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Never too early: the impact of a shadowing programme in paediatric and congenital cardiac surgery for undergraduate college students
- Zachary Brennan, Matthew Purlee, Omar M. Sharaf, Isabella E. Badhwar, Colton Brown, Liam Kugler, Douglas J. Weinstein, Jonah S. Bassuk, Yasmine Baydoun, Dan Neal, Yuriy Stukov, Kirsten Freeman, Tyler Wallen, Giles J. Peek, Mark S. Bleiweis, Jeffrey P. Jacobs
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- Journal:
- Cardiology in the Young / Volume 33 / Issue 4 / April 2023
- Published online by Cambridge University Press:
- 03 May 2023, pp. 514-519
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Purpose:
Diversification of the medical and cardiothoracic surgical workforce represents an ongoing need. A congenital cardiac surgery shadowing programme for undergraduate students was implemented at the University of Florida Congenital Heart Center.
Methods:Students shadowing in the Congenital Heart Center from 17 December 2020 through 20 July 2021 were sent a survey through Qualtrics to evaluate the impact of their shadowing experience. The main objectives of the survey were to determine the personal relationship(s) of the students to physicians prior to shadowing, how the presence or absence of physicians in the family of a given student related to the exposure of the student to a medical setting prior to shadowing, and the interest of the students in medicine and cardiothoracic surgery prior to and after the shadowing experience. Survey responses included “Yes/No” questions, scaled responses using a Likert scale, selection lists, and free text responses. When applicable, t-tests were utilised to assess differences between student groups.
Results:Of the 37 students who shadowed during the study period, 26 (70%) responded. Most students were female (58%, n = 15), and the mean age was 20.9 ± 2.4 years. Students spent a mean duration of 95 ± 138 hours shadowing providers as part of the shadowing programme. Likert scale ratings of interest in the professions of medicine, surgery, and cardiothoracic surgery all increased after the shadowing experience (p < 0.01). Students with a family member in medicine had more clinical exposure prior to the shadowing programme (p < 0.01).
Conclusion:A surgical shadowing programme at a Congenital Heart Center may have an important formative impact on the views of undergraduate students regarding potential careers in surgery and medicine. Additionally, students without family members in medicine tend to have less prior exposure to medicine and could likely benefit more from this type of shadowing programme.
Producers marketing a novel crop: a field-level view of hemp market channels
- Rebecca Hill, Becca B.R. Jablonski, Laney Van, Ming Wang, Buddhika Patalee, Jonathan Shepherd, Matt LeRoux, Tyler Mark, Daniel F. Mooney, Dawn Thilmany
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- Journal:
- Renewable Agriculture and Food Systems / Volume 38 / 2023
- Published online by Cambridge University Press:
- 17 April 2023, e22
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We assess emerging relationships between production decisions and market channel selection among a small sample of hemp growers (22) in Colorado and Kentucky using qualitative interviews. We found producers differences by market channel, product and state. For instance, producers who relied on intermediated marketing strategies cultivated more acres on average and used fewer distinct market channels and strategies than those relying on direct markets. Product differences were found regarding processing, storage and perishability. Respondents identified four factors critical to their choice of market channels for their hemp products: research, profitability, trust and knowledge. The findings can help inform public and private decision-making regarding best hemp marketing practices and future needs of the hemp industry.
Pandemic response gaps: Infection prevention and control lessons learned during coronavirus disease 2019 (COVID-19) outbreaks in skilled nursing facilities in Detroit, Michigan
- Avnish Sandhu, Jordan Micah F. Polistico, Monica P. Meyer, Gonzalo Gonzalez, Keith Kiama, Mark Lebednick, Tyler Prentiss, Helina Misikir, Jessica Heinonen, John Zervos, Paul E. Kilgore, Marcus J. Zervos, Lauren R. Fink, Najibah K. Rehman, Catherine Maples, Teena Chopra
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 6 / June 2023
- Published online by Cambridge University Press:
- 10 August 2022, pp. 915-919
- Print publication:
- June 2023
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Background:
Hospitalizations among skilled nursing facility (SNF) residents in Detroit increased in mid-March 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Outbreak response teams were deployed from local healthcare systems, the Centers for Disease Control and Prevention (CDC), and the Detroit Health Department (DHD) to understand the infection prevention and control (IPC) gaps in SNFs that may have accelerated the outbreak.
Methods:We conducted 2 point-prevalence surveys (PPS-1 and PPS-2) at 13 Detroit SNFs from April 8 to May 8, 2020. The DHD and partners conducted facility-wide severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing of all residents and staff and collected information regarding resident cohorting, staff cohorting, and personnel protective equipment (PPE) utilized during that time.
Results:Resident cohorting had been implemented in 7 of 13 (58.3%) SNFs prior to point-prevalence survey 1 (PPS-1), and other facilities initiated cohorting after obtaining PPS-1 results. Cohorting protocols of healthcare practitioners and environmental service staff were not established in 4 (31%) of 13 facilities, and in 3 facilities (23.1%) the ancillary staff were not assigned to cohorts. Also, 2 SNFs (15%) had an observation unit prior to PPS-1, 2 (15%) had an observation unit after PPS-1, 4 (31%) could not establish an observation unit due to inadequate space, and 5 (38.4%) created an observation unit after PPS-2.
Conclusion:On-site consultations identified gaps in IPC knowledge and cohorting that may have contributed to ongoing transmission of SARS-CoV-2 among SNF residents despite aggressive testing measures. Infection preventionists (IPs) are critical in guiding ongoing IPC practices in SNFs to reduce spread of COVID-19 through response and prevention.
A hedonic analysis of factors impacting the value of planters on the used machinery market
- John Allison, Jr., Tyler B. Mark, Kenneth H. Burdine, Jordan M. Shockley
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- Journal:
- Agricultural and Resource Economics Review / Volume 51 / Issue 2 / August 2022
- Published online by Cambridge University Press:
- 22 March 2022, pp. 266-282
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A hedonic model was employed to examine factors that influence the resale price of row crop planters on the used machinery market. Planter sale data from 2016 to 2018 were utilized to conduct the analysis. Results suggested that the primary factors impacting planter resale prices were make, age, condition, planter configuration, row number, and row spacing. As a function of age (depreciation), planter values were generally determined to decrease at a decreasing rate. Finally, it was determined that there was a significant interaction between the variables make and age, suggesting that different planter makes depreciate differently.
Chemical and Radiation Training for Public Health and Nursing Students: An Under-Utilized Disaster Response Demographic
- Sukhi Atti, Emily Kiernan, Mark Layer, Aynur Sahin, Shaikhah Alotiabi, Waleed Als uk aiti, Sydney Shuk, Kayla Lindros, Tyler Giberson, Ziad Kazzi
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- Journal:
- Prehospital and Disaster Medicine / Volume 34 / Issue s1 / May 2019
- Published online by Cambridge University Press:
- 06 May 2019, pp. s107-s108
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- May 2019
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Introduction:
Public health (PH) and nursing students are an underutilized demographic in disaster response. Knowledge of the disaster response phase may enhance student understanding of preparedness, and provide response capabilities.
Aim:A single four-hour simulation-based training session, with toxicologists as instructors, can effectively improve PH and nursing student knowledge and skills in chemical and radiation response, despite minimal prior experience.
Methods:A convenience sample was used to test PH and nursing students in a response training program. An introductory lecture and simulation training reviewed: mass casualty care, triage, personal protective equipment, decontamination, and chemical and radiation exposure toxidromes. An examination was administered pre-training, and then post-training, to evaluate relevant training, knowledge, risk perception, and comfort in response capabilities to chemical and radiation incidents.
Results:Forty-two students attended the course; 39 were included in the study. Seventy-two percent (n=28) of participants had no prior disaster training. Overall, there were significant differences between the pre-test and post-test scores for all students [95% CI: 5.4 (4.7-6.1); p<0.0001, paired t-test]; maximum score 15/15. Comparing scores of nursing and PH students, despite statistical difference in pre-test scores (median, IQR: 9.0 (7.5-10±2.0); 7.0 (5.7-9.0) respectively; p=0.048, Mann Whitney U-test), there were no statistical differences in post-test scores (median, IQR: 14.0 (13.0-14.0); 13.0 (12.0-14.0), respectively, Mann Whitney U-test). All students recognized nerve agent toxidrome and performed SALT triage after the training (p <0.0001, McNemar test). Subjectively, participant comfort level in responding to a chemical or radiological incident improved (p <0.0001, McNemar test). Individual risk perception for chemical or radiological disasters did not improve after training.
Discussion:Improvement of knowledge and comfort was demonstrated, irrespective of previous experience. Simulation-based training of chemical and radiation disaster preparedness, led by medical toxicologists, is an effective means of educating PH and nursing students, with minimal prior fluency.
24-h severe energy restriction impairs postprandial glycaemic control in young, lean males
- David J. Clayton, Jack Biddle, Tyler Maher, Mark P. Funnell, Jack A. Sargeant, James A. King, Carl J. Hulston, David J. Stensel, Lewis J. James
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- Journal:
- British Journal of Nutrition / Volume 120 / Issue 10 / 28 November 2018
- Published online by Cambridge University Press:
- 07 November 2018, pp. 1107-1116
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- 28 November 2018
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Intermittent energy restriction (IER) involves short periods of severe energy restriction interspersed with periods of adequate energy intake, and can induce weight loss. Insulin sensitivity is impaired by short-term, complete energy restriction, but the effects of IER are not well known. In randomised order, fourteen lean men (age: 25 (sd 4) years; BMI: 24 (sd 2) kg/m2; body fat: 17 (4) %) consumed 24-h diets providing 100 % (10 441 (sd 812) kJ; energy balance (EB)) or 25 % (2622 (sd 204) kJ; energy restriction (ER)) of estimated energy requirements, followed by an oral glucose tolerance test (OGTT; 75 g of glucose drink) after fasting overnight. Plasma/serum glucose, insulin, NEFA, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP) and fibroblast growth factor 21 (FGF21) were assessed before and after (0 h) each 24-h dietary intervention, and throughout the 2-h OGTT. Homoeostatic model assessment of insulin resistance (HOMA2-IR) assessed the fasted response and incremental AUC (iAUC) or total AUC (tAUC) were calculated during the OGTT. At 0 h, HOMA2-IR was 23 % lower after ER compared with EB (P<0·05). During the OGTT, serum glucose iAUC (P<0·001), serum insulin iAUC (P<0·05) and plasma NEFA tAUC (P<0·01) were greater during ER, but GLP-1 (P=0·161), GIP (P=0·473) and FGF21 (P=0·497) tAUC were similar between trials. These results demonstrate that severe energy restriction acutely impairs postprandial glycaemic control in lean men, despite reducing HOMA2-IR. Chronic intervention studies are required to elucidate the long-term effects of IER on indices of insulin sensitivity, particularly in the absence of weight loss.
ALS-Resistant Spotted Spurge (Chamaesyce maculata) Confirmed in Georgia
- Patrick E. McCullough, J. Scott McElroy, Jialin Yu, Hui Zhang, Tyler B. Miller, Shu Chen, Christopher R. Johnston, Mark A. Czarnota
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- Journal:
- Weed Science / Volume 64 / Issue 2 / June 2016
- Published online by Cambridge University Press:
- 20 January 2017, pp. 216-222
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Metsulfuron is used for POST control of spotted spurge in many warm-season turfgrasses. A suspected resistant (R) biotype of spotted spurge was collected from turfgrass in Georgia with a history of exclusive metsulfuron use. Research was conducted to evaluate the resistance level of this biotype to metsulfuron, efficacy of other mechanisms of action for control, and the molecular basis for resistance. Compared with a susceptible (S) biotype, the R biotype required >90 and >135 times greater metsulfuron rates to reach 50% injury and reduce biomass 50% from the nontreated, respectively. The R biotype was also resistant to trifloxysulfuron but was injured equivalent to the S biotype from dicamba, glyphosate, and triclopyr. Gene sequencing of the R biotype revealed a Trp574 to Leu substitution that has conferred resistance to acetolactate synthase (ALS) inhibitors in previous research. This is the first report of ALS resistance in spotted spurge. More importantly, this is the first report of a herbicide-resistant broadleaf weed from a turfgrass system in the United States.
