Impacts of Milk Fraud on Food Safety and Nutrition with Special Emphasis on Developing Countries

Milk in its natural form has a high food value, since it is comprised of a wide variety of nutrients which are essential for proper growth and maintenance of the human body. In recent decades, there has been an upsurge in milk consumption worldwide, especially in developing countries, and it is now forming a significant part of the diet for a high proportion of the global population. As a result of the increased demand, in addition to the growth in competition in the dairy market and the increasing complexity of the supply chain, some unscrupulous producers are indulging in milk fraud. This malpractice has become a common problem in the developing countries, which lack strict vigilance by food safety authorities. Milk is often subjected to fraud (by means of adulteration) for financial gain, but it can also be adulterated due to ill-informed attempts to improve hygiene conditions. Water is the most common adulterant used, which decreases the nutritional value of milk. If the water is contaminated, for example, with chemicals or pathogens, this poses a serious health risk for consumers. To the diluted milk, inferior cheaper materials may be added such as reconstituted milk powder, urea, and cane sugar, even more hazardous chemicals including melamine, formalin, caustic soda, and detergents. These additions have the potential to cause serious health-related problems. This review aims to investigate the impacts of milk fraud on nutrition and food safety, and it points out the potential adverse human health effects associated with the consumption of adulterated milk.

A Largest Matching Area Approach to Image Denoising

Given the success of patch-based approaches to image denoising,this paper addresses the ill-posed problem of patch size selection.Large patch sizes improve noise robustness in the presence of good matches, but can also lead to artefacts in textured regions due to the rare patch effect; smaller patch sizes reconstruct details more accurately but risk over-fitting to the noise in uniform regions. We propose to jointly optimize each matching patch’s identity and size for gray scale image denoising, and present several implementations.The new approach effectively selects the largest matching areas, subject to the constraints of the available data and noise level, to improve noise robustness. Experiments on standard test images demonstrate our approach’s ability to improve on fixed-size reconstruction, particularly at high noise levels, on smoother image regions.

Do women who intermittently attend breast screening differ from those women who attend every invitation and those who never attend?

OBJECTIVES:

Analysis of screening uptake usually dichotomizes women into attenders and non-attenders, though many women respond positively to some but not all invitations. This paper studies these intermittent attenders.

METHODS:

A cohort of 8,571 women invited for consecutive breast screens in the Northern Ireland Breast Screening Programme were followed in a study linking screening and census records. Multivariate logistic analysis was used to analyze the characteristics of those who attended both times (consistent), once (intermittent or 'one-time only'), or not at all (non-attenders).

RESULTS:

Overall, 15.5% of women attended once and 13.4% were non-attenders. Non-attenders were characteristically disadvantaged (as measured by social renting, car access, and employment status), less likely to be married, and more likely to be healthy. One-time attenders were younger, and suffering poor health, though there was no association with either social renting or employment status. Privately rented accommodation and city living was associated with both one-time attendance and non-attendance.

CONCLUSIONS:

One-time attenders are an important and distinct subgroup of screening invitees in this analysis. Their distinct characteristics suggest that transitory factors, such as change in marital status, ill-health, or addressing difficulties through change of residence are important. These distinct characteristics suggest the need for different approaches to increase attendance, among both intermittent attenders and those not attending at all.

Housing, Regeneration and Community Asset Transfer

Community asset transfer enables local groups to own or manage a government owned facility and/or related services. For critics, it is merely an extension of roll-back neoliberalism, permitting the state to withdraw from welfare and transfer risk from local government to ill-defined communities. The paper uses quantitative and case study data from Northern Ireland to demonstrate its transformative potential by challenging the notion of private property rights, enabling communities to accumulate and endanger forms of cooperative consumption. It concludes by highlighting the implications for more progressive forms of social economics in relation to public and private markets and government sponsorship of its own development.

