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Background and Hypothesis In a complex world, gathering information and adjusting our beliefs about the world is of paramount importance. The literature suggests that patients with psychotic disorders display a tendency to draw early conclusions based on limited evidence, referred to as the jumping-to-conclusions bias , but few studies have examined the computational mechanisms underlying this and related belief-updating biases. Here, we employ a computational approach to understand the relationship between jumping-to-conclusions, psychotic disorders, and delusions. Study Design We modeled probabilistic reasoning of 261 patients with psychotic disorders and 56 healthy controls during an information sampling task—the fish task—with the Hierarchical Gaussian Filter. Subsequently, we examined the clinical utility of this computational approach by testing whether computational parameters, obtained from fitting the model to each individual's behavior, could predict treatment response to Metacognitive Training using machine learning. Study Results We observed differences in probabilistic reasoning between patients with psychotic disorders and healthy controls, participants with and without jumping-to-conclusions bias, but not between patients with low and high current delusions. The computational analysis suggested that belief instability was increased in patients with psychotic disorders. Jumping-to-conclusions was associated with both increased belief instability and greater prior uncertainty. Lastly, belief instability predicted treatment response to Metacognitive Training at the individual level. Conclusions Our results point towards increased belief instability as a key computational mechanism underlying probabilistic reasoning in psychotic disorders. We provide a proof-of-concept that this computational approach may be useful to help identify suitable treatments for individual patients with psychotic disorders. [ABSTRACT FROM AUTHOR]

Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

The objective of this research was to evaluate effects of replacing sorghum x Sudangrass hay with ground juniper in gestating ewe supplements on pre- and postpartum growth performance, serum metabolites and hormonal concentrations, milk fatty acid composition, and progeny preweaning performance. In a completely randomized design, commercial Rambouillet ewes (age = 3 to 5 yr; initial BW = 65.2 ± 1.6 kg) on a base diet of long-stem sorghum x Sudangrass hay were assigned to 1 of 4 dietary supplements in which ground juniper replaced 0% (CNTL), 33% (18JUN), 66% (36JUN), or 100% (54JUN) of the ground sorghum x Sudangrass hay in a pelleted supplement with ground juniper from d 38 ± 4 of gestation to 2 d postpartum. Treatment DM diet intake overall (g/kg BW) in ewes receiving no juniper was similar (P ≥ 0.38) to that of those receiving increasing concentrations of juniper. Changes in ewe BW and BCS were similar (P ≥ 0.24) in ewes throughout gestation. All serum metabolites and hormones were within normal clinical ranges; however, serum IGF-1 decreased linearly (P = 0.003), alanine increased (linear; P = 0.003), and serum Na decreased (linear; P = 0.049) as the percentage of juniper increased in the diet. Ewe milk fatty acid composition was similar (P > 0.05) for the majority of fatty acids across treatment groups, with the exception of arachidonic acid (C20:4n6) being greater (P < 0.02) in 54JUN vs. CNTL ewe milk. Lamb birth weights were similar (P = 0.13), whereas lamb ADG tended to differ (quadratic; P = 0.06) from d 0 to 14, with 18JUN being the least. At weaning, BW tended (P = 0.09) to linearly decrease in lambs born to ewes consuming greater concentrations of juniper but were not different (P = 0.26) between CNTL and 18JUN, 36JUN, and 54JUN. Results indicated that feeding increasing levels of ground juniper in supplements did not negatively alter ewe performance or serum metabolites and hormones measured pre- and postpartum. Lamb birth weight and preweaning performance appeared unaffected by maternal consumption of ground juniper containing supplements. Results also provide novel information regarding the effects of plant secondary compound consumption throughout pregnancy on ewe and progeny performance and health. [ABSTRACT FROM AUTHOR]

