Commonwealth collaboration in foreign affairs, 1939-1947 : the British perspective

This thesis studies the modes of collaboration between the members of the British Commonwealth in foreign affairs, with particular emphasis on the United Kingdom's methods of keeping the other members informed and ascertaining their views. It is not an attempt at a comprehensive survey of the foreign relations of the U. K. or the individual Dominions, but is designed as a study of the attitudes towards collaboration over the span of nearly a decade, using specific examples of successful or deficient collaboration to illustrate the policy of the U. K. and its response to the attitudes of its partners. The first chapter takes the form of a survey of Commonwealth relations in the late 1930s. The second chapter considers Commonwealth collaboration during the first five years of the war, with special attention to two aspects; the transmission of information to the Dominions and their participation in the higher direction of the war. The next chapter, concentrates on the U. K.'s plans for the post-war period, specifically the representation of the association internationally and the F. O.'s consideration of methods by which the U. K. could increase contacts between the member countries. In the fourth chapter attention is given to the policies of the Dominion Governments and their plans for the Commonwealth after the war, both in terms of the international position of the Commonwealth and their individual association with it. Chapter five studies the only war-time Prime Ministers' Meeting, in 1944, at which the member states discussed the establishment of the proposed world organisation and the Commonwealth's association with it, and measures to improve collaboraton within the Commonwealth. Chapter six considers the degree of harmony in the policies of the member countries on some important aspects of international policy, such as the, Great Power veto or the position of 'middle' ranking states within the U. N. The dual role of the U.K. as a member of the Commonwealth and of the Great Power elite is also studied with a view to assessing the compatibility of these two. The next chapter considers the U. K. 's attempts to promote close collaboration at the various international conferences between 1944 and 1946 and the efforts made to produce a bonsensus on policy. The 1945 San Francisco Conference is looked at in particular detail to demonstrate the contact which took place between Commonwealth Ministers and officials. In chapter eight three examples of collaboration on aspects of U. K. policy - the-1946 Anglo-Egyptian Treaty and the re-negotiation of the treaties with France and the U. S. S. R. in the same year - are studied as examples of problems which remained in Commonwealth collaboration in the, post=war. The latter two illustrate the importance of the U. K. 's attitude with regard to transmitting information in advance of policy decisions, and the difficulties entailed by the divergence in Dominion attitudes. Consideration is also given to the role of the Dominion High Commissioners in London, in terms of the information provided for them and their status within the diplomatic community. Finally, chapter nine looks ahead to the expansion of the Commonwealth and the key position of India. This does not involve a study of Anglo-Indian relations, or the U. K. 's policy in granting, India independence. It considers three issues raised by the independence of India and the question of its future association with the Commonwealth: first, the effect on the U. K. 's policy of transmitting information to fellow members; secondly, the stimulus which India's new status provided for the r. 0. to reconsider its position in relation to Commonwealth liaison; thirdly, the discussions which were prompted about the fundamental basis of the Commonwealth relationship and the feasibility of permitting a republican state to be a member

Nursing Roles and Strategies in End-of-Life Decision Making in Acute Care: A Systematic Review of the Literature

The objective of this paper is to analyze the literature concerning nurses' roles and strategies in EOL decision making in acute care environments, synthesize the findings, and identify implications for future research. We conducted searches in CINAHL and PubMed, using a broad range of terms. The 44 articles retained for review had quantitative and qualitative designs and represented ten countries. These articles were entered into a matrix to facilitate examining patterns, themes, and relationships across studies. Three nursing roles emerged from the synthesis of the literature: information broker, supporter, and advocate, each with a set of strategies nurses use to enact the roles. Empirical evidence linking these nursing roles and strategies to patients and family members outcomes is lacking. Understanding how these strategies and activities are effective in helping patients and families make EOL decisions is an area for future research

Life course dietary patterns and bone health in later life in a British birth cohort study

