Food consumption of Sri Lankan adults : an appraisal of serving characteristics

Objective The main aim of the present study was to identify food consumption in Sri Lankan adults based on serving characteristics. Design Cross-sectional study. Fruits, vegetables, starch, meat, pulses, dairy products and added sugars in the diet were assessed with portion sizes estimated using standard methods. Setting Twelve randomly selected clusters from the Sri Lanka Diabetes and Cardiovascular Study. Subjects Six hundred non-institutionalized adults. Results The daily intake of fruit (0·43), vegetable (1·73) and dairy (0·39) portions were well below national recommendations. Only 3·5 % of adults consumed the recommended 5 portions of fruits and vegetables/d; over a third of the population consumed no dairy products and fewer than 1 % of adults consumed 2 portions/d. In contrast, Sri Lankan adults consumed over 14 portions of starch and 3·5 portions of added sugars daily. Almost 70 % of those studied exceeded the upper limit of the recommendations for starch intake. The total daily number of meat and pulse portions was 2·78. Conclusions Dietary guidelines emphasize the importance of a balanced and varied diet; however, a substantial proportion of the Sri Lankan population studied failed to achieve such a recommendation. Nutrition-related diseases in the country may be closely correlated with unhealthy eating habits.

Characteristics of men aged 50 years or older who do not take up skin self-examination following an educational intervention

Men aged 50 years or older are at high risk of melanoma, and both incidence and mortality are increasing in this group1. Skin self-examination (SSE) could be one avenue to improve outcomes from melanoma. Several recent intervention trials successfully increased SSE, but resistance to such interventions is less well studied. This posthoc secondary analysis of interventional study data aimed to identify characteristics of older men who did not take up SSE for the early signs of skin cancer, despite exposure to educational materials during a randomized intervention trial

Neurological drugs and opioids for pain management

20.1 Epilepsy and an introduction to drugs used to treat 20.1.1 Introduction to epilepsy 20.1.2 Treatment of partial seizures 20.1.3 Treatment of generalised seizures 20.1.4 Treatment of status epilepticus 20.2 Neurodegenerative disorders; principles of treatment 20.2.1 Introduction to neurodegenerative disorders 20.2.2 Parkinson’s disease 20.2.2.1 Introduction to Parkinson’s disease 20.2.2.2 Dopaminergic system 20.2.2.3 Treatment to enhance the dopaminergic system 20.2.2.4 Treatment to inhibit the cholinergic system 20.2.3 Dementia/Alzheimer’s disease 20.2.3.1 Introduction to Alzheimer’s disease 20.2.3.2 Treatment of Alzheimer’s disease 20.2.4 Amyotrophic lateral sclerosis 43.4.1 Introduction 43.4.2 Treatment 20.3. Pain and opioid analgesics 20.3.1 Introduction to pain and analgesia 20.3.2 Introduction to opioids 20.3.3 Tolerance and physical dependence 20.3.4 Effects of opioids 20.3.5 Agonists at opioid μ receptors 20.3.6 Toxicity to opioids This section deals with the neurologic drugs. The neurologic drugs are used to treat epilepsy and neurodegenerative diseases such as Parkinson’s disease and Alzheimer’s disease. The opioids for pain management are also discussed in this section.

