Cancer associated malnutrition: prevalence of cachexia, sarcopenia and impact on treatment outcomes, survival and health related quality of life

Malnutrition, sarcopenia and cancer cachexia (CC) are prevalent among cancer patients and can have detrimental effects on clinical outcomes such as quality of life (QoL) and overall survival. Cachexia is associated with lower tolerance for chemotherapy, which limits the total dose that can be delivered, the number of symptomatic responses and any survival advantage that might be accrued. Moreover, for the majority who do not respond, cachexia may be exacerbated by systemic chemotherapy, thus increasing the net symptom burden experienced by patients. The multitude of interactions between cancer location, treatments, nutritional status and QoL has never been thoroughly explored in an Irish cancer cohort. The objectives of this thesis were to further understand nutritional status, especially body composition in ambulatory cancer patients and determine the relationship between nutritional status using different assessment criteria and QoL, chemotherapy toxicity and survival among cancer patients undergoing chemotherapy. Results aimed to identify baseline factors that may be predictive of poor outcome, toxicities to chemotherapy and disease-free and overall survival. This thesis broadly divides into two sections. The first section (Chapters 3 & 4) focuses on improving our knowledge of the nutritional status of Irish cancer outpatients using a cross sectional study design. A study of 517 patients referred for chemotherapy was conducted using computed tomography (CT) imaging (body composition) and a survey that documented oncologic data, weight loss (WL) data and QoL data. We revealed that a significant proportion of Irish cancer patients undergoing chemotherapy experience unintentional WL over the previous 6 months (62%), sarcopenia (45%) and CC (43%), and the distribution of WL and nutritional risk were associated with site of primary tumour and treatment intent. Patients that had sarcopenia, nutritional risk, or CC had significantly reduced functional abilities, more symptoms and adverse global QoL. In the second section of this thesis (Chapters 5 & 6) the potential link between developing toxicity to antineoplastic regimens in patients with sarcopenia was conducted by way of retrospective studies. A retrospective serial CT analysis defined the prevalence of sarcopenia in patients with metastatic renal cell carcinoma (mRCC) and metastatic castrate resistant prostate cancer (mCRPC), which was then correlated with dose limiting toxicities of sunitinib and docetaxel respectively. Sarcopenia was prevalent in patients with mRCC and mCRPC, was an occult condition in patients with normal/high BMI, was associated with less treatment days, was a significant predictor of DLT in patients receiving sunitinib and a significant predictor of neutropenia and neurosensory toxicities in patients receiving docetaxel. This thesis attempted to address the underlying research deficiencies in Irish oncology nutritional data at national level. The findings from this thesis have implications for the planning of cancer care interventions and indicate that further research is required to improve nutritional screening, in particular for CC and sarcopenia, in the hope that timely intervention can improve both patient-centered and oncologic outcomes.

Self-organized vegetation patterning as a fingerprint of climate and human impact on semi-arid ecosystems

Spatially periodic vegetation patterns are well known in arid and semi-arid regions around the world. Mathematical models have been developed that attribute this phenomenon to a symmetry-breaking instability. Such models are based on the interplay between competitive and facilitative influences that the vegetation exerts on its own dynamics when it is constrained by arid conditions, but evidence for these predictions is still lacking. Moreover, not all models can account for the development of regularly spaced spots of bare ground in the absence of a soil prepattern. We applied Fourier analysis to high-resolution, remotely sensed data taken at either end of a 40-year interval in southern Niger. Statistical comparisons based on this textural characterization gave us broad-scale evidence that the decrease in rainfall over recent decades in the sub-Saharan Sahel has been accompanied by a detectable shift from homogeneous vegetation cover to spotted patterns marked by a spatial frequency of about 20 cycles km-1. Wood cutting and grazing by domestic animals have led to a much more marked transition in unprotected areas than in a protected reserve. Field measurements demonstrated that the dominant spatial frequency was endogenous rather than reflecting the spatial variation of any pre-existing heterogeneity in soil properties. All these results support the use of models that can account for periodic vegetation patterns without invoking substrate heterogeneity or anisotropy, and provide new elements for further developments, refinements and tests. This study underlines the potential of studying vegetation pattern properties for monitoring climatic and human impacts on the extensive fragile areas bordering hot deserts. Explicit consideration of vegetation self-patterning may also improve our understanding of vegetation and climate interactions in arid areas. © 2006 The Authors.

