Low myo-inositol and high glutamine levels in brain are associated with neuropsychological deterioration after induced hyperammonemia

The neuropsychological effect of hyperammonemia is variable. This study tests the hypothesis that the effect of ammonia on the neuropsychological function in patients with cirrhosis is determined by the ability of the brain to buffer ammonia-induced increase in glutamine within the astrocyte by losing osmolytes like myo-inositol (mI) and not by the magnitude of the induced hyperammonemia. Fourteen cirrhotic patients with no evidence of overt hepatic encephalopathy were given a 75-g amino acid (aa) solution mimicking the hemoglobin molecule to induce hyperammonemia. Measurement of a battery of neuropsychological function tests including immediate memory, ammonia, aa, and short-echo time proton magnetic resonance spectroscopy were performed before and 4 h after administration of the as solution. Eight patients showed deterioration in the Immediate Memory Test at 4 h. Demographic factors, severity of liver disease, change in plasma ammonia, and as profiles after the as solution were similar in those that showed a deterioration compared with those who did not. In patients who showed deterioration in the memory test, the mI-to-creatine ratio (mI/Cr) was significantly lower at baseline than those that did not deteriorate. In contrast, the glutamate/glutamine-to-Cr ratio was significantly greater in the patients that deteriorated. The observation that deterioration in the memory test scores was greater in those with lower mI/Cr supports the hypothesis that the neuropsychological effects of induced hyperammonemia is determined by the capacity of the brain to handle ammonia-induced increase in glutamine

Media outlets and their moguls: why concentrated individual or family ownership is bad for editorial independence

This article investigates the levels of owner influence in 211 different print and broadcast outlets in 32 different European media markets. Drawing on the literature from industrial organisation, it sets out reasons why we should expect greater levels of influence where ownership of individual outlets is concentrated; where it is concentrated in the hands of individuals or families; and where ownership groups own multiple outlets in the same media market. Conversely, we should expect lower levels of influence where ownership is dispersed between transnational companies. The articles uses original data on the ownership structures of these outlets, and combines it with reliable expert judgments as to the level of owner influence in each of the outlets. These hypotheses are tested and confirmed in a multilevel regression model of owner influence. The findings are relevant for policy on ownership limits in the media, and for the debate over transnational versus local control of media

Use of Russian space hardware in the Space Exploration Initiative

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics, 1993.Includes bibliographical references (leaves 182-193).by Paul J. Shawcross.M.S

One-neutron removal reactions on light neutron-rich nuclei

A study of high energy (43--68 MeV/nucleon) one-neutron removal reactions on a range of neutron-rich psd-shell nuclei (Z = 5--9, A = 12--25) has been undertaken. The inclusive longitudinal and transverse momentum distributions for the core fragments, together with the cross sections have been measured for breakup on a carbon target. Momentum distributions for reactions on tantalum were also measured for a subset of nuclei. An extended version of the Glauber model incorporating second order noneikonal corrections to the JLM parametrisation of the optical potential has been used to describe the nuclear breakup, whilst the Coulomb dissociation is treated within first order perturbation theory. The projectile structure has been taken into account via shell model calculations employing the psd-interaction of Warburton and Brown. Both the longitudinal and transverse momentum distributions, together with the integrated cross sections were well reproduced by these calculations and spin-parity assignments are thus proposed for $^{15}$B, $^{17}$C, $^{19-21}$N, $^{21,23}$O, $^{23-25}$F. In addition to the large spectroscopic amplitudes for the $\nu2$s$_{1/2}$ intruder configuration in the N=9 isotones,$^{14}$B and $^{15}$C, significant $\nu2$s$_{1/2}^2$ admixtures appear to occur in the ground state of the neighbouring N=10 nuclei $^{15}$B and $^{16}$C. Similarly, crossing the N=14 subshell, the occupation of the $\nu2$s$_{1/2}$ orbital is observed for $^{23}$O, $^{24,25}$F. Analysis of the longitudinal and transverse momentum distributions reveals that both carry spectroscopic information, often of a complementary nature. The general utility of high energy nucleon removal reactions as a spectroscopic tool is also examined.Comment: 50 pages, 19 figures, submitted to Phys. Rev.

British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 3: special circumstances

\ua9 2023 BMJ Publishing Group. All rights reserved.The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Part 1 addresses outpatient management of compensated cirrhosis: screening for hepatocellular cancer, varices and osteoporosis, vaccination and lifestyle measures. Part 2 concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. In this, the third part of the guidance, we focus on special circumstances encountered in managing people with cirrhosis, namely surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis

British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 1: compensated cirrhosis

\ua9 2023 BMJ Publishing Group. All rights reserved.The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Here, in part one, we focus on outpatient management of compensated cirrhosis, encompassing hepatocellular cancer surveillance, screening for varices and osteoporosis, vaccination and lifestyle measures. We also introduce a compensated cirrhosis care bundle for use in the outpatient setting. Part two concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. The third part of the guidance covers special circumstances encountered in managing people with cirrhosis: surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis