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

Accretions of Various Types of Dark Energies onto Morris-Thorne Wormhole

In this work, we have studied accretion of the dark energies onto Morris-Thorne wormhole. For quintessence like dark energy, the mass of the wormhole decreases and phantom like dark energy, the mass of wormhole increases. We have assumed two types of dark energy like variable modified Chaplygin gas (VMCG) and generalized cosmic Chaplygin gas (GCCG). We have found the expression of wormhole mass in both cases. We have found the mass of the wormhole at late universe and this is finite. For our choices the parameters and the function $B(a)$, these models generate only quintessence dark energy (not phantom) and so wormhole mass decreases during evolution of the universe. Next we have assumed 5 kinds of parametrizations of well known dark energy models. These models generate both quintessence and phantom scenarios. So if these dark energies accrete onto the wormhole, then for quintessence stage, wormhole mass decreases upto a certain value (finite value) and then again increases to infinite value for phantom stage during whole evolution of the universe. We also shown these results graphically.Comment: 9 pages, 7 figures. arXiv admin note: text overlap with arXiv:1112.615

Hematological and Biochemical Parameters of Pregnant and Lactating Goats in Rangeland of Cholistan Desert, Bahawalpur, Pakistan

Jattal goats (n=90) of approximately 2-6 years of age being reared in Cholistan desert of Pakistan were studied during January to December, 2015 to examine the alterations in hematochemical parameters of Jattal goats at different reproductive phases while feeding on natural vegetations of desert areas of Cholistan. These were divided into three equal groups (non-pregnant, pregnant and lactating). Blood samples were collected by jugular vein puncture from goats of these three groups. Hematological parameters, white blood cells (WBC), lymphocytes (LYM), monocytes (MON), granulocytes (GRA), red blood cells ( RBC), hemoglobin (Hb), hematocrit ( HCT), mean corpuscular volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration ( MCHC) and red cell distribution width RDW were recorded. The results obtained revealed that all these parameters were generally lower in non-pregnant goats. The study revealed that significant higher values of hemoglobin (Hb), mean cell hemoglobin (MCH) and mean corpuscular volume (MCV) were observed in the lactating goats (P<0.05). Pregnant goats showed a significantly (P<0.05) higher values of leucocytes (WBC) than lactating and non-pregnant goats. Plasma sodium (Na) and potassium (K) concentration were markedly lower in lactating goats. Plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly lower in pregnant goats. The Plasma concentration of cholesterol and triglycerides were higher in pregnant goats. In conclusion in present study changes in some hematochemical parameters have been determined in pregnant, non-pregnant and lactating goats of Jattal breed.Jattal goats (n=90) of approximately 2-6 years of age being reared in Cholistan desert of Pakistan were studied during January to December, 2015 to examine the alterations in hematochemical parameters of Jattal goats at different reproductive phases while feeding on natural vegetations of desert areas of Cholistan. These were divided into three equal groups (non-pregnant, pregnant and lactating). Blood samples were collected by jugular vein puncture from goats of these three groups. Hematological parameters, white blood cells (WBC), lymphocytes (LYM), monocytes (MON), granulocytes (GRA), red blood cells ( RBC), hemoglobin (Hb), hematocrit ( HCT), mean corpuscular volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration ( MCHC) and red cell distribution width RDW were recorded. The results obtained revealed that all these parameters were generally lower in non-pregnant goats. The study revealed that significant higher values of hemoglobin (Hb), mean cell hemoglobin (MCH) and mean corpuscular volume (MCV) were observed in the lactating goats (P<0.05). Pregnant goats showed a significantly (P<0.05) higher values of leucocytes (WBC) than lactating and non-pregnant goats. Plasma sodium (Na) and potassium (K) concentration were markedly lower in lactating goats. Plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly lower in pregnant goats. The Plasma concentration of cholesterol and triglycerides were higher in pregnant goats. In conclusion in present study changes in some hematochemical parameters have been determined in pregnant, non-pregnant and lactating goats of Jattal breed

Free text adversity statements as part of a contextualised admissions process:a qualitative analysis

