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The aim of the present study was to describe the energy, nutrient and crude v. disaggregated food intake measured using 7 d diet diaries (7dDD) for the full baseline Norfolk cohort recruited for the European Prospective Investigation into Cancer (EPIC-Norfolk) study, with emphasis on methodological issues. The first data collection took place between 1993 and 1998 in Norfolk, East Anglia (UK). Of the 30 445 men and women, aged 40–79 years, registered with a general practitioner invited to participate in the study, 25 639 came for a health examination and were asked to complete a 7dDD. Data from diaries with data recorded for at least 1 d were obtained for 99 % members of the cohort; 10 354 (89·8 %) of the men and 12 779 (91·5 %) of the women completed the diet diaries for all 7 d. Mean energy intake (EI) was 9·44 (sd 2·22) MJ/d and 7·15 (sd 1·66) MJ/d, respectively. EI remained approximately stable across the days, but there was apparent under-reporting among the participants, especially among those with BMI >25 kg/m2. Micronutrient density was higher among women than among men. In conclusion, under-reporting is an issue, but not more so than that found in national surveys. How foods were grouped (crude or disaggregated) made a difference to the estimates obtained, and comparison of intakes showed wide limits of agreement. The choice of variables influences estimates obtained from the food group data; while this may not alter the ranking of individuals within studies, this issue may be relevant when comparing absolute food intakes between studies.
A diet rich in phyto-oestrogens has been suggested to protect against a variety of common diseases but UK intake data on phyto-oestrogens or their food sources are sparse. The present study estimates the average intakes of isoflavones, lignans, enterolignans and coumestrol from 7 d food diaries and provides data on total isoflavone, lignan and phyto-oestrogen consumption by food group.
Development of a food composition database for twelve phyto-oestrogens and analysis of soya food and phyto-oestrogen consumption in a population-based study.
Men and women, aged 40–79 years, from the general population participating in the Norfolk arm of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) between 1993 and 1997, with nutrient and food data from 7 d food diaries.
A subset of 20 437 participants.
The median daily phyto-oestrogen intake for all men was 1199 μg (interquartile range 934–1537 μg; mean 1504 μg, sd 1502 μg) and 888 μg for all women (interquartile range 710–1135 μg; mean 1205 μg, sd 1701 μg). In soya consumers, median daily intakes were higher: 2861 μg in men (interquartile range 1304–7269 μg; mean 5051 μg, sd 5031 μg) and 3142 μg in women (interquartile range 1089–7327 μg; mean 5396 μg, sd 6092 μg). In both men and women, bread made the greatest contribution to phyto-oestrogen intake – 40·8 % and 35·6 %, respectively. In soya consumers, vegetable dishes and soya/goat's/sheep's milks were the main contributors – 45·7 % and 21·3 % in men and 38·4 % and 33·7 % in women, respectively.
The ability to estimate phyto-oestrogen intake in Western populations more accurately will aid investigations into their suggested effects on health.
Background: Individuals experiencing psychosis can present with elevated levels of depression and anxiety. Research suggests that aspects of depression and anxiety may serve an avoidant function by limiting the processing of more distressing material. Acceptance and Commitment Therapy suggests that avoidance of aversive mental experiences contributes to psychological inflexibility. Depression and anxiety occurring in the context of psychosis have a limiting effect on quality of life. No research to date has investigated how levels of psychological flexibility and mindfulness are associated with depression and anxiety occurring following psychosis. Aims: This study investigated associations psychological flexibility and mindfulness had with depression and anxiety following psychosis. Method: Thirty participants with psychosis were recruited by consecutive referral on the basis that they were experiencing emotional dysfunction following psychosis. The Hospital Anxiety and Depression Scale (HADS), Positive and Negative Syndrome Scale (PANSS), Acceptance and Action Questionnaire (AAQ-II) and the Kentucky Inventory of Mindfulness Skills (KIMS) were used. A cross-sectional correlational design was used. Results: The depression and anxiety subscales of the HADS both had significant correlations with psychological flexibility (as assessed by the AAQ-II) and aspects of mindfulness (as assessed by the KIMS). Hierarchical regression analyses indicated that psychological flexibility, but not mindfulness, contributed significantly to models predicting 46% of variance in both depression and anxiety scores. Conclusions: Although aspects of mindfulness are associated with depression and anxiety following an episode of psychosis, psychological flexibility appears to account for a larger proportion of variance in depression and anxiety scores in this population.
