Impact of Pickering Intervention on the Stability of W1/O/W2 Double Emulsions of Relevance to Foods.

Although water-in-oil-in-water (W1/O/W2) double emulsions have been associated with a spectrum of potential applications in foods, their complex microstructure is significantly unstable. Pickering stabilization, reputed for superior and longer-term interfacial stabilization when compared to surfactant-stabilized systems, could provide the opportunity to enhance double-emulsion stability. The current work presents a systematic study on the impact of progressively adopting such a Pickering intervention onto one or both interfaces of W1/O/W2 emulsions relevant to foods. A range of surfactants/emulsifiers and particles have been used at the W1/O or O/W2 interface of the W1/O/W2 microstructure and, where appropriate, cross-compared with the equivalent interfaces of simple emulsions (W/O and O/W, respectively). As the aqueous compartments of all investigated systems were not osmotically balanced (at the point of formulating/forming these), any advantages in terms of double-emulsion stability enhancement can be directly attributed to the employed particle stabilization. It is demonstrated that, although partial Pickering intervention can encourage stability (particularly if that is introduced at the inner W1/O interface), only complete Pickering stabilization of the double microstructure can ensure that the oil globule size is maintained and the internal water phase is retained over a storage period of one month.

Measuring the impact of channel length on liquid flow through an ideal Plateau border and node system.

The phenomenon of foam drainage is a complex multi-scale process that unites molecular level interactions with bulk foam characteristics. Foam drainage is primarily governed by the flow of liquid in the channels and junctions that form between bubbles, which are known as Plateau borders (PBs) and nodes respectively. Existing theoretical work predicts the surface rheology of the PB and node air-liquid interface to influence liquid flow rates; however, direct experimental observations of this phenomenon remain scarce. This study recognises the clear need for a reproducible, accurate and standardised approach to directly studying liquid flow at the scale of a theoretically 'ideal' PB-node architecture. Measurements of PB geometric profiles and their apparent surface shear viscosities, µs, were made for an aqueous solution of Sodium Dodecyl Sulphate (SDS) at varying PB lengths, l1, and liquid flow rates in the range 10 µl min-1 ≤ Q ≤ 200 µl min-1. Geometric profiles displayed previously unobserved transitions between PB relaxation and expansion towards the node, with expansion dominating under conditions approaching conventional foam drainage. Average values of µs in the PB relaxation regions showed virtually inviscid behaviour, with magnitudes of 10-8 g s-1 < µs < 10-4 g s-1 for l1 in the range 27.5 mm ⪆ l1 ⪆ 8.0 mm. Decreasing magnitudes of µs and degrees of shear thinning were observed with increasing l1. This was attributed to a compressibility of the interface that was limited by an SDS concentration dependence on l1. Numerical evaluation predicted the appearance of Marangoni forces that scaled strongly with liquid shear rates, and could therefore have been responsible for the apparent shear thinning behaviour.

The Neuronal Encoding of Oral Fat by the Coefficient of Sliding Friction in the Cerebral Cortex and Amygdala.

Fat in the diet contributes to the pleasant mouthfeel of many foods, but overconsumption may contribute to obesity. Here we analyze what properties of fat in the mouth are sensed, by analyzing the responses of neurons in the macaque insular taste cortex, and two areas to which it projects the orbitofrontal cortex where the pleasantness of fat is represented, and the amygdala. We discovered that the firing rate responses of these fat-responsive neurons are correlated with the coefficient of sliding friction (CSF) and not with viscosity which reflects food thickness. Other, not fat-sensitive, neurons encoded viscosity and not the CSF. Neuronal population analyses confirmed that fat-responsive neurons conveyed information about the CSF but not about viscosity. Conversely the viscosity-sensitive neuronal population conveyed information about viscosity but not about the CSF. This new understanding of the representation of oral fat in the cerebral cortex and amygdala opens the way for the systematic development of foods with the pleasant mouthfeel of fat, together with ideal nutritional content and has great potential to contribute to healthy eating and a healthy body weight.

Fabrication and Utilization of Bifunctional Protein/Polysaccharide Coprecipitates for the Independent Codelivery of Two Model Actives from Simple Oil-in-Water Emulsions.

Aside from single active microencapsulation, there is growing interest in designing structures for the coencapsulation and codelivery of multiple species. Although currently achievable within solid systems, significant challenges exist in realizing such functionality in liquid formulations. The present study reports on a novel microstructural strategy that enables the coencapsulation and corelease of two actives from oil-in-water emulsions. This is realized through the fabrication of sodium caseinate/chitosan (NaCAS/CS) complexes that in tandem function as encapsulants of one active (hydrophilic) but also as ("Pickering-like") stabilizers to emulsion droplets containing a secondary active (hydrophobic). Confocal microscopy confirmed that the two coencapsulated actives occupied distinct emulsion microstructure regions; the hydrophilic active was associated with the NaCAS/CS complexes at the emulsion interface, while the hydrophobic active was present within the oil droplets. Aided by their segregated coencapsulation, the two actives exhibited markedly different corelease behaviors. The hydrophilic active exhibited triggered release that was promoted by changes to pH, which weakened the protein-polysaccharide electrostatic interactions, resulting in particle swelling. The hydrophobic secondary active exhibited sustained release that was impervious to pH and instead controlled by passage across the interfacial barrier. The employed microstructural approach can therefore lead to the segregated coencapsulation and independent corelease of two incompatible actives, thus offering promise for the development of liquid-emulsion-based formulations containing multiple actives.

VMAT to arclet plan conversion in a treatment planning system : Feasibility and dosimetric relationship between VMAT, arclet, and stationary fields.

AIM: The aim of this study was to make dynamic rotation treatment with mARC available for the non-dedicated Philips Pinnacle treatment planning system by converting SmartArc plans, offering insight into the relationship between SmartArc, mARC, and stationary field irradiation. METHODS: A scripting solution is presented that can be run in the Pinnacle system. This allows for the conversion of SmartArc plans into mARC format. The dose distribution of the converted mARC plan can be evaluated both in the form of a "real" mARC plan with arclets and-as is generally done in treatment planning systems certified for mARC planning-by approximating the arclets as stationary fields. We present the proof of principle and dosimetric comparisons. RESULTS: The converted plans were irradiated without problems. For the measured 3D dose distributions, on average over 90 % points agreed with the calculated dose distributions (mARC and stationary field plans) within the gamma criteria of 3 % deviation in the local dose, 3-mm distance to agreement, for all dose values above 10 % of the maximum. The agreement between the three calculated dose distributions (SmartArc with both converted plans) was above 87 % (above 92 % when comparing mARC with stationary fields). CONCLUSION: Our solution offers the possibility of mARC planning in Pinnacle. The dose comparisons furthermore prove that the dosimetric differences between SmartArc and mARC, when appropriately translated, are minor.

Australian clinical practice guidelines for the diagnosis and management of Barrett's esophagus and early esophageal adenocarcinoma.

Barrett's esophagus (BE), a common condition, is the only known precursor to esophageal adenocarcinoma (EAC). There is uncertainty about the best way to manage BE as most people with BE never develop EAC and most patients diagnosed with EAC have no preceding diagnosis of BE. Moreover, there have been recent advances in knowledge and practice about the management of BE and early EAC. To aid clinical decision making in this rapidly moving field, Cancer Council Australia convened an expert working party to identify pertinent clinical questions. The questions covered a wide range of topics including endoscopic and histological definitions of BE and early EAC; prevalence, incidence, natural history, and risk factors for BE; and methods for managing BE and early EAC. The latter considered modification of lifestyle factors; screening and surveillance strategies; and medical, endoscopic, and surgical interventions. To answer each question, the working party systematically reviewed the literature and developed a set of recommendations through consensus. Evidence underpinning each recommendation was rated according to quality and applicability.

On Time Domain Analysis of Photoplethysmogram Signals for Monitoring Heat Stress.

There are a limited number of studies on heat stress dynamics during exercise using the photoplethysmogram (PPG) and its second derivative (APG). However, we investigate the most suitable index from short PPG signal recordings for heat stress assessment. The APG waveform consists of a, b, c and d waves in systole and an e wave in diastole. Our preliminary results indicate that the use of the energy of aa area, derived from PPG signals measured from emergency responders in tropical conditions, is promising in determining the heat stress level using 20-s recordings. After examining 14 time domain features using leave-one-out cross-validation, we found that the aa energy extracted from PPG signals is the most informative feature for classifying heat-stressed subjects, with an overall accuracy of 79%. Moreover, the combination of the aa energy with the traditional Sensors 2015, 15 24717 heart rate variability index of heat stress (i.e., the square root of the mean of the squares of the successive aa intervals) improved the heat stress detection to an overall accuracy of 83%.

A literature review of medical record keeping by foreign medical teams in sudden onset disasters.

