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Are you a picky eater? Do you worry that food will make you vomit or choke? Do you find eating to be a chore? If yes, this book is for you! Your struggles could be caused by Avoidant Restrictive Food Intake Disorder (ARFID); a disorder characterized by eating a limited variety or volume of food. You may have been told that you eat like a child, but ARFID affects people right across the lifespan, and this book is the first specifically written to support adults. Join Drs. Jennifer Thomas, Kendra Becker, and Kamryn Eddy - three ARFID experts at Harvard Medical School - to learn how to beat your ARFID at home and unlock a healthier relationship with food. Real-life examples show that you are not alone, while practical tips, quizzes, worksheets, and structured activities, take you step-by-step through the latest evidence-based treatment techniques to support your recovery.
The Pro Milone numbers among Cicero's most famous speeches. In it he defends his friend T. Annius Milo against the charge of murdering P. Clodius Pulcher, Cicero's own archenemy. Clodius' death, Milo's trial, and their aftermath consumed Roman public life in 52 BC, involving every major political figure of the day. Although Cicero's defense failed, the published speech remains one of his finest, a fascinating document from a turbulent time, full of interest both historical and rhetorical. This edition, aimed at students and scholars alike, provides readers with the help that they need to appreciate the speech as a literary masterpiece and a historical text. Including a comprehensive introduction and a newly constituted Latin text, it provides detailed treatment of Cicero's language, style, and rhetorical techniques, as well as full discussion of the historical background and the larger social and cultural issues relevant to the speech.
The species–area relationship (SAR) describes a range of related phenomena that are fundamental to the study of biogeography, macroecology and community ecology. While the subject of ongoing debate for a century, surprisingly, no previous book has focused specifically on the SAR. This volume addresses this shortfall by providing a synthesis of the development of SAR typologies and theory, as well as empirical research and application to biodiversity conservation problems. It also includes a compilation of recent advances in SAR research, comprising novel SAR-related theories and findings from the leading authors in the field. The chapters feature specific knowledge relating to terrestrial, marine and freshwater realms, ensuring a comprehensive volume relevant to a wide range of fields, with a mix of review and novel material and with clear recommendations for further research and application.
Since the commercialization of herbicide-resistant (HR) crops, primarily glyphosate-resistant (GR) crops, their adoption increased rapidly. Multiple HR traits in crops such as canola (Brassica napus L.), corn (Zea mays L.), cotton (Gossypium hirsutum L.), and soybean [Glycine max (L.) Merr.] are available in recent years, and management of their volunteers need attention to prevent interference and yield loss in rotational crops. The objectives of this review were to summarize HR crop traits in barley (Hordeum vulgare L.), canola, corn, cotton, rice (Oryza sativa L.), soybean, sugarbeet (Beta vulgaris L.), and wheat (Triticum aestivum L.); assess their potential for volunteerism; and review existing literature on the interference of HR crop volunteers, yield loss, and their management in rotational crops. Herbicide-resistant crop volunteers are problem weeds in agronomic cropping systems, and the impact of volunteerism depends on several factors such as crop grown in rotation, the density of volunteers, management practices, and micro-climate. Interference of imidazolinone-resistant (IR) barley or wheat volunteers can be a problem in rotational crops, particularly when IR crops such as canola or wheat are grown. Herbicide-resistant canola volunteers are abundant in the Northern Great Plains due to high fecundity, seed loss before or during harvest, secondary seed dormancy, and can interfere in crops grown in rotation such as flax (Linum usitatissimum L.), field peas (Pisum sativum L.), and soybean. Herbicide-resistant corn volunteers are competitive in crops grown in rotation such as corn, cotton, soybean, and sugarbeet, with yield loss depending on the density of HR corn volunteers. Volunteers of HR cotton, rice, soybean, and sugarbeet are not major concerns and can be controlled with existing herbicides. Herbicide options would be limited if the crop volunteers are multiple HR; therefore, a record-keeping of cultivar planted the previous year and selecting herbicide is important. The increasing use of 2,4-D, dicamba, glufosinate, and glyphosate in North American cropping systems requires research on herbicide interactions and alternative herbicides or methods for controlling multiple HR crop volunteers.
To examine associations between diet and risk of developing gastroesophageal reflux disease (GERD)
Prospective cohort with a median follow-up of 15.8 years. Baseline diet was measured using a food frequency questionnaire. GERD was defined as self-reported current or history of daily heartburn or acid regurgitation beginning at least two years after baseline. Sex-specific logistic regressions were performed to estimate odds ratios for GERD associated with diet quality scores and intakes of nutrients, food groups, and individual foods and beverages. The effect of substituting saturated fat for monounsaturated or polyunsaturated fat on GERD risk was examined.
