A comprehensive approach to evaluate nutritional status in Crohn's patients in the era of biologic therapy: a case-control study

Objectives - Evaluate the nutritional status of patients with inactive or mildly active Crohn's disease (CD), and identify possible causes for potential deficiencies. Methods - A total of 78 CD patients and 80 healthy controls were evaluated in respect of nutritional status, dietary intake, and life styles factors. Results - These 73/78 CD patients were on immunomodulating therapies. Mean body mass index (BMI) was lower in patients as compared to controls (P= 0.006) but 32% of CD patients and 33.8% of controls had a BMI > 25, whereas 8% and 23.8% in each group, respectively, were obese (BMI > 30Kg/m(2)). Fat free mass was significantly decreased in both genders (P < 0.05) whereas fat mass was decreased only in males (P= 0.01). Energy intake was significantly lower in CD patients (P < 0.0001) and we observed significantly lower adjusted mean daily intakes of carbohydrates, monounsaturated fat, fiber, calcium, and vitamins C, D, E, and K (P < 0.05). 29% of patients had excluded grains from their usual diet, 28% milk, 18% vegetables, and 11% fruits. Milk exclusion resulted in a significantly lower consumption of calcium and vitamin K (P < 0.001) and the exclusion of vegetables was associated to a lower consumption of vitamins C and E (P < 0.05). Physical activity was significantly lower in CD patients (P= 0.01) and this lack of physical activity was inversely correlated with increased fat mass percentage (r=-0.315, P= 0.001). Conclusions - Results showed that the most prevalent form of malnutrition in CD patients was an excess of body weight, which was concomitant with an inadequate dietary intake, namely micronutrients, clearly related to dietary exclusion of certain foods.

Tackling Food Poverty: Only a more comprehensive approach will work

Lessons from the Decent Food for All(DFfA) Intervention

Life experiences of elderly with cancer pain: the existential comprehensive approach

OBJECTIVE Understanding the experiences of elderly with cancer pain. METHOD Qualitative research based on Heidegger's phenomenology. 12 elderly cancer patients from a city in northwest Paraná were interviewed from November 2013 to February 2014. RESULTS Analysis performed by vague, median and interpretive understanding which resulted in two ontological themes: Cancer pain: unveiling the imprisonment and impositions experienced by the elderly, and Unveiling the anguish of living with cancer pain; it revealed not only how the elderly experience pain in their daily lives, but also how hard it is to live with its particularities. CONCLUSION Cancer pain has biopsychosocial repercussions for the elderly, generating changes in their existence in the world, requiring holistic and authentic care.

Comprehensive approach for the detection of antifungal compounds using a susceptible strain of Candida albicans and confirmation of in vivo activity with the Galleria mellonella model.

An efficient screening strategy for the identification of potentially interesting low-abundance antifungal natural products in crude extracts that combines both a sensitive bioautography assay and high performance liquid chromatography (HPLC) microfractionation was developed. This method relies on high performance thin layer chromatography (HPTLC) bioautography with a hypersusceptible engineered strain of Candida albicans (DSY2621) for bioactivity detection, followed by the evaluation of wild type strains in standard microdilution antifungal assays. Active extracts were microfractionated by HPLC in 96-well plates, and the fractions were subsequently submitted to the bioassay. This procedure enabled precise localisation of the antifungal compounds directly in the HPLC chromatograms of the crude extracts. HPLC-PDA-mass spectrometry (MS) data obtained in parallel to the HPLC antifungal profiles provided a first chemical screening about the bioactive constituents. Transposition of the HPLC analytical conditions to medium-pressure liquid chromatography (MPLC) allowed the efficient isolation of the active constituents in mg amounts for structure confirmation and more extensive characterisation of their biological activities. The antifungal properties of the isolated natural products were evaluated by their minimum inhibitory concentration (MIC) in a dilution assay against both wild type and engineered strains of C. albicans. The biological activity of the most promising agents was further evaluated in vitro by electron microscopy and in vivo in a Galleria mellonella model of C. albicans infection. The overall procedure represents a rational and comprehensive means of evaluating antifungal activity from various perspectives for the selection of initial hits that can be explored in more in-depth mode-of-action studies. This strategy is illustrated by the identification and bioactivity evaluation of a series of antifungal compounds from the methanolic extract of a Rubiaceae plant, Morinda tomentosa, which was used as a model in these studies.

Kansainvälisen kokonaisvaltaisen kriisinhallintastrategian (Comprehensive Approach) mahdollisuudet Suomen kokonaismaanpuolustuksen kansainvälisen ulottuvuuden kehittämiseen : voimakasta normipainetta vai pientä hienosäätöä?

