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Diabetes requires challenging lifelong dietary management, affects quality of life and heightens the impact of affective functioning. The aim of this study was to investigate the relationship between Nutrition Quality of Life (NQOL) and affective functioning in a sample of Omani patients with type 2 diabetes. A sample of 149 adults with type 2 diabetes was conveniently recruited from seven Primary Health Centers (PHCs) during follow-up visits. Data were gathered via face-to-face interviews. Pearson correlation and χ2 test of independence were applied to examine associations at P < 0⋅05. Most patients had poor glycemic control (71⋅1 %), BMI ≥ 25 kg/m2 (85⋅2 %) and central obesity (75⋅8 %), and moderate (54⋅4 %) and poor (32⋅9 %) level of NQOL. Based on the Hospital Anxiety and Depression Scale (HADS), 16⋅1 and 23⋅5 % of the sample endorsed the presence of anxiety and depression, respectively. A significant negative correlation was found between NQOL and HADS (r −0⋅590, P = 0⋅000), anxiety (r −0⋅597, P = 0⋅000) and depression (r −0⋅435, P = 0⋅000). There was a significant association between NQOL and HADS, χ2 (2) = 38⋅21, P < 0⋅01 that was large, Cramer's V = 0⋅51. Also, there were significant associations (P < 0⋅01) between NQOL and HADS when controlling for HbA1c, BMI, waist circumference and HMNT that were moderately to largely strong, Cramer's V = 0⋅43–0⋅55. There is an evident association between NQOL and affective functioning in adults with type 2 diabetes. Further research is recommended to confirm these relationships and to guide intervention programmes at PHCs to help improve the general quality of life of such patients.
Since 2009, mid-upper arm circumference (MUAC) has become an accepted measure for screening children for acute malnutrition and determining eligibility for services to manage acute malnutrition. Use of MUAC has increased the reach and enhanced the quality of community-based management of acute malnutrition services. Increasingly, MUAC is also used to assess nutritional status and eligibility for nutrition support among adolescents and adults, including pregnant and lactating women and HIV and TB clients. However, globally recognised cut-offs have not been established to classify malnutrition among adults using MUAC. Therefore, different countries and programmes use different MUAC cut-offs to determine eligibility for programme services. Patient monitoring guidelines provided by WHO for country adaptation to support the integrated management of adult illness do not include MUAC, in part because guidance does not exist about what MUAC cut-off should trigger further action.
To determine if a global mid-upper arm circumference (MUAC) cut-off can be established to classify underweight in adults (men and non-pregnant women).
We conducted an individual participant data meta-analysis (IPDMA) to explore the sensitivity (SENS) and specificity (SPEC) of various MUAC cut-offs for identifying underweight among adults (defined as BMI < 18·5 kg/m2). Measures of diagnostic accuracy were determined every 0·5 cm across MUAC values from 19·0 to 26·5 cm. A bivariate random effects model was used to jointly estimate SENS and SPEC while accounting for heterogeneity between studies. Various subgroup analyses were performed.
Twenty datasets from Africa, South Asia, Southeast Asia, North America and South America were included.
All eligible participants from the original datasets were included.
The total sample size was 13 835. Mean age was 32·6 years and 65 % of participants were female. Mean MUAC was 25·7 cm, and 28 % of all participants had low BMI (<18·5 kg/m2). The area under the receiver operating characteristic curve for the pooled dataset was 0·91 (range across studies 0·61–0·98). Results showed that MUAC cut-offs in the range of ≤23·5 to ≤25·0 cm could serve as an appropriate screening indicator for underweight.
MUAC is highly discriminatory in its ability to distinguish adults with BMI above and below 18·5 kg/m2. This IPDMA is the first step towards determining a global MUAC cut-off for adults. Validation studies are needed to determine whether the proposed MUAC cut-off of 24 cm is associated with poor functional outcomes.
To estimate the total energy and micronutrient intakes of children 9–24 months of age and evaluate the probability of adequacy (PA) of the diet in seven MAL-ED sites.
Cohort study. Food intake was registered monthly using 24-h recalls beginning at 9 months. We estimated PA for thirteen nutrients and overall mean PA (MPA) by site and 3-month periods considering estimated breast milk intake.
Seven sites in Asia, Africa and Latin America.
