Search

The Last Interglacial period (LIG) is a period with increased summer insolation at high northern latitudes, which results in strong changes in the terrestrial and marine cryosphere. Understanding the mechanisms for this response via climate modelling and comparing the models' representation of climate reconstructions is one of the objectives set up by the Paleoclimate Modelling Intercomparison Project for its contribution to the sixth phase of the Coupled Model Intercomparison Project. Here we analyse the results from 16 climate models in terms of Arctic sea ice. The multi-model mean reduction in minimum sea ice area from the pre industrial period (PI) to the LIG reaches 50 % (multi-model mean LIG area is 3.20×106 km2, compared to 6.46×106 km2 for the PI). On the other hand, there is little change for the maximum sea ice area (which is 15–16×106 km2 for both the PI and the LIG. To evaluate the model results we synthesise LIG sea ice data from marine cores collected in the Arctic Ocean, Nordic Seas and northern North Atlantic. The reconstructions for the northern North Atlantic show year-round ice-free conditions, and most models yield results in agreement with these reconstructions. Model–data disagreement appear for the sites in the Nordic Seas close to Greenland and at the edge of the Arctic Ocean. The northernmost site with good chronology, for which a sea ice concentration larger than 75 % is reconstructed even in summer, discriminates those models which simulate too little sea ice. However, the remaining models appear to simulate too much sea ice over the two sites south of the northernmost one, for which the reconstructed sea ice cover is seasonal. Hence models either underestimate or overestimate sea ice cover for the LIG, and their bias does not appear to be related to their bias for the pre-industrial period. Drivers for the inter-model differences are different phasing of the up and down short-wave anomalies over the Arctic Ocean, which are associated with differences in model albedo; possible cloud property differences, in terms of optical depth; and LIG ocean circulation changes which occur for some, but not all, LIG simulations. Finally, we note that inter-comparisons between the LIG simulations and simulations for future climate with moderate (1 % yr−1) CO2 increase show a relationship between LIG sea ice and sea ice simulated under CO2 increase around the years of doubling CO2. The LIG may therefore yield insight into likely 21st century Arctic sea ice changes using these LIG simulations.

Abstract Purpose The number of older adults with head and neck squamous cell carcinoma (HNSCC) is continuously increasing. Older HNSCC patients may be more vulnerable to radiotherapy-related toxicities, so that extrapolation of available normal tissue complication probability (NTCP) models to this population may not be appropriate. Hence, we aimed to investigate the correlation between organ at risk (OAR) doses and chronic toxicities in older patients with HNSCC undergoing definitive radiotherapy. Methods Patients treated with definitive radiotherapy, either alone or with concomitant systemic treatment, between 2009 and 2019 in a large tertiary cancer center were eligible for this analysis. OARs were contoured based on international consensus guidelines, and EQD2 doses using α/ß values of 3 Gy for late effects were calculated based on the radiation treatment plans. Treatment-related toxicities were graded according to Common Terminology Criteria for Adverse Events version 5.0. Logistic regression analyses were carried out, and NTCP models were developed and internally validated using the bootstrapping method. Results A total of 180 patients with a median age of 73 years fulfilled the inclusion criteria and were analyzed. Seventy-three patients developed chronic moderate xerostomia (grade 2), 34 moderate dysgeusia (grade 2), and 59 moderate-to-severe (grade 2–3) dysphagia after definitive radiotherapy. The soft palate dose was significantly associated with all analyzed toxicities (xerostomia: OR = 1.028, dysgeusia: OR = 1.022, dysphagia: OR = 1.027) in the multivariable regression. The superior pharyngeal constrictor muscle was also significantly related to chronic dysphagia (OR = 1.030). Consecutively developed and internally validated NTCP models were predictive for the analyzed toxicities (optimism-corrected AUCs after bootstrapping: AUCxerostomia=0.64, AUCdysgeusia=0.60, AUCdysphagia=0.64). Conclusions Our data suggest that the dose to the soft palate is associated with chronic moderate xerostomia, moderate dysgeusia and moderate-to-severe dysphagia in older HNSCC patients undergoing definitive radiotherapy. If validated in external studies, efforts should be undertaken to reduce the soft palate dose in these patients.

