Seawater carbonate chemistry and elemental composition of purple sea urchin (Strongylocentrotus purpuratus) calcite in a laboratory experiment

Ocean acidification will likely have negative impacts on invertebrates producing skeletons composed of calcium carbonate. Skeletal solubility is partly controlled by the incorporation of "foreign" ions (e.g. magnesium) into the crystal lattice of these skeletal structures, a process that is sensitive to a variety of biological and environmental factors. Here we explore effects of life stage, oceanographic region of origin, and changes in the partial pressure of carbon dioxide in seawater (pCO2) on trace elemental composition in the purple sea urchin (Strongylocentrotus purpuratus). We show that, similar to other urchin taxa, adult purple sea urchins have the ability to precipitate skeleton composed of a range of biominerals spanning low- to high-Mg calcites. Mg / Ca and Sr / Ca ratios were substantially lower in adult spines compared to adult tests. On the other hand, trace elemental composition was invariant among adults collected from four oceanographically distinct regions spanning a range of carbonate chemistry conditions (Oregon, Northern California, Central California, and Southern California). Skeletons of newly settled juvenile urchins that originated from adults from the four regions exhibited intermediate Mg / Ca and Sr / Ca between adult spine and test endmembers, indicating that skeleton precipitated during early life stages is more soluble than adult spines and less soluble than adult tests. Mean skeletal Mg / Ca or Sr / Ca of juvenile skeleton did not vary with source region when larvae were reared under present-day, global-average seawater carbonate conditions (400 µatm; pHT = 8.02 ± 0.03 1 SD; Omega calcite = 3.3 ± 0.2 1 SD). However, when reared under elevated pCO2 (900 µatm; pHT = 7.73 ± 0.03; Omega calcite = 1.8 ± 0.1), skeletal Sr / Ca in juveniles exhibited increased variance across the four regions. Although larvae from the northern populations (Oregon, Northern California, Central California) did not exhibit differences in Mg or Sr incorporation under elevated pCO2 (Sr / Ca = 2.10 ± 0.06 mmol/mol; Mg / Ca = 67.4 ± 3.9 mmol/mol), juveniles of Southern California origin partitioned ~8% more Sr into their skeletons when exposed to higher pCO2 (Sr / Ca = 2.26 ± 0.08 vs. 2.09 ± 0.005 mmol/mol 1 SD). Together these results suggest that the diversity of carbonate minerologies present across different skeletal structures and life stages in purple sea urchins does not translate into an equivalent geochemical plasticity of response associated with geographic variation or temporal shifts in seawater properties. Rather, composition of S. purpuratus skeleton precipitated during both early and adult life history stages appears relatively robust to spatial gradients and predicted future changes in carbonate chemistry. An exception to this trend may arise during early life stages, where certain populations of purple sea urchins may alter skeletal mineral precipitation rates and composition beyond a given pCO2 threshold. This potential for geochemical plasticity during early development in contrast to adult stage geochemical resilience adds to the growing body of evidence that ocean acidification can have differing effects across organismal life stages.

Seawater carbonate chemistry and calcification during a tropical lagoon study at SW lagoon of New Caledonia, 1994

Carbon dioxide and oxygen fluxes were measured in 0.2 m2 enclosures placed at the water sediment interface in the SW lagoon of New Caledonia. Experiments, performed at several stations in a wide range of environments, were carried out both in darkness to estimate respiration and at ambient light, to assess the effects of primary production. The community respiratory quotient (CRQ = CO2 production rate/02 consumption rate) and the community photosynthetic quotient (CPQ= gross O2 production rate/gross CO2 consumption rate) were calculated by functional regressions. The CRQ value, calculated from 61 incubations, was 1.14 (S.E. 0.05) and the CPQ value, obtained from 18 incubations, was 1.03 (S.E. 0.08). The linearity of the relationship between the O2 and the CO2 fluxes suggests that these values are representative for the whole lagoon

Impacts moléculaires d’un excès d’acides gras sur l’androgenèse des cellules surrénaliennes

