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We have previously shown higher intake of cruciferous vegetables is inversely associated with carotid artery intima-media thickness. To further test the hypothesis that an increased consumption of cruciferous vegetables is associated with reduced indicators of structural vascular disease in other areas of the vascular tree, we aimed to investigate the cross-sectional association between cruciferous vegetable intake and extensive calcification in the abdominal aorta. Dietary intake was assessed, using a food frequency questionnaire, in 684 older women from the Calcium Intake Fracture Outcome Study. Cruciferous vegetables included cabbage, Brussels sprouts, cauliflower and broccoli. Abdominal aortic calcification (AAC) was scored using the Kauppila AAC24 scale on dual energy x-ray absorptiometry (DXA) lateral spine images, and was categorised as “not extensive” (0-5) or “extensive” (≥6). Mean age was 74.9 (SD 2.6) y, median cruciferous vegetable intake was 28.2 (IQR 15.0-44.7) g/d, and 128/684 (18.7%) women had extensive AAC scores. Those with higher intakes of cruciferous vegetables (>44.6 g/d) were associated with a 46% lower odds of having extensive AAC in comparison to those with lower intakes (<15.0 g/d) after adjustment for lifestyle, dietary and cardiovascular disease risk factors (ORQ4 vs Q1=0.54, 95%CI 0.30, 0.97, P=0.036). Total vegetable intake and each of the other vegetable types were not related to extensive AAC (P>0.05 for all). This study strengthens the hypothesis that higher intake of cruciferous vegetables may protect against vascular calcification.
Cognitive impairment is considered a core feature of major depressive disorder (MDD) and research into psychological treatments aiming to address cognitive impairment are gaining momentum. Compared with the well-established research base of cognitive treatment trials in schizophrenia, including meta-analyses, mood disorder research is much more preliminary.
To focus on identifying the important factors to consider in developing larger-scale psychological treatment trials targeting cognitive impairment in mood disorders. Trial design recommendations have been published for cognitive treatment trials in bipolar disorder.
An in-depth discussion of methodological considerations in the development of cognitive treatment trials for MDD.
Methodological considerations include: screening for, and defining, cognitive impairment; mood state when cognitive intervention begins; medication monitoring during cognitive interventions; use of concomitant therapy; level of therapist involvement; duration and dose of treatment; choice of specific cognitive training exercises; home practice; improving adherence; appropriate comparison therapies in clinical trials; and choice of primary outcomes.
As well as guidance for clinical trial development, this review may be helpful for clinicians wanting to provide cognitive interventions for individuals with MDD.
Ergothioneine (ERG) is an unusual thio-histidine betaine amino acid that has potent antioxidant activities. It is synthesised by a variety of microbes, especially fungi (including in mushroom fruiting bodies) and actinobacteria, but is not synthesised by plants and animals who acquire it via the soil and their diet, respectively. Animals have evolved a highly selective transporter for it, known as solute carrier family 22, member 4 (SLC22A4) in humans, signifying its importance, and ERG may even have the status of a vitamin. ERG accumulates differentially in various tissues, according to their expression of SLC22A4, favouring those such as erythrocytes that may be subject to oxidative stress. Mushroom or ERG consumption seems to provide significant prevention against oxidative stress in a large variety of systems. ERG seems to have strong cytoprotective status, and its concentration is lowered in a number of chronic inflammatory diseases. It has been passed as safe by regulatory agencies, and may have value as a nutraceutical and antioxidant more generally.
The evidence supporting the efficacy of antibiotic therapy in the treatment of chronic rhinosinusitis is not compelling. A limited number of studies show that the changes in the nasal microbiome in patients following drug therapy are unpredictable and variable. The evidence for the impact of oral antibiotics on the gut microbiota is stronger, possibly as a result of differences in drug distribution to various sites around the body. There are few studies on sinus mucosal and mucus levels of oral antibiotics used in the treatment of chronic rhinosinusitis. The distribution dependent effects of antibiotics on the sinonasal microbiome is unclear.