Understanding treatment characteristics of constructed stormwater wetlands

Constructed wetlands are a common structural treatment measure employed to remove stormwater pollutants and forms an important part of the Water Sensitive Urban Design (WSUD) treatment suite. In a constructed wetland, a range of processes such as settling, filtration, adsorption, and biological uptake play a role in stormwater treatment. Occurrence and effectiveness of these processes are variable and influenced by hydraulic, chemical and biological factors. The influence of hydraulic factors on treatment processes are of particular concern. This paper presents outcomes of a comprehensive study undertaken to define the treatment performance of a constructed wetland highlighting the influence of hydraulic factors. The study included field monitoring of a well established constructed wetland for quantity and quality factors, development of a conceptual hydraulic model to simulate water movement within the wetland and multivariate analysis of quantity and quality data to investigate correlations and to define linkages between treatment performance and influential hydraulic factors. Total Suspended Solids (TSS), Total Nitrogen (TN) and Total Phosphorus (TP) concentrations formed the primary pollutant parameters investigated in the data analysis. The outcomes of the analysis revealed significant reduction in event mean concentrations of all three pollutants species. Treatment performance of the wetland was significantly different for storm events above and below the prescribed design event. For events below design event, TSS and TN load reduction was comparatively high and strongly influenced by high retention time. For events above design event, TP load reduction was comparatively high and was found to be influenced by the characteristics of TP wash-off from catchment surfaces.

Comparative study of depth-dependent characteristics of equine and human osteochondral tissue from the medial and lateral femoral condyles

Articular cartilage defects are common after joint injuries. When left untreated, the biomechanical protective function of cartilage is gradually lost, making the joint more susceptible to further damage, causing progressive loss of joint function and eventually osteoarthritis (OA). In the process of translating promising tissue-engineering cartilage repair approaches from bench to bedside, pre-clinical animal models including mice, rabbits, goats, and horses, are widely used. The equine species is becoming an increasingly popular model for the in vivo evaluation of regenerative orthopaedic approaches. As there is also an increasing body of evidence suggesting that successful lasting tissue reconstruction requires an implant that mimics natural tissue organization, it is imperative that depth-dependent characteristics of equine osteochondral tissue are known, to assess to what extent they resemble those in humans. Therefore, osteochondral cores (4-8 mm) were obtained from the medial and lateral femoral condyles of equine and human donors. Cores were processed for histology and for biochemical quantification of DNA, glycosaminoglycan (GAG) and collagen content. Equine and human osteochondral tissues possess similar geometrical (thickness) and organizational (GAG, collagen and DNA distribution with depth) features. These comparable trends further underscore the validity of the equine model for the evaluation of regenerative approaches for articular cartilage.

Molecular dynamics studies of the effects of branching characteristics on the crystalline structure of polyethylene

Molecular dynamics simulations were carried out on single chain models of linear low-density polyethylene in vacuum to study the effects of branch length, branch content, and branch distribution on the polymer’s crystalline structure at 300 K. The trans/gauche (t/g) ratios of the backbones of the modeled molecules were calculated and utilized to characterize their degree of crystallinity. The results show that the t/g ratio decreases with increasing branch content regardless of branch length and branch distribution, indicating that branch content is the key molecular parameter that controls the degree of crystallinity. Although t/g ratios of the models with the same branch content vary, they are of secondary importance. However, our data suggests that branch distribution (regular or random) has a significant effect on the degree of crystallinity for models containing 10 hexyl branches/1,000 backbone carbons. The fractions of branches that resided in the equilibrium crystalline structures of the models were also calculated. On average, 9.8% and 2.5% of the branches were found in the crystallites of the molecules with ethyl and hexyl branches while C13 NMR experiments showed that the respective probabilities of branch inclusion for ethyl and hexyl branches are 10% and 6% [Hosoda et al., Polymer 1990, 31, 1999–2005]. However, the degree of branch inclusion seems to be insensitive to the branch content and branch distribution.

Shear buckling characteristics of cold-formed steel channel beams

Cold-formed steel members are increasingly used as primary structural elements in the building industries around the world due to the availability of thin and high strength steels and advanced cold-forming technologies. Cold-formed lipped channel beams (LCB) are commonly used as flexural members such as floor joists and bearers. However, their shear capacities are determined based on conservative design rules. For the shear design of LCB web panels, their elastic shear buckling strength must be determined accurately including the potential post-buckling strength. Currently the elastic shear buckling coefficients of LCB web panels are determined by assuming conservatively that the web panels are simply supported at the junction between their flange and web elements. Hence finite element analyses were conducted to investigate the elastic shear buckling behavior of LCBs. An improved equation for the higher elastic shear buckling coefficient of LCBs was proposed based on finite element analysis results and included in the ultimate shear capacity equations of the North American cold-formed steel codes. Finite element analyses show that relatively short span LCBs without flange restraints are subjected to a new combined shear and flange distortion action due to the unbalanced shear flow. They also show that significant post-buckling strength is available for LCBs subjected to shear. New equations were also proposed in which post-buckling strength of LCBs was included.

