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India has the second largest number of people with type 2 diabetes (T2D) globally. Epidemiological evidence indicates that consumption of white rice is positively associated with T2D risk, while intake of brown rice is inversely associated. Thus, we explored the effect of substituting brown rice for white rice on T2D risk factors among adults in urban South India. A total of 166 overweight (BMI ≥ 23 kg/m2) adults aged 25–65 years were enrolled in a randomised cross-over trial in Chennai, India. Interventions were a parboiled brown rice or white rice regimen providing two ad libitum meals/d, 6 d/week for 3 months with a 2-week washout period. Primary outcomes were blood glucose, insulin, glycosylated Hb (HbA1c), insulin resistance (homeostasis model assessment of insulin resistance) and lipids. High-sensitivity C-reactive protein (hs-CRP) was a secondary outcome. We did not observe significant between-group differences for primary outcomes among all participants. However, a significant reduction in HbA1c was observed in the brown rice group among participants with the metabolic syndrome (−0·18 (se 0·08) %) relative to those without the metabolic syndrome (0·05 (se 0·05) %) (P-for-heterogeneity = 0·02). Improvements in HbA1c, total and LDL-cholesterol were observed in the brown rice group among participants with a BMI ≥ 25 kg/m2 compared with those with a BMI < 25 kg/m2 (P-for-heterogeneity < 0·05). We observed a smaller increase in hs-CRP in the brown (0·03 (sd 2·12) mg/l) compared with white rice group (0·63 (sd 2·35) mg/l) (P = 0·04). In conclusion, substituting brown rice for white rice showed a potential benefit on HbA1c among participants with the metabolic syndrome and an elevated BMI. A small benefit on inflammation was also observed.
The purpose of this study is the verification of intensity modulated radiation therapy (IMRT) head neck treatment planning with one-dimensional and two-dimensional (2D) dosimeters using imaging and radiation oncology core (IROC) Houston head & neck (H&N) phantom.
The image of the H&N phantom was obtained by computed tomography scan which was then transferred to Pinnacle@3 treatment planning system (TPS) for treatment planning. The contouring of the target volumes and critical organ were done manually and dose constraints were set for each organ according to IROC prescription. The plan was optimised by adoptive convolution algorithm to meet the IROC criteria and collapse cone convolution algorithm calculated the delivered doses for treatment. Varian Clinac 2110 was used to deliver the treatment plan to the phantom, the process of irradiation and measurement were repeated three times for reproducibility and reliability. The treatment plan was verified by measuring the doses from thermoluminescent dosimeters (TLDs) and GafChromic external beam therapy 2 films. The agreement between the planned and delivered doses were checked by calculating the percentage dose differences, analysing their isodose line profiles and 2D gamma maps.
The average percent dose difference of 1·8% was obtained between computed doses by TPS and measured doses from TLDs, however these differences were found to be higher for organ at risk. The film dose profile was well in agreement with the planned dose distribution with distance to agreement of 1·5 mm. The gamma analysis of the computed and recorded doses passed the criteria of 3%/3 mm with passing percentages of >96%, which shows successful authentication of delivered doses for IMRT.
IMRT pre-treatment validation can be done with IROC anthropomorphic phantoms, which is essential for the delivery of modulated radiotherapies. It was concluded that films and TLDs can be used as quality assurance tools for IMRT.
To verify dose delivery and quality assurance of volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer.
The Imaging and Radiation Oncology Core Houston (IROC-H) H&N phantom with thermoluminescent dosimeters (TLDs) and films, were imaged with computed tomography scan and the reconstructed image was transferred to pinnacle treatment planning system (TPS). On TPS, the planning target volume (PTV), secondary target volume (STV) and organ at risk (OAR) were delineated manually and a treatment plan was made. The dose constraints were determined for the concerned organs according to IROC-H prescription. The treatment plan was optimised using adoptive convolution algorithm to improve dose homogeneity and conformity. The dose calculation was performed using C.C Convolution algorithm and a Varian True Beam linear accelerator was used to deliver the treatment plan to the H&N phantom. The delivered radiation dose to the phantom was measured through TLDs and GafChromic external beam radiotherapy 2 (EBT2) films. The dosimetric performance of the VMAT delivery was studied by analysing percent dose difference, isodose line profile and gamma analysis of the TPS-computed dose and linac-delivered doses.
