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We have previously shown that 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 FFQ, 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 lateral spine images and was categorised as ‘not extensive’ (0–5) or ‘extensive’ (≥6). Mean age was 74·9 (sd 2·6) years, median cruciferous vegetable intake was 28·2 (interquartile range 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 with those with lower intakes (<15·0 g/d) after adjustment for lifestyle, dietary and CVD risk factors (ORQ4 v. 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.
Differences in daytime sleepiness, lifestyle disruptions, and emotional distress were compared across nine groups taking sleep-promoting substances. Groups included individuals taking zopiclone (n = 274), amitriptyline (n = 107), lorazepam (n = 258), oxazepam (n= 141), diphenhydramine HCl (n = 99), triazolam(n = 137), long acting benzodiazepines (n = 120), temazepam (n = 176), and miscellaneous other medications (n = 286). Data were gathered by self-report, using standardized instruments in a mail-back questionnaire procedure. Respondents included the first 1,598 participants enrolled in a Canadian multicentre project, including six sites attached to academic psychiatric units. Results indicated that quality of life effects differed across groups in both daytime sleepiness and lifestyle disruptions (illness intrusiveness), but not in depressive symptoms. Daytime sleepiness was significantly higher among people taking diphenhydramine HCl as compared to temazepam, zopiclone, lorazepam, and oxazepam. Illness intrusiveness was significantly higher among patients taking amitriptyline as compared to those taking triazolam, oxazepam, long-acting benzodiazepines, and zopiclone. It may be useful to inform patients of differences in psychosocial outcomes when prescribing hypnotic medications.
Empathy is critical to the development of professionalism in medical students, but evidence suggests that empathy actually declines over the course of undergraduate medical education.
Improving medical student empathy by encouraging students to think about the person behind the illness.
Two interventions were studied. From December 2015 until November 2016, a fourth year psychiatry medical student book club was conducted. Students were asked to read an autobiography of a lived experience of psychosis. The old age simulation suit aims to simulate the sensory and physical impairments faced by older adults with age related illnesses. A training session provided a transient experience of old age for the students.
Forty-four students completed the feedback on the book club. Twenty-eight (64%) stated that they strongly agreed with the statement ‘the book club encouraged me to consider the person behind the illness’. Thirty-nine (89%) stated that after attending the book club their empathy towards people with mental health problems had increased. Eleven students completed full feedback following the old age simulation session. Empathy statements relating to living in an ageing body improved from the pre-test median score of 4 (range 1–7) to a median score of 6 (range 2–8) post-teaching session. Empathy statements focusing on sensory and physical impairments had pre-test score median of 3 (range 1–7) and post-test median 8 (range 3–9).
Feedback from these sessions has demonstrated that with a little creativity, empathy training can be delivered to medical students with a positive impact.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
When Charles Lyell chronicles humankind's rise to geologic power in the Principles of Geology, he talks out of both sides of his mouth. Detailing the human species’ seemingly unmatched force as a terrestrial “levelling agent,” he ruminates on an unsettling possibility that haunts the present: “it admits of reasonable doubt whether, upon the whole, we fertilize or impoverish the lands we occupy.” Already at the time of Lyell's writing, the human species had “displaced” or altogether extinguished “a number of beasts of prey, birds, and animals of every class” (2:148) through deforestation, hunting, and the “progress of colonization” (2:150–51). But elsewhere in the Principles, Lyell puts into question what this history of environmental degradation otherwise seems to assert: that to be human is to possess a singular capacity for mastery. Thus, Lyell declares, “we ought always, before we decide that any part of the influence of man is novel and anomalous, carefully to consider all the powers of other animate agents which may be limited or superseded by him” (2:206). Tracing how swarms of insects gave dramatic and lasting shape to the German arboreal landscape in ways that humans could never replicate, he concludes: “[I]t does not follow that this kind of innovation”—human innovation—“is unprecedented” (2:206). Even as Lyell imagines humankind as “superior” in its capacity to act as “a single species,” he persistently lingers with the very real possibility that humans do not possess a “novel and anomalous” hold over the world (2:207, emphasis original). Instead, the Principles traces how the world is shaped by “physical causes” and nonhuman agencies that elude control and unmask the relative “insignifican[ce]” of humankind's “aggregate force” (2:207). Inasmuch as humans comprise only one part of an agential assemblage whose shifting interactions elude anthropogenic mastery, the Principles imagines humankind as interpenetrated by and profoundly susceptible to nonhuman life-forms and forces. According to Lyell, then, deep history speaks not only of the human species’ seemingly privileged capacity for action but also its nonintentionality, noninstrumentality, and vulnerability. That the Principles tells a story about the porous interfaces between human and nonhuman geologic agents is perhaps surprising, given that it emerged and participated in a moment which, for many, marks the zenith of imperial and anthropogenic power.
