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The objective was to investigate which predictive equations provide the best estimates of resting energy expenditure (REE) in postpartum women with overweight and obesity. Lactating women with overweight or obesity underwent REE measurement by indirect calorimetry, and fat-free mass (FFM) was assessed by dual-energy X-ray absorptiometry at three postpartum stages. Predictive equations based on body weight and FFM were obtained from the literature. Performance of the predictive equations were analysed as the percentage of women whose REE was accurately predicted, defined as a predicted REE within ±10 % of measured REE. REE data were available for women at 10 weeks (n 71), 24 weeks (n 64) and 15 months (n 57) postpartum. Thirty-six predictive equations (twenty-five weight-based and eleven FFM-based) were validated. REE was accurately predicted in ≥80 % of women at all postpartum visits by six predictive equations (two weight-based and four FFM-based). The weight-based equation with the highest performance was that of Henry (weight, height, age 30–60 years) (HenryWH30−60), with an overall mean of 83 % accurate predictions. The HenryWH30−60 equation was highly suitable for predicting REE at all postpartum visits (irrespective of the women's actual age), and the performance was sustained across changes in weight and lactation status. No FFM-based equation was remarkably superior to HenryWH30−60 for the total postpartum period.
Finally, we will be able to present a grand summary of weak decays, list open questions, and present a shoping list for the coming years. energy observables that could be useful for the search for NP, in particular beyond the reach of the LHC. Subsequently, with the goal to distinguish various NP models we will discuss DNA charts proposed already in a number of papers.
For as long as he was able, Swift continued to send important poems to press in London, while Polite Conversation was published in strategically different editions there and in Dublin. Directions to Servants, finally sent to press unfinished, was brought out by Faulkner a few days after Swift’s death in 1745. But Faulkner soon lost ground to the London copy-holders, whose new 1755 edition, first advertised as to be edited by ‘an intimate Friend of the Author’, was in the event edited by a professional man of letters, John Hawkesworth, and boasted the novelty of a fashionable large quarto. The first publication of The History of the Four Last Years of the Queen in 1758 showed that even an editor who had known Swift personally could still denounce his politics. In 1765 Swift’s cousin Deane Swift added to Hawkesworth’s edition new material from family manuscripts. The volumes‘ imposing quarto option, and its clean modern pages, confirm just how much Swift in print had changed from the modest formats and expressive typography of its author’s lifetime.
From 1921 until 1936, musician Willem Van de Wall pioneered the modern use of therapeutic music in American prisons and psychiatric institutions. His therapy was steeped in the methods and philosophy of social control, and after World War II, it shaped the professionalizing field of music therapy. Van de Wall's influence reveals an overlooked connection between modern clinical practice and the techniques of control employed in prisons and psychiatric hospitals of the early twentieth century. Given music therapy's broader impact as an element of postwar self-help culture, its relationship to social control practices also disrupts longstanding scholarly ideas about the so-called “therapeutic ethos.” The therapeutic ethos did not originate solely in efforts by the middle classes to adjust to bourgeois modernity. The case of music therapy suggests that some elements of “therapeutic culture” were always coercive and always directed toward the maintenance of race, gender, and class hierarchies.
The aims of this study were to examine the preparedness of vulnerable people ages 75 years and older and to clarify the characteristics of older adults that are associated with disaster preparedness.
We conducted interviews with persons requiring special care ages 75 years and older living in coastal communities of western Japan, where earthquakes and tsunami disasters are a concern. The survey included participant characteristics such as demographic indicators, physical function, health status, community involvement, and disaster preparedness. Binomial logistic regression analysis was performed with participant characteristics as independent variables and disaster preparedness as the dependent variables.
The characteristics related to disaster preparedness were age, family composition, cognitive function, level of interaction with neighbors, and participation in community activities.
Being female, living alone, and having cognitive impairment were factors that led to decreased disaster preparedness. However, it was suggested that close human interactions in the community facilitated preparedness. Community engagement is crucial in reducing disaster damage and recovering effectively. In order to facilitate preparedness measures for persons requiring special care ages 75 and older, it is important to establish community preparedness.
