Pathogenic simian immunodeficiency virus infection is associated with expansion of the enteric virome

PubMed Central

Handley, Scott; Thackray, Larissa B.; Zhao, Guoyan; Presti, Rachel; Miller, Andrew; Droit, Lindsay; Abbink, Peter; Maxfield, Lori F.; Kambal, Amal; Duan, Erning; Stanley, Kelly; Kramer, Joshua; Macri, Sheila C.; Permar, Sallie R.; Schmitz, Joern E.; Mansfield, Keith; Brenchley, Jason M.; Veazey, Ronald S.; Stappenbeck, Thaddeus S.; Wang, David; Barouch, Dan H.; Virgin, Herbert W.

2012-01-01

SUMMARY Pathogenic simian immunodeficiency virus (SIV) infection is associated with enteropathy which likely contributes to AIDS progression. To identify candidate etiologies for AIDS enteropathy, we used next generation sequencing to define the enteric virome during SIV infection in nonhuman primates. Pathogenic, but not non-pathogenic, SIV infection was associated with significant expansion of the enteric virome. We identified at least 32 previously undescribed enteric viruses during pathogenic SIV infection and confirmed their presence using viral culture and PCR testing. We detected unsuspected mucosal adenovirus infection associated with enteritis as well as parvovirus viremia in animals with advanced AIDS, indicating the pathogenic potential of SIV-associated expansion of the enteric virome. No association between pathogenic SIV infection and the family-level taxonomy of enteric bacteria was detected. Thus, enteric viral infections may contribute to AIDS enteropathy and disease progression. These findings underline the importance of metagenomic analysis of the virome for understanding AIDS pathogenesis. PMID:23063120

Combined enteral and parenteral nutrition.

PubMed

Wernerman, Jan

2012-03-01

To review and discuss the evidence and arguments to combine enteral nutrition and parenteral nutrition in the ICU, in particular with reference to the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study. The EPaNIC study shows an advantage in terms of discharges alive from the ICU when parenteral nutrition is delayed to day 8 as compared with combining enteral nutrition and parenteral nutrition from day 3 of ICU stay. The difference between the guidelines from the European Society of Enteral and Parenteral Nutrition in Europe and American Society for Parenteral and Enteral Nutrition/Society of Critical Care Medicine in North America concerning the combination of enteral nutrition and parenteral nutrition during the initial week of ICU stay was reviewed. The EPaNIC study clearly demonstrates that early parenteral nutrition in the ICU is not in the best interests of most patients. Exactly at what time point the combination of enteral nutrition and parenteral nutrition should be considered is still an open question.

Improved enteral tolerance following step procedure: systematic literature review and meta-analysis.

PubMed

Fernandes, Melissa A; Usatin, Danielle; Allen, Isabel E; Rhee, Sue; Vu, Lan

2016-10-01

Surgical management of children with short bowel syndrome (SBS) changed with the introduction of the serial transverse enteroplasty procedure (STEP). We conducted a systematic review and meta-analysis using MEDLINE and SCOPUS to determine if children with SBS had improved enteral tolerance following STEP. Studies were included if information about a child's pre- and post-STEP enteral tolerance was provided. A random effects meta-analysis provided a summary estimate of the proportion of children with enteral tolerance increase following STEP. From 766 abstracts, seven case series involving 86 children were included. Mean percent tolerance of enteral nutrition improved from 35.1 to 69.5. Sixteen children had no enteral improvement following STEP. A summary estimate showed that 87 % (95 % CI 77-95 %) of children who underwent STEP had an increase in enteral tolerance. Compilation of the literature supports the belief that SBS subjects' enteral tolerance improves following STEP. Enteral nutritional tolerance is a measure of efficacy of STEP and should be presented as a primary or secondary outcome. By standardizing data collection on children undergoing STEP procedure, better determination of nutritional benefit from STEP can be ascertained.

Anti-Hu antibodies activate enteric and sensory neurons

PubMed Central

Li, Qin; Michel, Klaus; Annahazi, Anita; Demir, Ihsan E.; Ceyhan, Güralp O.; Zeller, Florian; Komorowski, Lars; Stöcker, Winfried; Beyak, Michael J.; Grundy, David; Farrugia, Gianrico; De Giorgio, Roberto; Schemann, Michael

2016-01-01

IgG of type 1 anti-neuronal nuclear antibody (ANNA-1, anti-Hu) specificity is a serological marker of paraneoplastic neurological autoimmunity (including enteric/autonomic) usually related to small-cell lung carcinoma. We show here that IgG isolated from such sera and also affinity-purified anti-HuD label enteric neurons and cause an immediate spike discharge in enteric and visceral sensory neurons. Both labelling and activation of enteric neurons was prevented by preincubation with the HuD antigen. Activation of enteric neurons was inhibited by the nicotinic receptor antagonists hexamethonium and dihydro-β-erythroidine and reduced by the P2X antagonist pyridoxal phosphate-6-azo (benzene-2,4-disulfonic acid (PPADS) but not by the 5-HT3 antagonist tropisetron or the N-type Ca-channel blocker ω-Conotoxin GVIA. Ca++ imaging experiments confirmed activation of enteric neurons but not enteric glia. These findings demonstrate a direct excitatory action of ANNA-1, in particular anti-HuD, on visceral sensory and enteric neurons, which involves nicotinic and P2X receptors. The results provide evidence for a novel link between nerve activation and symptom generation in patients with antibody-mediated gut dysfunction. PMID:27905561

30 CFR 77.508-1 - Lightning arresters; wires entering buildings.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Lightning arresters; wires entering buildings... OF UNDERGROUND COAL MINES Electrical Equipment-General § 77.508-1 Lightning arresters; wires entering buildings. Lightning arresters protecting exposed telephone wires entering buildings shall be provided at...

30 CFR 77.508-1 - Lightning arresters; wires entering buildings.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Lightning arresters; wires entering buildings... OF UNDERGROUND COAL MINES Electrical Equipment-General § 77.508-1 Lightning arresters; wires entering buildings. Lightning arresters protecting exposed telephone wires entering buildings shall be provided at...

30 CFR 77.508-1 - Lightning arresters; wires entering buildings.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Lightning arresters; wires entering buildings... OF UNDERGROUND COAL MINES Electrical Equipment-General § 77.508-1 Lightning arresters; wires entering buildings. Lightning arresters protecting exposed telephone wires entering buildings shall be provided at...

30 CFR 77.508-1 - Lightning arresters; wires entering buildings.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Lightning arresters; wires entering buildings... OF UNDERGROUND COAL MINES Electrical Equipment-General § 77.508-1 Lightning arresters; wires entering buildings. Lightning arresters protecting exposed telephone wires entering buildings shall be provided at...

30 CFR 77.508-1 - Lightning arresters; wires entering buildings.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Lightning arresters; wires entering buildings... OF UNDERGROUND COAL MINES Electrical Equipment-General § 77.508-1 Lightning arresters; wires entering buildings. Lightning arresters protecting exposed telephone wires entering buildings shall be provided at...

Diagnosing clostridial enteric disease in poultry.

PubMed

Cooper, Kerry K; Songer, J Glenn; Uzal, Francisco A

2013-05-01

The world's poultry industry has grown into a multibillion-dollar business, the success of which hinges on healthy intestinal tracts, which result in effective feed conversion. Enteric disease in poultry can have devastating economic effects on producers, due to high mortality rates and poor feed efficiency. Clostridia are considered to be among the most important agents of enteric disease in poultry. Diagnosis of enteric diseases produced by clostridia is usually challenging, mainly because many clostridial species can be normal inhabitants of the gut, making it difficult to determine their role in virulence. The most common clostridial enteric disease in poultry is necrotic enteritis, caused by Clostridium perfringens, which typically occurs in broiler chickens but has also been diagnosed in various avian species including turkeys, waterfowl, and ostriches. Diagnosis is based on clinical and pathological findings. Negative culture and toxin detection results may be used to rule out this disease, but isolation of C. perfringens and/or detection of its alpha toxin are of little value to confirm the disease because both are often found in the intestine of healthy birds. Ulcerative enteritis, caused by Clostridium colinum, is the other major clostridial enteric disease of poultry. Diagnosis of ulcerative enteritis is by documentation of typical pathological findings, coupled with isolation of C. colinum from the intestine of affected birds. Other clostridial enteric diseases include infections produced by Clostridium difficile, Clostridium fallax, and Clostridium baratii.

Enteral Nutrition Is a Risk Factor for Airway Complications in Subjects Undergoing Noninvasive Ventilation for Acute Respiratory Failure.

PubMed

Kogo, Mariko; Nagata, Kazuma; Morimoto, Takeshi; Ito, Jiro; Sato, Yuki; Teraoka, Shunsuke; Fujimoto, Daichi; Nakagawa, Atsushi; Otsuka, Kojiro; Tomii, Keisuke

2017-04-01

Early enteral nutrition is recommended for mechanically ventilated patients in several studies and guidelines. In contrast, the effects of early enteral nutrition on noninvasive ventilation (NIV) have not been investigated extensively. The lack of an established method of airway protection suggests that enteral nutrition administration to these patients could increase airway complications and worsen outcomes. Between January 2007 and January 2015, 150 patients were admitted to our respiratory department for acute respiratory failure and received NIV for >48 h. Of these, 107 subjects incapable of oral intake were retrospectively analyzed. Clinical background and complications were compared in subjects who did and did not receive enteral nutrition. Sixty of the 107 subjects (56%) incapable of oral intake who received NIV also received enteral nutrition. Serum albumin concentration was significantly lower in subjects who received enteral nutrition than in those who did not (mean 2.7 ± 0.68 mg/dL vs 3.0 ± 0.75 mg/dL, P = .048). The rate of airway complications was significantly higher (53% [32/60] vs 32% [15/47], P = .03), and median NIV duration was significantly longer (16 [interquartile range 7-43] d vs 8 [5-20] d, P = .02) in subjects who received enteral nutrition than in those who did not. Multivariate analysis showed that enteral nutrition was unrelated to in-hospital mortality. Among subjects receiving NIV, enteral nutrition was associated with increased risk of airway complications but did not affect mortality. Enteral nutrition should be carefully considered in these patients. Copyright © 2017 by Daedalus Enterprises.

Surface properties of semi-synthetic enteric coating films: Opportunities to develop bio-based enteric coating films for colon- targeted delivery

USDA-ARS?s Scientific Manuscript database

This study investigated the surface properties of the semi-synthetic enteric coating materials for potential colon- targeted bioactive delivery. The enteric coating materials were produced by combining nanoscale resistant starch, pectin, and carboxymethylcellulose. The surface properties of the co...

75 FR 68040 - Proposed Information Collection Activity: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-04

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0663 (Pay Now Enter Info Page)] Proposed... of automated collection techniques or the use of other forms of information technology. Title: Pay... make online payments through VA's Pay Now Enter Info Page Web site. Data entered on the Pay Now Enter...

9 CFR 113.204 - Mink Enteritis Vaccine, Killed Virus.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Mink Enteritis Vaccine, Killed Virus... REQUIREMENTS Killed Virus Vaccines § 113.204 Mink Enteritis Vaccine, Killed Virus. Mink Enteritis Vaccine... prior to challenge. If unfavorable reactions attributable to the vaccine occur, the serial is...

9 CFR 113.204 - Mink Enteritis Vaccine, Killed Virus.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Mink Enteritis Vaccine, Killed Virus... REQUIREMENTS Killed Virus Vaccines § 113.204 Mink Enteritis Vaccine, Killed Virus. Mink Enteritis Vaccine... prior to challenge. If unfavorable reactions attributable to the vaccine occur, the serial is...

9 CFR 113.204 - Mink Enteritis Vaccine, Killed Virus.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Mink Enteritis Vaccine, Killed Virus... REQUIREMENTS Killed Virus Vaccines § 113.204 Mink Enteritis Vaccine, Killed Virus. Mink Enteritis Vaccine... prior to challenge. If unfavorable reactions attributable to the vaccine occur, the serial is...

9 CFR 113.204 - Mink Enteritis Vaccine, Killed Virus.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Mink Enteritis Vaccine, Killed Virus... REQUIREMENTS Killed Virus Vaccines § 113.204 Mink Enteritis Vaccine, Killed Virus. Mink Enteritis Vaccine... prior to challenge. If unfavorable reactions attributable to the vaccine occur, the serial is...

9 CFR 113.204 - Mink Enteritis Vaccine, Killed Virus.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Mink Enteritis Vaccine, Killed Virus... REQUIREMENTS Killed Virus Vaccines § 113.204 Mink Enteritis Vaccine, Killed Virus. Mink Enteritis Vaccine... prior to challenge. If unfavorable reactions attributable to the vaccine occur, the serial is...

An introduction to food and waterborne viruses: diseases, transmission, outbreaks, detection and control

USDA-ARS?s Scientific Manuscript database

Enteric viruses are the number one cause of foodborne illness throughout the world. In addition to foods, contaminated drinking water is another major cause of enteric viral illness. Among the enteric viruses are the noroviruses, hepatitis A and E viruses, enteric adenoviruses, rotavirus, and astro...

A novel subset of enteric neurons revealed by ptf1a:GFP in the developing zebrafish enteric nervous system.

PubMed

Uribe, Rosa A; Gu, Tiffany; Bronner, Marianne E

2016-03-01

The enteric nervous system, the largest division of the peripheral nervous system, is derived from vagal neural crest cells that invade and populate the entire length of the gut to form diverse neuronal subtypes. Here, we identify a novel population of neurons within the enteric nervous system of zebrafish larvae that express the transgenic marker ptf1a:GFP within the midgut. Genetic lineage analysis reveals that enteric ptf1a:GFP(+) cells are derived from the neural crest and that most ptf1a:GFP(+) neurons express the neurotransmitter 5HT, demonstrating that they are serotonergic. This transgenic line, Tg(ptf1a:GFP), provides a novel neuronal marker for a subpopulation of neurons within the enteric nervous system, and highlights the possibility that Ptf1a may act as an important transcription factor for enteric neuron development. © 2016 Wiley Periodicals, Inc.

30 CFR 77.1502 - Auger holes; restriction against entering.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Auger holes; restriction against entering. 77... UNDERGROUND COAL MINES Auger Mining § 77.1502 Auger holes; restriction against entering. No person shall be permitted to enter an auger hole except with the approval of the MSHA Coal Mine Safety and Health District...

30 CFR 77.1502 - Auger holes; restriction against entering.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Auger holes; restriction against entering. 77... UNDERGROUND COAL MINES Auger Mining § 77.1502 Auger holes; restriction against entering. No person shall be permitted to enter an auger hole except with the approval of the MSHA Coal Mine Safety and Health District...

30 CFR 77.1502 - Auger holes; restriction against entering.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Auger holes; restriction against entering. 77... UNDERGROUND COAL MINES Auger Mining § 77.1502 Auger holes; restriction against entering. No person shall be permitted to enter an auger hole except with the approval of the MSHA Coal Mine Safety and Health District...

30 CFR 77.1502 - Auger holes; restriction against entering.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Auger holes; restriction against entering. 77... UNDERGROUND COAL MINES Auger Mining § 77.1502 Auger holes; restriction against entering. No person shall be permitted to enter an auger hole except with the approval of the MSHA Coal Mine Safety and Health District...

A Comparative Study of Recent Trends and Characteristics of Students Entering American Junior Colleges, 1968-72.

ERIC Educational Resources Information Center

Fenske, Robert H.; Scott, Craig S.

Recent changes in the background characteristics and attributes of students entering American junior colleges are compared with those of students entering colleges offering baccalaureate and graduate degrees. Comparisons are also made between students entering private and public junior colleges. The characteristics and attributes are: Level of…

77 FR 69650 - Agency Information Collection Activities: Holders or Containers Which Enter the United States...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-20

... Activities: Holders or Containers Which Enter the United States Duty Free AGENCY: U.S. Customs and Border... information collection requirement concerning the Holders or Containers which Enter the United States Duty... concerning the following information collection: Title: Holders or Containers which Enter the United States...

30 CFR 77.1502 - Auger holes; restriction against entering.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Auger holes; restriction against entering. 77... UNDERGROUND COAL MINES Auger Mining § 77.1502 Auger holes; restriction against entering. No person shall be permitted to enter an auger hole except with the approval of the MSHA Coal Mine Safety and Health District...

Expansion and differentiation of neural progenitors derived from the human adult enteric nervous system.

PubMed

Metzger, Marco; Bareiss, Petra M; Danker, Timm; Wagner, Silvia; Hennenlotter, Joerg; Guenther, Elke; Obermayr, Florian; Stenzl, Arnulf; Koenigsrainer, Alfred; Skutella, Thomas; Just, Lothar

2009-12-01

Neural stem and progenitor cells from the enteric nervous system have been proposed for use in cell-based therapies against specific neurogastrointestinal disorders. Recently, enteric neural progenitors were generated from human neonatal and early postnatal (until 5 years after birth) gastrointestinal tract tissues. We investigated the proliferation and differentiation of enteric nervous system progenitors isolated from human adult gastrointestinal tract. Human enteric spheroids were generated from adult small and large intestine tissues and then expanded and differentiated, depending on the applied cell culture conditions. For implantation studies, spheres were grafted into fetal slice cultures and embryonic aganglionic hindgut explants from mice. Differentiating enteric neural progenitors were characterized by 5-bromo-2-deoxyuridine labeling, in situ hybridization, immunocytochemistry, quantitative real-time polymerase chain reaction, and electrophysiological studies. The yield of human neurosphere-like bodies was increased by culture in conditional medium derived from fetal mouse enteric progenitors. We were able to generate proliferating enterospheres from adult human small or large intestine tissues; these enterospheres could be subcultured and maintained for several weeks in vitro. Spheroid-derived cells could be differentiated into a variety of neuronal subtypes and glial cells with characteristics of the enteric nervous system. Experiments involving implantation into organotypic intestinal cultures showed the differentiation capacity of neural progenitors in a 3-dimensional environment. It is feasible to isolate and expand enteric progenitor cells from human adult tissue. These findings offer new strategies for enteric stem cell research and future cell-based therapies.

Damage to enteric neurons occurs in mice that develop fatty liver disease but not diabetes in response to a high-fat diet.

PubMed

Rivera, L R; Leung, C; Pustovit, R V; Hunne, B L; Andrikopoulos, S; Herath, C; Testro, A; Angus, P W; Furness, J B

2014-08-01

Disorders of gastrointestinal functions that are controlled by enteric neurons commonly accompany fatty liver disease. Established fatty liver disease is associated with diabetes, which itself induces enteric neuron damage. Here, we investigate the relationship between fatty liver disease and enteric neuropathy, in animals fed a high-fat, high-cholesterol diet in the absence of diabetes. Mice were fed a high-fat, high-cholesterol diet (21% fat, 2% cholesterol) or normal chow for 33 weeks. Liver injury was assessed by hematoxylin and eosin, picrosirius red staining, and measurement of plasma alanine aminotransaminase (ALT). Quantitative immunohistochemistry was performed for different types of enteric neurons. The mice developed steatosis, steatohepatitis, fibrosis, and a 10-fold increase in plasma ALT, indicative of liver disease. Oral glucose tolerance was unchanged. Loss and damage to enteric neurons occurred in the myenteric plexus of ileum, cecum, and colon. Total numbers of neurons were reduced by 15-30% and neurons expressing nitric oxide synthase were reduced by 20-40%. The RNA regulating protein, Hu, became more concentrated in the nuclei of enteric neurons after high-fat feeding, which is an indication of stress on the enteric nervous system. There was also disruption of the neuronal cytoskeletal protein, neurofilament medium. Enteric neuron loss and damage occurs in animals with fatty liver disease in the absence of glucose intolerance. The enteric neuron damage may contribute to the gastrointestinal complications of fatty liver disease. © 2014 John Wiley & Sons Ltd.

7 CFR 319.8-14 - Mexican cotton and covers not otherwise enterable.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 5 2013-01-01 2013-01-01 false Mexican cotton and covers not otherwise enterable. 319... Cotton and Covers Special Conditions for the Entry of Cotton and Covers from Mexico § 319.8-14 Mexican cotton and covers not otherwise enterable. Mexican cotton and covers not enterable under § 319.8-11...

7 CFR 319.8-14 - Mexican cotton and covers not otherwise enterable.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 5 2011-01-01 2011-01-01 false Mexican cotton and covers not otherwise enterable. 319... Cotton and Covers Special Conditions for the Entry of Cotton and Covers from Mexico § 319.8-14 Mexican cotton and covers not otherwise enterable. Mexican cotton and covers not enterable under § 319.8-11...

7 CFR 319.8-14 - Mexican cotton and covers not otherwise enterable.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 5 2010-01-01 2010-01-01 false Mexican cotton and covers not otherwise enterable. 319... Cotton and Covers Special Conditions for the Entry of Cotton and Covers from Mexico § 319.8-14 Mexican cotton and covers not otherwise enterable. Mexican cotton and covers not enterable under § 319.8-11...

7 CFR 319.8-14 - Mexican cotton and covers not otherwise enterable.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 5 2014-01-01 2014-01-01 false Mexican cotton and covers not otherwise enterable. 319... Cotton and Covers Special Conditions for the Entry of Cotton and Covers from Mexico § 319.8-14 Mexican cotton and covers not otherwise enterable. Mexican cotton and covers not enterable under § 319.8-11...

7 CFR 319.8-14 - Mexican cotton and covers not otherwise enterable.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 5 2012-01-01 2012-01-01 false Mexican cotton and covers not otherwise enterable. 319... Cotton and Covers Special Conditions for the Entry of Cotton and Covers from Mexico § 319.8-14 Mexican cotton and covers not otherwise enterable. Mexican cotton and covers not enterable under § 319.8-11...

Thermal inactivation of enteric viruses and bioaccumulation of enteric foodborne viruses in live oysters (Crassostrea virginica)

USDA-ARS?s Scientific Manuscript database

Human enteric viruses are one of the main causative agents of shellfish associated outbreaks. In this study, the kinetics of viral bioaccumulation in live oysters and the heat stability of the most predominant enteric viruses were determined in both tissue culture and in oyster tissues. A human nor...

Early postoperative enteral nutrition is useful for recovering gastrointestinal motility and maintaining the nutritional status.

PubMed

Kawasaki, Naruo; Suzuki, Yutaka; Nakayoshi, Tomoko; Hanyu, Nobuyoshi; Nakao, Masatoshi; Takeda, Akihiro; Furukawa, Yoshiyuki; Kashiwagi, Hideyuki

2009-01-01

The efficacy of enteral nutrition in postoperative nutritional management is known, but the effects on gastrointestinal motility and nutrition have not yet been elucidated. The purpose of this study was to compare the effects of enteral and parenteral nutrition soon after open abdominal surgery on gastrointestinal motility and nutritional status. A partial resection of rectum models was prepared to compare two types of nutrient administration: enteral nutrition and total parenteral nutrition. The differences between the effects of nutrition types in terms of gastrointestinal motility and nutritional status were investigated. Enteral nutrition contributed to recovery of gastrointestinal motility and maintenance of nutritional status. Enteral nutrition should therefore be initiated soon after surgery if the gastrointestinal tract is available.

Luminous Enteric Bacteria of Marine Fishes: a Study of Their Distribution, Densities, and Dispersion †

PubMed Central

Ruby, E. G.; Morin, J. G.

1979-01-01

Three taxa of luminous bacteria (Photobacterium fischeri, P. phosphoreum, and Beneckea spp.) were found in the enteric microbial populations of 22 species of surface- and midwater-dwelling fishes. These bacteria often occurred in concentrations ranging between 105 and 107 colony-forming units per ml of enteric contents. By using a genetically marked strain, it was determined that luminous cells entering the fish during ingestion of seawater or contaminated particles traversed the alimentary tract and survived the digestive processes. After excretion, luminous bacteria proliferated extensively on the fecal material and became distributed into the surrounding seawater. Thus, this enteric habitat may serve as an enrichment of viable cells entering the planktonic luminous population. PMID:16345429

Enteral Formulas in Nutrition Support Practice: Is There a Better Choice for Your Patient?

PubMed

Escuro, Arlene A; Hummell, A Christine

2016-12-01

Over the past few decades, the number of enteral formulas for use in hospitalized, critically ill, and home enteral patients has dramatically increased. Several enteral nutrition (EN) formula categories exist, which makes it challenging for clinicians to sort through the product claims and find the appropriate formula for the patient. Many formulas are available within each category, some of which may be significantly different from one another. Numerous systematic reviews of existing research and clinical practice guidelines evaluate the use of specialty formulas. This review aims to examine the differences in various enteral formula categories, identify applications in clinical practice, and evaluate the existing evidence and guideline recommendations for use of specific types of enteral formulas.

Enteric microbiota leads to new therapeutic strategies for ulcerative colitis.

PubMed

Chen, Wei-Xu; Ren, Li-Hua; Shi, Rui-Hua

2014-11-14

Ulcerative colitis (UC) is a leading form of inflammatory bowel disease that involves chronic relapsing or progressive inflammation. As a significant proportion of UC patients treated with conventional therapies do not achieve remission, there is a pressing need for the development of more effective therapies. The human gut contains a large, diverse, and dynamic population of microorganisms, collectively referred to as the enteric microbiota. There is a symbiotic relationship between the human host and the enteric microbiota, which provides nutrition, protection against pathogenic organisms, and promotes immune homeostasis. An imbalance of the normal enteric microbiota composition (termed dysbiosis) underlies the pathogenesis of UC. A reduction of enteric microbiota diversity has been observed in UC patients, mainly affecting the butyrate-producing bacteria, such as Faecalibacterium prausnitzii, which can repress pro-inflammatory cytokines. Many studies have shown that enteric microbiota plays an important role in anti-inflammatory and immunoregulatory activities, which can benefit UC patients. Therefore, manipulation of the dysbiosis is an attractive approach for UC therapy. Various therapies targeting a restoration of the enteric microbiota have shown efficacy in treating patients with active and chronic forms of UC. Such therapies include fecal microbiota transplantation, probiotics, prebiotics, antibiotics, helminth therapy, and dietary polyphenols, all of which can alter the abundance and composition of the enteric microbiota. Although there have been many large, randomized controlled clinical trials assessing these treatments, the effectiveness and safety of these bacteria-driven therapies need further evaluation. This review focuses on the important role that the enteric microbiota plays in maintaining intestinal homeostasis and discusses new therapeutic strategies targeting the enteric microbiota for UC.

Association Between Enteral Feeding, Weight Status, and Mortality in a Medical Intensive Care Unit.

PubMed

Vest, Michael T; Kolm, Paul; Bowen, James; Trabulsi, Jillian; Lennon, Shannon L; Shapero, Mary; McGraw, Patty; Halbert, James; Jurkovitz, Claudine

2018-03-01

Clinical practice guidelines recommend enteral nutrition for most patients receiving mechanical ventilation. However, recently published evidence on the effect of enteral nutrition on mortality, particularly for patients who are well nourished, is conflicting. To examine the association between enteral feeding and hospital mortality in critically ill patients receiving mechanical ventilation and to determine if body mass index mediates this relationship. A retrospective cohort study of patients receiving mechanical ventilation admitted to a medical intensive care unit in 2013. Demographic and clinical variables were collected. Cox proportional hazards regression was used to examine the relationship between an enteral feeding order and hospital mortality and to determine if the relationship was mediated by body mass index. Of 777 patients who had 811 hospitalizations requiring mechanical ventilation, 182 (23.4%) died in the hospital. A total of 478 patients (61.5%) received an order for enteral tube feeding, which was associated with a lower risk of death (hazard ratio, 0.41; 95% CI, 0.29-0.59). Body mass index did not mediate the relationship between mortality and receipt of an order for enteral feeding. Median stay in the unit was 3.6 days. Most deaths (72.0%) occurred more than 48 hours after admission. The finding of a positive association between an order for enteral feeding and survival supports enteral feeding of patients in medical intensive care units. Furthermore, the beneficial effect of enteral feeding appears to apply to patients regardless of body mass index. ©2018 American Association of Critical-Care Nurses.

Predicting Full Enteral Feeding in the Postoperative Period in Infants with Congenital Diaphragmatic Hernia.

PubMed

Zozaya, Carlos; Triana, Miryam; Madero, Rosario; Abrams, Steven; Martinez, Leopoldo; Amesty, Maria Virginia; Pipaón, Miguel Sáenz de

2017-10-01

Introduction  The objective of the study is to examine the factors associated with time to achieve full enteral feeding after repair of congenital diaphragmatic hernia. Materials and Methods  Demographic, clinical, and therapeutic data were retrospectively assessed, and uni- and multivariate Cox regression were performed to examine factors predictive of achieving full enteral feeding that was defined as time to achieve120 mL/kg/d after surgical repair. Results  Of 78 infants, 66 underwent intervention before hospital discharge. All infants who survived had reached full enteral feeding at the time of hospital discharge by a median of 22 days (range: 2-119 days) after surgery and 10 days (range: 1-91) after initiation of postoperative enteral feedings. Independent risk factors associated with a longer time to reach full enteral feeding achievement included gastroesophageal reflux and days of antibiotics in the postoperative period. Daily stool passage preoperatively predicted earlier enteral tolerance. Conclusion  Infants who survive congenital diaphragmatic hernia generally are able to achieve full enteral feedings after surgical repair. A longer time to full feeding is needed in the most severe cases, but some specific characteristics can be used to help identify patients at higher risk. Although some of these characteristics are unavoidable, others including rational antibiotic usage and active gastroesophageal reflux prevention and treatment are feasible and may improve enteral tolerance. Georg Thieme Verlag KG Stuttgart · New York.

36 CFR 1280.64 - What entrance should I use to enter the National Archives at College Park?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What entrance should I use to enter the National Archives at College Park? 1280.64 Section 1280.64 Parks, Forests, and Public Property... enter the National Archives at College Park? You may enter the National Archives at College Park...

Experiential Journey of Females Who Enter or Re-Enter College Later in Life to Degree Completion

ERIC Educational Resources Information Center

Johnston, Rita Audy

2017-01-01

Given the scope and paucity of knowledge about the lived experiences of the female adult student entering or re-entering college later in life to degree completion, this research study identified significant themes in their lived experiences. With an appreciative eye, this study captured the female adult students' lived experiences conveyed in a…

[Role of nutritional support in the treatment of enteric fistulas].

PubMed

Amodeo, Corrado; Caglià, Pietro; Gandolfo, Luigi; Veroux, Massimiliano; Brancato, Giovanna; Donati, Marcello

2002-01-01

Enteric fistulas are nowadays considered an important therapeutic challenge. Artificial, total parenteral and enteral nutrition have allowed an improvement in the healing of these fistulas and a lower incidence of mortality. Fourteen patients with enteric fistulas (10 men, 4 women; mean age: 64.4 years; range: 20-80 years) were observed. The fistula was located in the large bowel in 11 patients, in the ileum in 2, and in the jejunum in 1. Thirteen patients received enteral nutrition. The patient with the jejunal fistula received total parenteral nutrition for 30 days and then enteral nutrition. The fistulas were successfully treated in 11 patients. One patients underwent surgery after 6 weeks of treatment with enteral nutrition because of lack of improvement of the symptomatology. In two patients, with advanced cancer of the colon and stomach, respectively, only a reduction of the fistula output was achieved. Nutritional support in the treatment of enteric fistulas is an effective procedure widely utilised to restore adequate nutritional status and bowel rest, which are two important targets for achieving fistula closure. Nutritional support is also useful in the management of patients undergoing surgery in order to reduce the postoperative complication rate.

How do swine practitioners and veterinary pathologists arrive at a diagnosis of Clostridium perfringens type A enteritis in neonatal piglets?

PubMed

Chan, Gloria; Farzan, Abdolvahab; Prescott, John F; Friendship, Robert

2013-05-01

A questionnaire was administered to 22 veterinary practitioners and 17 veterinary pathologists to investigate the methods used for diagnosis of Clostridium perfringens type A enteritis in neonatal pigs. Practitioners generally diagnosed C. perfringens type A associated enteritis by age of onset of diarrhea (between 1 to 7 days of age). Most practitioners (95%) were moderately to very confident in their diagnosis. Pathologists generally diagnosed C. perfringens type A associated enteritis by combinations of isolation of the organism, genotyping or detecting the toxins of the organism, and ruling out other pathogens through histopathology. Almost half (41%) of the pathologists were not confident of their diagnosis. This study reports that the current diagnostic method for C. perfringens type A enteritis is not specific, and although many pathologists expressed reservations about making a diagnosis of C. perfringens type A enteritis, most practitioners were confident in their diagnosis, even though reported clinical signs of clostridial diarrhea are similar to those of a number of other enteric diseases.

High-fat enteral nutrition reduces intestinal mucosal barrier damage after peritoneal air exposure.

PubMed

Tan, Shan-Jun; Yu, Chao; Yu, Zhen; Lin, Zhi-Liang; Wu, Guo-Hao; Yu, Wen-Kui; Li, Jie-Shou; Li, Ning

2016-05-01

Peritoneal air exposure is needed in open abdominal surgery, but long-time exposure could induce intestinal mucosal barrier dysfunction followed by many postoperative complications. High-fat enteral nutrition can ameliorate intestinal injury and improve intestinal function in many gastrointestinal diseases. In the present study, we investigated the effect of high-fat enteral nutrition on intestinal mucosal barrier after peritoneal air exposure and the underlying mechanism. Male adult rats were administrated saline, low-fat or high-fat enteral nutrition via gavage before and after peritoneal air exposure for 3 h. Rats undergoing anesthesia without laparotomy received saline as control. Twenty four hours after surgery, samples were collected to assess intestinal mucosal barrier changes in serum D-lactate levels, intestinal permeability, intestinal tight junction protein ZO-1 and occludin levels, and intestinal histopathology. The levels of malondialdehyde and the activity of superoxide dismutase in the ileum tissue were also measured to assess the status of intestinal oxidative stress. High-fat enteral nutrition significantly decreased the serum D-lactate level and increased the intestinal tight junction protein ZO-1 level when compared to the group treated with low-fat enteral nutrition (P < 0.05). Meanwhile, histopathologic findings showed that the intestinal mucosal injury assessed by the Chiu's score and the intestinal epithelial tight junction were also improved much more in the high-fat enteral nutrition-treated group (P < 0.05). In addition, the intestinal malondialdehyde level was lower, and the intestinal superoxide dismutase activity was higher in the high-fat enteral nutrition-treated group than that in the low-fat enteral nutrition-treated group (P < 0.05). These results suggest that high-fat enteral nutrition could reduce intestinal mucosal barrier damage after peritoneal air exposure, and the underlying mechanism may be associated with its antioxidative action. Perioperative administration of high-fat enteral nutrition may be a promising intervention to preserve intestinal mucosal barrier function in open abdominal surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Enteral nutrition - child - managing problems

MedlinePlus

... page: //medlineplus.gov/ency/patientinstructions/000164.htm Enteral nutrition - child - managing problems To use the sharing features ... trouble breathing, call 911. References Mcclave SA. Enteral nutrition. In: Goldman L, Schafer AI, eds. Goldman-Cecil ...

Enteric disease episodes and the risk of acquiring a future sexually transmitted infection: a prediction model in Montreal residents.

PubMed

Caron, Melissa; Allard, Robert; Bédard, Lucie; Latreille, Jérôme; Buckeridge, David L

2016-11-01

The sexual transmission of enteric diseases poses an important public health challenge. We aimed to build a prediction model capable of identifying individuals with a reported enteric disease who could be at risk of acquiring future sexually transmitted infections (STIs). Passive surveillance data on Montreal residents with at least 1 enteric disease report was used to construct the prediction model. Cases were defined as all subjects with at least 1 STI report following their initial enteric disease episode. A final logistic regression prediction model was chosen using forward stepwise selection. The prediction model with the greatest validity included age, sex, residential location, number of STI episodes experienced prior to the first enteric disease episode, type of enteric disease acquired, and an interaction term between age and male sex. This model had an area under the curve of 0.77 and had acceptable calibration. A coordinated public health response to the sexual transmission of enteric diseases requires that a distinction be made between cases of enteric diseases transmitted through sexual activity from those transmitted through contaminated food or water. A prediction model can aid public health officials in identifying individuals who may have a higher risk of sexually acquiring a reportable disease. Once identified, these individuals could receive specialized intervention to prevent future infection. The information produced from a prediction model capable of identifying higher risk individuals can be used to guide efforts in investigating and controlling reported cases of enteric diseases and STIs. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Cellular changes in the enteric nervous system during ageing.

PubMed

Saffrey, M Jill

2013-10-01

The intrinsic neurons of the gut, enteric neurons, have an essential role in gastrointestinal functions. The enteric nervous system is plastic and continues to undergo changes throughout life, as the gut grows and responds to dietary and other environmental changes. Detailed analysis of changes in the ENS during ageing suggests that enteric neurons are more vulnerable to age-related degeneration and cell death than neurons in other parts of the nervous system, although there is considerable variation in the extent and time course of age-related enteric neuronal loss reported in different studies. Specific neuronal subpopulations, particularly cholinergic myenteric neurons, may be more vulnerable than others to age-associated loss or damage. Enteric degeneration and other age-related neuronal changes may contribute to gastrointestinal dysfunction that is common in the elderly population. Evidence suggests that caloric restriction protects against age-associated loss of enteric neurons, but recent advances in the understanding of the effects of the microbiota and the complex interactions between enteric ganglion cells, mucosal immune system and intestinal epithelium indicate that other factors may well influence ageing of enteric neurons. Much remains to be understood about the mechanisms of neuronal loss and damage in the gut, although there is evidence that reactive oxygen species, neurotrophic factor dysregulation and/or activation of a senescence associated phenotype may be involved. To date, there is no evidence for ongoing neurogenesis that might replace dying neurons in the ageing gut, although small local sites of neurogenesis would be difficult to detect. Finally, despite the considerable evidence for enteric neurodegeneration during ageing, and evidence for some physiological changes in animal models, the ageing gut appears to maintain its function remarkably well in animals that exhibit major neuronal loss, indicating that the ENS has considerable functional reserve. © 2013 Elsevier Inc. All rights reserved.

Serum albumin level in the management of postoperative enteric fistula for gastrointestinal cancer patients.

PubMed

Lu, Chien-Yu; Wu, Deng-Chyang; Wu, I-Chen; Chu, Koung-Shing; Sun, Li-Chu; Shih, Ying-Ling; Chen, Fang-Ming; Hsieh, Jan-Sing; Wang, Jaw-Yuan

2008-01-01

Postoperative enteric fistula is a serious complication and cause of death following gastrointestinal (GI)-tract surgery. Many reports have demonstrated the effectiveness of parenteral nutrition in the spontaneous closure of enteric fistula. Our study was aimed at analyzing the prognostic factors of parenteral nutritional support in the treatment of enteric fistula for patients with GI-tract cancer following surgery. GI-tract cancer patients receiving surgical interventions, which then unfortunately developed enteric fistula, were included in our study. All of them had to have received parenteral nutrition soon after leakages were recognized, and they were subsequently divided into successful and unsuccessful (classified as "failure") groups according to spontaneous closure of fistula or not, respectively. The studied patients' laboratory data were collected to identify the clinically relevant prognostic factors. Fifty-three primary GI-tract cancer patients with postoperative enteric fistulas were enrolled into our study. Of these, 33 patients were considered as successful parenteral nutritional therapy (successful group) and the other 20 patients (failure group) were not. After a period of parenteral nutritional therapy, serum total bilirubin, creatinine, C-reactive protein (CRP), hemoglobin, and albumin were significantly different between these two groups (all p < .05). Using a multivariate logistic regression analysis, it was determined that increased serum albumin level was an independent predictive factor of successful management for enteric fistula (p = .029), in addition to the well-known lower drainage amount (< 500 mL/day) from the enteric fistula (p = .013). Our observations show that both serum albumin levels and drainage amounts from the enteric fistula can be potentially used as important prognostic predictors of healing enteric fistula under total parenteral nutrition in patients following surgery for GI-tract malignancies.

Human milk consumption and full enteral feeding among infants who weigh

PubMed

Sisk, Paula M; Lovelady, Cheryl A; Gruber, Kenneth J; Dillard, Robert G; O'Shea, T Michael

2008-06-01

Establishing enteral feeding is an important goal in the care of very low birth weight infants. In such infants, receipt of >/=50 mL/kg per day human milk during hospitalization has been associated with shorter time to full enteral feeding. The objective of this study was to determine whether high proportions (>/=50%) of human milk during feeding advancement are associated with shorter time to full enteral feeding and improved feeding tolerance. This was a prospective cohort study of very low birth weight infants (n = 127) who were grouped into low (<50%; n = 34) and high (>/=50%; n = 93) human milk consumption groups according to their human milk proportion of enteral feeding during the time of feeding advancement. The primary outcomes of interest were ages at which 100 and 150 mL/kg per day enteral feedings were achieved. The high human milk group reached 100 mL/kg per day enteral feeding 4.5 days faster than the low human milk group. The high human milk group reached 150 mL/kg per day enteral feeding 5 days faster than the low human milk group. After adjustment for gestational age, gender, and respiratory distress syndrome, times to reach 100 and 150 mL/kg per day were significantly shorter for those in the high human milk group. Infants in the high human milk group had a greater number of stools per day; other indicators of feeding tolerance were not statistically different. In infants who weighed

Enteral Contrast in the Computed Tomography Diagnosis of Appendicitis

PubMed Central

Drake, Frederick Thurston; Alfonso, Rafael; Bhargava, Puneet; Cuevas, Carlos; Dighe, Manjiri K.; Florence, Michael G.; Johnson, Morris G.; Jurkovich, Gregory J.; Steele, Scott R.; Symons, Rebecca Gaston; Thirlby, Richard C.; Flum, David R.

2014-01-01

Objective Our goal was to perform a comparative effectiveness study of intravenous (IV)-only versus IV + enteral contrast in computed tomographic (CT) scans performed for patients undergoing appendectomy across a diverse group of hospitals. Background Small randomized trials from tertiary centers suggest that enteral contrast does not improve diagnostic performance of CT for suspected appendicitis, but generalizability has not been demonstrated. Eliminating enteral contrast may improve efficiency, patient comfort, and safety. Methods We analyzed data for adult patients who underwent nonelective appendectomy at 56 hospitals over a 2-year period. Data were obtained directly from patient charts by trained abstractors. Multivariate logistic regression was utilized to adjust for potential confounding. The main outcome measure was concordance between final radiology interpretation and final pathology report. Results A total of 9047 adults underwent appendectomy and 8089 (89.4%) underwent CT, 54.1% of these with IV contrast only and 28.5% with IV + enteral contrast. Pathology findings correlated with radiographic findings in 90.0% of patients who received IV + enteral contrast and 90.4% of patients scanned with IV contrast alone. Hospitals were categorized as rural or urban and by their teaching status. Regardless of hospital type, there was no difference in concordance between IV-only and IV + enteral contrast. After adjusting for age, sex, comorbid conditions, weight, hospital type, and perforation, odds ratio of concordance for IV + enteral contrast versus IV contrast alone was 0.95 (95% CI: 0.72–1.25). Conclusions Enteral contrast does not improve CT evaluation of appendicitis in patients undergoing appendectomy. These broadly generalizable results from a diverse group of hospitals suggest that enteral contrast can be eliminated in CT scans for suspected appendicitis. PMID:24598250

Evaluation of routine enteric pathogens in hospitalized patients: A Canadian perspective

PubMed Central

Gough, Kevin; Alfa, Michelle; Harding, Godfrey

1996-01-01

Diarrhea is a frequently encountered problem in hospitalized patients. Since nosocomial spread of routine enteric pathogens such as Salmonella species, Shigella species, Campylobacter species and Escherichia coli O:157 H:7 seldom occurs, testing for these organisms in patients hospitalized for longer than three days has been questioned. The goal of this study was to determine the length of hospitalization preceding detection of routine enteric pathogens and Clostridium difficile cytotoxin, and to develop guidelines for enteric cultures from hospitalized patients. The enteric pathogens detected in 1991 were C difficile toxin B(+), 77%; Campylobacter species, 10%; Salmonella species, 9%; E coli O:157 H:7, 3%; and Shigella species, 1%. For 1992, these numbers were 86%, 9%, 3%, 2% and 0%, respectively. None of the routine enteric pathogens isolated in 1991 or 1992 was detected in patients after their second day of hospitalization. Routine cultures for enteric pathogens on hospitalized patients were eliminated in February 1993, and physician ordering practices were monitored. With the exception of one campylobacter isolate per year, all routine enteric pathogens isolated in 1993 and 1994 were detected by the second day of hospitalization. Compliance with the changed protocol was 76% measured over a four-month period in 1993 and 74% over the year 1994. Savings of $3,648.10 were associated with rejecting 191 ‘inappropriate’ specimens in 1994. It was concluded that routine enteric cultures are unnecessary for patients hospitalized more than two days, and that appreciable financial savings can be achieved if revised protocols for processing stool cultures are instituted. However, when enteric protocol changes are in place compliance must be evaluated to ensure appropriate utilization. PMID:22514438

Water quality indicators: bacteria, coliphages, enteric viruses.

PubMed

Lin, Johnson; Ganesh, Atheesha

2013-12-01

Water quality through the presence of pathogenic enteric microorganisms may affect human health. Coliform bacteria, Escherichia coli and coliphages are normally used as indicators of water quality. However, the presence of above-mentioned indicators do not always suggest the presence of human enteric viruses. It is important to study human enteric viruses in water. Human enteric viruses can tolerate fluctuating environmental conditions and survive in the environment for long periods of time becoming causal agents of diarrhoeal diseases. Therefore, the potential of human pathogenic viruses as significant indicators of water quality is emerging. Human Adenoviruses and other viruses have been proposed as suitable indices for the effective identification of such organisms of human origin contaminating water systems. This article reports on the recent developments in the management of water quality specifically focusing on human enteric viruses as indicators.

The Use of Enteric Contrast Media for Diagnostic CT, MRI, and Ultrasound in Infants and Children: A Practical Approach.

PubMed

Callahan, Michael J; Talmadge, Jennifer M; MacDougall, Robert; Buonomo, Carlo; Taylor, George A

2016-05-01

Enteric contrast media are commonly administered for diagnostic cross-sectional imaging studies in the pediatric population. The purpose of this manuscript is to review the use of enteric contrast media for CT, MRI, and ultrasound in infants, children, and adolescents and to share our experiences at a large tertiary care pediatric teaching hospital. The use of enteric contrast material for diagnostic imaging in infants and children continues to evolve with advances in imaging technology and available enteric contrast media. Many principles of enteric contrast use in pediatric imaging are similar to those in adult imaging, but important differences must be kept in mind when imaging the gastrointestinal tract in infants and children, and practical ways to optimize the imaging examination and the patient experience should be employed where possible.

Settling and survival profile of enteric pathogens in the swine effluent for water reuse purpose.

PubMed

Fongaro, G; Kunz, A; Magri, M E; Schissi, C D; Viancelli, A; Philippi, L S; Barardi, C R M

2016-11-01

The present study evaluated the pathogens persistence and settling profile in swine effluent. We determined the enteric pathogens settling characteristics, their survival and inactivation profile in swine effluent (for water reuse purpose) and in sludge (generated after aerobic treatment - during secondary settling process). The study was performed in laboratorial-scale and in full-scale (manure treatment plant). Enteric viruses and enteric bacteria were used as biomarkers. Results showed that these enteric pathogens were significantly reduced from swine effluent during secondary settling process, and enteric viruses removal was correlated with the suspended solids decantation. The design of secondary settlers can be adapted to improve pathogens removal, by diminishing the solids loading rate per area and time, ending in higher hydraulic retention times. Copyright © 2016 Elsevier GmbH. All rights reserved.

Intensive care nurses' knowledge of enteral nutrition: A descriptive questionnaire.

PubMed

Morphet, Julia; Clarke, Angelique B; Bloomer, Melissa J

2016-12-01

Nurses have an important role in the delivery and management of enteral nutrition in critically ill patients, to prevent iatrogenic malnutrition. It is not clear how nurses source enteral nutrition information. This study aimed to explore Australian nurses' enteral nutrition knowledge and sources of information. Data were collected from members of the Australian College of Critical Care Nurses in May 2014 using an online questionnaire. A combination of descriptive statistics and non-parametric analyses were undertaken to evaluate quantitative data. Content analysis was used to evaluate qualitative data. 359 responses were included in data analysis. All respondents were Registered Nurses with experience working in an Australian intensive care unit or high dependency unit. Most respondents reported their enteral nutrition knowledge was good (n=205, 60.1%) or excellent (n=35, 10.3%), but many lacked knowledge regarding the effect of malnutrition on patient outcomes. Dietitians and hospital protocols were the most valuable sources of enteral nutrition information, but were not consistently utilised. Significant knowledge deficits in relation to enteral nutrition were identified. Dietitians were the preferred source of nurses' enteral nutrition information, however their limited availability impacted their efficacy as an information resource. Educational opportunities for nurses need to be improved to enable appropriate nutritional care in critically ill patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Heterogeneity and phenotypic plasticity of glial cells in the mammalian enteric nervous system.

PubMed

Boesmans, Werend; Lasrado, Reena; Vanden Berghe, Pieter; Pachnis, Vassilis

2015-02-01

Enteric glial cells are vital for the autonomic control of gastrointestinal homeostasis by the enteric nervous system. Several different functions have been assigned to enteric glial cells but whether these are performed by specialized subtypes with a distinctive phenotype and function remains elusive. We used Mosaic Analysis with Double Markers and inducible lineage tracing to characterize the morphology and dynamic molecular marker expression of enteric GLIA in the myenteric plexus. Functional analysis in individually identified enteric glia was performed by Ca(2+) imaging. Our experiments have identified four morphologically distinct subpopulations of enteric glia in the gastrointestinal tract of adult mice. Marker expression analysis showed that the majority of glia in the myenteric plexus co-express glial fibrillary acidic protein (GFAP), S100β, and Sox10. However, a considerable fraction (up to 80%) of glia outside the myenteric ganglia, did not label for these markers. Lineage tracing experiments suggest that these alternative combinations of markers reflect dynamic gene regulation rather than lineage restrictions. At the functional level, the three myenteric glia subtypes can be distinguished by their differential response to adenosine triphosphate. Together, our studies reveal extensive heterogeneity and phenotypic plasticity of enteric glial cells and set a framework for further investigations aimed at deciphering their role in digestive function and disease. © 2014 Wiley Periodicals, Inc.

A single-centre experience of Roux-en-Y enteric drainage for pancreas transplantation.

PubMed

Amin, Irum; Butler, Andrew J; Defries, Gail; Russell, Neil K; Harper, Simon J F; Jah, Asif; Saeb-Parsy, Kourosh; Pettigrew, Gavin J; Watson, Christopher J E

2017-04-01

Exocrine drainage following pancreas transplantation can be achieved by drainage into the bladder or bowel, the latter typically by direct duodeno-jejunostomy; the use of Roux-en-Y enteric drainage is uncommon. We report a retrospective analysis of a single-centre experience of Roux-en-Y enteric drainage following pancreas transplantation. Over a 14-year period (2001-2015), 204 consecutive adult pancreas transplants were performed (96.6% simultaneous pancreas and kidney transplants), of which 26.0% were from donors after circulatory death (DCD). During a median follow-up of 67 months (range 13-183 months), 14 (6.9%) recipients experienced complications related to their enteric drainage. Complications during follow-up included early enteric anastomotic haemorrhage (five patients), non-anastomotic enteric bleeding (one patient), small bowel obstruction (four patients) and graft duodenal perforation (two within 6 weeks, five beyond 12 months). No recipient lost their graft as a direct result of complications related to enteric drainage. Patient and pancreas graft survival at 1 year was 99.0% and 94.0% and at 5 years 91.3% and 84.9%, respectively. We conclude that Roux-en-Y enteric drainage following pancreas transplantation is a safe and effective procedure and facilitates graft salvage in the event of graft duodenal perforation. © 2017 Steunstichting ESOT.

Do enteric neurons make hypocretin?

PubMed

Baumann, Christian R; Clark, Erika L; Pedersen, Nigel P; Hecht, Jonathan L; Scammell, Thomas E

2008-04-10

Hypocretins (orexins) are wake-promoting neuropeptides produced by hypothalamic neurons. These hypocretin-producing cells are lost in people with narcolepsy, possibly due to an autoimmune attack. Prior studies described hypocretin neurons in the enteric nervous system, and these cells could be an additional target of an autoimmune process. We sought to determine whether enteric hypocretin neurons are lost in narcoleptic subjects. Even though we tried several methods (including whole mounts, sectioned tissue, pre-treatment of mice with colchicine, and the use of various primary antisera), we could not identify hypocretin-producing cells in enteric nervous tissue collected from mice or normal human subjects. These results raise doubts about whether enteric neurons produce hypocretin.

Effectiveness of the herbal medicine daikenchuto for radiation-induced enteritis.

PubMed

Takeda, Takashi; Kamiura, Shouji; Kimura, Tadashi

2008-07-01

Radiation-induced enteritis is a serious clinical problem for which there is currently no recommended standard management. Daikenchuto (DKT) is a Japanese herbal medicine that has been used to treat adhesive bowel obstruction in Japan. This report describes a patient with radiation-induced enteritis whose clinical symptoms were much improved by treatment with DKT. The patient was administered DKT, a traditional Japanese herbal formula, orally (2.5 g 3 times daily). Abdominal distention was evaluated objectively with computed tomography. Gastrointestinal symptoms associated with radiation-induced enteritis were controlled successfully with DKT treatment. DKT treatment may be useful for the management of radiation-induced enteritis.

Retinoic acid temporally orchestrates colonization of the gut by vagal neural crest cells.

PubMed

Uribe, Rosa A; Hong, Stephanie S; Bronner, Marianne E

2018-01-01

The enteric nervous system arises from neural crest cells that migrate as chains into and along the primitive gut, subsequently differentiating into enteric neurons and glia. Little is known about the mechanisms governing neural crest migration en route to and along the gut in vivo. Here, we report that Retinoic Acid (RA) temporally controls zebrafish enteric neural crest cell chain migration. In vivo imaging reveals that RA loss severely compromises the integrity and migration of the chain of neural crest cells during the window of time window when they are moving along the foregut. After loss of RA, enteric progenitors accumulate in the foregut and differentiate into enteric neurons, but subsequently undergo apoptosis resulting in a striking neuronal deficit. Moreover, ectopic expression of the transcription factor meis3 and/or the receptor ret, partially rescues enteric neuron colonization after RA attenuation. Collectively, our findings suggest that retinoic acid plays a critical temporal role in promoting enteric neural crest chain migration and neuronal survival upstream of Meis3 and RET in vivo. Copyright © 2017 Elsevier Inc. All rights reserved.

How do swine practitioners and veterinary pathologists arrive at a diagnosis of Clostridium perfringens type A enteritis in neonatal piglets?

PubMed Central

Chan, Gloria; Farzan, Abdolvahab; Prescott, John F.; Friendship, Robert

2013-01-01

A questionnaire was administered to 22 veterinary practitioners and 17 veterinary pathologists to investigate the methods used for diagnosis of Clostridium perfringens type A enteritis in neonatal pigs. Practitioners generally diagnosed C. perfringens type A associated enteritis by age of onset of diarrhea (between 1 to 7 days of age). Most practitioners (95%) were moderately to very confident in their diagnosis. Pathologists generally diagnosed C. perfringens type A associated enteritis by combinations of isolation of the organism, genotyping or detecting the toxins of the organism, and ruling out other pathogens through histopathology. Almost half (41%) of the pathologists were not confident of their diagnosis. This study reports that the current diagnostic method for C. perfringens type A enteritis is not specific, and although many pathologists expressed reservations about making a diagnosis of C. perfringens type A enteritis, most practitioners were confident in their diagnosis, even though reported clinical signs of clostridial diarrhea are similar to those of a number of other enteric diseases. PMID:24155437

Enterocolitis induced by autoimmune targeting of enteric glial cells: A possible mechanism in Crohn's disease?

NASA Astrophysics Data System (ADS)

Cornet, Anne; Savidge, Tor C.; Cabarrocas, Julie; Deng, Wen-Lin; Colombel, Jean-Frederic; Lassmann, Hans; Desreumaux, Pierre; Liblau, Roland S.

2001-11-01

Early pathological manifestations of Crohn's disease (CD) include vascular disruption, T cell infiltration of nerve plexi, neuronal degeneration, and induction of T helper 1 cytokine responses. This study demonstrates that disruption of the enteric glial cell network in CD patients represents another early pathological feature that may be modeled after CD8+ T cell-mediated autoimmune targeting of enteric glia in double transgenic mice. Mice expressing a viral neoself antigen in astrocytes and enteric glia were crossed with specific T cell receptor transgenic mice, resulting in apoptotic depletion of enteric glia to levels comparable in CD patients. Intestinal and mesenteric T cell infiltration, vasculitis, T helper 1 cytokine production, and fulminant bowel inflammation were characteristic hallmarks of disease progression. Immune-mediated damage to enteric glia therefore may participate in the initiation and/or the progression of human inflammatory bowel disease.

Ca2+ Responses in Enteric Glia are Mediated by Connexin-43 Hemichannels and Modulate Colonic Transit in Mice

PubMed Central

Fried, David; Gomez-Suarez, Roberto A.; Leinninger, Gina M.; Sévigny, Jean; Parpura, Vladimir; Gulbransen, Brian D.

2014-01-01

Background & Aims In the enteric nervous system, neurotransmitters initiate changes in Ca2+ (Ca2+ responses) in glia, but it is not clear how this process affects intestinal function. We investigated whether Ca2+-mediated responses in enteric glial are required to maintain gastrointestinal function. Methods We used in situ Ca2+ imaging to monitor glial Ca2+ responses, which were manipulated with pharmacologic agents or via glia-specific disruption of the gene encoding connexin-43 (Cx43) (hGFAP::creERT2+/−/Cx43f/f mice). Gastrointestinal function was assessed based on pellet output, total gut transit, colonic bead expulsion, and muscle tension recordings. Proteins were localized and quantified by immunohistochemistry, immunoblot, and reverse transcription PCR analyses. Results Ca2+ responses in enteric glia of mice were mediated by Cx43 hemichannels. Cx43 immunoreactivity was confined to enteric glia within the myenteric plexus of the mouse colon; the Cx43 inhibitors carbenoxolone and 43Gap26 inhibited the ability of enteric glia to propagate Ca2+ responses. In vivo attenuation of Ca2+ responses in the enteric glial network slowed gut transit overall and delayed colonic transit—these changes are also observed during normal aging. Altered motility with increasing age was associated with reduced glial Ca2+-mediated responses and changes in glial expression of Cx43 mRNA and protein. Conclusions Ca2+-mediated responses in enteric glia regulate gastrointestinal function in mice. Altered intercellular signaling between enteric glia and neurons might contribute to motility disorders. PMID:24211490

Absolute Bioavailability and Pharmacokinetics of Linezolid in Hospitalized Patients Given Enteral Feedings

PubMed Central

Beringer, Paul; Nguyen, Megan; Hoem, Nils; Louie, Stan; Gill, Mark; Gurevitch, Michael; Wong-Beringer, Annie

2005-01-01

Linezolid is a new antimicrobial agent effective against drug-resistant gram-positive pathogens which are common causes of infections in hospitalized patients. Many such patients rely on the intravenous or enteral route for nutrition and drug administration. Therefore, the bioavailability of linezolid administered enterally in the presence of enteral feedings in hospitalized patients was examined. Eighteen subjects were assessed in a randomized single-dose crossover study; 12 received continuous enteral feedings, while 6 did not (controls). Both groups received linezolid 600 mg intravenously and orally (control) or enterally, with the alternate route of administration separated by a 24-h washout period. Pharmacokinetic parameters derived from noncompartmental and compartmental analysis incorporating linear and nonlinear elimination pathways were compared between groups: F, Ka, Vs, K23, K32, Vmax, Km, and K20 (bioavailability, absorption rate constant, volume of central compartment normalized to body weight, intercompartmental rate constants, maximum velocity, Michaelis-Menten constant, and elimination rate constant, respectively). Pharmacokinetic (PK) data were available from 17 patients. The linezolid oral suspension was rapidly and completely absorbed by either the oral or enteral route of administration. Bioavailability was unaltered in the presence of enteral feedings. PK estimates remain similar regardless of the model applied. At the therapeutic dose used, only slight nonlinearity in elimination was observed. A linezolid oral suspension may be administered via the enteral route to hospitalized patients without compromise in its excellent bioavailability and rapid rate of absorption. Compartmental pharmacokinetic analysis offers a more flexible study application, since bioavailability (F) can be estimated directly with intermixed intravenous/oral doses without a need for a washout period. PMID:16127039

Positive Enteric Contrast Material for Abdominal and Pelvic CT with Automatic Exposure Control: What Is the Effect On Patient Radiation Exposure?

PubMed Central

Wang, Zhen J.; Chen, Katherine S.; Gould, Robert; Coakley, Fergus V.; Fu, Yanjun; Yeh, Benjamin M.

2014-01-01

Objective To assess the effect of positive enteric contrast administration on automatic exposure control (AEC) CT radiation exposure in 1) a CT phantom, and 2) a retrospective review of patients. Materials and Methods We scanned a CT phantom containing simulated bowel that was sequentially filled with water and positive enteric contrast, and recorded the mean volume CT dose index (CTDIvol). We also identified 17 patients who had undergone 2 technically comparable CT scans of the abdomen and pelvis, one with positive enteric contrast and the other with oral water. Paired student t-tests were used to compare the mean CTDIvol between scans performed with and without positive enteric contrast. Both the phantom and patient CT scans were performed using AEC with a fixed noise index. Results The mean CTDIvol for the phantom with simulated bowel containing water and positive enteric contrast were 8.2 ± 0.2 mGy, and 8.7 ± 0.1 mGy (6.1% higher than water, p=0.02), respectively. The mean CTDIvol for patients scanned with oral water and with positive enteric contrast were 11.8mGy and 13.1mGy, respectively (p=0.003). This corresponded to a mean CTDIvol which was 11.0% higher (range: 0.0–20.7% higher) in scans with positive enteric contrast than those with oral water in patients. Conclusions When automatic exposure control is utilized for abdominopelvic CT, the radiation exposure, as measured by CTDIvol, is higher for scans performed with positive enteric contrast than those with oral water. PMID:21493028

21 CFR 558.555 - Semduramicin.

Code of Federal Regulations, 2011 CFR

2011-04-01

... paragraph (d)(1) of this section; for prevention of necrotic enteritis caused by Clostridium perfringens... enteritis caused by Clostridium perfringens susceptible to virginiamycin; for increased rate of weight gain...; for prevention of necrotic enteritis caused by C. perfringens susceptible to virginiamycin. Feed...

21 CFR 558.555 - Semduramicin.

Code of Federal Regulations, 2012 CFR

2012-04-01

... paragraph (d)(1) of this section; for prevention of necrotic enteritis caused by Clostridium perfringens... enteritis caused by Clostridium perfringens susceptible to virginiamycin; for increased rate of weight gain...; for prevention of necrotic enteritis caused by C. perfringens susceptible to virginiamycin. Feed...

21 CFR 558.555 - Semduramicin.

Code of Federal Regulations, 2013 CFR

2013-04-01

... paragraph (d)(1) of this section; for prevention of necrotic enteritis caused by Clostridium perfringens... enteritis caused by Clostridium perfringens susceptible to virginiamycin; for increased rate of weight gain...; for prevention of necrotic enteritis caused by C. perfringens susceptible to virginiamycin. Feed...

Do enteric neurons make hypocretin? ☆

PubMed Central

Baumann, Christian R.; Clark, Erika L.; Pedersen, Nigel P.; Hecht, Jonathan L.; Scammell, Thomas E.

2008-01-01

Hypocretins (orexins) are wake-promoting neuropeptides produced by hypothalamic neurons. These hypocretin-producing cells are lost in people with narcolepsy, possibly due to an autoimmune attack. Prior studies described hypocretin neurons in the enteric nervous system, and these cells could be an additional target of an autoimmune process. We sought to determine whether enteric hypocretin neurons are lost in narcoleptic subjects. Even though we tried several methods (including whole mounts, sectioned tissue, pre-treatment of mice with colchicine, and the use of various primary antisera), we could not identify hypocretin-producing cells in enteric nervous tissue collected from mice or normal human subjects. These results raise doubts about whether enteric neurons produce hypocretin. PMID:18191238

Home enteral nutrition: organisation of services.

PubMed

Green, Sue; Dinenage, Sarah; Gower, Morwenna; Van Wyk, Johanna

2013-05-01

This article discusses how services for people receiving enteral nutrition via a nasogastric or gastrostomy tube at home are organised. The home enteral nutrition team's role is also explored. The National Institute for Health and Care Excellence outlines the need for nutritional support in adults to be high quality and cost effective. It is important therefore that local services are able to provide people receiving enteral nutrition with safe and effective care that they consider satisfactory. The discussion is pertinent to nurses caring for older people because gastrostomy tube placement is increasingly common in people aged over 60. A gastrostomy tube is the usual route by which enteral nutrition is given in the community.

CNET OPN Automated Budget System (COABS)

DTIC Science & Technology

1981-03-01

Automated Budget System. Please enter Today’s Date (mm/dd/yy): // Enter the date required in a series of three two digit numbers. Zero fill fields...containing a single digit . After the date is entered the following four prompts will appear as the RETURN key is touched: Please enter the address of...of item is a four digit number that makes this record unique from all other records of the same functional commander, equipment type, and fiscal year

CALUTRON RECEIVER

DOEpatents

Brunk, W.O.

1959-09-29

A description is given for an improved calutron receiver having a face plate lying at an angle to the direction of the entering ion beams but having an opening, the plane of which is substantially perpendicular to that of the entering ion beams. By so positioning the opening in the receiver, the effective area through which the desired material may enter the receiver is increased, and at the same time the effective area through which containattng material may enter the receiver is reduced.

Detection of human cytomegalovirus (CMV) DNA in feces has limited value in predicting CMV enteritis in patients with intestinal graft-versus-host disease after allogeneic stem cell transplantation.

PubMed

Sun, Y-Q; Xu, L-P; Han, T-T; Zhang, X-H; Wang, Y; Han, W; Wang, F-R; Wang, J-Z; Chen, H; Chen, Y-H; Yan, C-H; Chen, Y; Liu, K-Y; Huang, X-J

2015-10-01

Cytomegalovirus (CMV) enteritis after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is difficult to diagnose. We aimed to evaluate the sensitivity and specificity of the detection of CMV DNA in feces for predicting CMV enteritis. HSCT patients with intestinal graft-versus-host disease (GVHD) were enrolled if they met the following criteria: (i) underwent a colonoscopy and (ii) peripheral blood and feces specimens were available for CMV DNA detection within 24 h of colonoscopy. The colonoscopy histology was used as the gold standard for diagnosing CMV enteritis. Fifty-six patients underwent 58 colonoscopy examinations, and 7 were diagnosed as having CMV enteritis. Within 24 h of colonoscopy, 9 patients had detectable CMV in the feces and 19 patients had detectable CMV in the plasma, respectively. In the 7 patients with CMV enteritis, only 2 had detectable CMV in the stool, resulting in a sensitivity of 28.6%. In the 51 patients without CMV enteritis, 44 had no detectable CMV in the stool, with a specificity of 86.3%. We concluded that CMV detection in the feces was not a good predictor of CMV enteritis in patients with intestinal GVHD after allo-HSCT. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Medication administration via enteral tubes: a survey of nurses' practices.

PubMed

Phillips, Nicole Margaret; Endacott, Ruth

2011-12-01

This article is a report of a study examining the practices of acute care nurses when administering medication via enteral tubes. Administering medication via enteral tubes is predominantly a nursing responsibility across countries. It is important to establish what nurses actually do when giving enteral medication to inform policy and continuing education development. In 2007, a survey was conducted using a random sample of acute care nurses at two large metropolitan hospitals in Melbourne, Australia. There were 181 Registered Nurses who participated in the study; 92 (50.8%) practised in intensive care units, 52 (28.7%) in surgical areas, 30 (16.6%) in medical areas and 7 (3.9%) were from combined medical-surgical areas. The questionnaire was developed by the researchers and a pilot study was conducted in August 2006 to test reliability, face validity and user-friendliness of the tool. Nurses reported using a range of methods to verify enteral tube position prior to administering enteral medication; some were unreliable methods. A majority reported administering enteric-coated and slow or extended release forms of medication, and giving solid forms of medication when liquid form was available. Nearly all (96%) reported flushing a tube after giving medication, 28% before, and 12% always flushed between each medication. Enteral medication administration practices are inconsistent. Some nurses are using unsafe practices and may therefore compromise patient care. © 2011 Blackwell Publishing Ltd.

Evidence of hypercoagulability in dogs with parvoviral enteritis.

PubMed

Otto, C M; Rieser, T M; Brooks, M B; Russell, M W

2000-11-15

To determine whether dogs with naturally occurring canine parvoviral (CPV) enteritis have laboratory evidence of hypercoagulability. Case-control study. Animals-9 dogs with naturally occurring CPV enteritis and 9 age-matched control dogs. Blood was collected from all dogs within 24 hours of admission for thromboelastography (TEG) and determination of activated partial thromboplastin time (aP-TT), prothrombin time (PT), antithrombin III (AT) activity, and fibrinogen concentration. Fibrin-fibrinogen degradation product (FDP) concentration, D-dimer concentration, and platelet count were obtained in dogs with CPV enteritis only. Records were reviewed for evidence of thrombosis or phlebitis. All 9 dogs with CPV enteritis had evidence of hypercoagulability, determined on the basis of significantly increased TEG maximum amplitude and decreased AT activity. Fibrinogen concentration was significantly higher in dogs with CPV enteritis than in control dogs. The aPTT was moderately prolonged in dogs with CPV enteritis, and FDP concentration was < 5 mg/ml in 7 of 9 dogs. No dogs had a measurable D-dimer concentration. Platelet counts were within reference range. Four of 9 dogs had clinical evidence of venous thrombosis or phlebitis associated with catheters. One dog had multifocal splenic thrombosis identified at necropsy. Dogs with CPV enteritis have a high prevalence of clinical thrombosis or phlebitis and laboratory evidence of hypercoagulability without disseminated intravascular coagulopathy. Thromboelastography may help identify hypercoagulable states in dogs.

Critical analysis of the factors associated with enteral feeding in preventing VAP: a systematic review.

PubMed

Chen, Yu-Chih

2009-04-01

Ventilator-associated pneumonia (VAP) is a common cause of morbidity in critically ill patients. Appropriate enteral feeding is the most important factor associated with the prevention of VAP. However, the standardization of enteral feeding methods needs clarification. The purpose of this systematic review was to synthesize the factors associated with enteral feeding in order to prevent VAP and to describe the characteristics of these factors. A comprehensive search was undertaken involving all major databases from their inception to September 2008 using medical subject heading terms associated with enteral feeding in relation to VAP. The overall reference list of identified studies was audited, and eligible studies included randomized controlled trials, controlled before-and-after (pre-post) studies and meta-analyses. To generate the characteristics of the factors associated with VAP, the reported components of these trials were pinpointed and categorized. A total of 14 papers were found that had investigated the factors linking enteral feeding and VAP. For these, 11 were randomized controlled trials, 1 was a meta-analysis and 2 were case-controlled analyses. Twelve of these 14 studies were conducted at a single institute and 2 were conducted at multiple institutes. The sample sizes varied from 10 to 2,528 subjects. Three major issues were identified based on the purpose of study interventions, and these were the effects of feeding method (continuous vs. intermittent), feeding site on aspiration (gastric vs. small bowel), and the timing of enteral feeding (early vs. late). The evidence suggests that a correct choice of enteral feeding method can effectively reduce complications due to aspiration. Furthermore, intermittent enteral feeding and with a small residual volume feed can reduce gastroesophageal reflux, and increased total intake volume and early feeding can reduce ICU mortality. Nonetheless, the effects of these choices on preventing VAP still need further evaluation. A set of clinical guidelines based on these evidence-based findings with respect to enteral feeding is required, particularly one that covers all aspects of the enteral feeding process.

A novel enteric neuron-glia coculture system reveals the role of glia in neuronal development.

PubMed

Le Berre-Scoul, Catherine; Chevalier, Julien; Oleynikova, Elena; Cossais, François; Talon, Sophie; Neunlist, Michel; Boudin, Hélène

2017-01-15

Unlike astrocytes in the brain, the potential role of enteric glial cells (EGCs) in the formation of the enteric neuronal circuit is currently unknown. To examine the role of EGCs in the formation of the neuronal network, we developed a novel neuron-enriched culture model from embryonic rat intestine grown in indirect coculture with EGCs. We found that EGCs shape axonal complexity and synapse density in enteric neurons, through purinergic- and glial cell line-derived neurotrophic factor-dependent pathways. Using a novel and valuable culture model to study enteric neuron-glia interactions, our study identified EGCs as a key cellular actor regulating neuronal network maturation. In the nervous system, the formation of neuronal circuitry results from a complex and coordinated action of intrinsic and extrinsic factors. In the CNS, extrinsic mediators derived from astrocytes have been shown to play a key role in neuronal maturation, including dendritic shaping, axon guidance and synaptogenesis. In the enteric nervous system (ENS), the potential role of enteric glial cells (EGCs) in the maturation of developing enteric neuronal circuit is currently unknown. A major obstacle in addressing this question is the difficulty in obtaining a valuable experimental model in which enteric neurons could be isolated and maintained without EGCs. We adapted a cell culture method previously developed for CNS neurons to establish a neuron-enriched primary culture from embryonic rat intestine which was cultured in indirect coculture with EGCs. We demonstrated that enteric neurons grown in such conditions showed several structural, phenotypic and functional hallmarks of proper development and maturation. However, when neurons were grown without EGCs, the complexity of the axonal arbour and the density of synapses were markedly reduced, suggesting that glial-derived factors contribute strongly to the formation of the neuronal circuitry. We found that these effects played by EGCs were mediated in part through purinergic P2Y 1 receptor- and glial cell line-derived neurotrophic factor-dependent pathways. Using a novel and valuable culture model to study enteric neuron-glia interactions, our study identified EGCs as a key cellular actor required for neuronal network maturation. © 2016 The Authors. The Journal of Physiology © 2016 The Physiological Society.

A novel enteric neuron–glia coculture system reveals the role of glia in neuronal development

PubMed Central

Le Berre‐Scoul, Catherine; Chevalier, Julien; Oleynikova, Elena; Cossais, François; Talon, Sophie; Neunlist, Michel

2016-01-01

Key points Unlike astrocytes in the brain, the potential role of enteric glial cells (EGCs) in the formation of the enteric neuronal circuit is currently unknown.To examine the role of EGCs in the formation of the neuronal network, we developed a novel neuron‐enriched culture model from embryonic rat intestine grown in indirect coculture with EGCs.We found that EGCs shape axonal complexity and synapse density in enteric neurons, through purinergic‐ and glial cell line‐derived neurotrophic factor‐dependent pathways.Using a novel and valuable culture model to study enteric neuron–glia interactions, our study identified EGCs as a key cellular actor regulating neuronal network maturation. Abstract In the nervous system, the formation of neuronal circuitry results from a complex and coordinated action of intrinsic and extrinsic factors. In the CNS, extrinsic mediators derived from astrocytes have been shown to play a key role in neuronal maturation, including dendritic shaping, axon guidance and synaptogenesis. In the enteric nervous system (ENS), the potential role of enteric glial cells (EGCs) in the maturation of developing enteric neuronal circuit is currently unknown. A major obstacle in addressing this question is the difficulty in obtaining a valuable experimental model in which enteric neurons could be isolated and maintained without EGCs. We adapted a cell culture method previously developed for CNS neurons to establish a neuron‐enriched primary culture from embryonic rat intestine which was cultured in indirect coculture with EGCs. We demonstrated that enteric neurons grown in such conditions showed several structural, phenotypic and functional hallmarks of proper development and maturation. However, when neurons were grown without EGCs, the complexity of the axonal arbour and the density of synapses were markedly reduced, suggesting that glial‐derived factors contribute strongly to the formation of the neuronal circuitry. We found that these effects played by EGCs were mediated in part through purinergic P2Y1 receptor‐ and glial cell line‐derived neurotrophic factor‐dependent pathways. Using a novel and valuable culture model to study enteric neuron–glia interactions, our study identified EGCs as a key cellular actor required for neuronal network maturation. PMID:27436013

Enteric-coated aspirin versus other antiplatelet drugs in acute non-cardioembolic ischemic stroke: post-marketing study in Japan.

PubMed

Takahashi, Shunichi; Mizuno, Osamu; Sakaguchi, Toshiaki; Yamada, Takashi; Inuyama, Lyo

2014-01-01

Japanese guidelines recommend aspirin 160-300 mg/day, starting within 48 h, for patients with acute cerebral infarction. However, there are few reports evaluated in Japanese patients. Our objective was to examine the safety and efficacy of enteric-coated aspirin, compared with other oral antiplatelet drugs, in Japanese patients with acute ischemic stroke. We performed a prospective, non-randomized, observational and multicenter study between June 2005 and December 2007. Patients with symptomatic acute ischemic stroke, including transient ischemic attack (TIA), who started enteric-coated aspirin or other antiplatelet drugs within 7 days of hospitalization were registered. Outcome measures evaluated within 3 months were incidence of cerebral and non-cerebral hemorrhagic events, recurrence of ischemic stroke or TIA, non-cerebral ischemic events and death from any cause. Overall, 2,548 and 830 patients treated with enteric-coated aspirin (100-300 mg/day) or other antiplatelet drugs, respectively, were registered; approximately 60% were male, mean age was 70 years, 85% had pre-existing cardiovascular disease or other complications. Enteric-coated aspirin of 100 mg was mainly prescribed, and only approximately half of the patients were started on it within 48 h after onset of ischemic stroke. Safety and efficacy population excluded patients without follow-up data were 2,521 in enteric-coated aspirin and 807 in other antiplatelets. Hemorrhagic events occurred in 46 (1.8%) in the enteric-coated aspirin group and in 13 (1.6%) in the other antiplatelet drugs group, there was not significant. Recurrent ischemic stroke or TIA occurred in 39 (1.5%) of the enteric-coated aspirin and in 18 (2.2%) of other antiplatelet drugs, and there were any-cause death in 16 (0.6%) and 8 (1.0%). Incidences were slightly lower in the enteric-coated aspirin group compared with the other antiplatelet drugs group, but not statistically significant. It seems that these results showed the safety and efficacy of the enteric-coated aspirin in acute stroke care in Japanese patients. Incidence of hemorrhagic events was comparable between the enteric-coated aspirin group and the other antiplatelet drugs group.

Ammonia modifies enteric neuromuscular transmission through glial γ-aminobutyric acid signaling.

PubMed

Fried, David E; Watson, Ralph E; Robson, Simon C; Gulbransen, Brian D

2017-12-01

Impaired gut motility may contribute, at least in part, to the development of systemic hyperammonemia and systemic neurological disorders in inherited metabolic disorders, or in severe liver and renal disease. It is not known whether enteric neurotransmission regulates intestinal luminal and hence systemic ammonia levels by induced changes in motility. Here, we propose and test the hypothesis that ammonia acts through specific enteric circuits to influence gut motility. We tested our hypothesis by recording the effects of ammonia on neuromuscular transmission in tissue samples from mice, pigs, and humans and investigated specific mechanisms using novel mutant mice, selective drugs, cellular imaging, and enzyme-linked immunosorbent assays. Exogenous ammonia increased neurogenic contractions and decreased neurogenic relaxations in segments of mouse, pig, and human intestine. Enteric glial cells responded to ammonia with intracellular Ca 2+ responses. Inhibition of glutamine synthetase and the deletion of glial connexin-43 channels in hGFAP :: Cre ER T2+/- /connexin43 f/f mice potentiated the effects of ammonia on neuromuscular transmission. The effects of ammonia on neuromuscular transmission were blocked by GABA A receptor antagonists, and ammonia drove substantive GABA release as did the selective pharmacological activation of enteric glia in GFAP::hM3Dq transgenic mice. We propose a novel mechanism whereby local ammonia is operational through GABAergic glial signaling to influence enteric neuromuscular circuits that regulate intestinal motility. Therapeutic manipulation of these mechanisms may benefit a number of neurological, hepatic, and renal disorders manifesting hyperammonemia. NEW & NOTEWORTHY We propose that local circuits in the enteric nervous system sense and regulate intestinal ammonia. We show that ammonia modifies enteric neuromuscular transmission to increase motility in human, pig, and mouse intestine model systems. The mechanisms underlying the effects of ammonia on enteric neurotransmission include GABAergic pathways that are regulated by enteric glial cells. Our new data suggest that myenteric glial cells sense local ammonia and directly modify neurotransmission by releasing GABA. Copyright © 2017 the American Physiological Society.

Early Serum Gut Hormone Concentrations Associated with Time to Full Enteral Feedings in Preterm Infants.

PubMed

Shanahan, Kristen H; Yu, Xinting; Miller, Laura G; Freedman, Steven D; Martin, Camilia R

2018-04-03

The primary objective of this study was to evaluate early postnatal serum gut hormone concentrations in preterm infants as predictors of time to full enteral feedings. The secondary objective was to identify infant characteristics and nutritional factors that modulate serum gut hormone concentrations and time to full enteral feedings. Sixty-four preterm infants less than 30 weeks of gestation were included in this retrospective cohort study. Serum gut hormone concentrations at postnatal days 0 and 7 were measured using enzyme-linked immunosorbent assays. Linear regression and mediation analyses were performed. Median (IQR) serum concentrations of glucose-dependent insulinotropic peptide (GIP) and peptide YY (PYY) on postnatal day 7 were 31.3 pg/mL (18.2, 52.3) and 1181.7 pg/mL (859.0, 1650.2), respectively. GIP and PYY concentrations on day 7 were associated with days to full enteral feedings after adjustment for confounders (β = -1.1, p = 0.03; and β = -0.002, p = 0.02, respectively). Nutritional intake was correlated with serum concentrations of GIP and PYY on postnatal day 7 and time to full enteral feedings. Mediation analysis revealed that the effect of serum gut hormone concentrations on time to full enteral feedings was not fully explained by nutritional intake. Intrauterine growth restriction (IUGR), mechanical ventilation on postnatal day 7, and patent ductus arteriosus (PDA) treated with indomethacin were associated with longer time to full enteral feedings. Serum concentrations of GIP and PYY on postnatal 7 are independently associated with time to full enteral feedings. The link between serum gut hormone concentrations and time to full enteral feedings is not fully mediated by nutritional factors, suggesting an independent mechanism underlying the influence of gut hormones on feeding tolerance and time to full enteral feedings.

Microbiological quality and safe handling of enteral diets in a hospital in Minas Gerais, Brazil.

PubMed

Pinto, Raquel Oliveira Medrado; Correia, Eliznara Fernades; Pereira, Keyla Carvalho; Costa Sobrinho, Paulo de Souza; da Silva, Daniele Ferreira

2015-06-01

Contamination of enteral diets represents a high risk of compromising the patient's medical condition. To assess the microbiological quality and aseptic conditions in the preparation and administration of handmade and industrialized enteral diets offered in a hospital in the Valley of Jequitinhonha, MG, Brazil, we performed a microbiological analysis of 50 samples of diets and 27 samples of surfaces, utensils, and water used in the preparation of the diets. In addition, we assessed the good handling practices of enteral diets according to the requirements specified by the Brazilian legislation. Both kinds of enteral diets showed contamination by coliforms and Pseudomonas spp. No sample was positive for Staphylococcus aureus and Salmonella spp. On the other hand, Listeria spp. was detected in only one sample of handmade diets. Contamination was significantly higher in the handmade preparations (p < 0.05). Nonconformities were detected with respect to good handling practices, which may compromise the diet safety. The results indicate that the sanitary quality of the enteral diets is unsatisfactory, especially handmade diets. Contamination by Pseudomonas spp. is significant because it is often involved in infection episodes. With regard to aseptic practices, it was observed the need of implementing new procedures for handling enteral diets.

Collagen 18 and agrin are secreted by neural crest cells to remodel their microenvironment and regulate their migration during enteric nervous system development.

PubMed

Nagy, Nandor; Barad, Csilla; Hotta, Ryo; Bhave, Sukhada; Arciero, Emily; Dora, David; Goldstein, Allan M

2018-05-08

The enteric nervous system (ENS) arises from neural crest cells that migrate, proliferate, and differentiate into enteric neurons and glia within the intestinal wall. Many extracellular matrix (ECM) components are present in the embryonic gut, but their role in regulating ENS development is largely unknown. Here, we identify heparan sulfate proteoglycan proteins, including collagen XVIII (Col18) and agrin, as important regulators of enteric neural crest-derived cell (ENCDC) development. In developing avian hindgut, Col18 is expressed at the ENCDC wavefront, while agrin expression occurs later. Both proteins are normally present around enteric ganglia, but are absent in aganglionic gut. Using chick-mouse intestinal chimeras and enteric neurospheres, we show that vagal- and sacral-derived ENCDCs from both species secrete Col18 and agrin. Whereas glia express Col18 and agrin, enteric neurons only express the latter. Functional studies demonstrate that Col18 is permissive whereas agrin is strongly inhibitory to ENCDC migration, consistent with the timing of their expression during ENS development. We conclude that ENCDCs govern their own migration by actively remodeling their microenvironment through secretion of ECM proteins. © 2018. Published by The Company of Biologists Ltd.

Efficacy of octreotide in the management of chronic diarrhoea in AIDS.

PubMed

Romeu, J; Miró, J M; Sirera, G; Mallolas, J; Arnal, J; Valls, M E; Tortosa, F; Clotet, B; Foz, M

1991-12-01

Patients with HIV infection were studied to assess the efficacy of octreotide, a somatostatin analogue, in the long-term management of refractory diarrhoea. Dosage of subcutaneous octreotide was increased progressively at 48 h intervals from 150 to 300, 750 and 1500 micrograms/day according to response. Twenty-nine patients, 21 with Cryptosporidium enteritis, one with Isospora belli enteritis and seven with no identifiable pathogen were selected for the study; four of these were excluded from the study because of death during the first month (two cases), abdominal pain and acute pancreatitis (one case each). Twenty-five patients were evaluable for response. Ten patients (four with Cryptosporidium enteritis, five without an identifiable pathogen and one with I. belli enteritis) achieved a complete response (40%) and nine cases (all with cryptosporidial enteritis) had a partial response (36%). Patients with higher weight and Karnofsky performance status and non-cryptosporidial enteritis had a better response to treatment. Mean durations of treatment and response were 4.2 +/- 4.2 and 4.4 +/- 4.5 months, respectively. In the absence of specific agents for cryptosporidial enteritis and HIV enteropathy, octreotide was found to be useful in the management of chronic diarrhoea in AIDS patients.

Enteral vs. parenteral nutrition for the critically ill patient: a combined support should be preferred.

PubMed

Heidegger, Claudia-Paula; Darmon, Patrice; Pichard, Claude

2008-08-01

Current recommendations suggest starting enteral feeding as soon as possible whenever the gastrointestinal tract is functioning. The disadvantage of enteral support is that insufficient energy and protein coverage can occur. This review focuses on some recent findings regarding the nutritional support of critically ill patients and evaluates the data presented. An increasing nutritional deficit during a long ICU stay is associated with increased morbidity (infection rate, wound healing, mechanical ventilation, length of stay, duration of recovery), and costs. Evidence shows that enteral nutrition can result in underfeeding and that nutritional goals are frequently reached only after 1 week. Contrary to former beliefs, recent meta-analyses of ICU studies showed that parenteral nutrition is not related to a surplus mortality and may even be associated with improved survival. Early enteral nutrition is recommended for critically ill patients. Supplemental parenteral nutrition combined with enteral nutrition can be considered to cover the energy and protein targets when enteral nutrition alone fails to achieve the caloric goal. Whether such a combined nutritional support provides additional benefit on the overall outcome has to be proven in further studies on clinical outcome, including physical and cognitive functioning, quality of life, cost-effectiveness, and cost-utility.

Intestine, immunity, and parenteral nutrition in an era of preferred enteral feeding.

PubMed

Barrett, Meredith; Demehri, Farokh R; Teitelbaum, Daniel H

2015-09-01

To review the benefits of enteral nutrition in contrast to the inflammatory consequences of administration of parenteral nutrition and enteral deprivation. To present the most recent evidence for the mechanisms of these immunologic changes and discuss potential areas for modification to decrease infectious complications of its administration. There is significant data supporting the early initiation of enteral nutrition in both medical and surgical patients unable to meet their caloric goals via oral intake alone. Despite the preference for enteral nutrition, some patients are unable to utilize their gut for nutritious gain and therefore require parenteral nutrition administration, along with its infectious complications. The mechanisms behind these complications are multifactorial and have yet to be fully elucidated. Recent study utilizing both animal and human models has provided further information regarding parenteral nutrition's deleterious effect on intestinal epithelial barrier function along with the complications associated with enterocyte deprivation. Changes associated with parenteral nutrition administration and enteral deprivation are complex with multiple potential areas for modification to allow for safer administration. Recent discovery of the mechanisms behind these changes present exciting areas for future study as to make parenteral nutrition administration in the enterally deprived patient safer.

21 CFR 558.311 - Lasalocid.

Code of Federal Regulations, 2011 CFR

2011-04-01

... of bacterial enteritis caused by E. coli and bacterial pneumonia caused by P. multocida organisms... improved feed efficiency; and for treatment of bacterial enteritis caused by E. coli and bacterial... treatment of bacterial enteritis caused by E. coli and bacterial pneumonia caused by P. multocida organisms...

Stents for colorectal obstruction: Past, present, and future

PubMed Central

Kim, Eui Joo; Kim, Yoon Jae

2016-01-01

Since the development of uncovered self-expanding metal stents (SEMS) in the 1990s, endoscopic stents have evolved dramatically. Application of new materials and new designs has expanded the indications for enteral SEMS. At present, enteral stents are considered the first-line modality for palliative care, and numerous types of enteral stents are under development for extended clinical usage, beyond a merely palliative purpose. Herein, we will discuss the current status and the future development of lower enteral stents. PMID:26811630

Pediatric Enteric Feeding Techniques: Insertion, Maintenance, and Management of Problems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nijs, Els L. F., E-mail: nijs@email.chop.ed; Cahill, Anne Marie, E-mail: cahill@email.chop.ed

Enteral feeding is considered a widespread, well-accepted means of delivering nutrition to adults and children who are unable to consume food by mouth or who need support in maintaining adequate nutrition for a variety of reasons, including acute and chronic disease states. Delivery of enteral feeding to nutritionally deprived patients may be achieved by several means. In this article, the indications and insertion of enteral access in children will be reviewed. In addition, common complications and management of problems will be discussed.

FORTRAN Programs for Aerodynamic Analyses on the Microvax/2000 CAD CAE Workstation

DTIC Science & Technology

1988-09-01

file exists, you must compile the program by typing, FOR DUBLET [Returni The next step is to link the program by entering, LINK DUBLET [Return] The...files DUBLET.EXE and DUBLET.OBJ will now exist and you will be able to run the program. Running the Program To run the program, type DUBLET [Return...by entering 0.1 [Return] Now enter the number of intervals you desire the doublet distribution to have by enter- ing 10 [Return] The screen should now

A Pilot Review of Gradual Versus Goal Re-initiation of Enteral Nutrition after Burn Surgery in the Hemodynamically Stable Patient

DTIC Science & Technology

2014-01-01

benefits of enteral nutrition (EN), the American Society for Parenteral and Enteral Nutrition (ASPEN) and the Society of Critical Care Medicine (SCCM...instances where parenteral nutrition was used rather than EN or the subject consumed food orally). Because the change in clinical practice included only...therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N

Prevalence, characteristics and correlates of enteric pathogenic protozoa in drinking water sources in Molyko and Bomaka, Cameroon: a cross-sectional study.

PubMed

Nsoh, Fuh Anold; Wung, Buh Amos; Atashili, Julius; Benjamin, Pokam Thumamo; Marvlyn, Eba; Ivo, Keumami Katte; Nguedia, Assob Jules Clément

2016-11-08

Access to potable water remains a major challenge particularly in resource-limited settings. Although the potential contaminants of water are varied, enteric pathogenic protozoa are known to cause waterborne diseases greatly. This study aimed at investigating the prevalence, characteristics and correlates of enteric pathogenic protozoa in drinking water sources in Buea, Cameroon. A cross-sectional study was conducted using 155 water samples collected from various drinking sources (boreholes, springs, taps and wells). Each sample was subjected to physicochemical examinations (pH, turbidity, odour and sliminess) and parasitological analysis (wet mount, modified Ziehl-Neelsen stain) to determine the presence of enteric pathogenic protozoa. A data collection tool was used to note characteristics of collected samples and the data was analysed using EPI-INFO Version 3.5.3. The overall prevalence of enteric pathogenic protozoa in water sources was 62.6 %. Eight species of enteric protozoa were observed with Cryptosporidium parvum being the most predominant (45.8 %). Spring water was the most contaminated source with enteric protozoa (85.7 %) while pipe borne water had all eight species of protozoa identified. A pH of 6 was the only significant factor associated with the prevalence of these pathogens in water sources. The prevalence of enteric protozoa in water sources in Molyko and Bomaka is high, spring water is the most contaminated water source and Cryptosporidium parvum is the most common protozoa contaminating water. A water pH of 6 is associated to the prevalence of protozoa. Community members need to be educated to treat water before drinking to avoid infection by enteric protozoa in water and further studies with larger samples of water need to be conducted to find other correlates of the presence of protozoa in water.

Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study.

PubMed

Khan, Faraz A; Squires, Robert H; Litman, Heather J; Balint, Jane; Carter, Beth A; Fisher, Jeremy G; Horslen, Simon P; Jaksic, Tom; Kocoshis, Samuel; Martinez, J Andres; Mercer, David; Rhee, Susan; Rudolph, Jeffrey A; Soden, Jason; Sudan, Debra; Superina, Riccardo A; Teitelbaum, Daniel H; Venick, Robert; Wales, Paul W; Duggan, Christopher

2015-07-01

In a large cohort of children with intestinal failure (IF), we sought to determine the cumulative incidence of achieving enteral autonomy and identify patient and institutional characteristics associated with enteral autonomy. A multicenter, retrospective cohort analysis from the Pediatric Intestinal Failure Consortium was performed. IF was defined as severe congenital or acquired gastrointestinal diseases during infancy with dependence on parenteral nutrition (PN) >60 days. Enteral autonomy was defined as PN discontinuation >3 months. A total of 272 infants were followed for a median (IQR) of 33.5 (16.2-51.5) months. Enteral autonomy was achieved in 118 (43%); 36 (13%) remained PN dependent and 118 (43%) patients died or underwent transplantation. Multivariable analysis identified necrotizing enterocolitis (NEC; OR 2.42, 95% CI 1.33-4.47), care at an IF site without an associated intestinal transplantation program (OR 2.73, 95% CI 1.56-4.78), and an intact ileocecal valve (OR 2.80, 95% CI 1.63-4.83) as independent risk factors for enteral autonomy. A second model (n = 144) that included only patients with intraoperatively measured residual small bowel length found NEC (OR 3.44, 95% CI 1.36-8.71), care at a nonintestinal transplantation center (OR 6.56, 95% CI 2.53-16.98), and residual small bowel length (OR 1.04 cm, 95% CI 1.02-1.06 cm) to be independently associated with enteral autonomy. A substantial proportion of infants with IF can achieve enteral autonomy. Underlying NEC, preserved ileocecal valve, and longer bowel length are associated with achieving enteral autonomy. It is likely that variations in institutional practices and referral patterns also affect outcomes in children with IF. Copyright © 2015 Elsevier Inc. All rights reserved.

Medication administration through enteral feeding tubes.

PubMed

Williams, Nancy Toedter

2008-12-15

An overview of enteral feeding tubes, drug administration techniques, considerations for dosage form selection, common drug interactions with enteral formulas, and methods to minimize tube occlusion is given. Enteral nutrition through a feeding tube is the preferred method of nutrition support in patients who have a functioning gastrointestinal tract but who are unable to be fed orally. This method of delivering nutrition is also commonly used for administering medications when patients cannot swallow safely. However, several issues must be considered with concurrent administration of oral medications and enteral formulas. Incorrect administration methods may result in clogged feeding tubes, decreased drug efficacy, increased adverse effects, or drug-formula incompatibilities. Various enteral feeding tubes are available and are typically classified by site of insertion and location of the distal tip of the feeding tube. Liquid medications, particularly elixirs and suspensions, are preferred for enteral administration; however, these formulations may be hypertonic or contain large amounts of sorbitol, and these properties increase the potential for adverse effects. Before solid dosage forms are administered through the feeding tube, it should be determined if the medications are suitable for manipulation, such as crushing a tablet or opening a capsule. Medications should not be added directly to the enteral formula, and feeding tubes should be properly flushed with water before and after each medication is administered. To minimize drug-nutrient interactions, special considerations should be taken when administering phenytoin, carbamazepine, warfarin, fluoroquinolones, and proton pump inhibitors via feeding tubes. Precautions should be implemented to prevent tube occlusions, and immediate intervention is required when blockages occur. Successful drug delivery through enteral feeding tubes requires consideration of the tube size and placement as well as careful selection and appropriate administration of drug dosage forms.

Infection strategies of enteric pathogenic Escherichia coli

PubMed Central

Clements, Abigail; Young, Joanna C.; Constantinou, Nicholas; Frankel, Gad

2012-01-01

Enteric Escherichia coli (E. coli) are both natural flora of humans and important pathogens causing significant morbidity and mortality worldwide. Traditionally enteric E. coli have been divided into 6 pathotypes, with further pathotypes often proposed. In this review we suggest expansion of the enteric E. coli into 8 pathotypes to include the emerging pathotypes of adherent invasive E. coli (AIEC) and Shiga-toxin producing enteroaggregative E. coli (STEAEC). The molecular mechanisms that allow enteric E. coli to colonize and cause disease in the human host are examined and for two of the pathotypes that express a type 3 secretion system (T3SS) we discuss the complex interplay between translocated effectors and manipulation of host cell signaling pathways that occurs during infection. PMID:22555463

Ability of select probiotics to reduce enteric Campylobacter colonization in broiler chickens

USDA-ARS?s Scientific Manuscript database

Campylobacter is the leading cause of foodborne enteritis worldwide and is primarily caused by consumption/mishandling of contaminated poultry. Probiotic use in poultry has been an effective strategy in reducing many enteric pathogens, but has not demonstrated consistent reduction against Campylobac...

Entering Research

ERIC Educational Resources Information Center

Lawless, Ann; Sedorkin, Barbara

2007-01-01

This article presents a short story of the authors, who show how they have "entered research", that is, entered the earliest conception of research and the early formation of research collaboration. As the authors worked together, they realised they had common concerns and life experiences. Each proudly identifies as working class…

42 CFR 414.408 - Payment rules.

Code of Federal Regulations, 2014 CFR

2014-10-01

... initially furnished and enteral nutrition equipment are calculated based on the bids submitted and accepted... wheelchairs. (2) Payment for used purchased durable medical equipment and enteral nutrition equipment is made...) Enteral nutrition supplies. (4) OTS orthotics. (h) Rented equipment—(1) Capped rental DME. Subject to the...

42 CFR 414.408 - Payment rules.

Code of Federal Regulations, 2012 CFR

2012-10-01

... initially furnished and enteral nutrition equipment are calculated based on the bids submitted and accepted... wheelchairs. (2) Payment for used purchased durable medical equipment and enteral nutrition equipment is made...) Enteral nutrition supplies. (4) OTS orthotics. (h) Rented equipment—(1) Capped rental DME. Subject to the...

42 CFR 414.408 - Payment rules.

Code of Federal Regulations, 2013 CFR

2013-10-01

... initially furnished and enteral nutrition equipment are calculated based on the bids submitted and accepted... wheelchairs. (2) Payment for used purchased durable medical equipment and enteral nutrition equipment is made...) Enteral nutrition supplies. (4) OTS orthotics. (h) Rented equipment—(1) Capped rental DME. Subject to the...

42 CFR 414.408 - Payment rules.

Code of Federal Regulations, 2011 CFR

2011-10-01

... initially furnished and enteral nutrition equipment are calculated based on the bids submitted and accepted... wheelchairs. (2) Payment for used purchased durable medical equipment and enteral nutrition equipment is made...) Enteral nutrition supplies. (4) OTS orthotics. (h) Rented equipment—(1) Capped rental DME. Subject to the...

12 CFR 48.1 - Authority, purpose, and scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

....1 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY RETAIL FOREIGN EXCHANGE... or enter into retail foreign exchange transactions. A national bank offering or entering into retail... associations. A Federal savings association may offer or enter into retail foreign exchange transactions. A...

DEVELOPMENT OF HOMOLOGOUS VIRAL INTERNAL CONTROLS FOR USE IN RT-PCR ASSAYS OF WATERBORNE ENTERIC VIRUSES

EPA Science Inventory

Enteric viruses often contaminate water sources causing frequent outbreaks of gastroenteritis. Reverse transcription-polymerase chain reaction (RT-PCR) assays are commonly used for detection of human enteric viruses in environmental and drinking water samples. RT-PCR provides ...

Processing Strategies to Inactivate Enteric Viruses in Shellfish: Limitations of Surrogate Viruses and Molecular Methods

USDA-ARS?s Scientific Manuscript database

Noroviruses, hepatitis A and E viruses, sapovirus, astrovirus, rotavirus, Aichi virus, enteric adenoviruses, poliovirus, and other enteroviruses enter shellfish through contaminated seawater or by contamination during handling and processing, resulting in outbreaks ranging from isolated to epidemic....

Agoraphobia.

ERIC Educational Resources Information Center

Brehony, Kathleen A.

Agoraphobia is the most pervasive and serious phobic response seen by clinicians, accounting for approximately 50 to 60% of all phobic problems. The symptoms of agoraphobia, a condition in which an individual fears entering public areas, include fears of leaving home, fainting, entering open and closed spaces, shopping, entering social situations,…

Population Density, Poor Sanitation, and Enteric Infections in Nueva Santa Rosa, Guatemala.

PubMed

Jarquin, Claudia; Arnold, Benjamin F; Muñoz, Fredy; Lopez, Beatriz; Cuéllar, Victoria M; Thornton, Andrew; Patel, Jaymin; Reyes, Lisette; Roy, Sharon L; Bryan, Joe P; McCracken, John P; Colford, John M

2016-04-01

Poor sanitation could pose greater risk for enteric pathogen transmission at higher human population densities because of greater potential for pathogens to infect new hosts through environmentally mediated and person-to-person transmission. We hypothesized that incidence and prevalence of diarrhea, enteric protozoans, and soil-transmitted helminth infections would be higher in high-population-density areas compared with low-population-density areas, and that poor sanitation would pose greater risk for these enteric infections at high density compared with low density. We tested our hypotheses using 6 years of clinic-based diarrhea surveillance (2007-2013) including 4,360 geolocated diarrhea cases tested for 13 pathogens and a 2010 cross-sectional survey that measured environmental exposures from 204 households (920 people) and tested 701 stool specimens for enteric parasites. We found that population density was not a key determinant of enteric infection nor a strong effect modifier of risk posed by poor household sanitation in this setting. © The American Society of Tropical Medicine and Hygiene.

Morphology of congenital portosystemic shunts emanating from the left gastric vein in dogs and cats.

PubMed

White, R N; Parry, A T

2013-09-01

To describe the anatomy of congenital portosystemic shunts emanating from the left gastric vein in dogs and cats. A retrospective review of a consecutive series of dogs and cats managed for congenital portosystemic shunts. Forty-six dogs and 27 cats met the inclusion criteria of a congenital portosystemic shunt emanating from the left gastric vein. Of the 46 dogs, 28 (61%) had a shunt that entered the left phrenic vein, 10 (22%) had a shunt that entered the post hepatic caudal vena cava and in 8 (17%) the shunt entered the azygos vein. Of the 27 cats, 19 (70%) had a shunt that entered the left phrenic vein and 8 (30%) had a shunt that entered the post hepatic caudal vena cava. The systemic vein into which the shunt entered was consistent showing three common presentations: left gastro-phrenic, left gastro-caval and left gastro-azygos. This information may help with surgical planning in cases undergoing shunt closure surgery. © 2013 British Small Animal Veterinary Association.

Risk of introduction of BSE into Japan by the historical importation of live cattle from the United Kingdom.

PubMed

Sugiura, Katsuaki; Kusama, Toyoko; Yoshida, Tomotaro; Shinoda, Naoki; Onodera, Takashi

2009-02-01

All cattle imported from the United Kingdom to Japan since 1980 and slaughtered before 2002 were traced (n=33), and the number of cattle that were possibly infected with BSE and entered the animal feed chain was calculated. Because there was no effective system to avoid recycling of the BSE agent via animal feed until the early 1990s, of the 33 cattle imported from the UK into Japan, most probably 7 or 8 were infected and entered the animal feed chain, 2 of which entered the animal feed chain in each of 1992 and 1993. In terms of infectivity, 400-550 cattle oral ID(50) of the BSE agent entered the feed chain in each of these years. The amount of infectivity that entered the feed chain in 1989, 1991 and 1995 was smaller but still substantial, suggesting that the BSE agent might have entered the Japanese feed chain in any of these years.

Population Density, Poor Sanitation, and Enteric Infections in Nueva Santa Rosa, Guatemala

PubMed Central

Jarquin, Claudia; Arnold, Benjamin F.; Muñoz, Fredy; Lopez, Beatriz; Cuéllar, Victoria M.; Thornton, Andrew; Patel, Jaymin; Reyes, Lisette; Roy, Sharon L.; Bryan, Joe P.; McCracken, John P.; Colford, John M.

2016-01-01

Poor sanitation could pose greater risk for enteric pathogen transmission at higher human population densities because of greater potential for pathogens to infect new hosts through environmentally mediated and person-to-person transmission. We hypothesized that incidence and prevalence of diarrhea, enteric protozoans, and soil-transmitted helminth infections would be higher in high-population-density areas compared with low-population-density areas, and that poor sanitation would pose greater risk for these enteric infections at high density compared with low density. We tested our hypotheses using 6 years of clinic-based diarrhea surveillance (2007–2013) including 4,360 geolocated diarrhea cases tested for 13 pathogens and a 2010 cross-sectional survey that measured environmental exposures from 204 households (920 people) and tested 701 stool specimens for enteric parasites. We found that population density was not a key determinant of enteric infection nor a strong effect modifier of risk posed by poor household sanitation in this setting. PMID:26856919

Medium-chain triglyceride-rich enteral nutrition is more effective than low-fat enteral nutrition in rat colitis, but is equal in enteritis.

PubMed

Tsujikawa, T; Ohta, N; Nakamura, T; Yasuoka, T; Satoh, J; Fukunaga, T; Itohi, A; Uda, K; Ihara, T; Andoh, A; Sasaki, M; Fujiyama, Y; Bamba, T

2001-10-01

Although enteral nutrition (EN) therapy for Crohn's disease has been confirmed to be as effective as steroid therapy, the precise mechanism responsible for the effects of EN remains unclear, although some of the therapeutic effects of EN are believed to be due to a low dietary fat content. In order to elucidate the influence of fat in EN, it is important to investigate not only the quantity of fat, but also the source of the fat. We compared two enteral nutritional formulae: Elental (Ajinomoto) (elemental diet; ED), which contains only 1.5% fat, provided as long-chain triglycerides (LCT), versus Twinline (Snow Brand Milk Products) (TL), which contains a high percentage of fat (20.4%), provided mainly as medium-chain triglycerides (MCT). These formulae were tested on rat enteritis and rat colitis induced by trinitrobenzene sulfonic acid (TNBS). Both ED and TL reduced the manifestations of enteritis. TL had a stronger anti-inflammatory effect than ED for colitis. TL also had nutritional advantages as compared with ED, as shown by the total serum protein in the TL group being significantly higher than that in the ED group. The results indicate that intraluminal MCT is suitable as a fat energy source during intestinal inflammation in rats. We suggest that Twinline may be more useful to improve nutritional status and to reduce the mucosal inflammation in rat colitis, but that Twinline is equal in effect to Elental for rat enteritis.

The enter-educate approach.

PubMed

Piotrow, P T; Coleman, P L

1992-03-01

This article describes how the Population Communication Services (PCS) has seized on the "enter-educate" approach, the blending of popular entertainment with social messages, to change reproductive health behavior. The enter-educate approach spreads its message through songs, soap operas, variety shows, and other types of popular entertainment mediums. Because they entertain, enter-educate projects can capture the attention of an audience -- such as young people -- who would otherwise scorn social messages. And the use of population mediums makes it possible to reach a variety of audiences. Funded by USAID, PCS began its first enter-educate project in response to the increasing number of teenage pregnancies in Latin America. PCS developed 2 songs and videos, which featured popular teenage singers to serve as role models, to urge abstinence. The songs became instant hits. Since then, PCS has mounted more then 80 major projects in some 40 countries. Highlights of programs range from a successful multi-media family planning campaign in Turkey to humorous television ads in Brazil promoting vasectomy. Recently, PCS initiated projects to teach AIDS awareness. At the core of the enter-educate approach is the social learning theory which holds that much behavior is learned through the observation of role-models. Health professionals work alongside entertainers to produce works that have audience appeal and factual social messages. The enter-educate approach works because it is popular, pervasive, personal, persuasive, and profitable. PCS has found that enter-educate programs pay for themselves through cost sharing and cost recovery.

Serotonergic neurotransmission in the gut.

PubMed

Gershon, M D

1982-01-01

Serotonin (5-hydroxytryptamine; 5-HT) was first suggested to be a neurotransmitter in the enteric nervous system (ENS) by Gershon, Drakontides, and Ross in 1965 (38); however, it has not been until recently that 5-HT has finally satisfied all of the criteria necessary for proof of its transmitter role. 5-HT has not been shown by biochemical, histochemical, and immunocytochemical techniques to be present in enteric neurons. The amine has also been demonstrated to be released from stimulated enteric neurons by a Ca+2-dependent mechanism. The enteric neurons that contain 5-HT synthesize the amine from the dietary amino acid L-tryptophan. A specific, high-affinity uptake mechanism for 5-HT is another feature of enteric serotonergic neurons and probably serves as an inactivating mechanism for the amine. Physiologically, evidence derived by Wood and Mayer (103) from studies with intracellular microelectrodes indicates that 5-HT mimics the action of the transmitter responsible for eliciting slow epsps in one of the types of enteric neuron (the AH cell). In addition, Julé has determined that enteric serotonergic neurons are involved in the descending suppression of vagal excitation of the gut that accompanies peristalsis (67). Since the neurons that contain 5-HT survive for extended periods of time in organotypic tissue culture, it is clear that they are intrinsic to the gut itself. It may now be assumed, therefore, that there are enteric serotonergic neurons. Questions now arise as to their role in gastrointestinal function and the cellular biology of this neuronal class.

Enteral nutrition in inflammatory bowel disease.

PubMed Central

Gassull, M A; Abad, A; Cabré, E; González-Huix, F; Giné, J J; Dolz, C

1986-01-01

To assess the effect of the addition of enteral tube feeding with polymeric diets to the standard treatment of acute attacks of inflammatory bowel disease a total of 43 patients admitted to hospital (23 with Crohn's disease and 20 with ulcerative colitis) were studied retrospectively. Total enteral nutrition was given to 26 as the sole nutritional supply and to 17 in conjunction with a normal ward diet, when appropriate, according to the severity of attack (control group). Nutritional state was assessed and classified in all patients at admission and at the end of the study, by measuring the triceps skinfold thickness, mid arm muscle circumference, and serum albumin concentration as representative of body fat, muscle protein, and visceral protein, respectively. At admission the three nutritional variables were not statistically different between the groups. There was a significantly positive effect on mid arm muscle circumference in patients on total enteral nutrition compared with the control group, but there was no effect on either triceps skinfold thickness or serum albumin concentration. The percentage of subjects requiring intravenous albumin infusion, however, was significantly less in the group fed enterally than in the control group. In addition, fewer patients in the group fed enterally required surgical treatment compared with the control group, despite the fact that one of the criteria for starting enteral nutritional support was the expectancy that surgery would be needed. Total enteral nutrition was well tolerated and no major side effects arose during its use in patients with acute exacerbations of inflammatory bowel disease. PMID:3098646

Treatment of Experimentally Induced Caval Thrombosis With Oral Low Molecular Weight Heparin and Delivery Agent in a Porcine Model of Deep Venous Thrombosis

PubMed Central

Salartash, Khashayar; Lepore, Michael; Gonze, Mark D.; Leone-Bay, Andrea; Baughman, Robert; Charles Sternbergh, W.; Bowen, John C.; Money, Samuel R.

2000-01-01

Objective This experiment evaluated enterally administered low molecular weight heparin (LMWH) combined with sodium N-[10-(2-hydroxybenzoyl)amino] decanoate (SNAD) for the treatment of induced venous thrombosis. Summary Background Data SNAD is a delivery agent that potentiates the gastrointestinal absorption of LMWH. Methods Forty female pigs were equally assigned to four groups: control (saline); enteral LMWH, 2,000 IU/kg; enteral SNAD, 50 mg/kg; and enteral LMWH, 2,000 IU/kg and SNAD, 50 mg/kg. Under fluoroscopic guidance, the infrarenal vena cava was occluded with a balloon catheter. Two milliliters of ethanol was injected into the distal vena cava. The inflated balloon catheter remained in situ for 5 days, at which time animals angiographically exhibiting thrombus were randomly assigned to the four groups. Study medications were dosed at 12-hour intervals by means of a gastrostomy tube placed previously. After 7 days of treatment, thrombus was extracted. A separate group of 10 animals was used to measure plasma antifactor Xa levels for 6 hours after enteral dosing of LMWH/SNAD. Results The amount of residual thrombus after treatment with enteral LMWH/SNAD was significantly decreased. Antifactor Xa levels were significantly elevated in the LMWH/SNAD group versus baseline. Conclusion The combination of enterally administered LMWH and SNAD given for 7 days appeared to decrease caval thrombosis in this model of deep vein thrombosis. Enteral LMWH/SNAD effected an increase in plasma levels of antifactor Xa. PMID:10816621

Architecture of enteric neural circuits involved in intestinal motility.

PubMed

Costa, M; Brookes, S H

2008-08-01

This short review describes the conceptual development in the search for the enteric neural circuits with the initial identifications of the classes of enteric neurons on the bases of their morphology, neurochemistry, biophysical properties, projections and connectivity. The discovery of the presence of multiple neurochemicals in the same nerve cells in specific combinations led to the concept of "chemical coding" and of "plurichemical transmission". The proposal that enteric reflexes are largely responsible for the propulsion of contents led to investigations of polarised reflex pathways and how these may be activated to generate the coordinated propulsive behaviour of the intestine. The research over the past decades attempted to integrate information of chemical neuroanatomy with functional studies, with the development of methods combining anatomical, functional and pharmacological techniques. This multidisciplinary strategy led to a full accounting of all functional classes of enteric neurons in the guinea-pig, and advanced wiring diagrams of the enteric neural circuits have been proposed. In parallel, investigations of the actual behaviour of the intestine during physiological motor activity have advanced with the development of spatio-temporal analysis from video recordings. The relation between neural pathways, their activities and the generation of patterns of motor activity remain largely unexplained. The enteric neural circuits appear not set in rigid programs but respond to different physico-chemical contents in an adaptable way (neuromechanical hypothesis). The generation of the complex repertoire of motor patterns results from the interplay of myogenic and neuromechanical mechanisms with spontaneous generation of migratory motor activity by enteric circuits.

Commercial Passenger Vehicles: Safety Inspection of Commercial Buses and Vans Entering into the United States from Mexico

DOT National Transportation Integrated Search

1997-08-08

In response to concerns about whether commercial passenger vehicles entering the United States from Mexico are meeting U.S. safety standards, this report describes (1) the number and types of commercial passenger vehicles entering U.S. border states ...

78 FR 14585 - Agency Information Collection Activities: Application for Advance Permission to Enter as...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-06

... DEPARTMENT OF HOMELAND SECURITY U.S. Citizenship and Immigration Services [OMB Control Number 1615-0017] Agency Information Collection Activities: Application for Advance Permission to Enter as... Collection. (2) Title of the Form/Collection: Application for Advance Permission to Enter as Nonimmigrant...

Retention of Enteric Viruses by the Hemocytes of the Eastern Oyster (Crassostrea virginica)

USDA-ARS?s Scientific Manuscript database

Shellfish are an important vector for transmission of enteric pathogens. Interventions, such as depuration, do not adequately clear enteric viruses, while fecal bacteria levels are significantly reduced. Why viruses are retained in the bivalve flesh is not well understood. We hypothesize that phagoc...

15 CFR 301.8 - Instructions for entering instruments through Customs and Border Protection under subheading 9810...

Code of Federal Regulations, 2014 CFR

2014-01-01

... ADMINISTRATION, DEPARTMENT OF COMMERCE MISCELLANEOUS REGULATIONS INSTRUMENTS AND APPARATUS FOR EDUCATIONAL AND SCIENTIFIC INSTITUTIONS § 301.8 Instructions for entering instruments through Customs and Border Protection... 15 Commerce and Foreign Trade 2 2014-01-01 2014-01-01 false Instructions for entering instruments...

15 CFR 301.8 - Instructions for entering instruments through Customs and Border Protection under subheading 9810...

Code of Federal Regulations, 2013 CFR

2013-01-01

... ADMINISTRATION, DEPARTMENT OF COMMERCE MISCELLANEOUS REGULATIONS INSTRUMENTS AND APPARATUS FOR EDUCATIONAL AND SCIENTIFIC INSTITUTIONS § 301.8 Instructions for entering instruments through Customs and Border Protection... 15 Commerce and Foreign Trade 2 2013-01-01 2013-01-01 false Instructions for entering instruments...

15 CFR 301.8 - Instructions for entering instruments through Customs and Border Protection under subheading 9810...

Code of Federal Regulations, 2010 CFR

2010-01-01

... ADMINISTRATION, DEPARTMENT OF COMMERCE MISCELLANEOUS REGULATIONS INSTRUMENTS AND APPARATUS FOR EDUCATIONAL AND SCIENTIFIC INSTITUTIONS § 301.8 Instructions for entering instruments through Customs and Border Protection... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Instructions for entering instruments...

15 CFR 301.8 - Instructions for entering instruments through Customs and Border Protection under subheading 9810...

Code of Federal Regulations, 2011 CFR

2011-01-01

... ADMINISTRATION, DEPARTMENT OF COMMERCE MISCELLANEOUS REGULATIONS INSTRUMENTS AND APPARATUS FOR EDUCATIONAL AND SCIENTIFIC INSTITUTIONS § 301.8 Instructions for entering instruments through Customs and Border Protection... 15 Commerce and Foreign Trade 2 2011-01-01 2011-01-01 false Instructions for entering instruments...

15 CFR 301.8 - Instructions for entering instruments through Customs and Border Protection under subheading 9810...

Code of Federal Regulations, 2012 CFR

2012-01-01

... ADMINISTRATION, DEPARTMENT OF COMMERCE MISCELLANEOUS REGULATIONS INSTRUMENTS AND APPARATUS FOR EDUCATIONAL AND SCIENTIFIC INSTITUTIONS § 301.8 Instructions for entering instruments through Customs and Border Protection... 15 Commerce and Foreign Trade 2 2012-01-01 2012-01-01 false Instructions for entering instruments...

Calcium Montmorillonite-based dietary supplement attenuates Necrotic Enteritis induced by Eimeria maxima and Clostridium perfringens in broilers

USDA-ARS?s Scientific Manuscript database

We provide the first description of Dietary Supplement of sorbent minerals attenuates Necrotic Enteritis Induced by Eimeria maxima and Clostridium perfringens in Broilers. Necrotic enteritis (NE) is a poultry disease caused by Clostridium perfringens and characterized by severe intestinal necrosis....

Four phage endolysins that are lytic for clostridium perfringens

USDA-ARS?s Scientific Manuscript database

Clostridium perfringens is a bacterial pathogen and the cause of necrotic enteritis in poultry, and a source of food poisoning and gas gangrene in people. C. perfringens can also cause mild to severe enteritis in pigs. In the EU, the occurrence of C. perfringens-associated necrotic enteritis in pou...

27 CFR 646.153 - Authority of appropriate ATF officers to enter business premises.

Code of Federal Regulations, 2010 CFR

2010-04-01

... REGULATIONS RELATING TO ALCOHOL AND TOBACCO CONTRABAND CIGARETTES Other Provisions Relating to the Distribution of Cigarettes § 646.153 Authority of appropriate ATF officers to enter business premises. Any appropriate ATF officer may enter the business premises of any distributor of cigarettes to inspect the...

27 CFR 646.153 - Authority of appropriate ATF officers to enter business premises.

Code of Federal Regulations, 2011 CFR

2011-04-01

... REGULATIONS RELATING TO ALCOHOL AND TOBACCO CONTRABAND CIGARETTES Other Provisions Relating to the Distribution of Cigarettes § 646.153 Authority of appropriate ATF officers to enter business premises. Any appropriate ATF officer may enter the business premises of any distributor of cigarettes to inspect the...

27 CFR 646.153 - Authority of appropriate ATF officers to enter business premises.

Code of Federal Regulations, 2013 CFR

2013-04-01

... REGULATIONS RELATING TO ALCOHOL AND TOBACCO CONTRABAND CIGARETTES Other Provisions Relating to the Distribution of Cigarettes § 646.153 Authority of appropriate ATF officers to enter business premises. Any appropriate ATF officer may enter the business premises of any distributor of cigarettes to inspect the...

27 CFR 646.153 - Authority of appropriate ATF officers to enter business premises.

Code of Federal Regulations, 2014 CFR

2014-04-01

... REGULATIONS RELATING TO ALCOHOL AND TOBACCO CONTRABAND CIGARETTES Other Provisions Relating to the Distribution of Cigarettes § 646.153 Authority of appropriate ATF officers to enter business premises. Any appropriate ATF officer may enter the business premises of any distributor of cigarettes to inspect the...

9 CFR 355.21 - Products entering inspected plants.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Products entering inspected plants... Products entering inspected plants. All products of a kind certified under this part or materials to be used in the preparation of such products when brought into an inspected plant shall be identified and...

9 CFR 355.21 - Products entering inspected plants.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Products entering inspected plants... Products entering inspected plants. All products of a kind certified under this part or materials to be used in the preparation of such products when brought into an inspected plant shall be identified and...

9 CFR 355.21 - Products entering inspected plants.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Products entering inspected plants... Products entering inspected plants. All products of a kind certified under this part or materials to be used in the preparation of such products when brought into an inspected plant shall be identified and...

9 CFR 355.21 - Products entering inspected plants.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Products entering inspected plants... Products entering inspected plants. All products of a kind certified under this part or materials to be used in the preparation of such products when brought into an inspected plant shall be identified and...

9 CFR 355.21 - Products entering inspected plants.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Products entering inspected plants... Products entering inspected plants. All products of a kind certified under this part or materials to be used in the preparation of such products when brought into an inspected plant shall be identified and...

25 CFR 11.604 - Declaration of invalidity.

Code of Federal Regulations, 2010 CFR

2010-04-01

... enter a decree declaring the invalidity of a marriage entered into under the following circumstances: (1) A party lacked capacity to consent to the marriage, either because of mental incapacity or infirmity... to enter into a marriage by fraud or duress; or (3) A party lacks the physical capacity to consummate...

Consolidated Afloat Networks and Enterprise Services (CANES). Manpower, Personnel, and Training Implications

DTIC Science & Technology

2009-01-01

certification and proceed to a unit. They are represented in the stock “Later pass to 4YOS ,” and the rest of their career follows the same path as ITs who...In the Status Quo and the Base Case, all ITs enter on a four-years-of-service ( 4YOS ) contract. In Case 1, which reflects current plans for ITs, the...IT community is split between those entering with 4YOS and those entering with 6YOS contracts. Thirty-five percent of the community enters with a

Effect of Calcium Ions on the Disintegration of Enteric-Coated Solid Dosage Forms.

PubMed

Al-Gousous, Jozef; Langguth, Peter

2016-02-01

To investigate the effect of calcium ions on the disintegration of enteric-coated dosage forms, disintegration testing was performed on enteric-coated aspirin tablets in the presence and absence of calcium in the test media. The results show that the presence of calcium ions retards the disintegration of enteric-coated dosage forms. This finding, which has not been reported in scientific literature, sheds light on the importance of conducting well-designed detailed investigations into the potential of calcium from dietary sources, calcium supplements, antacids, and/or phosphate binders affecting the absorption of drugs formulated into enteric-coated dosage forms. Moreover, it shows the necessity to investigate the potential of the occurrence of additional nutrient-excipient interactions. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

The Preparation of Capsaicin-Chitosan Microspheres (CCMS) Enteric Coated Tablets

PubMed Central

Chen, Jian; Huang, Gui-Dong; Tan, Si-Rong; Guo, Jiao; Su, Zheng-Quan

2013-01-01

This study aimed to research the preparation and content determination of capsaicin-chitosan microspheres (CCMS) enteric coated tablets. The core tablets were prepared with the method of wet granulation. Nine formulae were designed to determine the optimal formula of the core tablet. Eudragit L100 was used to prepare the CCMS enteric-coated tablets. The effect of enteric coated formulation variables such as content of talc (10%, 25% and 40%), plasticisers (TEC and DBS), dosage of plasticiser (10%, 20% and 30%) and coating weight (2%, 3% and 5%) were evaluated for drug release characteristics. The in vitro release was studied using 0.1 N HCl and pH 6.8 phosphate buffer. Enteric coated tablets without ruptures or swelling behaviour over 2 h in 0.1 N HCl indicated that these tablets showed acid resistance. The accumulated release rate in phosphate buffer (pH 6.8) revealed that the prepared tablets were able to sustain drug release into the intestine and a first-order release was obtained for capsaicin. This research is the first report of the preparation and content determination of CCMS enteric coated tablets. The sustained release behavior of enteric coated formulations in pH 6.8 phosphate buffer demonstrated that it would be a potential drug delivery platform for sustained delivery of gastric irritant drugs. PMID:24351818

Mining free-text medical records for companion animal enteric syndrome surveillance.

PubMed

Anholt, R M; Berezowski, J; Jamal, I; Ribble, C; Stephen, C

2014-03-01

Large amounts of animal health care data are present in veterinary electronic medical records (EMR) and they present an opportunity for companion animal disease surveillance. Veterinary patient records are largely in free-text without clinical coding or fixed vocabulary. Text-mining, a computer and information technology application, is needed to identify cases of interest and to add structure to the otherwise unstructured data. In this study EMR's were extracted from veterinary management programs of 12 participating veterinary practices and stored in a data warehouse. Using commercially available text-mining software (WordStat™), we developed a categorization dictionary that could be used to automatically classify and extract enteric syndrome cases from the warehoused electronic medical records. The diagnostic accuracy of the text-miner for retrieving cases of enteric syndrome was measured against human reviewers who independently categorized a random sample of 2500 cases as enteric syndrome positive or negative. Compared to the reviewers, the text-miner retrieved cases with enteric signs with a sensitivity of 87.6% (95%CI, 80.4-92.9%) and a specificity of 99.3% (95%CI, 98.9-99.6%). Automatic and accurate detection of enteric syndrome cases provides an opportunity for community surveillance of enteric pathogens in companion animals. Copyright © 2014 Elsevier B.V. All rights reserved.

Microbiological quality and safe handling of enteral diets in a hospital in Minas Gerais, Brazil

PubMed Central

Pinto, Raquel Oliveira Medrado; Correia, Eliznara Fernades; Pereira, Keyla Carvalho; Costa, Paulo de Souza; da Silva, Daniele Ferreira

2015-01-01

Contamination of enteral diets represents a high risk of compromising the patient's medical condition. To assess the microbiological quality and aseptic conditions in the preparation and administration of handmade and industrialized enteral diets offered in a hospital in the Valley of Jequitinhonha, MG, Brazil, we performed a microbiological analysis of 50 samples of diets and 27 samples of surfaces, utensils, and water used in the preparation of the diets. In addition, we assessed the good handling practices of enteral diets according to the requirements specified by the Brazilian legislation. Both kinds of enteral diets showed contamination by coliforms and Pseudomonas spp. No sample was positive for Staphylococcus aureus and Salmonella spp. On the other hand, Listeria spp. was detected in only one sample of handmade diets. Contamination was significantly higher in the handmade preparations (p < 0.05). Nonconformities were detected with respect to good handling practices, which may compromise the diet safety. The results indicate that the sanitary quality of the enteral diets is unsatisfactory, especially handmade diets. Contamination by Pseudomonas spp. is significant because it is often involved in infection episodes. With regard to aseptic practices, it was observed the need of implementing new procedures for handling enteral diets. PMID:26273278

Homeostasis alteration within small intestinal mucosa after acute enteral refeeding in total parenteral nutrition mouse model

PubMed Central

Feng, Yongjia; Barrett, Meredith; Hou, Yue; Yoon, Hong Keun; Ochi, Takanori

2015-01-01

Feeding strategies to care for patients who transition from enteral nutrient deprivation while on total parenteral nutrition (TPN) to enteral feedings generally proceed to full enteral nutrition once the gastrointestinal tract recovers; however, an increasing body of literature suggests that a subgroup of patients may actually develop an increased incidence of adverse events, including death. To examine this further, we studied the effects of acute refeeding in a mouse model of TPN. Interestingly, refeeding led to some beneficial effects, including prevention in the decline in intestinal epithelial cell (IEC) proliferation. However, refeeding led to a significant increase in mucosal expression of proinflammatory cytokines, including tumor necrosis factor-α (TNF-α), as well as an upregulation in Toll-like receptor 4 (TLR-4). Refeeding also failed to prevent TPN-associated increases in IEC apoptosis, loss of epithelial barrier function, and failure of the leucine-rich repeat-containing G protein-coupled receptor 5-positive stem cell expression. Transitioning from TPN to enteral feedings led to a partial restoration of the small bowel microbial population. In conclusion, while acute refeeding led to some restoration of normal gastrointestinal physiology, enteral refeeding led to a significant increase in mucosal inflammatory markers and may suggest alternative strategies to enteral refeeding should be considered. PMID:26635320

Alternative method for enteric coating of HPMC capsules resulting in ready-to-use enteric-coated capsules.

PubMed

Huyghebaert, Nathalie; Vermeire, An; Remon, Jean Paul

2004-04-01

The aim of this study was to develop an alternative method for enteric coating of HPMC capsules that avoids the sealing step before coating, resulting in ready-to-use enteric-coated capsules for the use in retail or hospital pharmacy or R&D sections of pharmaceutical industry and for the production of enteric-coated heat and moisture sensitive biomaterials. HPMC caps and bodies 00 (Vcaps, Capsugel) were coated separately in a fluid bed apparatus prior to filling (GPCG-1, Glatt) with Eudragit L30D-55 or Eudragit FS 30 D (Röhm), Aqoat AS-HF (Shin-Etsu) and Sureteric (Colorcon), using an optimised coating process. The coated bodies were filled and closed with the coated caps without encountering problems of coating damage. The release in 0.1N HCl after 2h from capsules coated with Eudragit L30D-55, Eudragit FS 30 D, Aqoat AS-HF and Sureteric was 0.6+/-.03, 0.6+/-0.3, 1.2+/-0.2 and 7.3+/-1.9%, respectively. The alternative method was reproducible and offered a way to overcome the time-consuming and expensive sealing step required using the conventional coating procedure. The obtained enteric-coated HPMC capsules can be stored (un)-filled for at least 6 months without loosing enteric properties.

A Comparison of Attitudes Toward Opioid Agonist Treatment among Short-Term Buprenorphine Patients

PubMed Central

Kelly, Sharon M.; Brown, Barry S.; Katz, Elizabeth C.; O’Grady, Kevin E.; Mitchell, Shannon Gwin; King, Stuart; Schwartz, Robert P.

2014-01-01

Background Obtaining data on attitudes toward buprenorphine and methadone of opioid-dependent individuals in the United States may help fashion approaches to increase treatment entry and improve patient outcomes. Objectives This secondary analysis study compared attitudes toward methadone and buprenorphine of opioid-dependent adults entering short-term buprenorphine treatment (BT) with opioid-dependent adults who are either entering methadone maintenance treatment or not entering treatment. Methods The 417 participants included 132 individuals entering short-term BT, 191 individuals entering methadone maintenance, and 94 individuals not seeking treatment. Participants were administered an Attitudes toward Methadone scale and its companion Attitudes toward Buprenorphine scale. Demographic characteristics for the three groups were compared using χ2 tests of independence and one-way analysis of variance. A repeated-measures multivariate analysis of variance with planned contrasts was used to compare mean attitude scores among the groups. Results Participants entering BT had significantly more positive attitudes toward buprenorphine than toward methadone (p < .001) and more positive attitudes toward BT than methadone-treatment (MT) participants and out-of-treatment (OT) participants (p < .001). In addition, BT participants had less positive attitudes toward methadone than participants entering MT (p < .001). Conclusions Participants had a clear preference for a particular medication. Offering a choice of medications to OT individuals might enhance their likelihood of entering treatment. Treatment programs should offer a choice of medications when possible to new patients, and future comparative effectiveness research should incorporate patient preferences into clinical trials. Scientific Significance These data contribute to our understanding of why people seek or do not seek effective pharmacotherapy for opioid addiction. PMID:22242643

Interaction between levodopa and enteral nutrition.

PubMed

Cooper, Mandelin K; Brock, David G; McDaniel, Cara M

2008-03-01

To report and discuss a drug-nutrient interaction involving levodopa and protein in enteral nutrition. A 77-year-old male with Parkinson's disease was admitted to an intensive care unit for an intracerebral hemorrhage. To provide nutritional support, an oral gastric tube was placed and continuous enteral nutrition was initiated, with 1.4 g/kg of protein administered daily. The following medications were continued during hospitalization: immediate-release carbidopa/levodopa 25 mg/100 mg, with 1.5 tablets administered 4 times daily; pramipexole 1.5 mg 3 times daily; and entacapone 200 mg 4 times daily. Despite this drug therapy, the patient developed severe rigidity. A review of the literature revealed a potential interaction between levodopa and protein intake. To resolve this interaction, the amount of protein in the enteral nutrition was decreased to 0.9 g/kg/day and the nutritional administration was changed from continuous enteral feeding to bolus feeding, with levodopa given between boluses. After these adjustments, the patient showed marked improvement of parkinsonian symptoms. The drug-nutrient interaction between protein and levodopa in outpatient settings has been reported widely in the literature; however, this interaction has not been previously reported with continuous enteral nutrition. Decreased parkinsonian symptom control, despite adherence to an established medication regimen, together with dramatic improvement observed after manipulation of enteral nutrition delivery and content, strongly suggest interference with levodopa absorption. Use of the Naranjo probability scale supports a probable interaction between the protein content in tube feeds and levodopa, resulting in decreased levodopa efficacy. Clinicians should be cognizant of the potential drug-nutrient interaction between levodopa and enteral nutrition.

Porcine circovirus type 2 (PCV2) enteric disease: an independent condition or part of the systemic disease?

PubMed

Baró, J; Segalés, J; Martínez, J

2015-03-23

Intestinal disorders in growing and finishing pigs have been associated with several infectious agents, including Porcine circovirus type 2 (PCV2). This virus has been mainly related with PCV2-systemic disease (PCV2-SD); nevertheless, some authors have suggested a possible restricted intestinal infection of this virus associated with enteric clinical signs. This condition has been referred as PCV2-enteric disease (PCV2-ED). The present study analysed retrospectively, from a pathological point of view, the relation between intestinal disorders and PCV2 infection in nursery and growing-finishing pigs. Among the 96 selected pigs suffering from enteric disease and submitted for necropsy between 1998 and 2011, the most prevalent enteric lesions were catarrhal enteritis/colitis (77.1%), followed by fibrinous lesions (11.5%), granulomatous inflammation (4.2%) and other lesions such as haemorrhages or ulceration (4.2%). Seventy-two pigs (75%) were positive for PCV2 by in situ hybridization (ISH). Among positive pigs for PCV2 ISH, 39 animals suffered from PCV2-SD and 33 had no lymphoid lesions but low amount of viral nucleic acid in several lymphoid tissues, therefore, these animals did not qualify for PCVD-ED. In conclusion, all animals with enteric disorders that were positive to PCV2 by ISH had evidence of viral systemic infection. These results suggest that PCV2-ED is probably a negligible condition and PCV2 mainly contributes to enteric clinical disorders in relation to PCV2-SD occurrence. Copyright © 2015 Elsevier B.V. All rights reserved.

Employee and work-related predictors for entering rehabilitation: a cohort study of civil servants.

PubMed

Lamminpää, Anne; Kuoppala, Jaana; Väänänen-Tomppo, Irma; Hinkka, Katariina

2012-07-01

The aim of this study was to determine how employee well-being, psychosocial factors at work, leadership and perceived occupational health services predict entering rehabilitation as modelled in the Job Well-being Pyramid. A random population of 967 civil servants participated in a survey on psychosocial factors and health at work in 2000 in Finland. A total of 147 employees entered rehabilitation during the median follow-up time of 7 years. Permanent employment, large organizations, feedback from supervisors, client violence and physically monotonous work were associated with an increased rate of entering rehabilitation, whereas physical jobs, clear aims, high appreciation, job satisfaction and job enjoyment were associated with a decreased rate of entering rehabilitation. Employee well-being in general was also associated with entering rehabilitation, and this was decreased by good work ability, good health, mental well-being and physical fitness and increased by constant musculoskeletal symptoms. On the other hand, support from supervisors, job control, work pressure, team climate at work, communication, bullying and discrimination, physical work environment, and sense of coherence appeared to have no association. Various psychosocial factors at work and job well-being predict entering rehabilitation. The association between employee health and entering rehabilitation refers to the fact that the selection process for rehabilitation works reasonably well and those in need of rehabilitation are also granted it. In general, these findings coincide well with the Job Well-being Pyramid model. Improving job conditions and well-being at work is likely to decrease the need for rehabilitation.

Clinical and microbiological profile of a retrospective cohort of enteric fever in 2 Spanish tertiary hospitals.

PubMed

Sánchez-Montalvá, Adrián; Martínez-Pérez, Ángela; Pérez-Molina, José Antonio; González-López, Juan José; Lopez-Vélez, Rogelio; Salvador, Fernando; Sánchez, Irene; Planes, Anna M; Molina, Israel

2015-05-01

Enteric fever in high-income countries is diagnosed mainly in patients returning from endemic countries. We assess the clinical, microbiological, and prognosis aspects of enteric fever in 2 Spanish tertiary hospitals. A retrospective observational study was conducted at Vall d'Hebron University Hospital and Ramón y Cajal University Hospital in Spain. We reviewed medical records of all patients who were diagnosed with enteric fever from January 2000 to January 2014 at these hospitals. We identified 47 patients with enteric fever episodes. According to their travel history, 35 (74.5%) patients had travelled to highly endemic countries. Imported enteric fever was acquired mainly in Asia (70.3%). Imported infections were implicated in travelers (48.6%), visiting friends and relatives (40%) and immigrants (11.4%). We found that 12 patients were diagnosed with enteric fever without a travel history (autochthonous infection). The resistance profile of the isolates showed decreased ciprofloxacin susceptibility in 66.7% of the imported group and 8.3% of the autochthonous group (P = 0.001). Salmonella strains from patients returning from Asia had an increased risk of having decreased ciprofloxacin susceptibility (odds ratio, 52.25; 95% confidence interval: 8.6-317.7). Patients with imported enteric fever are at higher risk for having a Salmonella strain with decreased ciprofloxacin susceptibility, especially in patients returning from Asia. Initial treatment with third-generation cephalosporin or azithromycin is strongly recommended until a drug-susceptibility test is available. Prevention strategies such as pretravel counseling and immunization before travel may be beneficial.

49 CFR 236.512 - Cab signal indication when locomotive enters block where restrictive conditions obtain.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Cab signal indication when locomotive enters block... Systems Standards § 236.512 Cab signal indication when locomotive enters block where restrictive... within a block, wherein any condition described in § 236.205 obtains, the cab signals shall indicate...

9 CFR 590.26 - Egg products entering or prepared in official plants.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Egg products entering or prepared in..., DEPARTMENT OF AGRICULTURE EGG PRODUCTS INSPECTION INSPECTION OF EGGS AND EGG PRODUCTS (EGG PRODUCTS INSPECTION ACT) Scope of Inspection § 590.26 Egg products entering or prepared in official plants. Eggs and...

49 CFR 236.512 - Cab signal indication when locomotive enters block where restrictive conditions obtain.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Automatic Train Stop, Train Control and Cab Signal Systems Standards § 236.512 Cab signal indication when locomotive enters block where restrictive conditions obtain. The automatic cab signal system shall be arranged so that when a locomotive enters or is...

19 CFR 10.570 - Goods re-entered after repair or alteration in Singapore.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Goods re-entered after repair or alteration in... States-Singapore Free Trade Agreement Goods Returned After Repair Or Alteration § 10.570 Goods re-entered... alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment...

19 CFR 10.1034 - Goods re-entered after repair or alteration in Korea.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Goods re-entered after repair or alteration in... States-Korea Free Trade Agreement Goods Returned After Repair Or Alteration § 10.1034 Goods re-entered... alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment...

19 CFR 10.1034 - Goods re-entered after repair or alteration in Korea.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Goods re-entered after repair or alteration in... States-Korea Free Trade Agreement Goods Returned After Repair Or Alteration § 10.1034 Goods re-entered... alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment...

19 CFR 10.827 - Goods re-entered after repair or alteration in Bahrain.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Goods re-entered after repair or alteration in... States-Bahrain Free Trade Agreement Goods Returned After Repair Or Alteration § 10.827 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.934 - Goods re-entered after repair or alteration in Peru.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Goods re-entered after repair or alteration in... States-Peru Trade Promotion Agreement Goods Returned After Repair Or Alteration § 10.934 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment that...

19 CFR 10.570 - Goods re-entered after repair or alteration in Singapore.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Goods re-entered after repair or alteration in... States-Singapore Free Trade Agreement Goods Returned After Repair Or Alteration § 10.570 Goods re-entered... alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment...

19 CFR 10.827 - Goods re-entered after repair or alteration in Bahrain.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Goods re-entered after repair or alteration in... States-Bahrain Free Trade Agreement Goods Returned After Repair Or Alteration § 10.827 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.934 - Goods re-entered after repair or alteration in Peru.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Goods re-entered after repair or alteration in... States-Peru Trade Promotion Agreement Goods Returned After Repair Or Alteration § 10.934 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment that...

19 CFR 10.787 - Goods re-entered after repair or alteration in Morocco.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Goods re-entered after repair or alteration in... States-Morocco Free Trade Agreement Goods Returned After Repair Or Alteration § 10.787 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.787 - Goods re-entered after repair or alteration in Morocco.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Goods re-entered after repair or alteration in... States-Morocco Free Trade Agreement Goods Returned After Repair Or Alteration § 10.787 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.490 - Goods re-entered after repair or alteration in Chile.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Goods re-entered after repair or alteration in... States-Chile Free Trade Agreement Goods Returned After Repair Or Alteration § 10.490 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.787 - Goods re-entered after repair or alteration in Morocco.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Goods re-entered after repair or alteration in... States-Morocco Free Trade Agreement Goods Returned After Repair Or Alteration § 10.787 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.490 - Goods re-entered after repair or alteration in Chile.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Goods re-entered after repair or alteration in... States-Chile Free Trade Agreement Goods Returned After Repair Or Alteration § 10.490 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.570 - Goods re-entered after repair or alteration in Singapore.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Goods re-entered after repair or alteration in... States-Singapore Free Trade Agreement Goods Returned After Repair Or Alteration § 10.570 Goods re-entered... alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment...

19 CFR 10.570 - Goods re-entered after repair or alteration in Singapore.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Goods re-entered after repair or alteration in... States-Singapore Free Trade Agreement Goods Returned After Repair Or Alteration § 10.570 Goods re-entered... alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment...

19 CFR 10.827 - Goods re-entered after repair or alteration in Bahrain.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Goods re-entered after repair or alteration in... States-Bahrain Free Trade Agreement Goods Returned After Repair Or Alteration § 10.827 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.570 - Goods re-entered after repair or alteration in Singapore.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Goods re-entered after repair or alteration in... States-Singapore Free Trade Agreement Goods Returned After Repair Or Alteration § 10.570 Goods re-entered... alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment...

19 CFR 10.827 - Goods re-entered after repair or alteration in Bahrain.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Goods re-entered after repair or alteration in... States-Bahrain Free Trade Agreement Goods Returned After Repair Or Alteration § 10.827 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.827 - Goods re-entered after repair or alteration in Bahrain.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Goods re-entered after repair or alteration in... States-Bahrain Free Trade Agreement Goods Returned After Repair Or Alteration § 10.827 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.1034 - Goods re-entered after repair or alteration in Korea.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Goods re-entered after repair or alteration in... States-Korea Free Trade Agreement Goods Returned After Repair Or Alteration § 10.1034 Goods re-entered... alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment...

19 CFR 10.787 - Goods re-entered after repair or alteration in Morocco.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Goods re-entered after repair or alteration in... States-Morocco Free Trade Agreement Goods Returned After Repair Or Alteration § 10.787 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.490 - Goods re-entered after repair or alteration in Chile.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Goods re-entered after repair or alteration in... States-Chile Free Trade Agreement Goods Returned After Repair Or Alteration § 10.490 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.934 - Goods re-entered after repair or alteration in Peru.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Goods re-entered after repair or alteration in... States-Peru Trade Promotion Agreement Goods Returned After Repair Or Alteration § 10.934 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment that...

19 CFR 10.787 - Goods re-entered after repair or alteration in Morocco.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Goods re-entered after repair or alteration in... States-Morocco Free Trade Agreement Goods Returned After Repair Or Alteration § 10.787 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.490 - Goods re-entered after repair or alteration in Chile.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Goods re-entered after repair or alteration in... States-Chile Free Trade Agreement Goods Returned After Repair Or Alteration § 10.490 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

19 CFR 10.490 - Goods re-entered after repair or alteration in Chile.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Goods re-entered after repair or alteration in... States-Chile Free Trade Agreement Goods Returned After Repair Or Alteration § 10.490 Goods re-entered...” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or other treatment which...

42 CFR 137.285 - Are Self-Governance Tribes required to accept Federal environmental responsibilities to enter...

Code of Federal Regulations, 2011 CFR

2011-10-01

...-Governance Tribes required to accept Federal environmental responsibilities to enter into a construction... 42 Public Health 1 2011-10-01 2011-10-01 false Are Self-Governance Tribes required to accept Federal environmental responsibilities to enter into a construction project agreement? 137.285 Section 137...

38 CFR 36.4527 - Direct housing loans to Native American veterans on trust lands.

Code of Federal Regulations, 2010 CFR

2010-07-01

... American veteran if: (1) The Secretary has entered into a memorandum of understanding with respect to such... organization that has jurisdiction over the veteran has entered into a memorandum of understanding with any... to paragraph (b)(2) of this section, each memorandum of understanding entered into by the Secretary...

78 FR 9720 - Agency Information Collection Activities: Holders or Containers Which Enter the United States...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-11

... Activities: Holders or Containers Which Enter the United States Duty Free AGENCY: U.S. Customs and Border... or Containers which enter the United States Duty Free. This is a proposed extension of an information..., or other technological techniques or other forms of information. Title: Holders or Containers which...

46 CFR 154.1850 - Entering cargo handling spaces.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 5 2013-10-01 2013-10-01 false Entering cargo handling spaces. 154.1850 Section 154... cargo handling spaces. (a) The master shall ensure that the ventilation system under § 154.1200 is in operation for 30 minutes before a person enters one of the following: (1) Spaces containing cargo pumps...

46 CFR 154.1850 - Entering cargo handling spaces.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 5 2012-10-01 2012-10-01 false Entering cargo handling spaces. 154.1850 Section 154... cargo handling spaces. (a) The master shall ensure that the ventilation system under § 154.1200 is in operation for 30 minutes before a person enters one of the following: (1) Spaces containing cargo pumps...

46 CFR 154.1850 - Entering cargo handling spaces.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 5 2010-10-01 2010-10-01 false Entering cargo handling spaces. 154.1850 Section 154... cargo handling spaces. (a) The master shall ensure that the ventilation system under § 154.1200 is in operation for 30 minutes before a person enters one of the following: (1) Spaces containing cargo pumps...

46 CFR 154.1850 - Entering cargo handling spaces.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 5 2011-10-01 2011-10-01 false Entering cargo handling spaces. 154.1850 Section 154... cargo handling spaces. (a) The master shall ensure that the ventilation system under § 154.1200 is in operation for 30 minutes before a person enters one of the following: (1) Spaces containing cargo pumps...

46 CFR 154.1850 - Entering cargo handling spaces.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 5 2014-10-01 2014-10-01 false Entering cargo handling spaces. 154.1850 Section 154... cargo handling spaces. (a) The master shall ensure that the ventilation system under § 154.1200 is in operation for 30 minutes before a person enters one of the following: (1) Spaces containing cargo pumps...

77 FR 74861 - Agency Information Collection Activities: Application for Advance Permission To Enter as...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-18

...-0017] Agency Information Collection Activities: Application for Advance Permission To Enter as...: Extension, Without Change, of a Currently Approved Collection. (2) Title of the Form/Collection: Application for Advance Permission to Enter as Nonimmigrant [Pursuant to Section 212(d)(3)(A(ii) of the INA]. (3...

NREL Scientists Report First Solar Cell Producing More Electrons In

Science.gov Websites

Photocurrent Than Solar Photons Entering Cell | News | NREL NREL Scientists Report First Solar Cell Producing More Electrons In Photocurrent Than Solar Photons Entering Cell News Release: NREL Scientists Report First Solar Cell Producing More Electrons In Photocurrent Than Solar Photons Entering Cell

48 CFR 1846.672-1 - Preparation instructions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... instructions/limits for material environmental control (e.g., temperature, humidity, aging, freezing, and shock... entered at the end of the statement and an explanatory note in Block 16; (B) Sign and date; and (C) Enter... an “X” in the appropriate box(es); (B) Sign and date; and (C) Enter the typed, stamped, or printed...

Scramjet Isolator Modeling and Control

DTIC Science & Technology

2011-12-01

12 γ Ratio of specific heats . . . . . . . . . . . . . . . . . . . . 12 p1 Static pressure entering shock . . . . . . . . . . . . . . . . 12 M1 Mach...138 MAve Average stream Mach number . . . . . . . . . . . . . . . . 138 γ Ratio of specific heats ... heats , p1 is the static pressure entering the shock, and M1 is the Mach number of the flow entering the shock. Subsequent researchers [9] took a

Characterization of Clostridium perfringens strains isolated from clinically healthy and necrotic enteritis-afflicted broiler chickens

USDA-ARS?s Scientific Manuscript database

Clostridium perfringens (CP) Type A strains are the main etiological factor for necrotic enteritis (NE), one of the important enteric diseases in poultry, which has gained worldwide attention during the last decade and is responsible for the annual loss of 6 billion dollars in US poultry industry. ...

What Motivational Factors Influence African American Males to Enter a Doctorial Program

ERIC Educational Resources Information Center

Humphreys, Phillip

2010-01-01

Purpose: The purpose of this study was to determine the motivational factors that influence African American men to enter a doctoral program by identifying the motivational factors that influenced them to enter a doctorial program. The findings were compared to Dr. Gloria J. Hill's dissertation study (2005), "What Motivational Factors Influence…

15 CFR 270.323 - Requests for permission to enter and inspect property where building components, materials...

Code of Federal Regulations, 2012 CFR

2012-01-01

... CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Collection and Preservation of Evidence... Team, the Lead Investigator or their designee may request permission to enter and inspect property... be inspected and to carry out the duties of the Team. (b) Requests for permission to enter and...

15 CFR 270.323 - Requests for permission to enter and inspect property where building components, materials...

Code of Federal Regulations, 2010 CFR

2010-01-01

... CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Collection and Preservation of Evidence... Team, the Lead Investigator or their designee may request permission to enter and inspect property... be inspected and to carry out the duties of the Team. (b) Requests for permission to enter and...

15 CFR 270.323 - Requests for permission to enter and inspect property where building components, materials...

Code of Federal Regulations, 2014 CFR

2014-01-01

... CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Collection and Preservation of Evidence... Team, the Lead Investigator or their designee may request permission to enter and inspect property... be inspected and to carry out the duties of the Team. (b) Requests for permission to enter and...

15 CFR 270.323 - Requests for permission to enter and inspect property where building components, materials...

Code of Federal Regulations, 2011 CFR

2011-01-01

... CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Collection and Preservation of Evidence... Team, the Lead Investigator or their designee may request permission to enter and inspect property... be inspected and to carry out the duties of the Team. (b) Requests for permission to enter and...

15 CFR 270.323 - Requests for permission to enter and inspect property where building components, materials...

Code of Federal Regulations, 2013 CFR

2013-01-01

... CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Collection and Preservation of Evidence... Team, the Lead Investigator or their designee may request permission to enter and inspect property... be inspected and to carry out the duties of the Team. (b) Requests for permission to enter and...

9 CFR 590.26 - Egg products entering or prepared in official plants.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Egg products entering or prepared in..., DEPARTMENT OF AGRICULTURE EGG PRODUCTS INSPECTION INSPECTION OF EGGS AND EGG PRODUCTS (EGG PRODUCTS INSPECTION ACT) Scope of Inspection § 590.26 Egg products entering or prepared in official plants. Eggs and...

Adenocarcinoma of the thymus, enteric type: report of 2 cases, and proposal for a novel subtype of thymic carcinoma.

PubMed

Moser, Bernhard; Schiefer, Ana Iris; Janik, Stefan; Marx, Alexander; Prosch, Helmut; Pohl, Wolfgang; Neudert, Barbara; Scharrer, Anke; Klepetko, Walter; Müllauer, Leonhard

2015-04-01

We report 2 cases of primary thymic adenocarcinoma with enteric differentiation. One carcinoma occurred in a 41-year-old man as a 7-cm-diameter cystic tumor and the other one in a 39-year-old woman as a 6-cm-diameter solid mass. Both tumors were located in the anterior mediastinum. Clinical staging did not reveal any extrathymic tumor. Histologically, the tumors were classified as adenocarcinoma, not otherwise specified, and a mucinous (colloid) carcinoma, respectively. Immunohistochemically, both tumors were positive for cytokeratin 20 (CK20), CDX2, and carcinoembryonic antigen, reflecting enteric differentiation. A review of the literature on 43 other cases of primary thymic adenocarcinomas suggested 11 further cases with enteric differentiation, as assessed by CK20 and/or CDX2 expression. We propose that thymic adenocarcinoma with enteric differentiation represents a novel subtype of thymic carcinoma. It is mostly of mucinous morphology and frequently associated with thymic cysts. The clinical outcome is variable. Recognition of primary thymic adenocarcinoma with enteric differentiation is helpful for the differentiation from metastatic disease, mainly from the gastrointestinal tract.

Relative disease susceptibility and clostridial toxin antibody responses in three commercial broiler lines coinfected with Clostridium perfringens and Eimeria maxima using an experimental model of necrotic enteritis.

PubMed

Jang, Seung I; Lillehoj, Hyun S; Lee, Sung-Hyen; Lee, Kyung Woo; Lillehoj, Erik P; Hong, Yeong Ho; An, Dong-Jun; Jeoung, D Hye-Young; Chun, Ji-Eun

2013-09-01

Necrotic enteritis is an enteric disease of poultry resulting from infection by Clostridium perfringens with coinfection by Eimeria spp. constituting a major risk factor for disease pathogenesis. This study compared three commercial broiler chicken lines using an experimental model of necrotic enteritis. Day-old male Cobb, Ross, and Hubbard broilers were orally infected with viable C. perfringens and E. maxima and fed a high-protein diet to promote the development of experimental disease. Body weight loss, intestinal lesions, and serum antibody levels against alpha-toxin and necrotic enteritis B-like (NetB) toxin were measured as parameters of disease susceptibility and host immune response. Cobb chickens exhibited increased body weight loss compared with Ross and Hubbard breeds and greater gut lesion severity compared with Ross chickens. NetB antibody levels were greater in Cobb chickens compared with the Ross or Hubbard groups. These results suggest that Cobb chickens may be more susceptible to necrotic enteritis in the field compared with the Ross and Hubbard lines.

The Impact of Oxygen on Bacterial Enteric Pathogens.

PubMed

Wallace, N; Zani, A; Abrams, E; Sun, Y

2016-01-01

Bacterial enteric pathogens are responsible for a tremendous amount of foodborne illnesses every year through the consumption of contaminated food products. During their transit from contaminated food sources to the host gastrointestinal tract, these pathogens are exposed and must adapt to fluctuating oxygen levels to successfully colonize the host and cause diseases. However, the majority of enteric infection research has been conducted under aerobic conditions. To raise awareness of the importance in understanding the impact of oxygen, or lack of oxygen, on enteric pathogenesis, we describe in this review the metabolic and physiological responses of nine bacterial enteric pathogens exposed to environments with different oxygen levels. We further discuss the effects of oxygen levels on virulence regulation to establish potential connections between metabolic adaptations and bacterial pathogenesis. While not providing an exhaustive list of all bacterial pathogens, we highlight key differences and similarities among nine facultative anaerobic and microaerobic pathogens in this review to argue for a more in-depth understanding of the diverse impact oxygen levels have on enteric pathogenesis. Copyright © 2016 Elsevier Inc. All rights reserved.

Enteral and Parenteral Nutrition in the Perioperative Period: State of the Art

PubMed Central

Abunnaja, Salim; Cuviello, Andrea; Sanchez, Juan A.

2013-01-01

Nutritional support of surgical and critically ill patients has undergone significant advances since 1936 when Studley demonstrated a direct relationship between pre-operative weight loss and operative mortality. The advent of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, have allowed clinicians to treat malnutrition and improve surgical patient’s outcomes. We reviewed the literature for the current status of perioperative nutrition comparing parenteral nutrition with enteral nutrition. In a surgical patient with established malnutrition, nutritional support should begin at least 7–10 days prior to surgery. Those patients in whom eating is not anticipated beyond the first five days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Compared to parenteral nutrition, enteral nutrition is associated with fewer complications, a decrease in the length of hospital stay, and a favorable cost-benefit analysis. In addition, many patients may benefit from newer enteral formulations such as Immunonutrition as well as disease-specific formulations. PMID:23429491

Enteral nutrition for optimal growth in preterm infants

PubMed Central

2016-01-01

Early, aggressive nutrition is an important contributing factor of long-term neurodevelopmental outcomes. To ensure optimal growth in premature infants, adequate protein intake and optimal protein/energy ratio should be emphasized rather than the overall energy intake. Minimal enteral nutrition should be initiated as soon as possible in the first days of life, and feeding advancement should be individualized according to the clinical course of the infant. During hospitalization, enteral nutrition with preterm formula and fortified human milk represent the best feeding practices for facilitating growth. After discharge, the enteral nutrition strategy should be individualized according to the infant's weight at discharge. Infants with suboptimal weight for their postconceptional age at discharge should receive supplementation with human milk fortifiers or nutrient-enriched feeding, and the enteral nutrition strategy should be reviewed and modified continuously to achieve the target growth parameters. PMID:28194211

Role of classic signs as diagnostic predictors for enteric fever among returned travellers: Relative bradycardia and eosinopenia.

PubMed

Matono, Takashi; Kutsuna, Satoshi; Kato, Yasuyuki; Katanami, Yuichi; Yamamoto, Kei; Takeshita, Nozomi; Hayakawa, Kayoko; Kanagawa, Shuzo; Kaku, Mitsuo; Ohmagari, Norio

2017-01-01

The lack of characteristic clinical findings and accurate diagnostic tools has made the diagnosis of enteric fever difficult. We evaluated the classic signs of relative bradycardia and eosinopenia as diagnostic predictors for enteric fever among travellers who had returned from the tropics or subtropics. This matched case-control study used data from 2006 to 2015 for culture-proven enteric fever patients as cases. Febrile patients (>38.3°C) with non-enteric fever, who had returned from the tropics or subtropics, were matched to the cases in a 1:3 ratio by age (±3 years), sex, and year of diagnosis as controls. Cunha's criteria were used for relative bradycardia. Absolute eosinopenia was defined as an eosinophilic count of 0/μL. Data from 160 patients (40 cases and 120 controls) were analysed. Cases predominantly returned from South Asia (70% versus 18%, p <0.001). Relative bradycardia (88% versus 51%, p <0.001) and absolute eosinopenia (63% versus 38%, p = 0.008) were more frequent in cases than controls. In multivariate logistic regression analysis, return from South Asia (aOR: 21.6; 95% CI: 7.17-64.9) and relative bradycardia (aOR: 11.7; 95% CI: 3.21-42.5) were independent predictors for a diagnosis of enteric fever. The positive likelihood ratio was 4.00 (95% CI: 2.58-6.20) for return from South Asia, 1.72 (95% CI: 1.39-2.13) for relative bradycardia, and 1.63 (95%CI: 1.17-2.27) for absolute eosinopenia. The negative predictive values of the three variables were notably high (83-92%);. however, positive predictive values were 35-57%. The classic signs of relative bradycardia and eosinopenia were not specific for enteric fever; however both met the criteria for being diagnostic predictors for enteric fever. Among febrile returned travellers, relative bradycardia and eosinopenia should be re-evaluated for predicting a diagnosis of enteric fever in non-endemic areas prior to obtaining blood cultures.

Exocrine drainage in vascularized pancreas transplantation in the new millennium

PubMed Central

El-Hennawy, Hany; Stratta, Robert J; Smith, Fowler

2016-01-01

The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder (systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion. In the new millennium, pancreas transplants are performed predominantly as pancreatico-duodenal grafts with enteric diversion of the pancreatic ductal secretions coupled with iliac vein provision of insulin (systemic-enteric technique) although the systemic-bladder technique endures as a preferred alternative in selected cases. In the early 1990s, a novel technique of venous drainage into the superior mesenteric vein combined with bowel exocrine diversion (portal-enteric technique) was designed and subsequently refined over the next ≥ 20 years to re-create the natural physiology of the pancreas with first-pass hepatic processing of insulin. Enteric drainage usually refers to jejunal or ileal diversion of the exocrine secretions either with a primary enteric anastomosis or with an additional Roux limb. The portal-enteric technique has spawned a number of newer and revisited techniques of enteric exocrine drainage including duodenal or gastric diversion. Reports in the literature suggest no differences in pancreas transplant outcomes irrespective of type of either venous or exocrine diversion. The purpose of this review is to examine the literature on exocrine drainage in the new millennium (the purported “enteric drainage” era) with special attention to technical variations and nuances in vascularized pancreas transplantation that have been proposed and studied in this time period. PMID:27358771

Beneficial Effects of Early Enteral Nutrition After Major Rectal Surgery: A Possible Role for Conditionally Essential Amino Acids? Results of a Randomized Clinical Trial.

PubMed

van Barneveld, Kevin W Y; Smeets, Boudewijn J J; Heesakkers, Fanny F B M; Bosmans, Joanna W A M; Luyer, Misha D; Wasowicz, Dareczka; Bakker, Jaap A; Roos, Arnout N; Rutten, Harm J T; Bouvy, Nicole D; Boelens, Petra G

2016-06-01

To investigate direct postoperative outcome and plasma amino acid concentrations in a study comparing early enteral nutrition versus early parenteral nutrition after major rectal surgery. Previously, it was shown that a low plasma glutamine concentration represents poor prognosis in ICU patients. A preplanned substudy of a previous prospective, randomized, open-label, single-centre study, comparing early enteral nutrition versus early parenteral nutrition in patients at high risk of postoperative ileus after surgery for locally advanced or locally recurrent rectal cancer. Early enteral nutrition reduced postoperative ileus, anastomotic leakage, and hospital stay. Tertiary referral centre for locally advanced and recurrent rectal cancer. A total of 123 patients with locally advanced or recurrent rectal carcinoma requiring major rectal surgery. Patients were randomized (ALEA web-based external randomization) preoperatively into two groups: early enteral nutrition (early enteral nutrition, intervention) by nasojejunal tube (n = 61) or early parenteral nutrition (early parenteral nutrition, control) by jugular vein catheter (n = 62). Eight hours after the surgical procedure artificial nutrition was started in hemodynamically stable patients, stimulating oral intake in both groups. Blood samples were collected to measure plasma glutamine, citrulline, and arginine concentrations using a validated ultra performance liquid chromatography-tandem mass spectrometric method. Baseline concentrations were comparable for both groups. Directly after rectal surgery, a decrease in plasma amino acids was observed. Plasma glutamine concentrations were higher in the parenteral group than in the enteral group on postoperative day 1 (p = 0.027) and day 5 (p = 0.008). Arginine concentrations were also significantly increased in the parenteral group at day 1 (p < 0.001) and day 5 (p = 0.001). Lower plasma glutamine and arginine concentrations were measured in the enteral group, whereas a better clinical outcome was observed. We conclude that plasma amino acids do not provide a causal explanation for the observed beneficial effects of early enteral feeding after major rectal surgery.

[Clinical investigation of formula feeding in extremely low birth weight infants].

PubMed

Liang, Zhiqiang; Lu, Lu; Zhou, Yingchun; Chen, Shangqin; Huang, Yumei; Lin, Zhenlang

2014-01-01

To explore the relationship between gastric retention and full enteral feeding during the course of feeding in extremely low birth weight (ELBW, birth weight <1 000 g) infants. A total of 43 ELBW infants were fed with formula according to the strategy for premature infants feeding of Canadian Society of Neonatology. The information such as gastric retention, the time they finish full enteral feeding and sucking spontaneously and complication were recorded. These infants had transition to full enteral feeding step by step since initiating formula feeding on the second day of life. The volume of gastric retention and the duration of gastric retention was analyzed with the time of attaining full enteral feeding and sucking spontaneously by linear regression. Forty-one infants finished the course, the remaining 2 infants got necrotizing enterocolitis (NEC) and were rescued by surgery. The incidence was 4.6%. In 18 infants full enteral feeding could not be initiated successfully on the second day of life, the incidence was 43.9%. The peak duration of gastric retention was the first week of feeding. The average time of attaining enteral feeding was (26.71 ± 12.24) days. The proportion of different residual contents was simlar, the major content was milky content after 3 weeks of feeding. The gastric retention time had a significant effect of on the time of attaining full enteral feeding (β = 1.045, P = 0.001) and sucking well (β = 0.787, P = 0.034) . The course of formula feeding ELBW infants to attaining full enteral feeding was a long period, in the early stage of formula feeding the occurrence of gastric retention was high; the amount of formula during the first week of feeding should be slowly increased as compared to the second week; the present strategy and aggressive strategy should be done 2 weeks later. The time of attaining full enteral feeding can be predicted by the duration of gastric retention.

Field Trial of Attenuated Salmonella Typhi Live Oral Vaccine TY21A in Liquid and Enteric-Coated Formulations and Epidemiological Survey for Incidence of Diarrhea due to Shigella Species

DTIC Science & Technology

1989-03-01

and absolute efficacy of three doses of Ty2la vaccine given in enteric-coated capsule or liquid formulation. Intensive clinical and bacteriologic...TABLES Table 1. Evaluation of the efficacy of three doses of the enteric-coated capsule formulation of Ty2la live oral vaccine given within one week in...November, 1986 thzough February, 1989 of a field trial in Area Sur Oriente and Area Norte assessing the efficacy of Ty21a vaccine in liquid or enteric

Enteric infections, diarrhea, and their impact on function and development

PubMed Central

Petri, William A.; Miller, Mark; Binder, Henry J.; Levine, Myron M.; Dillingham, Rebecca; Guerrant, Richard L.

2008-01-01

Enteric infections, with or without overt diarrhea, have profound effects on intestinal absorption, nutrition, and childhood development as well as on global mortality. Oral rehydration therapy has reduced the number of deaths from dehydration caused by infection with an enteric pathogen, but it has not changed the morbidity caused by such infections. This Review focuses on the interactions between enteric pathogens and human genetic determinants that alter intestinal function and inflammation and profoundly impair human health and development. We also discuss specific implications for novel approaches to interventions that are now opened by our rapidly growing molecular understanding. PMID:18382740

Recommendations for the use of medications with continuous enteral nutrition.

PubMed

Wohlt, Paul D; Zheng, Lan; Gunderson, Shelly; Balzar, Sarah A; Johnson, Benjamin D; Fish, Jeffrey T

2009-08-15

Recommendations for the use of medications with continuous enteral nutrition are provided. A literature review was conducted to identify primary literature reporting medication interactions with continuous enteral nutrition. For medications without supporting literature, manufacturers were contacted for information. Package inserts for specific medications were also investigated for any information to help guide recommendations. If no specific recommendations were made by the pharmaceutical manufacturer or the package insert concerning administration of products with continuous enteral nutrition, a tertiary database was consulted. Recommendations were generated by a consensus of clinicians for those medications that lacked specific recommendations in the primary literature or from the pharmaceutical manufacturer. Documentation of medication interactions with continuous enteral nutrition and food was then collated along with specific recommendations on how to administer the medication with regard to continuous enteral nutrition. Recommendations were classified as strong (grade 1) or weak (grade 2). The quality of evidence was classified as high (grade A), moderate (grade B), or low (grade C). Forty-six medications commonly given to hospitalized patients were evaluated. Twenty-four medications had recommendations based on available data, and the remaining 22 medications had recommendations based on a consensus of clinicians. There was a lack of published data regarding drug-nutrient interactions for a majority of the drugs commonly administered to patients receiving continuous enteral nutrition. Clinicians should recognize potential drug-nutrient interactions and use available evidence to optimize patients' drug therapy.

[Biological evaluation of a protein mixture intended for enteral nutrition].

PubMed

Meneses, J Olza; Foulquie, J Porres; Valero, G Urbano; de Victoria, E Martínez; Hernández, A Gil

2008-01-01

Enteral nutrition is the best way to feed or supplement the diet when gastrointestinal tract functions of patients are partially or totally preserved. Whenever total enteral nutrition is needed, it represents the only source of nutrients for patients. Thus, it is mandatory to ensure that high biological value proteins are included in enteral formulae. To assess the biological quality of a protein blend constituted by 50% potassium caseinate, 25% whey protein and 25% pea protein intended to be used in enteral nutrition products. Forty Wistar rats (20 male and 20 female), with initial body weight of 51 g, where divided into four groups and feed for 10 days with: casein (Control), experimental protein blend (Experimental), liophylized normo- and hyperproteic enteral nutrition formulae adapted to the animal nutritional requirements (Normoproteic and Hyperproteic). Protein efficiency ratio (PER), apparent digestibility coefficient (ADC), relationship between retained and absorbed nitrogen (R/A) and relationship between retained and consumed nitrogen (R/I) where calculated. Experimental and control groups had similar values for all analysed indices (PER, ADC, R/A and R/I). These indices where also similar between normo and hyperproteic groups, but lower than experimental and control groups, except in PER, where normoproteic group was either similar to control and hiperproteic group. The quality of the protein blend used in this study is high. It is a good protein source to be used in the development of new enteral nutritional products.

10 CFR 835.208 - Limits for members of the public entering a controlled area.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Limits for members of the public entering a controlled area. 835.208 Section 835.208 Energy DEPARTMENT OF ENERGY OCCUPATIONAL RADIATION PROTECTION Standards for Internal and External Exposure § 835.208 Limits for members of the public entering a controlled...

19 CFR 10.624 - Goods re-entered after repair or alteration in a Party.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Goods re-entered after repair or alteration in a....624 Goods re-entered after repair or alteration in a Party. (a) General. This section sets forth the..., “repairs or alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or...

19 CFR 10.890 - Goods re-entered after repair or alteration in Oman.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Goods re-entered after repair or alteration in... States-Oman Free Trade Agreement Goods Returned After Repair Or Alteration § 10.890 Goods re-entered...” means restoration, renovation, cleaning, re-sterilizing, or other treatment which does not destroy the...

19 CFR 10.890 - Goods re-entered after repair or alteration in Oman.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Goods re-entered after repair or alteration in... States-Oman Free Trade Agreement Goods Returned After Repair Or Alteration § 10.890 Goods re-entered...” means restoration, renovation, cleaning, re-sterilizing, or other treatment which does not destroy the...

19 CFR 10.624 - Goods re-entered after repair or alteration in a Party.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Goods re-entered after repair or alteration in a....624 Goods re-entered after repair or alteration in a Party. (a) General. This section sets forth the..., “repairs or alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or...

19 CFR 10.890 - Goods re-entered after repair or alteration in Oman.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Goods re-entered after repair or alteration in... States-Oman Free Trade Agreement Goods Returned After Repair Or Alteration § 10.890 Goods re-entered...” means restoration, renovation, cleaning, re-sterilizing, or other treatment which does not destroy the...

19 CFR 10.624 - Goods re-entered after repair or alteration in a Party.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Goods re-entered after repair or alteration in a....624 Goods re-entered after repair or alteration in a Party. (a) General. This section sets forth the..., “repairs or alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or...

19 CFR 10.890 - Goods re-entered after repair or alteration in Oman.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Goods re-entered after repair or alteration in... States-Oman Free Trade Agreement Goods Returned After Repair Or Alteration § 10.890 Goods re-entered...” means restoration, renovation, cleaning, re-sterilizing, or other treatment which does not destroy the...

19 CFR 10.624 - Goods re-entered after repair or alteration in a Party.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Goods re-entered after repair or alteration in a....624 Goods re-entered after repair or alteration in a Party. (a) General. This section sets forth the..., “repairs or alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or...

19 CFR 10.624 - Goods re-entered after repair or alteration in a Party.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Goods re-entered after repair or alteration in a....624 Goods re-entered after repair or alteration in a Party. (a) General. This section sets forth the..., “repairs or alterations” means restoration, addition, renovation, re-dyeing, cleaning, re-sterilizing, or...

Effect of dietary capsicum and turmeric oleoresins on host-pathogen interaction in experimental necrotic enteritis in three commercial broiler chicken breeds

USDA-ARS?s Scientific Manuscript database

Necrotic enteritis (NE) is among the most economically important enteric diseases affecting the poultry industry worldwide. In an effort to develop alternatives to antibiotics strategies to reduce the negative impact of NE to gut health, we investigated the efficacy of dietary phytonutrient mixture...

Immune role of gut microbiota and effect of dietary capsicum and turmeric oleoresins on Necrotic enteritis susceptibility in three commercial broiler chicken breeds

USDA-ARS?s Scientific Manuscript database

Necrotic enteritis (NE) is among the most economically important enteric diseases affecting the poultry industry worldwide. In an effort to develop alternatives to antibiotics strategies to reduce the negative impact of NE to gut health, we investigated the efficacy of a dietary phytonutrient mixtu...

22 CFR 53.3 - Attempt of a citizen to enter without a valid passport.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Attempt of a citizen to enter without a valid passport. 53.3 Section 53.3 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORT REQUIREMENT AND EXCEPTIONS § 53.3 Attempt of a citizen to enter without a valid passport. The appropriate...

22 CFR 53.3 - Attempt of a citizen to enter without a valid passport.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Attempt of a citizen to enter without a valid passport. 53.3 Section 53.3 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORT REQUIREMENT AND EXCEPTIONS § 53.3 Attempt of a citizen to enter without a valid passport. The appropriate...

22 CFR 53.3 - Attempt of a citizen to enter without a valid passport.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Attempt of a citizen to enter without a valid passport. 53.3 Section 53.3 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORT REQUIREMENT AND EXCEPTIONS § 53.3 Attempt of a citizen to enter without a valid passport. The appropriate...

22 CFR 53.3 - Attempt of a citizen to enter without a valid passport.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Attempt of a citizen to enter without a valid passport. 53.3 Section 53.3 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORT REQUIREMENT AND EXCEPTIONS § 53.3 Attempt of a citizen to enter without a valid passport. The appropriate...

22 CFR 53.3 - Attempt of a citizen to enter without a valid passport.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Attempt of a citizen to enter without a valid passport. 53.3 Section 53.3 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORT REQUIREMENT AND EXCEPTIONS § 53.3 Attempt of a citizen to enter without a valid passport. The appropriate...

The role of gut bacteria in Schmallenberg virus transmission by Culicoides biting midges

USDA-ARS?s Scientific Manuscript database

When an arbo-virus enters a vector it will first enter the gut system of this insect before entering cells of the insect body. Once in the gut-system, arbo-viruses and gut microbiota can interact with each other. We wondered if different gut bacterial communities could influence virus infection of b...

28 CFR 48.4 - Application for approval of joint newspaper operating arrangement entered into after July 24, 1970.

Code of Federal Regulations, 2010 CFR

2010-07-01

... newspaper operating arrangement entered into after July 24, 1970. 48.4 Section 48.4 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) NEWSPAPER PRESERVATION ACT § 48.4 Application for approval of joint newspaper operating arrangement entered into after July 24, 1970. (a) Persons desiring to obtain the...

START! The Successful Transitions and Retention Track Program: A Comprehensive Approach to Supporting GED Holders Entering College

ERIC Educational Resources Information Center

Nix, J. Vincent; Michalak, Megan B.

2012-01-01

Students entering college face many obstacles to success. Students who received a General Education Development (GED) face additional barriers that must be addressed in order for success in higher education. The Successful Transitions and Retention Track Program employs a holistic approach to addressing the needs of GED holders entering college.

Characterization of clostridium perfringens netB+tpel+ type A atrains isolated from necrotic enteritis-afflicted broiler chickens

USDA-ARS?s Scientific Manuscript database

Clostridium perfringens (CP) Type A strains are the key etiological factor in induction of necrotic enteritis (NE), one of the important enteric diseases in poultry, responsible for the annual loss of $ 6 billions to worldwide poultry industry. Several CP toxin genes were found to be critical in the...

Gay Youth in American Public High Schools: Invisible Diversity.

ERIC Educational Resources Information Center

Reed, Donald B.

Gay youth enter high school with the knowledge that they are different and with the belief that heterosexuality is normal and that homosexuality is not normal. Also, gay youth enter high school with the belief that honesty and integrity are important personal values. Additionally, the gay youth enter high school without family knowledge of their…

30 CFR 774.11 - Post-permit issuance requirements for regulatory authorities and other actions based on ownership...

Code of Federal Regulations, 2010 CFR

2010-07-01

... actions, we, the regulatory authority, must enter into AVS the data shown in the following table— We must enter into AVS all . . . Within 30 days after . . . (1) permit records the permit is issued or... enter the results of each enforcement action, including administrative and judicial decisions, into AVS...

Nitric oxide regulation of colonic epithelial ion transport: a novel role for enteric glia in the myenteric plexus

PubMed Central

MacEachern, Sarah J; Patel, Bhavik A; McKay, Derek M; Sharkey, Keith A

2011-01-01

Abstract Enteric glia are increasingly recognized as important in the regulation of a variety of gastrointestinal functions. Here we tested the hypothesis that nicotinic signalling in the myenteric plexus results in the release of nitric oxide (NO) from neurons and enteric glia to modulate epithelial ion transport. Ion transport was assessed using full-thickness or muscle-stripped segments of mouse colon mounted in Ussing chambers. The cell-permeant NO-sensitive dye DAR-4M AM and amperometry were utilized to identify the cellular sites of NO production within the myenteric plexus and the contributions from specific NOS isoforms. Nicotinic receptors were localized using immunohistochemistry. Nicotinic cholinergic stimulation of colonic segments resulted in NO-dependent changes in epithelial active electrogenic ion transport that were TTX sensitive and significantly altered in the absence of the myenteric plexus. Nicotinic stimulation of the myenteric plexus resulted in NO production and release from neurons and enteric glia, which was completely blocked in the presence of nitric oxide synthase (NOS) I and NOS II inhibitors. Using the NO scavenger 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (PTIO), neuronal and enteric glial components of NO production were demonstrated. Nicotinic receptors were identified on enteric neurons, which express NOS I, and enteric glia, which express NOS II. These data identify a unique pathway in the mouse colon whereby nicotinic cholinergic signalling in myenteric ganglia mobilizes NO from NOS II in enteric glia, which in coordinated activity with neurons in the myenteric plexus modulates epithelial ion transport, a key component of homeostasis and innate immunity. PMID:21558161

Randomised clinical trial: enteral nutrition does not improve the long-term outcome of alcoholic cirrhotic patients with jaundice.

PubMed

Dupont, B; Dao, T; Joubert, C; Dupont-Lucas, C; Gloro, R; Nguyen-Khac, E; Beaujard, E; Mathurin, P; Vastel, E; Musikas, M; Ollivier, I; Piquet, M-A

2012-05-01

Malnutrition and jaundice are independent prognostic factors in cirrhosis. To assess the impact of enteral nutrition on the survival of alcoholic cirrhotic patients with jaundice but without acute alcoholic hepatitis. The study was a multicentre prospective randomised controlled trial comparing effects of enteral nutrition vs. a symptomatic support in patients with alcoholic cirrhosis and jaundice (bilirubin ≥51 µmol/L) but without severe acute alcoholic hepatitis. A total of 99 patients were randomised to receive either the conventional symptomatic treatment (55 patients) or the symptomatic support associated with 35 kcal/Kg/day of enteral nutrition during 4 weeks followed by an oral nutritional support during 2 months (44 patients). Randomisation was stratified on nutritional status. One-year survival curves were compared using the Kaplan-Meier method and Logrank test. Populations in both arms were similar. One-year survival was similar in the overall population (27/44 patients (61.4%) in the enteral nutrition arm vs. 36/55 (65.5%) in the control arm; Logrank P = 0.60) and in the subgroup suffering from malnutrition [18/29 patients (62.1%) in the enteral nutrition arm vs. 20/32 (62.5%) in the control arm; Logrank P = 0.99]. There was no statistical difference for bilirubin, prothrombin rate, Child-Pugh score, albumin or nutritional assessment. Complications during treatment (bleeding, encephalopathy, infection) occurred in 23% of patients in the enteral nutrition group (10/44) vs. 16% (9/55) of the control patients (P = 0.59). Enteral nutrition does not improve the survival and hepatic or nutritional parameters of cirrhotic patients with jaundice. © 2012 Blackwell Publishing Ltd.

Implementing an educational program to improve critical care nurses' enteral nutritional support.

PubMed

Kim, Hyunjung; Chang, Sun Ju

2018-05-11

Although international nutrition societies recommend enteral nutrition guidelines for patients in intensive care units (ICUs), large gaps exist between these recommendations and actual clinical practice. Education programs designed to improve nurses' knowledge about enteral nutrition are therefore required. In Korea, there are no educational intervention studies about evidence-based guidelines of enteral nutrition for critically ill patients. We aimed to evaluate the effects of an education program to improve critical care nurses' perceptions, knowledge, and practices towards providing enteral nutritional support for ICU patients. A quasi-experimental, one-group study with a pre- and post-test design was conducted from March to April 2015. Nurses (N = 205) were recruited from nine ICUs from four tertiary hospitals in South Korea. The education program comprised two sessions of didactic lectures. Data were collected before (pre-test) and 1 month after (post-test) the education program using questionnaires that addressed nurses' perceptions, knowledge, and practices relating to providing enteral nutritional support for ICU patients. After the program, nurses showed a significant improvement in their perceptions and knowledge of enteral nutrition for ICU patients. There was a significant improvement in inspecting nostrils daily, flushing the feeding tube before administration, providing medication that needs to be crushed correctly, changing feeding sets, and adjusting feeding schedules. The findings indicate that an enteral nutrition education program could be an effective strategy to increase critical care nurses' support for the critically ill. This education program can be incorporated into hospital education or in-service training for critical care nurses to strengthen their perceptions and knowledge of nutritional support in the ICU. This may improve the clinical outcomes of ICU patients. Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

The effects of enteral feeding improvement massage on premature infants: A randomised controlled trial.

PubMed

Kim, Hee-Young; Bang, Kyung-Sook

2018-01-01

To prove the effects of an enteral feeding improvement massage for premature infants with regard to their feeding, growing and superior mesentery artery blood flow aspect by a randomised controlled trial. Premature infants have feeding-related problems related to eating and absorbing nutrition due to their immature gastrointestinal function. Studies regarding the effectiveness of premature infants' enteral feeding improvement by tactile stimulation massage are rare. The study group was composed of 55 patients. Of the 55 patients, 26 were randomised into an experimental group and 29 were randomised into a control group. They were all born <34 weeks of gestational age between 1 July 2011 and 30 March 2012. Premature infants in the experimental group received enteral feeding improvement massage twice a day for 14 days, and infants in the control group received a sham exercise. The collected data were analysed by spss 19.0, through t test, chi-square test (Fisher's exact) and ANCOVA. (i) The experimental group had reached the day of full enteral feeding significantly faster. (ii) The experimental group had a higher superior mesentery artery peak velocity (V max ) and lower RI (resistant index). (iii) The experimental group of the feeding-intolerant subgroup had a higher superior mesentery artery V max and V min . (iv) The experimental group had a heavier weight and larger head circumference after 14 days. This study demonstrates that enteral feeding improvement massage can be helpful for achieving earlier full enteral feeding, more increased superior mesentery artery, and faster growing. In particular, it can be a therapeutic, independent and evidence-based nursing intervention for feeding-intolerant premature infants. Neonatal nurses in neonatal intensive care unit can apply enteral feeding improvement massage massage for feeding-intolerant infants. © 2017 John Wiley & Sons Ltd.

In vivo comparison of tantalum, tungsten, and bismuth enteric contrast agents to complement intravenous iodine for double-contrast dual-energy CT of the bowel

PubMed Central

Rathnayake, Samira; Mongan, John; Torres, Andrew S.; Colborn, Robert; Gao, Dong-Wei; Yeh, Benjamin M; Fu, Yanjun

2016-01-01

To assess the ability of dual-energy CT (DECT) to separate intravenous contrast of bowel wall from intraluminal contrast, we scanned 16 rabbits on a clinical DECT scanner: n=3 using only iodinated intravenous contrast; and n=13 double-contrast enhanced scans using iodinated intravenous contrast and experimental enteric non-iodinated contrast agents in the bowel lumen (5 bismuth-, 4 tungsten-, and 4 tantalum-based). Representative image pairs from conventional CT images and DECT iodine density maps of small bowel (116 pairs from 232 images) were viewed by four abdominal imaging attending radiologists to independently score each comparison pair on a visual analog scale (−100 to +100%) for: 1) preference in small bowel wall visualization; and 2) preference in completeness of intraluminal enteric contrast subtraction. Median small bowel wall visualization was scored 39 and 42 percentage points (95% CI: 30–44% and 36–45%, p<0.001 both) higher at double-contrast DECT than at conventional CT with enteric tungsten and tantalum contrast, respectively. Median small bowel wall visualization at double-contrast DECT was scored 29 and 35 percentage points (95% CI: 20–35% and 33–39%, p<0.001 both) higher with enteric tungsten and tantalum, respectively, than with bismuth contrast. Median completeness of intraluminal enteric contrast subtraction in double-contrast DECT iodine density maps was scored 28 and 29 percentage points (95% CI: 15–31% and 28–33%, p<0.001 both) higher with enteric tungsten and tantalum, respectively, than with bismuth contrast. Results suggest that in vivo double-contrast DECT with iodinated intravenous and either tantalum- or tungsten-based enteric contrast provide better visualization of small bowel than conventional CT. PMID:26892945

Enteric nervous system abnormalities are present in human necrotizing enterocolitis: potential neurotransplantation therapy

PubMed Central

2013-01-01

Introduction Intestinal dysmotility following human necrotizing enterocolitis suggests that the enteric nervous system is injured during the disease. We examined human intestinal specimens to characterize the enteric nervous system injury that occurs in necrotizing enterocolitis, and then used an animal model of experimental necrotizing enterocolitis to determine whether transplantation of neural stem cells can protect the enteric nervous system from injury. Methods Human intestinal specimens resected from patients with necrotizing enterocolitis (n = 18), from control patients with bowel atresia (n = 8), and from necrotizing enterocolitis and control patients undergoing stoma closure several months later (n = 14 and n = 6 respectively) were subjected to histologic examination, immunohistochemistry, and real-time reverse-transcription polymerase chain reaction to examine the myenteric plexus structure and neurotransmitter expression. In addition, experimental necrotizing enterocolitis was induced in newborn rat pups and neurotransplantation was performed by administration of fluorescently labeled neural stem cells, with subsequent visualization of transplanted cells and determination of intestinal integrity and intestinal motility. Results There was significant enteric nervous system damage with increased enteric nervous system apoptosis, and decreased neuronal nitric oxide synthase expression in myenteric ganglia from human intestine resected for necrotizing enterocolitis compared with control intestine. Structural and functional abnormalities persisted months later at the time of stoma closure. Similar abnormalities were identified in rat pups exposed to experimental necrotizing enterocolitis. Pups receiving neural stem cell transplantation had improved enteric nervous system and intestinal integrity, differentiation of transplanted neural stem cells into functional neurons, significantly improved intestinal transit, and significantly decreased mortality compared with control pups. Conclusions Significant injury to the enteric nervous system occurs in both human and experimental necrotizing enterocolitis. Neural stem cell transplantation may represent a novel future therapy for patients with necrotizing enterocolitis. PMID:24423414

Enteral and parenteral nutrition in the conservative treatment of pancreatic fistula: a randomized clinical trial.

PubMed

Klek, Stanislaw; Sierzega, Marek; Turczynowski, Lukasz; Szybinski, Piotr; Szczepanek, Kinga; Kulig, Jan

2011-07-01

Postoperative pancreatic fistula is the most common and potentially life-threatening complication after pancreatic surgery. Although nutritional support is a key component of conservative therapy in such cases, there have been no well-designed clinical trials substantiating the superiority of either total parenteral nutrition or enteral nutrition. This study was conducted to compare the efficacy and safety of both routes of nutritional intervention. A randomized clinical trial was conducted in a tertiary surgical center of pancreatic and gastrointestinal surgery. Seventy-eight patients with postoperative pancreatic fistula were treated conservatively and randomly assigned to groups receiving for 30 days either enteral nutrition or total parenteral nutrition. The primary end point was the 30-day fistula closure rate. After 30 days, closure rates in patients receiving enteral and parenteral nutrition were 60% (24 of 40) and 37% (14 of 38), respectively (P=.043). The odds ratio for the probability that fistula closes on enteral nutrition compared to total parenteral nutrition was 2.571 (95% confidence interval [CI]: 1.031-6.411). Median time to closure was 27 days (95% CI: 21-33) for enteral nutrition, and no median time was reached in total parenteral nutrition (P=.047). A logistic regression analysis identified only 2 factors significantly associated with fistula closure, ie, enteral nutrition (odds ratio=6.136; 95% CI: 1.204-41.623; P=.043) and initial fistula output of ≤200 mL/day (odds ratio=12.701; 95% CI: 9.102-47.241; P<.001). Enteral nutrition is associated with significantly higher closure rates and shorter time to closure of postoperative pancreatic fistula. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

Effect of herbal medicine daikenchuto on oral and enteral caloric intake after liver transplantation: A multicenter, randomized controlled trial.

PubMed

Kaido, Toshimi; Shinoda, Masahiro; Inomata, Yukihiro; Yagi, Takahito; Akamatsu, Nobuhisa; Takada, Yasutsugu; Ohdan, Hideki; Shimamura, Tsuyoshi; Ogura, Yasuhiro; Eguchi, Susumu; Eguchi, Hidetoshi; Ogata, Satoshi; Yoshizumi, Tomoharu; Ikegami, Toshihiko; Yamamoto, Michio; Morita, Satoshi; Uemoto, Shinji

2018-03-20

Postoperative early oral or enteral intake is a crucial element of the Enhanced Recovery After Surgery (ERAS) protocol. However, normal food intake or enteral feeding cannot be started early in the presence of coexisting bowel dysfunction in patients undergoing liver transplantation (LT). The aim of this multicenter, randomized, double-blinded, placebo-controlled trial was to determine the enhancement effects of the Japanese herbal medicine Daikenchuto (DKT) on oral/enteral caloric intake in patients undergoing LT. A total of 112 adult patients undergoing LT at 14 Japanese centers were enrolled. The patients were randomly assigned to receive either DKT or placebo from postoperative day (POD) 1 to 14. The primary endpoints were total oral/enteral caloric intake, abdominal distension, and pain on POD 7. The secondary endpoints included sequential changes in total oral/enteral caloric intake after LT, and portal venous flow volume and velocity in the graft. A total of 104 patients (DKT, n = 55; placebo, n = 49) were included in the analyses. There were no significant differences between the two groups in terms of primary endpoints. However, postoperative total oral/enteral caloric intake was significantly accelerated in the DKT group compared with the placebo group (P = 0.023). Moreover, portal venous flow volume (POD 10, 14) and velocity (POD 14) were significantly higher in the DKT group than in the placebo group (P = 0.047, P = 0.025, P = 0.014, respectively). Postoperative administration of DKT may enhance total oral/enteral caloric intake and portal venous flow volume and velocity after LT and favorably contribute to the performance of the ERAS protocol. Copyright © 2018 Elsevier Inc. All rights reserved.

Surveillance of enteric viruses and coliphages in a tropical urban catchment.

PubMed

Rezaeinejad, S; Vergara, G G R V; Woo, C H; Lim, T T; Sobsey, M D; Gin, K Y H

2014-07-01

An assessment of the occurrence and concentration of enteric viruses and coliphages was carried out in highly urbanized catchment waters in the tropical city-state of Singapore. Target enteric viruses in this study were noroviruses, adenoviruses, astroviruses and rotaviruses. In total, 65 water samples were collected from canals and the reservoir of the Marina catchment on a monthly basis over a period of a year. Quantitative PCR (qPCR) and single agar layer plaque assay (SAL) were used to enumerate target enteric viruses and coliphages in water samples, respectively. The most prevalent pathogen were noroviruses, detected in 37 samples (57%), particularly norovirus genogroup II (48%), with a mean concentration of 3.7 × 10(2) gene copies per liter. Rotavirus was the second most prevalent virus (40%) with a mean concentration of 2.5 × 10(2) GC/L. The mean concentrations of somatic and male-specific coliphages were 2.2 × 10(2) and 1.1 × 10(2) PFU/100 ml, respectively. The occurrence and concentration of each target virus and the ratio of somatic to male-specific coliphages varied at different sampling sites in the catchment. For sampling sites with higher frequency of occurrence and concentration of viruses, the ratio of somatic to male-specific coliphages was generally much lower than other sampling sites with lower incidences of enteric viruses. Overall, higher statistical correlation was observed between target enteric viruses than between enteric viruses and coliphages. However, male-specific coliphages were positively correlated with norovirus concentrations. A multi-level integrated surveillance system, which comprises the monitoring of bacterial indicators, coliphages and selected enteric viruses, could help to meet recreational and surface water quality criteria in a complex urbanized catchment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Descriptive study of enteric zoonoses in Ontario, Canada, from 2010 - 2012.

PubMed

Whitfield, Yvonne; Johnson, Karen; Hobbs, Leigh; Middleton, Dean; Dhar, Badal; Vrbova, Linda

2017-02-21

Contact with animals and their environment has long been recognized as an important source of enteric zoonoses. However, there are limited data available on the burden of illness associated with specific types of animals in Canada. This study describes the overall burden of enteric zoonoses in Ontario, Canada from 2010 to 2012. Confirmed cases of seven enteric zoonotic diseases (campylobacteriosis, cryptosporidiosis, giardiasis, listeriosis, salmonellosis, verotoxin-producing E. coli (VTEC) infection, and yersiniosis) with episode dates from 2010 to 2012 were extracted from the integrated Public Health Information System (iPHIS). Reported exposures were categorized as animal contact, foodborne, waterborne and 'other', with animal contact grouped into nine sub-categories based on the type of animal or transmission setting. Overall incidence rates and proportions by animal exposure categories, age and sex-specific incidence rates and hospitalization and death proportions were calculated and sex proportions compared. Our study found that approximately 26% of the enteric pathogens assessed during the 2010 to 2012 period reported contact with animals and their environments as the mode of transmission. Of enteric disease cases reporting animal contact, farm exposures were reported for 51.3%, dog or cat exposures for 26.3%, and reptile or amphibian exposures for 8.9%. Contact with animals was reported more frequently during the period 2010 to 2012 in comparison to the period 1997 to 2003 when 6% or less of enteric cases were associated with animal contact. Public health professionals, stakeholders associated with animals and their related industries (e.g., pet treats, mobile zoos, abattoirs), and the public should recognize that animal contact is an important source of enteric illnesses in order to take measures to reduce the burden of illness from animal sources.

Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus

PubMed Central

Clyman, Ronald; Wickremasinghe, Andrea; Jhaveri, Nami; Hassinger, Denise C.; Attridge, Joshua T.; Sanocka, Ulana; Polin, Richard; Gillam-Krakauer, Maria; Reese, Jeff; Mammel, Mark; Couser, Robert; Mulrooney, Neil; Yanowitz, Toby D.; Derrick, Matthew; Jegatheesan, Priya; Walsh, Michele; Fujii, Alan; Porta, Nicolas; Carey, William A.; Swanson, Jonathan R.

2013-01-01

Objective To test the hypothesis that infants who are just being introduced to enteral feedings will advance to full enteral nutrition at a faster rate if they receive “trophic” (15 ml/kg/day) enteral feedings while receiving indomethacin or ibuprofen treatment for patent ductus arteriosus (PDA). Study design Infants were eligible for the study if they were 231/7 – 306/7 weeks gestation, weighed 401–1250 g at birth, received maximum enteral volumes ≤60 ml/kg/day and were about to be treated with indomethacin or ibuprofen. A standardized “feeding advance regimen” and guidelines for managing feeding intolerance were followed at each site (n=13). Results Infants (n=177; 26.3±1.9 wks (±SD) gestation) were randomized at 6.5±3.9 days to receive “trophic” feeds (“feeding” group, n=81: indomethacin=80%, ibuprofen=20%) or no feeds (“fasting (npo)” group, n=96: indomethacin=75%, ibuprofen=25%) during the drug administration period. Maximum daily enteral volumes prior to study entry were 14±15 ml/kg/day. After drug treatment, infants randomized to the “feeding” arm required fewer days to reach the study’s feeding volume endpoint (120 ml/kg/day). Although the enteral feeding endpoint was reached at an earlier postnatal age, the age at which central venous lines were removed did not differ between the two groups. There were no differences between the two groups in the incidence of infection, necrotizing enterocolitis, spontaneous intestinal perforation or other neonatal morbidities. Conclusion Infants required less time to reach the feeding volume endpoint if they were given “trophic” enteral feedings when they received indomethacin or ibuprofen treatments. PMID:23472765

The Mast Cell Degranulator Compound 48/80 Directly Activates Neurons

PubMed Central

Schemann, Michael; Kugler, Eva Maria; Buhner, Sabine; Eastwood, Christopher; Donovan, Jemma; Jiang, Wen; Grundy, David

2012-01-01

Background Compound 48/80 is widely used in animal and tissue models as a “selective” mast cell activator. With this study we demonstrate that compound 48/80 also directly activates enteric neurons and visceral afferents. Methodology/Principal Findings We used in vivo recordings from extrinsic intestinal afferents together with Ca++ imaging from primary cultures of DRG and nodose neurons. Enteric neuronal activation was examined by Ca++ and voltage sensitive dye imaging in isolated gut preparations and primary cultures of enteric neurons. Intraluminal application of compound 48/80 evoked marked afferent firing which desensitized on subsequent administration. In egg albumen-sensitized animals, intraluminal antigen evoked a similar pattern of afferent activation which also desensitized on subsequent exposure to antigen. In cross-desensitization experiments prior administration of compound 48/80 failed to influence the mast cell mediated response. Application of 1 and 10 µg/ml compound 48/80 evoked spike discharge and Ca++ transients in enteric neurons. The same nerve activating effect was observed in primary cultures of DRG and nodose ganglion cells. Enteric neuron cultures were devoid of mast cells confirmed by negative staining for c-kit or toluidine blue. In addition, in cultured enteric neurons the excitatory action of compound 48/80 was preserved in the presence of histamine H1 and H2 antagonists. The mast cell stabilizer cromolyn attenuated compound 48/80 and nicotine evoked Ca++ transients in mast cell-free enteric neuron cultures. Conclusions/Significance The results showed direct excitatory action of compound 48/80 on enteric neurons and visceral afferents. Therefore, functional changes measured in tissue or animal models may involve a mast cell independent effect of compound 48/80 and cromolyn. PMID:23272218

Development of a Simple, Peripheral-Blood-Based Lateral-Flow Dipstick Assay for Accurate Detection of Patients with Enteric Fever

PubMed Central

Khan, Iqbal Hassan; Sayeed, M. Abu; Sultana, Nishat; Islam, Kamrul; Amin, Jakia; Faruk, M. Omar; Khan, Umama; Khanam, Farhana; Ryan, Edward T.

2016-01-01

Enteric fever is a systemic infection caused by typhoidal strains of Salmonella enterica and is a significant cause of mortality and morbidity in many parts of the world, especially in resource-limited areas. Unfortunately, currently available diagnostic tests for enteric fever lack sensitivity and/or specificity. No true clinically practical gold standard for diagnosing patients with enteric fever exists. Unfortunately, microbiologic culturing of blood is only 30 to 70% sensitive although 100% specific. Here, we report the development of a lateral-flow immunochromatographic dipstick assay based on the detection of Salmonella enterica serovar Typhi (S. Typhi) lipopolysaccharide (LPS)-specific IgG in lymphocyte culture secretion. We tested the assay using samples from 142 clinically suspected enteric fever patients, 28 healthy individuals residing in a zone where enteric fever is endemic, and 35 patients with other febrile illnesses. In our analysis, the dipstick detected all blood culture-confirmed S. Typhi cases (48/48) and 5 of 6 Salmonella enterica serovar Paratyphi A blood cultured-confirmed cases. The test was negative in all 35 individuals febrile with other illnesses and all 28 healthy controls from the zone of endemicity. The test was positive in 19 of 88 individuals with suspected enteric fever but with negative blood cultures. Thus, the dipstick had a sensitivity of 98% compared to blood culture results and a specificity that ranged from 78 to 100% (95% confidence interval [CI], 70 to 100%), depending on the definition of a true negative. These results suggest that this dipstick assay can be very useful for the detection of enteric fever patients especially in regions of endemicity. PMID:26961857

Report of 111 Consecutive Patients Enrolled in the International Serial Transverse Enteroplasty (STEP) Data Registry: A Retrospective Observational Study

PubMed Central

Jones, Brian A; Hull, Melissa A; Potanos, Kristina M; Zurakowski, David; Fitzgibbons, Shimae C; Ching, Y Avery; Duggan, Christopher; Jaksic, Tom; Kim, Heung Bae

2016-01-01

Background The International Serial Transverse Enteroplasty (STEP) Data Registry is a voluntary online database created in 2004 to collect information on patients undergoing the STEP procedure. The aim of this study was to identify preoperative factors significantly associated with 1) transplantation or death, or 2) attainment of enteral autonomy following STEP. Study Design Data were collected from September 2004 to January 2010. Univariate and multivariate logistic regression analyses were applied to determine predictors of transplantation/death or enteral autonomy post-STEP. Time to reach full enteral nutrition was estimated using a Kaplan-Meier curve. Results Fourteen of the 111 patients in the Registry were excluded due to inadequate follow-up. Of the remaining 97 patients, 11 patients died, and 5 progressed to intestinal transplantation. On multivariate analysis, higher direct bilirubin and shorter pre-STEP bowel length were independently predictive of progression to transplantation or death (p = .05 and p < .001, respectively). Of the 78 patients who were ≥7 days of age and required parenteral nutrition (PN) at the time of STEP, 37 (47%) achieved enteral autonomy after the first STEP. Longer pre-STEP bowel length was also independently associated with enteral autonomy (p = .002). The median time to reach enteral autonomy based on Kaplan-Meier analysis was 21 months (95% CI: 12-30). Conclusions Overall mortality post-STEP was 11%. Pre-STEP risk factors for progressing to transplantation or death were higher direct bilirubin and shorter bowel length. Among patients who underwent STEP for short bowel syndrome, 47% attained full enteral nutrition post-STEP. Patients with longer pre-STEP bowel length were significantly more likely to achieve enteral autonomy. PMID:23357726

Preoperative enteral access is not necessary prior to multimodality treatment of esophageal cancer.

PubMed

Jenkins, Thomas K; Lopez, Alexandra N; Sarosi, George A; Ben-David, Kfir; Thomas, Ryan M

2018-04-01

Surgical enteral access prior to multimodality treatment for esophageal cancer is controversial as dysphagia is often used for feeding tube referral. We hypothesized that enteral access before neoadjuvant chemoradiation for esophageal cancer provides no benefit compared to that placed during definitive esophagectomy. Patients undergoing esophagectomy for esophageal malignancy from 2007 - 2014 were retrospectively identified. Clinicopathologic factors were recorded including preoperative enteral access, weight change, nutritional laboratory works, and perioperative complications. Of 156 identified patients, 99 (63.5%) received neoadjuvant chemoradiation and comprised the study cohort. Fifty (50.5%) underwent enteral access (gastrostomy [14], jejunostomy [32], other [4]; "Access Group") prior to chemoradiation followed by esophagectomy and were compared to 49 "No-Access" patients who underwent enteral access during esophagectomy. Clinicopathologic variables were similar between cohorts. The Access and No-Access cohorts had similar reported dysphagia (86% vs 75.5%, respectively; P = .2) and mean preesophagectomy serum albumin (3.9 vs 4 gm/dL, respectively; P = .2). Weight loss ± 6-month periesophagectomy was similar between access versus No-Access cohorts (-11.2% vs -15.4%, respectively; P = .1). Weight loss during this period was likewise similar for patients with dysphagia in the Access (-11%) versus No-Access group (-15.2%, P = .1). No difference in complication rates was noted between Access (64%) and No-Access groups (51%, P = .2). Despite healthcare provider bias, there seems to be no nutritional or perioperative benefit for enteral access before neoadjuvant chemoradiation for esophageal malignancy. Patients with esophageal malignancy should therefore proceed to appropriate neoadjuvant and surgical therapy with enteral access performed during definitive resection or reserved for those with frank obstruction on endoscopy. Published by Elsevier Inc.

Immunostaining to visualize murine enteric nervous system development.

PubMed

Barlow-Anacker, Amanda J; Erickson, Christopher S; Epstein, Miles L; Gosain, Ankush

2015-04-29

The enteric nervous system is formed by neural crest cells that proliferate, migrate and colonize the gut. Following colonization, neural crest cells must then differentiate into neurons with markers specific for their neurotransmitter phenotype. Cholinergic neurons, a major neurotransmitter phenotype in the enteric nervous system, are identified by staining for choline acetyltransferase (ChAT), the synthesizing enzyme for acetylcholine. Historical efforts to visualize cholinergic neurons have been hampered by antibodies with differing specificities to central nervous system versus peripheral nervous system ChAT. We and others have overcome this limitation by using an antibody against placental ChAT, which recognizes both central and peripheral ChAT, to successfully visualize embryonic enteric cholinergic neurons. Additionally, we have compared this antibody to genetic reporters for ChAT and shown that the antibody is more reliable during embryogenesis. This protocol describes a technique for dissecting, fixing and immunostaining of the murine embryonic gastrointestinal tract to visualize enteric nervous system neurotransmitter expression.

Inadequately Treated Wastewater as a Source of Human Enteric Viruses in the Environment

PubMed Central

Okoh, Anthony I.; Sibanda, Thulani; Gusha, Siyabulela S.

2010-01-01

Human enteric viruses are causative agents in both developed and developing countries of many non-bacterial gastrointestinal tract infections, respiratory tract infections, conjunctivitis, hepatitis and other more serious infections with high morbidity and mortality in immunocompromised individuals such as meningitis, encephalitis and paralysis. Human enteric viruses infect and replicate in the gastrointestinal tract of their hosts and are released in large quantities in the stools of infected individuals. The discharge of inadequately treated sewage effluents is the most common source of enteric viral pathogens in aquatic environments. Due to the lack of correlation between the inactivation rates of bacterial indicators and viral pathogens, human adenoviruses have been proposed as a suitable index for the effective indication of viral contaminants in aquatic environments. This paper reviews the major genera of pathogenic human enteric viruses, their pathogenicity and epidemiology, as well as the role of wastewater effluents in their transmission. PMID:20644692

Communication Skill Attributes Needed for Vocational Education enter The Workplace

NASA Astrophysics Data System (ADS)

Wahyuni, L. M.; Masih, I. K.; Rejeki, I. N. Mei

2018-01-01

Communication skills are generic skills which need to be developed for success in the vocational education entering the workforce. This study aimed to discover the attributes of communication skill considered important in entering the workforce as perceived by vocational education students. The research was conducted by survey method using questionnaire as data collecting tool. The research population is final year student of D3 Vocational education Program and D4 Managerial Vocational education in academic year 2016/2017 who have completed field work practice in industry. The sampling technique was proportional random sampling. Data were analyzed with descriptive statistics and independent sampel t-test. Have ten communication skills attributes with the highest important level required to enter the workplace as perceived by the vocational education diploma. These results indicate that there was the same need related communication skills to enter the workforce

Disease-specific Alterations in the Enteric Virome in Inflammatory Bowel Disease

PubMed Central

Norman, Jason M.; Handley, Scott A.; Baldridge, Megan T.; Droit, Lindsay; Liu, Catherine Y.; Keller, Brian C.; Kambal, Amal; Monaco, Cynthia L.; Zhao, Guoyan; Fleshner, Phillip; Stappenbeck, Thaddeus S.; McGovern, Dermot P.B.; Keshavarzian, Ali; Mutlu, Ece A.; Sauk, Jenny; Gevers, Dirk; Xavier, Ramnik J.; Wang, David; Parkes, Miles; Virgin, Herbert W.

2015-01-01

SUMMARY Decreases in the diversity of enteric bacterial populations are observed in patients with Crohn’s disease (CD) and ulcerative colitis (UC). Less is known about the virome in these diseases. We show that the enteric virome is abnormal in CD and UC patients. In-depth analysis of preparations enriched for free virions in the intestine revealed that CD and UC were associated with a significant expansion of Caudovirales bacteriophages. The viromes of CD and UC patients were disease- and cohort-specific. Importantly, it did not appear that expansion and diversification of the enteric virome was secondary to changes in bacterial populations. These data support a model in which changes in the virome may contribute to intestinal inflammation and bacterial dysbiosis. We conclude that the virome is a candidate for contributing to, or being a biomarker for, human inflammatory bowel disease and speculate that the enteric virome may play a role in other diseases. PMID:25619688

Factors detracting students from applying for an obstetrics and gynecology residency.

PubMed

Gariti, Dominique L; Zollinger, Terrell W; Look, Katherine Y

2005-07-01

This study compares perception about the characteristics of obstetrics-gynecology (OG) of medical students who choose to pursue a residency in OG and those students who choose to enter another specialty. Fourth-year medical students were asked to complete a survey addressing their perceptions about OG. Responses were compared of (1) those entering OG to those entering other specialties, (2) those entering OG to those who seriously considered entering OG but chose another discipline, and (3) males to females. Chi-square tests were used for the comparisons. Of the 267 eligible students, 137 (51.1%) completed the survey. Clerkship satisfaction was rated as high by 88.9% of students choosing OG vs 10.2% (P<.0005) of those who chose another discipline. The emerging predominance of female providers detracted 38.5% of males vs 10.2% of females (P<.0005). Student perception of an OG clerkship may detract them from pursuing OG as a career.

[Nutritional therapy of duodenocutaneous fistula].

PubMed

Sun, Yuan-shui; Shao, Qin-shu; Xu, Xiao-dong; Hu, Jun-feng; Xu, Ji; Shi, Dun; Ye, Zai-yuan

2010-09-01

To summarize the experience in nutritional support for the management of duodenocutaneous fistula. Data of 32 patients with duodenocutaneous fistula in Zhejiang provincial people's hospital from January 1999 to December 2009 were analyzed retrospectively. The mean duration of nutritional support was 35.6 days (range, 8-82 days). Eight received total parenteral nutrition, 2 total enteral nutrition, and 22 parenteral nutrition combined with enteral nutrition respectively. Succus entericus reinfusion with enteral nutrition was used in 11 cases, glutamine-enriched nutritional support in 28 cases, somatostatin in 12 cases. In these patients, the healing rate was 75.0% after conservative treatment. In the 8 patients who underwent surgery, 6 were cured and 2 died (due to severe abdominal infection and multiple organ failure). A total of 30 patients had the fistulas cured and discharged. Parenteral nutrition combined with enteral nutrition, succus entericus reinfusion combined with enteral nutrition, glutamine-enriched nutritional support and somatostatin are important factors for the healing of duodenocutaneous fistulas.

Parasitic diseases and urban development.

PubMed Central

Mott, K. E.; Desjeux, P.; Moncayo, A.; Ranque, P.; de Raadt, P.

1990-01-01

The distribution and epidemiology of parasitic diseases in both urban and periurban areas of endemic countries have been changing as development progresses. The following different scenarios involving Chagas disease, lymphatic filariasis, leishmaniasis and schistosomiasis are discussed: (1) infected persons entering nonendemic urban areas without vectors; (2) infected persons entering nonendemic urban areas with vectors; (3) infected persons entering endemic urban areas; (4) non-infected persons entering endemic urban areas; (5) urbanization or domestication of natural zoonotic foci; and (6) vectors entering nonendemic urban areas. Cultural and social habits from the rural areas, such as type of house construction and domestic water usage, are adopted by migrants to urban areas and increase the risk of disease transmission which adversely affects employment in urban populations. As the urban health services must deal with the rise in parasitic diseases, appropriate control strategies for the urban setting must be developed and implemented. PMID:2127380

Planar cell polarity genes control the connectivity of enteric neurons

PubMed Central

Sasselli, Valentina; Boesmans, Werend; Vanden Berghe, Pieter; Tissir, Fadel; Goffinet, André M.; Pachnis, Vassilis

2013-01-01

A highly complex network of intrinsic enteric neurons is required for the digestive and homeostatic functions of the gut. Nevertheless, the genetic and molecular mechanisms that regulate their assembly into functional neuronal circuits are currently unknown. Here we report that the planar cell polarity (PCP) genes Celsr3 and Fzd3 are required during murine embryogenesis to specifically control the guidance and growth of enteric neuronal projections relative to the longitudinal and radial gut axes. Ablation of these genes disrupts the normal organization of nascent neuronal projections, leading to subtle changes of axonal tract configuration in the mature enteric nervous system (ENS), but profound abnormalities in gastrointestinal motility. Our data argue that PCP-dependent modules of connectivity established at early stages of enteric neurogenesis control gastrointestinal function in adult animals and provide the first evidence that developmental deficits in ENS wiring may contribute to the pathogenesis of idiopathic bowel disorders. PMID:23478408

26 CFR 31.3121(l)-1 - Agreements entered into by domestic corporations with respect to foreign subsidiaries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Agreements entered into by domestic corporations with respect to foreign subsidiaries. 31.3121(l)-1 Section 31.3121(l)-1 Internal Revenue INTERNAL... (Chapter 21, Internal Revenue Code of 1954) General Provisions § 31.3121(l)-1 Agreements entered into by...

31 CFR 19.305 - May I enter into a covered transaction with an excluded or disqualified person?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false May I enter into a covered transaction with an excluded or disqualified person? 19.305 Section 19.305 Money and Finance: Treasury Office...) Responsibilities of Participants Regarding Transactions Doing Business with Other Persons § 19.305 May I enter into...

31 CFR 19.305 - May I enter into a covered transaction with an excluded or disqualified person?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false May I enter into a covered transaction with an excluded or disqualified person? 19.305 Section 19.305 Money and Finance: Treasury Office...) Responsibilities of Participants Regarding Transactions Doing Business with Other Persons § 19.305 May I enter into...

31 CFR 19.305 - May I enter into a covered transaction with an excluded or disqualified person?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false May I enter into a covered transaction with an excluded or disqualified person? 19.305 Section 19.305 Money and Finance: Treasury Office...) Responsibilities of Participants Regarding Transactions Doing Business with Other Persons § 19.305 May I enter into...

31 CFR 19.305 - May I enter into a covered transaction with an excluded or disqualified person?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false May I enter into a covered transaction with an excluded or disqualified person? 19.305 Section 19.305 Money and Finance: Treasury Office...) Responsibilities of Participants Regarding Transactions Doing Business with Other Persons § 19.305 May I enter into...

31 CFR 19.305 - May I enter into a covered transaction with an excluded or disqualified person?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false May I enter into a covered transaction with an excluded or disqualified person? 19.305 Section 19.305 Money and Finance: Treasury Office...) Responsibilities of Participants Regarding Transactions Doing Business with Other Persons § 19.305 May I enter into...

Independent Assessment Plan: LAV-25

DTIC Science & Technology

1989-06-27

Pages. Enter the total Block 7. Performing Organization Name(s) and number of pages. Address(es. Self -explanatory. Block 16. Price Code, Enter...organization Blocks 17. - 19. Security Classifications. performing the report. Self -explanatory. Enter U.S. Security Classification in accordance with U.S...Security Block 9. S oonsorina/Monitoring Acenc Regulations (i.e., UNCLASSIFIED). If form .Names(s) and Address(es). Self -explanatory. contains classified

19 CFR 181.64 - Goods re-entered after repair or alteration in Canada or Mexico.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 2 2013-04-01 2013-04-01 false Goods re-entered after repair or alteration in... Samples and Goods Returned After Repair or Alteration § 181.64 Goods re-entered after repair or alteration... otherwise provided in this section, the following declarations shall be filed in connection with the entry...

19 CFR 181.64 - Goods re-entered after repair or alteration in Canada or Mexico.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 2 2014-04-01 2014-04-01 false Goods re-entered after repair or alteration in... Samples and Goods Returned After Repair or Alteration § 181.64 Goods re-entered after repair or alteration... otherwise provided in this section, the following declarations shall be filed in connection with the entry...

19 CFR 181.64 - Goods re-entered after repair or alteration in Canada or Mexico.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 2 2012-04-01 2012-04-01 false Goods re-entered after repair or alteration in... Samples and Goods Returned After Repair or Alteration § 181.64 Goods re-entered after repair or alteration... otherwise provided in this section, the following declarations shall be filed in connection with the entry...

19 CFR 181.64 - Goods re-entered after repair or alteration in Canada or Mexico.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 2 2011-04-01 2011-04-01 false Goods re-entered after repair or alteration in... Samples and Goods Returned After Repair or Alteration § 181.64 Goods re-entered after repair or alteration... otherwise provided in this section, the following declarations shall be filed in connection with the entry...

43 CFR 404.56 - If a financial assistance agreement is entered into for a rural water supply project that...

Code of Federal Regulations, 2010 CFR

2010-10-01

... entered into for a rural water supply project that benefits more than one Indian tribe, is the approval of... Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Miscellaneous § 404.56 If a financial assistance agreement is entered into for a rural water supply project that...

Construction of recombinant Newcastle disease virus expressing the S1 protein of Turkey enteric coronavirus for use as a bivalent vaccine

USDA-ARS?s Scientific Manuscript database

Turkey enteric coronavirus (TCoV) causes a contagious form of enteritis in turkeys, generally recognized in the field by outward signs including diarrhea and decreased weight gain, resulting in severe economic losses for the poultry industry in the US. To date there is no commercial vaccine availab...

Comparing Entering Freshmen's Perceptions of Campus Marijuana and Alcohol Use to Reported Use

ERIC Educational Resources Information Center

Gold, Gregg J.; Nguyen, Alyssa T.

2009-01-01

Use of marijuana and alcohol among current college students (N = 1101) was compared to the perceptions and use of entering freshmen (N = 481) surveyed before the start of classes. Entering freshmen significantly misperceived campus norms for marijuana use, over-estimating that almost every student used in the last 30 days, p less than 0.001.…

Relative disease susceptibility and clostridial toxin antibody responses in three commercial broiler lines co-infected with Clostridium perfringens and Eimeria maxima using an experimental model of necrotic enteritis

USDA-ARS?s Scientific Manuscript database

Necrotic enteritis is an enteric disease of poultry resulting from infection by Clostridium perfringens with co-infection by Eimeria spp. constituting a major risk factor for disease pathogenesis. This study compared three commercial broiler chicken lines using an experimental model of necrotic ente...

Division of Waste Management | Welcome

Science.gov Websites

Resources I need information on ... Expand I need information on ... Open Records About Us Expand About Us Name Use SHIFT+ENTER to open the menu (new window). Job Title Use SHIFT+ENTER to open the menu (new window). Business Phone Use SHIFT+ENTER to open the menu (new window). Jon Maybriar Director 502-782-6702

SRI PUFF 8 Computer Program for One-Dimensional Stress Wave Propagation

DTIC Science & Technology

1980-03-01

raial product. UNCLASSIFIED SECURITY CLASSIFICATION OF THIS PAGE (Tfhen Data Entered) REPORT DOCUMENTATION PAGE READ INSTRUCTIONS BEFORE COMPLETING...EDITION OF I NOV 6S (S OBSOLETE UNCLASSIFIED SECURITY CLASSIFICATIOK OF THIS PAGE (When Data Entered) UNCLASSIFIED SECURITY CLASSIFICATION OF THIS...aspects of wave propagation calculations. UNCLASSIFIED SECURITY CLASSIFICATION OF THIS PAGEfWhen Data Entered) FOREWORD This volume constitutes a

Enteral Nutrition in Pediatric Patients

PubMed Central

2018-01-01

Pediatric patients require specialized attention and have diverse demands for proper growth and development, and thus need a different approach and interest in nutritional assessment and supply. Enteral nutrition is the most basic and important method of nutritional intervention, and its indications should be identified. Also, the sites, modes, types, and timing of nutritional intervention according to the patient's condition should be determined. In addition, various complications associated with enteral nutrition supply should be identified, and prevention and treatment are required. This approach to enteral nutrition and proper administration can help in the proper growth and recovery of pediatric patients with nutritional imbalances or nutritional needs. PMID:29383300

Parenteral nutrition in the ICU setting: need for a shift in utilization.

PubMed

Oshima, Taku; Hiesmayr, Michael; Pichard, Claude

2016-03-01

The difficulties to feed the patients adequately with enteral nutrition alone have drawn the attention of the clinicians toward the use of parenteral nutrition, although recommendations by the recent guidelines are conflicting. This review focuses on the intrinsic role of parenteral nutrition, its new indication, and modalities of use for the critically ill patients. A recent trial demonstrated that selecting either parenteral nutrition or enteral nutrition for early nutrition has no impact on clinical outcomes. However, it must be acknowledged that the risk of relative overfeeding is greater when using parenteral nutrition and the risk of underfeeding is greater when using enteral nutrition because of gastrointestinal intolerance. Both overfeeding and underfeeding in the critically ill patients are associated with deleterious outcomes. Thus, early and adequate feeding according to the specific energy needs can be recommended as the optimal feeding strategy. Parenteral nutrition can be used to substitute or supplement enteral nutrition, if adequately prescribed. Testing for enteral nutrition tolerance during 2-3 days after ICU admission provides the perfect timing to start parenteral nutrition, if needed. In case of absolute contraindication for enteral nutrition, consider starting parenteral nutrition carefully to avoid overfeeding.

Antimicrobial Properties of Garlic Oil against Human Enteric Bacteria: Evaluation of Methodologies and Comparisons with Garlic Oil Sulfides and Garlic Powder

PubMed Central

Ross, Z. M.; O'Gara, E. A.; Hill, D. J.; Sleightholme, H. V.; Maslin, D. J.

2001-01-01

The antimicrobial effects of aqueous garlic extracts are well established but those of garlic oil (GO) are little known. Methodologies for estimating the antimicrobial activity of GO were assessed and GO, GO sulfide constituents, and garlic powder (GP) were compared in tests against human enteric bacteria. Test methodologies were identified as capable of producing underestimates of GO activity. Antimicrobial activity was greater in media lacking tryptone or cysteine, suggesting that, as for allicin, GO effects may involve sulfhydryl reactivity. All bacteria tested, which included both gram-negative and -positive bacteria and pathogenic forms, were susceptible to garlic materials. On a weight-of-product basis, 24 h MICs for GO (0.02 to 5.5 mg/ml, 62 enteric isolates) and dimethyl trisulfide (0.02 to 0.31 mg/ml, 6 enteric isolates) were lower than those for a mixture of diallyl sulfides (0.63 to 25 mg/ml, 6 enteric isolates) and for GP, which also exhibited a smaller MIC range (6.25 to 12.5 mg/ml, 29 enteric isolates). Viability time studies of GO and GP against Enterobacter aerogenes showed time- and dose-dependent effects. Based upon its thiosulfinate content, GP was more active than GO against most bacteria, although some properties of GO are identified as offering greater therapeutic potential. Further exploration of the potential of GP and GO in enteric disease control appears warranted. PMID:11133485

Correlates of protection for enteric vaccines.

PubMed

Holmgren, Jan; Parashar, Umesh D; Plotkin, Stanley; Louis, Jacques; Ng, Su-Peing; Desauziers, Eric; Picot, Valentina; Saadatian-Elahi, Mitra

2017-06-08

An immunological Correlate of Protection (CoP) is an immune response that is statistically interrelated with protection. Identification of CoPs for enteric vaccines would help design studies to improve vaccine performance of licensed vaccines in low income settings, and would facilitate the testing of future vaccines in development that might be more affordable. CoPs are lacking today for most existing and investigational enteric vaccines. In order to share the latest information on CoPs for enteric vaccines and to discuss novel approaches to correlate mucosal immune responses in humans with protection, the Foundation Mérieux organized an international conference of experts where potential CoPs for vaccines were examined using case-studies for both bacterial and viral enteric pathogens. Experts on the panel concluded that to date, all established enteric vaccine CoPs, such as those for hepatitis A, Vi typhoid and poliovirus vaccines, are based on serological immune responses even though these may poorly reflect the relevant gut immune responses or predict protective efficacy. Known CoPs for cholera, norovirus and rotavirus could be considered as acceptable for comparisons of similarly composed vaccines while more work is still needed to establish CoPs for the remaining enteric pathogens and their candidate vaccines. Novel approaches to correlate human mucosal immune responses with protection include the investigation of gut-originating antibody-secreting cells (ASCs), B memory cells and follicular helper T cells from samples of peripheral blood during their recirculation. Copyright © 2017.

Australasian neonatal intensive care enteral nutrition survey: implications for practice.

PubMed

Cormack, Barbara; Sinn, John; Lui, Kei; Tudehope, David

2013-04-01

This survey investigated standardised feeding guidelines and nutrition policy in Australasian neonatal intensive care units and compared these with previously published surveys and international consensus nutrition recommendations. An electronic survey on enteral nutrition comprising a wide range of questions about clinical practice was e-mailed to all 25 Australasian neonatal intensive care unit directors of tertiary perinatal centres. Twenty-five surveys were distributed; 24 (96%) were completed. All respondents preferred breast milk as the first feed. For infants <1000 g, 58% started feeds at 1 mL every 4 hours and 83% started enteral feeds on day 0-2 in the absence of contraindications. The identification of bile-stained gastric aspirates significant enough to withhold feeds varied. Multicomponent breast milk fortifiers were added by 58% when enteral feeds reached 150 mL/kg day, while 21% added these earlier at 120 mL/kg day or less. Iron supplementation was started at 4 weeks by 63% and at 6 weeks by 27%. Only 42% of units had a neonatal dietitian. Of the 24 units who responded, 58% had no written enteral feeding guidelines. Enteral nutrition was initiated earlier than in the past. Great variation remains in clinical practices. Nutritional implications are discussed. Standardisation of feeding guidelines and enteral nutrition policy based on current evidence and international consensus nutrition recommendations may be beneficial and should be encouraged. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

16 CFR Figure 4 to Part 1513 - Neck Portion of “B” Section of Probe Enters Completely Into Opening

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Neck Portion of âBâ Section of Probe Enters Completely Into Opening 4 Figure 4 to Part 1513 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... 1513—Neck Portion of “B” Section of Probe Enters Completely Into Opening ER22DE99.010 ...

16 CFR Figure 4 to Part 1513 - Neck Portion of “B” Section of Probe Enters Completely Into Opening

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Neck Portion of âBâ Section of Probe Enters Completely Into Opening 4 Figure 4 to Part 1513 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... 1513—Neck Portion of “B” Section of Probe Enters Completely Into Opening ER22DE99.010 ...

16 CFR Figure 4 to Part 1513 - Neck Portion of “B” Section of Probe Enters Completely Into Opening

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Neck Portion of âBâ Section of Probe Enters Completely Into Opening 4 Figure 4 to Part 1513 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... 1513—Neck Portion of “B” Section of Probe Enters Completely Into Opening ER22DE99.010 ...

16 CFR Figure 4 to Part 1513 - Neck Portion of “B” Section of Probe Enters Completely Into Opening

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Neck Portion of âBâ Section of Probe Enters Completely Into Opening 4 Figure 4 to Part 1513 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... 1513—Neck Portion of “B” Section of Probe Enters Completely Into Opening ER22DE99.010 ...

16 CFR Figure 4 to Part 1513 - Neck Portion of “B” Section of Probe Enters Completely Into Opening

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Neck Portion of âBâ Section of Probe Enters Completely Into Opening 4 Figure 4 to Part 1513 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... 1513—Neck Portion of “B” Section of Probe Enters Completely Into Opening ER22DE99.010 ...

22 CFR 1006.415 - What must I do if a Federal agency excludes the participant or a principal after I enter into a...

Code of Federal Regulations, 2010 CFR

2010-04-01

... participant or a principal after I enter into a covered transaction? 1006.415 Section 1006.415 Foreign...) Responsibilities of Inter-American Foundation Officials Regarding Transactions § 1006.415 What must I do if a Federal agency excludes the participant or a principal after I enter into a covered transaction? (a) You...

Enteric Parasites of Orangutans (Pongo Pygmaeus) in Indonesia.

DTIC Science & Technology

1978-10-27

Special Report 78-9 L EVEL ENTERIC PARASITES OF ORANGUTANS (Pongo pygmaeus) IN INDONESIA Erich E. Stafford, Austin L. Moede, Richard J. Brown... orangutans , is difficult because of the lack of information as to possible etiologic agents. FINDINGS This paper tabulates identified enteric parasitic...ova in three groups of orangutans living in their native habitat. This information will be useful to those laboratories attempting to treat parasitic

Advanced Unmanned Search System (AUSS) Surface Navigation, Underwater Tracking, and Transponder Network Calibration

DTIC Science & Technology

1992-09-01

5 ENTER PULSE REP PERIOD ................................ 900 ENTER RETURN TO TOP LEVEL C-5 26. SBS1 RECEIVER ----- HYDROPHONE ----- HYDRI ...HYDROPHONE ----- HYDRI PRECISION RETURN 1 LEVEL 29. HEADING INPUT ------ GYRO 1 ------ CONTINUE RANGE GATE OFF ----- FILTER OFF RETURN TO TOP LEVEL 30...700 ENTER RETURN TO TOP LEVEL 12. SBSI RECEIVER ------ HYDROPHONE ------ HYDRI PRECISION RETURN 1 LEVEL 13. HEADING INPUT ------ GYRO 1

2 CFR 180.415 - What must I do if a Federal agency excludes the participant or a principal after I enter into a...

Code of Federal Regulations, 2010 CFR

2010-01-01

... the participant or a principal after I enter into a covered transaction? 180.415 Section 180.415 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS... excludes the participant or a principal after I enter into a covered transaction? (a) You as a Federal...

5 CFR 919.415 - What must I do if a Federal agency excludes the participant or a principal after I enter into a...

Code of Federal Regulations, 2010 CFR

2010-01-01

... excludes the participant or a principal after I enter into a covered transaction? 919.415 Section 919.415 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED... § 919.415 What must I do if a Federal agency excludes the participant or a principal after I enter into...

An Analysis of When Officers Should Enter the Army Contracting Career Field

DTIC Science & Technology

2016-06-01

NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT AN ANALYSIS OF WHEN OFFICERS SHOULD ENTER THE ARMY...TYPE AND DATES COVERED MBA professional report 4. TITLE AND SUBTITLE AN ANALYSIS OF WHEN OFFICERS SHOULD ENTER THE ARMY CONTRACTING CAREER FIELD...courses of action provide an alternative to the existing professional timeline in order to allow officers to serve in contracting positions earlier

Sense of Direction: The Importance of Helping Community College Students Select and Enter a Program of Study

ERIC Educational Resources Information Center

Moore, Colleen; Shulock, Nancy

2011-01-01

The California Community Colleges (CCC) are committed to increasing the rate at which entering students persist to completion of a certificate or degree or transfer to a university. Recent research suggests that efforts to increase student success in community colleges need to focus on helping new students choose and enter a program of study. Too…

Role of classic signs as diagnostic predictors for enteric fever among returned travellers: Relative bradycardia and eosinopenia

PubMed Central

Matono, Takashi; Kutsuna, Satoshi; Kato, Yasuyuki; Katanami, Yuichi; Yamamoto, Kei; Takeshita, Nozomi; Hayakawa, Kayoko; Kanagawa, Shuzo; Kaku, Mitsuo; Ohmagari, Norio

2017-01-01

Background The lack of characteristic clinical findings and accurate diagnostic tools has made the diagnosis of enteric fever difficult. We evaluated the classic signs of relative bradycardia and eosinopenia as diagnostic predictors for enteric fever among travellers who had returned from the tropics or subtropics. Methods This matched case-control study used data from 2006 to 2015 for culture-proven enteric fever patients as cases. Febrile patients (>38.3°C) with non-enteric fever, who had returned from the tropics or subtropics, were matched to the cases in a 1:3 ratio by age (±3 years), sex, and year of diagnosis as controls. Cunha’s criteria were used for relative bradycardia. Absolute eosinopenia was defined as an eosinophilic count of 0/μL. Results Data from 160 patients (40 cases and 120 controls) were analysed. Cases predominantly returned from South Asia (70% versus 18%, p <0.001). Relative bradycardia (88% versus 51%, p <0.001) and absolute eosinopenia (63% versus 38%, p = 0.008) were more frequent in cases than controls. In multivariate logistic regression analysis, return from South Asia (aOR: 21.6; 95% CI: 7.17–64.9) and relative bradycardia (aOR: 11.7; 95% CI: 3.21–42.5) were independent predictors for a diagnosis of enteric fever. The positive likelihood ratio was 4.00 (95% CI: 2.58–6.20) for return from South Asia, 1.72 (95% CI: 1.39–2.13) for relative bradycardia, and 1.63 (95%CI: 1.17–2.27) for absolute eosinopenia. The negative predictive values of the three variables were notably high (83–92%);. however, positive predictive values were 35–57%. Conclusions The classic signs of relative bradycardia and eosinopenia were not specific for enteric fever; however both met the criteria for being diagnostic predictors for enteric fever. Among febrile returned travellers, relative bradycardia and eosinopenia should be re-evaluated for predicting a diagnosis of enteric fever in non-endemic areas prior to obtaining blood cultures. PMID:28644847

[The participation of hospital pharmacy services in enteral nutrition].

PubMed

Hidalgo, F J; Bermejo, T; de Juana, P; Delgado, E; García, D

1995-01-01

We present the results of a study done in the departments of hospital pharmacy of our country with the aim of knowing their participation in the use and clinical follow up of patients with enteral nutrition. 293 questionnaires were sent out, and 121 were filled out and returned (41.3%). The responses were classified into three groups, according to the number of hospital beds, considering > or = 1000 (large), 500-1000 (medium), and < or = 500 (small). The data were analyzed by means of a statistical program (R-Sigma Horus). 79% (68) of the small hospitals have a unitary dose drug dispensation system, and the Enteral Nutrition was distributed through this system in 53% (50) of them; only 29% (27) of them have a stock of these preparations on the wards. 93% (14) and 65% (54) of the large and small hospitals respectively, prefer the use of enteral nutrition as opposed to parenteral nutrition. 85% (11) of the large hospitals have protocols for the use of enteral nutrition, this being 62% (10) and 59% (47) in medium and small hospitals. The committees for artificial nutrition are present in 75% of the large hospitals, in addition to which, in 66% of these there is a nutritional support team. A pharmacist from the department of pharmacy participates in both multidisciplinary groups. If it is necessary to manipulate the enteral nutrition preparations, in 30% of the departments of pharmacy of the smaller hospitals, this is centralized, being done by personnel of the department itself; in 59% of them (19) there is a specific area for the elaboration, which is not the case in large hospitals. Drugs are mixed with the enteral nutrition in 25% (1), 12% (1), and 9% (4) of the large, medium and small hospitals respectively. There is great, active participation of the hospital pharmacists in the activities of the multidisciplinary nutritional support systems, although at the present time, the involvement of the departments of pharmacy in the centralization of the manipulation of the enteral nutrition is reduced. It is necessary therefore, to implement the development of enteral nutrition programs with a quality guarantee from the departments of pharmacy.

Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction.

PubMed

Gabor, S; Renner, H; Matzi, V; Ratzenhofer, B; Lindenmann, J; Sankin, O; Pinter, H; Maier, A; Smolle, J; Smolle-Jüttner, F M

2005-04-01

After resective and reconstructive surgery in the gastrointestinal tract, oral feeding is traditionally avoided in order to minimize strain to the anastomoses and to reduce the inherent risks of the postoperatively impaired gastrointestinal motility. However, studies have given evidence that the small bowel recovers its ability to absorb nutrients almost immediately following surgery, even in the absence of peristalsis, and that early enteral feeding would preserve both the integrity of gut mucosa and its immunological function. The aim of this study was to investigate the impact of early enteral feeding on the postoperative course following oesophagectomy or oesophagogastrectomy, and reconstruction. Between May 1999 and November 2002, forty-four consecutive patients (thirty-eight males and six females; mean age 62, range 30-82) with oesophageal carcinoma (stages I-III), who had undergone radical resection and reconstruction, entered this study (early enteral feeding group; EEF). A historical group of forty-four patients (thirty-seven males and seven females; mean age 64, range 41-79; stages I-III) resected between January 1997 and March 1999 served as control (parenteral feeding group; PF). The duration of both postoperative stay in the Intensive Care Unit (ICU) and the total hospital stay, perioperative complications and the overall mortality were compared. Early enteral feeding was administered over the jejunal line of a Dobhoff tube. It started 6 h postoperatively at a rate of 10 ml/h for 6 h with stepwise increase until total enteral nutrition was achieved on day 6. In the controls oral enteral feeding was begun on day 7. If compared to the PF group, EEF patients recovered faster considering the duration of both stay in the ICU and in the hospital. There was a significant difference in the interval until the first bowel movements. No difference in overall 30 d mortality was identified. A poor nutritional status was a significant prognostic factor for an increased mortality. Early enteral feeding significantly reduces the duration of ICU treatment and total hospital stay in patients who undergo oesophagectomy or oesophagogastrectomy for oesophageal carcinoma. The mortality rate is not affected.

Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome.

PubMed

Sparks, Eric A; Khan, Faraz A; Fisher, Jeremy G; Fullerton, Brenna S; Hall, Amber; Raphael, Bram P; Duggan, Christopher; Modi, Biren P; Jaksic, Tom

2016-01-01

Necrotizing enterocolitis (NEC) remains one of the most common underlying diagnoses of short bowel syndrome (SBS) in children. The relationship between the etiology of SBS and ultimate enteral autonomy has not been well studied. This investigation sought to evaluate the rate of achievement of enteral autonomy in SBS patients with and without NEC. Following IRB approval, 109 patients (2002-2014) at a multidisciplinary intestinal rehabilitation program were reviewed. The primary outcome evaluated was achievement of enteral autonomy (i.e. fully weaning from parenteral nutrition). Patient demographics, primary diagnosis, residual small bowel length, percent expected small bowel length, median serum citrulline level, number of abdominal operations, status of the ileocecal valve (ICV), presence of ileostomy, liver function tests, and treatment for bacterial overgrowth were recorded for each patient. Median age at PN onset was 0 weeks [IQR 0-0]. Median residual small bowel length was 33.5 cm [IQR 20-70]. NEC was present in 37 of 109 (33.9%) of patients. 45 patients (41%) achieved enteral autonomy after a median PN duration of 15.3 [IQR 7.2-38.4]months. Overall, 64.9% of patients with NEC achieved enteral autonomy compared to 29.2% of patients with a different primary diagnosis (p=0.001, Fig. 1). Patients with NEC remained more likely than those without NEC to achieve enteral autonomy after two (45.5% vs. 12.0%) and four (35.7% vs. 6.3%) years on PN (Fig. 1). Logistic regression analysis demonstrated the following parameters as independent predictors of enteral autonomy: diagnosis of NEC (p<0.002), median serum citrulline level (p<0.02), absence of a jejunostomy or ileostomy (p=0.013), and percent expected small bowel length (p=0.005). Children with SBS because of NEC have a significantly higher likelihood of fully weaning from parenteral nutrition compared to children with other causes of SBS. Additionally, patients with NEC may attain enteral autonomy even after long durations of parenteral support. Copyright © 2016 Elsevier Inc. All rights reserved.

Enteral tube feeding for cystic fibrosis.

PubMed

Conway, S P; Morton, A; Wolfe, S

2008-04-16

Enteral tube feeding is routinely used in many cystic fibrosis centres when weight for height percentage is less than 85%, when there has been weight loss for longer than a two-month period or when there has been no weight gain for two to three months (under five years old) or for six months (over five years old). To examine the evidence that in people with cystic fibrosis supplemental enteral tube feeding improves nutritional status, respiratory function, and quality of life without significant adverse effects. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also contacted the companies that market enteral feeds and reviewed their databases. Date of the most recent search of the Group's Cystic Fibrosis Trials Register: November 2007. All randomised controlled trials comparing supplemental enteral tube feeding for one month or longer with no specific intervention in people with cystic fibrosis. Thirteen trials were identified by the search; however, none were eligible for inclusion in this review. There are no trials included in this review. Supplemental enteral tube feeding is widely used throughout the world to improve nutritional status in people with cystic fibrosis. The methods mostly used, nasogastric or gastrostomy feeding, are invasive, expensive, and may have a negative effect on self-esteem and body image. Reported use of enteral tube feeding suggests that it results in nutritional and respiratory improvement and it is disappointing that their efficacy has not been fully assessed by randomised controlled trials. With the more frequent recommendations to use enteral tube feeding as an early rather than a late intervention, this systematic review identifies the need for a multicentre, randomised controlled trial assessing both efficacy and possible adverse effects of enteral tube feeding in cystic fibrosis. There are no trials included in the review and we have not identified any relevant trials up to November 2007. We therefore do not plan to update this review until new trials are published.

United States Air Force Summer Research Program -- 1991. High School Apprenticeship Program (HSAP) Reports, Volume 13: Wright Laboratory

DTIC Science & Technology

1991-12-01

ei a. "h:2 ;.::,e :v a :ei.w co±’eague. CAct. Alien Andrews. SAF. who s*_ese_ . zne tere in mod i: at:ons ch he m i emen tec tha nabed "he :CT -L work...program by entering: SET COMMAND SYS $SYSTEM:SAVE85 i0. Load the LOAD85 program by entering: SET COMMAND SYS $SYSTEM:LOAD85 11. Connect the VT340 with the...SYSINT CUROFF 4. Load the LOAD85 program by entering: SET COMMAND SYS $SYSTEM:LOAD85 5. Display the image to be printed on the screen by entering: LOAD85

Altered Virome and Bacterial Microbiome in Human Immunodeficiency Virus-Associated Acquired Immunodeficiency Syndrome

PubMed Central

Monaco, Cynthia L.; Gootenberg, David B.; Zhao, Guoyan; Handley, Scott A.; Ghebremichael, Musie S.; Lim, Efrem S.; Lankowski, Alex; Baldridge, Megan T.; Wilen, Craig B.; Flagg, Meaghan; Norman, Jason M.; Keller, Brian C.; Luévano, Jesús Mario; Wang, David; Boum, Yap; Martin, Jeffrey N.; Hunt, Peter W.; Bangsberg, David R.; Siedner, Mark J.; Kwon, Douglas S.; Virgin, Herbert W.

2016-01-01

SUMMARY Human immunodeficiency virus (HIV) infection is associated with increased intestinal translocation of microbial products and enteropathy as well as alterations in gut bacterial communities. However, whether the enteric virome contributes to this infection and resulting immunodeficiency remains unknown. We characterized the enteric virome and bacterial microbiome in a cohort of Ugandan patients, including HIV-uninfected or HIV-infected subjects and those either treated with anti-retroviral therapy (ART) or untreated. Low peripheral CD4 T cell counts were associated with an expansion of enteric adenovirus sequences and this increase was independent of ART treatment. Additionally, the enteric bacterial microbiome of patients with lower CD4 T counts exhibited reduced phylogenetic diversity and richness with specific bacteria showing differential abundance, including increases in Enterobacteriaceae, which have been associated with inflammation. Thus, immunodeficiency in progressive HIV infection is associated with alterations in the enteric virome and bacterial microbiome, which may contribute to AIDS-associated enteropathy and disease progression. PMID:26962942

Transplantation of enteric nervous system stem cells rescues nitric oxide synthase deficient mouse colon

PubMed Central

McCann, Conor J.; Cooper, Julie E.; Natarajan, Dipa; Jevans, Benjamin; Burnett, Laura E.; Burns, Alan J.; Thapar, Nikhil

2017-01-01

Enteric nervous system neuropathy causes a wide range of severe gut motility disorders. Cell replacement of lost neurons using enteric neural stem cells (ENSC) is a possible therapy for these life-limiting disorders. Here we show rescue of gut motility after ENSC transplantation in a mouse model of human enteric neuropathy, the neuronal nitric oxide synthase (nNOS−/−) deficient mouse model, which displays slow transit in the colon. We further show that transplantation of ENSC into the colon rescues impaired colonic motility with formation of extensive networks of transplanted cells, including the development of nNOS+ neurons and subsequent restoration of nitrergic responses. Moreover, post-transplantation non-cell-autonomous mechanisms restore the numbers of interstitial cells of Cajal that are reduced in the nNOS−/− colon. These results provide the first direct evidence that ENSC transplantation can modulate the enteric neuromuscular syncytium to restore function, at the organ level, in a dysmotile gastrointestinal disease model. PMID:28671186

Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients.

PubMed

Portanova, Michel

2010-08-16

Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent total gastrectomy, 9 of them had esophagojejunal fistula (5.2%). In three selected patients a trans-anastomotic naso-enteral feeding tube was placed under fluoroscopic vision when the fistula was clinically detected and a complete polymeric enteral formula was used. The complete closing of the esophagojejunal fistula was obtained in day 8, 14 and 25 respectively. In some selected cases it is possible to make a successful enteral nutrition using a feeding tube distal to the leak area inserted with the help of fluoroscopic vision. The specialized management of a gastric surgery unit and nutritional therapy unit are highlighted.

Trophic or full nutritional support?

PubMed

Arabi, Yaseen M; Al-Dorzi, Hasan M

2018-06-04

Full nutritional support during the acute phase of critical illness has traditionally been recommended to reduce catabolism and prevent malnutrition. Approaches to achieve full nutrition include early initiation of nutritional support, targeting full nutritional requirement as soon as possible and initiation of supplemental parenteral nutrition when enteral nutrition does not reach the target. Existing evidence supports early enteral nutrition over delayed enteral nutrition or early parenteral nutrition. Recent randomized controlled trials have demonstrated that permissive underfeeding or trophic feeding is associated with similar outcomes compared with full feeding in the acute phase of critical illness. In patients with refeeding syndrome, patients with high nutritional risk and patients with shock, early enteral nutrition targeting full nutritional targets may be associated with worse outcomes compared with less aggressive enteral nutrition strategy. A two-phase approach for nutritional support may more appropriately account for the physiologic changes during critical illness than one-phase approach. Further evidence is awaited for the optimal protein amount during critical illness and for feeding patients at high nutritional risk or with acute gastrointestinal injury.

Altered Virome and Bacterial Microbiome in Human Immunodeficiency Virus-Associated Acquired Immunodeficiency Syndrome.

PubMed

Monaco, Cynthia L; Gootenberg, David B; Zhao, Guoyan; Handley, Scott A; Ghebremichael, Musie S; Lim, Efrem S; Lankowski, Alex; Baldridge, Megan T; Wilen, Craig B; Flagg, Meaghan; Norman, Jason M; Keller, Brian C; Luévano, Jesús Mario; Wang, David; Boum, Yap; Martin, Jeffrey N; Hunt, Peter W; Bangsberg, David R; Siedner, Mark J; Kwon, Douglas S; Virgin, Herbert W

2016-03-09

Human immunodeficiency virus (HIV) infection is associated with increased intestinal translocation of microbial products and enteropathy as well as alterations in gut bacterial communities. However, whether the enteric virome contributes to this infection and resulting immunodeficiency remains unknown. We characterized the enteric virome and bacterial microbiome in a cohort of Ugandan patients, including HIV-uninfected or HIV-infected subjects and those either treated with anti-retroviral therapy (ART) or untreated. Low peripheral CD4 T cell counts were associated with an expansion of enteric adenovirus sequences and this increase was independent of ART treatment. Additionally, the enteric bacterial microbiome of patients with lower CD4 T counts exhibited reduced phylogenetic diversity and richness with specific bacteria showing differential abundance, including increases in Enterobacteriaceae, which have been associated with inflammation. Thus, immunodeficiency in progressive HIV infection is associated with alterations in the enteric virome and bacterial microbiome, which may contribute to AIDS-associated enteropathy and disease progression. Copyright © 2016 Elsevier Inc. All rights reserved.

Injectable Ammonium Chloride Used Enterally for the Treatment of Persistent Metabolic Alkalosis in Three Pediatric Patients

PubMed Central

Mathew, Jennie T.; Bio, Laura L.

2012-01-01

Enteral administration of injectable ammonium chloride may offer an effective method for the treatment of persistent metabolic alkalosis, without the adverse effects associated with the intravenous route. This case series describes 3 pediatric patients who received ammonium chloride enterally for the treatment of persistent metabolic alkalosis. The patients were a 2-month-old female infant, a 6-week-old male infant, and a 3-year-old male toddler. Four to 18 doses of ammonium chloride were administered enterally (range, 3-144 mEq/dose). Two of the 3 patients achieved resolution of metabolic alkalosis with ammonium chloride, while 1 patient's condition was refractory to treatment. Resolution of metabolic alkalosis occurred at 4 and 8 days, which required a total weight-based dose of 10.7 mEq/kg and 18 mEq/kg, respectively. No adverse effects were recorded. The use of ammonium chloride injection administered enterally was a safe and effective option in 2 of the 3 pediatric patients with persistent metabolic alkalosis. PMID:23118664

[The use experience of enteral nutrition pump (Applix Smart)].

PubMed

Kobayashi, Kaoru; Shirai, Atsushi; Uryu, Shinichi; Kikuchi, Shiro; Momozono, Shinobu; Shimizu, Haruyuki

2006-12-01

Nutritional management by using enteral feeding method of nutrition is required for patients of gastroenterological disease with functional disorder in digestion-absorption, and for cases where the patients have difficulty in taking food orally. There are many cases where enteral nutrition pumps are used for administration of nutritious medicines. Approximately 150 enteral nutrition pumps (including house use and home rental) have currently been utilized at our facility. The department of ME Center takes care of enteral nutrition pumps for maintenance and control. On the other hand, we needed to conduct a study for a new pump in replacing Frenta System IV due to the pump was no longer available. At this presentation, we are introducing a new pump manufactured by Fresenius as a replacement of the Frenta System IV. In the meantime, we would like to report a comparison examination of the pump based on its functionality, performance and user friendliness from the view from a clinical technologist as well.

41 CFR 105-68.365 - What must I do if I learn of information required under § 105-68.355 after entering into a...

Code of Federal Regulations, 2010 CFR

2010-07-01

... learn of information required under § 105-68.355 after entering into a covered transaction with a... if I learn of information required under § 105-68.355 after entering into a covered transaction with... person at a higher tier, you must provide immediate written notice to that person if you learn either...

41 CFR 105-68.365 - What must I do if I learn of information required under § 105-68.355 after entering into a...

Code of Federal Regulations, 2011 CFR

2011-01-01

... learn of information required under § 105-68.355 after entering into a covered transaction with a... if I learn of information required under § 105-68.355 after entering into a covered transaction with... person at a higher tier, you must provide immediate written notice to that person if you learn either...

Longitudinal Study of Students Entering High School in 1979: The Relationship between First Term Performance and School Completion.

ERIC Educational Resources Information Center

Troob, Charles

A longitudinal analysis of students who entered New York City high schools in 1979 supports the perception that most future dropouts can be identified at the beginning of their high school careers. This study examined the records of more than a quarter of the 1979 entering class at New York City high schools. Analyses were performed on attendance,…

Effect of ecological immune-enhanced enteral nutrition on patients with gastrointestinal fistulas.

PubMed

Wang, Q-H

2017-05-01

The aim of this study was to determine the effects of early ecological immune-enhanced enteral nutrition on the nutritional status, immune function and intestinal mucosal barrier in patients with gastrointestinal fistulas. 54 patients with gastrointestinal fistulas were randomized to either the ecological immune-enhanced enteral nutrition group (EIEN group, 28) or the parenteral nutrition group (PN group, 26). The changes in the immunity, nutrition index and intestinal mucosal barrier indexes before the ecological immune-enhanced enteral nutrition support and at 7 days and 14 days after the ecological immune-enhanced enteral nutrition support were determined. Compared with the PN group, the indexes of the CD3 and CD4 positive cells, the CD4/CD8 values and the plasma levels of IgA and IgM were significantly higher than those in EIEN group (p<0.05). Moreover, with EIEN nutritional support, the nutrition indexes, such as the plasma ALB, PA and TFN, and the intestinal mucosal barrier index (the plasma D-lactate levels and endotoxin levels), also recovered gradually to normal levels and were higher than those of the PN group (p<0.05). For patients with gastrointestinal fistulas, ecological immune-enhanced enteral nutrition can not only improve the cellular immunity function, humoral immunity, and nutritional status but also enhance the intestinal mucosal barrier.

Microbial cell preparation in enteral feeding in critically ill patients: A randomized, double-blind, placebo-controlled clinical trial.

PubMed

Malik, Ausama A; Rajandram, Retnagowri; Tah, Pei Chien; Hakumat-Rai, Vineya-Rai; Chin, Kin-Fah

2016-04-01

Gut failure is a common condition in critically ill patients in the intensive care unit (ICU). Enteral feeding is usually the first line of choice for nutrition support in critically ill patients. However, enteral feeding has its own set of complications such as alterations in gut transit time and composition of gut eco-culture. The primary aim of this study was to investigate the effect of microbial cell preparation on the return of gut function, white blood cell count, C-reactive protein levels, number of days on mechanical ventilation, and length of stay in ICU. A consecutive cohort of 60 patients admitted to the ICU in University Malaya Medical Centre requiring enteral feeding were prospectively randomized to receive either treatment (n = 30) or placebo (n = 30). Patients receiving enteral feeding supplemented with a course of treatment achieved a faster return of gut function and required shorter duration of mechanical ventilation and shorter length of stay in the ICU. However, inflammatory markers did not show any significant change in the pretreatment and posttreatment groups. Overall, it can be concluded that microbial cell preparation enhances gut function and the overall clinical outcome of critically ill patients receiving enteral feeding in the ICU. Copyright © 2015 Elsevier Inc. All rights reserved.

Evaluation of vaccines against enteric infections: a clinical and public health research agenda for developing countries

PubMed Central

Clemens, John

2011-01-01

Enteric infections are a major cause of morbidity and mortality in developing countries. To date, vaccines have played a limited role in public health efforts to control enteric infections. Licensed vaccines exist for cholera and typhoid, but these vaccines are used primarily for travellers; and there are two internationally licensed vaccines for rotavirus, but they are mainly used in affluent countries. The reasons that enteric vaccines are little used in developing countries are multiple, and certainly include financial and political constraints. Also important is the need for more cogent evidence on the performance of enteric vaccines in developing country populations. A partial inventory of research questions would include: (i) does the vaccine perform well in the most relevant settings? (ii) does the vaccine perform well in all epidemiologically relevant age groups? (iii) is there adequate evidence of vaccine safety once the vaccines have been deployed in developing countries? (iv) how effective is the vaccine when given in conjunction with non-vaccine cointerventions? (v) what is the level of vaccine protection against all relevant outcomes? and (vi) what is the expected population level of vaccine protection, including both direct and herd vaccine protective effects? Provision of evidence addressing these questions will help expand the use of enteric vaccines in developing countries. PMID:21893543

Gastroenteric tube feeding: Techniques, problems and solutions

PubMed Central

Blumenstein, Irina; Shastri, Yogesh M; Stein, Jürgen

2014-01-01

Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision. PMID:25024606

Clinical review: optimizing enteral nutrition for critically ill patients - a simple data-driven formula

PubMed Central

2011-01-01

In modern critical care, the paradigm of 'therapeutic nutrition' is replacing traditional 'supportive nutrition'. Standard enteral formulas meet basic macro- and micronutrient needs; therapeutic enteral formulas meet these basic needs and also contain specific pharmaconutrients that may attenuate hyperinflammatory responses, enhance the immune responses to infection, or improve gastrointestinal tolerance. Choosing the right enteral feeding formula may positively affect a patient's outcome; targeted use of therapeutic formulas can reduce the incidence of infectious complications, shorten lengths of stay in the ICU and in the hospital, and lower risk for mortality. In this paper, we review principles of how to feed (enteral, parenteral, or both) and when to feed (early versus delayed start) patients who are critically ill. We discuss what to feed these patients in the context of specific pharmaconutrients in specialized feeding formulations, that is, arginine, glutamine, antioxidants, certain ω-3 and ω-6 fatty acids, hydrolyzed proteins, and medium-chain triglycerides. We summarize current expert guidelines for nutrition in patients with critical illness, and we present specific clinical evidence on the use of enteral formulas supplemented with anti-inflammatory or immune-modulating nutrients, and gastrointestinal tolerance-promoting nutritional formulas. Finally, we introduce an algorithm to help bedside clinicians make data-driven feeding decisions for patients with critical illness. PMID:22136305

Enteric bacterial proteases in inflammatory bowel disease- pathophysiology and clinical implications

PubMed Central

Carroll, Ian M; Maharshak, Nitsan

2013-01-01

Numerous reports have identified a dysbiosis in the intestinal microbiota in patients suffering from inflammatory bowel diseases (IBD), yet the mechanism(s) in which this complex microbial community initiates or perpetuates inflammation remains unclear. The purpose of this review is to present evidence for one such mechanism that implicates enteric microbial derived proteases in the pathogenesis of IBD. We highlight and discuss studies demonstrating that proteases and protease receptors are abundant in the digestive system. Additionally, we investigate studies demonstrating an association between increased luminal protease activity and activation of protease receptors, ultimately resulting in increased intestinal permeability and exacerbation of colitis in animal models as well as in human IBD. Proteases are essential for the normal functioning of bacteria and in some cases can serve as virulence factors for pathogenic bacteria. Although not classified as traditional virulence factors, proteases originating from commensal enteric bacteria also have a potential association with intestinal inflammation via increased enteric permeability. Reports of increased protease activity in stools from IBD patients support a possible mechanism for a dysbiotic enteric microbiota in IBD. A better understanding of these pathways and characterization of the enteric bacteria involved, their proteases, and protease receptors may pave the way for new therapeutic approaches for these diseases. PMID:24431894

Hepatic and peripheral glucose metabolism in intensive care patients receiving continuous high- or low-carbohydrate enteral nutrition.

PubMed

Tappy, L; Berger, M; Schwarz, J M; McCamish, M; Revelly, J P; Schneiter, P; Jéquier, E; Chioléro, R

1999-01-01

The suppression of endogenous glucose production during parenteral nutrition is impaired in critically ill patients. It is, however, unknown whether enteral administration of carbohydrates, which normally promote hepatic glucose uptake, improves hepatic glucose metabolism in such patients. We studied two groups of 7 patients during a 3-day continuous isocaloric enteral nutrition. A high-carbohydrate, low-lipid (EN-C) or a high-lipid, low-carbohydrate (EN-L) nutrient mixture was administered. Endogenous glucose production assessed with [2H7]glucose was similarly increased in both groups, indicating absence of its suppression by carbohydrate feeding. Gluconeogenesis estimated from [13C]glucose synthesis during [13C]bicarbonate infusion also was not suppressed by EN-C compared with EN-L. Systemic appearance of exogenous glucose was monitored by enteral infusion of [6,6-2H]glucose and was not different from the rate of glucose equivalent administered enterally, indicating no significant hepatic uptake of glucose in both groups. Plasma glucose and insulin concentrations were slightly higher with EN-C, although not significantly, and plasma triglycerides were similar in both groups. Both nutrition formulas were well tolerated clinically. These results indicate that enteral carbohydrate administration, whatever its quantity, fails to suppress endogenous glucose production and to promote net splanchnic glucose uptake in critically ill patients.

Demographic and substance abuse trends among pregnant and non-pregnant women: eleven years of treatment admission data.

PubMed

McCabe, Jennifer E; Arndt, Stephan

2012-11-01

The objective of this study was to identify demographic and substance abuse trends among pregnant women entering treatment over eleven years. This study compiled the publicly available Treatment Episode Datasets from the Substance Abuse Mental Health Services Administration from 1998 to 2008. Subjects included 1,724,479 women entering publicly funded substance abuse treatment for the first time, 81,818 of whom were pregnant. Compared to non-pregnant women, pregnant women were more likely to be younger, minority, never married, less educated, homeless, and on public-assistance or have no income. Referrals from health care providers (HCPs) among pregnant women entering treatment have stayed consistently low while referrals from the criminal justice system accounted for the largest portion of pregnant women entering treatment. Over the past eleven years, there has been a general decline in alcohol abuse and an increase in drug abuse among women entering treatment; this trend was more pronounced in pregnant women. Unlike their non-pregnant counterparts, pregnant women were more likely to report marijuana, not alcohol, as their primary problem substance as well as other drugs like methamphetamine and cocaine. Over the past eleven years, trends in the demographics and patterns of substance abuse among women have changed; some of these trends were unique to pregnant women. A large proportion of pregnant women entering treatment are referred by the criminal justice system. Knowledge surrounding the demographics and abuse patterns of pregnant women entering treatment can inform HCPs and community programs in their screening and outreach efforts.

Benefits of probiotics on enteral nutrition in preterm neonates: a systematic review.

PubMed

Athalye-Jape, Gayatri; Deshpande, Girish; Rao, Shripada; Patole, Sanjay

2014-12-01

The optimization of enteral nutrition is a priority in preterm neonates worldwide. Probiotics are known to improve gut maturity and function in preterm neonates. To our knowledge, previous systematic reviews have not adequately assessed the effects of probiotic supplementation on enteral nutrition in preterm neonates. We assessed the evidence on effects of probiotics on enteral nutrition in preterm neonates. A systematic review of randomized controlled trials (RCTs) of probiotic supplementation in preterm (gestation <37 wk) or low-birth-weight (birth weight <2500 g) neonates was conducted. With the use of the Cochrane Neonatal Review Group strategy, we searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Cumulative Index of Nursing and Allied Health Literature databases and proceedings of Pediatric Academic Society meetings in April 2014. A total of 25 RCTs (n = 5895) were included in the review. A meta-analysis (random-effects model) of data from 19 of 25 trials (n = 4527) estimated that the time to full enteral feeds was shorter in the probiotic group (mean difference: -1.54 d; 95% CI: -2.75, -0.32 d; P < 0.00001, I(2) = 93%). Other benefits included fewer episodes of feed intolerance, better weight gain and growth velocity, decreased transition time from orogastric to breast feeds, and increased postprandial mesenteric flow. There were no adverse effects of probiotic supplementation. Probiotics reduced the time to full enteral feeds in preterm neonates. Additional research is necessary to assess the optimal dose, duration, and probiotic strain or strains used specifically for facilitating enteral nutrition in this population. © 2014 American Society for Nutrition.

Increased Nutrient Sensitivity and Plasma Concentrations of Enteral Hormones during Duodenal Nutrient Infusion in Functional Dyspepsia

PubMed Central

Bharucha, Adil E.; Camilleri, Michael; Burton, Duane D.; Thieke, Shannon L.; Feuerhak, Kelly J.; Basu, Ananda; Zinsmeister, Alan R.

2015-01-01

Objectives Functional dyspepsia is predominantly attributed to gastric sensorimotor dysfunctions. The contribution of intestinal chemosensitivity to symptoms is not understood. We evaluated symptoms and plasma hormones during enteral nutrient infusion and the association with impaired glucose tolerance and quality-of-life (QOL) scores in functional dyspepsia vs health. Design Enteral hormonal responses and symptoms were measured during isocaloric and isovolumic dextrose and lipid infusions into the duodenum in 30 patients with functional dyspepsia (n=27) or nausea and vomiting (n=3) and 35 healthy controls. Infusions were administered in randomized order over 120 minutes each, with a 120-minute washout. Cholecystokinin, glucose-dependent insulinotropic peptide, glucagonlike peptide 1 (GLP1), and peptide YY were measured during infusions. Results Moderate or more severe symptoms during lipid (4 controls vs 14 patients) and dextrose (1 control vs 12 patients) infusions were more prevalent in patients than controls (P≤.01), associated with higher dyspepsia symptom score (P=.01), worse QOL (P=.01), and greater plasma hormone concentrations (eg, GLP1 during lipid infusion). Moderate or more severe symptoms during enteral infusion explained 18%, and depression score explained 21%, of interpatient variation in QOL. Eight patients had impaired glucose tolerance, associated with greater plasma GLP1 and peptide YY concentrations during dextrose and lipid infusions, respectively. Conclusions Increased sensitivity to enteral dextrose and lipid infusions was associated with greater plasma enteral hormone concentrations, more severe daily symptoms, and worse QOL in functional dyspepsia. These observations are consistent with the hypothesis that enteral hormones mediate increased intestinal sensitivity to nutrients in functional dyspepsia. PMID:25403365

Effect of parvoviral enteritis on plasma citrulline concentration in dogs.

PubMed

Dossin, O; Rupassara, S I; Weng, H-Y; Williams, D A; Garlick, P J; Schoeman, J P

2011-01-01

Plasma citrulline concentration is a reliable marker of global enterocyte mass in humans and is markedly decreased in diffuse small intestinal diseases. However, the relationship between acute intestinal damage and plasma citrulline concentration in dogs has never been documented. That dogs with parvoviral enteritis have a lower plasma citrulline concentration than healthy dogs and that plasma citrulline concentration is a predictor of death in puppies with parvoviral enteritis. Sixty-one dogs with spontaneous parvoviral enteritis and 14 healthy age-matched control dogs. Observational cohort study. Plasma citrulline concentration was measured by liquid chromatography and tandem mass spectrometry in blood samples collected at admission and each day until death or discharge from the hospital. Parvovirus enteritis was confirmed by electron microscopy on a fecal sample. Median (interquartile range) plasma citrulline concentrations at admission were 2.8 μmol/L (range: 0.3, 49.0; P < .001 versus controls) in survivors (n = 49), 2.1 μmol/L (range: 0.5, 6.4, P < .001 versus controls) in nonsurvivors (n = 12) and 38.6 μmol/L (range: 11.4, 96.1) in controls (n = 14), respectively. There was no significant difference in plasma citrulline concentration between survivors and nonsurvivors within the parvovirus-infected puppies, and plasma citrulline concentration was not significantly associated with outcome in parvoviral enteritis. There were no significant changes in plasma citrulline concentration over the 8-day follow-up period. Parvovirus enteritis is associated with a severe decrease in plasma citrulline concentration that does not appear to have any significant prognostic value. Copyright © 2011 by the American College of Veterinary Internal Medicine.

Enteral Arginine Does Not Increase Superior Mesenteric Arterial Blood Flow but Induces Mucosal Growth in Neonatal Pigs123

PubMed Central

Puiman, Patrycja J.; Stoll, Barbara; van Goudoever, Johannes B.; Burrin, Douglas G.

2011-01-01

Arginine is an essential amino acid in neonates synthesized by gut epithelial cells and a precursor for NO that regulates vasodilatation and blood flow. Arginine supplementation has been shown to improve intestinal integrity in ischemia-reperfusion models and low plasma levels are associated with necrotizing enterocolitis. We hypothesized that enteral arginine is a specific stimulus for neonatal intestinal blood flow and mucosal growth under conditions of total parenteral nutrition (TPN) or partial enteral nutrition (PEN). We first tested the dose dependence and specificity of acute (3 h) enteral arginine infusion on superior mesenteric artery (SMA) blood flow in pigs fed TPN or PEN. We then determined whether chronic (4 d) arginine supplementation of PEN increases mucosal growth and if this was affected by treatment with the NO synthase inhibitor, NG-nitro-l-arginine methyl ester (L-NAME). Acute enteral arginine infusion increased plasma arginine dose dependently in both TPN and PEN groups, but the plasma response was markedly higher (100–250%) in the PEN group than in the TPN group at the 2 highest arginine doses. Baseline SMA blood flow was 90% higher in the PEN (2.37 ± 0.32 L⋅kg−1⋅h−1) pigs than in the TPN pigs (1.23 ± 0.17 L⋅kg−1⋅h−1), but was not affected by acute infusion individually of arginine, citrulline, or other major gut fuels. Chronic dietary arginine supplementation in PEN pigs induced mucosal growth in the intestine, but this effect was not prevented by treatment with L-NAME. Intestinal crypt cell proliferation, protein synthesis, and phosphorylation of mammalian target of rapamycin and p70S6 kinase were not affected by dietary arginine. We conclude that partial enteral feeding, but not acute enteral arginine, increases SMA blood flow in the neonatal pig. Furthermore, supplementing arginine in partial enteral feeding modestly increases intestinal mucosal growth and was NO independent. PMID:21106927

Inhibiting Inducible Nitric Oxide Synthase in Enteric Glia Restores Electrogenic Ion Transport in Mice with Colitis

PubMed Central

MacEachern, Sarah J.; Patel, Bhavik A.; Keenan, Catherine M.; Dicay, Michael; Chapman, Kevin; McCafferty, Donna-Marie; Savidge, Tor C.; Beck, Paul L.; MacNaughton, Wallace K.; Sharkey, Keith A.

2015-01-01

Background & Aims Disturbances in the control of ion transport lead to epithelial barrier dysfunction in patients with colitis. Enteric glia regulate intestinal barrier function and colonic ion transport. However, it is not clear whether enteric glia are involved in the epithelial hypo-responsiveness. We investigated enteric glial regulation of ion transport in mice with trinitrobenzene sulphonic acid- or dextran sodium sulfate-induced colitis and in Il10−/− mice. Methods Electrically-evoked ion transport was measured in full-thickness segments of colon from CD1 and Il10−/− mice with or without colitis in Ussing chambers. Nitric oxide (NO) production was assessed using amperometry. Bacterial translocation was investigated in the liver, spleen and blood of mice. Results Electrical stimulation of the colon evoked a tetrodotoxin-sensitive chloride secretion. In mice with colitis, ion transport almost completely disappeared. Inhibiting inducible NO synthase (NOS2), but not neuronal NOS (NOS1), partially restored the evoked secretory response. Blocking glial function with fluoroacetate, which is not a NOS2 inhibitor, also partially restored ion transport. Combined NOS2 inhibition and fluoroacetate administration fully restored secretion. Epithelial responsiveness to vasoactive intestinal peptide was increased after enteric glial function was blocked in mice with colitis. In colons of mice without colitis, NO was produced in the myenteric plexus almost completely via NOS1. NO production was increased in mice with colitis, compared to mice without colitis; a substantial proportion of NOS2 was blocked by fluoroacetate administration. Inhibition of enteric glial function in vivo reduced the severity of trinitrobenzene sulphonic acid -induced colitis and associated bacterial translocation. Conclusions Increased production of NOS2 in enteric glia contributes to the dysregulation of intestinal ion transport in mice with colitis. Blocking enteric glial function in these mice restores epithelial barrier function and reduces bacterial translocation. PMID:25865048

Evaluation of the suitability of a plant virus, pepper mild mottle virus, as a surrogate of human enteric viruses for assessment of the efficacy of coagulation-rapid sand filtration to remove those viruses.

PubMed

Shirasaki, N; Matsushita, T; Matsui, Y; Yamashita, R

2018-02-01

Here, we evaluated the removal of three representative human enteric viruses - adenovirus (AdV) type 40, coxsackievirus (CV) B5, and hepatitis A virus (HAV) IB - and one surrogate of human caliciviruses - murine norovirus (MNV) type 1 - by coagulation-rapid sand filtration, using water samples from eight water sources for drinking water treatment plants in Japan. The removal ratios of a plant virus (pepper mild mottle virus; PMMoV) and two bacteriophages (MS2 and φX174) were compared with the removal ratios of human enteric viruses to assess the suitability of PMMoV, MS2, and φX174 as surrogates for human enteric viruses. The removal ratios of AdV, CV, HAV, and MNV, evaluated via the real-time polymerase chain reaction (PCR) method, were 0.8-2.5-log 10 when commercially available polyaluminum chloride (PACl, basicity 1.5) and virgin silica sand were used as the coagulant and filter medium, respectively. The type of coagulant affected the virus removal efficiency, but the age of silica sand used in the rapid sand filtration did not. Coagulation-rapid sand filtration with non-sulfated, high-basicity PACls (basicity 2.1 or 2.5) removed viruses more efficiently than the other aluminum-based coagulants. The removal ratios of MS2 were sometimes higher than those of the three human enteric viruses and MNV, whereas the removal ratios of φX174 tended to be smaller than those of the three human enteric viruses and MNV. In contrast, the removal ratios of PMMoV were similar to and strongly correlated with those of the three human enteric viruses and MNV. Thus, PMMoV appears to be a suitable surrogate for human enteric viruses for the assessment of the efficacy of coagulation-rapid sand filtration to remove viruses. Copyright © 2017 Elsevier Ltd. All rights reserved.

Risk and prognostic factors for pneumonia and choking amongst Parkinson's disease patients with dysphagia.

PubMed

Goh, Kwang-Hwee; Acharyya, Sanchalika; Ng, Samuel Yong-Ern; Boo, Jasmine Pei-Ling; Kooi, Amanda Hui-Juan; Ng, Hwee-Lan; Li, Wei; Tay, Kay-Yaw; Au, Wing-Lok; Tan, Louis Chew-Seng

2016-08-01

To evaluate the time to hospitalisation and baseline factors associated with pneumonia/choking in Parkinson's Disease (PD) patients. Although dysphagia and pneumonia are common problems in PD, scarce research has been performed. A total of 194 PD patients who underwent a VFS evaluation were retrospectively selected. The mode of feeding and admissions for pneumonia/choking were analyzed. Baseline clinical and demographic variables were compared between feeding groups. Kaplan-Meier survival analysis was performed to estimate time to pneumonia/choking. Clinical variables significantly associated with pneumonia/choking free survival were identified using Cox regression. Hospitalisation for pneumonia/choking occurred in 89 out of 194 patients, with the highest admission rate in rejected enteral feeding group (66.7%), followed by enteral feeding (61.8%) and oral feeding (38.8%) groups. The estimates of median time to event were 11, 14, and 47 months for rejected enteral feeding, enteral and oral feeding groups respectively (log-rank test p < 0.001). The rejected enteral feeding group had the highest risk of pneumonia/choking (HR 4.61, 95%CI:2.33-9.08, p < 0.001), followed by enteral feeding group (HR 2.29, 95%CI:1.25-4.19, p = 0.007), when compared to oral feeding group after adjusting for possible confounders. A stepwise Cox regression showed that the rejected enteral feeding (HR 4.89, 95%CI:2.19-10.88, p < 0.001), enteral mode of feeding (HR 2.43, 95%CI:1.11-5.32, p = 0.026), and Charlson weighted index of co-morbidity (HR 1.27, 95%CI:1.03-1.58, p = 0.028) were independently associated with higher hazard of pneumonia/choking. Compliance to feeding recommendations is important to reduce the risk of hospitalisation for pneumonia/choking. The recommended mode of feeding and comorbidity index was significantly associated with pneumonia/choking risk. Copyright © 2016 Elsevier Ltd. All rights reserved.

Study of tolerance and acceptance of a high energy density enteral formula in patients coronary unit study

PubMed

Izaola, Olatz; De la Fuente, Beatriz; Gómez Hoyos, Emilia; López Gómez, Juan José; Torres, Beatriz; Ortola, Ana; De Luis, Daniel A

2017-02-01

Objective: The aim of our study was to evaluate the tolerance of enteral formula with high energetic density in patients hospitalized in a coronary care unit requering enteral support for at least five days. Methods: Opened, non-comparative, nonrandomized, descriptive study, evaluating the tolerance of enteral formula with high energy density in patients admitted to a coronary care unit. Results: 31 patients were included with a mean age of 67.32 ± 13.8 years, 66.7% were male. The average prescribed final volume Nutrison Energy® was 928.5 ± 278.5 mL/day (range: 800-1,500 mL/day). The average duration of enteral nutrition was 11.2 ± 3.2 days. The average calorie intake was 1,392 ± 417 cal/day, with 169.9 ± 50.9 g/day of carbohydrates, 53.8 ± 16.1 g/day of fat and 55.7 ± 16.9 g/day of protein. After administration there was a significant increased levels of transferrin. A total of 3 patients had an episode of diarrhea (9.7%). The number of patients experiencing at least one episode of gastric residue was 5 (16.1%) not forced in any way to withdra wing enteral nutrition, forcing in 2 patients to diminish the nutritional intake volume for 24 hours. During nutritional support, in only 3 patients it was required to decrease the volume made the previous day energy formula. With regard to vomiting, in 1 patient this situation (3.2%) was verified. No patient in the study presented any digestive complications associated with the administration of the enteral nutrition formula. Finally, no adverse events related to the administered formulation were recorded. Conclusions: The results show that enteral formula with high energy density is a well-tolerated formula with a very low frequency of gastrointestinal symptoms, which favors compliance.

A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered?

PubMed

De Jonghe, B; Appere-De-Vechi, C; Fournier, M; Tran, B; Merrer, J; Melchior, J C; Outin, H

2001-01-01

To assess the amount of nutrients delivered, prescribed, and required for critically ill patients and to identify the reasons for discrepancies between prescriptions and requirements and between prescriptions and actual delivery of nutrition. Prospective cohort study. Twelve-bed medical intensive care unit in a university-affiliated general hospital. Fifty-one consecutive patients, receiving nutritional support either enterally or intravenously for > or = 2 days. We followed patients for the first 14 days of nutritional delivery. The amount of calories prescribed and the amount actually delivered were recorded daily and compared with the theoretical energy requirements. A combined regimen of enteral and parenteral nutrition was administered on 58% of the 484 nutrition days analyzed, and 63.5% of total caloric intake was delivered enterally. Seventy-eight percent of the mean caloric amount required was prescribed, and 71% was effectively delivered. The amount of calories actually delivered compared with the amount prescribed was significantly lower in enteral than in parenteral administration (86.8% vs. 112.4%, p < .001). Discrepancies between prescription and delivery of enterally administered nutrients were attributable to interruptions caused by digestive intolerance (27.7%, mean daily wasted volume 641 mL), airway management (30.8%, wasted volume 745 mL), and diagnostic procedures (26.6%, wasted volume 567 mL). Factors significantly associated with a low prescription rate of nutritional support were the administration of vasoactive drugs, central venous catheterization, and the need for extrarenal replacement. An inadequate delivery of enteral nutrition and a low rate of nutrition prescription resulted in low caloric intake in our intensive care unit patients. A large volume of enterally administered nutrients was wasted because of inadequate timing in stopping and restarting enteral feeding. The inverse correlation between the prescription rate of nutrition and the intensity of care required suggests that physicians need to pay more attention to providing appropriate nutritional support for the most severely ill patients.

Patient needs and research priorities in the enteral nutrition market - a quantitative prioritization analysis.

PubMed

Weenen, T C; Jentink, A; Pronker, E S; Commandeur, H R; Claassen, E; Boirie, Y; Singer, P

2014-10-01

A quantitative systematic identification and prioritization of unmet needs and research opportunities in relation to enteral nutrition was conducted by means of a tailor-made health research prioritization process. The research objectives were reached by conducting qualitative interviews followed by quantitative questionnaires targeting enteral nutrition key opinion leaders (KOLs). (1) Define disease areas that deserve more research attention; (2) Rank importance of product characteristics of tube feeding (TF) and oral nutritional supplements (ONS); (3) Assess involvement of KOLs in enteral nutrition R&D process. KOLs ranked three product characteristics and three disease areas that deserve additional research attention. From these, overall priority scores were calculated by multiplying ranks for both product characteristics and disease areas. 17 qualitative interviews were conducted and 77 questionnaires (response rate 35%) were completed and returned. (1) Disease areas in ONS and TF with highest priorities are: ONS: general malnutrition & geriatrics, TF: intensive care. (2) TF product characteristics with highest priorities are: composition and clinical evidence from a KOL perspective; tolerance and ease of use from a patient perspective. ONS product characteristics with highest priorities are: composition, clinical evidence and taste from a KOL perspective; taste from a patient perspective. We find a high discrepancy between product characteristic prioritization from a KOL and patient perspective. (3) Although 62% of all KOLs give advice to enteral nutrition companies on patient needs, they under-influence the setting of research priorities by enteral nutrition companies. This study provides a systematic approach to achieve research prioritization in enteral nutrition. In addition to providing new directions for enteral nutrition research and development, this study highlights the relevance of involving KOLs in the identification of research priorities as they have the ability to provide a balanced view of the unmet patient needs. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Enteral nutrition in end of life care: the Jewish Halachic ethics.

PubMed

Greenberger, Chaya

2015-06-01

Providing versus foregoing enteral nutrition is a central issue in end-of-life care, affecting patients, families, nurses, and other health professionals. The aim of this article is to examine Jewish ethical perspectives on nourishing the dying and to analyze their implications for nursing practice, education, and research. Jewish ethics is based on religious law, called Halacha. Many Halachic scholars perceive withholding nourishment in end of life, even enterally, as hastening death. This reflects the divide they perceive between allowing a fatal disease to naturally run its course until an individual's vitality (life force or viability) is lost versus withholding nourishment for the vitality that still remains. The latter they maintain introduces a new cause of death. Nevertheless, coercing an individual to accept enteral nourishment is generally considered undignified and counterproductive. A minority of Halachic scholars classify withholding enteral nutrition as refraining from prolonging life, permitted under certain circumstances, especially in situations where nutritional problems flow directly from a fatal pathology. In the very final stages of dying, moreover, there is a general consensus that enteral nourishment may be withheld, providing that this reflects the dying individuals' wishes. In the event of enteral nourishment becoming a source of overwhelming discomfort, two Halachic ethical mandates would come into conflict: sustaining life by providing nourishment and alleviating suffering. As in all moral conflicts, these would have to be resolved in practice. This article presents the issue of enteral nourishment as it unfolds in Halacha in comparison to secular and other religious perspectives. It is meant to serve as a foundation for nurses to reflect on their own practice and to explore the implications for nursing practice, education, and research. In a world that remains broadly religious, it is important to sensitize health practitioners to the similarities and differences among religions and between secular and religious approaches to ethical issues. © The Author(s) 2014.

Inhibiting Inducible Nitric Oxide Synthase in Enteric Glia Restores Electrogenic Ion Transport in Mice With Colitis.

PubMed

MacEachern, Sarah J; Patel, Bhavik A; Keenan, Catherine M; Dicay, Michael; Chapman, Kevin; McCafferty, Donna-Marie; Savidge, Tor C; Beck, Paul L; MacNaughton, Wallace K; Sharkey, Keith A

2015-08-01

Disturbances in the control of ion transport lead to epithelial barrier dysfunction in patients with colitis. Enteric glia regulate intestinal barrier function and colonic ion transport. However, it is not clear whether enteric glia are involved in epithelial hyporesponsiveness. We investigated enteric glial regulation of ion transport in mice with trinitrobenzene sulfonic acid- or dextran sodium sulfate-induced colitis and in Il10(-/-) mice. Electrically evoked ion transport was measured in full-thickness segments of colon from CD1 and Il10(-/-) mice with or without colitis in Ussing chambers. Nitric oxide (NO) production was assessed using amperometry. Bacterial translocation was investigated in the liver, spleen, and blood of mice. Electrical stimulation of the colon evoked a tetrodotoxin-sensitive chloride secretion. In mice with colitis, ion transport almost completely disappeared. Inhibiting inducible NO synthase (NOS2), but not neuronal NOS (NOS1), partially restored the evoked secretory response. Blocking glial function with fluoroacetate, which is not a NOS2 inhibitor, also partially restored ion transport. Combined NOS2 inhibition and fluoroacetate administration fully restored secretion. Epithelial responsiveness to vasoactive intestinal peptide was increased after enteric glial function was blocked in mice with colitis. In colons of mice without colitis, NO was produced in the myenteric plexus almost completely via NOS1. NO production was increased in mice with colitis, compared with mice without colitis; a substantial proportion of NOS2 was blocked by fluoroacetate administration. Inhibition of enteric glial function in vivo reduced the severity of trinitrobenzene sulfonic acid-induced colitis and associated bacterial translocation. Increased production of NOS2 in enteric glia contributes to the dysregulation of intestinal ion transport in mice with colitis. Blocking enteric glial function in these mice restores epithelial barrier function and reduces bacterial translocation. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Graduation Outcomes of Students Who Entered New York City Public Schools in Grade 5 or 6 as English Learner Students. REL 2017-237

ERIC Educational Resources Information Center

Kieffer, Michael J.; Parker, Caroline E.

2017-01-01

This longitudinal study analyzes high school graduation outcomes of students who entered New York City public schools in grade 5 or 6 as English learner students. It extends the work of Kieffer and Parker (2016) by investigating the high school graduation rates and the types of diploma earned by the 1,734 students who entered New York City public…

A Comparison of Entering Full-Time Freshmen at the University of Tennessee, Knoxville, With Entering Full-Time Freshmen in Other Universities, Fall 1973. Office of Institutional Research Vol. 14, No. 18.

ERIC Educational Resources Information Center

Larsen, Suzanne W.

The responses of the entering full-time freshmen at UTK are compared with those of the norm group for public universities with "low selectivity" on the descriptive, attitudinal, and expectancy items of the American Council on Education's annual freshman survey. Two additional comparisons were made. One was with the responses from the…

29 CFR 1471.300 - What must I do before I enter into a covered transaction with another person at the next lower tier?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 4 2012-07-01 2012-07-01 false What must I do before I enter into a covered transaction with another person at the next lower tier? 1471.300 Section 1471.300 Labor Regulations Relating to....300 What must I do before I enter into a covered transaction with another person at the next lower...

21 CFR 1404.300 - What must I do before I enter into a covered transaction with another person at the next lower tier?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 9 2012-04-01 2012-04-01 false What must I do before I enter into a covered transaction with another person at the next lower tier? 1404.300 Section 1404.300 Food and Drugs OFFICE OF... Participants Regarding Transactions Doing Business with Other Persons § 1404.300 What must I do before I enter...

Using electronic questionnaires to collect patient reported history.

PubMed

Benoit, Angie; Dykes, Patricia; Chang, Frank; Gertman, Paul; Vandever, Woodrow; Li, Qi; Wald, Jonathan

2007-10-11

EMR adoption has faced a major barrier around time and effort required to enter clinical data. In addition, patient entered data has not been effectively used by clinicians to identify critical clinical issues and drive best clinical interventions. By allowing patients to enter historical clinical data, using online questionnaires before their visit, it will have a positive impact on office workflow, physician and patient satisfaction, and support population based health and risk assessment.

41 CFR 105-68.350 - What must I do if I learn of information required under § 105-68.335 after entering into a...

Code of Federal Regulations, 2010 CFR

2010-07-01

... learn of information required under § 105-68.335 after entering into a covered transaction with the....350 What must I do if I learn of information required under § 105-68.335 after entering into a covered... if you learn either that— (a) You failed to disclose information earlier, as required by § 105-68.335...

Effects of enterally- and parenterally-administered bombesin on intestinal luminal tryptic activity and protein in the suckling rat.

PubMed

Pollack, P F; Adamson, C; Koldovsky, O

1989-04-15

Because of the presence of bombesin-like immunoreactivity in milk, we investigated if enteral administration of bombesin affects the intestinal luminal content of trypsin and protein in 12-14-day-old rats. Bombesin (40 micrograms/kg), given either orogastrically or subcutaneously, produced a significant elevation in the intestinal content of trypsin activity. Thus, enterally-administered bombesin can produce acute biologic effects in suckling rats.

41 CFR 105-68.350 - What must I do if I learn of information required under § 105-68.335 after entering into a...

Code of Federal Regulations, 2011 CFR

2011-01-01

... learn of information required under § 105-68.335 after entering into a covered transaction with the....350 What must I do if I learn of information required under § 105-68.335 after entering into a covered... if you learn either that— (a) You failed to disclose information earlier, as required by § 105-68.335...

21 CFR 558.555 - Semduramicin.

Code of Federal Regulations, 2014 CFR

2014-04-01

... paragraph (d)(1) of this section; for prevention of necrotic enteritis caused by Clostridium perfringens...; for prevention of necrotic enteritis caused by C. perfringens susceptible to virginiamycin. Feed...

Helping Immigrants Become Teachers.

ERIC Educational Resources Information Center

Ross, Flynn

2001-01-01

Describes Newcomers Entering Teaching, a program designed by the Portland (Maine) Public Schools to prepare recent immigrants and refugees to enter local university's 9-month teacher-certification program. (PKP)

[Curative effect analysis of bile reinfusion combined with enteral nutrition support before surgery of hilar cholangiocarcinoma].

PubMed

Song, P; Mao, L; Bian, X J; Zhou, T; Fan, Y Y; Zhang, J; Xie, M; Qiu, Y D

2018-05-01

Objective: To investigate the clinical effect of bile reinfusion combined with enteral nutrition support before surgery for hilar cholangiocarcinoma. Methods: A retrospective analysis of patients with hilar cholangiocarcinoma who underwent surgical treatment at Nanjing Drum Tower Hospital Hepato-biliary-pancreatic Surgery Department from July 2010 to August 2017 was completed.A total of 52 cases were finally enrolled in our study.All the patients included, on the basis of whether they received preoperative drainage and bile reinfusion, were divided into non-drainage group( n =15) and drainage group( n =37). Differences of clinical indicators, including operation time, intraoperative bleeding and serum liver function index levels at day 1, 3, 7 postoperative, postoperative complications(liver failure, biliary fistula, pleural effusion, peritoneal effusion, abdominal cavity infection, death in hospital), tumor classification, R0 resection, postoperative hospitalization time between the 2 groups were analyzed. At the same time, in the drainage group, patients were divided into non-enteral nutrition subgroup( n =13) and enteral nutrition subgroup( n =24) according to whether they received enteral nutrition before operation. The normal distribution data of the group was statistically analyzed by independent sample t test, the non-normal distribution data of the group was statistically analyzed by rank-sum test. The count data was statistically analyzed by non-calibration and correction of the square test. Results: There was no statistically significant difference in general infomation such as age, gender, and serum liver function between non-drainage group and drainage group( P >0.05). There was no statistically significant difference in general information such as age, gender, and serum liver function between non-enteral nutrition group and enteral nutrition group( P >0.05). The rate of vascular resection and reconstruction(33.3%) and operating time(10.8(2.2)h) in drainage group were both higher than those in non-drainage group(6.7% and 8.3(3.0)h), the differences were both statistically significant(χ(2)=4.397, Z =1.595; both P <0.05). The level of AST at the 7th day after surgery in drainage group(32.8(17.3)U/L) was significantly lower than that in non-drainage group(55.0(64.7)U/L), the difference was statistically significant( Z =-2.212, P <0.05). The level of TBil at 1st day after surgery in drainage group(43.6(91.2)μmol/L) was lower than that in non-drainage group(91.2(188.4)μmol/L), the difference was statistically significant( Z =-2.150, P <0.05). The rate of pancreatoduodenectomy(25.0%) and average operating time(11.1(1.3)h) in the enteral nutrition group were both higher than those in the non-enteral nutrition group(0, 9.0(2.6)h). The differences were both statistically significant(χ(2)=3.879, Z =-2.693; P <0.05). The average level of AST at the 1st day after surgery in enteral nutrition group(396.4(268.3)U/L) was significantly lower than that in non-enteral nutrition group(642.5(341.1)U/L), the difference was statistically significant( Z =-2.483, P <0.05). The average level of TBil at the 1st, 3th day after surgery in enteral nutrition group(38.8(21.5)μmol/L and 30.0(25.6)μmol/L) were both lower than those in non-enteral nutrition group(60.9(75.2)μmol/L and 46.5(50.0)μmol/L), the differences were both statistically significant( Z =-2.416, -2.026; P <0.05). The level of CRP at 1st, 3th day after surgery((41.9±31.1)mg/L, (50.8±31.4)mg/L)in enteral nutrition subgroup was lower than that in non-enteral nutrition subgroup((64.4±33.6)mg/L, (74.1±35.3)mg/L), the differences were both statistically significant( t =1.456, 1.675; P <0.05). Conclusion: Based on the present study , there is no effective improvement on postoperative recovery using bile reinfusion combined with nutrition support before R0 resection of hilar cholangiocarcinoma.

Using participatory epidemiology to assess factors contributing to common enteric pathogens in Ontario: results from a workshop held at the Ontario Veterinary College, University of Guelph, Ontario

PubMed Central

2014-01-01

Background Common enteric pathogens that cause gastrointestinal illness are transmitted to humans through food, water or direct contact. This poses a significant concern to public health as enteric pathogens can cause disease in a large number of people, and cost a substantial amount to treat and prevent. In order to gain a better understanding of the occurrence of enteric disease in Ontario, this study explored public health professionals’ perceptions of major contributing factors for common enteric pathogens. Methods A case study was conducted as part of a two week training workshop in Participatory Epidemiology held at the Ontario Veterinary College, University of Guelph, in May 2013. Eight semi-structured interviews and four focus groups were conducted with representatives from the Public Health Agency of Canada, the University of Guelph, and three health regions in Southern Ontario. Written notes and pictures captured the qualitative information provided. Results were then analyzed using the mixed methods techniques of triangulation, convergence, and paradox. Results A total of fifty factors that contribute to enteric disease were identified across all interviews and focus groups. These contributing factors were grouped into key themes (travel, food handling, industry (farm-to-fork), water, geography, demographics, and behaviours) and were categorized as either a risk factor or susceptibility factor. Informants emphasized the complex relationships between the identified factors, and highlighted why these complexities make it difficult to determine where and how a person most likely acquired an enteric pathogen. Workshop participants observed differences in the type and quality of information collected during interviews and focus groups; we hypothesize that this may be attributed to the dynamics between group members (i.e. focus group discussions) as opposed to one-on-one interviews. Conclusions The information gathered will serve as a starting point to further explore contributing factors for common enteric pathogens. The identified complexities would be best explored by conducting additional surveillance, as well as interviews and focus groups with a more diverse group of stakeholders. This type of qualitative study can enhance knowledge of enteric pathogen surveillance and contribute to the development of resources and initiatives to holistically address the occurrence of gastrointestinal illness. PMID:24767430

Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial.

