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Existing internet-based prevention and treatment programmes for binge eating are composed of multiple distinct modules that are designed to target a broad range of risk or maintaining factors. Such multi-modular programmes (1) may be unnecessarily long for those who do not require a full course of intervention and (2) make it difficult to distinguish those techniques that are effective from those that are redundant. Since dietary restraint is a well-replicated risk and maintaining factor for binge eating, we developed an internet- and app-based intervention composed solely of cognitive-behavioural techniques designed to modify dietary restraint as a mechanism to target binge eating. We tested the efficacy of this combined selective and indicated prevention programme in 403 participants, most of whom were highly symptomatic (90% reported binge eating once per week).
Participants were randomly assigned to the internet intervention (n = 201) or an informational control group (n = 202). The primary outcome was objective binge-eating frequency. Secondary outcomes were indices of dietary restraint, shape, weight, and eating concerns, subjective binge eating, disinhibition, and psychological distress. Analyses were intention-to-treat.
Intervention participants reported greater reductions in objective binge-eating episodes compared to the control group at post-test (small effect size). Significant effects were also observed on each of the secondary outcomes (small to large effect sizes). Improvements were sustained at 8 week follow-up.
Highly focused digital interventions that target one central risk/maintaining factor may be sufficient to induce meaningful change in core eating disorder symptoms.
Tracheal intubation and mechanical ventilation provide essential support for patients with respiratory failure, but the course of mechanical ventilation may be complicated by adverse ventilator-associated events (VAEs), which may or may not be associated with infection. We sought to understand how the frequency of subglottic suction, an indicator of the quantity of sputum produced by ventilated patients, relates to the onset of all VAEs and infection-associated VAEs.
We performed a case-crossover study including 87 patients with VAEs, and we evaluated 848 days in the pre-VAE period at risk for a VAE.
Setting and participants:
Critically ill patients were recruited from the medical intensive care unit of an academic medical center.
We used the number of as-needed subglottic suctioning events performed per calendar day to quantify sputum production, and we compared the immediate pre-VAE period to the preceding period. We used CDC surveillance definitions for VAE and to categorize whether events were infection associated or not.
Sputum quantity measured by subglottic suction frequency is greater in the period immediately prior to VAE than in the preceding period. However, it does not discriminate well between infection-associated VAEs and VAEs without associated infection.
Subglottic suction frequency may serve as a valuable marker of sputum quantity, and it is associated with risk of a VAE. However, our results require validation in a broader population of mechanically ventilated patients and intensive care settings.
Betavoltaics (BV) cells (or nuclear batteries) have long-lasting power and high volumetric energy densities that open a broad range of applications that are not currently available, especially in low-power electronics for the internet-of-things, internal medical devices, and harsh environments. The introduction of very low-power electronics has opened up a market for the wide and accepted use of BV cells. As BVs have potentially decades-long useful lifetimes and are anticipated to be used in harsh environments, a method to describe accelerated contact aging has been developed. Monte Carlo radiation simulations show that energy can be deposited in the interface 10-50 times faster than real-world applications. The models can be used to design contact aging experiments for BV cell deployments.
Creutzfeldt-Jakob disease (CJD) is a fatal neurological illness for which accurate diagnosis is paramount. Real-time quaking-induced conversion (RT-QuIC) is a prion-specific assay with high sensitivity and specificity for CJD. The Canadian endpoint quaking-induced conversion (EP-QuIC) test is similar, but unlike RT-QuIC there is little data regarding its diagnostic utility in clinical practice. In this exploratory predictive value analysis of EP-QuIC in CJD, the negative predictive value (NPV) and positive predictive value (PPV) was 100% and 83%, respectively, with one false-positive result identified. Re-testing this sample with an optimized EP-QuIC protocol eliminated this false-positive result, leading to a PPV of 100%.
Adults with congenital heart disease face psychological challenges although an understanding of depression vs. anxiety symptoms is unclear. We analyzed the prevalence of elevated symptoms of anxiety and depression and explored associations with demographic and medical factors as well as quality of life.
Adults with congenital heart disease enrolled from an outpatient clinic completed the Hospital Anxiety and Depression Scale and two measures of quality of life: the Linear Analogue Scale and the Satisfaction with Life Scale. Medical data were obtained by chart review.