This review highlights that relative drug concentrations and their efficacy on microbiota at different sites is an important subject for future studies investigating chronic rhinosinusitis.
Public awareness of ‘red flag’ symptoms for head and neck cancer is low. There is a lack of evidence regarding patient concerns and expectations in consultations for cancer assessment.
This prospective questionnaire study examined the symptoms, concerns and expectations of 250 consecutive patients attending an ‘urgent suspicion of cancer’ clinic at a tertiary referral centre.
The patients’ most frequent responses regarding their concerns were ‘no concerns’ (n = 72, 29 per cent); ‘all symptoms’ were a cause for concern (n = 65, 26 per cent) and ‘neck lump’ was a symptom causing concern (n = 37, 17 per cent). The expectations of patients attending clinic were that they would find out what was wrong with them, followed by having no expectations at all. Overall patient knowledge of red flag symptoms was lacking and their expectations were low.
Patients with non-cancer symptoms are frequently referred with suspected cancer. Patients with red flag symptoms are not aware of their significance and they have low expectations of healthcare.
Burning postharvest sugarcane residue is a standard practice to remove extraneous leaf material before spring regrowth. Live-fires were simulated from field-collected postharvest sugarcane residue and seeds of divine nightshade and itchgrass were exposed to dry and moistened postharvest residue (PHR) at four densities (6.1, 12.1, 18.2, and 24.2 Mg ha−1) and a nonburned control. The moisture content of residue exposed to simulated rainfall was 14% more in Experiment 2 than Experiment 1; however, burning PHR with 44% moisture when wind speeds were lower allowed the fire to continue and created a smoldering effect that reduced weed emergence by 23% when compared with burning PHR with 30% moisture during breezy conditions. The moistened 6.1 Mg ha−1 PHR treatment resulted in 53% more divine nightshade and itchgrass emergence when compared with dry 6.1 Mg ha−1 PHR after burning, and greater emergence was attributed to more seed survival for divine nightshade than itchgrass. The PHR moisture condition failed to influence the burn duration; however, the burn duration increased 103% and 56% as the amount of PHR increased from 6.1 to 12.1 Mg ha−1 and 12.1 to 18.2 Mg ha−1, respectively. The combination of high wind speeds and moistened PHR did not enhance the maximum burn temperature near the soil surface, but surface-deposited divine nightshade and itchgrass seeds were susceptible to prolonged exposure times at 100 C. Burning PHR from fields with poor stands or older ratoon, especially when PHR is abundantly wet, will not produce temperatures lethal to divine nightshade and itchgrass seeds. The fluid-filled and fleshy content that comprises divine nightshade fruit protected seed from short durations of high temperatures, but may not insulate seeds long enough when exposed to a smoldering fire.
Altica is a rare first-farming village site in the Basin of Mexico that has survived to modern times. Thus, it provides a glimpse into life during the Early–Middle Formative period. While valuable archaeological information on the village was recovered in excavation, only four burials comprising four individuals were recovered, a very small sample. Two individuals are older-aged females; the third, a middle-aged male, was accompanied by prestigious nonperishable goods and indicates that there are status differences even at this early date. The final individual was a young male buried in a deviant manner, suggesting possible foul play. While all individuals have indicators of periods of poor health, stable isotopes of carbon and nitrogen paint a more complete picture of the types of foods these individuals consumed over their lifetime. Radiogenic strontium isotopes of tooth enamel identify one individual, the young male buried in a deviant manner, as non-native to the Altica region. Thus, there is mystery in the manner of death, but even in this small sample, the wider connections Altica had that are so evident in the artefactual analysis are found in the skeletons. In addition, accelerator mass spectrometry radiocarbon dating provides a chronology of occupation through the people.
Epistaxis is the most common ENT emergency. This study aimed to assess one-year mortality rates in patients admitted to a large teaching hospital.
