Carbohydrates – Guidelines on Parenteral Nutrition, Chapter 5

The main role of carbohydrates in the human body is to provide energy. Carbohydrates should always be infused with PN (parenteral nutrition) in combination with amino acids and lipid emulsions to improve nitrogen balance. Glucose should be provided as a standard carbohydrate for PN, whereas the use of xylite is not generally recommended. Fructose solutions should not be used for PN. Approximately 60% of non-protein energy should be supplied as glucose with an intake of 3.0–3.5 g/kg body weight/day (2.1–2.4 mg/kg body weight/min). In patients with a high risk of hyperglycaemia (critically ill, diabetes, sepsis, or steroid therapy) an lower initial carbohydrate infusion rate of 1–2 g/kg body weight/day is recommended to achieve normoglycaemia. One should aim at reaching a blood glucose level of 80–110 mg/dL, and at least a glucose level <145 mg/dL should be achieved to reduce morbidity and mortality. Hyperglycaemia may require addition of an insulin infusion or a reduction (2.0–3.0 g/kg body weight/day) or even a temporary interruption of glucose infusion. Close monitoring of blood glucose levels is highly important

Making exercise count: Considerations for the role of exercise in back pain treatment

Introduction: Chronic low back pain (CLBP) is pain that has persisted for greater than three months. It is common and burdensome and represents a significant proportion of primary health presentations. For the majority of people with CLBP, a specific nociceptive contributor cannot be reliably identified, and the pain is categorised as ‘non-specific’. Exercise therapy is recommended by international clinical guidelines as a first-line treatment for non-specific CLBP. Aim: This comprehensive review aims to synthesise and appraise the current research to provide practical, evidence-based guidance concerning exercise prescription for non-specific CLBP. We discuss detailed initial assessment and being informed by patient preferences, values, expectations, competencies and goals. Methods: We searched the Cochrane Database of Systematic Reviews, PubMed and the Physiotherapy Evidence Database (PEDro) using broad search terms from January 2000 to March 2021, to identify the most recent clinical practice guidelines, systematic reviews and randomised controlled trials on exercise for CLBP. Results/Discussion: Systematic reviews show exercise is effective for small, short-term reductions in pain and disability, when compared with placebo, usual care, or waiting list control, and serious adverse events are rare. A range of individualised or group-based exercise modalities have been demonstrated as effective in reducing pain and disability. Despite this consensus, controversies and significant challenges remain. Conclusion: To promote recovery, sustainable outcomes and self-management, exercise can be coupled with education strategies, as well as interventions that enhance adherence, motivation and patient self-efficacy. Clinicians might benefit from intentionally considering their own knowledge and competencies, potential harms of exercise and costs to the patient. This comprehensive review provides evidence-based practical guidance to health professionals who prescribe exercise for people with non-specific CLBP

Controlling photocurrent channels in scanning tunneling microscopy

We investigate photocurrents driven by femtosecond laser excitation of a (sub)-nanometer tunnel junction in an ultrahigh vacuum low-temperature scanning tunneling microscope (STM). The optically driven charge transfer is revealed by tip retraction curves showing a current contribution for exceptionally large tip-sample distances, evidencing a strongly reduced effective barrier height for photoexcited electrons at higher energies. Our measurements demonstrate that the magnitude of the photo-induced electron transport can be controlled by the laser power as well as the applied bias voltage. In contrast, the decay constant of the photocurrent is only weakly affected by these parameters. Stable STM operation with photoelectrons is demonstrated by acquiring constant current topographies. An effective non-equilibrium electron distribution as a consequence of multiphoton absorption is deduced by the analysis of the photocurrent using a one-dimensional potential barrier model

Sensitivity limitations in optical speed meter topology of gravitational-wave antennae

The possible design of QND gravitational-wave detector based on speed meter principle is considered with respect to optical losses. The detailed analysis of speed meter interferometer is performed and the ultimate sensitivity that can be achieved is calculated. It is shown that unlike the position meter signal-recycling can hardly be implemented in speed meter topology to replace the arm cavities as it is done in signal-recycled detectors, such as GEO 600. It is also shown that speed meter can beat the Standard Quantum Limit (SQL) by the factor of $\sim 3$ in relatively wide frequency band, and by the factor of $\sim 10$ in narrow band. For wide band detection speed meter requires quite reasonable amount of circulating power $\sim 1$ MW. The advantage of the considered scheme is that it can be implemented with minimal changes in the current optical layout of LIGO interferometer.Comment: 20 pages, 12 figure

Postoperative Immune Suppression in Visceral Surgery: Characterisation of an Intestinal Mouse Model

Background: Postoperatively acquired immune dysfunction is associated with a higher mortality rate in case of septic complications. As details of this severe clinical problem are still unknown, animal models are essential to characterise the mechanisms involved. Methods: Mice were laparotomised and the small intestine was pressed smoothly in antegrade direction. For extension of trauma, the intestine was manipulated three times consecutively. Following this, the ex vivo cytokine release of splenocytes was determined. The degree of surgical trauma was analysed by detection of HMGB1 and IL-6 in serum and by neutrophil staining in the muscularis mucosae. Results: We adapted the previously described animal model of intestinal manipulation to provide a model of surgically induced immune dysfunction. Following intestinal manipulation, the mice showed elevated serum levels of HMGB1 and IL-6 and increased infiltration of granulocytes into the muscularis mucosae. Ex vivo cytokine release by splenocytes was suppressed in the postoperative period. The degree of suppression correlated with the extent of surgical trauma. Conclusions: In this study, we describe a surgically induced immune dysfunction animal model, in which a significant surgical trauma is followed by an immune dysfunction. This model may be ideal for the characterisation of the postoperative immune dysfunction syndrome

