The brain-gut interaction: the conversation and the implications

Bi-directional interactions between the gut and the brain play a role in health and disease. It is involved in glucose homeostasis, satiety and obesity, functional gastrointestinal disorders and possibly in inflammatory disorders such as inflammatory bowel disease. Data is starting to elucidate the conversation between the mini brain, enteric nervous system (ENS) and the central nervous system. Various factors play a role in the conversation including sensory output via afferents, neurotransmitters and the gut microbiota

Glucose: the worst of all evils?

The acute phase response is associated with metabolic derangements, including hyperglycaemia. Hyperglycaemia is associated with adverse clinical outcomes, including increased morbidity and mortality in various patient populations. The obvious question is: does tight blood glucose control improve morbidity and mortality in critically ill patients? Tight glycaemic control (TGC) or intensive insulin therapy (IIT) has become a major area of research, debate and controversies. The belief that hyperglycaemia is a physiological response and intervention is only warranted when the renal threshold is exceeded rapidly changed to aggressive control and, currently, clinical practice is moving to a mid-point between the two.

The nutritional management of a central venous incident

A central venous incident (CVI) is the second leading cause of death worldwide, and is associated with permanent disabilities.There are many nutrition and lifestyle modifiable risk factors for a CVI. These include diabetes, and hypercholesterolaemia and hypertension, all of which are largely preventable, and involve effective, low-cost treatment. Malnutrition in CVI patients ranges from 6-62%, and often worsens during hospitalisation owing to multiple factors, including dysphagia, the inadequate intake of food, inactivity and metabolic changes in the clinical setting. When malnutrition is present in patients who have an acute CVI, the increased risk of poor functional outcomes relates to complications such as gastrointestinal bleeding, pressure ulcers, and urinary tract and respiratory infections. These are associated with higher mortality and increased length of stay in hospital, and contribute to decreased quality of life and impaired rehabilitative outcomes. Screening and nutritional assessment is vital on admission. The Mini Nutritional Assessment and Patient-Generated Subjective Global Assessment have been validated in this patient population. The energy and protein requirements of stroke patients are poorly defined. There is some evidence for the supplementation of antioxidants, but the efficacy thereof depends on their ability to cross the blood-brain-barrier. Large-scale studies are necessary to assess the effect on neurocognitive recovery. Meeting requirements in this patient population is a challenge because of dysphagia, as well as neurological and cognitive deficiencies, and is best achieved with the support of a multidisciplinary team. Early enteral nutrition improves survival, while oral nutrition supplements improve nutrient intake and quality of life

Nutritional management of the burn patient

The incidence of burn injuries is on the increase in Africa due to migration to urban areas and the development of slum areas, but there is a paucity of such data on the African continent. The South African Medical Research Council has indicated that 3.2% of the South African population is burned annually, with 50% of individuals who suffer burns being younger than 20 years. The Red Cross Children’s Hospital admits 650 to 900 children with burn injuries annually. Burn injury, the most severe type of injury from a metabolic point of view, is characterised by the most profound alterations in basal metabolic rate and urinary nitrogen excretion. In addition, requirements for and/or metabolism of macro- and micronutrients are altered or increased. The major improvement in burn survival can be attributed to many factors, one being the development and implementation of improved methods of nutritional support that optimise host defences, enhance wound healing and support the metabolic response to stress. The greatest threats to survival from burns are still infection/sepsis, with burn wound sepsis and nosocomial pneumonia, including ventilatorassociated pneumonia (VAP), being the leading causes of death.2,3 Effective medical nutrition therapy in patients with burn  injuries requires an understanding of the physiologic and metabolic alterations that accompany the burn injury, alterations in the immune  system and the role of reactive oxygen species (ROS)

Nutritional assessment of the critically ill patient

Nutritional status screening, assessment and monitoring is essential in the critically ill patient to reduce morbidity and mortality and to decrease hospitalisation costs. We in South Africa should establish where we are in terms of hospital-acquired malnutrition, perform a gap analysis and define a strategy to correct our shortcomings. We need to set a mission and vision for where we want to be. Elements to be addressed will include promoting a greater awareness of the negative consequences of existing and acquired malnutrition in the critically ill patient introducing an appropriate screening tool(s) based on our local patient demographics and financial resources, and sensitise the relevant role players. Adequate nutrition is a vital part of successful treatment, and should be sold as such

Virtual integration platform for computational fluid dynamics

Computational Fluid Dynamics (CFD) tools used in shipbuilding industry involve multiple disciplines, such as resistance, manoeuvring, and cavitation. Traditionally, the analysis was performed separately and sequentially in each discipline, which often resulted in conflict and inconsistency of hydrodynamic prediction. In an effort to solve such problems for future CFD computations, a Virtual Integration Platform (VIP) has been developed in the University of Strathclyde within two EU FP6 projects - VIRTUE and SAFEDOR1. The VIP provides a holistic collaborative environment for designers with features such as Project/Process Management, Distributed Tools Integration, Global Optimisation, Version Management, and Knowledge Management. These features enhance collaboration among customers, ship design companies, shipyards, and consultancies not least because they bring together the best expertise and resources around the world. The platform has been tested in seven European ship design companies including consultancies. Its main functionalities along with advances are presented in this paper with two industrial applications

Highly efficient, dual state emission from an organic semiconductor

We report highly efficient, simultaneous fluorescence and phosphorescence (74% yield) at room temperature from a single molecule ensemble of (BzP)PB dispersed into a polymer host. The slow phosphorescence (208 ms lifetime) is very efficient (50%) at room temperature and only possible because the non-radiative rate for the triplet state is extremely low. The ability of an organic molecule to function as an efficient dual state emitter at room temperature is unusual and opens new fields of applications including the use as broadband down-conversion emitters, optical sensors and attenuators, exciton probes, and spin-independent intermediates for F\"orster resonant energy transfer