Compliance with preoperative oral nutritional supplements in patients at nutritional risk─only a question of will?

BACKGROUND/OBJECTIVES: Preoperative nutrition has been shown to reduce morbidity after major gastrointestinal (GI) surgery in selected patients at risk. In a randomized trial performed recently (NCT00512213), almost half of the patients, however, did not consume the recommended dose of nutritional intervention. The present study aimed to identify the risk factors for noncompliance. SUBJECTS/METHODS: Demographic (n=5) and nutritional (n=21) parameters for this retrospective analysis were obtained from a prospectively maintained database. The outcome of interest was compliance with the allocated intervention (ingestion of ⩾11/15 preoperative oral nutritional supplement units). Uni- and multivariate analyses of potential risk factors for noncompliance were performed. RESULTS: The final analysis included 141 patients with complete data sets for the purpose of the study. Fifty-nine patients (42%) were considered noncompliant. Univariate analysis identified low C-reactive protein levels (P=0.015), decreased recent food intake (P=0.032) and, as a trend, low hemoglobin (P=0.065) and low pre-albumin (P=0.056) levels as risk factors for decreased compliance. However, none of them was retained as an independent risk factor after multivariate analysis. Interestingly, 17 potential explanatory parameters, such as upper GI cancer, weight loss, reduced appetite or co-morbidities, did not show any significant correlation with reduced intake of nutritional supplements. CONCLUSIONS: Reduced compliance with preoperative nutritional interventions remains a major issue because the expected benefit depends on the actual intake. Seemingly, obvious reasons could not be retained as valid explanations. Compliance seems thus to be primarily a question of will and information; the importance of nutritional supplementation needs to be emphasized by specific patients' education.

Using vegetation to characterize the avalanche to Canal del Roc Roig, Vall de Núria (Eastern Pyrenees, Spain)

Avalanche hazard maps of high accuracy are difficult to produce. For land-use planning and management purposes, a good knowledge of extreme run-out zones and frequencies of avalanches is required. In the present work, vegetation recognition (especially focused on Pinus uncinata trees) and dendrochronological techniques are used to characterize avalanches that have occurred in historical times, helping to determine both the extent of large or extreme avalanches and their occurrence in time. Vegetation was studied at the Canal del Roc Roig (eastern Pyrenees, Spain) avalanche path. The avalanches descending this path affect the railway that reaches the Vall de Núria resort and the run-up to the opposite slope. During winter 1996, two important avalanches affecting this path were well documented. These are compared with the results of the vegetation study, consisting of an inventory of flora, the recording of vegetation damages along eight transverse profiles at different altitudes on the path and a dendrochronological sampling campaign. The data obtained contributed to a characterization of the predominant snow accumulation in the starting zone, the 1996 avalanches and the range of frequencies of large avalanches. Also, traces of avalanches that increase the path mapped in the avalanche paths map published by the Institut Cartogràfic de Catalunya in 2000 were identified, improving the initial existing information.

Using vegetation to characterize the avalanche to Canal del Roc Roig, Vall de Núria (Eastern Pyrenees, Spain)

Avalanche hazard maps of high accuracy are difficult to produce. For land-use planning and management purposes, a good knowledge of extreme run-out zones and frequencies of avalanches is required. In the present work, vegetation recognition (especially focused on Pinus uncinata trees) and dendrochronological techniques are used to characterize avalanches that have occurred in historical times, helping to determine both the extent of large or extreme avalanches and their occurrence in time. Vegetation was studied at the Canal del Roc Roig (eastern Pyrenees, Spain) avalanche path. The avalanches descending this path affect the railway that reaches the Vall de Núria resort and the run-up to the opposite slope. During winter 1996, two important avalanches affecting this path were well documented. These are compared with the results of the vegetation study, consisting of an inventory of flora, the recording of vegetation damages along eight transverse profiles at different altitudes on the path and a dendrochronological sampling campaign. The data obtained contributed to a characterization of the predominant snow accumulation in the starting zone, the 1996 avalanches and the range of frequencies of large avalanches. Also, traces of avalanches that increase the path mapped in the avalanche paths map published by the Institut Cartogràfic de Catalunya in 2000 were identified, improving the initial existing information.

