Patient's satisfaction towards healthcare services and its associated factors at the highest patient loads government primary care clinic in Pahang.

INTRODUCTION: Patient satisfaction is widely used to monitor the quality of health care services. A significant patient load may influence health care services and patient satisfaction. Klinik Kesihatan Bandar Kuantan, Pahang (KKBK) has the highest patient loads in Pahang state, followed by Klinik Kesihatan Beserah and Klinik Kesihatan Kurnia. There are up to 700 attendees at KKBK per day, representing a population of 209679. KKBK had receives several complaints and patient unhappiness with its health care services, despite the administration's efforts to improve the clinics healthcare delivery. Thus, this study aimed to measure patients' satisfaction towards health care services at Pahang's highest patient loads primary care clinic. MATERIALS AND METHODS: A cross-sectional study was conducted at Klinik Kesihatan Bandar Kuantan, Kuantan, Pahang. Patients were selected using stratified random sampling, and 201 participants were selected. The selected participants were asked to fill up the self-administered validated questionnaires consisting of background characteristics and Patient Satisfaction Questionnaire 18 (PSQ-18). Data collection period was from March 2022 to August 2022. Descriptive analysis was used to describe the background characteristics of respondents and the score of patient satisfaction. Multiple linear regression was used to determine the factors associated with patient satisfaction while adjusting for cofounders. RESULTS: A total of 201 eligible data points were analysed in the study. The respondent mean age was 47.1 ± 16.9. Most respondents were Malay (68.7%), having secondary education (54.2%) and predominantly from the B40 income class (88.1%). The overall mean patient satisfaction score was 3.83 ± 0.31. There were significant associations between overall satisfaction with patient education level (B = -0.144; 95% CI -0.246, -0.042; p = 0.006), waiting time (B = -0.371; 95% CI -0.534, -0.209; p = 0.001) and consultation duration (B = -0.154; 95% CI -0.253, -0.055; p = 0.0020). It was found that patients with secondary education were less satisfied compared to patients with primary education level on health care services they received. Meanwhile, those who were not happy with the waiting time and consultation duration showed less satisfaction with overall healthcare services. CONCLUSION: Despite serving the most significant number of patients in Pahang state, most of the patient were satisfied by the health care services at Klinik Kesihatan Bandar Kuantan. However, it is recommended to improve the waiting time and the consultation time in this clinic.

Suction rectal biopsy (SRB) in Hirschsprung's Disease: Is a single macroscopically adequate sample sufficient?

Hirschsprung's Disease (HD) is a congenital disorder causing severe constipation in infants and children. Suction rectal biopsy (SRB) is the preferred technique for obtaining tissue samples for histopathological evaluation. In low-resource settings like Malaysia, cost-effective diagnostic approaches are necessary, making single sample SRB valuable. This study evaluates the diagnostic accuracy and sufficiency of a single macroscopically adequate sample in suction rectal biopsies for the histopathological confirmation of HD. We conducted a retrospective study of children who underwent suction rectal biopsies for the diagnosis of HD at Hospital Raja Perempuan Zainab II (HRPZII), Kota Bharu, Kelantan. A total of 68 patients were included in the study. The inadequacy rate for bedside SRB was 14%, comparable to current literature. Our study found no statistically significant association between sample inadequacy and gestational age, gender, birth weight, or weight at biopsy. Complication rates were 0%, consistent with literature reports. Calretinin staining, an additional technique, was performed in 23 biopsy episodes, with a 4.3% inadequacy rate, compared to 20% in specimens not subjected to calretinin staining. The cost of SRB almost doubled with each additional sample taken, significant in low-resource environments. In conclusion, single sample SRBs can be adequately diagnostic and cost-effective in low-resource settings, providing valuable insights for healthcare facilities in Malaysia and other developing countries. The use of adjunctive techniques such as calretinin staining may improve diagnostic accuracy while maintaining cost-effectiveness. Further prospective studies with larger sample sizes are needed to validate these findings.

The Association of Eating Behaviour with Physical Activity and Screen Time among Adolescents in the Klang Valley, Malaysia: A Cross-Sectional Study.

