This article examines the influence of national and local forces on housing prices in 20 local US real estate markets during the recent housing price run-up and decline. We use reduced-form panel data fixed-effects models with robust SEs to determine the impact of national and local effects on housing prices in 20 US cities across time. A national home price index and mortgage rate are used to measure national impacts on the local markets. A mix of socio-economic variables estimates local impacts. We find no results indicating that national trends lack relevance in local markets; however, we find wide support for the additional inclusion of local socio-economic factors in all markets. The findings are consistent with an environment in which national polices and trends influence all markets; however local policymakers and investors can continue to expect geographic differences in market outcomes.

Homebuyers and commercial real estate buyers who borrow funds using mortgages all must face the choice of whether to assume a fixed or an adjustable rate mortgage. Other mortgage forms with alternative characteristics are available, but the deciding question remains the same. Fixed rate mortgages never change over time, but have a high initial rate: adjustable rate, interest-only or hybrid mortgages begin with lower rates, but they change at fixed intervals over time. In contrast to professionals, consumers are often ill-equipped to understand the benefits and drawbacks of mortgage instruments. With poor product knowledge they may find the choice between fixed and variable rate mortgages overwhelming. They need help in making informed decisions. Giving the bulk of consumers the knowledge that a university level finance course conveys is not possible. Thus, there is a need for a simple applicable technique that can improve financial choice. This paper offers a straightforward forecasting model, to make the decision easier and relatively risk free. Adjustable mortgages are not always the best choice, especially in a rising interest rate market or one that has a strong possibility of rising. The model is a decision making tool that may help ordinary consumers make the best choice. Alternatively, mortgage company personnel may use the forecast to aid consumers in selecting the best mortgage.

Editor's note: Figure 1, Figure 2, Figure 3 that accompany this article are available online at . Approved February 2011 by the Quality Management Committee of the American Dietetic Association (ADA) House of Delegates and the Executive Committee of the Dietitians in Integrative and Functional Medicine Dietetic Practice Group of the ADA. Scheduled review date: June 2016. Questions regarding the Standards of Practice and Standards of Professional Performance for RDs in Integrative and Functional Medicine may be addressed to ADA quality management staff: Sharon McCauley, MS, MBA, RD, LDN, FADA, director, Quality Management at [email protected] The Dietitians in Integrative and Functional Medicine (DIFM) Dietetic Practice Group (DPG) of the American Dietetic Association (ADA), under the guidance of the ADA Quality Management Committee and its Scope of Dietetics Practice Framework Sub-Committee, has developed Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians (RDs) in Integrative and Functional Medicine (see the Web site exclusive Figure 1, Figure 2, Figure 3 at www.adajournal.org). These documents build on the ADA Revised 2008 SOP for RDs in Nutrition Care and SOPP for RDs (1American Dietetic Association Revised 2008 Standards of Practice for Registered Dietitians in Nutrition Care; Standards of Professional Performance for Registered Dietitians; Standards of Practice for Dietetic Technicians, Registered, in Nutrition Care; and Standards of Professional Performance for Dietetic Technicians, Registered.J Am Diet Assoc. 2008; 108 (1538-1542.e9)Google Scholar). ADA's Code of Ethics (2American Dietetic Association/Commission on Dietetic Registration Code of Ethics for the Profession of Dietetics and Process for Consideration of Ethics IssuesJ Am Diet Assoc. 2009; 109: 1461-1467Google Scholar) and the 2008 SOP in Nutrition Care and SOPP for RDs are decision tools within the Scope of Dietetics Practice Framework (3O'Sullivan-Maillet J. Skates J. Pritchett E. Scope of dietetics practice framework.J Am Diet Assoc. 2005; 105: 634-640Google Scholar) that guide the practice and performance of RDs in all settings. The concept of scope of practice is fluid (4Visocan B. Swift J. Understanding and using the scope of dietetics practice framework: A step-wise approach.J Am Diet Assoc. 2006; 106: 459-463Google Scholar), changing in response to the expansion of knowledge, the health care environment, and technology. An RD's legal scope of practice is defined by state legislation (eg, state licensure law) and differs from state to state. An RD may determine his or her own individual scope of practice using the Scope of Dietetics Practice Framework, which takes into account federal regulations; state laws; institutional policies and procedures; and individual competence, accountability, and responsibility for his or her own actions. ADA's Revised 2008 SOP in Nutrition Care and SOPP reflect the minimum competent level of dietetics practice and professional performance for RDs. These standards serve as blueprints for the development of focus area SOP and SOPP for RDs in competent, proficient, and expert levels of practice. The SOP in Nutrition Care address the four steps of the Nutrition Care Process (NCP) and activities related to person-centered care (5Lacey K. Pritchett E. Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management.J Am Diet Assoc. 2003; 103: 1061-1072Google Scholar). They are designed to promote the provision of safe, effective, and efficient food and nutrition services, facilitate evidence-based practice, and serve as a professional evaluation resource. The SOPP are authoritative statements that describe a competent level of behavior in the professional role. Categorized behaviors that correlate with professional performance are divided into six separate standards. These focus area standards are a guide for self-evaluation and expanding practice; that is, a means of identifying areas for professional development. These standards provide a tool for demonstrating competency in delivering integrative and functional medical nutrition therapy (IFMNT), a term used by DIFM to identify a type of medical nutrition therapy incorporating both integrative and functional medicine practices for chronic disease conditions. They are used by RDs to assess their current level of practice and to determine the education and training required to maintain currency in this focus area and advancement to a higher level of practice. In addition, the Standards may be used to assist RDs in transitioning their knowledge and skills to a new focus area of practice. Like the SOP in Nutrition Care and SOPP for RDs, the indicators (measurable action statements that illustrate how each standard can be applied in practice; see Figure 2, Figure 3, available online at www.adajournal.org) for the SOP and SOPP for RDs in Integrative and Functional Medicine were developed with input and consensus of content experts representing diverse practice and geographic perspectives. The SOP and SOPP for RDs in Integrative and Functional Medicine were reviewed and approved by the Executive Committee of the DIFM DPG, the Scope of Dietetics Practice Framework Sub-Committee, and ADA's Quality Management Committee. In dietetics, a competent practitioner is an RD who is starting in practice after having obtained RD registration by the Commission on Dietetic Registration or an experienced RD who has newly assumed responsibility to provide nutrition care in a new focus area. A focus area is defined as an area of dietetics practice that requires focused knowledge, skills, and experience. A competent practitioner who has obtained RD status and is starting in professional employment requires on-the-job skills as well as engaging in tailored continuing education to enhance knowledge and skills. This RD starts with technical training and interaction for advancement and expanding breadth of competence. The practice of a competent RD may include responsibilities across several areas of practice, including, but not limited to, more than one of the following: community, clinical, consultation and business, research, education, and food and nutrition management. A proficient practitioner is an RD who is generally 3 years or more beyond entry level into the profession, who has obtained operational job performance skills, and is successful in the chosen focus area of practice. This proficient practitioner demonstrates additional knowledge, skills, and experience in a focus area of dietetics practice. This RD may acquire specialist credentials, if available, to demonstrate proficiency in a focus area of practice. An expert practitioner is an RD who is recognized within the profession and has mastered the highest degree of skill in or knowledge of a certain focus or generalized area of dietetics through additional knowledge, experience, and/or training. An expert practitioner exhibits a set of characteristics that include leadership and vision, and demonstrates effectiveness in planning, achieving, evaluating, and communicating targeted outcomes. An expert practitioner may have expanded or specialist roles or both, and may possess an advanced credential, if available, in a focus area of practice. The practice often is more complex and the practitioner has a high degree of professional autonomy and responsibility (6American Dietetic AssociationScope of Dietetics Practice Framework Definition of Terms.http://www.eatright.org/scopeGoogle Scholar). These standards, along with the ADA's Code of Ethics (2American Dietetic Association/Commission on Dietetic Registration Code of Ethics for the Profession of Dietetics and Process for Consideration of Ethics IssuesJ Am Diet Assoc. 2009; 109: 1461-1467Google Scholar), answer the questions: Why is an RD uniquely qualified to provide IFMNT? What knowledge, skills, and competencies does an RD need to demonstrate for the provision of safe, effective, and quality IFMNT care at the competent, proficient, and expert levels? DIFM DPG of ADA represents a focus area of more than 2,550 members who apply their knowledge of integrative medicine and functional medicine to personalize client care. RDs who practice IFMNT develop and provide person-centered nutrition interventions in health and chronic disease using two principles. First, they recognize that each client has a unique genetic make-up. Second, each client functions in an environment with internal and external factors that influence interactions (7Cantwell M.F. Map of the spirit: Diagnosis and treatment of spiritual disease.Adv Mind Body Med. 2008; 23: 6-16Google Scholar) between the mind, body, and spirit such as physical, social, and lifestyle factors (8Liu C.J. A study on the efficacy of body-mind-spirit group therapy for patients with breast cancer.J Clin Nurs. 2008; 17: 2539-2549Google Scholar). An IFMNT RD employs a systems assessment of a person's biochemical individuality (9Gahl W.A. Chemical individuality: Concept and outlook.J Inherit Metab Dis. 2008; 31: 630-640Google Scholar) to develop a plan using the NCP (5Lacey K. Pritchett E. Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management.J Am Diet Assoc. 2003; 103: 1061-1072Google Scholar). The assessment includes information from emerging sciences such as nutritional genomics (10Ryan-Harshman M. Nutritional genomics and dietetic professional practice.Can J Diet Pract Res. 2008; 69: 177-182Google Scholar) and environmental toxicology. An RD practicing IFMNT may act independently in private practice or as part of an integrative medicine or functional medicine health care team. Both integrative medicine and functional medicine are central to the practice of dietetics practitioners in DIFM. They represent a broader paradigm of medicine that is person-centered, oriented to healing, and the use of both conventional and complementary therapies. Many practitioners are currently using either an integrative or functional medicine approach that is complementary to conventional medicine practices, and include the major tenets that DIFM RDs embrace (11Genuis S.J. Evolution in pediatric health care.Pediatr Int. 2010; 52: 640-643Google Scholar, 12Genuis S.J. Lobo R.A. Potential amelioration of morbidity in patients with chromosomal anomalies: Relevance to Bardet-Biedl syndrome.Clin Genetics. 