Abstract Background Medical schools globally are encouraged to widen access and participation for students from less privileged backgrounds. Many strategies have been implemented to address this inequality, but much still needs to be done to ensure fair access for all. In the literature, adverse circumstances include financial issues, poor educational experience and lack of professional-status parents. In order to take account of adverse circumstances faced by applicants, The University of Dundee School of Medicine offers applicants the opportunity to report circumstances which may have resulted in disadvantage. Applicants do this by completing a free text statement, known as an ‘adversity statement’, in addition to the other application information. This study analysed adversity statements submitted by applicants during two admissions cycles. Analysis of content and theme was done to identify the information applicants wished to be taken into consideration, and what range of adverse circumstances individuals reported. Methods This study used a qualitative approach with thematic analysis to categorise the adversity statements. The data was initially analysed to create a coding framework which was then applied to the whole data set. Each coded segment was then analysed for heterogeneity and homogeneity, segments merged into generated themes, or to create sub-themes. Results The data set comprised a total of 384 adversity statements. These showed a wide range of detail involving family, personal health, education and living circumstances. Some circumstances, such as geographical location, have been identified and explored in previous research, while others, such as long term health conditions, have had less attention in the literature. The degree of impact, the length of statement and degree of detail, demonstrated wide variation between submissions. Conclusions This study adds to the debate on best practice in contextual admissions and raises awareness of the range of circumstances and impact applicants wish to be considered. The themes which emerged from the data included family, school, personal health, and geographical location issues. Descriptions of the degree of impact that an adverse circumstance had on educational or other attainment was found to vary substantially from statements indicating minor, impact through to circumstances stated as causing major impact

Predicting hospital-onset Clostridium difficile using patient mobility data: A network approach

This is the final version. Available from Cambridge University Press via the DOI in this record. Objective: To examine the relationship between unit-wide Clostridium difficile infection (CDI) susceptibility and inpatient mobility and to create contagion centrality as a new predictive measure of CDI. Design: Retrospective cohort study. Methods: A mobility network was constructed using 2 years of patient electronic health record data for a 739-bed hospital (n = 72,636 admissions). Network centrality measures were calculated for each hospital unit (node) providing clinical context for each in terms of patient transfers between units (ie, edges). Daily unit-wide CDI susceptibility scores were calculated using logistic regression and were compared to network centrality measures to determine the relationship between unit CDI susceptibility and patient mobility. Results: Closeness centrality was a statistically significant measure associated with unit susceptibility (P< .05), highlighting the importance of incoming patient mobility in CDI prevention at the unit level. Contagion centrality (CC) was calculated using inpatient transfer rates, unit-wide susceptibility of CDI, and current hospital CDI infections. The contagion centrality measure was statistically significant (P< .05) with our outcome of hospital-onset CDI cases, and it captured the additional opportunities for transmission associated with inpatient transfers. We have used this analysis to create easily interpretable clinical tools showing this relationship as well as the risk of hospital-onset CDI in real time, and these tools can be implemented in hospital EHR systems Conclusions: Quantifying and visualizing the combination of inpatient transfers, unit-wide risk, and current infections help identify hospital units at risk of developing a CDI outbreak and, thus, provide clinicians and infection prevention staff with advanced warning and specific location data to inform prevention efforts.University of Rochester Clinical and Translational Science InstituteNational Institutes of HealthBurroughs Wellcome Fund Institutional Program Unifying Population and Laboratory Based Science

Breath of impact: Unveiling the dynamics of exhalation-driven deposition of polydisperse particles in lung across varied physical activities

Continuous deposition of workplace pollutant particles on lung airways during respiratory actions seriously threatens the lung health of persons performing tasks in polluted environments. This study aims to analyze the exhalation-driven deposition of fine and coarse occupational pollutant particles in polydisperse form. Computer simulations are conducted to study the patterns of deposition of grain dust, coal fly ash, and bituminous coal particles. Key findings include the observation of early emergence of secondary flows in the real model, a notable shift in deposition patterns towards the post-bifurcation zones, and influence of physical activity intensity on particle deposition. Additionally, deposition primarily occurs near cranial ridge during inhalation, while exhalation leads to deposition in pre- and post-bifurcation zones. PM2.5 deposition is minimal and random in idealized model but becomes more significant and consistent in real model. This research underscores the increased risk of lung diseases for workers in polluted environments during vigorous activity

