Association between low functional health literacy and mortality in older adults: longitudinal cohort study

Objective To investigate the association between low functional health literacy (ability to read and understand basic health related information) and mortality in older adults

The pictorial wit of Domenico Tiepolo

This thesis takes a new approach to Domenico Tiepolo’s (1727-1804), Divertimento Per li Regazzi (c.1795-1804), it is arguably the artists most enigmatic graphic work, which features the commedia dell’arte character Pulcinella. The drawings have hitherto been subject to rigorous connoisseurial analysis. Indeed, in his introduction to ten of the drawings in a catalogue of Italian Eighteenth-Century Drawings in The Robert Lehman Collection at the Metropolitan Museum of Art, New York, James Byam Shaw states that this particular series of drawings has now become so famous ‘that it is hardly necessary to add to the literature of the series.’1 In my opinion it would be a great pity if future generations of scholars were discouraged by this remark, for I believe the drawings still have much to ‘tell’ the contemporary art historian and would further benefit from increasingly interpretative readings. Previously, scholars have regarded Domenico Tiepolo as an imitator of his father, Giambattista Tiepolo (1696-1770), and interpreted the re-appropriation of motifs in the Divertimento as signs of old age and fatigue. I suggest, on the contrary, that in this series of drawings in particular, Domenico was an innovator. This project carves out new territories within the study of the series in that it focuses on the playful nature of the drawings, and how the suite can be understood in relation to contemporary theory concerning games and play, and ludic musical/improvisatory forms. Additionally, the drawings are discussed as a case history in a now popular emerging dialectic on the late works of aged artists: here I consider how these drawings, often funny, poignant, sensitive and delicate reveal how the elderly painter reconciles himself not only to the passing of his own life and the extinction of his family line but to an entire political, cultural and visual tradition.EThOS - Electronic Theses Online ServiceGladys Krieble Delmas Foundation (GKDF)GBUnited Kingdo

The pictorial wit of Domenico Tiepolo

This thesis takes a new approach to Domenico Tiepolo’s (1727-1804), Divertimento Per li Regazzi (c.1795-1804), it is arguably the artists most enigmatic graphic work, which features the commedia dell’arte character Pulcinella. The drawings have hitherto been subject to rigorous connoisseurial analysis. Indeed, in his introduction to ten of the drawings in a catalogue of Italian Eighteenth-Century Drawings in The Robert Lehman Collection at the Metropolitan Museum of Art, New York, James Byam Shaw states that this particular series of drawings has now become so famous ‘that it is hardly necessary to add to the literature of the series.’1 In my opinion it would be a great pity if future generations of scholars were discouraged by this remark, for I believe the drawings still have much to ‘tell’ the contemporary art historian and would further benefit from increasingly interpretative readings. Previously, scholars have regarded Domenico Tiepolo as an imitator of his father, Giambattista Tiepolo (1696-1770), and interpreted the re-appropriation of motifs in the Divertimento as signs of old age and fatigue. I suggest, on the contrary, that in this series of drawings in particular, Domenico was an innovator. This project carves out new territories within the study of the series in that it focuses on the playful nature of the drawings, and how the suite can be understood in relation to contemporary theory concerning games and play, and ludic musical/improvisatory forms. Additionally, the drawings are discussed as a case history in a now popular emerging dialectic on the late works of aged artists: here I consider how these drawings, often funny, poignant, sensitive and delicate reveal how the elderly painter reconciles himself not only to the passing of his own life and the extinction of his family line but to an entire political, cultural and visual tradition

Objectively assessed physical activity, adiposity, and inflammatory markers in people with type 2 diabetes.

