A Comparison of Vegetarian Diets and the Standardized Western Diet in Nutrient Adequacy and Weight Status

Over the past several decades, Americans have shifted how much and of what kinds of meats they consume, and sometimes totally exclude animal products. As many as 11% of Americans follow some kind of vegetarian diet, which have been linked to lower rates of obesity, heart disease, and diabetes mellitus; however, these diets may increase the likelihood of deficient in several key nutrients commonly obtained from meat-containing foods, such as calcium, iron, protein, and vitamin B12 . The objective of this research was to compare the nutritional and weight status among vegans (those who consumed no animal products), lacto-ovo vegetarians (consumed no meat but dairy and egg products), and omnivores (meat eaters). Dietary intakes from the National Health and Nutrition Examination Survey (NHANES) were recoded the diets into vegan, lacto-ovo vegetarians, and meat eaters based on the foods reported during their 24-hour dietary recall interview. Weight status was assessed using measured height and weight for body mass index (BMI) and waist circumference (WC). The nutrient intakes were compared to the recommended intakes of the Dietary Reference Intakes. Vegans and vegetarians were significantly less likely to be obese or centrally obese compared to meat eaters (P<0.001). Vegans and vegetarians had significantly lower total and energy-adjusted intakes of protein, calcium, vitamin C, and fiber, compared to omnivores (P<0.001). Less than a quarter of vegans met recommendations for intakes of protein, fiber, vitamin B12, calcium and magnesium (P<0.01). Despite having healthier weight status profile, vegans and vegetarians were more likely to have inadequate intakes of key nutrients needed to sustain a healthy lifestyle. Vegans and vegetarians may need education on the strengths and weaknesses of each diet to optimize their health status based on their lifestyle diet choice.No embarg

Improving Health Literacy Among Veterans Through an Educational Campaign on Urgent and Emergent Care: A Quality Improvement Project

Background: Inappropriate use of the VAMC UCC can translate to delays in care and costly transfers. A local VAMC UCC noted that many of their veterans presented for care at the UCC rather than choose to seek care at a local emergency department. This quality improvement project focused on the impact of educational handouts in improving understanding of the VAMC UCC capabilities to overall reduce inappropriate visits and delays in patient care. Methods: Veteran participants utilizing the UCC (n = 10) completed pre-intervention surveys regarding their current health literacy using the Brief Health Literacy screening tool (BRIEF), as well as current knowledge on the VAMC UCC. Participants also completed a quiz on which facilities they would use for certain conditions, such as chest pain or cold symptoms. Following the pre-intervention survey, participants were provided with an educational handout summarizing the appropriate uses of the UCC as well as frequently asked questions about the VAMC. Results: The post-intervention survey responses resulted in a 4% improvement in knowledge about use of UCC and emergency services, and 80% of the participants stating they would use this handout in the future when choosing health care services. Conclusion: Overall, this project shows potential at improving understanding of patients visiting the VAMC UCC, and in the future reducing inappropriate visits and delays in care

Cutting Out the Middleman: Why Look and Feel Should Be Ignored in Trade Dress Law

(Excerpt) Part I of this Note discusses the background and elements of general trade dress law. Part II discusses the narrower issue of look and feel in the context of websites and outlines how courts have currently addressed the look and feel issue. Part III proposes that courts ignore the artificial look and feel distinction and instead apply normal trade dress analyses and elements. This solution, which requires that courts adhere to a workable standard that serves the underlying purpose of trade dress law, allows recognition of the distinctive characteristics of website trade dress claims, while reducing the risk of overprotection by keeping vague and generic terms, like look and feel, out of the calculation

