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Whole grain cereal breakfast consumption has been associated with beneficial effects on glucose and insulin metabolism as well as satiety. Pearl millet is a popular ancient grain variety that can be grown in hot, dry regions. However, little is known about its health effects. This study investigated the effect of a pearl millet porridge (PMP) compared with a well-known Scottish oats porridge (SOP) on glycaemic, gastrointestinal, hormonal and appetitive responses. In a randomized, two way crossover trial, 26 healthy participants consumed two iso-energetic/volumetric PMP or SOP breakfast meals, served with a drink of water. Blood samples for glucose, insulin, GLP-1, GIP and PYY, gastric volumes and appetite ratings were collected for two hours postprandially, followed by an ad libitum meal and food intake records for the remainder of the day. The incremental area under the curve (iAUC2h) for blood glucose was not significantly different between the porridges (p ˃ 0.05). The iAUC2h gastric volume was larger for PMP compared with SOP (p = 0.045). The iAUC2h GIP concentration was significantly lower for PMP compared with SOP (p = 0.001). Other hormones and appetite responses were similar between meals. In conclusion, this study reports, for the first time, data on glycaemic and physiological responses to a pearl millet breakfast, showing that this ancient grain could represent a sustainable, alternative, with health-promoting characteristics comparable to oats. GIP is an incretin hormone linked to triacylglycerol absorption in adipose tissue, therefore the lower GIP response for PMP may be an added health benefit.
Consuming whey protein before a meal may reduce postprandial glucose excursions, however, optimising timing of supplementation is important to improve its clinical utility. A total of thirteen centrally obese, insulin-resistant males (waist circumference: 121 (sem 3) cm; homeostasis model assessment for insulin resistance (HOMA-IR): 6·4 (sem 1·2)) completed four experimental conditions in a single-blind, crossover design. Participants consumed mixed-macronutrient breakfast and lunch meals on all occasions, with 20 g whey protein consumed 15 min before (PRE), alongside (DUR) or 15 min post-breakfast (POST) or omitted (CON). Capillary glucose and plasma concentrations of insulin, TAG and NEFA, in addition to subjective appetite ratings, were collected for 180 min after each meal. PRE and DUR reduced post-breakfast glucose peak by 17·0 (sem 1·9) % (P<0·001) and 9·2 (sem 2·9) % (P=0·046), respectively, compared with CON. Post-breakfast glucose AUC was lower following PRE compared with POST and CON (PRE: 982 (sem 30) v. POST: 1031 (sem 36) and CON: 1065 (sem 37) mmol/l×180 min; P≤0·042) but similar to DUR (1013 (sem 32) mmol/l×180 min; P=0·77). Insulin was lower during PRE, when compared with POST and DUR (both P≤0·042) but similar to CON. There were no between-condition differences in measures of postprandial lipaemia or appetite, and no effect of condition post-lunch. Consumption of whey protein as a preload or alongside a mixed-macronutrient breakfast reduces postprandial glucose excursions in centrally obese, insulin-resistant males. Whey consumed as a preload has superior glycaemic-lowering effects. Supplementation at breakfast does not alter glycaemic responses to subsequent meals.
