Impaired belief updating and devaluation in adult women with bulimia nervosa

Recent models of bulimia nervosa (BN) propose that binge-purge episodes ultimately become automatic in response to cues and insensitive to negative outcomes. Here, we examined whether women with BN show alterations in instrumental learning and devaluation sensitivity using traditional and computational modeling analyses of behavioral data. Adult women with BN (n = 30) and group-matched healthy controls (n = 31) completed a task in which they first learned stimulus-response-outcome associations. Then, participants were required to repeatedly adjust their responses in a “baseline test”, when different sets of stimuli were explicitly devalued, and in a “slips-of-action test”, when outcomes instead of stimuli were devalued. The BN group showed intact behavioral sensitivity to outcome devaluation during the slips-of-action test, but showed difficulty overriding previously learned stimulus-response associations on the baseline test. Results from a Bayesian learner model indicated that this impaired performance could be accounted for by a slower pace of belief updating when a new set of previously learned responses had to be inhibited (p = 0.036). Worse performance and a slower belief update in the baseline test were each associated with more frequent binge eating (p = 0.012) and purging (p = 0.002). Our findings suggest that BN diagnosis and severity are associated with deficits in flexibly updating beliefs to withhold previously learned responses to cues. Additional research is needed to determine whether this impaired ability to adjust behavior is responsible for maintaining automatic and persistent binge eating and purging in response to internal and environmental cues

Assessment of nutritional status in haemodialysis patients using PG-SGA and handgrip strength

In this cross-sectional study, we primarily aimed to assess prevalence of malnutrition by the Patient Generated Subjective Global Assessment (PGSGA), and muscle strength in haemodialysis patients. Second, we explored to which extent these patients are able to complete the patient component of the PG-SGA, aka PG-SGA Short Form (SF) (weight, intake, symptoms, activities/functioning) independently

Starting, building and sustaining a program of research in emergency medicine in Canada

Objective: To develop pragmatic recommendations for starting, building and sustaining a program of research in emergency medicine (EM) in Canada at sites with limited infrastructure and/or prior research experience. Methods: At the direction of the Canadian Association of Emergency Physicians (CAEP) academic section, we assembled an expert panel of 10 EM researchers with experience building programs of research. Using a modified Delphi approach, our panel developed initial recommendations for (1) starting, (2) building, and (3) sustaining a program of research in EM. These recommendations were peer-reviewed by emergency physicians and researchers from each of the panelist’s home institutions and tested for face and construct validity, as well as ease of comprehension. The recommendations were then iteratively revised based on feedback and suggestions from peer review and amended again after being presented at the 2020 CAEP academic symposium. Results: Our panel created 15 pragmatic recommendations for those intending to start (formal research training, find mentors, local support, develop a niche, start small), build (funding, build a team, collaborate, publish, expect failure) and sustain (become a mentor, obtain leadership roles, lead national studies, gain influence, prioritize wellness) a program of EM research in centers without an established research culture. Additionally, we suggest four recommendations for department leads aiming to foster a program of research within their departments. Conclusion: These recommendations serve as guidance for centres wanting to establish a program of research in EM

The Public Domain

Background/Aims: Growth Hormone (GH) dosage in childhood is adjusted for body size, but there is no consensus whether body weight (BW) or body surface area (BSA) should be used. We aimed at comparing the biological effect and cost-effectiveness of GH treatment dosed per m(2) BSA in comparison with dosing per kg BW in girls with Turner syndrome (TS). Methods: Serum IGF-I, GH dose, and adult height gain (AHG) from girls participating in two Dutch and five Swedish studies on the efficacy of GH were analyzed, and the cumulative GH dose and costs were calculated for both dose adjustment methods. Additional medication included estrogens (if no spontaneous puberty occurred) and oxandrolone in some studies. Results: At each GH dose, the serum IGF-I standard deviation score remained stable over time after an initial increase after the start of treatment. On a high dose (at 1 m(2) equivalent to 0.056-0.067 mg/kg/day), AHG was at least equal on GH dosed per m(2) BSA compared with dosing per kg BW. The cumulative dose and cost were significantly lower if the GH dose was adjusted for m(2) BSA. Conclusion: Dosing GH per m(2) BSA is at least as efficacious as dosing per kg BW, and is more cost-effective. (c) 2014 S. Karger AG, Basel

The Tarantula massive binary monitoring: III. Atmosphere analysis of double-lined spectroscopic systems