Triclopyr Absorption and Translocation by Eurasian Watermilfoil (Myriophyllum spicatum) Following Liquid and Granular Applications
- Joseph D. Vassios, Scott J. Nissen, Tyler J. Koschnick, Mark A. Heilman
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- Journal:
- Weed Science / Volume 62 / Issue 1 / March 2014
- Published online by Cambridge University Press:
- 20 January 2017, pp. 22-28
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One method that appears promising for the treatment of Eurasian watermilfoil in areas of high water exchange is the use of herbicide-impregnated granules. Experiments were conducted using liquid triclopyr-triethylamine and granules impregnated with triclopyr-triethylamine to test this theory. Uniform, multistemmed Eurasian watermilfoil plants were selected for these experiments. Plants were treated in clear acrylic cylinders containing 7 L of water with 0.5 mg/L triclopyr as the liquid triethylamine plus 20 kBq 14C-triclopyr or blank granules impregnated with triclopyr triethylamine plus 20 kBq of 14C-triclopyr. Plants were harvested 6, 12, 24, 48, 96, and 192 h after treatment (HAT) and the radioactivity in the apical meristems, remaining shoot and root was determined with sample oxidation and liquid scintillation spectroscopy. There were no significant differences in overall herbicide absorption by Eurasian watermilfoil following liquid and granular triclopyr treatments; however, differences were observed between plant parts. Apical meristems accumulated the most radioactivity, whereas roots accumulated very little radioactivity following liquid treatment. Granular applications resulted in 7.5 times more radioactivity in the Eurasian watermilfoil roots then the liquid triclopyr application; therefore, long-term control of well-established Eurasian watermilfoil plants could improve with granular applications, especially in areas where rapid herbicide dilution could be an issue.
3 - Future demand for infrastructure services
- from Part II - Analysing national infrastructure
- Edited by Jim W. Hall, University of Oxford, Martino Tran, University of Oxford, Adrian J. Hickford, University of Southampton, Robert J. Nicholls, University of Southampton
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- The Future of National Infrastructure
- Published online:
- 05 February 2016
- Print publication:
- 25 February 2016, pp 31-53
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Notes on Contributors
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- By Charles Altieri, Faith Barrett, Alfred Bendixen, David Bergman, Edward Brunner, Stephen Burt, Susan Castillo Street, Michael C. Cohen, Robert Daly, Betty Booth Donohue, Jim Egan, Richard Flynn, Ed Folsom, Stephen Fredman, Frank Gado, Roger Gilbert, Rigoberto González, Nick Halpern, Jeffrey A. Hammond, Kevin J. Hayes, Matthew Hofer, Tyler Hoffman, Christoph Irmscher, Virginia Jackson, Joseph Jonghyun Jeon, John D. Kerkering, George S. Lensing, Mary Loeffelholz, Wendy Martin, Cristanne Miller, David Chioni Moore, Walton Muyumba, John Timberman Newcomb, Bob Perelman, Siobhan Phillips, Brian M. Reed, Elizabeth Renker, Eliza Richards, Reena Sastri, Robin G. Schulze, Mark Scroggins, David E. E. Sloane, Angela Sorby, Juliana Spahr, Willard Spiegelman, Lisa M. Steinman, Ernest Suarez, Joseph T. Thomas, Lesley Wheeler, David Wojahn
- Edited by Alfred Bendixen, Princeton University, New Jersey, Stephen Burt, Harvard University, Massachusetts
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- The Cambridge History of American Poetry
- Published online:
- 05 December 2014
- Print publication:
- 27 October 2014, pp xi-xviii
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Contributors
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- By Pat Alger, Eric Anderson, Henry Atmore, Steven Gould Axelrod, Thomas Bailey, Jonathan N. Barron, James Barszcz, David Chandler, John Xiros Cooper, David Evans, Robert Faggen, Lesley Lee Francis, Dana Gioia, Robert Bernard Hass, Tyler Hoffman, Tim Kendall, Karen L. Kilcup, Grzegorz Kosc, Jonathan Levin, Marit MacArthur, Alec Marsh, Paul Morrison, Paul Muldoon, Jay Parini, William Pritchard, Mark Richardson, Margery Sabin, Mark Scott, Lisa Seale, Donald G. Sheehy, Yasuko Shiojiri, Sean Street, Joseph M. Thomas, David Tutein
