Patients with Refractory Ascites Treated with alfapump® System have Better Health-related Quality of Life as Compared to those Treated with Large Volume Paracentesis: The Results of a Multicenter Randomized Controlled Study

Background Refractory ascites (RA) is a complication of cirrhosis which is treated with large volume paracentesis (LVP) as the standard of care. Alfapump® system is a fully implantable pump system which reduces the need for LVP. The aim was to assess health-related quality of life (HRQL) in patients treated with alfapump® versus LVP. Methods The data were collected in a multicenter open-label randomized controlled trial (clinicaltrials.gov #NCT01528410). Subjects with cirrhosis Child–Pugh class B or C accompanied by RA were randomized to receive alfapump® or LVP. The SF-36v2 and CLDQ scores were compared between the two treatment arms at screening and monthly during treatment. Results Of 60 subjects randomized, HRQL data were available for 58 (N = 27 received alfapump® and N = 31 received LVP only). At baseline, no differences were seen between the treatment arms (all p > 0.05): age 61.9 ± 8.4, 79.3% male, MELD scores 11.7 ± 3.3, 85.2% Child–Pugh class B, 70.7% had alcoholic cirrhosis. The mean number of LVP events/subject was lower in alfapump® than LVP (1.1 vs. 8.6, p  0.05) in the first 3 months. Multivariate analysis showed that treatment with alfapump® was independently associated with better HRQL at 3 months (total CLDQ score: beta = 0.67 ± 0.33, p = 0.05). Conclusion As compared to LVP, the use of alfapump® system is associated with both a reduction in the number of LVP events and improvement of health-related quality of life

Survey of highly non-Keplerian orbits with low-thrust propulsion

Celestial mechanics has traditionally been concerned with orbital motion under the action of a conservative gravitational potential. In particular, the inverse square gravitational force due to the potential of a uniform, spherical mass leads to a family of conic section orbits, as determined by Isaac Newton, who showed that Kepler‟s laws were derivable from his theory of gravitation. While orbital motion under the action of a conservative gravitational potential leads to an array of problems with often complex and interesting solutions, the addition of non-conservative forces offers new avenues of investigation. In particular, non-conservative forces lead to a rich diversity of problems associated with the existence, stability and control of families of highly non-Keplerian orbits generated by a gravitational potential and a non-conservative force. Highly non-Keplerian orbits can potentially have a broad range of practical applications across a number of different disciplines. This review aims to summarize the combined wealth of literature concerned with the dynamics, stability and control of highly non-Keplerian orbits for various low thrust propulsion devices, and to demonstrate some of these potential applications

Seabird Trophic Position Across Three Ocean Regions Tracks Ecosystem Differences

We analyze recently collected feather tissues from two species of seabirds, the sooty tern (Onychoprion fuscatus) and brown noddy (Anous stolidus), in three ocean regions (North Atlantic, North Pacific, and South Pacific) with different human impacts. The species are similar morphologically and in the trophic levels from which they feed within each location. In contrast, we detect reliable differences in trophic position amongst the regions. Trophic position appears to decline as the intensity of commercial fishing increases, and is at its lowest in the Caribbean. The spatial gradient in trophic position we document in these regions exceeds those detected over specimens from the last 130 years in the Hawaiian Islands. Modeling suggests that climate velocity and human impacts on fish populations strongly align with these differences

Culture and Subjectivity in Neoliberal and postfeminist times

My aim in this paper is to think through a number of issues concerning the relationship between culture and subjectivity. It seems to me that exploring the relationship of changing forms of political organisation, social relations and cultural practices to changing modes and experiences of subjecthood and subjectivity are among the most important and urgent tasks for critical intellectual work. These questions go to the heart of understanding power, ideology and agency and they require research that is interdisciplinary, psychosocial and intersectional. My particular focus in this short article is on the interrelations between changing representational practices in visual culture and changing subjectivity/ies. I argue that neoliberalism and postfeminism are central to understanding contemporary media culture, and I put the case for research which does not retreat from exploring how these broader social/political/economic/cultural discourses and formations may relate to subjectivity

