Food Order and Timing Effects on Glycaemic and Satiety Responses to Partial Fruit-for-Cereal Carbohydrate Exchange: A Randomized Cross-Over Human Intervention Study.

Postprandial glycaemic response amplitude plays a critical role in diabetic complications, but is subject to food order and temporal separation within a meal. Effects of partial fruit-for-cereal carbohydrate exchange on glycaemic and appetite responses, as affected by food order and separation, were examined using kiwifruit (KF) and wheaten breakfast cereal biscuit (WB). In a randomized cross-over intervention study, 20 subjects ingested 51.7 g of available carbohydrate as 74 g WB alone, or as 200 g KF and 37 g WB, each delivering 25.85 g of available carbohydrate. The 200 g KF was partially exchanged for 37 g of WB, at 90 min and 30 min before, at the same time as, or 30 min after, ingesting WB. Incremental satiety responses were derived from appetite scores measured using a visual analogue scale, and capillary blood glucose responses were monitored. In all exchanges, KF reduced the glycaemic response (iAUC) by 20-30% with no loss of total satiation. The incremental glycaemic and satiety responses to food ingestion followed each other closely. Glycaemic response amplitudes were reduced almost 50% compared with 74 g WB when KF ingestion preceded WB ingestion by 30 min, and less when the KF was ingested with or 30 min after the cereal. The results suggest that fruit most effectively suppresses the digestion of cereal carbohydrates if ingested long enough before the cereal to prevent overlap of the glycaemic responses, but close enough for fruit components that impede carbohydrate digestion or uptake to interact with the ingested cereal in the gut. Ethics approval was obtained from the Human and Disabilities Ethics Committee (HDEC) of the New Zealand Ministry of Health. The trial was registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12615000744550).

Demystifying artificial intelligence in pharmacy.

PURPOSE: To provide pharmacists and other clinicians with a basic understanding of the underlying principles and practical applications of artificial intelligence (AI) in the medication-use process. SUMMARY: "Artificial intelligence" is a general term used to describe the theory and development of computer systems to perform tasks that normally would require human cognition, such as perception, language understanding, reasoning, learning, planning, and problem solving. Following the fundamental theorem of informatics, a better term for AI would be "augmented intelligence," or leveraging the strengths of computers and the strengths of clinicians together to obtain improved outcomes for patients. Understanding the vocabulary of and methods used in AI will help clinicians productively communicate with data scientists to collaborate on developing models that augment patient care. This primer includes discussion of approaches to identifying problems in practice that could benefit from application of AI and those that would not, as well as methods of training, validating, implementing, evaluating, and maintaining AI models. Some key limitations of AI related to the medication-use process are also discussed. CONCLUSION: As medication-use domain experts, pharmacists play a key role in developing and evaluating AI in healthcare. An understanding of the core concepts of AI is necessary to engage in collaboration with data scientists and critically evaluating its place in patient care, especially as clinical practice continues to evolve and develop.

Self-Reported Visual Quality of Life After Combat Ocular Trauma.

OBJECTIVES: To describe the visual outlook and quality of life of service members after combat ocular trauma. METHODS: In a single-center, prospective observational study of service members sustaining ocular trauma, participants underwent a series of ocular examinations and noninvasive tests, including the National Eye Institute Visual Functioning Questionnaire (VFQ-25). RESULTS: Of the 165 enrolled participants, 137 completed the VFQ-25. The mean VFQ-25 composite score was 74.4 ± 20.7 (range: 1.4-100). Among 118 participants with visual acuity assessment, 92% had best corrected visual acuity (BCVA) of 20/20 or better in at least one eye. Among participants with severe vision loss (BCVA ≤20/200), there was no statistically significant difference in self-reported general health compared to those without severe vision loss (p = 0.17). However, there was a significantly lower visual quality of life reported in the composite score and all of the 11 subscales of the VFQ-25. CONCLUSIONS: While this study provides evidence that combat ocular trauma is associated with a lower visual quality of life, limitations include the relatively small sample size and the limited documentation of the use of eye protection at time of injury among participants.

Revisiting the surface anatomy of the sciatic nerve in the gluteal region in children using computed tomography.