OBJECTIVE: Inflammatory processes may play an important role in the development of acute coronary syndromes in people with type 2 diabetes; thus, strategies to control inflammation are of clinical importance. We examined the cross-sectional association between objectively assessed physical activity and inflammatory markers in a sample of people with type 2 diabetes. METHODS: Participants were 71 men and 41 women (mean age=63.9±7 years), without a history of cardiovascular disease, drawn from primary care clinics. Physical activity was objectively measured using waist-worn accelerometers (Actigraph GT3X) during waking hours for seven consecutive days. RESULTS: We observed inverse associations between moderate-to-vigorous physical activity (per 10 min) with plasma interleukin-6 (B=-0.035, 95% CI -0.056 to -0.015), interleukin-1ra (B=-0.033, 95% CI -0.051 to -0.015), and monocyte chemotactic protein-1 (B=-0.011, 95% CI -0.021 to 0.000). These associations largely persisted in multivariable adjusted models, although body mass index considerably attenuated the effect estimate. CONCLUSIONS: These data demonstrate an inverse association between physical activity and inflammatory markers in people with type 2 diabetes

The anxiolytic effects of cognitive behavior therapy for insomnia: preliminary results from a web-delivered protocol

Though the efficacy of cognitive behavior therapy for insomnia (CBTI) is well-established, the paucity of credentialed providers hinders widespread access. Further, the impact of alternatives such as web-delivered CBTI has not been adequately tested on common insomnia comorbidities such as anxiety. Therefore, we assessed the impact of an empirically validated web-delivered CBTI intervention on insomnia and comorbid anxiety symptoms. A sample of 22 adults (49.8±13.5 yo; 62.5% female) with DSM-5 based insomnia were randomized to either an active CBTI treatment group (n = 13) or an information-control (IC) group (n = 9). Participants in the CBTI group underwent a standard CBTI program delivered online by a 'virtual' therapist, whereas the IC group received weekly 'sleep tips' and general sleep hygiene education via electronic mail. All participants self-reported sleep parameters, including sleep onset latency (SOL), insomnia symptoms per the Insomnia Severity Index (ISI), and anxiety symptoms per the Beck Anxiety Inventory (BAI) at both baseline as well as follow- up assessment one week post-treatment. There were no significant differences between the CBTI and IC groups on baseline measures. The CBTI group showed significantly larger reductions in BAI scores (t = 2.6; p < .05; Cohen's d = .8) and ISI scores (t = 2.1; p < .05; Cohen's d = .9) at follow-up than did the IC group. Further, changes in SOL from baseline (62.3±44.0 minutes) to follow-up (22.3±14.4 minutes) in the CBTI group were also significantly greater (t = 2.3; p < .05; Cohen's d = .9) than in the IC group (baseline: 55.0±44.2 minutes; follow-up: 50.±60.2 minutes).This study offers preliminary evidence that a web-delivered CBTI protocol with minimal patient contact can improve comorbid anxiety symptoms among individuals with insomnia

The pros and cons of getting engaged in an online social community embedded within digital cognitive behavioral therapy for insomnia: survey among users

Background: Sleepio is a proven digital sleep improvement programme based on cognitive behavioural therapy (CBT) techniques. Users have the option to join an online community that includes weekly expert discussions, peer-to-peer discussion forums and personal message walls. Objective: The aims of this study were to (1) explore the reasons for deciding to engage with the Sleepio online community, (2) explore the potential benefits arising from engagement with the online community, (3) identify and describe any problematic issues related to use of the online community. Methods: In total, 100 respondents (70% female; mean age 51, range 26-82 years) completed the online survey. Most respondents had started Sleepio with chronic sleep problems (59% to to 10 years, 35% >10years), and had actively engaged with the online community (85% had made a discussion or wall post). At the time of the survey, respondents had used Sleepio for a median of 12 weeks (range from 3 weeks to 2 years). Results: Responses to the open-ended questions were analysed using thematic analysis. This analysis revealed five initial drivers for engagement including: 1) the desire to connect with people facing similar issues; 2) seeking personalised advice; 3) curiosity; 4) being invited by other members; and 5) wanting to use all available sleep improvement tools. Advantages of engagement included: access to continuous support, reduced sense of isolation, being part of a non-judgmental community, personalised advice, positive comparisons with others, encouragement to keep going, and altruism. Five potential disadvantages were: design and navigation issues, uncertain quality of user-generated content, negative comparisons with others, excessive time commitments, and data privacy concerns. Participants related their community experiences to engagement with the Sleepio programme with the many stating it had supported their efforts to achieve sleep improvement, as well as helping with adherence and commitment to the programme. Conclusions: Despite some concerns, members regarded the Sleepio community as a valuable resource. Online communities may be a useful means through which to support long-term engagement with online therapy for insomnia

