Preparation and Characterizationof Palm-Based Functional Lipid Nanodispersions

Poor solubility of functional lipids has made their use problematic in food industry especially in food formulations. The difficulties to find a suitable formulation or solution are even greater especially when the functional lipids are poorly soluble in both aqueous and organic solutions, which may prone to reduce bioavailability. The main objective of this study was to prepare and characterize palm-based functional lipids nanodispersions. The observations presented in this study confirmed that the nanosized droplets formed using emulsification-evaporation is relatively simple and effective technique especially for producing nanodispersions of palm-based functional lipids (tocopherols-tocotrienols and carotenoids). Droplet size can be produced in a controlled way by adjusting the processing parameters such as pressure and cycle number accordingly. This study indicated that by increasing the energy input beyond moderate pressures (20 – 80 MPa) and cycles (1 - 3) led to “overprocessing” of droplets. Results have revealed that homogenization pressures have significant (P < 0.05) influence on the average droplet size and droplet size distribution (PI). On the contrary, the processing cycle had not significantly effect the average droplet size and size distribution (P > 0.05). Preliminary studies have shown droplet diameters in the range of 90 - 120 nm for prepared α-tocopherol nanodispersions. Meanwhile, nano-droplet resulted from nanodispersions prepared with palm-based functional lipids extended from 95 – 130 nm and 140 – 210 nm for tocopherols-tocotrienols and carotenoids, respectively. During storage duration, all prepared nanoemulsions showed good physical stability. However, the content of the prepared nanodispersions was significantly (P < 0.05) reduced during storage. Investigation on the effect of polyoxyethylene sorbitan esters and sodium caseinate also revealed that the average droplet size significantly (P < 0.05) increased with increasing chain length of fatty acid and increasing the HLB value. Among the prepared nanodispersions, the palm-based tocopherols-tocotrienols nanodispersions containing Polysorbate 20 illustrated the smallest average droplet sizes and narrowest size distribution (201.8 ± 1.4 nm; PI, 0.399 ± 0.022); while palm-based carotenoids nanodispersions containing sodium caseinate had the largest average droplet size (386.3 ± 4.0nm; PI, 0.465 ± 0.021); thus indicating more emulsifying role induced by Polysorbate 20 compared to sodium caseinate

Palm-based functional lipid nanodispersions : preparation, characterization and stability evaluation.

The objective of the present study was to investigate the effect of high-pressure homogenization conditions, namely pressure (20–80 MPa) and number of cycles (1–3 cycles), on the properties of palm-based functional lipids. Nanodispersions prepared with palm-based functional lipid and Tween 20 were characterized by monitoring their physicochemical and morphological properties. The results showed that high-pressure homogenizer was an efficient emulsification technique producing small emulsion droplets with narrow size distribution. In general, the results showed that different homogenization conditions had significant (p < 0.05) effect on the size distribution of prepared nanodispersions. Average particles ranging from 95 to 130 nm and 140 to 210 nm were obtained for the nanoemulsions containing palm-based tocopherol–tocotrienol and carotenoid, respectively. However, this study indicated that increasing the energy input beyond moderate pressures (20–80 MPa) and cycles (1–3) led to “over-processing” of droplets. The nanodispersions proved to be physically stable and showed good stability during 12 weeks of storage

Effect of polyoxyethylene sorbitan esters and sodium caseinate on physicochemical properties of palm-based functional lipid nanodispersions.

The main objective of the present study was to investigate the effect of polyoxyethylene sorbitan esters and sodium caseinate on physicochemical properties of palm-based functional lipid nanodispersions prepared by the emulsification-evaporation technique. The results indicated that the average droplet size increased significantly (P < 0.05) by increasing the chain length of fatty acids and also by increasing the hydrophile-lipophile balance value. Among the prepared nanodispersions, the nanoemulsion containing Polysorbate 20 showed the smallest average droplet size (202 nm) and narrowest size distribution for tocopherol-tocotrienol nanodispersions, while sodium caseinate-stabilized nanodispersions containing carotenoids had the largest average droplet size (386 nm), thus indicating a greater emulsifying role for Polysorbate 20 compared with sodium caseinate

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Relating sensory perception to chewing dynamics : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Food Technology at Massey University, Auckland, New Zealand

Understanding the mechanism behind the dynamic changes of food structure during oral processing is the key area for food texture studies. Food texture is a sensory perception derived from the structure of food, and oral processing plays an important role in this perception. This research aimed to establish a method to explore the relationships between oral processing and sensory perception, using biscuits of varying compositional and structural properties as a model food system. The initial study verified the capability of the Temporal Dominance of Sensations (TDS) technique to describe the textural aspects of a model food system whose structural properties change throughout oral processing. By standardizing the time-axis of the TDS curves from first bite to swallow, the technique was able to discriminate the textural properties of the samples of different sugar to fat ratios over the consumption period. The key differences of this type of standardization method were the attribute dominance rates and range in times to select the first dominant attribute. Moderate training of panellists on the definitions of the attributes showed performance improvement; clearer TDS curves (higher dominance rates) and reduced times to make the first dominant attribute selection (at least 10% faster). It was observed that subjects used a greater number of chewing cycles to process a food sample when they were also performing a sensory task such as TDS. The observation holds regardless of the level of training. When the TDS task was performed initially (the first sample), subjects need time to explore and learn the task hence slower chew frequency. This effect can be eliminated by introducing warm up samples before each session to ensure familiarity to samples and task. Overall, the samples were discriminated in their textural properties throughout chewing. The TDS technique appeared to be relevant to relate to the changing food properties in the mouth. The hardness levels of the sample marked an influence at the early stage of a chewing sequence, influencing the first dominant attributed selected and the oral processing. As food evolves during oral processing, other associated attributes become dominant in response to changing structural properties in the mouth. All samples undergo various structural changes in the mouth before reaching a definite state before swallowing. Two types of masticatory adaptations were present; adaptation to the task performed and adaptation to the altered textural properties in the mouth. The reproducibility of the TDS curves was also performed. This study demonstrated that for a food sample with five attributes to be evaluated in triplicate, at least 10 subjects were needed (i.e. 30 observations). This is true as the TDS technique is based on food evolution in the mouth. Further exploration of the TDS technique was performed using Discrete Point TDS. The technique offered new information that the typical TDS technique could not. The method was capable of differentiating the dominant attribute at each specific stage during mastication. This is not measurable with the conventional TDS technique and is less time consuming. In addition, intensity scores were found to complement the standard TDS data. The present study also showed the need to combine the TDS technique with masticatory recordings to investigate the dynamic mechanisms of the food behaviours throughout food oral processing. The simultaneous recording of the TDS technique, electromyography (EMG), and electromagnetic articulograph (EMA) confirmed that human masticatory apparatus adapted (chew frequency) to the altered textural properties caused by changing food sample composition and structure which also continued to evolve in the mouth. Evaluation of dynamic changes in sensory perception at various mastication stages helped in explaining the food evolution in the mouth and its responding oral processing strategies. The early chewing stage was dedicated to the fracture mechanism of the food where attributes such as hard and crunchy/crispy were most dominant. Mid chewing was dedicated to effort used to masticate food into a bolus which was suitable for swallowing; this included effort to reduce food particle sizes and incorporate saliva and the attributes crumbly and dry were most dominant. The end of chewing was dedicated to removing food materials from around the mouth for swallow, where sticky was most dominant. These associations supported the hypothesis that masticatory parameters are controlled by the sensory input and are linked to food properties, where a range of different food structure is responsible for the changes in the chewing strategies. Findings from this research demonstrated the strong correlation between the TDS profiles and chewing dynamics provided a new and improved technique for the food industry, in particular for designing foods with desired sensory properties. Moreover, the study confirmed that a complete understanding of texture can only be obtained through collaboration among different disciplines

Evaluation des politiques de chomage Elements de problematique. Tome 2

Available at INIST (FR), Document Supply Service, under shelf-number : RP 10490 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueSIGLEFRFranc

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58\ub75%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31\ub72%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10\ub72%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12\ub73%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9\ub74%] of 7339 patients), middle (549 [14\ub70%] of 3918 patients), and low (298 [23\ub72%] of 1282) HDI (p&lt;0\ub7001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17\ub78%] of 574 patients in high-HDI countries; 74 [31\ub74%] of 236 patients in middle-HDI countries; 72 [39\ub78%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1\ub760, 95% credible interval 1\ub705\u20132\ub737; p=0\ub7030). 132 (21\ub76%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16\ub76%) of 295 patients in high-HDI countries, in 37 (19\ub78%) of 187 patients in middle-HDI countries, and in 46 (35\ub79%) of 128 patients in low-HDI countries (p&lt;0\ub7001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant