943 resultados para 20-MUC 5
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Older adults, especially those acutely ill, are vulnerable to developing malnutrition due to a range of risk factors. The high prevalence and extensive consequences of malnutrition in hospitalised older adults have been reported extensively. However, there are few well-designed longitudinal studies that report the independent relationship between malnutrition and clinical outcomes after adjustment for a wide range of covariates. Acutely ill older adults are exceptionally prone to nutritional decline during hospitalisation, but few reports have studied this change and impact on clinical outcomes. In the rapidly ageing Singapore population, all this evidence is lacking, and the characteristics associated with the risk of malnutrition are also not well-documented. Despite the evidence on malnutrition prevalence, it is often under-recognised and under-treated. It is therefore crucial that validated nutrition screening and assessment tools are used for early identification of malnutrition. Although many nutrition screening and assessment tools are available, there is no universally accepted method for defining malnutrition risk and nutritional status. Most existing tools have been validated amongst Caucasians using various approaches, but they are rarely reported in the Asian elderly and none has been validated in Singapore. Due to the multiethnicity, cultural, and language differences in Singapore older adults, the results from non-Asian validation studies may not be applicable. Therefore it is important to identify validated population and setting specific nutrition screening and assessment methods to accurately detect and diagnose malnutrition in Singapore. The aims of this study are therefore to: i) characterise hospitalised elderly in a Singapore acute hospital; ii) describe the extent and impact of admission malnutrition; iii) identify and evaluate suitable methods for nutritional screening and assessment; and iv) examine changes in nutritional status during admission and their impact on clinical outcomes. A total of 281 participants, with a mean (+SD) age of 81.3 (+7.6) years, were recruited from three geriatric wards in Tan Tock Seng Hospital over a period of eight months. They were predominantly Chinese (83%) and community-dwellers (97%). They were screened within 72 hours of admission by a single dietetic technician using four nutrition screening tools [Tan Tock Seng Hospital Nutrition Screening Tool (TTSH NST), Nutritional Risk Screening 2002 (NRS 2002), Mini Nutritional Assessment-Short Form (MNA-SF), and Short Nutritional Assessment Questionnaire (SNAQ©)] that were administered in no particular order. The total scores were not computed during the screening process so that the dietetic technician was blinded to the results of all the tools. Nutritional status was assessed by a single dietitian, who was blinded to the screening results, using four malnutrition assessment methods [Subjective Global Assessment (SGA), Mini Nutritional Assessment (MNA), body mass index (BMI), and corrected arm muscle area (CAMA)]. The SGA rating was completed prior to computation of the total MNA score to minimise bias. Participants were reassessed for weight, arm anthropometry (mid-arm circumference, triceps skinfold thickness), and SGA rating at discharge from the ward. The nutritional assessment tools and indices were validated against clinical outcomes (length of stay (LOS) >11days, discharge to higher level care, 3-month readmission, 6-month mortality, and 6-month Modified Barthel Index) using multivariate logistic regression. The covariates included age, gender, race, dementia (defined using DSM IV criteria), depression (defined using a single question “Do you often feel sad or depressed?”), severity of illness (defined using a modified version of the Severity of Illness Index), comorbidities (defined using Charlson Comorbidity Index, number of prescribed drugs and admission functional status (measured using Modified Barthel Index; MBI). The nutrition screening tools were validated against the SGA, which was found to be the most appropriate nutritional assessment tool from this study (refer section 5.6) Prevalence of malnutrition on admission was 35% (defined by SGA), and it was significantly associated with characteristics such as swallowing impairment (malnourished vs well-nourished: 20% vs 5%), poor appetite (77% vs 24%), dementia (44% vs 28%), depression (34% vs 22%), and poor functional status (MBI 48.3+29.8 vs 65.1+25.4). The SGA had the highest completion rate (100%) and was predictive of the highest number of clinical outcomes: LOS >11days (OR 2.11, 95% CI [1.17- 3.83]), 3-month readmission (OR 1.90, 95% CI [1.05-3.42]) and 6-month mortality (OR 3.04, 95% CI [1.28-7.18]), independent of a comprehensive range of covariates including functional status, disease severity and cognitive function. SGA is therefore the most