Home parenteral nutrition with an omega-3-fatty-acid-enriched MCT/LCT lipid emulsion in patients with chronic intestinal failure (the HOME study):study protocol for a randomized, controlled, multicenter, international clinical trial

BACKGROUND: Home parenteral nutrition (HPN) is a life-preserving therapy for patients with chronic intestinal failure (CIF) indicated for patients who cannot achieve their nutritional requirements by enteral intake. Intravenously administered lipid emulsions (ILEs) are an essential component of HPN, providing energy and essential fatty acids, but can become a risk factor for intestinal-failure-associated liver disease (IFALD). In HPN patients, major effort is taken in the prevention of IFALD. Novel ILEs containing a proportion of omega-3 polyunsaturated fatty acids (n-3 PUFA) could be of benefit, but the data on the use of n-3 PUFA in HPN patients are still limited. METHODS/DESIGN: The HOME study is a prospective, randomized, controlled, double-blind, multicenter, international clinical trial conducted in European hospitals that treat HPN patients. A total of 160 patients (80 per group) will be randomly assigned to receive the n-3 PUFA-enriched medium/long-chain triglyceride (MCT/LCT) ILE (Lipidem/Lipoplus® 200 mg/ml, B. Braun Melsungen AG) or the MCT/LCT ILE (Lipofundin® MCT/LCT/Medialipide® 20%, B. Braun Melsungen AG) for a projected period of 8 weeks. The primary endpoint is the combined change of liver function parameters (total bilirubin, aspartate transaminase and alanine transaminase) from baseline to final visit. Secondary objectives are the further evaluation of the safety and tolerability as well as the efficacy of the ILEs. DISCUSSION: Currently, there are only very few randomized controlled trials (RCTs) investigating the use of ILEs in HPN, and there are very few data at all on the use of n-3 PUFAs. The working hypothesis is that n-3 PUFA-enriched ILE is safe and well-tolerated especially with regard to liver function in patients requiring HPN. The expected outcome is to provide reliable data to support this thesis thanks to a considerable number of CIF patients, consequently to broaden the present evidence on the use of ILEs in HPN. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03282955. Registered on 14 September 2017

Asia-Pacific Economic and Business History Conference (APEBH 2013): Markets, Institutions and People in Economic Crisis and Recovery

This study investigates the relationship between financial development, international trade and economic growth in case of Australia over the period of 1965-2010. The ARDL bounds testing approach to cointegration was applied to examine the long run relationship among the series, while stationarity properties of the variables were tested by applying two structural break tests i.e. Zivot-Andrews (1992) and Clemente et al. (1998). Our empirical evidence confirmed the long run relationship among the variables. The results showed that financial development, international trade and capital are the drivers of economic growth both in short run as well as in long run. The feedback effect exists between international trade and economic growth. Financial development Granger causes economic growth validating supply-side hypothesis in case of Australia

Construction Accident Factors That Can Be Addressed During the Design Phase

The construction industry experiences accidents at alarmingly high rates, recording the highest fatality rate and the second-highest injury rate among all UK industries as of 2023. Substantial efforts have been directed towards reducing accidents and improving safety. A critical focus is the design phase of construction projects, which holds significant potential to reduce accidents in subsequent phases. This study aimed to identify factors leading to construction accidents that can be moderated during the design phase and the extent of designer influence over these causes. A quantitative survey and qualitative interviews were conducted with construction industry participants worldwide. A total of 298 participants from 46 countries responded to the survey, and six engaged in qualitative interviews. The findings identified five causal variables of accidents that designers can influence during the design phase: the permanent structure, temporary structure, building equipment, building materials, and site environment. However, Qualitative findings further reveal that designers do not exert equal influence over these areas. They have the strongest influence on the permanent structure and building materials, moderate influence on the temporary structure and site environment, and the least influence on building equipment. Content analysis revealed weaknesses in Construction Hazard Prevention through Design (CHPtD) methods and identified eleven challenges faced by designers. These include insufficient consideration of the project’s full life cycle, limited involvement of other stakeholders in design decisions, and inadequate site experience and safety knowledge among designers -all of which hinder effective CHPtD implementation-. The findings underscore the critical role of designers in mitigating construction hazards and highlight the need for targeted interventions to enhance their impact on accident prevention. This study contributes to the field by identifying five key variables and illustrating the degree of influence designers have on each. These insights could improve training for designers on site-specific safety considerations and promote collaboration among stakeholders, making CHPtD more effective, ultimately reducing construction-related accidents and improving overall industry safety

