24 results
A five-year quasi-experimental study to evaluate the impact of empiric antibiotic order sets on antibiotic use metrics among hospitalized adult patients
- Wesley D. Kufel, Jeffrey M. Steele, Rahul Mahapatra, Mitchell V. Brodey, Dongliang Wang, Kristopher M. Paolino, Paul Suits, Derek W. Empey, Stephen J. Thomas
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 45 / Issue 5 / May 2024
- Published online by Cambridge University Press:
- 25 January 2024, pp. 609-617
- Print publication:
- May 2024
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Objective:
Evaluation of adult antibiotic order sets (AOSs) on antibiotic stewardship metrics has been limited. The primary outcome was to evaluate the standardized antimicrobial administration ratio (SAAR). Secondary outcomes included antibiotic days of therapy (DOT) per 1,000 patient days (PD); selected antibiotic use; AOS utilization; Clostridioides difficile infection (CDI) cases; and clinicians’ perceptions of the AOS via a survey following the final study phase.
Design:This 5-year, single-center, quasi-experimental study comprised 5 phases from 2017 to 2022 over 10-month periods between August 1 and May 31.
Setting:The study was conducted in a 752-bed tertiary care, academic medical center.
Intervention:Our institution implemented AOSs in the electronic medical record (EMR) for common infections among hospitalized adults.
Results:For the primary outcome, a statistically significant decreases in SAAR were detected from phase 1 to phase 5 (1.0 vs 0.90; P < .001). A statistically significant decreases were detected in DOT per 1,000 PD (4,884 vs 3,939; P = .001), fluoroquinolone orders (407 vs 175; P < .001), carbapenem orders (147 vs 106; P = .024), and clindamycin orders (113 vs 73; P = .01). No statistically significant change in mean vancomycin orders was detected (991 vs 902; P = .221). A statistically significant decrease in CDI cases was also detected (7.8, vs 2.4; P = .002) but may have been attributable to changes in CDI case diagnosis. Clinicians indicated that the AOSs were easy to use overall and that they helped them select the appropriate antibiotics.
Conclusions:Implementing AOS into the EMR was associated with a statistically significant reduction in SAAR, antibiotic DOT per 1,000 PD, selected antibiotic orders, and CDI cases.
Clarifying status of DNNs as models of human vision
- Jeffrey S. Bowers, Gaurav Malhotra, Marin Dujmović, Milton L. Montero, Christian Tsvetkov, Valerio Biscione, Guillermo Puebla, Federico Adolfi, John E. Hummel, Rachel F. Heaton, Benjamin D. Evans, Jeffrey Mitchell, Ryan Blything
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- Journal:
- Behavioral and Brain Sciences / Volume 46 / 2023
- Published online by Cambridge University Press:
- 06 December 2023, e415
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On several key issues we agree with the commentators. Perhaps most importantly, everyone seems to agree that psychology has an important role to play in building better models of human vision, and (most) everyone agrees (including us) that deep neural networks (DNNs) will play an important role in modelling human vision going forward. But there are also disagreements about what models are for, how DNN–human correspondences should be evaluated, the value of alternative modelling approaches, and impact of marketing hype in the literature. In our view, these latter issues are contributing to many unjustified claims regarding DNN–human correspondences in vision and other domains of cognition. We explore all these issues in this response.
