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Preliminary evidence suggests that a ketogenic diet may be effective for bipolar disorder.
Aims
To assess the impact of a ketogenic diet in bipolar disorder on clinical, metabolic and magnetic resonance spectroscopy outcomes.
Method
Euthymic individuals with bipolar disorder (N = 27) were recruited to a 6- to 8-week single-arm open pilot study of a modified ketogenic diet. Clinical, metabolic and MRS measures were assessed before and after the intervention.
Results
Of 27 recruited participants, 26 began and 20 completed the ketogenic diet. For participants completing the intervention, mean body weight fell by 4.2 kg (P < 0.001), mean body mass index fell by 1.5 kg/m2 (P < 0.001) and mean systolic blood pressure fell by 7.4 mmHg (P < 0.041). The euthymic participants had average baseline and follow-up assessments consistent with them being in the euthymic range with no statistically significant changes in Affective Lability Scale-18, Beck Depression Inventory and Young Mania Rating Scale. In participants providing reliable daily ecological momentary assessment data (n = 14), there was a positive correlation between daily ketone levels and self-rated mood (r = 0.21, P < 0.001) and energy (r = 0.19 P < 0.001), and an inverse correlation between ketone levels and both impulsivity (r = −0.30, P < 0.001) and anxiety (r = −0.19, P < 0.001). From the MRS measurements, brain glutamate plus glutamine concentration decreased by 11.6% in the anterior cingulate cortex (P = 0.025) and fell by 13.6% in the posterior cingulate cortex (P = <0.001).
Conclusions
These findings suggest that a ketogenic diet may be clinically useful in bipolar disorder, for both mental health and metabolic outcomes. Replication and randomised controlled trials are now warranted.
Recent evidence from case reports suggests that a ketogenic diet may be effective for bipolar disorder. However, no clinical trials have been conducted to date.
Aims
To assess the recruitment and feasibility of a ketogenic diet intervention in bipolar disorder.
Method
Euthymic individuals with bipolar disorder were recruited to a 6–8 week trial of a modified ketogenic diet, and a range of clinical, economic and functional outcome measures were assessed. Study registration number: ISRCTN61613198.
Results
Of 27 recruited participants, 26 commenced and 20 completed the modified ketogenic diet for 6–8 weeks. The outcomes data-set was 95% complete for daily ketone measures, 95% complete for daily glucose measures and 95% complete for daily ecological momentary assessment of symptoms during the intervention period. Mean daily blood ketone readings were 1.3 mmol/L (s.d. = 0.77, median = 1.1) during the intervention period, and 91% of all readings indicated ketosis, suggesting a high degree of adherence to the diet. Over 91% of daily blood glucose readings were within normal range, with 9% indicating mild hypoglycaemia. Eleven minor adverse events were recorded, including fatigue, constipation, drowsiness and hunger. One serious adverse event was reported (euglycemic ketoacidosis in a participant taking SGLT2-inhibitor medication).
Conclusions
The recruitment and retention of euthymic individuals with bipolar disorder to a 6–8 week ketogenic diet intervention was feasible, with high completion rates for outcome measures. The majority of participants reached and maintained ketosis, and adverse events were generally mild and modifiable. A future randomised controlled trial is now warranted.
The Elicited Imitation Task (EIT) is a popular technique for efficiently measuring global proficiency in multiple languages, and accumulated evidence indicates high reliability and strong relationships with other proficiency measures. Nevertheless, several dimensions of EIT design remain open to investigation, including the assumption that a pause is required in between the aural stimulus and oral response, to ensure processing of the input and prevent so-called parroting. This study investigated the relationship between three poststimulus pause conditions, learners’ proficiency and working memory, and their EIT scores as well as their perceptions of task difficulty, mental effort, focus, and interest. Findings indicated no differences in performances or perceptions between the 0-second pause, 2-second pause, and 5-second pause conditions, and a weak relationship between EIT performance and working memory. Across all conditions, the EIT distinguished consistently among proficiency levels, correlated strongly with a criterion proficiency measure, and produced remarkably reliable scores.