The feeding of high fibre diets to sows prior to ovulation has been shown to have beneficial effects on embryo viability, leading to a possible increase in piglet litter size. This trial was conducted to look at the effect of feeding sows a high fibre diet from mid lactation until breeding on subsequent litter size on a commercially run farm. The sows used were either Large White or Large White x Landrace in genotype and ranged from parity 1 to 7. The sows were allocated to receive either a cereal-based control diet (C), or a high fibre diet (HF) of similar specification but containing unmolassed sugar beet pulp (USBP) at a 20% inclusion rate during lactation and 40% from weaning to oestrus. The diets were fed from day 11 of lactation until oestrus. The sows were inseminated at oestrus and then fed a standard gestation diet until farrowing. The trial was conducted over a 3-month period and in total 198 sows received the HF diet with the rest of the sows over the 3-month period acting as controls (496) on the cereal-based diet. The effect of the diet on total litter size and the number of piglets born alive per sow was analysed in a general linear model (Minitab release 12.1). The combined results for both breed types showed that sows fed the HF diet had a significantly higher number of piglets born (12.37 ± 0.27 versus 11.41 ± 0.26, P<0.01) and a higher number of piglets born alive (11.47 ± 0.26 versus 10.85± 0.26, P<0.01) compared to 130 control fed sows matched for farrowing week. The difference in piglet litter size was still apparent when all the control sows farrowing over the 3 month trial period were included in the statistical analysis, with values of 12.47 ± 0.27 versus 11.79 ± 0.15 (P<0.05) for total number of piglets born and 11.77 ± 0.26 versus 11.16 ± 0.14 (P<0.05) for the number of piglets born alive for the HF and control diet respectively. Based on the results from this trial and previous studies, feeding a diet with a high content of USBP during late lactation and prior to insemination can increase the total number of piglets in the litter and the number of piglets born alive. This effect is less marked in crossbred sows with high baseline performance.
Although the need for pigs to lie down on long journeys is not in question, there is evidence that they may not choose to do so on journeys of less than 3h (Hunter et al., 1994). These observations were undertaken to determine how pigs in the 95 to 100 kg weight range behaved on short journeys. A three-tier floating-deck vehicle with weld-mesh flooring was used because the popularity of three-deck vehicles is increasing (Riches et al., 1996).
Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication.
To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions.
Systematic thematic synthesis.
Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes.
Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to involvement and the value of their expertise. Organisational initiatives should mandate prescriber responsibility to overcome barriers to involvement.
The importance of teamwork is being increasingly recognised in healthcare. Nonetheless, it is equally recognised that teamwork is difficult. In this article, I explore whether we can learn lessons from musicians, orchestras, and conductors as we build our teams. The evolution of the role of the conductor provides useful lessons on leadership and the evolving role of the members of the orchestra on how team members can contribute to a shared outcome. The uncertainty of jazz provides useful lessons for innovation in an increasingly turbulent healthcare environment.
Pre-weaning mortality is a major source of economic loss to the pig industry which despite improvements in husbandry and farrowing crate design remains about 10% of piglets borne alive. The causes of death are multi-factorial (Varley, 1995) but a large proportion may be due to low neonatal vigor. Commercial pig diets do not normally contain long chain n-3 fatty acids, a deficiency of which has been implicated in reduced visual and neural development in premature human babies and in experimental animals. The objectives of the present experiment were to quantify the causes of piglet mortality in sows of modern genotype and to determine the effects of salmon oil supplementation of the diet of the sow, providing long-chain n-3 fatty acids, on this mortality.
Due to their extremely small luminosity compared to the stars they orbit, planets outside our own Solar System are extraordinarily difficult to detect directly in optical light. Careful photometric monitoring of distant stars, however, can reveal the presence of exoplanets via the microlensing or eclipsing effects they induce. The international PLANET collaboration is performing such monitoring using a cadre of semi-dedicated telescopes around the world. Their results constrain the number of gas giants orbiting 1–7 AU from the most typical stars in the Galaxy. Upgrades in the program are opening regions of “exoplanet discovery space” – toward smaller masses and larger orbital radii – that are inaccessible to the Doppler velocity technique.
To determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website (http://medicare.gov/hospitalcompare) can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals.
Secondary analysis of publicly available HAI data for calendar year 2013.
We assessed the availability of HAI data for geographically proximate hospitals (ie, hospitals within the same referral region) and then analyzed these data to determine whether they are useful to differentiate hospitals. We assessed data for the 6 HAIs reported by hospitals to the Centers for Disease Control and Prevention (CDC).
