A Case of Carcinoid Heart Disease and Echocardiographic Findings

Abstract: Carcinoid heart disease occurs in approximately 50% of patients with carcinoid syndrome. Right heart involvement resulting in tricuspid regurgitation, tricuspid stenosis, pulmonic regurgitation and pulmonic stenosis is most common. We report a case of tricuspid heart disease resulting in tricuspid regurgitation, tricuspid stenosis, pulmonic regurgitation and pulmonic stenosis

Vitamin K2 (menaquinone) Supplementation and its Benefits in Cardiovascular Disease, Osteoporosis, and Cancer

Vitamin K is known to play an essential role in the coagulation cascade; however, a growing body of research has found that a subtype of this vitamin, vitamin K2 (menaquinone) may have a beneficial effect in osteoporosis, cardiovascular disease, and cancer. This purpose of this article is to provide a comprehensive review of recent literature regarding menaquinone and its role in human health. This review discusses the physiology of menaquinone, its clinical benefits in cardiovascular disease, osteoporosis, and cancer, and how it may interact with certain medications. The authors conclude that menaquinone supplementation has been shown to improve carboxylation of osteocalcin and matrix-Gla protein to their active forms, two proteins that possess important roles in calcium distribution. In the setting of cardiovascular disease, menaquinone intake has been shown to lower the risk of coronary calcification and coronary heart disease, and a randomized controlled trial has demonstrated that it can reduce arterial stiffness. In osteoporosis, menaquinone has been shown by numerous randomized controlled trials to decrease the rate of bone loss at the lumbar spine and forearm and reduce the risk of fracture. In cancer, menaquinone intake has been shown to reduce overall incidence and mortality; clinical trials have suggested that it may have a role in reducing recurrence and death from hepatocellular carcinoma. However, in all clinical settings, more large randomized controlled trials are needed to definitively determine the clinical benefits of menaquinone supplementation, as many studies have failed to show any significant benefit. Lastly, more research is needed to determine how menaquinone supplementation interacts with medications such as warfarin, bile-acid sequestrants, orlistat, mineral oil and CYP3A4 substrates

High Temperature Microwave Dielectric Properties of JSC-1AC Lunar Simulant

Microwave heating has many potential lunar applications including sintering regolith for lunar surface stabilization and heating regolith for various oxygen production reactors. The microwave properties of lunar simulants must be understood so this technology can be applied to lunar operations. Dielectric properties at microwave frequencies for a common lunar simulant, JSC-1AC, were measured up to 1100 C, which is approximately the melting point. The experimentally determined dielectric properties included real and imaginary permittivity (epsilon', epsilon"), loss tangent (tan delta), and half-power depth, the di stance at which a material absorbs 50% of incident microwave energy. Measurements at 2.45 GHz revealed tan delta of JSC-1A increases from 0.02 at 25 C to 0.31 at 110 C. The corresponding half-power depth decreases from a peak of 286 mm at 110 C, to 13 mm at 1100 C. These data indicate that JSC-1AC becomes more absorbing, and thus a better microwave heater as temperature increases. A half-power depth maximum at 100-200 C presents a barrier to direct microwave heating at low temperatures. Microwave heating experiments confirm the sluggish heating effect of weak absorption below 200 C, and increasingly strong absorption above 200 C, leading to rapid heating and melting of JSC-1AC

Determining Quasar Black Hole Mass Functions from their Broad Emission Lines: Application to the Bright Quasar Survey

