodcock-Johnson Passage Comprehension-3, and the Peabody Individual Achievement Test and compared which children were identified by each test as being in the lowest 10%. Although a child who performs so poorly might be expected to do poorly on all tests, the authors found that the average overlap between tests in diagnosing comprehension difficulties was only 43%. Consistency in diagnosis was greater for younger children, when comprehension deficits are the result of weaker decoding skills, than for older children. Inconsistencies between tests were just as evident when identifying the top performers. The different children identified as having a comprehension deficit by each test were compared on four profile variables-word decoding skill, IQ, ADHD symptoms, and working memory skill-to understand the nature of the different deficits assessed by each test. Theoretical and practical implications of these test differences in defining and diagnosing comprehension deficits are discussed.

Comprehension tests often compare accuracy on inferential versus literal questions and find inferential harder than literal, and poor comprehenders performing worse than controls. Difficulties in integration are assumed to be the reason. This research explores another reason - differences in memory for the passage information underlying the questions. Thirty-nine poor comprehenders and 39 controls were given multiple-paragraph passages, which they retold before answering questions. Retellings permitted assessing question accuracy as a function of memory for the text underlying each question. Inferential accuracy was poorer than literal, and the expected group effect obtained. However, when text memory was perfect, group differences disappeared, indicating that poor comprehenders can generate inferences as well as controls, if they have the relevant information in memory. These findings show that text memory is crucial in distinguishing poor comprehension.

Studies of subtypes of DSM-IV attention-deficit/hyperactivity disorder (ADHD) have provided inconsistent support for the discriminant validity of the combined type (ADHD-C) and predominantly inattentive type (ADHD-I). A large sample of children and adolescents with ADHD (N = 410) and a comparison group without ADHD (N = 311) were used to test the internal and external validity of sluggish cognitive tempo (SCT), a dimension characterized by low energy and sleepy and sluggish behavior. SCT scores were then incorporated in analyses of ADHD subtypes to test whether the discriminant validity of ADHD-C and ADHD-I could be improved by including SCT symptoms as part of the criteria for ADHD-I. Factor analyses of parent and teacher ratings indicated that six SCT items loaded on a factor separate from symptoms of ADHD and other psychopathology, providing important support for the internal validity of SCT. The external validity of SCT was supported by significant associations between SCT and measures of functional impairment and neuropsychological functioning when symptoms of ADHD and other psychopathology were controlled. However, contrary to initial predictions, high levels of SCT did not identify a subgroup of ADHD-I that was clearly distinct from ADHD-C. Instead, the current results suggest that DSM-IV inattention and SCT are separate but correlated symptom dimensions that are each independently associated with important aspects of functional impairment and neuropsychological functioning.

This first cross-country twin study of individual differences in reading growth from post-kindergarten to post-second grade analyzed data from 487 twin pairs from the United States, 267 twin pairs from Australia, and 280 twin pairs from Scandinavia. Data from two reading measures were fit to biometric latent growth models. Individual differences for the reading measures at post-kindergarten in the United States and Australia were due primarily to genetic influences and to both genetic and shared environmental influences in Scandinavia. In contrast, individual differences in growth generally had large genetic influences in all countries. These results suggest that genetic influences are largely responsible for individual differences in early reading development. In addition, the timing of the start of formal literacy instruction may affect the etiology of individual differences in early reading development but have only limited influence on the etiology of individual differences in growth., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Two groups of fourth-grade children were selected from a population sample (N=926) to be either poor oral comprehenders (poor oral comprehension but normal word decoding) or poor decoders (poor decoding but normal oral comprehension). By examining both groups in the same study with varied cognitive and literacy predictors, and examining them both retrospectively and prospectively, we could assess how distinctive and stable the predictors of each deficit are. Predictors were assessed retrospectively at preschool and at the end of kindergarten, Grade 1, and Grade 2. Group effects were significant at all test occasions, including those for preschool vocabulary (worse in poor oral comprehenders) and rapid automatized naming (RAN) (worse in poor decoders). Preschool RAN and vocabulary prospectively predicted Grade 4 group membership (77-79% correct classification) within the selected samples. Reselection in preschool of "at-risk" poor decoder and poor oral comprehender subgroups based on these variables led to significant but relatively weak prediction of subtype membership at Grade 4. Implications of the predictive stability of our results for identification and intervention of these important subgroups are discussed., (Copyright © 2012 Elsevier Inc. All rights reserved.)

