bluuebunny/crossref_metadata_2025 huggingface dataset:
Meiotic delay of mouse spermatocytes carrying x-ray-induced translocations
Authors: van Buul P.P.W. , Seelen C.M.J. , Goudzwaard J.H.
Published: May 2008

The kinetics of spermatocyte progression through meiotic prophase in cells with or without induced translocations were studied in mice that had been exposed to x-rays. Pulse-labeling experiments using 3H-thymidine, followed by autoradiographic analysis, indicated that at higher x-ray doses (6 and 7 Gy), translocation-carrying cells tend to spend more time in meiotic prophase than do normal cells. At 2 Gy, no such delay seemed to be present. The observed delay may explain the reduction in transmission of translocations to the next generation reported by others.
Heterochromatin characterization of sex chromosomes in Triturus marmoratus (Urodela, Salamandridae)
Authors: Herrero P. , de la Torre J , Gosálvez J. , Sumner A.T.
Published: May 2008

The sex chromosomes of the Iberian marbled newt, Triturus marmoratus, were studied using various banding techniques, including restriction enzyme/nick translation (RE/NT) procedures. Four types of heterochromatin on the sex chromosomes could be distinguished: (1) distamycin A/DAPI and chromomycin A3/distamycin A positive, EcoRI/NT negative, and HaeIII/Nυ and HinfI/NT positive; (2) distamycin A/DAPI and chromomycin A3/distamycin A positive, but RE/NT negative; (3) AT rich, but RE/NT negative; and (4) distamycin A/DAPI and chromomycin A3/distamycin A positive, EcoRl/NΙ and HinfI/NΙ negative, but Haelll/NT positive. These data suggest a common origin for the terminal heterochromatic domains of both the X and Y chromosomes in this species.
Induction of R-bands on human chromosomes by TfiI as the consequence of local differences in target richness
Authors: Tagarro I. , González-Aguilera J.J. , Fernández-Peralta A.M.
Published: May 2008

We present a new restriction enzyme-banding pattern on fixed human chromosomes. R-bands are induced by Tfil, an enzyme that cuts DNA at GA(A/T)TC, that is, at HinfI sites having A or T in the central position. Results suggest that regional differences in the frequency of targets are responsible for the effect caused by this enzyme, whereas conformational differences between G- and R-bands would not affect the enzyme action.
Cytogenetics of bisexual/unisexual species of Poecilia
Authors: Sola L. , Rossi AR. , Iaselli V. , Rasch EM. , Monaco PJ.
Published: May 2008

Chromosomes of Poecilia mexicana mexicana, one of the bisexual species involved in the hybrid origin of the unisexual teleost fish species P. formosa, were analyzed by several staining techniques. Sex-specific, differential heterochromatin, found in other congeneric species, was not observed in P. m. mexicana. Nucleolar organizer regions were polymorphic among individual specimens within a given population sample. A single specimen exhibiting intraindividual variability of chromosome pair 1 and a specimen with a triploid karyotype are also described.
Assignment of the NRAS protooncogene to chromosome 12 of Syrian hamster by in situ hybridization
Authors: Issa T. , Porter R. , Parry E.M. , Parry J.M.
Published: May 2008

The NRAS protooncogene codes for a GTP binding/GTPase p21 protein which resides on the inner surface of the plasma mebrane. Using a human cDNA probe for NRAS, we have assigned the gene to Syrian hamster chromosome 12 with the most likely localization being 12qa5.
Linkage of the thyroid peroxidase locus (Tpo) to markers in the proximal part of Chromosome 12 of the mouse
Authors: Taylor B.A. , Reifsnyder P.C. , DiLauro R.
Published: May 2008

RFLP analysis of the thyroid peroxidase gene among recombinant inbred mouse strains allowed its localization within the Chromosome 12 linkage group.
The Relationship Between Bonding with Nonhuman Animals and Students' Attitudes Toward Science
Authors: Sorge Carmen
Published: May 2008

This paper examines the relationship of bonding with nonhuman animals during an interactive, animal-in-the-wild science program (Talking Talons) and the science attitudes of 358 young children between the ages of 8 and 14 Talking Talons utilizes typically wild animals such as raptors, reptiles, and bats in a school-based educational science curriculum. Qualitative data from interviews with students in the program indicated that "bonding with animals" (BWA) and the educators (BWE) within the program were related to increased positive attitudes toward science. The program used quantitative methods to examine these dual relationships—with animals and with educators- on student attitude toward science. The program performed a step-wise multiple regression with "Attitude toward Science" as the dependent variable and "Gender," "Age," and "Bonding with Animals" as independent variables. Both "Bonding with Animals" and "Bonding with the Educator" contributed significantly to prediction of the participants' science attitudes. Altogether 28% of the variance in "Science Attitude" was predicted by both "Gender" and "Age" (10%), "Bonding with Animals" (16%) and "Bonding with Educator" (2%). Bonding with the animals had a large quantifiable relationship with student attitudes toward science.
Signification and Truth Epistemology at the Crossroads of Semantics and Ontology in Augustine's Early Philosophical Writings
Authors: Germann Nadja , Cesalli Laurent
Published: May 2008

