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BACKGROUND & AIMS: Indirect comparisons suggest that alternate-day fasting (ADF) may produce greater improvements in body composition, fat distribution, and/or the adipokine profile compared to daily calorie restriction (CR), but this has not been tested directly. In a pre-planned secondary analysis of a randomized controlled trial, we compared changes in the VAT:SAT ratio, FFM:total mass ratio, and the adipokine profile between ADF and CR. METHODS: Overweight and obese participants (n = 100) were randomized to 1) ADF (alternating every 24-h between consuming 25% or 125% of energy needs); 2) CR (consuming 75% of needs every day); or 3) control (consuming 100% of needs every day) for 24 wk. RESULTS: The VAT:SAT ratio did not change in any group. The FFM:total mass ratio increased in both ADF (0.03 ± 0.00) and CR (0.03 ± 0.01) compared to the control group (P < 0.01), with no differences between the intervention groups. Circulating leptin decreased in both the ADF group (−18 ± 6%) and CR group (−31 ± 10%) relative to the control group (P < 0.05), with no differences between the intervention groups. Circulating levels of adiponectin, resistin, IL-6, and TNF-α did not change in either intervention group relative to the control group. CONCLUSION: ADF and CR similarly improve the FFM:total mass ratio and reduce leptin after a 24-wk intervention.

Since 2009, the Working Group on the ‘Anthropocene’ (or, commonly, AWG for Anthropocene Working Group), has been critically analysing the case for formalization of this proposed but still informal geological time unit. The study to date has mainly involved establishing the overall nature of the Anthropocene as a potential chronostratigraphic/geochronologic unit, and exploring the stratigraphic proxies, including several that are novel in geology, that might be applied to its characterization and definition. A preliminary summary of evidence and interim recommendations was presented by the Working Group at the 35th International Geological Congress in Cape Town, South Africa, in August 2016, together with results of voting by members of the AWG indicating the current balance of opinion on major questions surrounding the Anthropocene. The majority opinion within the AWG holds the Anthropocene to be stratigraphically real, and recommends formalization at epoch/series rank based on a mid-20th century boundary. Work is proceeding towards a formal proposal based upon selection of an appropriate Global boundary Stratotype Section and Point (GSSP), as well as auxiliary stratotypes. Among the array of proxies that might be used as a primary marker, anthropogenic radionuclides associated with nuclear arms testing are the most promising; potential secondary markers include plastic, carbon isotope patterns and industrial fly ash. All these proxies have excellent global or near-global correlation potential in a wide variety of sedimentary bodies, both marine and non-marine.

This study examined what characteristics predict weight loss success with alternate day fasting (ADF). Four 8-week trials of ADF (n=121) were included in the analysis. Subjects aged 50-59 y achieved greater (P=0.01) weight loss than other age groups. Males and females achieved similar weight loss. Caucasian subjects achieved greater (P=0.03) weight loss than other races. Baseline body weight and baseline BMI did not predict degree of weight loss achieved with the diet. These findings may help clinicians to decide which population groups may benefit most from an ADF approach.

The rise of plastics since the mid-20th century, both as a material element of modern life and as a growing environmental pollutant, has been widely described. Their distribution in both the terrestrial and marine realms suggests that they are a key geological indicator of the Anthropocene, as a distinctive stratal component. Most immediately evident in terrestrial deposits, they are clearly becoming widespread in marine sedimentary deposits in both shallow- and deep-water settings. They are abundant and widespread as macroscopic fragments and virtually ubiquitous as microplastic particles; these are dispersed by both physical and biological processes, not least via the food chain and the ‘faecal express’ route from surface to sea floor. Plastics are already widely dispersed in sedimentary deposits, and their amount seems likely to grow several-fold over the next few decades. They will continue to be input into the sedimentary cycle over coming millennia as temporary stores – landfill sites – are eroded. Plastics already enable fine time resolution within Anthropocene deposits via the development of their different types and via the artefacts (‘technofossils’) they are moulded into, and many of these may have long-term preservation potential when buried in strata.

