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The Cambridge companion to Rudyard Kipling
\"Rudyard Kipling (1865-1936) is among the most popular, acclaimed and controversial of writers in English. His books have sold in great numbers, and he remains the youngest writer to have won the Nobel Prize in Literature. Many associate Kipling with poems such as 'If-', his novel Kim, his pioneering use of the short story form and such works for children as the Just So Stories. For others, though, Kipling is the very symbol of the British Empire and a belligerent approach to other peoples and races. This Companion explores Kipling's main themes and texts, the different genres in which he worked and the various phases of his career. It also examines the 'afterlives' of his texts in postcolonial writing and through adaptations of his work. With a chronology and guide to further reading, this book serves as a useful introduction for students of literature and of Empire and its after effects\"-- Provided by publisher.
Book
Effect of Sustaining Lifestyle Modifications (Nonsmoking, Weight Reduction, Physical Activity, and Mediterranean Diet) After Healing of Myocardial Infarction, Percutaneous Intervention, or Coronary Bypass (from the REasons for Geographic and Racial Differences in Stroke Study)
Guidelines recommend lifestyle modification for patients with coronary heart disease (CHD). Few data demonstrate which lifestyle modifications, if sustained, reduce recurrent CHD and mortality risk in cardiac patients after the postacute rehabilitation phase. We determined the association between ideal lifestyle factors and recurrent CHD and all-cause mortality in REasons for Geographic and Racial Differences in Stroke study participants with CHD (n = 4,174). Ideal lifestyle factors (physical activity ≥4 times/week, nonsmoking, highest quartile of Mediterranean diet score, and waist circumference <88 cm for women and <102 cm for men) were assessed through questionnaires and an in-home study visit. There were 447 recurrent CHD events and 745 deaths over a median 4.3 and 4.5 years, respectively. After multivariable adjustment, physical activity ≥4 versus no times/week and non-smoking versus current smoking were associated with reduced hazard ratios (HRs; 95% confidence interval [CI]) for recurrent CHD (HR 0.69, 95% CI 0.54 to 0.89 and HR 0.50, 95% CI 0.39 to 0.64, respectively) and death (HR 0.71, 95% CI 0.59 to 0.86 and HR 0.53, 95% CI 0.44 to 0.65, respectively). The multivariable-adjusted HRs (and 95% CIs) for recurrent CHD and death comparing the highest versus lowest quartile of Mediterranean diet adherence were 0.77 (95% CI 0.55 to 1.06) and 0.84 (95% CI 0.67 to 1.07), respectively. Neither outcome was associated with waist circumference. Comparing participants with 1, 2, and 3 versus 0 ideal lifestyle factors (non-smoking, physical activity ≥4 times/week, and highest quartile of Mediterranean diet score), the HRs (and 95% CIs) were 0.60 (95% CI 0.44 to 0.81), 0.49 (95% CI 0.36 to 0.67), and 0.38 (95% CI 0.21 to 0.67), respectively, for recurrent CHD and 0.65 (95% CI 0.51 to 0.83), 0.57 (95% CI 0.43 to 0.74), and 0.41 (95% CI 0.26 to 0.64), respectively, for death. In conclusion, maintaining smoking cessation, physical activity, and Mediterranean diet adherence is important for secondary CHD prevention.
Journal Article
علم الأحياء بالتقصي : مساق في علم الأحياء التجريبي
يتناول كتاب (علم الأحياء بالتقصي : مساق في علم الأحياء التجريبي) والذي قام بتأليفه (روبرت كلارك) في مجلد من القطع المتوسط موضوع (علم الأحياء التجريبي واللافقاريات) مستعرضا المحتويات التالية : الفصل الأول : توزيع الكائنات الحية، الفصل الثاني : الحيوانات والنباتات والأمكنة، الفصل الثالث : تنوع الأنظمة البيئية، الفصل الرابع : دراسة التنوع، الفصل الخامس : وحدات الحياة، الفصل السادس : النمو، الفصل السابع : إنجاز العمل، الفصل الثامن : الطاقة من الشمس، الفصل التاسع : طرق انتقال الطاقة، الفصل العاشر : تحرر الطاقة، الفصل الحادي : عشر المواد بين الحياة والموت.
Book
PLASMIC score to aid diagnosis of aHUS: an analysis of C5 inhibitor clinical trials and the PINC AI™ healthcare database
Background
Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy (TMA) that can lead to end organ damage and death without treatment. The ability to rapidly distinguish aHUS from other forms of TMA is key for optimal patient management. The PLASMIC Score was developed to identify individuals with thrombotic thrombocytopenic purpura (TTP), a TMA subtype characterized by severe ADAMTS13 deficiency (< 10%), using 7 commonly available laboratory variables and aspects of the patient’s medical history. This study aimed to assess the distribution of PLASMIC Scores in patients with known aHUS, and evaluate the utility of the PLASMIC Score in the diagnostic pathway of aHUS in patients with confirmed TMA.
