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.     

A randomized study of a pH sensor feeding tube vs a standard feeding tube in patients requiring enteral nutrition

RATIONALE AND OBJECTIVES: A survey of chief residents of academic radiology programs is conducted annually on behalf of the American Association of Academic Chief Residents in Radiology (A3CR2). Data are obtained to improve the training of diagnostic radiology residents and to increase the understanding of radiologists and their associates about issues of interest to radiologists in training. METHODS: Questionnaires were mailed to 133 accredited programs in the United States and Canada. A wide variety of demographic and common interest questions were asked. The analysis took into account geographic location of the responders and the size of the residency program. Comparisons were made to the data from prior years. RESULTS: Completed surveys from 93 programs (70%) were returned. The percentage of women residents is increasing. Important regional and size variations exist in several areas including salary, workload, prior clinical training, resident/fellow ratios, post residency plans, and call schedules. Although many chief residents feel knowledgeable about the health care system, opinions about the future of radiology and medical care are tentative. CONCLUSIONS: This survey provides important demographic information about academic radiology residency programs. The summary information regarding plans for fellowship training, resident call schedules, and opinions about socioeconomic issues may be useful for chief residents, program directors, and departmental chairmen.     

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.     

Clinical evaluation of ultrasound hyperthermia system

The plasma membrane represents an impermeable barrier to proteins and other macromolecules. However, certain exogenous proteins are able to cross cellular membranes and gain access to the cytosol. The best examples are bacterial and plant protein toxins, acting on intracellular targets. During last few years the number of known proteins possessing the capability to cross cellular membranes in the reverse direction and reach the nucleus has increased (acidic and basic fibroblast growth factor, interleukin 1, angiogenin, Schwannoma derived growth factor, homeoprotein Antennapedia, HIV-1 Tat protein are some examples). Here, the role of transport of exogenous acidic fibroblast growth factor to the nuclear location as a part of the growth factor signaling is discussed, and the current knowledge on this issue is reviewed.     

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)     

Studies on the survival of Ascaris suum eggs under laboratory and simulated field conditions

Hypovolemia has been associated with the induction of nitric oxide synthase which is believed to result in an over-production of nitric oxide. In the present study, we have examined the effects of noradrenaline following haemorrhage on cardiac output, blood pressure, mean circulatory filling pressure and vascular resistance in anaesthetized rats after pre-treatment with nitric oxide synthase inhibitor, L-N6-(1-iminoethyl)lysine or dexamethasone. Hypovolemic haemorrhage resulted in induction of nitric oxide synthase, as measured in lungs, and both dexamethasone and L-N6-(1-iminoethyl)lysine inhibited the activity of the inducible form of nitric oxide synthase. An infusion of noradrenaline significantly increased cardiac output, blood pressure and mean circulatory filling pressure in animals pre-treated with L-N6-(1-iminoethyl)lysine and dexamethasone when compared with saline pre-treatment. In addition, the administration of noradrenaline significantly reduced venous resistance in animals pre-treated with L-N6-(1-iminoethyl)lysine when compared with saline pre-treatment. The results of this investigation indicated that the impact of noradrenaline on cardiac output, blood pressure and mean circulatory filling pressure was greater in hypovolemic rats treated with L-N6-(1-iminoethyl)lysine or dexamethasone. In addition, we found that in the hypovolemic state, the greater increase in cardiac output during the infusion of noradrenaline after inhibition of nitric oxide synthase was predominantly due to reduced resistance to venous return.     

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)     

Comparative observations on some bionomics of Japanese ixodid ticks under laboratory cultural conditions

Seventeen species of Japanese ixodid ticks of the genera Amblyomma, Boophilus, Haemaphysalis, Ixodes, and Rhipicephalus were reared in the laboratory under almost the same cultural conditions. Their major biological characters, such as feeding, molting, oviposition, and hatching, were summarized in tables. There were some differences in these bionomics among the species. The general characteristics common to all the ticks, except Amblyomma testudinarium, were as follows. The feeding period in immature stages and adult females was 3 approximately 5 and 7 approximately 14 days, respectively. The engorged body weight in larvae, numphs, and females was 0.3 approximately 0.5, 3.5 approximately 5.0, and 100 approximately 300 mg, respectively. The potential sexuality could be estimated from the nymphal engorged weight in five species. The larval and nymphal molting periods at 25 degrees C were alike, or 10 approximately 20 days, and there were no significant sexual differences in nymphal molting period among six species. The body weight just after molting in nymphs, males, and females was 0.25 approximately 0.3, 1 approximately 2, and 2 approximately 3 mg, respectively. The pre-oviposition, oviposition, and egg-incubation periods at 25 degrees C were 4 approximately 10 days, 2 approximately 3 weeks, and 1 month, respectively.     

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.     

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.     

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.