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Purpose: Late toxicities such as arthritis, common after Breast Cancer (BC), impacts quality of life and restricts the ability to exercise. Epidemiology studies have inked higher intake of polyphenol-rich foods with less arthritis. Laboratory studies show these food reduce intraarticular inflammation and oxidative stress, allowing greater mobility although clinical intervention studies are lacking.\ud \ud Methods: This was an open label evaluation of a polyphenol-rich whole food supplement (Pomi-T) supplied to volunteer members of the Japanese Women’s Cancer Support Group, Tokyo. 44 of 120 women responded to invitations. Joint discomfort, mobility, mood and hot flushes were recorded at baseline and after 2 months Pomi-T using validated questionnaires. 38 of 44 completed pre and post forms (average age of 48, range 26-62 years).\ud \ud Results: The mean improvement in mood was 1.9 (19.96-18.06), with a paired T-test of p=0.01. Mean reduction in hot flush score was 6.68 (38.41-31.71), with a two tailed sign test of p=0.016. Mean reduction in joint pain, stiffness and immobility was 3.84 (25.21-21.37), with a two tailed sign test of p=0.011. Positive comments from individuals included an unexpected reduction in hay fever symptoms in 8 patients.\ud \ud Conclusion: This open labelled study demonstrated that symptomatic women with BC had a statistically significant reduction in arthralgia, hot flushes and improved mood after consuming a polyphenol-rich nutritional supplement. The reduction hay fever symptoms requires separate exploration but this pilot has provided sufficient encouragement and justification to proceed to a more statistically robust double-blind, randomised control trial.

Background: Socio-economic inequalities in colon cancer survival exist in high-income countries, but the reasons are unclear. We assessed the mediating effects of stage at diagnosis, comorbidities, and treatment (surgery and intravenous chemotherapy) on survival from colon cancer. Methods: We identified 2,203 people aged 15 to 79 years with first primary colon cancer diagnosed in Victoria, Australia, between 2008 and 2011. Colon cancer cases were identified through the Victorian Cancer Registry (VCR), and clinical information was obtained from hospital records. Deaths till December 31, 2016 (n = 807), were identified from Victorian and national death registries. Socio-economic disadvantage was based on residential address at diagnosis. For stage III disease, we decomposed its total effect into direct and indirect effects using interventional mediation analysis. Results: Socio-economic inequalities in colon cancer survival were not explained by stage and were greater for men than women. For men with stage III disease, there were 161 [95% confidence interval (CI), 67–256] additional deaths per 1,000 cases in the 5 years following diagnosis for the most disadvantaged compared with the least disadvantaged. The indirect effects through comorbidities and intravenous chemotherapy explained 6 (95% CI, −10–21) and 15 (95% CI, −14–44) per 1,000 of these additional deaths, respectively. Surgery did not explain the observed gap in survival. Conclusions: Disadvantaged men have lower survival from stage III colon cancer that is only modestly explained by having comorbidities or not receiving chemotherapy after surgery. Impact: Future studies should investigate the potential mediating role of factors occurring beyond the first year following diagnosis, such as compliance with surveillance for recurrence and supportive care services.

Background and Purpose While excessive daytime sleepiness can predate Parkinson’s disease in late-life, its association with parkinsonian-like (P-L) symptoms in middle age are unknown. Since neurodegeneration can appear decades before a diagnosis of Parkinson’s disease, identifying clinical features associated with this early progression is important. The purpose of this study was to determine the association of daytime sleepiness with P-L symptoms in a population-based sample of middle-aged Korean adults. Methods During 2013 and 2014, daytime sleepiness and P-L symptoms were assessed in 2,063 males and females aged 50–64 years who were participating in the Korean Genome and Epidemiology Study. The severity of daytime sleepiness was quantified by the score on the Epworth Sleepiness Scale (ESS). Self-reported P-L symptoms included nine motor disorders commonly associated with Parkinson’s disease. Participants with parkinsonism and related conditions are excluded. Results The prevalence of excessive daytime sleepiness (ESS score >10) was 7.0%. The frequencies of P-L symptoms ranged from 0.5% (for “trouble buttoning buttons”) to 18.4% (for “handwriting smaller than it once was”). After adjustment for covariates and multiple testing, the relative odds of P-L symptoms comparing the 80th and 20th percentiles of ESS scores was 1.6 (p=0.001) for “voice is softer than it once was,” 2.1 (p

