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This study aimed to investigate the rate of dizziness and occurrence of benign paroxysmal positional vertigo in the elderly by physical examination in those reporting dizziness symptoms when lying down or turning over in bed.
A total of 498 people, aged 70–85 years, were asked to complete a questionnaire regarding dizziness symptoms. Subjects answering that they became dizzy in bed were asked to participate in a physical examination and diagnostic manoeuvres investigating benign paroxysmal positional vertigo.
A total of 324 participants (65 per cent) completed the questionnaire. More than one-quarter (29 per cent) reported dizziness and 32 (10 per cent) reported dizziness when turning in bed. Of these 32 persons, 22 (69 per cent) underwent a physical examination. Six participants tested positive for benign paroxysmal positional vertigo.
Ten per cent of the elderly participants reported positional symptoms, and 6 out of 22 fulfilled diagnostic criteria for benign paroxysmal positional vertigo. Furthermore, benign paroxysmal positional vertigo was established despite a delay between questionnaire completion and investigation, emphasising that this type of dizziness may not be a self-limiting disorder.
Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.
Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.
A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29–0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit–risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.
Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
To produce a practice guideline that includes a set of detailed consensus principles regarding the prescription of antipsychotics (APs) amongst people with dementia living in care homes.
We used a modified Delphi consensus procedure with three rounds, where we actively specified and optimized statements throughout the process, utilizing input from four focus groups, carried out in UK, Norway, and the Netherlands. This was done to identify relevant themes and a set of statement that experts agreed upon using the Research and Development/University of California at Los Angeles (RAND/UCLA) methodology.
A total of 72 scientific and clinical experts and 14 consumer experts reached consensus upon 150 statements covering five themes: (1) General prescription stipulations, (2) assessments prior to prescription, (3) care and treatment plan, (4) discontinuation, and (5) long-term treatment.
In this practice guideline, novel information was provided about detailed indication and thresholds of symptoms, risk factors, circumstances at which APs should be stopped or tapered, specific criteria for justifying long-term treatment, involvement of the multidisciplinary team, and family caregiver in the process of prescription. The practice guideline is based on formal consensus of clinicians and consumer experts and provides clinicians relevant practical information that is lacking in current guidelines.
Health-beneficial effects of adhering to a healthy Nordic diet index have been suggested. However, it has not been examined to what extent the included dietary components are exclusively related to the Nordic countries or if they are part of other European diets as well, suggesting a broader preventive potential. The present study describes the intake of seven a priori defined healthy food items (apples/pears, berries, cabbages, dark bread, shellfish, fish and root vegetables) across ten countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) and examines their consumption across Europe.
Cross-sectional study. A 24 h dietary recall was administered through a software program containing country-specific recipes. Sex-specific mean food intake was calculated for each centre/country, as well as percentage of overall food groups consumed as healthy Nordic food items. All analyses were weighted by day and season of data collection.
Multi-centre, European study.
Persons (n 36 970) aged 35–74 years, constituting a random sample of 519 978 EPIC participants.
The highest intakes of the included diet components were: cabbages and berries in Central Europe; apples/pears in Southern Europe; dark bread in Norway, Denmark and Greece; fish in Southern and Northern countries; shellfish in Spain; and root vegetables in Northern and Central Europe. Large inter-centre variation, however, existed in some countries.
Dark bread, root vegetables and fish are strongly related to a Nordic dietary tradition. Apples/pears, berries, cabbages, fish, shellfish and root vegetables are broadly consumed in Europe, and may thus be included in regional public health campaigns.
In 2010, a marked increase in listeriosis incidence was observed in Finland. Listeria monocytogenes PFGE profile 96 was responsible for one-fifth of the reported cases and a cluster of PFGE profile 62 was also detected. Investigations revealed two fishery production plants with persistent Listeria contamination. It appears likely that the plants were at least partly responsible for the increase of listeriosis. Epidemiological investigation revealed that 57% (31/54) of cases with underlying immunosuppressive condition or medication reported eating gravad or cold-smoked fish. Two public notices were issued by THL and Evira informing which groups were most at risk from the effects of listeriosis and should therefore be cautious in consuming certain products. Systematic sampling of foods and adequate epidemiological investigation methods are required to identify the sources of Listeria infections. Continuous control measures at fishery production plants producing risk products are essential.
