bluuebunny/crossref_metadata_2025 huggingface dataset:
Taurolidine 2% as an Antimicrobial Lock Solution for Prevention of Recurrent Catheter‐Related Bloodstream Infections
Authors: Jurewitsch Brian , Lee Tundra , Park Joan , Jeejeebhoy Khursheed
Published: May 2008

Background: This case report describes our preliminary data on the use of taurolidine as a lock technique. Taurolidine is a novel antimicrobial agent that has found a niche in Europe for prevention of bacteremia in home parenteral nutrition (HPN) patients who have multiple catheter‐related bloodstream infections. Methods: A 29‐year‐old male with short bowel syndrome was admitted 18 times in 9 years for treatment of Gram‐positive, Gram‐negative, and yeast‐associated catheter‐related bloodstream infections. Management consisted of conventional antibiotic treatment in accordance with blood culture and sensitivity results as well as catheter removal in 10 cases. Ten months before the last infection, the patient was instructed to instil 1.5 mL taurolidine 2% daily into his central line after finishing his HPN infusion and has continued to do so 2 years to date. Results: The incidence of catheter‐related bloodstream infections decreased from 8.5 to 1.5 infections per 1000 catheter days. Conclusions: These data support previous observations made outside North America and suggest that taurolidine may prove to be an effective and safe antimicrobial agent for the prevention of recurrent catheter‐related bloodstream infections. (Journal of Parenteral and Enteral Nutrition 22:242–244, 1998)
Osteomyelitis of the Clavicle After Subclavian Vein Catheterization
Authors: Judich A. , Haik J. , Rosin D. , Kuriansky J. , Zwas S.T. , Ayalon A.
Published: May 2008

Osteomyelitis of the clavicle or the stemoclavicular joint is a rare complication of subclavian vein catheterization. Soft tissue infections around the puncture site occur frequently and respond well to topical and antibiotic treatment. If symptoms persist for several weeks, osteomyelitis or sternoclavicular pyo‐arthrosis should be considered. Bone and gallium scintigraphy scans and computerized tomography scans are helpful diagnostic measures. (Journal of Parenteral and Enteral Nutrition 22:245–246, 1998)
Parenteral Glutamine Infusion Alters Insulin‐Mediated Glucose Metabolism
Authors: Borel Myfanwy J. , Williams Phillip E. , Jabbour Kareem , Levenhagen Deanna , Kaizer Ellen , Flakoll Paul J.
Published: May 2008

Background:Glutamine is a conditionally essential amino acid that is critical for many basic cellular processes. Its supplementation has been found to be beneficial during several critical illnesses. This study examines the effects of increased glutamine availability on insulin‐mediated glucose homeostasis in vivo in multicatheterized conscious canines (n = 5). Methods: Two weeks before the study, catheters were placed in the femoral artery and the portal, hepatic, femoral, and renal veins for blood sampling and in the splenic vein for intraportal infusion of insulin and glucagon. Doppler probes were placed to measure blood flow. The metabolic study consisted of equilibration, basal, and experimental periods during which [3‐3H]glucose was infused to measure glucose kinetics. During the 5‐hour experimental period, a hyperinsulinemic‐euglycemic clamp was performed by infusing somatostatin, basal glucagon, fivefold basal insulin, and glucose to maintain euglycemia. The experimental period was divided evenly into two subperiods performed in random order: (1) IV glutamine infusion (0.72 mmol kg−1h−1) and (2) IV saline infusion. Results: With glutamine, the glucose required to maintain euglycemia was increased 46% over saline (6.8 ± 1.0 to 9.9 ± 1.7 mg kg−1min−1). In addition, whole‐body glucose production and utilization were increased by 1.4 and 4.6 mg kg−1min−1, respectively. Finally, the increase in whole‐body glucose utilization was manifested by increased hepatic and hindlimb glucose utilization.Conclusions:Increased glutamine availability blunted insulin's action on glucose production and enhanced insulin‐mediated glucose utilization with the changes in utilization being threefold greater than the changes in production. Thus parenteral glutamine has potential benefit as a nutrient adjuvant during clinical situations associated with insulin resistance.(Journal of Parenteral and Enteral Nutrition22:280–285, 1998)
TNF‐α and IL‐6 Synergistically Inhibit Ketogenesis From Fatty Acids and α‐Ketoisocaproate in Isolated Rat Hepatocytes
Authors: Pailla Karine , Lim Soo‐Kyung , De Bandt Jean‐Pascal , Aussel Christian , Giboudeau Jacqueline , Troupel Solange , Cynober Luc , Blonde‐Cynober Françoise
Published: May 2008