We examined reading comprehension in children with ADHD by assessing their ability to build a coherent mental representation that allows them to recall central and peripheral information. We compared children with ADHD (mean age 9.78) to word reading-matched controls (mean age 9.89) on their ability to retell a passage. We found that even though children with ADHD recalled more central than peripheral information, they showed their greatest deficit, relative to controls, on central information-a centrality deficit (Miller and Keenan, Annals of Dyslexia 59:99-113, 2009). We explored the cognitive underpinnings of this deficit using regressions to compare how well cognitive factors (working memory, inhibition, processing speed, and IQ) predicted the ability to recall central information, after controlling for word reading ability, and whether these cognitive factors interacted with ADHD symptoms. Working memory accounted for the most unique variance. Although previous evidence for reading comprehension difficulties in children with ADHD have been mixed, this study suggests that even when word reading ability is controlled, children with ADHD have difficulty building a coherent mental representation, and this difficulty is likely related to deficits in working memory.

Identical and fraternal twins (N=540, age 8 to 18 years) were tested on three different measures of writing (Woodcock-Johnson III Tests of Achievement-Writing Samples and Writing Fluency; Handwriting Copy from the Group Diagnostic Reading and Aptitude Achievement Tests), three different language skills (phonological awareness, rapid naming, and vocabulary), and three different reading skills (word recognition, spelling, and reading comprehension). Substantial genetic influence was found on two of the writing measures, writing samples and handwriting copy, and all of the language and reading measures. Shared environment influences were generally not significant, except for Vocabulary. Non-shared environment estimates, including measurement error, were significant for all variables. Genetic influences among the writing measures were significantly correlated (highest between the speeded measures writing fluency and handwriting copy), but there were also significant independent genetic influences between copy and samples and between fluency and samples. Genetic influences on writing were significantly correlated with genetic influences on all of the language and reading skills, but significant independent genetic influences were also found for copy and samples, whose genetic correlations were significantly less than 1.0 with the reading and language skills. The genetic correlations varied significantly in strength depending on the overlap between the writing, language, and reading task demands. We discuss implications of our results for education, limitations of the study, and new directions for research on writing and its relations to language and reading.

We explored the etiology of individual differences in reading development from post-kindergarten to post-4 th grade by analyzing data from 487 twin pairs tested in Colorado. Data from three reading measures and one spelling measure were fit to biometric latent growth curve models, allowing us to extend previous behavioral genetic studies of the etiology of early reading development at specific time points. We found primarily genetic influences on individual differences at post-1 st grade for all measures. Genetic influences on variance in growth rates were also found, with evidence of small, nonsignificant, shared environmental influences for two measures. We discuss our results, including their implications for educational policy.

