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Robotic surgery is becoming increasingly popular in bariatric-metabolic surgery. However, its superiority regarding postoperative outcomes compared with conventional laparoscopy has not been clearly proven. With growing adoption of robotic surgery and improved technologies, benefits should become more evident. Evaluate readmission and reoperation rates after bariatric-metabolic surgery performed by conventional laparoscopy versus robotic-assisted from 2015 to 2021. Academic institution. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was reviewed for primary bariatric operations performed with conventional laparoscopy versus robotic-assisted. Postoperative outcomes were compared in a propensity score-matched sample. Of 1,059,348 cases meeting inclusion criteria, 921,322 (87%) were conventional laparoscopic bariatric-metabolic surgeries, which were matched 1:1 with robotic-assisted cases (138,026). Reoperation (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00–1.15, P =.0463), postoperative morbidity (OR 1.07; 95% CI 1.01–1.12, P =.0193), readmission (OR 1.14; 95% CI 1.09–1.18, P <.0001), and emergency department visits (OR 1.06; 95% CI 1.03–1.09, P =.0003) at 30 days postoperatively were significantly greater for robotic-assisted cases. Robotic-assisted cases had a similar mortality rate at 30 days postoperatively and length of stay >3 days when compared with conventional laparoscopic cases. Similar results were observed in cases from 2020 to 2021, except for reoperation and emergency department visits, which showed no difference between groups and length of stay >3 days, which was greater in robotic-assisted cases. Our results show a greater readmission and reoperation rate and greater morbidity at 30 days postoperatively in robotic-assisted bariatric-metabolic surgery compared with conventional laparoscopy. Analyzing only cases performed between 2020 and 2021, robotic surgery also does not show superiority over conventional laparoscopy. [ABSTRACT FROM AUTHOR]

Obesity and its associated lifestyle are known risk factors for early-onset colorectal cancer and are associated with poor postoperative and survival outcomes in older patients. We aimed to investigate the impact of obesity on the outcomes of early-onset colorectal cancers. Retrospective review of all patients undergoing primary resection of colon or rectal adenocarcinoma at our institution between 2015–2022. Patients who had palliative resections, resections performed at another institution, appendiceal tumors, and were underweight were excluded. The primary endpoint was survival according to the patient's body mass index: normal weight (18–24.9 kg/m2), overweight (25–29.9 kg/m2), and obesity (≥30 kg/m2). Patient and tumor characteristics and survival were compared between the three groups. A total of 279 patients aged <50 years with colorectal cancer were treated at our hospital; 120 were excluded from the analysis for the following reasons: main treatment or primary resection performed at another hospital (n = 97), no resection/palliative resection (n = 23), or body mass index <18 kg/m2 (n = 2). Of these, 157 patients were included in the analysis; 61 (38.9%) were overweight and 45 (28.7%) had obesity. Except for a higher frequency of hypertension in the overweight (P =.062) and obese (P =.001) groups, no differences in patient or tumor characteristics were observed. Mean overall survival was 89 months with normal weight, 92 months with overweight, and 65 months with obesity (P =.032). Mean cancer-specific survival was 95 months with normal weight, 94 months with overweight, and 68 months with obesity (P =.018). No statistically significant difference in disease-free survival (75 vs 70 vs 59 months, P =.844) was seen. Individuals with early-onset colorectal cancer who are overweight or obese present with similar tumor characteristics and postoperative morbidity to patients with normal weight. However, obesity may have a detrimental impact on their survival. Addressing obesity as a modifiable risk factor might improve early-onset colorectal cancer prognosis. [ABSTRACT FROM AUTHOR]

Transanal dissection is increasingly used in laparoscopic surgery for total mesorectal excision of lower rectal cancers. Several studies compared outcomes of laparoscopic total mesorectal excision with and without transanal dissection, yet there is a paucity of high-quality evidence. This meta-analysis aimed to provide a pooled comparative analysis of outcomes of laparoscopic total mesorectal excision with and without transanal dissection based on evidence from randomized controlled trials. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2022–compliant systematic review of randomized controlled trials compared laparoscopic total mesorectal excision with and without transanal dissection. PubMed, Scopus, and Web of Science were searched through March 2023. The Medical Subject Headings terms used in the search were Rectal neoplasms, Proctectomy, Laparoscopy, and Transanal. The main outcomes included operative and pathologic outcomes. The risk of bias was assessed using the Risk of Bias version 2 tool, and certainty of the evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary study outcome was conversion to open surgery. Four randomized controlled trials (1,339 patients; median age 61.2 years) were included; 671 patients underwent laparoscopic total mesorectal excision with transanal dissection, and 668 underwent laparoscopic total mesorectal excision without transanal dissection. Both groups were similar in age, body mass index, and disease stage, but the laparoscopic total mesorectal excision with transanal dissection group had a higher male-to-female ratio, received neoadjuvant therapy and had a hand-sewn anastomosis more often. Patients who underwent laparoscopic total mesorectal excision with transanal dissection had lower conversion rates (odds ratio = 0.179; P =.001), a higher likelihood of achieving complete total mesorectal excision (odds ratio = 1.435; P =.025), and fewer harvested lymph nodes (weighted mean difference = –1.926; P =.035). The groups had similar operative times (weighted mean difference = –3.476; P =.398), total complications (odds ratio = 0.94; P =.665), major complications (odds ratio = 1.112; P =.66), anastomotic leak (odds ratio = 0.67; P =.432), positive circumferential resection margin (odds ratio = 0.549; P =.155), and positive distal margins (odds ratio = 0.559; P =.171). Laparoscopic total mesorectal excision with transanal dissection was associated with lower odds of conversion to open surgery, greater likelihood of achieving complete total mesorectal excision, and fewer harvested lymph nodes than laparoscopic total mesorectal excision without transanal dissection. [ABSTRACT FROM AUTHOR]