The percent dose difference of 3.8% was observed between the planned and measured doses of TLDs and a 1.5-mm distance to agreement (DTA) was observed by comparing isodose line profiles. Passed the gamma criteria of 3%/3 mm was with good percentages.
The dosimetric performance of VMAT delivery for a challenging H&N radiotherapy can be verified using TLDs and films embedded in an anthropomorphic H&N phantom.
Co-circulation of Chikungunya and Dengue viral infections (CHIKV and DENV) have been reported mainly due to transmission by common Aedes vector. The purpose of the study was to identify and characterise the circulating strains of CHIKV and DENV in DENV endemic region of New Delhi during 2016. CHIKV and DENV were identified in the blood samples (n = 130) collected from suspected patients by RT-PCR. CHIKV was identified in 26 of 65 samples (40%). Similarly, DENV was detected in 48 of 120 samples (40%). Co-infection with both the viruses was identified in five (9%) of the samples. Interestingly, concurrent infection with DENV, CHIKV and Plasmodium vivax was detected in two samples. CHIKV strains (n = 11) belonged to the ECSA genotype whereas DENV-3 sequences (n = eight) clustered in Genotype III by phylogenetic analysis. Selection pressure of E1 protein of CHIKV and CprM protein of DENV-3 revealed purifying selection with four and two positive sites, respectively. Four amino acids of the CHIKV were positively selected and had high entropy suggesting probable variations. Co-circulation of both viruses in DENV endemic regions warrants effective monitoring of these emerging pathogens via comprehensive surveillance for implementation of effective control measures.
Graphene nanosheets were prepared by pulsed Nd:YAG laser ablation of graphite target in H2O under ambient conditions. The synthesized graphene nanosheets were characterized by high resolution transmission electron microscope (HRTEM), X-ray diffraction (XRD), Raman spectroscopy and Selected Area Electron Diffraction (SAED). The obtained structural and morphological analysis confirmed that the graphene nanosheets could be formed in an aqueous medium via one step method where a nanosecond pulsed near-infrared (NIR) laser (λ = 1064 nm) is used to ablate the surface of a pure graphite target. Compared to other used chemical methods to synthesis graphene nanosheets, laser ablation is an easy, versatile, environmental friendly and rapidly growing method for the synthesis of nanostructured materials such as graphene nanosheets. This technique showed normal operation in liquid medium (i.e. water or organic) under ambient conditions. Our study confirmed the great potential of laser ablation in liquid method for the fabrication of graphene nanosheets based nanofluids wich has a potential applicatiuon as a heat transfer fluid.
The Eastern Gangetic Plain is among the world's most intensively farmed regions, where rainfed and irrigated agriculture coexist. While the region and especially Bangladesh is a major producer of rice (Oryza sativa L. ssp. indica), there is potential to further develop sustainable rice production systems. Specifically, there is scope to include a replacement crop for the short fallow between rice crops in the dominant cropping pattern of rainfed monsoon rice harvest followed by irrigated spring rice. The aim of the current research was to identify a suitable cool-season legume crop – pea (Pisum sativum L.) or lentil (Lens culinaris Medik. ssp. culinaris) – that could be grown in the brief period between rice crops. The study comprised four crop sequence experiments comparing legume cultivars differing in maturity grown in between both long and short duration rice cultivars. These experiments were done at the Bangladesh Rice Research Institute regional station at Rajshahi over three cropping cycles. This was followed by an evaluation of pea vs. fallow between rice crops on three farmers’ fields in one cropping cycle. Here it is demonstrated that green pod vegetable pea is one of the best options to intensify the rainfed monsoon rice–fallow–spring irrigated rice cropping system, notwithstanding other remunerative rabi cropping options that could displace boro rice. The inclusion of an extra crop, pea as green pod vegetable, increased farm productivity by 1·4-fold over the dominant cropping sequence (rice–fallow–rice) and farm net income by fourfold. The study highlighted the advantages in total system productivity and monetary return of crop intensification with the inclusion of a pea crop between successive rice crops instead of a fallow period.
Older adults are a potentially medically vulnerable population with increased mortality rates during and after disasters. To evaluate the impact of a natural disaster on this population, we performed a temporal and geospatial analysis of emergency department (ED) use by adults aged 65 years and older in New York City (NYC) following Hurricane Sandy’s landfall.
