bluuebunny/crossref_metadata_2025 huggingface dataset:
Civil Service Reform
Authors: Gossett Charles W.
Published: April 2009

In 1996, the State of Georgia passed the Merit System Reform Act, which made dramatic changes to the traditional civil service system in the state. These reforms included placing all newly hired civil servants in positions that were “at will” and greatly decentralized responsibility for recruitment and classification to individual operating agencies. The role of the central personnel office changed from that of a regulating agency ensuring that merit principles were followed to a consulting service organization designed to encourage best practices. This article examines these changes as manifestations of a “managerialist” ideology more concerned with empowering managers for the sake of greater efficiency than with protecting individual employee rights.
Public Employment in Georgia State Agencies
Authors: Kuykendall Christine L. , Facer Rex L.
Published: April 2009

Georgia’s 1996 elimination of merit protections for newly hired employees challenges the legal protections that act as a barrier to unfettered government action. This article reviews the implications of Georgia’s reforms in light of constitutional protections and judicial precedent. Although this reform effort sought to avoid employees’ procedural due process rights by eliminating merit status for newly hired employees, federal and state judicial decisions indicate that those rights may not be so easy to extinguish. The most pressing challenge involves the constitutional right to due process. The Supreme Court has determined that public employment may rise to the level of a property right, requiring procedural due process. The courts have used a variety of standards to confer a property right interest, including the existence of language in policy and procedure manuals. Accordingly, many of Georgia’s agencies may have unknowingly promulgated employee regulations that lead to the expectation of a property right in continued employment.
From Fire to Frying Pan: The Impact of Major-Power War Involvement on Major-Power Dispute Involvement, 1816-1975
Authors: Stoll Richard J.
Published: April 2009

This paper sought to plug a gap in the literature on war, by exploring its impact on subsequent dispute involvements. The present effort was confined to an examination of the major powers, and only their major power-major power experiences were studied. This may limit the generalizeability of the results. Nevertheless, there is some tendency for major powers to decrease their dispute involvement, even though the drop may not be large, particularly over the first ten years after the war involvement. In most cases, the trend is for the major power to become involved in one less dispute over the next ten years than in the previous decade. Although it is disheartening to observe that major powers do not learn more from their war behavior (i.e., experience a quicker and more dramatic drop), and that World War II was followed by an increase in dispute involvement by the superpowers, we can also interpret these results as showing that most major power governments are not imprisoned by their past wars. That is, these results indicate that the government of a major power generally views each possible dispute involvement as a separate situation. Coupling the results of this paper with earlier results showing a lack of periodicity and cycles in major power war involvements, we may take the optimistic view that in any situation that a government contemplates dispute involvement, it may be possible to dissuade it from crossing this conflict threshold, since it is not necessary to overcome the effect of past war experiences. The research findings are somewhat dull, but they do offer hope for conflict containment.
Foundations of A Theory of Economic Warfare and Arms Control
Authors: Wolfson Murray , Farrell John P.
Published: April 2009

War is carried out even in “peacetime” by exerting economic pressure in the form of forced deterring expenditure as well as by military threat. Peace can achieved only by considering both economic and military arms control. In this paper, disarmament and its verification by fiscal control are studied as a means of negotiating a reduction and elimination of both dimensions of war. This is first done under simplifying assumptions, but then is followed by an analysis of the complete theory of economic and military interactions.
Power Transition and Conflict Initiation
Authors: Geller Daniel S.
Published: April 2009

Most theories of war and lesser forms of international conflict rest on assumptions of rational choice. Moreover, many of these explanations explicitly incorporate decision maker estimates of relative power among competitors. However, a major theory of great power war-power transition theory-postulates initiation by the weaker contender. This study demonstrates that among the strongest states an interactive relationship exists between the static power balance, differential growth rates in capabilities, and conflict initiation: initiation patterns are associated with changes in a state's relative military/economic power and power potential. The findings are consistent with the inherent logic of power transition theory and are consonant with an assumption of rational calculation in decisions involving conflict initiation. The results may be interpreted as reinforcing the realist contention that a shifting power balance is of critical significance among the causes of war and peace.
Camp David: Was The Agreement Fair?
Authors: Brams Steven J. , Togman Jeffrey M.
Published: April 2009

The agreement between Egypt and Israel at Camp David in 1978 is used to illustrate how a fair-division procedure called Adjusted Winner (AW), in which two sides allocate 100 points over the issues that divide them, could have been used to reach a settlement. AW satisfies the properties of envy-freeness (each side is ensured of receiving at least 50 of its points and hence does not envy the other side), equitability (each side receives the same number of points over 50), and efficiency (there is no other settlement better for both players). While the actual agreement at Camp David seems to reflect quite well what AW would have yielded on the six issues that divided the two sides, this agreement probably could have been achieved more expeditiously, and in a less crisis-driven atmosphere, if AW had been used.
A Critical Look at the Use of Computing Technologies in Planning Education
Authors: Urey Gwen
Published: April 2009