Over the last few decades, the time adolescents spend using electronic devices has increased significantly. The aim of this study was to evaluate the impact of screen time and physical activity on eating behaviour in adolescents. This study used the Physical Activity Questionnaire for Adolescents (PAQ-A) Malay version and the Dutch Eating Behaviour Questionnaire (DEBQ) Malay version methods with secondary students around the Klang Valley. The sampling technique used was purposive sampling. With parents' consent, an online survey was conducted among adolescent school children aged between 13 and 17 years during the COVID-19 pandemic in the Klang Valley, Malaysia. There were 372 respondents participating in this study. The results showed that 99.4% of them had more than 4 h screen time a day, and that 38.5% have more than three devices at home. Moreover, there was a significant mean difference in screen time for console games without a handheld device between male and female adolescents (p < 0.05). There was also a significant mean difference in the emotional, restricted and external eating behaviour scores between male and female adolescents (p < 0.001). There was a significant relationship between physical activity and the time duration spent on a television, telephone and laptop during weekends (p < 0.05). There was a significant relationship between eating behaviour and time spent watching television and using laptops during weekends (p < 0.05). Based on the moderation model, gender as a moderator variable indicated that there was a significant relationship between screen time and interaction screen time and gender with emotional eating (p < 0.001). Female adolescents had a stronger relationship between screen time and emotional eating compared to male adolescents (p < 0.05). Meanwhile, for physical activity level as a moderator variable, the results showed that there was a significant interaction between screen time and physical activity for emotional eating behaviour (p < 0.05). In conclusion, this study indicates that screen time was higher among female adolescents and significantly related to emotional eating behaviour. Therefore, the educational sector should emphasise the motivation of adolescents to engage in physical activity, reduce their screen time and eat healthy foods such as fruits and vegetables.

Prevalence of Relative Energy Deficiency in Sport (RED-S) among National Athletes in Malaysia.

Relative energy deficiency in sport (RED-S), which underpins the concept of low energy availability (LEA), can negatively affect athletes' health and performance. This study aims to investigate the prevalence of RED-S among national athletes in Malaysia. A total of 192 national athletes (97 males, 18-39 years old) responded to an online survey regarding the RED-S risk. Most athletes (67.2%) were classified as having a medium/high RED-S risk. Female (41.2%), weight-class (23.9%), and intermittent sports (20.3%) had the highest prevalence of medium/high RED-S risk. Overall, most athletes spent 2-5 h daily (55.2%) and 6-7 days weekly (53.6%) practicing or playing their sport, and 47.9% reported feeling tired recently. The athletes were also terrified of being overweight (61.5%), worried about what they eat (64.7%), concerned about having fat on their bodies (62.6%), and thinking about burning calories while exercising (69.3%). Only 16.7% of the athletes had a prior history of stress fractures, and 40.6% continued to participate in activities 6-7 days per week while injured. The majority of female athletes (88.3%) had regular menstrual cycles. These findings support the notion that RED-S screening should be addressed in the athletic community. Future research is needed to clinically assess these athletes and investigate the impacts of RED-S on their health and sports performance.

Carbohydrate mouth rinse is no more effective than placebo on running endurance of dehydrated and heat acclimated athletes.

PURPOSE: To determine whether carbohydrate mouth rinsing would improve endurance running performance of tropical natives in a warm-humid (30 °C and 70% relative humidity) environment. METHOD: Twelve endurance male runners [age 25 ± 3 years; peak aerobic capacity ([Formula: see text]O2peak) 57.6 ± 3.6 mL.kg-1.min-1] completed three time-to-exhaustion (TTE) trials at ~ 70% [Formula: see text]O2peak while swilling 25 ml of a 6% carbohydrate (CHO) or taste-matched placebo (PLA) as well as no mouth rinse performed in the control (CON) trial. RESULTS: TTE performance was significantly longer in both CHO and PLA trials when compared with the CON trial (54.7 ± 5.4 and 53.6 ± 5.1 vs. 48.4 ± 3.6 min, respectively; p < 0.001 and p = 0.012, respectively), but was not significantly different between CHO and PLA trials (p = 1.000). The rating of perceived exertion was not different between the CHO and PLA trials, however, was significantly affected when compared to the CON trial (p < 0.001). A similar effect was observed for perceived arousal level between the CHO and PLA trials to the CON trial. Core temperature, mean skin temperature and skin blood flow were not significantly different between the three trials (all p > 0.05). Similarly, plasma lactate and glucose as well as exercise heart rate were not influenced by the trials. CONCLUSIONS: The present study demonstrates that mouth rinsing, whether carbohydrate or placebo, provides an ergogenic benefit to running endurance when compared to CON in a heat stress environment. Nevertheless, the results do not support the notion that rinsing a carbohydrate solution provides a greater advantage as previously described among non-heat acclimated individuals within a temperate condition.