This case study discusses an online second language teacher education course, designed for teachers, teacher educators, directors of studies and course designers, created and run by the authors, who are both members of a language services cooperative in Barcelona. Information about the cooperative is given, and the events leading to the start of the project are described. Having outlined Long’s (2015) approach to task-based language teaching (TBLT), which serves as the model for the course, we describe the course itself, and the components of its twelve sessions. We go on to explain how we wrote the course and how, once complete, it was marketed. The first implementation of the course is then described, including details of the participants’ working roles; their highest qualifications; their engagement with course activities; the completion rates; and feedback. We then explain how the second implementation reflected changes we made to the course as a result of our reflections and feedback. Finally, we discuss the strengths and weaknesses of the course, paying particular attention to loop input (Woodward, 2003) and to the principle of faithfully reflecting TBLT processes so that the course practices what it preaches.
At its most complete, task-based language teaching is a holistic approach to experiential language education. It consists of teachers and learners, materials, assessments, and other elements that combine in a particular logic to form complex programs of language learning. In order to understand, improve, and maximize their effectiveness, task-based programs should be evaluated comprehensively and regularly, as they are implemented in a variety of educational settings. This chapter describes how evaluation methods can be applied to developing task-based language programs and classes, determining their outcomes and impacts, and identifying aspects in need of adjustment. It also shows how good evaluations may provide the best test of how and how well TBLT theory can be put into practice for improving language learning.
We present the data and initial results from the first pilot survey of the Evolutionary Map of the Universe (EMU), observed at 944 MHz with the Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The survey covers $270 \,\mathrm{deg}^2$ of an area covered by the Dark Energy Survey, reaching a depth of 25–30 $\mu\mathrm{Jy\ beam}^{-1}$ rms at a spatial resolution of $\sim$11–18 arcsec, resulting in a catalogue of $\sim$220 000 sources, of which $\sim$180 000 are single-component sources. Here we present the catalogue of single-component sources, together with (where available) optical and infrared cross-identifications, classifications, and redshifts. This survey explores a new region of parameter space compared to previous surveys. Specifically, the EMU Pilot Survey has a high density of sources, and also a high sensitivity to low surface brightness emission. These properties result in the detection of types of sources that were rarely seen in or absent from previous surveys. We present some of these new results here.
The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia and will cover the full ASKAP band of 700–1800 MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey and Sydney University Molonglo Sky Survey radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with $\sim$ 15 arcsec resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination $+41^\circ$ made over a 288-MHz band centred at 887.5 MHz.
Clement of Rome, traditionally the fourth pope and third successor to Peter, is a mysterious figure whose historical traces are as slight as his reputation and fame are great. His authentic letter to the Corinthian Church from 96 is of great importance; his legend and cult have grown great over the centuries, notably in connection with the Basilica di San Clemente in Rome. Excavations underneath the current twelfth-century basilica led to the discovery of an original fourth–fifth-century church, and beneath it are Roman buildings of the first and second centuries. At this site, visitors can journey back in time from the present day street level, through twelfth-and fourth-century strata, all the way down to the first-century Roman level. Such a journey takes the visitor through a series of complex historical realities, matched in their complexity by the history and narratives surrounding Clement himself. A study of Clement's legends, his writing, and the historical context in which he carried out his priestly life reveal much about the early Church in Rome, allowing us to make contact with a colleague of St. Peter himself.
Contextualizing Clement in Rome
Although his biographical information is elusive, Clement is sometimes linked to the Roman patrician Titus Flavius Clemens (50–95) and his wife Domitilla. Titus was a nephew of the former emperor Vespasianus (69–79) and as such a great nephew of the emperor Domitian (81–96), who nonetheless put Titus to death and exiled his wife in 96 on the grounds of godlessness and deviation into Jewish practices. Legend has sometimes associated Clement with Titus Flavius Clemens himself, though more frequently with a freedman of his household. Scholars now argue that the source of their treason would have been a refusal to sacrifice to the cult of Domitian's divine genius.
Though Titus Flavius Clemens is not now considered to have been Christian, many hypothesize that his wife indeed was of the Christian faith. Returning from exile after the death of Domitian, she may have been responsible for the donation of lands to the Christian community that eventually formed the Catacombe di Domitilla on the Appian Way.
Monarch butterflies (Danaus plexippus (Linnaeus) (Lepidoptera: Nymphalidae)) in eastern North America migrate each year from overwintering areas in Mexico to cover a large breeding distribution across the United States of America and southern Canada. In 2012, monarch butterflies migrated well beyond their usual range, resulting in an extended breeding distribution compared to typical years. We used stable isotope (δ2H, δ13C) measurements in wing chitin to determine the area of natal origin of these butterflies. Most monarch butterflies collected in May, June, and July from Manitoba and Alberta, Canada had natal origins in the North American Midwest. Monarch butterflies collected in Alberta and Saskatchewan, Canada in August and September had local natal origins indicating successful recruitment of offspring from colonising individuals. However, it is unknown whether these offspring migrated successfully to overwintering areas. Our work highlights the ability of monarch butterflies to colonise distant breeding areas and demonstrates how stable isotopes can be used to understand the dynamics of range-edge populations.