Using John Forester’s elaboration of Habermas’s theory of communicative action, technological biases that result in the distortion of ordinary communication are explored. Planning instruction related to computing technologies should include critical appraisal of their potential for distortion of communication. The findings from an assessment reveal that students’ naive use of spreadsheet technologies increases the likelihood that analytic reports will be marred by distortions of communication. Planning students should be taught to anticipate systematic communication distortions that may arise as inevitable consequences of technological dimensions of everyday decisions. Further investigation is needed into the roles of computing technology in planning classrooms.
Contextualizing Toulmin's Model in the Writing Classroom
Authors: Lunsford Karen J.
Published: April 2009

Although Toulmin models of argumentation are pervasive in composition textbooks, research on the model's use in writing classrooms has been scarce'typically limited to evaluating how students' essays align with the model's elements (claim, data, warrant, qualifier, rebuttal, backing) construed as objective standards. That approach discounts Toulmin's emphasis on context. In contrast, this study of a major university's summer composition program for high school students employs Wenger's notion of communities of practice and Bakhtin's notion of response to trace how classroom contexts mediate students' and teachers' understandings of a Toulmin model. The article presents a case study of a controversy that emerged when participants attempted to identify the main claim in one student's essay. The controversy arose, the analysis suggests, as participants positioned competing tacit and explicit representations of claims with/against other rhetorical terms (for example, thesis), variously interpreted the assigned tasks, and negotiated over tasks and texts.
From the Dynamic Style to the Synoptic Style in Spectroscopic Articles in the Physical Review
Authors: Vande Kopple William J.
Published: April 2009

This article presents evidence that, from selected spectroscopic articles in the earliest volumes of the Physical Review to other selected spectroscopic articles from the same journal in 1980, a shift in sentence style takes place. This shift is from what M.A.K. Halliday calls the dynamic style (which reflects happenings, processes, and actions) to the synoptic style (which reflects things, structures, and categories). The article proposes that the early writers used the dynamic style primarily to set information in a distinct time and thus to avoid giving the impression that the information should be regarded as widely generalizable. It also proposes that the later writers used the synoptic style because it allowed them to represent processes as things, to delineate many fine shades of meaning, and to extend their arguments economically. The article concludes by suggesting areas of future research for students of scientific style and for composition scholars.
3-Methylcrotonyl-CoA Carboxylase Deficiency: Phenotypic Variability in a Family
Authors: Tuba Eminoglu F. , Ozcelik Aysima A. , Okur Ilyas , Tumer Leyla , Biberoglu Gursel , Demir Ercan , Hasanoglu Alev , Baumgartner Matthias R.
Published: April 2009

A family with 3-methylcrotonyl-CoA carboxylase deficiency with different clinical features is described. A 15-month-old boy, who was the index patient, was admitted to the hospital with atonic seizure. His brother had delayed language development and their uncle had been followed with diagnosis of epilepsy for the last 5 years. Urinary organic acid analysis displayed elevated 3-hydroxyisovaleric acid and 3-methylcrotonylglycine, analysis of acylcarnitines showed elevated 3-hydroxyisovalerylcarnitine and decreased free carnitine levels in both the patients and their uncle. Methylcrotonyl-CoA carboxylase activity in cultured fibroblasts displayed a low residual activity of 2.2% of the median control value while propionyl-CoA carboxylase activity was normal in the index patient. Mutation analysis revealed a large homozygous deletion of 2264 bp (c.873+4524_6787de12264) in the MCCA gene, which has not been described to date. Adult-onset afebrile seizures have not been reported in the literature. Our cases are an example of this wide phenotypic variability within a single family.
Clinical Research: PEG Feeding Tube Placement Following a Stroke: When to Place, When to Wait
Authors: Scolapio James S. , Romano Michelle , Meschia James F. , Tarrosa Vilia , Chukwudelunzu Felix E.
Published: April 2009

Background: When to place a percutaneous endoscopic gastrostomy (PEG) feeding tube in acute poststroke patients remains controversial. The aim of this study was to determine clinical predictors of long‐term enteral feeding following a stroke. Method: Medical records of patients at St. Luke's Hospital (Mayo Clinic) from 1995 to 1998 were reviewed for acute stroke that resulted in PEG placement. Comorbid medical illness, stroke subtypes, Glasgow score, swallow evaluation, and time of PEG placement to discontinuation or death were recorded. Results: Thirty‐two patients were eligible for study. Mean follow‐up was 4 months poststroke. Mean age was 71.3 years. Twenty‐five patients had an ischemic stroke, and 7 had primary intracranial hemorrhage. Swallow evaluation was abnormal in 21 of the 23 patients tested. A PEG tube was placed a mean of 8.4 days poststroke in all patients studied. At final follow‐up, only 5 surviving patients regained swallowing function in less than 4 weeks and no longer required the PEG. These patients were younger, had mild dysphagia, and had less comorbid medical illness and ischemic strokes compared with the group who did not regain swallow function in 4 weeks. Conclusion: Nonhemorrhagic stroke, mild oropharyngeal dysphagia, limited comorbidities, and younger age help predict patients that may need nutrition support for < 4 weeks following a stroke. These patients may best be served with temporary nasogastric feeding tubes.
Clinical Research: Is Routine Vitamin K Supplementation Required in Hospitalized Patients Receiving Parenteral Nutrition?
Authors: Duerksen Donald R. , Papineau Noreen
Published: April 2009

Vitamin K is not a component of the multivitamin preparation added to parenteral nutrition solutions, and hospitalized patients receiving parenteral nutrition (PN) support are at risk of developing vitamin K deficiency. In this study, 70 consecutive patients receiving PN were followed prospectively to determine the incidence of a raised international normalized ratio (INR). Over a 3‐week period, 20% of patients developed a raised INR compared with baseline. All elevations were mild, with no patients developing clinical bleeding. An alternative to routinely supplementing vitamin K is monitoring INR and supplementing those individuals with elevated coagulation parameters.
Current Literature: Prospective Evaluation of Risk Factors for Bloodstream Infection in Patients Receiving Home Infusion Therapy
Authors: Tokars JI , Cookson ST , McArthur MA
Published: April 2009

Background: Intravenous therapy in the outpatient and home settings is commonplace for many diseases and nutritional disorders. Few data are available on the rate of and risk factors for bloodstream infection among patients receiving such therapy. Objective: To determine rates of and risk factors for bloodstream infection among patients receiving home infusion therapy. Design: Prospective, observational cohort study. Setting: Cleveland, Ohio, and Toronto, Ontario, Canada. Patients: Patients receiving home infusion therapy through a central or midline catheter. Measurements: Primary laboratory‐confirmed bloodstream infection. Results: Among 827 patients (988 catheters), the most common diagnoses were infections other than HIV (67%), cancer (24%), nutritional and digestive disease (17%), heart disease (14%), receipt of bone marrow or solid organ transplants (11%), and HIV infection (7%). Sixty‐nine bloodstream infections occurred during 69,532 catheter days (0.99 infections per 1000 days). In a Cox regression model with time‐dependent covariates, independent risk factors for bloodstream infection were recent receipt of a bone marrow transplant (hazard ratio, 5.8 [95% CI, 3.0 to 11.3]), receipt of total parenteral nutrition (hazard ratio, 4.1 [CI, 2.3 to 7.2]), receipt of therapy outside the home (for example, in an outpatient clinic or physician's office) (hazard ratio, 3.6 [CI, 2.2 to 5.9]), use of a multilumen catheter (hazard ratio, 2.8 [CI, 1.7 to 4.7]), and previous bloodstream infection (hazard ratio, 2.5 [CI, 1.5 to 4.2]). Rates of bloodstream infection per 1000 catheter‐days varied from 0.16 for patients with none of these 5 risk factors to 6.77 for patients with 3 or more risk factors. Centrally inserted venous catheters were associated with a higher risk than implanted ports were, but the difference was not statistically significant. Conclusion: Bloodstream infections seem to be infrequent among outpatients receiving infusions through central and midline catheters. However, the rate of infection increases with bone marrow transplantation, parenteral nutrition, infusion therapy in a hospital clinic or physician's office, and use of multilumen catheters. Compared with implanted ports or peripherally inserted catheters, centrally inserted venous catheters may confer greater risk for bloodstream infection. (Ann Intern Med 131:340–347, 1999)
Clinical Research: Microbial Contamination of Low‐Profile Balloon Gastrostomy Extension Tubes and Three Cleaning Methods
Authors: Smarszcz Roxanne M. , Proicou George C. , Dugle Janis E.
Published: April 2009

It is common practice to wash and reuse low‐profile gastrostomy (LPG) extension tubes for several weeks or as long as the tubes remain functional. This laboratory study investigated three different cleaning methods and their effectiveness for lowering the microbial contamination of extension tubes challenged with Staphylococcus epidermidis, Enterobacter aerogenes, Candida albicans, and Acinetobacter. The Food and Drug Administration (FDA) limit of an aerobic plate count exceeding 10,000 (104) organisms per gram of product for microbial contamination of enteral formulas was used as the standard. One hundred thirty‐two extension tubes were used (66 analyzed at 8 days and the remaining 66 analyzed at 18 days), 30 per each inoculated group and 12 with uninoculated formula. Each group was divided into three subgroups for cleaning methods: (1) tap water flush and air drying; (2) warm, soapy water flush followed by a tap water flush and air drying; and (3) warm, soapy water flush followed by a tap water flush and then a final flush with 30 mL of a quaternary ammonium sanitizer at a concentration of 200 parts per million (ppm) and air drying. The medication port was not flushed and the tube was not soaked in the quaternary ammonium sanitizer. A modified version of method 3 was used on days 14 to 17 of the study after day 8 results were obtained. In this method, after the final sanitizer flush, the Y‐ports were manually agitated in the sanitizer solution for 15 seconds and the tubes were then fully immersed in the solution for 2 minutes. The first two cleaning methods, ie, tap water flush and soap and water flush followed by a tap water flush, were not found to be effective in reducing bacteria and yeast contamination ≤10,000 (104) colony‐forming units (CFU) per sample at 18 days. The third cleaning method, which included flushing with soap, tap water, and a quaternary ammonium sanitizer, manual agitation for 15 seconds and immersion in sanitizer for 2 minutes, was found to be effective in reducing bacterial and yeast contamination to ≤2.4 × 103. The findings suggest that the common practice of washing the extension tube in soapy water, rinsing, and air drying is ineffective for reducing the microbial count to ≤10,000 (104). However, adding a quaternary ammonium sanitizer flush, agitation, and 2‐minute soak to the cleaning regimen reduced the microbial count to acceptable levels at 18 days, suggesting that the LPG extension tubes can potentially be used safely for at least 2 weeks if this protocol is followed.
Clinical Observation: Outpatient Intravenous Antibiotic Therapy for Catheter Infections in Patients on Home Parenteral Nutrition
Authors: Campo Mercedes , Moreno José Manuel , Albiñana Sandra , Valero Maria Angeles , Gomis Pilar , León‐Sanz Miguel
Published: April 2009

