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To detect modest associations of dietary intake with disease risk, observational studies need to be large and control for moderate measurement errors. The reproducibility of dietary intakes of macronutrients, food groups and dietary patterns (vegetarian and Mediterranean) was assessed in adults in the UK Biobank study on up to five occasions using a web-based 24-h dietary assessment (n 211 050), and using short FFQ recorded at baseline (n 502 655) and after 4 years (n 20 346). When the means of two 24-h assessments were used, the intra-class correlation coefficients (ICC) for macronutrients varied from 0·63 for alcohol to 0·36 for polyunsaturated fat. The ICC for food groups also varied from 0·68 for fruit to 0·18 for fish. The ICC for the FFQ varied from 0·66 for meat and fruit to 0·48 for bread and cereals. The reproducibility was higher for vegetarian status (κ > 0·80) than for the Mediterranean dietary pattern (ICC = 0·45). Overall, the reproducibility of pairs of 24-h dietary assessments and single FFQ used in the UK Biobank were comparable with results of previous prospective studies using conventional methods. Analyses of diet–disease relationships need to correct for both measurement error and within-person variability in dietary intake in order to reliably assess any such associations with disease in the UK Biobank.
Sleep disturbances are prevalent in cancer patients, especially those with advanced disease. There are few published intervention studies that address sleep issues in advanced cancer patients during the course of treatment. This study assesses the impact of a multidisciplinary quality of life (QOL) intervention on subjective sleep difficulties in patients with advanced cancer.
This randomized trial investigated the comparative effects of a multidisciplinary QOL intervention (n = 54) vs. standard care (n = 63) on sleep quality in patients with advanced cancer receiving radiation therapy as a secondary endpoint. The intervention group attended six intervention sessions, while the standard care group received informational material only. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), administered at baseline and weeks 4 (post-intervention), 27, and 52.
The intervention group had a statistically significant improvement in the PSQI total score and two components of sleep quality and daytime dysfunction than the control group at week 4. At week 27, although both groups showed improvements in sleep measures from baseline, there were no statistically significant differences between groups in any of the PSQI total and component scores, or ESS. At week 52, the intervention group used less sleep medication than control patients compared to baseline (p = 0.04) and had a lower ESS score (7.6 vs. 9.3, p = 0.03).
Significance of results
A multidisciplinary intervention to improve QOL can also improve sleep quality of advanced cancer patients undergoing radiation therapy. Those patients who completed the intervention also reported the use of less sleep medication.
Analysis of human remains and a copper band found in the center of a Late Archaic (ca. 5000–3000 cal BP) shell ring demonstrate an exchange network between the Great Lakes and the coastal southeast United States. Similarities in mortuary practices suggest that the movement of objects between these two regions was more direct and unmediated than archaeologists previously assumed based on “down-the-line” models of exchange. These findings challenge prevalent notions that view preagricultural Native American communities as relatively isolated from one another and suggest instead that wide social networks spanned much of North America thousands of years before the advent of domestication.
Migration was a key social process contributing to the creation of the ‘Chaco World’ between AD 800 and 1200. Dynamic social network analysis allows for evaluation of several migration scenarios, and demonstrates that Chaco’s earliest ninth-century networks show interaction with areas to the west and south, rather than migration to the Canyon from the Northern San Juan. By the late eleventh century, Chaco Canyon was tied strongly to the Middle and Northern San Juan, while a twelfth-century retraction of networks separated the Northern and Southern San Juan areas prior to regional depopulation. Understanding Chaco migration is important for comprehending both its uniqueness in U.S. Southwest archaeology and for comparison with other case studies worldwide.
Limited research exists examining the biopsychosocial experience of patients diagnosed with metastatic renal cell carcinoma (mRCC), a disease commonly associated with a poor prognosis. The purpose of this study was to describe rates and types of distress in mRCC patients and explore the relationship between distress and overall survival.
A cohort of 102 patients with mRCC treated at a single institution was assessed by a touch screen–based instrument comprising 22 core items spanning physical, practical, functional, and emotional domains. Association between biopsychosocial distress and clinicopathologic criteria was interrogated. Overall survival was compared between patients with low distress versus high distress.