Advocacy at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery
- Bistra Zheleva, Amy Verstappen, David M. Overman, Farhan Ahmad, Sulafa K.M. Ali, Zohair Y. Al Halees, Joumana Ghandour Atallah, Isabella E. Badhwar, Carissa Baker-Smith, Maria Balestrini, Amy Basken, Jonah S. Bassuk, Lee Benson, Horacio Capelli, Santo Carollo, Devyani Chowdhury, M. Sertaç Çiçek, Mitchell I. Cohen, David S. Cooper, John E. Deanfield, Joseph Dearani, Blanca del Valle, Kathryn M. Dodds, Junbao Du, Frank Edwin, Ekanem Ekure, Nurun Nahar Fatema, Anu Gomanju, Babar Hasan, Lewis Henry, Christopher Hugo-Hamman, Krishna S. Iyer, Marcelo B. Jatene, Kathy J. Jenkins, Tara Karamlou, Tom R. Karl, James K. Kirklin, Christián Kreutzer, Raman Krishna Kumar, Keila N. Lopez, Alexis Palacios Macedo, Bradley S. Marino, Eva M. Marwali, Folkert J. Meijboom, Sandra S. Mattos, Hani Najm, Dan Newlin, William M. Novick, Sir Shakeel A. Qureshi, Budi Rahmat, Robert Raylman, Irfan Levent Saltik, Craig Sable, Nestor Sandoval, Anita Saxena, Emma Scanlan, Gary F. Sholler, Jodi Smith, James D. St Louis, Christo I. Tchervenkov, Koh Ghee Tiong, Vladimiro Vida, Susan Vosloo, Douglas J. “DJ” Weinstein, James L. Wilkinson, Liesl Zuhlke, Jeffrey P. Jacobs
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- Journal:
- Cardiology in the Young / Volume 33 / Issue 8 / August 2023
- Published online by Cambridge University Press:
- 24 August 2023, pp. 1277-1287
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The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
Deep problems with neural network models of human vision
- Jeffrey S. Bowers, Gaurav Malhotra, Marin Dujmović, Milton Llera Montero, Christian Tsvetkov, Valerio Biscione, Guillermo Puebla, Federico Adolfi, John E. Hummel, Rachel F. Heaton, Benjamin D. Evans, Jeffrey Mitchell, Ryan Blything
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- Behavioral and Brain Sciences / Volume 46 / 2023
- Published online by Cambridge University Press:
- 01 December 2022, e385
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Deep neural networks (DNNs) have had extraordinary successes in classifying photographic images of objects and are often described as the best models of biological vision. This conclusion is largely based on three sets of findings: (1) DNNs are more accurate than any other model in classifying images taken from various datasets, (2) DNNs do the best job in predicting the pattern of human errors in classifying objects taken from various behavioral datasets, and (3) DNNs do the best job in predicting brain signals in response to images taken from various brain datasets (e.g., single cell responses or fMRI data). However, these behavioral and brain datasets do not test hypotheses regarding what features are contributing to good predictions and we show that the predictions may be mediated by DNNs that share little overlap with biological vision. More problematically, we show that DNNs account for almost no results from psychological research. This contradicts the common claim that DNNs are good, let alone the best, models of human object recognition. We argue that theorists interested in developing biologically plausible models of human vision need to direct their attention to explaining psychological findings. More generally, theorists need to build models that explain the results of experiments that manipulate independent variables designed to test hypotheses rather than compete on making the best predictions. We conclude by briefly summarizing various promising modeling approaches that focus on psychological data.
Derivation and validation of risk prediction for posttraumatic stress symptoms following trauma exposure
- Raphael Kim, Tina Lin, Gehao Pang, Yufeng Liu, Andrew S. Tungate, Phyllis L. Hendry, Michael C. Kurz, David A. Peak, Jeffrey Jones, Niels K. Rathlev, Robert A. Swor, Robert Domeier, Marc-Anthony Velilla, Christopher Lewandowski, Elizabeth Datner, Claire Pearson, David Lee, Patricia M. Mitchell, Samuel A. McLean, Sarah D. Linnstaedt
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- Psychological Medicine / Volume 53 / Issue 11 / August 2023
- Published online by Cambridge University Press:
- 01 July 2022, pp. 4952-4961
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Background
Posttraumatic stress symptoms (PTSS) are common following traumatic stress exposure (TSE). Identification of individuals with PTSS risk in the early aftermath of TSE is important to enable targeted administration of preventive interventions. In this study, we used baseline survey data from two prospective cohort studies to identify the most influential predictors of substantial PTSS.
MethodsSelf-identifying black and white American women and men (n = 1546) presenting to one of 16 emergency departments (EDs) within 24 h of motor vehicle collision (MVC) TSE were enrolled. Individuals with substantial PTSS (⩾33, Impact of Events Scale – Revised) 6 months after MVC were identified via follow-up questionnaire. Sociodemographic, pain, general health, event, and psychological/cognitive characteristics were collected in the ED and used in prediction modeling. Ensemble learning methods and Monte Carlo cross-validation were used for feature selection and to determine prediction accuracy. External validation was performed on a hold-out sample (30% of total sample).
ResultsTwenty-five percent (n = 394) of individuals reported PTSS 6 months following MVC. Regularized linear regression was the top performing learning method. The top 30 factors together showed good reliability in predicting PTSS in the external sample (Area under the curve = 0.79 ± 0.002). Top predictors included acute pain severity, recovery expectations, socioeconomic status, self-reported race, and psychological symptoms.
ConclusionsThese analyses add to a growing literature indicating that influential predictors of PTSS can be identified and risk for future PTSS estimated from characteristics easily available/assessable at the time of ED presentation following TSE.
Satellite patches, patch expansion, and doubling time as decision metrics for invasion control: Pennisetum ciliare expansion in southwestern Arizona
- Jaron D. Weston, Mitchel P. McClaran, Richard K. Whittle, Christian W. Black, Jeffrey S. Fehmi
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- Invasive Plant Science and Management / Volume 12 / Issue 1 / March 2019
- Published online by Cambridge University Press:
- 01 May 2019, pp. 36-42
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Essential variables to consider for an efficient control strategy for invasive plants include dispersion pattern (i.e., satellite or invasion front) and patch expansion rate. These variables were demonstrated for buffelgrass [Pennisetum ciliare (L.) Link], a C4 perennial grass introduced from Africa, which has invaded broadly around the world. The study site was along a roadway in southern Arizona (USA). The P. ciliare plant distributions show the pattern of clumping associated with the satellite (nascent foci) colonization pattern (average nearest neighbor test, z-score −47.2, P<0.01). The distance between patches ranged from 0.743 to 12.8 km, with an average distance between patches of 5.6 km. Median patch expansion rate was 271% over the 3-yr monitoring period versus 136% found in other studies of established P. ciliare patches. Targeting P. ciliare satellite patches as a control strategy may exponentially reduce the areal doubling time, while targeting the largest patches may have less effect on the invasion speed.
The 2017 Seventh World Congress of Paediatric Cardiology and Cardiac Surgery: “The Olympics of our Profession”
- Part of
- Mitchell I. Cohen, Jeffrey P. Jacobs, Sertac Cicek
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- Journal:
- Cardiology in the Young / Volume 27 / Issue 10 / December 2017
- Published online by Cambridge University Press:
- 29 December 2017, pp. 1865-1869
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The 1st World Congress of Paediatric Cardiology was held in London, United Kingdom, in 1980, organised by Dr Jane Somerville and Prof. Fergus Macartney. The idea was that of Jane Somerville, who worked with enormous energy and enthusiasm to bring together paediatric cardiologists and surgeons from around the world. The 2nd World Congress of Paediatric Cardiology took place in New York in 1985, organised by Bill Rashkind, Mary Ellen Engle, and Eugene Doyle. The 3rd World Congress of Paediatric Cardiology was held in Bangkok, Thailand, in 1989, organised by Chompol Vongraprateep. Although cardiac surgeons were heavily involved in these early meetings, a separate World Congress of Paediatric Cardiac Surgery was held in Bergamo, Italy, in 1988, organised by Lucio Parenzan. Thereafter, it was recognised that surgeons and cardiologists working on the same problems and driven by a desire to help children would really rather meet together. A momentous decision was taken to initiate a Joint World Congress of Paediatric Cardiology and Cardiac Surgery. A steering committee was established with membership comprising the main organisers of the four separate previous Congresses and additional members were recruited in an effort to achieve numerical equality of cardiologists and surgeons and a broad geographical representation. The historic 1st “World Congress of Paediatric Cardiology and Cardiac Surgery” took place in Paris in June, 1993, organised by Jean Kachaner. The next was to be held in Japan, but the catastrophic Kobe earthquake in 1995 forced relocation to Hawaii in 1997. Then followed Toronto, Canada, 2001, organised by Bill Williams and Lee Benson; Buenos Aires, Argentina, 2005, organised by Horatio Capelli and Guillermo Kreutzer; Cairns, Australia, 2009, organised by Jim Wilkinson; Cape Town, South Africa, 2013, organised by Christopher Hugo-Hamman; and Barcelona, Spain, 2017, organised by Sertac Cicek. With stops in Europe (1993), Asia-Pacific (1997), North America (2001), South America (2005), Australia (2009), Africa (2013), and Europe again (2017), in 2021, The World Congress of Paediatric Cardiology and Cardiac Surgery will be held for the first time in the continental United States.1 The 8th World Congress of Paediatric Cardiology and Cardiac Surgery will be held in Washington DC, United States of America, 19–24 September, 2021, and will be organised by Jeffrey P. Jacobs and Gil Wernovsky. Mitchell I. Cohen served as the Scientific Program Co-Chair for the 2017 World Congress of Paediatric Cardiology and Cardiac Surgery, and he will again serve as the Scientific Program Co-Chair for the 2021 World Congress of Paediatric Cardiology and Cardiac Surgery along with Kathyrn Dodds RN, MSN, CRNP. Information about the upcoming 8th World Congress of Paediatric Cardiology and Cardiac Surgery can be found at www.WCPCCS2021.org