Le syndrome des ovaires polykystiques (SOPK) touche entre 5 à 10 % des femmes en âge de procréer et est associé à de nombreuses complications. Ce désordre endocrinien est caractérisé par des niveaux circulants élevés d’androgènes, dont la production est principalement modulée par la P450c17 et son cofacteur, soit la P450oxydoréductase (POR). Plusieurs études démontrent que l’hyperandrogénie présente chez les femmes SOPK pourrait être causée par la formation de phénomènes toxiques survenant à la suite de l’exposition des tissus non adipeux à un excès d’acides gras non estérifiés (AGNE), appelé lipotoxicité. Ainsi, l’objectif de cette étude est de déterminer les mécanismes cellulaires sous-jacents à l’hyperandrogénie induite par la surexposition des cellules productrices d’androgènes aux AGNE. Pour y arriver, les cellules surrénaliennes bovines (CSB) ont été exposées en présence de forskoline (Fsk; 1X/2 jours; 10 µM; activateur des adénylates cyclases) et d’oléate (acide gras monoinsaturé, 2X/jour; 200 µM) durant 48 heures. Par la suite, le milieu de culture a été prélevé afin de doser le DHEA (principal androgène surrénalien) par ELISA. De plus, les protéines ont été récoltées afin de déterminer l’expression protéique de la P450c17 et de POR par Western blot. Finalement, pour déterminer les activités 17αhydroxylase et 17,20-lyase de la P450c17, la concentration de plusieurs stéroïdes a été déterminé par LC-MS/MS et le ratio produit/substrat a été effectué. Les résultats sont présentés en moyenne ± SEM. Ainsi, sous stimulation à la Fsk, la présence de 200 µM d’oléate (vs absence d’oléate) augmente la production de DHEA de 114% par les CSB (n=17; 214 ± 20% vs 100 ± 0%; p<0,0001). De plus, l’ajout d’oléate n’affecte pas l’expression de la P450c17 (n=8; 98 ± 6% vs 100 ± 0%; p=0,74) et de POR (n=7; 119 ± 13% vs 100 ± 0%; p= 0,22). Finalement, la présence d’oléate augmente l’activité 17αhydroxylase de la P450c17 de 124% (n=7; 224 ± 19% vs 100 ± 0%; p= 0,02) et tends à augmenter l’activité 17,20-lyase de la P450c17 de 81% (n=7; 181 ± 28% vs 100 ± 0%; p= 0,08). Ainsi, l’augmentation de la production des androgènes induite par les AGNE pourrait être due principalement à leurs effets sur l’augmentation des deux activités enzymatiques de la P450c17, sans effet significatifs sur l’expression de la P450c17 ni de son cofacteur POR. Les mécanismes sous-jacents à l’augmentation des activités de la P450c17 demeurent à élucider.

Association between vaginal bacterial microbiota and the presence and clinical presentation of vulvovaginal candidiasis

Thesis (Master's)--University of Washington, 2016-08

Comparative study of stereopsis with three different tests: TNO®, Stereo Acuity Test Fly® and StereoTAB® in students in higher school

Purpose: Stereopsis is the perception of depth based on retinal disparity. Global stereopsis depends on the process of random dot stimuli and local stereopsis depends on contour perception. The aim of this study was to correlate 3 stereopsis tests: TNO®, StereoTA B®, and Fly Stereo Acuity Test® and to study the sensitivity and correlation between them, using TNO® as the gold standard. Other variables as near convergence point, vergences, symptoms and optical correction were correlated with the 3 tests. Materials and Methods: Forty-nine students from Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), aged 18-26 years old were included. Results: The stereopsis mean (standard-deviation-SD) values in each test were: TNO® = 87.04” ±84.09”; FlyTest® = 38.18” ±34.59”; StereoTA B® = 124.89’’ ±137.38’’. About the coefficient of determination: TNO® and StereoTA B® with R2 = 0.6 e TNO® and FlyTest® with R2 =0.2. Pearson correlation coefficient shows a positive correlation between TNO® and StereoTA B® (r = 0.784 with α = 0.01). Phi coefficient shows a strong and positive association between TNO® and StereoTA B® (Φ = 0.848 with α = 0.01). In the ROC Curve, the StereoTA B® has an area under the curve bigger than the FlyTest® with a sensivity of 92.3% for 94.4% of specificity, so it means that the test is sensitive with a good discriminative power. Conclusion: We conclude that the use of Stereopsis tests to study global Stereopsis are an asset for clinical use. This type of test is more sensitive, revealing changes in Stereopsis when it is actually changed, unlike the test Stereopsis, which often indicates normal Stereopsis, camouflaging a Stereopsis change. We noted also that the StereoTA B ® is very sensitive and despite being a digital application, possessed good correlation with the TNO®.

