bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vulnerability due to Nocturnal Tornadoes
Authors: Ashley Walker S. , Krmenec Andrew J. , Schwantes Rick 
Published: May 2008

Abstract
This study investigates the human vulnerability caused by tornadoes that occurred between sunset and sunrise from 1880 to 2007. Nocturnal tornadoes are theorized to enhance vulnerability because they are difficult to spot and occur when the public tends to be asleep and in weak building structures. Results illustrate that the nocturnal tornado death rate over the past century has not shared the same pace of decline as those events transpiring during the daytime. From 1950 to 2005, a mere 27.3% of tornadoes were nocturnal, yet 39.3% of tornado fatalities and 42.1% of killer tornado events occurred at night. Tornadoes during the overnight period (local midnight to sunrise) are 2.5 times as likely to kill as those occurring during the daytime hours. It is argued that a core reason why the national tornado fatality toll has not continued to decrease in the past few decades is due to the vulnerability to these nocturnal events. This vulnerability is magnified when other factors such as escalating mobile (or “manufactured”) home stock and an increasing and spreading population are realized. Unlike other structure types that show no robust demarcation between nocturnal and daytime fatalities, nearly 61% of fatalities in mobile homes take place at night revealing this housing stock’s distinct nocturnal tornado vulnerability. Further, spatial analysis illustrates that the American South’s high nocturnal tornado risk is an important factor leading to the region’s high fatality rate. The investigation emphasizes a potential break in the tornado warning dissemination system utilized currently in the United States.
Management of Chronic Pancreatitis
Authors: Giger Urs , Stanga Zeno , DeLegge Mark H. 
Published: May 2008

Chronic pancreatitis (CP) is an inflammatory disorder that results in permanent impairment of the glandular anatomy of the pancreas with or without functional abnormalities. The pathogenesis of CP is usually unclear, except in the case of alcohol‐induced disease. The most common symptoms of CP are abdominal pain, diarrhea, and weight loss often requiring recurring hospitalization. Over time, pancreatic endocrine and exocrine dysfunction may develop as the disease progresses, and a variety of complications can occur. Among the possible complications are nutrient malabsorption and diabetes mellitus.The treatment of CP is difficult and challenging for every physician. Relieving pain is the first step in treating CP. This symptom needs to be controlled, often with narcotics, which can cause dependence. Diarrhea usually indicates the presence of steatorrhea, which is often treated with a high‐calorie, high‐protein, and low‐fat diet to minimize symptoms of the underlying disease and to promote weight retention or gain. Pancreatic replacement therapy is used to combat maldigestion and malabsorption. Patients with diabetes may need insulin therapy for glycemic control. The use of parenteral nutrition for bowel rest is a standard approach in patients with symptomatic CP. The use of jejunal enteral feeding recently has been evaluated for efficacy in CP patients.The role of pancreatic endotherapy in the management of CP is evolving. Several reports have suggested that endoscopic therapy aimed at decompressing the obstructed pancreatic duct can be associated with pain relief in some patients. Surgery should be considered in patients who fail medical therapy.
New Drugs for Management of Diabetes: Insulin Analogues, Inhaled Insulin, Pramlintide, and Novel Peptides
Authors: Mouser Jay F. 
Published: May 2008

Diabetes mellitus has reached epidemic proportions and contributes to considerable morbidity and mortality in the form of metabolic, microvascular, and macrovascular complications. Although there is no cure, large controlled studies demonstrate the importance of strict glycemic control in reducing progression of microvascular disease and associated morbidity. Insulin replacement is necessary for all patients with type 1 diabetes. In treatment of type 2 diabetes, more timely addition of insulin as patients fail to attain glycemic targets on combinations of oral agents has become widely accepted.Pharmacokinetic properties of human insulins limit their ability to mimic physiologic insulin secretion. Analog insulins (prandial and basal) are designed with improved physiologic pharmacokinetic characteristics to enable more simplified insulin dosage adjustments and a reduced risk for hypoglycemia. Inhaled administration has emerged as a promising route for noninvasive prandial insulin. Clinical trials are under way to further characterize safety and efficacy of inhaled insulin preparations.Despite numerous pharmacologic advancements, the majority of diabetic patients continue to have inadequate glycemic control. New information regarding biochemistry and pathophysiology of the disease is providing exciting opportunities for drug development. Promising new therapeutic classes include the synthetic analog of amylin (pramlintide), glucagon‐like peptide (GLP‐1) derivatives, and dipeptidyl peptidase IV inhibitors. Intriguingly, GLP‐1 hormones may have important biologic actions aside from stimulating insulin release, including inhibition of gastric motility and acid secretion, suppression of glucagon secretion, and islet cell proliferation. Although additional studies are needed, perhaps these emerging agents will have greater efficacy and safety because of a higher degree of selectivity for their molecular targets.
Challenges of Providing Nutrition Support in the Outpatient Dialysis Setting
Authors: Moore Eileen , Celano Joe 
Published: May 2008

Malnutrition is prevalent in maintenance hemodialysis (MHD) patients and has been strongly associated with increased morbidity and mortality. There are numerous contributors to the development, occurrence, and persistence of malnutrition in the MHD patient. Intensive diet counseling and use of enteral supplements may not be effective interventions for patients exhibiting high nutrition risk. More aggressive nutrition options such as enteral and parenteral support are less often used and have associated risks. Intradialytic parenteral nutrition (IDPN) as a form of PN delivered during the dialysis procedure is a convenient and attractive convention that is underused because of its history and controversy.There is a lack of randomized controlled trials demonstrating improved morbidity and mortality with all nutrition support interventions in MHD patients. This research is particularly crucial for IDPN in order to render change in Medicare reimbursement. Qualification of patients for this therapy is difficult because of the very strict coverage criteria. For those patients who do qualify for IDPN, clinician nutrition support knowledge is essential for safe administration of solutions and effective physical, metabolic, and nutrition management of the patient. Attention to other factors that contribute to malnutrition in MHD such as treatment adequacy and comorbid conditions is important; however, the early detection of malnutrition in the MHD patient with appropriate level of nutrition intervention is critical. Future improved understanding of the malnutrition of uremia will allow for development and investigation of other strategies that are anti‐catabolic or anabolic.
Home Nutrition Support Patient Education Materials
Authors: Evans Mary Ann , Liffrig Therese K. , Nelson Jennifer K. , Compher Charlene 
Published: May 2008

The practice of providing specialized enteral and parenteral nutrition to patients in the home setting has expanded nationwide during the past decade. Accompanying this growth has been an increased need for education of patients, families, and care providers in techniques of administering intravenous and tube feedings safely after discharge from the hospital.To meet this demand for information, written home nutrition support (HNS) education materials have been developed by hospital nutrition support teams, patient education specialists, home care providers, and formula manufacturers. The time and financial costs of developing these materials may be prohibitive in certain institutions that need HNS education resources. A directory of the printed materials available has been compiled to facilitate communication and exchange of HNS education information among institutions. The directory is presented with this article, with important characteristics to consider in the development of HNS education materials.
Nutrition Risk Classification: A Reproducible and Valid Tool for Nurses
Authors: Kovacevich Debra S. , Boney Anthony R. , Braunschweig Carol L. , Perez Anne , Stevens Mary 
Published: May 2008

Background:Incorporating the nursing staff to assist with the screening process on admission will allow patients who are at nutritional risk to be assessed by registered dietitians earlier in their hospital stay. The goal of this study was to develop an objective, valid, reproducible nutrition screen for use by registered nurses (RNs) to allow for nutrition classifications of hospitalized patients.Methods:The current nursing admission assessment form was modified to contain questions on weight loss history, percentage of ideal body weight, and alterations in dietary intake and gastrointestinal function. Assessments were completed within 48 hours of admission. On the basis of the answers to these questions, patients were classified as “at nutritional risk” or “low nutritional risk.” In phase 1, to assess reproducibility of the form, a prospective study between staff RNs and a nutritionist was undertaken on 186 consecutive adult admissions. Nutrition screening and classification was done independently by both practitioners. In phase 2 of the study, prospective validation of the form contrasting prealbumin (PAB) levels with RN nutritional risk classification (n = 56) was investigated.Results:Interobserver agreement of nutrition classification between RN and nutritionist was 97.3% (p = .95). Twenty‐nine patients were classified at low nutritional risk (27 normal PAB and 2 low PAB); 27 patients were classified as at nutritional risk (16 normal PAB and 11 low PAB) (χ3= 8.9, p > .003, power 0.8). The sensitivity of the tool was 84.6%.Conclusion:To our knowledge, this is the first nutrition screening tool designed for staff RNs that has been tested for both validity and reproducibility.
pH and Concentration of Bilirubin in Feeding Tube Aspirates As Predictors of Tube Placement NA Metheny, BJ Stewart, L Smith, et al. Nursing Research 48(4):189–196, 1999
Authors: Zimmaro Bliss Donna 
Published: May 2008

