Controlling bacterial contamination of an enteral formula through the use of a unique closed system: contamination, enteral formulas, closed system

Contamination of enteral diets may play an essential role in formula tolerance and safety for patients. Contaminated enteral formula commonly support microbiological growth. Commercially sterile liquid formulas received from the manufacturer are required by the Food & Drug Administration (FDA) to be shelf-stable and free from enteric pathogens. This study examined the use of large volume, closed system containers in a typical nursing home. Large volume (1500 mL) containers with unique pierceable caps and piercing spikes were studied to determine their ability to reduce the incidence of microbiological contamination due to their design and ability to decrease handling requirements. This study took place in a room of a typical nursing home. In this clinical setting, 211 containers and administration spike sets were evaluated following a 36-h hangtime. Contamination was virtually nondetectable. Nursing staff in a clinical facility can effectively utilize a large volume, prefilled, ready-to-use feeding system to achieve delivery of noncontaminated product for up to 36 h hangtime.     

Clinical and laboratory evaluation of a new thin-walled self-expanding tracheobronchial silicone stent: progress and pitfalls

The demand-control model (DC model) in occupational epidemiology suggests that health, an individual attribute, is partly determined by work organization, via the interplay of demand and control, job strain. The objective of this study was empirical assessment of the model's tenet of an organizational determination of individual health. An emerging analytic method, multi-level modelling, permits such an assessment. The study encompasses two large Swedish human service organizations. It was based on a nationally representative sample of 291 local organizational units (level 2) with 8296 employees (level 1), a median of 18 employees per unit. 5730 persons (69.1%) completed the questionnaire. Listwise deletion of missing data left a net study base of 4756 individuals in 284 units. Missing data were largely random. Demand and control were measured by standard questions and combined into a job strain index. Two such indices were calculated, one for quantitative demands and one for emotional demands. Individual attributes included age, gender, marital status, having children, social anchorage, and education. There were two dependent variables, self-assessed psychovegetative symptoms (worry, anxiousness, sadness, sleep difficulties, restlessness, and tension) and exhaustion (fatigue, feelings of being used up and overworked), both measured as summative indices. For psychovegetative health, a null model yielded 2.2% level 2 variance, unchanging when individual attributes were included in a random intercepts model. Inclusion of the strain variables rendered level 2 variance non-significant, decreasing level 1 variance by 23% and level 2 variance by 62%. For exhaustion, level 2 variation was 8.3% in the null model and 1.6% in the final model, with strain variables. The strain variables utilized in the DC-model thus draw a substantial part of their variation from the organizational level. It is concluded that the claim of the DC model to rely on organizational factors receives support.     

Clinical reliability of single-lead VDD pacing from evaluation of P-wave sensing under dynamic conditions

In a group of 20 patients implanted with a single-lead VDD pacing system, a wide interindividual variability was found in P-wave amplitude changes occurring under dynamic conditions, even though they were of minor clinical relevance because constant atrial tracking was maintained.     

Clinical and laboratory considerations in the use of a new all-ceramic restorative system

Ceramic systems are continually under development in an effort to refine their clinical application. An all-ceramic full-coverage crown system (Procera, Nobel Biocare, Westmont, IL) that utilizes computer technology and industrial presses to fabricate precise copings has recently been introduced. Using this system, aluminous porcelain is baked over a high-strength, high-purity aluminum oxide coping to fabricate a functional, biocompatible, and aesthetic restoration. This article presents a discussion of the clinical and laboratory considerations that are involved in the utilization of this all-ceramic system.     

Clinical evaluation of a renal mass diagnostic expert system

In this paper, we describe our clinical evaluation of the diagnostic accuracy of the renal mass diagnostic system (RMDS) and of seven physicians. To investigate the value of intravenous urography (IVU) and/or retrograde urography (RU) in diagnosing renal parenchymal tumors and tumors of the renal pelvis, RMDS and the seven physicians were tested with and without the information regarding IVU/RU at two different times. From this study we believe that RMDS can help residents in making more accurate presurgical renal mass diagnosis, and may eliminate the need for IVU/RU in the diagnosing process for a specific group of patients.     

School feeding in Jamaica: a review of its evaluation

This paper reviews two studies that evaluated the school feeding program in Jamaica. The first examined 115 children aged 12-13 y who were enrolled in three classes in a poor, rural school. One class was served the standard school meal at 0900 whereas the other two classes served as controls. The outcome variables included school achievement, attendance, and weight gain. After one semester, the class receiving the meal showed improved arithmetic scores and school attendance compared with the control classes; however, they showed no weight gain. The academic improvement remained significant after school attendance was controlled for. It was therefore hypothesized that the gains in arithmetic resulted from the alleviation of hunger in the classroom. The other study, conducted in a metabolic ward, examined the effects of missing breakfast on cognitive function in 90 children aged 9-10 y and of differing nutritional status. Using a crossover design, the investigators tested each child on two mornings 1 wk apart, once after serving them breakfast and second without. Breakfast, consisting of the school program meal, was served at 0800. When severely malnourished, stunted, or wasted children received no breakfast, their performance in various cognitive tests deteriorated. These results indicate that alleviation of hunger was one of the mechanisms by which school feeding improved academic achievement in the previous study. Undernourished children are more likely to benefit from school feeding programs than are adequately nourished children.     

Nutritional support: formulas and delivery of enteral feeding. I. Enteral formulas

Hospital malnutrition is a recognized condition that may be treated with a variety of feeding modalities. It is possible to achieve the goal of nutritional repletion with enteral feedings. Enteral feedings can now be prescribed for more types of patients because of our ability to better manipulate nutrition sources and the availability of modules and formulas designed for special use. The lower costs associated with enteral feeding have made it an option when nutritional support is required for a patient who has a functioning gastrointestinal tract.     

Continuing investment under conditions of failure: A laboratory study of the limits to escalation.

100 business students participated in a laboratory experiment designed to test for limiting factors in the process of escalation. Ss were instructed to assume the role of the financial vice-president of a large conglomerate. It was explained that the company had declined in recent years and that management had identified several divisions that might benefit from developmental investment. Ss decided how to spend a developmental budget and typed their decisions into a computer. The computer gave them immediate performance reports. Whichever divisions Ss started out with continued to decline, whereas alternative divisions, if there were alternatives, improved. A questionnaire was administered at the end of the simulation. Commitment and investment alternatives available to the Ss were manipulated. Results support the hypothesized de-escalation process (i.e., although escalation occurs during the 1st stage of investment, a de-escalation process may be typical later on) and show that the availability of alternative investments also limited escalation. A survival analysis of S investments suggested that commitment may not be the dominant process in escalation and de-escalation. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Placebo-controlled evaluation of a modified life virus vaccine against feline infectious peritonitis: safety and efficacy under field conditions

A modified live virus vaccine against feline infectious peritonitis (FIP) was evaluated in a double blind, placebo-controlled field trial in two high-risk populations. The vaccine was found to be safe and efficacious in one population of cats that had low antibody titre against feline coronavirus (FCoV) at the time of vaccination. Although clinically healthy at the time of vaccination, retrospectively some vaccinees that later came down with FIP were found to be RT-PCR positive for FCoV in plasma and showed changes in blood parameters consistent with early stage of FIP. It is concluded that vaccination can protect cats with no or low FCoV antibody titres and that in some cats vaccine failure was probably due to pre-existing infection.     

The relative power of training evaluation designs under different cost configurations.

After noting that the statistical power of training evaluation designs is a complex function of sample size, the reliability of the dependent measure, the correlation between pre- and posttest measures, and whether a randomized pretest–posttest or randomized posttest-only design is used, the authors show that the costs of conducting an evaluation are important considerations that also affect the relative power of the designs. Specifically, S costs, administrative costs, and item development costs are different components that can absorb resources when training evaluations are conducted. When total cost resources are fixed, these separate costs affect the relative power of pretest–posttest and posttest-only designs differently, and the posttest-only design may be the more preferred design under many different conditions. In other words, a variety of design and parameter tradeoffs affect power when total costs are fixed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

降雨和地震条件下浅层黄土滑坡三维稳定性评价

以兰州市大沙沟流域浅层黄土滑坡为研究对象,整合降雨渗透模型到黄土斜坡三维确定性模型,评价不同降雨和地震耦合效应下浅层黄土滑坡稳定性,并用混淆矩阵法和受试者工作特征曲线法（ROC）评价稳定性评价预测的结果。研究结果发现,耦合降雨入渗和地震的三维确定性模型,对流域尺度浅层黄土滑坡稳定性评价具有较好效果,能作为降雨和地震诱发黄土滑坡灾害评价和早期预警的工具,对加强不同尺度极端事件下黄土滑坡灾害时空灾害评价和预测具有重要参考价值。      

Rhythmicity of torpor in a marsupial hibernator, the mountain pygmy-possum (Burramys parvus), under natural and laboratory conditions

Circadian rhythms have been observed in most mammals, but their importance and function remain controversial with respect to daily cycles during hibernation. We investigated the timing of arousals from and entries into hibernation for both free-living and captive mountain pygmy-possums (Burramys parvus). Under both natural and laboratory conditions most arousals and entries were entrained with the light-dark cycle. Entries occurred mainly during the night and arousals preferably around dusk, which coincides with the onset of the normal activity phase for the nocturnal pygmy-possums. This entrainment prevailed throughout the hibernation season although only the laboratory animals were constantly subjected to photoperiodic stimuli, whereas under natural conditions hibernacula are shielded from photic cues and diurnal temperature fluctuations. Nevertheless, possums left their hibernacula frequently throughout winter and were occasionally trapped close to the snow surface suggesting that during the periods of post-arousal normothermia they can be exposed to environmental stimuli. It thus appears that the synchronisation with the photocycle was governed by a temperature-compensated circadian clock which was reset periodically during short activity periods. For the mountain pygmy-possum, entrainment with the photocycle probably has two functions: 1. Entrainment ensures that foraging bouts during the hibernation season remain synchronised with the dark phase. 2. Information about the prevailing climatic conditions sampled during short activity periods enables them to time final spring emergence from hibernation when snow melt begins and ensures that the breeding season can commence as early as possible.     