To evaluate the association between novel pre- and post-operative biomarker levels and 30-day unplanned readmission or mortality after paediatric congenital heart surgery.
Children aged 18 years or younger undergoing congenital heart surgery (n = 162) at Johns Hopkins Hospital from 2010 to 2014 were enrolled in the prospective cohort. Collected novel pre- and post-operative biomarkers include soluble suppression of tumorgenicity 2, galectin-3, N-terminal prohormone of brain natriuretic peptide, and glial fibrillary acidic protein. A model based on clinical variables from the Society of Thoracic Surgery database was developed and evaluated against two augmented models.
Unplanned readmission or mortality within 30 days of cardiac surgery occurred among 21 (13%) children. The clinical model augmented with pre-operative biomarkers demonstrated a statistically significant improvement over the clinical model alone with a receiver-operating characteristics curve of 0.754 (95% confidence interval: 0.65–0.86) compared to 0.617 (95% confidence interval: 0.47–0.76; p-value: 0.012). The clinical model augmented with pre- and post-operative biomarkers demonstrated a significant improvement over the clinical model alone, with a receiver-operating characteristics curve of 0.802 (95% confidence interval: 0.72–0.89; p-value: 0.003).
Novel biomarkers add significant predictive value when assessing the likelihood of unplanned readmission or mortality after paediatric congenital heart surgery. Further exploration of the utility of these novel biomarkers during the pre- or post-operative period to identify early risk of mortality or readmission will aid in determining the clinical utility and application of these biomarkers into routine risk assessment.
The Canadian Stroke Best Practice Recommendations suggests that patients suspected of transient ischemic attack (TIA)/minor stroke receive urgent brain imaging, preferably computed tomography angiography (CTA). Yet, high requisition rates for non-cerebrovascular patients overburden limited radiological resources, putting patients at risk. We hypothesize that our clinical decision support tool (CDST) developed for risk stratification of TIA in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization.
Retrospective study design with clinical information gathered from ED patient referrals to an outpatient TIA unit in Victoria, BC, from 2015-2016. Actual CTA orders by ED and TIA unit staff were compared to hypothetical CTA ordering if our CDST had been used in the ED upon patient arrival.
For 1,679 referrals, clinicians ordered 954 CTAs. Our CDST would have ordered a total of 977 CTAs for these patients. Overall, this would have increased the number of imaged-TIA patients by 89 (10.1%) while imaging 98 (16.1%) fewer non-cerebrovascular patients over the 2-year period. Our CDST would have ordered CTA for 18 (78.3%) of the recurrent stroke patients in the sample.
Our CDST could enhance CTA utilization in the ED for suspected TIA patients, and facilitate guideline-based stroke care. Use of our CDST would increase the number of TIA patients receiving CTA before ED discharge (rather than later at TIA units) and reduce the burden of imaging stroke mimics in radiological departments.
The role of vegetable and fruit intake in reducing falls risk in elderly populations is uncertain. This study examined the associations of vegetable and fruit intake with falls-related hospitalisations in a prospective cohort study of elderly women (n 1429, ≥70 years), including effects on muscular function, which represented a potential causal pathway. Muscular function, measured using grip strength and timed-up-and-go (TUG), and vegetable and fruit intake, quantified using a validated FFQ, were assessed at baseline (1998). Incident falls-related hospitalisation over 14·5-year follow-up was captured by the Hospital Morbidity Data Collection, linked via the Western Australian Data Linkage System. Falls-related hospitalisation occurred in 568 (39·7 %) of women. In multivariable-adjusted models, falls-related hospitalisations were lower in participants consuming more vegetables (hazard ratio (HR) per 75 g serve: 0·90 (95 % CI 0·82, 0·99)), but not fruit intake (per 150 g serve: 1·03 (95 % CI 0·93, 1·14)). Only total cruciferous vegetable intake was inversely associated with falls-related hospitalisation (HR: per 20 g serve: 0·90 (95 % CI 0·83, 0·97)). Higher total vegetable intake was associated with lower odds for poor grip strength (OR: 0·87 (95 % CI 0·77, 0·97)) and slow TUG (OR: 0·88 (95 % CI 0·78, 0·99)). Including grip strength and TUG in the multivariable-adjusted model attenuated the association between total vegetable intake and falls-related hospitalisations. In conclusion, elderly women with higher total and cruciferous vegetable intake had lower injurious falls risk, which may be explained in a large part by better physical function. Falls reduction may be considered an additional benefit of higher vegetable intake in older women.
