Loss of appetite in acutely ill medical inpatients: physiological response or therapeutic target?

Loss of appetite and ensuing weight loss is a key feature of severe illnesses. Protein-energy malnutrition (PEM) contributes significantly to the adverse outcome of these conditions. Pharmacological interventions to target appetite stimulation have little efficacy but considerable side effects. Therefore nutritional therapy appears to be the logical step to combat inadequate nutrition. However, clinical trial data demonstrating benefits are sparse and there is no current established standard algorithm for use of nutritional support in malnourished, acutely ill medical inpatients. Recent high-quality evidence from critical care demonstrating harmful effects when parenteral nutritional support is used indiscriminately has led to speculation that loss of appetite in the acute phase of illness is indeed an adaptive, protective response that improves cell recycling (autophagy) and detoxification. Outside critical care, there is an important gap in high quality clinical trial data shedding further light on these important issues. The selection, timing, and doses of nutrition should be evaluated as carefully as with any other therapeutic intervention, with the aim of maximising efficacy and minimising adverse effects and costs. In light of the current controversy, a reappraisal of how nutritional support should be used in acutely ill medical inpatients outside critical care is urgently required. The aim of this review is to discuss current pathophysiological concepts of PEM and to review the current evidence for the efficacy of nutritional support regarding patient outcomes when used in an acutely ill medical patient population outside critical care.

Neural representation and clinically relevant moderators of individualised self-criticism in healthy subjects

Many people routinely criticise themselves. While self-criticism is largely unproblematic for most individuals, depressed patients exhibit excessive self-critical thinking, which leads to strong negative affects. We used functional magnetic resonance imaging in healthy subjects (N = 20) to investigate neural correlates and possible psychological moderators of self-critical processing. Stimuli consisted of individually selected adjectives of personally negative content and were contrasted with neutral and negative non-self-referential adjectives. We found that confrontation with self-critical material yielded neural activity in regions involved in emotions (anterior insula/hippocampus-amygdala formation) and in anterior and posterior cortical midline structures, which are associated with self-referential and autobiographical memory processing. Furthermore, contrasts revealed an extended network of bilateral frontal brain areas. We suggest that the co-activation of superior and inferior lateral frontal brain regions reflects the recruitment of a frontal top-down pathway, representing cognitive reappraisal strategies for dealing with evoked negative affects. In addition, activation of right superior frontal areas was positively associated with neuroticism and negatively associated with cognitive reappraisal. Although these findings may not be specific to negative stimuli, they support a role for clinically relevant personality traits in successful regulation of emotion during confrontation with self-critical material.

The Importance of Patency in Patients with Critical Limb Ischemia Undergoing Endovascular Revascularization for Infrapopliteal Arterial Disease.

Critical limb ischemia (CLI) represents the most severe form of peripheral arterial disease (PAD) and frequently occurs in medically frail patients. CLI patients frequently exhibit multi-segmental PAD commonly including the tibial arterial segment. Endovascular therapy has been established as first-line revascularization strategy for most CLI patients. Restenosis was reported to occur in up to more than two-thirds of CLI patients undergoing angioplasty of complex tibial arterial obstructions. Nevertheless, favorable clinical outcomes were observed for infrapopliteal angioplasty when compared with bypass surgery, despite higher patency rates for the latter. Based on these observations, infrapopliteal patency was considered to be only of secondary importance upon clinical outcomes in CLI patients. In contrast to these earlier observations, however, recent findings from two randomized clinical trials indicate that infrapopliteal patency does impact on clinical outcomes in CLI patients. The purpose of the present manuscript is to provide a critical reappraisal of the present literature on the clinical importance of tibial arterial patency in CLI patients undergoing endovascular revascularization and to discuss utility and limitations of currently available anti-restenosis technologies.