Is the live birth rate (LBR) in fresh embryo transfer IVF cycles affected by serum progesterone concentration on the day of embryo transfer? A single-centre retrospective analysis of prospectively collected data from women who underwent IVF or intracytoplasmic sperm injection between July 2019 and July 2020, and had a fresh day 5 single embryo transfer. Overall, 825 first and second stimulation cycles were included. Patients underwent a gonadotrophin-releasing hormone antagonist protocol with human chorionic gonadotrophin (HCG) trigger, and received vaginal-only luteal phase support. The study population was an everyday patient cohort, treated with the unit's usual stimulation protocols. The correlation between serum progesterone concentrations on the day of embryo transfer and the incidence of positive HCG, clinical pregnancy and live birth were examined. Patients were divided into four groups based on serum progesterone concentrations (<150, 150–250, 251–400 and >400 nmol/l). The data were further interrogated using additional progesterone cut-offs. There was no concentration of progesterone below or above which the chance of pregnancy was reduced. The chance of live birth following a blastocyst transfer was no different across the four groups (29.8, 26.6, 32.7 and 31.5%, respectively, P = 0.55). There was no negative association between progesterone and chance of pregnancy when other progesterone thresholds were applied. Estimates were adjusted for confounding factors such as maternal age. Serum progesterone concentration on the day of fresh embryo transfer does not correlate with the LBR. [ABSTRACT FROM AUTHOR]

Background A possible driver of obesity is insensitivity (passive overconsumption) to food energy density (ED, kcal/g); however, it is unclear whether this insensitivity applies to all meals. Objectives We assessed the influence of ED on energy intake (kcal) across a broad and continuous range of EDs comprised of noncovertly manipulated, real-world meals. We also allowed for the possibility that the association between energy intake and ED is nonlinear. Methods We completed a secondary analysis of 1519 meals which occurred in a controlled environment as part of a study conducted by Hall and colleagues to assess the effects of food ultra-processing on energy intake. To establish the generalizability of the findings, the analyses were repeated in 32,162 meals collected from free-living humans using data from the UK National Diet and Nutrition Survey (NDNS). Segmented regressions were performed to establish ED "breakpoints" at which the association between consumed meal ED and mean centered meal caloric intake (kcal) changed. Results Significant breakpoints were found in both the Hall et al. data set (1.41 kcal/g) and the NDNS data set (1.75 and 2.94 kcal/g). Centered meal caloric intake did not increase linearly with consumed meal ED, and this pattern was captured by a 2-component ("volume" and "calorie content" [biologically derived from the sensing of fat, carbohydrate, and protein]) model of physical meal size (g), in which volume is the dominant signal with lower energy-dense foods and calorie content is the dominant signal with higher energy-dense foods. Conclusions These analyses reveal that, on some level, humans are sensitive to the energy content of meals and adjust meal size to minimize the acute aversive effects of overconsumption. Future research should consider the relative importance of volume and calorie-content signals, and how individual differences impact everyday dietary behavior and energy balance. [ABSTRACT FROM AUTHOR]

Data on 14 selected environmental indicators that include air, water, land and biodiversity from 33 countries are analyzed by using a principal component analysis (PCA) with bootstrap confidence intervals. The purpose is to determine the interrelationships and effective dimensionality of the data and evaluate their application in designing environmental indices. The bootstrap method was incorporated to compensate for the deficiency of the PCA. The results of the study are discussed.

Study Objective: To examine the presence of sonographic evidence of adenomyosis (SEOA) in patients undergoing laparoscopic surgery for the investigation of endometriosis and to assess if there is an association between SEOA and endometriosis severity. Using gene expression analysis, we also aimed to determine if gene expression in eutopic endometria differed in patients with and without adenomyosis.Design: A prospective study (Canadian Task Force classification II-2).Setting: A tertiary medical center.Patients: Reproductive-age women who underwent laparoscopic surgery after presenting to a pelvic pain-focused gynecology clinic.Interventions: Endometrial tissue, detailed patient questionnaires, pathology, and surgical notes were collected. Sonographic data from tertiary ultrasounds performed up to 12 months before surgery were retrospectively added (n = 234, researchers blinded to surgical and pathological findings). Gene array data from endometrial biopsies (n = 41) were used to analyze differential gene expression; patients were divided into 2 groups according to the presence or absence of SEOA.Measurements and Main Results: Of the 588 patients recruited, 234 (40%) had an available pelvic scan and were included in this study. The average age of the included women was 30.6 years, with 35% having SEOA. Patients with SEOA were 5.4 years older (p = .02). There was no significant difference in the rates of endometriosis between groups; however, patients with SEOA were more likely to have stage IV endometriosis (41% vs 9.8%, p <.001). Patients with SEOA were also more likely to have other markers of severe endometriosis such as endometriomas and deep infiltrating endometriosis (p <.001). No significant difference was observed in endometrial gene expression between adenomyosis cases and controls after adjusting for menstrual c`ycle phases and the presence/absence of endometriosis.Conclusion: Sonographic features of adenomyosis may be included as a component of the clinical assessment when attempting to predict the presence of severe endometriosis. No differences in gene expression were observed. Further research is needed to characterize uterine adenomyosis and to explore molecular pathways involved in its pathogenesis. [ABSTRACT FROM AUTHOR]