Breathing exercise for hypertensive patients: A scoping review.

Background: Non-pharmacological management of hypertension includes weight loss, alcohol and sodium restriction, regular exercise, and relaxation. In people with overweight hypertension, systolic blood pressure (SBP) and diastolic blood pressure (DBP) can be decreased via exercise and weight loss together. Breathing exercises are one method of relaxing. Objectives: The aim of this scoping review is to map the information that is currently available about the advantages of breathing exercises in decreasing blood pressure in hypertension patients. Methods: This scoping review adheres to Arksey and O'Malley's framework, which entails identifying review questions, seeking pertinent evidence, choosing pertinent studies, mapping data, and discussing, concluding, and reporting the findings. The PRISMA flowchart is used to show how the evidence search process works. Results: As a result, 339 articles in total were retrieved from the three databases. 20 papers total were included in this review after screening. In 14 of the 20 investigations, participants with stage 1 and stage 2 essential hypertension, two with pre-hypertension, and four with Isolated Systolic Hypertension (ISH) were studied. The respondents' ages ranged from 18 to 75. The systolic blood pressure declined by 4-54.22 mmHg, while the diastolic blood pressure dropped by 3-17 mmHg. Conclusion: Slow breathing can be used as an alternate, non-pharmacological therapy for hypertension individuals to reduce blood pressure. Systematic Review Registration: (https://osf.io/ta9u6/).

Relationship between physical activity and musculoskeletal disorders among low income housewives in Kuala Lumpur: A cross sectional study.

Housewives play a crucial role in their families' and communities' quality of life. However, musculoskeletal disorders are common among housewives due to housework and lack of physical activity. These musculoskeletal problems have been associated to leisure physical activity. As a result, the goal of this study was to determine the incidence of musculoskeletal problems and their association to physical activity among low-income women in Kuala Lumpur. A cross-sectional research was done among 82 housewives in Kuala Lumpur's low-income housing area. Housewives were asked to fill out a sociodemographic questionnaire, a short version of the International Physical Activity Questionnaire (IPAQ), the Nordic Musculoskeletal Questionnaire (NMQ), and body mass index were measured by researcher. The total prevalence of musculoskeletal problems was found to be 89.0%, with the lowest frequency in the lower back (35%), followed by the knee (31%), ankle or foot (31%), and elbow (1% %). The subjects spent an average of 117.6 + 474.8 minutes per week on MVPA and 524 + 810.3 MET minutes per week on physical activity. A total of 88% of the participants had a low level of physical activity, 8.5 percent had a moderate level of activity, and 3.7% had a high level of activity. In a Chi-square test, there was no significant association between musculoskeletal problems and physical activity. The primary sociodemographic factors impacting musculoskeletal diseases were body mass index and household income, while the primary variables influencing physical activity were household income and education level, according to a logistic regression test. In a Poisson regression test, only body mass index had a significant relationship with number of musculoskeletal disorders. In conclusion, housewives are likely to suffer from musculoskeletal problems, with a high incidence in the lower back, knees, ankles, and feet, and the majority of them engage in little physical activity. Furthermore, the high percentage of musculoskeletal problems in this study varies with the findings of other research based on the type of housework done by housewives in low-cost housing areas. Future research should look at identifying the sorts of household tasks and positions employed, as well as the amount of hours spent on housework each week.

Can Acute Exercise Lower Cardiovascular Stress Reactivity? Findings from a Scoping Review.

