Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre

Background & aims: The key to preventing refeeding syndrome (RS) is identifying and appropriately managing patients at risk. We evaluated our clinical management of RS risk in patients starting total parenteral nutrition (TPN). / Methods: Patients commencing TPN at University College London Hospital between January and July 2015 were prospectively followed-up for 7-days. Eighty patients were risk assessed for RS and categorized into risk groups. High and low risk RS groups were compared focussing on the onset of biochemical features of RS (hypophosphatemia, hypokalaemia and hypomagnesemia) and initial clinical assessment. Statistical analysis was conducted using t-tests and Mann–Whitney U tests. / Results: Sixty patients (75%) were identified as high-risk for RS and received lower initial calories (12.8 kcal/kg/day, p < 0.05). All high-risk patients received a high potency vitamin preparation compared to 35% in the low risk group (p < 0.05). Daily phosphate, magnesium and potassium plasma levels were monitored for seven days in 25%, 30% and 53.8% of patients, respectively. Hypophosphatemia developed in 30% and hypomagnesaemia and hypokalaemia in 27.5% of all patients. Approximately 84% of patients had one or more electrolyte abnormalities, which occurred more frequently in high-risk RS patients (p < 0.05). Low risk patients developed mild hypophosphatemia at a much lower percentage than high-risk RS (20% vs 33.3%, respectively). / Conclusion: A significant proportion of patients commencing TPN developed biochemical features of RS (but no more serious complications) despite nutritional assessment, treatment, and follow up in accordance with national recommendations. High vs low risk RS patients were more likely to have electrolyte abnormalities after receiving TPN regardless of preventative measures. Additional research is required to further optimise the initial nutritional approach to prevent RS in high-risk patients

Capacity Value of Wind Power

Power systems are planned such that they have adequate generation capacity to meet the load, according to a defined reliability target. The increase in the penetration of wind generation in recent years has led to a number of challenges for the planning and operation of power systems. A key metric for generation system adequacy is the capacity value of generation. The capacity value of a generator is the contribution that a given generator makes to generation system adequacy. The variable and stochastic nature of wind sets it apart from conventional energy sources. As a result, the modeling of wind generation in the same manner as conventional generation for capacity value calculations is inappropriate. In this paper a preferred method for calculation of the capacity value of wind is described and a discussion of the pertinent issues surrounding it is given. Approximate methods for the calculation are also described with their limitations highlighted. The outcome of recent wind capacity value analyses in Europe and North America, along with some new analysis, are highlighted with a discussion of relevant issues also given

Identification of occult metastases of medullary thyroid carcinoma by pentagastrin-stimulated intravenous calcitonin sampling followed by targeted surgery

BACKGROUND: High calcitonin (CT) serum levels suggest metastatic spread in medullary thyroid carcinoma (MTC) after thyroidectomy. In limited disease stages, however, morphological investigations including ultrasound, magnetic resonance imaging (MRI) and 18F-FDG positron emission tomography ([18F]FDG-PET) may often fail to identify exact tumour sites. OBJECTIVE: The aim of the present study was to establish an improved strategy to identify small cervical tumours by combining pentagastrin stimulation with bilateral cervical intravenous CT sampling followed by high-resolution ultrasound. DESIGN AND PATIENTS: Six MTC patients were examined, of whom five patients already had bilateral neck dissection. Five patients had sporadic MTC, and one patient suffered from MEN2a. RESULTS: Retrospective analysis of all patients revealed a highly sensitive positive correlation between an early calcitonin peak (20–40 s after pentagastrin injection) and site of cervical tumour affection. Postinterventional ultrasound examination of the affected regions of the neck revealed suspicious presence; in some cases small lymph nodes of less than 1 cm in size were then surgically excised. On histology, small tumours could be identified in four patients. Postsurgical examination revealed a clear decline of basal serum calcitonin levels in four patients (between −41% and −100%). In two patients CT normalized to baseline levels (< 10 pg/ml) and in another two patients CT rendered to near normal (14 and 17 pg/ml). CONCLUSION: Pentagastrin stimulation-based intravenous catheter sampling may be beneficial in the diagnostic work-up of MTC after thyroidectomy. Our data show that an early calcitonin peak (20–40 s after administration of pentagastrin) helps to identify tumour-affected regions

Adiposity in childhood brain tumors: A report from the Canadian Study of determinants of endometabolic health in children (CanDECIDE Study)