• Small or superficial target volumes are optimal for MRT. • Peak doses up to 100 Gy can be achieved with acceptable valley dose to OARs. • Treatment volume is a more important factor than depth in determining PVDR. Synchrotron Microbeam Radiation Therapy (MRT) is a pre-clinical modality characterised by spatial dose fractionation on a microscopic scale. Treatment planning studies using clinical datasets have not yet been conducted. Our aim was to investigate MRT dose-distributions in scenarios refractory to conventional treatment and to identify optimal settings for a future Phase I trial. MRT plans were generated for seven scenarios where re-irradiation was performed clinically. A hybrid algorithm, combining Monte Carlo and convolution-based methods, was used for dose-calculation. The valley dose to organs at risk had to respect the single fraction tolerance doses achieved in the corresponding re-irradiation plans. The resultant peak dose and the peak-to-valley dose ratio (PVDR) at the tumour target volume were assessed. Peak doses greater than 80 Gy in a single fraction, and PVDRs greater than 10, could be achieved for plans with small (<35 cm3) or shallow volumes, particularly recurrent glioblastoma, head and neck tumours, and select loco-regionally recurrent breast cancer sites. Treatment volume was a more important factor than treatment depth in determining the PVDR. The mean PVDR correlated strongly with the size of the target volume (r s = −0.70, p = 0.01). The PVDRs achieved in these clinical scenarios are considerably lower than those reported in previous pre-clinical studies. Our findings suggest that head and neck sites will be optimal scenarios for MRT. [ABSTRACT FROM AUTHOR]

• A non-linear association exists between meal caloric intake and meal energy density. • Meal caloric intake increases with energy density in lower energy-dense meals. • Meal caloric intake decreases slightly with energy density in higher energy-dense meals. • The non-linear pattern in meal caloric intake suggests that human are sensitive to calories. • The results lend further support for our two-component theoretical model of meal size (g). Previously, we demonstrated a non-linear association between meal caloric intake and meal energy density (ED, kcal/g) in data from a controlled trial in the US and from free-living participants in the UK [1]. In both datasets, meal caloric intake increased with ED in lower energy-dense meals (below ∼1.75 kcal/g) and decreased in higher energy-dense meals (above ∼1.75 kcal/g). In the current study, we sought to explore whether this pattern extends to data from free-living participants in Argentina (N = 2738 meals) and Malaysia (N = 4658 meals). Again, a significant breakpoint was found in both the Argentinean (2.04 kcal/g (SE = 0.06)) and Malaysian (2.17 kcal/g (SE = 0.06)) datasets with mean centered meal caloric intake increasing with ED below the breakpoint and decreasing above the breakpoint. These results lend further support for our two-component theoretical model of meal size (g) in which a volume signal is dominant in lower energy-dense meals and a calorie-content signal is dominant in higher energy-dense meals. Together, our research adds to evidence supporting human sensitivity to calories and exposes a complexity in the correspondence between meal energy content and meal size in everyday (non-manipulated) meals. Further research is needed to provide causal evidence for this sensitivity and whether individual variation impacts meal size and energy balance. [ABSTRACT FROM AUTHOR]

Steviol glycoside sweeteners are extracted and purified from the Stevia rebaudiana Bertoni plant, a member of the Asteraceae (Compositae) family that is native to South America, where it has been used for its sweet properties for hundreds of years. With continued increasing rates of obesity, diabetes, and other related comorbidities, in conjunction with global public policies calling for reductions in sugar intake as a means to help curb these issues, low- and no-calorie sweeteners (LNCSs, also known as high-potency sweeteners) such as stevia are gaining interest among consumers and food manufacturers. This appeal is related to stevia being plant-based, zero calorie and with a sweet taste that is 50-350 times sweeter than sugar, making it an excellent choice for use in sugar- and calorie-reduced food and beverage products. Despite the fact that the safety of stevia has been affirmed by several food regulatory and safety authorities around the world, insufficient education about stevia's safety and benefits, including continuing concern with regard to the safety of LNCSs in general, deters health professionals and consumers from recommending or using stevia. Therefore, the aim of this review and the stevia symposium that preceded this review at the ASN's annual conference in 2017 was to examine, in a comprehensive manner, the state of the science for stevia, its safety and potential health benefits, and future research and application. Topics covered included metabolism, safety and acceptable intake, dietary exposure, impact on blood glucose and insulin concentrations, energy intake and weight management, blood pressure, dental caries, naturality and processing, taste and sensory properties, regulatory status, consumer insights, and market trends. Data for stevia are limited in the case of energy intake and weight management as well as for the gut microbiome; therefore, the broader literature on LNCSs was reviewed at the symposium and therefore is also included in this review. [ABSTRACT FROM AUTHOR]