Data were analyzed for 4,561 hospitals representing 88% of registered community and federal government hospitals in the United States. Healthcare-associated infection data are only useful for comparing hospitals if they are available for multiple hospitals within a geographic region. We found that data availability differed by HAI. Clostridium difficile infections (CDI) data were most available, with 82% of geographic regions (ie, hospital referral regions) having >50% of hospitals reporting them. In contrast, 4% of geographic regions had >50% of member hospitals reporting surgical site infections (SSI) for hysterectomies, which had the lowest availability. The ability of HAI data to differentiate hospitals differed by HAI: 72% of hospital referral regions had at least 1 pair of hospitals with statistically different risk-adjusted CDI rates (SIRs), compared to 9% for SSI (hysterectomy).
HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI. CDI and catheter-associated urinary tract infection (CAUTI) are more likely to differentiate hospitals than the other publicly reported HAIs.
This talk is about the limits to the precision of stellar photometry in comparing one star with another in a single CCD frame. This is concerned with bright stars, and concentrates on three problems at the 0.1 percent level of accuracy: how to flatfield; how to deal with varying point-spread-functions that vary across an image; how to deal with the fact that the response inside a pixel is not uniform. The first is the well-known difficulty of getting a uniform illumination across the CCD to use as a flatfield; the use of a rotatable CCD mounting and of drift-scanning is discussed. The second depends on the ability to detect and define small, but significant, changes in the PSF. The third is the fact that the pixels of optical CCDs can have non-uniformities inside them of ten percent, and these when folded with the PSF produce systematic errors significant at the 0.1 percent level; with infra-red arrays these problems can be much worse. The use of software to model these variations and reduce these errors is described.
Emerging CVD risk factors (e.g. HDL function and central haemodynamics) may account for residual CVD risk experienced by individuals who meet LDL-cholesterol and blood pressure (BP) targets. Recent evidence suggests that these emerging risk factors can be modified by polyphenol-rich interventions such as soya, but additional research is needed. This study was designed to investigate the effects of an isoflavone-containing soya protein isolate (delivering 25 and 50 g/d soya protein) on HDL function (i.e. ex vivo cholesterol efflux), macrovascular function and blood markers of CVD risk. Middle-aged adults (n 20; mean age=51·6 (sem 6·6) years) with moderately elevated brachial BP (mean systolic BP=129 (sem 9) mmHg; mean diastolic BP=82·5 (sem 8·4) mmHg) consumed 0 (control), 25 and 50 g/d soya protein in a randomised cross-over design. Soya and control powders were consumed for 6 weeks each with a 2-week compliance break between treatment periods. Blood samples and vascular function measures were obtained at baseline and following each supplementation period. Supplementation with 50 g/d soya protein significantly reduced brachial diastolic BP (−2·3 mmHg) compared with 25 g/d soya protein (Tukey-adjusted P=0·03) but not the control. Soya supplementation did not improve ex vivo cholesterol efflux, macrovascular function or other blood markers of CVD risk compared with the carbohydrate-matched control. Additional research is needed to clarify whether effects on these CVD risk factors depend on the relative health of participants and/or equol producing capacity.
Management and general treatment approaches
Penny J. M. Banerjee, East Midlands Centre for Forensic Mental Health, Arnold Lodge, Leicester, UK,
Simon Gibbon, East Midlands Centre for Forensic Mental Health, Arnold Lodge, Leicester, UK,
Nick Huband, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
Echocardiographic screening for rheumatic heart disease in asymptomatic children may result in early diagnosis and prevent progression. Physician-led screening is not feasible in Malawi. Task shifting to mid-level providers such as clinical officers may enable more widespread screening.
With short-course training, clinical officers can accurately screen for rheumatic heart disease using focussed echocardiography.
A total of eight clinical officers completed three half-days of didactics and 2 days of hands-on echocardiography training. Clinical officers were evaluated by performing screening echocardiograms on 20 children with known rheumatic heart disease status. They indicated whether children should be referred for follow-up. Referral was indicated if mitral regurgitation measured more than 1.5 cm or there was any measurable aortic regurgitation. The κ statistic was calculated to measure referral agreement with a paediatric cardiologist. Sensitivity and specificity were estimated using a generalised linear mixed model, and were calculated on the basis of World Heart Federation diagnostic criteria.
