BACKGROUND:There is a high malnutrition risk in patients with gastrointestinal tumors. Yet it is unknown when malnutrition manifests and how changes in nutritional status are related to quality of life and fatigue at different stages of oncologic therapy. PATIENTS AND METHODS:In a prospective observational study, we recruited patients with initial diagnosis of any gastrointestinal tumor requiring systemic therapy and respective patients already receiving treatment. Subjects underwent comprehensive nutritional assessment at enrollment and after 3 months. In addition, patients reported data on physical activity (IPAQ-SF), quality of life (SF-12), and fatigue (EORTC QLQ-FA12). Besides baseline associations, relations between changes in nutritional status and patient-reported outcomes during treatment were analyzed. RESULTS:We included 66 patients (mean(±SD) age: 62.1(±10.6) yrs.; 68% male), of which 29 had received initial diagnosis and 37 were already undergoing treatment. Baseline clinical characteristics and nutritional status were comparable between groups. With 88% of patients, GLIM-defined malnutrition was highly prevalent at baseline and associated with fatigue, reduced physical activity, and quality of life (P < .01, respectively). Among 36 study completers, only minor fat mass (P = .033) and progressed weight loss (P = .025) indicated further nutritional deterioration. Development of cachexia, but not malnutrition or sarcopenia, during treatment was associated with impaired patient-reported outcomes, ie, higher fatigue (rho = 0.400; P = .019) and lowered physical activity (rho=-0.423; P = .013). CONCLUSION:Most patients with gastrointestinal cancer are malnourished already at diagnosis. Impaired nutritional status is closely linked with reduced quality of life and fatigue, especially their physical components. Trials are warranted to test whether optimized nutrition support can halt further aggravation during treatment.
This study examines the influence of the steel potential E on the chloride threshold CT for carbon steel reinforcement embedded in concrete. Building upon the authors’ previous findings in alkaline solutions, this study uses realistic concrete conditions, providing a quantitative model for concrete systems. Concrete specimens with embedded rebars were exposed to a cyclic wetting–drying regime using NaCl solution while being subjected to varying levels of cathodic polarization until corrosion initiation occurred. The results suggest that CT remains largely independent of potential above a threshold potential ET0 but increases progressively at more cathodic potentials. The relationship can be expressed as C_T = 1.30% /cem wt.for E ≥ - 160 mV_SCE and C_T = 1.30 · 10^ - 160 - E/520% /cem wt.for E < - 160 mV_SCE, corresponding to a cathodic potential shift of 520 mV/dec required for a tenfold increase in CT. The increase in CT is likely attributed to both intrinsic and extrinsic mechanisms: intrinsic effects involve beneficial modifications of the passive layer composition induced by cathodic polarization, while extrinsic effects arise from chloride migration and hydroxide generation near the steel surface. The results emphasize the role of polarization-induced spatial variability in corrosion initiation. Incorporating this behavior into predictive corrosion models could significantly enhance service life assessment of reinforced concrete structures.
Assists—the number of last passes before a goal—have been a predominant metric to evaluate offensive players contribution in association football. This poses two major limitations: first, assist definitions differ across data collection vendors, and second, the focus on passes leading to goals creates a strong dependency on the player taking the shot. We introduce the term potential assists comprising all actions, that prepare a teammate’s shot regardless of conversion. Additionally, we use expert-knowledge to derive an objective definition for potential assists and show that it can be detected with a substantial inter-rater reliability (Fleiss’ κ =0.63 , n=5 ). Using this definition, we utilize video footage to label 500 assists manually and train multiple supervised machine learning models to classify potential assists based on 29 features derived from positional and event data. We apply our automated detection approach on 105 DFB-Pokal matches and demonstrate a scalable method to enhance automatic event detection and improve the comparability of assist statistics for application in player assessment and scouting.
IntroductionMedium-chain triglycerides (MCTs) are widely used in clinical and nutritional contexts due to their rapid metabolism and therapeutic potential. However, concerns regarding their tolerability persist, particularly with respect to gastrointestinal side effects. This systematic review examines the occurrence and characteristics of side effects following oral MCT consumption.MethodsIn accordance with the PRISMA guidelines and the Cochrane Handbook, a systematic literature search was conducted in PubMed and Web of Science. Studies reporting side effects following oral, gastric or enteral MCT administration were included. Data on study design, population characteristics, MCT formulation, dosage, and reported side effects were extracted and synthesized. Side effects were analyzed quantitatively or qualitatively in studies using non-standard reporting formats. Risk of bias was assessed using the RoB 2 tool for randomized studies and the ROBINS-I tool for non-randomized studies.ResultsThirty three studies comprising 1,100 participants were included. Gastrointestinal symptoms were the most frequently reported side effects, particularly diarrhea, abdominal pain, discomfort, and nausea. While these symptoms were often described as mild, moderate to severe reactions and dropouts due to side effects were not uncommon, especially at higher doses. Substantial heterogeneity in study design, dosing strategies, and reporting practices limited comparability. Temporal aspects of side effects and long-term tolerability were insufficiently investigated, and evidence regarding the influence of MCT composition and co-administration strategies on tolerability remained inconclusive. A high proportion of studies reported industry involvement, and risk-of-bias assessment indicated that 26.3% (RoB 2)-−78.6% (ROBINS-I) of the included studies were at high/serious risk of bias.ConclusionsGastrointestinal side effects represent a consistent and clinically relevant limitation of MCT use. Standardized methodologies and targeted research are needed to better understand and mitigate these effects, thereby improving the safety and applicability of MCT-based interventions.
Companies increasingly adopt service-oriented strategies to enhance competitiveness and growth through service excellence. However, implementation remains inconsistent due to divergent definitions and limited integration with service management frameworks. Service excellence is variously equated with total quality management, employee responsiveness, cultural competence, or customer experience, creating conceptual ambiguity that hinders practical application. The service triangle, which highlights the interrelationships among organizations, employees, and customers, has received limited attention in this context. This study synthesized fragmented definitions of service excellence to identify shared elements and proposed a unifying definition. It also examined the service triangle as a strategic framework for implementation by clarifying the roles of managers, frontline staff, and customers. By linking service excellence to the service triangle, the study offered directions for future research and a cohesive model for translating excellence into coordinated, actionable practice.