This article is about the conception of truth and signification in Augustine's early philosophical writings. In the first, semantic-linguistic part, the gradual shift of Augustine's position towards the Academics is treated closely. It reveals that Augustine develops a notion of sign which, by integrating elements of Stoic epistemology, is suited to function as a transmitter of true knowledge through linguistic expressions. In the second part, both the ontological structure of signified (sensible) things and Augustine's solution to the apparent tautologies of mathematical truths are examined. Again his notion of sign turns out to be the keystone; this time, however, the natural in contrast to the conventional sign of linguistic expressions. In their complementarity, both parts show how Augustine intensely struggles with and (partially) overcomes the skepticism of the sensible world through his conception of sign and signification.
Hosea's (In)Fertility God
Authors: Keefe Alice
Published: May 2008

This paper challenges the prevailing view of Hosea's concept of God as a deity wholly other than and opposed to the fertility deities of Canaan. This view depends upon the dominant reading of Hosea's sexual metaphors in which "adultery" with the baalim is understood as a critique of popular fertility religious practices. This paper argues that the theological conflict Hosea addresses is not one of fertility religion verses faith in a "God of History," but rather of localized and/or nationalized concepts of deity verses the prophet's vision of YHWH as a high god who incorporates into Himself all the powers of all the gods, including the powers of fertility.
Reading Hosea and Imagining YHWH
Authors: Ben Zvi Ehud
Published: May 2008

As the readers among whom and for whom the book of Hosea was composed read and reread it they could not but construe images of YHWH. In the process, metaphors from different source conceptual domains were evoked. Each of them involved important aspects of the worldview of these readers, their understanding of themselves and their deity, and very often a sense of resistance to imperial ideological constructions. The centrally enabling metaphor of YHWH as didactic communicator, that is teacher of Israel, played a central role in the social and ideological worldview of the literati who wrote, read, and reread the book of Hosea and other prophetic and authoritative books in ancient Yehud and reflected the social roles of the literati and of the repertoire of prophetic books that evolved in ancient Yehud, among which the book of Hosea, in its present form, evolved and found its place.
A Parameterization of Shear-Driven Turbulence for Ocean Climate Models
Authors: Jackson L. , Hallberg R. , Legg S.
Published: May 2008

This paper presents a new parameterization for shear-driven, stratified, turbulent mixing that is pertinent to climate models, in particular the shear-driven mixing in overflows and the Equatorial Undercurrent. This parameterization satisfies a critical requirement for climate applications by being simple enough to be implemented implicitly and thereby allowing the parameterization to be used with time steps that are long compared to both the time scale on which the turbulence evolves and the time scale with which it alters the large-scale ocean state.

The mixing is expressed in terms of a turbulent diffusivity that is dependent on the shear forcing and a length scale that is the minimum of the width of the low Richardson number region (Ri = N 2/|uz|2, where N is the buoyancy frequency and |uz| is the vertical shear) and the buoyancy length scale over which the turbulence decays [Lb = Q1/2/N, where Q is the turbulent kinetic energy (TKE)]. This also allows a decay of turbulence vertically away from the low Richardson number region over the buoyancy scale, a process that the results show is important for mixing across a jet. The diffusivity is determined by solving a vertically nonlocal steady-state TKE equation and a vertically elliptic equilibrium equation for the diffusivity itself.

High-resolution nonhydrostatic simulations of shear-driven stratified mixing are conducted in both a shear layer and a jet. The results of these simulations support the theory presented and are used, together with discussions of various limits and reviews of previous work, to constrain parameters.
A Form of Potential Vorticity Equation for Depth-Integrated Flow with a Free Surface
Authors: Hughes Chris W.
Published: May 2008

A form of linear, barotropic potential vorticity equation is derived for an ocean with a free surface, in which only one scalar variable appears (ocean bottom pressure, or subsurface pressure). Unlike quasigeostrophic or rigid-lid derivations, the only approximation made (apart from linearization) is that changes in the circulation must be slow compared with the inertial frequency. Effects of stratification are included, but only parametrically in the sense that density is treated as a given quantity or forcing term rather than a variable.
Generation of a Buoyancy-Driven Coastal Current by an Antarctic Polynya
Authors: Wilchinsky Alexander V. , Feltham Daniel L.
Published: May 2008

Descent and spreading of high salinity water generated by salt rejection during sea ice formation in an Antarctic coastal polynya is studied using a hydrostatic, primitive equation three-dimensional ocean model called the Proudman Oceanographic Laboratory Coastal Ocean Modeling System (POLCOMS). The shape of the polynya is assumed to be a rectangle 100 km long and 30 km wide, and the salinity flux into the polynya at its surface is constant. The model has been run at high horizontal spatial resolution (500 m), and numerical simulations reveal a buoyancy-driven coastal current. The coastal current is a robust feature and appears in a range of simulations designed to investigate the influence of a sloping bottom, variable bottom drag, variable vertical turbulent diffusivities, higher salinity flux, and an offshore position of the polynya. It is shown that bottom drag is the main factor determining the current width. This coastal current has not been produced with other numerical models of polynyas, which may be because these models were run at coarser resolutions. The coastal current becomes unstable upstream of its front when the polynya is adjacent to the coast. When the polynya is situated offshore, an unstable current is produced from its outset owing to the capture of cyclonic eddies. The effect of a coastal protrusion and a canyon on the current motion is investigated. In particular, due to the convex shape of the coastal protrusion, the current sheds a dipolar eddy.
A Joint Statistical and Dynamical Assessment of Atmospheric Response to North Pacific Oceanic Variability in CCSM3
Authors: Zhong Yafang , Liu Zhengyu
Published: May 2008