Standard management of infectious complications in home parenteral nutrition (HPN) patients includes hospitalization and use of IV antibiotics (1 to 4 weeks). Outpatient IV antibiotic therapy (OPIVAT) has proven to be safe, practical and cost‐effective for a variety of infections. The aim of this retrospective review is to describe our experience with OPIVAT for suspected catheter‐related infections in patients receiving HPN. The records of all HPN patients in our program were reviewed. Since 1993, eleven adults and seven children received HPN for a total of 5420 and 1212 days respectively. During the follow‐up there were 21 febrile episodes in the adult patients, nine catheter‐related infections, and 12 non‐catheter‐related febrile episodes. All received initially empiric antibiotic treatment (Teicoplanin or Vancomycin plus Ceftriaxone). If the patient's general condition was good, the treatment was administered at home, otherwise he or she remained in the hospital until the results of the blood cultures were available. Most of the febrile episodes treated entirely at home corresponded to non‐catheter related infections. No patients developed complications related to infections. None of the patients with catheter‐related bloodstream infection who received OPIVAT needed to be admitted or readmitted to the hospital during the course of the treatment. It was only necessary to remove the catheter as an inpatient in one patient with a tunnel infection. In most of the HPN programs, if the patient presents fever and no infectious focus is found, admission is recommended. IV antibiotics are started until the results of blood cultures are available. Our findings suggest that, even in the presence of catheter‐related bloodstream infection, if the patient's general condition is good, antibiotic treatment can be safely administered at home.
Clinincal Observations: Nutrient Supplements in Clinical Care
Authors: Sardesai Vishwananth M. , Myers Todd
Published: April 2009

Popular demand for and interest in alternative medicine has increased considerably in recent years. Several of these therapies, if administered correctly, may be safe and effective complements to conventional medical treatment. Of greater concern is the ingestion of various herbs and chemicals marketed as dietary supplements. Unlike pharmaceutical drugs that are subject to rigorous testing, dietary supplements are exempt from FDA clinical scrutiny as a result of the Dietary Supplement Health and Education Act of 1994. Some supplements may have health benefits but many may be intrinsically dangerous when ingested alone or in combination with other supplements or drugs. Adverse effects of a few of the popular supplements are described in this article. Patients who use supplements are often guided by misconceptions or inaccurate information. Therefore, it is important that physicians and other health care professionals understand the potential associated health consequences so that they can help patients make informed decision about their use. To increase physicians' awareness about the unconventional therapies, there is a need for inclusion of alternative medicine as part of the medical curriculum.
Clinical Research: Validation of Objective Criteria for Predicting Tolerance to Enteral Feeding in Medical Intensive Care Unit Patients
Authors: Skipper Annalynn , Peloquin Theodore J. , Gregoire Mary B. , Tangney Christine C.
Published: April 2009

The purpose of this study was to determine if indicators of cardiopulmonary function identified critically ill patients who tolerate enteral feeding. Medical records of 149 patients (age, 24 to 100 years) admitted to the medical intensive care unit who had a pulmonary artery catheter placed and were started on enteral feeding were reviewed retrospectively. Of 118 patients with cardiac index < 2 L/min/m2, mean arterial blood pressure < 70 mm Hg with α‐sympathetic stimulation, and oxygen saturation < 95% on an FIO 2 of > 60% and with > 5 cm positive end‐expiration pressure, 79 (67%) did not tolerate enteral feedings. Sensitivity was 17% and specificity was 78%. In conclusion, with the aforementioned cutoffs, cardiac index, mean arterial pressure, and oxygen saturation may identify critically ill patients likely to be intolerant of enteral feeding.
Dairy Product‐Induced Diarrhea After Bowel Surgery: A Performance Improvement Opportunity
Authors: Stike Rose L. , Sipe Paul , Peters Kristi , Green Dale , Fielding L. Peter
Published: April 2009