Background: Nicotinic acid (NA), long used for the treatment of dyslipidemia, has shown problems with undesirable side effects and safety issues. Wax-matrix, extended-release niacin (WMER) and inositol hexanicotinate (IHN) have both been formulated to increase patient tolerability. Several trials of WMER demonstrated good efficacy in improving dyslipidemia; however, there are few scientific data on the use of IHN., Objective: This study was designed to compare the efficacy and tolerability of WMER and IHN to each other and placebo to help clinicians make an informed choice of NA agents., Methods: This was a 6-week blinded, placebo-controlled trial comparing 1500 mg/d of WMER with 1500 mg/d IHN. Subjects with mild-to-moderate dyslipidemia (low-density lipoprotein = 130-190/dL) were randomized, after a 4-week diet lead-in period, to three parallel study arms (40 subjects/arm). Diet, pill compliance, and side effects were monitored as well as lipid and blood chemistry profiles (baseline, 6 weeks). A dose-reduction protocol was included for subjects who did not tolerate the 1500-mg dose of NA. A pharmacokinetic substudy was conducted on subjects from the WMER (n = 5) and IHN (n = 5) groups., Results: WMER demonstrated significant improvements in total cholesterol = -11%, low-density lipoprotein = -18%, high-density lipoprotein = +12%, and non-high-density lipoprotein = -15% (P < .001), whereas IHN and placebo showed no significant improvement in lipids. All groups had good medication compliance and treatment tolerance with only one dropout in the WMER group as the result of flushing. Blood chemistries showed small (24%-27%) mean increases in hepatic transaminases; six subjects completed the study at reduced dosage protocol with good lipid results. Pharmacokinetics demonstrated an intermediate release and absorption rate for WMER over 6 hours and IHN showed no evidence of bioavailability., Conclusion: WMER demonstrated good tolerance and efficacy and extended-release kinetics. IHN was well tolerated but was no better than placebo in lipid improvement and showed no evidence of bioavailability., (Copyright © 2013 National Lipid Association. Published by Elsevier Inc. All rights reserved.)

The present study explored whether different executive control and speed measures (working memory, inhibition, processing speed, and naming speed) independently predict individual differences in word reading and reading comprehension. Although previous studies suggest these cognitive constructs are important for reading, the authors analyze the constructs simultaneously to test whether each is a unique predictor. Latent variables from 483 participants (ages 8-16 years) were used to portion each cognitive and reading construct into its unique and shared variance. In these models 2 specific issues are addressed: (a) Given that the wide age range may span the theoretical transition from "learning to read" to "reading to learn," the authors first test whether the relation between word reading and reading comprehension is stable across 2 age groups (ages 8-10 and 11-16); and (b) the main theoretical question of interest: whether what is shared and what is separable for word reading and reading comprehension are associated with individual differences in working memory, inhibition, and measures of processing and naming speed. The results indicated that (a) the relation between word reading and reading comprehension is largely invariant across the age groups, and (b) working memory and general processing speed, but not inhibition or the speeded naming of non-alphanumeric stimuli, are unique predictors of both word reading and comprehension, with working memory equally important for both reading abilities and processing speed more important for word reading. These results have implications for understanding why reading comprehension and word reading are highly correlated yet separable, (. (PsycINFO Database Record (c) 2012 APA, all rights reserved).)

This study replicated and extended a phenomenon in the text memory literature referred to as the centrality deficit Miller & Keenan (Annals of Dyslexia 59:99-113, 2009). It examined how reading in a foreign language (L2) affects one's text representation and ability to recall the most important information. Readers recalled a greater proportion of central than of peripheral ideas, regardless of whether reading in their native language (L1) or a foreign language (L2). Nonetheless, the greatest deficit in participants' L2 recalls, as compared with L1 recalls, was on the central, rather than the peripheral, information. This centrality deficit appears to stem from resources being diverted from comprehension when readers have to devote more cognitive resources to lower level processes (e.g., L2 word identification and syntactic processing), because the deficit was most evident among readers who had lower L2 proficiency. Prior knowledge (PK) of the passage topic helped compensate for the centrality deficit. Readers with less L2 proficiency who did not have PK of the topic displayed a centrality deficit, relative to their L1 recall, but this deficit dissipated when they did possess PK.

While prior knowledge of a passage topic is known to facilitate comprehension, little is known about how it affects word identification. We examined oral reading errors in good and poor readers when reading a passage where they either had prior knowledge of the passage topic or did not. Children who had prior knowledge of the topic were matched on decoding skill to children who did not know the topic so that the groups differed only on knowledge of the passage topic. Prior knowledge of the passage topic was found to significantly increase fluency and reduce reading errors, especially errors based on graphic information, in poor readers. Two possible mechanisms of how prior knowledge might operate to facilitate word identification were evaluated using the pattern of error types, as was the relationship of errors to comprehension. Implications of knowledge effects for assessment and educational policy are discussed.

