Nutritional support in children with end-stage liver disease : a randomized crossover trial of a branched-chain amino acid supplement

Malnutrition is common in children with end-stage liver disease (ESLD) awaiting orthotopic liver transplantation (OLT), and nutritional support is assuming an important role in preoperative management. To evaluate preoperative nutritional therapy, 19 children (median age 1.25 y) with ESLD awaiting OLT were prospectively studied. Two high-energy, isoenergetic and isonitrogenous nutritional formulations delivered nasogastrically were compared: a branched-chain amino acid (BCAA)-enriched semielemental formulation and a matched standard semielemental formulation. Twelve of 19 patients completed a randomized controlled study before OLT and 10 of 19 completed a full crossover study. Improvements in weight and height occurred during the BCAA supplements, with no statistical change on the standard formulation. Significant increases in total body potassium, midupper arm circumference, and subscapular skinfold thickness occurred during the BCAA supplements, whereas no significant changes occurred during the standard formulation period. Significantly fewer albumin infusions were required during the BCAA supplement. These findings suggest that BCAA-enriched formulas have advantages over standard semielemental formulas in improving nutritional status in children with ESLD. and are deserving of wider application and study.

The nature of malnutrition in children with end-stage liver disease awaiting orthotopic liver transplantation

To evaluate malnutrition in chronic liver disease, and its relationship to nutrient deficiencies and hepatic dysfunction. 27 children with end-stage liver disease were studied. Mean protein-energy intakes were 70% of recommended daily intakes. The patients were underweight and stunted with reduced mean triceps and subscapular skinfold thicknesses and midupper arm circumference. Mean total body potassium was only 63 ± 18% of that expected for age and sex. Deficiency of essential fatty acids (32%), and low concentrations of fat-soluble vitamins (A, 92%; E, 32%), iron (32%), zinc (42%), and selenium (13%) were common. Serum ammonia concentrations were raised in all patients, and increased methionine, tyrosine, and glutamic acid, and reduced glutamine concentrations were noted. There was no correlation between the degree of malnutrition and the degree of liver synthetic function, the degree of cholestasis, or the degree of liver injury. We suggest that potentially correctable factors in addition to liver failure (eg, inadequate absorbed intake) were important determinants of malnutrition in these patients.

Pre-operative nutritional support in children with end-stage liver disease accepted for liver transplantation: An approach to management

Pre-operative nutritional support was studied in 28 children with end-stage liver disease awaiting orthotopic liver transplantation. Nasogastric supplemental administration of a standard semi-elemental enteral nutritional formula was compared with a similar formula enriched with branched chain amino acids, and with a group receiving oral nutrition only. The duration of treatment in all groups was similar (mean 90 days). Energy intakes in the supplemented groups were 120-150% of recommended daily intakes (RDI), whereas ad libitum intakes in the oral group ranged 58-100% RDI. A significant improvement in mean Z-score for body weight (denoting catch-up) was noted only in those children who received nasogastric supplements enriched with branched-chain amino acids. The standard enterally-fed group maintained their body weight and Z-scores did not change significantly. In contrast, body weight Z-scores in those fed orally declined significantly. Nutritional supportive therapy of malnourished children with end-stage liver disease can minimize or improve nutritional status in children awaiting liver transplantation. The use of nutritional formulae rich in branche-chain amino acids may have nutritional advantages in children with chronic liver disease which require further study and evaluation.

Monoblock cylinder internally pressurised under asymmetric end constraints Some aspects of design

The finite element method is used to analyse stresses and displacements in a monoblock cylinder open at one end only. The cylinder is internally pressurised. The analysis shows that the minimum pressure required to cause yield in the cylinder decreases rapidly with increasing cylinder height until the height is about the same as the outer radius of the cylinder, beyond which the decrease is marginal. Introduction of a fillet at the internal corner enhances the design pressure substantially while a fillet at the outer corner affects this pressure only marginally.

A Dual Seven-Level Inverter Supply for an Open-End Winding Induction Motor Drive

This paper develops a seven-level inverter structure for open-end winding induction motor drives. The inverter supply is realized by cascading four two-level and two three-level neutral-point-clamped inverters. The inverter control is designed in such a way that the common-mode voltage (CMV) is eliminated. DC-link capacitor voltage balancing is also achieved by using only the switching-state redundancies. The proposed power circuit structure is modular and therefore suitable for fault-tolerant applications. By appropriately isolating some of the inverters, the drive can be operated during fault conditions in a five-level or a three-level inverter mode, with preserved CMV elimination and DC-link capacitor voltage balancing, within a reduced modulation range.

A Front end Switched Rectifier DC Source for Neutral Point Balancing of A NPC Three-Level Inverter for The Full Modulation Range

A switched DC voltage three level NPC is proposed in this paper to eliminate capacitor balancing problems in conventional three-level Neutral Point Clamped (NPC) inverter. The proposed configuration requires only one DC link with a voltage V-dc/2, where V-dc is the DC link voltage in a onventional NPC inverter. To get rated DC link voltage (V-dc), the voltage source is alternately onnected in parallel to one of the two series capacitors using two switches and two diodes with device voltage rating of V-dc/2. The frequency at which the voltage source is switched is independent and will not affect the operation of NPC inverter. The switched voltage source in this configuration balances the capacitors automatically. The proposed configuration can also be used as a conventional two level inverter in lower modulation range, thereby increases the reliability of the drive system. A space vector based PWM scheme is used to verify this proposed topology.

On a Two-Dimensional Problem in the End-Block Design of Post-Tensioned Prestressed Concrete Beams

Abstract is not available.

Transcending “the Impossible” : From Dead End to Expansive Learning

This dissertation investigates changes in bank work and the experience of impossibility attached to these by workers at the local level from the viewpoint of work-related well-being and collective learning. A special challenge in my work is to conceptualize the experience of impossibility as related to change, and as a starting point and tool for development work. The subject of the dissertation, solving the impossible as a collective learning process, came up as a central theme in an earlier project: Work Units between the Old and the New (1997 – 1999). Its aim was to investigate how change is constructed as a long-term process, starting from the planning of the change until its final realization in everyday banking work. I studied changes taking place in the former Postipankki (Postal Bank), later called Leonia. The three-year study involved the Branch Office of Martinlaakso, and was conducted from the perspective of well-being in a change process. The sense of impossibility involved in changes turned out to be one of the most crucial factors impairing the sense of well-being. The work community that was the target of my study did not have the available tools to construct the change locally, or to deal with the change-related impossibility by solving it through a mutual process among themselves. During the last year of the project, I carried out an intervention for development in the Branch Office, as collaboration between the researchers and the workers. The purpose of the intervention was to resolve such perceived change-related impossibility as experienced repeatedly and considered by the work community as relevant to work-related well-being. The documentation of the intervention – audio records from development sessions, written assignments by workers and assessment or evaluation interviews – constitute the essential data for my dissertation. The earlier data, collected and analysed during the first two years, provides a historical perspective on the process, all the way from construction of the impossibility towards resolving and transcending it. The aim of my dissertation is to understand the progress of developmental intervention as a shared, possibly expansive learning process within a work community and thus to provide tools for perceiving and constructing local change. I chose the change-related impossibility as a starting point for development work in the work community and as a target of conceptualization. This, I feel, is the most important contribution of my dissertation. While the intervention was in progress, the concept of impossibility started emerging as a stimulating tool for development work. An understanding of such a process can be applied to development work outside banking work as well. According to my results, it is pivotal that a concept stimulating development is strongly connected with everyday experiences of and speech about changes in work activity, as well as with the theoretical framework of work development. During this process, development work on a local level became of utmost interest as a case study for managing change. Theoretically, this was conceptualized as so-called second-order work and this concept accompanies us all the way through the research process. Learning second-order work and constructing tools based on this work have proved crucial for promoting well-being in the change circumstances in a local work unit. The lack of second-order work has led to non-well-being and inability to transcend the change-related sense of impossibility in the work community. Solving the impossible, either individually or situationally, did not orient the workers towards solving problems of impossibility together as a work community. Because the experience of the impossibility and coming to terms with transcending it are the starting point and the target of conceptualization in this dissertation, the research provides a fresh viewpoint on the theoretical framework of change and developmental work. My dissertation can facilitate construction of local changes necessitated by the recent financial crisis, and thus promote fluency and well-being in work units. It can also support change-related well-being in other areas of working life.