Once gastrointestinal function has returned after bowel surgery, a dairy‐based liquid diet appears to be associated with an increased incidence of diarrhea when compared with a soft‐solid diet. This retrospective study explores the hypothesis that these observations are causally related. We have modeled potential clinical and cost savings benefits, which might be derived from a change in clinical practice using a clear liquid and then soft‐solid diet and avoiding the use of a dairy‐based liquid diet. A chart review of 257 patients who had undergone bowel surgery over a 15‐month period contained 64 patients with conditions predisposing to postoperative diarrhea. These patients were excluded leaving a study population of 193 patients. A model was developed to estimate dollar cost savings based on differences between groups of patients' length of stay (LOS). Of the 193 patients studied, the majority received an early postoperative dairy‐based nutritional regimen (60%), whereas the remainder (40%) progressed directly from clear fluids to a soft‐solid diet. The incidence of diarrhea was substantially different between these two groups (32% vs 5%, p < .001). Patients with diarrhea had a median length of stay of 10 days (range 5 to 34), and the figure for those without diarrhea was 7 (range 2 to 28) days (p < .001). The median costs for patients with and without diarrhea were $10,337 and $6,751, respectively (p <.001). In patients with a dairy‐based nutritional regimen who developed diarrhea, a change to the soft‐solid diet led to diarrhea frequency reduction (X2 = 12.06, p = .002). Extrapolating our findings to the national level, we estimate that approximately 560,000 patients per annum (p.a.) have a similar clinical profile. A nomogram model showed conservative estimates that there is a potential national LOS savings of approximately 200,000 days, which could save $250 million p.a. With these clinical and financial findings, a concerted prospective nationwide effort to confirm this hypothesis appears to be eminently worthwhile.
Clinical Observations: Arginine vs Protein Supplementation in HIV‐infected Men
Authors: Stechmiller Joyce K. , Lentz‐Slick Ashley , Bender Bradley S. , Hoffinger Renee , Langkamp‐Henken Bobbi
Published: April 2009

Background: The enhancement of immune function and nutritional status is a challenge in the care of HIV‐infected persons. The semiessential amino acid, L‐arginine, has been shown to enhance immune function by promoting T‐cell proliferation and nitrogen retention in animal and human models. Objective: We studied the effect of three levels of arginine supplementation in isonitrogenous doses on immune function and parameters commonly used to assess nutritional status. The side effect profile of oral arginine in HIV‐infected male volunteers was also assessed. Design: The study design was experimental double‐blinded with 19 HIV patients from an outpatient clinic randomized to consume 20 g (n = 7), 10 g (n = 6), or 0 g (n = 6) of arginine per day for four weeks. Protein powder was added to 0 g and 10 g arginine doses to make them isonitrogenous with the 20 g arginine dose. To assess immune function, peripheral blood CD4 T‐cell numbers and viral loads were obtained at week 0, 4, and 8. The parameters used to assess nutritional status included weight, body mass index (BMI), body cell mass (BCM), albumin, and body fat at week 0, week 4, and week 8. A series of weekly (weeks 0 to 4) 3‐day diet records was collected from each patient, and dietary protein, energy, and dietary arginine were determined. Results: Three‐day diet records collected from each patient indicated that compliance was good, and the side‐effect profile of the oral arginine supplement was favorable during the one‐month period. In the three groups, the following were identified: weight gain was 1.1 kg at week 4 for the 20 g arginine group, ‐0.09 kg in the 10 g arginine group, and ‐0.45 kg in the 0 g arginine group (p > .05). There was an increase in BCM at week 4 in all three supplemented groups with a larger increase (1% vs 0.5%) in BCM from baseline to week 4 for the patients treated with protease inhibitors vs other antiretroviral agents (p > .05). Viral load and CD4 lymphocyte counts were not changed in the three groups with supplementation, Conclusions: The study findings suggest that enrichment of a diet with protein or arginine may improve BCM and supplementation with arginine 20 g per day may safely increase body weight. However, arginine or protein supplementation did not significantly changes analyzed nutritional or immunological parameters in this population. Further study needs to consider a larger sample and a longer study duration to determine if changes are statistically significant.
A Comprehensive Pediatric Inpatient Nutrition Support Package: A Multi‐disciplinary Approach
Authors: Creamer Kevin M. , Chan Debora Schotic , Sutton Christine , DeLeon Carmen , Moreno Carol , Shoupe B. Alan
Published: April 2009

Objective: To develop an easy‐to‐use system for initiating and monitoring enteral and parenteral nutrition support for pediatric inpatients. Design: A multidisciplinary pediatric nutrition support team developed a system to deliver appropriate nutrition support to pediatric inpatients. The package was devised and implemented to improve timeliness, safety, and efficacy of pediatric inpatient nutrition support. The goals included an easy to complete nutrition assessment, a system for early appropriate initiation of nutrition, advancement toward projected goal calories, and monitoring parameters for improved outcomes. Results The comprehensive evidence based package consisted of a four‐sided laminated pocket reference with flow charts and tables; concise enteral and parenteral clinical nutrition support pathways; and computerized parenteral nutrition order form, a lab order set, and four one‐page information sheets for initiation and advancement of age specific parenteral nutrition. A lecture summarizing this manuscript with handouts and bibliography heightened awareness in each department primarily responsible for the care for pediatric patients (Pediatrics, Family Practice, and Surgery) in our hospital. Conclusion: This package is a comprehensive educational tool for our housestaff. We believe it increases the likelihood of appropriate nutrition assessment and delivery by physicians working with pediatric inpatients at our hospital. It is easily adaptable to fit the needs of any inpatient pediatric nutrition support practice setting.
Classic Article: Commentary on “Metabolic Studies in Total Parenteral Nutrition with Lipid in Man. Comparison with Glucose
Authors: Miller Sarah J.
Published: April 2009