This review examines the merits of ‘food addiction’ as an explanation of excessive eating (i.e., eating in excess of what is required to maintain a healthy body weight). It describes various apparent similarities in appetites for foods and drugs. For example, conditioned environmental cues can arouse food and drug-seeking behaviour, ‘craving’ is an experience reported to precede eating and drug taking, ‘bingeing’ is associated with both eating and drug use, and conditioned and unconditioned tolerance occurs to food and drug ingestion. This is to be expected, as addictive drugs tap into the same processes and systems that evolved to motivate and control adaptive behaviours, including eating. The evidence, however, shows that drugs of abuse have more potent effects than foods, particularly in respect of their neuroadaptive effects that make them ‘wanted.’ While binge eating has been conceptualised as form of addictive behaviour, it is not a major cause of excessive eating, because binge eating has a far lower prevalence than obesity. Rather, it is proposed that obesity results from recurrent overconsumption of energy dense foods. Such foods are, relatedly, both attractive and (calorie for calorie) weakly satiating. Limiting their availability could partially decrease excessive eating and consequently decrease obesity. Arguably, persuading policy makers that these foods are addictive could support such action. However, blaming excessive eating on food addiction could be counterproductive, because it risks trivialising serious addictions, and because the attribution of excessive eating to food addiction implies an inability to control one's eating. Therefore, attributing everyday excessive eating to food addiction may neither explain nor significantly help reduce this problem. [ABSTRACT FROM AUTHOR]

We investigated whether histological evidence of early atherosclerosis was present in the umbilical artery of 21 pregnancies complicated by severe perinatal inflammation, and 21 controls matched for gestational age, sex and birth weight. Severe chorioamnionitis with funisitis was associated with increased numbers of CD68 and CD45 positive cells (both P < 0.01), indicating accumulation of monocyte-derived macrophages in lesion-susceptible regions. A down-regulation of SMA expression (P = 0.01) was also observed. These preliminary findings suggest that chorioamnionitis with funisitis may promote changes in the intima and media of the umbilical artery similar to that seen in early atherosclerosis. [ABSTRACT FROM AUTHOR]

• Participants ate 38 g chocolate vs apple matched for weight (38 g) and calories (380 g). • Measures dissociated body sensations indicative of distention and calorie effects. • These sensations had different body locations, valence, and postprandial time courses. • Hunger was affected by food volume and calories. • Fullness was affected primarily by food volume. Gastric distension and detection of macronutrients (calories) in the gut are determinants of satiation and satiety. We tested effects of these variables on body sensations after eating, and their connection with visual-analogue scale (VAS) hunger and fullness ratings. Participants completed VAS ratings and quality and location of body sensations tasks after consumption of milk chocolate (38 g, 200 kcal) versus fresh apple fruit matched for weight (38 g, 20 kcal) and matched for calories (380 g, 200 kcal). Effects of food weight (380 vs 38 g) were large and located predominantly in the abdominal region. They also occupied a greater body area and occurred sooner after eating than effects related to calories (200 vs 20 kcal). The same pattern was apparent in the results from the quality of sensations task. VAS ratings indicated that hunger was affected by food volume and calories, whereas fullness was affected primarily by food volume. Together, these results provide evidence of dissociation of the perceived after-effects of food ingestion related to food volume and food calorie content in humans. Additionally, the studies demonstrate the utility of two rarely used, semi-quantitative tasks, which generate information on the identity, intensity, valence, and location of eating-related sensations. [ABSTRACT FROM AUTHOR]

The idea that food intake is motivated by (or in anticipation of) ‘hunger’ arising from energy depletion is apparent in both public and scientific discourse on eating behaviour. In contrast, our thesis is that eating is largely unrelated to short-term energy depletion. Energy requirements meal-to-meal are trivial compared with total body energy stores, and energy supply to the body's tissues is maintained if a meal or even several meals are missed. Complex and exquisite metabolic machinery ensures that this happens, but metabolic regulation is only loosely coupled with the control of energy intake. Instead, food intake needs to be controlled because the limited capacity of the gut means that processing a meal presents a significant physiological challenge and potentially hinders other activities. We illustrate the relationship between energy (food) intake and energy expenditure with a simple analogy in which: (1) water in a bathtub represents body energy content, (2) water in a saucepan represents food in the gut, and (3) the bathtub is filled via the saucepan. Furthermore, (4) it takes hours to process and pass the full energy (macronutrient) content of the saucepan to the bathtub, and (5) both the saucepan and bathtub resist filling, representing negative feedbacks on appetite (desire to eat). This model is consistent with the observations that appetite is reduced acutely by energy intake (a meal added to the limited capacity of the saucepan/gut), but not increased by an acute increase in energy expenditure (energy removed from the large store of energy in the bathtub/body). The existence of relatively very weak but chronic negative feedback on appetite proportional to body fatness is supported by observations on the dynamics of energy intake and weight gain in rat dietary obesity. (We use the term ‘appetite’ here because ‘hunger’ implies energy depletion.) In our model, appetite is motivated by the accessibility of food and the anticipated and experienced pleasure of eating it. The latter, which is similar to food reward, is determined primarily by the state of emptiness of the gut and food liking related to the food's sensory qualities and macronutrient value and the individual's dietary history. Importantly, energy density adds value because energy dense foods are less satiating kJ for kJ and satiation limits further intake. That is, energy dense foods promote energy intake by virtue (1) of being more attractive and (2) having low satiating capacity kJ for kJ, and (1) is partly a consequence of (2). Energy storage is adapted to feast and famine and that includes unevenness over time of the costs of obtaining and ingesting food compared with engaging in other activities. However, in very low-cost food environments with energy dense foods readily available, risk of obesity is high. This risk can be and is mitigated by dietary restraint, which in its simplest form could mean missing the occasional meal. Another strategy we discuss is the energy dilution achieved by replacing some sugar in the diet with low-calorie sweeteners. Perhaps as or more significant, though, is that belief in short-term energy balancing (the energy depletion model) may undermine attempts to eat less. Therefore, correcting narratives of eating to be consistent with biological reality could also assist with weight control. [ABSTRACT FROM AUTHOR]

