bluuebunny/crossref_metadata_2025 huggingface dataset:
Parenteral nutrition in the critically-ill patient: more harm than good?
Authors: Heyland D. K.
Published: February 2011

While many studies have reported that providing parenteral nutrition (PN) can change nutritional outcomes, there are limited data that demonstrate that PN influences clinically-important end points in critically-ill patients. The purpose of the present paper is to systematically review and critically appraise the literature to examine the relationship between PN and morbidity and mortality in the critically-ill patient. Studies comparing enteral nutrition (EN) with PN and studies comparing PN with no PN were reviewed. The results suggest that EN is associated with reduced infectious complications in some critically-ill subgroups. PN, on the other hand, is associated with increased morbidity and mortality in critically-ill patients. When nutritional support is indicated, EN should be used preferentially over PN. Further studies are needed to define the optimal timing and composition of PN in patients not tolerating sufficient EN. Strategies to optimize EN delivery and minimize PN utilization in critically-ill patients are indicated.
Summary of a systematic review on oral nutritional supplement use in the community
Authors: Stratton Rebecca J.
Published: February 2011

Despite a marked increase in the prescription of oral nutritional supplements (ONS) in the community (Department of Health, 1991–7), there is still uncertainty about the value of their use in patients with different diseases. To answer questions about the effects on ONS on body weight and structure, spontaneous food intake and body function, a critical systematic review was undertaken (Stratton & Elia, 1999a). Eighty-four trials were reviewed (forty-five randomized, thirty-nine non-randomized; 2570 patients; diagnoses including chronic obstructive pulmonary disease, Crohn’s disease, cystic fibrosis, human immunodeficiency virus and acquired immune deficiency syndrome and cancer). Most studies (83 %) were conducted in patients living at home. The supplements were typically mixed macronutrients in liquid form, providing < 0.42–10.5 MJ/d for 1 week–2 years. The studies reviewed in patients with predominantly chronic conditions living in the community suggested that: (1) ONS produce demonstrable clinical (including functional) benefits, but the nature and extent of these benefits varies with the underlying chronic condition; (2) ONS increase total energy intake with > 50 % of the energy from ONS typically additional to that from habitual food intake; (3) improvements in body weight, total energy intake and body function following ONS appear to occur more frequently in individuals with a BMI < 20 kg/m2 than in those with a BMI > 20 kg/m2.
Charting the physical activity patterns of contemporary children and adolescents
Authors: Fox Kenneth R. , Riddoch Chris
Published: February 2011

The impact of physical inactivity on health is well accepted throughout the medical and health service community. However, the case has largely been established through epidemiological studies with adults. Substantial attention has been paid to the activity levels of children and adolescents, largely because of changing lifestyles that have threatened the opportunity to be active and also introduced attractive sedentary alternatives such as playing computer games. The research evidence that children have become less active to the point where it is seriously damaging their current and future health has been difficult to establish. This situation is due to difficulties in establishing sensitive health risk markers, and also with the assessment of the different elements of physical activity which in children and adolescents is a complex profile of social behaviours. Self report of activity is unreliable with young children, and objective measures are required that are cheap and effective with large samples and that are capable of measuring levels, volume and patterns of physical activity. Accelerometry in combination with diaries offers the best current solution for most activity–health relationships, and for informing intervention need and design.
Cellular and molecular aspects of iron and immune function
Authors: Brock Jeremy H. , Mulero Victoriano
Published: February 2011

Fe plays a critical role in the immune system and defence against infection. However, many aspects of the way in which Fe influences these processes at the molecular and cellular level are unclear. The present review summarizes the role of Fe in lymphocyte activation and proliferation, and discusses how Fe is handled by macrophages.
Glutathione and immune function
Authors: Dröge Wulf , Breitkreutz Raoul
Published: February 2011

The immune system works best if the lymphoid cells have a delicately balanced intermediate level of glutathione. Even moderate changes in the intracellular glutathione level have profound effects on lymphocyte functions. Certain functions, such as the DNA synthetic response, are exquisitely sensitive to reactive oxygen intermediates and, therefore, are favoured by high levels of the antioxidant glutathione. Certain signal pathways, in contrast, are enhanced by oxidative conditions and favoured by low intracellular glutathione levels. The available evidence suggests that the lymphocytes from healthy human subjects have, on average, an optimal glutathione level. There is no indication that immunological functions such as resistance to infection or the response to vaccination may be enhanced in healthy human subjects by administration of glutathione or its precursor amino acid cysteine. However, immunological functions in diseases that are associated with a cysteine and glutathione deficiency may be significantly enhanced and potentially restored by cysteine supplementation. This factor has been studied most extensively in the case of human immunodeficiency virus (HIV)-infected patients who were found to experience, on average, a massive loss of S equivalent to a net loss of approximately 4 g cysteine/d. Two randomized placebo-controlled trials have shown that treatment of HIV-infected patients with N-acetyl-cysteine caused in both cases a significant increase in all immunological functions under test, including an almost complete restoration of natural killer cell activity. It remains to be tested whether cysteine supplementation may be useful also in other diseases and conditions that are associated with a low mean plasma cystine level and impaired immunological functions.
Ethical dilemmas in choosing a healthful diet: vote with your fork!
Authors: Nestle Marion
Published: February 2011