A study was undertaken of patients on a regimen of total parenteral nutrition comparing the nitrogen balance, energy substrates, blood amino acids, immunoreactive insulin, and immunoreactive glucagon levels during the sequential infusion of nonprotein calories as either glucose alone (glucose system) or 83% as Intralipid (Pharmacia Fine Chemicals, Montreal, Canada) and 17% glucose (lipid system). These nonprotein calories were administered with a constant background of amino acids (1 g/kg per day), vitamins, and minerals. Each system was infused for a week at a time and the order of infusion randomized. In some patients whole blood arteriovenous (A‐V) levels of amino acids were measured across forearm muscle. During the glucose system there was a significantly higher level of pyruvate, lactate, alanine, and immunoreactive insulin, consistent with glucose being the principal source of energy. In contrast, during the lipid system there was a rise in free fatty acids and ketone bodies with a fall in insulin, suggesting that lipid was now the principal source of energy. Despite these two very diverse metabolic situations the nitrogen balance with both systems was positive to a comparable degree after the establishment of equilibrium. Correspondingly, A‐V differences of whole blood amino acid nitrogen showed uptake by muscle to an equivalent degree with both systems. Clinical studies indicated that the lipid system as defined herein could be infused by peripheral vein for up to 43 days with resultant weight gain, elevation of serum proteins, and healing of fistulae. Our studies suggest that for both metabolic and clinical reasons exogenously infused lipid is a suitable source of nonprotein calories. (J Clin Invest 57:125–136, 1976)
Aluminum: A Problem Trace Metal in Nutrition Support
Authors: Davis Anne , Spillane Ray , Zublena Lise
Published: April 2009

Aluminum contaminates both enteral and parenteral nutrients. Contamination depends on the amount of aluminum present naturally in chemicals or from the manufacturing process. Enteral nutrients such as soy formula, preterm infant formula, and casein hydrolysate formula that are highly processed are heavily contaminated with aluminum. Intravenous calcium, phosphorus, and albumin solutions have high aluminum content (>500 mcg/L). The kidney is the dominant organ for aluminum excretion. Even with normal renal function, only 30%–60% of an aluminum load from parenteral nutrition is excreted in the urine, resulting in tissue accumulation of aluminum. The risk for toxicity is greatest in infants with chronic renal insufficiency and long‐term pediatric parenteral nutrition patients. Rapid growth in the infant can theoretically potentiate aluminum toxicity in all infants. The critical level of aluminum loading that results in bone disorders is not known. To minimize tissue accumulation, aluminum content of parenteral and enteral nutrients for infants and children should be reduced.
Fluid Management in Enteral Nutrition
Authors: Lipp Joanna , Lord Linda M. , Scholer Lori H.
Published: April 2009

Hydration is an essential component of enteral nutrition management. There are various ways to calculate fluid requirements, most of which are based on some estimate of lean body mass and fluid losses. Once fluid requirement estimates are made, the fluids must be given (if indicated) and there must be ongoing assessment of the patient's clinical hydration status. There are also various ways to provide fluids in enterally fed patients, but for most patients, tap water as a bolused flush suffices to meet fluid needs.
Experience of a Clinical Outcome‐Based Pediatric Nutrition Support Service
Authors: Cimino Michael A. , Claxton Nancy , Manz Carolyn , Kelly Traci , Rossi Thomas M.
Published: April 2009

In an era of reduced health care resources, ongoing documentation of nutrition interventions and resultant clinical outcomes are essential in supporting nutrition support services. Nutrition interventions and clinical outcomes obtained from an ongoing quality‐improvement program for a nutrition support service in a tertiary care pediatric hospital is presented. Consecutive cases of inpatients with intermediate‐ to high‐level nutrition risk who were hospitalized from June 1996 through May 1997 were reviewed for standard interventions offered by nutrition support staff members, including recommendations for diet alteration, supplements, TPN, enteral feedings, and nutrition instruction. Of 5369 admissions, 1422 (26.5%) were classified as intermediate‐ to high‐level nutritional risk, requiring 2896 initial and follow‐up interventions for which outcome was documented in 1184 cases (83.3%). Improvement was noted more often for cases receiving interventions within 72 hours of admission (91% vs. 82%, p = .031) and requiring the least change in behavior or in complex patients. Poor outcome was frequently associated with psychosocial issues. Length of hospitalization was greater for nutritional risk cases (7.2 days) compared with no‐risk cases (3.5 days) and was not associated with clinical outcome. Overall, a high rate of improvement in nutritional status was noted and varied with time to intervention and type of intervention. Clinical improvement was not associated with duration of hospitalization for intermediate‐ to high‐level nutritional risk cases. Psychosocial issues were most frequently associated with poor nutritional outcome.
Protein‐Energy Undernutrition Among Elderly Hospitalized Patients: A Prospective Study
Authors: Sullivan D H , Sun S , Walls R C , Kovacevich Debra S.
Published: April 2009

