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In Reasons and Persons, Derek Parfit takes issue with Bernard Williams’ view of the relation between love and identity. Williams thought that, in a world where there were several co-existing replicas of one’s beloved, our current conception of love would begin to crumble. Parfit agrees with Williams in the branching case of replication, but thought that, where replication takes a non-branching form, our ordinary view of love would remain intact. I believe Parfit arrives at this conclusion because he has not fully appreciated the degree to which Williams’ claim is primarily about a view of love rather than one of identity.
To determine whether probiotic prophylaxes reduce the odds of Clostridium difficile infection (CDI) in adults and children.
Individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs), adjusting for risk factors.
We searched 6 databases and 11 grey literature sources from inception to April 2016. We identified 32 RCTs (n=8,713); among them, 18 RCTs provided IPD (n=6,851 participants) comparing probiotic prophylaxis to placebo or no treatment (standard care). One reviewer prepared the IPD, and 2 reviewers extracted data, rated study quality, and graded evidence quality.
Probiotics reduced CDI odds in the unadjusted model (n=6,645; odds ratio [OR] 0.37; 95% confidence interval [CI], 0.25–0.55) and the adjusted model (n=5,074; OR, 0.35; 95% CI, 0.23–0.55). Using 2 or more antibiotics increased the odds of CDI (OR, 2.20; 95% CI, 1.11–4.37), whereas age, sex, hospitalization status, and high-risk antibiotic exposure did not. Adjusted subgroup analyses suggested that, compared to no probiotics, multispecies probiotics were more beneficial than single-species probiotics, as was using probiotics in clinical settings where the CDI risk is ≥5%. Of 18 studies, 14 reported adverse events. In 11 of these 14 studies, the adverse events were retained in the adjusted model. Odds for serious adverse events were similar for both groups in the unadjusted analyses (n=4,990; OR, 1.06; 95% CI, 0.89–1.26) and adjusted analyses (n=4,718; OR, 1.06; 95% CI, 0.89–1.28). Missing outcome data for CDI ranged from 0% to 25.8%. Our analyses were robust to a sensitivity analysis for missingness.
Moderate quality (ie, certainty) evidence suggests that probiotic prophylaxis may be a useful and safe CDI prevention strategy, particularly among participants taking 2 or more antibiotics and in hospital settings where the risk of CDI is ≥5%.
A past history of self-harm is a significant risk factor for suicide in older people. The aims of this study are to (i) characterize older people who present with self-harm to emergency departments (EDs); and (ii) determine the predictors for repeat self-harm and suicide.
Demographic and clinical data were retrospectively collected on older people (age 65+ years), who presented to seven EDs in New Zealand following an episode of self-harm between 1st July 2010 and 30th June 2013. In addition, 12-month follow-up information on repeat self-harm and suicide was collected.
The sample included 339 older people (55.2% female) with an age range of 65–96 years (mean age = 75.0; SD = 7.6). Overdose (68.7%) was the most common method of self-harm. 76.4% of the self-harm cases were classified as suicide attempts. Perceived physical illness (47.8%) and family discord (34.5%) were the most common stressors. 12.7% of older people repeated self-harm and 2.1% died by suicide within 12 months. Older people who had a positive blood alcohol reading (OR = 3.87, 95% Cl = 1.35–11.12, p = 0.012) and were already with mental health services at the index self-harm (OR = 2.73, 95% Cl = 1.20–6.25, p = 0.047) were more likely to repeat self-harm/suicide within 12 months.
Older people who self-harm are at very high risk of repeat self-harm and suicide. Screening and assessment for alcohol use disorders should be routinely performed following a self-harm presentation, along with providing structured psychological treatment as an adjunct to pharmacological treatment for depression and interventions to improve the person's resilience resources.