Dietary guidelines for health promotion and disease prevention in the USA recommend a consumption pattern based largely on grains, fruit and vegetables, with smaller amounts of meat and dairy foods, and even smaller amounts of foods high in fat and sugar. Such diets are demonstrably health promoting, but following them raises ethical issues related to the role of nutritionists in advising the public about healthful dietary choices, as well as to the role of the food industry in food production and marketing. In the USA a shift towards a more plant-based diet would affect the economic interests of producers of food commodities, food products and meals prepared outside the home; it would also affect the environment, food prices, trade with other countries (developing as well as industrialized) and relationships among the food industry, government agencies (domestic and international) and food and nutrition professionals. In a free-market economy any dietary choice has consequences for food producers. Thus, considerations of ethical dilemmas in choosing healthful diets suggest that food choices are political acts that offer opportunities for all parties concerned to examine the consequences of such choices and ‘vote with forks’.
High-meat diets and cancer risk
Authors: Bingham Sheila A.
Published: February 2011

Up to 80 % of breast, bowel and prostate cancers are attributed to dietary practices, and international comparisons show strong positive associations with meat consumption. Estimates of relative risk obtained from cohort investigations are in the same direction, although generally weak, and red and processed meats rather than white meat seem to be associated with elevated risk of colon cancer. In breast cancer, there are consistent associations with total meat intake and there is evidence of a dose response. Despite these associations with meat, existing studies suggest that vegetarians do not have reduced risk of breast, bowel or prostate cancer, but there are no quantitative estimates of amounts of meat consumed by meat eaters in these cohort studies. Possible mecha-nisms underlying epidemiological associations include the formation of heterocyclic amines in meat when it is cooked. These heterocyclic amines require acetylation by P450 enzymes, and individuals with the fast-acetylating genotype who eat high amounts of meat may be at increased risk of large-bowel cancer. NH3 and N-nitroso compounds (NOC) formed from residues by bacteria in the large bowel are probably also important. NH3 is a promotor of large-bowel tumours chemically induced by NOC, and some of the chromosomal mutations found in human colo-rectal cancer are consistent with effects of NOC and heterocyclic amines. However, the type, amount, and cooking method of meat or protein associated with increased risk are not certain. The effects of high levels of meat on NH3 and NOC output are not reduced by increasing the amount of fermenta-ble carbohydrate in the diet, but interaction between meat, NSP and vegetable intakes on the risk of cancer has not been studied comprehensively. The interaction between dietary low-penetrance genetic polymorphic and somatic mutation factors has also been investigated to a limited extent. Current Department of Health (1998) recommendations are that meat consumption should not rise, and that consumers at the top end of the distribution should consider a reduction in intakes.
The influence of maternal nutrient restriction in early to mid-pregnancy on placental and fetal development in sheep
Authors: Heasman L. , Clarke L. , Stephenson T. J. , Symonds M. E.
Published: February 2011

Placental weight is a primary factor determining size at birth in many species. In sheep, placental weight peaks at approximately mid-gestation, with structural remodelling occurring over the second half of pregnancy to meet the increasing nutritional demands of the growing fetus. Numerous factors influence placental growth and development in sheep, and many workers (see Kelly, 1992) have investigated the role of maternal nutrition as a regulator of placental and fetal size. We have studied the effects of feeding ewes approximately 50 % of their recommended energy requirements during early to mid-pregnancy on fetal and placental indices measured at mid-gestation (i.e. 80 d) and close to term (i.e. 145 d). Maternal nutrient restriction is associated with a reduction in placental weight at 80 d, but an increase in placental weight at 145 d of gestation, compared with ewes fed adequately in early pregnancy. No significant effect on fetal weight was observed at either 80 or 145 d gestation, although differences in body dimensions and the insulin-like growth factor-1 axis were found in lambs from nutrient-restricted ewes delivered close to term. Maternal nutrition during pregnancy plays a pivotal role in the regulation of fetal and placental development in sheep, and therefore has the potential to influence both short- and longer-term health outcomes.
The effect of vitamin A on epithelial integrity
Authors: McCullough F. S. W. , Northrop-Clewes C. A. , Thurnham D. I.
Published: February 2011