Background: Portion size is an important driver of larger meals. However, effects on food choice remain unclear.Objective: Our aim was to identify how portion size influences the effect of palatability and expected satiety on choice.Methods: In Study 1, adult participants (n = 24, 87.5% women) evaluated the palatability and expected satiety of 5 lunchtime meals and ranked them in order of preference. Separate ranks were elicited for equicaloric portions from 100 to 800 kcal (100-kcal steps). In Study 2, adult participants (n = 24, 75% women) evaluated 9 meals and ranked 100-600 kcal portions in 3 contexts (scenarios), believing that 1) the next meal would be at 1900, 2) they would receive only a bite of one food, and 3) a favorite dish would be offered immediately afterwards. Regression analysis was used to quantify predictors of choice.Results: In Study 1, the extent to which expected satiety and palatability predicted choice was highly dependent on portion size (P < 0.001). With smaller portions, expected satiety was a positive predictor, playing a role equal to palatability (100-kcal portions: expected satiety, β: 0.42; palatability, β: 0.46). With larger portions, palatability was a strong predictor (600-kcal portions: β: 0.53), and expected satiety was a poor or negative predictor (600-kcal portions: β: -0.42). In Study 2, this pattern was moderated by context (P = 0.024). Results from scenario 1 replicated Study 1. However, expected satiety was a poor predictor in both scenario 2 (expected satiety was irrelevant) and scenario 3 (satiety was guaranteed), and palatability was the primary driver of choice across all portions.Conclusions: In adults, expected satiety influences food choice, but only when small equicaloric portions are compared. Larger portions not only promote the consumption of larger meals, but they encourage the adoption of food choice strategies motivated solely by palatability. [ABSTRACT FROM AUTHOR]

Background It is a legal requirement to supply a breath analysis sample when requested by Police at roadside checkpoints. The current device requires a 1 L sample at 8 L·min − 1 . Court disputes commonly attribute respiratory disease for failure to produce a sample. Objective To determine whether respiratory disease aetiology and/or severity precludes an adequate breath sample using a modern evidential breath analyser. Methods Subjects performed breath analysis following standard Police procedure. Three efforts within 15 min were allowed and any reasons for failure recorded. Results 24 subjects with interstitial lung disease (ILD) and 26 subjects with chronic obstructive pulmonary disease (COPD) were studied and met minimum respiratory function criteria as per device specifications. 18 ILD subjects (75%) and 24 COPD subjects (92%) were able to provide a sample. All subjects with a vital capacity below 1.5 L were unable to provide a sample. Discussion In the balance of probabilities most patients with lung disease are able to supply an evidential breath sample. The exception is a very severe disease, particularly in volume limited patients. [ABSTRACT FROM AUTHOR]

Abstract: This work investigates the liquid–liquid phase equilibrium of reaction mixtures arising from the ethanolysis of vegetable oil. Knowledge of equilibrium phase distribution of key components in such biphasic systems is essential for guiding the design and optimisation of a counter-current extractive reactor for lipasic biodiesel production. Waste cottonseed frying oil was reacted with (to different conversion levels) in the presence of lipase B (Novozym 435). The reaction mixtures were then combined with aqueous solutions of ethanol (5, 15 and 25%v/v) at three different volume fractions (0.20, 0.35 and 0.50) and allowed to equilibrate at 318K, followed by compositional analysis of the resultant organic phase (mainly composed of glycerides and fatty acid ethyl esters) and aqueous phase (largely water and ethanol). Distribution coefficients of ethanol and water peaked at moderate reaction extents (40–50%) and could be described by a decaying sinusoidal expression (with respect to extent of reaction) symptomatic of the dynamics for two interacting mixing tanks-in-series implicating species migration between the organic and aqueous phases. Equilibrium aqueous glycerol concentration profiles also exhibited double maxima at reaction extents of 57% and 95% with the magnitude increasing at higher organic phase volume fraction. Among the operating variables studied, reaction extent had the most significant influence on phase equilibrium possibly due to changes in the hydrophilicity of the reaction medium occasioned by compositional variation in the course of the reaction. In particular, a linear relationship was found between global and organic phase molar ratio of ethanol-to-fatty acid residues. Consequently, the findings of this study would permit a realistic determination of the rate-composition envelope as a function of the organic volume fraction along the extractive reactor column and hence, improved biodiesel recovery efficiency. [Copyright &y& Elsevier]

