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

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

Corrigendum to design data for the 3D printer modification to print gels and pastes and the corresponding firmware.

[This corrects the article DOI: 10.1016/j.dib.2021.106974.].

Understanding the mechanical performance of raw and cooked potato cells.

The micromechanics of individual potato cells comprising of cell wall and embedded native or gelatinised starch were explored. Micromanipulation can be used to compare cells of distinct strengths and study (bio)mechanical issues related to industrial processing (e.g. heat treatment). Two commercial types of potato, 'baking' and 'Maris Piper' were selected to conduct microcompression experiments. Cells isolated from 'Maris Piper' raw tubers appeared to be more resistant to deformation than the respective ones from the 'baking' cultivar. Cooked cells suffered a decrease in their turgidity which resulted in clusters of observed behaviours, with force-deformation curves showing a single or multiple bursting events. This study provides fundamental work and an insight on the behaviour of potato cells via an exploratory investigation of how different elements of the potato tissue can be measured. The results obtained can be used to relate cellular biology to mechanical properties and could also pave the way to understanding other starch-containing cells (e.g. pea, lentils, wheat).

Dual stimuli-sensitive carrageenan-based formulation for additive manufacturing.

The design and development of controlled release systems of molecules of interest (nutrients, flavors, and drugs) have attracted significant attention over several years. Herein, we report a formulation of dual temperature and electro responsive κ- and ι-carrageenan based hydrogel for efficient food material and drug delivery. The microstructure and the thermal behavior of the hydrogel were characterized. The in-vitro drug release from the hydrogel was also studied. Using this carrageenan-based formulation and folic acid as the drug model, a high drug loading, and a sustained release because of either electric field or temperature were observed. In principle, the proposed formulation does not rely on 3D printing to perform its function; however, it adds to the feedstocks for 3D printing in the food and pharmaceutical industries. For the future, this could allow potentially more complex smart structures to be created from this material, further tuning release behavior.

Design data for the 3D printer modification to print gels and pastes and the corresponding firmware.

In order to deposit gel and paste-like materials, a commercially available HICTOP Prusa i3 plastic 3D printer was modified. The modification included replacing the existing plastic microextruder with a customised 3D printed syringe pump which could hold a syringe containing the printing material. The arrangement also allowed the temperature in the syringe to be controlled. Since the hardware of the printer was changed significantly, a new firmware was loaded on the 3D printer which was customised to enable it to perform its new function. The present data consists of the 3D image files of the syringe pump assembly and instructions on how to assemble the components. It also provides a copy of the modified firmware with a list of the changes made to it. This data will allow the readers to modify a similar type of 3D printer to print pastes and gels. This can be achieved by recreating the entire syringe pump assembly by 3D printing the given 3D image file data. With some changes, these designs can also be adapted to a variety of different printers. Similarly, the given firmware can also be loaded onto a similar type of printer. The list and explanation of the changes made to the firmware also allow such changes to be made to the respective firmwares of a variety of different printers.

A simplified fluid resuscitation formula for burns in mass casualty scenarios: Analysis of the consensus recommendation from the WHO Emergency Medical Teams Technical Working Group on Burns.

BACKGROUND: Burn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines. METHODS: The TWGB formula was numerically compared with 2-4 mL/kg/%TBSA for adults and the Galveston formula for children. RESULTS: In adults, the TWGB formula estimated fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20-25% and the 50-60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance fluids. Beyond 60% TBSA, the TWGB formula underestimated fluid to be given in all age groups. CONCLUSION: The TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.

Mechanical properties of starch-filled alginate gel particles.

The aim of this work was to investigate the mechanical behaviour of alginate-based composite particles. Alginate gel beads with entrapped starch were used as the replicates of storage cells of plant tissue. Beads were formulated using different ratios of both ingredients and were produced using two methods, resulting in particles in the macro- and micro-scale size range. Compression tests revealed an effect of bead size on mechanical properties and a dominant role of the alginate on the material properties. Starch was successfully encapsulated as native granules in the beads and once encompassed, it suffered restricted swelling, up to 45 % of its original size, after undergoing heating. Force versus displacement data were fitted to both an empirical and the Hertz model and Young's modulus was found to increase only with heated starch inclusions. Microscopy was deemed crucial for the interpretation of mechanical measurements.