To validate the Psychogeriatric Inventory of Disconcerting Symptoms and Syndromes (PGI-DSS), a single scale in A4 format comprising four disconcerting syndromes (violence, refusal, words, and acts). The scale enables an immediate conversion of a qualitative assessment to a quantitative assessment. The PGI-DSS was compared with the Neuro Psychiatric Inventory for Nursing Homes (NPI-NH).
Cross-sectional descriptive and correlational studies.
Thirty geriatric care units and nursing homes.
Raters interviewed nurses and nursing assistants in charge of older adults hospitalized in geriatric care units or living in nursing homes (N = 226).
The French version of the PGI-DSS and the French version of the NPI-NH.
The correlation coefficient between the PGI-DSS and the NPI-NH was 0.70 (p < 0.0001). The PGI-DSS threshold score corresponding to the NPI threshold score was 17 (specificity: 87%, sensitivity: 63%). Four statistical factors, corresponding to the four clinical syndromes, explained 53.4% of the total variance. The internal consistency of the PGI-DSS (Cronbach’s alpha = 0.695) was higher than that of the NPI-NH (Cronbach’s alpha = 0.474). Test–retest reliability was better for the PGI-DSS than for the NPI-NH. The intraclass correlations were 0.80 [0.73; 0.86] and 0.75 [0.67; 0.83], respectively. Interrater reliability was better for the PGI-DSS than for the NPI-NH. The intraclass correlations were 0.65 [0.55–0.76] and 0.55 [0.43–0.68], respectively.
The PGI-DSS was developed to overcome the limitations of the NPI-NH. New, brief, easy to administer in less than 4 minutes, foldable in four parts, pocket-sized, easy-to-read in the palm of the hand, PGI-DSS could have similar or better statistical properties than the NPI-NH. Whereas the 10 domains in the NPI-NH have clinical utility for clinicians, the four easily understandable syndromes in the PGI-DSS can help avoid inappropriate attitudes and can guide psychosocial interventions. It could likewise improve dialogue between caregivers and clinicians.
The use of quality-adjusted life-years (QALYs) to set healthcare priorities has been criticized as unfair to people with disabilities that affect their health or lifespan. For instance, because many quality-of-life assessments associate paraplegia with lower quality of life, individuals with paraplegia are assigned lower priority for transplantable organs when those organs are distributed using QALY-based approaches. This consequence of using QALYs to set priorities has prompted a variety of responses. Some have argued that priorities should be set using life-years rather than QALYs. Others have argued that discriminating against people with disabilities is justified.
This paper provides a brief overview of issues to consider in evaluating patient benefit from health care. Different types of measures are described and it is noted that the choice of measure is dependent upon the purpose of the study. The cost-utility approach to evaluation is discussed in more detail. This approach is often criticised but it raises important issues in medical decision-making and has considerable potential in the evaluation of patient benefit from health care.
In this chapter, I show how the infamous Fact magazine episode of 1964 began. What motivated Ralph Ginzburg to publish his “survey” of psychiatrists and to create a psychological profile of Barry Goldwater? I reassess Ginzburg’s controversial but now almost forgotten career as a provocateur and alleged pornographer (a charge that conservative politicians made loosely, based on his conviction for distributing the highbrow Eros magazine). Ginzburg remained committed to free speech and journalistic freedom in an era when television, newspapers, and direct mail advertising were flourishing. But was the survey ethical? Was Goldwater mentally ill and a danger to the country, as Ginzburg and many psychiatrists claimed? I make use of rarely explored sources, including the transcript of the Goldwater v. Ginzburg libel case, Ralph Ginzburg’s papers, and an original interview with Fact managing editor Warren Boroson. In an era when the Supreme Court decision in New York Times v. Sullivan had dramatically loosened libel law and established a new standard for libel called “actual malice,” Ginzburg had every reason to believe he might prevail in the courts, and in the court of public opinion.
Patients with distributive shock who are unresponsive to traditional vasopressors are commonly considered to have severe distributive shock and are at high mortality risk. Here, we assess the cost-effectiveness of adding angiotensin II to the standard of care (SOC) for severe distributive shock in the US critical care setting from a US payer perspective.
