A systematic review of the nutritional consequences of esophagectomy

Background & aims As improved outcomes after esophagectomy have been observed over the last two decades, the focus on care has shifted to survivorship and quality of life. The aim of this review was to determine changes in nutrition after esophagectomy and to assess the evidence for extended nutrition support. Methods A search strategy was developed to identify primary research reporting change in nutritional status a minimum of one month after esophagectomy. Results Changes in nutritional parameters reported by 18 studies indicated a weight loss of 5–12% at six months postoperatively. More than half of patients lost >10% of body weight at 12 months. One study reported a persistent weight loss of 14% from baseline three years after surgery. Three studies reporting on longer term follow up noted that 27%–95% of patients failed to regain their baseline weight. Changes in dietary intake (three studies) indicated inadequate energy and protein intake up to three years after surgery. Global quality of life scores reported in one study correlated with better weight preservation. There were a high frequency of gastrointestinal symptoms reported in six studies, most notably in the first year after surgery, but persisting up to 19 years. Extended enteral nutrition on a selective basis has been reported in several studies. Conclusions Nutritional status is compromised in the months/years following oesophagectomy and may never return to baseline levels. The causes/consequences of weight loss/impaired nutritional intake require further investigation. The role of extended nutritional support in this population remains unclear

Frost weathering of chalk

The processes and factors that determine the heave and fracture of frost-susceptible bedrock exposed to temperature cycling above and below 0°C are little known but important to understanding of rock deformation, weathering and ground conditions. To investigate the early stages of heave, settlement and fracture of intact chalk, physical modelling experiments were performed on blocks of Saint Cyr Tuffeau and Totternhoe Clunch. Unidirectional (downward) freezing simulated seasonally frozen bedrock in non-permafrost regions, and bidirectional (upward from permafrost and downward from the surface) simulated an active layer above permafrost. Heave and settlement of the top of the blocks were monitored in relation to rock temperature and unfrozen water content. Heave and settlement showed complex behavior that varied with moisture content, freezing regime and time. Progressive heave of wet chalk during thaw periods (simulated summers) is attributed to microcracking in near-surface permafrost. Macrocracking was favoured near the rock top during unidirectional freezing and near the permafrost table during bidirectional freezing, producing extensive fracture networks. Four processes, operating singly or in combination, account for the heave and settlement behavior: (1) thermal expansion and contraction in dry chalk; (2) volumetric expansion of freezing water, causing bursts of heave; (3) ice segregation, causing sustained heave and rock fracture; and (4) freeze‒thaw cycling, causing initial consolidation and settling of wet chalk during unidirectional freezing. The experimental data and field observations of chalk weathering profiles elucidate the nature and origin of chalk brecciation. Type 1 brecciation (angular or subangular rock fragments separated by unfilled fractures with matched sides) is attributed primarily to ice segregation. Type 2 brecciation (subangular to rounded lumps of rock—lithorelicts—set in a fine-grained matrix of the same, but softer and remoulded material) probably resulted from frost weathering and limited ground movement, particularly beneath the sides and bottoms of wet (now dry) valleys

Doubly charged Higgs from ee-γ\gamma scattering in the 3-3-1 Model

We studied the production and signatures of doubly charged Higgs bosons in the process $\gamma e^- \rightarrow H^{--}E^+$, where $E^+$ is a heavy lepton, at the $e^-e^+$ International Linear Collider (ILC) and CERN Linear Collider (CLIC). The intermediate photons are given by the Weizs$\ddot{a}$cker-Williams and laser backscattering distributions. We found that significant signatures are obtained by bremsstrahlung and backward Comptom scattering of laser. A clear signal can be obtained for doubly charged Higgs bosons, doubly charged gauge bosons and heavy leptons

Photon and Z induced heavy charged lepton pair production at a hadron supercollider

We investigate the pair production of charged heavy leptons via photon-induced processes at the proposed CERN Large Hadron Collider (LHC). Using effective photon and Z approximations, rates are given for $L^+L^-$ production due to $\gamma \gamma$ fusion and $Z \gamma$ fusion for the cases of inelastic, elastic and semi-elastic $pp$ collisions. These are compared with the corresponding rates for production via the gluon fusion and Drell-Yan mechanisms. Various $\gamma \gamma$ and $Z \gamma$ differential luminosities for $pp$ collisions are also presented.Comment: 22 pages, RevTex 3.0, 6 uuencoded and compressed postscript figures included. Reference to one paper changed from the original preprint number to the published version. Everything else unchange