Independent co-delivery of model actives with different degrees of hydrophilicity from oil-in-water and water-in-oil emulsions stabilised by solid lipid particles via a Pickering mechanism: a-proof-of-principle study.

HYPOTHESIS: The development of vehicles for the co-encapsulation of actives with diverse characteristics and their subsequent controllable co-delivery is gaining increasing research interest. Predominantly centred around pharmaceutical applications, the majority of such co-delivery approaches have been focusing on solid formulations and less so on liquid-based systems. Simple emulsions can be designed to offer a liquid-based microstructural platform for the compartmentalised multi-delivery of actives. EXPERIMENTS: In this work, solid lipid nanoparticle stabilised Pickering emulsions were used for the co-encapsulation/co-delivery of two model actives with different degrees of hydrophilicity. Lipid particles containing a model hydrophobic active were prepared in the presence of either Tween 20 or whey protein isolate, and were then used to stabilise water-in-oil or oil-in-water emulsions, containing a secondary model active within their dispersed phase. FINDINGS: Solid lipid nanoparticles prepared with either type of emulsifier were able to provide stable emulsions. Release kinetic data fitting revealed that different co-delivery profiles can be achieved by controlling the surface properties of the lipid nanoparticles. The current proof-of-principle study presents preliminary data that confirm the potential of this approach to be utilised as a flexible liquid-based platform for the segregated co-encapsulation and independent co-release of different combinations of actives, either hydrophobic/hydrophilic or hydrophobic/hydrophobic, with diverse release profiles.

Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020.

Health and logistical needs in emergencies have been well recognised. The last 7 years has witnessed improved professionalisation and standardisation of care for disaster affected communities - led in part by the World Health Organisation Emergency Medical Team (EMT) initiative. Mass casualty incidents (MCIs) resulting in burn injuries present unique challenges. Burn management benefits from specialist skills, expert knowledge, and timely availability of specialist resources. With burn MCIs occurring globally, and wide variance in existing burn care capacity, the need to strengthen burn care capability is evident. Although some high-income countries have well-established disaster management plans, including burn specific plans, many do not - the majority of countries where burn mass casualty events occur are without such established plans. Developing globally relevant recommendations is a first step in addressing this deficit and increasing preparedness to deal with such disasters. Global burn experts were invited to a succession of Technical Working Group on burns (TWGB) meetings to: 1) review literature on burn care in MCIs; and 2) define and agree on recommendations for burn care in MCIs. The resulting 22 recommendations provide a framework to guide national and international specialist burn teams and health facilities to support delivery of safe care and improved outcomes to burn patients in MCIs.

How to Formulate for Structure and Texture via Medium of Additive Manufacturing-A Review.

Additive manufacturing, which is also known as 3D printing, is an emerging and growing technology. It is providing significant innovations and improvements in many areas such as engineering, production, medicine, and more. 3D food printing is an area of great promise to provide an indulgence or entertaining experience, personalized food product, or specific nutritional needs. This paper reviews the additive manufacturing methods and materials in detail as well as their advantages and disadvantages. After a full discussion of 3D food printing, the reports on edible printed materials are briefly presented and discussed. In the end, the current and future outlook of additive manufacturing in the food industry is shown.

A flow velocity dependence of dynamic surface tension in Plateau borders of foam.