Financiamiento universitario: teoría y propuesta de reforma para el Perú

El presente trabajo está dividido en dos grandes partes: Una primera, referida a aspectos teóricos del financiamiento de las universidades; y una segunda, en la cual se aplican los principios esbozados a la reforma de la "universidad peruana". Se revisan los principales aspectos del actual sistema de financiamiento y se esbozan los lineamientos generales de una propuesta de un nuevo esquema de financiamiento de la universidad peruana. Se incluyen la idea de los aportes fiscales competitivos, la implementación de un sistema de créditos educativos (para lo cual se realizan simulaciones numéricas) y la necesidad de implementar y/o potenciar fuentes de diversificación de ingresos.

Nickel isotope fractionation during laterite Ni ore smelting and refining: implications for tracing the sources of Ni in smelter-affected soils

Nickel isotope ratios were measured in ores, fly ash, slags and FeNi samples from two metallurgical plants located in the Goiás State, Brazil (Barro Alto, Niquelândia). This allowed investigating the mass-dependent fractionation of Ni isotopes during the Ni-laterite ore smelting and refining. Feeding material exhibits a large range of δ60Ni values (from 0.02 ± 0.10 ‰ to 0.20 ± 0.05 ‰, n=7), explained by the diversity of Ni-bearing phases, and the average of δ60Nifeeding materials was found equal to 0.08 ± 0.08‰ (2SD, n=7). Both δ60Ni values of fly ash (δ60Ni = 0.07 ± 0.07‰, n=10) and final FeNi produced (0.05 ± 0.02 ‰, n=2) were not significantly different from the feeding materials ones. These values are consistent with the very high production yield of the factories. However, smelting slags present the heaviest δ60Ni values of all the smelter samples, with δ60Ni ranging from 0.11 ± 0.05 ‰ to 0.27 ± 0.05 ‰ (n=8). Soils were also collected near and far from the Niquelândia metallurgical plant, to evaluate the potential of Ni isotopes for tracing the natural vs anthropogenic Ni in soils. The Ni isotopic composition of the non-impacted topsoils developed on ultramafic rocks ranges from -0.26 ± 0.09 ‰ to -0.04 ± 0.05 ‰ (n=20). On the contrary, the Ni isotopic composition of the non-ultramafic topsoils, collected close to the plant, exhibit a large variation of δ60Ni, ranging from -0.19 ± 0.13 ‰ up to 0.10 ± 0.05 ‰ (n=4). This slight but significant enrichment in heavy isotopes highlight the potential impact of smelting activity in the surrounding area, as well as the potential of Ni isotopes for discerning anthropogenic samples (heavier δ60Ni values) from natural ones (lighter δ60Ni values). However, given the global range of published δ60Ni values (from -1.03 to 2.5 ‰) and more particularly those associated to natural weathering of ultramafic rocks (from -0.61 to 0.32‰), the use of Ni isotopes for tracing environmental contamination from smelters will remain challenging.

Weight Loss in the Chiropractic Profession

Background: Excess weight places a significant burden on health. Clinical practice guidelines advise healthcare professionals to provide weight management interventions to patients with overweight and obesity. Chiropractic practice may provide a unique opportunity to deliver weight management interventions to those with overweight and obesity. However, little has been done to address overweight and obesity within the chiropractic profession. Identifying the extent of this evidence-practice gap in chiropractic practice is the first step in addressing this issue. Objectives: This thesis was to assess the clinical practices of weight loss provided by chiropractors. The primary objectives were to 1) determine the prevalence of overweight and obesity in the adult patient population that sought chiropractic care, 2) describe the frequency and distribution of chiropractor directed weight management intervention, 3) identify associations between chiropractor directed weight management interventions and specific patient-level and chiropractor-level variables, and 4) examine the interaction between patient weight and comorbid conditions and whether chiropractors offered weight management interventions. Methods: Data from the Ontario Chiropractic Observational and Analysis Study was used (N = 42 chiropractors, N = 3523 patient encounters). Multilevel logistic regression was performed. Patient-level as well as chiropractor-level variables were investigated and associations with weight management provided by chiropractors were identified. Results: The majority of patients who sought chiropractic were overweight or obese (61.2%). Weight loss was provided to only 5.4% of patients. Chiropractors who graduated between 1995 and 2005 (OR: 0.02, 95% CI: 0.00 - 0.13) or prior to 1995 (OR: 0.08, 95% CI: 0.01 - 0.42) provided weight management significantly less than chiropractors who graduated between 2005 and 2014. No significant interaction was observed between patient adiposity and comorbid conditions with chiropractors directed weight loss. Conclusion: The majority of patients who seek chiropractic care are overweight and obese. Chiropractors are in a unique position to help improve patient health through offering weight management. However, this opportunity has not been fully realized by the chiropractic profession.