Patients in Intensive Care Unit (ICU) often require sedatives which commonly include midazolam and the more recently developed α2-receptor agonist, dexmedetomidine. It was our aim to compare the sedative and clinical effectiveness of dexmedetomidine vs midazolam in adults admitted to ICU, using an objective appraisal of randomized control trials. Medline, Embase, SCOPUS, Web of Knowledge, Cinhal, the United States National Library of Medicine, and the Cochrane Database of Systematic Reviews were searched using keywords: 'dexmedetomidine', 'midazolam', and 'intensive care'. These were limited to human studies and adults (>18 yr old). Six randomized controlled trials were found and were critically appraised using a standardized appraisal method. Two papers described the time spent by each intervention group within a specified target sedation range and both found no statistically significant difference between midazolam and dexmedetomidine (P=0.18 and P=0.15). A third paper found no statistically significant difference in the length of time that patients were sedated within a target zone (P=0.445). Two additional pilot studies did not report P values as they were insufficiently statistically powered. A final paper found that, of the eight occasions measured, patients on dexmedetomidine were more often within the target sedation range than patients on midazolam. The sedative benefits of dexmedetomidine vs midazolam remain inconclusive. While some secondary outcomes showed clinical effectiveness of dexmedetomidine, more research is needed to validate the findings of these studies. [ABSTRACT FROM AUTHOR]

Rising feed costs and recurring feed shortages necessitate the investigation into alternative and underutilized feed resources. Nutritional characteristics of Juniperus species are either unknown or limited to leaves and ground material from small stems. Therefore, the objective was to quantify nutritional characteristics, 48-h true IVDMD (tIVDMD), microbial gas production, and secondary compound characteristics of entire woody plant material of 4 Juniperus species-- Juniperus pinchotii, Juniperus monosperma, Juniperus ashei, and Juniperus virginiana--at immature and mature stages of growth. Immature plants had greater CP concentrations and lower NDF concentrations (P < 0.001) than mature plants regardless of species. Mature plants also had greater (P < 0.001) concentrations of ADF compared with immature plants with the exception of J. virginiana. In general, immature J. pinchotii, J. monosperma, and J. ashei had greater (P < 0.02) tIVDMD and total 48-h and asymptotic gas production than mature plants. Immature J. monosperma and J. pinchotii plants were more digested (tIVDMD; P < 0.001) than immature J. virginiana and J. ashei, but tIVDMD did not differ in mature plant material across species. Condensed tannins (CT) were greater (P < 0.001) in immature J. pinchotii and J. ashei than mature plants; differences in CT concentrations among immature species were also detected (P < 0.04). Volatile oil yields were similar across maturity and species with 1 exception: immature J. pinchotii yielded more (P < 0.02) volatile oil than mature material. Volatile oil composition across species varied and contained a range of 65 to 70 terpene compounds. The dominant terpenes across species were generally greater (P < 0.05) in immature vs. mature plant material with the exception of J. virginiana. Labdane acids were negligible in J. pinchotii, J. ashei, and J. virginiana and greater in J. monosperma (P < 0.001). Ground material from mature juniper species, although inferior in nutritional quality compared with immature plants, is comparable to traditional lowquality roughage ingredients. Given that J. pinchotii has been successfully fed in lamb feedlot diets, the similarities of J. pinchotii, J. ashei and J. monosperma suggest that all three species have potential to be effective roughage ingredients. [ABSTRACT FROM AUTHOR]

Background Recent evidence has suggested an association between postoperative non-steroidal anti-inflammatory drugs ( NSAIDs) and increased operation-specific complications. This study aimed to determine the safety profile following gastrointestinal surgery across a multicentre setting in the UK. Methods This multicentre study was carried out during a 2-week interval in September-October 2013. Consecutive adults undergoing elective or emergency gastrointestinal resection were included. The study was powered to detect a 10 per cent increase in major complications (grade III-V according to the Dindo-Clavien classification). The effect of administration of NSAIDs on the day of surgery or the following 2 days was risk-adjusted using propensity score matching and multivariable logistic regression to produce adjusted odds ratios ( ORs). The type of NSAID and the dose were registered. Results Across 109 centres, early postoperative NSAIDs were administered to 242 (16·1 per cent) of 1503 patients. Complications occurred in 981 patients (65·3 per cent), which were major in 257 (17·1 per cent) and minor (Dindo-Clavien grade I- II) in 724 (48·2 per cent). Propensity score matching created well balanced groups. Treatment with NSAIDs was associated with a reduction in overall complications ( OR 0·72, 95 per cent confidence interval 0·52 to 0·99; P = 0·041). This effect predominately comprised a reduction in minor complications with high-dose NSAIDs ( OR 0·57, 0·39 to 0·89; P = 0·009). Conclusion Early use of NSAIDs is associated with a reduction in postoperative adverse events following major gastrointestinal surgery. [ABSTRACT FROM AUTHOR]

Effects of using ground redberry juniper and dried distillers grains with solubles (DDGS) in Rambouillet lamb (n = 45) feedlot diets on growth, blood serum, fecal, and wool characteristics were evaluated. In a randomized design study with 2 feeding periods (Period 1 = 64% concentrate diet, 35 d; Period 2 = 85% concentrate diet, 56 d), lambs were individually fed 5 isonitrogenous diets: a control diet (CNTL) that contained oat hay but not DDGS or juniper or DDGS-based diets in which 0 (OJUN), 33 (33JUN), 66 (66JUN), or 100% (100JUN) of the oat hay was replaced by juniper. During Period 1, lambs fed CNTL had greater (P <0.05) DMI and ADG and tended to have greater (P < 0.10) G:F than lambs fed OJUN or lambs fed DDGS-based diets. Lamb DMI, ADG, and G:F quadratically increased (P < 0.008) as juniper increased in the DDGS-based diets. During Period 2, lambs fed CNTL had greater (P < 0.05) DMI than lambs fed OJUN or lambs fed DDGS-based diets, but ADG was similar (P > 0.41). Compared to OJUN, lambs fed CNTL had similar (P = 0.12) G:F and tended to have less G:F (P = 0.07) than lambs fed DDGS-based diets. Among lambs fed DDGS-based diets, DMI was similar (P > 0.19), ADG increased linearly (P = 0.03), and G:F tended to decrease quadratically (P = 0.06) as juniper increased in the diet. Serum IGF-1, serum urea N (SUN), and fecal N were greater (P < 0.05) and serum Ca and P and fecal P were similar (P >0.13) for lambs fed CNTL vs. lambs fed DDGS-based diets (CNTL). Within lambs fed DDGS-based diets, SUN increased quadratically (P = 0.01) and fecal N increased linearly (P = 0.004), which can partially be attributed to increased dietary urea and condensed tannin intake. Most wool characteristics were not affected, but wool growth per kilogram of BW decreased quadratically (P = 0.04) as percentage of juniper increased in the DDGS-based diets. When evaluating the entire 91-d feeding trial, results indicated that replacing all of the ground oat hay with ground juniper leaves and stems in lamb growing and finishing diets is not detrimental to animal performance and that DDGS-based diets can reduce total feedlot costs, as compared to sorghum grain and cottonseed meal-based diets. However, compared to using juniper or oat hay as the sole roughage source, using both during the growing period (Period 1) enhanced growth performance and further reduced total feedlot costs. [ABSTRACT FROM AUTHOR]

ABSTRACT. The 2007 UK National Radiotherapy Advisory Group report indicated that the number and type of staff available is one of the ‘‘rate-limiting’’ steps in improving productivity in radiotherapy departments. Retaining well-trained, satisfied staff is key to meeting the objectives of the report; burnout is an important factor linked to satisfaction and attrition. The results of a survey measuring burnout in a sample of radiotherapists (therapy radiographers) are presented and considered against norms for the health sector and burnout in therapists from Canada and the USA. Case study methodology was used studying six radiotherapy departments selected because of close geographical proximity and differing vacancy rates for radiotherapists. An anonymous survey of radiotherapists used the Maslach Burnout Inventory (MBI) and other workforce-related measures (e.g. job satisfaction scales, measures of professional plateau, intentions to leave, job characteristics and demographic data); the results of the burnout questionnaire alone are presented in this paper. A total of 97 completed questionnaires were returned (representing a 28% response rate). The average score for emotional exhaustion was higher than the MBI norms, with 38% of respondents reporting emotional exhaustion (an element of burnout). The data presented support and validated a previous qualitative study, and highlighted key areas of concern requiring further study. A correlation between burnout and job dissatisfaction and intention to leave was identified; managers may want to consider encouraging role extension and good leadership qualities in treatment unit leaders to minimise the potential for burnout. [ABSTRACT FROM AUTHOR]