Exaggerated cardiovascular reactivity to and delayed recovery from stress increase the risk of cardiovascular diseases in the future. While exercise training has been shown to attenuate stress-induced cardiovascular reactivity and enhance recovery from stress, the effects with acute exercise are less characterized. The aim of this scoping review was to explore the range and characteristics of published evidence regarding acute exercise on cardiovascular reactivity and stress recovery. The secondary objective was to highlight research gaps and implications for future research. A total of 36 articles met the review inclusion/exclusion criteria, involving 1200 participants from various age groups, fitness and health status. Blood pressure (BP) reactivity was the most measured outcome, followed by heart rate (HR) reactivity, and to some extent, heart rate variability. Overall, acute exercise particularly of the moderate-intensity aerobic type effectively reduced stress-induced BP reactivity in the general population. The effects on HR reactivity and cardiovascular recovery were inconclusive. Further research would be recommended to establish if other forms of exercise intensity or type are equally beneficial to lower exaggerated cardiovascular responses to stress. Despite methodological differences and limitations, the available evidence supports the therapeutic potential of acute exercise in addressing the ill effects of stress on cardiovascular health.

Systemic review of global case reports on ankle pseudo aneurysm: Analysis of epidemiology, clinical presentation, diagnosis and treatment.

INTRODUCTION: Pseudo aneurysm of the ankle is a rare presentation and the management is complex due to the complex anatomy. The aim of this review is to examine the epidemiology, etiology, diagnostic modalities used and management. This is the first systematic review of this topic in literature. METHODS: We performed a systematic review in multiple databases (including PubMed, MEDLINE, EMBASE, and Scopus) from 1966 to May 18, 2019, to identify all case reports and case series describing patients with ankle pseudo aneurysm. This systematic review was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA). Our inclusion criteria included patients with ankle pseudo aneurysm of any age. We excluded reports in which the individual level data is not available. Patients demographic (gender, age), clinical characteristics (precipitating event, duration), diagnostic modality and treatment were recorded. RESULT: There were in total 23 case reports identified on ankle pseudo aneurysm from 1966 until 2018. Among these twenty-three reports, 16 (70%) were male and seven (30%) patients were female. Age distribution showed higher number of reports among young adults, 15 patients (65%). Based on our systematic review trauma (48%), arthroscope (48%) and arthrodesis (4%) were the etiologies described in all these case reports. Ultrasound duplex and CT Angiogram has been used as a single modality in three reports each. In fifteen patients (65%) combination of imaging has been used for diagnosis. Anterior tibial artery is the most commonly injured vessel among the reported cases, comprised of 14 (61%) patients. Among these arthroscopes were the highest reported precipitating events, 9 (64%), followed by trauma in four patients (29%) and arthrodesis in one patient (7%). Treatment modalities described in all previous reports were excision and ligation, 10 (42%); excision of sac and primary repair, 4 (17%); excision of sac followed by reversed saphenous venous graft repair, 2 (8%); US guided compression, 2 (8%); US guided thrombin injection, 4 (17%); stenting, 1 (4%) and coiling, 1 (4%). CONCLUSION: Ankle pseudoaneurysm is mostly preventable by detailed initial assessment following trauma or careful approach during arthroscope. Evolving diagnostic modality and treatment has shed some light into noninvasive management of pseudo aneurysm of ankle.

Cellobiohydrolase B of Aspergillus niger over-expressed in Pichia pastoris stimulates hydrolysis of oil palm empty fruit bunches.