Genetic and environmental relations between vocabulary and reading skills were explored longitudinally from preschool through grades 2 and 4. At preschool there were strong shared-environment and weak genetic influences on both vocabulary and print knowledge, but substantial differences in their source. Separation of etiology for vocabulary and reading continued for word recognition and decoding through grade 4, but genetic and environmental correlations between vocabulary and reading comprehension approached unity by grade 4, when vocabulary and word recognition accounted for all of the genetic and shared environment influences on reading comprehension.

Does the choice of test for assessing reading comprehension influence the outcome of genetic analyses? A twin design compared two types of reading comprehension tests classified as primarily associated with word decoding (RC-D) or listening comprehension (RC-LC). For both types of tests, the overall genetic influence is high and nearly identical. However, the tests differed significantly in how they covary with the genes associated with decoding and listening comprehension. Although Cholesky decomposition showed that both types of comprehension tests shared significant genetic influence with both decoding and listening comprehension, RC-D tests shared most genetic variance with decoding, and RC-LC tests shared most with listening comprehension. Thus, different tests used to measure the same construct may manifest very different patterns of genetic covariation. These results suggest that the apparent discrepancies among the findings of previous twin studies of reading comprehension could be due at least in part to test differences.

The current study examined the phonological and semantic contributions to the verbal short-term memory (VSTM) deficit in Down syndrome (DS) by experimentally manipulating the phonological and semantic demands of VSTM tasks. The performance of 18 individuals with DS (ages 11-25) and 18 typically developing children (ages 3-10) matched pairwise on receptive vocabulary and gender was compared on four VSTM tasks, two tapping phonological VSTM (phonological similarity, nonword discrimination) and two tapping semantic VSTM (semantic category, semantic proactive interference). Group by condition interactions were found on the two phonological VSTM tasks (suggesting less sensitivity to the phonological qualities of words in DS), but not on the two semantic VSTM tasks. These findings suggest that a phonological weakness contributes to the VSTM deficit in DS. These results are discussed in relation to the DS neuropsychological and neuroanatomical phenotype.

We examined text memory in children with word reading deficits to determine how these difficulties impact representations of text meaning. We show that even though children with poor word decoding recall more central than peripheral information, they show a significantly bigger deficit relative to controls on central than on peripheral information. We call this the centrality deficit and argue that it is the consequence of insufficient cognitive resources for connecting ideas together due to these children's resources being diverted from comprehension to word decoding. We investigated a possible compensatory mechanism for making these connections. Because a text representation is a synthesis of text information and a reader's prior knowledge, we hypothesized that having knowledge of the passage topic might reduce or eliminate the centrality deficit. Our results support this knowledge compensation hypothesis: The centrality deficit was evident when poor readers did not have prior knowledge, but was eliminated when they did. This presents an exciting avenue to pursue for possible remediation of reading comprehension in children with word identification difficulties.

Moderation of the level of genetic influence on children's high reading ability by environmental influences associated with parental education was explored in two independent samples of identical and fraternal twins from the United States and Great Britain. For both samples, the heritability of high reading performance increased significantly with lower levels of parental education. Thus, resilience (high reading ability despite lower environmental support) is more strongly influenced by genotype than is high reading ability with higher environmental support. This result provides a coherent account when considered alongside results of previous research showing that heritability for low reading ability decreased with lower levels of parental education.

Lexical priming was assessed in children with reading disability (RD) and in age-matched controls (M= 11.5 years), in visual and auditory lexical decision tasks. In the visual task, children with RD were found to have deficits in semantic (SHIP-BOAT), phonological/graphemic (GOAT-BOAT), and combined (FLOAT-BOAT) priming. The same pattern of semantic priming deficits also occurred in auditory lexical decisions, suggesting that the semantic deficits are not confined to reading. Children with RD also showed less priming than reading-age matched controls, suggesting that their priming deficits are not simply due to lower reading level but are due to the reading disability in particular. These semantic deficits may contribute to both the word reading and the comprehension problems seen in children with RD.

Previous studies have shown that peptides derived from milk proteins can improve blood pressure. Therefore, the authors tested the blood pressure-lowering effects of a hydrolyzed whey protein supplement rich in bioactive peptides. In a 6-week controlled study, 30 prehypertensive or stage 1 hypertensive subjects (blood pressure >or=120/80 mm Hg and

Previous studies have shown that peptides derived from milk proteins can improve blood pressure. Therefore, the authors tested the blood pressure-lowering effects of a hydrolyzed whey protein supplement rich in bioactive peptides. In a 6-week controlled study, 30 prehypertensive or stage 1 hypertensive subjects (blood pressure ≥120/80 mm Hg and ≤155/95 mm Hg) were randomized to receive 20 g/d of either a hydrolyzed whey protein (active treatment) or an unmodified whey protein (control treatment). Blood pressure, blood lipids, safety measures, side effects, and diet were evaluated throughout the trial. After completion of treatment, a 4-week follow-up was conducted. There was a mean reduction of 8.0+3.2 mm Hg in systolic blood pressure (P<.05) and of 5.5±2.1 mm Hg in diastolic blood pressure (P<.05) in the treatment group compared with the control group. Low-density lipoprotein cholesterol and high-sensitivity C-reactive protein were significantly improved by treatment. Whey-derived peptides might be a viable treatment option for prehypertensive and/or stage 1 hypertensive populations.

A diet that includes 5 to 10 g/d of viscous soluble fiber reduces cardiovascular disease (CVD) events and death independent of baseline risk. Consuming foods rich in viscous soluble fiber reduces low-density lipoprotein cholesterol (LDL-C) blood levels 10% to 15% with expected reduction in CVD events by 10% to 15%. Routinely counsel adults at risk of CVD to promote a healthy diet: assess dietary fiber consumption; recommend specific foods rich in viscous soluble fiber; monitor LDL-C levels and encourage increased dietary fiber intake at follow-up visits; motivate patients to comply with recommendations.

Scientific evidence continues to accumulate regarding fasting serum triglycerides as an independent risk factor for coronary heart disease. In response, the National Cholesterol Education Program has revised the acceptable level of fasting triglycerides from <200 mg/dL to <150 mg/dL. A significant percentage of Americans suffer from hypertriglyceridemia, and considering the expanding numbers of individuals who are physically inactive, overweight, and suffering from the metabolic syndrome, it is expected that these numbers will continue to rise over the next decade. Fortunately, nutraceutical and lifestyle options have been shown to substantially and consistently reduce this risk factor. This review will focus on management options for the hypertriglyceridemic patient with an emphasis on nicotinic acid, pantethine, fish oils (eicosapentaenoic and docosahexaenoic acids), and modified carbohydrate diets.

Recent breakthroughs in technology have produced tests for HIV antibody that are highly accurate and easy to use and can give a preliminary result in 20 minutes or less. These rapid HIV tests will be used increasingly in labor and delivery wards, emergency departments, urgent care centers, and the primary care office. They have unique applications for healthcare worker exposures, military operations, public health venues, and developing countries. In this article, Drs Keenan, Keenan, and Branson discuss the advantages and limitations of rapid HIV testing in various settings.

