111 research outputs found
Energy expenditure and substrate utilization during critical illness
No full textBackground: Critical illness leads to major alterations in metabolism. The net result is a state where catabolism predominates over anabolism. The associated loss of lean body mass is significant and potentially harmful. It is commonly held that providing calories and protein from nutrition may attenuate this response. Despite significant research efforts, an optimal dose for these therapies remains to be defined. The metabolic rate of ICU patients is readily measured by indirect calorimetry. Questions regarding the accuracy of modern instruments in the setting of mechanical ventilation have been an impediment to wider application of this technique. The physiological effects of common nutritional interventions on protein balance are difficult to assess in clinical practice but can be quantified using stable isotope tracers.Aims: The studies of this thesis had two main aims: to validate techniques for gas exchange measurements in ICU, and to describe the effects of energy and/or amino acid supplementation on protein kinetics. In studies I and II we evaluated the measurement properties of three new instruments for indirect calorimetry in mechanically ventilated ICU patients against a clinical gold standard (Deltatrac). Study III investigated the effects of a supplemental amino acid infusion on whole-body protein balance in critically ill patients. In study IV, we quantified whole-body protein kinetics after 24 hours of full-dose or half-dose enteral nutrition in a randomized cross-over study design.Results: In study I, we performed 48 measurements with the evaluated instruments and reference method in sequence. Mean resting energy expenditure (REE) was similar between Quark RMR and Deltatrac (p = 0.17). Mean REE from CCM Express was 64% higher than Deltatrac (p Conclusions: Measured energy expenditure is variable between instruments for indirect calorimetry. Apart from one device, agreement compared to the reference method was better than what is commonly accepted for other monitoring technologies in critical care. The studies of protein kinetics indicate that an increase in energy or amino acid delivery improves whole-body protein balance in critically ill patients. Indirect calorimetry and tracer techniques are promising methods to further our understanding of alterations in energy metabolism and substrate utilization during critical illness. In turn, this knowledge may assist in the development of clinical trials with patient-centered outcomes.List of scientific papersI. Indirect calorimetry in mechanically ventilated patients: A systematic comparison of three instruments. Sundström M, Tjäder I, Rooyackers O, Wernerman J. Clin Nutr. 2013 Feb;32(1):118-21. https://doi.org/10.1016/j.clnu.2012.06.004 II. Measuring energy expenditure in the intensive care unit: a comparison of indirect calorimetry by E-sCOVX and Quark RMR with Deltatrac II in mechanically ventilated critically ill patients. Sundström Rehal M, Fiskaare E, Tjäder I, Norberg Å, Rooyackers O, Wernerman J. Crit Care. 2016 Mar 5;20:54. https://doi.org/10.1186/s13054-016-1232-6 III. A supplemental intravenous amino acid infusion sustains a positive protein balance for 24 hours in critically ill patients. Sundström Rehal M, Liebau F, Tjäder I, Norberg Å, Rooyackers O, Wernerman J. Crit Care. 2017 Dec 6;21(1):298. https://doi.org/10.1186/s13054-017-1892-x IV. Whole-body protein kinetics in critically ill patients during 50 or 100% energy provision by enteral nutrition: A randomized cross-over study. Sundström Rehal M, Liebau F, Wernerman J, Rooyackers O. [Submitted]</p
Tove Jansson: The Trixter Children's Author
No full textIn the essay, based on my book The Trixter Children's Author - Tove Jansson and the Metamorphosis of the Moomin Oeuvre, I shed new light upon the transformations that the main motifs, the Moomin family and the Moominvalley, undergo throughout the the oeuvre. I also trace Jansson's radical revisions of the earlier moomin books. In her final revision of the Moomin series, Jansson not only transformed the earlier spate of self-contained books into a coherent " family romance" suite but also submitted her works and characters to psychoanalysis. I argue that the final Moomin suite should be considered the "true" Moomin oeuvre
sj-docx-1-ctj-10.1177_17407745231176773 – Supplemental material for Handling intercurrent events and missing data in non-inferiority trials using the estimand framework: A tuberculosis case study
No full textSupplemental material, sj-docx-1-ctj-10.1177_17407745231176773 for Handling intercurrent events and missing data in non-inferiority trials using the estimand framework: A tuberculosis case study by Sunita Rehal, Suzie Cro, Patrick PJ Phillips, Katherine Fielding and James R Carpenter in Clinical Trials</p
"Design of a charge sensitive preamplifier on high resistivity silicon".