Vitamin A is the generic term for a variety of fat-soluble substances including retinol, retinyl palmitate and the provitamin A carotenoids such as all-trans-β-carotene. Vitamin A is commonly known as the anti-infective vitamin and has an essential role in vision and cellular differentiation, the latter providing a unique core mechanism helping to explain the influence of vitamin A on epithelial barriers. Alterations in the epithelial lining of vital organs occur early in deficiency, suggesting a potentially important role for the barrier function. Vitamin A deficiency (VAD) is most commonly recognized in the eye. The conjunctival-impression cytology test detects the presence of larger irregular keratinized cells and the absence of mucous-secreting goblet cells, indicative of VAD. The method is simple, quick and sensitive in populations where VAD is present. In the respiratory tract, observational studies all show an association with VAD, although vitamin A supplementation studies appear to have little effect on respiratory disease. Organ-specific targeting may improve success rates. The dual-sugar intestinal-permeability test allows the effect of vitamin A supplementation to be monitored on the gastrointestinal tract. Two vitamin A supplementation studies were carried out recently in Orissa State, India. Healthy infants of weaning age were administered orally eight weekly doses of 5.0 mg retinol equivalents and hospitalized infants received one large oral dose 60 mg retinol equivalents in the form of retinyl palmitate. Improvements in gut integrity and haematological status were observed in both studies. In summary, the response of the eye to vitamin A supplementation is well established; the present review highlights some of the more recent observations examining the effects of vitamin A.
Vitamins and lung cancer
Authors: Virtamo Jarmo
Published: February 2011

Lung cancer is the most common cancer in the world, and smoking is the major risk factor, accounting for about 90% of the cases. Diet has also been implicated in the development of lung cancer, although the specific nutrients remain to be elucidated. Vitamins with antioxidant activity have received much attention. β-Carotene, the most efficient provitamin A, was found to be inversely related to the risk of lung cancer in many prospective epidemiological studies, especially in studies measuring serum concentrations of β-carotene. The findings from controlled trials, however, contradict the hypothesis that β-carotene could prevent lung cancer, but rather suggest increased risk of lung cancer with supplementary β-carotene. Data from both prospective studies and a controlled trial suggest no role for vitamin E in lung carcinogenesis. Some prospective epidemiological studies suggest an inverse relationship between dietary vitamin C and the risk of lung cancer, but due to the high correlation between dietary vitamin C and vegetable and fruit intake the independent role of dietary vitamin C is difficult to estimate. Studies using prediagnostic plasma concentrations of ascorbic acid do not support the involvement of vitamin C in lung carcinogenesis, and no controlled trials of vitamin C on lung cancer have been published. Thus, supplementation with antioxidant vitamins cannot be recommended for the prevention of lung cancer. Non-smoking is the most important target in the prevention of lung cancer. High i ntakes of vegetables and fruits may provide additional protection and are unlikely to be harmful.
Meat production in developing countries
Authors: Gill Margaret
Published: February 2011

Developing countries have very diverse food consumption patterns and agricultural production systems. The proportion of meat in national diets varies from negligible in some countries in central Africa to 30–40% in some countries in Latin America and Mongolia. However, the demand for meat in developing countries is increasing rapidly (53%/year from 1982 to 1993), as the result of population growth and the trend for people to move to the cities. Growth rates in consumption are greatest in Asia, with China dominating the statistics, in view of the size of its population. Theoretically, livestock production can be increased to meet this demand, but the multiple roles of livestock in developing countries must be recognized if this is to be achieved in a sustainable manner. Resource-poor farmers who keep livestock may value more highly their contribution to livelihoods and to crop production, through provision of draught power and improvements in soil fertility through the recycling of manure, than the production of more meat. Recognition of the goals of the farmer and the wishes of the consumer regarding meat quality need to be reflected in the way in which opportunities for increasing meat production are identified and communicated to farmers. The impact of the global economy on cereal prices, for example, will also influence which interventions will be economically viable. Interpretation of information in an integral manner, using geographical information systems, mathematical models and/or simple spreadsheet models will be an important ingredient in turning scientific knowledge into increased meat production in developing countries.
Unsaturated fatty acids
Authors: Roche Helen M.
Published: February 2011

There is good scientific evidence that dietary fatty acid composition is involved in the aetiology of many diseases. Increasing the supply of n−3 polyunsaturated fatty acids (PUFA) may reduce the risk of CHD. Several scientific organizations (for example, see Department of Health, 1991, 1994; British Nutrition Foundation, 1992; Scientific Committee for Food, 1993; Food and Agriculture Organization/World Health Organization, 1998) have made recommendations for n−3 PUFA; however, there is a high degree of variation both in terms of the type and amount of n−3 PUFA (up to 7-fold). This variation reflects the different scientific axioms which underlie the different recommendations. Optimal nutrition may be defined in terms of the level of a nutrient required to avoid deficiency, or the amount required to have an effect on biomarkers and functional indicators of nutrient intake, or the level of a nutrient which prevents disease. Functional biomarkers of n−3 PUFA include plasma, platelet and erythrocyte phospholipid-n−3 PUFA levels. Plasma triacylglycerol concentrations represent a functional indicator of n−3 PUFA because n−3 PUFA exert a consistent hypotriacylglycerolaemic effect which is dose-dependent and persistent. In terms of disease status, epidemiological studies have demonstrated that the incidence of CHD is inversely associated with consumption of n−3 PUFA. Despite the health benefits of n−3 PUFA, the mean daily intake falls far short of most of the recommendations. Increasing fish intake is the most obvious way to increase n−3 PUFA intake. However, a large percentage (up to 65) of the population do not eat fish. Thus, there is a need for alternative sources of n−3 PUFA, such as functional foods, whose unique fatty acid composition could fortify staple foods thereby promoting optimal levels of n−3 PUFA intake.
Optimal nutrition: fibre and phytochemicals
Authors: Rowland Ian
Published: February 2011

