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Postprandial glycaemia and insulinaemia are important risk factors for type 2 diabetes. The prevalence of insulin resistance in adolescents is increasing, but it is unknown how adolescent participant characteristics such as BMI, waist circumference, fitness and maturity offset may explain responses to a standard meal. The aim of the present study was to examine how such participant characteristics affect the postprandial glycaemic and insulinaemic responses to an ecologically valid mixed meal. Data from the control trials of three separate randomised, crossover experiments were pooled, resulting in a total of 108 participants (fifty-two boys, fifty-six girls; aged 12·5 (SD 0·6) years; BMI 19·05 (SD 2·66) kg/m2). A fasting blood sample was taken for the calculation of fasting insulin resistance, using the homoeostatic model assessment of insulin resistance (HOMA-IR). Further capillary blood samples were taken before and 30, 60 and 120 min after a standardised lunch, providing 1·5 g/kg body mass of carbohydrate, for the quantification of blood glucose and plasma insulin total AUC (tAUC). Hierarchical multiple linear regression demonstrated significant predictors for plasma insulin tAUC were waist circumference, physical fitness and HOMA-IR (F(3,98) = 36·78, P < 0·001, adjusted R2 = 0·515). The variance in blood glucose tAUC was not significantly explained by the predictors used (F(7,94) = 1·44, P = 0·198). Significant predictors for HOMA-IR were BMI and maturity offset (F(2,102) = 14·06, P < 0·001, adjusted R2 = 0·021). In summary, the key findings of the study are that waist circumference, followed by physical fitness, best explained the insulinaemic response to an ecologically valid standardised meal in adolescents. This has important behavioural consequences because these variables can be modified.
Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends.
To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’.
Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.
In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97).
There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.
Imagine a society comprising individuals who realize their maximal potential in every facet of their lives. In this society, people work together to better their communities and the lives of others. Individually, the citizens are free of disease, physically fit, well-educated masters of their craft, and they engage in a life of recreation and interconnectedness with family, neighbors, and friends while living with purpose and passion. Is this utopia too good to be true? The voice of reason may say life is not perfect; there are too many ever-changing variables. We are familiar with the physical law of entropy stating that randomness, or disorder, increases with time. However, why not aim toward a society as described above? We can strive to be the best version of ourselves, both on the micro, individual level and on the macro, societal level.
Wellness is often intimidating. Pursuing it requires significant commitment and carries emotional risk/vulnerability . While fear can be a strong motivator, it can also be the reason one may not try or follow-through with a plan. In most cases, fear prevents us from being able to accomplish what we wish to. In the case of wellness, we found that due to the commitment many were challenged by the fear of not being able to achieve the results and goals they had set for themselves. For example, if one was never taught, or had modeled, how to live a life full of joy, love, and wellness, they will fear a life different than what they were taught, whether by observation or directly. Occasionally it can be more difficult and painful to break a pattern than to live in it . The path to wellness will likely be unique for each and every one of us.
This chapter provides an overview of the use of affect-based interventions to change behavior. Affect is defined in terms of affect proper and affect processing; both of these terms are used regularly in research on affect interventions. The evidence of direct modification of these affect constructs is then reviewed. Based on this evidence, step-by-step guides to techniques focusing on changing two key aspects of affective processing are provided: changing affective attitudes and anticipated affect. The guides to these techniques include typical means of delivery, target audience, behaviors, enabling or inhibiting factors, training and skills required, intensiveness, typical materials needed, and typical examples of implementation. In addition, application of implementation intentions, fear appeals, evaluative conditioning, and exercise games as other ways to change affect as a means to changing behavior are reviewed. Finally, two additional intervention pathways that could have impact on behavior change are reviewed: direct modification of other sources of behavioral influence (e.g., traditional social cognitive factors) in order to overcompensate for the impact of affect and self-regulation of the intensity of the affect experience as a means of inhibiting its impact.