2011; 79: 482-488Google Scholar, 13Holman H. Chronic disease-the need for a new clinical education.JAMA. 2004; 292: 1057-1059Google Scholar). In addition, they may include safe “alternative medicine” traditions (eg, use of products and practices that are not part of standard care such as massage or homeopathy). DIFM RDs appreciate that all individuals have unique metabolic patterns often based on genetics that affect health needs. Thus, the concept of individuality is central to every aspect of both integrative and functional medicine, from clinical assessment and diagnosis to the broad spectrum of prevention and disease management (14Williams R.J. Biochemical Individuality: The Key to Understanding What Shapes Your Health. Keats Publishing, New Canaan, CT1998Google Scholar). Client uniqueness encompasses both voluntary activities, such as decision making and emotional responses, and the involuntary activities of nutrient metabolism, cellular processing of information, and communication between organ systems. A unique central theme of functional medicine used by DIFM RDs in clinical practice is to hear the patient's story (15What is functional medicine? Working with a functional medicine practitioner.http://www.functionalmedicine.org/content_management/files/What_is_FM_and_Working_with_a_FM_Practitioner_2pg.pdfGoogle Scholar) to support client well-being and consider the beliefs, attitudes, and motivations, as well as the physical, mental, and emotional aspects of the individual. Indeed, the focus on addressing the root cause of disease and focus on preventive care are central tenets of IFMNT. In the integrative and functional medicine paradigm, optimal health is described as “something other than the absence of disease; conceived as an integrated function of biology, environment, and behavior; and measured as a product of physical, mental, social, and spiritual variables” (15What is functional medicine? Working with a functional medicine practitioner.http://www.functionalmedicine.org/content_management/files/What_is_FM_and_Working_with_a_FM_Practitioner_2pg.pdfGoogle Scholar). The functional medicine model was first proposed in the early 1980s by Jeffrey Bland, PhD (16Synthesis by Jeffrey Bland PhD.http://www.jeffreybland.com/content/Dr_Jeffrey_Bland.aspxGoogle Scholar). This dynamic, science-based (17Shao A. Mackay D. A Commentary on the nutrient-chronic disease relationship and the new paradigm of evidence-based nutrition.Nat Med J. 2010; 2: 12Google Scholar) approach considers the complex interactions among a person's genetic predispositions, environmental inputs, and lifestyle to assess, prevent, and treat chronic disease. Internal and external factors are recognized to give rise to core physiological imbalances and dysfunction in physiological systems, including the significant influence that “long-latency nutritional insufficiencies” (18McCann J.C. Ames B.N. Vitamin K, an example of triage theory: Is micronutrient inadequacy linked to diseases of aging?.Am J Clin Nutr. 2009; 90: 889-907Google Scholar, 19Heaney R. Long latency deficiency disease: Insights from calcium and vitamin D EV McCollum Award Lecture.Am J Clin Nutr. 2003; 78: 912-919Google Scholar) have on the development of chronic disease (20Swift K.M. Redmond E. Dean S. What's integrative and functional medicine? Dietitians in Integrative and Functional Medicine Web site.http://www.integrativerd.org/site.cfm?page=what_is_integrative_medicineGoogle Scholar). Both integrative medicine and functional medicine focus on the biochemical pathways that are the basis of extensive metabolic networks and the genes that underlie these pathways (21Fasano A. Surprises from celiac disease; study from a potentially fatal food triggered disease has uncovered a process that may contribute to many autoimmune disorders.Sci Am. 2009; : 54-61Google Scholar). Nutrients play essential roles in the cellular metabolism of these networks that are influenced by a person's unique diet–gene–environment interactions throughout the lifetime (22Genuis S.J. Bouchard T.P. Celiac disease presenting as autism.J Child Neurol. 2010; 25: 114Google Scholar). Integrative medicine and functional medicine both propose that even a minor imbalance within the body can produce a cascade of biological triggers commonly termed a “snowball effect,” with long-latency effects that can eventually lead to poor health and chronic illness (18McCann J.C. Ames B.N. Vitamin K, an example of triage theory: Is micronutrient inadequacy linked to diseases of aging?.Am J Clin Nutr. 2009; 90: 889-907Google Scholar, 19Heaney R. Long latency deficiency disease: Insights from calcium and vitamin D EV McCollum Award Lecture.Am J Clin Nutr. 2003; 78: 912-919Google Scholar, 23Kaplan B.J. Crawford S.G. Field C.J. Simpson J.S. Vitamins, minerals, and mood.Psychol Bull. 2007; 133: 747-760Google Scholar). To address such situations, IFMNT practitioners use a range of assessment tools in practice. These include a nutrition-focused physical exam (24Touger-Decker R. Physical assessment skills for dietetics practice: The past, the present and recommendations for the future.Top Clin Nutr. 2006; 21: 191-198Google Scholar) and conventional laboratory data along with functional tests (25Lord R.S. Bralley J.A. Laboratory Evaluations for Integrative and Functional Medicine.2nd ed. Metametrix Institute, Duluth, GA2008Google Scholar) to assess the integrity of the metabolic networks and core imbalances that may be present. Early intervention to address core imbalances is thought to impede or prevent the snowball effect. For this reason the two types of medicine focus on restoring optimal function as well as managing symptoms and promoting overall health. The integrative and functional medicine approaches were driven initially by consumer demand (26Eisenberg D.M. Davis R.B. Ettner S.L. Appel S. Wilkey S. Van Rompay M. Kessler R.C. Trends in alternative medicine use in the United States, from 1990 to 1997: Results of a follow-up national survey.JAMA. 1998; 280: 1569-1575Google Scholar) and are now increasingly accepted by health care providers and institutions (15What is functional medicine? Working with a functional medicine practitioner.http://www.functionalmedicine.org/content_management/files/What_is_FM_and_Working_with_a_FM_Practitioner_2pg.pdfGoogle Scholar, 27Jones D.S. Hofmann L. Quinn S. 21st Century Medicine: A New Model for Medical Education and Practice. Institute for Functional Medicine, Gig Harbor, WA2009Google Scholar). They reaffirm the importance of the therapeutic relationship, a focus on the whole person and lifestyle, a renewed attention to healing, and a willingness to use all appropriate therapeutic approaches whether they originate in conventional or alternative medicine (27Jones D.S. Hofmann L. Quinn S. 21st Century Medicine: A New Model for Medical Education and Practice. Institute for Functional Medicine, Gig Harbor, WA2009Google Scholar). IFMNT incorporates varied modalities such as therapeutic food elimination diets (28Drisko J. Bischoff B. Hall M. McCallum R. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics.J Am Coll Nutr. 2006; 25: 514-522Google Scholar); dietary supplements, including vitamins, minerals, and botanicals (29Farnsworth N.R. The University of Illinois at Chicago/National Institutes of Health Center for Botanical Dietary Supplements Research for Women's Health: From plant to clinical use.Am J Clin Nutr. 2008; 87: 504S-508SGoogle Scholar, 30Rosenfeld J. Nutrition and dietary supplements in motor neuron disease.Phys Med Rehabil Clin N Am. 2008; 19: 573-589Google Scholar); gastrointestinal interventions (21Fasano A. Surprises from celiac disease; study from a potentially fatal food triggered disease has uncovered a process that may contribute to many autoimmune disorders.Sci Am. 2009; : 54-61Google Scholar, 22Genuis S.J. Bouchard T.P. Celiac disease presenting as autism.J Child Neurol. 2010; 25: 114Google Scholar, 30Rosenfeld J. Nutrition and dietary supplements in motor neuron disease.Phys Med Rehabil Clin N Am. 2008; 19: 573-589Google Scholar); and detoxification programs (31Siener R. Change in the fatty acid pattern of erythrocyte membrane phospholipids after oral supplementation of specific fatty acids in patients with gastrointestinal diseases.Eur J Clin Nutr. 2010; 64: 410-418Google Scholar, 32Maizes V. Integrative medicine and patient-centered care.Explore (NY). 