Of 130 patients (median age = 32 years; 55% female), 55 (42%) had elevated anxiety symptoms and 16 (12%) had elevated depression symptoms on subscales of the Hospital Anxiety and Depression Scale. Most patients with elevated depression symptoms also had elevated anxiety symptoms (15/16; 94%). Of 56 patients with at least one elevated subscale, 37 (66%) were not receiving mental health treatment. Compared to patients with 0 or 1 elevated subscales, patients with elevations in both (n=15) were less likely to be studying or working (47% vs. 81%; p=0.016) and reported lower scores on the Linear Analogue Scale (60 vs. 81, p<0.001) and the Satisfaction with Life Scale (14 vs. 28, p<0.001).
Among adults with congenital heart disease, elevated anxiety symptoms are common and typically accompany elevated depressive symptoms. The combination is associated with unemployment and lower quality of life. Improved strategies to provide psychosocial care and support appropriate engagement in employment are required.
Given over to Death by Sin; rescued from Death by Love: these are the complementary polarities of Britten's Donne settings.
The Holy Sonnets of John Donne is a cycle of nine songs composed between 2 and 19 August 1945. Although Britten composed the songs quickly, he had apparently been contemplating setting the Holy Sonnets for some time. Peter Pears first mentions reading the poems with him in February 1943; he raised the possibility of Britten setting them in August 1944. The songs were written immediately after Britten returned from a concert tour of Nazi concentration camps with Yehudi Menuhin. Britten deliberately chose to put himself in the way of this experience, which was evidently likely to be traumatic: he replaced the pianist originally engaged for the tour at his own request. For obvious reasons of sexuality and ethnicity, he must have reflected that, in other circumstances, he and Menuhin might both have been in the camps. After Britten's death, Pears reported how shocking the experience had been to Britten, and that it coloured everything he wrote subsequently.
Listening for the colouration of that experience in the music Britten wrote immediately, we might hear it as sympathy with the victims and horror of the wickedness of those who inflict suffering, repudiated as alien to oneself. Or we might hear it as a new and shocking sense of the possibilities of wickedness that bears on who oneself might be, unknown to oneself and in other circumstances. Insofar as we hear Britten's experience of the camps in these songs, Donne's poems, largely concerned with the poet's own sinful nature and the need for penitence, are more congruent with the second reflection. So too is the exclamation Britten placed at the opening as a keynote for the sequence: ‘Oh my blacke Soule!’. Both Britten and Pears described the subject of the cycle as death, Britten connecting this with his experience of the camps. Clearly death is a subject. Even more important in the cycle overall – as suggested by the cover illustration of the first publication, El Greco's ‘Saint Peter Penitent’ – is this general effect of sin: separating the sinner from God. Complementary to this, given a central position in the cycle by the placing and treatment of a sonnet on the death of Donne's wife, Anne, is the effect of love: bringing the sinner to God.
The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species’ recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.
Gurga Chiya and Tepe Marani are small, adjacent mounds located close to the town of Halabja in the southern part of the Shahrizor Plain, one of the most fertile regions of Iraqi Kurdistan. Survey and excavation at these previously unexplored sites is beginning to produce evidence for human settlement spanning the sixth to the fourth millennia, c. 5600–3300 cal. b.c. In Mesopotamian chronology this corresponds to the Late Neolithic through to Chalcolithic periods; the Halaf, Ubaid, and Uruk phases of conventional culture history. In Iraqi Kurdistan, documentation of these periods—which witnessed many important transformations in prehistoric village life—is currently very thin. Here we offer a preliminary report on the emerging results from the Shahrizor Plain, with a particular focus on the description of material culture (ceramic and lithic assemblages), in order to establish a benchmark for further research. We also provide a detailed report on botanical remains and accompanying radiocarbon dates, which allow us to place this new evidence in a wider comparative framework. A further, brief account is given of Late Bronze Age material culture from the upper layers at Gurga Chiya. We conclude with observations on the significance of the Shahrizor Plain for wider research into the later prehistory of the Middle East, and the importance of preserving and investigating its archaeological record.
In the 1970s, Feldman and Moore classified separably acting von Neumann algebras containing Cartan maximal abelian self-adjoint subalgebras (MASAs) using measured equivalence relations and 2-cocycles on such equivalence relations. In this paper we give a new classification in terms of extensions of inverse semigroups. Our approach is more algebraic in character and less point-based than that of Feldman and Moore. As an application, we give a restatement of the spectral theorem for bimodules in terms of subsets of inverse semigroups. We also show how our viewpoint leads naturally to a description of maximal subdiagonal algebras.