This study was a retrospective case note analysis of all patients admitted to the Queen Elizabeth University Hospital in Glasgow with epistaxis over a 12-month period.
The one-year overall mortality for a patient admitted with epistaxis was 9.8 per cent. The patients who died were older (mean age 77.2 vs 68.8 years; p = 0.002), had a higher Cumulative Illness Rating Scale-Geriatric score (9.9 vs 6.7; p < 0.001) and had a higher performance status score (2 or higher vs less than 2; p < 0.001). Other risk factors were a low admission haemoglobin level (less than 128 g/dl vs 128 g/dl or higher; p = 0.025), abnormal coagulation (p = 0.004), low albumin (less than 36 g/l vs more than 36 g/l; p < 0.001) and longer length of stay (p = 0.046).
There are a number of risk factors associated with increased mortality after admission with epistaxis. This information could help with risk stratification of patients at admission and enable the appropriate patient support to be arranged.
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Teotihuacan's Tlajinga district is a cluster of neighborhoods on the southern periphery of the city best known for earlier investigations at Compound 33:S3W1. New research includes excavations at two other apartment compounds and along the southern extension of the Street of the Dead. Excavation contexts, major finds, chronology, and preliminary interpretations are the subject of this article. We highlight evidence attesting to a major obsidian-blade workshop at Compound 17:S3E1, offerings, and other features at that compound and Compound 18:S3E1, and the tempo and processes of urbanization viewed through well-recorded stratigraphic sequences of the compounds and the Street of the Dead. We conclude that significant occupation began in the Miccaotli phase, but it was not until some point in the Early Tlamimilolpa phase that the dominant housing type became apartment compounds; the continuation of the axis of Street of the Dead in the district was accomplished by excavating in the volcanic tuft substrate (tepetate) and could have been undertaken by the inhabitants of the district themselves; and the presence of items such as a sculpted stone face, marine shell, and polychrome pottery demonstrates that commoners at Teotihuacan enjoyed some access to finer items within the interregional economy.
Skeletal remains from Tlajinga 33 (33:S3W1) have been the focus of research in the southern sector of Teotihuacan since excavations took place in the 1980s. Recent excavations in Tlajinga Compounds 17 and 18 (17:S3E1 and 18:S3E1, respectively), located along the southern Street of the Dead, recovered nine additional skeletons. This article is a description of the burials from Compounds 17 and 18 and a comparative analysis of health, diet, and chronology across all three compounds (Compounds 17, 18, and 33). Here, we test the hypothesis that individuals between residential compounds at Tlajinga lived similar lives and that health and biogeochemical markers of individuals will reflect these similarities. Although the sample size is small, the paleopathological analysis of individuals at Compounds 17 and 18 indicates morbidity patterns similar to Tlajinga 33, but also that these residents were perhaps less susceptible to stressors during periods of juvenile growth. Stable carbon and nitrogen isotopes suggest that, overall, diets were analogous across compounds, but Compounds 17 and 18 were able to supplement their diet with a greater variety of plant resources. There were no clear dietary differences between higher and lower status individuals, however. Finally, accelerated mass spectrometry radiocarbon (AMS 14C) dates indicate that residential living may have occurred later at Compound 18 than at Compound 17 and Tlajinga 33.
There is little consensus on how best to manage head and neck cancer with palliative intent. Predicting outcome is difficult and reported survival varies. The present study sought to delineate local practice and outcomes in patients treated with palliative intent.
The clinical records of all head and neck cancer patients treated with palliative intent presenting between 2015 and 2016 to our multidisciplinary team were reviewed.
Eighty-four patients (21.5 per cent) were treated with palliative intent. All had squamous cell carcinoma. Mean survival time was 151 days (standard deviation = 121.1; range, 8–536 days). Of the patients, 83.3 per cent had a palliative care referral; 74.1 per cent had a hospice referral. Patients received a variety of interventions, and there was an associated complication in 8.2 per cent. The mean number of days spent in hospital for interventions was 11.9 days (standard deviation = 12.5; range, 0–41 days).