High rates of distress (20.7%) were found among patients newly diagnosed with mRCC. Among those domains contributing to distress, pain, fatigue, and financial comorbidity were the most commonly reported by patients with mRCC. A trend toward poorer overall survival in those patients with high distress versus low distress was observed among mRCC patients.
Significance of results
Based on data from a relatively large sample of patients, this study provides the first specific insights into the potential impact of biopsychosocial distress and outcomes among patients with mRCC.
The impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.
Phenology is a key ecosystem process that reflects climate–vegetation functioning, and is an indicator of global environmental changes. Recently, it has been suggested that land-use change and timber extraction promote differences in forest phenology. We use remote-sensing data to describe regional leaf phenological patterns in combination with field data from 131 plots in old-growth and disturbed forests distributed over subtropical forests of Argentina (54–65°W). We assessed how climate is related to phenological patterns, and analysed how changes in forest structural characteristics such as stock of above-ground biomass relate to the observed phenological signals across the gradient. We found that the first three axes of a principal component analysis explained 85% of the variation in phenological metrics across subtropical forests, ordering plots mainly along indicators of seasonality and productivity. At the regional scale, the relative importance of forest biomass in explaining variation in phenological patterns was about 15%. Climate showed the highest relative importance, with temperature and rainfall explaining Enhanced Vegetation Index metrics related to seasonality and productivity patterns (27% and 47%, respectively). Within forest types, climate explains the major fraction of variation in phenological patterns, suggesting that forest function may be particularly sensitive to climate change. We found that forest biomass contributed to explaining a proportion of leaf phenological variation within three of the five forest types studied, and this may be related to changes in species composition, probably as a result of forest use.
Addressing archaeology's most compelling substantive challenges requires synthetic research that exploits the large and rapidly expanding corpus of systematically collected archaeological data. That, in turn, requires a means of combining datasets that employ different systematics in their recording while at the same time preserving the semantics of the data. To that end, we have developed a general procedure that we call query-driven, on-the-fly data integration that is deployed within the Digital Archaeological Record digital repository. The integration procedure employs ontologies that are mapped to the original datasets. Integration of the ontology-based dataset representations is done at the time the query is executed, based on the specific content of the query. In this way, the original data are preserved, and data are aggregated only to the extent necessary to obtain semantic comparability. Our presentation draws examples from the largest application to date: an effort by a research community of Southwest US faunal analysts. Using 24 ontologies developed to cover a broad range of observed faunal variables, we integrate faunal data from 33 sites across the late prehistoric northern Southwest, including about 300,000 individually recorded faunal specimens.
We present an indentation-scope that interfaces with confocal microscopy, enabling direct observation of the three-dimensional (3D) microstructural response of coatings on substrates. Using this method, we compared microns-thick polymer coatings on glass with and without silica nanoparticle filler. Bulk force data confirmed the >30% modulus difference, while microstructural data further revealed slip at the glass-coating interface. Filled coatings slipped more and about two times faster, as reflected in 3D displacement and von Mises strain fields. Overall, these data indicate that silica-doping of coatings can dramatically alter adhesion. Moreover, this method compliments existing theoretical and modeling approaches for studying indentation in layered systems.
The relationship between sildenafil dosing, exposure, and systemic hypotension in infants is incompletely understood.
The aim of this study was to characterise the relationship between predicted sildenafil exposure and hypotension in hospitalised infants.
We extracted information on sildenafil dosing and clinical characteristics from electronic health records of 348 neonatal ICUs from 1997 to 2013, and we predicted drug exposure using a population pharmacokinetic model.
We identified 232 infants receiving sildenafil at a median dose of 3.2 mg/kg/day (2.0, 6.0). The median steady-state area under the concentration–time curve over 24 hours (AUC24,SS) and maximum concentration of sildenafil (Cmax,SS,SIL) were 712 ng×hour/ml (401, 1561) and 129 ng/ml (69, 293), respectively. Systemic hypotension occurred in 9% of the cohort. In multivariable analysis, neither dosing nor exposure were associated with systemic hypotension: odds ratio=0.96 (95% confidence interval: 0.81, 1.14) for sildenafil dose; 0.87 (0.59, 1.28) for AUC24,SS; 1.19 (0.78, 1.82) for Cmax,SS,SIL.