Stress and coping in African American grandparents who are raising grandchildren

Over the years, substantial increases have occurred in the number of children being raised by their grandparents. A small number of studies have reported that grandparents raising grandchildren experience an increase in stress due to the demands of caregiving. The primary objectives of this study were to: (1) determine the degree of stress in African American (AA) grandparents who are raising their grandchildren age 12 years or younger; (2) identify the variables pertaining to the demographic characteristics of the grandparent caregiver and characteristics of the caregiving situation; (3) identify the coping strategies reported by AA grandparents; and (4) identify the relative importance of demographic and situational variables pertaining to the grandparent caregiver and caregiving situation, and coping strategies in influencing the degree of stress experienced. ^ An exploratory, descriptive, cross sectional design was used to study stress and coping in 50 AA grandparents who ranged in age from 44–87 years (M = 63.12). Data were collected via one personal interview in January/February 2001 at area senior centers or churches which the grandparent attends in Harris County, Texas. Five home interviews were done as requested by grandparents. ^ The instruments used to measure stress and coping were the Parenting Stress Index developed by Abidin and Folkman and Lazarus' Ways of Coping Questionnaire. Results of the study found that the grandparents is this study were a highly stressed group. Ninety-four percent of the sample demonstrated a “clinically significant” level of stress. Situational variables associated with lower stress levels were use of counseling, use of special school programs such as tutoring and special education, and increased length of caregiving (>5 years). ^ The most frequently used coping strategies overall were seeking social support and positive reappraisal. Six coping strategies were significantly correlated to lower reported stress: positive reappraisal, accepting responsibility, confrontive coping, self-control, planful problem solving, and distancing. ^ The findings from this study have limited generalizability. Nonetheless, this study was useful in adding to the limited amount of literature on AA grandparents who are rearing their grandchildren. The results clearly suggest the need for affordable counseling, support groups, education related to available resources, stress management, and interventions that increase the use of coping strategies found to reduce perceived stress. Future research should investigate levels of stress in AA and other grandparent caregivers longitudinally, as well as focus on stress and coping in grandparents raising grandchildren with special needs. ^

(Table 1) Radiocarbon ages of Holocene samples obtained from the Schaabe sandbar on Rügen Island

Lithological and stratigraphical data obtained from 167 boreholes from the Schaabe spit in northeast Rügen and 46 radiocarbon datings mainly on peats, as well as interpretation of diatoms and palynological assemblages lead to a reappraisal of its sedimentational history and morphological development. The new local shoreline displacement curve is compared and discussed with the previous curve of Vorpommern (Southern Baltic Sea).

La problemática del agro en la perspectiva de Aldo Ferrer : Una reevaluación del discurso político de 'La Economía Argentina' y la práctica histórica durante la apertura nacionalista (1970-1971)

La actualidad que tienen los estudios historiográficos sobre las cuestiones del agro argentino en el siglo XX y el crecimiento de trabajos de investigación y de balances sobre dicha producción generan un contexto propicio para la reevaluación crítica de los aportes que se han hecho a la historia del agro argentino desde la perspectiva cepalina, mas específicamente aquella expresada en la amplia producción del economista Aldo Ferrer: su explicación de la problemática agraria desde el análisis de las debilidades internas del sistema productivo argentino y las falencias básicas del funcionamiento de la economía capitalista constituye un discurso en perspectiva histórica que manifiesta las representaciones identitarias que los sectores capitalistas nacionales tenían del agro argentino a fines de la década del sesenta. El análisis de su clásica obra La Economía Argentina (1963) permite argumentar que en su abordaje teórico y metodológico del desarrollo económico argentino la cuestión agraria ocupa el centro de los problemas que han aquejado al sistema productivo argentino durante todo el siglo XX y especialmente durante la etapa denominada de "apertura nacionalista" (1970-1971) en la cual el autor tuvo una activa participación política como Ministro de Economía de la Nación Argentina.

Cultura literaria y movilidad social en la Antigüedad tardía : La carrera de Décimo Magno Ausonio

La carrera de Décimo Magno Ausonio constituye uno de los ejemplos paradigmáticos de una excepcional movilidad ascendente en el Bajo Imperio Romano, por lo que ha recibido considerable atención. El objetivo del presente trabajo es ofrecer una reevaluación de la evidencia y de las principales interpretaciones ofrecidas en la historiografía, centrando la atención en el papel de la cultura literaria en el éxito de Ausonio. Este análisis revela que la educación puede servir como un factor clave en el ascenso social, pero sólo si otros factores intervienen, especialmente el establecimiento de conexiones familiares con miembros de la elite

La problemática del agro en la perspectiva de Aldo Ferrer : Una reevaluación del discurso político de 'La Economía Argentina' y la práctica histórica durante la apertura nacionalista (1970-1971)

La actualidad que tienen los estudios historiográficos sobre las cuestiones del agro argentino en el siglo XX y el crecimiento de trabajos de investigación y de balances sobre dicha producción generan un contexto propicio para la reevaluación crítica de los aportes que se han hecho a la historia del agro argentino desde la perspectiva cepalina, mas específicamente aquella expresada en la amplia producción del economista Aldo Ferrer: su explicación de la problemática agraria desde el análisis de las debilidades internas del sistema productivo argentino y las falencias básicas del funcionamiento de la economía capitalista constituye un discurso en perspectiva histórica que manifiesta las representaciones identitarias que los sectores capitalistas nacionales tenían del agro argentino a fines de la década del sesenta. El análisis de su clásica obra La Economía Argentina (1963) permite argumentar que en su abordaje teórico y metodológico del desarrollo económico argentino la cuestión agraria ocupa el centro de los problemas que han aquejado al sistema productivo argentino durante todo el siglo XX y especialmente durante la etapa denominada de "apertura nacionalista" (1970-1971) en la cual el autor tuvo una activa participación política como Ministro de Economía de la Nación Argentina.

Cultura literaria y movilidad social en la Antigüedad tardía : La carrera de Décimo Magno Ausonio

La carrera de Décimo Magno Ausonio constituye uno de los ejemplos paradigmáticos de una excepcional movilidad ascendente en el Bajo Imperio Romano, por lo que ha recibido considerable atención. El objetivo del presente trabajo es ofrecer una reevaluación de la evidencia y de las principales interpretaciones ofrecidas en la historiografía, centrando la atención en el papel de la cultura literaria en el éxito de Ausonio. Este análisis revela que la educación puede servir como un factor clave en el ascenso social, pero sólo si otros factores intervienen, especialmente el establecimiento de conexiones familiares con miembros de la elite

La problemática del agro en la perspectiva de Aldo Ferrer : Una reevaluación del discurso político de 'La Economía Argentina' y la práctica histórica durante la apertura nacionalista (1970-1971)

La actualidad que tienen los estudios historiográficos sobre las cuestiones del agro argentino en el siglo XX y el crecimiento de trabajos de investigación y de balances sobre dicha producción generan un contexto propicio para la reevaluación crítica de los aportes que se han hecho a la historia del agro argentino desde la perspectiva cepalina, mas específicamente aquella expresada en la amplia producción del economista Aldo Ferrer: su explicación de la problemática agraria desde el análisis de las debilidades internas del sistema productivo argentino y las falencias básicas del funcionamiento de la economía capitalista constituye un discurso en perspectiva histórica que manifiesta las representaciones identitarias que los sectores capitalistas nacionales tenían del agro argentino a fines de la década del sesenta. El análisis de su clásica obra La Economía Argentina (1963) permite argumentar que en su abordaje teórico y metodológico del desarrollo económico argentino la cuestión agraria ocupa el centro de los problemas que han aquejado al sistema productivo argentino durante todo el siglo XX y especialmente durante la etapa denominada de "apertura nacionalista" (1970-1971) en la cual el autor tuvo una activa participación política como Ministro de Economía de la Nación Argentina.

Cultura literaria y movilidad social en la Antigüedad tardía : La carrera de Décimo Magno Ausonio

La carrera de Décimo Magno Ausonio constituye uno de los ejemplos paradigmáticos de una excepcional movilidad ascendente en el Bajo Imperio Romano, por lo que ha recibido considerable atención. El objetivo del presente trabajo es ofrecer una reevaluación de la evidencia y de las principales interpretaciones ofrecidas en la historiografía, centrando la atención en el papel de la cultura literaria en el éxito de Ausonio. Este análisis revela que la educación puede servir como un factor clave en el ascenso social, pero sólo si otros factores intervienen, especialmente el establecimiento de conexiones familiares con miembros de la elite

Foraminiferal assemblages and stable isotopes across the early Paleogene carbonate facies of Perth Abyssal Plain off Western Australia