A cohort of 20,926 participants (62% women) aged 40-59 years at recruitment between 1990-1994
For men, total fat intake was associated with increased risk of GERD (OR 1.05 per 5g/d; 95%CI 1.01-1.09; p=0.016), whereas total carbohydrate (OR 0.89 per 30g/d; 95%CI 0.82-0.98; p=0.010) and starch intakes (OR 0.84 per 30g/d; 95%CI 0.75-0.94; p=0.005) were associated with reduced risk. Nutrients were not associated with risk for women. For both sexes, substituting saturated fat for polyunsaturated or monounsaturated fat did not change risk. For both sexes, fish, chicken, cruciferous vegetables, and carbonated beverages were associated with increased risk, whereas total fruit and citrus were associated with reduced risk. No association was observed with diet quality scores.
Diet is a possible risk factor for GERD, but food considered as triggers of GERD symptoms might not necessarily contribute to disease development. Potential differential associations for men and women warrant further investigation.
The objective of this paper is to demonstrate that the gradient-constrained discounted Steiner point algorithm (GCDSPA) described in an earlier paper by the authors is applicable to a class of real mine planning problems, by using the algorithm to design a part of the underground access in the Rubicon gold mine near Kalgoorlie in Western Australia. The algorithm is used to design a decline connecting two ore bodies so as to maximize the net present value (NPV) associated with the connector. The connector is to break out from the access infrastructure of one ore body and extend to the other ore body. There is a junction on the connector where it splits in two near the second ore body. The GCDSPA is used to obtain the optimal location of the junction and the corresponding NPV. The result demonstrates that the GCDSPA can be used to solve certain problems in mine planning for which currently available methods cannot provide optimal solutions.
Cholinergic deficits are a hallmark of Alzheimer’s disease (AD) and Lewy body dementia (LBD). The nucleus basalis of Meynert (NBM) provides the major source of cortical cholinergic input; studying its functional connectivity might, therefore, provide a tool for probing the cholinergic system and its degeneration in neurodegenerative diseases. Forty-six LBD patients, 29 AD patients, and 31 healthy age-matched controls underwent resting-state functional magnetic resonance imaging (fMRI). A seed-based analysis was applied with seeds in the left and right NBM to assess functional connectivity between the NBM and the rest of the brain. We found a shift from anticorrelation in controls to positive correlations in LBD between the right/left NBM and clusters in right/left occipital cortex. Our results indicate that there is an imbalance in functional connectivity between the NBM and primary visual areas in LBD, which provides new insights into alterations within a part of the corticopetal cholinergic system that go beyond structural changes.
Dopaminergic imaging is an established biomarker for dementia with Lewy bodies, but its diagnostic accuracy at the mild cognitive impairment (MCI) stage remains uncertain.
To provide robust prospective evidence of the diagnostic accuracy of dopaminergic imaging at the MCI stage to either support or refute its inclusion as a biomarker for the diagnosis of MCI with Lewy bodies.
We conducted a prospective diagnostic accuracy study of baseline dopaminergic imaging with [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane single-photon emission computerised tomography (123I-FP-CIT SPECT) in 144 patients with MCI. Images were rated as normal or abnormal by a panel of experts with access to striatal binding ratio results. Follow-up consensus diagnosis based on the presence of core features of Lewy body disease was used as the reference standard.
At latest assessment (mean 2 years) 61 patients had probable MCI with Lewy bodies, 26 possible MCI with Lewy bodies and 57 MCI due to Alzheimer's disease. The sensitivity of baseline FP-CIT visual rating for probable MCI with Lewy bodies was 66% (95% CI 52–77%), specificity 88% (76–95%) and accuracy 76% (68–84%), with positive likelihood ratio 5.3.
It is over five times as likely for an abnormal scan to be found in probable MCI with Lewy bodies than MCI due to Alzheimer's disease. Dopaminergic imaging appears to be useful at the MCI stage in cases where Lewy body disease is suspected clinically.
There is ongoing debate regarding the relationship between clinical symptoms and cognition in schizophrenia spectrum disorders (SSD). The present study aimed to explore the potential relationships between symptoms, with an emphasis on negative symptoms, and social and non-social cognition.
Hierarchical cluster analysis with k-means optimisation was conducted to characterise clinical subgroups using the Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms in n = 130 SSD participants. Emergent clusters were compared on the MATRICS Consensus Cognitive Battery, which measures non-social cognition and emotion management as well as demographic and clinical variables. Spearman’s correlations were then used to investigate potential relationships between specific negative symptoms and emotion management and non-social cognition.