DO TIME MANAGEMENT FACTORS IMPEDE STUDENTS’ ACADEMIC ACHIEVEMENT? : A CASESTUDY – SOHAR UNIVERSITY, OMAN

Purpose: The objective of the research study is to critically analyze the factors impeding time management towards students’ academic performance achievement. Design/methodology/approach: The study was carried out using a well-defined questionnaire collecting samples from 164 undergraduate students studying in the Faculty of Business, Sohar University, Sultanate of Oman from a population of 700 undergraduate students. For the study, the cluster-sampling method was adopted. SPSS was used to perform the statistical analysis. Findings: The empirical results reveal that none of the claimed factors related to time management influence the academic performance of the students. The students’ performance is purely based on their efforts and on their own self-management. Thus, it was concluded that it is the responsibility of the students to manage their time for which they should make their own plans. Practical Implications: The study confirms that the student's stay at the hostel facilitates them to improve their academic performances. It is also interpreted that the students are carried away by the domestic work during their stay at home, parents should take utmost not to deprived of their time for study. Parents should make necessary arrangements to reduce their travel time. Students should have their own self-control and self-commitment to manage and plan their own time for study purposes. Originality/value: The research work is of its first kind as it focuses on the impact of time management factors on the academic performances of the students

The Association between Chronic Arsenic Exposure and Hypertension: A Meta-Analysis

Background. There is inconclusive evidence from cross-sectional and cohort studies that arsenic exposure is a risk factor involved in the development of hypertension. Methods. A database search, using several keywords, was conducted to identify relevant studies. Separate odds ratio estimates for arsenic exposure with concentration only and arsenic exposure with duration, including biomarker, were extracted from studies that met all inclusion criteria. The extracted odds ratios (OR) comparing the highest exposure categories with the lowest in each study were pooled using the random effects methods of meta-analysis. Heterogeneity of odds ratios in the included studies were analyzed using I2 statistics. Results. Eight studies were analyzed. Using the exposure as arsenic concentration in the drinking water, the OR estimate was 1.9 (95% CI: 1.2–3.0), with the I2 = 92%, while using the exposure as concentration and duration, the OR estimate was 1.4 (95% CI: 0.95–2.0) with the I2 = 80%. Meta-regression was done and the quality of exposure measurement was found to be significantly associated with the effect measure. For a one unit increase in the score from exposure assessment, the odds ratio decreased by 6%. No publication bias was evident. The only major weaknesses of this study were heterogeneity across studies and small sample size. Conclusions. The study findings provide limited evidence for a relationship between arsenic and hypertension. In summary, the relationship between arsenic exposure and hypertension is still inconclusive and needs further validation through prospective cohort studies

Wandering Mucosal Melanoma Presenting as Occult Gastrointestinal Blood Loss Anemia