BACKGROUND: Medical records are a tenet of good medical practice and provide one method of communicating individual follow-up arrangements, informing research data, and documenting medical intervention. METHODS: The objective of this review was to look at one source (the published literature) of medical records used by foreign medical teams (FMTs) in sudden onset disasters (SODs). The published literature was searched systematically for evidence of what medical records have been used by FMTs in SODs. Findings The style and content of medical records kept by FMTs in SODs varied widely according to the published literature. Similarly, there was great variability in practice as to what happens to the record and/or the data from the record following its use during a patient encounter. However, there was a paucity of published work comprehensively detailing the exact content of records used. Interpretation Without standardization of the content of medical records kept by FMTs in SODs, it is difficult to ensure robust follow-up arrangements are documented. This may hinder communication between different FMTs and local medical teams (LMTs)/other FMTs who may then need to provide follow-up care for an individual. Furthermore, without a standard method of reporting data, there is an inaccurate picture of the work carried out. Therefore, there is not a solid evidence base for improving the quality of future response to SODs. Further research targeting FMTs and LMTs directly is essential to inform any development of an internationally agreed minimum data set (MDS), for both recording and reporting, in order that FMTs can reach the World Health Organization (WHO) standards for FMT practice.

Long-term follow-up reveals low incidence of colorectal cancer, but frequent need for resection, among Australian patients with inflammatory bowel disease.

BACKGROUND & AIMS: Inflammatory bowel disease can require surgical resection and also lead to colorectal cancer (CRC). We investigated the cumulative incidence of resection surgeries and CRC among patients with ulcerative colitis (UC) or Crohn's disease (CD). METHODS: We analyzed data from a cohort of patients who participated in an inflammatory bowel disease study (504 with UC and 377 with CD) at 2 academic medical centers in Sydney, Australia from 1977 to 1992 (before the development of biologic therapies). We collected follow-up data on surgeries and development of CRC from hospital and community medical records or via direct contact with patients during a median time period of 14 years. Cumulative incidences of resection surgeries and CRC were calculated by competing risk survival analysis. RESULTS: Among patients with UC, CRC developed in 24, for a cumulative incidence of 1% at 10 years (95% confidence interval [CI], 0%-2%), 3% at 20 years (95% CI, 1%-5%), and 7% at 30 years (95% CI, 4%-10%). Their cumulative incidence of colectomy was 15% at 10 years (95% CI, 11%-19%), 26% at 20 years (95% CI, 21%-30%), and 31% at 30 years (95% CI, 25%-36%). Among patients with CD, 5 of 327 with colon disease developed CRC, with a cumulative incidence of CRC of 1% at 10 years (95% CI, 0%-2%), 1% at 20 years (95% CI, 0%-2%), and 2% at 30 years (95% CI, 0%-4%). Among all patients with CD, the cumulative incidence of resection was 32% at 5 years (95% CI, 27%-37%), 43% at 10 years (95% CI, 37%-49%), and 53% at 15 years (95% CI, 46%-58%). Of these 168 subjects, 42% required a second resection within 15 years of the first surgery (95% CI, 33%-50%). CONCLUSIONS: Patients with UC have a low incidence of CRC during a 30-year period (7% or less); the incidence among patients with CD is even lower. However, almost one-third of patients with UC and about 50% of those with CD will require surgery.

Detection of a and b waves in the acceleration photoplethysmogram.

BACKGROUND: Analyzing acceleration photoplethysmogram (APG) signals measured after exercise is challenging. In this paper, a novel algorithm that can detect a waves and consequently b waves under these conditions is proposed. Accurate a and b wave detection is an important first step for the assessment of arterial stiffness and other cardiovascular parameters. METHODS: Nine algorithms based on fixed thresholding are compared, and a new algorithm is introduced to improve the detection rate using a testing set of heat stressed APG signals containing a total of 1,540 heart beats. RESULTS: The new a detection algorithm demonstrates the highest overall detection accuracy--99.78% sensitivity, 100% positive predictivity--over signals that suffer from 1) non-stationary effects, 2) irregular heartbeats, and 3) low amplitude waves. In addition, the proposed b detection algorithm achieved an overall sensitivity of 99.78% and a positive predictivity of 99.95%. CONCLUSIONS: The proposed algorithm presents an advantage for real-time applications by avoiding human intervention in threshold determination.

Self-structuring foods based on acid-sensitive low and high acyl mixed gellan systems to impact on satiety.