HYPOTHESIS: Liquid drainage through foams is a multiscale process, that primarily occurs through channels known as Plateau borders (PBs). Recent experimental studies of isolated PBs have observed variations in channel surface tension, γ, with liquid flow rate, Q, for systems containing soluble low molecular weight surfactant (LMWS). The current study proposes that the dynamic surface tension (DST) could be responsible for this effect, where the residence time of surfactant molecules in the PB is similar to the time required for their adsorption to the channel interface. EXPERIMENTS: Profile geometries of isolated 'ideal' PB's were created in a bespoke experimental setup at controlled forced liquid flow rates. Average surfactant residence times, τRes, were calculated for solutions of Sodium dodecylsulfate (SDS), Tween 20 (T20) and Tween 80 (T80), and used to calculate corresponding average DST values in discrete regions of measured PB profiles. DST values were combined with microscale drainage theory to assess the potential physical implications on liquid flow. FINDINGS: Significant variations in the magnitude of γ were calculated based on surfactant characteristics, where only the rapid adsorption of SDS was sufficient to produce DST values approaching equilibrium. These findings seriously question assumptions of near equilibrium surface tension in LMWS foam systems above their critical micelle concentration (CMC). Furthermore, the presence of surface tension gradients identified using this discrete approach, highlights the need to further refine the current theory to a continuous approach incorporating Marangoni effects.

Freeze-Dried Gellan Gum Gels as Vitamin Delivery Systems: Modelling the Effect of pH on Drying Kinetics and Vitamin Release Mechanisms.

Freeze-dried gellan gum gels present great potential as delivery systems for biocompounds, such as vitamins, in food products. Here, we investigate the effect of modifying the gel pH-prior to the encapsulation process-on drying and release kinetics, and on delivery mechanisms from the substrate. Gellan gum gels were prepared at pH 5.2, 4 and 2.5 and loaded with riboflavin before being freeze-dried. Release tests were then carried out at ambient temperature in water. Five drying kinetics models were fitted to freeze-drying experimental curves using regression analysis. The goodness-of-fit was evaluated according to (i) the root mean squared error (ii), adjusted R-square (iii), Akaike information criterion (iv) and Bayesian information criterion. The Wang and Singh model provided the most accurate descriptions for drying at acidified pH (i.e., pH 4 and pH 2.5), while the Page model described better freeze-drying at pH 5.2 (gellan gum's natural pH). The effect of pH on the vitamin release mechanism was also determined using the Korsmeyer-Peppas model, with samples at pH 5.2 showing a typical Fickian behaviour, while acidified samples at pH 4 combined both Fickian and relaxation mechanisms. Overall, these results establish the basis for identifying the optimal conditions for biocompound delivery using freeze-dried gellan gels.

COVID-19 and thermoregulation-related problems: Practical recommendations.

The COVID-19 pandemic started in the cold months of the year 2020 in the Northern hemisphere. Concerns were raised that the hot season may lead to additional problems as some typical interventions to prevent heat-related illness could potentially conflict with precautions to reduce coronavirus transmission. Therefore, an international research team organized by the Global Health Heat Information Network generated an inventory of the specific concerns about this nexus and began to address the issues. Three key thermal and covid-19 related topics were highlighted: 1) For the general public, going to public cool areas in the hot season interferes with the recommendation to stay at home to reduce the spread of the virus. Conflicting advice makes it necessary to revise national heat plans and alert policymakers of this forecasted issue. 2) For medical personnel working in hot conditions, heat strain is exacerbated due to a reduction in heat loss from wearing personal protective equipment to prevent contamination. To avoid heat-related injuries, medical personnel are recommended to precool and to minimize the increase in body core temperature using adopted work/rest schedules, specific clothing systems, and by drinking cold fluids. 3) Fever, one of the main symptoms of COVID-19, may be difficult to distinguish from heat-induced hyperthermia and a resting period may be necessary prior to measurement to avoid misinterpretation. In summary, heat in combination with the COVID-19 pandemic leads to additional problems; the impact of which can be reduced by revising heat plans and implementing special measures attentive to these compound risks.

Influence of Ethanol on Emulsions Stabilized by Low Molecular Weight Surfactants.