Bulk carbonate content, planktic and benthic foraminiferal assemblages, stable isotope compositions of bulk carbonate and Nuttallides truempyi (benthic foraminifera), and non-carbonate mineralogy were examined across ~30 m of carbonate-rich Paleogene sediment at Deep Sea Drilling Project (DSDP) Site 259, on Perth Abyssal Plain off Western Australia. Carbonate content, mostly reflecting nannofossil abundance, ranges from 3 to 80% and generally exceeds 50% between 35 and 57 mbsf. A clay-rich horizon with a carbonate content of about 37% occurs between 55.17 and 55.37 mbsf. The carbonate-rich interval spans planktic foraminiferal zones P4c to P6b (~57-52 Ma), with the clay-rich horizon near the base of our Zone P5 (upper)-P6b. Throughout the studied interval, benthic species dominate foraminiferal assemblages, with scarce planktic foraminifera usually of poor preservation and limited species diversity. A prominent Benthic Foraminiferal Extinction Event (BFEE) occurs across the clay-rich horizon, with an influx of large Acarinina immediately above. The delta13C records of bulk carbonate and N. truempyi exhibit trends similar to those observed in upper Paleocene-lower Eocene (~57-52 Ma) sediment from other locations. Two successive decreases in bulk carbonate and N. truempyi delta13C of 0.5 and 1.0? characterize the interval at and immediately above the BFEE. Despite major changes in carbonate content, foraminiferal assemblages and carbon isotopes, the mineralogy of the non-carbonate fraction consistently comprises expanding clay, heulandite (zeolite), quartz, feldspar (sodic or calcic), minor mica, and pyrolusite (MnO2). The uniformity of this mineral assemblage suggests that Site 259 received similar non-carbonate sediment before, during and after pelagic carbonate deposition. The carbonate plug at Site 259 probably represents a drop in the CCD from ~57 to 52-51 Ma, as also recognized at other locations.

Early Eocene benthic foraminifera of DSDP Hole 48-401

Within the last decade, several early Eocene hyperthermals have been detected globally. These transient warming events have mainly been characterized geochemically - using stable isotopes, carbonate content measurements or XRF core scanning - yet detailed micropaleontological records are sparse, limiting our understanding of the driving forces behind hyperthermals and of the contemporaneous paleoceanography. Here, detailed geochemical and quantitative benthic foraminiferal records are presented from lower Eocene pelagic sediments of Deep Sea Drilling Project Site 401 (Bay of Biscay, northeast Atlantic). In calcareous nannofossil zone NP11, several clay-enriched levels correspond to negative d13C and d18O bulk-rock excursions with amplitudes of up to ~0.75 per mil, suggesting that significant injections of 12C-enriched greenhouse gasses and small temperature rises took place. Coeval with several of these hyperthermal events, the benthic foraminiferal record reveals increased relative abundances of oligotrophic taxa (e.g. Nuttallides umbonifera) and a reduction in the abundance of buliminid species followed by an increase of opportunistic taxa (e.g. Globocassidulina subglobosa and Gyroidinoides spp.). These short-lived faunal perturbations are thought to be caused by reduced seasonality of productivity resulting in a decreased Corg flux to the seafloor. Moreover, the sedimentological record suggests that an enhanced influx of terrigenous material occurred during these events. Additionally, the most intense d13C decline (here called level d) gives rise to a small, yet pronounced long-term shift in the benthic foraminiferal composition at this site, possibly due to the reappraisal of upwelling and the intensification of bottom water currents. These observations imply that environmental changes during (smaller) hyperthermal events are also reflected in the composition of deep-sea benthic communities on both short (<100 kyr) and longer time scales. We conclude that the faunal patterns of the hyperthermals observed at Site 401 strongly resemble those observed in other deep-sea early Paleogene hyperthermal deposits, suggesting that similar processes have driven them.

Geochemistry of Lesser Antilles lavas

We present new U-series disequilibrium and radiogenic isotope data for 7 mafic lavas from the Lesser Antilles arc. These are combined with published data in an internally consistent model that quantitatively estimates the amount of sediment and fluid added to the source of the Lesser Antilles arc system. Some lavas form an array consistent with bulk sediment addition (0.2-2%) whereas others appear to require addition of 0.4-2% sediment melt, particularly in the south of the arc. Evidence for both bulk sediment and sediment melt addition can be found within both the northern and central sections of the arc suggesting a thermal structure whereby the upper portions of the subducted sediment pile lie close to their solidus beneath much of the arc. Addition of up to 5% fluid derived from altered oceanic crust to these sediment enriched mantle wedge source regions can simulate the majority of the lavas on a plot of 207Pb/204Pb versus Ce/Pb. By taking into account the range in calculated wedge compositions and allowing for some mobility of Th in the fluid, the same model can also account for much of the observed range of U-Th-Ra disequilibria, especially if the eclogitic residue contains trace amounts of rutile. The implication of this more complex model is that the time scales for fluid addition and differentiation could be significantly shorter than those estimated in some previous studies.