Ice stratigraphy at the Pâkitsoq ice margin, West Greenland, derived from gas records
- Hinrich Schaefer, Vasilii V. Petrenko, Edward J. Brook, Jeffrey P. Severinghaus, Niels Reeh, Joe R. Melton, Logan Mitchell
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- Journal:
- Journal of Glaciology / Volume 55 / Issue 191 / 2009
- Published online by Cambridge University Press:
- 08 September 2017, pp. 411-421
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Horizontal ice-core sites, where ancient ice is exposed at the glacier surface, offer unique opportunities for paleo-studies of trace components requiring large sample volumes. Following previous work at the Pâkitsoq ice margin in West Greenland, we use a combination of geochemical parameters measured in the ice matrix (δ18Oice) and air occlusions (δ18Oatm, δ15N of N2 and methane concentration) to date ice layers from specific climatic intervals. The data presented here expand our understanding of the stratigraphy and three-dimensional structure of ice layers outcropping at Pâkitsoq. Sections containing ice from every distinct climatic interval during Termination I, including Last Glacial Maximum, Bølling/Allerød, Younger Dryas and the early Holocene, are identified. In the early Holocene, we find evidence for climatic fluctuations similar to signals found in deep ice cores from Greenland. A second glacial–interglacial transition exposed at the extreme margin of the ice is identified as another outcrop of Termination I (rather than the onset of the Eemian interglacial as postulated in earlier work). Consequently, the main structural feature at Pâkitsoq is a large-scale anticline with accordion-type folding in both exposed sequences of the glacial–Holocene transition, leading to multiple layer duplications and age reversals.
Summary of the Snowmastodon Project Special Volume A high-elevation, multi-proxy biotic and environmental record of MIS 6–4 from the Ziegler Reservoir fossil site, Snowmass Village, Colorado, USA
- Ian M. Miller, Jeffrey S. Pigati, R. Scott Anderson, Kirk R. Johnson, Shannon A. Mahan, Thomas A. Ager, Richard G. Baker, Maarten Blaauw, Jordon Bright, Peter M. Brown, Bruce Bryant, Zachary T. Calamari, Paul E. Carrara, Michael D. Cherney, John R. Demboski, Scott A. Elias, Daniel C. Fisher, Harrison J. Gray, Danielle R. Haskett, Jeffrey S. Honke, Stephen T. Jackson, Gonzalo Jiménez-Moreno, Douglas Kline, Eric M. Leonard, Nathaniel A. Lifton, Carol Lucking, H. Gregory McDonald, Dane M. Miller, Daniel R. Muhs, Stephen E. Nash, Cody Newton, James B. Paces, Lesley Petrie, Mitchell A. Plummer, David F. Porinchu, Adam N. Rountrey, Eric Scott, Joseph J.W. Sertich, Saxon E. Sharpe, Gary L. Skipp, Laura E. Strickland, Richard K. Stucky, Robert S. Thompson, Jim Wilson
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- Quaternary Research / Volume 82 / Issue 3 / November 2014
- Published online by Cambridge University Press:
- 20 January 2017, pp. 618-634
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In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean–atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010–2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between ~140 and 55 ka, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5.
Retirement Policies and Support for Emergency Service Personnel: The Transition to Retirement
- Mairéad Bracken-Scally, Sinéad McGilloway, Jeffrey T. Mitchell
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- Journal:
- Canadian Journal on Aging / La Revue canadienne du vieillissement / Volume 35 / Issue 2 / June 2016
- Published online by Cambridge University Press:
- 26 April 2016, pp. 161-174
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The aim of this study was to explore policies and procedures to support employees who retire from the emergency services. Interviews were conducted with participants who were familiar with existing policies and procedures in a large ambulance (n = 8) and fire (n = 6) service in Ireland. Four key themes were identified: (1) “I don’t think it’s a job at 65 to be running out on an emergency ambulance”; (2) “They do genuinely feel a wee bit isolated”; (3) improving the “cultural shock”; and (4) “I just keep going and hope for the best”. Findings point towards retirement as a major life change and highlight a need for more structured, effective pre-retirement preparation. Factors unique to emergency service personnel include the physical and emotional stress involved in emergency service; a strong identification with the service; and a lack of clarity about rules and entitlements, requiring better information and preparation.
