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A simple, nondestructive method to suppress pressure pulses in fluid-filled piping was proposed and theoretically analyzed in the previous companion paper. In this paper, the proposed method is verified experimentally. The results of experiments performed for the range of parameters of practical importance indicated that the attenuation of pressure pulses was sufficiently large for practical applications and in accordance with the theoretical predictions. This paper describes the experimental setup and the test models of the proposed pulse suppression devices and discusses the experimental results. In particular, the measured attenuation factors (transmitted pressure/incident pressure) are presented and compared with the theoretical predictions., Two models were tested to verify a pressure-pulse suppression (PPS) method developed and the magnitude of pressure attenuation. The models simulated the basic and optional configuration of the PPS device. Results show that water jets were formed, proving the theories that maximum energy dissipation reduces pressure pulse. The magnitude of the pressure attenuation for both theoretical and experimental models agreed with each other.

Purpose: The purpose of the present study was to establish a semi‐automated threshold‐based image segmentation algorithm to detect and objectively quantify corneal cystine crystal deposition in ocular cystinosis with anterior segment optical coherence tomography (AS‐OCT). Methods: This prospective, observational, comparative study included 88 eyes of 45 patients from the German Cystinosis Registry Study as well as 68 eyes of 35 healthy control subjects. All eyes were imaged with AS‐OCT (Cirrus HD‐OCT 5000, Carl Zeiss Meditec AG, Jena, Germany). As an initial step, B‐scan images were subjectively analysed for typical changes in morphology in comparison to healthy controls. Based on the experience gained, an objective semi‐automated B‐scan image segmentation algorithm was developed using a grey scale value‐based threshold method to automatically quantify corneal crystals. Results: On AS‐OCT B‐scans, corneal crystals appeared as hyperreflective deposits within the corneal stroma. The crystals were distributed either in all stromal layers (43 eyes, 49%) or confined to the anterior (23 eyes, 26%) or posterior stroma (22 eyes, 25%), respectively. The novel automatic B‐scan image segmentation algorithm was most efficient in delineating corneal crystals at higher grey scale thresholds (e.g. 226 of a maximum of 255). Significant differences in suprathreshold grey scale pixels were observable between cystinosis patients and healthy controls (p < 0.001). In addition, the algorithm was able to detect an age‐dependent depth distribution profile of crystal deposition. Conclusion: Objective quantification of corneal cystine crystal deposition is feasible with AS‐OCT and can serve as a novel biomarker for ocular disease control and topical treatment monitoring. [ABSTRACT FROM AUTHOR]

Abstract Background Low- and middle-income countries often lack the fiscal, infrastructural and human resources to conduct evidence-based research; similar constraints may also hinder the application of good clinical practice guidelines based on research findings from high-income countries. While the context of health organizations is increasingly recognized as an important consideration when such guidelines are implemented, there is a paucity of studies that have considered local contexts of resource-scarcity against recommended clinical guidelines. Methods This paper sets out to explore the implementation of the NICE Guideline 11 on family interventions when working with persons with intellectual disability and challenging behavior by a group of psychologists employed in a government health facility in Cape Town, South Africa. Results In the absence of evidence-based South African research, we argue that aspects of the guidelines, in particular those that informed our ethos and conceptual thinking, could be applied by clinical psychologists in a meaningful manner notwithstanding the relative scarcity of resources. Conclusion We have argued that where guidelines such as the NICE Guidelines do not apply contextually throughout, it remains important to retain the principles behind these guidelines in local contexts. Limitations of this study exist in that the data were drawn only from the clinical experience of authors. Some of the implications for future research in resource-constrained contexts such as ours are discussed. Smaller descriptive, qualitative studies are necessary to explore the contextual limitations and resource strengths that exist in low- and middle-income settings, and these studies should be more systematic than drawing only on the clinical experience of authors, as has been done in this study.