Properties of healthcare teaming networks as a function of network construction algorithms

This is the final version. Available on open access from Public Library of Science via the DOI in this recordData Availability: The Center for Medicare Services Outpatient Claims DE-SynPUF (DE-SynPUF)\cite{RN120} test set is publicly available from the CMS web site. The full 2013 Medicare Part B Limited Data Set for Medicare claims can be obtained from the Center for Medicare Services. This data is bound by a privacy and limited distribution agreement, as well as HIPAA regulations, and thus cannot be made public with this manuscript. However, the files can be requested from the Center for Medicare Services by individual investigators and used to reproduce our findings. Release of the derived networks is also limited by Medicare requirements to remove nodes and edges where the total number of shared patients 11 shared patients, and these are available on figshare.com as referenced in the Supplemental Data section of the manuscript.Network models of healthcare systems can be used to examine how providers collaborate, communicate, refer patients to each other, and to map how patients traverse the network of providers. Most healthcare service network models have been constructed from patient claims data, using billing claims to link a patient with a specific provider in time. The data sets can be quite large (106±108 individual claims per year), making standard methods for network construction computationally challenging and thus requiring the use of alternate construction algorithms. While these alternate methods have seen increasing use in generating healthcare networks, there is little to no literature comparing the differences in the structural properties of the generated networks, which as we demonstrate, can be dramatically different. To address this issue, we compared the properties of healthcare networks constructed using different algorithms from 2013 Medicare Part B outpatient claims data. Three different algorithms were compared: Binning, sliding frame, and trace-route. Unipartite networks linking either providers or healthcare organizations by shared patients were built using each method. We find that each algorithm produced networks with substantially different topological properties, as reflected by numbers of edges, network density, assortativity, clustering coefficients and other structural measures. Provider networks adhered to a power law, while organization networks were best fit by a power law with exponential cutoff. Censoring networks to exclude edges with less than 11 shared patients, a common de-identification practice for healthcare network data, markedly reduced edge numbers and network density, and greatly altered measures of vertex prominence such as the betweenness centrality. Data analysis identified patterns in the distance patients travel between network providers, and a striking set of teaming relationships between providers in the Northeast United States and Florida, likely due to seasonal residence patterns of Medicare beneficiaries. We conclude that the choice of network construction algorithm is critical for healthcare network analysis, and discuss the implications of our findings for selecting the algorithm best suited to the type of analysis to be performed.National Institute of HealthPhilip Templeton FoundationUniversity of Rochester Center for Health Informatic

Application of heliox for optimized drug delivery through respiratory tract

Understanding the transportation and deposition (TD) of inhaled particles in the upper respiratory tract is crucial for predicting health risks and treating pulmonary diseases. The available literature reports highly turbulent flow in the extrathoracic (ET) region during normal breathing, which leads to higher deposition of the drug aerosol in this region. To improve the targeted deposition of inhaled drugs, in the tracheobronchial airways, it is essential to understand the flow and particle transport dynamics and reduce the turbulence behavior at the ET region. The less-dense heliox gas could reduce the turbulence behavior at the ET; however, the knowledge of heliox inhalation therapies in drug aerosol TD remains underachieved to realize the full potential for assisted breathing and drug delivery. Additionally, the impact of the inhalation of heliox mixed with other gases on particle deposition is missing in the literature. Therefore, this study aims to develop a mixture model to advance the knowledge of inhalation therapy. A heliox (78% helium and 22% oxygen) and a mixture of heliox and air are used to understand the flow behavior and particle TD in airways. The impact of different inhalation and Stokes numbers on the deposition efficiencies in the ideal and age-specific upper airways is studied. The study reports that less-dense heliox gas has lower turbulence intensity and results in lower deposition efficiency in the G3–G5 lung airways compared to air and mixture inhalations. Moreover, slightly higher deposition efficiencies during mixture inhalation as compared to air inhalation are found in the upper airways. The deposition patterns of different inhalations obtained in this study could help improve targeted drug delivery into the upper and deeper lung airways.</jats:p