A randomised controlled trial of six weeks of home enteral nutrition versus standard care after oesophagectomy or total gastrectomy for cancer: report on a pilot and feasibility study.

BACKGROUND: Poor nutrition in the first months after oesophago-gastric resection is a contributing factor to the reduced quality of life seen in these patients. The aim of this pilot and feasibility study was to ascertain the feasibility of conducting a multi-centre randomised controlled trial to evaluate routine home enteral nutrition in these patients. METHODS: Patients undergoing oesophagectomy or total gastrectomy were randomised to either six weeks of home feeding through a jejunostomy (intervention), or treatment as usual (control). Intervention comprised overnight feeding, providing 50 % of energy and protein requirements, in addition to usual oral intake. Primary outcome measures were recruitment and retention rates at six weeks and six months. Nutritional intake, nutritional parameters, quality of life and healthcare costs were also collected. Interviews were conducted with a sample of participants, to ascertain patient and carer experiences. RESULTS: Fifty-four of 112 (48 %) eligible patients participated in the study over the 20 months. Study retention at six weeks was 41/54 patients (76 %) and at six months was 36/54 (67 %). At six weeks, participants in the control group had lost on average 3.9 kg more than participants in the intervention group (95 % confidence interval [CI] 1.6 to 6.2). These differences remained evident at three months (mean difference 2.5 kg, 95 % CI -0.5 to 5.6) and at six months (mean difference 2.5 kg, 95 % CI -1.2 to 6.1). The mean values observed in the intervention group for mid arm circumference, mid arm muscle circumference, triceps skin fold thickness and right hand grip strength were greater than for the control group at all post hospital discharge time points. The economic evaluation suggested that it was feasible to collect resource use and EQ-5D data for a full cost-effectiveness analysis. Thematic analysis of 15 interviews identified three main themes related to the intervention and the trial: 1) a positive experience, 2) the reasons for taking part, and 3) uncertainty of the study process. CONCLUSIONS: This study demonstrated that home enteral feeding by jejunostomy was feasible, safe and acceptable to patients and their carers. Whether home enteral feeding as 'usual practice' is a cost-effective therapy would require confirmation in an appropriately powered, multi-centre study. TRIAL REGISTRATION: UK Clinical Research Network ID 12447 (main trial, first registered 30 May 2012); UK Clinical Research Network ID 13361 (qualitative substudy, first registered 30 May 2012); ClinicalTrials.gov NCT01870817 (first registered 28 May 2013)

The Finance Act 1956 and the switching of Pension Schemes

The word ‘switch’ has come to be used to describe a variety of operations in connexion with pension schemes. A scheme may be ‘switched’ from one life office to another; a scheme may be ‘switched’ from without-profits to with-profits; or the two operations may be combined. This paper attempts to deal, however, with an operation which is the direct result of the Finance Act 1956—the switching of a scheme approved under Section 388(1) of the Income Tax Act 1952 to a scheme approved under Section 379 of the same Act—and it is assumed that the operation takes place within the one life office.The operation in question has its origin in the somewhat detached view of life taken by our legislators and by the administrators whose duty it is to advise them.</jats:p

Territory Between Product and Project: Rethinking the Limits

Territories are made out of limits. In our almost entirely artificialized territories, distinguishing urban from nature, city from country, becomes more complex and less relevant. However, the relationships between the actors who inhabit these territories and their ecologies are translated into a series of limits: Spatial realities, edges, plots, fences, thresholds, recognizable or invisible features; they produce and design the marks that shape the land, those multiple traces that constantly rewrite it as a palimpsest. Through those marks, the territory shows the social and spatial relationships that are being organized on its ground and inside its soil. Limits as “products” as places of relations, of confrontations and of contrasts between materials of the territory. Urbanism is a discipline that through limits establishes rights. And men, by various means, manipulate, create, install, transform these limits like so many “projects” which organize the relations between them. Therefore, the topic of limits is constantly swinging between a situation rooted in the physical and material reality of the territories and a highly conceptual and projectual concept. This is what makes its ambiguity and its richness. Describing limits in their physical reality, as product, and in their conceptual and transdisciplinary uses, as a project (Corboz in Le territoire comme palimpseste, pp 14–35, 1983), is then a way of looking at Belgian urban and rural territory under the assumption that one can transform the tools built around the concept of limit into the practice of urbanism. In contemporary territories, limits are places of potentiality and it is important to consider their ability to be transformed. This essay investigates the concept of limit in urbanism and its potential reinterpretation within the frame of the Belgian urban landscape

Hedge Funds ::Risks and Regulation /

This text is the inaugural volume of the Institute for Law and Finance Series. It contains the proceedings of the ILF/DAI May 2003 conference entitled "Hedge Funds: Risks and Regulation", and presents papers discussing the economic characteristics of and regulatory strategies for addressing hedge funds. Leading authorities discuss the regulatory frameworks in Germany, the United Kingdom and the United States.[Hedge Funds. Risiken und Regulierung]Bei diesem Buch handelt es sich um den Einführungsband der Schriftenreihe des Institute for Law and Finance. Er enthält die Beiträge der ILF/DAI-Konferenz, die im Mai 2003 unter dem Titel "Hedge Funds: Risiken und Regulierung" stattfand. Die Beiträge diskutieren die wirtschaftlichen Merkmale von Hedge Funds und Strategien der Regulierung von Fonds. Die ersten beiden Aufsätze untersuchen Hedge Funds aus ökonomischem Blickwinkel. Alexander M. Ineichen, Geschäftsführer und Leiter von AIS Research bei UBS, erläutert die ökonomische Realität von Hedge Funds frei von den Mythen, die sich um sie gerankt haben. Im Anschluss stellt Franklin R. Edwards, Professor und Direktor des Zentrums für das Studium von Zukunftsmärkten an der Columbia Business School in New York, dar, wie die Regulierung von Hedge Funds auf ihre ökonomische Kernrealität, die Ziele finanzieller Stabilität und des Schutzes der Investoren zugeschnitten sein müsste. Als nächste stellen Marcia L. MacHarg, Partnerin bei Debevoise & Plimpton LLP, Ashley Kovas, Manager in der Abteilung für Businessstandards der Finanzdienstleistungsbehörde in London, und Edgar Wallach, Partner von Hengeler Mueller, den Stand der relevanten Regulierungsstrukturen in den Vereinigten Staaten, in Großbritannien und in Deutschland vor. Das Buch schließt mit einer Analyse der Gesellschaftsstrukturen, die auf deutsche Hedge Funds angewendet werden, verfasst von Kai-Uwe Steck, einem Mitglied der German Asset Management practice group der Shearman & Sterling LLP