No full textA low noise, fast charge sensitive preamplifier was designed on high resistivity, detector grade silicon. It is built at the surface of a fully depleted region of n-type silicon. This allows the preamplifier to be placed very close to a detector anode. The preamplifier uses the classical input cascode configuration with a capacitor and a high value resistor in the feedback loop. The output stage of the preamplifier can drive a load up to 20pF. The power dissipation of the preamplifier is 13mW. The amplifying elements are ''Single Sided Gate JFETs'' developed especially for this application. Preamplifiers connected to a low capacitance anode of a drift type detector should achieve a rise time of 20ns and have an equivalent noise charge (ENC), after a suitable shaping, of less than 50 electrons. This performance translates to a position resolution better than 3..mu..m for silicon drift detectors. 6 refs., 9 figs
Correction: Rehal et al. A Tomato Pomace Enriched Gluten-Free Ready-to-Cook Snack’s Nutritional Profile, Quality, and Shelf Life Evaluation. Horticulturae 2022, 8, 403
No full textThe Horticulturae Editorial Office wishes to make the following changes to the author’s paper [...
P.09.KR
No full textHaving been the first generation to be born and brought up as an Indian in my family and also having been exposed to surroundings that are highly western in nature, has to be the most significant influence as a person and particulary to work
Characterization of the prostaglandin pathway in mesenteric lymphatic vessels in physiological conditions and experimental ileitis
No full textBibliography: p. 111-126Some pages are in colour.Includes copy of animal protocol approval. Original copy with original Partial Copyright Licence
Representation and Reflection. Imagery and verbal language in the early stages of the design process
No full textThis thesis investigates why verbal language is not sufficient to express the experience and desires of the users and how imagery can be combined with words in the early stages of the design task to make this process go smother. <p>A communication tool has been elaborated from a set of experiments simulating the dialogue in the initial phase of the design process. The basic hypothesis is that the associative use of pictures (images) enriches communication and supports participants with regard to being able to better express that which is tacit, implicit or difficult to articulate verbally. But how can verbal language be an obstacle in the dialogue between actors from different professions in the initial phase of a design process? <p>In architecture, and particularly during the initial design phase, the concepts expressed verbally by users and clients are rather diffuse. The content of a concept is concise only within the praxis and the language game in which it circulates. It cannot be communicated between actors acting from different praxes without ambiguousness. <p>How is it possible to get round this difficulty? A foreseeable solution advocated in this research would be to complement verbal language with pictures used in an associative manner. But how can the picture complement verbal language in order to sustain this dialogue? <p>The picture is not submitted to a system of rules as words are. When used associatively the picture becomes an open sign or symbol to which different significations can be assigned according to the participants' fantasy and imagination. The content of the concepts then becomes negotiable. In this kind of communication the picture acts as a key opening up the sense that verbal language has fixed in accordance with the different language games. The picture is, thanks to its free association, a sign virgin of sense that serves to open up views and construct the new language appropriated to the design situation. <p>This construction is an act of design. Thus, design is not just a business for the expert. The right to think aloud, 'to design', is not just a result of making processes of change more democratic; it is also what helps to develop democracy
Ethics and artistic methods in Tove Jansson's Moominsuite
No full textThe article focus on the ethics of Tove Jansson’s by analyzing her grotesque aesthetics and the way she treats and shaps her figures in her final Moomin suite. The Moomin Suite is the author´s final, overall Moomin work consisting in eight books, published after a second and radical set of revision in 1969-70. In the Suite there is a special ‘emotional-axiological attitude’ (Bachtin) toward the characters, that includes an unprejudiced interest to each of them regardless of their differing characteristics or inclinations. There is also an abolition of conventional hierarchies of values represented by the characters, that is, between ridiculous and admirable personalities, between desirable and pitiful qualities, between one desire and another. The author’s use of grotesque, a guileless narrator, shaped to correspond to the naïve characters’ imaginations and conceptual worlds, a mask of psychological naïvité and character studies without psychological introspection are some of the artistic methods I deal with
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