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To examine the relationship between protein intake and the risk of incident premenstrual syndrome (PMS).
Nested case–control study. FFQ were completed every 4 years during follow-up. Our main analysis assessed protein intake 2–4 years before PMS diagnosis (for cases) or reference year (for controls). Baseline (1991) protein intake was also assessed.
Nurses’ Health Study II (NHS2), a large prospective cohort study of registered female nurses in the USA.
Participants were premenopausal women between the ages of 27 and 44 years (mean: 34 years), without diagnosis of PMS at baseline, without a history of cancer, endometriosis, infertility, irregular menstrual cycles or hysterectomy. Incident cases of PMS (n 1234) were identified by self-reported diagnosis during 14 years of follow-up and validated by questionnaire. Controls (n 2426) were women who did not report a diagnosis of PMS during follow-up and confirmed experiencing minimal premenstrual symptoms.
In logistic regression models adjusting for smoking, BMI, B-vitamins and other factors, total protein intake was not associated with PMS development. For example, the OR for women with the highest intake of total protein 2–4 years before their reference year (median: 103·6 g/d) v. those with the lowest (median: 66·6 g/d) was 0·94 (95 % CI 0·70, 1·27). Additionally, intakes of specific protein sources and amino acids were not associated with PMS. Furthermore, results substituting carbohydrates and fats for protein were also null.
Overall, protein consumption was not associated with risk of developing PMS.
Studies of the Supreme Court of Canada (SCC) focus largely on its policy-making role and its interpretation of the Charter of Rights. However, less studied are the Court's decisions in earlier periods, especially in comparison to the Charter years and in cases beyond civil rights and liberties. This study fills a gap in the scholarship by analyzing the universe of decisions from 1945 to 2005 in criminal, tax and tort cases. Utilizing Baum's (1988, 1989) method to examine policy change, I explore policy trends on the Supreme Court. The findings suggest that, for the most part, the SCC has remained a stable, consistent body over the course of its modern history. It appears that most of the variation in judicial output across time is due to issue change with some shifts due to personnel and membership change.
We aimed to explore multiple perspectives regarding barriers to and facilitators of advance care planning (ACP) among African Americans to identify similarities or differences that might have clinical implications.
Qualitative study with health disparities experts (n = 5), community members (n = 9), and seriously ill African American patients and caregivers (n = 11). Using template analysis, interviews were coded to identify intrapersonal, interpersonal, and systems-level themes in accordance with a social ecological framework.
Participants identified seven primary factors that influence ACP for African Americans: religion and spirituality; trust and mistrust; family relationships and experiences; patient-clinician relationships; prognostic communication, care preferences, and preparation and control. These influences echo those described in the existing literature; however, our data highlight consistent differences by group in the degree to which these factors positively or negatively affect ACP. Expert participants reinforced common themes from the literature, for example, that African Americans were not interested in prognostic information because of mistrust and religion. Seriously ill patients were more likely to express trust in their clinicians and to desire prognostic communication; they and community members expressed a desire to prepare for and control the end of life. Religious belief did not appear to negate these desires.
Significance of results
The literature on ACP in African Americans may not accurately reflect the experience of seriously ill African Americans. What are commonly understood as barriers to ACP may in fact not be. We propose reframing stereotypical barriers to ACP, such as religion and spirituality, or family, as cultural assets that should be engaged to enhance ACP. Although further research can inform best practices for engaging African American patients in ACP, findings suggest that respectful, rapport-building communication may facilitate ACP. Clinicians are encouraged to engage in early ACP using respectful and rapport building communication practices, including open-ended questions.
Approximately 8–20 % of reproductive-aged women experience premenstrual syndrome (PMS), substantially impacting quality of life. Women with PMS are encouraged to reduce fat intake to alleviate symptoms; however, its role in PMS development is unclear. We evaluated the association between dietary fat intake and PMS development among a subset of the prospective Nurses’ Health Study II cohort. We compared 1257 women reporting clinician-diagnosed PMS, confirmed by premenstrual symptom questionnaire and 2463 matched controls with no or minimal premenstrual symptoms. Intakes of total fat, subtypes and fatty acids were assessed via FFQ. After adjustment for age, BMI, smoking, Ca and other factors, intakes of total fat, MUFA, PUFA and trans-fat measured 2–4 years before were not associated with PMS. High SFA intake was associated with lower PMS risk (relative risk (RR) quintile 5 (median=28·1 g/d) v. quintile 1 (median=15·1 g/d)=0·75; 95 % CI 0·58, 0·98; Ptrend=0·07). This association was largely attributable to stearic acid intake, with women in the highest quintile (median=7·4 g/d) having a RR of 0·75 v. those with the lowest intake (median=3·7 g/d) (95 % CI 0·57, 0·97; Ptrend=0·03). Individual PUFA and MUFA, including n-3 fatty acids, were not associated with risk. Overall, fat intake was not associated with higher PMS risk. High intake of stearic acid may be associated with a lower risk of developing PMS. Additional prospective research is needed to confirm this finding.