BACKGROUND: Aspergillus niger, along with many other lignocellulolytic fungi, has been widely used as a commercial workhorse for cellulase production. A fungal cellulase system generally includes three major classes of enzymes i.e., ß-glucosidases, endoglucanases and cellobiohydrolases. Cellobiohydrolases (CBH) are vital to the degradation of crystalline cellulose present in lignocellulosic biomass. However, A. niger naturally secretes low levels of CBH. Hence, recombinant production of A. niger CBH is desirable to increase CBH production yield and also to allow biochemical characterisation of the recombinant CBH from A. niger. METHODS: In this study, the gene encoding a cellobiohydrolase B (cbhB) from A. niger ATCC 10574 was cloned and expressed in the methylotrophic yeast Pichia pastoris X-33. The recombinant CBHB was purified and characterised to study its biochemical and kinetic characteristics. To evaluate the potential of CBHB in assisting biomass conversion, CBHB was supplemented into a commercial cellulase preparation (Cellic® CTec2) and was used to hydrolyse oil palm empty fruit bunch (OPEFB), one of the most abundant lignocellulosic waste from the palm oil industry. To attain maximum saccharification, enzyme loadings were optimised by response surface methodology and the optimum point was validated experimentally. Hydrolysed OPEFB samples were analysed using attenuated total reflectance FTIR spectroscopy (ATR-FTIR) to screen for any compositional changes upon enzymatic treatment. RESULTS: Recombinant CBHB was over-expressed as a hyperglycosylated protein attached to N-glycans. CBHB was enzymatically active towards soluble substrates such as 4-methylumbelliferyl-ß-D-cellobioside (MUC), p-nitrophenyl-cellobioside (pNPC) and p-nitrophenyl-cellobiotrioside (pNPG3) but was not active towards crystalline substrates like Avicel® and Sigmacell cellulose. Characterisation of purified CBHB using MUC as the model substrate revealed that optimum catalysis occurred at 50 °C and pH 4 but the enzyme was stable between pH 3 to 10 and 30 to 80 °C. Although CBHB on its own was unable to digest crystalline substrates, supplementation of CBHB (0.37%) with Cellic® CTec2 (30%) increased saccharification of OPEFB by 27%. Compositional analyses of the treated OPEFB samples revealed that CBHB supplementation reduced peak intensities of both crystalline cellulose Iα and Iß in the treated OPEFB samples. DISCUSSION: Since CBHB alone was inactive against crystalline cellulose, these data suggested that it might work synergistically with other components of Cellic® CTec2. CBHB supplements were desirable as they further increased hydrolysis of OPEFB when the performance of Cellic® CTec2 was theoretically capped at an enzyme loading of 34% in this study. Hence, A. niger CBHB was identified as a potential supplementary enzyme for the enzymatic hydrolysis of OPEFB.

High-performance integrated field-effect transistor-based sensors.

Field-effect transistors (FETs) have succeeded in modern electronics in an era of computers and hand-held applications. Currently, considerable attention has been paid to direct electrical measurements, which work by monitoring changes in intrinsic electrical properties. Further, FET-based sensing systems drastically reduce cost, are compatible with CMOS technology, and ease down-stream applications. Current technologies for sensing applications rely on time-consuming strategies and processes and can only be performed under recommended conditions. To overcome these obstacles, an overview is presented here in which we specifically focus on high-performance FET-based sensor integration with nano-sized materials, which requires understanding the interaction of surface materials with the surrounding environment. Therefore, we present strategies, material depositions, device structures and other characteristics involved in FET-based devices. Special attention was given to silicon and polyaniline nanowires and graphene, which have attracted much interest due to their remarkable properties in sensing applications.

Evaluation of limb load asymmetry using two new mathematical models.

Quantitative measurement of limb loading is important in orthopedic and neurological rehabilitation. In current practice, mathematical models such as Symmetry index (SI), Symmetry ratio (SR), and Symmetry angle (SA) are used to quantify limb loading asymmetry. Literatures have identified certain limitations with the above mathematical models. Hence this study presents two new mathematical models Modified symmetry index (MSI) and Limb loading error (LLE) that would address these limitations. Furthermore, the current mathematical models were compared against the new model with the goal of achieving a better model. This study uses hypothetical data to simulate an algorithmic preliminary computational measure to perform with all numerical possibilities of even and uneven limb loading that can occur in human legs. Descriptive statistics are used to interpret the limb loading patterns: symmetry, asymmetry and maximum asymmetry. The five mathematical models were similar in analyzing symmetry between limbs. However, for asymmetry and maximum asymmetry data, the SA and SR values do not give any meaningful interpretation, and SI gives an inflated value. The MSI and LLE are direct, easy to interpret and identify the loading patterns with the side of asymmetry. The new models are notable as they quantify the amount and side of asymmetry under different loading patterns.

Effects of exercise before or after meal ingestion on fat balance and postprandial metabolism in overweight men.

