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Consumption of certain berries appears to slow postprandial glucose absorption, attributable to polyphenols, which may benefit exercise and cognition, reduce appetite and/or oxidative stress. This randomised, crossover, placebo-controlled study determined whether polyphenol-rich fruits added to carbohydrate-based foods produce a dose-dependent moderation of postprandial glycaemic, glucoregulatory hormone, appetite and ex vivo oxidative stress responses. Twenty participants (eighteen males/two females; 24 (sd 5) years; BMI: 27 (sd 3) kg/m2) consumed one of five cereal bars (approximately 88 % carbohydrate) containing no fruit ingredients (reference), freeze-dried black raspberries (10 or 20 % total weight; LOW-Rasp and HIGH-Rasp, respectively) and cranberry extract (0·5 or 1 % total weight; LOW-Cran and HIGH-Cran), on trials separated by ≥5 d. Postprandial peak/nadir from baseline (Δmax) and incremental postprandial AUC over 60 and 180 min for glucose and other biochemistries were measured to examine the dose-dependent effects. Glucose AUC0–180 min trended towards being higher (43 %) after HIGH-Rasp v. LOW-Rasp (P=0·06), with no glucose differences between the raspberry and reference bars. Relative to reference, HIGH-Rasp resulted in a 17 % lower Δmax insulin, 3 % lower C-peptide (AUC0–60 min and 3 % lower glucose-dependent insulinotropic polypeptide (AUC0–180 min) P<0·05. No treatment effects were observed for the cranberry bars regarding glucose and glucoregulatory hormones, nor were there any treatment effects for either berry type regarding ex vivo oxidation, appetite-mediating hormones or appetite. Fortification with freeze-dried black raspberries (approximately 25 g, containing 1·2 g of polyphenols) seems to slightly improve the glucoregulatory hormone and glycaemic responses to a high-carbohydrate food item in young adults but did not affect appetite or oxidative stress responses at doses or with methods studied herein.
Introduction: Acute aortic syndrome (AAS) is a time sensitive aortic catastrophe that is often misdiagnosed. There are currently no Canadian guidelines to aid in diagnosis. Our goal was to adapt the existing American Heart Association (AHA) and European Society of Cardiology (ESC) diagnostic algorithms for AAS into a Canadian evidence based best practices algorithm targeted for emergency medicine physicians. Methods: We chose to adapt existing high-quality clinical practice guidelines (CPG) previously developed by the AHA/ESC using the GRADE ADOLOPMENT approach. We created a National Advisory Committee consisting of 21 members from across Canada including academic, community and remote/rural emergency physicians/nurses, cardiothoracic and cardiovascular surgeons, cardiac anesthesiologists, critical care physicians, cardiologist, radiologists and patient representatives. The Advisory Committee communicated through multiple teleconference meetings, emails and a one-day in person meeting. The panel prioritized questions and outcomes, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. The algorithm was prepared and revised through feedback and discussions and through an iterative process until consensus was achieved. Results: The diagnostic algorithm is comprised of an updated pre test probability assessment tool with further testing recommendations based on risk level. The updated tool incorporates likelihood of an alternative diagnosis and point of care ultrasound. The final best practice diagnostic algorithm defined risk levels as Low (0.5% no further testing), Moderate (0.6-5% further testing required) and High ( >5% computed tomography, magnetic resonance imaging, trans esophageal echocardiography). During the consensus and feedback processes, we addressed a number of issues and concerns. D-dimer can be used to reduce probability of AAS in an intermediate risk group, but should not be used in a low or high-risk group. Ultrasound was incorporated as a bedside clinical examination option in pre test probability assessment for aortic insufficiency, abdominal/thoracic aortic aneurysms. Conclusion: We have created the first Canadian best practice diagnostic algorithm for AAS. We hope this diagnostic algorithm will standardize and improve diagnosis of AAS in all emergency departments across Canada.
To evaluate the efficacy of multiple ultraviolet (UV) light decontamination devices in a radiology procedure room.
We compared the efficacy of 8 UV decontamination devices with a 4-minute UV exposure time in reducing recovery of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile spores on steel disk carriers placed at 5 sites on a computed tomography patient table. Analysis of variance was used to compare reductions for the different devices. A spectrometer was used to obtain irradiance measurements for the devices.