Atmospheric response to North Pacific oceanic variability is assessed in Community Climate System Model, version 3 (CCSM3) using two statistical methods and one dynamical method. All methods identify an equivalent barotropic low response to a warmer sea surface temperature (SST) anomaly in the Kuroshio Extension region (KOE) during early–midwinter. While all three methods capture the major features of the response, the generalized equilibrium feedback assessment method (GEFA) isolates the impact of KOE SST from a complex context, and thus makes itself an excellent choice for similar practice.
Response of the Zonal Mean Atmospheric Circulation to El Niño versus Global Warming
Authors: Lu Jian , Chen Gang , Frierson Dargan M. W.
Published: May 2008

The change in the zonal mean atmospheric circulation under global warming is studied in comparison with the response to El Niño forcing, by examining the model simulations conducted for the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. In contrast to the strengthening and contraction of the Hadley cell and the equatorward shift of the tropospheric zonal jets in response to El Niño, the Hadley cell weakens and expands poleward, and the jets move poleward in a warmed climate, despite the projected “El Niño–like” enhanced warming over the equatorial central and eastern Pacific. The hydrological impacts of global warming also exhibit distinct patterns over the subtropics and midlatitudes in comparison to the El Niño.

Two feasible mechanisms are proposed for the zonal mean circulation response to global warming: 1) The increase in static stability of the subtropical and midlatitude troposphere, a robust result of the quasi-moist adiabatic adjustment to the surface warming, may stabilize the baroclinic eddy growth on the equatorward side of the storm tracks and push the eddy activity and the associated eddy-driven wind and subsidence poleward, leading to the poleward expansion of the Hadley cell and the shift of midlatitude jets; 2) the strengthening of the midlatitude wind at the upper troposphere and lower stratosphere, arguably a consequence of increases in the meridional temperature gradient near the tropopause level due to the tropospheric warming and tropopause slope, may increase the eastward propagation of the eddies emanating from the midlatitudes, and thus the subtropical region of wave breaking displaces poleward together with the eddy-driven circulation. Both mechanisms are somewhat, if not completely, distinct from those in response to the El Niño condition.
Mesoscale to Submesoscale Transition in the California Current System. Part III: Energy Balance and Flux
Authors: Capet X. , McWilliams J. C. , Molemaker M. J. , Shchepetkin A. F.
Published: May 2008

This is the last of a suite of three papers about the transition that occurs in numerical simulations for an idealized equilibrium, subtropical, eastern-boundary upwelling current system similar to the California Current. The transition is mainly explained by the emergence of ubiquitous submesoscale density fronts and ageostrophic circulations about them in the weakly stratified surface boundary layer. Here the high-resolution simulations are further analyzed from the perspective of the kinetic energy (KE) spectrum shape and spectral energy fluxes in the mesoscale-to-submesoscale range in the upper ocean. For wavenumbers greater than the mesoscale energy peak, there is a submesoscale power-law regime in the spectrum with an exponent close to −2. In the KE balance an important conversion from potential to kinetic energy takes place at all wavenumbers in both mesoscale and submesoscale ranges; this conversion is the energetic counterpart of the vertical restratification flux and frontogenesis discussed in the earlier papers. A significant forward cascade of KE occurs in the submesoscale range en route to dissipation at even smaller scales. This is contrary to the inverse energy cascade of geostrophic turbulence and it is, in fact, fundamentally associated with the horizontally divergent (i.e., ageostrophic) velocity component. The submesoscale dynamical processes of frontogenesis, frontal instability, and breakdown of diagnostic force balance are all essential elements of the energy cycle of potential energy conversion and forward KE cascade.
Application of the Semi-Lagrangian Inherently Conserving and Efficient (SLICE) Transport Method to Divergent Flows on a C Grid
Authors: Mahidjiba Ahmed , Qaddouri Abdessamad , Côté Jean
Published: May 2008

Local conservation with the Semi-Lagrangian Inherently Conserving and Efficient (SLICE) transport method with a new trajectory algorithm is studied. Validation results of 1D and 2D passive advection with this new algorithm, which converges twice as fast as the old one, on the Arakawa C grid of a model in Cartesian coordinates are obtained. The effects of numerically computed divergence and trajectories on the results were also investigated. Random small-scale errors due to the divergence, especially with realistic winds, can be observed. The total mass is conserved, however, and is not affected since the results show clearly that SLICE ensures a perfect local conservation. This work represents the first step toward implementation of SLICE in the operational Canadian Global Environmental Multiscale (GEM) model.
Evaluating the Usefulness of a New Set of Hurricane Classification Indices
Authors: Jordan Mark R. , Clayson Carol Anne
Published: May 2008