We describe a Bayesian approach to estimating quasar black hole mass functions (BHMF) when using the broad emission lines to estimate black hole mass. We show how using the broad line mass estimates in combination with statistical techniques developed for luminosity function estimation leads to statistically biased results. We derive the likelihood function for the BHMF based on the broad line mass estimates, and derive the posterior distribution for the BHMF, given the observed data. We develop our statistical approach for a flexible model where the BHMF is modelled as a mixture of Gaussian functions. Statistical inference is performed using markov chain monte carlo (MCMC) methods. Our method has the advantage that it is able to constrain the BHMF even beyond the survey detection limits at the adopted confidence level, accounts for measurement errors and the intrinsic uncertainty in broad line mass estimates, and provides a natural way of estimating the probability distribution of any quantities derived from the BHMF. We conclude by using our method to estimate the local active BHMF using the z < 0.5 Bright Quasar Survey sources. At z = 0.2, the quasar BHMF falls off approximately as a power law with slope ~ 2 for M_{BH} > 10^8. Our analysis implies that z < 0.5 broad line quasars have a typical Eddington ratio of ~ 0.4 and a dispersion in Eddington ratio of < 0.5 dex (abridged).Comment: 25 pages, 14 figures, emulate ApJ style, accepted by Ap

Peptide YY (PYY) Is Expressed in Human Skeletal Muscle Tissue and Expanding Human Muscle Progenitor Cells

Peptide YY (PYY) is considered a gut peptide with roles in post-prandial appetite and glucose regulation. Circulating PYY protein levels increase during aerobic exercise. Furthermore, people who have greater increases in muscle progenitor cells (hMPCs), the adult stem cell population responsible for skeletal muscle (SkM) repair, after resistance training have higher PYY transcript levels in SkM prior to training. Currently, examination of PYY expression patterns in SkM and/or hMPCs is lacking. Our objective was to identify the expression patterns of PYY in SkM and hMPCs. PYY and the associated Y receptors were analyzed in SkM biopsy tissue and cultured hMPCs from young and old human participants. Additional experiments to assess the role and regulation of PYY in hMPCs were performed. In SkM, PYY and one of the three Y receptors (Y1r) were detectable, but expression patterns were not affected by age. In expanding hMPCs, PYY and all three Y receptor (Y1r, Y2r, and Y5r) proteins were expressed in a temporal fashion with young hMPCs having greater levels of Y receptors at various time points. Exogenous PYY did not affect hMPC population expansion. hMPC PYY levels increased following the metabolic stimulus, 5-Aminoimidazole-4-carboxamide ribonucleotide (AICAR), but were not affected by the inflammatory stimulus, tumor necrosis factor alpha (TNFα). In conclusion, PYY and Y receptor expression are not impacted by age in SkM tissue but are reduced in old vs. young expanding hMPCs. Furthermore, endogenous PYY production is stimulated by low energy states and thus may be integral for skeletal muscle and hMPC responses to metabolic stimuli

The Demographics of Broad Line Quasars in the Mass-Luminosity Plane II. Black Hole Mass and Eddington Ratio Functions

We employ a flexible Bayesian technique to estimate the black hole mass and Eddington ratio functions for Type 1 (i.e., broad line) quasars from a uniformly-selected data set of ~58,000 quasars from the SDSS DR7. We find that the SDSS becomes significantly incomplete at M_{BH} < 3 x 10^8 M_{Sun} or L / L_{Edd} < 0.07, and that the number densities of Type 1 quasars continue to increase down to these limits. Both the mass and Eddington ratio functions show evidence of downsizing, with the most massive and highest Eddington ratio black holes experiencing Type 1 quasar phases first, although the Eddington ratio number densities are flat at z < 2. We estimate the maximum Eddington ratio of Type 1 quasars in the observable Universe to be L / L_{Edd} ~ 3. Consistent with our results in Paper I, we do not find statistical evidence for a so-called "sub-Eddington boundary" in the mass-luminosity plane of broad line quasars, and demonstrate that such an apparent boundary in the observed distribution can be caused by selection effect and errors in virial BH mass estimates. Based on the typical Eddington ratio in a given mass bin, we estimate typical growth times for the black holes in Type 1 quasars and find that they are typically comparable to or longer than the age of the universe, implying an earlier phase of accelerated (i.e., with higher Eddington ratios) and possibly obscured growth. The large masses probed by our sample imply that most of our black holes reside in what are locally early type galaxies, and we interpret our results within the context of models of self-regulated black hole growth.Comment: Submitted to ApJ, 25 pages (emulateapj), 15 figures; revised to match accepted version with primary changes to the introduction and discussion, replaced Fig 1

Changing behaviour: Increasing the effectiveness of workplace interventions in creating pro-environmental behaviour change

There is a great deal of research outlining interventions to increase pro-environmental behaviour, many of which are aimed at employees. However, to date the results for these have not lived up to their initial promise. Instead of offering another intervention, we propose a model which identifies psychological conditions under which these interventions are most likely to succeed. Through the integration of previously separate literatures from experimental social psychology, organisational psychology, organisational behaviour and environmental psychology, we suggest that the degree to which the intervention-related goal is efficacious and attractive, self-concordant, in conflict with other goals, and perceived to be completed will affect the level and type of behaviour change. Our model aims to provide actionable knowledge that extends our understanding of the effectiveness of workplace interventions designed to increase green organisational behaviour

Balanced translocation linked to psychiatric disorder, glutamate and cortical structure/function

Rare genetic variants of large effect can help elucidate the pathophysiology of brain disorders. Here we expand the clinical and genetic analyses of a family with a (1;11)(q42;q14.3) translocation multiply affected by major psychiatric illness and test the effect of the translocation on the structure and function of prefrontal, and temporal brain regions. The translocation showed significant linkage (LOD score 6.1) with a clinical phenotype that included schizophrenia, schizoaffective disorder, bipolar disorder, and recurrent major depressive disorder. Translocation carriers showed reduced cortical thickness in the left temporal lobe, which correlated with general psychopathology and positive psychotic symptom severity. They showed reduced gyrification in prefrontal cortex, which correlated with general psychopathology severity. Translocation carriers also showed significantly increased activation in the caudate nucleus on increasing verbal working memory load, as well as statistically significant reductions in the right dorsolateral prefrontal cortex glutamate concentrations. These findings confirm that the t(1;11) translocation is associated with a significantly increased risk of major psychiatric disorder and suggest a general vulnerability to psychopathology through altered cortical structure and function, and decreased glutamate levels

BRITICE Glacial Map, version 2: a map and GIS database of glacial landforms of the last British-Irish Ice Sheet

During the last glaciation, most of the British Isles and the surrounding continental shelf were covered by the British–Irish Ice Sheet (BIIS). An earlier compilation from the existing literature (BRITICE version 1) assembled the relevant glacial geomorphological evidence into a freely available GIS geodatabase and map (Clark et al. 2004: Boreas 33, 359). New high-resolution digital elevation models, of the land and seabed, have become available casting the glacial landform record of the British Isles in a new light and highlighting the shortcomings of the V.1 BRITICE compilation. Here we present a wholesale revision of the evidence, onshore and offshore, to produce BRITICE version 2, which now also includes Ireland. All published geomorphological evidence pertinent to the behaviour of the ice sheet is included, up to the census date of December 2015. The revised GIS database contains over 170 000 geospatially referenced and attributed elements – an eightfold increase in information from the previous version. The compiled data include: drumlins, ribbed moraine, crag-and-tails, mega-scale glacial lineations, glacially streamlined bedrock (grooves, roches moutonnées, whalebacks), glacial erratics, eskers, meltwater channels (subglacial, lateral, proglacial and tunnel valleys), moraines, trimlines, cirques, trough-mouth fans and evidence defining ice-dammed lakes. The increased volume of features necessitates different map/database products with varying levels of data generalization, namely: (i) an unfiltered GIS database containing all mapping; (ii) a filtered GIS database, resolving data conflicts and with edits to improve geo-locational accuracy (available as GIS data and PDF maps); and (iii) a cartographically generalized map to provide an overview of the distribution and types of features at the ice-sheet scale that can be printed at A0 paper size at a 1:1 250 000 scale. All GIS data, the maps (as PDFs) and a bibliography of all published sources are available for download from: https://www.sheffield.ac.uk/geography/staff/clark_chris/britice