Four standard vertical tower low-pressure mercury devices achieved 2 log10CFU or greater reductions in VRE and MRSA and ~1 log10CFU reductions in C. difficile spores, whereas a pulsed-xenon device resulted in less reduction in the pathogens (P<.001). In comparison to the vertical tower low-pressure mercury devices, equal or greater reductions in the pathogens were achieved by 3 nonstandard low-pressure mercury devices that included either adjustable bulbs that could be oriented directly over the exam table, a robotic base allowing movement along the side of the table during operation, or 3 vertical towers operated simultaneously. The low-pressure mercury devices produced primarily UV-C light, whereas the pulsed-xenon device produced primarily UV-A and UV-B light. The time required to move the devices from the corner of the room and set up for operation varied from 18 to 59 seconds.
Many currently available UV devices could provide an effective and efficient adjunct to manual cleaning and disinfection in radiology procedure rooms.
In 4 hospitals, we demonstrated frequent dispersal of fluorescent tracer and fluoroquinolone-resistant gram-negative bacilli from sink drains to sink bowls and to surfaces outside the bowl. Fluorescent tracer dispersal correlated inversely with the depth of the sink bowl. Modifications in sink design could substantially reduce the risk for pathogen dissemination.
We report single-shot transient absorption (SSTA) measurements of an organic film of 3,3’-Diethyloxatricarbocyanine iodide (DOTCI). In SSTA, the pump-probe time delay is spatially encoded by using a tilted pump pulse. Translation of the sample during SSTA measurements averages over any spatial heterogeneity in the film. We demonstrate that exciton dynamics measured with the single-shot technique agrees with traditional transient absorption measurements of the same film. A signal-to-noise ratio of ∼40 is achieved in 10 s. The ability to measure exciton dynamics in organic films will enable future SSTA measurements of exciton dynamics during the molecular aggregation events that result in film formation.
Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.
To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.
Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.
Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.
A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.
We must define a special function, which is identical to neither health nor illness: the function of the Anomalous. The Anomalous is always at the frontier […] it traces a line-between […] This is the Thing or Entity of terror.
Gilles Deleuze, Dialogues II
Let us recognise […] the subject's efficacy in the gnomon he erects, a gnomon that constantly indicates truth's site to him.
Jacques Lacan, Écrits
As Brian Massumi remarks in his notes to the translation of A Thousand Plateaus, the word ‘flight’ does not quite convey everything at stake in the notion of ‘ligne de fuite’ that has ‘a different range of meanings’. For example, it has less to do with the act of flying than with that of fleeing, making an exit or vanishing. The English word flight can also mean flee, of course, as in the flight from some object of fear, or in the act of putting-to-flight. A line, meanwhile, is not just something along which one might travel, but can also function as a frontier that differentiates or separates two planes, fields or territories. Let us say between Lacan and Deleuze, for example, or even Deleuze and Guattari. No doubt we can regard these proper names as designating certain zones or discursive fields of philosophy and analysis as well as authors. At the same time there is also the question of the relation between the author and his or her work. The significant term that is highlighted by the ‘line of flight’, however, is neither of the proper names but the ‘and’ that marks the borderline between the two. As Deleuze writes, ‘AND is neither one thing nor the other, it's always in-between, between two things … there's always a border, a line of flight or flow, only we don't see it because it's the least perceptible of things’. The ‘and’ is imperceptible, or rather overlooked because it is there on the surface, as plain as day, the word that links and separates a couple or a concatenation of elements. Clearly, given the various meanings of the ‘ligne de fuite’, ‘and’ does not denote a harmonious unity like ying and yang, say, but a multiplicity that may well be discordant in its conjunctive parts, a disjunctive synthesis perhaps.
A common symptom of psychiatric and medical disorders, agitation often appears in a variety of medical environments. This practical guide explores the origins of the condition and the differing approaches and treatments available. The biology of agitation is discussed, followed by specific chapters on substance abuse, medical causes, personality disorders, and treatment in pediatrics and the elderly. Treatment options including psychiatric work-ups, medical work-ups, psychopharmacology, de-escalation, and calming techniques are provided. The complexities of legal issues, patients' rights, and prehospital settings are also addressed, providing physicians, nurses, and mental health workers with a comprehensive resource in providing safe, focused, and effective treatment.
The collective response of electrons in an ultrathin foil target irradiated by an ultraintense (
) laser pulse is investigated experimentally and via 3D particle-in-cell simulations. It is shown that if the target is sufficiently thin that the laser induces significant radiation pressure, but not thin enough to become relativistically transparent to the laser light, the resulting relativistic electron beam is elliptical, with the major axis of the ellipse directed along the laser polarization axis. When the target thickness is decreased such that it becomes relativistically transparent early in the interaction with the laser pulse, diffraction of the transmitted laser light occurs through a so called ‘relativistic plasma aperture’, inducing structure in the spatial-intensity profile of the beam of energetic electrons. It is shown that the electron beam profile can be modified by variation of the target thickness and degree of ellipticity in the laser polarization.