This paper provides a thorough evaluation of the hurricane indices (i.e., intensity, damage, and surge) recently proposed by Kantha. A database of past U.S. landfalling hurricanes was developed, and the indices were calculated based upon each storm’s individual parameters. Comparisons are made among various storms’ index values based on actual intensity, damage, and surge values. Only the surge index provided information that added appreciably to the information provided by the Saffir–Simpson scale; the value of the surge index as a prelandfall surge indicator and as a postanalysis tool is explored.
Advancing Boundary Model for Moisture Diffusion in A Composite Laminate
Authors: Chang Ting-Wei , Chih Hsing Wang  , Tsai Cho-Liang
Published: May 2008

Fick's diffusion law is applied to a one-dimensional diffusion case in which moisture diffuses through both surfaces into a composite laminate submerged in water. The advancing boundary model is adopted to study the moisture diffusion depth and also the moisture content distribution in the laminate. The major contribution of this work is establishing the procedure to obtain the required parameters for quantifying the depth of diffusion and the moisture content distribution which are related to the induced real-time hygric strain and important to the design of a composite structure that is to be used in a marine environment.
Gastric Bypass Surgery in Adolescents With Morbid Obesity
Authors: Strauss RS , Bradley LJ , Brolin RE
Published: May 2008

Objective: The objective was to review retrospectively all patients undergoing bariatric surgery at a large university medical center. Methods: Ten adolescents 17 years or younger underwent gastric bypass surgery; 7 of 10 adolescents had severe obesity‐related morbidities. Follow‐up>1 year was present in 9 of 10 adolescents. Results: The average weight before surgery was 148 ± 37 kg. Postoperative recovery was uneventful in all adolescents; 9 of 10 adolescents had weight loss in excess of 30 kg (mean weight loss was 53.6 ± 25.6 kg). Obesity related morbidities resolved in all adolescents. Five adolescents had mild iron deficiency anemia, and 3 adolescents had transient folate deficiency. Late complications requiring operative treatment occurred in 4 of the adolescents. Conclusion: Gastric bypass surgery was an effective method for weight reduction in morbidly obese adolescents. The procedure was well tolerated, with few unanticipated side effects. Gastric bypass remains a last resort option for severely obese adolescents for whom other dietary and behavioral approaches to weight loss have been unsuccessful.
Similar Metabolic Responses to Standardized Total Parenteral Nutrition of Septic and Nonseptic Critically Ill Patients
Authors: Zauner C , Schuster BI , Schneeweiss B
Published: May 2008

Background: Nutritional support is an important link between the response to injury and recovery in critical illness. Objective: Our goal was to evaluate energy and substrate metabolism in septic and nonseptic critically ill patients in the resting state and during the administration of standardized total parenteral nutrition. Design: This was a prospective, clinical cohort study of 25 consecutively admitted critically ill patients either with (n = 14) or without (n = 11) sepsis who received total parenteral nutrition. Resting energy expenditure was measured on days 0, 2, and 7 by indirect calorimetry. Energy and substrate balances were calculated on days 2 and 7. Results: Resting energy expenditure was not significantly different between septic and nonseptic patients on day 0 (2.65± 0.49 and 2.36 ± 0.56 kJ × min–1 ×m–2, respectively). Energy balances were positive for both groups on days 2 (0.68 ± 0.4 and 0.74 ± 0.6 kJ × min–1 × m–2, respectively; NS) and 7 (0.65 ± 0.3 and 0.78 ± 0.5 kJ × min–1× m–2, respectively; NS). Substrate balances were not significantly different between groups on days 0, 2, and 7. Resting energy expenditure on day 0 was negatively correlated with the severity of illness in septic patients only (r = −0.58, P < 0.05). Conclusions: Metabolic changes were not significantly different between septic and nonseptic critically ill patients during the administration of standardized total parenteral nutrition. A disease‐specific macronutrient composition of total parenteral nutrition formulas does not seem to be necessary in either septic or nonseptic critically ill patients.
Catch‐up Growth in Small‐for‐Gestational‐Age Term Infants: A Randomized Trial
Authors: Fewtrell MS , Morley R , Abbott RA
Published: May 2008

Background: Small‐for‐gestational‐age (SGA) term infants are at risk of long‐term growth deficits. Objective: The objectives were to test the hypothesis that postnatal growth in SGA term infants can be altered by dietary intervention and to examine whether there is a critical window for nutritional programming of the growth trajectory during the first 9 mo postnatally. Design: Healthy term (gestation > or =37 wk) infants with birth weights below the 10th centile were randomly assigned to receive standard term formula (TF; n = 147) or nutrient‐enriched formula (EF; n = 152) for the first 9 mo; 175 breast‐fed SGA term infants formed a reference group. The main outcome measures were weight, length, and occipitofrontal head circumference (OFC) at 9 and 18 mo. Results: The infants fed the EF showed greater gains in length by 9 (1.1 cm; 95% CI: 0.38, 1.79) and 18 (1.0 cm; 0.25, 1.83) mo and in OFC by 9 (0.5 cm; 0.1, 0.9) and 18 (0.6 cm; 0.2, 1.1) mo than did infants fed the TF; the differences were larger in females. The dietary effects were independent of the pattern of growth retardation. Breast‐fed infants showed greater gains in weight and OFC by 18 mo than did infants fed the TF; however, these differences disappeared after adjustment for age, parental size, and birth order. Conclusions: Linear growth and OFC gains in SGA term infants improve after nutritional intervention during the first 9 mo of life and the effects persist for ≥9 mo beyond the intervention period. Further information on whether catch‐up growth is beneficial or detrimental to long‐term outcomes is required before public health interventions can be recommended.
Gastric Feeding With Erythromycin Is Equivalent to Transpyloric Feeding in the Critically Ill
Authors: Boivin MA , Levy H
Published: May 2008