De la musique avant toute chose [music above everything]
(Paul Verlaine, ‘Art Poétique’)
Beethoven, Wagner, Stravinsky: these are the composers most obviously in, behind and around T. S. Eliot's poetry. Beethoven, the apogee of Classicism; Wagner, the epitome, zenith and in embryo the decadence of Romanticism; Stravinsky, a Proteus of modernism, myth-and-motors, pastiche, jazz and neoclassicism: Beethoven, behind Four Quartets ; Wagner, in The Waste Land ; Stravinsky, a contemporary with whom Eliot was in dialogue. Together they are an index of Classical and Romantic legacies in modernist eclecticism. But music is more to Eliot than three composers, however broadly representative. The Wagnerian backgrounds of French Symbolism mean that music is fundamental to Eliot's aesthetics. And although he had no technical training, music was the art that personally affected Eliot most deeply.
Stravinsky commented on their connection from his own point of view:
Were Eliot and myself merely trying to refit old ships while the other side – Joyce, Schoenberg – sought new forms of travel? I believe that this distinction, much traded on a generation ago, has disappeared. (An era is shaped only by hindsight, of course, and hindsight reduces to convenient unities, but all artists know that they are part of the same thing.) Of course we seemed, Eliot and myself, to have exploited an apparent discontinuity, to have made art out of the disjecta membra, the quotations from other poets and composers, the references to earlier styles (‘hints of earlier and other creation’), the detritus that betokened a wreck. But we used it, and anything that came to hand, to rebuild, and we did not pretend to have invented new conveyors or new means of travel. […]
Twenty-four isolates of Aspergillus sojae, A. parasiticus, A. oryzae and A. flavus, including a number that have the capacity to produce aflatoxin, have been compared using amplified fragment length polymorphisms (AFLPs). Based on analysis of 12 different primer combinations, 500 potentially polymorphic fragments have been identified. Analysis of the AFLP data consistently and clearly separates the A. sojae/A. parasiticus isolates from the A. oryzae/A. flavus isolates. Furthermore, there are markers that can be used to distinguish the A. sojae isolates from those of A. parasiticus, which form the basis for species-specific markers. However, whilst there were many polymorphisms between isolates within the A. oryzae/A. flavus subgroup, no markers could be identified that distinguish between the two species. Sequencing of the ribosomal DNA ITS (internal transcribed spacers) from selected isolates also separated the A. sojae/A. parasiticus subgroup from the A. oryzae/A. flavus subgroup, but was unable to distinguish between the A. sojae and A. parasiticus isolates. Some ITS variation was found between isolates within the A. oryzae/A. flavus subgroup, but did not correlate with the species classification, indicating that it is difficult to use molecular data to separate the two species. In addition, sequencing of ribosomal ITS regions and AFLP analysis suggested that some species annotations in public culture collections may be inaccurate.
Objective: This study compared medical history and findings on initial clinical examination in Native Americans diagnosed with possible or probable Alzheimer's disease (AD) at Native American satellite clinics of the University of Texas (UT) Southwestern Medical Center's Alzheimer's Disease Center with those of Whites diagnosed with probable AD at the UT Southwestern Medical Center's Alzheimer's Disease Clinic. Methods: The information reviewed was contained in the database of the UT Southwestern Alzheimer's Disease Center. Results: In relation to Whites, Native Americans had slightly but significantly greater age at onset of symptoms (71.7 vs. 69.6 years, t = −2.08, p = .04) and equivalent cognitive scores at evaluation (Mini-Mental State Exam score = 17.4 vs. 18.5, t = 0.98, p = .33), despite significantly lower educational level (11.4 vs. 13.4 years, t = 5.63, p < .001). Native Americans were more frequently depressed on examination (22.8% vs. 9.5%, χ2 = 12, p = .001) and reported diabetes, hypertension, and heart disease significantly more often than did Whites (p < .01 for all), but their survival time after AD diagnosis was similar to that of Whites despite these comorbidities. Conclusions: With the exception of a greater prevalence of depression and cardiovascular risk factors in Native Americans than in Whites, Native Americans had a course of illness similar to that of Whites.