Background: Intellectual disability (ID) is the most prevalent disability in the world. People with intellectual disability (PWID) frequently experience extreme violations of numerous human rights. Despite greater prevalence in South Africa than in high-income countries, most ID research currently comes from the Global North. This leaves us with few contextually sensitive studies to draw from to advance inclusive citizenship. Objectives: Our scoping review aims to investigate pertinent ID rights issues in South Africa, synthesise quantitative and qualitative studies, and provide a synopsis of available evidence on which to base future work. We aim to clarify key concepts, address gaps in the literature and identify opportunities for further research. Method: We followed strict eligibility criteria. Medical subject heading terms were entered into seven databases. Seven reviewers worked independently, two per paper. Quantitative and qualitative data extraction forms were designed. We followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and registered a protocol. An inductive approach enabled a thematic analysis of selected studies. Results: By following PRISMA guidelines, 82 studies were assessed for eligibility of which 59 were included. Ten sub-themes were integrated into four main themes: the right not to be discriminated against, the right to psychological and bodily integrity, the right to accommodating services and challenges to rights implementation. Conclusion: People with intellectual disability face compound difficulties when trying to assert their constitutionally entitled rights. This ongoing project requires serious commitment and action. Statutory obligations to nurture every South African’s human rights naturally extend to PWID and their supporters who forge ahead in a disabling environment.

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Objective: In children with presymptomatic type 1 diabetes, intermittent hyperglycemia and rising hemoglobin A1c levels are a known signal of progression toward insulin-dependency. Episodes of hypoglycemia, however, have also been reported in one published case. We investigated the prevalence of hypoglycemia and its association with disease progression in children with presymptomatic type 1 diabetes., Methods: We compared the frequency of hypoglycemic fasting blood glucose levels (<60 mg/dL) in 48 autoantibody negative and 167 multiple β-cell autoantibody positive children aged 2 to 5 years. We classified the autoantibody positive children into three categories based on their glucose levels in fasting state (hypoglycemic [<60 mg/dL], normoglycemic [60-99 mg/dL] or hyperglycemic [≥100 mg/dL]). We then compared the glucose levels under challenge during oral glucose tolerance tests (OGTTs) between the three categories., Results: In the autoantibody positive children, 5.1% of the fasting samples were hypoglycemic, while in the autoantibody negative children no hypoglycemia was observed. Hypoglycemia occurred more often in autoantibody positive children who had already entered stage 2 or stage 3 of type 1 diabetes than in stage 1 patients (P = 0.02). Children who had hypoglycemic compared to normoglycemic fasting blood glucose values had higher 120-minute blood glucose values under OGTT challenge, and a higher rate of pathological OGTTs (P = 0.04)., Conclusions: Fasting hypoglycemia seems to be an indicator of disease progression in presymptomatic type 1 diabetes and may therefore represent a novel marker for the identification of children who should be monitored more closely for progression toward insulin-dependent type 1 diabetes., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Although detection of children at high risk of developing type 1 diabetes and diagnosis of early stages is possible, up to now there exists no approved therapy to delay or prevent type 1 diabetes. Thus it is vital to develop evidence-based interventions. For this a sufficient number of trial participants is crucial but difficult to obtain especially in asymptomatic children., Aim: Identifying family characteristics that lead to or impede trial participation and analyze reasons stated by families for non-participation., Methods: Participants for the Fr1da Insulin Intervention study are recruited from the Fr1da study, a population based screening for early stage type 1 diabetes in Bavaria. Families with eligible children were invited to enroll. We analyzed sex and age of the child, distance of the family to the study center in Munich and the existence of a first degree family member with type 1 as possible influential factors for study participation. We also analyzed reasons stated by families who declined study participation in a phone interview., Results: Of 146 eligible children 77 (53%) were enrolled into the trial. None of the tested family characteristics differed significantly between the enrolling and the families not participating, but in general enrolling families lived closer to the study site than families not participating. This is also reflected in the reasons given by non-participating families. The most frequent reason stated were time restrictions. The second most frequent reason was the venous blood draw., Conclusion: The factors for non-participation identified in this project need be taken into account for the design of future trials in young children to ensure proper recruitment and thus to generate valid results for medical treatment of children. More research on the reason of participation and non-participation in clinical trials is needed.