In 2010, 7/44 (16%) reported foodborne outbreaks in Finland were linked with raw beetroot consumption. We reviewed data from the national outbreak registry in order to hypothesize the aetiology of illness and to prevent further outbreaks. In the seven outbreaks, 124 cases among 623 respondents were identified. Consumption of raw beetroot was strongly associated with gastrointestinal illness (relative risk 8·99, 95% confidence interval 6·06–13·35). The illness was characterized by sudden onset of gastrointestinal symptoms; the median incubation time was 40 min and duration of illness 5 h. No common foodborne pathogens or toxins were found in either clinical or beetroot samples, but all tested beetroot samples were of poor quality according to total bacterial counts. Beta-haemolytic Pseudomonas fluorescens was detected in several beetroot samples but its effect on human health is unknown. No outbreaks were reported after the Finnish Food Safety Authority Evira advised against serving raw beetroot in institutional canteens.
Energy is essential for human development and energy systems are a crucial entry point for addressing the most pressing global challenges of the 21st century, including sustainable economic and social development, poverty eradication, adequate food production and food security, health for all, climate protection, conservation of ecosystems, peace and security. Yet, more than a decade into the 21st century, current energy systems do not meet these challenges.
A major transformation is therefore required to address these challenges and to avoid potentially catastrophic future consequences for human and planetary systems. The Global Energy Assessment (GEA) demonstrates that energy system change is the key for addressing and resolving these challenges. The GEA identifies strategies that could help resolve the multiple challenges simultaneously and bring multiple benefits. Their successful implementation requires determined, sustained and immediate action.
Transformative change in the energy system may not be internally generated; due to institutional inertia, incumbency and lack of capacity and agility of existing organizations to respond effectively to changing conditions. In such situations clear and consistent external policy signals may be required to initiate and sustain the transformative change needed to meet the sustainability challenges of the 21st century.
The industrial revolution catapulted humanity onto an explosive development path, whereby, reliance on muscle power and traditional biomass was replaced mostly by fossil fuels. In 2005, some 78% of global energy was based on fossil energy sources that provided abundant and ever cheaper energy services to more than half the people in the world.
Energy is essential for human development and energy systems are a crucial entry point for addressing the most pressing global challenges of the 21st century, including sustainable economic, and social development, poverty eradication, adequate food production and food security, health for all, climate protection, conservation of ecosystems, peace, and security. Yet, more than a decade into the 21st century, current energy systems do not meet these challenges.
In this context, two considerations are important. The first is the capacity and agility of the players within the energy system to seize opportunities in response to these challenges. The second is the response capacity of the energy system itself, as the investments are long-term and tend to follow standard financial patterns, mainly avoiding risks and price instabilities. This traditional approach does not embrace the transformation needed to respond properly to the economic, environmental, and social sustainability challenges of the 21st century.
A major transformation is required to address these challenges and to avoid potentially catastrophic consequences for human and planetary systems. The GEA identifies strategies that could help resolve the multiple challenges simultaneously and bring multiple benefits. Their successful implementation requires determined, sustained, and immediate action.
The industrial revolution catapulted humanity onto an explosive development path, whereby reliance on muscle power and traditional biomass was replaced mostly by fossil fuels. In 2005, approximately 78% of global energy was based on fossil energy sources that provided abundant and ever cheaper energy services to more than half the world's population.
Epidemiological studies suggest health-protective effects of flavan-3-ols and their derived compounds on chronic diseases. The present study aimed to estimate dietary flavan-3-ol, proanthocyanidin (PA) and theaflavin intakes, their food sources and potential determinants in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration cohort. Dietary data were collected using a standardised 24 h dietary recall software administered to 36 037 subjects aged 35–74 years. Dietary data were linked with a flavanoid food composition database compiled from the latest US Department of Agriculture and Phenol-Explorer databases and expanded to include recipes, estimations and retention factors. Total flavan-3-ol intake was the highest in UK Health-conscious men (453·6 mg/d) and women of UK General population (377·6 mg/d), while the intake was the lowest in Greece (men: 160·5 mg/d; women: 124·8 mg/d). Monomer intake was the highest in UK General population (men: 213·5 mg/d; women: 178·6 mg/d) and the lowest in Greece (men: 26·6 mg/d in men; women: 20·7 mg/d). Theaflavin intake was the highest in UK General population (men: 29·3 mg/d; women: 25·3 mg/d) and close to zero in Greece and Spain. PA intake was the highest in Asturias (men: 455·2 mg/d) and San Sebastian (women: 253 mg/d), while being the lowest in Greece (men: 134·6 mg/d; women: 101·0 mg/d). Except for the UK, non-citrus fruits (apples/pears) were the highest contributors to the total flavan-3-ol intake. Tea was the main contributor of total flavan-3-ols in the UK. Flavan-3-ol, PA and theaflavin intakes were significantly different among all assessed groups. This study showed heterogeneity in flavan-3-ol, PA and theaflavin intake throughout the EPIC countries.