Ryan A. McTaggart, Radiology Resident, Brown University Hospital Providence, RI,
Damian E. Dupuy, Director of Tumor, Ablation Rhode Island Hospital Professor of Diagnostic Imaging Brown Medical School Brown University Hospital Providence, RI,
Thomas DiPetrillo, Associate Professor, Brown School of Medicine Vice Chairman, Department of Radiation Oncology Brown University Hospital Providence, RI
Surgical resection has been the mainstay of treatment for the minority of patients diagnosed with primary lung cancer and for selected patients with pulmonary metastatic disease. However, most patients with thoracic malignancies have little recourse other than the modest therapeutic benefits of chemotherapy or radiotherapy, which offer little chance for quality, prolonged survival.
Thermal ablation is an exciting new technique that offers clinicians and patients new hope with a repeatable, effective, low-cost, and safe treatment to effectively palliate and, in some cases, cure both primary and metastatic thoracic malignancies either before or concurrent with systemic therapy and radiotherapy.
The natural history of thoracic malignancies is of locoregional treatment failure and distant recurrence, except for non-small cell, primary lung cancers less than 2 cm in diameter, for which the likelihood of regional (extra-segmental) spread is small and surgery may be most appropriate. Although thermal ablation strategies have been used in patients with primary lung cancer who are too sick or have disease burdens that are too great for surgical therapy, most thoracic oncologists now recognize that primary lung cancer, like metastatic lung cancer, is a systemic disease with bewildering heterogeneity at the start, and that effective, local palliation and systemic therapy for both primary and metastatic thoracic cancer is the goal.
In this chapter, we discuss the basic physics of thermal ablation, applications for thermal ablation therapy in the thorax and technical considerations for thermal ablation.
We present a mathematical model for determining the temperature field around radioactive waste containers in very deep geological boreholes. The model is first used to predict the temperature rise for some simple, but well-established cases with known solutions in order to verify the numerical work. The temperature distribution is then determined for two variants of the deep bore hole concept; a low temperature variant and a high temperature variant. The results from these studies are discussed in terms of their utility in establishing deep borehole disposal as a workable concept.
There is increasing evidence for a significant effect of processed meat (PM) intake on cancer risk. However, refined knowledge on how components of this heterogeneous food group are associated with cancer risk is still missing. Here, actual data on the intake of PM subcategories is given; within a food-based approach we considered preservation methods, cooking methods and nutrient content for stratification, in order to address most of the aetiologically relevant hypotheses.
Design and setting
Standardised computerised 24-hour diet recall interviews were collected within the framework of the European Prospective Investigation into Cancer and Nutrition (EPIC), a prospective cohort study in 27 centres across 10 European countries.
Subjects were 22 924 women and 13 031 men aged 35–74 years.
Except for the so-called ‘health-conscious’ cohort in the UK, energy-adjusted total PM intake ranged between 11.1 and 47.9 g day−1 in women and 18.8 and 88.5 g day−1 in men. Ham, salami-type sausages and heated sausages contributed most to the overall PM intake. The intake of cured (addition of nitrate/nitrite) PM was highest in the German, Dutch and northern European EPIC centres, with up to 68.8 g day−1 in men. The same was true for smoked PM (up to 51.8 g day−1). However, due to the different manufacturing practice, the highest average intake of NaNO2 through PM consumption was found for the Spanish centres (5.4 mg day−1 in men) as compared with German and British centres. Spanish centres also showed the highest intake of NaCl-rich types of PM; most cholesterol- and iron-rich PM was consumed in central and northern European centres. Possibly hazardous cooking methods were more often used for PM preparation in central and northern European centres.
We applied a food-based categorisation of PM that addresses aetiologically relevant mechanisms for cancer development and found distinct differences in dietary intake of these categories of PM across European cohorts. This predisposes EPIC to further investigate the role of PM in cancer aetiology.
To describe the average consumption of carbohydrate-providing food groups among study centres of the European Prospective Investigation into Cancer and Nutrition (EPIC).
Of the 27 redefined EPIC study centres, 19 contributed subjects of both genders and eight centres female participants only (men, n=13 031; women, n=22924, after exclusion of subjects under 35 and over 74 years of age from the original 36 900 total). Dietary data were obtained using the 24-hour recall methodology using the EPIC-SOFT software. The major sources of dietary carbohydrate were identified, and 16 food groups were examined.