It is unclear how timing of exercise relative to meal ingestion influences substrate balance and metabolic responses. The present study aimed to compare the effects of exercise performed before or after breakfast on fat balance and postprandial metabolism. A total of ten sedentary overweight men (aged 28.1 (SEM 10.7) years, BMI 29.0 (SEM 2.8) kg/m2) underwent three trials in random order involving: (1) performing no exercise (CON), or walking for 60 min at 50% maximal O2 uptake either (2) before (Ex-Meal) or (3) after (Meal-Ex) consuming a standardised breakfast meal. In each trial an ad libitum lunch was provided 3.5 h after breakfast. Substrate utilisation was assessed by indirect calorimetry and blood was taken at regular intervals over an 8.5 h observation period. At the end of the observation period, fat balances in the Ex-Meal (-1043 (SEM 270) kJ) and Meal-Ex (-697 (SEM 201) kJ) trials were both significantly lower than CON (204 (SEM 165) kJ) and fat balance in the Ex-Meal trial was significantly lower than in the Meal-Ex trial (all P , 0.0001). Compared with the CON trial, the 8.5 h postprandial TAG response was only significantly lowered in the Ex-Meal trial (-17%, P = 0.025) and not in the Meal-Ex trial (-11%, P < 0.20). Both the Ex-Meal and Meal-Ex trials showed significantly lowered insulin responses relative to the CON trial (by 19 and 24%, respectively, P < 0.01 for both). There were no differences in lunch energy intake between trials. The present findings suggest that there may be an advantage for body fat regulation and lipid metabolism in exercising before compared with after breakfast. However, further study is needed to determine whether the present findings extend over the long term under free-living conditions.

Solution structures, dynamics, and ice growth inhibitory activity of peptide fragments derived from an antarctic yeast protein.

Exotic functions of antifreeze proteins (AFP) and antifreeze glycopeptides (AFGP) have recently been attracted with much interest to develop them as commercial products. AFPs and AFGPs inhibit ice crystal growth by lowering the water freezing point without changing the water melting point. Our group isolated the Antarctic yeast Glaciozyma antarctica that expresses antifreeze protein to assist it in its survival mechanism at sub-zero temperatures. The protein is unique and novel, indicated by its low sequence homology compared to those of other AFPs. We explore the structure-function relationship of G. antarctica AFP using various approaches ranging from protein structure prediction, peptide design and antifreeze activity assays, nuclear magnetic resonance (NMR) studies and molecular dynamics simulation. The predicted secondary structure of G. antarctica AFP shows several α-helices, assumed to be responsible for its antifreeze activity. We designed several peptide fragments derived from the amino acid sequences of α-helical regions of the parent AFP and they also showed substantial antifreeze activities, below that of the original AFP. The relationship between peptide structure and activity was explored by NMR spectroscopy and molecular dynamics simulation. NMR results show that the antifreeze activity of the peptides correlates with their helicity and geometrical straightforwardness. Furthermore, molecular dynamics simulation also suggests that the activity of the designed peptides can be explained in terms of the structural rigidity/flexibility, i.e., the most active peptide demonstrates higher structural stability, lower flexibility than that of the other peptides with lower activities, and of lower rigidity. This report represents the first detailed report of downsizing a yeast AFP into its peptide fragments with measurable antifreeze activities.

Using a novel computer-based approach to assess the acute effects of exercise on appetite-related measures.

Measuring food intake using standard buffet meals can be complicated by sensory and external cues which can alter energy intake. The present study was designed to examine the effects of acute exercise on non-metabolic factors related to appetite and food intake using a computer-based assessment. Twenty-seven men and women participated in two sessions in random order: 60-min walking on the treadmill (exercise trial; EX) or seated rest (control trial; CON). Subjective hunger and fullness, food liking, food utility, and ideal portion size were assessed before and immediately after exercise or rest, and hourly for 2 h. The findings showed that an acute bout of moderate intensity exercise had an anorexigenic effect; characterised by diminished hunger (-17.4%, p=0.004) and lower prospective ideal portion size (-7.7%, p=0.003) compared to no exercise. This novel, computer-based assessment, is a useful alternative to buffet meals setting and allows for the determination of non-metabolic factors associated with feeding behaviour in relation to exercise.

Fault diagnosis of the polypropylene production process (UNIPOL PP) using ANFIS.