Previous studies of live-collected pre-weapons testing mollusk shells in the northern Gulf of California have demonstrated that the local radiocarbon reservoir effect (ΔR) is large and highly variable. To test the validity of this observation for paired charcoal and shell samples from archaeological contexts, we dated samples from four shell midden locations and six midden layers from the eastern shoreline of the Gulf of California near Puerto Peñasco, Sonora, Mexico. Dated charcoal samples were small twigs or brushy plants used to cook shellfish and the shells dated within each midden showed signs of burning. Ages range from approximately 5700 to 1900 cal BP. The offset between the modeled marine 14C age for calibrated ages of the middens and measured shell 14C age (ΔR) averaged 425 yr with a standard deviation of 115 yr.
To explore shoppers’ responses to the taste of different types of cow’s milk in a blind taste test and to examine their willingness to purchase lower-fat milk as part of an in-store marketing intervention.
Participants were recruited on-site in the supermarket to participate in a blind taste test of three varieties of cow’s milk and asked to guess what type they sampled.
The taste testing was conducted as part of the Healthy Retail Solution (HRS) intervention that took place in four large supermarkets in Philadelphia, PA, USA over the course of six months.
Adults (n 444) at participating Philadelphia supermarkets.
The majority of participants at all stores reported typically purchasing higher-fat milk. Forty per cent of participants reported buying whole milk, 38 % purchased milk with 2 % fat. Very few participants correctly identified all three milk samples during the taste test (6·9 %) and a majority of participants were unable to identify the type of milk they self-reported typically purchased.
Most consumers could not accurately distinguish between various types of milk. Taste testing is a promising strategy to introduce lower-fat milks to consumers who have not tried them before. Campaigns to purchase skimmed, 1 % or 2 % milk may result in significant energy reduction over time and can serve as a simple way to combat overweight and obesity.
Corner stores, also known as bodegas, are prevalent in low-income urban areas and primarily stock high-energy foods and beverages. Little is known about individual-level purchases in these locations. The purpose of the present study was to assess corner store purchases (items, nutritional characteristics and amount spent) made by children, adolescents and adults in a low-income urban environment.
Evaluation staff used 9238 intercept surveys to directly examine food and beverage purchases.
Intercepts were collected at 192 corner stores in Philadelphia, PA, USA.
Participants were adult, adolescent and child corner store shoppers.
Among the 9238 intercept surveys, there were 20 244 items. On average, at each corner store visit, consumers purchased 2·2 (sd 2·1) items (1·3 (sd 2·0) foods and 0·9 (sd 0·9) beverages) that cost $US 2·74 (sd $US 3·52) and contained 2786·5 (sd 4454·2) kJ (666·0 (sd 1064·6) kcal). Whether the data were examined as a percentage of total items purchased or as a percentage of intercepts, the most common corner store purchases were beverages, chips, prepared food items, pastries and candy. Beverage purchases occurred during 65·9 % of intercepts and accounted for 39·2 % of all items. Regular soda was the most popular beverage purchase. Corner store purchases averaged 66·2 g of sugar, 921·1 mg of sodium and 2·5 g of fibre per intercept. Compared with children and adolescents, adults spent the most money and purchased the most energy.
Urban corner store shoppers spent almost $US 3·00 for over 2700 kJ (650 kcal) per store visit. Obesity prevention efforts may benefit from including interventions aimed at changing corner store food environments in low-income, urban areas.
The present multi-centre randomised weight-loss trial evaluated the efficacy of a low-intensity 12-week online behavioural modification programme, with or without a fortified diet beverage using a 2 × 2 factorial design. A total of 572 participants were randomised to: (1) an online basic lifestyle information (OBLI) intervention, consisting of one online informational class about tips for weight management; (2) an online behavioural weight management (OBWM) intervention, entailing 12 weekly online classes focused on weight-loss behaviour modification; (3) an OBLI intervention plus a fortified diet cola beverage (BEV) containing green tea extract (total catechin 167 mg), soluble fibre dextrin (10 g) and caffeine (100 mg) (OBLI+BEV); (4) OBWM+BEV. Assessments included height, weight, dual-energy X-ray absorptiometry-derived body composition, and waist circumference (WC). Attrition was 15·7 %. Intention-to-treat (ITT) models demonstrated a main effect for type of Internet programme, with those assigned to the OBWM condition losing significantly more weight (F= 7·174; P= 0·008) and fat mass (F= 4·491; P= 0·035) than those assigned to the OBLI condition. However, there was no significant main effect for the OBWM condition on body fat percentage (F= 2·906; P= 0·089) or WC (F= 3·351; P= 0·068), and no significant main effect for beverage use or significant interactions between factors in ITT models. A 12-week, low-intensity behaviourally based online programme produced a greater weight loss than a basic information website. The addition of a fortified diet beverage had no additional impact.
Five recent radiocarbon assays on wood charcoal within archaeological sites from the Puerto Peñasco area, Sonora, Mexico indicate use of the marine resources of the northern Gulf of California area during the Middle Archaic through the Late Archaic periods, ca. 3800 B.C.–A.D. 100. The archaeological shell middens of the region are generally thought of as remains associated with Ceramic period Hohokam marine shell collecting forays with there being little consideration given to the likelihood of an Archaic period component being present. The importance of these age estimates is that they are derived from carbonized botanical remains rather than shell. Because of considerable variability in the carbon reservoir effect, age estimates derived from marine shell from the northern Gulf of California have limited reliability. The seasonality of collection is also considered through a preliminary study of stable oxygen isotope ratios in two shell samples. The results suggests that these shellfish were collected in the late fall, winter, and perhaps very early spring.
The present study assessed the impact of the 2009 food packages mandated by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on perceived sales, product selection and stocking habits of small, WIC-authorized food stores.
A cross-sectional study involving in-depth interviews with store managers/owners.
Small, WIC-authorized food stores in eight major cities in the USA.
Fifty-two store managers/owners who had at least 1 year of experience in the store prior to study participation.
The WIC-approved food products (fresh, canned and frozen fruits; fresh, canned and frozen vegetables; wholegrain/whole-wheat bread; white corn/whole-wheat tortillas; brown rice; lower-fat milk (<2 %)) were acquired in multiple ways, although acquisition generally occurred 1–2 times/week. Factors such as customer requests (87 %), refrigerator/freezer availability (65 %) and profitability (71 %) were rated as very important when making stocking decisions. Most managers/owners perceived increases in sales of new WIC-approved foods including those considered most profitable (wholegrain/whole-wheat bread (89 %), lower-fat milk (89 %), white corn/whole wheat tortillas (54 %)), but perceived no changes in sales of processed fruits and vegetables. Supply mechanisms and frequency of supply acquisition were only moderately associated with perceived sales increases.
Regardless of type or frequency of supply acquisition, perceived increases in sales provided some evidence for the potential sustainability of these WIC policy efforts and translation of this policy-based strategy to other health promotion efforts aimed at improving healthy food access in underserved communities.
There is debate over the casual factors for the rise in body weight in the UK. The present study investigates whether increases between 1986 and 2000 for men and women were a result of increases in mean total energy intake, decreases in mean physical activity levels or both. Estimates of mean total energy intake in 1986 and 2000 were derived from food availability data adjusted for wastage. Estimates of mean body weight for adults aged 19–64 years were derived from nationally representative dietary surveys conducted in 1986–7 and 2000–1. Predicted body weight in 1986 and 2000 was calculated using an equation relating body weight to total energy intake and sex. Differences in predicted mean body weight and actual mean body weight between the two time points were compared. Monte Carlo simulation methods were used to assess the stability of the estimates. The predicted increase in mean body weight due to changes in total energy intake between 1986 and 2000 was 4·7 (95 % credible interval 4·2, 5·3) kg for men and 6·4 (95 % credible interval 5·9, 7·1) kg for women. Actual mean body weight increased by 7·7 kg for men and 5·4 kg for women between the two time points. We conclude that increases in mean total energy intake are sufficient to explain the increase in mean body weight for women between 1986 and 2000, but for men, the increase in mean body weight is likely to be due to a combination of increased total energy intake and reduced physical activity levels.