Systematic review of interventions to improve the psychological well-being of general practitioners

BACKGROUND: The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the broader, positive outcome of well-being. Our primary outcome was to evaluate systematically the research evidence regarding the effectiveness of interventions designed to improve General Practitioner (GP) well-being across two continua; psychopathology (mental ill-health focus) and 'languishing to flourishing' (positive mental health focus). In addition we explored the extent to which developments in well-being research may be integrated within existing approaches to design an intervention that will promote mental health and prevent mental illness among these doctors.

METHODS: Medline, Embase, Cinahl, PsychINFO, Cochrane Register of Trials and Web of Science were searched from inception to January 2015 for studies where General Practitioners and synonyms were the primary participants. Eligible interventions included mental ill-health prevention strategies (e.g. promotion of early help-seeking) and mental health promotion programmes (e.g. targeting the development of protective factors at individual and organizational levels). A control group was the minimum design requirement for study inclusion and primary outcomes had to be assessed by validated measures of well-being or mental ill-health. Titles and abstracts were assessed independently by two reviewers with 99 % agreement and full papers were appraised critically using validated tools.

RESULTS: Only four studies (with a total of 997 GPs) from 5392 titles met inclusion criteria. The studies reported statistically significant improvement in self-reported mental ill-health. Two interventions used cognitive-behavioural techniques, one was mindfulness-based and one fed-back GHQ scores and self-help information.

CONCLUSION: There is an urgent need for high quality, controlled studies in GP well-being. Research on improving GP well-being is limited by focusing mainly on stressors and not giving systematic attention to the development of positive mental health.

Fluid strategies and outcomes in patients with acute respiratory distress syndrome, systemic inflammatory response syndrome and sepsis: a protocol for a systematic review and meta-analysis

Background
Fluid administration to critically ill patients remains the subject of considerable controversy. While intravenous fluid given for resuscitation may be life-saving, a positive fluid balance over time is associated with worse outcomes in critical illness. The aim of this systematic review is to summarise the existing evidence regarding the relationship between fluid administration or balance and clinically important patient outcomes in critical illness.

Methods
We will search Medline, EMBASE, the Cochrane Central Register of Controlled Trials from 1980 to the present and key conference proceedings from 2009 to the present. We will include studies of critically ill adults and children with acute respiratory distress syndrome (ARDS), sepsis and systemic inflammatory response syndrome (SIRS). We will include randomised controlled trials comparing two or more fluid regimens of different volumes of fluid and observational studies reporting the relationship between volume of fluid administered or fluid balance and outcomes including mortality, lengths of intensive care unit and hospital stay and organ dysfunction. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. We will conduct a narrative and/or meta-analysis as appropriate.

Discussion
While fluid management has been extensively studied and discussed in the critical care literature, no systematic review has attempted to summarise the evidence for post-resuscitation fluid strategies in critical illness. Results of the proposed systematic review will inform practice and the design of future clinical trials.

Systematic review registration
PROSPERO CRD42013005608. (http://​www.​crd.​york.​ac.​uk/​PROSPERO/​)

Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review

BACKGROUND: Care of critically ill patients in intensive care units (ICUs) often requires potentially invasive or uncomfortable procedures, such as mechanical ventilation (MV). Sedation can alleviate pain and discomfort, provide protection from stressful or harmful events, prevent anxiety and promote sleep. Various sedative agents are available for use in ICUs. In the UK, the most commonly used sedatives are propofol (Diprivan(®), AstraZeneca), benzodiazepines [e.g. midazolam (Hypnovel(®), Roche) and lorazepam (Ativan(®), Pfizer)] and alpha-2 adrenergic receptor agonists [e.g. dexmedetomidine (Dexdor(®), Orion Corporation) and clonidine (Catapres(®), Boehringer Ingelheim)]. Sedative agents vary in onset/duration of effects and in their side effects. The pattern of sedation of alpha-2 agonists is quite different from that of other sedatives in that patients can be aroused readily and their cognitive performance on psychometric tests is usually preserved. Moreover, respiratory depression is less frequent after alpha-2 agonists than after other sedative agents.

OBJECTIVES: To conduct a systematic review to evaluate the comparative effects of alpha-2 agonists (dexmedetomidine and clonidine) and propofol or benzodiazepines (midazolam and lorazepam) in mechanically ventilated adults admitted to ICUs.