The mean κ statistic comparing clinical officer referrals with the paediatric cardiologist was 0.72 (95% confidence interval: 0.62, 0.82). The κ value ranged from a minimum of 0.57 to a maximum of 0.90. For rheumatic heart disease diagnosis, sensitivity was 0.91 (95% confidence interval: 0.86, 0.95) and specificity was 0.65 (95% confidence interval: 0.57, 0.72).
There was substantial agreement between clinical officers and paediatric cardiologists on whether to refer. Clinical officers had a high sensitivity in detecting rheumatic heart disease. With short-course training, clinical officer-led echo screening for rheumatic heart disease is a viable alternative to physician-led screening in resource-limited settings.
Hospital-acquired infection (HAI) data are reported to the public on the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. We previously found that public understanding of these data is poor. Our objective was to develop an improved method for presenting HAI data that could be used on the CMS website.
Randomized controlled trial comparing understanding of data presented using the current CMS presentation strategy versus a new strategy.
A 760-bed tertiary referral hospital.
A total of 61 patients were randomly selected within 24 hours of admission.
Participants were shown HAI data as presented on the CMS Hospital Compare website (control arm) or data formatted using a new method (experimental arm).
No statistically significant demographic differences were identified between study arms. Although 47% percent of participants said a website for comparing hospitals would have been helpful, only 10% had ever used such a website. Participants viewing data using the new presentation strategy compared hospitals correctly 56% of the time, compared with 32% in the control arm (P=.0002).
Understanding of HAI data increased significantly with the new data presentation method compared to the method currently used on the CMS Hospital Compare website. Many participants expressed interest in a website for comparing hospitals. Improved methods for presenting CMS HAI data, such as the one assessed here, should be adopted to increase public understanding.
This paper presents a color magnitude diagram for the enigmatic cluster ω Centauri (NGC 5139 = C1328 − 472) tracing the main sequence down to V ~ 21.5. The spread in color on the upper main sequence is confirmed as intrinsic to the cluster. The CCD observations were made using the SAAO 1 m telescope with the UCL CCD camera and the RGO CCD camera at the prime focus of the AAT.
Eddington is a space mission for extrasolar planet finding and for asteroseismic observations. It has been selected by ESA as an F2/F3 reserve mission with a potential implementation in 2008-13. Here we describe Eddington's capabilities to detect extrasolar planets, with an emphasis on the detection of habitable planets. Simulations covering the instrumental capabilities of Eddington and the stellar distributions in potential target fields lead to predictions of about 10,000 planets of all sizes and temperatures, and a few tens of terrestrial planets that are potentially habitable. Implications of Eddington for future larger scale missions are briefly discussed.
The emerging statistical properties from the first 50 extrasolar planets are startlingly different from the picture that was imagined prior to 1995. About 0.75% of nearby solar type stars harbor jovian planets in 3 to 5 day circular orbits. Another ∽7% of stars have jupiter–mass companions orbiting in eccentric orbits within 3.5 AU. The mass distribution of substellar companions rises abruptly near 5 MJup and continues increasing down to the detection limit near 1 MJup-Orbital eccentricities correlate positively with semimajor axes, even for planets beyond the tidal circularization zone within 0.1 AU, distinguishing planets from binary stars. The planet bearing stars are metal–rich relative to both nearby stars and to the Sun. Analogs of Solar System planets have not been detected to date as they require precision of 3 m s−1 maintained for more than a decade.
Here we present a short progress report of a comprehensive search for variability in the globular cluster 47 Tucanae. Using the MSSSO 40” telescope and a combined V+R filter, we are searching for variability across a 52×52' field centered on the cluster. The main aim is to search for transiting ‘Hot Jupiter’ planets in this cluster, the results of which are still being produced, but a natural side product is a deep catalogue of variable stars within the cluster field. The experiment samples the whole of the cluster (except the inner 5'), thus probing the uncrowded outer regions where the stellar densities are lower, increasing the prospects for the survivability of planetary systems. Half of the currently identified variable stars are new discoveries. We have data for 36,000 stars with masses similar to that of the Sun for the main transit search.