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

BackgroundExposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.ObjectivesTo synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.Design(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis (NMA) of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.SettingsNorth America (11), the Netherlands (1) and Israel (1) for the systematic review of controlled trials of interventions; the USA (4) and the UK (1) for the systematic review of qualitative studies of participant and professional experience of interventions; and the UK for the overview of current UK provision of interventions and consultations with young people, parents, service providers and commissioners.ParticipantsA total of 1345 children for the systematic review of controlled trials of interventions; 100 children, 202 parents and 39 professionals for the systematic review of qualitative studies of participant and professional experience of interventions; and 16 young people, six parents and 20 service providers and commissioners for the consultation with young people, parents, service providers and commissioners.InterventionsPsychotherapeutic, advocacy, parenting skills and advocacy, psychoeducation, psychoeducation and advocacy, guided self-help.Main outcome measuresInternalising symptoms and externalising behaviour, mood, depression symptoms and diagnosis, post-traumatic stress disorder symptoms and self-esteem for the systematic review of controlled trials of interventions and NMA; views about and experience of interventions for the systematic review of qualitative studies of participant and professional experience of interventions and consultations.Data sourcesMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, Social Care Online, Sociological Abstracts, Social Science Citation Index, World Health Organization trials portal and clinicaltrials.gov.Review methodsA narrative review; a NMA and incremental cost-effectiveness analysis; and a qualitative synthesis.ResultsThe evidence base on targeted interventions was small, with limited settings and types of interventions; children were mostly &lt; 14 years of age, and there was an absence of comparative studies. The interventions evaluated in trials were mostly psychotherapeutic and psychoeducational interventions delivered to the non-abusive parent and child, usually based on the child’s exposure to DVA (not specific clinical or broader social needs). Qualitative studies largely focused on psychoeducational interventions, some of which included the abusive parent. The evidence for clinical effectiveness was as follows: 11 trials reported improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes. In terms of evidence of cost-effectiveness, there were no economic studies of interventions. Cost-effectiveness was modelled on the basis of the NMA, estimating differences between types of interventions. The outcomes measured in trials were largely confined to children’s mental health and behavioural symptoms and disorders, although stakeholders’ concepts of success were broader, suggesting that a broader range of outcomes should be measured in trials. Group-based psychoeducational interventions delivered to children and non-abusive parents in parallel were largely acceptable to all stakeholders. There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.ConclusionsThe evidence base regarding the acceptability, clinical effectiveness and cost-effectiveness of interventions to improve outcomes for children exposed to DVA is underdeveloped. There is an urgent need for more high-quality studies, particularly trials, that are designed to produce actionable, generalisable findings that can be implemented in real-world settings and that can inform decisions about which interventions to commission and scale. We suggest that there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes. With regard to the UK, we have identified three types of programme that could be justifiably prioritised for further study: psycho-education delivered to mothers and children, or children alone; parent skills training in combination with advocacy: and interventions involving the abusive parent/caregiver. We also suggest that there is need for key stakeholders to come together to explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date.Future work recommendationsThere is a need for well-designed, well-conducted and well-reported UK-based randomised controlled trials with cost-effectiveness analyses and nested qualitative studies. Development of consensus in the field about core outcome data sets is required. There is a need for further exploration of the acceptability and effectiveness of interventions for specific groups of children and young people (i.e. based on ethnicity, age, trauma exposure and clinical profile). There is also a need for an investigation of the context in which interventions are delivered, including organisational setting and the broader community context, and the evaluation of qualities, qualifications and disciplines of personnel delivering interventions. We recommend prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials, and exploratory trials of interventions that engage both the abusive and the non-abusive parent.Study registrationThis study is registered as PROSPERO CRD42013004348 and PROSPERO CRD420130043489.FundingThe National Institute for Health Research Public Health Research programme.</jats:sec