Summary of the 2015 International Paediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute
- Jeffrey P. Jacobs, James A. Quintessenza, Tom R. Karl, Alfred Asante-Korang, Allen D. Everett, Susan B. Collins, Genaro A. Ramirez-Correa, Kristin M. Burns, Mitchell Cohen, Steven D. Colan, John M. Costello, Kevin P. Daly, Rodney C. G. Franklin, Charles D. Fraser, Kevin D. Hill, James C. Huhta, Sunjay Kaushal, Yuk M. Law, Steven E. Lipshultz, Anne M. Murphy, Sara K. Pasquali, Mark R. Payne, Joseph Rossano, Girish Shirali, Stephanie M. Ware, Mingguo Xu, Marshall L. Jacobs
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- Journal:
- Cardiology in the Young / Volume 25 / Issue S2 / August 2015
- Published online by Cambridge University Press:
- 17 September 2015, pp. 8-30
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In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children’s Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children’s Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary “think-tank”. The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute, to describe the “state of the art” of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Increasing the Appeal of Neurosurgery to Qualified Medical Students in Canada
- Mitchell P. Wilson, Jeffrey A. Pugh
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 39 / Issue 5 / September 2012
- Published online by Cambridge University Press:
- 02 December 2014, pp. 667-669
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Discordant MZ Twins With Cleft Lip and Palate: A Model for Identifying Genes in Complex Traits
- Maria Adela Mansilla, Jane Kimani, Laura E. Mitchell, Kaare Christensen, Dorret I. Boomsma, Sandy Daack-Hirsch, Buena Nepomucena, Diego F. Wyszynski, Temis M. Felix, Nicholas G. Martin, Jeffrey C. Murray
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- Journal:
- Twin Research and Human Genetics / Volume 8 / Issue 1 / 01 February 2005
- Published online by Cambridge University Press:
- 21 February 2012, pp. 39-46
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Monozygotic (MZ) twins may be discordant for complex traits due to differential environmental exposure in utero, epigenetic variability in imprinting, X chromosome inactivation, or stochastic effects. Occasionally MZ twins may be discordant for chromosomal and single gene disorders due to somatic mosaicism. For complex traits, which are due to the interactive effects of multiple genes and environmental factors, the affected twin of a discordant MZ pair offers the possibility for identifying somatic mutations in candidate genes. DNA sequencing of candidate genes in discordant MZ twins can identify those rare etiologic mutational events responsible for the different phenotypes since the confounding effects of common single nucleotide polymorphisms are eliminated, as DNA sequences should be identical in MZ pairs. In this report we describe the extensive DNA sequencing of 18 candidate genes in a sample of MZ and dizygotic (DZ) twins with nonsyndromic cleft lip with or without cleft palate. We were unable to identify any somatic differences in approximately 34 Kb of DNA sequenced in 13 MZ pairs, for a total of approximately 900 Kb of sequence comparisons, supporting the hypothesis that nonetiologic posttwinning mutations are rare. While no etiologic variants were identified in this study, sequence comparisons of discordant MZ twins can serve as a tool for identifying etiologic mutations in clefting and other complex traits.
Conservation tillage for organic agriculture: Evolution toward hybrid systems in the western USA
- John M. Luna, Jeffrey P. Mitchell, Anil Shrestha
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- Journal:
- Renewable Agriculture and Food Systems / Volume 27 / Issue 1 / March 2012
- Published online by Cambridge University Press:
- 08 February 2012, pp. 21-30
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Organic farming has been historically dependent on conventional tillage operations to convert perennial pasture leys to annual crop rotations, incorporate crop residues, compost and cover crops, as well as to mechanically kill existing vegetation. Conventional tillage, however, has long been known to lead to soil degradation and erosion. A recently developed no-till organic production system that uses a roller–crimper technology to mechanically kill cover crops was evaluated in two states in the western United States. In Washington, pumpkins (Cucurbita spp.) grown in a no-till roller–crimper (NT-RC) system produced yields 80% of conventional tillage, but with fewer weeds. However, in California on-farm research trials in organic cotton (Gossypium barbadense L.), tomato (Lycopersicon esculentum Mill.), eggplant (Solanum melongena L.) and cowpea (Vigna unguiculata (L.) Walp.), the no-till system produced virtual crop failure, or yields less than 20% of the standard production method. The major problems associated with rolled cover crops in California included reduced crop seedling emergence, planter impediment with excessive residue, lack of moisture and delay in transplanting of vegetable crops due to continued growth of cover crops, in-season crop competition from cover crop regrowth and impracticability of using cultivators. Further, excessive dry residue during summer in California can present the risk of fire. In both California and Oregon, considerable success has been demonstrated with zone tillage (strip tillage) in conventionally produced field and vegetable crops. In a replicated Oregon trial, the organic strip tillage treatment produced 85% of the broccoli (Brassica oleracea L.) yield compared to a conventional tillage treatment. Our studies suggest that the zone tillage concept may offer opportunities to overcome many of the agronomic challenges facing no-till.