Damage detection in slab-on-girder bridges using vibration characteristics

This paper develops and applies a multi-criteria procedure, incorporating changes in natural frequencies, modal flexibility and the modal strain energy, for damage detection in slab-on-girder bridges. The proposed procedure is first validated through experimental testing of a model bridge. Numerically simulated modal data obtained through finite element analyses are then used to evaluate the vibration parameters before and after damage and used as the indices for assessment of the state of structural health. The procedure is illustrated by its application to full scale slab-on-girder bridges under different damage scenarios involving single and multiple damages on the deck and girders.

Influence of Rainfall and Catchment Characteristics on Urban Stormwater Quality

The accuracy and reliability of urban stormwater quality modelling outcomes are important for stormwater management decision making. The commonly adopted approach where only a limited number of factors are used to predict urban stormwater quality may not adequately represent the complexity of the quality response to a rainfall event or site-to-site differences to support efficient treatment design. This paper discusses an investigation into the influence of rainfall and catchment characteristics on urban stormwater quality in order to investigate the potential areas for errors in current stormwater quality modelling practices. It was found that the influence of rainfall characteristics on pollutant wash-off is step-wise based on specific thresholds. This means that a modelling approach where the wash-off process is predicted as a continuous function of rainfall intensity and duration is not appropriate. Additionally, other than conventional catchment characteristics, namely, land use and impervious surface fraction, other catchment characteristics such as impervious area layout, urban form and site specific characteristics have an important influence on both, pollutant build-up and wash-off processes. Finally, the use of solids as a surrogate to estimate other pollutant species was found to be inappropriate. Individually considering build-up and wash-off processes for each pollutant species should be the preferred option.

Lynch syndrome-associated breast cancers: clinicopathologic characteristics of a case series from the colon cancer family registry

Purpose: The recognition of breast cancer as a spectrum tumor in Lynch syndrome remains controversial. The aim of this study was to explore features of breast cancers arising in Lynch syndrome families. Experimental Design: This observational study involved 107 cases of breast cancer identified from the Colorectal Cancer Family Registry (Colon CFR) from 90 families in which (a) both breast and colon cancer co-occurred, (b) families met either modified Amsterdam criteria, or had at least one early-onset (<50 years) colorectal cancer, and (c) breast tissue was available within the biospecimen repository for mismatch repair (MMR) testing. Eligibility criteria for enrollment in the Colon CFR are available online. Breast cancers were reviewed by one pathologist. Tumor sections were stained for MLH1, PMS2, MSH2, and MSH6, and underwent microsatellite instability testing. Results: Breast cancer arose in 35 mutation carriers, and of these, 18 (51%) showed immunohistochemical absence of MMR protein corresponding to the MMR gene mutation segregating the family. MMR-deficient breast cancers were more likely to be poorly differentiated (P = 0.005) with a high mitotic index (P = 0.002), steroid hormone receptor–negative (estrogen receptor, P = 0.031; progesterone receptor, P = 0.022), and to have peritumoral lymphocytes (P = 0.015), confluent necrosis (P = 0.002), and growth in solid sheets (P < 0.001) similar to their colorectal counterparts. No difference in age of onset was noted between the MMR-deficient and MMR-intact groups. Conclusions: MMR deficiency was identified in 51% of breast cancers arising in known mutation carriers. Breast cancer therefore may represent a valid tissue option for the detection of MMR deficiency in which spectrum tumors are lacking

Physical activity amongst people with chronic back pain : an investigation of perceived barriers and facilitators to inform intervention development

Previous research has indicated people with non-specific low back pain who are physically inactive face a poorer prognosis than people with back pain who participate in low or moderate intensity physical activity. They also face a greater risk of other lifestyle related health conditions, such as diabetes and heart disease. For these reasons, contemporary non-surgical interventions for low back pain aim to incorporate a return to physical activity. However, there is a lack of empirical evidence supporting physical activity interventions for this purpose. It is likely that people with low back pain face additional challenges when trying to commence (or return to) regular physical activity. This exploratory qualitative research aimed to map out perceived barriers and facilitators to undertaking physical activity among people with non-specific low back pain to inform future intervention development.

Pain management

Regardless of the setting in which they work, nurses are responsible for the assessment and management of clients with pain. Pain is a key consideration in all patient care, and nurses play a critical role in pain management. Indeed, throughout history nurses have made important contributions to our understanding and management of pain through research and clinical practice. This chapter aims to provide an introduction to some key concepts in pain management and to encourage you to reflect on some of your own assumptions about pain.

A history of heart interventions moderates the relationship between psychological variables and the presence of chest pain in older women with self-reported coronary heart disease

Objectives: This study examines the hypothesis that a past history of heart interventions will moderate the relationship between psychosocial factors (stressful life events, social support, perceived stress, having a current partner, having a past diagnosis of depression or anxiety over the past 3 years, time pressure, education level, and the mental health index) and the presence of chest pain in a sample of older women. Design: Longitudinal survey over a 3-year period. Methods: The sample was taken from a prospective cohort study of 10,432 women initially aged between 70 and 75 years, who were surveyed in 1996 and then again in 1999. Two groups of women were identified: those reporting to have heart disease but no past history of heart interventions (i.e., coronary artery bypass graft/angioplasty) and those reporting to have heart disease with a past history of heart interventions. Results: Binary logistic regression analysis was used to show that for the women with self-reported coronary heart disease but without a past history of heart intervention, feelings of time pressure as well as the number of stressful life events experienced in the 12 months prior to 1996 were independent risk factors for the presence of chest pain, even after accounting for a range of traditional risk factors. In comparison, for the women with self-reported coronary heart disease who did report a past history of heart interventions, a diagnosis of depression in the previous 3 years was the significant independent risk factor for chest pain even after accounting for traditional risk factors. Conclusion: The results indicate that it is important to consider a history of heart interventions as a moderator of the associations between psychosocial variables and the frequency of chest pain in older women. Statement of Contribution: What is already known on this subject? Psychological factors have been shown to be independent predictors of a range of health outcomes in individuals with coronary heart disease, including the presence of chest pain. Most research has been conducted with men or with small samples of women; however, the evidence does suggest that these relationships exist in women as well as in men. What does this study add? Most studies have looked at overall relationships between psychological variables and health outcomes. The few studies that have looked at moderators have mainly examined gender as a moderator. To our knowledge, this is the first published study to examine a history of heart interventions as a moderator of the relationship between psychological variables and the presence of chest pain.

The prevalence and perception of pain amongst hospital in-patients

The aim of this paper is to describe the prevalence and perceptions of pain and pain management amongst hospital in-patients. A cross-sectional descriptive survey of 205 patients was conducted. Presence and severity of pain was assessed using verbal descriptor and visual analogue scales, and perceptions of pain were assessed using multi-item scales. Although the severity of pain reported was consistent across age groups and clinical areas, women in the study sample were significantly more likely to report high levels of pain than men. Differences in how men and women communicate their pain were observed, with women indicating that they were less willing to ask for help with their pain. Results suggest that pain continues to be an important problem for a large number of men and women in hospital, and that the experience of pain impacts negatively upon their well-being. Gender differences in the experience of and response to pain remain important considerations for clinical nurses who have major responsibilities for the management of pain in hospitalized patients.