Objective: To determine whether adding erythromycin to a gastric feeding regimen could render it as effective in meeting nutritional needs as transpyloric feeding. Design: Randomized, controlled study. Setting: University hospital medical, surgical, and neurologic care intensive care units. Patients: Critically ill patients, requiring a projected 96 hrs of enteral feeding, who had no specific indication for tube location (gastric or transpyloric). Eighty patients were randomized. Interventions: Patients were randomized to gastric feeding with erythromycin (200 mg IV) given every 8 hrs or feeding through a transpylorically placed feeding tube. Goal rate and feeding advancement were determined by protocol. Measurements and Main Results: During the 96‐hr period, the gastric group received 74% of their goal calories and the transpyloric group received 67%. The only day on which gastric feedings were superior was the first study day, where the gastric group attained 55% of their goal, compared with 44% in the transpyloric group. This 1‐day difference was the result of an initial failure of tube placement in some subjects. Exclusion of these patients did not change overall results. Nutritional indexes, length of stay in the intensive care unit, ventilator dependence, and survival were not different between the two groups. Conclusions: Gastric feeding with erythromycin as a prokinetic is equivalent to transpyloric feeding in meeting the nutritional goals of the critically ill.
Screening for Hospitalization and Nutritional Risk Among Community‐Dwelling Older Persons
Authors: Jensen GL , Friedmann JM , Coleman CD
Published: May 2008

Background: The potential for the use of nutritional screening to identify older persons at risk of hospitalization has not been contrasted with the use of tools developed for predicting hospital admissions. Objective: Our goal was to compare the associations of items from the Level II Nutrition Screen (LII) and the Probability of Repeated Admissions (Pra) questionnaire with the outcome of hospitalization. Design: This was a cohort study of participants in a Medicare managed‐risk health plan who completed both the LII and Pra (n = 386). All hospitalizations within 1 y of screening were recorded. Hierarchical multivariate logistic regression was used to model associations with hospitalization. Results: Pra items that retained significant associations with hospitalization were self‐reported health, hospitalization in the past year, and >6 doctor visits in the past year (positive predictive value: 20%; sensitivity: 53.1; specificity: 69.7). LII items that retained significant associations with hospitalization were eating problems and polypharmacy (positive predictive value: 17.9%; sensitivity: 58.0; specificity: 56.3). Those persons designated by the Pra score as being at high risk of hospitalization (Pra ≥ 0.30, 75th percentile) were also more likely to report weight loss, polypharmacy, consumption of a special diet, and functional limitation on the LII. Conclusions: Retained items from the Pra and the LII were comparable in identifying participants at risk of hospitalization. These observations suggest that nutritional risk factors such as eating problems, weight loss, and consumption of special diets should be considered in the management of older persons at risk of hospitalization, irrespective of the screening approach selected.
Nutritional Therapy for Cancer‐Induced Weight Loss
Authors: Capra Sandra , Bauer Judith , Davidson Wendy , Ash Susan
Published: May 2008

Nutrition issues facing people with cancer are significant. The role of nutrition therapy is often assumed to be less important than pharmacologic interventions as outcomes are less clear in the literature. Especially important has been the focus on traditional outcomes such as morbidity and mortality rather than adopting a more patient‐centered approach and including quality of life as a key outcome. There is a general failure to recognize weight loss early enough and to implement nutrition interventions, which are effective. The nutrition intervention should be composed of both a prescription and an implementation method. To achieve compliance, the nutrition therapy should be implemented in an aggressive manner. Data show that when compliance is achieved, outcomes in the form of improved quality of life and functional capacity can be achieved. For people with cancer and their care‐givers, outcomes such as quality of life have meaning, and for patients with poor prognoses, this may hold more meaning than mortality and morbidity outcomes. Clinicians need to implement triage systems to identify patients for early intervention and focus on nutrient combinations. They need to be confident that with the right prescription and implementation, nutrition therapy can be successful and bring real benefit to patients with cancer.
Arginine: A Clinical Perspective
Authors: Basu Hemendra N. , Liepa George U.
Published: May 2008

Dietary arginine is commonly found in both plant and animal products and has also become popular as a dietary supplement over the past 20 years. Arginine has been shown to have a wide variety of effects on the body, including impact on the cardiovascular system, the immune system, and wound healing. Recently it has also been shown to interact with popular pharmaceutical therapies (ie, statin drugs) in a positive way. Research indicates that arginine is safe and has positive effects on the body when used for relatively short periods of time. Data regarding arginine's safety with long‐term use in pharmaceutical amounts is still not available for select patient populations (ie, cancer patients).
Scurvy in a Patient With Presumptive Oral Lichen Planus
Authors: Helms Amy E. , Brodell Robert T.
Published: May 2008