In this study, the investigators determined whether the concentration of bilirubin obtained from aspirates of newly inserted feeding tubes improved the ability of pH alone to predict feeding tube location. An algorithm to predict feeding tube location was developed. Aspirates of gastrointestinal fluid from adult, acutely ill patients who had nasogastric (n = 209) or nasointestinal (n = 228) small‐bore feeding tubes (8‐F or 10‐F) inserted were obtained within 5 minutes of radiographs confirming feeding tube placement. Patients were excluded if antacids or tube feedings had been administered within 4 hours preceding sample collection, any medications were administered orally or via feeding tube within 1 hour preceding sample collection, samples were grossly bloody, or if patients had a history of gastric surgery or trauma. Tracheobronchial secretions (n = 125) were obtained by suctioning patients who had an artificial airway; 24 pleural samples were obtained at the time of thoracenteses, and 1 sample was obtained from a feeding tube inadvertently positioned into the right mainstem bronchus. Approximately two‐thirds of the patients were receiving H2 ‐receptor antagonists. The pH and bilirubin concentration of samples were measured using standard methods and compared with the radiographs of feeding tube location.Mean pH levels in the intestine (7.35 ± 0.6) and lung (7.73 ± 0.4) were significantly higher than in the stomach (3.9 ±.15). Mean bilirubin levels in the stomach (1.28 ± 0.25 and lung (.08 ±.02) were significantly lower than in the intestine (12.73 ±.91 mg/dL). To develop the predictive algorithm, the pH and bilirubin values were dichotomized by visually inspecting the overlap of the data distributions and mean differences by tube sites. A pH of 5 or less and bilirubin less than 5 mg/dL successfully identified more than two‐thirds of the 209 feeding tubes radiographically confirmed as being in the stomach. Misclassification of 53 of the gastric feeding tubes as respiratory cases by this category was attributed to the effects of acid‐inhibiting medications. Thirteen of the gastric tubes were misclassified as being in the intestine, most likely due to acid‐inhibiting agents and reflux of intestinal fluid into the stomach. A pH greater than 5 and bilirubin of 5 or more correctly identified three‐fourths of the 228 tubes in the intestine. Fifty‐four of the intestinal tubes were misclassified as respiratory cases due to lower than expected bilirubin levels. A pH of less than 5 and bilirubin less than 5 mg/dL correctly classified 100% of the 150 respiratory cases. Approximately one‐fourth of the 437 gastrointestinal tube placements were misclassified as respiratory cases by this category. Use of the algorithm was estimated to reduce the number of x‐rays to exclude respiratory placements in 28% of the cases.
Maintenance of Gastrointestinal Function After Bowel Surgery and Immediate Enteral Full Nutrition. II. Clinical Experience, with Objective Demonstration of Intestinal Absorption and Motility
Authors: Moss Gerald 
Published: May 2008