1669 children followed from birth to 24 months of age.
Median estimated %energy from breast milk ranged from 4 to 70 % at 9–12 months, and declined to 0–39 % at 21–24 months. Iron bioavailability was low for all sites, but many diets were of moderate bioavailability for zinc. PA was optimal for most nutrients in Brazil and South Africa, except for iron and vitamin E (both), calcium and zinc (South Africa). PA for zinc increased only for children consuming a diet with moderate bioavailability. MPA increased 12–24 months as the quantity of complementary foods increased; however, PA for vitamin A remained low in Bangladesh and Tanzania. PA for vitamins D and E and iron was low for most sites and age groups.
MPA increased from 12 to 24 months as children consumed higher quantities of food, while nutrient density remained constant for most nutrients. Ways to increase the consumption of foods containing vitamins D, E and A, and calcium are needed, as are ways to increase the bioavailability of iron and zinc.
To develop a physiological data-driven model for early identification of impending cardiac arrest in neonates and infants with cardiac disease hospitalised in the cardiovascular ICU.
We performed a single-institution retrospective cohort study (11 January 2013–16 September 2015) of patients ≤1 year old with cardiac disease who were hospitalised in the cardiovascular ICU at a tertiary care children’s hospital. Demographics and diagnostic codes of cardiac arrest were obtained via the electronic health record. Diagnosis of cardiac arrest was validated by expert clinician review. Minute-to-minute physiological monitoring data were recorded via bedside monitors. A generalized linear model was used to compute a minute by minute risk score. Training and test data sets both included data from patients who did and did not develop cardiac arrest. An optimal risk-score threshold was derived based on the model’s discriminatory capacity for impending arrest versus non-arrest. Model performance measures included sensitivity, specificity, accuracy, likelihood ratios, and post-test probability of arrest.
The final model consisting of multiple clinical parameters was able to identify impending cardiac arrest at least 2 hours prior to the event with an overall accuracy of 75% (sensitivity = 61%, specificity = 80%) and observed an increase in probability of detection of cardiac arrest from a pre-test probability of 9.6% to a post-test probability of 21.2%.
Our findings demonstrate that a predictive model using physiologic monitoring data in neonates and infants with cardiac disease hospitalised in the paediatric cardiovascular ICU can identify impending cardiac arrest on average 17 hours prior to arrest.
Three-dimensional printing (3DP) is becoming a standard manufacturing practice for a variety of biomaterials and biomedical devices. This layer-by-layer methodology provides the ability to fabricate parts from computer-aided design files without the need for part-specific tooling. Three-dimensional printed medical components have transformed the field of medicine through on-demand patient care with specialized treatment such as local, strategically timed drug delivery, and replacement of once-functioning body parts. Not only can 3DP technology provide individualized components, it also allows for advanced medical care, including surgical planning models to aid in training and provide temporary guides during surgical procedures for reinforced clinical success. Despite the advancement in 3DP technology, many challenges remain for forward progress, including sterilization concerns, reliability, and reproducibility. This article offers an overview of biomaterials and biomedical devices derived from metals, ceramics, polymers, and composites that can be three-dimensionally printed, as well as other techniques related to 3DP in medicine, including surgical planning, bioprinting, and drug delivery.
Dust vortices with a void at the centre are reported in this paper. The role of the spatial variation of the plasma potential in the rotation of dust particles is studied in a parallel plate glow discharge plasma. Probe measurements reveal the existence of a local potential minimum in the region of formation of the dust vortex. The minimum in the potential well attracts positively charged ions, while it repels the negatively charged dust particles. Dust rotation is caused by the interplay of the two oppositely directed ion drag and Coulomb forces. The balance between these two forces is found to play a major role in the radial confinement of the dust particles above the cathode surface. Evolution of the dust vortex is studied by increasing the discharge current from 15 to 20 mA. The local minimum of the potential profile is found to coincide with the location of the dust vortex for both values of discharge currents. Additionally, it is found that the size of the dust vortex as well as the void at the centre increases with the discharge current.
