Nutritional support for head-injured patients

Copyright John Wiley & Sons. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2004, Issue 3. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.’ Perel, P. , Yanagawa, T. , Bunn, F. , Roberts, I. , Wentz, R. and Pierro, A. Nutritional support for head-injured patients. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001530. DOI: 10.1002/14651858.CD001530.pub2Background: Head injury increases the body's metabolic responses, and therefore nutritional demands. Provision of an adequate supply of nutrients is associated with improved outcome. The best route for administering nutrition (parenterally (TPN) or enterally (EN)), and the best timing of administration (for example, early versus late) of nutrients needs to be established. Objectives: To quantify the effect on mortality and morbidity of alternative strategies of providing nutritional support following head injury. Search strategy: Trials were identified by computerised searches of the Cochrane Injuries Group specialised register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, National Research Register, Web of Science and other electronic trials registers. Reference lists of trials and review articles were checked. The searches were last updated in July 2006. Selection criteria: Randomised controlled trials of timing or route of nutritional support following acute traumatic brain injury. Data collection and analysis: Two authors independently abstracted data and assessed trial quality. Information was collected on death, disability, and incidence of infection. If trial quality was unclear, or if there were missing outcome data, trialists were contacted in an attempt to get further information. Main results: A total of 11 trials were included. Seven trials addressed the timing of support (early versus delayed), data on mortality were obtained for all seven trials (284 participants). The relative risk (RR) for death with early nutritional support was 0.67 (95% CI 0.41 to 1.07). Data on disability were available for three trials. The RR for death or disability at the end of follow-up was 0.75 (95% CI 0.50 to 1.11). Seven trials compared parenteral versus enteral nutrition. Because early support often involves parenteral nutrition, three of the trials are also included in the previous analyses. Five trials (207 participants) reported mortality. The RR for mortality at the end of follow-up period was 0.66 (0.41 to 1.07). Two trials provided data on death and disability. The RR was 0.69 (95% Cl 0.40 to 1.19). One trial compared gastric versus jejunal enteral nutrition, there were no deaths and the RR was not estimable. Authors' conclusions: This review suggests that early feeding may be associated with a trend towards better outcomes in terms of survival and disability. Further trials are required. These trials should report not only nutritional outcomes but also the effect on death and disability.Peer reviewe

The Becklin-Neugebauer Object as a Runaway B Star, Ejected 4000 years ago from the theta^1C system

We attempt to explain the properties of the Becklin-Neugebauer (BN) object as a runaway B star, as originally proposed by Plambeck et al. (1995). This is one of the best-studied bright infrared sources, located in the Orion Nebula Cluster -- an important testing ground for massive star formation theories. From radio observations of BN's proper motion, we trace its trajectory back to Trapezium star theta^1C, the most massive (45 Msun) in the cluster and a relatively tight (17 AU) visual binary with a B star secondary. This origin would be the most recent known runaway B star ejection event, occurring only \~4000 yr ago and providing a unique test of models of ejection from multiple systems of massive stars. Although highly obscured, we can constrain BN's mass (~7 Msun) from both its bolometric luminosity and the recoil of theta^1C. Interaction of a runaway B star with dense ambient gas should produce a compact wind bow shock. We suggest that X-ray emission from this shocked gas may have been seen by Chandra: the offset from the radio position is ~300 AU in the direction of BN's motion. Given this model, we constrain the ambient density, wind mass-loss rate and wind velocity. BN made closest approach to the massive protostar, source ``I'', 500 yr ago. This may have triggered enhanced accretion and thus outflow, consistent with previous interpretations of the outflow being a recent (~10^3 yr) "explosive" event.Comment: 6 pages, accepted to ApJ Letter

Systematic Errors in Cosmic Microwave Background Interferometry

Cosmic microwave background (CMB) polarization observations will require superb control of systematic errors in order to achieve their full scientific potential, particularly in the case of attempts to detect the B modes that may provide a window on inflation. Interferometry may be a promising way to achieve these goals. This paper presents a formalism for characterizing the effects of a variety of systematic errors on interferometric CMB polarization observations, with particular emphasis on estimates of the B-mode power spectrum. The most severe errors are those that couple the temperature anisotropy signal to polarization; such errors include cross-talk within detectors, misalignment of polarizers, and cross-polarization. In a B mode experiment, the next most serious category of errors are those that mix E and B modes, such as gain fluctuations, pointing errors, and beam shape errors. The paper also indicates which sources of error may cause circular polarization (e.g., from foregrounds) to contaminate the cosmologically interesting linear polarization channels, and conversely whether monitoring of the circular polarization channels may yield useful information about the errors themselves. For all the sources of error considered, estimates of the level of control that will be required for both E and B mode experiments are provided. Both experiments that interfere linear polarizations and those that interfere circular polarizations are considered. The fact that circular experiments simultaneously measure both linear polarization Stokes parameters in each baseline mitigates some sources of error.Comment: 19 pages, 9 figures, submitted to Phys. Rev.