Context. Accurate stellar parameters of individual objects in binary systems are essential to constrain the effects of binarity on stellar evolution. These parameters serve as a prerequisite to probing existing and future theoretical evolutionary models. Aims. We aim to derive the atmospheric parameters of the 31 double-lined spectroscopic binaries in the Tarantula Massive Binary Monitoring sample. This sample, composed of detached, semi-detached and contact systems with at least one of the components classified as an O-type star, is an excellent test-bed to study how binarity can impact our knowledge of the evolution of massive stars. Methods. In the present paper, 32 epochs of FLAMES/GIRAFFE spectra are analysed by using spectral disentangling to construct the individual spectra of 62 components. We then apply the CMFGEN atmosphere code to determine their stellar parameters and their helium, carbon, and nitrogen surface abundances. Results. Among the 31 systems that we study in the present paper, we identify between 48 and 77% of them as detached, likely pre-interacting systems, 16% as semi-detached systems, and between 5 and 35% as systems in or close to contact phase. Based on the properties of their components, we show that the effects of tides on chemical mixing are limited. Components on longer-period orbits show higher nitrogen enrichment at their surface than those on shorter-period orbits, in contrast to expectations of rotational or tidal mixing, implying that other mechanisms play a role in this process. For semi-detached systems, components that fill their Roche lobe are mass donors. They exhibit higher nitrogen content at their surface and rotate more slowly than their companions. By accreting new material, their companions spin faster and are likely rejuvenated. Their locations in the N − v sin i diagram tend to show that binary products are good candidates to populate the two groups of stars (slowly rotating, nitrogen-enriched objects and rapidly rotating non-enriched objects) that cannot be reproduced through single-star population synthesis. Finally, we find no peculiar surface abundances for the components in (over-)contact systems, as has been suggested by evolutionary models for tidal mixing. Conclusions. This sample, consisting of 31 massive binary systems, is the largest sample of binaries composed of at least one O-type star to be studied in such a homogeneous way by applying spectral disentangling and atmosphere modelling. The study of these objects gives us strong observational constraints to test theoretical binary evolutionary tracks

Brane Inflation, Solitons and Cosmological Solutions: I

In this paper we study various cosmological solutions for a D3/D7 system directly from M-theory with fluxes and M2-branes. In M-theory, these solutions exist only if we incorporate higher derivative corrections from the curvatures as well as G-fluxes. We take these corrections into account and study a number of toy cosmologies, including one with a novel background for the D3/D7 system whose supergravity solution can be completely determined. This new background preserves all the good properties of the original model and opens up avenues to investigate cosmological effects from wrapped branes and brane-antibrane annihilation, to name a few. We also discuss in some detail semilocal defects with higher global symmetries, for example exceptional ones, that could occur in a slightly different regime of our D3/D7 model. We show that the D3/D7 system does have the required ingredients to realise these configurations as non-topological solitons of the theory. These constructions also allow us to give a physical meaning to the existence of certain underlying homogeneous quaternionic Kahler manifolds.Comment: Harvmac, 115 pages, 9 .eps figures; v2: typos corrected, references added and the last section expanded; v3: Few minor typos corrected and references added. Final version to appear in JHE

Non-Kaehler Heterotic String Compactifications with non-zero fluxes and constant dilaton

We construct new explicit compact supersymmetric valid solutions with non-zero field strength, non-flat instanton and constant dilaton to the heterotic equations of motion in dimension six. We present balanced Hermitian structures on compact nilmanifolds in dimension six satisfying the heterotic supersymmetry equations with non-zero flux, non-flat instanton and constant dilaton which obey the three-form Bianchi identity with curvature term taken with respect to either the Levi-Civita, the (+)-connection or the Chern connection. Among them, all our solutions with respect to the (+)-connection on the compact nilmanifold $M_3$ satisfy the heterotic equations of motion.Comment: LaTeX, 16 pp., no figures, new Theorem 1.1, references adde

Impact of nationwide enhanced implementation of best practices in pancreatic cancer care (PACAP-1): A multicenter stepped-wedge cluster randomized controlled trial

Background: Pancreatic cancer has a very poor prognosis. Best practices for the use of chemotherapy, enzyme replacement therapy, and biliary drainage have been identified but their implementation in daily clinical practice is often suboptimal. We hypothesized that a nationwide program to enhance implementation of these best practices in pancreatic cancer care would improve survival and quality of life. Methods/design: PACAP-1 is a nationwide multicenter stepped-wedge cluster randomized controlled superiority trial. In a per-center stepwise and randomized manner, best practices in pancreatic cancer care regarding the use of (neo)adjuvant and palliative chemotherapy, pancreatic enzyme replacement therapy, and metal biliary stents are implemented in all 17 Dutch pancreatic centers and their regional referral networks during a 6-week initiation period. Per pancreatic center, one multidisciplinary team functions as reference for the other centers in the network. Key best practices were identified from the literature, 3 years of data from existing nationwide registries within the Dutch Pancreatic Cancer Project (PACAP), and national expert meetings. The best practices follow the Dutch guideline on pancreatic cancer and the current state of the literature, and can be executed within daily clinical practice. The implementation process includes monitoring, return visits, and provider feedback in combination with education and reminders. Patient outcomes and compliance are monitored within the PACAP registries. Primary outcome is 1-year overall survival (for all disease stages). Secondary outcomes include quality of life, 3- and 5-year overall survival, and guideline compliance. An improvement of 10% in 1-year overall survival is considered clinically relevant. A 25-month study duration was chosen, which provides 80% statistical power for a mortality reduction of 10.0% in the 17 pancreatic cancer centers, with a required sample size of 2142 patients, corresponding to a 6.6% mortality reduction and 4769 patients nationwide. Discussion: The PACAP-1 trial is designed to evaluate whether a nationwide program for enhanced implementation of best practices in pancreatic cancer care can improve 1-year overall survival and quality of life. Trial registration: ClinicalTrials.gov, NCT03513705. Trial opened for accrual on 22th May 2018

Measurements of differential production cross sections for a Z boson in association with jets in pp collisions at root s=8 TeV

Peer reviewe