Methods
Data from eculizumab (NCT01194973) and ravulizumab (NCT02949128) clinical trials were utilized to calculate and evaluate PLASMIC Score distribution in aHUS patients. Real-world patient-level data from the PINC AI™ Healthcare Database (PHD) were used to evaluate the performance of the PLASMIC Score in identifying aHUS in patients with documented TMA diagnoses and renal impairment (primary analysis population;
n
= 110), and subsequent sensitivity analyses were performed in alternative populations.
Results
A total of 94 aHUS patients from the eculizumab and ravulizumab clinical trials dataset were evaluated; 18/36 (50.0%) and 27/58 (46.6%) patients in the eculizumab and ravulizumab trials, respectively, had a PLASMIC Score of 4, and most patients (~ 85%) had PLASMIC Scores ≤ 5 (range: 3–5), which were distributed similarly between the trials. Among the 110 patients with undifferentiated TMA (primary analysis) from the PHD, a PLASMIC Score cutoff of ≤ 5 yielded sensitivity, specificity and positive predictive value (PPV) and negative predictive values (NPV) of 86.5%, 71.4%, 92.8% and 55.6%, respectively, for identifying probable aHUS. Similar diagnostic performance was observed at a cutoff value of ≤ 5 in further sensitivity analyses. A cutoff value of ≤ 4 yielded a lower PPV (62.9%), yet a higher NPV (85.7%), with only 3 patients misclassified as TTP.
Conclusion
Application of the PLASMIC Score in the aHUS diagnostic pathway may support clinical judgement and ascertain confidence in the earlier identification and subsequent treatment of patients with aHUS, thereby improving patient outcomes.
Journal Article
Parker : to get away clean, you have to play dirty
Parker is a thief who has an unusual code. He doesn't steal from the poor or hurt innocent people. He is asked to join four other guys, one of whom is related to a known mobster. They pull off the job flawlessly and Parker wants to part ways with them. When he refuses to join them for another job, they try to kill him. They dispose of his body, but someone finds him ... still alive. After recovering, he sets out to get back at the ones who tried to kill him, another one of his codes.
DVD
An Improved Variant of Soybean Type 1 Diacylglycerol Acyltransferase Increases the Oil Content and Decreases the Soluble Carbohydrate Content of Soybeans
Kinetically improved diacylglycerol acyltransferase (DGAT) variants were created to favorably alter carbon partitioning in soybean (Glycine max) seeds. Initially, variants of a type 1 DGAT from a high-oil, high-oleic acid plant seed, Corylus americana, were screened for high oil content in Saccharomyces cerevisiae. Nearly all DGAT variants examined from high-oil strains had increased affinity for oleoyl-CoA, with S₀.₅ values decreased as much as 4.7-fold compared with the wild-type value of 0.94 μM. Improved soybean DGAT variants were then designed to include amino acid substitutions observed in promising C. americana DGAT variants. The expression of soybean and C. americana DGAT variants in soybean somatic embryos resulted in oil contents as high as 10% and 12%, respectively, compared with only 5% and 7.6% oil achieved by overexpressing the corresponding wild-type DGATs. The affinity for oleoyl-CoA correlated strongly with oil content. The soybean DGAT variant that gave the greatest oil increase contained 14 amino acid substitutions out of a total of 504 (97% sequence identity with native). Seed-preferred expression of this soybean DGAT1 variant increased oil content of soybean seeds by an average of 3% (16% relative increase) in highly replicated, single-location field trials. The DGAT transgenes significantly reduced the soluble carbohydrate content of mature seeds and increased the seed protein content of some events. This study demonstrated that engineering of the native DGAT enzyme is an effective strategy to improve the oil content and value of soybeans.