Background: During sepsis, lipid metabolism is shunted toward triacylglycerol synthesis and hepatic lipogenesis. A decrease in ketogenesis from free fatty acids also is observed, probably mediated by cytokines involved in host response to infection. Whether such an inhibition of ketogenesis occurs with other ketone body precursors such as ketoacids is not known. The aim of this study was to determine the effects of tumor necrosis factor alpha (TNF‐α) and interleukin 6 (IL‐6) on hepatic ketone body production from octanoic acid, a medium‐chain fatty acid, and from a‐ketoisocaproate (KIC), the ketoanalogue of leucine. Methods: The experiments were conducted in cultured hepatocytes isolated from 24‐hour‐fasted Sprague‐Dawley rats. Hepatocyte monolayers were incubated for 6 hours, with either KIC or octanoic acid (1 mmol/L), in the presence of glucagon and TNF‐α (25 μg/L) IL‐6 (15 μg/L) and/or IL‐6. Acetoacetate, β‐hydroxybutyrate, and free fatty acids were determined in culture medium by enzymatic methods and KIC was measured by high‐performance liquid chromatography. Results: KIC and octanoic acid uptake by hepatocytes was 79% and 92%, respectively, over 6 hours, and cytokines had no influence. However, TNF‐α and IL‐6 caused inhibition of ketogenesis from α‐ketoisocaproate (5.6% ± 2.3% and 4.4% ± 3.0%, respectively), and from octanoic acid (7.9% ± 2.9%, 5.7% ± 3.2%, respectively). In addition, when the two cytokines were present together in the culture medium, the inhibition was enhanced (inhibition of ketogenesis from KIC: 14.0% ± 4.8%; from octanoic acid: 11.6% ± 3.4%). Conclusions: In our experimental conditions, cytokines mediate an inhibition of ketogenesis; this process could be explained by a direct effect of cytokines on metabolic pathways of octanoic acid and KIC oran indirect effect by modification of the mitochondrial redox state. (Journal of Parenteral and Enteral Nutrition 22:286–290, 1998)
Total Nutrient Admixtures Appear Safer than Lipid Emulsion Alone as Regards Microbial Contamination: Growth Properties of Microbial Pathogens at Room Temperature
Authors: Didier Maria E. , Fischer Shelly , Maki Dennis G.
Published: May 2008

Background: The extraordinary growth properties of most microorganisms in 10% and 20% lipid emulsions has led to the Centers for Disease Control and Prevention recommendation that if lipids are given through an IV line, the administration set should be replaced every 24 hours rather than the usual 72‐hour interval used for crystalloid solutions, including those used for conventional total parenteral nutrition. For nearly 15 years, parenteral alimentation has been given as a total nutrient admixture (TNA), with the glucose, amino acids, and lipid mixed within the same bag and infused continuously over 24 hours. Methods: We prospectively studied in a representative TNA (17.6% glucose, 5% amino acids, 4% lipid; pH 5.6, osmolality 1778) and in a control solution, 5% dextrose‐in‐water (D5%/W), the growth properties at 4, 25, and 35°C of three isolates each of Staphylococcus epidermidis, Staphylococcus aureus, Enterobacter cloacae, Klebsiella oxytoca, Serratia marcescens, Acinetobacter calcoaceticus, Stenotrophomonas maltophilia, Pseudomonas aeruginosa, Burkholderia cepacia, Flavobacterium spp, and Candida albicans, and two isolates of Staphylococcus saprophyticus, the species that are most likely to contaminate TNA during preparation or administration and that have been implicated in >95% of all outbreaks and sporadic cases of nosocomial bloodstream infections traced to contaminated parenteral admixtures reported in the world literature. Results: Growth in TNA at 25 and 35°C occurred with only two species, C. albicans and S. saprophyticus, and only after 24 to 48 hours; D5%/W allowed growth at 25°C of two Gram‐negative species, S. marcescens and B. cepacia. Conclusions: We conclude that TNA is a poor growth medium for most nosocomial pathogens and is no better than D5%/W The need to replace administration sets every 24 hours with TNA should be reconsidered and ideally be studied in a prospective randomized trial. (Journal of Parenteral and Enteral Nutrition 22:291–296,1998)
Cost and Outcome Analysis of Home Parenteral and Enteral Nutrition
Authors: Reddy Prabashni , Malone Margaret
Published: May 2008

Background: Previous estimates of the cost of home parenteral and enteral nutrition (HPEN) have excluded hospitalization costs or were conducted abroad and have limited applicability in the United States. Few studies have used validated measures to determine the effect of home nutrition support on quality of life. Method: A cost and clinical outcome analysis was performed by retrospective review of charts of patients receiving HPEN from 1991 to 1996. Questionnaires to determine the influence of therapy on lifestyle (n = 41) and a general health status questionnaire, the short form 36‐item survey (n = 39), were mailed to patients. Results: The annual cost per patient for parenteral solutions was $55,193 ± 30,596 (mean ± SD) based on Medicare charges and for enteral tube feedings was $9605 ± 9327. The annual cost of hospitalization ranged from zero to $140,220 in the parenteral nutrition group and from zero to $39,204 in the enteral nutrition group. The annual number of hospitalizations per patient for patients receiving parenteral nutrition ranged from 0.52 to 1.10, compared with 0 to 0.50 in the enteral nutrition population. The health status of HPEN patients was significantly lower (p <.05) in five of the eight short‐form 36 health domains compared with the general population. The areas of lifestyle most frequently affected were travel, sleep, exercise and leisure. Conclusions: The majority of the cost of therapy was associated with the direct provision of nutrition, although in some patients the hospitalization expenditure exceeded this cost. Home nutrition support had a significant negative impact on a patient's quality of life and lifestyle. (Journal of Parenteral and Enteral Nutrition 22:302–310, 1998)
Enteral Glutamine Supplementation for Very‐Low‐Birth‐Weight Infants Decreases Hospital Costs
Authors: Dallas Michael J. , Bowling Dan , Roig Juan C. , Auestad Nancy , Neu Josef
Published: May 2008