Given that small food stores may be important retail food sources in low-income urban communities, our objective was to examine cross-city comparative data documenting healthy food availability within such facilities, particularly those located in low-income areas and nearby schools.
Food stores in Baltimore, Maryland; Minneapolis/St. Paul, Minnesota; Oakland, California; and Philadelphia, Pennsylvania were selected for assessment based on proximity to low-income schools. Stores were defined as: (i) single-aisle (n 45); (ii) small (2–5 aisles; n 52); and (iii) large (≥6 aisles; n 8). Staff conducted in-store audits to assess the presence/absence of twenty-eight healthy items, organized within five categories: (i) fresh fruits/vegetables, (ii) processed fruits/vegetables, (iii) healthy beverages/low-fat dairy, (iv) healthy snacks and (v) other healthy staple foods.
The availability of healthy food items was low, particularly in single-aisle and small stores, and there was significant cross-site variability in the availability of healthy snacks (P < 0·0001) and other healthy staple foods (P < 0·0001). No cross-site differences existed for fruits/vegetables or healthy beverages/low-fat dairy availability. Healthy food availability scores increased significantly with store size for nearly all food/beverage categories (P < 0·01).
Overall, healthy food availability in these venues was limited. Region-specific factors may be important to consider in understanding factors influencing healthy food availability in small urban markets. Data suggest that efforts to promote healthy diets in low-income communities may be compromised by a lack of available healthy foods. Interventions targeting small stores need to be developed and tailored for use in urban areas across the USA.
Romantic love and its predecessor eros have both been characterized as forms of egoistic love. Part of this claim is concerned specifically with the relation between love and knowledge. Real love, it is claimed, is prior to knowledge and is not motivated by it. Romantic love and eros according to this view are egoistic in that they are motivated by a desire for knowledge. Agapic love characterized by bestowal represents a true form of love unmotivated by selfish desires. I argue that such an emphasis on bestowal at the expense of knowledge or appraisal of the beloved is problematic. The knowledge dimension of romantic love, rather than contributing to selfishness, can be a means of freeing us from egoism when we understand identity in its relational or social form.
Verticillium fungicola, a severe mycopathogen of the cultivated mushroom Agaricus bisporus, was successfully transformed using both PEG-mediated and Agrobacterium-mediated techniques. PEG-mediated co-transformation was successful with hygromycin B resistance (hph), uidA (β-glucuronidase GUS), and green fluorescent protein (GFP) genes. Agrobacterium-mediated transformation was successful with the hph gene. Transformation frequencies of up to 102 transformants per μg DNA and 4068 transformants per 105 conidia were obtained for PEG-mediated and Agrobacterium-mediated transformation respectively. Expression of integrated genes in co-transformants was stable after 18 months of successive sub-culturing on non-selective medium, and following storage at −80 °C in glycerol. Molecular analysis of PEG-mediated transformants showed integration of the transforming genes into the target genome. Molecular analysis of Agrobacterium-mediated transformants showed integration of transforming DNA as single copies within the target genome. Co-transformants exhibited symptoms of disease in inoculation experiments and were at least as virulent as the wild-type fungus. GFP and GUS expression were observed in-vivo with the GFP-tagged strain showing great potential as a tool in epidemiological and host-pathogen interaction studies. The development of transformation systems for V. fungicola will allow in-depth molecular studies of the interaction of this organism with A. bisporus.
Health-check attendance intention and behaviour in young men and women was compared, and the data used to determine whether health belief model constructs were able to predict such intentions and behaviour. Sixty male and sixty female respondents completed questionnaires asking about past health-check attendance behaviour, future attendance intention, and health beliefs. More females than males had previously attended a general health check, and females had stronger intentions to do so in the future. Regression analyses indicated that health-check attendance intention was predicted for both males and females by responses to cues to action. For females, previous health-check attendance was related to responses to cues to action and perceptions of barriers to attendance. None of the health belief model constructs was found to account for previous attendance behaviour of males. The results of the study support recent calls for health promotion initiatives aimed at men, but suggest that they should target cognitions other than those included within the health belief model.
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