Journal Article
Changes in Insulin Secretion and Action in Adults With Familial Risk for Type 2 Diabetes Who Curtail Their Sleep
OBJECTIVE: Experimental sleep deprivation is accompanied by changes in glucose regulation. However, the effects of chronic sleep insufficiency on insulin secretion and action in populations at high risk for type 2 diabetes are not known. This study examined the relationship between objectively documented habitual sleep curtailment and measures of insulin sensitivity, insulin secretion, and oral glucose tolerance in free-living adults with parental history of type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 47 healthy participants with parental history of type 2 diabetes (26 female/21 male, mean [SD] age 26 [4] years and BMI 23.8 [2.5] kg/m2) completed 13 (SD = 2) days of sleep and physical activity monitoring by wrist actigraphy and waist accelerometry while following their usual lifestyle at home. Laboratory polysomnography was used to screen for sleep disorders. Indices of diabetes risk based on oral glucose tolerance tests were compared between participants with habitual short sleep and those with usual sleep duration >6 h/day. RESULTS: Consistent with a behavioral pattern of habitual sleep curtailment, short sleepers obtained an average of 1.5 h less sleep per night and showed signs of increased sleep pressure. Participants who habitually curtailed their sleep had considerably higher indices of insulin resistance and increased insulin secretion but maintained normal glucose tolerance similar to that of subjects who slept more. CONCLUSIONS: Young lean adults with parental history of type 2 diabetes who habitually curtail their sleep have increased insulin resistance and compensatory hyperinsulinemia—a pattern that has been associated with higher risk of developing diabetes in such susceptible individuals.
Journal Article
Sedentary behavior and subclinical atherosclerosis in African Americans: cross-sectional analysis of the Jackson heart study
BACKGROUND: Previous studies have reported conflicting results as to whether an association exists between sedentary time and cardiovascular disease (CVD) risk among African Americans. These studies, however, were limited by lack of consideration of sedentary behavior in leisure versus non-leisure settings. To elucidate this relation, we investigated the associations of television (TV) viewing time and occupational sitting with carotid intima-media thickness (CIMT), a subclinical atherosclerosis measure, in a community-based sample of African Americans. METHODS: We studied 3410 participants from the Jackson Heart Study, a single-site, community-based study of African Americans residing in Jackson, MS. CIMT was assessed by ultrasonography and represented mean far-wall thickness across right and left sides of the common carotid artery. TV viewing time, a measure of leisure sedentary behavior, and occupational sitting, a measure of non-leisure sedentary behavior, were assessed by questionnaire. RESULTS: In a multivariable regression model that included physical activity and CVD risk factors, longer TV viewing time (2–4 h/day and >4 h/day) was associated with greater CIMT (adjusted mean ± SE difference from referent [<2 h/day] of 0.009 ± 0.008 mm for 2–4 h/day, and 0.028 ± 0.009 mm for >4 h/day; P-trend =0.001). In contrast, more frequent occupational sitting (‘sometimes’ and ‘often/always’) was associated with lower CIMT (adjusted mean ± SE difference from referent [‘never/seldom’]:−0.021 ± 0.009 mm for ‘sometimes’, and−0.018 ± 0.008 mm for ‘often/always’; P-trend = 0.042). CONCLUSIONS: Longer TV viewing time was associated with greater CIMT, while occupational sitting was associated with lower CIMT. These findings suggest the role of sedentary behaviors in the pathogenesis of CVD among African Americans may vary by whether individuals engage in leisure versus non-leisure sedentary behaviors.
Journal Article
Discovering patient groups in sequential electronic healthcare data using unsupervised representation learning
Unsupervised feature learning methods inspired by natural language processing (NLP) models are capable of constructing patient-specific features from longitudinal Electronic Health Records (EHR).
We applied document embedding algorithms to real-world paediatric intensive care (PICU) EHR data to extract patient-specific features from 1853 patients' PICU journeys using 647 unique lab tests and medication events. We evaluated the clinical utility of the patient features via a K-means clustering analysis.
We trained a document embedding model under a unique evaluation pipeline and obtained latent patient feature vectors for all 1853 patients. We performed unsupervised clustering to the patient vectors as a downstream analysis and obtained 5 distinct clusters via hyperparameter optimisation. Significant variations (p<0.0001) within both patient characteristics and surgery intervention and diagnostic profiles were detected.
The K-means clustering results demonstrated the clinical utilities of the patient-specific features learned from the embedding algorithms. The latent patient features obtained via the embedding process enabled direct applications of other machine learning algorithms. Future work will focus on utilising the temporal information within EHR and extending EHR embedding algorithms to develop personalised patient journey predictions.
Journal Article
The intrusive hyphen is everywhere
When can a hyphen be described as ‘intrusive’? As with many other ‘rules’ of grammar and of punctuation, use of the hyphen is limited to a specific syntactical context. Hence, to use a hyphen where it should not be used makes it intrusive. Just like the apostrophe, it cannot be used arbitrarily. There is, for instance, a tattooist parlour in the English town of Oldham whose shopfront advertises Inkcredible Tatoo's (sic) and, with it, both the owner's or owners’ ability to play on words in writing and their inability to sign a plural form correctly – the rule being that apostrophes are not used to mark the plural of either common or proper nouns in written English.
Journal Article