Relationship between alcohol abuse upper gastro-intestinal haemorrhage and nutritional status during acute hospital admission

This thesis is concerned with the effect of alcohol consumption on the pathogenesis of bleeding from the upper gastrointestinal tract via nutritional pathways. Altered nutritional status is a frequently recognised clinical accompaniement of heavy alcohol consumption in hospitalized patients. Similarly, upper gastrointestinal bleeding is frequently accompanied by the presence of heavy alcohol consumption. Nevertheless, the clinical quantification of alcohol intake is often descriptive, so that a link between alcohol use and upper gastrointestinal haemorrhage via nutritional mechanisms has been only generally defined. In the literature review, the methods of defining alcohol use and abuse, using interview, biochemical and haematological techniques are noted. The relationship between alcohol abuse and nutrient imbalances is reviewed, especially in relation to possible effects on the gastrointestinal tract, appetite and eating habits. A further section reviews the relationship between alcohol use and anatomical lesions of the upper gastrointestinal tract likely to lead to bleeding. Following the chapter in which the methods used in this thesis are described. Chapter 4 seeks to describe the study population and its subgroups in this thesis in relation to interview, biochemical and haematological methods. Alcohol use is defined in relation to (1) a clinical classification of heavy or light drinking, based on a questionnaire administered in Casualty, (2) a quantified method of determining alcohol consumption during a subsequent ward dietetic assessment, (3) in relation to a biochemical definition (recent drinking and non-drinking), and a classification of (1) and (2) called, for the purposes of this thesis, \u27alcohol abusers\u27 and \u27nonabusers\u27. Heavy, regular and recent drinkers and alcohol abusers tend to be male and younger than light, infrequent and nonrecent drinkers and nonabusers. Chapter 5 relates the nutritional status of those patients admitted acutely to hospital in relation to the groups defined in Chapter 4, Nutritional status is defined in terms of food intake, anthropometry, biochemical and haematological parameters. Different methods of defining alcohol use give rise to different patterns of nutritional impairment. Chapter 6 relates the nutritional status of those patients admitted acutely to hospital in relation to the presence or absence of an endoscopically defined site of upper gastrointestinal bleeding. A difference is seen between those bleeding from a Mailory-weiss tear and other sites of bleeding, similarly, biochemical differences in nutritional status emerge between those patients who presented in shock, and those who did not. Chapter 7 explores the relationships between biochemical markers of nutritional status and haemostatic variables in the groups of abusers/non-abusers, the various sites of primary bleeding/controls, and shock/non-shock. Serum copper appears to be related to altered haemostasis in a manner not apparently described elsewhere

Academics and Social Networking Sites: Benefits, Problems and Tensions in Professional Engagement with Online Networking

The web has had a profound effect on the ways people interact, with online social networks arguably playing an important role in changing or augmenting how we connect with others. However, uptake of online social networking by the academic community varies, and needs to be understood. This paper presents an independent, novel analysis of a large-scale dataset published by Nature Publishing Group detailing the results of a survey about academics use of online social networking services. An open coding approach was used to analyse 480 previously unused text responses. The analysis revealed a wide range of benefits and also problems associated with engaging with online networking, and tensions within this. The analysis provides further insight into the nuances of uptake, by exploring clusters of co-reported benefits and problems within the qualitative analysis. The findings will help move forward current debates surrounding social media use by academics from being viewed in solely beneficial terms, towards an understanding of the problems and tensions that arise through academic work online

Poor physical function in elderly women in low-level aged care is related to muscle strength rather than to measures of sarcopenia

