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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. The present 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 randomised, two-way crossover trial, twenty-six healthy participants consumed two isoenergetic/isovolumetric PMP or SOP breakfast meals, served with a drink of water. Blood samples for glucose, insulin, glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide (GIP), peptide YY, gastric volumes and appetite ratings were collected 2 h postprandially, followed by an ad libitum meal and food intake records for the remainder of the day. The incremental AUC (iAUC2h) for blood glucose was not significantly different between the porridges (P > 0·05). The iAUC2h for gastric volume was larger for PMP compared with SOP (P = 0·045). The iAUC2h for GIP concentration was significantly lower for PMP compared with SOP (P = 0·001). Other hormones and appetite responses were similar between meals. In conclusion, the present 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 with oats. GIP is an incretin hormone linked to TAG absorption in adipose tissue; therefore, the lower GIP response for PMP may be an added health benefit.
To estimate the lifetime prevalence and potential determinants of psychotic experience(s) (PEs) in the general population of Qatar – a small non-war afflicted, conservative, high-income, middle-eastern country with recent rapid urbanization including an influx of migrants.
A probability-based sample (n = 1353) of non-migrants and migrants were interviewed face-to-face and administered a 7-item psychosis screener adapted from the Composite International Diagnostic Interview, the Kessler 6-item psychological distress scale, and the 5 items assessing odd (paranormal) beliefs and magical thinking (OBMT) from the Schizotypal Personality Questionnaire. Using bivariate and logistic regression analyses, lifetime prevalence rates of PEs were estimated then compared before and after adjustment for socio-demographics, Arab ethnicity, psychological distress, and OBMT.
Prevalence of PEs was 27.9%. Visual hallucinations were most common (12.8%), followed by persecutory delusions (6.7%) and auditory hallucinations (6.9%). Ideas of reference (3.6%) were least prevalent. PEs were significantly higher in Arabs (34.7%) compared with non-Arabs (16.4%, p < 0.001) with the exception of ideas of reference and paranoid delusions. Female gender was associated with a higher prevalence of PEs in the Arab group only (p < 0.001). Prevalence of PEs was significantly higher among Arabs (48.8% v. 15.8%, p < 0.001) and non-Arabs (35.2% v. 7.3%, p < 0.001) with OBMT. Arab ethnicity (OR = 2.10, p = 0.015), psychological distress (OR = 2.29 p = 0.003), and OBMT (OR = 6.25, p < 0.001) were independently associated with PEs after adjustment for all variables.
Ethnicity, but not migration was independently associated with PEs. Evidence linking Arab ethnicity, female gender, and psychological distress to PEs through associations with OBMT was identified for future prospective investigations.
Large lattice and thermal expansion coefficients mismatches between III-Nitride (III N) epitaxial layers and their substrates inevitably generate defects on the interfaces. Such defects as dislocations affect the reliability, life time, and performance of photovoltaic (PV) devices. High dislocation densities in epitaxial layer generate higher v-shaped pits densities on the layer top surface that also directly affect the device performance. Therefore, using an approach such as the embedded void approach (EVA) for defects reduction in the epitaxial layers is essential. EVA relies on the generation of high densities of embedded microvoids (∼108/cm2), with ellipsoidal shapes. These tremendous number of microvoids are etched near the interface between the III N thin-film and its substrate where the dislocation densities present with higher values.
This article used a 3-D constitutive model that accounts the crystal plasticity formulas and specialized finite element (FE) formulas to model the EVA in multi-junction PV and therefore to study the effect of the embedded void approach on the defects reduction. Mesh convergence and 2-D analytical solution validation is conducted with accounting thermal stresses. Several aspect and volume ratios of the embedded microvoids are used to optimize the microvoid dimensions.
Glasses doped with rare earth elements (lanthanide series) are the most popular materials used in upconversion devices. The main aspect to develop these devices is to find suitable host materials for rare earth ions. The host material should have a high transmission of the upconverted photons, high thermal stability, good mechanical properties, low price, and easy to manufacture and shaping. Present work is concerned with studying the mechanical and structural properties for the oxide glass system doped with rare earth metal (erbium oxide, Er2O3). Ultrasonic pulse-echo technique is used to measure the sound velocities in the glass system (30%B2O3·30%Bi2O3·20%Li2O·10%BaO·10%Pb3O4·xEr2O3), (x = 0, 0.5, 1, 2, 3, 4) mol%. Ultrasound velocities (longitudinal and shear) are measured as a function of the Er2O3 content at a frequency of 4 MHz for longitudinal wave and 2 MHz for the shear wave at a temperature of 300 K. The elastic moduli and some physical parameters, such as Debye temperature, coordination number, and compressibility, were evaluated. Furthermore, the dimensionality of the glass network has been calculated in terms of the d ratio which equals G/B ratio. These parameters beside the x-ray diffraction, differential scanning calorimetry, and Fourier Transform Infrared (FTIR) measurements throw more light on the structure of the glass system. The measurements in this study exhibit remarkable anomalous changes in the network structure of the investigated glass doped with Er2O3.
Homozygous homeobox A1 (HOXA1) mutations cause a spectrum of abnormalities in humans including bilateral profound deafness. This study evaluates the possible role of HOXA1 mutations in familial, non-syndromic sensorineural deafness.