Flavonols, flavanones and flavones (FLAV) are sub-classes of flavonoids that exert cardioprotective and anti-carcinogenic properties in vitro and in vivo. We aimed to estimate the FLAV dietary intake, their food sources and associated lifestyle factors in ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. FLAV intake and their food sources for 36 037 subjects, aged between 35 and 74 years, in twenty-seven study centres were obtained using standardised 24 h dietary recall software (EPIC-SOFT). An ad hoc food composition database on FLAV was compiled using data from US Department of Agriculture and Phenol-Explorer databases and was expanded using recipes, estimations and flavonoid retention factors in order to increase its correspondence with the 24 h dietary recall. Our results showed that the highest FLAV-consuming centre was the UK health-conscious group, with 130·9 and 97·0 mg/d for men and women, respectively. The lowest FLAV intakes were 36·8 mg/d in men from Umeå and 37·2 mg/d in women from Malmö (Sweden). The flavanone sub-class was the main contributor to the total FLAV intake ranging from 46·6 to 52·9 % depending on the region. Flavonols ranged from 38·5 to 47·3 % and flavones from 5·8 to 8·6 %. FLAV intake was higher in women, non-smokers, increased with level of education and physical activity. The major food sources were citrus fruits and citrus-based juices (especially for flavanones), tea, wine, other fruits and some vegetables. We concluded that the present study shows heterogeneity in intake of these three sub-classes of flavonoids across European regions and highlights differences by sex and other sociodemographic and lifestyle factors.
Since contradictory data can be found in the literature, it is often difficult to assess the susceptibility of crevice corrosion of stainless steels in service conditions for a given marine application. The initiation and propagation of crevice corrosion in natural seawater were evaluated for five different duplex stainless steel grades together with some austenitic grades. A CREVCORR-type assembly was used to simulate crevice configurations involving the use of plastic crevice formers. The standard pressure applied on the crevice assembly was 3 N/mm2. Pressure of about 20 N/mm2 was also applied on some selected specimens in order to assess the effect of crevice geometry on crevice corrosion. The effect of environmental parameters (i.e. temperature, flowing conditions, residual chlorine, and dissolved oxygen content) and of surface roughness on the crevice corrosion initiation and propagation were investigated, allowing the assessment of limits of applications for some tested stainless steel grades. The less alloyed duplex stainless steels were evaluated in stagnant seawater at 5 °C and 20 °C. The duplex stainless steel UNS S32205, with PREN = 37, was also evaluated under the same conditions of exposure. The high alloyed stainless steels with PREN above 40 were evaluated in the expected most severe conditions of exposure, namely in 0.5 ppm-chlorinated seawater at 20 °C, in seawater at 30 °C (not chlorinated and with 0.5 ppm of residual chlorine) and in seawater at 50 °C (not chlorinated and with 0.5 ppm of residual chlorine). As expected the less alloyed duplex stainless steels showed limited crevice corrosion resistance in the tested media while UNS S32205 showed better resistance in the less severe tested condition of exposure. In demanding media it was shown that the limits of application of highly alloyed stainless steels are highly dependent on the crevice geometry (i.e. specimen roughness and applied pressure at gasket location).
A hybrid code has been used for three-dimensional simulations of the stellar wind interaction with the ionosphere of an Earth-sized close-in extrasolar planet. The hybrid code treats electrons as a massless, charge-neutralizing, adiabatic fluid while ions are treated as macroparticles. To study the effects of an expanding ionosphere, a consequence of an expanding atmosphere as for e.g. exoplanet HD 209458 b, we have compared the simulation results for an ordinary stationary ionosphere with the results for an expanding ionosphere. In both cases we can identify bow shock, magnetopause and ion-composition boundary. The expanding ionosphere pushes the bow shock and magnetopause upstream and increases the size of the entire interaction region, creating a large wake behind the planet dominated only by the expanding ionosphere.