The clinical and scientific literature overwhelmingly deals with fibroids as a single entity or disease. This convenient assumption of homogeneity may be an important oversight given that substantial evidence exists for heterogeneity between fibroids at many levels. Failure to recognize and accommodate fibroid heterogeneity can have significant ramifications for both clinical treatment decisions and research protocol design. The aim of this article is to review the current knowledge of fibroid heterogeneity and to identify key areas where fibroid heterogeneity should be taken into consideration both clinically and when designing research protocols. Uterine leiomyomata display significant and well-documented heterogeneity in symptoms, diagnostic imaging appearance, pathology, genetic background and therapeutic requirements. Additional research is needed to better understand fibroid heterogeneity as it relates to pathogenesis, molecular targets for potential new therapies, patient symptoms and, ultimately, treatment. To this list should also be added heterogeneity of genetics, Lifestyle and individual clinical characteristics of the fibroid. Increasingly, an understanding of uterine leiomyoma heterogeneity will be of importance for clinicians who see patients with this common and costly disease. [ABSTRACT FROM AUTHOR]

Abstract: There is currently a need to improve the commercial feasibility of lipasic biodiesel production in order to make it an attractive alternative to conventional biodiesel processes. One such means is to apply process intensification principles, by combining reaction and product separation steps into a stirred countercurrent extractive reactor (XRC). Benefits include continuous operation, enhanced biodiesel yield via removal of by-products into a separate phase and lower capital and operating costs due to fewer unit operations. This study involves steady-state modelling of an 8-stage XRC employing oil feed and aqueous ethanol solvent, using lipase as catalyst. Modelling utilised commercial process simulation software coupled to an iterative method for estimation of dispersed phase holdup to investigate the influence of operating conditions and feed compositions on XRC performance. Results suggest the optimum solvent composition lies in the range of 50 – 70 vol% ethanol for oil feeds containing between 0 – 50 wt% free fatty acids. Increasing stage efficiency was detrimental to biodiesel yield, indicating that non-ideal reactive stages are preferable in the XRC. Incorporation of a raffinate recycle stream improved biodiesel yield, while recycling extract led to only minor downturn in yield and glycerol recovery provided that solvent to feed ratio was maintained above 1.5. [Copyright &y& Elsevier]

The purpose of this study was to assess the efficacy of pulsed radiofrequency (PRF) applied to the suprascapular nerve for pain relief in medically unfit patients with painful cuff tear arthropathy. Twelve patients with chronic shoulder pain due to cuff tear arthropathy were recruited. The mean age was 68 years (range, 60-83 years). The suprascapular nerve was targeted at the suprascapular notch with PRF. The patients were assessed with the Oxford score, Constant score, and visual analog scale (VAS) pain score before ablation and 3 and 6 months after ablation. Statistical analysis was undertaken by use of the Friedman test. Ten patients showed improvement in the VAS score (P = .24) and Constant score (P = .005) and eleven in the Oxford score (P = .001). There was a deterioration in the VAS scores between 3 and 6 months, suggesting that the benefits were starting to wear off with time (P > .05). We conclude that PRF may be a useful therapeutic adjunct in patients with painful, end-stage rotator cuff tear arthropathy who are medically unfit for surgery. [Copyright &y& Elsevier]

Background: Greater dietary intakes of n-3 long-chain polyunsaturated fatty acids (n-3 PUFAs) may be beneficial for depressed mood. Objective: This study aimed to systematically review all published randomized controlled trials investigating the effects of n-3 PUFAs on depressed mood. Design: Eight medical and health databases were searched over all years of records until June 2006 for trials that exposed participants to n-3 PUFAs or fish, measured depressed mood, were conducted on human participants, and included a comparison group. Results: Eighteen randomized controlled trials were identified; 12 were included in a meta-analysis. The pooled standardized difference in mean outcome (fixed-effects model) was 0.13 SDs (95% CI: 0.01, 0.25) in those receiving n-3 PUFAs compared with placebo, with strong evidence of heterogeneity (I2 = 79%, P < 0.001). The presence of funnel plot asymmetry suggested that publication bias was the likely source of heterogeneity. Sensitivity analyses that excluded one large trial increased the effect size estimates but did not reduce heterogeneity. Metaregression provided some evidence that the effect was stronger in trials involving populations with major depression-the difference in the effect size estimates was 0.73 (95% CI: 0.05, 1.41; P = 0.04), but there was still considerable heterogeneity when trials that involved populations with major depression were pooled separately (I2 = 72%, P = 0.001). Conclusions: Trial evidence that examines the effects of n-3 PUFAs on depressed mood is limited and is difficult to summarize and evaluate because of considerable heterogeneity. The evidence available provides little support for the use of n-3 PUFAs to improve depressed mood. Larger trials with adequate power to detect clinically important benefits are required. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents an operational approach to setting prices for groundwater in accordance with the interannual variability of monsoon rainfall and the dynamic cost of groundwater use to society. The pricing system is designed for the state of Tamil Nadu, India, where groundwater is largely unregulated and the electricity for pumping is heavily subsidized. Depletion of aquifers during the primary growing season causes environmental damage and drying of wells. The proposed price-setting system estimates the marginal social cost of groundwater use based on the current state of aquifer storage and the forecast of the coming monsoon. Prices are set prior to onset of the monsoon so farmers can plan crop rotations according to the expectation of seasonal rainfall as reflected in the pricing signal. During years that forecasts accurately characterize the probability distribution of monsoon outcomes the market signal encourages economically efficient use of the resource. When monsoons differ from the expected outcome farmers are cushioned by ancillary effects of the pricing system. [Copyright &y& Elsevier]