The present experiment was designed to elucidate the mechanism of the methionine-sparing effect of excess branched-chain amino acids (BCAA) reported in the previous paper (Langer & Fuller, 2000). Twelve growing gilts (30–35 kg) were prepared with arterial catheters. After recovery, they received for 7 d a semipurified diet with a balanced amino acid pattern. On the 7th day blood samples were taken before (16 h postabsorptive) and after the morning meal (4 h postprandial). The animals were then divided into three groups and received for a further 7 d a methionine-limiting diet (80 % of requirement) (1) without any amino acid excess; (2) with excess leucine (50 % over requirement); or (3) with excesses of all three BCAA (leucine, isoleucine, valine, each 50 % over the requirement). On the 7th day blood samples were taken as in the first period, after which the animals were killed and liver and muscle samples taken. Plasma amino acid and branched-chain keto acid (BCKA) concentrations in the blood and branched-chain keto-acid dehydrogenase (BCKDH; EC 18.104.22.168) activity in liver and muscle homogenates were determined. Compared with those on the balanced diet, pigs fed on methionine-limiting diets had significantly lower (P < 0·05) plasma methionine concentrations in the postprandial but not in the postabsorptive state. There was no effect of either leucine or a mixture of all three BCAA fed in excess on plasma methionine concentrations. Excess dietary leucine reduced (P < 0·05) the plasma concentrations of isoleucine and valine in both the postprandial and postabsorptive states. Plasma concentrations of the BCKA reflected the changes in the corresponding amino acids. Basal BCKDH activity in the liver and total BCKDH activity in the biceps femoris muscle were significantly (P < 0·05) increased by excesses of leucine or all BCAA.
Four rats were housed in cages with mesh floors; another four rats were housed in tubular anti-coprophagy cages, in which they could not turn round to reach their own faeces. Both groups were fed for 6 d on a low-protein diet containing fermentable carbohydrates and 15NH4Cl. At the end of the experiment the rats were killed and their carcasses were homogenized, lysine was isolated by ion-exchange chromatography and its 15N enrichment measured by isotope-ratio mass spectrometry. The 15N enrichment in the lysine of the microbial fraction of faeces and the total amount of lysine in the body were also determined in order to estimate the amount of microbial lysine absorbed. The 15N enrichment in body lysine of non-coprophagic rats was not different from that previously measured in rats given unlabelled NH4Cl, but in coprophagic rats it was significantly higher. The daily absorption of microbial lysine by the coprophagic rats accounted for 20·7 (SE 2·55) mg/kg body weight0·75 but was only 0·5 (SE 1·04) mg/kg body weight0·75 for the non-coprophagic rats. This value was not significantly different from zero. The utilization of microbial amino acids via coprophagy resulted in a higher weight gain (adjusted for intake) in the coprophagic group (15·5 g/6 d) than in the non-coprophagic rats (3·1 g/6 d). It was concluded that, in rats, the utilization of microbial lysine occurred exclusively via coprophagy.
The absorption of lysine synthesised by the gastrointestinal microflora was estimated by comparing the15N incorporated into body lysine in four germ-free (15N-GF) and four conventional (15N-CV) rats. They were fed for 10d on a protein-free diet containing fermentable carbohydrates and 15NHM4Cl; another four conventional rats (control), fed on the same diet but with unlabelled NH4Cl, were used to estimate the natural abundance of 15N. The eviscerated carcass of each rat was homogenized and a sample hydrolysed. Lysine was isolated by ion-exchange chromatography and its 15N enrichment was measured by isotope-ratio mass spectrometry. The 15N-CV rats significantly incorporated 15N into their body lysine. The 15N-GF rats had a statistically significant, although small, incorporation of 15body lysine, probably arising from a measurement artifact. It was concluded, therefore, that all [15N]lysine was of microbial origin. The total lysine content in the body and the 15N enrichment of lysine in the microbial fraction of the faeces of the 15N-CV rats were also determined. The amount of microbial lysine absorbed by the 15N-CV rats was estimated by dividing the total amount of [15N]lysine in the body by the enrichment of microbial lysine. It was estimated that the daily absorption of microbial lysine by the conventional rats was 21·3 (SE 2·04) mg/kg body weight0·75
The existing models for the “classical” Portevin-Le-Chatelier effect have been analyzed, and the non-linear dynamical model has been proposed in order to quantify the nature of temporal instabilities in fatigued metallic alloys. The model employs the concept of a positive feed-back among the populations of mobile, immobile and Cottrell-type dislocations with atmospheres of point defects. Three major types of loading have been numerically simulated: pure sinusoidal, creep fatigue (“the Lorenzo-Laird bursts”) and ramp loading (“the Neumann bursts”, when the amplitude of otherwise cyclic loading grows linearly with time). Computer movies of the temporal evolution of stress and dislocation densities have been prepared as an aide for analysis and illustration. The model successfully reproduces stress serrations in terms of the underlying dislocation mechanisms and thus for the first time establishes a fundamental link between the micro-and macromechanics of cyclic deformation.