Observational evidence from archival, pre-explosion images, suggests that progenitors of type-IIP SNe (SNe-IIP) have 8 ⩽ MP ⩽ 17 M⊙. However, the post-explosion temporal evolution of the event suggests that even in this mass range, the stellar evolutionary paths, the ensuing mass loss, and the eventual interaction of the supernova shock with the resulting CSM can show considerable diversity. Here we present the results from our program on multi-waveband (mainly optical) observations of SNe-IIP. Mass loss in their progenitors, with a massive and extended H-envelopes, is seen to occur via both strong stellar winds, or episodic mass ejections. Moreover, some type-IIP SNe also show unusually steep decline, characteristic of type-IIL (e.g. SN-IIP 2013ej). Our early and late-time spectrophotometry of these events shows CSM- shock interaction to varying degree among progenitors of comparable mass. Combined with X-ray data, our findings suggest that SNe-IIP progenitors can lose mass via strong stellar winds (e.g. SN2013ej, and SN2014cx), have episodic mass loss (SN2011ja), or have negligible mass loss (SN2012aw, SN2013ab).
A regional cross-country profile of fruit and vegetable (F&V) consumption is lacking in the Eastern Mediterranean Region (EMR). This study examines the prevalence of and differences in consumption of F&V ≥5 times/d among adolescents in eleven EMR countries, and describes differences in the proportions of taking F&V ≥5 times/d by sex, age and BMI. The study included 26 328 school adolescents (13–15 years) with complete data on consumption of F&V, age, sex, weight and height taken from the Global School-based Student Health Survey conducted in the EMR between 2005 and 2009. Overall, only 19·4 % of adolescents reported consuming F&V ≥5 times/d. The highest prevalence was reported in Djibouti (40·4 %) and the lowest was reported in Pakistan (10·0 %). Statistically significant differences in prevalence were observed across countries (P<0·05). With the exception of Oman, Libya and Djibouti, significantly more males than females ate F&V ≥5 times/d. The proportion of students consuming F&V ≥5 times/d also varied significantly in all countries based on BMI (P<0·0001), with students within normal BMI having the highest frequency. A negative trend was observed between age and intake of F&V ≥5 times/d in most of the eleven EMR countries except Jordan, Djibouti and Morocco. The prevalence of adequate intake of F&V is low in the eleven EMR countries. There is a need for interventions to increase the prevalence of adolescents consuming F&V ≥5 times/d. Interventions should take into consideration the psychosocial, environmental and socio-environmental factors influencing F&V intake within countries.
Regional cross-country profile of fruit and vegetable (F&V) consumption is lacking in the Eastern Mediterranean Region (EMR). This study examines the prevalence and differences of consuming F&V ≥5 times/d among adolescents in eleven EMR countries, and also describes differences in the proportions of taking F&V ≥5 times/d by sex, age and BMI. The study included 26 328 school adolescents (13–15 years) with complete data on consumption of F&V, age, sex, weight and height taken from the Global School-based Student Health Survey conducted in the EMR between 2005 and 2009. Overall, only 19·4 % of adolescents reported consuming F&V ≥5 times/d. The highest prevalence was reported in Djibouti (40·4 %) and the lowest was reported in Pakistan (10·0 %). Statistically significant differences in prevalence were observed across countries (P<0·05). With the exception of Oman, Libya and Djibouti, significantly more males than females ate F&V ≥5 times/d. Proportion of students consuming F&V ≥5 times/d also varied significantly in all counties based on BMI (P<0·0001), with students within normal BMI having the highest frequency. A negative trend was observed between age and the prevalence of taking F&V ≥5 times/d in most of the eleven EMR countries but Jordan, Djibouti and Morocco. The prevalence of adequate intake of F&V was low in the eleven EMR countries. There is a need for interventions to increase the prevalence of adolescents consuming F&V ≥5 times/d. Interventions should take into consideration psychosocial, environmental and socio-environmental factors influencing F&V intake within countries.