Laser Doppler anemometry measurements of the mean velocity and Reynolds stresses are carried out for a rough-surface favourable pressure gradient turbulent boundary layer. The experimental data is compared with smooth favourable pressure gradient and rough zero-pressure gradient data. The velocity and Reynolds stress profiles are normalized using various scalings such as the friction velocity and free stream velocity. In the velocity profiles, the effects of roughness are removed when using the friction velocity. The effects of pressure gradient are not absorbed. When using the free stream velocity, the scaling is more effective absorbing the pressure gradient effects. However, the effects of roughness are almost removed, while the effects of pressure gradient are still observed on the outer flow, when the mean deficit velocity profiles are normalized by the U∞ δ∗/δ scaling. Furthermore, when scaled with U2∞, the 〈u2〉 component of the Reynolds stress augments due to the rough surface despite the imposed favourable pressure gradient; when using the friction velocity scaling u∗2, it is dampened. It becomes ‘flatter’ in the inner region mainly due to the rough surface, which destroys the coherent structures of the flow and promotes isotropy. Similarly, the pressure gradient imposed on the flow decreases the magnitude of the Reynolds stress profiles especially on the 〈v2〉 and -〈uv〉 components for the u∗2 or U∞2 scaling. These effects are reflected in the boundary layer parameter δ∗/δ, which increase due to roughness, but decrease due to the favourable pressure gradient. Additionally, the pressure parameter Λ found not to be in equilibrium, describes the development of the turbulent boundary layer, with no influence of the roughness linked to this parameter. These measurements are the first with an extensive number of downstream locations (11). This makes it possible to compute the required x-dependence for the production term and the wall shear stress from the full integrated boundary layer equation. The finding indicates that the skin friction coefficient depends on the favourable pressure gradient condition and surface roughness.
Lichen cover and diversity were analysed on the dwarf shrub Helianthemum oelandicum (L.) Dum.Cours. at one site in the calcareous grassland of the area known as the ‘Great Alvar’ on the Island of Öland, Sweden. The age of 22 phorophytes was determined by ring counting and varied from 8 to 41 years and was accurately predicted by the root diameter. A total of 18 lichen species was found, with a range between 0 and 13 species per phorophyte. The number of lichen species on living H. oelandicum were correlated with the phorophyte age. The number of lichen species and their coverage were greater on dead compared with living phorophytes. The species number was also higher on thin branches compared with thick branches and roots and some of the species showed preferences for dead phorophytes, and for thin branches. This study of lichen colonization and growth on dwarf shrubs in relation to phorophyte age is a new application of herbchronology.
We present a set of global, self-consistent N-body/SPH simulations of the dynamic evolution of galactic discs with gas and including magnetic fields. We have implemented a description to follow the ideal induction equation in the SPH part of the code Vine. Results from a direct implementation of the field equations are compared to a representation by Euler potentials, which pose a ∇ ċ B-free description, a constraint not fulfilled for the direct implementation. All simulations are compared to an implementation of magnetic fields in the code Gadget. Starting with a homogeneous field we find a tight connection of the magnetic field structure to the density pattern of the galaxy in our simulations, with the magnetic field lines being aligned with the developing spiral pattern of the gas. Our simulations clearly show the importance of non-axisymmetry of the dynamic pattern for the evolution of the magnetic field.
A novel cryogenic electrostatic storage device consisting of two ion-beam storage rings with a common straight section for studies of interactions between oppositely charged ions at low and well-defined relative velocities is under construction at Stockholm University. Here we consider the prospect of using this new tool to measure cross-sections and rate coefficients for mutual neutralization reactions of importance in interstellar ion chemistry in general and specifically in cosmic pre-biotic ion chemistry.
To investigate the association of a posteriori dietary patterns with overall survival of older Europeans.
Design and setting
This is a multi-centre cohort study. Cox regression analysis was used to investigate the association of the prevailing, a posteriori-derived, plant-based dietary pattern with all-cause mortality in a population of subjects who were 60 years or older at recruitment to the European Prospective Investigation into Cancer and Nutrition (EPIC-Elderly cohort). Analyses controlled for all known potential risk factors.
In total, 74 607 men and women, 60 years or older at enrolment and without previous coronary heart disease, stroke or cancer, with complete information about dietary intakes and potentially confounding variables, and with known survival status as of December 2003, were included in the analysis.
An increase in the score which measures the adherence to the plant-based diet was associated with a lower overall mortality, a one standard deviation increment corresponding to a statistically significant reduction of 14% (95% confidence interval 5–23%). In country-specific analyses the apparent association was stronger in Greece, Spain, Denmark and The Netherlands, and absent in the UK and Germany.
Greater adherence to the plant-based diet that was defined a posteriori in this population of European elders is associated with lower all-cause mortality. This dietary score is moderately positively correlated with the Modified Mediterranean Diet Score that has been constructed a priori and was also shown to be beneficial for the survival of the same EPIC-Elderly cohort.