Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis

BACKGROUND: The efficacy of nutritional support in the management of malnutrition in chronic obstructive pulmonary disease (COPD) is controversial. Previous meta-analyses, based on only cross-sectional analysis at the end of intervention trials, found no evidence of improved outcomes. OBJECTIVE: The objective was to conduct a meta-analysis of randomized controlled trials (RCTs) to clarify the efficacy of nutritional support in improving intake, anthropometric measures, and grip strength in stable COPD. DESIGN: Literature databases were searched to identify RCTs comparing nutritional support with controls in stable COPD. RESULTS: Thirteen RCTs (n = 439) of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 11 RCTs), and enteral tube feeding (1 RCT)] with a control comparison were identified. An analysis of the changes induced by nutritional support and those obtained only at the end of the intervention showed significantly greater increases in mean total protein and energy intakes with nutritional support of 14.8 g and 236 kcal daily. Meta-analyses also showed greater mean (±SE) improvements in favor of nutritional support for body weight (1.94 ± 0.26 kg, P < 0.001; 11 studies, n = 308) and grip strength (5.3%, P < 0.050; 4 studies, n = 156), which was not shown by ANOVA at the end of the intervention, largely because of bias associated with baseline imbalance between groups. CONCLUSION: This systematic review and meta-analysis showed that nutritional support, mainly in the form of ONS, improves total intake, anthropometric measures, and grip strength in COPD. These results contrast with the results of previous analyses that were based on only cross-sectional measures at the end of intervention trials.

Tooth fracture risk analysis based on a new finite element dental structure models using micro-CT data

The finite element (FE) analysis is an effective method to study the strength and predict the fracture risk of endodontically-treated teeth. This paper presents a rapid method developed to generate a comprehensive tooth FE model using data retrieved from micro-computed tomography (μCT). With this method, the inhomogeneity of material properties of teeth was included into the model without dividing the tooth model into different regions. The material properties of the tooth were assumed to be related to the mineral density. The fracture risk at different tooth portions was assessed for root canal treatments. The micro-CT images of a tooth were processed by a Matlab software programme and the CT numbers were retrieved. The tooth contours were obtained with thresholding segmentation using Amira. The inner and outer surfaces of the tooth were imported into Solidworks and a three-dimensional (3D) tooth model was constructed. An assembly of the tooth model with the periodontal ligament (PDL) layer and surrounding bone was imported into ABAQUS. The material properties of the tooth were calculated from the retrieved CT numbers via ABAQUS user's subroutines. Three root canal geometries (original and two enlargements) were investigated. The proposed method in this study can generate detailed 3D finite element models of a tooth with different root canal enlargements and filling materials, and would be very useful for the assessment of the fracture risk at different tooth portions after root canal treatments.

Tampere region under the microscope : a critical analysis from the knowledge perspective

Purpose – In the context of global knowledge economy, knowledge-based urban development (KBUD) is seen as an effective development strategy for city-regions to survive, flourish and become highly competitive urban agglomerations – i.e., a knowledge city-region. This paper aims to evaluate the KBUD dynamics, capacity and potentials of a rapidly emerging knowledge city-region of Finland – Tampere region. Design/methodology/approach – The paper undertakes a review of the literature on regional development in the knowledge economy era. It adopts a qualitative analysis technique to scrutinize the dynamics, capacity and potentials of Tampere region. The semi-structured interview process starts with the pre-determined key actors of the city-region with an aim of determining the other key players. Next, with the participation of all key players to the interviews, the research reveals the principal issues, assets and mechanisms that relate to KBUD, and portrays the strengths, weaknesses, opportunities and threats of the city-region. A critical analysis of the findings along with the previous studies is undertaken to provide a clear picture of the dynamics, capacity and potentials of the emerging knowledge city-region. Originality/value – This paper reports the findings of a pioneering study focusing on the investigation of the KBUD dynamics, capacity and potentials of Tampere region. The paper critically evaluates the city-region from the knowledge perspective with the lens of KBUD, and the lessons learned and the methodological approach of the paper shed light to other city-regions seeking such development. Practical implications – The paper discusses the findings of a study from Tampere region that critically scrutinizes the KBUD experience of the city-region. The research provides an invaluable opportunity to inform the regional decision-, policy- and plan-making mechanisms by determining key issues, actors, assets, processes and potential development directions for the KBUD of Tampere region.

Modelling and analysis of the crush zone of a typical Australian passenger train

In this paper, a three-dimensional nonlinear rigid body model has been developed for the investigation of the crashworthiness of a passenger train using the multibody dynamics approach. This model refers to a typical design of passenger cars and train constructs commonly used in Australia. The high-energy and low-energy crush zones of the cars and the train constructs are assumed and the data are explicitly provided in the paper. The crash scenario is limited to the train colliding on to a fixed barrier symmetrically. The simulations of a single car show that this initial design is only applicable for the crash speed of 35 km/h or lower. For higher speeds (e.g. 140 km/h), the crush lengths or crush forces or both the crush zone elements will have to be enlarged. It is generally better to increase the crush length than the crush force in order to retain the low levels of the longitudinal deceleration of the passenger cars.

Health status and use of health services among recently arrived men with refugee backgrounds: A comparative analysis of urban and regional settlement in South-east Queensland

Approximately one-third of refugee and humanitarian entrants to Australia are adult men. Many of these men and their families settle in regional areas. Little is known about the health status of refugee men and the use of health services, and whether or not there are differences between those living in urban and regional areas. This paper reports on the cross-sectional differences in health status and use of health services among a group of 233 recently arrived refugee men living in urban and regional areas of South-east Queensland. Overall, participants reported good levels of subjective health status, moderate to good levels of well-being, and low prevalence of mental illness. Men living in urban areas were more likely to have a longstanding illness and report poorer health status than those settled in regional areas. In contrast, men living in regional areas reported poorer levels of well-being in the environment domain and were more likely to visit hospital emergency departments. Targeted health promotion programs will ensure that refugee men remain healthy and develop their full potential as members of the Australian community. Programs that facilitate refugees’ access to primary health care in regional areas may promote more appropriate use of hospital emergency departments by these communities.