This study investigated the in vitro acid-induced gelation of mixed systems of two biopolymers; low acyl and high acyl gellan gum. Rheological and texture analysis showed that these mixed gels displayed textures that lay between the material properties exhibited for the low and high acyl variants. DSC analysis showed that mixtures of the low acyl and high acyl forms exhibit two separate conformational transitions at temperatures coincident with each of the individual biopolymers. Various metabolically relevant pH environments and hydrocolloid concentrations were investigated. These resulted in very different acid gelled structures, which were characterised by texture analysis. The structures of the acid gels were shown to depend upon the pH, hydrocolloid concentration and proportion of each biopolymer used during their production. A selection of these mixed gellan structures were assessed post-production in terms of their response to prolonged exposure to an acidic (pH 1), stomach-like, environment. This resulted in a significant increase in the gel strength, regardless of the biopolymer proportions. The high acyl gellan was less acid-sensitive, and subsequently no evidence of acid gelation was observed with high acyl gellan at a proportion greater than 60% of the total biopolymer. The findings presented here demonstrate that structuring as well as de-structuring of mixed gellan acid gels can be controlled in acidic environments similar to those that are present in the stomach after food consumption.

National screening for colorectal cancer is associated with stage shift to earlier diagnosis.

BACKGROUND: Australia's National Bowel Cancer Screening Program consists of an immunohistochemical faecal occult blood test, targeting adults aged 50-74. Existing literature supports the principle of early detection of colorectal cancer (CRC) via national screening, but little is known about the association between colonoscopy or polypectomy rates and CRC stage over time. The aim of this study is to identify the longitudinal change to colonoscopy and polypectomy rates, and any stage shift associated with this screening program. METHODS: A retrospective data-linkage study was performed using the Australian national health database (Medicare) to obtain colonoscopy and polypectomy rates between 1998 and 2017. A second prospective database of CRC resection specimens was analysed for this period. The cohort was divided based on time intervals related to the National Bowel Cancer Screening Program: pre-commencement 1998-2006 (Period A), immediately post-commencement 2007-2011 (Period B), and subsequent years 2012-2017 (Period C). Linear regression was used to test relation between annualized predictor and response variables. RESULTS: Annual colonoscopy rates doubled, and polypectomy rates tripled during the study (P < 0.001). Annual colonoscopy rate correlated to a lower T-stage (P = 0.038) and lower N-stage (P = 0.026), and there was a 7% increase in early CRC (stage I-II) in Period C (P < 0.001). Across the study period there was also a significant increase in right-sided tumours, and concurrent MMR deficiency and BRAF mutation. CONCLUSION: Polypectomy and colonoscopy rates increased after the introduction of the National Bowel Cancer screening program. There was a clinically significant shift to earlier CRC stage which manifested 5 years after its implementation.

Physiological responses of medical team members to a simulated emergency in tropical field conditions.

INTRODUCTION: Responses to physical activity while wearing personal protective equipment in hot laboratory conditions are well documented. However less is known of medical professionals responding to an emergency in hot field conditions in standard attire. Therefore, the purpose of this study was to assess the physiological responses of medical responders to a simulated field emergency in tropical conditions. METHODS: Ten subjects, all of whom were chronically heat-acclimatized health care workers, volunteered to participate in this investigation. Participants were the medical response team of a simulated field emergency conducted at the Northern Territory Emergency Services training grounds, Yarrawonga, NT, Australia. The exercise consisted of setting up a field hospital, transporting patients by stretcher to the hospital, triaging and treating the patients while dressed in standard medical response uniforms in field conditions (mean ambient temperature of 29.3°C and relative humidity of 50.3%, apparent temperature of 27.9°C) for a duration of 150 minutes. Gastrointestinal temperature was transmitted from an ingestible sensor and used as the index of core temperature. An integrated physiological monitoring device worn by each participant measured and logged heart rate, chest temperature and gastrointestinal temperature throughout the exercise. Hydration status was assessed by monitoring the change between pre- and post-exercise body mass and urine specific gravity (USG). RESULTS: Mean core body temperature rose from 37.5°C at the commencement of the exercise to peak at 37.8°C after 75 minutes. The individual peak core body temperature was 38.5°C, with three subjects exceeding 38.0°C. Subjects sweated 0.54 L per hour and consumed 0.36 L of fluid per hour, resulting in overall dehydration of 0.7% of body mass at the cessation of exercise. Physiological strain index was indicative of little to low strain. CONCLUSIONS: The combination of the unseasonably mild environmental conditions and moderate work rates resulted in minimal heat storage during the simulated exercise. As a result, low sweat rates manifested in minimal dehydration. When provided with access to fluids in mild environmental conditions, chronically heat-acclimatized medical responders can meet their hydration requirements through ad libitum fluid consumption. Whether such an observation is replicated under a harsher thermal load remains to be investigated.