Background: There is growing evidence that glutamine may be a conditionally essential amino acid for critically ill patients, including preterm infants cared for in neonatal intensive care units (NICUs). In a randomized study of 68 very‐low‐birth‐weight (VLBW) infants, we found evidence of lower morbidity in a group fed glutamine‐supplemented preterm infant formula from postnatal day 3 to day 30 than in a group fed a standard formula. We report here the effects of the glutamine supplementation on hospital costs in these infants. Methods: The costs were analyzed by log‐rank tests and Kaplan‐Meier plots. Results: The median costs for hospitalization, radiology, pharmacy, laboratory, and the NICU, and the median number of utilization units were reduced with glutamine supplementation. Conclusions: This study provides the first evidence for decreased hospital costs in VLBW neonates who receive enteral glutamine supplementation. (Journal of Parenteral and Enteral Nutrition 22:352–356, 1998)
Quality of Life After Small Intestinal Transplantation and Among Home Parenteral Nutrition Patients
Authors: DiMartini Andrea , Rovera Giuseppe M. , Graham Toby O. , Furukawa Hiro , Todo Satoru , Funovits Mimi , Lu Sandy , Abu‐Elmagd Kareem
Published: May 2008

Background: The purpose of the study was to quantify changes in the quality of life of small bowel recipients before and after transplantation and of home parenteral nutrition (HPN)‐dependent patients before and after therapy. We examined quality of life across multiple areas of function including physical, social, and emotional indices. Methods: The Quality of Life Instrument in the form of a self‐administered questionnaire was completed voluntarily by the recipients of small intestinal transplants and by a cohort of HPN‐dependent patients. Results: Small intestinal transplant recipients reported significant improvement in the quality of their life and function. They also rated their quality of life and function during the pretransplant, TPNdependent period to be worse than before the development of chronic intestinal failure. Similarly, HPN recipients reported significant worsening across most areas of quality of life when they compared their premorbid period to the HPN‐dependent state. Conclusions: TPN dependence causes significant impairment in the quality of life in most areas of functioning. In contrast, small intestinal transplantation restores the quality of life among recipients with functioning grafts. (Journal of Parenteral and Enteral Nutrition 22:357–362, 1998)
Enterocyte Nutrient Transport Is Preserved in a Rabbit Model of Acute Intestinal Ischemia
Authors: Iannoli Pasquale , Miller Jennie H. , Ryan Charlotte K. , Sax Harry C.
Published: May 2008

Background: The use of enteral nutrition in patients with nonocclusive splanchnic hypoperfusion is controversial. This study aims to quantitate enterocyte nutrient transport and correlate function with morphology during intestinal ischemia. Methods: New Zealand White rabbits were randomized to control (celiotomy only) 60‐minute infra‐renal aortic clamp (IRC) or 60‐minute supraceliac aortic clamp (SCC). Small intestinal brush border membrane vesicles (BBMVs) were prepared by magnesium precipitation and serial differential centrifugation. Sodium‐dependent uptake of glucose, glutamine, alanine, leucine, and arginine into BBMVs was quantitated by rapid mixing and filtration. Histologic examination of the intestine was performed by a pathologist blinded to groups. Data are reported as mean values ± SEM, with significance determined by analysis of variance at p <.05. Results: Villus heights in the IRC and SCC groups were 20% and 48% less than control, respectively. SCC histology was characterized by extensive epithelial denudation and necrosis, whereas IRC had mild focal villus edema only. Sodium‐dependent glucose and leucine transport each exhibited nonsignificant increases of 20% to 25% in the IRC group and 30% to 55% in the SCC group. No changes were noted in sodium‐dependent glutamine, alanine, and arginine uptake or sodium‐independent transport. Conclusions: Enteral nutrient transport does not correlate with mucosal architecture, is maintained during splanchnic hypoperfusion states, and likely occurs via intact crypt cells. (Journal of Parenteral and Enteral Nutrition 22:387–392, 1998)
Protein Metabolism in Rats During Long‐Term Dietary Restriction: Influence of Aging
Authors: Felgines Catherine , Savanovitch Chantal , Farges Marie‐Chantal , Cynober Luc , Vasson Marie‐Paule
Published: May 2008

Background: Protein depletion is frequent in the elderly, but the underlying mechanisms are not yet fully understood. In particular, it is unknown whether there is a defect of adaptation to a restriction of food intake in the elderly. This study was performed to compare the effects of 6‐week dietary restriction (DR) on protein metabolism in both adult and aged rats. Methods: Adult (3‐month‐old) and aged (22‐month‐old) rats were acclimatized for 2 weeks and then fed a standard diet for 6 weeks, either ad libitum (control adult [C Adult] and aged [C Aged] rats) or with only 50% of the average intake of the second week of acclimatization (restricted adult [R Adult] and aged [R Aged] rats). Protein metabolism, in terms of tissue protein content, nitrogen balance, and 3‐methylhistidine (3‐MH) urinary excretion, was evaluated. Results: CAdult rats gained 30.4% of initial weight, whereas the body weight (BW) of CAged rats was maintained. DR induced a rapid decrease in BW during the first 2 weeks in R Adult rats, but afterward BW remained stable. In R Aged rats, BW loss was linear during the 6 weeks and significantly higher than for R Adult rats (p <.01). In both restricted groups, muscle protein content was moderately affected by DR, whereas DR induced a marked decrease in visceral protein content. Nitrogen balance was decreased by DR but stayed positive in R Adult rats, whereas it became null in R Aged rats. Conclusions: In terms of protein metabolism, aged rats adapted less efficiently than adult rats to a long‐term dietary restriction. (Journal of Parenteral and Enteral Nutrition 23:32–37,1999)
Intestinal Permeability After Early Postoperative Enteral Nutrition in Patients With Upper Gastrointestinal Malignancy
Authors: Brooks Ari D. , Hochwald Steven N. , Heslin Martin J. , Harrison Lawrence E. , Burt Michael , Brennan Murray F.
Published: May 2008

Background: Increased intestinal permeability may lead to sepsis in resected upper gastrointestinal (GI) cancer patients. This study sought to determine whether these patients demonstrated increased intestinal permeability and if early postoperative enteral nutrition would alter this result. Methods: Nineteen patients undergoing complete resection of upper GI malignancy were randomized into two groups: the nonfed group received IV crystalloid, and the fed group started enteral nutrition by jejunostomy on postoperative day (POD) 1. Six nonoperative volunteers were controls. The lactulose/mannitol test was performed on PODs 1 and 5. Ten grams of lactulose and 5 g of mannitol were given, and urine was collected for 6 hours. Results: All patients (nonfed, 1.895 ± 0.34; fed, 0.893 ± 0.24) had elevated lactulose/mannitol ratios on POD 1 us controls (0.262 ± 0.1; p <.008 and p =.05). These elevated levels returned toward control levels in both groups by day 5 (nonfed, 0.533 ± 0.1, p =.06; fed, 0.606 ± 0.12, p =.08). Conclusions: Major upper GI surgery for malignancy resulted in a significant increase in intestinal permeability on POD 1. With or without enteral nutrition, this measure of intestinal permeability returned to normal on POD 5 in well‐nourished patients. (Journal of Parenteral and Enteral Nutrition 23:75–79, 1999)
Predictive Versus Measured Energy Expenditure Using Limits‐of‐Agreement Analysis in Hospitalized, Obese Patients
Authors: Glynn Cecelia C. , Greene Geoffrey W. , Winkler Marion F. , Albina Jorge E.
Published: May 2008

Background: Accuracy of predictive formulae is crucial for therapeutic planning because indirect calorimetry measurement is not always possible or cost effective. Energy requirements are more difficult to predict in the acutely ill obese patient compared with lean patients because of an increased resting energy expenditure per lean body mass and a variable stress response to illness. Methods: A retrospective review of 726 patients identified 57 patients (32 spontaneous breathing, S; 25 ventilator dependent, V) with body mass indexes of 30–50 kg/m2. Limits‐of‐agreement analysis determined bias (the mean difference between measured and predicted values) and precision (the standard deviation of the bias) to evaluate the accuracy of predictive formulae compared with measured resting energy expenditure (MREE) by a Deltatrac Metabolic Monitor. Predictive accuracy was determined within ±10% MREE. The predictive formulae examined were: variations of the Harris‐Benedict equations using ideal, adjusted weights of 25% and 50% and actual weights with stress factors ranging from 1.0 to 1.5; the Ireton‐Jones equation for obesity; the Ireton—Jones equations for hospitalized patients (S and V); and the ratio of 21 kcalories per kilogram actual weight. Results: The mean MREE was 21 kcal/kg actual weight. The adjusted Harris‐Benedict average weight equation was optimal for predicting MREE for the combined S and V sets (bias = 182 ± 123; 67% ± 10% MREE), as well as the S subset (bias = 159 ± 112; 69% ± 10% MREE). Conclusions: The Harris‐Benedict equations using the average of actual and ideal weight and a stress factor of 1.3 most accurately predicted MREE in acutely ill, obese patients with BMIs of 30–50 kg/m2. Predictive formulae were least accurate for obese, ventilator‐dependent patients. (Journal of Parenteral and Enteral Nutrition 23:147–154, 1999)
The Metabolic Basis of the Increase in Energy Expenditure in Severely Burned Patients
Authors: Yu Young‐Ming , Tompkins Ronald G. , Ryan Colleen M. , Young Vernon R.
Published: May 2008

Background: Severe burn trauma is characterized by an elevated rate of whole‐body energy expenditure. Approach: In this short review, we have attempted to assess the metabolic characteristics of and basis for the persistent increase in energy expenditure during the flow phase of the injury. We consider some aspects of normal energy metabolism, including the contribution of the major adenosine triphosphate (ATP)‐consuming reactions to the standard or basal metabolic rate. Rate estimates are compiled from the literature for a number of these reactions in healthy adults and burned patients, and the values are related to the increased rates of whole‐body energy expenditure with burn injury. Results: Whole‐body protein synthesis, gluconeogene sis, urea production, and substrate cycles (total fatty acid and glycolytic‐gluconeogenic) account for approximately 22% 11%, 3%, 17%, and 4%, respectively, of the burn‐induced increase in total energy expenditure. Conclusions: These ATP consuming reactions, therefore, seem to explain approxi mately 57% of the increase in energy expenditure. The remainder of the increase may be due, in large part, to altered Na+‐K+‐ATPase activity and increased proton leak age across the mitochondrial membrane. (Journal of Paren teral and Enteral Nutrition 23:160–168, 1999)
1999 Jonathan E. Rhoads lecture. Isotopic Metaprobes, Nutrition, and the Roads Ahead
Authors: Young Vernon R. , Ajami Alfred M.
Published: May 2008