Supererogation has gained attention as a means of explaining the voluntary behaviours of individuals and organizations that are done for the benefit of others and which go above what is required of legislation and what may be expected by society. Whilst the emerging literature has made some significant headway in exploring supererogation as an ethical lens for the study of business there remain several important issues that require attention. These comprise, the lack of primary evidence upon which such examinations have been made, attention has been given to only singular pro-social acts of organizations, and the focus has been upon the actions of large organizations. Furthermore, Heyd’s (Supererogation, Cambridge University Press, 1982) original taxonomy of six supererogatory acts, comprising Moral Heroism, Beneficence, Volunteering, Favour, Forgiveness and Forbearance, has been considered to be complete and other forms of supererogatory acts have not yet been explored. In order to address these gaps this study poses the research questions: First, it studies how a single, contemporary SME performs multiple supererogatory acts in its attempts to address its social and environmental goals that go beyond CSR. Second, it seeks to gain a deeper theoretical understanding of Heyd’s (Supererogation, Cambridge University Press, 1982) taxonomy of six forms of supererogation through the capture of primary data. This research makes a three-year case study examination of a single SME that has been formally recognized for its work in addressing social and environmental issues at local, national and global levels. Primary data are acquired of the supererogatory acts that it performs through a three-year participant observation case study, utilizing 61 interviews and 3 focus groups with internal and external stakeholders. In doing so, it addresses the empirical limitations of the extant research, substantiates each of the forms that supererogatory acts may take, and makes a contribution to the theory of supererogation by identifying a further class of act that is ‘Sharing’.

Objective:To examine associations between diet and risk of developing gastro-oesophageal reflux disease (GERD).Design:Prospective cohort with a median follow-up of 15·8 years. Baseline diet was measured using a FFQ. GERD was defined as self-reported current or history of daily heartburn or acid regurgitation beginning at least 2 years after baseline. Sex-specific logistic regressions were performed to estimate OR for GERD associated with diet quality scores and intakes of nutrients, food groups and individual foods and beverages. The effect of substituting saturated fat for monounsaturated or polyunsaturated fat on GERD risk was examined.Setting:Melbourne, Australia.Participants:A cohort of 20 926 participants (62 % women) aged 40–59 years at recruitment between 1990 and 1994.Results:For men, total fat intake was associated with increased risk of GERD (OR 1·05 per 5 g/d; 95 % CI 1·01, 1·09; P = 0·016), whereas total carbohydrate (OR 0·89 per 30 g/d; 95 % CI 0·82, 0·98; P = 0·010) and starch intakes (OR 0·84 per 30 g/d; 95 % CI 0·75, 0·94; P = 0·005) were associated with reduced risk. Nutrients were not associated with risk for women. For both sexes, substituting saturated fat for polyunsaturated or monounsaturated fat did not change risk. For both sexes, fish, chicken, cruciferous vegetables and carbonated beverages were associated with increased risk, whereas total fruit and citrus were associated with reduced risk. No association was observed with diet quality scores.Conclusions:Diet is a possible risk factor for GERD, but food considered as triggers of GERD symptoms might not necessarily contribute to disease development. Potential differential associations for men and women warrant further investigation.

Rationale: The increased prevalence of obstructive sleep apnea (OSA) coincides with a severe shortage of sleep physicians. There is a need for widescale home-sleep-testing devices with accurate aut...

Sleep-disordered breathing (SDB) syndromes reflect complex pathophysiological interactions between upper airway obstruction, chemoreflex control of breathing, sleep arousability and fragmentation, and factors altering gas exchange (hypoxia and hypercapnia). In most healthy individuals, compensation (balanced CO2 loading and unloading) for acute hypercarbia occurs with recovery supra-tidal volume breaths that follows the apnea or hypopnea. Sleep hypoventilation manifests when there is a failure of CO2 compensation and, over time, can result in chronic hypercapnia during wakefulness. Failure of CO2 compensation can be induced by sedating medications that suppress respiratory drive and may also be seen in a variety of pathologies related to the lungs (chronic obstructive pulmonary disease [COPD], interstitial lung disease [ILD]), thoracic cage (kyphosis, obesity), and respiratory muscles (neuromuscular disease [NMD]) which can coexist with OSA. Therefore, hypercapnic OSA encompasses a variety of phenotypes: OSA with sleep stage-specific hypoventilation (i.e., rapid eye movement sleep [REM] hypoventilation), obesity hypoventilation (OHS)/OSA, pulmonary overlap syndromes (most notably COPD/OSA overlap), OSA with NMD, and OSA with medication effects (sedatives and/or opioids). We describe here a new and unique pattern of SDB, hypercapnic periodic breathing, exhibiting features of obstruction, hypercapnia, and a respiratory rhythm typical of hypocapnic periodic breathing. These patients are extraordinarily difficult to treat, as several therapeutic principles are mutually antagonist. Typically, multi-modal therapy is required-positive airway pressure, CO2 stabilization, acetazolamide, and supplemental oxygen.