Mosaicking with cosmic microwave background interferometers

Measurements of cosmic microwave background (CMB) anisotropies by interferometers offer several advantages over single-dish observations. The formalism for analyzing interferometer CMB data is well developed in the flat-sky approximation, valid for small fields of view. As the area of sky is increased to obtain finer spectral resolution, this approximation needs to be relaxed. We extend the formalism for CMB interferometry, including both temperature and polarization, to mosaics of observations covering arbitrarily large areas of the sky, with each individual pointing lying within the flat-sky approximation. We present a method for computing the correlation between visibilities with arbitrary pointing centers and baselines and illustrate the effects of sky curvature on the l-space resolution that can be obtained from a mosaic.Comment: 9 pages; submitted to Ap

Mapping the 3-D Dark Matter potential with weak shear

We investigate the practical implementation of Taylor's (2002) 3-dimensional gravitational potential reconstruction method using weak gravitational lensing, together with the requisite reconstruction of the lensing potential. This methodology calculates the 3-D gravitational potential given a knowledge of shear estimates and redshifts for a set of galaxies. We analytically estimate the noise expected in the reconstructed gravitational field, taking into account the uncertainties associated with a finite survey, photometric redshift uncertainty, redshift-space distortions, and multiple scattering events. In order to implement this approach for future data analysis, we simulate the lensing distortion fields due to various mass distributions. We create catalogues of galaxies sampling this distortion in three dimensions, with realistic spatial distribution and intrinsic ellipticity for both ground-based and space-based surveys. Using the resulting catalogues of galaxy position and shear, we demonstrate that it is possible to reconstruct the lensing and gravitational potentials with our method. For example, we demonstrate that a typical ground-based shear survey with redshift limit z=1 and photometric redshifts with error Delta z=0.05 is directly able to measure the 3-D gravitational potential for mass concentrations >10^14 M_\odot between 0.1<z<0.5, and can statistically measure the potential at much lower mass limits. The intrinsic ellipticity of objects is found to be a serious source of noise for the gravitational potential, which can be overcome by Wiener filtering or examining the potential statistically over many fields. We examine the use of the 3-D lensing potential to measure mass and position of clusters in 3-D, and to detect clusters behind clusters.Comment: 21 pages, including 24 figures, submitted to MNRA

Metamaterials: optical activity without chirality

We report that the classical phenomenon of optical activity, which is traditionally associated with chirality (helicity) of organic molecules, proteins, and inorganic structures, can be observed in artificial planar media which exhibit neither 3D nor 2D chirality. We observe the effect in the microwave and optical parts of the spectrum at oblique incidence to regular arrays of nonchiral subwavelength metamolecules in the form of strong circular dichroism and birefringence indistinguishable from those of chiral three-dimensional media

Cosmological Consequences of String-forming Open Inflation Models

We present a study of open inflation cosmological scenarios in which cosmic strings form betwen the two inflationary epochs. It is shown that in these models strings are stretched outside the horizon due to the inflationary expansion but must necessarily re-enter the horizon before the epoch of equal matter and radiation densities. We determine the power spectrum of cold dark matter perturbations in these hybrid models, finding good agreement with observations for values of $\Gamma=\Omega_0h\sim0.3$ and comparable contributions from the active and passive sources to the CMB. Finally, we briefly discuss other cosmological consequences of these models.Comment: 11 LaTeX pages with 3 eps figure

A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomised controlled trial.