Phospholipids at the interface: current trends and challenges.

Phospholipids are one of the major structural elements of biological membranes. Due to their amphiphilic character, they can adopt various molecular assemblies when dispersed in water, such as bilayer vesicles or micelles, which give them unique interfacial properties and render them very attractive in terms of foam or emulsion stabilization. This article aims at reviewing the properties of phospholipids at the air/water and oil/water interfaces, as well as the recent advances in using these natural components as stabilizers, alone or in combination with other compounds such as proteins. A discussion regarding the challenges and opportunities offered by phospholipids-stabilized structure concludes the review.

Designer colloids in structured food for the future.

Recent advances in the understanding of colloids has enabled the design of food products that are healthier and tastier, in line with consumer expectations. Specifically, emulsion design and hydrocolloid structuring can be used to address the issue of fat reduction in foods by allowing the production of reduced fat products that provide similar sensory attributes. Additionally, various techniques for encapsulating molecules, such as flavour, nutraceuticals or drugs, are now being developed. The application of such techniques in food products can improve micronutrient bioavailability by means of targeted and controlled delivery, increasing the nutritional value. Colloidal structures can also be designed to enhance consumer experience, mimic fat or control satiety. Such novel improvements, as well as their potential translation into commercial food products, are highlighted in this paper, which focuses primarily on the areas of emulsion technologies and hydrocolloids.

A prospective multicenter evaluation of a new side-port endoscopic ultrasound-fine-needle aspiration in solid upper gastrointestinal lesions.

BACKGROUND AND STUDY AIMS: Diagnostic yield of endoscopic ultrasound (EUS)-fine-needle aspiration (FNA) varies depending on the equipment used and the site targeted. Multiple needle passes are usually required to obtain a diagnosis. A new needle incorporating a side-port carries a theoretical advantage regarding acquisition of cytological material. The aim of the study was to demonstrate the safety and efficacy of the Olympus side-port needle in solid upper gastrointestinal indications. PATIENTS AND METHODS: A prospective multicenter evaluation of patients referred for EUS-FNA for solid lesions was performed across six tertiary gastroenterology referral centers in four capital cities in Australia. The main outcome measures include cytological diagnosis, number of needle passes required for diagnosis and complication rates. RESULTS: Thirty patients (17 men; 13 women) with a mean age of 67.5 years were studied. Indications included pancreatic or biliary mass in 24 patients, retroperitoneal or periduodenal mass in 2, enlarged lymph node in 2, a gastric submucosal tumor in 1 and a subcarinal mass in 1. The mean size of the lesions was 3.47 cm (range, 0.5-8 cm). All but one case had a diagnosis made (96.7%). The mean number of passes required to reach a diagnosis was 1.7. In neoplastic lesions the diagnosis was made with a mean of 1.6 passes. No complications were encountered. CONCLUSIONS: The new EUS-FNA needle with side port appears effective and safe in solid upper gastrointestinal EUS-FNA indications.

Emergency surgery data and documentation reporting forms for sudden-onset humanitarian crises, natural disasters and the existing burden of surgical disease.

Following large-scale disasters and major complex emergencies, especially in resource-poor settings, emergency surgery is practiced by Foreign Medical Teams (FMTs) sent by governmental and non-governmental organizations (NGOs). These surgical experiences have not yielded an appropriate standardized collection of data and reporting to meet standards required by national authorities, the World Health Organization, and the Inter-Agency Standing Committee's Global Health Cluster. Utilizing the 2011 International Data Collection guidelines for surgery initiated by Médecins Sans Frontières, the authors of this paper developed an individual patient-centric form and an International Standard Reporting Template for Surgical Care to record data for victims of a disaster as well as the co-existing burden of surgical disease within the affected community. The data includes surgical patient outcomes and perioperative mortality, along with referrals for rehabilitation, mental health and psychosocial care. The purpose of the standard data format is fourfold: (1) to ensure that all surgical providers, especially from indigenous first responder teams and others performing emergency surgery, from national and international (Foreign) medical teams, contribute relevant and purposeful reporting; (2) to provide universally acceptable forms that meet the minimal needs of both national authorities and the Health Cluster; (3) to increase transparency and accountability, contributing to improved humanitarian coordination; and (4) to facilitate a comprehensive review of services provided to those affected by the crisis.