Background For medical students, the emergency department (ED) often presents ethical problems not encountered in other settings. In many medical schools there is little ethics training during the clinical years. The benefits of reflective essay writing in ethics and professionalism education are well established. Objectives The purpose of this study was to determine and categorize the types of ethical dilemmas and scenarios encountered by medical students in the ED through reflective essays. Methods During a 4 th -year emergency medicine rotation, all medical students wrote brief essays on an ethical situation encountered in the ED, and participated in an hour debriefing session about these essays. Qualitative analysis was performed to determine common themes from the essays. The frequency of themes was calculated. Results The research team coded 173 essays. The most common ethical themes were autonomy (41%), social justice (32.4%), nonmaleficence (31.8%), beneficence (26.6%), fidelity (12%), and respect (8.7%). Many of the essays contained multiple ethical principles that were often in conflict with each other. In one essay, a student grappled with the decision to intubate a patient despite a preexisting do-not-resuscitate order. This patient encounter was coded with autonomy, beneficence, and nonmaleficence. Common scenarios included ethical concerns when caring for critical patients, treatment of pain, homeless or alcoholic patients, access to care, resource utilization, and appropriateness of care. Conclusion Medical students encounter patients with numerous ethically based issues. Frequently, they note conflicts between ethical principles. Such essays constitute an important resource for faculty, resident, and student ethics training.

Previous work has suggested that tectonically active regions act as speciation pumps for mammals and plant species, but little is known about how fast or widespread tectonism must be in order to directly influence evolution. Here, we use oxygen and hydrogen isotopic data from Miocene sedimentary deposits to characterize the topographic evolution of the southern Columbia Plateau/Snake River Plain and northern Rocky Mountain regions during the Yellowstone hotspot passage, with the ultimate goal of understanding whether topographic changes caused by the hotspot influenced mammalian evolution within those regions. We conducted oxygen isotope analyses of 130 samples of lacustrine, and paleosol carbonate from Miocene stratigraphic sections that span much of the northern Rocky Mountain region, and combined these data with previously published isotopic records. Collectively these isotopic data show that caldera formation associated with the Yellowstone hotspot has modified regional topography and rearranged drainages along the track of the hotspot, and that the hotspot has left a topographic depression in its wake. We explore the extent to which these topographic changes influenced or are decoupled from diversity changes exhibited by the local mammal faunas and conclude that the passage of the hotspot and consequent surface uplift created rainshadows in the lee of high-elevation calderas and/or generated large volumes of volcanic materials, influencing soils and vegetation. Collectively, that may explain a possible rise in mammal diversity in the CP/SRP region at ~ 14 Ma, coincident with a drop in diversity in the NRM. It is still unclear, however, how different taphonomic pathways and sample-standardization problems are influencing apparent diversity peaks at this temporal and geographic resolution.

Background: The ethical principle of autonomy is explored as it applies to situations in which patients' capacities to make decisions are questionable. Case Report: A 40-year-old man presented to the Emergency Department with an epidural hematoma, and refused to undergo emergent surgical treatment. Considering the acutely life-threatening nature of his problem and the inability to confirm the patient's capacity in the presence of a traumatic brain injury, the decision was made to proceed with emergent surgical treatment without consent. Discussion: The concept of conditional autonomy is introduced, defined, and employed to defend the process whereby a select group of patients may be treated without full knowledge of their wishes.