PIRRIST: Patient and public involvement (PPI) to enhance recruitment and retention in surgical trials

Meeting abstract from the 5th International Clinical Trials Methodology Conference (ICTMC 2019) https://ictmc2019.com

The silicon isotope composition of Ethmodiscus rexlaminated diatom mats from the tropical West Pacific: Implications for silicate cycling during the Last Glacial Maximum

The cause of massive blooms of Ethmodiscus rex laminated diatom mats (LDMs) in the eastern Philippine Sea (EPS) during the Last Glacial Maximum (LGM) remains uncertain. In order to better understand the mechanism of formation of E. rex LDMs from the perspective of dissolved silicon (DSi) utilization, we determined the silicon isotopic composition of single E. rex diatom frustules (δ30SiE. rex) from two sediment cores in the Parece Vela Basin of the EPS. In the study cores, δ30SiE. rex varies from −1.23‰ to −0.83‰ (average −1.04‰), a range that is atypical of marine diatom δ30Si and that corresponds to the lower limit of reported diatom δ30Si values of any age. A binary mixing model (upwelled silicon versus eolian silicon) accounting for silicon isotopic fractionation during DSi uptake by diatoms was constructed. The binary mixing model demonstrates that E. rex dominantly utilized DSi from eolian sources (i.e., Asian dust) with only minor contributions from upwelled seawater sources (i.e., advected from Subantarctic Mode Water, Antarctic Intermediate Water, or North Pacific Intermediate Water). E. rex utilized only ~24% of available DSi, indicating that surface waters of the EPS were eutrophic with respect to silicon during the LGM. Our results suggest that giant diatoms did not always use a buoyancy strategy to obtain nutrients from the deep nutrient pool, thus revising previously proposed models for the formation of E. rex LDMs

Patient and public involvement (PPI) in UK surgical trials: a survey and focus groups with stakeholders to identify practices, views, and experiences

Background and aims Historically, patient and public involvement (PPI) in the design and conduct of surgical trials has been absent or minimal, but it is now routinely recommended and even required by some research funders. We aimed to identify and describe current PPI practice in surgical trials in the United Kingdom, and to explore the views and experiences of surgical trial staff and patient or public contributors in relation to these practices. This was part of a larger study to inform development of a robust PPI intervention aimed at improving recruitment and retention in surgical trials. Methods Our study had two stages: 1) an online survey to identify current PPI practice in active UK-led, adult surgical trials; and 2) focus groups and interviews with key stakeholders (surgical trial investigators, administrators, and patient or public contributors) to explore their views and experiences of PPI. Results Of 129 eligible surgical trial teams identified, 71 (55%) took part in the survey. In addition, 54 stakeholders subsequently took part in focus groups or interviews. Sixty-five (92%) survey respondents reported some kind of PPI, most commonly at the design and dissemination stages and in oversight or advisory roles. The single most common PPI activity was developing participant information sheets (72%). Participants reported mixed practice and views on a variety of issues including the involvement of patients versus lay members of the public, recruitment methods, use of role descriptions and payment for the time of PPI contributors. They suggested some solutions, including the use of written role descriptions and databases of potential PPI contributors to aid recruitment. Conclusions UK surgical trials involve patients and members of the public in a variety of different ways, most commonly at the beginning and end of the trial lifecycle and in oversight or advisory roles. These are not without challenges and there remain uncertainties about who best to involve, why, and how. Future research should aim to address these issues