Mechanisms and Treatment of Weight Loss in Cancer

Weight loss and the development of cancer cachexia are well known to contribute to the morbidity and mortality of cancer patients. Loss of body mass is most commonly due to an imbalance between energy intake and energy expenditure. The aim of this study was to examine the nature of the negative energy balance in cancer patients and evaluate several new approaches to redress the host-tumour imbalance in cancer cachexia

How might your staff react to news of an institutional merger? - A psychological contract approach

Purpose: To understand the nature of staff/ employee (i.e. learning and teaching, curriculum support, and administrative staff) perceptions, anxieties and worries about early merger change in the UK further education (FE) sector. Design/methodology/approach: Survey data was collected from 128 out of 562 employees to examine perceptions of psychological contract (post-merger announcement) on an FE college in England. Paired t-tests were used to analyse quantitative data. Additionally, a content analysis of open-ended questions was incorporated as part of a combined methods survey evaluation approach for discussion and triangulation purposes. Findings: Quantitative results from t-tests showed there had been a decrease in the perception of fulfilled obligations in nine of the ten areas of the psychological contract. Qualitative results indicated that communications, job security and uncertainty were common negative outcomes post-merger announcement. Implications for education managers from the case study include: a need for improved organizational communication; developing trust and mentorship for greater employee support, as well as; promoting further employee training and new opportunities for teamwork. Research limitations/implications: Psychological contract theories for evaluating organizational change are useful given the recent interest in sharing public services and institutional mergers in the UK. This research demonstrates the benefits of using psychological contract, as well as how to apply such an evaluation for understanding staff concerns. Originality/value: The article demonstrates a usable (psychological contract) survey evaluation approach for studying the impact of early merger change on staff in the FE, or higher (HE) education sectors in the UK (or elsewhere)

Repeatability of fractional flow reserve despite variations in systemic and coronary hemodynamics

Objectives This study classified and quantified the variation in fractional flow reserve (FFR) due to fluctuations in systemic and coronary hemodynamics during intravenous adenosine infusion. Background Although FFR has become a key invasive tool to guide treatment, questions remain regarding its repeatability and stability during intravenous adenosine infusion because of systemic effects that can alter driving pressure and heart rate. Methods We reanalyzed data from the VERIFY (VERification of Instantaneous Wave-Free Ratio and Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis Severity in EverydaY Practice) study, which enrolled consecutive patients who were infused with intravenous adenosine at 140 μg/kg/min and measured FFR twice. Raw phasic pressure tracings from the aorta (Pa) and distal coronary artery (Pd) were transformed into moving averages of Pd/Pa. Visual analysis grouped Pd/Pa curves into patterns of similar response. Quantitative analysis of the Pd/Pa curves identified the “smart minimum” FFR using a novel algorithm, which was compared with human core laboratory analysis. Results A total of 190 complete pairs came from 206 patients after exclusions. Visual analysis revealed 3 Pd/Pa patterns: “classic” (sigmoid) in 57%, “humped” (sigmoid with superimposed bumps of varying height) in 39%, and “unusual” (no pattern) in 4%. The Pd/Pa pattern repeated itself in 67% of patient pairs. Despite variability of Pd/Pa during the hyperemic period, the “smart minimum” FFR demonstrated excellent repeatability (bias −0.001, SD 0.018, paired p = 0.93, r2 = 98.2%, coefficient of variation = 2.5%). Our algorithm produced FFR values not significantly different from human core laboratory analysis (paired p = 0.43 vs. VERIFY; p = 0.34 vs. RESOLVE). Conclusions Intravenous adenosine produced 3 general patterns of Pd/Pa response, with associated variability in aortic and coronary pressure and heart rate during the hyperemic period. Nevertheless, FFR – when chosen appropriately – proved to be a highly reproducible value. Therefore, operators can confidently select the “smart minimum” FFR for patient care. Our results suggest that this selection process can be automated, yet comparable to human core laboratory analysis

Maturity and maturity models in lean construction

In recent years there has been an increasing interest in maturity models in management-related disciplines; which reflects a growing recognition that becoming more mature and having a model to guide the route to maturity can help organisations in managing major transformational change. Lean Construction (LC) is an increasingly important improvement approach that organisations seek to embed. This study explores how to apply the maturity models to LC. Hence the attitudes, opinions and experiences of key industry informants with high levels of knowledge of LC were investigated. To achieve this, a review of maturity models was conducted, and data for the analysis was collected through a sequential process involving three methods. First a group interview with seven key informants. Second a follow up discussion with the same individuals to investigate some of the issues raised in more depth. Third an online discussion held via LinkedIn in which members shared their views on some of the results. Overall, we found that there is a lack of common understanding as to what maturity means in LC, though there is general agreement that the concept of maturity is a suitable one to reflect the path of evolution for LC within organisations

A pilot study of megestrol acetate and ibuprofen in the treatment of cachexia in gastrointestinal cancer patients.

Advanced gastrointestinal cancer patients with weight loss and an acute-phase response (n = 15) were given megestrol acetate (480 mg day(-1)) and ibuprofen (1200 mg day(-1)) for 6 weeks. Overall, there was an increase in body weight (P = 0.01) and a reduction in C-reactive protein concentrations (P = 0.02), with no change in total body water (P = 0.24) over this period. This regimen may be an effective non-toxic treatment for cancer cachexia and is worthy of further study

Reflective Functioning and Adolescent Psychological Adaptation: The Validity of the Reflective Functioning Scale-Adolescent Version

Adolescence is a critical period of rapid biological and social development and early signs of adult mental disorders emerge during this life stage. Previous studies suggest that mentalizing failures, specifically difficulties in reflective functioning (RF) are linked with psychological symptoms. However, relatively little is known about the association between RF and psychological adaptation in typical development. In this study, the relationship between RF, internalizing and externalizing symptoms were investigated in 95 adolescents using the revised Reflective Functioning Scale–Adolescent version. Results indicate that RF is associated with more self-reported internalizing symptoms. Moreover, the relationship between RF and externalizing symptoms are accounted for by the co-occurrence of internalizing and externalizing symptoms in typically developing adolescents. The implications of these findings are discussed and suggestions for future studies are presented