There is currently intense research interest in secondary plant metabolites because of their potential preventative effects on the chronic diseases of Western societies, especially cardiovascular disease and cancer. To date most of the research has focused on the identification of plant-derived substances and their potential protective effects against specific chronic diseases. The important issue of determining the optimal intake of those substances, such that the beneficial effects are maximized without manifestation of adverse effects, has yet to be addressed in most cases. Furthermore, there are no specific functional markers that can be used to assess optimal intake, although it may be possible to use biomarkers such as serum cholesterol if the rest of the diet is strictly controlled. The present review discusses a wide range of substances associated with plants, including dietary fibre, resistant starch, oligosaccharides, phyto-oestrogens, phytosterols, flavonoids, terpenes and isothiocyanates, and attempts where possible to indicate optimal intakes and to suggest functional markers.
Optimum nutrition: thiamin, biotin and pantothenate
Authors: Bender David A.
Published: February 2011

The metabolism of glucose is deranged in thiamin deficiency, but once any deficiency has been corrected there is no further effect of increased thiamin intake on the ability to metabolize glucose through either pyruvate dehydrogenase (EC1.2.4.1) and the citric acid cycle, or the pentose phosphate pathway, in which transketolase (EC2.2.1.1) is the thiamin-dependent step. It has been suggested that the Wernicke-Korsakoff syndrome is associated with a genetic variant of transketolase which requires a higher than normal concentration of thiamin diphosphate for activity. This finding would suggest that there may be a group of the population who have a higher than average requirement for thiamin, but the evidence is not convincing. There are no estimates of biotin requirements, but either coenzyme saturation of erythrocyte pyruvate carboxylase, or the excretion of 3-hydroxy-isovalerate (perhaps after a test dose of leucine) could be used to assess requirements in depletion–repletion studies. Biotin deficiency leads to impaired glucose tolerance, but it is unlikely that glucose tolerance could be used to assess optimum biotin status, since other more common factors affect glucose tolerance to a greater extent. Plasma triacylglycerol and non-esterified fatty acids are moderately elevated in pantothenic acid deficiency. However, this is unlikely to be useful in assessing pantothenate status, since again, other more common factors affect plasma lipids. To date there are no biochemical indices of adequate pantothenate nutrition, and no estimates of requirements.
Current knowledge concerning optimum nutritional status of riboflavin, niacin and pyridoxine
Authors: Powers Hilary J.
Published: February 2011

The term ‘optimum nutrition’ has evolved from a perceived need to base recommendations for nutrient intakes firmly in the context of function. It follows that ‘optimum nutritional status’ for individual nutrients should be defined in terms of biochemical or physiological markers having some functional value but also showing an appropriate relationship to nutrient intake. The present short review considers the current position regarding such markers for riboflavin, pyridoxine and niacin. It is concluded that whilst there are several biochemical measures which respond to changes in intake of each of these vitamins, no single measure is wholly satisfactory as a marker of optimum status.
Folate and vitamin B12
Authors: Scott John M.
Published: February 2011

The folates are made up of a pterdine ring attached to a p-aminobenzoate and a polyglutamyl chain. The active form is tetrahydrofolate which can have C1 units enzymically attached. These C1 units (as a formyl group) are passed on to enzymes in the purine pathway that insert the C−2 and C−8 into the purine ring. A methylene group (−CH2−) attached to tetrahydrofolate is used to convert the uracil-type pyrimidine base found in RNA into the thymine base found in DNA. A further folate cofactor, i.e. 5-methyltetrahydrofolate, is involved in the remethylation of the homocysteine produced in the methylation cycle back to methionine. After activation to S-adenosylmethionine this acts as a methyl donor for the dozens of different methyltransferases present in all cells. Folate deficiency results in reduction of purine and pyrimidine biosynthesis and consequently DNA biosynthesis and cell division. This process is most easily seen in a reduction of erythrocytes causing anaemia. Reduction in the methylation cycle has multiple effects less easy to identify. One such effect is certainly on the nerve cells, because interruption of the methylation cycle causing neuropathy can also happen in vitamin B12 deficiency due to reduced activity of the vitamin B12-dependent enzyme methionine synthase (EC 2.1.1.13). In vitamin B12 deficiency, blocking of the methylation cycle causes the folate cofactors in the cell to become trapped as 5-methyltetrahydrofolate. This process in turn produces a pseudo folate deficiency in such cells, preventing cell division and giving rise to an anaemia identical to that seen in folate deficiency.
Validity of animal models for the cholesterol-raising effects of coffee diterpenes in human subjects
Authors: de Roos Baukje , Sawyer Janet K. , Katan Martijn B. , Rudel Lawrence L.
Published: February 2011

Cafestol and kahweol, coffee lipids present in unfiltered coffee brews, potently increase LDL-cholesterol concentration in human subjects. We searched for an animal species in which cafestol similarly increases LDL-cholesterol. Such an animal model could be used subsequently as a model to study the mechanism of action of cafestol and kahweol. Cafestol and kahweol increased serum lipids in African green monkeys (Cercopithecus aethiops), cebus (Cebus apella) and rhesus (Macaca mulatta) monkeys, hamsters, rats and gerbils differently from the increase in human subjects. In African green monkeys, the rise in total cholesterol was less pronounced than that in human subjects. In addition, the increase in total cholesterol was predominantly due to a rise in HDL-cholesterol rather than LDL-cholesterol. Thus, the rise in plasma lipids might illustrate the mechanism in these monkeys rather than the mechanism in human subjects. In other animal species, cafestol and kahweol did not raise cholesterol consistently. The variability in effects on serum lipids could not be explained by the mode of administration or dose of diterpenes, nor by the amount of cholesterol in the diet. In conclusion, we did not find an animal model in which cafestol and kahweol elevate plasma lipoproteins to the same extent as in human subjects. For the time being, therefore, studies on the mechanism of action should be done preferably in human subjects.
Functionality of nutrients and thermal treatments of food
Authors: Hardy Joël , Parmentier Michel , Fanni Jacques
Published: February 2011

Since discovering fire man has used heat to modify the sensory properties and to preserve foodstuffs. Nutrients are involved in a number of reactions induced by this form of treatment. Some of these reactions are desirable, e.g. the improvement in the digestibility and the attractiveness of a food. Some reactions are undesirable because they lead to considerable nutritional loss or may result in the formation of mutagenic and carcinogenic molecules. The present paper reviews recent studies in which most of the modifications generated by thermal treatments at both the industrial and domestic level are demonstrated. We focus on the processes and the importance of thermal treatments used currently, as well as the necessity for optimization to minimize undesirable effects. Résumé L’homme a toujours recherché les moyens de développer ou modifier les propriétés sensorielles des aliments. Certaines sont souhaitées (amélioration de l’attractivité de l’aliment, meilleure digestibilité), d’autres sont proscrites en raison de la perte de qualité nutritionnelle ou de l’apparition de substances mutagènes et carcinogènes, par exemple. Cet article est une compilation des plus récents travaux sur les modifications générées par les traitements thermiques des aliments, tant au niveau industriel que domestique. Il insiste particulièrement sur les process. En conclusion, l’importance des traitements thermiques est aujourd’hui confirmée, mais il convient de poursuivre l’optimisation des procédés afin de réduire les effets indésirables.
The long-term consequences of intra-uterine protein malnutrition for glucose metabolism
Authors: Ozanne Susan E. , Hales C. Nicholas
Published: February 2011

Our initial observations, in epidemiological studies, linking indices of poor early (fetal and infant) growth to the subsequent development of poor glucose tolerance and the insulin resistance syndrome in adult life, have been confirmed in studies in a wide variety of populations around the world. These findings led us 5 years ago to propose the ‘thrifty phenotype’ hypothesis. Tests of this hypothesis in an animal model in which the pregnant and/or lactating rat dams are fed on an isoenergetic diet containing just under half the normal protein content are consistent with the ideas put forward. They have also allowed us to refine the hypothesis in the light of the new data as follows: (1) the growth of the fetus (and possibly infant) is quantitatively and qualitatively altered by its nutritional environment (which may include maternal diet-dependent changes in maternal hormones); (2) these changes serve to select between the growth rates of different tissues according to priorities which differ between males and females (nutritional thrift) and to alter organ function to constitute a thrifty offspring adapted to survival in poor nutritional circumstances (thrifty phenotype); (3) an individual so constituted suffers adverse consequences in adult life if he/she experiences good or supranormal nutrition; (4) both poor insulin secretion and insulin resistance can result from these adaptive processes; (5) the adverse consequences include loss of glucose tolerance and hypertension. The precise outcome of growth retardation during early life may vary according to the type and timing of the factors responsible for the retardation. It remains to be determined to what extent these potentially adverse effects can be delayed or prevented by a suitable postnatal diet. Experiments in animal models are largely consistent with the concepts proposed from human epidemiological studies. They show that the metabolism of the liver, muscle and adipose tissue may be programmed by maternal nutrition during gestation and lactation. The combination of early growth restriction and subsequent adult obesity reproduced in the rat are the main features of the insulin resistance syndrome.
Regulation of gene expression by glucose
Authors: Ferré P.
Published: February 2011