Mass gatherings and high-density activities, such as sporting events, conventions, and theme parks, are consistently included among highest-risk activities given the increased potential for widespread coronavirus disease 2019 (COVID-19) transmission. A more balanced risk management approach is required because absolute suppression of risk is unrealistic in all facets of life. Contact tracing remains a limiting factor in achieving such a balance. The use of Bluetooth or pairing devices is proposed to address this challenge. This simple approach, when applied in a manner that satisfies privacy and trust concerns, would allow high-risk encounters to be quickly identified, namely those where participants have spent 15 minutes or more within 6 ft of each other per current guidelines. If an attendee later tests positive for COVID-19 and tracing is required, the event organizer can provide a limited list of potential close contacts rather than an exhaustive list of all attendees. Contact tracers can, therefore, limit efforts to this concise group rather than needing to contact thousands of people or conduct mass media communications. Such a system, if institutionalized, supports risk assurance and safety measures for businesses by demonstrating a commitment to staff, customer protection, and ensuring high-risk encounters are logged, reinforcing longer-term societal pandemic resilience.
The Eighth Amendment to the United States Constitution proscribes governments from imposing “cruel and unusual punishments,” as well as excessive bail and fines. The Amendment has roots in a similar provision in the English Bill of Rights, which historically sought to prevent extreme punishments like the whipping, pillorying, defrocking, and life imprisonment of Titus Oates for perjury. Despite the historical importance of the Amendment, U.S. courts and scholars have given the Amendment and its prohibitions relatively little attention. In particular, the Supreme Court has construed its text quite narrowly, especially outside of the capital context.
As with many constitutional provisions, the language of the Eighth Amendment is open-ended and vague in its proscription of excessive bail, excessive fines, and cruel and unusual punishments. Because the language of the Constitution does not provide any additional descriptive information concerning what might make bail or fines excessive, or punishments cruel and unusual, courts must look beyond the text itself to ascertain the meaning of the Eighth Amendment. With respect to the prohibition on cruel and unusual punishments, the U.S. Supreme Court has, over the course of several decades, articulated a number of relevant underlying values that offer some guidance in interpreting this Eighth Amendment provision. These values are also helpful in assessing the excessiveness of bail and fines.
We describe 14 yr of public data from the Parkes Pulsar Timing Array (PPTA), an ongoing project that is producing precise measurements of pulse times of arrival from 26 millisecond pulsars using the 64-m Parkes radio telescope with a cadence of approximately 3 weeks in three observing bands. A comprehensive description of the pulsar observing systems employed at the telescope since 2004 is provided, including the calibration methodology and an analysis of the stability of system components. We attempt to provide full accounting of the reduction from the raw measured Stokes parameters to pulse times of arrival to aid third parties in reproducing our results. This conversion is encapsulated in a processing pipeline designed to track provenance. Our data products include pulse times of arrival for each of the pulsars along with an initial set of pulsar parameters and noise models. The calibrated pulse profiles and timing template profiles are also available. These data represent almost 21 000 h of recorded data spanning over 14 yr. After accounting for processes that induce time-correlated noise, 22 of the pulsars have weighted root-mean-square timing residuals of
in at least one radio band. The data should allow end users to quickly undertake their own gravitational wave analyses, for example, without having to understand the intricacies of pulsar polarisation calibration or attain a mastery of radio frequency interference mitigation as is required when analysing raw data files.
This book provides a theoretical and practical exploration of the constitutional bar against cruel and unusual punishments, excessive bail, and excessive fines. It explores the history of this prohibition, the current legal doctrine, and future applications of the Eighth Amendment. With contributions from the leading academics and experts on the Eighth Amendment and the wide range of punishments and criminal justice actors it touches, this volume addresses constitutional theory, legal history, federalism, constitutional values, the applicable legal doctrine, punishment theory, prison conditions, bail, fines, the death penalty, juvenile life without parole, execution methods, prosecutorial misconduct, race discrimination, and law & science.
This chapter presents the most common pediatric surgery, myringotomy and ear tube placement. The author reviews in the indications for eat tubes in the setting of a child with upper respiratory tract infection. The perioperative considerations for upper respiratory tract infection are considered with relation to case postponement.
In this chapter, the authors discuss the issues related to post-operative neonatal apnea with an example of an infant hernia repair. Neonatal apnea, its etiology and associated risk factors is reviewed. The use of infant spinal anesthesia versus general anesthesia and its relationship to neonatal post-operative apnea is discussed.