561 research outputs found
Sarcopenic obesity and associated body composition characteristics in individuals undergoing bariatric sugery: a retrospective study
No full textS279 Diabetologia (2023) 66 (Suppl 1):S1-S536 1 3 after bariatric surgery mitigating its positive effects on health status, leading to patient dissatisfaction and requiring the need for revisional surgery, which is associated with higher complication and mortality rates. Preoperative predictors contributing to IWL are not sufficiently studied. Therefore, we tried to identify preoperative predictors for IWL to identify patients at risk for IWL after bariatric surgery and thus to improve outcomes. Materials and methods: In this retrospective analytical study, patients who underwent sleeve gastrectomy (SG) or gastric bypass (GB) at our bariatric centre between March 2003 and December 2020 with complete 1 year follow-up data were included. IWL was defined as percentage excess weight loss (%EWL) less than 50% at 1 year after bariatric surgery. A total of 337 patients were included (83% female, 38% after SG, 62% after GB, BMI=46.4+-7.0 kg/m2, age 41+-11 years, from 17 to 67 years (means+-SD)). Kolmogorov-Smirnov test was used to assess the normality of quantitative data. A t-test was performed for parametric and a Mann-Whitney U test for non-parametric, continuous variables. A chi-squared test was performed for categorical variables. Results: 15% experienced IWL. The mean %EWL after 1 year was 82.1+-21.1% in the sufficient weight loss group and 35.8+-13.5% in the insufficient weight loss group. Predictors for sufficient weight loss were lower weight at baseline (p=0.023), lower BMI at baseline (p=0.02), higher HDL levels at baseline (p=0.025), gastric bypass as performed bariatric procedure (p=0.007) and no intake of ß-blockers (0.021). Age, waist circumference, sex, diabetes, HbA1c, fasting glucose and insulin, HOMA index, the intake of diabetes medication or insulin were no predictors for IWL. Conclusion: 15% of patients undergoing SG or GB experienced IWL defined as %EWL less than 50%. Predictors for sufficient weight loss were lower weight, lower BMI and higher HDL levels at baseline, gastric bypass as performed bariatric procedure and no intake of ß-blockers. Disclosure: V. Parzer: None. 551 Sarcopenic obesity and associated body composition characteristics in individuals undergoing bariatric sugery: a retrospective study Background and aims: Sarcopenia can coexist with obesity, together termed sarcopenic obesity (SO). SO is characterised by concomitant low muscle mass and function and excessive fat accumulation. As different relative indices of body composition are used to define SO, data on the prevalence of SO are divergent. This retrospective study aims to examine the prevalence of SO and its associations with pre-operative body composition characteristics, metabolic profile and weight loss success in bariatric surgery candidates. Materials and methods: Retrospective, cross-sectional study evaluating whole-body and regional body composition (assessed by dual-energy x-ray absorptiometry) and biochemical blood variables in adults (age 42±13 years) planned for bariatric surgery (n=78, 23% male, BMI 41.2±3.2 kg/m 2). SO diagnosis was based on sex-specific cut points for relative expressions of appendicular lean tissue mass (ALM, corrected for total body weight (ALM/w) or height squared (ALM/h 2)), as advocated by the Sarcopenic Obesity Global Leadership Initiative. Body composition variables, metabolic profile and weight loss (expressed as percentage total weight loss following surgery) were compared between ALM tertiles using Kruskal-Wallis and Mann-Whitney U tests
Sarcopenic obesity and associated body composition characteristics in individuals undergoing bariatric sugery: a retrospective study