The performance of a chemical process plant can gradually degrade due to deterioration of the process equipment and unpermitted deviation of the characteristic variables of the system. Hence, advanced supervision is required for early detection, isolation and correction of abnormal conditions. This work presents the use of an adaptive neuro-fuzzy inference system (ANFIS) for online fault diagnosis of a gas-phase polypropylene production process with emphasis on fast and accurate diagnosis, multiple fault identification and adaptability. The most influential inputs are selected from the raw measured data sets and fed to multiple ANFIS classifiers to identify faults occurring in the process, eliminating the requirement of a detailed process model. Simulation results illustrated that the proposed method effectively diagnosed different fault types and severities, and that it has a better performance compared to a conventional multivariate statistical approach based on principal component analysis (PCA). The proposed method is shown to be simple to apply, robust to measurement noise and able to rapidly discriminate between multiple faults occurring simultaneously. This method is applicable for plant-wide monitoring and can serve as an early warning system to identify process upsets that could threaten the process operation ahead of time.

Effects of exercise on postprandial responses to ad libitum feeding in overweight men.

PURPOSE: Previous exercise reduces the lipemic response to meals of fixed size. It is not known whether this triglyceride (TG) attenuation also occurs in response to ad libitum feeding because exercise might induce a compensatory increase in energy intake. It is also unclear whether the effects of a single exercise session on lipemia would be augmented by repeated exercise sessions on consecutive days. DESIGN: Ten sedentary overweight/obese men (aged 35 ± 6 yr) each participated in three 4-d trials in random order: CON (no exercise on days 1-3), EX-1 (exercise session on day 3), and EX-3 (exercise sessions on days 1-3). Each exercise session expended 33.5 kJ·kg−¹ body mass. Subjects consumed an isocaloric diet (provided by experimenters) and avoided alcohol on days 1-3 of all trials. On day 4 of each trial, participants underwent a 7-h metabolic assessment, during which an ad libitum buffet breakfast and lunch was provided, and postprandial plasma and expired air responses were assessed. RESULTS: Day 4 ad libitum energy intake was higher than CON in EX-3 (9216 ± 669 vs 7859 ± 492 kJ, P < 0.05) but not EX-1 (8335 ± 683 kJ). Postprandial TG responses were 27% and 25% lower in EX-1 and EX-3, respectively, than in CON (both P < 0.05), and postprandial insulin responses were 26% (P = 0.06) and 31% (P < 0.05) lower in EX-1 and EX-3, respectively, than in CON. Compared with CON, postprandial fat oxidation was 20% higher in EX-1 and 27% higher in EX-3 (both P < 0.05). CONCLUSIONS: Previous exercise attenuates the lipemic response to ad libitum meals, suggesting that exercise's TG-lowering effect will extend into "real-world" settings where food intake is not carefully controlled. This response is not augmented by exercising on repeated days.

Incidental radiological findings of susuk in the orofacial region.

Susuk, or charm needles, are inserted and worn subcutaneously in the face and other parts of the body, as they are believed to enhance beauty and youth, and for many other reasons such as treatment of headache, aches and pains in the joints, back or abdomen. The practice of inserting susuk is a traditional belief, genuinely cultural and superstitious, and common in the south-east Asian region. We present 13 cases of susuk, which was found incidentally on the radiographs as the patients came for various types of treatment at our centre.

Phage displayed Bacillus thuringiensis Cry1Ba4 toxin is toxic to Plutella xylostella.

We constructed recombinant phage particles displaying the Bacillus thuringiensis Cry1Ba4 active toxin using the pfUSE5 and pComb3X phagemid vectors. The recombinant phage particles were screened and evaluated for displayed biologically active Cry1Ba4 toxin against the target insect larvae. Concurrent expression of Cry1Ba4 protoxin was carried out using the pETBlue -2 plasmid expression vector in Escherichia coli Tuner (DE3)pLacI and the protoxin was successfully expressed at a size of 129 kDa. In the bioassay, 3.30 mg crude extract of Cry1Ba4 protoxin, 9.35 x 10(9) TU and 7.70 x 10(9) TU of induced recombinant phage particles carrying Cry1Ba4 active toxin displayed on pComb3X and pFUSE5, respectively, demonstrated mortality of greater than 85% against Plutella xylostella (third-instar) within 48 hours. Thus, we have successfully displayed the Cry1Ba4 activated toxin on the surface of a phage and demonstrated toxicity towards larvae.