Very metal-poor stars ([Fe/H] < –2.0) inform our understanding of the formation and evolution of the Galaxy, and the physical conditions in the earliest star-forming environments of the Universe. They play an integral part in the paradigms of stellar populations, stellar archaeology, and near-field cosmology. We review the carbon-rich and carbon-normal sub-populations of the most iron-poor stars, providing insight into chemical enrichment at the earliest times in the Universe. We also discuss the role of very metal-poor stars in providing insight into the Galaxy’s halo, thick disk, and bulge, and the promise they hold for the future. A comparison between the abundances obtained for the nine most Fe-poor stars ([Fe/H] < –4.5) (all but one of which is C-rich) with abundances obtained from far-field cosmology suggests that the former are the most chemically primitive objects yet observed and probably older than the DLA- and sub-DLA systems for which data are currently available from far-field studies.
Field experiments in 1984 and 1985 near Headland, AL involved the influence of 18 integrated weed management systems incorporated from nine herbicide-tillage systems (H-T) and two row patterns on control of large crabgrass and Texas panicum, crop yield, and net returns in grain sorghum. The conventional-tillage system plus herbicide combinations; alachlor preplant incorporated (PPI), atrazine postemergence (POST), and paraquat POST directed, provided 90% or greater control of large crabgrass throughout the season and high sorghum yields in one of two years; and 90% or greater control of Texas panicum from mid-June through mid-August and high sorghum yields in both years. Results in 1984 and 1985 similar to those above were obtained with strip tillage plus herbicide combinations; alachlor PPI, atrazine POST, and paraquat POST directed; alachlor PPI and tridiphane plus atrazine POST; and tridiphane plus atrazine POST and paraquat POST directed. Row patterns did not consistently influence control of large crabgrass, Texas panicum, or sorghum yield. Economic net returns ranged from – $20 to $210 per hectare for the large crabgrass control systems in 1984; however, low sorghum yields in 1985 resulted largely in negative returns. Similar net returns were obtained in the Texas panicum experiment.
Four substituted pyridazinone compounds inhibited the Hill reaction and photosynthesis in barley (Hordeum vulgare L., var. Dayton C.I. 9517). These inhibitions appeared to account for the phytotoxicity of 5-amino-4-chloro-2-phenyl-3(2H)-pyridazinone (pyrazon). The pyridazinone chemicals were weaker inhibitors than 2-chloro-4-(ethylamino)-6-(isopropylamino)-s-triazine (atrazine). Two substitutions onto the molecular structure of pyrazon result in a new experimental herbicide, 4-chloro-5-(dimethylamino)-2-(α,α,α-trifluoro-m-tolyl)-3(2H)-pyridazinone (hereinafter referred to as 6706), which retains the action mechanism of pyrazon but also has two additional biological properties. It is resistant to metabolic detoxication in plants, and it possesses a second mode of action involving interference with chloroplast development. The second action is like that expressed by 3-amino-s-triazole (amitrole) and by 3,4-dichlorobenzyl methylcarbamate (dichlormate). However, the new chemical is 100 to 1000 times more effective. The trifluoromethyl substitution on the phenyl ring and the dimethyl substitution on the amine are both required to give either of the two additional physiological properties. Analogs with only one of the two substitutions behave like pyrazon rather than like 6706.
The multifunctional set of services provided by farmland complicates the task of identifying which farmland should be preserved. For this reason many states and local governments establish criteria to rank and select parcels of farmland for protection. This study examines whether criteria commonly used by state programs to guide purchases of agricultural conservation easements influence public demand for farmland preservation. The results provide policy makers with additional information to assess current ranking criteria that set the standard for farmland preservation.
A preliminary national survey of ischemic stroke in the young (15-45 years) undertaken by the Canadian Stroke Consortium indicated that in 44% of 356 patients, no cause was found.
Objective:
To determine the reason for this high incidence of diagnostic uncertainty in young patients with ischemic stroke.