Four distinct clinical subgroups were identified: 1. high hallucinations, 2. mixed symptoms, 3. high negative symptoms, and 4. relatively asymptomatic. The high negative symptom subgroup was found to have significantly poorer emotion management than the high hallucination and relatively asymptomatic subgroups. No further differences between subgroups were observed. Correlation analyses revealed avolition-apathy and anhedonia-asociality were negatively correlated with emotion management, but not non-social cognition. Affective flattening and alogia were not associated with either emotion management or non-social cognition.
The present study identified associations between negative symptoms and emotion management within social cognition, but no domains of non-social cognition. This relationship may be specific to motivation, anhedonia and apathy, but not expressive deficits. This suggests that targeted interventions for social cognition may also result in parallel improvement in some specific negative symptoms.
We performed a prospective study of 501 patients, regardless of symptoms, admitted to the hospital, to estimate the predictive value of a negative nasopharyngeal swab for severe acute respiratory coronavirus virus 2 (SARS-CoV-2). At a positivity rate of 10.2%, the estimated negative predictive value (NPV) was 97.2% and the NPV rose as prevalence decreased during the study.
When airway management is indicated, to avoid a bad outcome, patient safety will be maximised by careful decision making about and careful implementation of the chosen approach. This chapter addresses planning for the safest approach to securing the airway by assessing the patient for anatomical and physiological predictors of difficulty with airway management. When such difficulty is predicted, awake tracheal intubation will often provide the best margin of safety; indications for the procedure are discussed. Equally, when technical difficulty is predicted, the pre-conditions required to safely proceed with airway management after the induction of general anaesthesia are addressed. Predicted or not, difficulty encountered with tracheal intubation or supraglottic airway use in the unconscious patient must be met with a methodical and stepwise approach. This includes calling for help, maintaining patient oxygenation and methodically proceeding from one device type or technique to another, thus avoiding multiple futile attempts with the same device. Failure of a maximum of three attempts at the intended technique (most often tracheal intubation or use of a supraglottic airway) should be taken as an indication to refrain from further attempts, call for help, maintain patient oxygenation and reassess the plan for next steps. Finally, a ‘cannot intubate, cannot oxygenate’ situation is defined by the failure to successfully oxygenate the patient with all of tracheal intubation, face mask ventilation or a supraglottic airway and requires prompt front of neck airway access (‘surgical airway’).
There is emerging evidence that the development of problematic aggression in childhood may be associated with specific physiological stress response patterns, with both biological overactivation and underactivation implicated. This study tested associations between sex-specific patterns of stress responses across the sympathetic nervous system (SNS) and hypothalamic–pituitary–adrenal (HPA) axis and peer nominations of aggression among 271 kindergarten children (Mean age = 5.32 years; 52% Female; 44% White). Upon entry to kindergarten, children participated in a multidomain standardized stress paradigm. Changes in pre-ejection period (PEP) and salivary cortisol were assessed. On a separate day, children provided peer ratings of physical and relational aggression in a standardized interview. As expected, there was a significant three-way interaction between PEP, cortisol reactivity, and sex, but only for physical aggression. Among boys, cortisol reactivity was positively associated with physical aggression only for those with higher SNS reactivity. Findings suggest that for boys, asymmetrical and symmetrical HPA/SNS reactivity may be associated with lower and higher risk for peer-directed physical aggression, respectively. Understanding the complex associations between multisystem physiology, child sex and peer-directed aggression in early childhood may offer insight into individual differences underlying the emergence of behavioral dysregulation in early peer contexts.
Two phases of archaeological investigation were performed in the Novi Sad City Museum at Petrovaradin Fortress. In this study, we summarize the results of geo-archaeological investigations of the second period of excavation inside the Novi Sad City Museum building. The fortress is situated on a Danube terrace with the top of the bedrock at ca.123 m asl. The investigated section consists of undisturbed fine-sandy silt. The grain-size distribution of the sediments indicates clearly its alluvial reworking but shows also a general similarity with typical primary loess in the region. All analyzed proxies indicate slightly stronger weathering in the upper part of the profile. Luminescence ages suggest that the investigated sequence covers the last glacial period and the terrace presumably formed during MIS 4. Subsequently, the Danube started its incision at the start of the next warmer period (MIS 3) onward. This terrace age and elevation enable us to derive an uplift rate of the terrace of ca. 0.73 mm/a for the last 60 ka, which seems to increase towards the present. Basal loessic material, in which artifacts occur, likely in the reworked position, indicate that the area close to today's Petrovaradin Fortress was already inhabited in MIS 5.