Malignant melanoma is a highly aggressive cancer arising from the skin, retina, and mucosal lining of the respiratory, gastrointestinal (GI), or genitourinary tracts, all of which contain melanocytes. Mucosal or extracutaneous melanomas (ECMs) are rare accounting for 1% of all melanomas. We herein report a case of a metastatic mucosal melanoma presenting as occult blood loss anemia. A 58-year-old male presented with generalized weakness, anorexia, weight loss, and intermittent melena for one year. On exam, he was tachycardic, borderline hypotensive, and pale without epigastric tenderness. Labs showed severe anemia [hemoglobin, Hgb 3.8 mg/dL, mean corpuscular volume (MCV) 72 fl] for which he received two units of red cells. Endoscopy revealed an 8 mm non-bleeding, gastric ulcer with a raised border and a clean base on the wall of the gastric body. Histologic analysis was consistent with malignant melanoma displaying strong positivity for S-100, Melan A, and HMB 45 stains. The CT of the abdomen revealed multifocal metastatic disease with subcutaneous, intramuscular, and perinephric implants with suspicion of small bowel carcinomatosis. The patient underwent an excisional biopsy for the abdominal wall mass and surgical pathology confirmed melanoma. The patient is planned to be started on immunotherapy for advanced disease. Most melanomas found in the GI tract are metastatic. Mucosal melanoma presenting as a gastric ulcer is extremely rare. As a result, metastasis from other sites must be ruled out before making a diagnosis of primary gastric melanoma (PGM). In our case, a widespread disease with unknown primary elucidated the diagnosis but post-operative inspection failed to find any potential lesion on the skin, genitals, or other organs, suggesting the possible diagnosis of metastatic gastric melanoma. However, follow-up is still required to confirm the diagnosis according to the established criteria. Pathologic diagnosis of melanoma requires the identification of melanin in the cytoplasm and immunohistochemistry with specific markers such as S-100, Melan A, and HMB-45. Although the pathologic diagnosis of PGM is similar to cutaneous melanoma, preoperative diagnosis is difficult due to the extremely low incidence, lack of obvious melanin pigmentation, similar microscopic patterns as more common gastric cancers, and lack of awareness among physicians and pathologists. The prognosis of mucosal melanoma is poor, with a five-year survival rate of 25% versus 80% for cutaneous melanoma. Advanced age, surgically unresectable disease, and lymph node involvement are all poor prognostic markers. There is no standard protocol for treatment. Surgery is the only curative treatment for the resectable disease. Adjuvant chemotherapy, radiation, and immunotherapy have an established role in cutaneous melanoma but there is only limited data on adjuvant systemic therapy with mucosal melanoma. Further research is imperative to establish proper management guidelines for this rare disease entity

Clinical and Radiological Evaluation of Pediatric Leukodystrophies: A Prospective Study from a Tertiary Care Center in Pakistan

Objective: To evaluate the clinical and magnetic resonance imaging (MRI) characteristics of pediatric patients with leukodystrophies and assess the diagnostic value of MRI in a low-resource setting. Materials & Methods: This prospective observational study was conducted at the Department of Radiology, Lady Reading Hospital, Peshawar, Pakistan, between January and November 2024. A total of 165 children under 14 years of age with clinically suspected leukodystrophies were included. MRI was performed using a 1.5 Tesla scanner and interpreted independently by two experienced radiologists. Radiological patterns were analyzed and correlated with clinical presentations. Statistical analysis assessed associations between imaging findings and specific symptoms. Results: Of the 165 patients, the mean age was 5.8 years, with a slight male predominance. Spasticity (74%), developmental delay or regression (65%), and seizures (42%) were the most common clinical presentations. MRI revealed bilateral symmetrical white matter abnormalities in 80% of cases. Metachromatic leukodystrophy showed frontal white matter involvement with U-fiber sparing; adrenoleukodystrophy demonstrated occipital changes with contrast enhancement; and Krabbe disease exhibited a tigroid pattern with thalamic and cerebellar involvement. Contrast enhancement was significantly associated with neuroregression (p = 0.01), while cerebellar atrophy correlated with seizures (p = 0.03). Conclusion: MRI provides critical diagnostic value for leukodystrophies in pediatric populations, especially in resource-limited environments. Recognizing characteristic imaging patterns facilitates early diagnosis, aiding timely intervention and improving outcomes