Response of peripheral nerve to cyclic compression in a laboratory rat model

Repetitive cyclic loading of a nerve has been proposed as a pathogenic factor in the development of occupational compression neuropathies. Little is known about the basic response of peripheral nerve to cyclic compression. We investigated the hypothesis that cyclic compression is more detrimental to nerve function than constant compression. We measured the amplitudes and velocities of distally evoked action potentials in the presence of constant or cyclic compression of the tibial nerve in rats. Seven groups were subjected to constant or cyclic compression for 6 h by a computer controlled, hydraulically activated compression chamber. Nerves were compressed with 0 (control group), 30, 60, or 90 mm Hg of constant pressure or 0-30, 20-50, or 30-60 mm Hg of cyclic compression for approximately 20,000 compression cycles. Action potentials were recorded every 15 min. The effects of cyclic compression on nerve conduction were equivalent to the effects of constant compression at the average applied pressure. Cyclic loading itself does not appear to be an important pathogenic factor in the development of nerve conduction block.     

Strategic choices for cost containment under a reformed U.S. health care system

The Clinton administration health reform proposal would impose global spending limits to bring the rate of increase in health care spending into line with the Consumer Price Index by 1999. This paper examines cost containment strategies available to states and health plans under externally imposed revenue limits. Drawing on the experience of state and local regulatory agencies, private sector managed care plans, and models in other countries, we contrast premium caps and provider rate setting as mechanisms to reduce growth in health care spending, and briefly consider the system-level regulatory structures necessary to oversee and control aggregate health care spending.     

Phosphate deficiency as a rare cause of osteomalacia--case report of several years of enteral feeding and antacid therapy

HISTORY AND CLINICAL FINDINGS: Floor-of-the-mouth cancer had been diagnosed and surgically treated in a 55-year-old man 4 years before the latest admission. For the last 3 years he had been fed through a percutaneous endoscopic gastrostomy (PEG). Since then he had experienced reflux oesophagitis which was being treated with aluminium-containing antacids. He was hospitalized for the surgical treatment of bilateral fractures of the neck of the femur. A surgical biopsy revealed osteomalacia but no metastasis. INVESTIGATIONS: The serum phosphate level was significantly reduced (0.21 mmol/l) and there was no detectable phosphate excretion in the 24-hour urine. Serum calcium concentration was unremarkable, but there was hypercalciuria (34.4 mmol/d). Alkaline phosphate activity was significantly raised (393 U/l) and parathormone level reduced (7 ng/l). Vitamin D concentration was unremarkable. TREATMENT AND COURSE: The phosphate content in the parenteral feed was at first increased and additional phosphate was given by mouth. The calcium and phosphate levels slowly became normal only after medication had been changed from antacids to H2-blockers. CONCLUSIONS: In this case osteomalacia was caused not by vitamin D deficiency but by a lack of phosphate. The reduced intestinal phosphate absorption by the antacids only partially explains the pronounced clinical signs. If antacids are taken over long periods the phosphate balance should be carefully monitored to avoid osteomalacia.     

Growth and development of the American bollworm Heliothis armigera Hubn. under laboratory mass rearing conditions

A kidney bean meal diet was the most satisfactory laboratory diet for the larvae of the American bollworm Heliothis armigera Hubn. Optimum rates of survival (63.5%) occurred and the larval growth was better than that of larvae reared on castor oil plant leaves. The pupal weight and the fecundity of the resulting adults were also much better than those on the control host plant.     

Estimation of the activity of an antiseptic agent on skin microbial flora under various conditions

The bacterial flora of the skin of the fore-arm was studied in fifteen normal subjects by a modified Williamson and Kligman technique. The quantitative results were in agreement with those found in other laboratories which indicates the reproducibility of the method. The action of an antiseptic containing 0.5 p. cent of benzalkonium chloride was studied under three conditions or single application of the antiseptic for five consecutive days and for 24 hours after the application of an occlusive dressing. The bacterial flora of the skin showed marked quantitative variations from one subject to another and, in the same subject, from one time to another. Evaluation of the activity of an antiseptic should take into consideration these physiological variations and also various conditions of use in practice. Are discussed also the factors leading to standardisation of the methods and the criteria of evaluation of the activity of antiseptics on the skin.