Objective: The couples coping with cancer together program (CCCT) is used to illustrate practical strategies to implement, evaluate, and grow a successful couples-based program in an NCI-designated CCC. CCCT is multimodal program utilizing psychoeducational, strategic, strengths-based, and problem-solving theoretical frameworks. CCCT integrates multiple intervention modalities, as the standard of care: patients/partners biopsychosocial screening, a standardized psychoeducational session, group intervention, and short-term couples counseling., Methods: Implementation strategies included: (a) identifying Values-Benefits-Outcomes for key stakeholders, (b) recruiting an interdisciplinary team, (c) utilizing a concurrent development model (implementing program components in small iterations), (d) integrating program into existing institutional processes, and (e) collecting data and credibility., Results: CCCT prospectively screened 1995 patients/partners simultaneously for biopsychosocial distress and 913 patient/partner completed program evaluations. Program satisfaction was extremely high: "I recommend this program, for other patients/partners (Patients 95.4% Partners 96.4%)." Ten of the 11 participating physicians anonymously surveyed responded and indicated 100% likely/very likely "to recommend the program to other physicians.", Conclusions: Couples-based programs are underutilized and have been shown to be important for adjustment and increased longevity. Despite barriers in the healthcare environment, implementing couples-based programs into standard of care are feasible. These strategies may be applicable to develop supportive care programs in various health-care settings., (© 2020 John Wiley & Sons, Ltd.)

Introduction: Age-related loss of muscle mass and strength, sarcopaenia, burdens many older adults. The process is accelerated with bed rest, protein intakes below requirements and the catabolic effect of certain illnesses. Thus, acutely ill, hospitalised older adults are particularly vulnerable. Protein supplementation can preserve muscle mass and/or strength and, combining this with resistance exercise training (RT), may have additional benefits. Therefore, this study investigates the effect of protein supplementation as an addition to offering RT among older adults while admitted to the geriatric ward and after discharge. This has not previously been investigated., Methods and Analysis: In a block-randomised, double-blind, multicentre intervention study, 165 older adults above 70 years, fulfilling the eligibility criteria, will be included consecutively from three medical departments (blocks of n=20, stratified by recruitment site). After inclusion, participants will be randomly allocated (1:1) to receive either ready-to-drink, protein-enriched, milk-based supplements (a total of 27.5 g whey protein/day) or isoenergetic placebo products (<1.5 g protein/day), twice daily as a supplement to their habitual diet. Both groups will be offered a standardised RT programme for lower extremity muscle strength (daily while hospitalised and 4×/week after discharge). The study period starts during their hospital stay and continues 12 weeks after discharge. The primary endpoint is lower extremity muscle strength and function (30 s chair-stand-test). Secondary endpoints include muscle mass, measures of physical function and measures related to cost-effectiveness., Ethics and Dissemination: Approval is given by the Research Ethic Committee of the Capital Region of Denmark (reference no. H-16018240) and the Danish Data Protection Agency (reference no. HGH-2016-050). There are no expected risks associated with participation, and each participant is expected to benefit from the RT. Results will be published in peer-reviewed international journals and presented at national and international congresses and symposiums., Trial Registration Number: NCT02717819 (9 March 2016)., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Introduction: Distress screening is now required for cancer center accreditation. Understanding patient and caregiver stress is critical to successful cancer care. This study examines the perceived emotional impact of breast cancer on both patients and partners., Methods: From March 2011-February 2016, patients and partners undertook an electronic, 48-point distress screen during their first visit at a surgical breast clinic. Distress was measured via self-reported concerns on a five point Likert scale. Respondents were also asked about preferred interventions. The ability of the patient and partner to manage emotions was assessed in relation to education, ethnicity, fatigue, anxiety, and depression using ordered logistic regression., Results: Of the 665 individuals screened, 51.7%(n = 344) were patients, while 48.3%(n = 321) were partners. Patients were more distressed than partners regarding fatigue, anxiety, depression, and worrying about the future (p < 0.005). Only 19.7% of partners requested information with regards to "managing emotions" compared to 46.3% of patients. In the univariate analysis, being a partner was protective (OR 0.49 (95%CI 0.34-0.70, p < 0.000) as was holding an advanced educational degree (OR 0.36 (95%CI 0.14-0.93) p = 0.035). In the multivariate regression, having more education remained protective, while being a partner was no longer protective (OR 0.93(95%CI 0.62-1.39, p = 0.789). Financial concerns, anxiety, depression, and worrying about the future remained statistically significant. Partners asked for help less than patients (OR 0.28 (95%CI 0.17-0.48), p < 0.000)., Conclusion: While partners have similar concerns as patients, they do not seek information or help in managing emotions as often as do patients. Both patient and partners with less education and increased financial distress were likely to report difficulty in managing emotions. This study identifies groups who would benefit from supportive measures even in the absence of a request for help., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Unlabelled: As lower-mass stars often host multiple rocky planets, gravitational interactions among planets can have significant effects on climate and habitability over long timescales. Here we explore a specific case, Kepler-62f (Borucki et al., 2013 ), a potentially habitable planet in a five-planet system with a K2V host star. N-body integrations reveal the stable range of initial eccentricities for Kepler-62f is 0.00 ≤ e ≤ 0.32, absent the effect of additional, undetected planets. We simulate the tidal evolution of Kepler-62f in this range and find that, for certain assumptions, the planet can be locked in a synchronous rotation state. Simulations using the 3-D Laboratoire de Météorologie Dynamique (LMD) Generic global climate model (GCM) indicate that the surface habitability of this planet is sensitive to orbital configuration. With 3 bar of CO2 in its atmosphere, we find that Kepler-62f would only be warm enough for surface liquid water at the upper limit of this eccentricity range, providing it has a high planetary obliquity (between 60° and 90°). A climate similar to that of modern-day Earth is possible for the entire range of stable eccentricities if atmospheric CO2 is increased to 5 bar levels. In a low-CO2 case (Earth-like levels), simulations with version 4 of the Community Climate System Model (CCSM4) GCM and LMD Generic GCM indicate that increases in planetary obliquity and orbital eccentricity coupled with an orbital configuration that places the summer solstice at or near pericenter permit regions of the planet with above-freezing surface temperatures. This may melt ice sheets formed during colder seasons. If Kepler-62f is synchronously rotating and has an ocean, CO2 levels above 3 bar would be required to distribute enough heat to the nightside of the planet to avoid atmospheric freeze-out and permit a large enough region of open water at the planet's substellar point to remain stable. Overall, we find multiple plausible combinations of orbital and atmospheric properties that permit surface liquid water on Kepler-62f., Key Words: Extrasolar planets-Habitability-Planetary environments. Astrobiology 16, 443-464.