Objective: This pilot study investigates the role of assisted-freehand ultrasound (AFUSON) elasticity imaging of the breast in assessing the contour, size and area of 23 early breast cancers by making comparison of AFUSON with the equivalent B-mode ultrasound images and gold standard histopathology slides. Methods: The B-mode, AFUSON and digitised histopathology slides of three early breast cancers were compared for contour, size and area with histopathology scans. AFUSON features that corresponded to areas of known malignant change on the histopathology slides were regarded as diagnostic. These diagnostic criteria were then applied to the B-mode and AFUSON elasticity images of all 23 breast cancers in the pilot study without having the availability of the histopathology scans for reference. Corresponding diameters were measured and the results were compared with the equivalent measurements on the scans of the histology slides. The results were tabulated in histogram form. Diagnostic confidence levels were evaluated. Results: Size dimension accuracy increased from 66% using B-mode alone to 82% using combined B-mode and AFUSON elasticity images. Tumour area accuracy was also increased. A small number of cases had a striking visual similarity of shape on AFUSON elasticity scans and histopathology slides. Conclusion: In spite of the shortfalls in this study, AFUSON elasticity imaging was capable of acquiring some high-quality images that showed strong correlation between AFUSON elasticity and scans of histology slides. Further studies will be carried out to refine the technique and determine if it has a role in the diagnosis and management of breast cancer. [ABSTRACT FROM AUTHOR]

We present a comparison between Gaussian processes (GPs) and artificial neural networks (ANNs) as methods for determining photometric redshifts for galaxies, given training-set data. In particular, we compare their degradation in performance as the training-set size is degraded in ways which might be caused by the observational limitations of spectroscopy. Using publicly available regression codes, we find that performance with large, complete training sets is very similar, although the ANN achieves slightly smaller rms errors. Training sets with brighter magnitude limits than the test data do not strongly affect the performance of either algorithm, until the limits are so severe that they remove almost all of the high-redshift training objects. Similarly, the introduction of a plausible number (up to 10 per cent) of inaccurate redshifts into the training set has little effect on either method. However, if the size of the training set is reduced by random sampling, the rms errors of both methods increase, but they do so to a lesser extent and in a much smoother manner for the case of GP regression; for the example presentedannz has rms errors 20 per cent worse than GP regression in the small training-set limit. Also, when training objects are removed at redshifts , to simulate the effects of the ‘redshift desert’ of optical spectroscopy, the GP regression is successful at interpolating across the redshift gap, while the ANN suffers from strong bias for test objects in this redshift range. Overall, GP regression has attractive properties for photometric redshift estimation, particularly for deep, high-redshift surveys where it is difficult to obtain a large, complete training set. At present, unlike the ANN code, public GP regression codes do not take account of inhomogeneous measurement errors on the photometric data, and thus cannot estimate reliable uncertainties on the predicted redshifts. However, a better treatment of errors is in principle possible, and the promising results in this paper suggest that such improved GP algorithms should be pursued. [ABSTRACT FROM AUTHOR]

The article presents a study that aims to compare the outcomes of definitive chemoradiotherapy (dCRT), surgery alone, and neoadjuvant chemotherapy followed by surgery (CS) in oesophageal cancer patients. It notes that the research considered the tumour type, disease stage, age, and sex of patients. Its findings showed that 173 patients out of 417 had dCRT, 126 underwent surgery alone, and 118 received CS. Moreover, the results indicated a need for randomized trial of dCRT and surgery alone.

Aims: To quantify and derive statistical relationships with which to predict the delivery of faecal bacteria (Escherichia coil) to a pastoral stream, by overland flow. Methods and Results: A large-scale (1050 m²) rainfall simulator, located upon a steep (18°) grazed hillside in New Zealand, was used to simulate 11 heavy rainfall events. Overland flow was generated and sampled throughout each event, before discharging to a headwater stream. The samples were subsequently analysed to determine the concentration of E. coil. Statistical analysis showed that the time elapsed since the last period of grazing was a statistically significant predictor of both the total number (load) and concentrations of E. coil in overland flow. Between 105 and 108 E. coil per m² of hillside were delivered to the stream within overland flow during each event, and peak concentrations ranged between 10³ and 107 most probable number per 100 ml. Conclusions: Under heavy rainfall on steep pastoral land, overland flow can transport substantial levels of faecal bacteria to streams. Under such conditions, it is unlikely that vegetated buffer strips will be particularly effective at attenuating bacteria within overland flow. Significance and Impact of the Study: This work has improved understanding of the importance of overland flow as a process contributing to the contamination of pastoral streams by faecal bacteria. In addition, the predictive relationships derived can be incorporated within catchment models. [ABSTRACT FROM AUTHOR]