Short-term mortality outcomes were based on 28-day survival rates from the ATHOS-3 study. Long-term outcomes were extrapolated to lifetime survival using individually estimated life expectancies for survivors. Resource use and adverse event costs were drawn from the published literature. Health outcomes evaluated were lives saved, life-years gained, and quality-adjusted life-years (QALYs) gained using utility estimates for the US adult population weighted for sepsis mortality. Deterministic and probabilistic sensitivity analyses assessed uncertainty around results. We analyzed patients with severe distributive shock from the ATHOS-3 clinical trial.
The addition of angiotensin II to the SOC saved .08 lives at Day 28 compared to SOC alone. The cost per life saved was estimated to be $108,884. The addition of angiotensin II to the SOC was projected to result in a gain of .96 life-years and .66 QALYs. This resulted in an incremental cost-effectiveness ratio of $12,843 per QALY. The probability of angiotensin II being cost-effective at a threshold of $50,000 per QALY was 86 percent.
For treatment of severe distributive shock, angiotensin II is cost-effective at acceptable thresholds.
The aim of this study was to evaluate long-term survival and risk factors associated with multidrug-resistant tuberculosis (MDR-TB) patient survival in Central China. Between December 2006 and June 2011, incident and retreatment adult MDR-TB patients were enrolled in the present study. Cox proportional hazard regression analysis was used to evaluate the risk factors affecting survival. The total follow-up period was 270 person-years (PY) for 356 MDR-TB cases in Wuhan. Of the 356 cases, 103 patients died, yielding an average case fatality rate of 381.2 per 1000 TB patients per year. Using adjusted Cox regression analysis, older age (adjusted hazard ratio (aHR) >3.0 starting from 30 years) and low education level (primary and middle school; aHR 1.67 (95% CI 1.01–2.77)) were independently associated with lower survival. Diabetes mellitus profoundly affected the survival of MDR-TB patients (aHR 1.95 (95% CI 1.30–2.93)). Our data demonstrate that coexistent diabetes significantly and negatively impacted MDR-TB patient survival. In addition, MDR-TB patients aged 60 years or older exhibited a greater risk of mortality during follow-up. Our findings emphasise that MDR-TB patients with comorbidities that increase their risk of death require additional medical interventions to reduce mortality.
The population surviving to old age in sub-Saharan Africa (SSA) is increasing rapidly in consonance with the rest of the world. Nevertheless, the sub-region offers unique challenges to survival across the lifespan. The determinants of health and ageing in SSA are thus likely different from those in higher income countries. The need to explore pressing epidemiological and health service challenges of older people living in SSA in the context of multiple social changes and rapid ageing of the population provided the rationale for the Ibadan Study of Ageing (ISA). This article appraises ISA findings in relation to late-life depression. It concludes that healthcare policies in SSA need to deliberately prioritise the treatment of depression and other mental health problems in late-life in order to stem the neglect of older people's mental health in the region.
The sixth chapter, “Gray Modernism,” argues that modernist experimentation with narrative form draws theoretical and disciplinary inspiration from the invention of gerontology and geriatrics as a science. During the twentieth century, aging becomes the subject of clinical interest, a temporal pathology detachable from the body it affects. Similarly, for modernist novels like Virginia Woolf’s Orlando, duration becomes separable from the highly charged aesthetic moments it contains. Though Orlando lives through many centuries, she does not grow old; instead, her greatest transformation occurs when her gender instantaneously switches from male to female. The novel creates a divide between the systems of duration and aging on the one hand, and the momentariness and constructedness of identity on the other. By breaking with the conventions that link duration and objective, shared time, Woolf situates aging in an ironic temporality that disrupts the forward press of years.
The demographic transition is a global event intensified during the last decades that represents population aging. Thus, the studies directed to the elderly 80 years of age or more with preserved cognitive functions (named SuperAgers) emerges as a possible path to full comprehension of the health of those aging with acceptable levels of functionality and independency.
To evaluate the cognitive performance of the elderly over 80 years old, associating the results to their educational level.
We evaluated 144 healthy elders with 80 years or more through the following cognitive tests Mini-Mental State Examination (MMSE), Cambridge Cognitive Examination (CAMCOG), Clock Drawing Test (CDT), and Verbal Fluency Test (VF) and compared the tests’ scores with their educational level segmented in years of formal education, being the groups ILLITR (<1 year of schooling), 1TO4 (from 1 to 4 years of schooling), and 5MORE (>5 years of schooling).