Eighteen patients undergoing colorectal excision had gastrointestinal function preserved. Paralytic ileus was avoided by efficient exclusion of swallowed air by aspiration of the esophagus. Full strength elemental diet was delivered into the duodenum immediately postoperatively at 100–150 ml/ hour. Virtually stoichiometric digestion, absorption, and utilization of dietary protein was demonstrated in six patients, for whom 125I‐albumin was added to the initial feedings. The 24‐hour urine contained 94 ± 4% of the activity. The same group of patients had hourly determinations of nitrogen balance. Each had achieved positive protein balance by 5 ± 3 hours postoperatively.The morning following surgery (17–24 hours postoperatively) the special nasogastric device was removed and intravenous feedings were discontinued, with transition to per os intake of elemental diet. Twelve patients had oral barium motility studies initiated at this time, with continued oral intake of elemental diet. On serial x‐rays, each showed clinically adequate peristalsis, with prompt passage of the contrast agent out of the stomach, through intestine and colon. The barium traversed anastomoses to enter the rectum and exit in a spontaneous bowel movement within the second 24‐hour period. Three patients were discharged within 48 hours of surgery (sigmoid resection, 2; right hemicolectomy, 1).Paralytic ileus develops after the usual postoperative regimens. Clinically adequate gastrointestinal function can be preserved by a regimen that includes efficient exclusion of swallowed air. This study documents the immediate enteral absorption of full nutrition (ie, 3000 kcal/day) as elemental diet. The x‐ray studies document preservation of even gastric and colonic function, permitting normal per os intake and discharge within 24–48 hours of major abdominal surgery.
Early Postoperative Nutritional Support Using the Serosal Tunnel Jejunostomy
Authors: Cobb L. Mason , Cartmill Andrea M. , Gilsdorf Robert B. 
Published: May 2008

A silicone rubber serosal tunnel jejunostomy for postoperative nutritional therapy was placed in 38 patients who had major operations. A dilute, chemically defined diet was begun within 48 hours of surgery and an attempt made to advance it slowly to full strength by the fifth day.No catheter‐related complications occurred. Intravenous fluid therapy was shortened to less than three days in 11 (29%) patients. Only 17 (45%) patients tolerated full‐strength feedings within the protocol time. Three (8%) patients depended on their tube feedings for over 30 days and the need for parenteral nutrition was avoided. Of six septic patients, four had complete intolerance of the diet; two of these developed massive gastric hypersecretion. Serum albumin was a statistically significant indicator of whether a patient could tolerate tube feedings. No patient with an albumin less than 3 g/dl tolerated full‐strength feedings and the patients with albumin greater than 4 g/dl had no problems.Postoperative feeding utilizing the serosal tunnel jejunostomy is technically safe, but feeding difficulties can be anticipated in those patients who are septic or severely malnourished; these are the patients whose nutritional needs are the greatest. The greatest benefits accrue to those patients who are in need of long‐term nutritional support. We recommend routine placement of these catheters in major operations.
Home Total Parenteral Nutrition: A Psycho‐Social Viewpoint
Authors: Robinovitch Arlene E. 
Published: May 2008

Home total parenteral nutrition (TPN) usually necessitates major and probably permanent changes in the patient's lifestyle. Among the nonmedical, nontechnological issues these patients face are the need to: (1) adhere to prescribed regimens to avoid crises and to control symptoms; (2) alter their self‐perceptions; (3) modify their accustomed roles; (4) reorder their priorities and re‐think their values; (5) deal with machine and medical center dependency; and (6) assign a monetary value to their lives. The emotional and environmental pressures that are the chief issues for these patients include financial, employment, psychological, and interpersonal problems such as depression, anger, anxiety, relief, body image, and self‐esteem.Patients on home TPN are best treated with a clinical team that serves both the patient and family as individuals and as a social system. Services offered include: (1) medical diagnosis, treatment, and rehabilitation; (2) professional and technical support services including pharmacy, dietary, and nursing to teach, demonstrate and monitor self‐care, nutrition, and use of the home TPN system; and (3) professional social work services to assist patients and families to deal with the feelings, relationships, environmental pressures, and advocacy needs associated with home TPN.
Effect of the Energy Source on Changes in Energy Expenditure and Respiratory Quotient During Total Parenteral Nutrition
Authors: Macfie J. , Holmfield J.H.M. , King R.F.G. , Hill G.L. 
Published: May 2008

It has been suggested that malnourished patients respond to glucose intake in excess of energy needs by a rise in respiratory quotient (RQ) above 1.0, indicating net fat synthesis. This would represent inefficient utilization of glucose as an energy source. It is unclear, however, whether this also occurs when some of the energy source is provided as a fat emulsion.Energy expenditure was measured by indirect calorimetry using a canopy hood and RQ, calculated from the analysis of 2 X 5 minute collections of expired air, were measured every 3rd day in two groups of surgical patients who received a 14‐day course of intravenous nutrition [total parenteral nutrition (TPN)]. Group I (mean ± 1 S.D. 57.4 ± 15.4 yers, 9 females, 3 males) received glucose as the only source (46.6 ± 9.2 kilocalories per kilogram per day and group II (55.8 ± 14.2 years, 5 males, 3 females) 60% of their calories as fat (44.0 ± 7.5 kilocalories per kilogram per day). Both groups were given similar amounts of crystalline amino acid solution (0.34 ± 0.007, 0.32 ± 0.005 gram nitrogen per kilogram per day, respectively) and no other intake. There was no significant difference between the groups mean values of body weight (52.3 ± 7.9 versus 57.9 ± 12.5 kilograms) or energy expenditure before TPN commenced (31.3 ± 6.5, 32.3 ± 3.0 kilocalories per square meter per hour). In group I there was a persistent elevation (p < 0.001) of mean RQ above 1.0 from the 9th day of TPN, together with a significant increase (p < 0.001) in mean energy expenditure which attained the value of 38.0 ± 4.8 kilocalories per square meter per hour on the 14th day. In group II, the mean RQ never exceeded 1.0. The rise in the mean expenditure in group II was significantly less (p < 0.02) than that observed in group I.This study shows that the use of glucose as the only energy source during TPN is associated with a greater rise in energy expenditure than is observed with a glucose‐fat regime and a persistent elevation of RQ above 1, indicating net lipogenesis. These results suggest, therefore, that complete oxidation of glucose occurs when it is the only source of nonprotein calories given during TPN.
Hemoglobin A1C in Home Parenteral Nutrition
Authors: Mirtallo Jay M. , Fabri Peter J. 
Published: May 2008

Hemoglobin A1C or glycosylated hemoglobin has been described as being effective in monitoring long‐term glucose control in diabetics. The usefulness of HbA1C in reflecting glucose homeostasis during chronic hypertonic dextrose infusions in 6 patients receiving cyclic home TPN was studied at monthly intervals. Grouped data for the 34 values representing study periods of 5 to 10 months averaged 7.5 ± 0.2% (Mean ± SEM) indicating that HbA1C levels were not elevated above normal (4–8%) in these patients while receiving a dextrose based diet. Final values of HbA1C (7.3 ± 0.4%, mean ± SEM) although lower than early values (8.7 ± 0.6%, mean ± SEM) were not significantly different (p > 0.05, Student's paired t‐test). The change in HbA1C that occurred in these patients probably reflects the response to an altered glucose load infused by the patient.HbA1C is a convenient and apparently accurate method of evaluating chronic glucose tolerance in patients receiving home TPN and may be used as an alternate method for monitoring glucose tolerance on an outpatient basis.
A Cost‐Utility Analysis of the Home Parenteral Nutrition Program at Toronto General Hospital: 1970–1982
Authors: Detsky Allan S. , Mclaughlin John R. , Abrams Howard B. , Whittaker J. Scott , Whitwell Jocelyn , L'Abbé Kristan , Jeejeebhoy Khursheed N. 
Published: May 2008

We performed an economic evaluation of a home parenteral nutrition (HPN) program by measuring the incremental costs and health outcomes for a cohort of 73 patients treated at our institution from November 1970 to July 1982.Over a 12‐year time frame, we estimate that HPN resulted in a net savings in health care costs of $19,232 per patient and an increase in survival, adjusted for quality of life, of 3.3 years, compared with the alternative of treating these patients in hospital with intermittent nutritional support when needed. This result was sensitive to assumptions made about the cost of the alternative treatment strategy. When these assumptions were most unfavorable to the HPN program, we estimated that HPN resulted in incremental costs of $48,180 over 12 years, $14,600 per quality‐adjusted life‐year gained.We conclude that the cost‐utility of HPN compares favorably with other health care programs, when HPN is used to treat patients with gut failure secondary to conditions such as Crohn's disease or acute volvulus. Since only one patient with active malignancy was enrolled in our HPN program, these results should not be extrapolated to patients with active malignancy. (Journal of Parenteral and Enteral Nutrition 10:49–57, 1986)