Scurvy is a disease caused by vitamin C deficiency. In this study, a patient with scurvy is presented with soreness and ulcerations of the mouth that were previously diagnosed as oral lichen planus. This disease is relatively more common than scurvy in the United States. Physicians should be aware that even in developed countries, soreness of the mouth and ulceration can be seen in patients with scurvy and potentially be misdiagnosed as oral lichen planus.
Weight‐Based Ordering: An Evaluation of Increased Guideline Use in Hospital Total Parenteral Nutrition Dosing
Authors: Dersch Deonne , Schoen Judy
Published: May 2008

Background: In the past, parenteral nutrition in the Calgary Health Region was ordered as volumes of standard solutions, which limited individualization. Ordering total parenteral nutrition (TPN) that falls within macronutrient dosing guidelines may minimize complications associated with TPN, such as hyperglycemia, azotemia, hepatic steatosis, or continued malnutrition and catabolism. The Foothills Medical Centre in Calgary changed to a weight‐based ordering system for TPN in 1999. This study's purpose was to determine if this change increased adherence to TPN dosing guidelines. Methods: Macronutrient doses in TPN solutions ordered as standard solutions were compared with those ordered by weight. Mean protein, dextrose, lipid, and kilocalorie doses and the number of orders deviating from guidelines were examined. Results: Weight‐based dosing showed a significant reduction in deviation from guidelines for kilocalorie dose compared with TPN ordered as standard solutions. There also was a significant increase in mean protein dose and reductions in mean dextrose load and mean kilocalorie dose in the weight‐based TPN group only, suggesting these changes were caused by the change in ordering method. Conclusions: Overall, weight‐based ordering increased adherence to TPN dosing guidelines. The study did not have the statistical power to show significant differences between weight‐based or standard TPN dosing; however, several trends were shown.
Enteral Feeding in the Critically Ill: Comparison Between the Supine and Prone Positions. A Prospective Crossover Study in Mechanically Ventilated Patients
Authors: van der Voort PHJ , Zandstra DF
Published: May 2008

Introduction: Prone position is effective in mechanically ventilated patients to improve oxygenation. It is unknown if prone position affects gastric emptying and the ability of continued enteral feeding. Aim: To determine tolerance of enteral feeding by measuring gastric residual volumes in enterally fed patients during supine and prone positions. Methods: Consecutive mechanically ventilated intensive care patients who were turned to prone position were included. All patients were studied for 6 hours in supine position, immediately followed by 6 hours in prone position, or vice versa. The rate of feeding was unchanged during the study period. Gastric residual volume was measured by suctioning the nasogastric tube after 3 and 6 hours in the same position. Wilcoxon test and regression analysis were used for analysis. Results: The median volume of administered enteral feeds was 95 mL after 6 hours in supine position and 110 mL after 6 hours in prone position (p = .85). In 10 patients, a greater gastric residual volume was found in prone position. In eight others a greater volume was found in supine position. In 18 of 19 patients, gastric residual volumes in both positions were ≥150 mL in 6 hours or ≤150 mL in 6 hours. Significantly more sedatives were used in prone position. Regression analysis excluded dopamine dose and the starting position as confounders. Conclusion: Our results suggest that enteral feeding can be continued when a patient is turned from supine to prone position or vice versa. The results indicate that patients with a clinically significant gastric residual volume in one position are likely to have a clinically significant gastric residual volume in the other position.
Catheter‐Related Upper Extremity Deep Venous Thrombosis in Cancer Patients: A Prospective Study Based on Doppler US
Authors: Luciani A , Clement O , Halimi P , Goudot D , Portier F , Bassot V , Luciani JA , Avan P , Frija G , Bonfils P
Published: May 2008

Purpose: This prospective study extending for >3 years had two objectives: (a) to use Doppler ultrasonography (US) to estimate the incidence of asymptomatic catheter‐related upper extremity deep venous thrombosis (DVT) in a large population and (b) to study the effect of the catheter position as an individual risk factor for catheter‐related DVT. Materials and Methods: Between October 1995 and June 1998, a total of 145 patients who had oropharyngeal tract cancer and who were fitted with the same totally implantable central venous catheters (CVCs) were included in the study. Follow‐up included (a) estimation of the position of each catheter tip on a chest radiograph obtained immediately after surgery and (b) regular monthly Doppler US screening for catheter‐related DVT. Results: Seventeen patients developed catheter‐related DVT; 13 of them were asymptomatic. The mean interval between CVC implantation and detection of thrombosis was 42.2 days. Correct positioning of the distal catheter tip was associated with a significantly lower rate of catheter‐related DVT. Only five of 87 patients with a correctly positioned distal catheter tip (ie, either in the superior vena cava or at the junction between the right atrium and the superior vena cava) developed thrombosis, compared with 12 of 26 patients with a misplaced catheter (p < .001). The side on which the CVC was implanted did not influence the catheter‐related DVT rate. Conclusion: The rate of asymptomatic catheter‐related DVT is high and could be lowered with correct initial CVC positioning.
Nutritional Approach in Malnourished Surgical Patients: A Prospective Randomized Study
Authors: Braga M , Gianotti L , Nespoli L , Radaelli G , Di Carlo V
Published: May 2008