Contributing Authors
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- By Caroline (Cal) Baier-Anderson, Larry Binning, Dominique Brossard, Alvin J. Bussan, Anthony J. Cavalieri, Jason R. Cavatorta, Jed Colquhoun, José Falck-Zepeda, Gregory D. Graff, Stewart M. Gray, The Rev. Lowell E. Grisham, Russell Groves, Michelle Mauthe Harvey, Molly M. Jahn, Shelley Jansky, Jiming Jiang, Nicholas Kalaitzandonakes, Keith Kelling, Deana Knuteson, Peggy G. Lemaux, Marty D. Matlock, William H. Meyers, Paul D. Mitchell, William Muir, Pamela Ronald, Matt Ruark, Eric S. Sachs, Mark K. Sears, Erin Silva, Walter R. Stevenson, Alison Van Eenennaam, Jeffrey D. Wolt, Jeff Wyman, David Zilberman
- Edited by Jennie S. Popp, University of Arkansas, Molly M. Jahn, University of Wisconsin, Madison, Marty D. Matlock, University of Arkansas, Nathan P. Kemper, University of Arkansas
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- Book:
- The Role of Biotechnology in a Sustainable Food Supply
- Published online:
- 05 June 2012
- Print publication:
- 31 January 2012, pp xiv-xviii
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20 - Advance directives and DNR orders
- from Section 3 - When a child dies: ethical issues at the end of life
- Edited by Douglas S. Diekema, Mark R. Mercurio, Mary B. Adam
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- Clinical Ethics in Pediatrics
- Published online:
- 07 October 2011
- Print publication:
- 08 September 2011, pp 112-117
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Summary
Case narrative
A 16-year-old female with advanced cystic fibrosis is admitted to the pediatric intensive care unit in severe respiratory distress. She is being supported by non-invasive ventilation, but her respiratory failure is progressing and she will likely need to be intubated in the next several hours. She has adamantly refused her pulmonologist’s request that she be listed for lung transplant, stating “I have thought about this for years, I have talked with other CF patients who did and did not get a lung transplant, and I would rather die than go through that.” Her parents want her to be listed for lung transplant. A short time later, while in severe respiratory distress, the patient asks to speak to her attending physician without her parents present. In this conversation she tells her physician, “I know I will not be able to communicate much longer, but no matter what happens do not let my parents list me for a lung transplant. I would rather die than go through all that transplant stuff.” Should the patient’s physician honor the adolescent’s wishes or those of her parents?
Introduction
In August 1976 the New England Journal of Medicine published the first descriptions of do-not-resuscitate (DNR) policies. The issue contained two separate articles from two Harvard teaching hospitals describing their policies on the framework for decision-making about the resuscitation status of patients at their hospital (Clinical Care Committee, 1976; Rabkin et al., 1976). A third article on the subject in that issue was a commentary by a Harvard law professor, and later Solicitor General of the United States, arguing that orders not to resuscitate were likely consistent and legal under the United States constitution (Fried, 1976).
34 - Resource allocation and triage in disasters and pandemics
- from Section 5 - Children, public health, and justice
- Edited by Douglas S. Diekema, Mark R. Mercurio, Mary B. Adam
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- Book:
- Clinical Ethics in Pediatrics
- Published online:
- 07 October 2011
- Print publication:
- 08 September 2011, pp 199-204
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Summary
Case narrative
A children’s hospital has formed a disaster planning committee to develop and implement a formal disaster policy. The committee’s work proceeds uneventfully until deliberations begin on a framework for triage. The committee struggles to reach consensus on a framework for determining who should receive limited resources and how those resources should be allocated following a mass casualty incident. Should those with the highest risk of mortality receive intervention? How should their prognosis be determined? Who should make the allocation decisions; should it be someone other than the actual caregivers? Under what conditions will caregivers who participate in reallocation of resources face civil and criminal penalties? In particular, the committee becomes highly polarized when it begins discussions around the following hypothetical scenario.A pandemic from influenza has caused severe shortages of mechanical ventilators and other life-sustaining treatments across the country. All of the intensive care unit (ICU) beds in the hospital are occupied by infants and children requiring mechanical ventilation, many of whom are critically ill from influenza. All non-emergency surgical cases have been canceled, and all step-down units and post-anesthesia recovery areas are being utilized. In addition, all of the hospitals in the region are experiencing the same shortages and therefore cannot provide any assistance. All but one of the hospital’s ventilators are being used by patients who would die without them. Given these circumstances, which of the following three patients in the hospital’s emergency department should be prioritized to receive the one available ventilator?