We found no association between sildenafil dosing or exposure with systemic hypotension. Continued assessment of sildenafil’s safety profile in infants is warranted.
In very low birth weight infants, persistence of a patent ductus arteriosus results in morbidity and mortality. Therapies to close the ductus are effective, but clinical outcomes may depend on the accuracy of diagnosis and the timing of administration. The objective of the present study was to characterise the association between early echocardiography, therapy for patent ductus arteriosus, and outcomes in very low birth weight infants.
This retrospective cohort study used electronic health record data on inborn infants of gestational age ⩽28 weeks and birth weight <1500 g who were discharged after day of life 7 from 362 neonatal ICU from 1997 to 2013. The primary outcome was death between day of life 7 and discharge. Secondary outcomes included bronchopulmonary dysplasia, necrotising enterocolitis, and grade 3 or 4 intraventricular haemorrhage.
This study included a total of 48,551 infants with a median gestational age of 27 weeks (interquartile range 25, 28) and birth weight 870 g (706, 1050). Early echocardiography – that is, performed during days of life 2 to 6 – was performed in 15,971/48,551 (33%) infants, and patent ductus arteriosus was diagnosed in 31,712/48,551 (65%). The diagnosis was more common in infants who had undergone early echocardiography (14,549/15,971 [91%] versus 17,163/32,580 [53%], p<0.001). In multivariable analysis, early echocardiography was not associated with reduced mortality (odds ratio 0.97, 95% CI 0.89–1.05). Results were similar in the subset of infants who received therapy for patent ductus arteriosus (odds ratio 1.01, 95% CI 0.90–1.15).
Early echocardiography was associated with an increased diagnosis of patent ductus arteriosus, but not with decreased mortality.
In April of 1939—seven years after the death of Lytton Strachey—Virginia Woolf published her essay “The Art of Biography,” in which she provided a pointed assessment of Strachey's final work Elizabeth and Essex: A Tragic History. At the time of its publication in 1928 (famously the same year as Orlando), Woolf had privately dismissed the biography as a “lively superficial meretricious book” (D3 208), describing it to Hugh Walpole as “all purple and gold, like the cheaper effects at the Pantomime” (L4 19). She deliberately avoided the subject with Strachey, and in 1929, wrote to Vita Sackville-West: “the spectre of Queen Eth stands between us” (L4 23). In “The Art of Biography,” however, Woolf seemed to revise her opinion of the book, suggesting that the failure of Elizabeth and Essex had more to do with the limitations of the biographic form than with Strachey's capacity as a writer. “Queen Elizabeth seemed to lend herself perfectly to the experiment,” she writes. “Very little was known about her. The society in which she lived was so remote that the habits, the motives, and even the actions of the people of that age were full of strangeness and obscurity” (CE4 224). As Woolf understood it, that “strangeness” was also the cause of the book's failure. The fact that “very little was known” meant that Strachey had been “urged to invent” (CE4 225), and yet in resorting to the strategies of fiction, Woolf felt that he had exposed the limits of biographic convention. “The combination proved unworkable” (CE4 224), she writes. “The Queen thus moves in an ambiguous world, between fact and fiction, neither embodied nor disembodied” (CE4 225).
Woolf's criticism of Elizabeth and Essex draws attention to the way that both she and Strachey wrote about the early modern, and its relationship with modernity. In her essay, for instance, Woolf quotes a passage from the second chapter of Strachey's biography, in which he wonders: “By what art are we to worm our way into those strange spirits, those even stranger bodies? The more clearly we perceive it, the more remote that singular universe becomes” (Strachey 8; CE4 224). This was a question that Woolf had already contemplated in her essay “The Strange Elizabethans” (1932), which opens the second series of The Common Reader.