BACKGROUND: Meningiomas are the most common primary benign brain tumors in adults. Given the extended life expectancy of most meningiomas, consideration of quality of life (QOL) is important when selecting the optimal management strategy. There is currently a dearth of meningioma-specific QOL tools in the literature. OBJECTIVE: In this systematic review, we analyze the prevailing themes and propose toward building a meningioma-specific QOL assessment tool. METHODS: A systematic search was conducted, and only original studies based on adult patients were considered. QOL tools used in the various studies were analyzed for identification of prevailing themes in the qualitative analysis. The quality of the studies was also assessed. RESULTS: Sixteen articles met all inclusion criteria. Fifteen different QOL assessment tools assessed social and physical functioning, psychological, and emotional well-being. Patient perceptions and support networks had a major impact on QOL scores. Surgery negatively affected social functioning in younger patients, while radiation therapy had a variable impact. Any intervention appeared to have a greater negative impact on physical functioning compared to observation. CONCLUSION: Younger patients with meningiomas appear to be more vulnerable within social and physical functioning domains. All of these findings must be interpreted with great caution due to great clinical heterogeneity, limited generalizability, and risk of bias. For meningioma patients, the ideal QOL questionnaire would present outcomes that can be easily measured, presented, and compared across studies. Existing scales can be the foundation upon which a comprehensive, standard, and simple meningioma-specific survey can be prospectively developed and validated.
Lake of the Woods (LOTW) is a large, complex lake basin once occupied by glacial Lake Agassiz. High-resolution seismic-reflection profiles and cores in the shallow, open southern basin of LOTW reveal a sedimentary architecture comprising four lacustrine units separated by three low-stand unconformities. These units represent several phases of Lake Agassiz and its changing configuration. One unconformity marks the Moorhead low phase and another marks the separation of LOTW from Lake Agassiz, perhaps ~10 cal ka BP, as the level of the latter fell, but before final drainage of Agassiz. Initially, the separate Holocene lake in the southern basin was broad and shallow, sometimes marshy or dry. Shortly after 8 cal ka BP, the southern basin dried up completely, despite the progressive rise of the northern outlet of the lake due to differential isostatic uplift. The resulting hiatus is related to the well-documented mid-Holocene arid interval in central North America. A return to wetter conditions in the late Holocene caused the southern basin of LOTW to refill since about 3800 cal yr BP. Late Holocene sediments have accumulated slightly asymmetrically in the basin, possible due to continued southward transgression of the lake as a result of isostatic tilting.
The study of extremely metal-poor (EMP; [Fe/H] <−3.0) and ultra metal-poor (UMP; [Fe/H] <−4.0) stars is crucial for better understanding first-star nucleosynthesis and constraining the initial mass function in the early Universe. However, UMP stars discovered in the past 25 years only number ~25. A few recent theoretical studies have pointed out that there is likely to exist large numbers of EMP and UMP stars in the periphery of the Galactic halo, at distances exceeding 30-50 kpc. We present identifications of several new EMP/UMP stars and introduce a survey to expedite discovering hundreds to thousands of EMP/UMP stars in the outermost halo (as well as in the local volume) over the next few years, which could revolutionize chemical-evolution studies of the Galaxy.
Narrow-band photometric surveys, such as the Javalambre Photometric Local Universe Survey (J-PLUS), provide not only a means of pre-selection for high-resolution follow-up, but open a new era of precision photometric stellar parameter determination. Using a family of machine learning algorithms known as Artificial Neural Networks (ANNs), we have obtained photometric estimates of effective temperature (Teff) and metallicity ([Fe/H]) across a wide parameter range of temperature and metallicity (4000 < Teff <7000 K; −3.5 <[Fe/H]<0.0) for a number of stars in the J-PLUS Early Data Release. With this methodology, we expect to increase the number of known Carbon-enhanced Metal-poor (CEMP; [C/Fe]>+0.7) stars by several orders of magnitude, as well as constrain the metallicity distribution function of the Milky Way Halo system.