The effect of ethanol on oil-in-water emulsions stabilized with low molecular weight surfactants was investigated. Oil-in-water emulsions were prepared containing varying percentages of ethanol and sunflower oil, and stabilized with different emulsifiers (Tween 20, Tween 80, and Lecithin). Droplet size, viscosity, density, and interfacial tension measurements were carried out. The droplet size of emulsions stabilized by each of the surfactants studied decreased with the addition of ethanol to the aqueous phase showing a minimum at a concentration of ethanol around 40%. The trend in droplet size is accompanied by a decrease in the interfacial tension between water and oil as the ethanol concentration increases. Viscosity measurements show that the change in viscosity of the final emulsion is the result of the change in viscosity of the continuous phase, as well as the change in solubility of the surfactants due to the addition of ethanol. The density of the continuous phase decreases with the addition of ethanol and it is possible to match the densities of the two phases in order to reduce the effect of creaming/sedimentation and improve stability. This study provides scientific evidence for the formulation of stable emulsions containing a range of ethanol form 0 to 40%. PRACTICAL APPLICATION: Formation and stability of food-grade emulsions in the presence of ethanol.

A Consensus Framework for the Humanitarian Surgical Response to Armed Conflict in 21st Century Warfare.

Importance: Armed conflict in the 21st century poses new challenges to a humanitarian surgical response, including changing security requirements, access to patients, and communities in need, limited deployable surgical assets, resource constraints, and the requirement to address both traumatic injuries as well as emergency surgical needs of the population. At the same time, recent improvements in trauma care and systems have reduced injury-related mortality. This combination of new challenges and medical capabilities warrants reconsideration of long-standing humanitarian surgery protocols. Objective: To describe a consensus framework for surgical care designed to respond to this emerging need. Design, Setting, and Participants: An international group of 35 representatives from humanitarian agencies, US military, and academic trauma programs was invited to the Stanford Humanitarian Surgical Response in Conflict Working Group to engage in a structured process to review extant trauma protocols and make recommendations for revision. Main Outcomes and Measures: The working group's method adapted core elements of a modified Delphi process combined with consensus development conference from August 3 to August 5, 2018. Results: Lessons from civilian and military trauma systems as well as recent battlefield experiences in humanitarian settings were integrated into a tiered continuum of response from point of injury through rehabilitation. The framework addresses the security and medical requirements as well as ethical and legal principles that guide humanitarian action. The consensus framework includes trained, lay first responders; far-forward resuscitation/stabilization centers; rapid damage control surgical access; and definitive care facilities. The system also includes nontrauma surgical care, injury prevention, quality improvement, data collection, and predeployment training requirements. Conclusions and Relevance: Evidence suggests that modern trauma systems save lives. However, the requirements of providing this standard of care in insecure conflict settings places new burdens on humanitarian systems that must provide both emergency and trauma surgical care. This consensus framework integrates advances in trauma care and surgical systems in response to a changing security environment. It is possible to reduce disparities and improve the standard of care in these settings.

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

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

Understanding and predicting sensory crispness of deep-fried battered and breaded coatings.

Crusted crispness refers to coatings with a dry and brittle surface contrasting a high-moisture core; it is desirable for the enjoyment and quality of deep-fried goods. This study aims to investigate instrumental measurements and sensory measurements of crispness. Deep-fried breadcrumb coatings of eight sizes were investigated: 4.0 mm, 2.8 mm, 2.0 mm, 1.4 mm, 1.0 mm, 710 µm, 500 µm, and 355 µm. Sensory profiling was carried out to develop a tailored lexicon for deep-fried battered and breaded shrimp. Principal component analysis highlights that large breadcrumb sizes correlate with crispness, hardness, particle size, surface color, color uniformity, surface irregularity, total porosity, maximum force, area, drop in force, number of sound peaks, and sound pressure level. Agglomerative hierarchical clustering was used to confirm clustering of samples according to breadcrumb size. Multiple factor analysis confirmed overall correlation between sensory measurements and instrumental measurements (RV = 0.810). Partial least squares regression was used to develop a predictive model for crispness from instrumental measurements (R2 = .854). The use of texture analysis and Acoustics provide information of the structures strength and deformation behavior, while X-ray microCT provides a high resolution and noninvasive method that acquires information on the internal morphology. These instrumental methods collectively demonstrate the relationship between microstructure to sensory. This study investigates how a change in the microstructure of deep-fried battered and breaded coatings affect crispness perception. These changes were investigated analytically and by using a sensory panel, this is important from a manufacturing perspective in order to understand what the major contributors are to a crisp texture. The key highlights of this study include both instrumental measurements and sensory measurements can be used to measure crispness as both types of testing are correlated. Changes in the size of breadcrumbs affect both instrumental measurements and sensory measurements. A predictive model can be re-simulated to allow prediction of crispness in deep-fried battered and breaded coatings.