Different interventions are used to manage head and neck cancer patients with palliative intent, and these may be associated with significant morbidity. Survival time is variable, often several months; thus, any treatment must take into account morbidity in conjunction with the patient's wishes.
We present a highly detailed study of calving dynamics at Tunabreen, a tidewater glacier in Svalbard. A time-lapse camera was trained on the terminus and programmed to capture images every 3 seconds over a 28-hour period in August 2015, producing a highly detailed record of 34 117 images from which 358 individual calving events were distinguished. Calving activity is characterised by frequent events (12.8 events h−1) that are small relative to the spectrum of calving events observed, demonstrating the prevalence of small-scale calving mechanisms. Five calving styles were observed, with a high proportion of calving events (82%) originating at, or above, the waterline. The tidal cycle plays a key role in the timing of calving events, with 68% occurring on the falling limb of the tide. Calving activity is concentrated where meltwater plumes surface at the glacier front, and a ~ 5 m undercut at the base of the glacier suggests that meltwater plumes encourage melt-under-cutting. We conclude that frontal ablation at Tunabreen may be paced by submarine melt rates, as suggested from similar observations at glaciers in Svalbard and Alaska. Using submarine melt rate to calculate frontal ablation would greatly simplify estimations of tidewater glacier losses in prognostic models.
Rayleigh–Bénard convection is one of the most well-studied models in fluid mechanics. Atmospheric convection, one of the most important components of the climate system, is by comparison complicated and poorly understood. A key attribute of atmospheric convection is the buoyancy source provided by the condensation of water vapour, but the presence of radiation, compressibility, liquid water and ice further complicate the system and our understanding of it. In this paper we present an idealized model of moist convection by taking the Boussinesq limit of the ideal-gas equations and adding a condensate that obeys a simplified Clausius–Clapeyron relation. The system allows moist convection to be explored at a fundamental level and reduces to the classical Rayleigh–Bénard model if the latent heat of condensation is taken to be zero. The model has an exact, Rayleigh-number-independent ‘drizzle’ solution in which the diffusion of water vapour from a saturated lower surface is balanced by condensation, with the temperature field (and so the saturation value of the moisture) determined self-consistently by the heat released in the condensation. This state is the moist analogue of the conductive solution in the classical problem. We numerically determine the linear stability properties of this solution as a function of Rayleigh number and a non-dimensional latent-heat parameter. We also present some two-dimensional, time-dependent, nonlinear solutions at various values of Rayleigh number and the non-dimensional condensational parameters. At sufficiently low Rayleigh number the system converges to the drizzle solution, and we find no evidence that two-dimensional self-sustained convection can occur when that solution is stable. The flow transitions from steady to turbulent as the Rayleigh number or the effects of condensation are increased, with plumes triggered by gravity waves emanating from other plumes. The interior dries as the level of turbulence increases, because the plumes entrain more dry air and because the saturated boundary layer at the top becomes thinner. The flow develops a broad relative humidity minimum in the domain interior, only weakly dependent on Rayleigh number when that is high.
Izapa is famous for its monumental architecture and extensive corpus of carved stelae dated to the Late Formative Guillén phase (300–100 cal b.c.). The site was first established, however, as the capital of a kingdom during the second half of the Middle Formative period (750–300 cal b.c.). Little is known of the first centuries of the site's occupation or how this early kingdom coalesced with Izapa as its capital. In 2012, the Izapa Regional Settlement Project (IRSP) excavated 21 test units and ran 10 radiocarbon accelerator mass spectrometry (AMS) dates in order to begin correcting this lacuna. These excavations were the first at the site to screen soil matrices and recover artifact samples that can be quantitatively analyzed.
