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During pregnancy, mothers-to-be should adapt their diet to meet increases in nutrient requirements. Pregnant women appear to be keener to adopt healthier diets, but not always successful.
The objective of this study was to determine whether a guided, stepwise and tailored dietary counseling program, designed using an optimization algorithm, could improve the nutrient adequacy of the diet of pregnant women, beyond generic guidelines.
80 pregnant women who attended Notre-Dame-de-Bon-Secours Maternity Clinic were randomly allocated to the control or intervention arms. Dietary data were obtained twice from an online 3-day dietary record. The nutrient adequacy of the diet was calculated using the PANDiet score, a 100-point diet quality index adapted to the specific nutrient requirements for pregnancy. Women were supplied with generic dietary guidelines in a reference booklet. In the intervention arm, they also received nine sets of tailored dietary advice identified by an optimization algorithm as best improving their PANDiet score.
78 pregnant women completed the 12-week dietary follow-up. Initial PANDiet scores were similar in the control and intervention arms (60.4±7.3 vs 60.3±7.3, P=0.92). The PANDiet score increased in the intervention arm (+3.6±9.3, P=0.02) but not in the control arm (-0.3±7.3, P=0.77), and these changes differed between arms (P=0.04). In the intervention arm, there were improvements in the probabilities of adequacy for ALA, thiamin, folate and cholesterol intakes (P<0.05).
Tailored dietary counseling using a computer-based algorithm is more effective than generic dietary counseling alone in improving the nutrient adequacy of the diet of French women in mid-pregnancy.
Cet article vise à identifier et analyser les idées qui ont accompagné l’émergence et la victoire de Donald Trump. Nous nous intéressons tout particulièrement au paléoconservatisme, un courant idéologique jusque-là méconnu, qui a néanmoins su articuler les frustrations et aspirations d'une partie importante de l’électorat américain. Critique des élites économiques et politiques associées aux deux grands partis, le paléoconservatisme prône un nationalisme identitaire qui menace de bouleverser l’équilibre déjà fragile entre les variantes libertarienne et socialement conservatrice qui dominent au Parti républicain depuis quelques décennies.
We present a broad study of linear, clustered, noble gas puffs irradiated with the frequency doubled (527 nm) Titan laser at Lawrence Livermore National Laboratory. Pure Ar, Kr, and Xe clustered gas puffs, as well as two mixed-gas puffs consisting of KrAr and XeKrAr gases, make up the targets. Characterization experiments to determine gas-puff density show that varying the experimental parameter gas-delay timing (the delay between gas puff initialization and laser-gas-puff interaction) provides a simple control over the gas-puff density. X-ray emission (>1.4 keV) is studied as a function of gas composition, density, and delay timing. Xe gas puffs produce the strongest peak radiation in the several keV spectral region. The emitted radiation was found to be anisotropic, with smaller X-ray flux observed in the direction perpendicular to both laser beam propagation and polarization directions. The degree of anisotropy is independent of gas target type but increases with photon energy. X-ray spectroscopic measurements estimate plasma parameters and highlight their difference with previous studies. Electron beams with energy in excess of 72 keV are present in the noble gas-puff plasmas and results indicate that Ar plays a key role in their production. A drastic increase in harder X-ray emissions (X-ray flash effect) and multi-MeV electron-beam generation from Xe gas-puff plasma occurred when the laser beam was focused on the front edge of the linear gas puff.
Strawberry decline disease, predominantly viral in origin, was a serious threat to the strawberry (Fragaria x ananassa Duchesne ex Rozier; Rosaceae) fields of Québec, Canada, between 2012 and 2014. Our aim was to monitor the abundance and activity of the main insect vectors: the strawberry aphid, Chaetosiphon fragaefolii (Cockerell) (Hemiptera: Aphididae) and the greenhouse whitefly, Trialeurodes vaporariorum Westwood (Hemiptera: Aleyrodidae). First, we compared the effectiveness of two trapping techniques, the yellow sticky trap and the yellow pan trap. Results showed that the sticky traps are more effective in capturing alates in flight. Second, we determined the peak flight period for each of the two vectors in several locations within the province of Québec. Results suggest that the peak abundance of winged C. fragaefolii is during the first two weeks of August, while the peak abundance of T. vaporariorum is in the last two weeks of September. Overall trap captures also found 53 different species of winged aphids, and we documented a new distribution record on commercial strawberry fields in Québec, Aleyrodes spiraeoides (Quaintance) (Hemiptera: Aleyrodidae). Species composition and significant information of flight periods will be useful for the management of virus-transmitting insects associated with strawberry decline disease in Québec.
The article considers populism not as common ideology but as a common strategy for implementing various distinct ideologies. Constitutional democracy and populist strategy are inherently connected. Populist strategies develop a specific rhetoric which takes root in the features of constitutional democracy. The populist rhetoric manipulates the rule-of-law and the majoritarian pillars of constitutional democracy by convincing a fictional majority that constitutional democracy gives rise to a tyranny of minorities. Populism in action represents the second facet of the populist strategy. It corresponds to a specific constitutional strategy of legal and constitutional reforms aiming at disrupting constitutional democracy. After exposing my theoretical assumption, I move to a comparative study of two countries, France and Hungary, selected according to the most different cases approach. I analyze first how Viktor Orban based his constitutional strategy on a progressive deconstruction of the post-communist legacy. I study then how Marine le Pen’s strategy consisted of a comprehensive reform of the French semi-presidential system via referendum. I finally conclude by recalling the essential role academics have to play in the fight against populism. My last point is a provocation, what if calling populism by its real diversity (fascism, racism and antisemitism) was the most efficient way to fight them?
Decision-making about replacement or modification of an implantable cardioverter defibrillator (ICD) must be patient-centered and clinically appropriate. We engaged both patients and health care professionals in a multi-method approach in order to recommend structures and processes that facilitate informed and shared decision-making.
A systematic literature review (2000 to 2017) was performed focusing on the patient's perspective and the optimal organization of structures and processes for decision-making. A province-wide field evaluation based on medical chart review was carried out to provide ‘real world’ evidence in Québec's six ICD implanting centers (1 July to 31 December, 2016; N = 418). Patients and health care professionals reviewed the findings of the review and field evaluation, and deliberated recommendations in an anonymous manner by electronic mail. A joint meeting focused on proposed recommendations concerning shared decision-making.
The patients provided feedback on the literature review based on their ICD experience, and highlighted the need for better and more interactive decision aids, clinical information and time, and a private space for sensitive discussions. The field evaluation underlined the variability of treatment choices at the time of replacement and that more than one in ten patients had undergone ICD deactivation. Proposed recommendations focus on multi-disciplinary, integrated follow-up of patients and outline best practice for incorporating patient wishes and life objectives when discussing treatment options. The multi-round consultation process allowed both patients and professionals to co-construct recommendations with our evaluation team.
This multi-method approach enriched our interpretation of literature and ‘real world’ data and facilitated identification and prioritization of important themes. Partnership with both patients and clinicians added a new and energizing dynamic to our evaluation and recommendation processes. We acknowledge the contribution of the members of the patient committee and the clinical experts committee.
Adelges tsugae Annand (Hemiptera: Adelgidae) has caused extensive mortality of hemlocks (Tsuga (Endlicher) Carrière; Pinaceae) in the eastern United States of America and was discovered recently in Nova Scotia, Canada. We evaluated the use of a Velcro-covered racquetball as a sampling device for A. tsugae wool. Specifically, we report on improvements to an earlier design and evaluate several factors seen in routine sampling that influence the ability of the ball to trap and retain adelgid wool. Velcro was found to be critical for trapping and retaining adelgid wool on the ball during flight and landing. Wooden beads, inserted in the ball, reduced deflection during flight and bounce during landing. Higher probability of trapping wool on the ball was associated with an ascent through the crown, with increasing diameter and density of ovisacs on branch tips, and with increasing abundance of woolly twigs on the forest floor. Higher probability of retaining wool on the ball was associated with Velcro surface area and with amount and location of wool loaded on the ball. These modifications improved detection surveys for A. tsugae in general.
A deterministic application θ:ℝ2→ℝ2 deforms bijectively and regularly the plane and allows the construction of a deformed random field X∘θ:ℝ2→ℝ from a regular, stationary, and isotropic random field X:ℝ2→ℝ. The deformed field X∘θ is, in general, not isotropic (and not even stationary), however, we provide an explicit characterization of the deformations θ that preserve the isotropy. Further assuming that X is Gaussian, we introduce a weak form of isotropy of the field X∘θ, defined by an invariance property of the mean Euler characteristic of some of its excursion sets. We prove that deformed fields satisfying this property are strictly isotropic. In addition, we are able to identify θ, assuming that the mean Euler characteristic of excursion sets of X∘θ over some basic domain is known.
This chapter presents a critical review of the literature on presenteeism. The goal is to summarize and identify the main conceptual and methodological limitations of presenteeism. More specifically, we critically review the presenteeism literature with a view to suggesting future research avenues that take into account the dynamic aspects of this phenomenon. First, some of the most popular and widely used definitions of presenteeism are presented along with their limitations. Then, we consider the various measures of presenteeism and suggest some improvements. Finally, we present methodological limitations based on an overview of research and current thinking in the field. This chapter highlights the methodological importance of considering small and medium-sized enterprises (SMEs) in future research.
Major depressive disorder (MDD) is a highly heterogeneous condition in terms of symptom presentation and, likely, underlying pathophysiology. Accordingly, it is possible that only certain individuals with MDD are well-suited to antidepressants. A potentially fruitful approach to parsing this heterogeneity is to focus on promising endophenotypes of depression, such as neuroticism, anhedonia, and cognitive control deficits.
Within an 8-week multisite trial of sertraline v. placebo for depressed adults (n = 216), we examined whether the combination of machine learning with a Personalized Advantage Index (PAI) can generate individualized treatment recommendations on the basis of endophenotype profiles coupled with clinical and demographic characteristics.
Five pre-treatment variables moderated treatment response. Higher depression severity and neuroticism, older age, less impairment in cognitive control, and being employed were each associated with better outcomes to sertraline than placebo. Across 1000 iterations of a 10-fold cross-validation, the PAI model predicted that 31% of the sample would exhibit a clinically meaningful advantage [post-treatment Hamilton Rating Scale for Depression (HRSD) difference ⩾3] with sertraline relative to placebo. Although there were no overall outcome differences between treatment groups (d = 0.15), those identified as optimally suited to sertraline at pre-treatment had better week 8 HRSD scores if randomized to sertraline (10.7) than placebo (14.7) (d = 0.58).
A subset of MDD patients optimally suited to sertraline can be identified on the basis of pre-treatment characteristics. This model must be tested prospectively before it can be used to inform treatment selection. However, findings demonstrate the potential to improve individual outcomes through algorithm-guided treatment recommendations.
In recent decades, speech act theorists began analyzing discourses in order to describe the logic that governs the use and understanding of language in the context of interlocutions. This paper is in the wake of those studies. It questions the fruitfulness of the notion of speech acts in literary pragmatics, analyzes some literary genres and proposes a discourse typology containing eight generic categories that reflect the possible links between factual and fictional discourses. In doing so, it offers a response to a question raised many years ago by a literary theorist that is directed to speech act theorists.
Introduction: Understanding the spatial distribution of opioid abuse at the local level may facilitate community intervention strategies. The purpose of this analysis was to apply spatial analytical methods to determine clustering of opioid-related emergency medical services (EMS) responses in the City of Calgary. Methods: Using opioid-related EMS responses in the City of Calgary between January 1st through October 31st, 2017, we estimated the dissemination area (DA) specific spatial randomness effects by incorporating the spatial autocorrelation using intrinsic Gaussian conditional autoregressive model and generalized linear mixed models (GLMM). Global spatial autocorrelation was evaluated by Morans I index. Both Getis-Ord Gi and the LISA function in Geoda were used to estimate the local spatial autocorrelation. Two models were applied: 1) Poisson regression with DA-specific non-spatial random effects; 2) Poisson regression with DA-specific G-side spatial random effects. A pseudolikelihood approach was used for model comparison. Two types of cluster analysis were used to identify the spatial clustering. Results: There were 1488 opioid-related EMS responses available for analysis. Of the responses, 74% of the individuals were males. The median age was 33 years ( IQR: 26-42 years) with 65% of individuals between 20 and 39 years, and 27% between 40 and 64 years. In 62% of EMS responses, poisoning/overdose was the chief complaint. The global Morans Index implied the presence of global spatial autocorrelation. Comparing the two models applied suggested that the spatial model provided a better fit for the adjusted opioid-related EMS response rate. Calgary Center and East were identified as hot spots by both types of cluster analysis. Conclusion: Spatial modeling has a better predictability to assess potential high risk areas and identify locations for community intervention strategies. The clusters identified in Calgarys Center and East may have implications for future response strategies.