Inferential processing and its component processes-working memory and set shifting-were examined in women with Fragile X Syndrome (FXS), in an attempt to understand the language phenotype of FXS and to better understand discourse processing by examining which components are affected by a biological breakdown. Participants read short passages and answered both factual and inference questions, and performance was correlated with neuropsychological measures of working memory and set-shifting. Three groups of nonretarded women were examined: (a) 12 women with FXS who carry the full mutation; (b) 22 women who carry the premutation; and (c) 16 women without the fragile X mutation. The results show that full mutation women do more poorly on both factual and inference questions. They do not appear to have a specific deficit in inferencing, however, because even though they do worse on inference questions than on factual questions, they do no worse, proportionately speaking, than the comparison groups. Analysis of the types of errors indicates that what underlies their poor performance on this discourse task is a specific deficit in working memory; the working memory deficit appears to be due specifically to FXS and not just to lower IQ. The deficits in discourse and working memory are also shown to relate to molecular measures of the syndrome.

Viscous dietary fibers can modify the alimentary responses to a meal and improve glucose tolerance. There may be a relationship between the effect of these fibers in the gut and the ability of the hormone cholecystokinin (CCK) to slow gastric emptying and affect glucose homeostasis. We investigated the acute and long-term (adaptive) glucose and CCK responses to liquid mixed test meals, with or without 5 g of solubilized cellulose (SC), a novel viscous fiber, in 33 hypercholesterolemic men and women. In the acute study, there was a lower peak CCK concentration (P = 0.01) after a SC-containing test meal compared with a fiber-free test meal. The CCK area under the curve responses also tended to be lower after the fiber-containing meal (P = 0.08). After a 6-wk intervention with 2.5 g of SC or placebo twice daily, fasting plasma glucose concentration tended to decrease in the SC group, whereas it increased in the control group (for between-group difference in change, P = 0.13). There were no differences between the groups in the changes from baseline to the end of the study in any other variable. There were significant gender differences in several variables at baseline. These findings support the hypothesis that CCK may mediate the effect of viscous fibers on glucose metabolism. The gender differences in glucose and CCK may explain some of the discrepancies in the results of similar experiments reported to date.

This study examined how prior knowledge and working memory capacity (WMC) influence the effect of a reading perspective on online text processing. In Experiment 1, 47 participants read and recalled 2 texts of different familiarity from a given perspective while their eye movements were recorded. The participants' WMC was assessed with the reading span test. The results suggest that if the reader has prior knowledge related to text contents and a high WMC, relevant text information can be encoded into memory without extra processing time. In Experiment 2, baseline processing times showed whether readers slow down their processing of relevant information or read faster through their relevant information. The results are discussed in the light of different working memory theories.

Coronary heart disease (CHD) remains a major cause of morbidity and mortality throughout North America. The role played by lipid abnormalities is now well established, and primary care physicians can play a major role in reversing the increasing prevalence of CHD by following the recommended guidelines of the National Cholesterol Expert Panel (NCEP ATP-III). While many physicians are aware of the importance of lowering lipid levels, a large number of patients still fail to reach their treatment goals. It is therefore important to identify patients at risk of developing coronary events due to abnormal lipid profiles and to quickly implement effective prevention programs. Although diet and other lifestyle modifications should form the basis of lipid management, the addition of lipid-modifying drugs is often necessary. Several lipid-modifying agents are available, but the proven efficacy and good tolerability of statins has increasingly made them the drugs of choice.

Objectives: Our study compared 2 whole grain oat-based cereals with 2 refined grain wheat-based cereals to determine their effects on the need for antihypertensive medications in people with high blood pressure (BP)., Study Design: This 12-week, randomized controlled parallel-group trial with = 6 weeks of voluntary follow-up was designed to investigate the antihypertensive effects of oats. After 4 weeks of baseline feeding, medication dose was maintained or reduced by half or completely throughout the middle 4 weeks of the study. In the final 4 weeks, participants continued cereal consumption; medication was adjusted according to the protocol., Population: Men and women (n = 88) being treated for hypertension with a mean baseline BP below 160/100., Outcomes Measured: Primary study outcomes included change in SBP and DBP as well as antihypertensive medication reduction. Secondary measures included blood lipid, fasting glucose, and insulin levels and side effects related to elevated BP and increased dietary fiber intake., Results: Seventy-three percent of participants in the oats group versus 42% in the control group were able to stop or reduce their medication by half. Treatment group participants whose medication was not reduced had substantial decreases in BP. The oats group experienced a 24.2-mg/dL reduction in total cholesterol levels, a 16.2-mg/dL decrease in low-density lipoprotein cholesterol levels, and a 15.03-mg/dL drop in plasma glucose levels vs controls., Conclusions: Results suggest that a diet containing soluble fiber-rich whole oats can significantly reduce the need for antihypertensive medication and improve BP control. Considering the lipid and glucose improvements as well, increased consumption of whole oats may significantly reduce cardiovascular disease risk.