The 1999 Jonathan E. Rhoads lecture, delivered by Vernon R. Young at the annual meeting of American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), San Diego, February 2, 1999, with the printed version coauthored with Alfred M. Ajami, is concerned with the application of isotopic probes and how, in particular, they may be used as diagnostic tools to enhance the role of nutrition in the comprehensive medical management of the patient. Following a brief review of the early uses of stable isotopes in metabolic research we consider the present and possible future application of stable isotope probes. The concept of a “gateway” enzyme in a discrete biochemical pathway and how the flow of substrate through this step might be assessed by giving a “metaprobe” is developed. The specific and desirable structural requirements of the metaprobe are considered. A number of examples are given that further exploit the concepts of “underground” metabolism and of metabolic “hijackers.” It is our view that we are on the verge of a new era where, for the many pragmatic and exciting reasons discussed, stable isotope probes will find and increasing use in the practice of clinical medicine and in the preventive and public health areas. (Journal of Parenteral and Enteral Nutrition 23:175–194, 1999)
Trace Element Contamination of Total Parenteral Nutrition. 1. Contribution of Component Solutions
Authors: Pluhator‐Murton Michelle M. , Fedorak Richard N. , Audette Robert J. , Marriage Barbara J. , Yatscoff Randall W. , Gramlich Leah M.
Published: May 2008

Background: Trace elements have been shown to contaminate total parenteral nutrition (TPN) solutions. Methods: This study used the multi‐elemental technology of inductively coupled plasma—mass spectrometry to demonstrate the extent to which trace elements were present in amounts above (ie, as contaminants) or below expected levels in eight TPN component solutions. Results: Of the 66 trace elements scanned, there were 12 trace element contaminants in amounts >1 μg/L (zinc, copper, manganese, chromium, selenium, boron, aluminum, titanium, barium, vanadium, arsenic, and strontium) in the eight component solutions studied. Trace element contaminants were present in all solutions, and different trace elements contaminated the solutions at various concentrations. Component solutions of amino acid, potassium chloride, calcium gluconate, and sodium chloride contained the greatest numbers of trace element contaminants, whereas the lowest numbers were present in sterile water and magnesium sulfate. Interlot and intermanufacturer variations were apparent. Measured concentrations of trace elements in the multi‐trace element additive solution also were higher than the labeled values. A comparison of the amounts of contaminated trace elements delivered by a typical TPN mixture relative to the amounts typically absorbed by the gastrointestinal tract indicates that the inadvertent delivery of trace elements from contaminated TPN solutions may be substantial. Conclusions: All eight components tested were contaminated with trace elements not intended to be present in the product, and similarly, the multi‐trace element component contained trace elements either above or below that which the label claimed. (Journal of Parenteral and Enteral Nutrition 23:222–227, 1999)
Infusion Protocol Improves Delivery of Enteral Tube Feeding in the Critical Care Unit
Authors: Spain David A. , McClave Stephen A. , Sexton Leslie K. , Adams Joyce L. , Blanford Barbara S. , Sullins Mary E. , Owens Nancy A. , Snider Harvy L.
Published: May 2008

Background: Numerous factors may impede the delivery of enteral tube feedings (ETF) in the intensive care unit (ICU). We designed a prospective study to determine whether the use of an infusion protocol could improve the delivery of ETF in the ICU. Methods: In a prior prospective study, we monitored all patients admitted to the medical intensive care unit (MICU) or cardiac care unit (CCU) who were made nil per os and placed on ETF (control group). We found that critically ill patients received only 52% of their goal calories, primarily due to physician underordering (66% of goal), frequent cessations of ETF (22% of the time), and slow advancement (14% at goal by 72 hours). Based on these findings, we developed an ETF protocol that incorporated standardized physician ordering and nursing procedures, rapid advancement, and limited ETF interruption. After extensive educational sessions, the ETF protocol was begun. Again, all patients admitted to the MICU or CCU who were made nil per os and placed on ETF were prospectively followed (protocol group). Results: Thirty‐one patients in the protocol group were followed during 312 days of ETF and compared with the control group (44 patients with 339 days of ETF). Despite efforts by the nutritional support team, the infusion protocol was used in only 18 patients (58%). The main reasons for noncompliance with the protocol were physician preference and system failure (ETF order sheet not placed in chart). When used, the infusion protocol improved physician ordering (control 66% of goal volume, noncompliant 68%, compliant 82%, p <.05); delivery of calories (control 52% of goal, noncompliant 55%, compliant 68%, p <.05); and advancement of ETF (control 14% at goal by 72 hours, noncompliant 31%, compliant 56%, p <.05). Although significant reduction in ETF cessation due to nursing care was noted, it represented only a fraction of the total time ETF were stopped. Cessation due to residual volumes, patient tolerance, and procedure continued to be a frequent occurrence and was often avoidable. Conclusions: An evidence‐based infusion protocol improved the delivery of ETF in the ICU, primarily because of better physician ordering and more rapid advancement. The nursing staff rapidly assimilated these changes. However, physicians' reluctance to use the protocol limited its efficacy and will need continued educational efforts. (Journal of Parenteral and Enteral Nutrition 23:288–292, 1999)
Validation of Bioimpedance Analysis as a Measure of Change in Body Cell Mass as Estimated by Whole‐Body Counting of Potassium in Adults
Authors: Kotler Donald P. , Rosenbaum Karen , Allison David B. , Wang Jack , Pierson Richard N.
Published: May 2008