BACKGROUND: The prevalence of male obesity is increasing but few men take part in weight loss programmes. We assessed the effect of a weight loss and healthy living programme on weight loss in football (soccer) fans. METHODS: We did a two-group, pragmatic, randomised controlled trial of 747 male football fans aged 35-65 years with a body-mass index (BMI) of 28 kg/m(2) or higher from 13 Scottish professional football clubs. Participants were randomly assigned with SAS (version 9·2, block size 2-9) in a 1:1 ratio, stratified by club, to a weight loss programme delivered by community coaching staff in 12 sessions held every week. The intervention group started a weight loss programme within 3 weeks, and the comparison group were put on a 12 month waiting list. All participants received a weight management booklet. Primary outcome was mean difference in weight loss between groups at 12 months, expressed as absolute weight and a percentage of their baseline weight. Primary outcome assessment was masked. Analyses were based on intention to treat. The trial is registered with Current Controlled Trials, number ISRCTN32677491. FINDINGS: 374 men were allocated to the intervention group and 374 to the comparison group. 333 (89%) of the intervention group and 355 (95%) of the comparison group completed 12 month assessments. At 12 months the mean difference in weight loss between groups, adjusted for baseline weight and club, was 4·94 kg (95% CI 3·95-5·94) and percentage weight loss, similarly adjusted, was 4·36% (3·64-5·08), both in favour of the intervention (p<0·0001). Eight serious adverse events were reported, five in the intervention group (lost consciousness due to drugs for pre-existing angina, gallbladder removal, hospital admission with suspected heart attack, ruptured gut, and ruptured Achilles tendon) and three in the comparison group (transient ischaemic attack, and two deaths). Of these, two adverse events were reported as related to participation in the programme (gallbladder removal and ruptured Achilles tendon). INTERPRETATION: The FFIT programme can help a large proportion of men to lose a clinically important amount of weight; it offers one effective strategy to challenge male obesity. FUNDING: Scottish Government and The UK Football Pools funded delivery of the programme through a grant to the Scottish Premier League Trust. The National Institute for Health Research Public Health Research Programme funded the assessment (09/3010/06)

Evaluation of Earbud and Wristwatch Heart Rate Monitors during Aerobic and Resistance Training

International Journal of Exercise Science 12(4): 374-384, 2019. Assessment of biometrics during exercise is evolving to create devices that are “all-inclusive , in an effort to decrease the number of devices required during exercise while providing comprehensive and accurate biometric measures. The purpose of this study was to determine the accuracy of two optical heart rate monitors, the Jabra earbud and the Mio Alpha wristwatch, during aerobic and anaerobic exercise. Twenty-two recreationally active participants (25.4 ± 6.9 years, 171 ± 11 cm, 73.9 ± 3.1 kg, and 25.2 ± 9.2% body fat) completed this study. Participants completed 30 minutes of treadmill activity, 25 minutes of high-intensity interval exercise (HIT), and 40 minutes of continuous outdoor activity of their choice, walking or running. Three heart rate (HR) monitors, (Polar chest strap, Mio Alpha, Jabra earbud) were worn during all exercises, with the Polar chest strap serving as the benchmark. HR was assessed in one-second intervals. Analyses included mean bias, mean absolute percent error (MAPE), and Lin’s concordance coefficient. Overall, the Mio Alpha had a MAPE of 5.73 ± 10.19% and a moderate correlation with the benchmark, r(c) = 0.771, performing better in the treadmill and outdoor conditions. The Jabra earbud had a MAPE of 3.14 ± 6.13%, and a high correlation with the benchmark, r(c) = 0.939, performing well in all three conditions. Placing a HR monitor in an earbud is a viable option for obtaining an accurate HR assessment during different types of exercise. The accuracy of the Mio Alpha was likely affected by wrist movements during the HIT training

Inverting the Sachs-Wolfe Formula: an Inverse Problem Arising in Early-Universe Cosmology

The (ordinary) Sachs-Wolfe effect relates primordial matter perturbations to the temperature variations $\delta T/T$ in the cosmic microwave background radiation; $\delta T/T$ can be observed in all directions around us. A standard but idealised model of this effect leads to an infinite set of moment-like equations: the integral of $P(k) j_\ell^2(ky)$ with respect to k ($0<k<\infty$) is equal to a given constant, $C_\ell$, for $\ell=0,1,2,...$. Here, P is the power spectrum of the primordial density variations, $j_\ell$ is a spherical Bessel function and y is a positive constant. It is shown how to solve these equations exactly for ~$P(k)$. The same solution can be recovered, in principle, if the first ~m equations are discarded. Comparisons with classical moment problems (where $j_\ell^2(ky)$ is replaced by $k^\ell$) are made.Comment: In Press Inverse Problems 1999, 15 pages, 0 figures, Late