No full textS279 Diabetologia (2023) 66 (Suppl 1):S1-S536 1 3 after bariatric surgery mitigating its positive effects on health status, leading to patient dissatisfaction and requiring the need for revisional surgery, which is associated with higher complication and mortality rates. Preoperative predictors contributing to IWL are not sufficiently studied. Therefore, we tried to identify preoperative predictors for IWL to identify patients at risk for IWL after bariatric surgery and thus to improve outcomes. Materials and methods: In this retrospective analytical study, patients who underwent sleeve gastrectomy (SG) or gastric bypass (GB) at our bariatric centre between March 2003 and December 2020 with complete 1 year follow-up data were included. IWL was defined as percentage excess weight loss (%EWL) less than 50% at 1 year after bariatric surgery. A total of 337 patients were included (83% female, 38% after SG, 62% after GB, BMI=46.4+-7.0 kg/m2, age 41+-11 years, from 17 to 67 years (means+-SD)). Kolmogorov-Smirnov test was used to assess the normality of quantitative data. A t-test was performed for parametric and a Mann-Whitney U test for non-parametric, continuous variables. A chi-squared test was performed for categorical variables. Results: 15% experienced IWL. The mean %EWL after 1 year was 82.1+-21.1% in the sufficient weight loss group and 35.8+-13.5% in the insufficient weight loss group. Predictors for sufficient weight loss were lower weight at baseline (p=0.023), lower BMI at baseline (p=0.02), higher HDL levels at baseline (p=0.025), gastric bypass as performed bariatric procedure (p=0.007) and no intake of ß-blockers (0.021). Age, waist circumference, sex, diabetes, HbA1c, fasting glucose and insulin, HOMA index, the intake of diabetes medication or insulin were no predictors for IWL. Conclusion: 15% of patients undergoing SG or GB experienced IWL defined as %EWL less than 50%. Predictors for sufficient weight loss were lower weight, lower BMI and higher HDL levels at baseline, gastric bypass as performed bariatric procedure and no intake of ß-blockers. Disclosure: V. Parzer: None. 551 Sarcopenic obesity and associated body composition characteristics in individuals undergoing bariatric sugery: a retrospective study Background and aims: Sarcopenia can coexist with obesity, together termed sarcopenic obesity (SO). SO is characterised by concomitant low muscle mass and function and excessive fat accumulation. As different relative indices of body composition are used to define SO, data on the prevalence of SO are divergent. This retrospective study aims to examine the prevalence of SO and its associations with pre-operative body composition characteristics, metabolic profile and weight loss success in bariatric surgery candidates. Materials and methods: Retrospective, cross-sectional study evaluating whole-body and regional body composition (assessed by dual-energy x-ray absorptiometry) and biochemical blood variables in adults (age 42±13 years) planned for bariatric surgery (n=78, 23% male, BMI 41.2±3.2 kg/m 2). SO diagnosis was based on sex-specific cut points for relative expressions of appendicular lean tissue mass (ALM, corrected for total body weight (ALM/w) or height squared (ALM/h 2)), as advocated by the Sarcopenic Obesity Global Leadership Initiative. Body composition variables, metabolic profile and weight loss (expressed as percentage total weight loss following surgery) were compared between ALM tertiles using Kruskal-Wallis and Mann-Whitney U tests
Specific traits of neo-Weberian states on the example of their reaction to the global financial crisis
No full textCelem artykułu jest zbadanie, w jakim zakresie wyróżnione w klasyfikacji Christophera Pollitta i Geerta Bouckaerta (2011) państwa neoweberowskie (New Weberian States – NWS) różnicowały swoje polityki w reakcji na globalny kryzys finansowy 2007/2008. Artykuł oparty jest na studiach literaturowych (z wykorzystaniem bazy ScienceDirect) i statystykach OECD. W pierwszej części przedstawiane są źródła neoweberowskiej koncepcji państwa, a następnie specyfika polityk publicznych. Zasadnicza część artykułu opisuje polityki państw NWS i Nowego Zarządzania Publicznego (NZP) w reakcji na globalny kryzys finansowy 2007/2008. W konkluzji autorzy stwierdzają, że analizowane państwa (w liczbie 11) w różny sposób i w różnej skali reagowały na globalny kryzys finansowy, a reakcja ta jest w znaczącym zakresie funkcją narodowych modeli kapitalizmu finansowego (Grittersová 2014), które nie pokrywają się z podziałem dokonanym przez Pollitta i Bouckaerta (2011).The goal of the paper is to inquire to what extent neo-Weberian states (NWS) identified by Pollitt & Bouckaert (2011) differentiated their policies in reaction to the global financial crisis of 2007/2008. The paper is based on desktop studies from ScienceDirect and OECD. In the first part of the paper, the sources of the concepts of neo-Weberian states are presented, followed by characteristic traits of public policies. The core of the paper is a presentation of the policies of neo-Weberian states on the one hand, and of New Public Management states on the other, in their reaction to the global financial crisis. The paper concludes that the eleven analyzed countries reacted to the global financial crisis in different ways and to a different degree. Their reactions ref lected their national models of financial capitalism (Grittersová 2014) rather than the categories identified by Pollitt & Bouckaert (2011)
REM sleep obstructive sleep apnoea
No full textObstructive sleep apnoea (OSA) can occur in both rapid eye movement (REM) and non-REM sleep or be limited to REM sleep, when the upper airway is most prone to collapse due to REM sleep atonia. Respiratory events are usually longer and more desaturating in REM than in NREM sleep. The prevalence of REM OSA is higher in women than in men and REM OSA usually occurs in the context of mild– moderate OSA based on the apnoea–hypopnoea index calculated for the entire sleep study. Studies have highlighted some detrimental consequences of REM OSA; for example, its frequent association with systemic hypertension and a degree of excessive daytime sleepiness similar to that found in nonsleep-stage-dependent OSA. Moreover, REM OSA could increase cardiometabolic risk. Continuous positive airway pressure (CPAP) treatment aimed at preventing REM OSA should be longer than the 4 h usually considered as good compliance, since REM sleep occurs mostly during the second half of the night. Unfortunately, patients with REM OSA show poor adherence to CPAP. Alternative non-CPAP treatments might be a good choice for REM OSA, but data are lacking. This review summarises the available data on REM OSA and critically examines the weaknesses and strengths of existing literature
Price competition between an expert and a non-expert
No full textprice competition;product differentiation;quality
Public administration
No full textAfter the rapid expansion of the welfare state in the 1950s and 1960s, the public
sector has been under considerable pressure in the past few decades. Declining
public confi dence in government institutions and growing demands on public
fi nances have prompted governments to initiate measures to trim the public sector
and make it more effi cient and effective. Reform strategies adopted can be catalogued
as: Maintain, Modernise, Marketise and Minimise (Pollit and Bouckaert 2004)
Podwodny spoiler na okręcie wojennym: dlaczego, kiedy i jak?
No full textThere are a lot of energy saving devices for ships on the market, but few have seen wide adoption on naval ships, with one exception: the bulbous bow. The bulbous bow was developed for naval ships in the early 20th century and is now widespread on a variety of ship designs. Many have wondered if the effect of the bulbous bow — reducing the resistance of a ship by reducing the bow wave — could be replicated somehow at the stern — by reducing the stern wave. This is exactly what is done by a novel and patented energy saving device called Hull Vane. Invented by Dutch hydrodynamicist Dr Peter van Oossanen for an America’s Cup sailing yacht in the early 21st century, research over the years has shown that this wing-shaped appendage works best on ships that combine a relatively high displacement with a relatively high top speed requirement — even if most sailing hours are done at half speed. Examples are certain offshore vessels, superyachts, patrol vessels and naval ships. On offshore patrol vessels, the resistance reduction from the Hull Vane ranges typically from 10 to 20% over the entire useful speed range. In this paper, the working principles of the Hull Vane will be described to give a better understanding of the device. An overview will be given of the work carried out on naval ships and coastguard ships (25 to 142 m), based on Computational Fluid Dynamics studies, model tests and full-scale applications. The question ‘Why?’ will be answered by translating the hydrodynamic effects to concrete capability improvements for naval ships: a lower fuel consumption, a longer range, reduced signature, a higher top speed and improved seakeeping.
The question ‘When?’ will zoom in on whether a Hull Vane® is something to be included in a newbuild or if it is something to be retrofitted to an existing ship. Finally the answer to the question ‘How?’ will explain the process of either integrating a Hull Vane in a newbuild project or retrofitting it during a midlife upgrade of an existing ship.Istnieje wiele urządzeń energooszczędnych dla statków dostępnych na rynku, ale niewiele z nich znalazło szerokie zastosowanie na okrętach wojennych, z jednym wyjątkiem: bulwiastym dziobem. Bulwiasty dziób został opracowany dla okrętów na początku XX wieku i obecnie jest szeroko rozpowszechniony na różnych konstrukcjach statków. Wiele osób zastanawiało się, czy efekt bulwiastego dzioba — zmniejszający opór statku przez zmniejszenie fali dziobowej — mógłby zostać w jakiś sposób zreplikowany na rufie — poprzez zmniejszenie fali rufowej. Dokładnie tak jest to wykonywane przez nowe, opatentowane urządzenie energooszczędne o nazwie Hull Vane. Skonstruowane ono zostało przez holenderskiego hydrodynamika dr. Petera van Oossanena dla jachtu biorącego udział w America’s Cup na początku XXI wieku. Badania z ostatnich lat wykazały, że występ w kształcie skrzydła najlepiej sprawdza się na statkach, które łączą stosunkowo dużą wyporność z wysokim zapotrzebowaniem na maksymalną prędkość — nawet jeśli większość godzin żeglarskich odbywa się z połową maksymalnej prędkości. Przykładami są niektóre jednostki przybrzeżne, superjachty, jednostki patrolowe i okręty marynarki wojennej. Na przybrzeżnych jednostkach patrolowych redukcja oporu z Hull Vane® waha się zwykle od 10 do 20% w całym zakresie użytecznych prędkości. W artykule zostaną opisane zasady działania Hull Vane® w celu lepszego zrozumienia urządzenia. Dokonany będzie przegląd pracy wykonywanej na okrętach i jednostkach straży przybrzeżnej (od 25 do 142 m) w oparciu o badania Computational Fluid Dynamics, testy modelowe i aplikacje na pełną skalę. Udzielona zostanie odpowiedź na pytanie „dlaczego?” poprzez wytłumaczenie oddziaływań hydrodynamicznych na udoskonalenia konkretnych zdolności okrętów wojennych: mniejsze zużycie paliwa, większy zasięg, zmniejszone pole magnetyczne, wyższą prędkość maksymalną i udoskonaloną dzielność. Pytanie „kiedy?” skupi się na tym, czy kadłub Hana Vane ma być częścią nowej konstrukcji, czy też jest czymś, co należy zmodernizować na istniejącym statku. Na koniec odpowiedź na pytanie „jak?” wyjaśni proces integracji Hull Vane® w nowo budowanym projekcie lub modernizacji w trakcie zmian w połowie eksploatacyjnego życia istniejącego statku
Revisiting the "Compliance-vs.-Rebalancing" Debate in WTO Scholarship a Unified Research Agenda
No full textThis paper constitutes an attempt to reframe and eventually deflate the ongoing “compliance-vs.-rebalancing” debate which has permeated WTO scholarship for the last 10 years. At face value, this controversy circles around object and purpose of WTO enforcement and the legal nature of dispute panels’ recommendations: Compliance advocates maintain that the objective of WTO enforcement is to induce compliance with DSB panel/AB rulings, and to deter future violations of the Agreement, while rebalancing advocates detect an inherent “pay-or-perform” logic in WTO enforcement. In the paper we examine the shortcomings of each approach separately. Our main criticism, however, concerns the substance of the entire debate. We find that scholars on both sides of the compliance/rebalancing controversy put an unduly rigid emphasis on the subsequent issues of WTO enforcement and the interpretation of the wording of the dispute settlement understanding. They thereby neglected systemic issues of contracting, viz. the nature of contractual entitlements, the need for trade policy flexibility mechanisms and the optimal design of the appropriate remedies. We redefine and recalibrate the compliance/rebalancing controversy along the lines of the nature of the WTO contract. This results in to three key findings: First, none of the two schools of thought succeeds in giving an accurate picture of the WTO treaty. Second, the two perspectives actually portray two strikingly different concepts of the WTO contract, and therefore have been at cross-purposes from the very beginning. This implies a third finding: The two schools of thought essentially describe different facets of the same complex WTO contract. Hence, they have hardly been at loggerheads at all, and are actually complementing each other in important aspects. We lay out a unified research agenda that practitioners, economists, trade lawyers, and international relations scholars alike can accept. The agenda may contribute to reconciling the two opposing views and help WTO scholarship tackle the real systemic issues of the WTO Agreement.WTO, dispute settlement, incomplete contracts, remedies, enforcement