Introduction: Psychosocial (PsySoc) distress in caregivers is a well-described entity, with some caregivers experiencing more distress than patients themselves. The American College of Surgeons' Commission on Cancer mandates that psychosocial services be provided to all cancer patients and their caregivers, through the entire continuum of cancer care., Methods: We developed a program for newly diagnosed breast cancer patients and their partners. Both were screened for biopsychosocial stressors. The couple was then paired with two clinican-educators trained in communication and gender differences, who educated the couple in communication-based problem solving and provided referrals to supportive services., Results: Eighty-six patients and 82 partners returned surveys. Compared to partners, patients were more likely to report feeling anxious or fearful (59 vs. 38%, p = 0.014), report difficulty in managing their emotions (46 vs. 11%, p = 0.003), and experience distress over being unable to take care of themselves (37 vs. 6%, p = 0.000). Interestingly, there was no difference between patients and partners in feeling unsupported by their partner (6 vs. 5%, p = 0.85) or in feeling down or depressed (29 vs. 30%, p = 0.96)., Discussion: Both patients and partners experience significant distress after a breast cancer diagnosis. We found that partners are equally likely to feel unsupported by their partner (patient) and feel down or depressed. Further study is needed to learn about both patients' and partners' significant distress over lack of support. Partner-focused PsySoc interventions should be initiated in all cancer centers to address the emotional needs of both breast cancer patients and their partners.