The 10 food groups contributing most carbohydrate were bread; fruit; milk and milk products; sweet buns, cakes and pies; potato; sugar and jam; pasta and rice; vegetables and legumes; crispbread; and fruit and vegetable juices. Consumption of fruits as well as vegetables and legumes was higher in southern compared with northern centres, while soft drinks consumption was higher in the north. Italian centres had high pasta and rice consumption, but breakfast cereal, potato, and sweet buns, cakes and pies were higher in northern centres. In Sweden, lower bread consumption was balanced with a higher consumption of crispbread, and with sweet buns, cakes and pies. Overall, men consumed higher amounts of vegetables and legumes, bread, soft drinks, potatoes, pasta and rice, breakfast cereal and sugar and jam than women, but fruit consumption appeared more frequent in women.
The study supports the established idea that carbohydrate-rich foods chosen in northern Europe are different from those in the Mediterranean region. When comparing and interpreting diet–disease relationships across populations, researchers need to consider all types of foods.
The aim of this study was to describe the variation of soy product intake in 10 European countries by using a standardised reference dietary method. A subsidiary aim was to characterise the pattern of soy consumption among a sub-group of participants with a habitual health-conscious lifestyle (HHL), i.e. non-meat eaters who are fish eaters, vegetarians and vegans.
A 24-hour dietary recall interview (24-HDR) was conducted among a sample (5–12%) of all cohorts (n = 36 900) in the European Prospective Investigation into Cancer and Nutrition (EPIC). Study participants totalled 35 955 after exclusion of subjects younger than 35 or older than 74 years of age. Soy products were subdivided into seven sub-groups by similarity. Distribution of consumption and crude and adjusted means of intake were computed per soy product group across countries. Intake of soy products was also investigated among participants with an HHL.
In total, 195 men and 486 women reported consuming soy products in the 24-HDR interview. Although soy product intake was generally low across all countries, the highest intake level was observed in the UK, due to over-sampling of a large number of participants with an HHL. The most frequently consumed soy foods were dairy substitutes in the UK and France and beans and sprouts among mid-European countries. For both genders, the sub-group of soy dairy substitutes was consumed in the highest quantities (1.2 g day−1 for men; 1.9 g day−1 for women). Participants with an HHL differed substantially from others with regard to demographic, anthropometric and nutritional factors. They consumed higher quantities of almost all soy product groups.
Consumption of soy products is low in centres in Western Europe. Soy dairy substitutes are most frequently consumed. Participants with an HHL form a distinct sub-group with higher consumptions of fruit, vegetables, legumes, cereals and soy products compared with the other participants.
To describe and compare the consumption of dairy products in cohorts included in the European Prospective Investigation into Cancer and Nutrition (EPIC).
Data from single 24-hour dietary recall interviews collected through a highly standardised computer-based program (EPIC-SOFT) in 27 redefined centres in 10 European countries between 1995 and 2000. From a total random sample of 36 900, 22 924 women and 13 031 men were selected after exclusion of subjects under 35 and over 74 years of age.
A high total consumption of dairy products was reported in most of the centres in Spain and in the UK cohort sampled from the general population, as well as in the Dutch, Swedish and Danish centres. A somewhat low consumption was reported in the Greek centre and in some of the Italian centres (Ragusa and Turin). In all centres and for both sexes, milk constituted the dairy sub-group with the largest proportion (in grams) of total dairy consumption, followed by yoghurt and other fermented milk products, and cheese. Still, there was a wide range in the contributions of the different dairy sub-groups between centres. The Spanish and Nordic centres generally reported a high consumption of milk, the Swedish and Dutch centres reported a high consumption of yoghurt and other fermented milk products, whereas the highest consumption of cheese was reported in the French centres.
The results demonstrate both quantitative and qualitative disparities in dairy product consumption among the EPIC centres. This offers a sound starting point for analyses of associations between dairy intake and chronic diseases such as cancer.
A new data-entry system (DINER – Data Into Nutrients for Epidemiological Research) for food record methods has been devised for the European Prospective Investigation into Cancer (EPIC) cohort study of 25 000 men and women in Norfolk. DINER has been developed to address the problems of efficiency and consistency of data entry, comparability of data, maximising information and future flexibility in large long-term population studies of diet and disease that use record methods to assess dietary intakes. DINER captures more detail than traditional systems and enables provision of new variables for specific food types or groups. The system has been designed to be fully flexible and easy to update. Analysis of consistency of data entry was tested in a group of 3525 participants entered by 25 coders.