Background Sleep fragmentation and sleep apnea are common in patients with atrial fibrillation (AF). We investigated the impact of radio‐frequency catheter ablation (RFCA) on sleep quality in patients with paroxysmal AF and the effect of a change in sleep quality on recurrence of AF. Methods and Results Of 445 patients who underwent RFCA for paroxysmal AF between October 2007 and January 2017, we analyzed 225 patients who had a 24‐hour Holter test within 6 months before RFCA. Sleep quality was assessed by cardiopulmonary coupling analysis using 24‐hour Holter data. We compared cardiopulmonary coupling parameters (high‐frequency coupling, low‐frequency coupling, very‐low‐frequency coupling) before and after RFCA. Six months after RFCA, the high‐frequency coupling (marker of stable sleep) and very‐low‐frequency coupling (rapid eye movement/wake marker) was significantly increased (29.84%–36.15%; P P =0.002, respectively) while low‐frequency coupling (unstable sleep marker) was decreased (41.25%–32.13%; P Conclusions Sleep quality improved after RFCA in patients with paroxysmal AF. The recurrence rate was significantly lower in patients who had unstable sleep before RFCA. These results suggest that RFCA can influence sleep quality, and sleep quality assessment before RFCA may provide a risk marker for recurrence after RFCA in patients with paroxysmal AF.

Long-lived (800 Ma) Paleo– to Mesoproterozoic accretionary orogens on the margins of Laurentia, Baltica, Amazonia, and Kalahari collided to form the core of the supercontinent, Rodinia. Accretionary orogens in Laurentia and Baltica record predominately radiogenic zircon eHf(t) and whole-rock Pb isotopic compositions, short crustal residence times (ca. 0.5 Ga), and the development of arc-backarc complexes. The accretionary orogenic record of Laurentia and Baltica is consistent with a retreating accretionary orogen and analogous to the Phanerozoic western Pacific orogenic system. In contrast, the Mesoproterozoic orogens of Amazon and Kalahari cratons record unradiogenic zircon eHf(t) values, ca. 0.8 Ga crustal residence times, and more ancient whole-rock Pb isotopic signatures. The accretionary orogenic record of Amazonia and Kalahari indicates the preferential incorporation of cratonic material in continental arcs of advancing accretionary orogens comparable to the Phanerozoic eastern Pacific orogenic system. Based on similarities in the geodynamic evolution of the Phanerozoic circum-Pacific orogens peripheral to Gondwana/Pangea, we suggest that the Mesoproterozoic accretionary orogens formed as peripheral subduction zones along the margin of the supercontinent Nuna (ca. 1.8–1.6 Ga). The eventual collapse of this peripheral subduction zone onto itself and closure of the external ocean around Nuna to form Rodinia is equivalent to the projected future collapse of the circum-Pacific subduction system and juxtaposition of Australia-Asia with South America. The juxtaposition of advancing and retreating accretionary orogens at the core of the supercontinent Rodinia demonstrates that supercontinent assembly can occur by the closure of external oceans and indicates that future closure of the Pacific Ocean is plausible.