Time and space: genetic structure of the common sea urchin paracentrotus lividus in the south-eastern iberian coast

Spatio-temporal variability in settlement and recruitment, high mortality during the first life-history stages, and selection may determine the genetic structure of cohorts of long-lived marine invertebrates at small scales. We conducted a spatial and temporal analysis of the common Mediterranean Sea urchin Paracentrotus lividus to determine the genetic structure of cohorts at different scales. In Tossa de Mar (NW Mediterranean), recruitment was followed over 5 consecutive springs (2006-2010). In spring 2008, recruits and two-year-old individuals were collected at 6 locations along East and South Iberian coasts separated from 200 to over 1,100 km. All cohorts presented a high genetic diversity based on a fragment of mtCOI. Our results showed a marked genetic homogeneity in the temporal monitoring and a low degree of spatial structure in 2006. In 2008, coupled with an abnormality in the usual circulation patterns in the area, the genetic structure of the southern populations studied changed markedly, with arrival of many private haplotypes. This fact highlights the importance of point events in renewing the genetic makeup of populations, which can only be detected through analysis of the cohort structure coupling temporal and spatial perspectives.

External Location Factors of Finnish Direct Investment in Central and Eastern European Transitional Economies

Tutkimuksen päätavoitteena oli selvittää suomalaisten suorien investointien maan valintaan vaikuttavia tekijöitä Itä- ja Keski-Euroopan kymmenessä siirtymätaloudessa. Empiirisessä osuudessa tarkasteltiin suomalaisten yritysten tärkeimpiä sijaintitekijöitä alueella ja yrityskohtaisten tekijöiden vaikutusta sijaintitekijöihin. Tutkimuksessa selvitettiin myös yritysten päämotiiveja investoida maihin. Laaditun investointikriteeristön mukaan maat pystyttiin laittamaan paremmuusjärjestykseen suomalaisen investoijan kannalta. Empiirisen osuuden aineisto kerättiin postikyselylomakkeella yrityksiltä, joilla on tai jotka ovat suunnittelemassa investointeja näihin maihin. Tutkimusote oli kvantitatiivinen. Tutkimustulokset osoittavat, että suomalaiset investoijat valitsevat Itä- ja Keski-Euroopan maan investointikohteeksi pääasiassa markkinapotentiaalin ja edullisten kustannusten perusteella. Myös infrastruktuuri vaikuttaa maan valintaan. Eri aloilla toimivien yritysten sijaintitekijöiden painotuksissa havaittiin eroja. Yrityksen koko ja päämotiivi vaikuttivat sijaintitekijöiden painotuksiin. Investointikriteereiden mukaan kaksi parasta investointimaata suomalaisille investoijille ovat Puola ja Viro. Vertailtaessa investointikriteereitä toteutuneisiin investointeihin voidaan todeta, että suomalaiset investoijat eivät ole hyödyntäneet investoinneilla saatavia etuja kaikissa kohdemaissa.

Coal deposition in carbonate rich shallow Lacustrine systems: The Calaf and Mequinenza sequences (Oligocene, eastern Ebro Basin, NE Spain)

Two main coal-bearing sequences developed during the Oligocene in the Tertiary Ebro Basin, the Calaf (early Oligocene) and Mequinenza (late Oligocene) coal basins. Coal deposition took place in shallow marsh-swamp-lake complexes which sometimes became closed and evolved under warm climatic conditions with fluctuating humidity. These shallow lacustrine systems are closely interrelated with the terminal parts of the distributive fluvial systems which spread from the tectonically active Ebro basin margins. Laterally extensive lignite-bearing sequences, including rather thin, lenticular autochthonous and/or hypautochthonous coal seams with high ash and sulphur contents, characterized coal deposition in the shallow lacustrine systems. Coal seam geometry, which makes them nearly subeconomic, resulted from the tectonic instability during basin margin evolution and the sometimes closed, arid conditions under which the lacustrine systems evolved. High ash and sulphur contents resulted from the inadequate isolation of peat forming environments from clastic influx and from the very low acidity and sometimes high sulphate contents of the lacustrine waters. Coal exploration in shallow lacustrine sequences similar to those described here must take into account that the spread of coal-forming environments and maxima of coal deposition are usually coincident with lake expansions and retraction or shifting of the terminal fluvial zones interrelated with the lacustrine areas.