Hypothesis: Perioperative administration of a supplemented enteral formula may decrease postoperative morbidity. Design: Randomized clinical trial. Setting: Department of surgery at a university hospital. Patients: One hundred ninety‐six registered malnourished patients (weight loss > or = 10%) who were candidates for major elective surgery for malignancy of the gastrointestinal tract. Intervention: After randomization (n = 150), one group received postoperative enteral feeding with a standard diet within 12 hours of surgery (control group; n = 50). Another group orally received 1 L/d for 7 consecutive days of a liquid diet enriched with arginine, omega‐3 fatty acids, and RNA (preoperative group; n = 50). After surgery, patients were given the same standard enteral formula as the control group. A third group orally received 1 L/d for 7 consecutive days of the enriched liquid diet. After surgery, patients were given enteral feeding with the same enriched formula (perioperative group; n = 50). Main Outcome Measures: Postoperative complications and length of hospital stay. Results: The 3 groups were comparable for baseline demographics, biochemical markers, comorbidity factors, and surgical variables. The intent‐to‐treat analysis showed that the total number of patients with complications was 24 in the control group, 14 in the preoperative group, and 9 in the perioperative group (p = .02, control group versus perioperative group). Postoperative length of stay was significantly shorter in the preoperative (13.2 days) and perioperative (12.0 days) groups than in the control group (15.3 days) (p = .01 and p = .001, respectively, versus the control group). Conclusion: Perioperative immunonutrition seems to be the best approach to support malnourished patients with cancer.
Megestrol Acetate Stimulates Weight Gain and Ventilation in Underweight COPD Patients
Authors: Weisberg J , Wanger J , Olson J
Published: May 2008

STUDY OBJECTIVES: To assess the effect of megestrol acetate (MA), a progestational appetite stimulant commonly used in patients with AIDS and cancer, on body weight and composition, respiratory muscle strength, arterial blood gas levels, and subjective perceptions in COPD patients. DESIGN AND SETTING: Prospective, double‐blind, randomized, placebo‐controlled trial conducted on an outpatient basis at 18 sites. PATIENTS: Underweight (<95% ideal body weight) COPD patients ≥40 years old. INTERVENTIONS: Either MA, 800 mg/d oral suspension, or placebo at a 1:1 ratio for 8 weeks. RESULTS:Of 145 randomized patients (63% men), 128 patients completed the trial. Body weight increased by 3.2 kg in the MA group and 0.7 kg in the placebo group (p< 0.001). Anthropometric and dual‐energy radiograph absorptiometry assessments confirmed that weight gain was mainly fat. Spirometry and maximal voluntary ventilation showed no significant changes from baseline in either group, and the difference in the change in maximum inspiratory pressure between groups was not significant. The 6‐min walk distances did not differ statistically between groups at week 2 and week 4, but were greater in the placebo group at week 8 (p < 0.012). Consistent with the known ability of MA to stimulate ventilation, PaCO(2) decreased (4.6 mm Hg, p < 0.001) and PaO(2) increased (2.8 mm Hg, p < 0.04) in the MA group. Questionnaires revealed that body image and appetite improved in the MA group but not the placebo group. Adverse event frequency and type were similar in both groups, but cortisol and testosterone (in men) levels decreased substantially in the MA group. CONCLUSIONS: We conclude that MA safely increased appetite and body weight, stimulated ventilation, and improved body image in underweight COPD patients, but did not improve respiratory muscle function or exercise tolerance.
Nutrition in Chronic Disease Management in the Elderly
Authors: White Jane V. , Brewer Daniel E. , Stockton M. David , Keeble Donald S. , Keenum Amy J. , Rogers Edwin S. , Lennon Elizabeth S.
Published: May 2008

Older Americans experience chronic disease at rates well above other segments of our society. Rates of health services use are also 2 to 3 times that of younger age groups. The most rapidly growing segments of America's aging population are also its most nutritionally vulnerable—women, minorities, and those 85 years of age and older. The routine incorporation of nutrition screening and intervention into chronic disease management protocols will lower healthcare services usage, decrease healthcare costs, help relieve the burden of human suffering experienced by older Americans with chronic disease, and improve quality of life for our nation's elders.
Ins and Outs of Enteral Access: Part 2—Long Term Access—Esophagostomy and Gastrostomy
Authors: Vanek Vincent W.
Published: May 2008

Access techniques for long‐term enteral nutrition (over 4 to 6 weeks) includes cervical esophagostomy and pharyngostomy, gastrostomy, and jejunostomy. Cervical esophagostomy and pharyngostomy are rarely used since the advent of better long‐term enteral access techniques that are easier to care for and have fewer complications; they are briefly reviewed only for historical completeness and to condemn their use. The different techniques of gastrostomy tube insertion and their indications, contraindications, advantages, and disadvantages are discussed. Part III (to be published in a later issue) of this series will review feeding jejunostomy.
Psychological Aspects of Bariatric Surgery
Authors: Greenberg Isaac
Published: May 2008