Context: Numerous studies have identified strong correlations between the severity of nutritional deficits and an increased risk of subsequent morbid events among the hospitalized elderly, but whether inadequate nutrient intake during hospitalization contributes to such nutritional deficits or the risk of adverse outcomes is not known. Objectives: To identify the distribution of average daily nutrient intake among the nonter–minally ill hospitalized elderly, ascertain what factors contribute to persistently low intakes, and determine whether the adequacy of nutrient intake correlates with the risk of mortality. Design: Prospective cohort study conducted from 1994 to 1997. Setting: University‐affiliated Department of Veterans Affairs hospital. Patients: A total of 497 patients 65 years or older (mean [SD] age, 74 [6] years; 97% male; 86% white) with a length of stay of 4 days or more. Main Outcome Measures: Daily in‐hospital nutrient intake, in‐hospital mortality, and 90‐day mortality. Results: A total of 102 patients (21%) had an average daily in‐hospital nutrient intake of <50% of their calculated maintenance energy requirements. Admission illness severity, average length of stay, and admission albumin and prealbumin levels for this low nutrient group did not differ significantly from those of the remaining patients. However, the low nutrient group had lower mean (SD) discharge serum total cholesterol (154 [44] mg/dL [4 [1.1] mmol/L] vs 173 [42] mg/dL [4.5 [1.1] mmol/L]; p = .001), albumin (29.1 [6.7] vs 33.2 [6.1] g/L, p = .001), and prealbumin (162 [69] vs 205 [68] mg/L;p = .001) concentrations and a higher rate of in‐hospital mortality (relative risk, 8.0; 95% confidence interval, 2.8 to 22.6) and 90‐day mortality (relative risk, 2.9; 95% confidence interval, 1.4 to 6.1). Contributing to the problem of inadequate nutrient intake, patients were frequently ordered to have nothing by mouth and were not fed by another route. Neither canned supplements nor nutrition support were used effectively. Conclusions: Throughout their hospitalization, many elderly patients were maintained on nutrient intakes far less than their estimated maintenance energy requirements, which may contribute to an increased risk of mortality. Given the difficulties reversing established nutritional deficits in the elderly, greater efforts should be made to prevent the development of such deficits during hospitalization. (JAMA 281:2013–2019, 1999)
Characteristics of Unified and Separate Early Childhood Education and Early Childhood Special Education Programs: A National Study
Authors: Dunne Lora Fader
Published: April 2009

This study examined the characteristics of course content, field experiences, and program administration at 14 unified early childhood/early child special education (ECE/ECSE) and 13 separate ECE and ECSE undergraduate teacher preparation programs across the United States. Students and faculty members at the 27 programs completed surveys to help determine the characteristics of unified and separate teacher education programs. In addition, personal interviews were conducted with students and faculty members at two unified and two separate early childhood/early child special education teacher preparation programs. Findings revealed that students from unified programs and ECSE programs had a balance of ECE and ECSE course content, as well as field experiences with children with and without disabilities in diverse settings. Conversely, ECE students were found to have minimal knowledge related to ECSE course content, and few, if any, field experiences with children with disabilities. State certification and program specific administrative structures were found to have an impact on faculty members' abilities to collaborate with other departments.
Graduates' Perceptions of Strengths and Needs in Interdisciplinary Teacher Preparation for Early Childhood Education: A State Study
Authors: Miller Patricia S. , Losardo Angela
Published: April 2009

While the national growth of interdisciplinary early childhood education (ECE) and early childhood special education (ECSE) teacher preparation has been documented, research into these programs is scarce. This study was conducted to gather graduates' perceptions of their preparation in a statewide system of ECE/ECSE interdisciplinary teacher preparation programs. A southeastern state implemented the new approach to preparing teachers to work with infants, toddlers, and young children with and without disabilities, and their families, in 1992. As one of the first stand-alone blended teacher preparation licenses, the Birth through Kindergarten license in this state is a competency-based approach to licensure combining the NAEYC and DEC preparation standards. A mail survey of graduates from seven state- and NCATE-approved blended programs was conducted during the first year of employment. Participants were asked to rate their preparation in state licensure competencies. Perceived strengths were higher in areas of general early childhood and child development than in areas specific to early childhood special education. Graduates reported a need in the preparation programs for more content and application in areas including working with families, behavior analysis, and working with children who have moderate to severe disabilities.
Pruning the Family Tree: An Unexplored Path to Family Business Continuity and Family Harmony
Authors: Lambrecht Johan , Lievens Jozef
Published: April 2009

It is assumed that over the generations family businesses inevitably face greater family complexity. The increasing family complexity can have repercussions for the family and the business. To counteract these negative effects of an increase in family complexity, it has been recommended that business families utilize conventional family and corporate governance methods. Pruning the family tree is an alternative method of handling family complexity. However, this alternative way has been largely ignored in research. This article explores the research question: Why and how do business families prune the family tree, thus simplifying the ownership, governance, and/or management structures of the family business? The research findings indicate that introducing simplicity by pruning can be a worthwhile path to family harmony and business performance and that there is no contradiction between pruning the family tree and governance of the family and the business.
Family Involvement in Ownership and Management: Exploring Nonlinear Effects on Performance
Authors: Sciascia Salvatore , Mazzola Pietro
Published: April 2009

