Short-term nutritional supplementation during management of pulmonary exacerbations in cystic fibosis: A controlled study, including effects of protein turnover

Effects of nutritional supplements on minimizing weight loss and abnormalities of protein turnover during pulmonary exacerbations in cystic fibrosis (CF) were studied by controlled trial. Patients received pulmonary therapy and either standard diet (n = 10) or adjunctive enteral supplements (n = 12). Initial protein turnover, measured by [15N]glycine kinetics, showed alterations of protein synthesis (P Syn) and catabolism (P Cat), which correlated with the degree of underweight, and negligible net protein deposition (P Dep). With treatment both groups had significant increases in mean body weight and forced expiratory volume in 1 s, expressed as percent predicted value for height (FEV1) by 3 wk, but a significant correlation between initial underweight and subsequent weight gain was observed only in supplemented patients. Mean P Syn and P Dep increased significantly (p < 0.001) only in the supplemented group. Pulmonary exacerbations in CF have important adverse effects on body-protein metabolism, similar to changes in protein-energy malnutrition and infection. These effects are reversed by short-term nutritional support. Strategic nutritional intervention should thus be considered in management, especially in malnourished patients.

The Queensland liver transplant programme: The first two years

Orthotopic liver transplantation began in Brisbane in January 1985. During the first two years of the programme an assessment committee evaluated 55 patients (38 adults, 17 children). Patients were either accepted for transplantation, rejected as unsuitable or deferred for elective reassessment. All of the 10 adults who were rejected for transplantation because they had 'too advanced' disease died within four months of assessment. Six children who were accepted for transplantation died before a suitable donor liver could be found. In the first two years, 21 orthotopic liver transplantations were performed on 18 patients (adults, 13 patients; children, five patients). Fifteen of 21 grafts were procured from within Queensland. Twelve (67%) patients are alive at three to 23 months and all have been discharged from hospital. Deaths in adults were due to sepsis (three patients), aspiration pneumonitis (one patient), rejection and hepatic artery thrombosis (one patient) and the recurrence of a hepatocellular carcinoma five months after discharge from hospital (one patient). Two patients underwent a second transplantation procedure because of chronic rejection at four months and at 11 months, respectively, after the initial operation. One patient received a second transplant for primary graft failure at four days after the operation. A scoring system which considered the presence of pre-operative patient factors, such as coma, ascites, malnutrition and previous abdominal surgery, partly predicted the operative blood loss and patient survival. In conclusion, orthotopic liver transplantation is being performed in Australia with survival rates that are comparable with those of established overseas units.

Learning with symmetric label noise: The importance of being unhinged

Convex potential minimisation is the de facto approach to binary classification. However, Long and Servedio [2008] proved that under symmetric label noise (SLN), minimisation of any convex potential over a linear function class can result in classification performance equivalent to random guessing. This ostensibly shows that convex losses are not SLN-robust. In this paper, we propose a convex, classification-calibrated loss and prove that it is SLN-robust. The loss avoids the Long and Servedio [2008] result by virtue of being negatively unbounded. The loss is a modification of the hinge loss, where one does not clamp at zero; hence, we call it the unhinged loss. We show that the optimal unhinged solution is equivalent to that of a strongly regularised SVM, and is the limiting solution for any convex potential; this implies that strong l2 regularisation makes most standard learners SLN-robust. Experiments confirm the unhinged loss’ SLN-robustness.

Psychosocial presentation of revisional LAGB patients: A qualitative study

This qualitative study offers insight into the experiences, expectations, perceptions and beliefs that may lead to laparoscopic adjustable gastric band patients’ failure to achieve expected weight loss and seek revisional bariatric surgery. The 23 participants from two sites were interviewed and data were analysed from a grounded theory methodology in order to build a causal model. Analysis of participants’ reports identified ‘unrealistic expectations of the LAGB’ as the core category. Additionally, the restriction of the band had a negative impact on participants’ social interactions, leading to feelings of deprivation and, thus, to a desire for reward from food choices and consequently an increase of consumption of high-calorie-dense foods. These foods were chosen because of their specific texture or ability to provide reward. The resulting increase in weight or failure to achieve excess weight loss, led to feelings of shame and loneliness and emotional eating resulting in increased the consumption of rewarding foods. Thus, identifying unrealistic expectations of laparoscopic adjustable gastric band (LAGB) and emotional eating behaviours are important in those who are present initially for primary bariatric and revisional bariatric surgery, as they may contribute specifically to these patients’ weight regain and consequent failure to achieve excess weight loss.

Designing an emotional strategy : Strengthening digital channel engagements

The emergence of new technologies has revolutionized the way companies interact and build relationships with customers. The channel–customer relationship has traditionally been managed via a push approach in communication (“What can we sell customers?”) with the hope of cultivating customer loyalty. However, emotional understandings of customers and how they feel about a product, service, or business can drastically alter consumers’ engagement, behavior, and purchasing preferences. This rapidly evolving landscape has left managers at a loss, and what they are experiencing is likely the beginning of a tectonic shift in the way digital channels are designed, monitored, and managed. In this article, digital channel relationships are examined, and useful concepts for clarifying and refining the emotional meaning behind company strategy and their relationship to corresponding digital channels are detailed. Using three case study examples, we discuss the process and impact of such emotionally aware digital channel designs. Recommendations are made regarding how companies can select, design, and maintain digital engagements based on their strategy and industry needs.

Evaluation of material crack using acoustic emission technique

Cracks in civil structures can result in premature failure due to material degradation and can result in both financial loss and environmental consequences. This thesis reports an effective technique using Acoustic Emission (AE) technique to assess the severity of the crack propagation in steel structures. The outcome of this work confirms that combination of AE parametric analysis and signal processing techniques can be used to evaluate crack propagation under different loading configurations. The technique has potential application to assess and monitor the condition of civil structures.