Choice of the End Functional Groups in Tri(p-phenylenevinylene) Derivatives Controls Its Physical Gelation Abilities

New supramolecular organogels based on all-trans-tri(p-phenylenevinylene) (TPV) systems possessing different terminal groups, e.g., oxime, hydrazone, phenylhydrazone, and semicarbazone have been synthesized. The self-assembly properties of the compounds that gelate in specific organic solvents and the aggregation motifs of these molecules in the organogels were investigated using UV−vis, fluorescence, FT-IR, and 1H NMR spectroscopy, electron microscopy, differential scanning calorimetry (DSC), and rheology. The temperature variable UV−vis and fluorescence spectroscopy in different solvents clearly show the aggregation pattern of the self-assemblies promoted by hydrogen bonding, aromatic π-stacking, and van der Waals interactions among the individual TPV units. Gelation could be controlled by variation in the number of hydrogen-bonding donors and acceptors in the terminal functional groups of this class of gelators. Also wherever gelation is observed, the individual fibers in gels change to other types of networks in their aggregates depending on the number of hydrogen-bonding sites in the terminal functions. Comparison of the thermal stability of the gels obtained from DSC data of different gelators demonstrates higher phase transition temperature and enthalpy for the hydrazone-based gelator. Rheological studies indicate that the presence of more hydrogen-bonding donors in the periphery of the gelator molecules makes the gel more viscoelastic solidlike. However, in the presence of more numbers of hydrogen-bonding donor/acceptors at the periphery of TPVs such as with semicarbazone a precipitation as opposed to gelation was observed. Clearly, the choice of the end functional groups and the number of hydrogen-bonding groups in the TPV backbone holds the key and modulates the effective length of the chromophore, resulting in interesting optical properties.

Increasing vegetable consumption: a means-end chain approach

Purpose – The purpose of this study is to illustrate how means-end chain theory can inform communications that effectively convey the health messages of vegetable consumption to various publics. Design/methodology/approach – Laddering interviews were conducted with 61 participants who consumed at least two serves of vegetables a day and were responsible in part or whole for shopping in their household. A means-end chain value map was then constructed using mecanalyst software. Findings – Using means-end theory, an example communications strategy was developed from the dominant chain. The health and wellness features that respondents associated with vegetables were “freshness”, a “source of vitamins and minerals”, and “high nutritional value”. In the mind of the consumer, these features were linked to the benefit concept “maintain energy and vitality”, which in turn was connected to the consequence “maintain an active life”. The end-states or goals participants ultimately connected to the health and wellness features of vegetables were that of “enjoy life” and “achieve goals”. Research limitations/implications – The research is limited in so far as subjects who consume less than two serves of vegetables are not recruited for this study. Practical implications – It is suggested that social marketing initiatives designed to increase vegetable consumption may base messages on health-related values or end-states of being to resonate more effectively with consumers. Social implications – High vegetable consumption is associated with a reduced risk of chronic disease. Effective strategies designed to increase vegetable consumption amongst populations may reduce the burden on health systems. Originality/value – This study illustrates how consumers' cognitive processes can inform social marketing communications.

Jacob Judey-Barosin with his wife Sonia nee Finkel after the end of World War II; Paris Portraits Couples

Early in 1943 the Barosins were arrested and sent to the deportation camp in Gurs. They were freed by French authorities and went into hiding until their liberation in 1944 in Paris. In 1947 they emigrated to the United States.

Rabbi Leo Baeck, E.L. Ehrlich of Basel, Herbert Strauss of Bern, and Rabbi Eugen Messinger of Bern outside of the West End Synagogue, London, at the International Meeting of the World Union for Progressive Judaism.

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Rabbi Eugen Messinger of Bern, Dr. Herbert Strauss of Bern and E.L. Ehrlich of Basel outside of the West End Synagogue, London, at the International Meeting of the World Union for Progressive Judaism.

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