Methods:
Neurologists in the ten Canadian stroke centers completed a detailed questionnaire for patients aged 15-45 years admitted to hospital between January 1993 and December 1997. Using a step-wise diagnostic algorithm incorporating clinical, neuroimaging, neurovascular and laboratory data, we divided patients into three groups: (1) those with established cause for the ischemic stroke, (2) those who remained unexplained despite adequate investigation, (3) those who remained unexplained but were, in our opinion, under-investigated.
Results:
In 197 patients (56%), an identified cause was established including cardioembolic sources (14%), extracranial arterial dissection (13%), lacunar infarcts (8%) atherosclerosis (6%). A miscellaneous group of 15%, included cerebral venous thrombosis, coagulopathies, vasculitis and others. In 159 patients (44%) with no apparent cause for their stroke, we considered only 81 (23%) adequately investigated, and 78 (21%) inadequately investigated.
Conclusion:
About one in five young patients was inadequately investigated by a stroke-oriented group of neurologists. The major problem appears to be restriction of investigations to neuroimaging alone (usually computerized cerebral tomography), without further tests such as cerebral angiography and cardiac imaging.
Task-based language assessment (TBLA) has generated interest since the early 1990s, primarily in conjunction with the ongoing development of task-based language teaching (TBLT) and the pursuit of developing appropriate testing models for this approach to pedagogy (Norris, 2002, 2009). However, tasks also offer considerable advantages for language assessment, beyond their obvious relevance within TBLT classes and programs. In fact, major innovations in the general domain of language assessment over the past two decades have occurred in conjunction with the introduction of tasks into assessment design, largely in response to the need for tests that better represent examinees’ abilities to use the language (Mislevy, Steinberg, & Almond, 2002), but also because tasks offer a meaningful space for language teachers, testers, learners, and others to examine, understand, and improve language learning endeavors (Van Gorp & Deygers, 2013). This article reviews the considerable range of current uses for TBLA, illustrating different types of assessment with concrete examples and highlighting distinct roles for tasks as a basic unit of analysis in test design, interpretation, and intended consequence. Ultimately, it argues that tasks offer a fundamental, though not exclusive, foundation for useful language assessment, and that task-based assessment, though challenging, is probably worth the effort.
Carotid Doppler is an accurate, safe and repeatable method of assessing arterial calibre, for distinguishing harmless neck bruits and to identify the stroke prone individual. It is completely non-invasive and can be used serially to monitor progression in carotid stenosis. It is a valuable clinical tool in diagnosis and management in patients at risk of stroke, but has definite limitations, such as in differentiating carotid occlusion from severe stenosis. B-mode imaging, although valuable in identifying arterial anatomy, and detecting plaques, cannot accurately evaluate the degree of stenosis. It is of limited value in identifying plaque hemorrhage and ulceration. Doppler ultrasound technology has advanced rapidly in the last decade, especially in the combination of B-mode imaging and Doppler (Duplex), as well as in evaluating of the intracranial circulation (transcranial Doppler). In the next decade, it may become the new gold standard for evaluating the extracranial and intracranial circulation.
We achieved a unique and timely recording of cerebral activity in a 70 year old woman immediately pre- and post-stroke, while studying the effect of acute cerebral infarction on sleep-electroencephalogram (EEG) patterns. Normal patterns, except for increased wakefulness, were recorded during two pre-infarct polysomnograms. Immediately following cerebral infarction increased delta activity was recorded from the infarcted hemisphere only. Initially, REM sleep could not be recorded from either side; however, on the third post infarct day REM sleep returned. Background EEG levels from both hemispheres became progressively slower, flatter and simpler. In addition, sleep spindles and the distinctive saw-tooth wave forms of sleep almost disappeared. At one year post-stroke sleep-EEG rhythm recordings from both hemispheres became more similar except for persisting delta activity from the left hemisphere. Unexpected deterioration of sleep-EEG pattern recordings from the undamaged hemisphere taken during the patient's clinical recovery remains unexplained. Serial sleep recording may facilitate the study of brain recovery, activity and reorganization following stroke.
Subclavian “steal”, when blood siphons from one vertebral artery to the other, has been suggested as a cause of brain stem ischaemia and stroke. We investigated 33 patients using transcranial Doppler to determine the direction and velocity of basilar blood flow. All patients had severe subclavian stenosis with reversed vertebral blood flow in the ipsilateral artery previously demonstrated by extracranial Doppler. Basilar flow was normal in direction in all cases, but its velocity was significantly increased (p<0.0008) compared to age- and sex-matched controls. These findings, in conjunction with previous observations using extracranial Doppler techniques, suggest that subclavian steal is little more than a harmless haemodynamic phenomenon.