Children with brain tumors (CBT) are at high risk of cardiovascular diseases and type 2 diabetes compared to the general population. Recently, adiposity has been reported to be more informative for cardiometabolic risk stratification than body mass index (BMI) in the general population. The goal of this study is to describe the adiposity phenotype in CBT, and to establish adiposity determinants. We recruited CBT (n = 56) and non-cancer controls (n = 106). Percent body fat (%FM), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were measured to determine total and central adiposity, respectively. Regression analyses were used to evaluate adiposity determinants. CBT had higher total and central adiposity compared to non-cancer controls despite having similar BMI measurements. Those with tumors at the supratentorial region had increased total and central adiposity, while those who received radiotherapy had increased total adiposity. In conclusion, CBT have increased total and central adiposity in the presence of similar BMI levels when compared to non-cancer controls. Adiposity, especially central adiposity, is a potential cardiometabolic risk factor present relatively early in life in CBT. Defining interventions to target adiposity may improve long-term outcomes by preventing cardiometabolic disorders in CBT

Estimated incidence of influenza-associated severe acute respiratory infections in Indonesia, 2013-2016

Background: Indonesia’s hospital- based Severe Acute Respiratory Infection (SARI) surveillance system, Surveilans Infeksi Saluran Pernafasan Akut Berat Indonesia (SIBI), was established in 2013. While respiratory illnesses such as SARI pose a significant problem, there are limited incidence- based data on influenza disease burden in Indonesia. This study aimed to estimate the incidence of influenza- associated SARI in Indonesia during 2013- 2016 at three existing SIBI surveillance sites.Methods: From May 2013 to April 2016, inpatients from sentinel hospitals in three districts of Indonesia (Gunung Kidul, Balikpapan, Deli Serdang) were screened for SARI. Respiratory specimens were collected from eligible inpatients and screened for influenza viruses. Annual incidence rates were calculated using these SIBI- enrolled influenza- positive SARI cases as a numerator, with a denominator catchment popula-tion defined through hospital admission survey (HAS) to identify respiratory- coded admissions by age to hospitals in the sentinel site districts.Results: From May 2013 to April 2016, there were 1527 SARI cases enrolled, of whom 1392 (91%) had specimens tested and 199 (14%) were influenza- positive. The overall estimated annual incidence of influenza- associated SARI ranged from 13 to 19 per 100 000 population. Incidence was highest in children aged 0- 4 years (82- 114 per 100 000 population), followed by children 5- 14 years (22- 36 per 100 000 population).Conclusions: Incidence rates of influenza- associated SARI in these districts indicate a substantial burden of influenza hospitalizations in young children in Indonesia. Further studies are needed to examine the influenza burden in other potential risk groups such as pregnant women and the elderly.This work was supported by the U.S. Centers for Disease Control and Prevention [Cooperative Agreement Number 5U51IP000346-05]

Metastatic colorectal cancer to a primary thyroid cancer

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Is cancer prevention influenced by the built environment? A multidisciplinary scoping review

This is the accepted version of the following article: Wray AJD, Minaker LM. Is cancer prevention influenced by the built environment? A multidisciplinary scoping review. Cancer. 2019 Jul 9, which has been published in final form at https://doi.org/10.1002/cncr.32376. This article may be used for non- commercial purposes in accordance with the Wiley Self-Archiving Policy.Background: The built environment is a significant determinant of human health. Globally, the growing prevalence of preventable cancers suggests a need to understand how features of the built environment shape exposure to cancer development and distribution within a population. Methods: We undertook a scoping review of how researchers across disparate fields understand and discuss the built environment in primary and secondary cancer prevention. We focused exclusively on peer-reviewed sources published from research conducted in Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States from 1990 to 2017. Results: The review captured 9958 potential results in the academic literature. We scoped this body of results to 268 relevant peer-reviewed journal articles indexed across 14 subject databases. Spatial proximity, transportation, land use and housing are well understood features of the built environment that shape cancer risk. Conclusions: Built environment features predominantly influence air quality, substance use, diet, physical activity and screening adherence, with impacts on breast, lung, colorectal, and overall cancer risk. The majority of evidence fails to provide direct recommendations for advancing cancer prevention policy and program objectives for municipalities. The expansion of interdisciplinary work in this area would serve to create significant population health impact.Canadian Cancer Society, Grant #704744 || University of Waterloo, Undergraduate Research Initiativ

THE VALUE TO THE SURGEON OF PARATHYROID HORMONE ASSAYS IN PRIMARY HYPERPARATHYROIDISM

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72424/1/j.1445-2197.1988.tb01084.x.pd