Kansallisen kokonaismaanpuolustuksemme toimintaympäristö on kylmän sodan jälkeisellä ajalla ollut voimakkaassa muutoksessa. Globalisoituvassa maailmassa turvallisuushaasteet ja -uhat muodostavat keskinäisriippuvuuden verkoston, joiden vaikutuksiltaan laajat seuraukset iskevät lyhyillä varoitusajoilla yhä voimakkaammin, etäämmälle ja perinteisistä valtioiden rajoista välittämättä. Kansainvälisessä toiminnassa on vakiintumassa käsitteellisellä tasolla termi ”Comprehensive Approach”- kuvaamaan kokonaisvaltaista lähestymistapaa uusiin turvallisuushaasteisiin vastaamiseksi laajan turvallisuuden käsiteympäristössä. Miten tämä käsite ymmärretään Suomelle keskeisimpien toimijoiden, eli Euroopan Unionin, Yhdistyneiden Kansakuntien, Naton, Yhdysvaltojen tai vaikkapa Pohjoismaiden osalta? Kansallisen varautumisemme päämäärä on kuitenkin säilynyt vuosien saatossa samana. Sen tehtävänä on ollut varmistaa ja ylläpitää yhteiskuntamme elintärkeät toiminnot kaikissa tilanteissa kansalaisten elinmahdollisuuksien turvaamiseksi sekä valtion toimintakyvyn säilyttämiseksi. Varautumisemme kulmakiveksi on vuosikymmenten kuluessa muotoutunut kokonaismaanpuolustuksen konsepti, jonka avulla kaikki tärkeimmät kansalliset voimavaramme on kyetty keskittämään kohti yhteistä päämäärää kriisitilanteesta selviämiseksi sekä on estetty pienen valtion rajallisten resurssien päällekkäinen kehittäminen tai käyttö. Suomen kriisivalmiuden nykytila ja tulevaisuus on kuitenkin yhä tiiviimmin sidoksissa kansainväliseen kehitykseen. Syrjäinen sijaintimme, riippuvuus ulkomaankaupasta pitkine kulje-tusyhteyksineen, talouden kasvava integraatio, sähköisen viestinnän kehitys, teknologinen kustannusten kasvu sekä erikoistumisen vaatimus lisäävät jatkuvasti alttiuttamme erilaisille häiriöille ja lisäävät varautumisen kokonaiskustannuksia. Myös luonnon ääri-ilmiöiden voimistuminen, energiariippuvuuden lisääntyminen sekä sotilaallisten kriisinhallintaoperaatioiden luonteen muutos edellyttävät kansallisen varautumisemme perusrakenteiden aktiivista ja kehittävää tarkastelua. Tämän diplomityön keskeisenä tarkoituksena on löytää ja tunnistaa konstruktivismin teorian viitekehyksessä niitä kansainvälisen kehityksen trendejä ja muutospaineita, jotka mahdollistavat oman kansallisen kokonaismaanpuolustuksen mallimme kehittämisen. Samalla Suomelle tarjoutuu mahdollisuus vaikuttaa aktiivisella omalla toiminnallaan ja osaamisellaan kansainväliseen kehitykseen sekä verkottumalla hyödyntää globaalia osaamispääomaa. Esimerkkeinä tästä onnistuneesta kaksisuuntaisesta vaikuttamisesta esitellään tässä tutkimustyössä Suomen toiminta monikansallisessa suorituskykyjen kehittämistoiminnassa (MNE- eksperimentaatiosarja) sekä merivalvonta-alalla toteutettu monenvälinen yhteistyö.

Functionality of several cake ingredients: a comprehensive approach

The roles of some cake ingredients – oil, a leavening agent, and inulin – in the structure and physicochemical properties of batter and cakes were studied in four different formulations. Oil played an important role in the batter stability, due to its contribution to increasing batter viscosity and occluding air during mixing. The addition of the leavening agent was crucial to the final height and sponginess of the cakes. When inulin was used as a fat replacer, the absence of oil caused a decrease in the stability of the batter, where larger air bubbles were occluded. Inulin dispersed uniformly in the batter could create a competition for water with the flour components: gluten was not properly hydrated and some starch granules were not fully incorporated into the matrix. Thus, the development of a continuous network was disrupted and the cake was shorter and softer; it contained interconnected air cells in the crumb, and was easily crumbled. The structure studies were decisive to understand the physicochemical properties.

THE CARE NEEDS OF WOMEN INFECTED WITH THE HUMAN PAPILLOMA VIRUS: A COMPREHENSIVE APPROACH

This study is founded on the phenomenology of Martin Heidegger, with the objective to understand the care needs of women infected with the human papilloma virus. Participants were fourteen women who had been diagnosed with this infection. The guiding questions were: What is it like to have this diagnosis? Tell me your experience, from when you received your diagnosis until today. What has your health care been like? The questions revealed the theme - seeking care as solicitude - which showed the importance of the support of family and friends. The presence of the infection as the cause of marital conflicts and separation was another highlighted aspect. The statements showed that there was a sense of resignation after an unsuccessful attempt to find accurate and clear information in order to make assertive decisions. Health interventions for infected women must overcome the traditional models of care, including interventions for health promotion and prevention, with trained professionals who are sensitive to the subjective dimension.

The port-Hamiltonian framework as a comprehensive approach to model and simulate complex systems

This thesis describes modelling tools and methods suited for complex systems (systems that typically are represented by a plurality of models). The basic idea is that all models representing the system should be linked by well-defined model operations in order to build a structured repository of information, a hierarchy of models. The port-Hamiltonian framework is a good candidate to solve this kind of problems as it supports the most important model operations natively. The thesis in particular addresses the problem of integrating distributed parameter systems in a model hierarchy, and shows two possible mechanisms to do that: a finite-element discretization in port-Hamiltonian form, and a structure-preserving model order reduction for discretized models obtainable from commercial finite-element packages.

Looking for a more comprehensive approach

The necessity/convenience for improving accuracy in determining the flood frequency is widely accepted further than among hydrologists, and is increasingly deepened in relationship with the statement of different thresholds related to the respective management systems. And both Scientific and Management Communities fully accept the necessity of living with determined levels of flood risk. Most of the approaches for “Advancing Methods” improving concentrate on the statistical ways, even since Climate in fact is not a Stationary process. The question is here reflected since the SMARTeST research and final highlights, policy and recommendations. The paper looks at a better agreement between Hydrology and the whole Climate as the result of the Global Thermal Machine and takes mainly into account a historical approach, trying to show the necessity of a wider collection and analysis of climate data for statistical approaches.

Looking for a more comprehensive approach

The necessity/convenience for improving accuracy in determining the flood frequency is widely accepted further than among hydrologists, and is increasingly deepened in relationship with the statement of different thresholds related to the respective management systems. And both Scientific and Management Communities fully accept the necessity of living with determined levels of flood risk. Most of the approaches for “Advancing Methods” improving concentrate on the statistical ways, even since Climate in fact is not a Stationary process. The question is here reflected since the SMARTeST research and final highlights, policy and recommendations. The paper looks at a better agreement between Hydrology and the whole Climate as the result of the Global Thermal Machine and takes mainly into account a historical approach, trying to show the necessity of a wider collection and analysis of climate data for statistical approaches.

The EU’s comprehensive approach towards security: the Lisbon Treaty and “smart power”. EU Centre Singpore Policy Brief No. 6, May 2013

The European Union (EU) has increasingly become a comprehensive security actor. With the development of the Common Foreign and Security Policy (CFSP), including the Common Security and Defence Policy (CSDP) as a reaction to the failure of the EU to act during the wars in Yugoslavia/Western Balkans in the 1990s, the EU has a wide range of instruments for crisis prevention, crisis management as well as post-crisis intervention at its disposal. Observers typically agree that “hard power” is no longer sufficient to address the complex security challenges of today’s world while the EU, often criticised for only utilising “soft power”, is now able to exercise “smart power”. Through a comprehensive approach, facilitated by the Lisbon Treaty, the EU can now use the various instruments at its disposal, such as diplomacy, development aid, humanitarian assistance, trade, sanctions, international cooperation and crisis management capabilities in a joined-up manner. This mix of tools and instruments is helping the EU to achieve the aim set out in its European Security Strategy: “a secure Europe in a better world”.

The EU Blue Card - is there a need for a more comprehensive approach? IES Policy Brief Issue 2015/3 June 2015

This Policy Brief reviews the implementation of the EU Blue Card (BC) Directive in Member States and offers some suggestions on how to improve its potential. Firstly, it traces back the origin of the current partitioned approach in labour migration and the objectives that an EU labour migration policy should achieve according to the Commission. Secondly, it reports on the content of the directive and its implementation in Member States. Thirdly, there is an analysis of the weaknesses of the directive in terms of numbers of BCs issued and harmonization achieved. Finally, recommendations are put forward on how to improve EU labour migration policy.