2009; 5: 277-289Google Scholar, 33Jones D.S. Textbook of Functional Medicine. The Institute for Functional Medicine, Gig Harbor, WA2005Google Scholar). IFMNT also appreciates the value of therapeutic interventions such as yoga, movement, imagery, and meditation in holistic health care (34Arizona Center for Integrative Medicine Web site.http://integrativemedicine.arizona.eduGoogle Scholar). Through changes in lifestyle, environment, and nutrition, integrative and functional medicine nutrition practitioners rely on their knowledge of the dynamic interplay of genetics, biochemical processes, and biological systems and networks for establishing an innovative, holistic nutrition care process (27Jones D.S. Hofmann L. Quinn S. 21st Century Medicine: A New Model for Medical Education and Practice. Institute for Functional Medicine, Gig Harbor, WA2009Google Scholar, 35Institute for Functional Medicine Web site.http://www.functionalmedicine.orgGoogle Scholar). The theories and practice of integrative and functional medicine have developed over time and are increasingly being incorporated into practice by diverse health care professionals (27Jones D.S. Hofmann L. Quinn S. 21st Century Medicine: A New Model for Medical Education and Practice. Institute for Functional Medicine, Gig Harbor, WA2009Google Scholar). During the past 30 years, two institutions have been leaders in the education of health care professionals in these two areas of medicine with a focus on the importance of nutrition. The Arizona Center for Integrative Medicine (34Arizona Center for Integrative Medicine Web site.http://integrativemedicine.arizona.eduGoogle Scholar) provides online courses, conferences, and publications, and offers the largest integrative medical fellowship in the United States, whereas The Institute for Functional Medicine (35Institute for Functional Medicine Web site.http://www.functionalmedicine.orgGoogle Scholar) offers educational programs and publications in functional medicine. The Institute for Functional Medicine proposed the Functional Medicine Matrix (Figure 4) (33Jones D.S. Textbook of Functional Medicine. The Institute for Functional Medicine, Gig Harbor, WA2005Google Scholar), as a useful tool for practitioners to use in their assessment and interactions with clients. The Matrix serves as a practical tool for capturing a patient's story as well as an organized system for identifying clinically relevant patterns within the complex symptoms characteristic of chronic disorders. The Matrix provides a framework that allows practitioners to probe the multiple dimensions involved in promoting health and preventing disease. This framework captures information in three sectors that are important to patient health: the patient's story and an assessment of the antecedents (preceding events), triggers (precipitates an event), and mediators (a substance that promotes a reaction) that contributed to a patient's health status (15What is functional medicine? Working with a functional medicine practitioner.http://www.functionalmedicine.org/content_management/files/What_is_FM_and_Working_with_a_FM_Practitioner_2pg.pdfGoogle Scholar); an assessment of parameters that support health, such as food and nutrition, exercise and movement, sleep and rest, relationships, meaning, and life purpose (27Jones D.S. Hofmann L. Quinn S. 21st Century Medicine: A New Model for Medical Education and Practice. Institute for Functional Medicine, Gig Harbor, WA2009Google Scholar); and an assessment of parameters such as inflammation biomarkers and body composition typically associated with core physiological imbalances and chronic disease development and perpetuation. Integrated throughout this framework is the honoring of the mind–body–spirit (36Puchalski C.M. The role of spirituality in health care.Proc (Bayl Univ Med Cent). 2001; 14: 352-357Google Scholar) uniqueness of an individual patient. The IFMNT Radial (Figure 5) (37Swift K. Noland D. Redmond E. The Integrative and Functional Medical Nutrition Therapy (IFMNT) Radial Copyright 2011.www.integrativerd.orgGoogle Scholar) has been established by three advanced practice DIFM members as a conceptual framework to assist dietetics practitioners implementing IFMNT in practice. It is a model for critical thinking that embraces both the science and art of personalized nutrition care with consideration of multiple conventional or alternative medicine disciplines. The circular architecture of the IFMNT Radial allows for the evaluation of complex interactions and interrelationships amongst the five key areas of IFMNT (38Walach H. Falkenbert T. Fonnebo V. Lewith G. Jonas W.B. Circular instead of hierarchial: Methodological principles for the evaluation of complex interventions.BMC Med Res Methodol. 2006; 6: 29Google Scholar). The individual is the central figure in a person-centered process based on the NCP principles of assessment, diagnosis, intervention, monitoring, and evaluation. The Radial depicts food as a determining factor in health and disease. Food contains the messages of biological information that influence the five key areas of IFMNT: lifestyle, systems (signs and symptoms), core imbalances, metabolic pathways, and biomarkers. All areas are interconnected and influenced by a person's biochemical and genetic uniqueness, illustrated by the DNA strands linking the five key areas. The lifestyle circle takes into account the many factors that an RD must consider in personalizing nutrition care, including access and availability to food, culture and traditions, environment, extent of movement or exercise, stress, and other critical factors. The systems circle represents each of the body systems; a full assessment of body systems is done with a hands-on nutrition-focused physical exam (24Touger-Decker R. Physical assessment skills for dietetics practice: The past, the present and recommendations for the future.Top Clin Nutr. 2006; 21: 191-198Google Scholar). Biomarkers can help to further evaluate abnormalities found in the nutrition physical exam or any of the systems (39Gibson R.S. Principles of Nutritional Assessment.in: 2nd ed. Oxford University Press, New York, NY2005: 385-388Google Scholar). Besides establishing the status of a single nutrient, reviewing biochemical assessments can give information on the functions of metabolic pathways or networks when interpreted within the clinical context in either health or disease. Metabolic pathways are driven by enzymes, the majority dependent on micronutrient cofactors that can be evaluated with biomarker assessments (25Lord R.S. Bralley J.A. Laboratory Evaluations for Integrative and Functional Medicine.2nd ed. Metametrix Institute, Duluth, GA2008Google Scholar, 39Gibson R.S. Principles of Nutritional Assessment.in: 2nd ed. Oxford University Press, New York, NY2005: 385-388Google Scholar). In addition, a person's micronutrient status can affect metabolic function because the body prioritizes available micronutrients for the most important functions (18McCann J.C. Ames B.N. Vitamin K, an example of triage theory: Is micronutrient inadequacy linked to diseases of aging?.Am J Clin Nutr. 2009; 90: 889-907Google Scholar, 40Ames B.N. Prevention of mutation, cancer, and other age-associated diseases by optimizing micronutrient intake.J Nucleic Acids. 2010; http://www.sage-hindawi.com/jna/2010/725071/https://doi.org/10.4061/2010/725071Google Scholar). Although the effects of this prioritization may be insignificant in the time frame of days or months, such ranking may contribute to chronic conditions, antioxidant stress, and premature aging (40Ames B.N. Prevention of mutation, cancer, and other age-associated diseases by optimizing micronutrient intake.J Nucleic Acids. 2010; http://www.sage-hindawi.com/jna/2010/725071/https://doi.org/10.4061/2010/725071Google Scholar) over years and throughout the life cycle. Clinicians involved in IFMNT must become well versed in nutritional biochemistry to fully understand these long latency effects. The core clinical imbalances concentrate and summarize the findings from each of the other circles, identifying their relationships to health. Imbalances in these core regions can have far-reaching effects and are a central foundation in IFMNT. Surrounding the Radial are precipitating factors such as food allergens and intolerances (21Fasano A. Surprises from celiac disease; study from a potentially fatal food triggered disease has uncovered a process that may contribute to many autoimmune disorders.Sci Am. 2009; : 54-61Google Scholar), negative thoughts and beliefs (41Bush T. Bruni N. Spiritual care as a dimension of holistic care: A relational interpretation.Int J Palliat Nurs. 2008; 11: 539-545Google Scholar, 42Lipton B.H. The Biology of Belief: Unleashing the Power of Consciousness, Matter & Miracles. Hay House, Carlsbad, CA2008Google Scholar), pathogens, and environmental exposures (43Kotsonis F.N. Mackey M.A. Nutritional Toxicology.2nd ed. Taylor & Francis, New York, NY2002Google Scholar). These factors can adversely affect an individual and may result in specific measurable biomarkers indicating imbalance in body systems, pathways, and networks. The metabolic impact varies, depending on genetic uniqueness and cellular integrity. An individual's ability to respond to external antagonists is also dependent on lifestyle factors (eg, food, culture, environment, movement, sleep, and stress) that determine resiliency. This group, previously known as the Nutrition in Complementary Care DPG, was originally established in 1998 by a group of RDs interested in broadening their skill sets in topics such as nutritional genomics, functional foods, dietary supplements (44Stargrove M.B. Treasure J. McKee D.L. Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. Mosby Elsevier, Maryland Heights, MO2008Google Scholar), and ancient traditions (33Jones D.S. Textbook of Functional Medicine. The Institute for Functional Medicine, Gig Harbor, WA2005Google Scholar) such as Chinese dietary therapy and Ayurveda. These topics were researched and discussed at professional meetings and in DPG newsletters. The DPG changed its name to DIFM in September 2009 to more definitively reflect the expertise of RDs in integrative and functional medical nutrition therapy. The vision of the DIFM DPG is to optimize health and healing through integrative and functional medicine nutrition practices; the long-range mission is to empower members to be leaders in personalized genomics, holistic care, and integrative and functional nutrition therapies (the DIFM DPG strategic plan is available at www.IntegrativeRD.org). Strategies to achieve this mission include: •Disseminating information about new and emerging technologies such as nutritional genomics;•Incorporating recent research into environmental toxins' aff

The author describes a particular instance of peer group pastoral supervision in which the techniques of psychodrama enable(d) the re-enactment of a challenging pastoral encounter in the (mental) health care chaplaincy setting. She goes on to think about the theological nature and significance of what took place, using the literary categories of "the epic," "the lyric" and "the dramatic" as "models" through which to explore its meaning. She reflects on the transformation that happened in and through the supervision and on what it was about the dramatic re-enactment that might have enabled this to happen, with particular reference to the Eucharist.

Objective The aim of this study was to explore women's decision-making about the balance of risks and benefits of taking hormone replacement therapy (HRT) based on the latest evidence from the Women's Health Initiative (WHI) trial of combined HRT.Methods Women aged 50-69 years, who were eligible for the Women's International Study of long Duration Oestrogen after Menopause (WISDOM) trial, were invited to participate in one of eight focus groups. Participants were asked to discuss their views about taking HRT based on the latest international evidence.Results and conclusions Eighty-two women participated overall. Qualitative content analysis was applied to the discussion transcripts. Women regarded the decisions they make about taking HRT as highly personal, and, for women currently taking HRT, the overwhelming reason for continuation was perceived improvement in quality of life regardless of either the risks or the benefits in the longer term.

There is evidence for genetic predisposition to prostate cancer. However, prostate cancer genes have been more difficult to find than genes for some of the other common cancers, such as breast and colon cancer. The reasons for this are discussed in this article and it is now becoming clear that prostate cancer is probably due to multiple genes, many of which are moderate or low penetrance. The advances in the Human Genome Project and technology, especially that of robotics, will help to overcome these problems.

Wilms tumor is an embryonal kidney cancer that affects one in 10000 chil-dren. Epidemiologic studies have shown that 1%–3% of cases of Wilms tumor are familial and that a predisposition to Wilms tumor is probably caused by rare germline mutations acting in a dominant fashion (1). The risks of Wilms tumor conferred by mutations in these genes are poorly characterized, with estimates of their penetrance ranging from 18% to 63% (2–4). These estimates represent an average of the risks of all genes that predispose an individual to Wilms tumor and, therefore, are influenced by popu-lation-dependent variation in the prevalence of mutations in different genes.

Predisposition to prostate cancer has a genetic component, and there are reports of familial clustering of breast and prostate cancer. Two highly penetrant genes that predispose individuals to breast cancer (BRCA1 and BRCA2) are known to confer an increased risk of prostate cancer of about 3-fold and 7-fold, respectively, in breast cancer families. Blood DNA from affected individuals in 38 prostate cancer clusters was analyzed for germline mutations in BRCA1 and BRCA2 to assess the contribution of each of these genes to familial prostate cancer. Seventeen DNA samples were each from an affected individual in families with three or more cases of prostate cancer at any age; 20 samples were from one of affected sibling pairs where one was less than or equal to 67 years at diagnosis, No germ-line mutations were found in BRCA1. Two germ-line mutations in BRCA2 were found, and both were seen in individuals whose age at diagnosis was very young (less than or equal to 56 years) and who were members of an affected sibling pair. One is a 4-bp deletion at base 6710 (exon 11) in a man who had prostate cancer at 54 Sears, and the other is a 2-bp deletion at base 5531 (ex:on 11) in a man who had prostate cancer at 56 years, In both cases, the wild-type allele was lost in the patient's prostate tumor at the BRCA2 locus. However, intriguingly, in neither case did the affected brother also carry the mutation. Germ-line mutations in BRCA2 may therefore account for about 5% of prostate cancer in familial clusters.

Predisposition to prostate cancer has a genetic component, and there are reports of familial clustering of breast and prostate cancer. Two highly penetrant genes that predispose individuals to breast cancer (BRCA1 and BRCA2) are known to confer an increased risk of prostate cancer of about 3-fold and 7-fold, respectively, in breast cancer families. Blood DNA from affected individuals in 38 prostate cancer clusters was analyzed for germ-line mutations in BRCA1 and BRCA2 to assess the contribution of each of these genes to familial prostate cancer. Seventeen DNA samples were each from an affected individual in families with three or more cases of prostate cancer at any age; 20 samples were from one of affected sibling pairs where one was ltoreq67 years at diagnosis. No germ-line mutations were found in BRCA1. Two germ-line mutations in BRCA2 were found, and both were seen in individuals whose age at …

Predisposition to prostate cancer has a genetic component, and there are reports of familial clustering of breast and prostate cancer. Two highly penetrant genes that predispose individuals to breast cancer (BRCA1 and BRCA2) are known to confer an increased risk of prostate cancer of about 3-fold and 7-fold, respectively, in breast cancer families. Blood DNA from affected individuals in 38 prostate cancer clusters was analyzed for germ-line mutations in BRCA1 and BRCA2 to assess the contribution of each of these genes to familial prostate cancer. Seventeen DNA samples were each from an affected individual in families with three or more cases of prostate cancer at any age; 20 samples were from one of affected sibling pairs where one was < or = 67 years at diagnosis. No germ-line mutations were found in BRCA1. Two germ-line mutations in BRCA2 were found, and both were seen in individuals whose age at diagnosis was very young (< or = 56 years) and who were members of an affected sibling pair. One is a 4-bp deletion at base 6710 (exon 11) in a man who had prostate cancer at 54 years, and the other is a 2-bp deletion at base 5531 (exon 11) in a man who had prostate cancer at 56 years. In both cases, the wild-type allele was lost in the patient's prostate tumor at the BRCA2 locus. However, intriguingly, in neither case did the affected brother also carry the mutation. Germ-line mutations in BRCA2 may therefore account for about 5% of prostate cancer in familial clusters.