South America lost more genera in the Quaternary megafaunal extinction than any other continent, but how it fits into the worldwide extinction has been unclear largely due to the lack of chronological resolution. This work evaluated 138 published radiocarbon dates for megafauna and 402 published dates for early (>8000 BP) South American archaeological sites. A total of 93 megafauna dates for 15 genera, and 110 archaeological dates on early human appearance, are robust enough to assess correspondence between last-appearance records of megafauna, first-appearance records of humans, and the Younger Dryas to Holocene climatic transition in six different regions of South America. Interesting patterns come to light, but are based on few dates, particularly in northern South America. No taxon other than Mylodon has >7 robust dates, and many taxa have less than 3 dates. Accordingly, an assessment of how likely it is that only a few dates will yield the youngest date in an underlying frequency distribution of dates was conducted, by applying probability and bootstrapping analyses to 27 dates on Mylodon from southern Patagonia, 26 of them from a single site. It was found that 15 dates out of a sample of 27 will commonly yield a date within 200 years of the youngest date in the sample. For that reason, and because even for a taxon with many dates it is likely that the youngest dated specimen pre-dates the actual time of extinction, most of the last-appearance dates are interpreted as recording the last time taxa were abundant on the landscape, rather than extinction per se . With those caveats in mind, on a continental scale most megafauna have last appearances after human arrival, but seem to last at least 1000 years after first human presence. Some taxa apparently survived >6000 years after humans entered South America and >1000 years after the end-Pleistocene climatic changes. Last-appearance patterns for megafauna differ from region to region, but in Patagonia, the Argentine and Uruguayan Pampas, and Brazil, extinctions seem more common after humans arrive and during intensified climatic change between 11.2 and 13.5 ka. This pattern suggests that a synergy of human impacts and rapid climate change—analogous to what is happening today—may enhance extinction probability. Nevertheless, even in these regions, some megafauna persisted for thousands of years after human arrival and after the climate warmed. These results highlight the need for future intensive dating efforts on South American megafauna and archaeological remains.

BACKGROUND: Influenza causes significant morbidity and mortality among patients, mostly those with immunosuppression, at extremes of age, and with significant comorbidities. Healthcare workers (HCWs) play a significant role in preventing morbidity and mortality of their hospitalized patients by being properly immunized against infectious diseases. However, compliance with influenza control programs has been limited overall in the United States, with only 36% of the workers with direct patient care annually immunized. New challenges were placed to increase immunization among HCWs in 2004-2005 due to the influenza vaccine shortage. OBJECTIVES: 1) Increase accessibility to influenza vaccination program for HCWs in high-risk areas at an academic hospital through several activities. 2) Demonstrate through results of aggregated data from 6 years that there was a significant improvement in compliance with the influenza vaccination in those high-risk patient areas. PROJECT: In the past 6 years, we increased the access to influenza vaccination throughout the hospital by 1) open visits to employee health service with nursing staff for vaccination throughout the “flu” season, 2) mobile clinics throughout the hospital's high-risk areas at the various working shifts, 3) intensive educational campaigns, and 4) 12-hour blitzes open to HCWs through a prioritized system. Data on influenza vaccine administered to high-risk HCWs was collected and analyzed by chi square comparing 1999-2000 (baseline) to 2003-2004 and 2004-2005 seasons. LESSONS LEARNED: There was a significant overall improvement in compliance with the influenza vaccination program in high-risk areas (p = 0.001) in the year 2003-2004, when compared with baseline year (1999-2000). Two out of five identified high-risk areas had no significant improvement over the past 6 years. Compliance with influenza can be improved with a multifaceted approach emphasizing accessibility. Influenza vaccine shortage may have played a significant role in increasing compliance with the “flu” vaccination among high-risk HCWs. High-risk areas with poor response to the vaccination program will require specific training and different strategic planning.

Battle Ground Lake is located in a volcanic crater outside the limit of the last glaciation in the southern Puget Trough, Washington. Fossil bryophyte fragments extracted from sediment-cores provide information on the local vegetation between 20,000–4500 yr B.P. and complement existing interpretations based on pollen and macrofossil data. Species belonging to three ecological groups were identified. Wetland taxa and species present in exposed upper-slope habitats during the Late Pleistocene were replaced by epiphytes and forest-dwellers when the crater walls became forested in the Holocene. All the species found as fossil fragments grow in the Pacific Northwest now and most present-day phytogeographical elements of this region have a Pleistocene record.