Background and Purpose. This study investigated whether the poor reliability of judgments of posteroantertior (PA) spinal stiffness is due to rater bias or is a consequence of raters each having individual concepts of PA stiffness. Subjects. Three pairs of manipulative physical therapists with a minimum of 5 years of experience took part in the study. Methods. The raters were required to make stiffness judgments of a series of metal springs, and their performance at this task was compared with that obtained when they rated the PA stiffness of patients with low back pain. A range of reliability indices were calculated and evaluated to establish whether rater bias contributed to poor reliability in either task. The relationship between each rater's estimates of the magnitude of the stimuli and the measured stiffness of the springs was also assessed using the Pearson Product-Moment Correlation Coefficient Results. The average intraclass correlation coefficient (2,1) for rating spring stiffness was found to be .60, whereas for human spines it was found to be .19. There was no evidence of rater bias contributing to poor reliability for rating stiffness of human spines. The average correlation between the rater's estimates of the magnitude of the stimuli and the measured stiffness of the stimuli was .80. Conclusion and Discussion. Physical therapists demonstrated much better ability to judge spring stiffness than the PA stiffness of human spines. This difference in performance implies that mechanical stiffness is not equivalent to the clinical concept of PA stiffness. Posteroanterior stiffness may have more than one dimension, and individual interpretation of stiffness as a construct may lead to rater disagreement in the clinic. The reliability of judgments of PA spinal stiffness may be enhanced in the future if its dimensions can be identified, defined, and taken into account during clinical procedures. [ABSTRACT FROM AUTHOR]

The inhalation of hazardous concentrations of fresh brown cadmium oxide fume that can occur in a confined space or with inadequate ventilation may give rise to acute pulmonary damage which may be fatal after a single exposure. A Special Short Exposure Limit (SSEL) is given for this fume. Long term exposure to cadmium dust or fume may give rise to shortness of breath, due to permanent lung damage, or to kidney damage characterised by renal tubular dysfunction. Current knowledge about the toxic effects of cadmium that have been observed in cadmium exposed workers is reviewed in the light of the actions of cadmium on the mammalian body. Recommendations are made for the type and frequency of medical surveillance on workers exposed to cadmium as well as for the techniques for measuring exposure. A hygiene standard is recommended of 0.05 mg cadmium/m for the respirable fraction of all cadmium compounds and, for that portion of tha total dust sample which is soluble in 0.1 N hydrochloric acid, the level shall not exceed 0.2 mg cadmium/m. [ABSTRACT FROM PUBLISHER]

BACKGROUND AND PURPOSE: The reliability and criterion-related validity of ratings of posteroanterior (PA) spinal stiffness made using reference values for comparison have not been investigated. In this study, mechanical reference stimuli for points on an 11-point rating scale were used to determine whether using a reference scale may be feasible. Subjects. Five different raters took part in 2 studies in which they rated 40 subjects who were asymptomatic for low back pain. METHODS: The interrater reliability of ratings was evaluated with intraclass correlation coefficients (ICCs) and standard errors of the measurement (SEMs). Criterion-related validity was evaluated by correlating judgments of PA spinal stiffness assessed manually with measurements of PA spinal stiffness provided by a mechanical device, the 'Stiffness Assessment Machine' (SAM). RESULTS: Although the reliability indices were generally high, with ICCs reaching .77 and with SEMs as low as 0.72 points, the evidence for criterion-related validity (i.e., the ability of the examiner to judge spinal stiffness levels) was not strong, with correlations reaching only .56. CONCLUSIONS AND DISCUSSION: The reference-based protocol allows for more reliable measures of PA stiffness judgments than previous protocols have; however, the human ratings are not highly correlated with the SAM measures. The protocol will have clinical value if judgments made using it are shown to be reliable in clinically relevant subjects and to have validity for clinical management of patients. [ABSTRACT FROM AUTHOR]