Objective: To assess the additional benefits of individualized nutritional counselling by a registered dietitian in geriatric patients' home after discharge from hospital, in relation to risk of re-admissions, functional status, nutritional status, use of social services and mortality., Design: Twelve-week single-blind randomized controlled study., Setting and Subjects: Geriatric medical patients (65+ years) at nutritional risk., Interventions: Participants were randomly allocated to receive a visit in their homes, either three individualized nutritional counselling by a registered dietitian complemented with three follow-up visits by general practitioners or three follow-up visits by general practitioners alone., Main Measures: Primary outcome was risk of re-admissions. Secondary outcomes were functional status (hand grip strength, chair stand, mobility, disability and tiredness in daily activities, rehabilitation capacity), nutritional status (weight, BMI, energy and protein intake), need of social services (home care, home nursing, meals-on-wheels) and mortality., Results: One hundred and fifty-two patients were included; 132 (87%) completed the first and 124 (82%) the second data collection after 12 weeks. Ten per cent of the participants had three contacts with their general practitioner, while compliance with the dietetic intervention was almost 100%. Odds ratio for re-admission and mortality after 26 weeks was 1.62 (95% confidence interval (CI) 0.85 to 3.10) and 0.60 (95% CI 0.17 to 2.13). The intervention had a positive effect on functional status (i.e. mobility, P = 0.029), and nutritional status (i.e. weight, P = 0.035; energy intake, P < 0.001; protein intake, P = 0.001) and the use of meals-on wheels was reduced (P = 0.084)., Conclusion: Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge.

Chilli peppers have been shown to enhance diet-induced thermogenesis (DIT) and reduce energy intake (EI) in some studies, but there are few data on other pungent spices. The primary aim of the present study was to test the acute effects of black pepper (pepper), ginger, horseradish and mustard in a meal on 4 h postprandial DIT. The secondary aim was to examine the effects on subjective appetite measures, ad libitum EI and energy balance. In a five-way placebo-controlled, single-blind, cross-over trial, twenty-two young (age 24·9 (SD 4·6) years), normal-weight (BMI 21·8 (SD 2·1) kg/m²) males were randomly assigned to receive a brunch meal with either pepper (1·3 g), ginger (20 g), horseradish (8·3 g), mustard (21 g) or no spices (placebo). The amounts of spices were chosen from pre-testing to make the meal spicy but palatable. No significant treatment effects were observed on DIT, but mustard produced DIT, which tended to be larger than that of placebo (14 %, 59 (SE 3) v. 52 (SE 2) kJ/h, respectively, P=0·08). No other spice induced thermogenic effects approaching statistical significance. Subjective measures of appetite (P>0·85), ad libitum EI (P=0·63) and energy balance (P=0·67) also did not differ between the treatments. Finally, horseradish decreased heart rate (P=0·048) and increased diastolic blood pressure (P= 0·049) compared with placebo. In conclusion, no reliable treatment effects on appetite, EI or energy balance were observed, although mustard tended to be thermogenic at this dose. Further studies should explore the possible strength and mechanisms of the potential thermogenic effect of mustard actives, and potential enhancement by, for example, combinations with other food components.

Green tea may stimulate energy metabolism; however, it is unclear if acute effects are caused by specific catechins, caffeine or their combination. The objective of the present study was to examine the separate and combined effects of different catechins and caffeine on energy expenditure (EE) and fat oxidation over a single day. Fifteen healthy, normal-weight males received capsules containing placebo, caffeine alone (150 mg), or caffeine plus a catechin mixture (600 mg) enriched in either epigallocatechin-3-gallate (EGCG), epigallocatechin or a mix of catechins, in a randomised cross-over double-blinded design. On each test day EE, respiratory quotient (RQ) and substrate oxidation were measured under sedentary conditions in a respiratory chamber for 13.5 h. We found no significant treatment effect on EE (P = 0.20) or RQ (P = 0.68). EGCG with caffeine insignificantly raised EE and fat oxidation v. caffeine-only and placebo (EE 5.71 (SE 0.12) v. 5.68 (SE 0.14) v. 5.59 (SE 0.13) MJ/12.5 h, respectively; fat oxidation 84.8 (SE 5.2) v. 80.7 (SE 4.7) v. 76.8 (SE 4.0) g/12.5 h). Catechin/caffeine combinations at these dosages and mode of application had non-significant acute effects on EE and fat oxidation. The maximum observed effect on EE of about 2 % could still be meaningful for energy balance over much longer period of exposure. However, higher short-term effects reported in the literature may reflect variations in green tea extracts, added caffeine, or synergies with physical activity. The specific mechanisms and conditions that may underpin observed longer-term benefits of catechin-enriched green tea consumption on body composition remain to be confirmed.