Severe obesity is a serious chronic condition associated with a variety of life‐threatening medical illnesses. It also has a major impact on mental health and quality of life. A higher than normal prevalence of psychopathology is seen in this population, and there seems to be a direct relationship between body mass index and the degree of psychosocial impairment. This impact on the overall quality of life may have more serious implications on public health than even the clear medical risks of obesity. Among the various psychological disorders seen in the obese treatment‐seeking population, there is a higher incidence of depression, anxiety, distorted body image, and eating disorders. This paper reviews the complex psychological issues related to bariatric surgery, offers recommendations regarding presurgical behavioral assessment, and reviews emerging data on the psychological impact of this important new treatment.
Enteral Nutrition in Patients With an Open Peritoneal Cavity
Authors: Tsuei Betty J. , Magnuson Barbara , Swintosky Marjorie , Flynn Julie , Boulanger Bernard R. , Ochoa Juan B. , Kearney Paul A.
Published: May 2008

Recent surgical advances have led to the increased survival of critically ill patients requiring postoperative nutritional supplementation. One technique, which has been increasingly used, is that of the open peritoneal cavity. In these cases, the peritoneum is left open, and the viscera are protected with a temporary dressing until the abdomen can be closed. The aim of this study was to evaluate the efficacy and tolerance of enteral nutrition in patients who need open peritoneal cavity management techniques. Patients at a tertiary referral center requiring the use of open peritoneal cavity management who received at least 4 days of enteral nutrition were included in the study. Retrospective data were collected on patients admitted between January 1999 and December 2000, and prospective data were collected on patients between January and May 2001. Energy expenditure and actual caloric and protein intake were determined in all patients. Prealbumin levels and nitrogen balance studies were analyzed when available. Intolerance, defined as diarrhea or gastric reflux, was also evaluated. Average daily total caloric intake was 77 ± 27%, and average daily protein intake was 68 ± 24% of estimated needs. Initial serum prealbumin levels were low and remained below normal but increased in some patients during the study. Average nitrogen balance studies from 3 patients was −15 ± 9.7 g/d. Diarrhea and gastric reflux occurred in 42% and 36% of patients, respectively, and were easily treated. Enteral nutrition can be effectively used in patients requiring open peritoneal cavity management after laparotomy. Overall, enteral nutrition is relatively well tolerated in this patient population.
Influence of Multivitamin Regimen on Urinary Oxalate in Home Parenteral Nutrition Patients
Authors: Fairholm Lydia , Saqui Olivia , Baun Mary , Allard Johane
Published: May 2008

Background: High urinary oxalate levels have been associated with high ascorbic acid intakes. An alteration in the vitamin regimen for home parenteral nutrition (HPN) patients because of product discontinuation resulted in provision of 500 mg instead of 100 mg ascorbic acid per HPN day. This regimen was associated with high urinary oxalate levels. Purpose: To determine if a switch from a multivitamin regimen containing 500 mg to one containing 100 mg of ascorbic acid daily would reduce urinary oxalate levels. Methods: A 24‐hour urine collection for oxalate was analyzed before switching the vitamin regimen back to 100 mg ascorbic acid and repeated 2 months after the change. A paired t test was conducted to compare measurements at baseline and at 2 months. Results: Overall, 18 patients completed both phases of this observational study. The initial urinary oxalate of 517 ± 63μ mol/day decreased to 425 ± 47 μmol/day after 2 months (p = .05). However, after applying the exclusion criteria, only 6 patients could be included. The baseline urinary oxalate of 649 ± 106μ mol/day decreased to 391 ± 57 μmol/day after 2 months (p = .006). Conclusions: A change in the parenteral regimen of HPN patients from 500 mg ascorbic acid to 100 mg ascorbic acid is associated with a decrease in urinary oxalate levels. This suggests that a moderate dose of parenteral ascorbic acid (100 mg/day) may limit urinary oxalate appearance in HPN patients.
Hypermanganesemia in an Acute Care Setting
Authors: O'Donnell Kelly , Radigan Amy
Published: May 2008

Hypermanganesemia has recently been reported in long‐term home parenteral nutrition patients receiving routine trace element supplementation. Because the regulation of manganese involves intestinal absorption and biliary excretion, patients receiving parenteral nutrition, especially those with hepatic dysfunction, may be at risk for manganese toxicity. This case study describes a patient in an acute care setting who had been receiving parenteral nutrition for 7 months. When neurologic symptoms developed, she was found to have a whole blood manganese level almost 3 times normal. Manganese was eliminated from the trace element solution, and a whole blood level was rechecked 3 months later, showing a significant decrease and a marked improvement in facial paralysis and headaches.
Neonatal Nutrition: A Focus on Parenteral Nutrition and Early Enteral Nutrition
Authors: Mayhew Susan L. , Gonzalez Edgar R.
Published: May 2008

No population has benefited more from the development and advancement of specialized nutrition support than pediatric patients. Today, neonates comprise the largest group of pediatric patients receiving parenteral nutrition (PN). Nutrient needs of neonates differ substantially from other populations, presenting unique challenges in optimizing nutrition care. Neonates are highly susceptible to catabolic stress because of reduced energy stores and markedly increased energy needs. Immature organ systems and metabolic pathways further complicate the delivery of adequate nutrition in the preterm neonate. Early nutrition support is essential to improve survival, reduce catabolism, promote growth, and limit developmental complications. This article discusses feeding strategies for PN and early enteral nutrition in neonates, particularly the preterm neonate.