Assessment of nutritional status and nutrition impact symptoms in patients undergoing resection for upper gastrointestinal cancer: Results from the multi-centre nourish point prevalence study

Background: Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications. Methods: Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications. Results: This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2–4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications. Conclusions: Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes

Accident causation and pre-accidental driving situations: Part 1. Overview and general statistics

WP2 of the European Project TRACE is concerned with “Types of Situations” to analyse the causation of road traffic accidents from the pre-accidental driving situation point of view. Four complementary situations were defined: stabilized situations, intersection, specific manoeuvre and degradation scenario. To reach this objective, the analysis is based on a common methodology composed on 3 steps: the “descriptive analysis” which from general statistics will allow to identify among the studied situations those them relevant and to give their characteristics, the “in-depth analysis” allowing to obtain accident causes from the generic description of the problems identified in the previous step and the risk analysis identifying the risk of being involved in an accident taking into account the results obtained from the ‘in–depth’ level. This report is dedicated to the descriptive analysis with the identification of the most relevant scenario regarding the situation in which the driver is involved just prior the accident. The results are based on the literature review, general statistics and the analysis of the national databases available in TRACE via WP8. Because the information level differ from databases to another, the available scenario presented here for the 4 predefined types of situations are generics and some specific situations could not have be distinguished. For each situation some key indicators are given, such as prevalence, severity, KSI (killed x severely injured), etc. When it is possible, these indicators are estimated at the EU27 level

Modified Gravity on the Brane and Dark Energy

We analyze the dynamics of an AdS5 braneworld with matter fields when gravity is allowed to deviate from the Einstein form on the brane. We consider exact 5-dimensional warped solutions which are associated with conformal bulk fields of weight -4 and describe on the brane the following three dynamics: those of inhomogeneous dust, of generalized dark radiation, and of homogeneous polytropic dark energy. We show that, with modified gravity on the brane, the existence of such dynamical geometries requires the presence of non-conformal matter fields confined to the brane.Comment: Revised version published in Gen. Rel. Grav. Typos corrected, updated reference and some remarks added for clarity. 11 pages, latex, no figure

Tight-binding g-Factor Calculations of CdSe Nanostructures

The Lande g-factors for CdSe quantum dots and rods are investigated within the framework of the semiempirical tight-binding method. We describe methods for treating both the n-doped and neutral nanostructures, and then apply these to a selection of nanocrystals of variable size and shape, focusing on approximately spherical dots and rods of differing aspect ratio. For the negatively charged n-doped systems, we observe that the g-factors for near-spherical CdSe dots are approximately independent of size, but show strong shape dependence as one axis of the quantum dot is extended to form rod-like structures. In particular, there is a discontinuity in the magnitude of g-factor and a transition from anisotropic to isotropic g-factor tensor at aspect ratio ~1.3. For the neutral systems, we analyze the electron g-factor of both the conduction and valence band electrons. We find that the behavior of the electron g-factor in the neutral nanocrystals is generally similar to that in the n-doped case, showing the same strong shape dependence and discontinuity in magnitude and anisotropy. In smaller systems the g-factor value is dependent on the details of the surface model. Comparison with recent measurements of g-factors for CdSe nanocrystals suggests that the shape dependent transition may be responsible for the observations of anomalous numbers of g-factors at certain nanocrystal sizes.Comment: 15 pages, 6 figures. Fixed typos to match published versio

Towards a formalism for mapping the spacetimes of massive compact objects: Bumpy black holes and their orbits

Observations have established that extremely compact, massive objects are common in the universe. It is generally accepted that these objects are black holes. As observations improve, it becomes possible to test this hypothesis in ever greater detail. In particular, it is or will be possible to measure the properties of orbits deep in the strong field of a black hole candidate (using x-ray timing or with gravitational-waves) and to test whether they have the characteristics of black hole orbits in general relativity. Such measurements can be used to map the spacetime of a massive compact object, testing whether the object's multipoles satisfy the strict constraints of the black hole hypothesis. Such a test requires that we compare against objects with the ``wrong'' multipole structure. In this paper, we present tools for constructing bumpy black holes: objects that are almost black holes, but that have some multipoles with the wrong value. The spacetimes which we present are good deep into the strong field of the object -- we do not use a large r expansion, except to make contact with weak field intuition. Also, our spacetimes reduce to the black hole spacetimes of general relativity when the ``bumpiness'' is set to zero. We propose bumpy black holes as the foundation for a null experiment: if black hole candidates are the black holes of general relativity, their bumpiness should be zero. By comparing orbits in a bumpy spacetime with those of an astrophysical source, observations should be able to test this hypothesis, stringently testing whether they are the black holes of general relativity. (Abridged)Comment: 16 pages + 2 appendices + 3 figures. Submitted to PR

Dark energy generated from a (super)string effective action with higher order curvature corrections and a dynamical dilaton

We investigate the possibility of a dark energy universe emerging from an action with higher-order string loop corrections to Einstein gravity in the presence of a massless dilaton. These curvature corrections (up to $R^4$ order) are different depending upon the type of (super)string model which is considered. We find in fact that Type II, heterotic, and bosonic strings respond differently to dark energy. A dark energy solution is shown to exist in the case of the bosonic string, while the other two theories do not lead to realistic dark energy universes. Detailed analysis of the dynamical stability of the de-Sitter solution is presented for the case of a bosonic string. A general prescription for the construction of a de-Sitter solution for the low-energy (super)string effective action is also indicated. Beyond the low-energy (super)string effective action, when the higher-curvature correction coefficients depend on the dilaton, the reconstruction of the theory from the universe expansion history is done with a corresponding prescription for the scalar potentials.Comment: 15 pages, 7 eps figures, minor corrections, published versio

Cooling Properties of Cloudy Bag Strange Stars

As the chiral symmetry is widely recognized as an important driver of the strong interaction dynamics, current strange stars models based on MIT bag models do not obey such symmetry. We investigate properties of bare strange stars using the Cloudy Bag Model, in which a pion cloud coupled to the quark-confining bag is introduced such that chiral symmetry is conserved. We find that in this model the decay of pions is a very efficient cooling way. In fact it can carry out most the thermal energy in a few milliseconds and directly convert them into 100MeV photons via pion decay. This may be a very efficient $\gamma$-ray burst mechanism. Furthermore, the cooling behavior may provide a possible way to distinguish a compact object between a neutron star, MIT strange star and Cloudy Bag strange star in observations.Comment: 23 pages, 14 figures, accepted by Astroparticle Physics, abstract appeared here has been shortene

Performance of the subcutaneous implantable cardioverter-defibrillator in patients with a primary prevention indication with and without a reduced ejection fraction versus patients with a secondary prevention indication

Background: The subcutaneous implantable defibrillator (S-ICD) provides an alternative to the transvenous ICD for the prevention of sudden cardiac death, but has not been well studied in the most commonly treated transvenous ICD patient population, namely, primary prevention (PP) patients with left ventricular dysfunction. Objective: The analyses in the present study were designed to compar