Abstract: Residual starch from flour wet milling, supplemented with crushed wheat grains, was hydrolysed and evaluated for ethanol production by Zymomonas mobilis ZM4 and an industrial ethanol-producing strain of Saccharomyces cerevisiae. The feasibility of replacing yeast extract with ammonium sulphate or corn steep liquor as a nitrogen source in the hydrolysed waste starch (HWS) media was confirmed. With glucose concentrations of 80–110gL−1, Z. mobilis ZM4 demonstrated superior fermentation kinetics in all three media, with higher specific rates of glucose uptake and ethanol production, greater productivities and ethanol yields close to theoretical. In a repeated batch process (five cycles), rapid cell concentration was achieved between cycles (via cell settling) with the flocculent strain Z. mobilis ZM401. This resulted in very significant productivity increases and illustrated the potential use of this strain for improved technology and cost reductions in larger scale processes. [Copyright &y& Elsevier]

Abstract: Data on travel behavior in developing countries like India is minimal. This is especially true for the relatively poor residents of urban India. They are dependent on fewer options for transportation and have little choice in terms of employment location given their dependence on walking or bicycles. This is significant in cities like Chennai because employment is highly concentrated in the center of the city. In this study, the results of a survey of 70 households in Chennai were analyzed to estimate statistical models of travel behavior with respect to mode choice and trip frequency. The households were located in two different parts of the city: one group of households lived close to the city center (in a settlement called Srinivasapuram) and the other at the periphery (in a location called Kannagi Nagar). We analyze the differences in travel behavior due to differences in accessibility to employment and services between the two settlement locations. The results indicate that differences in accessibility appear to strongly affect travel behavior. Residents in the centrally located settlement were more likely to use non-motorized modes for travel (walk or bicycle) than the peripherally located residents. It is vital therefore that, policy makers in India consider location of employment in the planning of new housing for low-income households. [Copyright &y& Elsevier]

This paper synthesizes the results of a collaborative study conducted by ADB and Harvard University under ADB’s Regional Technical Assistance 5542 (RETA 5542)—Environmental Indicators and Indices. The three methodological tools (cost of remediation (COR), environmental elasticity (EE) and environmental diamonds (ED)) used in the study are described and tested using new data from 16 countries. The study formulates the three methods that can be used to arrive at approximate costs to remediate environmental damage to the air, water, land and the ecosystems; makes an assessment of the state of environment vis-a-vis economic change; and provides a graphical representation of the state of the environment. It also gives an initial validation of the utility of environmental indices for assessing/reassessing on a micro-level the eco-environmental impacts of ADB’s past investments. [Copyright &y& Elsevier]

Beneficial effects for mood and cognitive performance are believed to influence food and drink choice. The purpose of the present study was to demonstrate a sensitive methodology for providing objective evidence of such effects. A mildly fatiguing repetitive task formed the context for assessing the potential restorative effects of caffeine-containing ‘energy’ drinks. The methodology used was designed to account for a range of theorised variations in the data, many of which are often overlooked in current research. Significant effects of the energy drinks on task performance and self-rated mood were found. These effects can be summarised with the terms ‘alerting’, ‘revitalising’, ‘awakening’ and providing mental energy, and appear to be mainly caffeine related. [Copyright &y& Elsevier]

Instrumentalist and critical narratives of resilience have seldom engaged discussing the 'values' underpinning it. We propose that mapping resilience values against worldviews can help translate the articulation of theoretical narratives as public policy. This can help establish an evidence-base to assess if resilience thinking is - in practice - the inclusive and participatory agenda that policy claims it to be; or – on the other hand – to understand the ways in which resilience is a new market for exploitation, as its critics have claimed. The inclusion of a worldviews perspective in conjunction with the contextual aspect of place approach associated with geographers will help actors design better resilience-led interventions, by targeting such interventions more appropriately to the values of the target audience. The paper summarizes two dominant narratives and suggests pathways for the inclusion of a third pathway that derives empirical approaches from values-oriented research at multiple scales. [ABSTRACT FROM AUTHOR]