- Edited by Mark Richardson, Doshisha University, Kyoto
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- Book:
- Robert Frost in Context
- Published online:
- 05 April 2014
- Print publication:
- 14 April 2014, pp ix-xvi
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Notes on Contributors
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- By Susan F. Beegel, Milton A. Cohen, Nancy R. Comley, Kirk Curnutt, Albert J. DeFazio, Suzanne del Gizzo, David M. Earle, Carl P. Eby, Robert E. Fleming, Stacey Guill, Peter L. Hays, Ryan Hediger, Gary Edward Holcomb, Jill Jividen, Hilary K. Justice, Verna Kale, Jeremy Kaye, J. Gerald Kennedy, Kelli A. Larson, Leonard J. Leff, Nghana tamu Lewis, Kevin Maier, Miriam B. Mandel, James H. Meredith, Peter Messent, Debra A. Moddelmog, Lisa Narbeshuber, Matthew Nickel, Charles M. Oliver, Mark P. Ott, James Plath, Russ Pottle, Ann Putnam, John Raeburn, Gail Sinclair, Sandra Spanier, Amy Strong, Thomas Strychacz, Frederic Svoboda, Robert W. Trogdon, Lisa Tyler, Alex Vernon, Emily O. Wittman, Susan Wrynn
- Edited by Debra A. Moddelmog, Ohio State University, Suzanne del Gizzo
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- Ernest Hemingway in Context
- Published online:
- 18 December 2013
- Print publication:
- 17 December 2012, pp xi-xxii
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A simple low-cost synthesis of brookite TiO2 nanoparticles
- Todd C. Monson, Mark A. Rodriguez, Jean L. Leger, Tyler E. Stevens, Dale L. Huber
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- Journal of Materials Research / Volume 28 / Issue 3 / 14 February 2013
- Published online by Cambridge University Press:
- 22 November 2012, pp. 348-353
- Print publication:
- 14 February 2013
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A new low-cost synthesis of brookite TiO2nanoparticles using isopropanol as both the solvent and ligand is described here. Other ligands can be bound to the titania surface during or postsynthesis to tailor the particles’ functionality. The often extremely rapid hydrolysis of titanium isopropoxide has been successfully controlled so that nanoparticle growth is achieved. The resulting 4-nm particles are nonagglomerated, stable in solution, and have a low polydispersity. The synthesis is scalable and enables the simple fabrication of large amounts of titania nanoparticles that do not scatter visible light and are highly suited for incorporation into optical composites.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. 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- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Initial plasticity onset in Zr- and Hf-rich bulk metallic glasses during instrumented indentation
- Tyler D. Krus, Thomas F. Juliano, Laszlo J. Kecskes, Mark R. VanLandingham
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- Journal of Materials Research / Volume 22 / Issue 5 / May 2007
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- 03 March 2011, pp. 1265-1269
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- May 2007
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Sudden jumps in nanoindentation load-displacement curves of bulk metallic glasses (BMGs) signify the onset of plastic deformation. These events are investigated on varying compositions of Zr- and Hf-rich BMGs. Load-versus-displacement graphs for spherical indentations are analyzed to determine displacement, load, intensity of deformation, energy per volume, energy loss, and pressure corresponding to these key locations. Attention is focused on pressure, energy loss, and energy per volume at initial plasticity in response to varying strain rates, indenter tip radii, preload, and material composition. Energy loss was found to correlate with preload. The Zr-rich metallic glass was found to plastically deform in response to smaller loads than Hf-rich specimens.