Treatment for major depressive disorder (MDD) is imprecise and often involves trial-and-error to determine the most effective approach. To facilitate optimal treatment selection and inform timely adjustment, the current study investigated whether neurocognitive variables could predict an antidepressant response in a treatment-specific manner.
In the two-stage Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) trial, outpatients with non-psychotic recurrent MDD were first randomized to an 8-week course of sertraline selective serotonin reuptake inhibitor or placebo. Behavioral measures of reward responsiveness, cognitive control, verbal fluency, psychomotor, and cognitive processing speeds were collected at baseline and week 1. Treatment responders then continued on another 8-week course of the same medication, whereas non-responders to sertraline or placebo were crossed-over under double-blinded conditions to bupropion noradrenaline/dopamine reuptake inhibitor or sertraline, respectively. Hamilton Rating for Depression scores were also assessed at baseline, weeks 8, and 16.
Greater improvements in psychomotor and cognitive processing speeds within the first week, as well as better pretreatment performance in these domains, were specifically associated with higher likelihood of response to placebo. Moreover, better reward responsiveness, poorer cognitive control and greater verbal fluency were associated with greater likelihood of response to bupropion in patients who previously failed to respond to sertraline.
These exploratory results warrant further scrutiny, but demonstrate that quick and non-invasive behavioral tests may have substantial clinical value in predicting antidepressant treatment response.
Cases of novel coronavirus disease 2019 (COVID-19) were first reported in Wuhan, China, in December 2019. In this report, we describe 3 clusters of COVID-19 infections among healthcare workers (HCWs), not associated with patient exposure, and the interventions undertaken to halt ongoing exposure and transmission at our cancer center.
A cluster of cases was defined as 2 or more cases of severe acute respiratory coronavirus virus 2 (SARS-CoV-2)–positive COVID-19 among HCWs who work in the same unit area at the same time. Cases were identified by real-time reverse transcription polymerase chain reaction testing. Contact tracing, facility observations, and infection prevention assessments were performed to investigate the 3 clusters between March 1 and April 30, 2020, with subsequent implementation of containment strategies.
The initial cluster involved HCWs from an ancillary services unit, with contacts traced back to a gathering in a break room in which 1 employee was symptomatic, although not yet diagnosed with COVID-19, with subsequent transmission to 7 employees. The second cluster involved 4 employees and was community related. The third cluster involved only 2 employees with possible transmission while working in the same office at the same time. A step-up approach was implemented to control the spread of infection among employees, including universal masking, enhanced cleaning, increase awareness, and surveillance testing. No nosocomial transmission to patients transpired.
To our knowledge, this is the first report of a hospital-based cluster of COVID-19 infections among HCWs in a cancer hospital describing our steps to mitigate further transmission.
Single-particle reconstruction can be used to perform three-dimensional (3D) imaging of homogeneous populations of nano-sized objects, in particular viruses and proteins. Here, it is demonstrated that it can also be used to obtain 3D reconstructions of heterogeneous populations of inorganic nanoparticles. An automated acquisition scheme in a scanning transmission electron microscope is used to collect images of thousands of nanoparticles. Particle images are subsequently semi-automatically clustered in terms of their properties and separate 3D reconstructions are performed from selected particle image clusters. The result is a 3D dataset that is representative of the full population. The study demonstrates a methodology that allows 3D imaging and analysis of inorganic nanoparticles in a fully automated manner that is truly representative of large particle populations.
This paper considers the effects of smoothly varying chordwise porosity of a finite perforated plate on turbulence–aerofoil interaction noise. The aeroacoustic model is made possible through the use of a novel Mathieu function collocation method, rather than a traditional Wiener–Hopf approach which would be unable to deal with chordwise-varying quantities. The main focus is on two bio-inspired porosity distributions, modelled from air flow resistance data obtained from the wings of barn owls (tyto alba) and common buzzards (buteo buteo). Trailing-edge noise is much reduced for the owl-like distribution, but, perhaps surprisingly, so too is leading-edge noise, despite both wings having similar porosity values at the leading edge. A general monotonic variation is then considered indicating that there may indeed be a significant acoustic impact of how the porosity is distributed along the whole chord of the plate, not just its values at the scattering edges. Through this investigation, it is found that a plate whose porosity continuously decreases from the trailing edge to a zero-porosity leading edge can, in fact, generate lower levels of trailing-edge noise than a plate whose porosity remains constant at the trailing-edge value.