Within the testing conditions of this study, the PL bundle does not affect anterior translation and rotation of the knee; the AM bundle is the primary restraint of the anterior translation but does not affect rotation of the knee while the lesion of the LCL increases tibial rotation and could be related to the pivot shift phenomenon, so it is more correct and biomechanical valid to assess and repair the associated lesion of the antero-lateral structure of the knee at the time of ACL surgery.

This chapter reviews the likely consequences of dietary change for human health and wellbeing in Asia where a transition is occurring from diets dominated by low fat, high fibre foods to increased consumption of processed and packaged convenience foods. These foods are higher in fats, sugars and salt and are linked to increased rates of diet-related non-communicable disease. The chapter traces between-country differences and considers the drivers of dietary change including economic growth and rising incomes, the effects of urbanization and changing family size, the industrialization of food systems and the liberalization of world trade. While levels of malnutrition have declined throughout the region, rates of obesity ad overweight have increased raising challenging questions for nutrition policy planners. Keywords Nutrition transition Á Dietary change Á Population health Á Obesity Á Asia What Is the Nutrition Transition? Throughout human history there have been profound shifts in population diets and these shifts inevitably have impacted on nutritional status and population health. In recent decades a particularly rapid process of change has been observed, first in high income countries but now also in low and middle income settings (Popkin 2002a, b; Drenowski and Popkin 1997; Popkin et al. 2012; Kearney 2010). Diets dominated by starchy, low variety, low fat, high fiber foods are being replaced by consumption of processed foods higher in fats, sugars and salt, and accompanied by rises in diet-related non-communicable disease. These changes in population diet

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High reflectance thermal barrier coatings consisting of 7% Yittria‐Stabilized Zirconia (7YSZ) and Al2O3 were deposited by co‐evaporation using electron beam physical vapor deposition (EB‐PVD). Multilayer 7YSZ and Al2O3 coatings with fixed layer spacing showed a 73% infrared reflectance maxima at 1.85 μm wavelength. The variable 7YSZ and Al2O3 multilayer coatings showed an increase in reflection spectrum from 1 to 2.75 μm. Preliminary results suggest that coating reflectance can be tailored to achieve increased reflectance over a desired wavelength range by controlling the thickness of the individual layers. In addition, microstructural enhancements were also used to produce low thermal conductive and high hemispherical reflective thermal barrier coatings (TBCs) in which the coating flux was periodically interrupted creating modulated strain fields within the TBC. TBC showed no macrostructural differences in the grain size or faceted surface morphology at low magnification as compared with standard TBC. The residual stress state was determined to be compressive in all of the TBC samples, and was found to decrease with increasing number of modulations. The average thermal conductivity was shown to decrease approximately 30% from 1.8 to 1.2 W/m‐K for the 20‐layer monolithic TBC after 2 h of testing at 1316°C. Monolithic modulated TBC also resulted in a 28% increase in the hemispherical reflectance, and increased with increasing total number of modulations.

Mortality from adult bacterial meningitis exceeds 50% in sub-Saharan Africa. We postulated that—particularly in individuals infected with human immunodeficiency virus (HIV)—herpes simplex virus, varicella zoster virus, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) in the cerebrospinal fluid (CSF) contribute to poor outcome. CSF from 149 Malawian adults with bacterial meningitis and 39 controls were analyzed using polymerase chain reaction. EBV was detected in 79 of 149 bacterial meningitis patients. Mortality (54%) was associated with higher CSF EBV load when adjusted for HIV (P = .01). CMV was detected in 11 of 115 HIV-infected patients, 8 of whom died. The mechanisms by which EBV and CMV contribute to poor outcome require further investigation.