A monolayer of mature polarized colonic epithelial cells (T84) able to generate and maintain a barrier to macromolecular flow was used to study pathophysiologic events that occur on microvillus cell exposure to Cryptosporidium parvum. By 24–48 h, several life cycle forms were seen in parasitophorous vacuoles near the apical cell surface, along with a time- and oocyst dose-dependent reduction in epithelial barrier function. As few as 105 organisms constituted a successful infecting dose, and heat inactivation of organisms markedly reduced the monolayer barrier alteration. Horseradish peroxidase flux studies demonstrated a substantial increase in macromolecular permeability of the monolayer, and lactate dehydrogenase determinations indicated modest injury of the T84 epithelial cells on exposure to oocysts. Thus, disruption of the epithelial cell barrier, not just opening of trans cellular channels for ion flow as reported previously, is responsible for the effects of C. parvum oocysts on intestinal epithelium. [ABSTRACT FROM PUBLISHER]

Three hydrographic sections running east from the coast of Shetland into the central northern North Sea have been surveyed since 1989. These sections cross the East Shetland Atlantic Inflow, which is one of the three northerly oceanic inflows to the North Sea. The East Shetland Atlantic Inflow has previously been discounted as of great importance to the hydrography and ecology of the North Sea. However, results from the hydrographic sections, current meter deployments and acoustic Doppler current profiler surveys reveal that the current is a persistent feature of North Sea circulation during the summer months. This inflow may form the western boundary of a cyclonic gyre in the bottom waters east of Shetland. When considering the ecological significance of the inflow it is evident that there have been substantial changes in the salinity of the northern North Sea, and of the adjacent oceanic waters during the past decades. A 20-year record of hydrographic parameters along the standard JONSIS section (59°17′N) suggests that these changes are related to decadal variability of the two western North Sea inflows; the Fair Isle Current and the ESAI. These changes are in turn related to changes in the oceanic waters at the entrance to the North Sea, as demonstrated by long-term time series generated from two standard sections in the Faroe–Shetland Channel. It is directly via the ESAI, and indirectly via the Fair Isle Current, that oceanic variability is communicated to the North Sea. [ABSTRACT FROM PUBLISHER]

The article presents a case study of a 65-year-old female who undergo routine screening mammogram and discovered a new lump in her right breast and a mild tender nodularity in both breasts occurred. She was diagnosed for assessment by the neurological team and giant cell arteritis (GCA) has been discovered. It mentions information on GCA such as it affects subclavian and cartodid arteries and the two artieries in the breast, aorta and femoropopliteal arteries.

Presents letters to the editor regarding several publications. Details of compilation of "The College Graces of Oxford and Cambridge"; Source of a quotation by Sir Arthur Quiller Couch; Need for books with the bookplate of Josiah Wedgwood and Thomas Bentley.

This study investigated the magnitude and rate of age-associated strength reductions in Australian independent urban-dwelling women and the relationship to muscle groups, limb dominance, and physical activity level. Independent urban-dwelling women aged 20 to 89 years (N = 217) performed maximal voluntary contractions with the dominant and nondominant knee extensors, plantar flexors, and handgrip. Anthropometric measurements were made and questionnaire responses used to obtain current physical activity levels. Trend analysis within analysis of variance and regression analysis on strength was performed. Limb muscle strength was found to be associated with increased age, muscle group, limb dominance, and activity. Self-reported physical activity levels declined with age but women who were more physically active for their age group were stronger in all muscle groups and had more lean body mass and lean thigh and leg cross-sectional area than relatively inactive women. Slopes of the linear reductions of maximal voluntary strength of the knee extensors, plantar flexors, and handgrip with age were significantly different (p < .05) at 9.3%, 7.4%, and 6.2% per decade, respectively. The limb muscle strength of healthy Australian independent and urban-dwelling women aged 20 to 89 years was found to be associated with age and three aspects of disuse: muscle group, relative levels of physical activity, and limb dominance. [ABSTRACT FROM AUTHOR]