The development of efficient large-area organic light emitting diodes (OLED) requires reliable and easily processable charge generation layers (CGL) with low excess voltage drop and high optical transparency. OVPD offers the advantage of a precise control of layer morphology, composition and thickness and is a powerful method for the deposition of advanced OLED designs. In this work, electrical doping of organic semiconductors using OVPD is investigated and applied to stacked OLED utilizing inorganic/organic CGL. The organic p-type dopant NDP-9 of Novaled GmbH is used for doping the hole transport material N,N‘-diphenyl-N,N‘-bis(1-naphthylphenyl)-1,1‘-biphenyl-4,4‘-diamine (α-NPD) in an AIXTRON OVPD tool. A doping concentration of 8 vol.% of NDP-9 in α-NPD is found optimal for hole injection as well as conductivity. This dopant concentration was employed in CGL with the structure: electron transport material/LiF/Al/α-NPD:8 vol.% NDP-9. External quantum efficiencies (EQE) of 15%, 35% and 50% and luminous efficiencies of 37 lm/W, 45 lm/W and 45 lm/W at 1000 cd/m2 are demonstrated for single, double- and triple-unit green phosphorescent OLED, respectively.
The light out-coupling potential of introducing a semitransparent Ag layer between the anode and the organic layer stack of monochrome bottom-emitting organic light emitting diodes (OLED) is examined. Red and green phosphorescent as well as deep-blue fluorescent resonant-cavity OLED (RC-OLED) comprising a semitransparent Ag layer are processed by means of organic vapor phase deposition (OVPD). An enhancement of the luminous efficiency of up to 81% can be observed.
The impressive efficiency enhancement can be explained by a reduced formation of substrate modes in combination with a strong narrowing of the emission spectrum leading to an increased true luminous efficiency.
Elevated striatal dopamine synthesis capacity is thought to be fundamental to the pathophysiology of schizophrenia and has also been reported in people at risk of psychosis. It is therefore unclear if striatal hyperdopaminergia is a vulnerability marker for schizophrenia, or a state feature related to the psychosis itself. Relatives of patients with schizophrenia are themselves at increased risk of developing the condition. In this study we examined striatal dopamine synthesis capacity in both members of twin pairs discordant for schizophrenia.
In vivo striatal dopamine synthesis capacity was examined using fluorine-18-l-dihydroxyphenylalanine (18F-DOPA) positron emission tomography (PET) scans in seven twin pairs discordant for schizophrenia and in a control sample of 10 healthy control twin pairs.
Striatal 18F-DOPA uptake was not elevated in the unaffected co-twins of patients with schizophrenia (p=0.65) or indeed in the twins with schizophrenia (p=0.89) compared to the control group. Levels of psychotic symptoms were low in the patients with schizophrenia who were in general stable [mean (s.d.) Positive and Negative Syndrome Scale (PANSS) total=56.8 (25.5)] whereas the unaffected co-twins were largely asymptomatic.
Striatal dopamine synthesis capacity is not elevated in symptom-free individuals at genetic risk of schizophrenia, or in well-treated stable patients with chronic schizophrenia. These findings suggest that striatal hyperdopaminergia is not a vulnerability marker for schizophrenia.
We present here new information on the effect of irradiation temperature on the strength and mechanical anisotropy of Zr-2.5%Nb CANDU pressure tube material. Polished samples aligned normal to the transverse (TN), axial (AN) and radial (RN) directions of the pressure tube were irradiated at 300°C with 8.5 MeV Zr+ ions to assess the effect of concurrent thermal annealing of the irradiation damage. Constant-load micro-indentation creep tests were performed at 25°C at indentation depths from 0.1 to 2.0 μm on the ion irradiated samples.
The increase in the initial indentation stress with increasing levels of Zr+ ion irradiation at 300°C was lower than that reported earlier for similar samples exposed to Zr+ irradiation at 25°C. While the anisotropy of the indentation stress decreased significantly with Zr+ ion irradiation, the level of the decrease was reduced when the irradiation was performed at 300oC compared to 25oC. The apparent activation energy ΔG0 of the obstacles that limit the rate of dislocation glide during indentation creep did not change with indentation direction but did increase with increasing levels of Zr+ ion damage. The values of ΔG0 were, again, lower for samples that were irradiated at 300°C than for those irradiated at 25oC.
The observed differences in the magnitude of, and the anisotropy of, the initial indentation stress and also the decrease in the apparent activation energy of the indentation creep process of Zr-2.5%Nb samples irradiated with Zr+ ions at 300oC compared to those irradiated at 25oC indicate the effect that concurrent thermal annealing has on the accumulation of irradiation damage. The effect of irradiation temperature on reducing the degree of, and the strength of, irradiation induced crystallographic damage must therefore be considered when predicting the strength and thermal creep behaviour of irradiated nuclear materials.