Research on the performance of family firms is growing, but results are mixed, especially for nonlisted companies. Thus, on the basis of the co-presence of benefits and disadvantages of family involvement in ownership and management, we explored the presence of nonlinear effects of these two variables on performance. We run regression analyses on data drawn from 620 privately held family firms in Italy: A negative quadratic relationship between family involvement in management and performance was found, but we did not find any association between family involvement in ownership and performance. Our results suggest that in privately held firms the positive effects that previous literature associates with the presence of family managers do not appear strong enough to compensate for the disadvantages deriving from a nonmonetary goal orientation, nor do they compensate for the costs deriving from the need to solve conflicts between family managers and the impossibility of enlarging the company's social and intellectual capital through the employment of nonfamily managers. Moreover, the quadratic nature of the relationship calls for greater attention to be paid to these effects by family business owners, especially in those cases where family involvement in management is high.
The nature of Prozac
Authors: Fraser Mariam
Published: April 2009

This article addresses the relations between ‘nature’ and ‘culture’ (and those characteristics associated with ‘the natural’ and ‘the cultural’) in the context of the debates about Prozac. Following Marilyn Strathern, I focus specifically on the contested issue of enablement - that is, on what Prozac does or does not enable, and on the relation between enablement and enhancement, normality and pathology. I argue that the implications of the model of the brain that accompanies explanations of Prozac are such that commentators are obliged to address not only the nature of normality but also the nature of nature itself. Through a close analysis of these debates, I suggest that critiques of Prozac should be understood not as objections to reductionism - to a biology that closes things down - but rather to one that opens things up: that opens up the relations between nature, culture, biology and the individual, relations that are now cross-cut and thrown about by artificiality. Objections to Prozac, then, might be characterized as an attempt to put these concepts back into their ‘proper’ positions, to re-establish the relationality between them. In conclusion, I argue that the biology put forward by proponents of psychopharmacology, regardless of the desirability of the latter, challenges not only the frequent assumptions that are made about the claims of materialist science, but also some of the terms and concepts that are commonly deployed in the social sciences.
The desire to understand and the politics of Wissenschaft: an analysis of the Historikerstreit
Authors: Peacock Mark S.
Published: April 2009

In 1986, a debate - der Historikerstreit (the historians’ dispute) - erupted in the German public sphere. It involved a number of historians who attempted to ‘revise’ approaches to the study of the Holocaust. Their endeavours met with fierce opposition, most notably from Jürgen Habermas, who accused them of trying to endow Germany with a presentable political image by relativizing the Holocaust. This article examines the conduct of the debate, in particular the manner in which each side alleged of the other that it was driven by political motives rather than wissenschaftliche interests. I consider the way in which Ernst Nolte tries to ‘understand’ the Holocaust, and discuss the difficulties of investigating the Holocaust in a wissenschaftlichen manner.1
Changes in Plasma Proteins in Rats Treated for Short Periods with Hepatotoxins or with Agents which Induce Cytochrome P450 Isoenzymes
Authors: Makarananda K. , Fox G.A. , Price S.C. , Hinton R.H.
Published: April 2009

We have compared the alterations in plasma proteins following treatment of rats with the centrilobular hepatotoxin carbon tetrachloride, the periportal hepatotoxin allyl alcohol and two inducers of hepatic microsomal drug metabolising enzymes, phenobarbitone and a mixture of polychlorinated biphenyls (Aroclor 1254). The results are compared with changes observed in animals treated with agents which caused proliferation of rat liver peroxisomes and described in an earlier publication. Our results indicate that:

1 There is a marked induction of a minor glycoprotein which migrates as a prealbumin following treatment with both inducers of microsomal mixed function oxidases and inducers of peroxisome proliferation.

2 There is a marked increase in a minor α1-glycoprotein when there is chemically-induced mitosis in the liver but not in mitosis following liver damage.

3 Two major α 1-glycoprotein are depressed in all forms of liver damage.

4 There are indications of specific protein responses to allyl alcohol, to inducers of microsomal mixed function oxidases and to inducers of peroxisome proliferation.
The Effects of a Single Intramuscular Injection of Atropine Sulphate on Visual Performance in Man
Authors: Kay C.D. , Morrison J.D.
Published: April 2009

The effects of a single intramuscular injection of 2 mg atropine sulphate on visual function were studied in volunteer subjects. The well-known effects of increased heart rate, dryness of the mouth, ncreased pupil diameter and reduced accommodative range were confirmed. Visual acuity, stereoacuity, red-green colour balance and reaction time to a visual stimulus were unaffected by atropine, while extraocular muscle balance (horizontal heterophoria and cyclophoria) underwent a transient change. There was no significant change in contrast sensitivity measurements to stationary sinusoidal grating patterns of spatial frequencies 1-30 c/deg; however contrast sensitivity o moving grating patterns of spatial frequencies 1-5 c/deg showed a sustained reduction which was ,till present at 6 h post-injection. It is concluded that atropine adversely affects movement letection but not stationary visual function.