Weight Loss in the Chiropractic Profession

Background: Excess weight places a significant burden on health. Clinical practice guidelines advise healthcare professionals to provide weight management interventions to patients with overweight and obesity. Chiropractic practice may provide a unique opportunity to deliver weight management interventions to those with overweight and obesity. However, little has been done to address overweight and obesity within the chiropractic profession. Identifying the extent of this evidence-practice gap in chiropractic practice is the first step in addressing this issue. Objectives: This thesis was to assess the clinical practices of weight loss provided by chiropractors. The primary objectives were to 1) determine the prevalence of overweight and obesity in the adult patient population that sought chiropractic care, 2) describe the frequency and distribution of chiropractor directed weight management intervention, 3) identify associations between chiropractor directed weight management interventions and specific patient-level and chiropractor-level variables, and 4) examine the interaction between patient weight and comorbid conditions and whether chiropractors offered weight management interventions. Methods: Data from the Ontario Chiropractic Observational and Analysis Study was used (N = 42 chiropractors, N = 3523 patient encounters). Multilevel logistic regression was performed. Patient-level as well as chiropractor-level variables were investigated and associations with weight management provided by chiropractors were identified. Results: The majority of patients who sought chiropractic were overweight or obese (61.2%). Weight loss was provided to only 5.4% of patients. Chiropractors who graduated between 1995 and 2005 (OR: 0.02, 95% CI: 0.00 - 0.13) or prior to 1995 (OR: 0.08, 95% CI: 0.01 - 0.42) provided weight management significantly less than chiropractors who graduated between 2005 and 2014. No significant interaction was observed between patient adiposity and comorbid conditions with chiropractors directed weight loss. Conclusion: The majority of patients who seek chiropractic care are overweight and obese. Chiropractors are in a unique position to help improve patient health through offering weight management. However, this opportunity has not been fully realized by the chiropractic profession.

ANÁLISE MICROCLIMÁTICA DA RESERVA PARTICULAR DO PATRIMÔNIO NATURAL POUSADA DAS ARARAS SERRANÓPOLIS-GO

Esta pesquisa teve por objetivo analisar o perfil topoclimático considerando a variação da temperatura do ar com a altitude em pontos distribuídos na trilha da Reserva Particular de Patrimônio Natural (RPPN) Pousada das Araras. Os dados de temperatura do ar foram coletados dos termohigrometros instalados, em cotas altimétricas distintas e com características diferentes de paisagem, (nascente, vegetação arbórea e campo aberto), na estação de inverno de 2010. O estudo do perfil topoclimático na RPPN nos permite inferir que há uma significativa correlação da temperatura com a topografia local e com a presença ou ausência de cobertura vegetal do solo. Embora a área de estudo apresenta uma amplitude altimétrica em torno de apenas 76 m, verificou-se, às 15h, um gradiente térmico de -0,08 a -0,11ºC/m, ou seja uma redução na temperatura com o aumento da altitude. Também foi observado que a cobertura vegetal afeta o gradiente térmico.

Cantón Poás.

Mapa base general del cantón de Poás.

The Effects of Various Types of Feed additives on The Chemical Composition of Local Chicken Meat (Gallus domestica).

Abstract. This study aims to determine the effect of giving various types of feed additives to the chemical composition value of super chicken chicken (Gallus domestica). This research is an experimental research using 20 super chicken chickens that come from chicken growth research (growth study). The design used in this study was Completely Randomized Design (RAL), consisting of 4 treatments and 5 replications. The treatment given was (A0 = control (Vita chick 0.7 gram / liter; A1 = 20 ml / liter probio-FM; A2 = 0.08% MOS-oligosaccharide / kg of feed and A3 = herbal leuser KI 5 ml / liter). is a 90 day old super chicken breast Chicken Variable observed moisture content, protein content and fat content The data obtained were analyzed by using vocabulary and tested further by Duncan's Multiple Range Test The results showed that treatment (P> 0,05) to the value of water content and protein of super chicken fowl.Average value of water content at each treatment A0 (69,81%), A1 (70,74%), A2 (71,56%) and A3 (71,52%) while mean value of protein A0 (18,95%), A1 (19,61%), A2 (19,01%) and A3 (19,14%)) P <0,05) to the fat content of super chicken flesh, mean of fat content were A0 (2.02%), A1 (1.49%), A2 (1.37%) and A3 (2.0%).