Introduction: About one-third of critically ill patients with acute kidney injury (AKI) develop persistently decreased kidney function, known as acute kidney disease (AKD), which may progress to chronic kidney disease (CKD). Although sepsis is the most common cause of AKI, little is known about sepsis-associated AKD.Methods: Using data from a large randomized trial including 1341 patients with septic shock, we studied patients with stage 2 or 3 AKI on day 1 of hospitalization. We defined AKD as a persistently reduced glomerular filtration rate for >7 days. In addition to clinical data, we measured several urinary biomarkers (tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 [TIMP-2*IGFBP7], neutrophil gelatinase-associated lipocalin [NGAL], kidney injury molecule-1 [KIM-1], liver-type fatty acid binding protein, and type 4 collagen) at 0, 6, and 24 hours, to predict AKD.Results: Of 598 patients, 119 (19.9%) died within 7 days, 318 (53.2%) had early reversal of AKI within the first 7 days, whereas 161 (26.9%) developed AKD. In patients with early reversal, 45 (14.2%) had relapsed AKI after early reversal, and only about one-third of these recovered. Among patients developing AKD, only 15 (9.3%) recovered renal function prior to discharge. Male sex, African American race, and underlying CKD were more predominant in patients developing AKD. None of the biomarkers tested performed well for prediction of AKD, although NGAL modestly increased the performance of a clinical model. Conclusions: AKD is common in patients with septic shock, especially among African American males and those with underlying CKD. Existing AKI biomarkers have limited utility for predicting AKD but might be useful together with clinical variables. Novel predictive biomarkers for renal recovery are needed.

BackgroundWe sought to determine the effects of alternative resuscitation strategies on microcirculatory perfusion and examine any association between microcirculatory perfusion and mortality in sepsis.MethodsThis was a prospective, formally designed substudy of participants in the Protocolized Care in Early Septic Shock (ProCESS) trial. We recruited from six sites with the equipment and training to perform these study procedures. All subjects were adults with septic shock, and each was assigned to alternative resuscitation strategies. The two main analyses assessed (1) the impact of resuscitation strategies on microcirculatory perfusion parameters and (2) the association of microcirculatory perfusion with 60-day in-hospital mortality. We measured sublingual microcirculatory perfusion using sidestream dark field in vivo video microscopy at the completion of the 6-h ProCESS resuscitation protocol and then again at 24 and 72 h.ResultsWe enrolled 207 subjects (demographics were similar to the overall ProCESS cohort) and observed 40 (19.3%) deaths. There were no differences in average perfusion characteristics between treatment arms. Analyzing the relationship between microcirculatory perfusion and mortality, we found an association between vascular density parameters and mortality. Total vascular density (beta = 0.006, p < 0.003), perfused vascular density (beta = 0.005, p < 0.04), and De Backer score (beta = 0.009, p < 0.01) were higher overall in survivors in a generalized estimating equation model, and this association was significant at the 72-h time point (p < 0.05 for each parameter).ConclusionsMicrocirculatory perfusion did not differ between three early septic shock treatment arms. We found an association between microcirculatory perfusion parameters of vascular density at 72 h and mortality.Trial registrationClinicalTrials.gov, NCT00510835. Registered on August 2, 2007.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2240-5) contains supplementary material, which is available to authorized users.

Background: There is currently considerable international debate around school closures/openings and the role of children in the transmission of coronavirus disease 2019 (COVID-19). Whilst evidence suggests that children are not impacted by COVID-19 as severely as adults, little is still known about their transmission potential, and with a lot of asymptomatic cases they may be silent transmitters (i.e. infectious without showing clinical signs of disease), albeit at a lower level than adults. In relation to this, it is somewhat concerning that in many countries children are cared for, or are often in close contact with, older individuals such as grandparents ─ the age group most at risk of acquiring serious respiratory complications resulting in death. Main text: We emphasise that in the absence of a vaccine or an effective therapeutic drug, preventive measures such as good hygiene practices ─ hand washing, cough etiquette, disinfection of surfaces and social distancing represent the major (in fact only) weapons that we have against COVID-19. Accordingly, we stress that there is a pressing need to develop specific COVID-19 prevention messages for schoolchildren. Conclusion: An entertainment education intervention for schoolchildren systematically implemented in schools would be highly effective and fill this need. With such measures in place there would be greater confidence around the opening of schools.