Improving Management of Limb Injuries in Disasters and Conflicts.

It has become clear that disaster relief needs to transition from good intentions or a charity-based approach to a professional, outcome-oriented response. The practice of medicine in disaster and conflict is a profession practiced in environments where lack of resources, chaos, and unpredictability are the norm rather than the exception. With this consideration in mind, the World Health Organization (WHO; Geneva, Switzerland) and its partners set out to improve the disaster response systems. The resulting Emergency Medical Team (EMT) classification system requires that teams planning on engaging in disaster response follow common standards for the delivery of care in resource-constraint environments. In order to clarify these standards, the WHO EMT Secretariat collaborated with the International Committee of the Red Cross (ICRC; Geneva, Switzerland) and leading experts from other stakeholder non-governmental organizations (NGOs) to produce a guide to the management of limb injuries in disaster and conflict.The resulting text is a free and open-access resource to provide guidance for national and international EMTs caring for patients in disasters and conflicts. The content is a result of expert consensus, literature review, and an iterative process designed to encourage debate and resolution of existing open questions within the field of disaster and conflict medical response.The end result of this process is a text providing guidance to providers seeking to deliver safe, effective care within the EMT framework that is now part of the EMT training and verification system and is being distributed to ICRC teams deploying to the field.This work seeks to encourage professionalization of the field of disaster and conflict response, and to contribute to the existing EMT framework, in order to provide for better care for future victims of disaster and conflict.Jensen G, Bar-On E, Wiedler JT, Hautz SC, Veen H, Kay AR, Norton I, Gosselin RA, von Schreeb J. Improving management of limb injuries in disasters and conflicts. Prehosp Disaster Med. 2019;34(3):330-334.

Role of the Drying Technique on the Low-Acyl Gellan Gum Gel Structure: Molecular and Macroscopic Investigations.

The effect of three drying processes (freeze, oven and supercritical CO2 drying) on CP Kelco low-acyl gellan gum gel was investigated, highlighting the role of the water removal mechanism (i.e. sublimation, evaporation and solvent replacement/extraction) and the process parameters on the gel structure, rather than focusing on the drying kinetics. It is the first time that a research paper not only compares the drying methods but also discusses and investigates how the molecular and macroscopic levels of gellan gum are affected during drying. Specifically, the dried gel structures were characterised by bulk density and shrinkage analyses as well as scanning electron microscope (SEM) and micro-computed tomography (µCT) microscopy. Micro-differential scanning calorimetry (µDSC) was used in a novel way to investigate the effect of the drying technique on the polymer disorder chains by partial melting of the gel. The resulting water uptake during rehydration was influenced by the obtained dried structure and, therefore, by the employed drying process. It was found that freeze-dried (FD) structures had a fast rehydration rate, while both oven-dried (OD) and supercritical CO2-dried (scCO2D) structures were slower. After 30 min, FD samples achieved a normalised moisture content (NMC) around 0.83, whereas OD and scCO2D samples around 0.33 and 0.19, respectively. In this context, depending on the role of the specific hydrocolloid in food (i.e. gelling agent, thickener, carrier), one particular dried-gel structure could be more appropriate than another. Graphical abstractFrom left to right: unprocessed hydrogels; µ-CT images of dried gels and unprocessed hydrogel; DSC curves after drying process.