DATA SOURCES: We searched major electronic databases (e.g. MEDLINE without revisions, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE and Cochrane Central Register of Controlled Trials) from 1999 to 2014.

METHODS: Evidence was considered from randomised controlled trials (RCTs) comparing dexmedetomidine with clonidine or dexmedetomidine or clonidine with propofol or benzodiazepines such as midazolam, lorazepam and diazepam (Diazemuls(®), Actavis UK Limited). Primary outcomes included mortality, duration of MV, length of ICU stay and adverse events. One reviewer extracted data and assessed the risk of bias of included trials. A second reviewer cross-checked all the data extracted. Random-effects meta-analyses were used for data synthesis.

RESULTS: Eighteen RCTs (2489 adult patients) were included. One trial at unclear risk of bias compared dexmedetomidine with clonidine and found that target sedation was achieved in a higher number of patients treated with dexmedetomidine with lesser need for additional sedation. The remaining 17 trials compared dexmedetomidine with propofol or benzodiazepines (midazolam or lorazepam). Trials varied considerably with regard to clinical population, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded outcome assessors. Compared with propofol or benzodiazepines (midazolam or lorazepam), dexmedetomidine had no significant effects on mortality [risk ratio (RR) 1.03, 95% confidence interval (CI) 0.85 to 1.24, I (2) = 0%; p = 0.78]. Length of ICU stay (mean difference -1.26 days, 95% CI -1.96 to -0.55 days, I (2) = 31%; p = 0.0004) and time to extubation (mean difference -1.85 days, 95% CI -2.61 to -1.09 days, I (2) = 0%; p < 0.00001) were significantly shorter among patients who received dexmedetomidine. No difference in time to target sedation range was observed between sedative interventions (I (2) = 0%; p = 0.14). Dexmedetomidine was associated with a higher risk of bradycardia (RR 1.88, 95% CI 1.28 to 2.77, I (2) = 46%; p = 0.001).

LIMITATIONS: Trials varied considerably with regard to participants, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded assessors.

CONCLUSIONS: Evidence on the use of clonidine in ICUs is very limited. Dexmedetomidine may be effective in reducing ICU length of stay and time to extubation in critically ill ICU patients. Risk of bradycardia but not of overall mortality is higher among patients treated with dexmedetomidine. Well-designed RCTs are needed to assess the use of clonidine in ICUs and identify subgroups of patients that are more likely to benefit from the use of dexmedetomidine.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42014014101.

FUNDING: The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Bouyid v Belgium: The “minimum level of severity” and Human Dignity's Role in Article 3 ECHR

The Grand Chamber of the European Court of Human Rights recently delivered an important judgment on Article 3 ECHR in the case of Bouyid v Belgium. In Bouyid, the Grand Chamber was called upon to consider whether slaps inflicted on a minor and an adult in police custody were in breach of Article 3 ECHR, which provides that ‘No one shall be subjected to torture or to inhuman or degrading treatment or punishment’. Overruling the Chamber judgment in the case, the Grand Chamber ruled by 14 votes to 3 that there had been a substantive violation of Article 3 in that the applicants had been subjected to degrading treatment by members of the Belgian police; it found that there had been a breach of the investigative duty under Article 3 also. In this comment, I focus on the fundamental basis of disagreement between the majority of the Grand Chamber and those who found themselves in dissent, on the question of whether there had been a substantive breach of Article 3. The crux of the disagreement lay in the understanding and application of the test of ‘minimum level of severity’, which the ECtHR has established as decisive of whether a particular form of ill-treatment crosses the Article 3 threshold, seen also in light of Article 3’s absolute character, which makes it non-displaceable – that is, immune to trade-offs of the type applicable in relation to qualified rights such as privacy and freedom of expression. I consider the way the majority of the Grand Chamber unpacked and applied the concept of dignity – or ‘human dignity’ – towards finding a substantive breach of Article 3, and briefly distil some of the principles underpinning the understanding of human dignity emerging in the Court’s analysis.

French Autopathography

Reacting against the assumption that ill people ‘surrender’ their bodies to medicine, first-person illness narratives attempt to restore the patient’s voice to an often dehumanizing and bewildering medical experience. This special issue complements recent medical humanities scholarship on English-language illness narratives by investigating a distinctly rich tradition of French autopathography. Diverse approaches and methodologies will be used to consider first-person perspectives on a range of illnesses, disabilities and disorders, including AIDS, cancer, physical pain, mental health issues, anorexia, and locked-in syndrome. The issue aims to promote interdisciplinary dialogue across genres (literature, film, philosophy) and examine the creative potential that lies at the interface of medicine and the arts.

Acute care teaching in the undergraduate nursing curriculum

AIM: To incorporate basic aspects of acute care into the undergraduate nursing programme by providing an opportunity for the development of knowledge and skills in the early recognition and assessment of deteriorating patients on general hospital wards.
BACKGROUND: Acute care initiatives implemented in the hospital setting to improve the identification and management of 'at risk' patients have focused on the provision of education for trained or qualified staff. However, to ensure student nurses are 'fit to practice' at the point of registration, it has been recommended that acute care theory and skills are incorporated into the undergraduate nursing curriculum.
PRACTICE DEVELOPMENT INITIATIVE: An 'Integrated Nursing Care' module was incorporated into year 3 of the undergraduate nursing programme to introduce students to acute care theory and practice. Module content focuses on the early detection and management of acute deterioration in patients with respiratory, cardiac, neurological or renal insufficiencies. We used a competency-based framework to ensure the application of theory to practice through the use of group seminars. High-fidelity patient-simulated clinical scenarios were a key feature. The United Kingdom Resuscitation Council Intermediate Life Support course is also an important component of the module.
CONCLUSIONS: Incorporating the Integrated Nursing Care module into the undergraduate nursing curriculum provides pre-registration students the opportunity to develop their knowledge and skills in acute care.
RELEVANCE TO CLINICAL PRACTICE: The provision of undergraduate education in care of the acutely ill patient in hospital is essential to improve nurses' competence and confidence in assessing and managing deteriorating patients in general wards at the point of registration.

Modelação da qualidade do ar e da saúde humana: da mesoescala à dose

O actual, e crescente, padrão de consumo tem repercussões no ambiente que, inevitavelmente, se reflectem na saúde humana. A poluição atmosférica assume-se, na Europa, como um problema ambiental premente, por ter um elevado impacte na saúde dos cidadãos. Entre estes, há grupos particularmente vulneráveis, como os idosos, os doentes crónicos e as crianças. Vários estudos colocam em evidência a sensibilidade dos doentes asmáticos, em particular das crianças, à poluição atmosférica. No entanto, permanece por esclarecer o facto de a poluição atmosférica poder causar o aumento da prevalência desta doença, assim como a identificação dos principais poluentes atmosféricos responsáveis e os níveis de exposição seguros. O objectivo desta tese consiste no estudo da relação entre a poluição atmosférica e a saúde, contribuindo para o conhecimento nesta temática através do desenvolvimento de uma ferramenta e da sua aplicação a um caso de estudo concreto. Neste caso de estudo analisou-se a relação entre vários poluentes atmosféricos e o agravamento da sintomatologia em crianças asmáticas. Neste âmbito, foi desenvolvido o modelo doseAr, que possibilita o cálculo da exposição e da dose inalada, ao nível individual, de poluentes atmosféricos. Os resultados da aplicação do doseAr permitem a identificação dos microambientes onde a contribuição para a exposição e dose inalada de poluentes é mais relevante. Os microambientes interiores, em particular aqueles onde é desenvolvida actividade física exigente, são identificados como especialmente importantes. A relação entre a exposição e a dose inalada é claramente associada ao agravamento da asma nestas crianças, apesar dos níveis de poluição identificados serem baixos, face aos padrões de qualidade do ar existentes.

A educação intercultural na formação contínua de professores de línguas

Situado entre o discurso investigativo e o profissional da Didática de Línguas, o presente estudo assenta: num entendimento da educação em línguas como um processo valorizador da diversidade linguística e cultural, tendo como fim último a promoção da intercompreensão e do diálogo intercultural, dentro dos pressupostos de uma didática das línguas e do plurilinguismo; na conceção do professor de línguas como um dos principais atores na educação de cidadãos / comunicadores interculturais, vendo-se, portanto, a braços com novas exigências, para as quais, muitas vezes, não se sente preparado; e nos pressupostos de que a identidade profissional condiciona fortemente a forma como o professor desempenha a sua ação didática, sendo este processo de se tornar professor contínuo e dependente, quer do sujeito-professor e dos seus percursos profissionais e formativos, quer do contexto (profissional, local, nacional, global) em que este se insere. Pretende-se, com este estudo, contribuir para que a educação intercultural seja uma realidade nas nossas escolas, potenciando a sua migração contextualizada dos documentos orientadores das políticas linguísticas e educativas nacionais e transnacionais e dos discursos da investigação em Didática de Línguas. Para o efeito, desenvolvemos um programa de investigação/formação denominado O Professor Intercultural, durante o ano letivo 2006/2007, com professores de línguas (materna e estrangeiras) de três escolas básicas e secundárias do distrito de Aveiro. Este programa integrava um curso (25 horas) e uma oficina (50 horas), ambas as ações de formação acreditadas pelo Conselho Científico-Pedagógico da Formação Contínua. Do ponto de vista formativo, com este programa pretendíamos levar as professoras em formação a desenvolver competências pessoais e profissionais que lhes permitissem gerir a diversidade nos seus contextos profissionais, tendo em vista o desenvolvimento nos seus alunos de uma competência de comunicação intercultural (CCI). Do ponto de vista investigativo, não só pretendíamos compreender as representações dos sujeitos relativamente à educação intercultural em geral e à CCI em particular; como também identificar princípios e estratégias de formação potenciadores do desenvolvimento de competências profissionais docentes para trabalhar a CCI, a partir das perspetivas dos próprios sujeitos. Trata-se, portanto, de um estudo de caso de cariz qualitativo e interpretativo / fenomenológico, com potencialidades heurísticas, que pretende evidenciar os sujeitos, as suas representações, as interações consigo e com os outros e a forma como conceptualizam a identidade profissional docente e as suas dinâmicas de desenvolvimento. Como instrumentos de recolha de dados, privilegiámos os Portefólios Profissionais que foram sendo construídos ao longo do percurso de formação; a sessão “Entre Línguas e Culturas” da plataforma Galanet (www.galanet.eu), recurso de formação no âmbito da oficina (entre fevereiro e maio de 2007); o “Diário do Investigador”; e as “entrevistas narrativas e de confrontação” efetuadas sensivelmente um ano após o final do programa de investigação/formação. Os resultados da análise de conteúdo revelam que os sujeitos consideram a CCI uma competência multidimensional e complexa, reconhecendo três componentes: afetiva (domínio do saber ser e saber viver com o outro), cognitiva (domínio do saber) e praxeológica (domínio do saber-fazer). A componente afetiva constitui, de acordo com os resultados, o motor de arranque do desenvolvimento desta competência, que, posteriormente, é alargada em dinâmicas de informação-(inter)ação-reflexão. Por outro lado, dada a grande pertinência que atribuem à abordagem intercultural e à urgência com que veem a sua integração escolar, os sujeitos consideram a CCI uma das competências inerentes à competência profissional docente, elemento integrador da identidade profissional, numa forte ligação com a missão ética e política que cada vez mais é associada ao docente (de línguas). Para além disso, percecionam o seu desenvolvimento profissional docente como um processo que os acompanha ao longo da vida, fruto das idiossincrasias e predisposições do próprio indivíduo, mas também das dinâmicas da sua formação, das caraterísticas dos contextos em que se movimenta e da colaboração com o Outro, no seu espaço profissional ou fora dele. Importa salientar que este desenvolvimento profissional é potenciado, segundo os nossos resultados, por propostas de formação assentes numa abordagem acional e reflexiva, articulando dinâmicas investigação-ação-reflexão como as propostas no nosso programa de formação, nomeadamente no âmbito da oficina. Neste quadro, concluímos o presente estudo, indicando alguns caminhos possíveis para a formação de professores de línguas para a educação intercultural.

Cooperative positioning for heterogeneous wireless systems

Future emerging market trends head towards positioning based services placing a new perspective on the way we obtain and exploit positioning information. On one hand, innovations in information technology and wireless communication systems enabled the development of numerous location based applications such as vehicle navigation and tracking, sensor networks applications, home automation, asset management, security and context aware location services. On the other hand, wireless networks themselves may bene t from localization information to improve the performances of di erent network layers. Location based routing, synchronization, interference cancellation are prime examples of applications where location information can be useful. Typical positioning solutions rely on measurements and exploitation of distance dependent signal metrics, such as the received signal strength, time of arrival or angle of arrival. They are cheaper and easier to implement than the dedicated positioning systems based on ngerprinting, but at the cost of accuracy. Therefore intelligent localization algorithms and signal processing techniques have to be applied to mitigate the lack of accuracy in distance estimates. Cooperation between nodes is used in cases where conventional positioning techniques do not perform well due to lack of existing infrastructure, or obstructed indoor environment. The objective is to concentrate on hybrid architecture where some nodes have points of attachment to an infrastructure, and simultaneously are interconnected via short-range ad hoc links. The availability of more capable handsets enables more innovative scenarios that take advantage of multiple radio access networks as well as peer-to-peer links for positioning. Link selection is used to optimize the tradeo between the power consumption of participating nodes and the quality of target localization. The Geometric Dilution of Precision and the Cramer-Rao Lower Bound can be used as criteria for choosing the appropriate set of anchor nodes and corresponding measurements before attempting location estimation itself. This work analyzes the existing solutions for node selection in order to improve localization performance, and proposes a novel method based on utility functions. The proposed method is then extended to mobile and heterogeneous environments. Simulations have been carried out, as well as evaluation with real measurement data. In addition, some speci c cases have been considered, such as localization in ill-conditioned scenarios and the use of negative information. The proposed approaches have shown to enhance estimation accuracy, whilst signi cantly reducing complexity, power consumption and signalling overhead.

“I used to think that they were all abnormal. And I was the normal one”: conceptualizing mental health and mental health treatment under Improving Access to Psychological Therapies (IAPT)

Background: Improving Access to Psychological Therapies (IAPT) was introduced in the United Kingdom in 2006 to provide more effective and efficient services to people experiencing mild to moderate mental ill health. The model represents a paradigm shift in how we provide psychological care to large populations. Aims: We wanted to document how the IAPT programme impacted on patients’ understanding of their mental health, and mental health treatment. Methods: We used Foucauldian Discourse Analysis to analyse six semi-structured research interviews with patients from one IAPT service in a major UK city. Results: Participants constructed their mental health problems as individual pathologies. Constructions of mental health and of treatment evidenced the privileging of personal responsibility and social productivity over dependency on others and the state. Conclusions: Services are functioning well for some. The role of IAPT in pathologising those who are dependent on people and services requires further commentary and action. Declaration of interest: The first author was employed by the same organisation that delivered the IAPT service, although through a separate staffing and management line.

Psychotherapy and its alternatives: Commentary on a critique

In this commentary, Michael Rustin reviews the articles in the symposium, outlining their main aims and arguments. He goes on to provide some critical reflections, asking questions about the key concept of the ‘therapeutic state’. He notes that little attention is given to psychoanalytic or other psychological theories of the mind, as distinct from the biological models which are the main object of criticism in the symposium. He argues that just as it is justifiable and useful to take account of theories of the mind in considering issues of mental health and therapy, so it is desirable also to take account of the structures of society which have responsibility for generating conditions of mental well- or ill-being, and to reflect on how these may be changed. The commentary argues that the counter-cultural and somewhat ‘post-modern’ critical approach which informs the symposium can only form part of a sufficient response to the problems which the symposium identifies.