Backgrouud: The body cell mass (BCM) is an important measure of macronutrient status, but measurements are difficult to obtain outside of sophisticated research laboratories. Bioimpedance analysis (BIA) is a simple technique that holds promise as a means of estimating body composition. The purpose of this study was to evaluate the ability of BIA to estimate changes in BCM as measured by whole body counting of 40K (TBK). Methods: Paired studies of BCM, including both TBK and BIA, were compared in 87 human immunodeficiency virus‐positive subjects and in 62 healthy, weight‐stable control adults. Potential errors in the predictions were examined. Results: BCM change by TBK and BIA correlated closely (r =.755). After accounting for errors related to repeat measures of TBK, the correlation coefficient was.784, with a standard error of the estimate of 1.24 kg. The differences between predicted and measured BCM change were consistent with a normal distribution. However, there was a systematic error in prediction, with BIA under‐predicting the magnitudes of both gains and losses in BCM by TBK. Conclusions: BIA is a useful surrogate for measuring changes in BCM in clinical circumstances. Because TBK assesses only intracellular potassium, whereas BIA reflects all intracellular cations, the underprediction of BCM change by BIA compared with TBK could be related to changes in intracellular potassium concentration as a result of malnutrition or its treatment. (Journal of Parenteral and Enteral Nutrition 23:345–349, 1999)
Hypermanganesemia in Long‐Term Intravenous Nutrition and Chronic Liver Disease
Authors: Wardle Catherine A. , Forbes Alastair , Roberts Norman B. , Jawhari A.V. , Shenkin Alan
Published: May 2008

Background: Hypermanganesemia and cholestatic liver disease are both recognized complications of long‐term IV nutrition. Manganese is primarily excreted in bile, and recent studies have indicated that manganese toxicity may play a role in the pathogenesis of IV nutrition‐associated cholestasis. Methods: Whole blood and plasma manganese concentrations were measured in patients receiving long‐term home IV nutrition (HIN, n = 30). Whole blood manganese concentrations also were measured in patients with chronic liver disease (CLD, n = 10) and control subjects (n = 10). Results: Whole blood manganese concentrations of all CLD patients were within the reference interval (73 to 210 nmol/L) and were not different from those of the control group (151 ± 44 nmol/L, CLD vs 155 ± 35 nmol/L, control; not significant), despite the presence of cholestasis. In contrast, whole blood manganese concentration was increased (>210 nmol/L) in 26 patients, and plasma manganese concentration increased (>23 nmol/L) in 23 of the patients receiving HIN. None of the patients exhibited neurologic signs of manganese toxicity. There was no correlation between whole blood manganese concentrations and markers of cholestasis, IV manganese intake, or duration of HIN. However, plasma manganese concentration correlated both with average weekly IV manganese intake (r =.44, p =.02) and with γ‐glutamyl transferase (r =.43, p =.02) and alkaline phosphatase activities (r =.55, p =.003). Conclusions: Cholestatic liver disease does not appear to contribute to increased whole blood manganese concentrations in patients not receiving HIN. Plasma manganese concentrations in patients receiving HIN reflect recent manganese exposure and impaired excretion where cholestasis is present. The lack of relationship between plasma and whole blood manganese concentrations suggests that factors other than manganese intake and excretion affect intracellular concentrations. (Journal of Parenteral and Enteral Nutrition 23:350–355, 1999)
The Use of Self-Generated Identification Codes in Longitudinal Research
Authors: Yurek Leo A. , Vasey Joseph , Sullivan Havens Donna
Published: May 2008

Longitudinal research designs involve data collection at multiple time points to measure change over time. Therefore, identification of the same respondents is essential at each time point so that data from the same respondents can be matched for comparison over time. Subject-generated identification codes permit an anonymous means to track respondents over multiple data collection points. This article describes the evolution of subject-generated identification codes, techniques to improve respondent match rates, and the authors' experience using this mechanism in a longitudinal study of staff registered nurses working in hospitals. Challenges, recommendations, and implications for using subject-generated identification codes are discussed.
When Is Diagnostic Testing Inappropriate or Irrational? Acceptable Regret Approach
Authors: Hozo Iztok , Djulbegovic Benjamin
Published: May 2008

The authors provide a new model within the framework of theories of bounded rationality for the observed physicians' behavior that their ordering of diagnostic tests may not be rational. Contrary to the prevailing thinking, the authors find that physicians do not act irrationally or inappropriately when they order diagnostic tests in usual clinical practice. When acceptable regret (i.e., regret that a decision maker finds tolerable upon making a wrong decision) is taken into account, the authors show that physicians tend to order diagnostic tests at a higher level of pretest probability of disease than predicted by expected utility theory. They also show why physicians tend to overtest when regret about erroneous decisions is extremely small. Finally, they explain variations in the practice of medicine. They demonstrate that in the same clinical situation, different decision makers might have different acceptable regret thresholds for withholding treatment, for ordering a diagnostic test, or for administering treatment. This in turn means that for some decision makers, the most rational strategy is to do nothing, whereas for others, it may be to order a diagnostic test, and still for others, choosing treatment may be the most rational course of action.
Before the Next Storm
Authors: Cheliotis Leonidas K.
Published: May 2008

This article offers a long overdue comprehensive review of the literature on the effectiveness of temporary release programs for prisoners. Following an account of how the public and criminal justice workers view temporary release, and against the “nothing works” proposition, it is shown that while in the community, prisoners tend to spend their time constructively and comply with the rules and regulations of temporary release; both home leave and work release schemes can be effective in reducing recidivism rates, and work release in particular may also enhance postrelease employment prospects.
Application of Semenov Theory of Thermal Ignition to Chemical Process Safety
Authors: Jones J.C.
Published: May 2008

The Semenov model of thermal ignition is reviewed and its applicability to chemical processing is discussed. Three such applications follow: to methyl ethyl ketone peroxide (MEKP), to an asphalt based material containing some organic peroxides, and to a cetane enhancer. Discussions herein of any independent piece of work should be seen as a `critique' rather than as a `criticism'.
Smoke, CO, and CO2 Measurements and Evaluation using Different Fire Testing Techniques for Flame Retardant Unsaturated Polyester Resin Formulations
Authors: Nazaré S. , Kandola B.K. , Horrocks A.R.
Published: May 2008

Smoke is considered to be the main fire hazard but its production depends on major variables, principally the chemical character and the burning rate of the polymer plus the availability of oxygen and hence ventilation. The main aim of this work is to study the effect of smoke suppressants on flammability and smoke production of flame retarded unsaturated polyester resin-nanocomposites using four different testing regimes representing different fire scenarios. Samples containing zinc borate, zinc stannates, ammonium polyphosphate with and without nanoclay are analyzed for smoke generation using cone calorimetry (well-ventilated fire), a tube furnace (fully developed fire), and a smoke density chamber (under-ventilated fire). Carbon monoxide (CO) and carbon dioxide (CO2) measurements using thermogravimetry-evolved gas analysis (TG-EGA), cone calorimetry, and tube furnace have also been analyzed and compared. Results have confirmed that the production of smoke, CO, and CO2 depend upon smoke suppressants and fire conditions used during testing samples.

From this study it is evident that tin additives have very little influence on flammability of unsaturated polyester resin but they reduce smoke formation. The slight flame retardant action of the Res/APP/ZB sample is due to enhanced cross-linking of APP in the presence of zinc borate, whereas zinc stannates do not promote cross-linking of APP and hence show no improvement in flame retardancy. Finally, the presence of nanoclay in flame retarded resin shows significant reduction in smoke formations in both well-ventilated and under-ventilated fire condition. However, in the presence of smoke suppressants used in this study, the nanoclay is not instrumental in further suppressing smoke formation.
Synthesis, Characterization and Preliminary Investigation of Blood Compatibility of Novel Epoxy-modified Polyurethane Networks
Authors: Yeganeh Hamid , Orang Fariba , Solouk Atefeh , Rafienia Mohammad
Published: May 2008

To prepare elastomers with acceptable physical properties and good blood compatibility, polyurethane networks were synthesized via crosslinking reaction of epoxy-terminated polyurethane prepolymers (EUPs) and hexamethylene diamine. EUPs were prepared by reacting glycidol and NCO-terminated polyurethanes. All new materials were characterized by conventional spectroscopic methods and properties were evaluated and correlated to their structure. Cytotoxcicity evaluation for the films of samples based on mouse fibroblasts (L929) revealed that these elastomers posed no threat to these cells. In vitro platelet-rich plasma contact test showed reduced number of adhered platelets on the surface of the films, particularly for those with maximum crystallinity and microphase structures and high hydrophilicity. The results obtained implied the potential for the utilization of these elastomers in biomedical applications.
Review of American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guidelines for Nutrition Support in Cancer Patients: Nutrition Screening and Assessment
Authors: Huhmann Maureen B. , August David A.
Published: May 2008

It is clear that cancer patients develop complex nutrition issues. Nutrition support may or may not be indicated in these patients depending on individual patient characteristics. This review article, the first in a series of articles to examine the A.S.P.E.N. Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients Cancer Guidelines, evaluates the evidence related to the use of nutrition screening and nutrition assessment in cancer patients. This first article will provide background concerning nutrition issues in cancer patients as well as discuss the role of nutrition screening and nutrition assessment in the care of cancer patients. The goal of this review is to enrich the discussion contained in the Clinical Guidelines, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequent published studies. Future articles will explore the guidelines related to nutrition support in oncology patients receiving anticancer therapies.
DPEJ Tube Placement Prevents Aspiration Pneumonia in High‐Risk Patients
Authors: Panagiotakis Panagiotis H. , DiSario James A. , Hilden Kristen , Ogara Maydeen , Fang John C.
Published: May 2008

Percutaneous endoscopic gastrostomy (PEG) or PEG tube with transgastric jejunostomy tube (PEG‐J) feeding has not been shown to decrease aspiration pneumonia. The aim of this study was to determine if direct percutaneous endoscopic jejunostomy (DPEJ) tube placement results in a decreased incidence of aspiration pneumonia in high‐risk patients. The design was a retrospective review of all patients receiving DPEJ tube for aspiration pneumonia from 1999 to 2005. Demographics, incidence of aspiration pneumonia, and outcomes were collected and compared before and after the DPEJ placement. Eleven patients (4 women, 7 men) were identified; their mean age was 44.9 years (range, 18‐94 years). The etiologies for recurrent aspiration pneumonia were neurologic disease (9), esophageal surgery (1), and severe debilitation (1). The mean follow‐up was 20.9 months (range, 6‐48 months). The patients' mean weight increased from 43.8 kg (range, 19‐55 kg) to 48.3 kg (range, 30‐65 kg) after placement (P < .001). The total number of documented aspiration pneumonia episodes for all patients decreased from 29 (mean, 3.64; range, 1‐6) before DPEJ placement to 3 (mean, 0.27; range, 0‐2) after DPEJ placement (P < .001). The mean number of aspiration pneumonia events per month prior to the DPEJ placement was 3.39 and postplacement was 0.42 (P < .001). DPEJ placement appears to decrease recurrent aspiration pneumonia in patients with history of aspiration pneumonia.
Protective effects of ethyl pyruvate treatment on paraquat-intoxicated rats
Authors: Lee JH , Kwon WY , Jo YH , Suh GJ , Youn YK
Published: May 2008

Although, numerous studies have attempted to reduce the oxygen radical injury induced by the antioxidants in paraquat intoxication, these antioxidant therapies have showed few survival benefits. Ethyl pyruvate (EP) may function as an effective scavenger of oxygen radicals, an anti-inflammatory agent and an energy source in many ischemia reperfusion models. The aim of this study was to evaluate the antioxidant and anti-inflammatory effects of EP on the lung and the liver tissues in paraquat-intoxicated rats. Rats were randomly given either a low (2 mg/kg i.p.) or high (40 mg/kg i.p.) EP dose, 30 min before or 1 h after paraquat (50 mg/kg i.p.) administration, and subsequently killed at 6 and 24 h. Glutathione (GSH) and malondialdehyde (MDA) levels of the lungs and the livers, and plasma nitric oxide (NO) concentrations were measured. Pretreatment of EP significantly decreased the MDA level in the lung and the liver tissues. EP also significantly decreased plasma NO concentrations at 6 h. EP pretreatment, however, failed to show significant change in GSH concentration. In post-treatment of EP, MDA levels in the lung tissue and plasma NO levels were significantly decreased. In conclusion, EP decreased the lipid peroxidation and seemed to exert an anti-inflammatory action in the paraquat intoxication rat model.
Social Presence in the Web-Based Classroom
Authors: Yildiz Senem
Published: May 2008

Social presence is a theory derived from social psychology to explain social interactions in a mediated communication and is defined as the degree to which interlocutors in a communications medium perceive each other as real. This study investigates the effect of computer-mediated communication on the social presence of international students who spoke English as a foreign language in two Web-based graduate courses offered in the United States and aims to explore how linguistic and cultural differences influenced their social presence.
Review Article: Access to End-Of-Life Care Venues
Authors: Hallenbeck James
Published: May 2008

Quality of care at the end of life is strongly correlated with where patients die. This review discusses the influence of patient and health system variables affecting access to common venues of death-the acute care hospital, the nursing home, and home-with or without hospice. Access to care is considered in terms of a flow model, wherein pressure gradients push patients toward care in certain venues and away from alternatives. Dynamic interactions between patient-specific variables and health care system variables influence the nature of patient flow, moving patients toward certain terminal venues of care and away from others. Efforts to improve quality of care at the end of life must be cognizant of these effects and should work to adjust patterns of flow in more favorable directions.
Trajectory Optimization Strategies for Supercavitating Underwater Vehicles
Authors: Ruzzene M. , Kamada R. , Bottasso C.L. , Scorcelletti F.
Published: May 2008

Supercavitating vehicles are characterized by substantially reduced hydrodynamic drag, in comparison with fully wetted underwater vehicles. Drag is localized at the nose of the vehicle, where a cavitator generates a cavity that completely envelopes the body, at the fins, and on the vehicle after-body. This unique loading configuration, the complex and non-linear nature of the interaction forces between vehicle and cavity, the unsteady behavior of the cavity itself and memory effects associated with its formation process make the control and maneuvering of supercavitating vehicles particularly challenging. This study presents an initial effort towards the evaluation of optimal trajectories for this class of underwater vehicles. Flight trajectories and maneuvering strategies for supercavitating vehicles are obtained through the solution of an optimal control problem. Given a cost function, and general constraints and bounds on states and controls, the solution of the optimal control problem yields control time histories that maneuver the vehicle according to the desired strategy, together with the associated flight path. The optimal control problem is solved using the direct transcription method, which does not require the derivation of the equations of optimal control and leads to the solution of a discrete parameter optimization problem. Examples of maneuvers and resulting trajectories are given to demonstrate the effectiveness of the proposed methodology and the generality of the formulation.
Study on Stability Improvement of Suspension Bridge with High-Sided Vehicles under Wind using Tuned-Liquid-Damper
Authors: Chen S.R. , Chang C.C. , Cai C.S.
Published: May 2008

Smooth and safe traffic on the highway system is crucial for a modern society. As the backbone of a highway system, key long-span suspension bridges as well as moving high-sided vehicles on the bridges are vulnerable to strong wind. Excessive vibration of bridges and vehicles may cause the bridge aerodynamic instability and vehicle accidents. When wind is strong, the excessive torsional response of the bridge also contributes to the discomfort of drivers or the occurrence of overturning accidents of vehicles moving on it. Potentials of adopting the tuned-liquid-damper (TLD) system as an enhancement measure for the stability of suspension bridges with high-sided vehicles are evaluated. Firstly, a general shallow water sloshing model in rectangular containers under off-axle rotation, lateral and vertical excitations is developed. The analytical platform of the general 3-D bridge—vehicle—TLD system under wind and road roughness excitations is introduced. Secondly, a parametric study of the off-axle TLDs in controlling torsional motion of a simple single torsional mode bridge model under broadband white noise excitation is conducted to investigate the effectiveness and mechanism of the TLD on torsional motion. Finally, a numerical analysis of TLDs installed on a real suspension bridge—vehicle—wind system in time history is carried out considering interactions between the multimode bridge structure, multiple vehicles and the wind excitation. The results suggest that the off-axle TLD system can effectively suppress the torsional response of the suspension bridge through acting as a pendulum damper in addition to a typical sloshing damper, but has little direct suppression effect on the vibrations of vehicles.