Chronic Idiopathic Intestinal Pseudo-Obstruction: A Working Diagnosis

Introduction Chronic intestinal pseudo-obstruction (CIP) is a rare and disabling motility syndrome, yet one that demands an extensive review of digestive motility and peristaltic pathophysiology. Primarily a disorder of the small intestine, CIP was first described by Dudley and colleagues in 1958; it is defined by severe signs and symptoms of intestinal obstruction (abdominal pain and distention, nausea, vomiting, and constipation), in addition to radiographic evidence of dilated bowel in the absence of a true, mechanical obstruction. Symptoms are often slowly progressive and diagnosis requires the presence of symptoms for at least six months.1 A 2013 national survey in Japan estimated the prevalence of CIP at 0.8 to 1.0 per 100,000, with an incidence rate of 0.21 to 0.24 per 100,000. In the same survey, the mean age at diagnosis is 63.1 years for males and 59.2 for females.2 CIP encompasses an extensive differential diagnosis, a complex, multidisciplinary work-up, and a vast array of potential treatment options based in intricate pathophysiology. CASE PRESENTATION: RC is a 75-year-old male who presented with recurrent small bowel obstructions (SBOs) between August and September 2014. He has no chronic medical conditions, and his past medical history is significant only for a community-acquired pneumonia and pleural empyema at age 50. His surgical history is significant only for a right inguinal hernia repair at age 7. Initially, his symptoms began in April 2014 and were mild, limited to constipation relieved with over the counter laxatives. After two brief admissions for SBOs that resolved with nasogastric tube decompression, RC presented on September 9, 2014 with a distended, tympanitic abdomen with absence of bowel sounds and minimal tenderness to palpation. A computed tomography (CT) scan demonstrated multiple dilated loops of small bowel with a transition point in the proximal ileum. A nasogastric tube was again placed but the obstruction persisted clinically and on repeat X-Rays. During an exploratory laparoscopy on September 15, 2014, the right colon and entire small bowel were palpated. No transition zone or small bowel abnormality was found and the peritoneal surfaces of all abdominal organs appeared normal. Ultimately, an ileocecectomy was performed and RC underwent a thorough diagnostic workup

Persistent risk for new, subsequent new and recurrent hepatocellular carcinoma despite successful anti-hepatitis B virus therapy and tumor ablation: The need for hepatitis B virus cure.

Hepatitis B virus (HBV) is one of the most significant hepatocarcinogens. The ultimate goal of anti-HBV treatment is to prevent the development of hepatocellular carcinoma (HCC). During the last two decades, with the use of currently available anti-HBV therapies (lamivudine, entecavir and tenofovir disoproxil fumatate), there has been a decrease in the incidence of HBV-associated HCC (HBV-HCC). Furthermore, several studies have demonstrated a reduction in recurrent or new HCC development after initial HCC tumor ablation. However, during an observation period spanning 10 to 20 years, several case reports have demonstrated the development of new, subsequent new and recurrent HCC even in patients with undetectable serum HBV DNA. The persistent risk for HCC is attributed to the presence of covalently closed circular DNA (cccDNA) in the hepatocyte nucleus which continues to work as a template for HBV replication. While a functional cure (loss of hepatitis B surface antigen and undetectable viral DNA) can be attained with nucleos(t)ide analogues, these therapies do not eliminate cccDNA. Of utmost importance is successful eradication of the transcriptionally active HBV cccDNA from hepatocyte nuclei which would be considered a complete cure. The unpredictable nature of HCC development in patients with chronic HBV infection shows the need for a complete cure. Continued support and encouragement for research efforts aimed at developing curative therapies is imperative. The aims of this minireview are to highlight these observations and emphasize the need for a cure for HBV

Celiac Disease: Clinical-Pathological Correlation in 100 Consecutive Patients

Introduction: Celiac Disease (CD) is an autoimmune disease that manifests as inflammation in the small intestine that can be measured by both serology (tTG-IgA) and pathology (Marsh scores). Despite having two clear etiologies defining the disease, the relationship between these markers and the clinical presentation is unclear but the age at presentation has thought to be correlated with a worsened pathology. Methods: This was a retrospective chart review at Thomas Jefferson University Hospital (TJUH). The study consisted of patients diagnosed with Celiac Disease at TJUH with both a Marsh score and a tTG-IgA antibody result. Analysis via correlation statistics looked at the relationship between age at diagnosis, body-mass index (BMI), presenting symptoms/complications, adherence to diet, and appropriate clinical values. Results: There was no correlation between serological and pathological markers. There was no correlation between presenting age and Marsh score. Patients who fit the clear-cut definition for Celiac Disease presented with a wide variety of symptoms. The three major presenting symptoms were abdominal pain, bloating, and diarrhea. Discussion: This study confirmed the nonspecific findings associated with the clinical presentation of Celiac Disease. Further investigation is warranted to determine the efficacy of implementing a screening protocol for Celiac Disease

Effect of Pooled Human Intravenous Globulin (IVIG) on the Reversal of Cholinergic Inhibition of Smooth Muscle by Immunoglobulins (IgGs) from Patients with Scleroderma (SSc)

Poster presented at: Digestive Disease Week (DDW) International meeting in San Diego, California. Backgrounds and Aims: The gastrointestinal (GI) tract is the most common internal organ system affected in SSc. We and others have shown before that the SSc immunoglobulins (IgGs) cause selective blockade of muscarinic type-3 cholinergic (M3-R) in the GI tract. Presently, there is no effective treatment for SSc although numerous cytotoxic and immunomodulatory agents have been employed with limited success and are marred with serious side effects. Present studies investigated the reversibility of SScIgGs-caused M3-R blockade by the pooled Intravenous immunoglobulins (IVIG)

Usefulness of Highly Sensitive AFP-L3 and DCP in Surveillance for Hepatocellular Carcinoma in Patients with a Normal Alpha-Fetoprotein

Background and aims: Early detection of Hepatocellular Carcinoma (HCC) is crucial for effective management. Incidence of HCC has increased in the United States largely attributed to hepatitis B and C virus. Lens culinaris agglutinin-reactive Alpha-Fetoprotein (AFP-L3) and Des-Gamma-Carboxy Prothrombin (DCP) are being recognized specific biomarkers for HCC. Methods: We measured AFP-L3 and DCP in serial serum specimens of a cohort of chronic hepatitis patients on HCC surveillance and compared these markers to abdominal imaging. Among fifty patients who developed HCC during surveillance, 30 were included in the study with available sera 1-2 years before, at diagnosis and post ablation of HCC. For controls, three consecutive annual sera were examined from 106 chronic hepatitis patients without HCC during surveillance for 5-10 years. The μTASWako i30 auto analyzer was used for the assay that utilizes the microfluidics chip based assay platform. It can fractionate AFP-L3 glycoform and calculates AFP-L3% if AFP level is ≥ 0.6 ng/mL. Results: Combination of AFP, AFP-L3 and DCP showed high sensitivity of 83% in all patients and 75% in patients with AFP\u3c20 ng/mL. AFP-L3 and DCP assays were useful in patients with low levels of AFP (\u3c20 ng/mL) and could detect significant AFP-L3% elevation in some patients more than one year before the diagnosis of HCC. Furthermore, AFP-L3 predicted recurrence of HCC. Conclusions: This is the first study in the U.S. patients using the μTASWako i30 analyzer to test these HCC biomarkers. Our results suggest that combinations of these biomarkers are highly useful for early detection of HCC

10-kV SiC MOSFET Power Module With Reduced Common-Mode Noise and Electric Field

The advancement of silicon carbide (SiC) power devices with voltage ratings exceeding 10 kV is expected to revolutionize medium- and high-voltage systems. However, present power module packages are limiting the performance of these unique switches. The objective of this research is to push the boundaries of high-density, high-speed, 10-kV power module packaging. The proposed package addresses the well-known electromagnetic and thermal challenges, as well as the prominent electrostatic and electromagnetic interference (EMI) issues associated with high-speed, 10-kV devices. The high-speed switching and high voltage rating of these devices causes significant EMI and high electric fields. Existing power module packages are unable to address these challenges, resulting in detrimental EMI and partial discharge that limit the converter operation. This article presents the design and testing of a 10-kV SiC mosfet power module that switches at a record 250 V/ns without compromising the signal and ground integrity due to an integrated screen reduces the common-mode current by ten times. This screen connection simultaneously increases the partial discharge inception voltage by more than 50%. With the integrated cooling system, the power module prototype achieves a power density of 4 W/mm 3

A wire-bond-less 10 KV SiC MOSFET power module with reduced common-mode noise and electric field

While wide-bandgap devices offer many benefits, they also bring new challenges for designers. In particular, the new 10 kV silicon carbide (SiC) MOSFETs can switch higher voltages faster and with lower losses than silicon devices while also being smaller in size. These features can result in premature dielectric breakdown, higher voltage overshoots, high-frequency current and voltage oscillations, and greater electromagnetic interference. In order to mitigate these side effects and thus fully utilize the benefits of these unique devices, advanced module packaging is needed. This work proposes a power module package with a small footprint (68 mm × 83 mm), low gate- and power-loop inductances (4 nH), increased partial discharge inception voltage (53 %), and reduced common-mode current (90 %)