1. Bat abundance, diversity and behaviour can be monitored by capturing bats for identification and measurement in the hand, but this has several disadvantages. These include disturbance to the bats, which limits the frequency with which captures can be made at an individual capture site, and potentially alters the behaviours being studied. 2. Passive recording and automated analysis and identification of bat calls offers an alternative, non-invasive approach to monitoring bats. In this study, we examine the effectiveness of acoustic monitoring in comparison with capture-based monitoring of seasonal swarming behaviour among several species of Myotis bats in southern Britain. 3. We show that both approaches have advantages and disadvantages for different tasks, but can be viewed as complementary methods for addressing different types of research questions. 4. We applied these complementary approaches, together with observations from infra-red video monitoring, to describe seasonal, overnight and species-specific variation in swarming behaviour in a multi-species community of Myotis bats. 5. In our study of swarming behaviour, capture and examination of bats in the hand was necessary for measuring sex ratios, reproductive status, and even for confirmation of species identification for some difficult to separate taxa. Capture is also an essential aspect of tagging bats for individual identification and tracking studies. 6. Passive acoustic monitoring is a valuable non-invasive method for continuous monitoring of within-night, seasonal and between-year variation in the abundance of bat calls. These can be used as an index of variation in relative abundance within -- but not between -- bat species.

Bat abundance, diversity, and behavior can be monitored by capturing bats for identification and measurement in the hand, but this has several disadvantages. These include disturbance to the bats, which limits the frequency with which captures can be made at an individual capture site, and potentially alters the behaviors being studied. Infrared video monitoring, passive acoustic recording and automated analysis and identification of bat calls offers an alternative set of noninvasive methods for monitoring bats. In this study, we examine the effectiveness of acoustic monitoring in comparison with capture-based and video monitoring of seasonal swarming behavior among several species of

Local weather can influence the growth and development of young birds either indirectly, by modifying prey availability, or directly, by affecting energetic trade‐offs. Such effects can have lasting implications for life history traits, but the nature of these effets may vary with the developmental stage of the birds, and over timescales from days to weeks. We examined the interactive effects of temperature, rainfall and wind speed on the mass of nestling and fledgling Barn Swallows Hirundo rustica both on the day of capture and averaging weather across the time since hatching. At the daily timescale, nestling mass was negatively correlated with temperature, but the strength of this association depended on the level of rainfall and wind speed; nestlings were typically heavier on dry or windy days, and the negative effect of temperature was strongest under calm or wet conditions. At the early lifetime timescale (i.e. from hatching to pre‐fledging), nestling mass was negatively correlated with temperature at low wind speed. Fledgling body mass was less sensitive to weather; the only weather effect evident was a negative correlation with temperature at the daily scale under high rainfall that became slightly positive under low rainfall. These changes are consistent with weather effects on the availability and distribution of insects within the landscape (e.g. causing high concentrations of flying insects) and with the effects of weather variation on nest microclimate. These results together demonstrate the impacts of weather on chick growth, over immediate (daily) and longer term (nestling/fledgling lifetime) timescales. This shows that sensitivity to local weather conditions varies across the early lifetime of young birds (nestling–fledgling stages) and illustrates the mechanisms by which larger scale (climate) variations influence the body condition of individuals.

Wildlife-vehicle collisions are one of the main causes of mortality for wild mammals and birds in the UK. Here, using a dataset of 54,000+ records collated by a citizen science roadkill recording scheme between 2014–2019, we analyse and present temporal patterns of wildlife roadkill of the 19 most commonly reported taxa in the UK (84% of all reported roadkill). Most taxa (13 out of 19) showed significant and consistent seasonal variations in road mortality and fitted one of two seasonal patterns; bimodal or unimodal: only three species (red foxVulpes vulpes, European polecatMustela putoriusand Reeves’ muntjac deerMuntiacus reevesi) showed no significant seasonality. Species that increase movement in spring and autumn potentially have bimodal patterns in roadkill due to the increase in mate-searching and juvenile dispersal during these respective time periods (e.g. European badgerMeles meles). Unimodal patterns likely represent increased mortality due to a single short pulse in activity associated with breeding (e.g. birds) or foraging (e.g. grey squirrelsSciurus carolinensisin autumn). Importantly, these patterns also indicate periods of increased risk for drivers, potentially posing a greater threat to human welfare. In addition to behaviour-driven annual patterns, abiotic factors (temperature and rainfall) explained some variance in roadkill. Notably, high rainfall was associated with decreased observations of two bird taxa (gulls and Eurasian magpiesPica pica) and European rabbitOryctolagus cuniculus. By quantifying seasonal patterns in roadkill, we highlight a significant anthropogenic impact on wild species, which is important in relation to conservation, animal welfare, and human safety.