In pursuit of a novel UTI treatment strategy - an "in silico" study of the FimH adhesin
No full textCarbohydrate-binding proteins (particularly lectins) are frequent targets of
present pharmaceutical research. While of high priority due to their involvement
in an array of pathophysiological events, these systems (along with their
saccharidic ligands) present many challenges related, in part, to the limited
means of their in-depth structural exploration. A foothold towards improving the
design throughput of carbohydrate-based drugs is provided by the
state-of-the-art in silico technologies, offering both means of structure
generation and refinement as well as rapid screening of putative ligands. In
this account, the application of some of these methods (docking, molecular
dynamics, and MM-GBSA/QSAR protocols), toward inhibiting FimH - a virulence
factor of urinary tract infections - is presented. The role of this bacterial
lectin involves the adhesion to highly-mannosylated urothelial cell surfaces.
This process is supported by the presence of urine flow, lead- ing to the
so-called catch-bonding characteristics. The presented work was focused
primarily on the rationalization and optimization of the binding of mannosidic
ligands with available crystallographic and in vitro data. As a result,
several series of new promising compounds were designed, with selected among
them synthesized, assayed, and published. In addition, an array of molecular
dynamics simulation techniques was employed to probe the structural properties
of the native, two-domain protein in presence and absence of shear conditions.
Through this, a receptor conformation was identified, that differed (including
the binding site) from ones previously employed in structure-based design
approaches. Given the wealth of data reporting the existence of FimH variants
with a broad range of affinities towards their natural ligands (further
dependent on many endogenic and exogenic factors), the reported discoveries may
lead to versatile and potent inhibitors, superior to currently applied
antibiotic treatments
The Optimal Design of Trade Policy Flexibility in the WTO
No full textThis paper is a contribution to the literature on rational design of trade agreements. The World Trade Organization (WTO) is an incomplete contract among sovereign states. Incomplete contracts contain gaps. Ex post, contractual gaps may leave gains from trade unrealized; they may create “regret” in signatories once unanticipated contingencies or sudden protectionist backlashes have occurred. Trade policy flexibility mechanisms, such as the “safeguards clause” under Art. XIX GATT, are geared towards seizing ex post regret by allowing parties affected by a protectionist shock to partially and temporarily withdraw from previously made trade liberalization concessions – given that they compensate the victim(s) of such backtracking behavior. This paper examines the somewhat understudied issue of optimal trade policy flexibility design in the WTO: In particular, we analyze whether ex post escape should be organized by means of a unilateral opt-out clause (a “liability rule” of escape), or a bilateral renegotiation provision (a “property rule” of escape). Modeling the WTO as a fully non-contingent tariff liberalization contract with contingencies (or “states of nature”) asymmetrically revealed, we find that a liability rule backed by expectation remedies payable to the affected victim Pareto-dominates both a renegotiation clause, as well as any other remedy arrangement connected to a liability rule. Only the remedial design of liability-cum-expectation damages yields the desirable incentives to liberalize ex ante, and to default ex post and therewith is able to replicate the outcomes of the hypothetical contracting ideal of the complete contingent contract.Incomplete contracts, remedies, enforcement, WTO, trade renegotiations, WTO Dispute Settlement,
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