A quantitative theory-versus-experiment comparison for the intense laser dissociation of H2+

A detailed theory-versus-experiment comparison is worked out for H$_2^+$ intense laser dissociation, based on angularly resolved photodissociation spectra recently recorded in H.Figger's group. As opposite to other experimental setups, it is an electric discharge (and not an optical excitation) that prepares the molecular ion, with the advantage for the theoretical approach, to neglect without lost of accuracy, the otherwise important ionization-dissociation competition. Abel transformation relates the dissociation probability starting from a single ro-vibrational state, to the probability of observing a hydrogen atom at a given pixel of the detector plate. Some statistics on initial ro-vibrational distributions, together with a spatial averaging over laser focus area, lead to photofragments kinetic spectra, with well separated peaks attributed to single vibrational levels. An excellent theory-versus-experiment agreement is reached not only for the kinetic spectra, but also for the angular distributions of fragments originating from two different vibrational levels resulting into more or less alignment. Some characteristic features can be interpreted in terms of basic mechanisms such as bond softening or vibrational trapping.Comment: submitted to PRA on 21.05.200

Muon Spin Rotation study of the (TMTSF)2ClO4(TMTSF)_2ClO_4 system

We report a study of the organic compound $(TMTSF)_2 ClO_4$ in both a sample cooled very slowly through the anion ordering temperature (relaxed state) and a sample cooled more rapidly (intermediate state). For the relaxed state the entire sample is observed to be superconducting below about T_c ~ 1.2 K. The second moment of the internal field distribution was measured for the relaxed state yielding an in-plane penetration depth of ~ 12000 Angstroms. The intermediate state sample entered a mixed phase state, characterized by coexisting macroscopic sized regions of superconducting and spin density wave (SDW) regions, below T_c ~ 0.87 K. These data were analyzed using a back-to-back cutoff exponential function, allowing the extraction of the first three moments of the magnetic field distribution. Formation of a vortex lattice is observed below 0.87 K as evidenced by the diamagnetic shift for the two fields in which we took intermediate state data.Comment: 6 pages, 3 figures, to be submitted to Physica

Refining and regaining skills in fixation/diversification stage performers: The Five-A Model

Technical change is one of many factors underpinning success in elite, fixation/diversification stage performers. Surprisingly, however, there is a dearth of research pertaining to this process or the most efficacious methods used to bring about such a change. In this paper we highlight the emergent processes, yet also the lack in mechanistic comprehension surrounding technical change, addressing issues within the motor control, sport psychology, coaching and choking literature. More importantly, we seek an understanding of how these changes can be made more secure to competitive pressure, and how this can be embedded within the process of technical change. Following this review, we propose The Five-A Model based on successful coaching techniques, psychosocial concomitants, the avoidance of choking and principles of effective behaviour change. Specific mechanisms for each stage are discussed, with a focus on the use of holistic rhythm-based cues as a possible way of internalising changes. Finally, we suggest the need for further research to examine these five stages, to aid a more comprehensive construction of the content and delivery of such a programme within the applied setting

Pulsar-wind nebulae and magnetar outflows: observations at radio, X-ray, and gamma-ray wavelengths

We review observations of several classes of neutron-star-powered outflows: pulsar-wind nebulae (PWNe) inside shell supernova remnants (SNRs), PWNe interacting directly with interstellar medium (ISM), and magnetar-powered outflows. We describe radio, X-ray, and gamma-ray observations of PWNe, focusing first on integrated spectral-energy distributions (SEDs) and global spectral properties. High-resolution X-ray imaging of PWNe shows a bewildering array of morphologies, with jets, trails, and other structures. Several of the 23 so far identified magnetars show evidence for continuous or sporadic emission of material, sometimes associated with giant flares, and a few possible "magnetar-wind nebulae" have been recently identified.Comment: 61 pages, 44 figures (reduced in quality for size reasons). Published in Space Science Reviews, "Jets and Winds in Pulsar Wind Nebulae, Gamma-ray Bursts and Blazars: Physics of Extreme Energy Release