The contribution of BRCA1 and BRCA2 to inherited breast cancer was assessed by linkage and mutation analysis in 237 families, each with at least four cases of breast cancer, collected by the Breast Cancer Linkage Consortium. Families were included without regard to the occurrence of ovarian or other cancers. Overall, disease was linked to BRCA1 in an estimated 52% of families, to BRCA2 in 32% of families, and to neither gene in 16% (95% confidence interval [CI] 6%-28%), suggesting other predisposition genes. The majority (81%) of the breast-ovarian cancer families were due to BRCA1, with most others (14%) due to BRCA2. Conversely, the majority of families with male and female breast cancer were due to BRCA2 (76%). The largest proportion (67%) of families due to other genes was found in families with four or five cases of female breast cancer only. These estimates were not substantially affected either by changing the assumed penetrance model for BRCA1 or by including or excluding BRCA1 mutation data. Among those families with disease due to BRCA1 that were tested by one of the standard screening methods, mutations were detected in the coding sequence or splice sites in an estimated 63% (95% CI 51%-77%). The estimated sensitivity was identical for direct sequencing and other techniques. The penetrance of BRCA2 was estimated by maximizing the LOD score in BRCA2-mutation families, over all possible penetrance functions. The estimated cumulative risk of breast cancer reached 28% (95% CI 9%-44%) by age 50 years and 84% (95% CI 43%-95%) by age 70 years. The corresponding ovarian cancer risks were 0.4% (95% CI 0%-1%) by age 50 years and 27% (95% CI 0%-47%) by age 70 years. The lifetime risk of breast cancer appears similar to the risk in BRCA1 carriers, but there was some suggestion of a lower risk in BRCA2 carriers <50 years of age.

A susceptibility gene for Wilms’ tumour (WT), designated FWT1, was previously mapped to chromosome 17q12–q21 by linkage analysis of a single family. We now confirm the existence of this gene by analysis of additional cases in the original family (3-point LOD score=5.69), and by detecting strong evidence of linkage to this region in an unrelated pedigree with seven cases of WT (3-point LOD score=2.56). Analysis of 11 smaller WT families confirms that there is genetic heterogeneity in familial WT, as three families exhibit strong evidence against linkage to FWT1. One of these was subsequently found to have a predisposing WT1 mutation. However, the other two families show evidence against both FWT1 and WT1, suggesting that at least one further familial WT gene exists. Analysis of the phenotype of 16 WT cases from the families linked to FWT1 demonstrates that they present at a significantly older age and a significantly later stage than both sporadic WT and the six cases from two families unlinked to either FWT1 or WT1. The results confirm the role of FWT1 in susceptibility to WT, provide strong evidence for genetic heterogeneity in familial WT and suggest there are phenotypic differences between familial WT due to FWT1, familial WT due to other genes and non-familial WT.

Prostate cancer shows evidence of familial aggregation, particularly at young ages at diagnosis, but the inherited basis of familial prostate cancer is poorly understood. Smith et al. recently found evidence of linkage to markers on Iq, at a locus designated "HPC1," in 91 families with multiple cases of early-onset prostate cancer. Using both parametric and nonparametric methods, we attempted to confirm this finding, in 60 affected related pairs and in 76 families with three or more cases of prostate cancer, but we found no significant evidence of linkage. The estimated proportion of linked families, under a standard autosomal dominant model, was 4%, with an upper 95% confidence limit of 31%. We conclude that the HPC1 locus is responsible for only a minority of familial prostate cancer cases and that it is likely to be most important in families with at least four cases of the disease.

Using transaction level data, we present the first analysis of the way that foreign investors choose among different types of United States real estate. Our findings, based on the conditional logit model analysis for the 1980-91 period are consistent with the hypothesis that foreign investors behave in a traditional profit maximizing, risk minimizing fashion. In choosing among investments in four major categories (apartment, office, retail and industrial) foreign investor choice is most sensitive to changes in capitalization rates, market activity and current rent levels.

The penetrance of the BRCA2 gene on chromosome 13q12-13 has been estimated in two large, systematically ascertained, linked families, by use of a maximum-likelihood method to incorporate both cancer-incidence data and 13q marker typings in the families. The cumulative risk of breast cancer in female gene carriers was estimated to be 59.8% by age 50 years (95% confidence interval [95% CI] 25.9%-78.5%) and 79.5% by age 70 years (95% CI 28.9%-97.5%). The cumulative risk of breast cancer in male carriers was estimated to be 6.3% (95% CI 1.4%-25.6%) by age 70 years. There was no evidence of any risk difference between the two families. These results indicate that the lifetime breast cancer risk in BRCA2 carriers, for at least a subset of mutations, is comparable to that for BRCA1. A significant excess of ovarian cancer in gene carriers was observed (relative risk 17.69, based on three cases), but the absolute risk of ovarian cancer was less than that reported for BRCA1. Significant excesses of laryngeal cancer (relative risk 7.67, based on two possible carriers) and prostate cancer (relative risk 2.89, based on five possible carriers) were also observed. One case of ocular melanoma, as well as a second eye cancer of unspecified histology, occurred in obligate gene carriers.