Introduction: With a Canadian aging population, the prevalence of mild traumatic brain injury (mTBI) among elderly is increasing and the age criterion of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We evaluated if increasing the age criterion of the CCHR would maintain its validity. Methods: We conducted an historical cohort study using the medical charts of all patients 65 years old or more who consulted at a Level One Trauma Centre emergency department (ED) for a mTBI between 2010 and 2014. The main outcome measures were clinically important brain injury (CIBI) on Computed Tomography (CT) and the presence of the CCHR criteria. The clinical and radiological data collection was standardized. Univariate analysis was performed to measure the predictive capacities of modified age cut-offs at 70 and 75 years old. Results: Out of the 104 confirmed mTBI in this study, 32 (30,8%) had CIBI on CT scan. Sensitivity and specificity [C.I. 95%] of the CCHR were 100% [89.1 - 100] and 0% [0.0 5.0] for an age criterion of 65 years old and above; 100% [89.1 - 100] and 4,2% [0.9 11.7] for a modified criterion of 70 years old; 100% [89.1 - 100] and 13,9% [6.9 24.1] for 75 years old. Furthermore, for an age criterion of 80 and 85 years old, sensitivity was respectively 90,6% [75.0 98.0] and 75,0% [56.6 88.5]. Conclusion: In our cohort, increasing the age criterion of the CCHR for minor head injury to 75 years old would benefit ED by further reducing CT scans without missing CIBI. A larger prospective study is indicated to confirm the proposed modification.
The response of Arctic ice masses to climate change is studied using ice cores containing information on past climatic and environmental features. Interpretation of this information requires accurate chronological data. Absolute dating of ice cores from sub-polar Arctic glaciers is possible using well-known radioactive layers deposited by atmospheric nuclear tests (maximum fallout in 1963) and the Chernobyl accident (1986). Analysis of several isotopes (3H, 137Cs) shows that 3H provides the most accurate dating of the 1963 maximum, as indicated also in comparison with results from total-beta measurements (90Sr and 137Cs). Mean annual net mass balances are derived from the dated ice cores from 1963 up to the date of the drillings. The 137Cs and 3H deposited by nuclear tests, after decay correction, are used to define a melt index for all 13 ice cores studied. The relative strength of melting and percolation post-depositional processes is studied on the basis of these 137Cs and 3H deposits.
We present in this work the development of a solar data assimilation method based on an axisymmetric mean field dynamo model and magnetic surface data. Our mid-term goal is to predict the solar quasi cyclic activity. We focus on the ability of our variational data assimilation algorithm to constrain the deep meridional circulation of the Sun based on solar magnetic observations. Within a given assimilation window, the assimilation procedure minimizes the differences between data and the forecast from the model, by finding an optimal meridional circulation in the convection zone, and an optimal initial magnetic field, via a quasi-Newton algorithm. We demonstrate the capability of the technique to estimate the meridional flow by a closed-loop experiment involving 40 years of synthetic, solar-like data. We show that the method is robust in estimating a (stochastic) time-varying flow fluctuating 30% about the average, and that the horizon of predictability of the method is ~ 1 cycle length.
A close reading of sources documenting the Vandal conquest (429–39 ce) reveals that contemporary authors did not present the event as a persecution. To be sure, they insisted on the devastation that the Vandals caused, the typical woes of war, but not on its religious motivation. The article argues that it was Augustine who, in his ep. ccxxviii, first presented a theological interpretation of the event that allowed later sources writing within the Augustinian tradition to frame the conquest retroactively as a persecution.
Cercariae, like miracidia, are non-parasitic larval stages implicated in the life cycle of all trematodes for the host-to-host parasite transmission. Almost all cercariae are free-living in the external environment. With a few exceptions (cercariae of Halipegus occidualis (Halipegidae) can live several months, Shostak & Esch, 1990a), cercariae have a short active life during which they do not feed, living on accumulated reserves. Most cercariae encyst as metacercariae in second intermediate hosts which are prey of the definitive host; in certain species, the interruption of the active life is achieved by an encystment in the external environment (or a simple immobile waiting strategy in a few species). In some two-host life cycles, the cercariae develop into adults after penetration (this is the case for various species causing human schistosomiasis). Some cercariae do not leave the mollusc which must then be ingested by the definitive host.