We undertook excavations in areas north and south of Group B, the original center of Izapa. This work dates the northern expansion of the site's main platform (under Mound 30a) to the Terminal Formative Itstapa phase (cal a.d. 100–300) that resulted in a doubling of the platform's size. Further, we documented that there were three distinct construction episodes in the Terminal Formative expansion and that a central staircase and ramp were built of stone during the second episode. Buried below the Terminal Formative platform expansion was a white clay surface built during the Escalón phase (750–500 cal b.c.) and used through to Guillén times. At the long, linear Mound 62 that defines the eastern edge of Izapa's site core, we documented two episodes of Guillén-phase monumental construction. Buried below this construction fill at Mound 62, a hearth feature and stone alignment are dated to the late Middle Formative based on radiocarbon assays and the results of ceramic analysis. Excavations at Mound 72 and 73 documented that Izapa's E-Group (newly recognized with lidar [light detection and ranging] data) was established in the late Middle Formative period and then significantly augmented during the Guillén phase. The architectural program at Izapa saw its apogee during the Late Formative period, but was first established during the preceding centuries of the Middle Formative. Ten new AMS dates confirm the dating of the Escalón, Frontera, and Guillén phases to 750–100 cal b.c.
Ceramic analysis allowed us to differentiate quantitatively between midden deposits and construction fill through the site's occupation and to recognize domestic versus public spaces during the first centuries of the Izapa kingdom's coalescence. We identify late Middle Formative period middens based on the high density of ceramics in addition to good surface preservation of sherds and a lack of temporal mixing of types. The designation of high-artifact density middens contrasts with the contents of Late and Terminal Formative construction fill with lower ceramic sherd densities and mixing of temporally diagnostic types. Off-mound contexts (where construction fill was mined) had even lower ceramic densities than construction fill and the sherds were very eroded. Analysis of ceramic remains from late Middle Formative period midden deposits also allowed us to infer differences in public and domestic areas of the site during the first centuries of its occupation. Formal and metric variables from these ceramic assemblages identify dish-to-jar ratios that differentiate domestic contexts (with an assortment of vessel forms) from more publically oriented areas of the site (with more serving dishes). The differential distribution of rim diameters of fancy and plain dishes allows us to identify areas of Izapa where domestic activities predominate and indicate that more publically oriented feasting practices occurred at the site center near the main pyramid (Mound 30a) during the late Middle Formative period.
Nearby star-forming galaxies offer a unique environment to study the populations of young (<100 Myr) accreting binaries. These systems are tracers of past populations of massive stars that heavily affect their immediate environment and parent galaxies. Using a Chandra X-ray Visionary program, we investigate the young neutron-star binary population in the low metallicity of the Small Magellanic Cloud (SMC) by reaching quiescent X-ray luminosity levels (~few times 1032 erg/s). We present the first measurement of the formation efficiency of high-mass X-ray binaries (HMXBs) as a function of the age of their parent stellar populations by using 3 indicators: the number ratio of HMXBs to OB stars, to the SFR, and to the stellar mass produced during the specific star-formation burst they are associated with. In all cases, we find that the HMXB formation efficiency increases as a function of time up to ~40–60 Myr, and then gradually decreases.
The six LIGO detections of merging black holes (BHs) allowed to infer slow spin values for the two pre-merging BHs. The three cases where the spins of the BHs can be determined in high-mass X-ray binaries (HMXBs) show that those BHs have high spin values. We discuss here scenarios explaining these differences in spin properties in these two classes of object.
INTEGRAL has been observing the γ-ray sky for 15 years and has discovered many high-energy sources of various nature. Among them, active galactic nuclei (AGN), low or high-mass X-ray binaries (LMXB and HMXB) and cataclysmic variables (CV) are rather difficult to differentiate from one another at high energies and require further optical or near-infrared observations to constrain their exact nature. Using near-infrared photometric and spectroscopic data from ESO VLT/ISAAC, we aim to reveal the nature of 14 high-energy INTEGRAL sources and improve the census of X-ray binaries. By comparing their spectral features to stellar spectra atlases, we identified 5 new CVs, 2 low or intermediate mass X-ray binaries, 2 HMXBs and 5 AGNs.