There is this intriguing but not yet well-explored suggestion that highly absorbable sucrose-sweetened drinks might exacerbate hunger by promoting temporal hypoglycemia-like responses already in non-diabetic healthy individuals. This might provide a possible additional explanatory mechanism for previous reported associations between consumption of sugar-sweetened drinks and body weight gain. The current study involves two separate and independently conducted human experiments exploring the effects of two different single-doses of sugar-sweetened beverages on temporal blood glucose nadir and possible related behavioral hypoglycemic-like symptoms in healthy participants. By way of two separately conducted between-subjects experiments, effects of 1) a low (29 g) sugar-containing beverage compared to a sweetened zero-energy drink and a milk drink (experiment-1) or 2) a high (80 g) sugar-sweetened beverage compared to a zero-energy and a non-sweetened colored water drink (experiment-2) were measured on changes in blood glucose, behavioral hypoglycemia, appetite and mood. Experiment-1 : The 29 g sucrose containing beverage caused a high (37%) glycemic increase and a smaller response (15%) to the milk drink, which both peaked 30 min after consumption, whereas the sweetened zero-energy drink had very little effect on blood glucose. Regardless of the different magnitude of peak glycemic responses, both the sugar and milk drinks rather equally caused blood glucose concentrations to return to normal and stable baseline values 90 min later. There were no (different) effects of the beverages on behavioral hypoglycemic-like symptoms, appetite or mood. Experiment-2 : the 80 g sucrose containing beverage caused a large (72%) glycemic peak response at +30 min after consumption, whereas neither the sweetened zero-energy nor the non-sweetened colored water drink had any meaningful effect on blood glucose. After intake of the 80 g sugar beverage, blood glucose concentrations remained elevated (13%) at +120 min and returned to lower baseline values in the direction of hypoglycemia levels at +165 min. There were no (differential) effects of the beverages on behavioral hypoglycemic symptoms, appetite or mood. The current findings indicate that instead of a low (29 g) sugar-containing beverage, a high (80 g) sugar-containing beverage caused blood glucose concentrations to fall below baseline values almost reaching hypoglycemia levels at the end of measurements. There were no hypoglycemic-like behavioral symptoms including changes in appetite or mood: at least not at end of measurements +165 min after consumption. Since this might include that in particular consumption of high-glycemic index drinks could still promote symptoms in the longer run, further research is needed to explore possible hypoglycemic-like effects of high dosages of sugar-sweetened beverages across more extended/delayed time measurements. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Effects of intense sweeteners on hunger, food intake, and body weight: A review" by B.J. Rolls in a 1991 issue.

Selecting savoury foods after consuming a protein depleted diet has been suggested to reflect protein seeking behaviour. The modern diet contains a large number of processed foods, many of which are highly savoury to taste, but not necessarily high in protein. The present two studies aimed to investigate the relationship between savoury taste and protein content (actual and participant estimated). Participants (S1 n = 20, S2 n = 37) completed 100 mm VAS ratings of sensory and nutritional qualities of 18 familiar foods, categorised as sweet low protein, savoury low protein and savoury high protein. In study 2, the individual foods were blended to a fine consistency to disguise their identity and ensure ratings were based primarily on taste. Multilevel linear regression was used to test associations between savoury taste and actual protein content. Protein content did not predict savoury taste rating, irrespective of category. The results also indicated that participants were generally accurate at estimating the protein content of foods, although there was a tendency towards overestimation. The magnitude of this error was increased in low protein savoury foods. Specifically, there was a shift in the spread of estimation scores which showed a greater level of overestimation in some blended compared to unblended foods, and predominantly in savoury foods which participants could not identify. These results provide evidence that savoury taste and protein content are not well linked in the current food environment, but taste may guide nutrient estimations about certain unidentified foods. [ABSTRACT FROM AUTHOR]

• Non-human animals show remarkable nutritional intelligence in food selection. • In humans, nutritional intelligence has been underestimated in everyday meals. • Nutritional intelligence is rooted in our cuisine. • Observational and flavour-nutrient learning work in concert to form a cuisine. • Modern food systems corrupt the benefits of cuisine in guiding dietary behaviour. • Intersection of social and biological factors is the key to human dietary behaviour. The social and cultural significance of food is woven into every aspect of our dietary behaviour, and it contributes to our complex interaction with food. To find order within this complexity scientists often look for dietary 'universals' - phenomena or basic principles that guide our food choice and meal size, irrespective of wider context. One such idea is that taste characteristics provide a signal for dietary composition (e.g., sweet taste signals carbohydrate). Others have suggested that behaviour is guided by learning and is based on associations that form between the flavour of a food and its post-ingestive effects. Despite a large body of research, evidence supporting both processes is equivocal, leading some to conclude that humans are largely indifferent to food composition. Here, we argue that human abilities to gauge the nutritional composition or value of food have been underestimated, and that they can be exposed by embracing alternative methods, including cross-cultural comparisons, large nutrition surveys, and the use of virtual portion-selection tools. Our group has focused on assessments of food choice and expected satiety, and how comparisons across everyday foods can reveal non-linear relationships with food energy density, and even the potential for sensitivity to micronutrient composition. We suggest that these abilities might reflect a complex form of social learning, in which flavour-nutrient associations are not only formed but communicated and amplified across individuals in the form of a cuisine. Thus, rather than disregarding sociocultural influences as extraneous, we might reimagine their role as central to a process that creates and imbues a 'collective dietary wisdom.' In turn, this raises questions about whether rapid dietary, technological, and cultural change disrupts a fundamental process, such that it no longer guarantees a 'nutritional intelligence' that confers benefits for health. [ABSTRACT FROM AUTHOR]