Objectives: The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. Methods: One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1–18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. Results: An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. Conclusions: We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640–652)
The Tiskilwa Till Member of the Wedron Formation represents deposition by basal melt-outin the marginal area of the Laurentide ice sheetduring the Woodfordian (late-Wisconsinan) in Illinois. Distinctive characteristics include: a very thick, homogeneous till; relatively little ablation till; red color; sandy texture; illite content that is relatively low withrespect to other Woodfordian tills; and the presence of discontinuous basal zones of differing composition.
Erosion and entrainment of debris from both distant and local source areas are evident in the Tiskilwa Jill. Basal thermal regime is suggested as a major controlling factor on the location of the zones of entrainment. The debris was homogenized en route to the margin and eventually was deposited as basal melt-out till near the margin. Deposition occurred within an interval of 6 ka or more during the first half of the Woodfordian.
Condors and vultures comprise the only group of terrestrial vertebrates in the world that are obligate scavengers, and these species move widely to locate ephemeral, unpredictable, and patchily-distributed food resources. In this study, we used high-resolution GPS location data to quantify monthly home range size of the critically endangered California Condor Gymnogyps californianus throughout the annual cycle in California. We assessed whether individual-level characteristics (age, sex and breeding status) and factors related to endangered species recovery program efforts (rearing method, release site) were linked to variation in monthly home range size. We found that monthly home range size varied across the annual cycle, with the largest monthly home ranges observed during late summer and early fall (July–October), a pattern that may be linked to seasonal changes in thermals that facilitate movement. Monthly home ranges of adults were significantly larger than those of immatures, but males and females used monthly home ranges of similar size throughout the year and breeding adults did not differ from non-breeding adults in their average monthly home range size. Individuals from each of three release sites differed significantly in the size of their monthly home ranges, and no differences in monthly home range size were detected between condors reared under captive conditions relative to those reared in the wild. Our study provides an important foundation for understanding the movement ecology of the California Condor and it highlights the importance of seasonal variation in space use for effective conservation planning for this critically endangered species.
Military health care providers (HCPs) have an integral role during disaster, humanitarian, and civic assistance (DHCA) missions. Since 50% of patients seen in these settings are children, military providers must be prepared to deliver this care.
The purpose of this systematic, integrative review of the literature was to describe the knowledge and clinical skills military health care providers need in order to provide care for pediatric outpatients during DHCA operations.
A systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed and CINAHL were conducted using terms such as Disaster*, Geological Processes, and Military Personnel. Thirty-one articles were included from database and manual searches.
Infectious diseases, vaccines, malnutrition, sanitation and wound care were among the most frequently mentioned of the 49 themes emerging from the literature. Concepts included endemic, environmental, vector-borne and vaccine-preventable diseases; enhanced pediatric primary care; and skills and knowledge specific to disaster, humanitarian and civic assistance operations.
Implications for Practice
The information provided is a critical step in developing curriculum specific to caring for children in DHCA. While the focus was military HCPs, the knowledge is easily translated to civilian HCPs who provide care to children in these situations.
JohnsonHL, GaskinsSW, SeibertDC. Clinical Skill and Knowledge Requirements of Health Care Providers Caring for Children in Disaster, Humanitarian and Civic Assistance Operations: An Integrative Review of the Literature. Prehosp Disaster Med.2013;28(1):1-8.
Abstract. While there is an extensive literature on the causes of dissensus on appellate courts in the US, few empirical studies exist of the causes of dissent in Canadian Supreme Court. The current study seeks to close that gap in the literature, proposing and then testing what we call a Canadian model of dissent. We find that the likelihood of dissent is strongly related to four broad factors that appear to exert independent influence on whether the Court is consensual or divided: political conflict, institutional structure, legal ambiguity in the law and variations in the leadership style of the chief justice.