There was positive influence of educational level on the cognitive tests’ score, which indicates higher cognitive reserve of the elderly with higher educational levels.
The functionality and independence of the so-called SuperAgers is determined by the cognitive reserve acquired throughout life, mainly developed by the years of formal education.
The aim of this network meta-analysis is to compare bone mineral density (BMD) changes among different osteoporosis prevention interventions in postmenopausal women. We searched MEDLINE, Embase and Cochrane Library from inception to 24 February 2019. Included studies were randomised controlled trials (RCT) comparing the effects of different treatments on BMD in postmenopausal women. Studies were independently screened by six authors in three pairs. Data were extracted independently by two authors and synthesised using Bayesian random-effects network meta-analysis. The results were summarised as mean difference in BMD and surface under the cumulative ranking (SUCRA) of different interventions. A total of ninety RCT (10 777 participants) were included. Ca, vitamin D, vitamin K, oestrogen, exercise, Ca + vitamin D, vitamin D + vitamin K and vitamin D + oestrogen were associated with significantly beneficial effects relative to no treatment or placebo for lumbar spine (LS). For femoral neck (FN), Ca, exercise and vitamin D + oestrogen were associated with significantly beneficial intervention effects relative to no treatment. Ranking probabilities indicated that oestrogen + vitamin D is the best strategy in LS, with a SUCRA of 97·29 % (mean difference: +0·072 g/cm2 compared with no treatment, 95 % credible interval (CrI) 0·045, 0·100 g/cm2), and Ca + exercise is the best strategy in FN, with a SUCRA of 79·71 % (mean difference: +0·029 g/cm2 compared with placebo, 95 % CrI –0·00093, 0·060 g/cm2). In conclusion, in postmenopausal women, many interventions are valuable for improving BMD in LS and FN. Different intervention combinations can affect BMD at different sites diversely.
Sally Bayley traces Plath’s emerging relationship to her journal persona and creed. Bayley focuses on the intense period of Plath’s late teenage years and early adulthood, including the beginnings of university education. She also reveals the importance of the diarists Plath read to Plath’s own journal activities and larger poetic practices. Of special importance is Virginia Woolf, and Bayley helps us to see afresh Plath’s off-quoted exhilaration at Woolf’s reference to cooking haddock and sausages, which says more about Plath herself than it does the subject of her comments. Bayley shows us how Plath’s ideas about the ‘melting’, emerging self, move from the journals and into poems such as ‘Ariel’ and ‘Lady Lazarus’.
Chapter 1 illuminates the inherent weaknesses of the French colonial empire on the eve of the Seven Years War and examines initial efforts to embark on imperial reform during peace negotiations between France and Britain. The chapter uses the correspondence of Jean-Antoine Riqueti de Mirabeau, governor of Guadeloupe in the Îles du Vent between 1753 and 1755, to shed light on the problems of the French Caribbean plantation complex and to show how Mirabeau’s experiences influenced the intellectual vision of his older brother, Victor Riqueti de Mirabeau, who co-founded Physiocracy together with François Quesnay. From here, the chapter analyses war-time discussions on the future of the French colonies within the Ministries of the Marine and of Foreign Affairs. While these discussions culminated in the well-known strategy to enhance the French Caribbean plantation complex, the chapter reveals that government officials were also contemplating alternative paths to empire rooted in a vision of mutual prosperity between the metropole and the colonies and a reorientation of colonial empire from the Americas to West Africa.
Memory of the period of political violence known as the anni di piombo continues to form part of the neofascist-antifascist antagonism in contemporary Italy. One of the most notable tragedies from that time occurred in Rome on 16 April 1973, when Stefano and Virgilio Mattei (sons of a local leader of the Movimento Sociale Italiano, MSI) died in an arson attack on the family home. In the wake of the attack, a campaign of misinformation and a failed judicial process created an incorrect but dominant narrative that implicated the MSI in the fire that killed Stefano and Virgilio. This article examines the subsequent construction of a counter-memory by the MSI leadership, who immediately cast the attack as a party tragedy and the deaths as martyrdom. It also considers the subsequent antagonistic approach to remembering adopted by neofascist groups in commemoration of the Mattei brothers following the dissolution of the MSI in 1995, and the ongoing incorporation of the brothers’ memory into fascist martyrology dating back to Mussolini's regime.