Background: Salatrim is modified triacylglycerol that is rich in short-chain fatty acids and stearic acid. It is used as a lower-calorie fat replacer. In addition, it has been hypothesized that salatrim's reduced absorption in the small intestine may lead to greater amounts of fat in the gastrointestinal tract, which may decrease appetite and energy intake through the release of appetite-regulating gastrointestinal hormones., Objective: We aimed to compare the effects of salatrim and traditional fat on appetite, ad libitum energy intake, and gastrointestinal hormones., Design: Twenty-two healthy, young, normal-weight men participated in a randomized, double-blind, crossover study. Test meals were a traditional fat meal and a salatrim meal with a mixture of traditional fat and salatrim. Visual analogue scales were used to record appetite and well-being every 30 min, and blood was sampled frequently. An ad libitum lunch was served 4.5 h after the test meal., Results: The salatrim meal increased fullness (P = 0.04) and decreased hunger (P = 0.06) significantly more than did the traditional fat meal. The traditional fat meal increased well-being (P = 0.02). There was no significant difference in ad libitum energy intake or overall energy intake between the 2 test days. No significant differences in blood glucose, insulin, triacylglycerol, ghrelin, cholecystokinin, glucagon-like peptide-1, or peptide YY concentrations were found. A significantly (P = 0.01) smaller increase in free fatty acids was observed after the salatrim meal than after the traditional fat meal., Conclusions: Salatrim had a modestly more suppressive effect on appetite than did a traditional fat. Gastrointestinal hormones did not seem to be involved.

Background: The reproducibility of the measurement of ad libitum energy intake (EI) is not well known. Furthermore, it is not known whether standardized conditions before the test day influence this measure., Objective: The objective was to examine the reproducibility and power of the measurement of ad libitum EI with and without prior diet standardization., Design: Fifty-five healthy, normal-weight men were tested in 2 groups, one with (D, n = 32) and one without (ND, n = 23) prior diet standardization, on 2 different identical occasions. They were given a standardized energy-fixed breakfast and then an ad libitum lunch 4.5 h later. Reproducibility was assessed by the coefficient of repeatability., Results: No effect of prior diet standardization was seen on the reproducibility of ad libitum EI (P = 0.56), but diet standardization increased ad libitum EI significantly (P < 0.001). The correlation between ad libitum EI on the 2 test days was r = 0.861 (R(2) = 0.742, P < 0.0001) and r = 0.654 (R(2) = 0.428, P < 0.001) in the D and ND groups, respectively. The coefficient of repeatability and CV were 1478 kJ and 8.9% compared with 1831 kJ and 14.5% in the D and ND groups, respectively. A paired design with a study power of 0.8 requires 17 and 26 subjects, with and without prior diet standardization, respectively, to detect a difference of 500 kJ in EI., Conclusions: The ad libitum test meal used to measure spontaneous EI is reproducible, and the reproducibility does not seem to be influenced by prior standardization. However, prior diet standardization exerts a significant effect on ad libitum EI.

Objective: The aim of this study was to determine whether overweight and obese individuals with type 2 diabetes have higher basal and 24-h energy expenditure compared with healthy control subjects before and after adjustment for body composition, spontaneous physical activity (SPA), sex, and age., Research Design and Methods: Data from 31 subjects with type 2 diabetes and 61 nondiabetic control subjects were analyzed. The 24-h energy expenditure, basal metabolic rate (BMR), and sleeping energy expenditure (EEsleep) between 1:00 a.m. and 6:00 a.m. were measured in whole-body respiratory chambers. Body composition was assessed by dual-energy X-ray absorptiometry (DXA)., Results: No significant differences in unadjusted EEsleep, BMR, and 24-h energy expenditure were observed between the type 2 diabetic group and the control group. After adjustment for fat-free mass (FFM), fat mass, SPA, sex, and age, EEsleep and BMR were, respectively, 7.7 and 6.9% higher in the type 2 diabetic group compared with the control group. This was equivalent to 144 +/- 40 kcal/day (P = 0.001) and 139 +/- 61 kcal/day (P = 0.026), respectively. Adjusted 24-h energy expenditure was 6.5% higher in the type 2 diabetic group compared with the nondiabetic control subjects (2,679 +/- 37 vs. 2,515 +/- 23 kcal/day, P = 0.002). In multiple regression analyses, FFM, fat mass, SPA, and diabetes status were all significant determinants of EEsleep and 24-h energy expenditure, explaining 83 and 81% of the variation, respectively., Conclusions: This study confirms reports in Pima Indians that basal and 24-h energy expenditure adjusted for body composition, SPA, sex, and age are higher in individuals with type 2 diabetes compared with nondiabetic control subjects and may be even more pronounced in Caucasians., (Copyright 2004 American Diabetes Association)