Julie L Woods1, Sandra Iuliano-Burns2, Susannah J King1, Boyd J Strauss1, Karen Z Walker11Nutrition and Dietetics Department, Monash University, Victoria, Australia; 2Endocrine Centre of Excellence, Department of Medicine, Austin Health, University of Melbourne, West Heidelberg, AustraliaPurpose: To determine the prevalence of sarcopenia and investigate relationships among body composition, muscle strength, and physical function in elderly women in low-level aged care.Subjects and methods: Sixty-three ambulatory women (mean age 86 years) participated in this cross-sectional study where body composition was determined by dual energy X-ray absorptiometry (DXA); ankle, knee, and hip strength by the Nicholas Manual Muscle Tester; and physical function by ‘timed up and go’ (TUG) and walking speed (WS) over 6 meters. Body composition data from a female reference group (n = 62, mean age 29 years) provided cut-off values for defining sarcopenia.Results: Elderly women had higher body mass index (P < 0.001), lower lean mass (P < 0.001), and higher fat mass (P < 0.01) than the young reference group. Only a small proportion (3.2%) had absolute sarcopenia (defined by appendicular skeletal muscle mass/height squared) whereas 37% had relative sarcopenia class II (defined by percentage skeletal muscle mass). Scores for TUG and WS indicated relatively poor physical function, yet these measures were not associated with muscle mass or indices of sarcopenia. In multivariate analysis, only hip abductor strength predicted both TUG and WS (both P = 0.01).Conclusion: Hip strength is a more important indicator of physical functioning than lean mass. Measurement of hip strength may therefore be a useful screening tool to detect those at risk of functional decline and requirement for additional care. Further longitudinal studies with a range of other strength measures are warranted.Keywords: aged care, body composition, muscle strength, sarcopenia&nbsp

Vitamin D in polycystic ovary syndrome: Relationship to obesity and insulin resistance

Scope: Polycystic ovary syndrome (PCOS) is underpinned by insulin resistance (IR). In PCOS, the relationships between vitamin D, adiposity, and IR are unclear. We aim to explore these relationships in lean and overweight women with PCOS. Methods and results: This is a cross-sectional study conducted in a tertiary medical center. Participants included 42 women with PCOS and 34 controls without PCOS. Vitamin D and metabolic markers were measured. Detailed body composition and gold standard hyperinsulinemic euglycemic clamps were performed. The main outcome measures were plasma levels of vitamin D, adiposity measures, and glucose infusion rate. Vitamin D levels were lower in overweight women with PCOS compared with overweight controls (31.6 and 46.1 nmol/L, respectively, p = 0.01). Vitamin D was not associated with IR after adjustment for confounders; however, there was a significant interaction between PCOS and percentage body fat. Further analysis by PCOS status revealed that vitamin D was associated with IR in the PCOS group (β coefficient 2.1, 95% CI 0.2–4.0, p = 0.03), but not in the non-PCOS group. Conclusion: Vitamin D is associated with IR in women with PCOS, but not in controls. Large intervention studies are needed to determine if vitamin D supplementation can improve IR in PCOS.Anju E. Joham, Helena J. Teede, Samantha Cassar, Nigel K. Stepto, Boyd J. Strauss, Cheryce L. Harrison, Jacqueline Boyle and Barbora de Courte

MaxEnt power spectrum estimation using the Fourier transform for irregularly sampled data applied to a record of stellar luminosity

The principle of maximum entropy is applied to the spectral analysis of a data signal with general variance matrix and containing gaps in the record. The role of the entropic regularizer is to prevent one from overestimating structure in the spectrum when faced with imperfect data. Several arguments are presented suggesting that the arbitrary prefactor should not be introduced to the entropy term. The introduction of that factor is not required when a continuous Poisson distribution is used for the amplitude coefficients. We compare the formalism for when the variance of the data is known explicitly to that for when the variance is known only to lie in some finite range. The result of including the entropic measure factor is to suggest a spectrum consistent with the variance of the data which has less structure than that given by the forward transform. An application of the methodology to example data is demonstrated.Comment: 15 pages, 13 figures, 1 table, major revision, final version, Accepted for publication in Astrophysics & Space Scienc

New fat free mass - fat mass model for use in physiological energy balance equations