GENETIC DIVERSITY AND STRUCTURE OF Oenocarpus mapora GERMPLASM CONSERVED AT EASTERN AMAZON

ABSTRACT The aim of this study was to evaluate the genetic diversity and structure in the germoplasm of Oenocarpus mapora conserved at Eastern Amazon. Thus, 88 individuals were genotyped with five microsatellite loci. These individuals belong to 24 accessions that were sampled in eight sample places of three Brazilian Amazon states conserved at the Active Germplasm Bank (AGB) of Embrapa Eastern Amazon. All loci were polymorphic and they generated 85 alleles with an average of 17 alleles per loci. Total genetic diversity (HE) was 0.48. Sample places were considered genetically distinct, with ?p = 0.354. The analysis of molecular variance (AMOVA) identified that the genetic portion among areas was of 36.14% and within 63.86%. The Nei distances varied from 0.091 between Abaetetuba and Santo Antônio do Tauá, both in the state of Pará (PA), to 4.18, between Parintins, AM and Rio Branco, AC. By means of Bayesian analysis, it was identified nine clusters that compose the accessions of the germplasm bank, with different distributions among individuals. The study showed high fixation rates per sample area, which indicates that there may have been significant inbreeding or crossing among parental individuals. It suggests that future samples should be made of different plants in natural populations. Even though, it was verified that there is considerable genetic variation in the germplasm of O. mapora.

Equipes infirmières somatiques et infirmier psychiatrique de liaison: la question de la relation soignant/soigné

Deux ans après la création du poste d'infirmier au Service de Psychiatrie de Liaison du CHUV à Lausanne, nous proposons de faire le constat de nos réflexions issues de cette nouvelle pratique. Nous voulons, en portant un regard extérieur sur les équipes infirmières, définir notre implication au sujet des difficultés relationnelles qu'elles peuvent rencontrer auprès d'un malade. Nous constatons que ce vécu difficile peut être influencé par des facteurs de stress liés au contexte des soins somatiques aigus, ceux-ci se surajoutant à une problématique relationnelle ou psychiatrique. Nous postulons que la position double du rôle de l'infirmier psychiatrique de liaison, que nous définissons dans cet article, (infirmier tiers pour les équipes infirmières, et infirmier "spécialiste" pour le patient), permet d'offrir des espaces intermédiaires de réflexions quant à une recherche de compréhension d'une relation soignant / soigné et de proposer des outils spécifiques aux équipes infirmières.

Inflammation in schizophrenia: A question of balance.

In the past decade, there has been renewed interest in immune/inflammatory changes and their associated oxidative/nitrosative consequences as key pathophysiological mechanisms in schizophrenia and related disorders. Both brain cell components (microglia, astrocytes, and neurons) and peripheral immune cells have been implicated in inflammation and the resulting oxidative/nitrosative stress (O&NS) in schizophrenia. Furthermore, down-regulation of endogenous antioxidant and anti-inflammatory mechanisms has been identified in biological samples from patients, although the degree and progression of the inflammatory process and the nature of its self-regulatory mechanisms vary from early onset to full-blown disease. This review focuses on the interactions between inflammation and O&NS, their damaging consequences for brain cells in schizophrenia, the possible origins of inflammation and increased O&NS in the disorder, and current pharmacological strategies to deal with these processes (mainly treatments with anti-inflammatory or antioxidant drugs as add-ons to antipsychotics).