Blur limits for defocus, astigmatism and trefoil

We investigated the limits at which blur due to defocus, crossed-cylinder astigmatism, and trefoil became noticeable, troublesome or objectionable. Black letter targets (0.1, 0.35 and 0.6 logMAR) were presented on white backgrounds. Subjects were cyclopleged and had effectively 5 mm pupils. Blur was induced with a deformable, adaptive-optics mirror operating under open-loop conditions. Mean defocus blur limits of six subjects with uncorrected intrinsic higher-order ocular aberrations ranged from 0.18 ± 0.08 D (noticeable blur criterion, 0.1 logMAR) to 1.01 ± 0.27 D (objectionable blur criterion, 0.6 logMAR. Crossed-cylinder astigmatic blur limits were approximately 90% of those for defocus, but with considerable meridional influences. In two of the subjects, the intrinsic aberrations of the eye were subsequently corrected before the defocus and astigmatic blur were added. This resulted in only minor reductions in their blur limits. When assessed with trefoil blur and corrected intrinsic ocular aberrations, the ratio of objectionable to noticeable blur limits in these two subjects was much higher for trefoil (3.5) than for defocus (2.5) and astigmatism (2.2).

New insights into appetite, inflammation and the use of fish oil in hemodialysis patients

Protein-energy wasting (PEW) is commonly seen in patients with chronic kidney disease (CKD). The condition is characterised by chronic, systemic low-grade inflammation which affects nutritional status by a variety of mechanisms including reducing appetite and food intake and increasing muscle catabolism. PEW is linked with co-morbidities such as cardiovascular disease, and is associated with lower quality of life, increased hospitalisations and a 6-fold increase in risk of death1. Significant gender differences have been found in the severity and effects of several markers of PEW. There have been limited studies testing the ability of anti-inflammatory agents or nutritional interventions to reduce the effects of PEW in dialysis patients. This thesis makes a significant contribution to the understanding of PEW in dialysis patients. It advances understanding of measurement techniques for two of the key components, appetite and inflammation, and explores the effect of fish oil, an anti-inflammatory agent, on markers of PEW in dialysis patients. The first part of the thesis consists of two methodological studies conducted using baseline data. The first study aims to validate retrospective ratings of hunger, desire to eat and fullness on visual analog scales (VAS) (paper and pen and electronic) as a new method of measuring appetite in dialysis patients. The second methodological study aims to assess the ability of a variety of methods available in routine practice to detect the presence of inflammation. The second part of the thesis aims to explore the effect of 12 weeks supplementation with 2g per day of Eicosapentaenoic Acid (EPA), a longchain fatty acid found in fish oil, on markers of PEW. A combination of biomarkers and psychomarkers of appetite and inflammation are the main outcomes being explored, with nutritional status, dietary intake and quality of life included as secondary outcomes. A lead in phase of 3 months prior to baseline was used so that each person acts as their own historical control. The study also examines whether there are gender differences in response to the treatment. Being an exploratory study, an important part of the work is to test the feasibility of the intervention, thus the level of adherence and factors associated with adherence are also presented. The studies were conducted at the hemodialysis unit of the Wesley Hospital. Participants met the following criteria: adult, stage 5 CKD on hemodialysis for at least 3 months, not expected to receive a transplant or switch to another dialysis modality during the study, absence of intellectual impairment or mental illness impairing ability to follow instructions or complete the intervention. A range of intermediate, clinical and patient-centred outcome measures were collected at baseline and 12 weeks. Inflammation was measured using five biomarkers: c-reactive protein (CRP), interleukin-6 (IL6), intercellular adhesion molecule (sICAM-1), vascular cell adhesion molecule (sVCAM-1) and white cell count (WCC). Subjective appetite was measured using the first question from the Appetite and Dietary Assessment (ADAT) tool and VAS for measurements of hunger, desire to eat and fullness. A novel feature of the study was the assessment of the appetite peptides leptin, ghrelin and