No anatomy text specifically describes the course of the sciatic nerve (SN) in the gluteal region in children. Anatomical information is largely derived from cadaveric studies of adults, so accurate anatomical information about the location of the SN in children is required. The aim of this study is to assess the surface anatomy of the SN in children using computed tomography (CT). After excluding studies with pelvic pathology, 75 CT scans were analyzed. Three groups were selected for analysis (0-2, 4-6, and 8-10 years). The position of the SN was measured between the posterior superior iliac spine (PSIS) and the ischial tuberosity (IT) and between the IT and the greater trochanter (GT) using 3-dimensional images. In the 0-2 age group, the SN crossed the middle third of a line between the PSIS and the IT in 94% and the GT and the IT in 80% of cases. In the 4-6 age group, the SN crossed the middle third of a line between the PSIS and the IT in 96% and the GT and the IT in 87%. In the 8-10 age group, the SN crossed the middle third of a line between the PSIS and the IT in 100% and the GT and the IT in 71%. The findings indicate that the SN in children is most accurately located in the middle third along a line drawn from the PSIS to the IT and the GT to the IT. Our study is the first to provide anatomical CT data from living children to guide interventions in the gluteal region.

Radiographic skeletal survey for non-accidental injury: systematic review and development of a national New Zealand protocol.

INTRODUCTION: Clinically occult fractures from non-accidental injury (NAI) are best detected on radiographic skeletal survey. However, there are regional variations regarding the views included in such surveys. We undertook a systematic review of the evidence supporting skeletal survey protocols to design a protocol that could be implemented across New Zealand. METHODS: In June 2013, we searched Medline, Google Scholar, the Cochrane database, UpToDate and relevant reference lists for English-language publications on skeletal survey in NAI from 1946. We included publications that contained a protocol or reported evidence supporting including, or excluding, specific views in a skeletal survey. All included publications were critically appraised. Based on this systematic review, a draft protocol was developed and presented to an Australian and New Zealand Society for Paediatric Radiology NAI symposium in October 2013. Feedback from the symposium and later discussions was incorporated into the final protocol. RESULTS: We identified 2 guidelines for skeletal survey, 13 other protocols and 15 articles providing evidence for inclusion of specific images in a skeletal survey. The guidelines scored poorly on critical appraisal of several aspects of their methods. We found no studies that validate any of the protocols or compare their performance. Evidence supporting inclusion in a skeletal survey is limited to ribs, spine, pelvis, hands and feet, and long bone views. Our final protocol is a standardised, two-tiered protocol consisting of between 17 and 22 views. CONCLUSION: A standardised protocol for radiographic skeletal survey protocol has been developed in New Zealand. We present it here for consideration by others.

Faith and religious beliefs in an outpatient military population.

BACKGROUND: This study of outpatients at a military medical center seeks to evaluate the extent that this population relies on religion and spirituality to cope with health-related stress. This study also assesses outpatients' desire for spiritual intervention in the context of their medical appointments. METHODS: A cross-sectional survey was conducted using a convenience sample of 670 outpatients presenting at a military medical center. RESULTS: The majority of respondents endorsed a Christian religious affiliation (87%), a belief in God (91%), and attendance at religious services at least a few times a month (53%). Respondents who were male, younger than age 43, and on active duty were significantly less likely to attend religious services, believe in God (or a 'higher power'), or rely on religion or spirituality to cope with illness. Outpatients presenting for procedures or treatments were more likely to desire prayer or other religious intervention, as compared to patients who had regular clinic appointments. CONCLUSIONS: Compared to the general US population, a higher percentage of this patient population believes in God (91% vs. 78%), attends religious services once a week or more (42% vs. 30%), and endorses a Christian religious affiliation (87% vs. 73%). Because one-third of the surveyed outpatients desired prayer or other religious support, we concluded that all outpatients should be explicitly notified of the pastoral care and counseling services that are available for them.

Biocompatibility and osseointegration of reconstituted keratin in an ovine model.

Reconstituted keratin has potential as a raw material for orthopaedic applications. The aim of this study was to investigate the in vivo biocompatibility and osseointegration of keratin materials in an ovine model. Six different modifications of the keratin polymer, based on porous or dense constructs, regenerated by either neutral or acidic treatment, with or without hydroxyapatite, were made as small rods and inserted into drilled round defects in the femur and tibia of sheep. Histology was carried out on samples taken at different time points up to 24 weeks postsurgery. All keratin implants showed similar histological profiles, which included granulation tissue surrounding and infiltrating the implants, followed by new bone formation radiating from the existing bone. By 8 weeks, new bone had grown to within a short distance of the implant surface, and in some places was in direct apposition to the keratin implant. In the 12 to 24-week period, there was peripheral resorption and infiltration of bony trabeculae with regard to the porous constructs only. The tissue reaction appeared to model that of a fairly inert material. Further work on improving the extent of osseointegration and acceleration of the biodegradation rate of reconstituted keratin is underway.