Forty-eight unrelated Middle Eastern families with either consanguinity or familial deafness were identified in a large deafness clinic, and the proband from each family was evaluated by chart review, audiogram, neuroimaging, and HOXA1 sequencing.
All 48 probands had normal neuro-ophthalmologic and general medical examinations except for refractive errors. All had congenital non-syndromic sensorineural hearing loss that was symmetric bilaterally and profound (>90 dBHL) in 33 individuals and varied from 40 to 90 dBHL in the remainder. Thirty-nine of these individuals had neuroimaging studies, all documenting normal internal carotid arteries and normal 6th, 7th, and 8th cranial nerves bilaterally. Of these, 27 had normal internal ear structures with the remaining 12 having mild to modest developmental abnormalities of the cochlea, semicircular canals, and/or vestibular aqueduct. No patient had homozygous HOXA1 mutations.
None of these patients with non-syndromic deafness had HOXA1 mutations. None had major inner ear anomalies, obvious cerebrovascular defects, or recognized congenital heart disease. HOXA1 is likely not a common cause of non-syndromic deafness in this Middle Eastern population.
We review clinical, neuroimaging, and genetic information on six individuals with isolated sulfite oxidase deficiency (ISOD).
All patients were examined, and clinical records, biochemistry, neuroimaging, and sulfite oxidase gene (SUOX) sequencing were reviewed.
Data was available on six individuals from four nuclear families affected by ISOD. Each individual began to seize within the first week of life. neurologic development was arrested at brainstem reflexes, and severe microcephaly developed rapidly. neuroimaging within days of birth revealed hypoplasia of the cerebellum and corpus callosum and damage to the supratentorial brain looking like severe hypoxic-ischemic injury that evolved into cystic hemispheric white matter changes. Affected individuals all had elevated urinary S-sulfocysteine and normal urinary xanthine and hypoxanthine levels diagnostic of ISOD. Genetic studies confirmed SUOX mutations in four patients.
ISOD impairs systemic sulfite metabolism, and yet this genetic disease affects only the brain with damage that is commonly confused with the clinical and radiologic features of severe hypoxic-ischemic encephalopathy.
This new, up-to-date, concise revision guide for the MRCS Part B examination equips candidates with the essential knowledge and armamentarium required to tackle the exam. Written in a model question-and-answer format to aid the breakdown of information, candidates can practise some of the most common exam questions they can expect to face. Including subdivisions on applied surgical science and critical care, anatomy and surgical pathology, surgical skills and patient safety and a section on clinical examinations of the limbs and spine, this guide will increase candidates' confidence in both exam technique and key concepts. MRCS Revision Guide: Limbs and Spine is a concise, handy pocket book; a 'must have' quick reference guide for busy surgical trainees studying for the MRCS examination.
Give some causes of acute confusion in the postoperative patient
• Pain, anxiety and disorientation can all commonly occur in patients in intensive care.
• Sepsis: systemic infection, or localized to chest, urinary tract, wound, etc.
• Hypoglycaemia, or hyperglycaemia with ketoacidosis.
• Respiratory failure, leading to hypoxaemia or hypercarbia: precipitating causes apart from chest infection include acute pulmonary oedema, pneumothorax, pulmonary embolism and sputum retention or atelectasis.
• Hypotension of any cause: e.g. bleeding, myocardial infarction, or arrhythmia leading to reduced cerebral perfusion.
• Acute renal or hepatic failure.
• Electrolyte disturbance: most commonly hypo- or hypernatraemia.
• Water imbalance: both dehydration and fluid overload.
• Acute urinary retention, especially in the elderly.
Further to the use of the chapters in this book as an aid for question-and-answer scenarios and practice with colleagues, here are a few more scenarios that may not be covered fully in independent chapters, which might be useful for consideration prior to the examination.
Surgical skills and patient safety
• Hand washing,
• Scrubbing for theatre and de-gowning,
• Insertion of urinary catheter,
• Intravenous cannulation, central venous pressure line (CVP) insertion, chest tube insertion, cricothyroidotomy: all with advanced trauma life support principles or scenarios,
• Suturing of laceration or excision biopsy of skin lesion (benign or malignant), including knowledge of margins and filling pathology forms,
• Postoperative analgesic ladder,
• Non-accidental injury in children – be aware of the signs.
• History of joint osteoarthritis – know the classic symptoms.
• History of lower back pain, radiating leg pain – differentiate between lumbar disc prolapse and spinal stenosis.
• History of limb claudication and ischaemia, and relevant investigations.
• Obtain patient consent for a hip or knee replacement as well as for treatment of a neck of femur fracture. Look out for the confused patient who may not be able to retain information or consent to an operation. Emergency procedures are different from elective cases. Consider the need for a mini mental state examination and discussion with family. Appreciate the different types of consent forms and the authority needed to obtain consent on behalf of a patient who lacks capacity.
• Order a theatre list with a selection of patients, including (some of): a child, MRSA-positive patient, elderly patient with a fractured neck of femur, diabetic patient, cardiac patient, patient with dirty wound or abscess. Discuss your reasoning.
• Refer an acutely ill patient to the intensive care unit or medical team. Refer a patient to the coroner. Inform your consultant of a multi-trauma patient (consider open fracture management, blood loss, external fixation, vascular or plastic surgery input, transfer to specialist unit). Be aware of the key information that must be discussed, depending on the scenario.