A 5-year-old girl, previously healthy, with severe pneumonia.
An 18-year-old boy with Duchenne muscular dystrophy, dependent on tracheostomy and mechanical ventilation for neuromuscular respiratory failure, wheelchair bound, and now with severe acute respiratory distress syndrome.
A 5-month-old infant with Down syndrome (trisomy 21), now with sepsis and multi-organ failure.
Contributors
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- By Aakash Agarwala, Linda S. Aglio, Rae M. Allain, Paul D. Allen, Houman Amirfarzan, Yasodananda Kumar Areti, Amit Asopa, Edwin G. Avery, Patricia R. Bachiller, Angela M. Bader, Rana Badr, Sibinka Bajic, David J. Baker, Sheila R. Barnett, Rena Beckerly, Lorenzo Berra, Walter Bethune, Sascha S. Beutler, Tarun Bhalla, Edward A. Bittner, Jonathan D. Bloom, Alina V. Bodas, Lina M. Bolanos-Diaz, Ruma R. Bose, Jan Boublik, John P. Broadnax, Jason C. Brookman, Meredith R. Brooks, Roland Brusseau, Ethan O. Bryson, Linda A. Bulich, Kenji Butterfield, William R. Camann, Denise M. Chan, Theresa S. Chang, Jonathan E. Charnin, Mark Chrostowski, Fred Cobey, Adam B. Collins, Mercedes A. Concepcion, Christopher W. Connor, Bronwyn Cooper, Jeffrey B. Cooper, Martha Cordoba-Amorocho, Stephen B. Corn, Darin J. Correll, Gregory J. Crosby, Lisa J. Crossley, Deborah J. Culley, Tomas Cvrk, Michael N. D'Ambra, Michael Decker, Daniel F. Dedrick, Mark Dershwitz, Francis X. Dillon, Pradeep Dinakar, Alimorad G. Djalali, D. John Doyle, Lambertus Drop, Ian F. Dunn, Theodore E. Dushane, Sunil Eappen, Thomas Edrich, Jesse M. Ehrenfeld, Jason M. Erlich, Lucinda L. Everett, Elliott S. Farber, Khaldoun Faris, Eddy M. Feliz, Massimo Ferrigno, Richard S. Field, Michael G. Fitzsimons, Hugh L. Flanagan Jr., Vladimir Formanek, Amanda A. Fox, John A. Fox, Gyorgy Frendl, Tanja S. Frey, Samuel M. Galvagno Jr., Edward R. Garcia, Jonathan D. Gates, Cosmin Gauran, Brian J. Gelfand, Simon Gelman, Alexander C. Gerhart, Peter Gerner, Omid Ghalambor, Christopher J. Gilligan, Christian D. Gonzalez, Noah E. Gordon, William B. Gormley, Thomas J. Graetz, Wendy L. Gross, Amit Gupta, James P. Hardy, Seetharaman Hariharan, Miriam Harnett, Philip M. Hartigan, Joaquim M. Havens, Bishr Haydar, Stephen O. Heard, James L. Helstrom, David L. Hepner, McCallum R. Hoyt, Robert N. Jamison, Karinne Jervis, Stephanie B. Jones, Swaminathan Karthik, Richard M. Kaufman, Shubjeet Kaur, Lee A. Kearse Jr., John C. Keel, Scott D. Kelley, Albert H. Kim, Amy L. Kim, Grace Y. Kim, Robert J. Klickovich, Robert M. Knapp, Bhavani S. Kodali, Rahul Koka, Alina Lazar, Laura H. Leduc, Stanley Leeson, Lisa R. Leffert, Scott A. LeGrand, Patricio Leyton, J. Lance Lichtor, John Lin, Alvaro A. Macias, Karan Madan, Sohail K. Mahboobi, Devi Mahendran, Christine Mai, Sayeed Malek, S. Rao Mallampati, Thomas J. Mancuso, Ramon Martin, Matthew C. Martinez, J. A. Jeevendra Martyn, Kai Matthes, Tommaso Mauri, Mary Ellen McCann, Shannon S. McKenna, Dennis J. McNicholl, Abdel-Kader Mehio, Thor C. Milland, Tonya L. K. Miller, John D. Mitchell, K. Annette Mizuguchi, Naila Moghul, David R. Moss, Ross J. Musumeci, Naveen Nathan, Ju-Mei Ng, Liem C. Nguyen, Ervant Nishanian, Martina Nowak, Ala Nozari, Michael Nurok, Arti Ori, Rafael A. Ortega, Amy J. Ortman, David Oxman, Arvind Palanisamy, Carlo Pancaro, Lisbeth Lopez Pappas, Benjamin Parish, Samuel Park, Deborah S. Pederson, Beverly K. Philip, James H. Philip, Silvia Pivi, Stephen D. Pratt, Douglas E. Raines, Stephen L. Ratcliff, James P. Rathmell, J. Taylor Reed, Elizabeth M. Rickerson, Selwyn O. Rogers Jr., Thomas M. Romanelli, William H. Rosenblatt, Carl E. Rosow, Edgar L. Ross, J. Victor Ryckman, Mônica M. Sá Rêgo, Nicholas Sadovnikoff, Warren S. Sandberg, Annette Y. Schure, B. Scott Segal, Navil F. Sethna, Swapneel K. Shah, Shaheen F. Shaikh, Fred E. Shapiro, Torin D. Shear, Prem S. Shekar, Stanton K. Shernan, Naomi Shimizu, Douglas C. Shook, Kamal K. Sikka, Pankaj K. Sikka, David A. Silver, Jeffrey H. Silverstein, Emily A. Singer, Ken Solt, Spiro G. Spanakis, Wolfgang Steudel, Matthias Stopfkuchen-Evans, Michael P. Storey, Gary R. Strichartz, Balachundhar Subramaniam, Wariya Sukhupragarn, John Summers, Shine Sun, Eswar Sundar, Sugantha Sundar, Neelakantan Sunder, Faraz Syed, Usha B. Tedrow, Nelson L. Thaemert, George P. Topulos, Lawrence C. Tsen, Richard D. Urman, Charles A. Vacanti, Francis X. Vacanti, Joshua C. Vacanti, Assia Valovska, Ivan T. Valovski, Mary Ann Vann, Susan Vassallo, Anasuya Vasudevan, Kamen V. Vlassakov, Gian Paolo Volpato, Essi M. Vulli, J. Matthias Walz, Jingping Wang, James F. Watkins, Maxwell Weinmann, Sharon L. Wetherall, Mallory Williams, Sarah H. Wiser, Zhiling Xiong, Warren M. Zapol, Jie Zhou
- Edited by Charles Vacanti, Scott Segal, Pankaj Sikka, Richard Urman
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- Book:
- Essential Clinical Anesthesia
- Published online:
- 05 January 2012
- Print publication:
- 11 July 2011, pp xv-xxviii
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Effects of distraction on the development of satiety
- Jeffrey M. Brunstrom, Gemma L. Mitchell
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- Journal:
- British Journal of Nutrition / Volume 96 / Issue 4 / October 2006
- Published online by Cambridge University Press:
- 08 March 2007, pp. 761-769
- Print publication:
- October 2006
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Two experiments explored the hypothesis that distraction causes a reduced sensitivity to the physiological and sensory cues that signal when to terminate a meal. In Experiment 1, eighty-eight females ate five ‘Jaffa Cakes’ either while distracted by a computer game or while sitting in silence. Analysis of the difference in rated hunger, fullness and desire to eat (pre- to post-intake) revealed that distracted participants experienced smaller changes in their desire to eat and fullness than did non-distracted participants. Experiment 2 assessed whether changes in ratings are attenuated because sensory-specific satiety (or a related process) fails to develop. Using a similar procedure, eighty-four females provided desire to eat, pleasantness and intensity ratings for Jaffa Cakes and for two ‘uneaten’ foods, both before and at three time-points after consuming five Jaffa Cakes. Non-distracted participants reported a reduction in their desire to eat the eaten food relative to the uneaten food (food-specific satiety), whereas distracted participants maintained a desire to eat all foods. Moreover, this difference between distracted and non-distracted participants was evident 5 and 10 min after the eating episode had terminated. The present findings invite speculation that distraction attenuates the development of sensory-specific satiety, and that this effect persists (at least for a brief period) after the distractor has terminated. More generally, this kind of phenomenon warrants further scrutiny because it holds the potential to contribute towards overeating, either by prolonging an eating episode or by reducing the interval between meals.