We used an all-payer claims database to analyze demographics, insurance status, geographic distribution, and health conditions for post-disaster ED visits among older adults. We compared ED patterns of use in the weeks before and after Hurricane Sandy throughout NYC and the most afflicted evacuation zones.
We found significant increases in ED utilization by older adults (and disproportionately higher in those aged ≥85 years) in the 3 weeks after Hurricane Sandy, especially in NYC evacuation zone one. Primary diagnoses with notable increases included dialysis, electrolyte disorders, and prescription refills. Secondary diagnoses highlighted homelessness and care access issues.
Older adults display heightened risk for worse health outcomes with increased ED visits after a disaster. Our findings suggest the need for dedicated resources and planning for older adults following a natural disaster by ensuring access to medical facilities, prescriptions, dialysis, and safe housing and by optimizing health care delivery needs to reduce the burden of chronic disease. (Disaster Med Public Health Preparedness. 2018;12:184–193)
Synthesis of Ni and Zn substituted nano-greigite,
Fe3S4, is achieved from single source
diethyldithiocarbamato precursor compounds, producing particles typically
50–100 nm in diameter with plate-like pseudohexagonal morphologies. Up to 12
wt.% Ni is incorporated into the greigite structure, and there is evidence
that Zn is also incorporated but Co is not substituted into the lattice. The
Fe L3 X-ray absorption spectra for these materials have a narrow
single peak at 707.7 eV and the resulting main X-ray magnetic circular
dichroism (XMCD) has the same sign at 708.75 eV. All XMCD spectra also have
a broad positive feature at 711 eV, a characteristic of covalent mixing. The
greigite XMCD spectra contrast with the three clearly defined XMCD site
specific peaks found in the ferrite spinel, magnetite. The Fe
L2,3X-ray absorption spectra and XMCD spectra of the
greigite reflect and reveal the high conductivity of greigite and the very
strong covalency of the Fe–S bonding. The electron hopping between
Fe3+ and Fe2+ on octahedral sites results in an
intermediate oxidation state of the Fe in the Oh site of
Fe2.5+ producing an effective formula of [Fe3+
↑]A-site[2Fe2.5+ ↓]B-siteS42–]. The Ni L2,3 X-ray absorption spectra and XMCD reveal substitution on the
Oh site with a strongly covalent character and an
oxidation state <Ni1.5+ in a representative formula
[Fe3+ ↑]A[[(2 – x)Fe2.5+
In vitro rumen methane output (IRMO) of over 200 feed/feed mix samples representing approximately 74 feed types was investigated in a series of completely randomized experiments. The samples comprised dry fodder, grass, tree leaves, cultivated grasses, cereal by-products, cereal grains, oilseed/meals, compound feeds and total mixed rations (TMRs) from the tropical regions. These samples were subjected to three in vitro gas production tests at 39 °C in 100 ml Heberle syringes. The first incubation was conducted with 200 mg dry matter (DM) substrate for 96 h to determine half-time gas production (t1/2, h) value of each sample. The second and third incubations were carried out simultaneously. The second incubation was done with 200 mg DM substrate until t1/2 time to determine IRMO and third with 500 mg DM to estimate in vitro dry matter digestibility (IVDMD) of each samples, respectively. The IRMO was expressed as ml/100 mg digestible substrate. Crude protein content (g/kg DM) was lowest in dry fodder samples and highest in oilseed meals, whereas it was similar in local grass and tree leaves. The IVDMD values ranged from 0·48 to 0·87; the lowest digestibility was recorded in tree leaves. The potential gas production (PGP, ml/200 mg DM) ranged from 9·76 to 61·3. The PGP from grasses and compound feeds was similar, whereas it was lowest in tree leaves. The rate constant (mg/h) was maximum in compound feed followed by oilseed meal. The rate constant was similar among other group of feedstuffs. The t1/2 time ranged from 9·8 to 19·4 h. The highest t1/2 time was recorded in local grass samples followed by dry fodder and cultivated grasses. However, they were similar among tree leaves, cereal grains, by-products and compound feeds. The methane % in the total gas varied from 9·79 (tree leaves) to 20·2 (local grasses). Among straw, IRMO varied from 3·88 (Zea mays fodder) to 12·0 (Sorghum vulgare) and it was lower in fruit tree leaves than cultivated grasses. Among protein and energy sources, IRMO was higher in cereal by-products as compared with cereal grains, oil meals and compound feed. The IRMO was similar among TMR, irrespective of the composition of the concentrate mixture. Nevertheless, it varied with the amount of concentrate in the TMR. This is the first exhaustive data on IRMO from the tropical region. Because of the substantial amount of dietary gross energy lost in methane, knowledge of the methane output from these feed ingredients will help in formulating low methane emitting diets for ruminants. Incorporation of tropical tree leaves in the diets and feeding TMR are potential strategies to reduce enteric methane emission in ruminants.