<p>Abstract</p> <p>Background</p> <p>The Forbes equation relating fat-free mass (<it>FFM</it>) to fat mass (<it>FM</it>) has been used to predict longitudinal changes in <it>FFM </it>during weight change but has important limitations when paired with a one dimensional energy balance differential equation. Direct use of the Forbes model within a one dimensional energy balance differential equation requires calibration of a translate parameter for the specific population under study. Comparison of translates to a representative sample of the US population indicate that this parameter is a reflection of age, height, race and gender effects.</p> <p>Results</p> <p>We developed a class of fourth order polynomial equations relating <it>FFM </it>to <it>FM </it>that consider age, height, race and gender as covariates eliminating the need to calibrate a parameter to baseline subject data while providing meaningful individual estimates of <it>FFM</it>. Moreover, the intercepts of these polynomial equations are nonnegative and are consistent with observations of very low <it>FM </it>measured during a severe Somali famine. The models preserve the predictive power of the Forbes model for changes in body composition when compared to results from several longitudinal weight change studies.</p> <p>Conclusions</p> <p>The newly developed <it>FFM</it>-<it>FM </it>models provide new opportunities to compare individuals undergoing weight change to subjects in energy balance, analyze body composition for individual parameters, and predict body composition during weight change when pairing with energy balance differential equations.</p

An iterative semi-implicit scheme with robust damping

An efficient, iterative semi-implicit (SI) numerical method for the time integration of stiff wave systems is presented. Physics-based assumptions are used to derive a convergent iterative formulation of the SI scheme which enables the monitoring and control of the error introduced by the SI operator. This iteration essentially turns a semi-implicit method into a fully implicit method. Accuracy, rather than stability, determines the timestep. The scheme is second-order accurate and shown to be equivalent to a simple preconditioning method. We show how the diffusion operators can be handled so as to yield the property of robust damping, i.e., dissipating the solution at all values of the parameter \mathcal D\dt, where $\mathcal D$ is a diffusion operator and \dt the timestep. The overall scheme remains second-order accurate even if the advection and diffusion operators do not commute. In the limit of no physical dissipation, and for a linear test wave problem, the method is shown to be symplectic. The method is tested on the problem of Kinetic Alfv\'en wave mediated magnetic reconnection. A Fourier (pseudo-spectral) representation is used. A 2-field gyrofluid model is used and an efficacious k-space SI operator for this problem is demonstrated. CPU speed-up factors over a CFL-limited explicit algorithm ranging from $\sim20$ to several hundreds are obtained, while accurately capturing the results of an explicit integration. Possible extension of these results to a real-space (grid) discretization is discussed.Comment: Submitted to the Journal of Computational Physics. Clarifications and caveats in response to referees, numerical demonstration of convergence rate, generalized symplectic proo

Growth and body composition in pku children— a three-year prospective study comparing the effects of l-amino acid to glycomacropeptide protein substitutes

Protein quality and quantity are important factors in determining lean body (muscle) mass (LBM). In phenylketonuria (PKU), protein substitutes provide most of the nitrogen, either as amino acids (AA) or glycomacropeptide with supplementary amino acids (CGMP-AA). Body composition and growth are important indicators of long-term health. In a 3-year prospective study comparing the impact of AA and CGMP-AA on body composition and growth in PKU, 48 children were recruited. N = 19 (median age 11.1 years, range 5–15 years) took AA only, n = 16 (median age 7.3 years, range 5–15 years) took a combination of CGMP-AA and AA, (CGMP50) and 13 children (median age 9.2 years, range 5–16 years) took CGMP-AA only (CGMP100). A dual energy X-ray absorptiometry (DXA) scan at enrolment and 36 months measured LBM, % body fat (%BF) and fat mass (FM). Height was measured at enrolment, 12, 24 and 36 months. No correlation or statistically significant differences (after adjusting for age, gender, puberty and phenylalanine blood concentrations) were found between the three groups for LBM, %BF, FM and height. The change in height z scores, (AA 0, CGMP50 +0.4 and CGMP100 +0.7) showed a trend that children in the CGMP100 group were taller, had improved LBM with decreased FM and % BF but this was not statistically significant. There appeared to be no advantage of CGMP-AA compared to AA on body composition after 3-years of follow-up. Although statistically significant differences were not reached, a trend towards improved body composition was observed with CGMP-AA when it provided the entire protein substitute requirement.publishersversionpublishe