Fatty acid synthase (EC 2.3.1.85) is an enzyme involved in the lipogenic pathway allowing fatty acid synthesis from glucose. Glucose up-regulates the transcription of the fatty acid synthase gene in both adipocytes and hepatocytes, with insulin having only an indirect role. The signal metabolite could be glucose-6-phosphate rather than glucose itself. The glucose response element of the fatty acid synthase gene has not yet been precisely identified, although a −2 kb region of the fatty acid synthase promoter is sufficient to confer nutritional responsiveness to a reporter gene. ADD1/SREBP1, a b-HLH-LZ transcription factor belonging to the sterol regulatory element-binding protein family might be involved in the transduction of the glucose effect. Finally, the stimulatory effect of glucose on the expression of the fatty acid synthase gene is inhibited by the activation of AMP-activated protein kinase. Interestingly enough, AMP-activated protein kinase is structurally and functionally related to the yeast SNF1 protein kinase complex which is essential for the transcriptional activation of glucose-repressed genes in Saccharomyces cerevisiae.
Vitamin E and infectious diseases in the aged
Authors: Han Sung Nim , Meydani Simin Nikbin
Published: February 2011

The incidence of infectious diseases, particularly respiratory diseases, increases with age. Age-associated decline in immune function contributes to the increased susceptibility of the aged to infections. Vitamin E supplementation has been shown to improve some aspects of immune function in aged animals and human subjects. The protective effect of vitamin E against viral or bacterial infections in experimentally-challenged young animals has been reported. We investigated the effects of supplementation with vitamin E and other antioxidants on resistance to influenza infection in young and old animals. While vitamin E-supplemented young mice showed only a modest reduction in lung viral titre, vitamin E-supplemented old mice exhibited a highly significant (P< 0.05) reduction in viral lung titre. In subsequent studies, we focused on the mechanism of vitamin E-induced reduction of influenza viral titre. The results of these studies as well as those reported by other investigators on the relationship between vitamin E and infectious diseases will be reviewed.
Vitamin A and immunity to viral, bacterial and protozoan infections
Authors: Semba R. D.
Published: February 2011

Studies in animal models and cell lines show that vitamin A and related retinoids play a major role in immunity, including expression of mucins and keratins, lymphopoiesis, apoptosis, cytokine expression, production of antibody, and the function of neutrophils, natural killer cells, monocytes or macrophages, T lymphocytes and B lymphocytes. Recent clinical trials suggest that vitamin A supplementation reduces morbidity and mortality in different infectious diseases, such as measles, diarrhoeal disease, measles-related pneumonia, human immunodeficiency virus infection and malaria. Immune responses vary considerably during different infections, and the available data suggest that the modulation of immune function by vitamin A may also vary widely, depending on the type of infection and immune responses involved.
Environment and infant immunity
Authors: Björkstén Bengt
Published: February 2011

Pregnancy is associated with a skewing towards T-helper (Th)2-like cell populations. During the first years of life, the neonatal immune responses towards allergens deviate towards a balanced Th1 and Th2-like immunity. The difference between atopic and nonatopic individuals may be how readily the immune deviation takes place. The high prevalence of allergies in industrialized countries is in contrast with the low prevalence of allergies in Eastern Europe, with a life style similar to that prevailing in Western Europe 40 years ago. The discussion on the impact of environmental changes on the incidence of asthma and other allergies has been limited mostly to the possible effects of a deteriorating air quality, poorly ventilated houses and an increased exposure to certain allergens, notably house dust mites. None of these factors can more than marginally explain the observed regional differences in the prevalence of allergic diseases. The concept of ‘life style’ should therefore be expanded considerably. The mother is a significant ‘environmental factor’ in early infancy. Human milk contains components that enhance the maturation of the immune system of the newborn infant. However, there are considerable individual variations in the composition of human milk. Recent studies indicate an imbalance in the gut flora of allergic, compared with non allergic infants, and in Swedish children compared with Estonian children. As the microbial flora drives the maturation of the immune system, changes in its composition may play a role for the higher prevalence of allergy. The future search for significant environmental factors should be directed towards other areas that have not yet been explored. The intestinal microflora is one of these factors that deserve a closer analysis.
Citalopram plus low-dose pipamperone versus citalopram plus placebo in patients with major depressive disorder: an 8-week, double-blind, randomized study on magnitude and timing of clinical response
Authors: Wade A. G. , Crawford G. M. , Nemeroff C. B. , Schatzberg A. F. , Schlaepfer T. , McConnachie A. , Haazen L. , Buntinx E.
Published: February 2011

Background

Selective serotonin reuptake inhibitors take several weeks to achieve their full antidepressant effects. Post-synaptic 5-HT2A receptor activation is thought to be involved in this delayed therapeutic effect. Pipamperone acts as a highly selective 5-HT2A/D4 antagonist when administered in low doses. The purpose of this study was to compare citalopram 40 mg once daily plus pipamperone 5 mg twice daily (PipCit) versus citalopram plus placebo twice daily for magnitude and onset of therapeutic effect.

Method

An 8-week, randomized, double-blind study in patients with major depressive disorder was carried out.

Results

The study population comprised 165 patients (citalopram and placebo, n=82; PipCit, n=83) with a mean baseline Montgomery–Asberg Depression Rating Scale (MADRS) score of 32.6 (s.d.=5.5). In the first 4 weeks, more citalopram and placebo than PipCit patients discontinued treatment (18% v. 4%, respectively, p=0.003). PipCit patients had significantly greater improvement in MADRS score at week 1 [observed cases (OC), p=0.021; last observation carried forward (LOCF), p=0.007] and week 4 (LOCF, p=0.025) but not at week 8 compared with citalopram and placebo patients. Significant differences in MADRS scores favoured PipCit in reduced sleep, reduced appetite, concentration difficulties and pessimistic thoughts. Mean Clinical Global Impression–Improvement scores were significantly improved after 1 week of PipCit compared with citalopram and placebo (OC and LOCF, p=0.002).

Conclusions

Although the MADRS score from baseline to 8 weeks did not differ between groups, PipCit provided superior antidepressant effects and fewer discontinuations compared with citalopram and placebo during the first 4 weeks of treatment, especially in the first week.
From Sound Shapes to Space-Form: investigating the relationships between Smalley's writings and works
Authors: Hirst David
Published: February 2011

By drawing concept diagrams of Smalley's seminal writings, I have attempted to show how Smalley's ideas on acousmatic music have evolved from manipulating sound objects to creating ‘space-forms’. The work Wind Chimes is analysed with respect to spectromorphology and sound shapes, and it is compared to the work Base Metals, which is analysed with respect to spectral space. A connection is then made between the evolution in writing and the evolution in composition.
Temporal Associations, Semantic Content and Source Bonding
Authors: Pasoulas Aki
Published: February 2011

Inspired by Denis Smalley's theoretical ideas on spectromorphology and Albert Bregman's (1990) auditory scene analysis, I began an investigation into the formation and segregation of timescales1 in electroacoustic music. This research inevitably led me to an exploration of the factors that shape our perception of time passing and estimation of durations, where spectromorphological issues intermingle with extra-musical associations, autobiographical experiences, emotional responses, and the surrounding environment at the time of listening. Ultimately, time perception affects the structural balance of a composition. This paper, which is part of my ongoing research, examines how the perception of time is affected by the semantic meaning and the spectromorphological characteristics of sound events.
Temporal dispersion of the emergence of intelligence: an inter-arrival time analysis
Authors: Hair Thomas W.
Published: February 2011

Many reasons for why extraterrestrial intelligences might avoid communications with our civilization have been proposed. One possible scenario is that all civilizations follow the lead of some particularly distinguished civilization. This paper will examine the impact the first successful civilization could have on all other subsequent civilizations within its sphere of influence and the ramifications of this as it relates to the Fermi Paradox. Monte Carlo simulation is used to map the inter-arrival times of early civilizations and to highlight the immense epochs of time that the earliest civilizations could have had the Galaxy to themselves.
Advance care planning in advanced cancer: Can it be achieved? An exploratory randomized patient preference trial of a care planning discussion
Authors: Jones Louise , Harrington Jane , Barlow Cate A , Tookman Adrian , Drake Robyn , Barnes Kelly , King Michael
Published: February 2011

Objective:

Little is known about the effectiveness of advance care planning in the United Kingdom, although policy documents recommend that it should be available to all those with life-limiting illness.

Method:

An exploratory patient preference randomized controlled trial of advance care planning discussions with an independent mediator (maximum three sessions) was conducted in London outpatient oncology clinics and a nearby hospice. Seventy-seven patients (mean age 62 years, 39 male) with various forms of recurrent progressive cancer participated, and 68 (88%) completed follow-up at 8 weeks. Patients completed visual analogue scales assessing perceived ability to discuss end-of-life planning with healthcare professionals or family and friends (primary outcome), happiness with the level of communication, and satisfaction with care, as well as a standardized measure of anxiety and depression.

Results:

Thirty-eight patients (51%) showed preference for the intervention. Discussions with professionals or family and friends about the future increased in the intervention arms, whether randomized or preference, but happiness with communication was unchanged or worse, and satisfaction with services decreased. Trial participation did not cause significant anxiety or depression and attrition was low.

Significance of results:

A randomized trial of advance care planning is possible. This study provides new evidence on its acceptability and effectiveness for patients with advanced cancer.
Refractory suffering: The impact of team dynamics on the interdisciplinary palliative care team
Authors: Swetenham Kate , Hegarty Meg , Breaden Katrina , Grbich Carol
Published: February 2011

Objective:

This qualitative study aimed to describe the skill sets that experienced palliative care clinicians possess when managing refractory suffering.

Method:

Thirteen tape recorded semi-structured interviews and four online questionnaires were completed by participants with at least two years clinical palliative care experience. The research team undertook cross sectional thematic analysis of the transcribed interviews.

Results:

In the face of refractory suffering, team cohesion was identified as a key requirement to support the interdisciplinary team. However, team cohesion was found to be undermined by philosophical differences between team members, a paradigm shift concerning cure versus care and individual opinions regarding the chosen approach and levels of respect between the individual disciplines involved in the care of a person with a life limiting illness.

Significance of results:

The findings of this study highlight the precarious nature of the interdisciplinary team when significant challenges are faced. As a result of witnessing refractory suffering the division and fracturing of teams can easily occur; often team members are completely unaware of its cause. The findings of this study contribute to the limited literature on the nature of refractory suffering from the perspective of the interdisciplinary team.
Polecats, lions, and foxes: Coasian bargaining theory and attempts to legitimate the Union as a constrained form of political power
Authors: Lord Christopher
Published: February 2011

It is often supposed that the European Union (EU) can be legitimated as a Pareto-improving bargain between its member states. This paper explores the assumptions of social choice and political philosophy that lie behind that claim. Starting out from a republican view that a polity needs to satisfy standards of non-arbitrariness if it is to be legitimate, the paper begins by explaining why ‘Coasian’ assumptions of Pareto improvement are so important to arguments for the continued indirect legitimacy of the EU by its member states. The paper then identifies four reasons from the social choice literature why attempts to follow a ‘Coasian’ pathway to Pareto improvement may fail to deliver forms of collective choice at the European level that are non-arbitrary from the point of view of all member state governments: non-neutral starting points, preference drift, indivisibilities, and multiple equilibria. These problems are, in turn, used to identify difficulties that mechanisms of indirect legitimation are likely to encounter in meeting two key conditions political philosophers specify for the non-arbitrary exercise of political power, namely, political justice and ‘democratic self-legislation’.
Democracy and administrative policy: contrasting elements of New Public Management (NPM) and post-NPM
Authors: Christensen Tom , Lægreid Per
Published: February 2011

This article presents an analytical platform for discussing and analyzing administrative reforms in terms of democracy. First, we present the democratic theory positions represented by output democracy and input democracy. These two positions are used to classify different types of reform. The second explanatory approach on democracy and reforms is transformative, and it applies a mixture of external features, domestic administrative culture, and polity features to understand variations in the democratic aspects of public sector reforms. Central issues are whether these reforms can be seen as alternatives or whether they complement each other in terms of layering processes. Third, we take a broad overview of New Public Management (NPM) and post-NPM reforms and carry out an in-depth analysis of a new administrative policy report by the Norwegian centre-left government. Finally, we discuss briefly the broader comparative implications of our findings.
A geochemical transport model for thermo‐hydro‐chemical (THC) coupled processes with saline water
Authors: Xie Mingliang , Kolditz Olaf , Moog Helge C.
Published: February 2011

Anhydrous MgSO4 is considered as a potential sealing material for the isolation of high‐level‐waste repositories in salt rock. When an aqueous solution, usually a brine type, penetrates the sealing, different MgSO4 hydrates along with other mineral phases form, removing free water from the solution. The uptake of water leads to an overall increase of solid phase volume. If deformation is constrained, the pore volume decreases and permeability is reduced. In order to simulate such processes, especially for conditions without free water, a coupling between OpenGeoSys and thermodynamic equilibrium calculations were implemented on the basis of the commercially available thermodynamic simulator ChemApp and the object‐oriented programming finite‐element method simulator OpenGeoSys. ChemApp uses the Gibbs energy minimization approach for the geochemical reaction simulation. Based on this method, the thermodynamic equilibrium of geochemical reactions can be calculated by giving the amount of each system component and the molar Gibbs energy of formation for all the possible phases and phase constituents. Activity coefficients in high‐saline solutions were calculated using the Pitzer formalism. This model has the potential to handle 1‐D, 2‐D, and 3‐D saturated and nonsaturated thermo‐hydro‐chemical coupled processes even with highly saline solutions under complex conditions. The model was verified by numerical comparison with other simulators and applied for the modeling of SVV experimental data.
Tracking the Deepwater Horizon Oil Spill: A Modeling Perspective
Authors: Liu Yonggang , Weisberg Robert H. , Hu Chuanmin , Zheng Lianyuan
Published: February 2011

The Deepwater Horizon oil spill was caused by a drilling rig explosion on 20 April 2010 that killed 11 people. It was the largest oil spill in U.S. history and presented an unprecedented threat to Gulf of Mexico marine resources. Although oil gushing to the surface diminished after the well was capped, on 15 July 2010, much remains to be known about the oil and the dispersants beneath the surface, including their trajectories and effects on marine life. A system for tracking the oil, both at the surface and at depth, was needed for mitigation efforts and ship survey guidance. Such a system was implemented immediately after the spill by marshaling numerical model and satellite remote sensing resources available from existing coastal ocean observing activities [e.g., Weisberg et al., 2009]. Analyzing this system's various strengths and weaknesses can help further improve similar systems designed for other emergency responses.