British Journal of UrologyVolume 79, Issue S1 p. 8-14 Familial prostate cancer: the evidence and the Cancer Research Campaign/British Prostate Group (CRC/BPG) UK Familial Prostate Cancer Study R.A. EELES FRCR, Corresponding Author R.A. EELES FRCR Senior Lecturer and Honorary Consultant Institute of Cancer Research, Sutton, Surrey, Institute of Public Health, Cambridge, UK Royal Marsden Hospital, Downs Road, Sutton, Surrey, Institute of Public Health, Cambridge, UK D.P. Dearnaley, FRCR in Cancer Genetics and Oncology, Senior Lecturer and Honorary Consultant.Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK. Tel: +44 181 642 6011 × 3523, Fax: +44 181 770 1489. E-mail: [email protected]Search for more papers by this authorD.P. DEARNALEY, D.P. DEARNALEY Institute of Cancer Research, Sutton, Surrey, Institute of Public Health, Cambridge, UK Royal Marsden Hospital, Downs Road, Sutton, Surrey, Institute of Public Health, Cambridge, UK D.P. Dearnaley, FRCR in Cancer Genetics and Oncology, Senior Lecturer and Honorary Consultant.Search for more papers by this authorA. ARDERN-JONES, A. ARDERN-JONES Royal Marsden Hospital, Downs Road, Sutton, Surrey, Institute of Public Health, Cambridge, UK A. Ardern-Jones, DipN Clinical Nurse Specialist in Cancer Genetics.Search for more papers by this authorR.J. SHEARER FRCS, R.J. SHEARER FRCS Consultant Surgeon Royal Marsden Hospital, Downs Road, Sutton, Surrey, Institute of Public Health, Cambridge, UKSearch for more papers by this authorD.F. EASTON, D.F. EASTON CRC Unit of Genetic Epidemiology, Institute of Public Health, Cambridge, UK D.F. Easton, PhD, Director, CRC Genetic Epidemiology Unit.Search for more papers by this authorD. FORD MSc, D. FORD MSc Statistician Institute of Cancer Research, Sutton, Surrey, Institute of Public Health, Cambridge, UKSearch for more papers by this authorS. EDWARDS BSc, S. EDWARDS BSc Molecular Scientist Institute of Cancer Research, Sutton, Surrey, Institute of Public Health, Cambridge, UKSearch for more papers by this authorA. DOWE, A. DOWE Research Nurse Royal Marsden Hospital, Downs Road, Sutton, Surrey, Institute of Public Health, Cambridge, UKSearch for more papers by this author105 collaborators, 105 collaboratorsSearch for more papers by this author R.A. EELES FRCR, Corresponding Author R.A. EELES FRCR Senior Lecturer and Honorary Consultant Institute of Cancer Research, Sutton, Surrey, Institute of Public Health, Cambridge, UK Royal Marsden Hospital, Downs Road, Sutton, Surrey, Institute of Public Health, Cambridge, UK D.P. Dearnaley, FRCR in Cancer Genetics and Oncology, Senior Lecturer and Honorary Consultant.Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK. Tel: +44 181 642 6011 × 3523, Fax: +44 181 770 1489. E-mail: [email protected]Search for more papers by this authorD.P. DEARNALEY, D.P. DEARNALEY Institute of Cancer Research, Sutton, Surrey, Institute of Public Health, Cambridge, UK Royal Marsden Hospital, Downs Road, Sutton, Surrey, Institute of Public Health, Cambridge, UK D.P. Dearnaley, FRCR in Cancer Genetics and Oncology, Senior Lecturer and Honorary Consultant.Search for more papers by this authorA. ARDERN-JONES, A. ARDERN-JONES Royal Marsden Hospital, Downs Road, Sutton, Surrey, Institute of Public Health, Cambridge, UK A. Ardern-Jones, DipN Clinical Nurse Specialist in Cancer Genetics.Search for more papers by this authorR.J. SHEARER FRCS, R.J. SHEARER FRCS Consultant Surgeon Royal Marsden Hospital, Downs Road, Sutton, Surrey, Institute of Public Health, Cambridge, UKSearch for more papers by this authorD.F. EASTON, D.F. EASTON CRC Unit of Genetic Epidemiology, Institute of Public Health, Cambridge, UK D.F. Easton, PhD, Director, CRC Genetic Epidemiology Unit.Search for more papers by this authorD. FORD MSc, D. FORD MSc Statistician Institute of Cancer Research, Sutton, Surrey, Institute of Public Health, Cambridge, UKSearch for more papers by this authorS. EDWARDS BSc, S. EDWARDS BSc Molecular Scientist Institute of Cancer Research, Sutton, Surrey, Institute of Public Health, Cambridge, UKSearch for more papers by this authorA. DOWE, A. DOWE Research Nurse Royal Marsden Hospital, Downs Road, Sutton, Surrey, Institute of Public Health, Cambridge, UKSearch for more papers by this author105 collaborators, 105 collaboratorsSearch for more papers by this author First published: 14 July 2014 https://doi.org/10.1111/j.1464-410X.1997.tb00795.xCitations: 22 All collaborators are given the same position in this paper and are listed at the end. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Office of Population Censuses and Surveys. UK, HMSO, 1992. 2 American Cancer Society Statistics, USA, 1994. 3 Coleman MP, Esteve J, Damiecki P, Arslan A, Renard H. Trends in cancer incidence and mortality. IARC, Lyon, France, 1993: ch. 21, p. 21. 4 Haas GP, Sakr W, Cassin B et al. The prevalence of prostate cancer in young black and white males. J Urol 1992; 147: 290A. 5 Woolf CM. An investigation of the familial aspects of carcinoma of the prostate. 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There is evidence that predisposition to cancer has a genetic component. Genetic models have suggested that there is at least one highly penetrant gene predisposing to this disease. The oncogene MXI1 on chromosome band 10q24-25 is mutated in a proportion of prostate tumours and loss of heterozygosity occurs at this site, suggesting the location of a tumour suppressor in this region. To investigate the possibility that MXI1 may be involved in inherited susceptibility to prostate cancer, we have sequenced the HLH and ZIP regions of the gene in 38 families with either three cases of prostate cancer or two affected siblings both diagnosed below the age of 67 years. These are the areas within which mutations have been described in some sporadic prostate cancers. No mutations were found in these two important coding regions and we therefore conclude that MXI1 does not make a major contribution to prostate cancer susceptibility.