A food list of 9000 food items and values for 24 000 portion sizes have been incorporated into the database, using information from the 5979 diaries coded since 1995. Analysis of consistency of entry indicated that this has largely been achieved. The effect of coders in a multivariate regression model was significant only if the three coders involved in early use of the program were included (P<0.013).
The development of DINER has facilitated the use of more accurate record methods in large-scale epidemiological studies of diet and disease. Furthermore, the retention of original information as an extensive food list allows greater flexibility in later analyses of data of multiple dietary hypotheses.
To describe methods and dietary habits of a large population cohort.
Prospective assessment of diet using diet diaries and food-frequency questionnaires, and biomarkers of diet in 24-h urine collections and blood samples.
Free living individuals aged 45 to 75 years living in Norfolk, UK.
Food and nutrient intake from a food-frequency questionnaire on 23 003 men and women, and from a 7-day diet diary from 2117 men and women. Nitrogen, sodium and potassium excretion was obtained from single 24-h urine samples from 300 individuals in the EPIC cohort. Plasma vitamin C was measured for 20 846 men and women.
The food-frequency questionnaire (FFQ) and the food diary were able to determine differences in foods and nutrients between the sexes and were reliable as judged by repeated administrations of each method. Plasma vitamin C was significantly higher in women than men. There were significant (P<0.001) differences in mean intake of all nutrients measured by the two different methods in women but less so in men. The questionnaire overestimated dairy products and vegetables in both men and women when compared with intakes derived from the diary, but underestimated cereal and meat intake in men. There were some consistent trends with age in food and nutrient intakes assessed by both methods, particularly in men. Correlation coefficients between dietary intake assessed from the diary and excretion of nitrogen and potassium in a single 24-h urine sample ranged from 0.36 to 0.47. Those comparing urine excretion and intake assessed from the FFQ were 0.09 to 0.26. The correlations between plasma vitamin C and dietary intake from the first FFQ, 24-h recall or diary were 0.28, 0.35 and 0.40.
EPIC Norfolk is one of the largest epidemiological studies of nutrition in the UK and the largest on which plasma vitamin C has been obtained. Methods for obtaining food and nutrient intake are described in detail. The results shown here for food and nutrient intakes can be compared with results from other population studies utilising different methods of assessing dietary intake. The utility of different methods used in different settings within the main EPIC cohort is described. The FFQ is to be used particularly in pooled analyses of risk from diet in relation to cancer incidence within the larger European EPIC study, where measurement error is more likely to be overcome by large dietary heterogeneity on an international basis. Findings in the UK, where dietary variation between individuals is smaller and hence the need to use a more accurate individual method greater, will be derived from the 7-day diary information on a nested case–control basis. 24-h recalls can be used in the event that diary information should not be forthcoming from some eventual cases. Combinations of results utilising all dietary methods and biomarkers may also be possible.
Field experiments were carried out on six sites in eastern Scotland between 1987 and 1989 to determine the effect of nitrogen on the yield, N uptake and grain N concentration of spring barley grown for malting. The effects of fertilizer applications at rates from 0 to 150 kg N ha-1 and the timing of application were studied, using three fertilizer forms: calcium nitrate, ammonium sulphate and ammonium nitrate. Calcium nitrate applications significantly increased grain N concentrations (P < 0·05), and grain yields (P < 0·01 and 0·05) at two sites, above the values obtained with the other fertilizers, but there was no effect at the other sites. Split applications of calcium nitrate increased yields above those from single applications in some treatments at two sites. At low rates, recovery of 15N-labelled fertilizer was greatest when applied as calcium nitrate. Recovery fell at higher rates in calcium nitrate treatments, but rose in ammonium sulphate treatments. Uptake of fertilizer N, during the period of stem elongation in June, was significantly greater (P < 0·05) in the calcium nitrate and ammonium nitrate treatments. Maximum uptake was usually reached by the time of anthesis. Uptake of soil N was not as great during the early sampling periods, but continued up to harvest in most treatments. There was evidence of losses, between anthesis and harvest, of fertilizer N previously taken up by the crop. The uptake of soil N remained constant over the range of fertilizer treatments except with ammonium sulphate, where there was evidence of increased uptake at higher fertilizer rates, possibly due to ‘pool substitution’ of 15N-labelled fertilizer. The variation in soil N uptake between sites was greater than the variation in fertilizer N uptake caused by different forms of fertilizer and different application times.