G326.3-1.8 (also known as MSH 15-56) has been detected in radio as a middle-aged composite supernova remnant (SNR) consisting of a SNR shell and a pulsar wind nebula (PWN) which has been crushed by the reverse shock. With the recent Fermi-LAT data release Pass 8 providing increased acceptance and angular resolution, we investigate the morphology of this SNR to disentangle the PWN from the SNR contributions and understand the nature of the γ-ray emission. We thus perform a morphological and spectral analysis from 300 MeV to 300 GeV which highlights the contributions from these two components. The simplest interpretation is hadronic emission from the SNR and harder leptonic emission from the PWN.
Telomere length is widely considered as a marker of biological aging. Clinical studies have reported associations between reduced telomere length and hypertension. The aim of this study was to compare telomere length in hypertensive and normotensive mice at pre-disease and established disease time points to determine whether telomere length differs between the strains before and after the onset of disease. Genomic DNA was extracted from kidney and heart tissues of 4-, 12-, and 20-week-old male hypertensive (BPH/2J) and normotensive (BPN/3J) mice. Relative telomere length (T/S) was measured using quantitative PCR. Age was inversely correlated with telomere length in both strains. In 4-week-old pre-hypertensive animals, no difference in T/S was observed between BPH/2J and BPN/3J animals in kidney or heart tissue (kidney p = 0.14, heart p = 0.06). Once the animals had established disease, at 12 and 20 weeks, BPH/2J mice had significantly shorter telomeres when compared to their age-matched controls in both kidney (12 weeks p < 0.001 and 20 weeks p = 0.004) and heart tissues (12 weeks p < 0.001 and 20 weeks p < 0.001). This is the first study to show that differences in telomere lengths between BPH/2J and BPN/3J mice occur after the development of hypertension and do not cause hypertension in the BPH/2J mice.
Applying an ecological approach to childhood obesity prevention requires a new way of thinking and working for many community-based practitioners who are used to focusing on individual behaviour change. The present study investigated individual and organizational characteristics associated with the application of an ecological approach by practitioners 6 months post-training.
Individual and organizational characteristics and outcomes of a 6-week online training course were assessed at pre-course, post-course and 6-month follow-up. The application of an ecological approach was measured by three outcomes (application of course content, implementation of an action plan and trying a different approach) and analysed using a generalized estimating equation model with a binomial distribution and logit link and linear mixed models.
An online course for participants in the USA and abroad.
Public health nutrition and youth development educators and their community partners, and other community practitioners, who completed the course and all three surveys (n 240).
One individual characteristic (networking utility) and three organizational characteristics (ecological approach within job scope, funding, course content applied to work) were positively and significantly associated with the application of an ecological approach (P<0·05). Individual characteristics that were negatively and significantly associated with the application of an ecological approach were being a registered dietitian and having ≥16 years of work experience (P<0·05).
Training of community practitioners and the scope and funding of their positions should explicitly emphasize the usefulness or utility of networking and the use of an ecological approach for preventing childhood obesity.
Over the last two decades or so the subject of Scottish emigration across the globe has blossomed as a core focus of research for modern historians. Broad studies have been published in addition to some on more specific themes such as return migration, the Scottish military, Scots and slavery, and the Scottish factor in empire, to name but a few of the topics which have resulted in important contributions. It could even be argued that there might now be something of a ‘diasporic turn’ in modern Scottish historical studies. If so, it is all to the good. For far too long students of Scottish history have concentrated exclusively on the homeland and failed to take account of the broader Scotland, the ‘Scotland’ originating from the vast migrations over the centuries which left imprints on Europe, England, Ireland, the Americas, the colonial Caribbean, Africa, Australasia, Asia and many other places across the globe.
Looking outwards can also provide manifest intellectual benefits for historians of small nations. As they pursue the study of the people who have gone away, so they may become more familiar with the potential pitfalls of introspection, parochialism and filiopietism, and the multiple connections of transnationalism and internationalism. But even then, rigorous contextualisation, allied with comparative analysis, must also surely be added to the mix. Until recent years numerous books on the Scots abroad since the nineteenth century have been replete with boosterism and ethnic conceit. Undeniably that genre may have leavened the pride in the identity of Scots living both at home and abroad. Nevertheless it marred the possibilities of a truly realistic and convincing perspective which was sensitive to historiographical balance and regard for both the lighter and darker aspects of the remarkable global migrations of the Scottish people.
A Global Force adds to the more sophisticated studies which have been plotting the worldwide significance of the Scottish diaspora. This scholarly and richly referenced volume adds a novel and intriguing dimension to existing contributions by focusing on countries in the Empire, dominions and commonwealth which have adopted Scottish regimental styles in their military formations. The authors all demonstrate the vital allure of Highlandism.