Plate section
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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- 18 December 2009
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- 23 September 2004, pp -
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17 - Information for family and friends
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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- 18 December 2009
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- 23 September 2004, pp 257-259
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Summary
AN is a disease, like asthma is a disease. It is not dieting, a strong wish to be thin, or malingering. People afflicted with AN have within their minds two realities. One reality is a normal and healthy one. Just like you and I, those who suffer from AN want to be happy, healthy, and normal. The other reality is best understood as a phobia, a state of immense fear and concern. In AN, the phobia is that of loss of control, leading to obesity. Just like a phobia of going outside, AN has far-reaching implications. The phobia of personal obesity leads to changes in exercise, eating, unusual behaviors, and AN almost constant state of fear, anxiety, and inability to cope with life. The weight loss that results from this phobic state can be life-threatening.
What causes anorexia nervosa?
Anorexia is a disease that occurs in about one in 100–200 women and about two in 1000 men. The onset of AN is preceded by weight loss. The weight loss may have occurred for any reason, e.g. dieting, travel, diarrhea, or after surgery. AN also requires a certain genetic make-up. AN cannot occur in those who do not have a genetic predisposition to the disease. Even with a genetic predisposition and weight loss, other factors, such as social, environmental, family, or psychological stressors, may be necessary for the disease to manifest itself.
3 - History, examination, and investigations
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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- 18 December 2009
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Summary
Special considerations for history taking in eating disorder patients
Leave your office to meet the patient and observe their behavior with those who have accompanied them. Note their state of affect and ability to walk, then gait, weakness, and unsteadiness.
Certain elements of the history, such as those related to abuse or sexual issues, may best be left to a subsequent interview when rapport has been developed.
Instruct the patient to change in a private area, to keep on their underwear, and to wear the gown open to the back. Examining the patient while fully dressed may lead to failure to observe the degree of emaciation and other physical signs. It is preferable to perform the physical examination in the presence of a female trusted by the patient. Do not do rectal, pelvic, or breast examination as part of an eating disorder assessment physical examination.
Mental status examination
General appearance and behavior
Does the patient appear physically unwell, anxious, or depressed? Is he or she emaciated, or are they wearing clothes that obscure their figure? Is the patient restless? Many anorexic patients are unable to sit still or even sit, even when asked to do so, and continually jiggle their feet.
Speech
Is the patient communicative, or do they answer only briefly and reluctantly. Does the patient set out to justify their reasons for dieting? Do they avoid eye contact when asked potentially confrontational questions about eating, exercise, vomiting, or laxative abuse?
4 - Medical manifestations by system
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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- 18 December 2009
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- 23 September 2004, pp 48-85
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Summary
The medical symptoms and signs of AN and, although less serious, of other eating disorders are part of the illness, and hence it is more appropriate to think of them as medical manifestations rather than merely complications. Although the disorder usually starts in adolescence, its course is often prolonged; AN patients may be ill for many years, and the majority of severely ill AN patients are in early or mid adult life. Hence, AN is a matter of concern for adult physicians as well as for pediatricians and adolescent medicine specialists. Figure 4.1 shows a mnemonic that is useful for remembering the physical signs of eating disorders.
Manifestations result from starvation or from the behaviors adopted to induce it. They are not indicative of underlying pathology. The inexperienced clinician who undertakes unnecessary investigations to exclude all possible causes for each abnormal finding is doing the patient a disservice by delaying appropriate treatment. Rather, all clinicians should be aware of the wide range of physical abnormalities that are commonly found in anorexic patients (Table 4.1). Many of these abnormalities, such as decreased serum concentrations of gonadotropins and steroid sex hormones, alterations to the peripheral metabolism of thyroid hormone, and raised circulating concentrations of cortisol and growth hormone, are best regarded as physiological adaptations to the state of starvation and do not require treatment. However, some medical complications are not only clinically important but are also life-threatening; these require special attention.
7 - Medical and nutritional therapy
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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- 18 December 2009
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- 23 September 2004, pp 128-170
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