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Intake of the plant-derived n-3 fatty acid α-linolenic acid (ALA) has been associated with anti-atherosclerotic properties. However, information on the association between ALA intake and development of peripheral artery disease (PAD) is lacking. In this follow-up study, we investigated the association between dietary intake of ALA and the rate of PAD among middle-aged Danish men and women enrolled into the Danish Diet, Cancer and Health cohort between 1993 and 1997. Incident PAD cases were identified through the Danish National Patient Register. Intake of ALA was assessed using a validated FFQ. Statistical analyses were performed using Cox proportional hazard regression allowing for separate baseline hazards among sexes and adjusted for established risk factors for PAD. During a median of 13·6 years of follow-up, we identified 950 valid cases of PAD with complete information on covariates. The median energy-adjusted ALA intake within the cohort was 1·76 g/d (95 % central range: 0·94–3·28). In multivariable analyses, we found no statistically significant association between intake of ALA and the rate of PAD (P = 0·339). Also, no statistically significant associations were observed in analyses including additional adjustment for co-morbidities and in sex-specific analyses. In supplemental analyses with additional adjustment for potential dietary risk factors, we found a weak inverse association of PAD with ALA intake above the median, but the association was not statistically significant (P = 0·314). In conclusion, dietary intake of ALA was not consistently associated with decreased risk of PAD.
EPA and DHA are important components of cell membranes. Since humans have limited ability for EPA and DHA synthesis, these must be obtained from the diet, primarily from oily fish. Dietary EPA and DHA intakes are constrained by the size of fish stocks and by food choice. Seed oil from transgenic plants that synthesise EPA and DHA represents a potential alternative source of these fatty acids, but this has not been tested in humans. We hypothesised that incorporation of EPA and DHA into blood lipids from transgenic Camelina sativa seed oil (CSO) is equivalent to that from fish oil. Healthy men and women (18–30 years or 50–65 years) consumed 450 mg EPA + DHA from either CSO or commercial blended fish oil (BFO) in test meals in a double-blind, postprandial cross-over trial. There were no significant differences between test oils or sexes in EPA and DHA incorporation into plasma TAG, phosphatidylcholine or NEFA over 8 h. There were no significant differences between test oils, age groups or sexes in postprandial VLDL, LDL or HDL sizes or concentrations. There were no significant differences between test oils in postprandial plasma TNFα, IL 6 or 10, or soluble intercellular cell adhesion molecule-1 concentrations in younger participants. These findings show that incorporation into blood lipids of EPA and DHA consumed as CSO was equivalent to BFO and that such transgenic plant oils are a suitable dietary source of EPA and DHA in humans.
We conducted a systematic review of randomised controlled trials (RCT) of increased intake of arachidonic acid (ARA) on fatty acid status and health outcomes in humans. We identified twenty-two articles from fourteen RCT. Most studies were conducted in adults. These used between 80 and 2000 mg ARA per d and were of 1–12 weeks duration. Supplementation with ARA doses as low as 80 mg/d increased the content of ARA in different blood fractions. Overall there seem to be few marked benefits for adults of increasing ARA intake from the typical usual intake of 100–200 mg/d to as much as 1000 mg/d; the few studies using higher doses (1500 or 2000 mg/d) also report little benefit. However, there may be an impact of ARA on cognitive and muscle function which could be particularly relevant in the ageing population. The studies reviewed here suggest no adverse effects in adults of increased ARA intake up to at least 1000–1500 mg/d on blood lipids, platelet aggregation and blood clotting, immune function, inflammation or urinary excretion of ARA metabolites. However, in many areas there are insufficient studies to make firm conclusions, and higher intakes of ARA are deserving of further study. Based on the RCT reviewed, there are not enough data to make any recommendations for specific health effects of ARA intake.