appropriate nutritional assessment tool for defining malnutrition. The TTSH NST was identified as the most suitable nutritional screening tool with the best diagnostic performance against the SGA (AUC 0.865, sensitivity 84%, specificity 79%). Overall, 44% of participants experienced weight loss during hospitalisation, and 27% had weight loss >1% per week over median LOS 9 days (range 2-50). Wellnourished (45%) and malnourished (43%) participants were equally prone to experiencing decline in nutritional status (defined by weight loss >1% per week). Those with reduced nutritional status were more likely to be discharged to higher level care (adjusted OR 2.46, 95% CI [1.27-4.70]). This study is the first to characterise malnourished hospitalised older adults in Singapore. It is also one of the very few studies to (a) evaluate the association of admission malnutrition with clinical outcomes in a multivariate model; (b) determine the change in their nutritional status during admission; and (c) evaluate the validity of nutritional screening and assessment tools amongst hospitalised older adults in an Asian population. Results clearly highlight that admission malnutrition and deterioration in nutritional status are prevalent and are associated with adverse clinical outcomes in hospitalised older adults. With older adults being vulnerable to risks and consequences of malnutrition, it is important that they are systematically screened so timely and appropriate intervention can be provided. The findings highlighted in this thesis provide an evidence base for, and confirm the validity of the current nutrition screening and assessment tools used among hospitalised older adults in Singapore. As the older adults may have developed malnutrition prior to hospital admission, or experienced clinically significant weight loss of >1% per week of hospitalisation, screening of the elderly should be initiated in the community and continuous nutritional monitoring should extend beyond hospitalisation.
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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.
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A genome-wide search for markers associated with BSE incidence was performed by using Transmission-Disequilibrium Tests (TDTs). Significant segregation distortion, i.e., unequal transmission probabilities of alleles within a locus, was found for three marker loci on Chromosomes (Chrs) 5, 10, and 20. Although TDTs are robust to false associations owing to hidden population substructures, it cannot distinguish segregation distortion caused by a true association between a marker and bovine spongiform encephalopathy (BSE) from a population-wide distortion. An interaction test and a segregation distortion analysis in half-sib controls were used to disentangle these two alternative hypotheses. None of the markers showed any significant interaction between allele transmission rates and disease status, and only the marker on Chr 10 showed a significant segregation distortion in control individuals. Nevertheless, the control group may have been a mixture of resistant and susceptible but unchallenged individuals. When new genotypes were generated in the vicinity of these three markers, evidence for an association with BSE was confirmed for the locus on Chr 5.
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Near-ripe ‘Kensington Pride’ mango (Mangifera indica L.) fruit with green skin colour generally return lower wholesale and retail prices. Pre-harvest management, especially nitrogen (N) nutrition, appears to be a major causal factor. To obtain an understanding of the extent of the problem in the Burdekin district (dry tropics; the major production area in Australia), green mature ‘Kensington Pride’ mango fruit were harvested from ten orchards and ripened at 20 ± 0.5 O C. Of these orchards, 70% produced fruit with more than 25% of the skin surface area green when ripe. The following year, the effect of N application on skin colour and other quality attributes was investigated on three orchards, one with a high green (HG) skin problem and two with a low green (LG) skin problem. N was applied at pre-flowering and at panicle emergence at the rate of 0,75,150,300 g per tree (soil applied) or 50 g per tree as foliar N for the HG orchard, and 0,150,300,450 g per tree (soil applied) or 50 g per tree (foliar) for the LG orchards. In all orchards the proportion of green colour on the ripe fruit was significantly (P<0.05) higher with soil applications of 150 g N or more per tree. Foliar sprays resulted in a higher proportion of green colour than the highest soil treatment in the HG orchard, but not in the LG orchards. Anthracnose disease severity was significantly (P<0.05) higher with 300 g of N per tree or foliar treatment in the HG orchard, compared with no additional N. Thus, N can reduce mango fruit quality by increasing green colour and anthracnose disease in ripe fruit.