Objectives: We assessed the short-term antihypertensive effects of soluble fiber-rich whole oat cereals when added to a standard American diet. In addition, multiple assessments of insulin sensitivity were conducted., Study Design: This was a randomized, controlled, parallel-group pilot study designed to compare an oat cereal group (standardized to 5.52 g/day beta-glucan) to a low-fiber cereal control group (less than 1.0 g/day total fiber) over 6 weeks., Population: A total of 18 hypertensive and hyperinsulinemic (= 10 U/mL or more) men and women completed the trial., Outcomes Measured: Primary study outcomes were changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Secondary outcomes included blood lipid, fasting glucose, and insulin levels and side effects related to elevated blood pressure and increased dietary fiber intake., Results: The oat cereal group experienced a 7.5 mm Hg reduction in SBP (P &lt.01) and a 5.5 mm Hg reduction in DBP (P &lt.02), while there was virtually no change in either SBP or DBP in the control group. In the oat cereal group, a trend was observed for a lower total insulin response to a glucose load, suggesting improved insulin sensitivity. However, this could not be confirmed using estimates from the Bergman Minimal Model, perhaps because of our small sample size. The oats group experienced a significant reduction in both total cholesterol (9%) and low-density lipoprotein cholesterol (14%)., Conclusions: The addition of oat cereals to the normal diet of patients with hypertension significantly reduces both SBP and DBP. Soluble fiber-rich whole oats may be an effective dietary therapy in the prevention and adjunct treatment of hypertension.

In 1998, 48% of persons who had HIV testing at publicly funded sites in the United States failed to return for test results and posttest counseling. Opportunities for timely HIV therapy were lost; valuable resources were wasted. This study tested the hypothesis that rapid HIV testing enables a high percentage of high-risk outreach clients to learn their serostatus. We did on-site counseling and rapid HIV testing at community-based organizations (e.g., chemical dependency programs, homeless shelters) in North Minneapolis. The project tested 735 persons. All but one (99.9%) learned their HIV serostatus. African Americans made up 79% of subjects. Rapid testing has a role to play in HIV outreach. It is useful in populations who are at high risk of HIV infection, who currently are not accessing HIV testing, and who have high failure to return rates. Future developments in rapid testing technology will make this testing option more convenient and cost-effective.

Semantic understanding of numbers and related concepts can be dissociated from rote knowledge of arithmetic facts. However, distinctions among different kinds of semantic representations related to numbers have not been fully explored. Working with numbers and arithmetic requires representing semantic information that is both analogue (e.g., the approximate magnitude of a number) and symbolic (e.g., what / means). In this article, the authors describe a patient (MC) who exhibits a dissociation between tasks that require symbolic number knowledge (e.g., knowledge of arithmetic symbols including numbers, knowledge of concepts related to numbers such as rounding) and tasks that require an analogue magnitude representation (e.g., comparing size or frequency). MC is impaired on a variety of tasks that require symbolic number knowledge, but her ability to represent and process analogue magnitude information is intact. Her deficit in symbolic number knowledge extends to a variety of concepts related to numbers (e.g., decimal points, Roman numerals, what a quartet is) but not to any other semantic categories that we have tested. These findings suggest that symbolic number knowledge is a functionally independent component of the number processing system, that it is category specific, and that it is anatomically and functionally distinct from magnitude representations., (Copyright 2001 Elsevier Science.)