Sagnac Interferometer as a Speed-Meter-Type, Quantum-Nondemolition Gravitational-Wave Detector

According to quantum measurement theory, "speed meters" -- devices that measure the momentum, or speed, of free test masses -- are immune to the standard quantum limit (SQL). It is shown that a Sagnac-interferometer gravitational-wave detector is a speed meter and therefore in principle it can beat the SQL by large amounts over a wide band of frequencies. It is shown, further, that, when one ignores optical losses, a signal-recycled Sagnac interferometer with Fabry-Perot arm cavities has precisely the same performance, for the same circulating light power, as the Michelson speed-meter interferometer recently invented and studied by P. Purdue and the author. The influence of optical losses is not studied, but it is plausible that they be fairly unimportant for the Sagnac, as for other speed meters. With squeezed vacuum (squeeze factor $e^{-2R} = 0.1$) injected into its dark port, the recycled Sagnac can beat the SQL by a factor $\sqrt{10} \simeq 3$ over the frequency band 10 {\rm Hz} \alt f \alt 150 {\rm Hz} using the same circulating power $I_c\sim 820$ kW as is used by the (quantum limited) second-generation Advanced LIGO interferometers -- if other noise sources are made sufficiently small. It is concluded that the Sagnac optical configuration, with signal recycling and squeezed-vacuum injection, is an attractive candidate for third-generation interferometric gravitational-wave detectors (LIGO-III and EURO).Comment: 12 pages, 6 figure

Surgical Trauma and Postoperative Immune Dysfunction

Background: In postoperative sepsis, mortality is increased due to the surgically induced immune dysfunction. Further causes of this traumatic effect on the immune system include burn injuries and polytrauma, as well as endogenous traumata like stroke. Several animal models have been defined to analyse the characteristics of trauma-induced immune suppression. This article will correlate our results from animal studies and clinical observations with the recent literature on postoperative immune suppression. Methods: The previously described model of surgically induced immune dysfunction (SID) was performed in mice by laparotomy and manipulation of the small intestine in the antegrade direction. Blood samples were collected 6 and 72 h following SID to analyse the white blood cell count and corticosterone levels. To assess the postoperative immune status in humans, we analysed expression of HLA-DR on monocytes of 118 patients by flow cytometry prior to and 24, 48 and 72 h after surgery. Results: The postoperative immune suppression in our SID model is characterised by lymphocytopenia and significantly increased corticosterone levels in mice dependent on the degree of surgical trauma. This is comparable to the postoperative situation in humans: major and especially long-lasting surgery results in a significantly reduced expression of HLA-DR on circulating monocytes. Previous studies describe a similar situation following burn injury and endogenous trauma, i.e. stroke. Conclusions: We suggest the completion of our previously published sepsis classification due to the immune status at the onset of sepsis: type A as the spontaneously acquired sepsis and type B as sepsis in trauma-induced pre-existing immune suppression

QND measurements for future gravitational-wave detectors

Second-generation interferometric gravitational-wave detectors will be operating at the Standard Quantum Limit, a sensitivity limitation set by the trade off between measurement accuracy and quantum back action, which is governed by the Heisenberg Uncertainty Principle. We review several schemes that allows the quantum noise of interferometers to surpass the Standard Quantum Limit significantly over a broad frequency band. Such schemes may be an important component of the design of third-generation detectors.Comment: 22 pages, 6 figures, 1 table; In version 2, more tutorial information on quantum noise in GW interferometer and several new items into Reference list were adde

Single shot acquisition of spatially resolved spin wave dispersion relations using X ray microscopy

For understanding magnonic materials the fundamental characterization of their frequency response is essential. However, determining full dispersion relations and real space wavelength measurements are challenging and time-consuming tasks. We present an approach for spin wave excitation by a modified Sinc pulse, which combines a cosine signal with a conventional Sinc function. The resulting adjustable frequency bands lead to a broadband spin wave excitation at uniform power levels. Subsequently, time resolved scanning transmission X-ray microscopy is used for direct imaging of all excited spin waves in real space. To demonstrate the capabilities of this approach, a modified Sinc excitation of an ultra-thin yttrium-iron-garnet film is shown that simultaneously reveals phase, amplitude, and k-space information from a single measurement. Consequently, this approach allows a fast and thorough access to the full dispersion relation including spatial maps of the individual spin wave modes, enabling complete characterization of magnonic materials down to the nanoscale in real and reciprocal space

A Prospective Study of the Association of Metacognitive Beliefs and Processes with Persistent Emotional Distress After Diagnosis of Cancer

Two hundred and six patients, diagnosed with primary breast or prostate cancer completed self-report questionnaires on two occasions: before treatment (T1) and 12 months later (T2). The questionnaires included: the Hospital Anxiety and Depression Scale; Impact of Events Scale; the Metacognitions Questionnaire-30 (MCQ-30) and the Illness Perceptions Questionnaire-revised. A series of regression analyses indicated that metacognitive beliefs at T1 predicted between 14 and 19 % of the variance in symptoms of anxiety, depression and trauma at T2 after controlling for age and gender. For all three outcomes, the MCQ-30 subscale ‘negative beliefs about worry’ made the largest individual contribution with ‘cognitive confidence’ also contributing in each case. For anxiety, a third metacognitive variable, ‘positive beliefs about worry’ also predicted variance in T2 symptoms. In addition, hierarchical analyses indicated that metacognitive beliefs explained a small but significant amount of variance in T2 anxiety (2 %) and T2 depression (4 %) over and above that explained by demographic variables, T1 symptoms and T1 illness perceptions. The findings suggest that modifying metacognitive beliefs and processes has the potential to alleviate distress associated with cancer