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Abstract It is widely considered that high pressure processing (HPP) results in better retention of micronutrients and phytochemicals compared to thermal pasteurization (TP), although some studies indicate that this may not be true in all cases. The aims of this study were (1) to objectively compare the effects of HPP under commercial processing conditions with thermal pasteurization (TP) on the stability of phenolic antioxidants in strawberries following processing and during storage and (2) to evaluate the influence of varietal differences and hence differences in biochemical composition of strawberries on the stability of phenolic antioxidants. Strawberry puree samples from cultivars Camarosa, Rubygem, and Festival were subjected to HPP (600 MPa/20 °C/5 min) and TP (88 °C/2 min). The activities of oxidative enzymes were evaluated before and after processing. Furthermore, the antioxidant capacity (total phenolic content (TPC), oxygen radical absorbance capacity (ORAC), and ferric reducing antioxidant power (FRAP)) and individual anthocyanins (by HPLC) were determined prior to and following processing and after three months of refrigerated storage (4 °C). Depending on the cultivar, HPP caused 15–38% and 20–33% inactivation of polyphenol oxidase and peroxidase, respectively, compared to almost complete inactivation of these enzymes by TP. Significant decreases (p < 0.05) in ORAC, FRAP, TPC and anthocyanin contents were observed during processing and storage of both HPP and TP samples. Anthocyanins were the most affected with only 19–25% retention after three months of refrigerated storage (4 °C). Slightly higher (p < 0.05) loss of TPC and antioxidant capacity were observed during storage of HPP samples compared to TP. Industrial Relevance: The results of the study demonstrated that both high pressure processing and thermal pasteurization result in high retention of phenolic phytochemicals in strawberry products. Under the conditions investigated, high pressure processing did not result in a better retention of phenolic phytochemicals compared to thermal pasteurization. In fact, a slightly higher loss of total polyphenol content and antioxidant capacity were observed during refrigerated storage of HPP processed samples. Our results showed that, high pressure processing may not always be a better alternative to thermal processing for strawberry puree processing if the main objective is better retention of phenolic antioxidants. However, it should be noted that other quality attributes such as sensory properties, where distinct advantages of HPP are expected, were outside the scope of this study.
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Objective To determine trends in the incidence of foot-related hospitalisation and amputation amongst persons with diabetes in Queensland (Australia) between 2005 and 2010 that coincided with changes in state-wide ambulatory diabetic foot-related complication management. Methods All data from cases admitted for the principal reason of diabetes foot-related hospitalisation or amputation in Queensland from 2005–2010 were obtained from the Queensland Hospital Admitted Patient Data Collection dataset. Incidence rates for foot-related hospitalisation (admissions, bed days used) and amputation (total, minor, major) cases amongst persons with diabetes were calculated per 1,000 person-years with diabetes (diabetes population) and per 100,000 person-years (general population). Age-sex standardised incidence and age-sex adjusted Poisson regression models were also calculated for the general population. Results There were 4,443 amputations, 24,917 hospital admissions and 260,085 bed days used for diabetes foot-related complications in Queensland. Incidence per 1,000 person-years with diabetes decreased from 2005 to 2010: 43.0% for hospital admissions (36.6 to 20.9), 40.1% bed days (391 to 234), 40.0% total amputations (6.47 to 3.88), 45.0% major amputations (2.18 to 1.20), 37.5% minor amputations (4.29 to 2.68) (p < 0.01 respectively). Age-sex standardised incidence per 100,000 person-years in the general population also decreased from 2005 to 2010: 23.3% hospital admissions (105.1 to 80.6), 19.5% bed days (1,122 to 903), 19.3% total amputations (18.57 to 14.99), 26.4% major amputations (6.26 to 4.61), 15.7% minor amputations (12.32 to 10.38) (p < 0.01 respectively). The age-sex adjusted incidence rates per calendar year decreased in the general population (rate ratio (95% CI)); hospital admissions 0.949 (0.942–0.956), bed days 0.964 (0.962–0.966), total amputations 0.962 (0.946–0.979), major amputations 0.945 (0.917–0.974), minor amputations 0.970 (0.950–0.991) (p < 0.05 respectively). Conclusions There were significant reductions in the incidence of foot-related hospitalisation and amputation amongst persons with diabetes in the population of Queensland over a recent six-year period.