Evidence for the contribution of individual foods and nutrients to bone health is weak. Few studies have considered hypothesis-based dietary patterns and bone health. We investigated whether a protein, calcium and potassium-rich (PrCaK-rich) dietary pattern over the adult life course, was positively associated with bone outcomes at 60-64 years of age. Diet diaries were collected at ages 36, 46, 53 and 60-64 years in 1263 participants (661 women) from the MRC National Survey of Health and Development. DXA and pQCT measurements were obtained at 60-64y, including size-adjusted bone mineral content (SA-BMC) and volumetric bone mineral density (vBMD). A food-based dietary pattern best explaining dietary calcium, potassium and protein intakes (g/1000?kcal) was identified using reduced rank regression. Dietary pattern z-scores were calculated for each individual, at each time point. Individual trajectories in dietary pattern z-scores were modelled to summarise changes in z-scores over the study period. Regression models examined associations between these trajectories and bone outcomes at 60-64y, adjusting for baseline dietary pattern z-score and other confounders. A consistent PrCaK-rich dietary pattern was identified within the population, over time. Mean [SD] dietary pattern z-scores at age 36 and 60-64 years were -0.32[0.97], 2.2[1.5] (women) and -0.35[0.98], 1.7[1.6] (men). Mean trajectory in dietary pattern z-scores [SD] was 0.07[0.02]SD units/year. Among women, a 0.02 SD unit/year higher trajectory in dietary pattern z-score over time was associated with higher SA-BMC (spine 1.40% [95% CI: 0.30,2.51]; hip 1.35% [95% CI: 0.48,2.23]) and vBMD (radius 1.81% [95% CI: 0.13,3.50]) at 60-64 y. No statistically significant associations were found in men. During adulthood, an increasing score for a dietary pattern rich in protein, calcium and potassium was associated with greater SA-BMC at fracture-prone sites in women. This study emphasises the importance of these nutrients, within the context of the whole diet, to bone healt

Randomised double blind placebo controlled trial investigating the effect of calcium and vitamin D supplementation on bone mineral density and bone metabolism in adult patients with cystic fibrosis

AbstractBackgroundLow bone mineral density (BMD) is prevalent in adults with cystic fibrosis and might be related to calcium and vitamin D malabsorption from the gastrointestinal tract. The aim of this study was to investigate the effect of calcium and vitamin D supplementation on BMD and bone metabolism in these subjects.MethodsPatients were invited to participate if they had a BMD Z score of −1 or less in the lumbar spine, proximal femur or distal forearm. Patients were randomised to receive calcium 1 g+vitamin D 800 IU or placebo daily, in addition to their regular vitamin D supplements (900 IU/day). BMD and bone biochemical markers were measured before and after 1 year of treatment.ResultsAfter 12 months, the treatment group (n=15) showed a reduced rate of bone loss compared with the control group (n=15) in the lumbar spine (mean difference 1.9% [CI −0.9% to 4.6%]), total hip (mean difference 0.7% [CI −2.2% to 3.5%]) and distal forearm (mean difference 1.7% [CI −2.2% to 5.5%]), but these changes did not reach statistical significance. There was also a trend towards a reduction in bone turnover in the treatment group.ConclusionsCalcium and vitamin D supplementation reduced the rate of bone turnover and bone loss in adult patients with cystic fibrosis, but these changes did not reach statistical significance. These data suggest that a longer term trial of this simple intervention would be justified

Genetic evidence for the most common risk factors for chronic axonal polyneuropathy in the general population

BACKGROUND AND PURPOSE: Chronic axonal polyneuropathy is a common disease, but the etiology remains only partially understood. Previous etiologic studies have identified clinical risk factors, but genetic evidence supporting causality between these factors and polyneuropathy are largely lacking. In this study, we investigate whether there is a genetic association of clinically established important risk factors (diabetes, body mass index [BMI], vitamin B12 levels, and alcohol intake) with chronic axonal polyneuropathy. METHODS: This study was performed within the population‐based Rotterdam Study and included 1565 participants (median age = 73.6 years, interquartile range = 64.6–78.8, 53.5% female), of whom 215 participants (13.7%) had polyneuropathy. Polygenic scores (PGSs) for diabetes, BMI, vitamin B12 levels, and alcohol intake were calculated at multiple significance thresholds based on published genome‐wide association studies. RESULTS: Higher PGSs of diabetes, BMI, and alcohol intake were associated with higher prevalence of chronic axonal polyneuropathy, whereas higher PGS of vitamin B12 levels was associated with lower prevalence of polyneuropathy. These effects were most pronounced for PGSs with lenient significance thresholds for diabetes and BMI (odds ratio [OR](diabetes, p < 1.0) = 1.21, 95% confidence interval [CI] = 1.05–1.39 and OR(BMI, p < 1.0) = 1.21, 95% CI = 1.04–1.41) and for the strictest significance thresholds for vitamin B12 level and alcohol intake (OR (vitamin B12, p < 5e‐6) = 0.79, 95% CI = 0.68–0.92 and OR(alcohol, p < 5e‐8) = 1.17, 95% CI = 1.02–1.35). We did not find an association between different PGSs and sural sensory nerve action potential amplitude, nor between individual lead variants of PGS (p ) (< 5e‐8) and polyneuropathy. CONCLUSIONS: This study provides evidence for polygenic associations of diabetes, BMI, vitamin B12 level, and alcohol intake with chronic axonal polyneuropathy. This supports the hypothesis of causal associations between well‐known clinical risk factors and polyneuropathy

Spitzer, Near-Infrared, and Submillimeter Imaging of the Relatively Sparse Young Cluster, Lynds 988e

We present {\it Spitzer} images of the relatively sparse, low luminosity young cluster L988e, as well as complementary near-infrared (NIR) and submillimeter images of the region. The cluster is asymmetric, with the western region of the cluster embedded within the molecular cloud, and the slightly less dense eastern region to the east of, and on the edge of, the molecular cloud. With these data, as well as with extant H$\alpha$ data of stars primarily found in the eastern region of the cluster, and a molecular $^{13}$CO gas emission map of the entire region, we investigate the distribution of forming young stars with respect to the cloud material, concentrating particularly on the differences and similarities between the exposed and embedded regions of the cluster. We also compare star formation in this region to that in denser, more luminous and more massive clusters already investigated in our comprehensive multi-wavelength study of young clusters within 1 kpc of the Sun.Comment: 21 pages, 6 tables, 13 figures. Full resolution figures at: http://astro.pas.rochester.edu/~tom/Preprints/L988e.pd

Alternative activation of macrophages by filarial nematodes is MyD88-independent

AbstractAlternative macrophage activation is largely defined by IL-4Rα stimulation but the contribution of Toll-like receptor (TLR) signaling to this phenotype is not currently known. We have investigated macrophage activation status under Th2 conditions in the absence of the core TLR adaptor molecule, MyD88. No impairment was observed in the ability of MyD88-deficient bone marrow derived macrophages to produce or express alternative activation markers, including arginase, RELM-α or Ym1, in response to IL-4 treatment in vitro. Further, we observed no difference in the ability of peritoneal exudate cells from nematode implanted wild type (WT) or MyD88-deficient mice to produce arginase or express the alternative activation markers RELM-α or Ym1. Therefore, MyD88 is not a fundamental requirement for Th2-driven macrophage alternative activation, either in vitro or in vivo

Motor development in infancy and spine shape in early old age: findings from a British birth cohort study

Spine shape changes dramatically in early life, influenced by attainment of developmental milestones such as independent walking. Whether these associations persist across life is unknown. Therefore, we investigated associations between developmental milestones and spine shape, as determined using statistical shape models (SSMs) of lumbar spine from DXA scans in 1327 individuals (688 female) at 60‐64y in the MRC National Survey of Health and Development. Lumbar lordosis angle (L4 inferior endplate to T12 superior endplate) was measured using the two‐line Cobb method. In analyses adjusted for sex, height, lean and fat mass, socioeconomic position and birthweight, later walking age was associated with greater lordosis described by SSM1 (regression coefficient 0.023, 95%CI 0.000‐0.047, p=0.05) and direct angle measurement. Modest associations between walking age and less variation in anterior‐posterior vertebral size caudally (SSM6) were also observed (0.021, 95%CI ‐0.002‐0.044, p=0.07). Sex interactions showed that later walking was associated with larger relative vertebral anterior‐posterior dimensions in men (SSM3; ‐0.043, 95%CI ‐0.075‐0.01, p=0.01) but not women (0.018, 95%CI ‐0.0007‐0.043, p=0.17). Similar associations were observed between age at independent standing and SSMs but there was little evidence of association between sitting age and spine shape. Unadjusted associations between walking age and SSMs 1 and 6 remained similar after adjustment for potential confounders and mediators. This suggests that these associations may be explained by altered mechanical loading of the spine during childhood growth, although other factors could contribute. Early life motor development, particularly walking, may have a lasting effect on features of spine morphology with clinical significance

Age at onset of walking in infancy is associated with hip shape in early old age

Bones' shapes and structures adapt to the muscle and reaction forces they experience during everyday movements. Onset of independent walking, at approximately 12 months, represents the first postnatal exposure of the lower limbs to the large forces associated with bipedal movements, and, accordingly, earlier walking is associated with greater bone strength. However, associations between early life loading and joint shape have not been explored. We therefore examined associations between walking age and hip shape at age 60-64y in 1423 individuals (740 women) from the MRC National Survey of Health and Development, a nationally-representative British birth cohort. Walking age in months was obtained from maternal interview at age 2y. Ten modes of variation in hip shape (HM1-HM10), described by statistical shape models, were ascertained from dual-energy X-ray absorptiometry (DXA) images. In sex-adjusted analyses, earlier walking age was associated with higher HM1 and HM7 scores; these associations were maintained after further adjustment for height, body composition and socioeconomic position. Earlier walking was also associated with lower HM2 scores in women only, and lower HM4 scores in men only. Taken together, this suggests that earlier walkers have proportionately larger (HM4) and flatter (HM1,4) femoral heads, wider (HM1,4,7) and flatter (HM1, 7) femoral necks, smaller neck-shaft angle (HM1,4), anteversion (HM2,7) and development of osteophytes (HM1). These results suggest that age at onset of walking in infancy is associated with variations in hip shape in older age. Early walkers have a larger femoral head and neck and smaller neck-shaft angle; these features are associated with reduced hip fracture risk, but also represent an osteoarthritic-like phenotype. Unlike results of previous studies of walking age and bone mass, associations in this study were not affected by adjustment for lean mass suggesting that associations may relate directly to skeletal loading in early life when joint shape changes rapidly. This article is protected by copyright. All rights reserved.</p

Active vitamin D (1,25-dihydroxyvitamin D) and bone health in middle-aged and elderly men: the European male aging study (EMAS)

&lt;p&gt;Context: There is little information on the potential impact of serum 1,25-dihydroxyvitamin D [1,25(OH)2D] on bone health including turnover.&lt;/p&gt; &lt;p&gt;Objective: The objective of the study was to determine the influence of 1,25(OH)2D and 25-hydroxyvitamin D [25(OH)D] on bone health in middle-aged and older European men.&lt;/p&gt; &lt;p&gt;Design, Setting, and Participants: Men aged 40–79 years were recruited from population registers in 8 European centers. Subjects completed questionnaires that included questions concerning lifestyle and were invited to attend for quantitative ultrasound (QUS) of the heel, assessment of height and weight, and a fasting blood sample from which 1,25(OH)2D, 25(OH)D, and PTH were measured. 1,25(OH)2D was measured using liquid chromatography tandem mass spectrometry. Bone markers serum N-terminal propeptide of type 1 procollagen (P1NP) and crosslinks (β-cTX) were also measured. Dual-energy x-ray absorptiometry (DXA) of the hip and lumbar spine was performed in 2 centers.&lt;/p&gt; &lt;p&gt;Main Outcome Measure(s): QUS of the heel, bone markers P1NP and β-cTX, and DXA of the hip and lumbar spine were measured.&lt;/p&gt; &lt;p&gt;Results: A total of 2783 men, mean age 60.0 years (SD 11.0) were included in the analysis. After adjustment for age and center, 1,25(OH)2D was positively associated with 25(OH)D but not with PTH. 25(OH)D was negatively associated with PTH. After adjustment for age, center, height, weight, lifestyle factors, and season, 1,25(OH)2D was associated negatively with QUS and DXA parameters and associated positively with β-cTX. 1,25(OH)2D was not correlated with P1NP. 25(OH)D was positively associated with the QUS and DXA parameters but not related to either bone turnover marker. Subjects with both high 1,25(OH)2D (upper tertile) and low 25(OH)D (lower tertile) had the lowest QUS and DXA parameters and the highest β-cTX levels.&lt;/p&gt; &lt;p&gt;Conclusions: Serum 1,25(OH)2D is associated with higher bone turnover and poorer bone health despite being positively related to 25(OH)D. A combination of high 1,25(OH)2D and low 25(OH)D is associated with the poorest bone health.&lt;/p&gt