This article explores the roles that language and the body play in the iconization of cross-modal personae (see Agha 2003, 2004). Focusing on a community of radical drag queens in San Francisco, I analyze the interplay of visual presentation and acoustic dimensions of /s/ in the construction of the fierce queen persona, which embodies an extreme, larger-than-life, and anti-normative type of femininity. Taking data from transformations—conversations during which queens visually transform from male-presenting into their feminine drag personae—I explore the effect of fluid visual presentation on linguistic production, and argue that changes in both the linguistic and visual streams increasingly invoke qualia (see Gal 2013; Harkness 2015) projecting ‘harshness’ and ‘sharpness’ in the construction of fierce femininity. I argue that personae like the fierce queen become iconized through rhematization (see Gal 2013), a process in which qualic congruences are construed and constructed across multiple semiotic modalities. (Iconization, rhematization, qualia, sociophonetics, gender, personae, drag queens)*
Emergency medicine (EM) requires physicians to deal with acutely ill patients in a fast-paced and dynamic environment, which creates a barrier to debriefing after critical events. These unique challenges can negatively impact wellness. We sought to adapt and implement a peer-support wellness program called ‘Ice Cream Rounds’ in an EM residency setting.
A needs assessment survey was conducted among EM residents at The University of Ottawa to gauge interest and obtain resident input regarding program design. The structure of the sessions was adapted from similar initiatives in Canadian Pediatric Residency programs.
Curriculum, Tool or Material
Confidential peer-support sessions were created and piloted. Residents preferred peer facilitators, rather than staff, so two residents obtained training the Faculty of Medicine’s Wellness Program to lead sessions. Attendance at rounds was voluntary; however, overall attendance was recorded along with feedback from pilot sessions. Discussion topics included difficult patient encounters, poor patient outcomes, challenges in residency, and ethical issues. Post implementation feedback demonstrated that Ice Cream Rounds was a helpful forum for residents to discuss important issues with colleagues.
This is the first Canadian EM training program to adapt, implement, and evaluate peer-support wellness rounds for debriefing, and this initiative can be easily adopted by any EM training program.
Arachidonic acid (ARA) and DHA, supplied primarily from the mother, are required for early development of the central nervous system. Thus, variations in maternal ARA or DHA status may modify neurocognitive development. We investigated the relationship between maternal ARA and DHA status in early (11·7 weeks) or late (34·5 weeks) pregnancy on neurocognitive function at the age of 4 years or 6–7 years in 724 mother–child pairs from the Southampton Women’s Survey cohort. Plasma phosphatidylcholine fatty acid composition was measured in early and late pregnancy. ARA concentration in early pregnancy predicted 13 % of the variation in ARA concentration in late pregnancy (β=0·36, P<0·001). DHA concentration in early pregnancy predicted 21 % of the variation in DHA concentration in late pregnancy (β=0·46, P<0·001). Children’s cognitive function at the age of 4 years was assessed by the Wechsler Preschool and Primary Scale of Intelligence and at the age of 6–7 years by the Wechsler Abbreviated Scale of Intelligence. Executive function at the age of 6–7 years was assessed using elements of the Cambridge Neuropsychological Test Automated Battery. Neither DHA nor ARA concentrations in early or late pregnancy were associated significantly with neurocognitive function in children at the age of 4 years or the age of 6–7 years. These findings suggest that ARA and DHA status during pregnancy in the range found in this cohort are unlikely to have major influences on neurocognitive function in healthy children.
n-3 Fatty acids are associated with better cardiovascular and cognitive health. However, the concentration of EPA, DPA and DHA in different plasma lipid pools differs and factors influencing this heterogeneity are poorly understood. Our aim was to evaluate the association of oily fish intake, sex, age, BMI and APOE genotype with concentrations of EPA, DPA and DHA in plasma phosphatidylcholine (PC), NEFA, cholesteryl esters (CE) and TAG. Healthy adults (148 male, 158 female, age 20–71 years) were recruited according to APOE genotype, sex and age. The fatty acid composition was determined by GC. Oily fish intake was positively associated with EPA in PC, CE and TAG, DPA in TAG, and DHA in all fractions (P≤0·008). There was a positive association between age and EPA in PC, CE and TAG, DPA in NEFA and CE, and DHA in PC and CE (P≤0·034). DPA was higher in TAG in males than females (P<0·001). There was a positive association between BMI and DPA and DHA in TAG (P<0·006 and 0·02, respectively). APOE genotype×sex interactions were observed: the APOE4 allele associated with higher EPA in males (P=0·002), and there was also evidence for higher DPA and DHA (P≤0·032). In conclusion, EPA, DPA and DHA in plasma lipids are associated with oily fish intake, sex, age, BMI and APOE genotype. Such insights may be used to better understand the link between plasma fatty acid profiles and dietary exposure and may influence intake recommendations across population subgroups.