People with depression tend to have lower heart rate variability (HRV), but the temporal sequence is poorly understood. In a sample of the general population, we prospectively examined whether HRV measures predict subsequent depressive symptoms or whether depressive symptoms predict subsequent levels of HRV.
Data from the fifth (1997–1999) and ninth (2007–2009) phases of the UK Whitehall II longitudinal population-based cohort study were analysed with an average follow-up of 10.5 years. The sample size for the prospective analysis depended on the analysis and ranged from 2334 (644 women) to 2276 (602 women). HRV measures during 5 min of supine rest were obtained. Depressive symptoms were evaluated by four cognitive symptoms of depression from the General Health Questionnaire.
At follow-up assessment, depressive symptoms were inversely associated with HRV measures independently of antidepressant medication use in men but not in women. Prospectively, lower baseline heart rate and higher HRV measures were associated with a lower likelihood of incident depressive symptoms at follow-up in men without depressive symptoms at baseline. Similar but statistically insignificant associations were found in women. Adjustments for known confounders including sociodemographic and lifestyle factors, cardiometabolic conditions or medication did not change the predictive effect of HRV on incident depressive symptoms at follow-up. Depressive symptoms at baseline were not associated with heart rate or HRV at follow-up in either sex.
These findings are consistent with an aetiological role of the autonomic nervous system in depression onset.
To assess the impact of an emergency intensive care unit (EICU) established concomitantly with a freestanding emergency department (ED) during the aftermath of Hurricane Sandy.
We retrospectively reviewed records of all patients in Bellevue’s EICU from freestanding ED opening (December 10, 2012) until hospital inpatient reopening (February 7, 2013). Temporal and clinical data, and disposition upon EICU arrival, and ultimate disposition were evaluated.
Two hundred twenty-seven patients utilized the EICU, representing approximately 1.8% of freestanding ED patients. Ambulance arrival occurred in 31.6% of all EICU patients. Median length of stay was 11.55 hours; this was significantly longer for patients requiring airborne isolation (25.60 versus 11.37 hours, P<0.0001 by Wilcoxon rank sum test). After stabilization and treatment, 39% of EICU patients had an improvement in their disposition status (P<0.0001 by Wilcoxon signed rank test); upon interhospital transfer, the absolute proportion of patients requiring ICU and SDU resources decreased from 37.8% to 27.1% and from 22.2% to 2.7%, respectively.
An EICU attached to a freestanding ED achieved significant reductions in resource-intensive medical care. Flexible, adaptable care systems should be explored for implementation in disaster response. (Disaster Med Public Health Preparedness. 2016;10:496–502)
Important transformations in psychiatric healthcare (HC) delivery have been implemented in Latin America during the beginning of 21st century. However, information on current service uses patterns is scant, obstructing the estimates and proper planning of service needs for general population. The current investigation aims to describe patterns and estimates predictors of 12-month HC use by individuals with mental disorders in São Paulo metropolitan area, Brazil.
Data are from São Paulo Mental Health Survey, a cross-sectional multistage representative study. Participants were face-to-face interviewed in their household, using a structured diagnostic interview, the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. A total of 5037 respondents, non-institutionalised, aged 18 years and older were interviewed. The response rate was 81.3%. We determined the percentages of individuals with 12-month DSM-IV anxiety, mood and substance disorders that received treatment in the 12 months prior to assessment in main service sectors (specialty mental health, general medicine, human services (HS), and complementary and alternative medicine). The number of visits and percentage of individuals who received treatment at minimally adequacy also was estimated. Multilevel regression controlled contextual variables that influenced the use of service and treatment adequacy.