In some people’s minds, the Aboriginalisation of education means placing Aboriginal teachers in community schools and training these Aboriginal teachers to teach and to conduct the school in the ways Westeners once did. That objective is as wrong-headed as it is racist.
The Aboriginalisation of education in each community can only mean the development of an Aboriginal pedagogy if it is to address the perennially documented failings (for example, McConnochie and Harker, 1985; Folds, 1987; Lanhupuy, 1987) of Western schools in the education of Aboriginal people. In this view, Aboriginal people will determine appropriate subject matters for curriculum, ways of teaching, ways of organising the social context of learning, and ways of structuring the relationship between school, community, and the State. That is, the institutionalisation of education will be contested primarily among Aboriginal views of the ways in which education can be coopted for Aboriginal purposes. Anything short of Aboriginalisation of pedagogy in this manifold sense runs the risk of enshrining forever the roles Western education has consistently and persistently used for the practices of cultural imperialism, political domination, and territorial colonisation.
Needle recapping has been shown to be one of the leading causes of needlestick injuries. Frequency of recapping has not been reported. This study was designed to determine the frequency of needle recapping by nursing personnel and the effect of bedside needle disposal units on the frequency of recapping and needlesticks. Seventy-four nurses carrying out 312 activities involving use of needles were observed. The subjects were not aware of the nature of the study. The recapping frequency was 93.9%. The study was repeated after educational programs and following installation of a hospital-wide bedside needle disposal system. Fifty-three nurses performing 151 activities with needles were observed. Frequency of recapping was 94%. There was no significant difference in the rate of recapping or needlestick injuries after installation of the new needle disposal system. Educational programs regarding recapping, a very common practice, may be ineffective. Alternate methods for preventing nee-dlesticks may be necessary.
Aboriginal teacher education is a distinctive educational activity. How distinctive Aboriginal teacher education needs to be and the forms it might take are a matter for action research (McTaggart and Garbutcheon-Singh, 1986) by Aboriginal teachers, their communities, and teacher educators working in Aboriginal schools, and from teacher education instititions. But there is experience available from which it is reasonable to propose some general principles which should guide immediate efforts in Aboriginal teacher education.
The pedagogical principles outlined below come from an action research project in Aboriginal teacher education conducted in the Northern Territory over the last two years. The project is known as D-Bate, the Deakin-Batchelor Aboriginal Teacher Education Program, a joint project of Batchelor College in the Northern Territory and the School of Education of Deakin University in Geelong, Victoria.
This paper generalizes the linear stability analysis of Pearson for Marangoni instability to the case where surface tension depends on both temperature and solute concentration. The results are expressed in terms of a thermal Marangoni number BT and a solutal Marangoni number BS. It is found when BS > 0 the onset of instability has the form of stationary convection, while when BS < 0 there are circumstances in which the onset of instability is in the form of oscillatory convection.
By way of an initial ideological stance, let us accept that the environmental concern which has erupted in the last decade in many parts of the world is both a positive and a permanent feature. It is positive and progressive in that it recognizes a deep-seated community urge to live in “productive harmony” with the natural systems by which we are surrounded, and that it compels a society to define its values and mobilize its social resources to realize them. It is permanent because it has, to all intents and purposes, become ingrained in the legal and administrative systems of many countries, as well as achieving international recognition through the holding of conferences, and in the accommodation of environmentalism within the structure of the United Nations itself.
Educational establishments and programmes must inevitably reflect this environmental concern. Whether or not educational establishments were the breeding grounds of the environmental movement, they cannot fail ultimately to incorporate a concern which has fast become part of the fabric of society. Universities in Western countries partly fostered the environmental movement of the 1960s and early 1970s, but very largely they followed it, or endeavoured to follow it. Environmentalism has been co-opted into the universities, showing up in the guise of research centres devoted to environmental issues, and a range of instructional programmes designed to introduce students to basic environmental concepts.
None the less, the basic propositions of environmentalism remain controversial. On the one hand we have those who prophesy universal ecological disaster lurking in the future unless mankind mends its ways. Among the best known of many advocates of this position we may cite two. Schumacher is concerned to show that many of the problems we presently discern arise from our devotion to the tenets of modern Western economics and business methods:
'…economic growth, which viewed from the point of view of economics, physics, chemistry and technology, has no discernible limit, must necessarily run into decisive bottlenecks when viewed from the point of view of the environmental sciences.[…]