Introduction: Patients in our ED were dissatisfied with their waiting experience, which resulted in patient anxiety and complaints. In 8 months, we aimed to (1) improve patient satisfaction with the ED waiting experience from triage to physician initial assessment by a 15% improvement in patients who rate their experience very good/excellent on a Likert Scale, and (2) improve patient knowledge of ED wait time by a 50% increase in understanding on a Likert Scale. Methods: We co-designed a display with ED patients to notify those in the waiting room of their wait process and wait time. The intervention was selected after root cause diagnostics including: Fishbone exercise, Pareto Diagram, and Driver Diagram. The display was co-designed with ED patients and improved via PDSA cycles to establish information displayed and how to incorporate it into the waiting experience. After co-design, a low-fidelity display was piloted in the waiting room. Results: A family of measures were evaluated using patient/provider surveys and hospital data metrics. Outcome measures were (1) percentage of patients who rated their ED experience as very good/excellent on a Likert scale, and (2) patients who had a clear/very clear understanding of their wait time on a Likert scale. Process measures were the percentage of patients who (1) looked at the wait time display, and (2) felt they could communicate their wait time to others. Balancing measures were clerk/nurse satisfaction and self-reported interruptions of patients asking wait time. Outcomes were tracked using statistical process charts and run charts. Following display implementation, patient rating of their ED experience and patient understanding of wait time showed positive improvement. Clerks/nurses were also more satisfied with their jobs and self-reported interruptions decreased. Conclusion: A low-fidelity wait time display co-designed with patients improved patient satisfaction and understanding of ED wait times. We plan to develop an automated electronic display that resembles the low-fidelity display and evaluate the impact of the intervention on the established measures. This intervention has the potential to be sustainable, feasible for other EDs, and require minimal upkeep costs.
Introduction: There is a high risk for communication breakdown, discontinuity of clinical care, and medical errors during ED physician handover. Locally, there is no standardized handover process to ensure adequate communication of critical information. Our aim was to use a locally developed handover tool to increase frequency of adequate physician handover during overnight shift change by 50% in 4 months. Methods: Using published best practices, local observational data, and stakeholder input, we determined critical components of ED handovers. We developed a structured communication tool for two unique populations in our ED: ED-VITAL for patients receiving active ED care; ED-VSA for patients who are admitted/referred. Strategies used to implement the tool included: engagement of staff physicians to introduce & modify the tool; formal education and training to ED residents; and provision of cognitive aids. A QI coordinator conducted direct observations of handovers using convenience sampling. We provided feedback to staff and resident physicians, and used their input to continuously modify the tool. The main outcome measure was adequate patient handover, defined as verbal communication of 50% of critical handover components, or documentation of key information on an electronic note. Process measures included tool utilization characteristics. Balance measures included time metrics such as handover duration. We present run charts and qualitative statistics. Results: We assessed 368 individual patient handovers (93 pre- & 275 post-implementation). The median proportion of patients in active ED care who were verbally handed over increased from 75% to 100%. The median proportion of adequate handovers improved from 50% to 72%. The time to deliver handover increased by 13 seconds per patient. Qualitative feedback from end users was positive overall, particularly for communication quality and resident educational value. Conclusion: Use of a standardized handover tool improved both verbal and documented communication during shift change. A customized approach, sensitive to local context, was important to successful implementation. Residents play a large role in handovers; strategies to improve handover processes that emphasize medical education appear to enhance success. Future PDSA cycles will focus on interventions to further enhance the utilization of the tool, and to measure direct impact on clinical outcomes.