Alfapump® system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study

BACKGROUND AND AIMS: Patients with refractory ascites (RA) require repeated large volume paracenteses (LVP), which involves frequent hospital visits and is associated with a poor quality-of-life. This study assessed safety and efficacy of an automated, low-flow pump (alfapump® [AP]) compared with LVP standard of care [SoC]. METHODS: A randomized controlled trial, in seven centers, with six month patient observation was conducted. Primary outcome was time to first LVP. Secondary outcomes included paracentesis requirement, safety, health-related quality-of-life (HRQoL), and survival. Nutrition, hemodynamics, and renal injury biomarkers were assessed in a sub-study at three months. RESULTS: Sixty patients were randomized and 58 were analyzed (27 AP, 31 SoC, mean age 61.9years, mean MELD 11.7). Eighteen patients were included in the sub-study. Compared with SoC, median time to first LVP was not reached after six months in the AP group, meaning a significant reduction in LVP requirement for the AP patients (AP, median not reached; SoC, 15.0days (HR 0.13; 95%CI 13.0-22.0; p<0.001), and AP patients also showed significantly improved Chronic Liver Disease Questionnaire (CLDQ) scores compared with SoC patients (p<0.05 between treatment arms). Improvements in nutritional parameters were observed for hand-grip strength (p=0.044) and body mass index (p<0.001) in the sub-study. Compared with SoC, more AP patients reported adverse events (AEs; 96.3% vs. 77.4%, p=0.057) and serious AEs (85.2 vs. 45.2%, p=0.002). AEs consisted predominantly of acute kidney injury in the immediate post-operative period, and re-intervention for pump related issues, and were treatable in most cases. Survival was similar in AP and SoC. CONCLUSIONS: The AP system is effective for reducing the need for paracentesis and improving quality of life in cirrhotic patients with RA. Although the frequency of SAEs (and by inference hospitalizations) was significantly higher in the AP group, they were generally limited and did not impact survival

"Mother-weights" and lost fathers: parents in South Asian American literature

That parent-child relationships should play a significant role within South Asian American literature is perhaps no surprise, since this is crucial material for any writer. But the particular forms they so often take – a dysfunctional mother-daughter dynamic, leading to the search for maternal surrogates; and the figure of the prematurely deceased father – are more perplexing. Why do families adhere to these patterns in so many South Asian American texts and what does that tell us about this œuvre? More precisely, why are mothers subjected to a harsher critique than fathers and what purpose does this critique serve? How might we interpret the trope of the untimely paternal death? In this article I will seek to answer these questions – arguably key to an understanding of this growing body of writing – by considering works produced between the 1990s and the early twenty-first century by a range of South Asian American writers

'It is fun, fitness and football really': a process evaluation of a football-based health intervention for men

Concerns about gender inequalities in longevity, particularly premature male mortality, have prompted a range of innovative approaches to health promotion work dating back to the 1980s. In developing such work, sport, and football in particular, has emerged as a gendered cultural field that has utility for engaging men in community health initiatives. Evaluations of such work have shown that health initiatives using football settings, football interventions or even club branding can have positive impact on various health measures in the short and longer term. However, little work to date has looked at the underlying mechanisms that generate success in such projects. This paper presents secondary analysis of data collected during the evaluation of the Premier League Health (PLH) programme specifically focusing on these underlying mechanisms and how/where gender (masculinities) appears in these processes. We draw on interview data with 16 staff who had been involved in the delivery of the PLH initiative and 58 men who took part. Thematic analysis highlighted two overarching (and underpinning) themes: 'Trust', what processes it was key to and how it was developed and sustained; and 'Change', including what it was facilitated by and what impact it had. The paper adds to our understanding of how active listening, flexibility and sustained engagement are key to community-based sports projects' success. Furthermore, it demonstrates how the physicality and sociability of involvement, rather than any direct focus on 'health', are important in acting as a springboard for facilitating reflection and aiding lifestyle changes for men. © 2013 Taylor & Francis

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability