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The hollow-fibre oxygenator is a key component of any extracorporeal circuit used to provide cardiopulmonary bypass (CPB) during open-heart surgery. Since the oxygenator is placed downstream of the pump, the energy losses over it have a direct impact on the quality of pulsatile pressure and flow waveforms. The objective of this study was to describe the effects of hydrodynamic characteristics of the oxygenator on energy transfer during pulsatile, normothermic CPB. Twenty-three adult patients scheduled for coronary bypass surgery were divided randomly into two groups, using either an oxygenator (Group 1) with a relatively high-resistance and low-compliance (2079 ± 148 dyn.s.cm-5 and 0.00348 ± 0.00071 ml.mmHg-1, respectively) or an oxygenator (Group 2) with a relatively low-resistance and high-compliance (884 ± 464 dyn.s.cm-5 and 0.01325 ± 0.00161 ml .mmHg-1, respectively). During perfusion, pre- and post-oxygenator pressures, radial artery pressure, and blood flow were recorded simultaneously. A 32% decline of mean pressure was observed in Group 1 and a 16% decline in Group 2 (p<0.0001). Another decrease by approximately 73% in mean pressure in the rest of the perfusion system was noted in both groups. The mean radial artery pressure did not differ between the groups (74 ± 6 mmHg in Group 1 and 73 ± 6 mmHg in Group 2, p=0.608). Although lower total energy transfer indices were noticed through the low-resistance oxygenator (Group 2), both oxygenators showed a decrease of the generated pump oscillatory energy of approximately 50%. Despite the differences in resistance and compliance of the hollow-fibre oxygenators used, both oxygenators cause a comparable loss of generated oscillatory energy. Exclusion of the oxygenator downstream of the pulsatile pump would improve energy transfer during CPB.

To review new putative mechanisms involved in the pathophysiology of a disturbed energy balance in cancer cachexia, which can lead to novel targets for clinical cachexia management. In the context of rapid developments in tumour treatment with potential systemic consequences, this article reviews recent data on energy requirements. Furthermore, we focus on new insights in brown adipose tissue (BAT) activity and reward processing in the brain in relation to the cachexia process.Nearly no new data have been published on energy requirements of cancer patients in the light of comprehensive new therapies in oncology. New developments, such as the introduction of staging with 18F-fluorodeoxyglucose PET-computed tomography scanning, led to the observation that BAT activation may contribute to impaired energy balance in cancer cachexia. Animal and human data to date provide an indication that BAT activation indeed occurs, but its quantitative impact on the degree of cachexia is controversial. The peripheral and central nervous system is known to influence satiation, with a possible role for impaired food reward processing in the brain. To date, there are limited confirmatory data, but this is an interesting new area to explore for better understanding and treating cancer-induced anorexia.The multimodal approach to counteract cancer cachexia should expand its targets to BAT and food reward processing in the brain.

Background: The gut microbiota is a putative target for dietary interventions for cardio-metabolic health (CMH), including prevention of obesity, type 2 diabetes, and cardiovascular disease. This has generated considerable interest, but the actual feasibility for diet or specific foods to induce measurable, sustained and meaningful benefits for CMH risk by this route remains uncertain. Scope and approach: This report summarises an expert workshop assessing the gut microbiota as a relevant, feasible and competitive target for CMH benefits by dietary interventions. It summarises the expert presentations and overall view of participants on the current status and outlook, considering also implications for the food industry. Key findings and conclusions: Changing the gut microbiota by diet is possible, but an assessment of the impact on CMH risk is still needed, including clarifying advantages above other known dietary routes. The individual gut microbiota composition may in part determine the impact of diet and its effects on health. Therefore, future developments may identify individuals at risk and thus possible modification of the microbiota to achieve benefits in susceptible (sub) populations depending on their initial microbiota composition. Prebiotics currently appear to be the most promising ingredients; however, required doses may be relatively high and the actual role of gut microbiota needs further assessment. Overall, causal evidence linking gut microbiota interventions with CMH benefits are developing in preclinical models but are still lacking in humans. A significant research effort is needed and ongoing to determine whether potential effects can be reliably substantiated.

Education in sustainable development is a goal recognised by a large number of countries and a vital concept in healthcare. It is therefore important that nurse education incorporates elements of sustainable development into nursing education curricula. However, there is limited research on student nurses' attitudes towards sustainability and no comparison of attitudes towards sustainability and its inclusion in the nursing curriculum across Europe.This project aims to assess student nurses' attitudes towards sustainability, its relevance to nursing and its inclusion in the nursing curricula. 1. To assess base-line attitudes at the start of nursing and midwifery training; 2. To compare sustainability awareness between students participating in training in a number of European universities.A comparative survey design using the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire.Nursing classes of Universities and Nursing Schools in four European countries were investigated using a questionnaire consisting of five sustainability-related items.916 nursing students (UK: 450, Germany: 196, Spain: 124, Switzerland: 146).Standard descriptive and inferential statistical methods were used to establish psychometric quality (Principal Components Analysis, Cronbach's alpha, Pearson correlations) and compare student nurses from the four countries.The reliability of SANS_2 was good (Cronbach's alpha=.82) and the five items loaded on a single factor which explained 58% of variance. ANOVA of the SANS_2 total score showed significant differences between countries with German nursing students showing more sustainability awareness than students from the UK and Spain.SANS_2 is a reliable instrument to assess nursing students' sustainability awareness; there are significant differences in sustainability awareness of students of different European countries. Limitations of the study include non-random sampling, possible method effects and social desirability effects.Sustainability will become increasingly important in clinical practice; greater knowledge about the attitudes of nurses towards sustainability can support the development and testing of sustainability-focused teaching and learning materials.

Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is a psychoactive recreational drug widely used by young people visiting dance parties, and has been associated with poor cognitive function. The current study assessed the influence of a single dose of MDMA 75 mg and alcohol 0.5 g/kg on cognition, psychomotor performance and driving-related task performance. Twelve healthy recreational ecstasy users participated in an experimental study conducted according to a double-blind, double-dummy, placebo-controlled three-way cross-over design. MDMA improved psychomotor performance, such as movement speed and tracking performance in a single task, as well as in a divided attention task. MDMA impaired the ability to predict object movement under divided attention. However, the inability to accurately predict object movement after MDMA may indicate impairment of particular performance skills relevant to driving. There was no effect of MDMA on visual search, planning or retrieval from semantic memory.

This paper, which summarizes the conclusions of a WHO Expert meeting, is aimed at proposing indications to develop technical specifications for an accurate and affordable blood pressure measuring device for office/clinic use in low resource settings. Blood pressure measuring devices to be used in low resource settings should be accurate, affordable, and easily available worldwide. Given the serious inherent inaccuracy of the auscultatory technique, validated and affordable electronic devices, that have the option to select manual readings, seem to be a suitable solution for low resource settings. The agreement on the technical specifications for automated blood pressure measuring devices for office/clinic use in low resource settings included the following features: high accuracy, adoption of electronic transducers and solar batteries for power supply, standard rates of cuff inflation and deflation, adequate cuff size, digital display powered by solar batteries, facilities for adequate calibration, environmental requirements, no need of memory function, resistance to shock and temperature changes, and low cost. Availability of a device with these features should be accompanied by adequate training of health care personnel, who should guarantee implementation of the procedures recommended in recent European and American Guidelines for accurate blood pressure measurement.

We have recently shown, in studies with patients with Type 1 (insulin dependent) diabetes, that alcohol intake at 21:00 h significantly reduced blood glucose values after 10-12 h, compared with control studies with no alcohol.We hypothesised that this was due to the following effects of alcohol: (1) alcohol metabolism increases NADH, leading to a reduction in hepatic gluconeogenesis; (2) increased glycogen phosphorylase activity depletes hepatic glycogen stores; (3) after the alcohol is metabolised, hepatic insulin sensitivity is increased, leading to the restoration of glycogen stores and reduction in blood glucose levels; and (4) consequently, after several hours, glycogen stores and insulin sensitivity return to normal.A model describing these changes (DiasNet-Alcohol) was implemented into the DiasNet model of human glucose metabolism. Our study suggests that the DiasNet-Alcohol model gives a reasonable approximation of these effects of alcohol on blood glucose concentration observed in our study and supports our hypothesis for the mechanism behind these effects in Type 1 diabetes.

Bioavailability has been used as a key indicator in chemical risk assessment yet poorly quantified risk factor. Worldwide, the framework used to assess potentially contaminated sites is similar, and the decisions are based on threshold contaminant concentration. The uncertainty in the definition and measurement of bioavailability had limited its application to environment risk assessment and remediation. Last ten years have seen major developments in bioavailability research and acceptance. The use of bioavailability in the decision making process as one of the key variables has led to a gradual shift towards a more sophisticated risk-based approach. Now a days, many decision makers and regulatory organisations 'more readily accept' this concept. Bioavailability should be the underlying basis for risk assessment and setting remediation goals of those contaminated sites that pose risk to environmental and human health. This paper summarises the potential application of contaminant bioavailability and bioaccessibility to the assessment of sites affected by different contaminants, and the potential for this to be the underlying basis for sustainable risk assessment and remediation in Europe, North America and Australia over the coming decade.