Biological production of CLA and investigation of anticarcinogenic activity

This study investigated a potential mechanism of action underlying the anticancer activity of conjugated lmoleic acid (CLA), referring to a mixture of positional and geometric conjugated isomers of lmoleic acid Ras, an oncogene necessary for normal cell function, when mutated results in uncontrolled cell proliferation and consequently tumour formation Western blot analysis suggested that c9, ill and flO, cl2 CLA isomers inhibit (P<0 05) expression and activation of mutated ras compared with ethanol control in SW480 cells, a numan colon cancer cell line. Lmoleic acid stimulated cell growth, however it reduced ras expression, suggestmg that events downstream of ras may be more critical targets for modulating growth by these fatty acids. A second objective was to investigate the cytotoxic effect of CLA-rich oils produced by thefermentation of lmoleic acid by selected CLA-producmg strains Lmoleic acid-nch oil fermented by B breve NCFB 2258 reduced growth of SW480 cells in a time dependant manner at a concentration of 84 \ig fat/ml This oil contained 20 \ig c9, t\ 1 CLA/ml. When pure fatty acids were combmed to mimic the fatty acid profiles of the microbially fermented oils, the growth inhibitory effect observed was only partly attributable to the CLA content of the oil. This study also examined a nutritional approach to the enrichment of CLA m milk fat by dietary supplementation of pre-selected cows on pasture with full fat rapeseeds Surprisingly, there was no significant effect on milk fat c9, /II CLA due to rapeseed supplementation. In addition, elaidic acid, a fatty acid not previously demonstrated to be influenced by rapeseed supplementation, increased significantly in the milk of cows on the supplemented diet. These unexpected results may be attributed to excessive ramfall throughout the period of the trial affecting pasture quality and possibly an altered biohydrogenation process

An analytical low-cost deployment strategy for satellite constellations

This work proposes a novel method for the deployment of a constellation of nano-satellites into Low Earth Orbit by using carrier vehicles to deliver the nano-satellites into the required orbit positions. The analytical solution presented allows for rapid exploration of the design space and a direct optimisation of the deployment strategy to minimise the time for complete constellation deployment. Traditionally, the deployment of satellite constellations requires numerous launches – at least one per orbital plane – which can be costly. Launching as a secondary payload may offer significant cost reductions, but this comes at the price of decreased control over the launch schedule and final orbit parameters. The analytical method presented here allows for the optimal positioning of the orbit planes of the constellation to be determined and the minimum time for deployment determined as a function of the manoeuvre ΔV. The effect of atmospheric drag on the manoeuvre propellant cost is also considered to ensure a realistic deployment scenario. A case study considering three constellation designs is presented which compares the cost of deployment using traditional launch methods with that of deploying the constellation using carrier vehicles. The results of this study show a significant reduction in cost when using the carrier vehicles on a dedicated launch, compared with launching the satellites individually. Most significantly, the launch cost when using carrier vehicles is primarily determined by the total number of satellites in the constellation, rather than the number of orbital planes. Thus, the carrier vehicle deployment strategy would allow for constellations with a large number of planes to be deployed for a fraction of the equivalent cost if traditional launch methods were used

Assessing Workflow in the Postanesthesia Care Unit

The postanesthesia care unit (PACU) environment must function smoothly as a critical recovery area for monitoring of immediate postoperative patients. Timely responsiveness to complications is imperative to ensure patient safety. Following postanesthesia observation, a patient is discharged from the PACU to home or is admitted to the hospital. If this transition is delayed by excessive discharge times or poorly managed patient adverse events, it can cause major bottlenecks and issues with throughput for the perioperative setting. This project aims to study the present workflow in the PACU, identify gaps in the workflow and provide recommendations to perioperative leadership. Current PACU practices were observed using an assessment tool to establish the barriers to a streamlined PACU workflow at a large urban academic hospital. Reoccurring workflow gaps were determined and collected data was presented to perioperative leadership with recommendations

The effectiveness of nonsteroidal anti-inflammatory agents in the treatment of pelvic inflammatory disease: a systematic review

BACKGROUND: Pelvic inflammatory disease (PID) is the result of infection ascending through the endocervix to the uterus and fallopian tubes. Inflammation driven by infected host cells appears to be central to the development of tissue damage and associated reproductive complications. Nonsteroidal anti-inflammatory agents (NSAIDs) therefore have the potential to reduce the sequelae associated with pelvic infection. METHODS: A search of four electronic reference databases, an internet search for relevant grey literature and a review of the bibliographies of identified publications was used to identify studies evaluating NSAIDs in the management of PID. A predefined search strategy was used to identify studies that included women with PID aged over 16 and diagnosed after 1980. Randomized controlled trials, nonrandomized controlled trials, and cohort studies with comparison group data were included without language restriction. Two reviewers independently assessed the studies against agreed criteria and extracted relevant data using a standardized pro forma. A meta-analysis to calculate the relative risk associated with NSAID use was planned if appropriate. RESULTS: Forty-three studies were identified. After reviewing abstracts or full texts, two randomized controlled trials were found to meet the selection criteria for inclusion. The use of NSAIDs was reported to improve tubal patency, reduce pelvic adhesions and reduce suprapubic pain but the studies were of poor quality with a high risk of bias. Meta-analysis of the data was not performed. CONCLUSIONS: Insufficient data is available to support or refute the efficacy of NSAIDs in the prevention of short or long-term complications of PID

Autism risk across generations: a population-based study of advancing grandpaternal and paternal age

Importance: Advancing paternal age has been linked to autism

What are the information needs of people with dementia and their family caregivers when they are admitted to a mental health ward and do current ward patient information leaflets meet their needs?

Introduction: An admission to a mental health ward is an uncertain and unexpected part of a person’s journey with dementia and consequently, families require information about what to expect and how to prepare. This study aimed to establish the information needs of people with dementia and their families at the point of admission to a mental health ward and to collate existing ward information leaflets to explore if they meet these information needs. Methods: This research was in two parts, (1) a qualitative study using focus groups, one with people with dementia and family carers with lived experience of such an admission (n=6) and another with Admiral Nurses (n=6) to explore information needs at the point of admission. (2) Each NHS mental health trust (n=67) was asked to provide a copy of their ward information shared at admission. A total of 30 leaflets were received from 15 NHS trusts, after removing duplicates 22 were included. A content analysis was conducted to evaluate to what extent leaflets met the information needs identified from focus groups. Results:Two main categories ‘honest, accurate and up to date information’ and ‘who is the information for’ and four subcategories were derived from focus group data. Participants felt that people with dementia and families were likely to have different information needs. Material for people with dementia needed to be in an accessible format. Information should cover the aim of the admission, a timeline of what to expect and details about how families will be involved in care. Practical information about what to pack and ward facilities was valued. Participants spoke about the need to consider the tone of the information given people are likely to be distressed. The information leaflets reviewed did not meet the information needs identified by focus group participants. Conclusions: People with dementia and family carers have different information needs at the point of admission to a mental health ward. Information provided to people with dementia needs to be in an accessible format with content relevant to these needs. Wards should aim to co-create information to ensure they meet people’s information need

Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: A comprehensive review

Background: Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives: To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples’ preferences, needs, opportunities and barriers to palliative care. Methods: A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly’s hierarchy of evidence-for-practice in qualitative research. Results: Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples’ experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions: The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas

HbA1c variability in adults with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) therapy compared to multiple daily injection (MDI) treatment

Objective To determine if continuous subcutaneous insulin infusion (CSII) therapy is associated with lower glycated haemoglobin (HbA1c) variability (long-term glycaemic variability; GV) relative to multiple daily injection (MDI) treatment in adults with type 1 diabetes mellitus (T1DM). Design Retrospective audit. Setting and participants Clinic records from 506 adults with T1DM from two tertiary Australian hospitals. Outcome measures Long-term GV was assessed by HbA1c SD and coefficient of variation (CV) in adults on established MDI or CSII therapy, and in a subset changing from MDI to CSII. Results Adults (n=506, (164 CSII), 50% women, mean±SD age 38.0±15.3 years, 17.0±13.7 years diabetes, mean HbA1c 7.8%±1.2% (62±13 mmol/mol) on CSII, 8.0%±1.5% (64±16 mmol/mol) on MDI) were followed for 4.1±3.6 years. CSII use was associated with lower GV (HbA1c SD: CSII vs MDI 0.5%±0.41% (6±6 mmol/mol) vs 0.7%±0.7% (9±8 mmol/mol)) and CV: CSII vs MDI 6.7%±4.6% (10±10 mmol/mol) vs 9.3%±7.3% (14±13 mmol/mol), both p<0.001. Fifty-six adults (73% female, age 36±13 years, 16±13 years diabetes, HbA1c 7.8%±0.8% (62±9 mmol/mol)) transitioned from MDI to CSII. Mean HbA1c fell by 0.4%. GV from 1 year post-CSII commencement decreased significantly, HbA1c SD pre-CSII versus post-CSII 0.7%±0.5% (8±5 mmol/mol) vs 0.4%±0.4% (5±4 mmol/mol); p<0.001, and HbA1c CV 9.2%±5.5% (13±8 mmol/mol) vs 6.1%±3.9% (9±5 mmol/mol); p<0.001. Conclusions In clinical practice with T1DM adults relative to MDI, CSII therapy is associated with lower HbA1c GV