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In the crystal, the backbone of Boc-(Aib-Val-Ala-Leu)2-Aib-OMe adopts a helical form with four alpha-type hydrogen bonds in the middle, flanked by 3(10)-type hydrogen bonds at either end. The helical molecules stack in columns with head-to-tail hydrogen bonds, either directly between NH and CO, or bridged by solvent molecules. The packing of the helices is parallel, even in space group P2(1). Cell parameters are a = 9.837(2) A, b = 15.565(3) A, c = 20.087(5) A, beta = 96.42(2) degrees, dcalc = 1.091 g/cm3 for C46H83N9O12.1.5H2O.0.67CH3OH. There appears to be some hydration of the backbone in this apolar helix.
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The aim of this study was to estimate the development of fertility in North-Central Namibia, former Ovamboland, from 1960 to 2001. Special attention was given to the onset of fertility decline and to the impact of the HIV epidemic on fertility. An additional aim was to introduce parish registers as a source of data for fertility research in Africa. Data used consisted of parish registers from Evangelical Lutheran congregations, the 1991 and 2001 Population and Housing Censuses, the 1992 and 2000 Namibia Demographic and Health Surveys, and the HIV sentinel surveillances of 1992-2004. Both period and cohort fertility were analysed. The P/F ratio method was used when analysing census data. The impact of HIV infection on fertility was estimated indirectly by comparing the fertility histories of women who died at an age of less than 50 years with the fertility of other women. The impact of the HIV epidemic on fertility was assessed both among infected women and in the general population. Fertility in the study population began to decline in 1980. The decline was rapid during the 1980s, levelled off in the early 1990s at the end of war of independence and then continued to decline until the end of the study period. According to parish registers, total fertility was 6.4 in the 1960s and 6.5 in the 1970s, and declined to 5.1 in the 1980s and 4.2 in the 1990s. Adjustment of these total fertility rates to correspond to levels of fertility based on data from the 1991 and 2001 censuses resulted in total fertility declining from 7.6 in 1960-79 to 6.0 in 1980-89, and to 4.9 in 1990-99. The decline was associated with increased age at first marriage, declining marital fertility and increasing premarital fertility. Fertility among adolescents increased, whereas the fertility of women in all other age groups declined. During the 1980s, the war of independence contributed to declining fertility through spousal separation and delayed marriages. Contraception has been employed in the study region since the 1980s, but in the early 1990s, use of contraceptives was still so limited that fertility was higher in North-Central Namibia than in other regions of the country. In the 1990s, fertility decline was largely a result of the increased prevalence of contraception. HIV prevalence among pregnant women increased from 4% in 1992 to 25% in 2001. In 2001, total fertility among HIV-infected women (3.7) was lower than that among other women (4.8), resulting in total fertility of 4.4 among the general population in 2001. The HIV epidemic explained more than a quarter of the decline in total fertility at population level during most of the 1990s. The HIV epidemic also reduced the number of children born by reducing the number of potential mothers. In the future, HIV will have an extensive influence on both the size and age structure of the Namibian population. Although HIV influences demographic development through both fertility and mortality, the effect through changes in fertility will be smaller than the effect through mortality. In the study region, as in some other regions of southern Africa, a new type of demographic transition is under way, one in which population growth stagnates or even reverses because of the combined effects of declining fertility and increasing mortality, both of which are consequences of the HIV pandemic.
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The study of molecular machines, and protein complexes in general, is a growth area of biology. Is there a computational method for inferring which combinations of proteins in an organism are likely to form a crystallizable complex? We use the Protein Data Bank (PDB) to assess the usefulness of inferred functional protein linkages for this task. We find that of 242 nonredundant prokaryotic protein complexes (complexes excluding structural variants of the same protein) from organisms that are shared between the current PDB and the Prolinks functional linkage database, 44% (107/242) contain proteins that are linked at high-confidence by one or more methods of computed functional linkages. This suggests that computing functional linkages will be useful in defining protein complexes for structural studies. We offer a database of such inferred linkages corresponding to likely protein complexes for some 629,952 pairs of proteins in 154 prokaryotes and archea.
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Chalcogenide glasses with compositions Ge7.5AsyTe92.5-y (y = 20, 40, 45, 47.5, 50, 52.5, 55) and Ge10AsyTe90-y (y = 15, 20, 22.5, 35, 40, 45, 50) have been prepared by the melt-quenching technique. The amorphous nature of these glasses has been confirmed by X-ray powder diffractometry. The thermal stability of these glasses has been studied using differential scanning calorimetry (DSC). The compositional dependence of the glass transition temperature, T(g), the crystallization temperatures, T(c1) and T(c2), and the melting temperature, T(m), are reported. The glass-forming tendency, K(gl), and the activation energy of crystallization, E, are calculated. The activation energy decreases with increasing tellurium content for both sets of glasses.
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A bioprocessing approach for the extraction of base, nuclear and precious metals from refractory and lean grade ores has been reviewed in this paper. Characteristic morphological features of Thiobacillus ferrooxidans, the organism which has been extensively used for biooxidation of sulphide ores have been discussed. Mechanisms of chemoautotrophy and mineral oxidation have been illustrated. The current engineering applications of this microorganism have also been brought out. Various methods for accelerating the growth of Thiobacillus ferrooxidans for faster biooxidation and genetic manipulation for development of desired strains have been outlined.
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Wet chemical reaction of hydrated alumina gels, Al2O3.yH(2)O(80
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The degradation kinetics of polycarbonate [poly(bisphenol A carbonate)] in benzene catalyzed by commercial (rutile) TiO2 (BET surface area = 11 m(2)/g), anatase TiO2 (156 m(2)/g), and 1 atom % Pt/TiO2 (111 m2/g), prepared by the solution combustion technique, was investigated at various temperatures (230-280 degreesC) and 50 atm. The time evolution of the molecular weight distribution (MWD) was determined by gel permeation chromatography (GPC) and modeled with continuous distribution kinetics to obtain the degradation rate coefficients. The rate coefficients for the catalytic degradation of polycarbonate increased by factors of 20, 3.5, and 1.3 compared to the rate coefficients for thermal degradation when catalyzed by nanosized TiO2 anatase, Pt/TiO2 anatase, and commercial TiO2, respectively, at 280 degreesC. The increased catalytic activity of combustion for synthesized TiO2 and 1% Pt/TiO2 might be due to the increased acidity and BET surface area. The activation energies, determined from the temperature dependencies of the rate coefficients, were 16.3, 21.5, and 39.1 kcal/mol for commercial TiO2, combustion-synthesized Pt/TiO2, and anatase TiO2, respectively.
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Development towards the combination of miniaturization and improved functionality of RFIC has been stalled due to the lack of high-performance integrated inductors. To meet this challenge, integration of magnetic material with high permeability as well as low conductivity is a must. Ferrite films are excellent candidates for RF devices due to their low cost, high resistivity, and low eddy current losses. Unlike its bulk counterpart, nanocrystalline zinc ferrite, because of partial inversion in the spinel structure, exhibits novel magnetic properties suitable for RF applications. However, most scalable ferrite film deposition processes require either high temperature or expensive equipment or both. We report a novel low temperature (< 200 degrees C) solution-based deposition process for obtaining high quality, polycrystalline zinc ferrite thin films (ZFTF) on Si (100) and on CMOS-foundry-fabricated spiral inductor structures, rapidly, using safe solvents and precursors. An enhancement of up to 20% at 5 GHz in the inductance of a fabricated device was achieved due to the deposited ZFTF. Substantial inductance enhancement requires sufficiently thick films and our reported process is capable of depositing smooth, uniform films as thick as similar to 20 mu m just by altering the solution composition. The method is capable of depositing film conformally on a surface with complex geometry. As it requires neither a vacuum system nor any post-deposition processing, the method reported here has a low thermal budget, making it compatible with modern CMOS process flow.
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El presente ensayo se realizó con el objetivo de medir el efecto de tres períodos de destete diferentes (20, 40 y 60 días respectivamente) sobre el Peso de la hembra al destete (PHD), Peso de la camada al destete (PCD) y Peso de la hembra al segundo parto (PHP2) en conejas primíparas. Para el análisis de los datos fue utilizado un Diseño Completamente Aleatorio (D.C.A.) con 4 repeticiones (hembras primíparas) para el destete de 20 días, 5 repeticiones para el destete de 40 días y 4 repeticiones para el destete de 60 días. La información utilizada para los análisis estadísticos provino de datos recaudados en registros reproductivos, de un conejar compuesto de 13 conejas y un padrote. La edad y peso promedio de los animales al inicio del ensayo fueron homogéneos (7 meses y 3.007 Kg respectivamente). El ensayo se realizó en el municipio de Rivas ubicado a 111 km de la ciudad de Managua, a 11º 26' de latitud Norte y 85º 44' de longitud Oeste, a una elevación de 57.77 m.s.n.m. Las variables en estudio fueron: Peso de la hembra al destete (PHD), Peso de la camada al destete (PCD), Peso de la hembra al segundo parto (PHP2). Los valores y desviación estándar para dichas variables fue de : 2.94483 ± 0.3071 Kg, promedios 2.8629 ± 1.5308 Kg y 3.0635 ± 0.2212 Kg, respectivamente. En el ANDEVA realizado para las diferentes variables, el efecto de los tratamientos sobre el Peso de la hembra al destete resultó no significativo. No así, para con las variables Peso de la camada al destete (PCD) y Peso de la hembra al segundo parto (PHP2), donde el efecto de los tratamientos sobre estas fue significativo. El efecto de la covariable (Peso de la hembra al primer parto) solamente resultó significativo para la variable Peso de la hembra al destete (PHD). Mediante la Separación de medias por la Prueba de DUNCAN se obtuvieron los siguientes promedios de las variables por tratamiento; Peso de la hembra al destete (PHD): 1.3469 Kg (t: 20 días), 2.9508 Kg (t: 40 días) y 2.9194 Kg (t: 60 días). Para el Peso de la camada al destete (PCD), los valores fueron: 1.3469 kg (t: 20 días), 2.6571 Kg (t: 40 días) y 4.6363 Kg (t: 60 días). Para el Peso de la hembra al segundo parto (PHP2) los valores fueron: 3.2895 Kg (t: 20 días), 3.0030 Kg (t: 40 días) y 2.9131 Kg (t: 60 días). Con la realización del Análisis de los Costos para hembras, se determinaron valores de 105.29, 127.42 y 148.65 (córdobas), para una hembra al destete en los tratamientos de 20, 40 y 60 días de destete respectivamente. Los costos para una hembra al segundo parto fueron: C$ 130.77 (t: 20 días), C$ 147.03 (t: 40 días) y C$168.26 (t: 60 días). Para gazapo al nacimiento los costos por tratamiento fueron los siguientes: C$ 4.43 (t: 20 días), C$ 4.60 (t: 40 días) y C$ 4.87 (t 60 días. Así también, se determinaron los costos de un gazapo al destete, obteniéndose valores de C$ 7.90, C$ 11.53 y C$15.82 para los tratamientos de 20, 40 y 60 días de destete respectivamente.