The mammary gland of lactating ruminants (Guinard & Rulquin 1994) does not appear to extract sufficient quantities of free amino acids (AA) to account for their output as milk protein. Based upon application of a precursor (blood or plasma free AA):product (casein) labelling technique (Backwell et al. 1996) in goats, results suggest that blood peptides or proteins taken up by the gland probably account for this deficit. However, the deficiency appears to be alleviated when supplemental protein or AA are infused (Guinard & Rulquin 1994), suggesting that uptake of peptide bound AA is reduced while that of the free AA is increased. The objective of the current study was to corroborate these findings, thus the precursonproduct labelling technique was applied in lactating goats to determine whether arterial free phenylalanine supply affects the contribution of peptide bound phenylalanine and tyrosine to casein synthesis and compare the results to the net uptake (NU) method.
There is increased interest in using forages other than grass hay as the basal diet for equines in the UK. Whilst a range of short-chopped dehydrated alfalfa based forages may be used as alternatives to grass hay in equine diets, there is very little information available on their likely intake characteristics, apparent digestibilities or their nutritive values. The objectives of the current experiment were:- 1) to determine the voluntary feed intake (VFI) characteristics of three alfalfa based forages when offered ad libitum to ponies, 2) to determine the in vivo apparent digestibility, digestible energy (DE) and digestible crude protein (DCP) contents of these forages and 3) to compare the actual energy and protein intakes with theoretical energy and protein requirements.
One of the goals of environmental education is the development of environmental literacy. The development of environmental literacy for preservice teachers is critical if they are to be confident and competent to deliver environmental education in schools. Little is known about the impact of environmental education on preservice teachers’ environmental literacy and their subsequent practices as teachers within schools in New Zealand. This study used a mixed-methods approach with a pretest and posttest design to examine the environmental literacy of preservice teachers enrolled in a compulsory environmental education paper as part of their Bachelor of Teaching program at a New Zealand university. The perceptions of the preservice teachers’ preparedness to teach environmental education was also examined. Findings indicate that despite only slight shifts in preservice teachers’ environmental literacy, their confidence to teach environmental education significantly increased after completing the paper. Increases in the strength of correlations between environmental knowledge and affective dispositions were observed upon completing the environmental education paper. Implications of findings for teacher education programs are discussed. This study could inform curriculum design and teaching and learning practices for effectively preparing preservice teachers to promote the development of the environmental literacy of students in their future schools.
EPA and DHA appear to be the most important n-3 fatty acids, but roles for n-3 docosapentaenoic acid are now also emerging. Intakes of EPA and DHA are usually low, typically below those recommended. Increased intakes result in higher concentrations of EPA and DHA in blood lipids, cells and tissues. Increased content of EPA and DHA modifies the structure of cell membranes and the function of membrane proteins. EPA and DHA modulate the production of lipid mediators and through effects on cell signalling can alter the patterns of gene expression. Through these mechanisms, EPA and DHA alter cell and tissue responsiveness in a way that often results in more optimal conditions for growth, development and maintenance of health. DHA has vital roles in brain and eye development and function. EPA and DHA have a wide range of physiological roles, which are linked to certain health or clinical benefits, particularly related to CVD, cancer, inflammation and neurocognitive function. The benefits of EPA and DHA are evident throughout the life course. Future research will include better identification of the determinants of variation of responses to increased intake of EPA and DHA; more in-depth dose–response studies of the effects of EPA and DHA; clearer identification of the specific roles of EPA, docosapentaenoic acid and DHA; testing strategies to enhance delivery of n-3 fatty acids to the bloodstream; and exploration of sustainable alternatives to fish-derived very long-chain n-3 fatty acids.
The poetry of Frank O'Hara (1926–66) takes place in the routes of New York City, both above and below the ground. This essay looks at the characteristics of his poetic lines, and some of the ways they invest themselves in each other, interacting complexly through rhymes and line breaks that we may struggle to negotiate. Then, broadening outwards to consider urban topographies and the experience of inhabiting the avenues of Manhattan, it discusses how the lines of a poem might relate to the lines of a subway system or street grid, and considers how O'Hara's poetry opens our attention, and our generosity, to the aspects of a cityscape that we habitually overlook.