Only 10.1% of respondents used some HC service in the 12 months prior to assessment for their psychiatric problems, including 3.9% of them being treated either by a psychiatrist, 3.5% by a non-psychiatrist mental health specialist, 3.3% by a general medical (GM) provider, 1.5% by a HS provider and 1.4% by a complementary and alternative medical provider. In general, those participants who received service in the mental health specialty sector reported more visits than those in the GM sector (median 3.9 v. 1.5 visits). The cases seen in specialty sector outnumber those visiting GM treatment in terms of minimally adequate treatment (54.6 v. 23.2%). The likelihood of receiving treatment was significantly greater among individuals diagnosed with any anxiety and mood disorder, presenting more severe disorders, and with possession of HC insurance.
The great majority of individuals with an active mental disorder in São Paulo were either untreated or insufficiently treated. Awareness and training programmes to GM professionals are advocated to improve recognition, care take and referral to specialty care when needed. Proper integration among HC sectors is recommended.
Present paper addresses the numerical study of Sisko fluid model over stretching cylinder with variable thermal conductivity. The governing equations are simplified by incorporating the boundary layer approximations. After employing suitable similarity transformations partial differential equations are reduced to ordinary differential equations. To obtain numerical solution shooting method in conjunction with Runge-Kutta-Fehlberg method is used. For the analysis of model, variations due to different physical parameters involved in momentum and heat equations are reflected through graphs. Also, the effects of physical parameters on skin-friction coefficient and Nusselt number are represented through graphs as well as tables.
Vitamin D plays an important role in skeletal health throughout life. Some studies have hypothesised that vitamin D may reduce the risk of other diseases. Our study aimed to estimate age-specific and sex-specific serum 25-hydroxyvitamin D (25(OH)D) status and to identify the determinants of serum 25(OH)D status in Hong Kong, a subtropical city in southern China. In 2009–2010, households in Hong Kong were followed up to identify acute respiratory illnesses, and sera from 2694 subjects were collected in three to four different study phases to permit measurement of 25(OH)D levels at different times of the year. A questionnaire survey on diet and lifestyle was conducted among children, with simultaneous serum collection in April and May 2010. The mean of serum 25(OH)D levels in age groups ranged from 39 to 63 nmol/l throughout the year with the mean values in all age groups in spring below 50 nmol/l. Children aged 6–17 years, and girls and women had significantly lower serum 25(OH)D levels than adults, and boys and men, respectively (all P< 0·001). We estimated that serum 25(OH)D levels in Hong Kong followed a lagged pattern relative to climatic season by 5 weeks with lowest observed levels in early spring (March). For children aged 6–17 years, reporting a suntan, having at least 1 servings of fish/week and having at least 1 serving of eggs/week were independently associated with higher serum 25(OH)D levels. Adequate sunlight exposure and increased intake of dietary vitamin D could improve vitamin D status, especially for children and females in the winter and spring.
The cropping systems of the Eastern Gangetic Plains of Bangladesh, India and Nepal are based on rice. There is a scope to intensify such systems through diversification with lentil, the most popular food legume. Two strategies were evaluated to fit lentil into the short fallow between successive monsoonal (i.e., T. aman) and pre-monsoonal (aus) or irrigated rice (boro) crop. These were early-flowering sole-cropped lentil and relay-sown lentil into rice. Firstly, 18 early-flowering lentil lines at three contrasting sowing dates were tested over two seasons on a research station at Ishurdi in Bangladesh. Secondly, relay sowing was evaluated at the same location with six early-flowering lines and two control cultivars in two seasons. It was also assessed on ten farms in Western Bangladesh, comparing relay with sole cropping over 3 years. Flowering in the early-flowering lentil lines was consistently 9–17 days earlier, than the control cultivars, but they did not achieve an economic yield (<1·0 t/ha). Relay sowing with an existing cultivar produced an economic yield of lentil, which was comparable or higher than sole-cropped lentil in all situations. The relay-sown lentil matured in sufficient time to allow the land to be prepared for the succeeding rain-fed rice crop. It was concluded that the substitution of relay-sown lentil for fallow in the monsoonal rice–fallow–rain-fed rice cropping pattern is a useful option to intensify and diversify cropping in the Eastern Gangetic Plain.