The phenotype of autoreactive T cells in type 1 diabetes is described as Th1, Th17 and/or Th21, but is largely uncharacterized. We combined multi-parameter cytokine profiling and proliferation, and identified GM-CSF producing cells as a component of the response to beta cell autoantigens proinsulin and GAD65. Overall cytokine profiles of CD4 + T cell were not altered in type 1 diabetes. In contrast, patients with recent onset type 1 diabetes had increased frequencies of proinsulin-responsive CD4 + CD45RA - T cells producing GM-CSF (p=0.002), IFNγ (p=0.004), IL-17A (p=0.008), IL-21 (p=0.011), and IL-22 (p=0.007), and GAD65-responsive CD4 + CD45RA - T cells producing IL-21 (p=0.039). CD4 + T cells with a GM-CSF + IFNγ - IL-17A - IL-21 - IL-22 - phenotype were increased in patients for responses to both proinsulin (p=0.006) and GAD65 (p=0.037). GM-CSF producing T cells are a novel phenotype in the repertoire of T helper cells in type 1 diabetes and consolidate a Th1/Th17 pro-inflammatory pathogenesis in the disease., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Incentive salience theory (IST) suggests that 'wanting' and liking are dissociable processes. We argue that explicit measures of wanting in humans can reflect the impact of implicit 'wanting' as envisaged by IST, suggesting that dissociations should also be evident for explicit judgments of wanting and liking. To test this, participants were asked to make ratings of these variables for 8 palatable snack foods - and in a related test salivation rate was also assessed. Participants viewed and sniffed each snack food and rated wanting, and then sampled it and rated liking and whether they wanted more of it. Following a lunch eaten to satiety, and composed in part of half of the palatable snack foods, participants repeated their evaluations of the snack foods (and salivation rate). Liking changed less across lunch than wanting and want more ratings, the last-mentioned changing the most. Change in liking was associated with change in salivation rate, independent of wanting, and change in wanting was associated with change in hunger independent of liking. We argue these dissociations are consistent with 'wanting' influencing explicit wanting, and that want more ratings may represent a 'purer' measure of IST 'wanting'., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Understanding cation exchange processes is important for evaluating early diagenetic and synsedimentary processes taking place in marine sediments. To quantify calcium (Ca) exchange and Ca-ammonium exchange in a seawater environment, we performed experiments with a radioactive (45)Ca tracer on clay mineral standards (Fithian illite, montmorillonite and kaolinite) and marine sediments from the North Atlantic Integrated Ocean Drilling Program Site U1306A in artificial seawater (ASW). The results show that equilibrium during the initial attachment of Ca as well as the exchange of Ca by [Formula: see text] is attained in less than 2 min. On average 8-20% of the exchangeable sites of the clay minerals were occupied by Ca in a seawater medium. The conditional selectivity coefficient, describing the [Formula: see text] exchange in ASW is mineral specific and it was determined to be 0.07 for montmorillonite, 0.05 for a natural marine sediment and 0.013 for Fithian illite.

The alterations of the lipid metabolism produced by placental insufficiency were investigated in animal experiments. Pregnant rabbits received Chlormadinon-acetate by intramuscular injection. The pregnancy was prolongated for 4 days, and a placental insufficiency developed. The lipid metabolism of the mothers and the fetuses was investigated by determination of beta-lipoproteides, triglycerides, cholesterol and HDL- and LDL/VLDL-cholesterol. The most important result is an increase of the concentrations of triglycerides and cholesterol of the fetuses during prolongation of pregnancy. Of the different cholesterol fractions estimated the LDL/VLDL-cholesterol-ratio excellently reflects the changes of the lipid metabolism during prolonged pregnancy.

In a randomized study the effect of an early prophylactic indomethacin treatment on the incidence of the patent ductus arteriosus (PDA) in very low birth weight infants (VLBWI) and their postnatal course were investigated. 19 VLBWI (weight 1221 +/- 158 g, gestational age 28.2 +/- 1.3 weeks) received 0.2 mg/kg indomethacin 3 times p.o. in 12 h intervals beginning on the 3rd day of life. 22 VLBWI with comparable weight (1250 +/- 154 g, gestational age 28.4 +/- 1 weeks), mode of delivery and postnatal adaptation served as controls. PDA was diagnosed clinically and by a decreased ratio of the systolic time intervals preejection period (PEP)/left ventricular ejection time (LVET) less than 0.3. PDA were seen in 7 indomethacin treated VLBWI and in 13 newborns of the control group. A symptomatic PDA developed in 4 infants of the latter group only. The indomethacin group was characterized by an increased ratio PEP/LVET from day 3 to 5 as an evidence for a diminished ductal shunt. Their weight loss was 3% lower and they regained their birth weight 5 days earlier. Otherwise, there were no differences in mortality and morbidity. Despite the proven efficacy of an early indomethacin treatment its use is recommended only for infants with a high risk for a PDA substantiated by a low ratio PEP/LVET less than or equal to 0.24 at the 3rd day of life.