Turbulence modelling and its impact on CFD predictions for cooling of electronic components

This paper will discuss Computational Fluid Dynamics (CFD) results from an investigation into the accuracy of several turbulence models to predict air cooling for electronic packages and systems. Also new transitional turbulence models will be proposed with emphasis on hybrid techniques that use the k-ε model at an appropriate distance away from the wall and suitable models, with wall functions, near wall regions. A major proportion of heat emitted from electronic packages can be extracted by air cooling. This flow of air throughout an electronic system and the heat extracted is highly dependent on the nature of turbulence present in the flow. The use of CFD for such investigations is fast becoming a powerful and almost essential tool for the design, development and optimization of engineering applications. However turbulence models remain a key issue when tackling such flow phenomena. The reliability of CFD analysis depends heavily on the turbulence model employed together with the wall functions implemented. In order to resolve the abrupt fluctuations experienced by the turbulent energy and other parameters located at near wall regions and shear layers a particularly fine computational mesh is necessary which inevitably increases the computer storage and run-time requirements. The PHYSICA Finite Volume code was used for this investigation. With the exception of the k-ε and k-ω models which are available as standard within PHYSICA, all other turbulence models mentioned were implemented via the source code by the authors. The LVEL, LVEL CAP, Wolfshtein, k-ε, k-ω, SST and kε/kl models are described and compared with experimental data.

The impact on students of coursework assessment deadlines and penalties

The use by students of an e-learning system that enhances traditional learning in a large university computing school where there are clear assessment deadlines and severe penalties for late submission of coursework is examined to assess the impact of changes to the deadline model on the way students use the system and on the results they achieve. It is demonstrated that the grade a student achieves is partly dependent on the time before the deadline when the work is completed - in general, students who submit earlier gain higher grades. Possible reasons for this are explored. Analysis of the data from a range of different implementations of deadline policies is presented. Suggestions are made on how to minimise any possible negative impact of the assessment policy on the student's overall learning.

Socialising young literacy learners into a discourse of failure: Dominant discourses in literacy teaching and assessment and their impact on the progression of young literacy learners into employment

This paper argues that contemporary literacy programmes are a mismatch for the expectations of both the government and employers as well as the goals of learners. It submits that the dominant discourses in literacy provision have led to the emergence of a learning culture which not only fails the learners but is also incapable of meeting the aspirations of both the government and employers. To support this argument, the paper reports a small scale research project that analyses the perceptions of learners, teachers and employers who were involved in a work placement scheme for young literacy learners in a college of further education. Data for the study were collected through focus group and face to face interviews and analysed using the framework of discourse analysis provided by Gill (2000) with findings codified and analysed thematically. The study found that teachers were aware that their learners were not adequately prepared for the world of work because of the demands of the dominant discourses of quality and performance measurement which were most obviously manifested in their assessment, teaching methods and the attitudes of learners. It found that employers perceive young learners as inadequate in terms of the workplace expectations. Learners in the study revealed that their workplace culture and expectations were totally different from the culture to which they had been socialised in their studies. The study concludes that unless the dominance of these discourses is ameliorated, young literacy learners will continue to be socialised into a discourse of failure.

Epidemiological and nutrition transition in developing countries: impact on human health and development

Whereas common infectious and parasitic diseases such as malaria and the HIV/AIDS pandemic remain major unresolved health problems in many developing countries, emerging non-communicable diseases relating to diet and lifestyle have been increasing over the last two decades, thus creating a double burden of disease and impacting negatively on already over-stretched health services in these countries. Prevalence rates for type 2 diabetes mellitus and CVD in sub-Saharan Africa have seen a 10-fold increase in the last 20 years. In the Arab Gulf current prevalence rates are between 25 and 35% for the adult population, whilst evidence of the metabolic syndrome is emerging in children and adolescents. The present review focuses on the concept of the epidemiological and nutritional transition. It looks at historical trends in socio-economic status and lifestyle and trends in nutrition-related non-communicable diseases over the last two decades, particularly in developing countries with rising income levels, as well as the other extreme of poverty, chronic hunger and coping strategies and metabolic adaptations in fetal life that predispose to non-communicable disease risk in later life. The role of preventable environmental risk factors for obesity and the metabolic syndrome in developing countries is emphasized and also these challenges are related to meeting the millennium development goals. The possible implications of these changing trends for human and economic development in poorly-resourced healthcare settings and the implications for nutrition training are also discussed.

Psychological bonds and their impact on behavioral loyalty in auditor-client relationships

Purpose – The purpose of this paper is to examine the effect of the psychological bond on behavioral loyalty (word-of-mouth, continuance and non-audit services) to audit firms providing services to companies listed on the Polish Stock Exchange. Design/methodology/approach – A model is proposed and tested using structural equation modeling with LISREL. Data were collected from top executives of companies listed on the Warsaw Stock Exchange. Findings – The psychological bond has a positive effect on word-of-mouth, continuance and non-audit services. Research limitations/implications – The current research is limited to the investigation of the psychological bond as an antecedent of behavioral loyalty in Poland. Future research should identify and assess other antecedents and replicate these across different countries. A longitudinal survey across different points in time might reveal more useful information about auditor-client relationships. Practical implications – Auditors need to consider ways in which they can develop the psychological bond with their clients. This bond is the basis for the client believing the audit firm is superior to others, which has been found to lead to behavioral loyalty in this study. In particular, management of the auditor brand and reputation, personal experience of the audit firm and alumni relations are discussed as ways of enhancing the psychological bond among client executives. Originality/value – This study is the first to examine the impact of the psychological bond on behavioral loyalty in auditor-client relationships.