peptide YY as biomarkers of appetite. Nutritional status/inflammation was assessed using the Malnutrition-Inflammation Score (MIS) and the Patient-Generated Subjective Global Assessment (PG-SGA). Dietary intake was measured using 3-day records. Quality of life was measured using the Kidney Disease Quality of Life Short Form version 1.3 (KDQOL-SF™ v1.3 © RAND University), which combines the Short-Form 36 (SF36) with a kidney-disease specific module2. A smaller range of these variables was available for analysis during the control phase (CRP, ADAT, dietary intake and nutritional status). Statistical analysis was carried out using SPSS version 14 (SPSS Inc, Chicago IL, USA). Analysis of the first part of the thesis involved descriptive and bivariate statistics, as well as Bland-Altman plots to assess agreement between methods, and sensitivity analysis/ROC curves to test the ability of methods to predict the presence of inflammation. The unadjusted (paired ttests) and adjusted (linear mixed model) change over time is presented for the main outcome variables of inflammation and appetite. Results are shown for the whole group followed by analyses according to gender and adherence to treatment. Due to the exploratory nature of the study, trends and clinical significance were considered as important as statistical significance. Twenty-eight patients (mean age 61±17y, 50% male, dialysis vintage 19.5 (4- 101) months) underwent baseline assessment. Seven out of 28 patients (25%) reported sub-optimal appetite (self-reported as fair, poor or very poor) despite all being well nourished (100% SGA A). Using the VAS, ratings of hunger, but not desire to eat or fullness, were significantly (p<0.05) associated with a range of relevant clinical variables including age (r=-0.376), comorbidities (r=-0.380) nutritional status (PG-SGA score, r=-0.451), inflammatory markers (CRP r=-0.383; sICAM-1 r=-0.387) and seven domains of quality of life. Patients expressed a preference for the paper and pen method of administering VAS. None of the tools (appetite, MIS, PG-SGA, albumin or iron) showed an acceptable ability to detect patients who are inflamed. It is recommended that CRP should be tested more frequently as a matter of course rather than seeking alternative methods of measuring inflammation. 27 patients completed the 12 week intervention. 20 patients were considered adherent based on changes in % plasma EPA, which rose from 1.3 (0.94)% to 5.2 (1.1)%, p<0.001, in this group. The major barriers to adherence were forgetting to take the tablets as well as their size. At 12 weeks, inflammatory markers remained steady apart from the white cell count which decreased (7.6(2.5) vs 7.0(2.2) x109/L, p=0.058) and sVCAM-1 which increased (1685(654) vs 2249(925) ng/mL, p=0.001). Subjective appetite using VAS increased (51mm to 57mm, +12%) and there was a trend towards reduction in peptide YY (660(31) vs 600(30) pg/mL, p=0.078). There were some gender differences apparent, with the following adjusted change between baseline and week 12: CRP (males -3% vs females +17%, p=0.19), IL6 (males +17% vs females +48%, p=0.77), sICAM-1 (males -5% vs females +11%, p=0.07), sVCAM-1 (males +54% vs females +19%, p=0.08) and hunger ratings (males 20% vs females -5%, p=0.18). On balance, males experienced a maintainence or reduction in three inflammatory markers and an improvement in hunger ratings, and therefore appeared to have responded better to the intervention. Compared to those who didn’t adhere, adherent patients maintained weight (mean(SE) change: +0.5(1.6) vs - 0.8(1.2) kg, p=0.052) and fat-free mass (-0.1 (1.6) vs -1.8 (1.8) kg, p=0.045). There was no difference in change between the intervention and control phase for CRP, appetite, nutritional status or dietary intake. The thesis makes a significant contribution to the evidence base for understanding of PEW in dialysis patients. It has advanced knowledge of methods of assessing inflammation and appetite. Retrospective ratings of hunger on a VAS appear to be a valid method of assessing appetite although samples which include patients with very poor appetite are required to confirm this. Supplementation with fish oil appeared to improve subjective appetite and dampen the inflammatory response. The effectiveness of the intervention is influenced by gender and adherence. Males appear to be more responsive to the primary outcome variables than females, and the quality of response is improved with better adherence. These results provide evidence to support future interventions aimed at reducing the effects of PEW in dialysis patients.