Résumé. Les causes de dissension dans les cours d'appel aux États-Unis font l'objet de nombreux articles et publications, mais il existe très peu d'études empiriques sur les causes de dissidence à la Cour suprême du Canada. La présente étude vise à combler cette lacune en proposant, un modèle canadien de dissension, puis en le mettant à l'épreuve. Nous avons constaté que le risque de dissension est fortement lié à quatre facteurs genéraux qui semblent exercer une influence indépendante, que la Cour soit en accord ou divisée. Ces facteurs sont le conflit politique, la structure institutionnelle, la présence d'une ambiguité juridique dans la loi et le style de direction du juge en chef.
Abstract. This study seeks to add to the current understanding of the political nature of the Supreme Court of Canada. We analyze a data set consisting of all nonunanimous published Supreme Court decisions for the period 1949 to 2000. A prior study by Tate and Sittiwong (1989) suggested a model of judge attributes for the period 1949 to 1985. We build on that analysis by extending the time period to 2000, which allows the impact of gender also to be assessed. We find that since the Court gained substantial docket control, the types of cases the Court hears has changed from the period studied by Tate and Sittiwong. In the more recent period, civil rights and liberties cases are much more substantial in number. We conclude some of the variables in the Tate and Sittiwong study may be time bound and we suggest a new model of attitudinal voting.
Résumé. Cet étude cherche de augmenter le savoir courant du le nature politique du Cour suprême du Canada. Nous analysons un ensemble de données non unanime compose de tout décisions publié du Cour suprême entre les années 1949 à 1985. Une enquête précède fait par Tate et Sittiwong (1989) a proposé un modèle des attributs des juges pour la période entre 1949 à 1985. Nous poursuivons laquelle analyse pour prolonger la période du temps jusqu'à 2000, ce que on permettre évalue l'effet du sexe aussi. Nous trouvons que comme le Cour a conquis considérable control du registre, les gendres dossier entendre par le Cour ont changé depuis le période de enquête de Tate y Sittiwong. Pendent le période plus récent les dossiers concernant les droits civiles et libertés sont beaucoup plus nombreux. Nous concluons que possiblement, quelques variables de l'enquête du Tate et Sittiwong soient liées par le temp et nous proposent un modèle neuf des votes attitudinal.
A study was conducted to determine whether intramammary antibiotic treatment of heifer mammary glands following the first milking after calving was effective for reducing the percentage of mammary quarters infected during early lactation. Jersey and Holstein heifers from two research herds were assigned to one of three treatment groups: (1) no intramammary infusion following the first milking after parturition, (2) intramammary infusion of all quarters with pirlimycin hydrochloride following the first milking after parturition and (3) intramammary infusion of all quarters with novobiocin sodium plus penicillin G procaine following the first milking after parturition. Almost 93% of Jersey heifers (40/43) and 73·1% of quarters (125/171) were infected at the first milking. Almost 77% of quarters (33/43) were cured following treatment with pirlimycin, 61·8% (21/34) were cured following treatment with penicillin-novobiocin and 39·6% (19/48) of infections were eliminated spontaneously in the untreated control group. Significantly fewer infections were observed in pirlimycin or penicillin-novobiocin treated mammary glands of Jersey heifers during early lactation than in untreated control mammary glands. Almost 89% of Holstein heifers (32/36) and 52·8% of quarters (76/144) were infected at the first milking. About 57% (12/21) of quarters were cured following treatment with pirlimycin, 41·4% (12/29) were cured following treatment with penicillin-novobiocin and 23·1% (6/26) of infections were eliminated spontaneously in the untreated negative control group. Significantly fewer infections were observed in pirlimycin treated mammary glands of Holstein heifers during early lactation than in untreated control mammary glands. However, no significant differences were observed following penicillin-novobiocin treatment of Holstein heifers after the first milking of lactation compared with untreated control quarters. Coagulase-negative staphylococci, Streptococcus uberis and Streptococcus dysgalactiae subsp dysgalactiae were isolated most frequently in heifers from both herds.
Nutrigenomics is the study of how constituents of the diet interact with genes, and their products, to alter phenotype and, conversely, how genes and their products metabolise these constituents into nutrients, antinutrients, and bioactive compounds. Results from molecular and genetic epidemiological studies indicate that dietary unbalance can alter gene–nutrient interactions in ways that increase the risk of developing chronic disease. The interplay of human genetic variation and environmental factors will make identifying causative genes and nutrients a formidable, but not intractable, challenge. We provide specific recommendations for how to best meet this challenge and discuss the need for new methodologies and the use of comprehensive analyses of nutrient–genotype interactions involving large and diverse populations. The objective of the present paper is to stimulate discourse and collaboration among nutrigenomic researchers and stakeholders, a process that will lead to an increase in global health and wellness by reducing health disparities in developed and developing countries.
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