PubMed

Rice, Todd W; Wheeler, Arthur P; Thompson, B Taylor; Steingrub, Jay; Hite, R Duncan; Moss, Marc; Morris, Alan; Dong, Ning; Rock, Peter

2012-02-22

The amount of enteral nutrition patients with acute lung injury need is unknown. To determine if initial lower-volume trophic enteral feeding would increase ventilator-free days and decrease gastrointestinal intolerances compared with initial full enteral feeding. The EDEN study, a randomized, open-label, multicenter trial conducted from January 2, 2008, through April 12, 2011. Participants were 1000 adults within 48 hours of developing acute lung injury requiring mechanical ventilation whose physicians intended to start enteral nutrition at 44 hospitals in the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Participants were randomized to receive either trophic or full enteral feeding for the first 6 days. After day 6, the care of all patients who were still receiving mechanical ventilation was managed according to the full feeding protocol. Ventilator-free days to study day 28. Baseline characteristics were similar between the trophic-feeding (n = 508) and full-feeding (n = 492) groups. The full-feeding group received more enteral calories for the first 6 days, about 1300 kcal/d compared with 400 kcal/d (P < .001). Initial trophic feeding did not increase the number of ventilator-free days (14.9 [95% CI, 13.9 to 15.8] vs 15.0 [95% CI, 14.1 to 15.9]; difference, -0.1 [95% CI, -1.4 to 1.2]; P = .89) or reduce 60-day mortality (23.2% [95% CI, 19.6% to 26.9%] vs 22.2% [95% CI, 18.5% to 25.8%]; difference, 1.0% [95% CI, -4.1% to 6.3%]; P = .77) compared with full feeding. There were no differences in infectious complications between the groups. Despite receiving more prokinetic agents, the full-feeding group experienced more vomiting (2.2% vs 1.7% of patient feeding days; P = .05), elevated gastric residual volumes (4.9% vs 2.2% of feeding days; P < .001), and constipation (3.1% vs 2.1% of feeding days; P = .003). Mean plasma glucose values and average hourly insulin administration were both higher in the full-feeding group over the first 6 days. In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance. clinicaltrials.gov Identifiers: NCT00609180 and NCT00883948.

Career influences among final year dental students who plan to enter private practice.

PubMed

Nashleanas, Benjamin M; McKernan, Susan C; Kuthy, Raymond A; Qian, Fang

2014-03-08

Existing research about the influence of educational debt on students' decision to enter general practice immediately after graduation is conflicting. Other potential factors that could affect this decision include the influence of a spouse or other family member, the importance of a mentoring dentist, and how students perceive the burden of their debt. The goal of this study was to examine the importance of debt on career decision-making while also considering the role of other influences. Responses to a self-completed questionnaire of all final (fourth) year students at the University of Iowa College of Dentistry from 2007 through 2010 were analyzed to identify the importance of educational debt and the influence of spouses, other family members, and mentoring dentists in the decision to enter private general practice immediately after graduation. Statistical analysis included bivariate tests (t-tests and Chi-square tests) and multivariable logistic regression. 58.9% of respondents (N = 156) planned to immediately enter private practice after dental school. Bivariate analyses revealed women to be more likely to enter private practice than their male counterparts (69.0% vs. 51.8%, p = .006). Students planning to enter practice immediately did not differ significantly from those with other career plans on the basis of marital status or having a family member in dentistry. Anticipated educational debt of at least $100,000 was positively associated with plans to enter private practice immediately after graduation. Self-reported importance of educational debt was not associated with career plans. However, the influence of a spouse, other family members, and family dentists were also positively associated with the decision to enter private practice. These factors all maintained significance in the final multivariable model (p < 0.05); however, educational debt of at least $100,000 was the strongest predictor of plans to enter private practice (OR = 2.34; p = 0.023). Since the 1970s, increasing numbers of dentists in the U.S. have pursued specialty training after dental school. However, rising educational debts may counter this trend as increasing numbers of dentists choose to immediately pursue general dentistry at graduation. This project has demonstrated the significant influence of educational debt, beyond other external influences.

[Enteral nutrition in burn patients].

PubMed

Pereira, J L; Garrido, M; Gómez-Cía, T; Serrera, J L; Franco, A; Pumar, A; Relimpio, F; Astorga, R; García-Luna, P P

1992-01-01

Nutritional support plays an important role in the treatment of patients with burns. Due to the severe hypercatabolism that develops in these patients, oral support is insufficient in most cases, and this makes it essential to initiate artificial nutritional support (either enteral or parenteral). Enteral nutrition is more physiological than parenteral, and data exist which show that in patients with burns, enteral nutrition exercises a protective effect on the intestine and may even reduce the hypermetabolic response in these patients. The purpose of the study was to evaluate the effectiveness and tolerance of enteral nutritional support with a hypercaloric, hyperproteic diet with a high content of branched amino acids in the nutritional support of patients suffering from burns. The study included 12 patients (8 males and 4 females), admitted to the Burns Unit. Average age was 35 +/- 17 years (range: 21-85 years). The percentage of body surface affected by the burns was 10% in two cases, between 10-30% in three cases, between 30-50% in five cases and over 50% in two cases. Initiation of the enteral nutrition was between twenty-four hours and seven days after the burn. The patients were kept in the unit until they were discharged, and the average time spent in the unit was 31.5 days (range: 17-63 days). Total energetic requirements were calculated based on Harris-Benedict, with a variable aggression factor depending on the body surface burned, which varied from 2,000 and 4,000 cal day. Nitrogenous balance was determined on a daily basis, and plasmatic levels of total proteins, albumin and prealbumin on a weekly basis. There was a significant difference between the prealbumin values at the initiation and finalization of the enteral nutrition (9.6 +/- 2.24 mg/dl compared with 19.75 +/- 5.48 mg/dl; p < 0.001). The nitrogenous balance improved, changing from -5.4 in the second week to positive values by the fourth and fifth weeks of treatment. Tolerance to the enteral diet was very good, and only mild complications such as diarrhoea developed in two patients. Enteral nutrition is a suitable nutritional support method for patients with burns, which maintains the nitrogenous balance positive and improves the visceral protein parameters in these patients at an early stage, with very few complications.

Career influences among final year dental students who plan to enter private practice

PubMed Central

2014-01-01

Background Existing research about the influence of educational debt on students’ decision to enter general practice immediately after graduation is conflicting. Other potential factors that could affect this decision include the influence of a spouse or other family member, the importance of a mentoring dentist, and how students perceive the burden of their debt. The goal of this study was to examine the importance of debt on career decision-making while also considering the role of other influences. Methods Responses to a self-completed questionnaire of all final (fourth) year students at the University of Iowa College of Dentistry from 2007 through 2010 were analyzed to identify the importance of educational debt and the influence of spouses, other family members, and mentoring dentists in the decision to enter private general practice immediately after graduation. Statistical analysis included bivariate tests (t-tests and Chi-square tests) and multivariable logistic regression. Results 58.9% of respondents (N = 156) planned to immediately enter private practice after dental school. Bivariate analyses revealed women to be more likely to enter private practice than their male counterparts (69.0% vs. 51.8%, p = .006). Students planning to enter practice immediately did not differ significantly from those with other career plans on the basis of marital status or having a family member in dentistry. Anticipated educational debt of at least $100,000 was positively associated with plans to enter private practice immediately after graduation. Self-reported importance of educational debt was not associated with career plans. However, the influence of a spouse, other family members, and family dentists were also positively associated with the decision to enter private practice. These factors all maintained significance in the final multivariable model (p < 0.05); however, educational debt of at least $100,000 was the strongest predictor of plans to enter private practice (OR = 2.34; p = 0.023). Conclusions Since the 1970s, increasing numbers of dentists in the U.S. have pursued specialty training after dental school. However, rising educational debts may counter this trend as increasing numbers of dentists choose to immediately pursue general dentistry at graduation. This project has demonstrated the significant influence of educational debt, beyond other external influences. PMID:24606674

Broadband Acoustic Resonance Dissolution Spectroscopy (BARDS): A rapid test for enteric coating thickness and integrity of controlled release pellet formulations.

PubMed

Alfarsi, Anas; Dillon, Amy; McSweeney, Seán; Krüse, Jacob; Griffin, Brendan; Devine, Ken; Sherry, Patricia; Henken, Stephan; Fitzpatrick, Stephen; Fitzpatrick, Dara

2018-06-10

There are no rapid dissolution based tests for determining coating thickness, integrity and drug concentration in controlled release pellets either during production or post-production. The manufacture of pellets requires several coating steps depending on the formulation. The sub-coating and enteric coating steps typically take up to six hours each followed by additional drying steps. Post production regulatory dissolution testing also takes up to six hours to determine if the batch can be released for commercial sale. The thickness of the enteric coating is a key factor that determines the release rate of the drug in the gastro-intestinal tract. Also, the amount of drug per unit mass decreases with increasing thickness of the enteric coating. In this study, the coating process is tracked from start to finish on an hourly basis by taking samples of pellets during production and testing those using BARDS (Broadband Acoustic Resonance Dissolution Spectroscopy). BARDS offers a rapid approach to characterising enteric coatings with measurements based on reproducible changes in the compressibility of a solvent due to the evolution of air during dissolution. This is monitored acoustically via associated changes in the frequency of induced acoustic resonances. A steady state acoustic lag time is associated with the disintegration of the enteric coatings in basic solution. This lag time is pH dependent and is indicative of the rate at which the coating layer dissolves. BARDS represents a possible future surrogate test for conventional USP dissolution testing as its data correlates directly with the thickness of the enteric coating, its integrity and also with the drug loading as validated by HPLC. Copyright © 2018 Elsevier B.V. All rights reserved.

The Influence of Household- and Community-Level Sanitation and Fecal Sludge Management on Urban Fecal Contamination in Households and Drains and Enteric Infection in Children

PubMed Central

Berendes, David; Kirby, Amy; Clennon, Julie A.; Raj, Suraja; Yakubu, Habib; Leon, Juan; Robb, Katharine; Kartikeyan, Arun; Hemavathy, Priya; Gunasekaran, Annai; Ghale, Ben; Kumar, J. Senthil; Mohan, Venkata Raghava; Kang, Gagandeep; Moe, Christine

2017-01-01

Urban sanitation necessitates management of fecal sludge inside and outside the household. This study examined associations between household sanitation, fecal contamination, and enteric infection in two low-income neighborhoods in Vellore, India. Surveys and spatial analysis assessed the presence and clustering of toilets and fecal sludge management (FSM) practices in 200 households. Fecal contamination was measured in environmental samples from 50 households and household drains. Enteric infection was assessed from stool specimens from children under 5 years of age in these households. The two neighborhoods differed significantly in toilet coverage (78% versus 33%) and spatial clustering. Overall, 49% of toilets discharged directly into open drains (“poor FSM”). Children in households with poor FSM had 3.78 times higher prevalence of enteric infection when compared with children in other households, even those without toilets. In the neighborhood with high coverage of household toilets, children in households with poor FSM had 10 times higher prevalence of enteric infection than other children in the neighborhood and drains in poor FSM clusters who had significantly higher concentrations of genogroup II norovirus. Conversely, children in households with a toilet that contained excreta in a tank onsite had 55% lower prevalence of enteric infection compared with the rest of the study area. Notably, households with a toilet in the neighborhood with low toilet coverage had more fecal contamination on floors where children played compared with those without a toilet. Overall, both toilet coverage levels and FSM were associated with environmental fecal contamination and, subsequently, enteric infection prevalence in this urban setting. PMID:28719269

Enteral nutrition volume is not correlated with lower respiratory tract infection in patients on mechanical ventilation.

PubMed

Colomar, A; Guardiola, B; Llompart-Pou, J A; Ayestarán, I; Rodríguez-Pilar, J; Ferreruela, M; Raurich, J M

To evaluate the effect of enteral nutrition volume, gastrointestinal function and the type of acid suppressive drug upon the incidence of lower respiratory tract infections in critically ill patients on mechanical ventilation (MV). A retrospective secondary analysis was carried out. The Intensive Care Unit of a University Hospital. Patients≥18-years-old expected to need MV for more than four days, and receiving enteral nutrition by nasogastric tube within 24h of starting MV. We correlated enteral nutrition volume administered during the first 10 days, gastrointestinal function and the type of acid suppressive therapy with the episodes of lower respiratory tract infection up until day 28. Cox proportional hazards ratios in univariate and adjusted multivariate models were used. Statistical significance was considered for p<0.05. Lower respiratory tract infection episodes. Sixty-six out of 185 patients (35.7%) had infection; 27 patients had ventilator-associated pneumonia; and 39 presented ventilator-associated tracheobronchitis. Uninfected and infected groups were similar in terms of enteral nutrition volume (54±12 and 54±9mL/h; p=0.94) and caloric intake (19.4±4.9 and 19.6±5.2kcal/kg/d; p=0.81). The Cox proportional hazards model showed neurological indication of MV to be the only independent variable related to infection (p=0.001). Enteral nutrition volume, the type of acid suppressive therapy, and the use of prokinetic agents were not significantly correlated to infection. Enteral nutrition volume and caloric intake, gastrointestinal dysfunction and the type of acid suppressive therapy used were not associated to lower respiratory tract infection in patients on MV. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Effects of oral glutamine during abdominal radiotherapy on chronic radiation enteritis: a randomized controlled trial.

PubMed

Vidal-Casariego, Alfonso; Calleja-Fernández, Alicia; Cano-Rodríguez, Isidoro; Cordido, Fernando; Ballesteros-Pomar, María D

2015-01-01

Glutamine has been proposed as a preventive treatment for toxicity related to cancer therapies. The aim of this study was to test the efficacy of glutamine in the prevention of radiation enteritis. A randomized, double-blind, controlled trial was performed including 69 patients who were assigned to receive either glutamine (Gln, 30 g/d) or placebo while they were receiving abdominal radiotherapy. Patients were re-evaluated 1 y after completion of treatment. The presence of chronic enteritis was assessed using the Radiation Therapy Oncology Group scale. Nutritional status was evaluated using subjective global assessment, weight, and bioimpedance. Relative risk (RR) and its confidence interval (CI) were also calculated. The trial initially included 69 patients (34 Gln, 35 placebo), but 11 patients were lost during follow-up (4 Gln, 7 placebo; P = 0.296). Chronic enteritis was developed by 14 % of patients: Gln 16.7 % versus placebo 11.1% (RR = 1.33; 95% CI, 0.35-5.03; P = 0.540). Most cases of enteritis were grade I (75%), with no differences between groups. The stool frequency increased after radiotherapy in patients who received Gln (from 1 ± 1 to 2 ± 2 stools per day, P = 0.012), but remained unchanged with placebo (1 ± 1 stools per day, P = 0.858; difference between groups P = 0.004). There were no differences between the two groups in terms of weight, fat mass, or fat-free mass index, or between patients with enteritis and those without intestinal toxicity. Chronic enteritis is a relatively infrequent phenomenon, and Gln administration during radiotherapy does not exert a protective effect. Copyright © 2015 Elsevier Inc. All rights reserved.

Modeling the infection dynamics of bacteriophages in enteric Escherichia coli: estimating the contribution of transduction to antimicrobial gene spread.

PubMed

Volkova, Victoriya V; Lu, Zhao; Besser, Thomas; Gröhn, Yrjö T

2014-07-01

Animal-associated bacterial communities are infected by bacteriophages, although the dynamics of these infections are poorly understood. Transduction by bacteriophages may contribute to transfer of antimicrobial resistance genes, but the relative importance of transduction among other gene transfer mechanisms is unknown. We therefore developed a candidate deterministic mathematical model of the infection dynamics of enteric coliphages in commensal Escherichia coli in the large intestine of cattle. We assumed the phages were associated with the intestine and were predominantly temperate. Model simulations demonstrated how, given the bacterial ecology and infection dynamics, most (>90%) commensal enteric E. coli bacteria may become lysogens of enteric coliphages during intestinal transit. Using the model and the most liberal assumptions about transduction efficiency and resistance gene frequency, we approximated the upper numerical limits ("worst-case scenario") of gene transfer through specialized and generalized transduction in E. coli by enteric coliphages when the transduced genetic segment is picked at random. The estimates were consistent with a relatively small contribution of transduction to lateral gene spread; for example, generalized transduction delivered the chromosomal resistance gene to up to 8 E. coli bacteria/hour within the population of 1.47 × 10(8) E. coli bacteria/liter luminal contents. In comparison, the plasmidic blaCMY-2 gene carried by ~2% of enteric E. coli was transferred by conjugation at a rate at least 1.4 × 10(3) times greater than our generalized transduction estimate. The estimated numbers of transductants varied nonlinearly depending on the ecology of bacteria available for phages to infect, that is, on the assumed rates of turnover and replication of enteric E. coli. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Compliance with nutrition support guidelines in acutely burned patients.

PubMed

Holt, Brennen; Graves, Caran; Faraklas, Iris; Cochran, Amalia

2012-08-01

Adequate and timely provision of nutritional support is a crucial component of care of the critically ill burn patient. The goal of this study was to assess a single center's consistency with Society of Critical Care Medicine/American Society for Parenteral and Enteral Nutrition (SCCM/ASPEN) guidelines for nutritional support in critically ill patients. Acutely burned patients >45kg in weight admitted to a regional burn center during a two-year period and who required 5 or more days of full enteral nutritional support were eligible for inclusion in this retrospective review. Specific outcomes evaluated include time from admission to feeding tube placement and enteral feeding initiation and percent of nutritional goal received within the first week of hospital stay. Descriptive statistics were used for all analyses. IRB approval was obtained. Thirty-seven patients were included in this retrospective review. Median age of patients was 44.9 years (IQR: 24.2-55.1), and median burn injury size was 30% (IQR: 19-47). Median time to feeding tube placement was 31.1h post admission (IQR: 23.6-50.2h), while median time to initiation of EN was 47.9h post admission (IQR: 32.4-59.9h). The median time required for patients to reach 60% of caloric goal was 3 days post-admission (IQR: 3-4.5). The median time for initiation of enteral nutrition was within the SCCM/ASPEN guidelines for initial nutrition in the critically ill patient. This project identified a 16h time lag between placement of enteral access and initiation of enteral nutrition. Development of a protocol for feeding tube placement and enteral nutrition management may optimize early nutritional support in the acutely injured burn patient. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Improvement in Parenteral Nutrition-Associated Cholestasis With the Use of Omegaven in an Infant With Short Bowel Syndrome.

PubMed

Strang, Brian J; Reddix, Bruce A; Wolk, Robert A

2016-10-01

Parenteral nutrition-associated cholestasis (PNAC) and liver disease have been associated with soybean oil-based intravenous fat emulsions (IVFEs). The benefit of fish oil-based IVFEs in the reversal of parenteral nutrition (PN)-associated liver damage includes allowing for longer PN duration without immediate need for bowel or liver transplantation. The present case involves an infant born with short bowel syndrome (SBS) requiring long-term PN with development of PNAC and subsequent administration of a fish oil-based IVFE. An infant born with SBS was initiated on PN and enteral feeds. After failed enteral progression, bowel lengthening by serial transverse enteroplasty (STEP) resulted in postoperative ileus with delayed enteral feeding for 4 weeks. The administration of long-term PN led to development of PNAC, resulting in initiation of a fish oil-based IVFE. After 4 months, the cholestasis had resolved. Despite the STEP, at 16 months, the child required bowel tapering due to inability to advance enteral feeding. Fish oil-based IVFE was effectively used to reverse PNAC in a child with SBS. Despite early STEP, the patient was not able to tolerate enteral feedings and required bowel tapering. This case illustrates that early surgical intervention did not allow for improved feed tolerance. This resulted in a significant period without enteral nutrition, leading to development of cholestasis. The use of fish oil-based IVFE may permit a longer duration of PN administration without the development of cholestasis or liver disease, allowing for longer time for bowel adaptation prior to the need for surgical intervention. © 2016 American Society for Parenteral and Enteral Nutrition.

Modeling the Infection Dynamics of Bacteriophages in Enteric Escherichia coli: Estimating the Contribution of Transduction to Antimicrobial Gene Spread

PubMed Central

Lu, Zhao; Besser, Thomas; Gröhn, Yrjö T.

2014-01-01

Animal-associated bacterial communities are infected by bacteriophages, although the dynamics of these infections are poorly understood. Transduction by bacteriophages may contribute to transfer of antimicrobial resistance genes, but the relative importance of transduction among other gene transfer mechanisms is unknown. We therefore developed a candidate deterministic mathematical model of the infection dynamics of enteric coliphages in commensal Escherichia coli in the large intestine of cattle. We assumed the phages were associated with the intestine and were predominantly temperate. Model simulations demonstrated how, given the bacterial ecology and infection dynamics, most (>90%) commensal enteric E. coli bacteria may become lysogens of enteric coliphages during intestinal transit. Using the model and the most liberal assumptions about transduction efficiency and resistance gene frequency, we approximated the upper numerical limits (“worst-case scenario”) of gene transfer through specialized and generalized transduction in E. coli by enteric coliphages when the transduced genetic segment is picked at random. The estimates were consistent with a relatively small contribution of transduction to lateral gene spread; for example, generalized transduction delivered the chromosomal resistance gene to up to 8 E. coli bacteria/hour within the population of 1.47 × 108 E. coli bacteria/liter luminal contents. In comparison, the plasmidic blaCMY-2 gene carried by ∼2% of enteric E. coli was transferred by conjugation at a rate at least 1.4 × 103 times greater than our generalized transduction estimate. The estimated numbers of transductants varied nonlinearly depending on the ecology of bacteria available for phages to infect, that is, on the assumed rates of turnover and replication of enteric E. coli. PMID:24814786

Identification of GLI Mutations in Patients With Hirschsprung Disease That Disrupt Enteric Nervous System Development in Mice.

PubMed

Liu, Jessica Ai-Jia; Lai, Frank Pui-Ling; Gui, Hong-Sheng; Sham, Mai-Har; Tam, Paul Kwong-Hang; Garcia-Barcelo, Maria-Mercedes; Hui, Chi-Chung; Ngan, Elly Sau-Wai

2015-12-01

Hirschsprung disease is characterized by a deficit in enteric neurons, which are derived from neural crest cells (NCCs). Aberrant hedgehog signaling disrupts NCC differentiation and might cause Hirschsprung disease. We performed genetic analyses to determine whether hedgehog signaling is involved in pathogenesis. We performed deep-target sequencing of DNA from 20 patients with Hirschsprung disease (16 men, 4 women), and 20 individuals without (controls), and searched for mutation(s) in GLI1, GLI2, GLI3, SUFU, and SOX10. Biological effects of GLI mutations were tested in luciferase reporter assays using HeLa or neuroblastoma cell lines. Development of the enteric nervous system was studied in Sufu(f/f), Gli3(Δ699), Wnt1-Cre, and Sox10(NGFP) mice using immunohistochemical and whole-mount staining procedures to quantify enteric neurons and glia and analyze axon fasciculation, respectively. NCC migration was studied using time-lapse imaging. We identified 3 mutations in GLI in 5 patients with Hirschsprung disease but no controls; all lead to increased transcription of SOX10 in cell lines. SUFU, GLI, and SOX10 form a regulatory loop that controls the neuronal vs glial lineages and migration of NCCs. Sufu mutants mice had high Gli activity, due to loss of Sufu, disrupting the regulatory loop and migration of enteric NCCs, leading to defective axonal fasciculation, delayed gut colonization, or intestinal hypoganglionosis. The ratio of enteric neurons to glia correlated inversely with Gli activity. We identified mutations that increase GLI activity in patients with Hirschsprung disease. Disruption of the SUFU-GLI-SOX10 regulatory loop disrupts migration of NCCs and development of the enteric nervous system in mice. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Continuous Manufacturing of Nitrocellulose by Magnesium Nitrate Method. Volume 1

DTIC Science & Technology

1979-06-01

enters a scrubber . The scrubber removes entrained acid, water, and NC fines from the air before it enters a Roots water sealed (lobe type) vacuum pump...and is exhausted to the atmosphere. The air enters the bottom of the scrubber and is forced (by vacuum) sequentially through two weir arrangements...the panel from left to right, the Eimco dewatering filter drive, vacuum pressure, receiver, vacuum scrubber , and pump controls may be seen along with

Effect of frame size and season on enteric methane (CH4) and carbon dioxide (CO2)emissions in Angus brood cows grazing native tall-grass prairie in central Oklahoma USA

USDA-ARS?s Scientific Manuscript database

Effect of frame size and season on enteric methane (CH4) and carbon dioxide (CO2) emissions in Angus brood cows grazing native tall-grass prairie in central Oklahoma, USA J.P.S. Neel USDA ARS, El Reno, OK A reduction in enteric CH4 production in ruminants is associated with improved production effic...

32 CFR 37.675 - Must I report when I enter into a TIA allowing a for-profit firm to use an IPA?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Must I report when I enter into a TIA allowing a for-profit firm to use an IPA? 37.675 Section 37.675 National Defense Department of Defense OFFICE OF... Must I report when I enter into a TIA allowing a for-profit firm to use an IPA? Yes, you must include...

[Indications and practice of enteral nutrition].

PubMed

Hallay, Judit; Nagy, Dániel; Fülesdi, Béla

2014-12-21

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient's condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy.

Entry of Yersinia Pestis into the Viable but Nonculturable State in a Low-Temperature Tap Water Microcosm

DTIC Science & Technology

2011-03-16

to enter the VBNC state [17,18,19,20]. In addition, many other bacterial pathogens, including Francisella tularensis, Vibrio cholerae, and Escherichia...sterilized distilled water microcosms at 4uC after 21 days [31]. Likewise, Linder and Oliver reported that Vibrio vulnificus entered the VBNC state... Vibrio cholerae, and Escherichia coli enter the VBNC state [12,21]. In addition, the two closest pathogenic relatives of Y. pestis, namely Y

Interactive Computer Graphics for System Analysis.

DTIC Science & Technology

1983-12-01

seven matrices have a maximum size of 10xlO and are named: AMAT BMAT CMAT DMAT KMAT FMAT GMAT ICECAP-II has available four transfer functions which B-1...is: COPY (source) (destination) The valid source and destination variables are: AMAT CMAT PMAT GTF KMAT BMAT DMAT GMAT HTF OLTF CLTF Transfer functions...Function: gtf, htf, oltf, cltf Enter choice of Matrix: AMAT, BMAT , CMAT, DMAT, FMAT, GMAT, KMAT Enter SETUP in order to set up State Space Model Enter

The central role of chloride in the metabolic acid-base changes in canine parvoviral enteritis.

PubMed

Burchell, Richard K; Schoeman, Johan P; Leisewitz, Andrew L

2014-04-01

The acid-base disturbances in canine parvoviral (CPV) enteritis are not well described. In addition, the mechanisms causing these perturbations have not been fully elucidated. The purpose of the present study was to assess acid-base changes in puppies suffering from CPV enteritis, using a modified strong ion model (SIM). The hypothesis of the study was that severe acid-base disturbances would be present and that the SIM would provide insights into pathological mechanisms, which have not been fully appreciated by the Henderson-Hasselbalch model. The study analysed retrospective data, obtained from 42 puppies with confirmed CPV enteritis and 10 healthy control dogs. The CPV-enteritis group had been allocated a clinical score, to allow classification of the data according to clinical severity. The effects of changes in free water, chloride, l-lactate, albumin and phosphate were calculated, using a modification of the base excess algorithm. When the data were summated for each patient, and correlated to each individual component, the most important contributor to the metabolic acid-base changes, according to the SIM, was chloride (P<0.001). Severely-affected animals tended to demonstrate hypochloraemic alkalosis, whereas mildly-affected puppies had a hyperchloraemic acidosis (P=0.007). In conclusion, the acid-base disturbances in CPV enteritis are multifactorial and complex, with the SIM providing information in terms of the origin of these changes. Copyright © 2014 Elsevier Ltd. All rights reserved.

A model of lytic, latent, and reactivating varicella-zoster virus infections in isolated enteric neurons.

PubMed

Gershon, Anne A; Chen, Jason; Gershon, Michael D

2008-03-01

Because human primary afferent neurons are not readily obtained, we sought to develop a model in which the lytic, latent, and reactivating phases of varicella-zoster virus (VZV) infection were recapitulated in neurons from an animal source. Enteric neurons were obtained from the small intestine of adult guinea pigs and from the bowel of fetal mice. Latency was established when these neurons were infected by cell-free VZV in the absence of fibroblasts or other cells of mesodermal origin. In contrast, lytic infection ensued when fibroblasts were present or when the enteric neurons were infected by cell-associated VZV. Latency was associated with the expression of a limited subset of viral genes, the products of which were restricted to the cytoplasm. Lysis was associated with the expression of viral glycoproteins, nuclear translocation of latency-associated gene products, and rapid cell death. Reactivation was accomplished by expressing VZV open reading frame (ORF) 61p or herpes simplex virus ICP0 in latently infected neurons. Isolated enteric neurons from guinea pigs and mice recapitulate latent gene expression in human cranial nerve and dorsal root ganglia. Expression of latency-associated VZV gene products was detected in 88% of samples of adult human intestine, suggesting that VZV not only infects enteric neurons but also is latent in the human enteric nervous system. This in vitro model should facilitate further understanding of latency and reactivation of VZV.

The Influence of High and Low Doses of Bisphenol A (BPA) on the Enteric Nervous System of the Porcine Ileum.

PubMed

Szymanska, Kamila; Makowska, Krystyna; Gonkowski, Slawomir

2018-03-20

Bisphenol A, used in the production of plastic, is able to leach from containers into food and cause multidirectional adverse effects in living organisms, including neurodegeneration and metabolic disorders. Knowledge of the impact of BPA on enteric neurons is practically non-existent. The destination of this study was to investigate the influence of BPA at a specific dose (0.05 mg/kg body weight/day) and at a dose ten times higher (0.5 mg/kg body weight/day), given for 28 days, on the porcine ileum. The influence of BPA on enteric neuron immunoreactive to selected neuronal active substances, including substance P (SP), vasoactive intestinal polypeptide (VIP), galanin (GAL), vesicular acetylcholine transporter (VAChT-used here as a marker of cholinergic neurons), and cocaine- and amphetamine-regulated transcript peptide (CART), was studied by the double immunofluorescence method. Both doses of BPA affected the neurochemical characterization of the enteric neurons. The observed changes depended on the type of enteric plexus but were generally characterized by an increase in the number of cells immunoreactive to the particular substances. More visible fluctuations were observed after treatment with higher doses of BPA. The results confirm that even low doses of BPA may influence the neurochemical characterization of the enteric neurons and are not neutral for living organisms.

The enteric nervous system modulates mammalian duodenal mucosal bicarbonate secretion.

PubMed

Hogan, D L; Yao, B; Steinbach, J H; Isenberg, J I

1993-08-01

Interaction of the enteric nerves in regulating mammalian duodenal mucosal bicarbonate secretion is not well understood. The purpose of the present experiments was to evaluate the role of the enteric nervous system on bicarbonate secretion from rabbit duodenal mucosa in vitro. Proximal duodenum from male New Zealand White rabbits was stripped of seromuscular layers, mounted in Ussing chambers, and studied under short-circuited conditions. Effects of electrical field stimulation, vasoactive intestinal polypeptide (VIP), carbachol, prostaglandin E2 (PGE2), dibutyryl-cyclic adenosine monophosphate (db-cAMP), and the neurotoxin tetrodotoxin (TTX) and muscarinic blockade by atropine were studied. Electrical field stimulation significantly (P < 0.01) stimulated bicarbonate secretion, short-circuit current (Isc), and electrical potential difference (PD) that was sensitive to both TTX and atropine. VIP-stimulated bicarbonate secretion was significantly inhibited by TTX (-73%), yet Isc and PD remained unchanged. Atropine decreased VIP-induced bicarbonate secretion (-69%) and Isc (-43%). Carbachol-stimulated bicarbonate secretion, Isc, and PD were abolished by atropine, whereas TTX was without affect. Neither TTX nor atropine had a significant effect on PGE2 or db-cAMP-stimulated bicarbonate secretion. These results suggest that (1) enteric nerve stimulation activates an acetylcholine receptor that in turn stimulates duodenal epithelial bicarbonate secretion; (2) VIP stimulates bicarbonate secretion, in large part, via the enteric nervous system; and (3) PGE2 and cAMP stimulate bicarbonate secretion independent of the enteric nervous system.

Recurring Necrotic Enteritis Outbreaks in Commercial Broiler Chicken Flocks Strongly Influence Toxin Gene Carriage and Species Richness in the Resident Clostridium perfringens Population

PubMed Central

Gaucher, Marie-Lou; Perron, Gabriel G.; Arsenault, Julie; Letellier, Ann; Boulianne, Martine; Quessy, Sylvain

2017-01-01

Extensive use of antibiotic growth promoters (AGPs) in food animals has been questioned due to the globally increasing problem of antibiotic resistance. For the poultry industry, digestive health management following AGP withdrawal in Europe has been a challenge, especially the control of necrotic enteritis. Much research work has focused on gut health in commercial broiler chicken husbandry. Understanding the behavior of Clostridium perfringens in its ecological niche, the poultry barn, is key to a sustainable and cost-effective production in the absence of AGPs. Using polymerase chain reaction and pulsed-field gel electrophoresis, we evaluated how the C. perfringens population evolved in drug-free commercial broiler chicken farms, either healthy or affected with recurring clinical necrotic enteritis outbreaks, over a 14-month period. We show that a high genotypic richness was associated with an increased risk of clinical necrotic enteritis. Also, necrotic enteritis-affected farms had a significant reduction of C. perfringens genotypic richness over time, an increase in the proportion of C. perfringens strains harboring the cpb2 gene, the netB gene, or both. Thus, necrotic enteritis occurrence is correlated with the presence of an initial highly diverse C. perfringens population, increasing the opportunity for the selective sweep of particularly virulent genotypes. Disease outbreaks also appear to largely influence the evolution of this bacterial species in poultry farms over time. PMID:28567032

Case-Control Studies of Sporadic Enteric Infections: A Review and Discussion of Studies Conducted Internationally from 1990 to 2009

PubMed Central

Fullerton, Kathleen E.; Scallan, Elaine; Kirk, Martyn D.; Mahon, Barbara E.; Angulo, Frederick J.; de Valk, Henriette; van Pelt, Wilfrid; Gauci, Charmaine; Hauri, Anja M.; Majowicz, Shannon; O’Brien, Sarah J.

2015-01-01

Epidemiologists have used case-control studies to investigate enteric disease outbreaks for many decades. Increasingly, case-control studies are also used to investigate risk factors for sporadic (not outbreak-associated) disease. While the same basic approach is used, there are important differences between outbreak and sporadic disease settings that need to be considered in the design and implementation of the case-control study for sporadic disease. Through the International Collaboration on Enteric Disease “Burden of Illness” Studies (the International Collaboration), we reviewed 79 case-control studies of sporadic enteric infections caused by nine pathogens that were conducted in 22 countries and published from 1990 through to 2009. We highlight important methodological and study design issues (including case definition, control selection, and exposure assessment) and discuss how approaches to the study of sporadic enteric disease have changed over the last 20 years (e.g., making use of more sensitive case definitions, databases of controls, and computer-assisted interviewing). As our understanding of sporadic enteric infections grows, methods and topics for case-control studies are expected to continue to evolve; for example, advances in understanding of the role of immunity can be used to improve control selection, the apparent protective effects of certain foods can be further explored, and case-control studies can be used to provide population-based measures of the burden of disease. PMID:22443481

Management of premature infants with extensive bowel resection with high volume enteral infusates.

PubMed

Alkalay, A L; Fleisher, D R; Pomerance, J J; Rosenthal, P

1995-05-01

To avoid long-term parenteral nutrition (PN), three premature infants with extensive bowel resections were fed high volume enteral infusates (HVEI). Following surgery an elemental hypo-osmolar gastric infusate was initiated. The infants were weaned of PN and were subsequently maintained on HVEI feeding. Rather than using the volume of the ileostomy outputs or the presence of reducing substances as guides for adjustment of enteral intake, we tolerated large ileostomy output and focused instead on the patients' hydration, serum electrolytes and acid base status. During HVEI feeding, the patients had sustained weight gain, while the mean +/- SD enteral intakes were 373 +/- 67, 689 +/- 132, and 415 +/- 108 ml/kg per day; osmolarity of enteral infusates were 250 +/- 25, 225 +/- 40 and 228 +/- 27 mosmol/l; caloric intakes were 163 +/- 29, 258 +/- 54, and 153 +/- 44 Kcal/kg per day; and ileostomy outputs were 113 +/- 47, 228 +/- 59, and 175 +/- 69 ml/kg per day, respectively. Gut adaptation lasted 122, 141, and 205 days, respectively. Re-anastomoses of the intestines were performed at the ages of 8, 78, and 36 months. At 18, 108, and 58 months, infants' weights were in the 50th, 20th, and 5th percentiles, respectively. No infant developed cirrhosis. High volume enteral infusate feeding in infants with extensive bowel resection may help achieve gut adaptation and may serve as an alternative nutrition modality to prolonged PN.

Meat-based enteral nutrition

NASA Astrophysics Data System (ADS)

Derevitskay, O. K.; Dydykin, A. S.

2017-09-01

Enteral nutrition is widely used in hospitals as a means of nutritional support and therapy for different diseases. Enteral nutrition must fulfil the energy needs of the body, be balanced by the nutrient composition and meet patient’s nutritional needs. Meat is a source of full-value animal protein, vitamins and minerals. On the basis of this research, recipes and technology for a meat-based enteral nutrition product were developed. The product is a ready-to-eat sterilised mixture in the form of a liquid homogeneous mass, which is of full value in terms of composition and enriched with vitamins and minerals, consists of particles with a size of not more than 0.3 mm and has the modified fat composition and rheological characteristics that are necessary for passage through enteral feeding tubes. The study presents experimental data on the content of the main macro- and micro-nutrients in the developed product. The new product is characterised by a balanced fatty acid composition, which plays an important role in correction of lipid metabolism disorders and protein-energy deficiency, and it is capable of satisfying patients’ daily requirements for vitamins and the main macro- and microelements when consuming 1500-2000 ml. Meat-based enteral nutrition can be used in diets as a standard mixture for effective correction of the energy and anabolic requirements of the body and support of the nutritional status of patients, including those with operated stomach syndrome.

Current laboratory diagnosis of opportunistic enteric parasites in human immunodeficiency virus-infected patients

PubMed Central

De, Anuradha

2013-01-01

Diarrhea is a major cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected individuals. Opportunistic enteric parasitic infections are encountered in 30-60% of HIV seropositive patients in developed countries and in 90% of patients in developing countries. Once the CD4+ cell count drops below 200 cells/μl, patients are considered to have developed acquired immunodeficiency syndrome (AIDS), with the risk of an AIDS-defining illness or opportunistic infection significantly increasing. Opportunistic enteric parasites encountered in these patients are Cryptosporidium, Isospora, Cyclospora, and microsporidia; as well as those more commonly associated with gastrointestinal disease, for example, Giardia intestinalis, Entamoeba histolytica, Strongyloides stercoralis, and also rarely Balantidium coli. In view of AIDS explosion in India, opportunistic enteric parasites are becoming increasingly important and it has to be identified properly. Apart from wet mounts, concentration methods for stool samples and special staining techniques for identification of these parasites, commercially available fecal immunoassays are widely available for the majority of enteric protozoa. Molecular methods such as polymerase chain reaction (PCR), PCR-restriction fragment length polymorphism, flow cytometry, and sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), have also come in the pipeline for early diagnosis of these infections. Proper disposal of the feces to prevent contamination of the soil and water, boiling/filtering drinking water along with improved personal hygiene might go a long way in preventing these enteric parasitic infections. PMID:23961436

Enteric disease surveillance under the AFHSC-GEIS: Current efforts, landscape analysis and vision forward

PubMed Central

2011-01-01

The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts. PMID:21388567

Application of a radiotelemetric system to evaluate the performance of enteric coated and plain aspirin tablets.

PubMed

Lui, C Y; Oberle, R; Fleisher, D; Amidon, G L

1986-05-01

The bioavailability of enteric coated and plain aspirin tablets was studied in four beagle dogs. Blood sampling for enteric coated tablets was planned with the aid of a radiotelemetric system. The release of aspirin from its dosage form was detected by monitoring the change in intestinal pH. Aspirin and salicylic acid levels in plasma obtained from the enteric coated dosage form exhibited familiar concentration versus time absorption profiles. Variation in the plasma concentrations of these two compounds within each dog studied (four runs each) was relatively small when time zero was adjusted to the commencement of tablet dissolution. The plasma levels obtained from plain aspirin (three runs each), however, show atypical absorption. The estimated absolute bioavailability was 0.432 +/- 0.0213 and 0.527 +/- 0.0260 for enteric coated and plain aspirin, respectively. Other pharmacokinetic parameters for these two dosage forms such as the highest observed plasma concentration (Cmax) (10.9 +/- 0.535 microgram/mL versus 13.6 +/- 1.88 micrograms/mL) and the time to reach Cmax (tmax) (26.6 +/- 1.94 min versus 31.0 +/- 7.04 min) agree well. The mean values for gastric emptying time, in vivo coating dissolution time, and in vivo disintegration/dissolution time of the tablet core for enteric coated aspirin are 48.7 +/- 7.23 min, 44.3 +/- 3.80 min, and 34.7 +/- 2.04 min, respectively.

21 CFR 520.2345c - Tetracycline boluses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... bacterial enteritis (scours) caused by E. coli and bacterial pneumonia caused by Pasteurella spp... tetracycline, bacterial enteritis caused by E. coli, and salmonella organisms susceptible to tetracycline. (ii...

21 CFR 520.2345c - Tetracycline boluses.

Code of Federal Regulations, 2011 CFR

2011-04-01

... bacterial enteritis (scours) caused by E. coli and bacterial pneumonia caused by Pasteurella spp... tetracycline, bacterial enteritis caused by E. coli, and salmonella organisms susceptible to tetracycline. (ii...

Salmonella Typhi and Salmonella Paratyphi A elaborate distinct systemic metabolite signatures during enteric fever

PubMed Central

Näsström, Elin; Vu Thieu, Nga Tran; Dongol, Sabina; Karkey, Abhilasha; Voong Vinh, Phat; Ha Thanh, Tuyen; Johansson, Anders; Arjyal, Amit; Thwaites, Guy; Dolecek, Christiane; Basnyat, Buddha; Baker, Stephen; Antti, Henrik

2014-01-01

The host–pathogen interactions induced by Salmonella Typhi and Salmonella Paratyphi A during enteric fever are poorly understood. This knowledge gap, and the human restricted nature of these bacteria, limit our understanding of the disease and impede the development of new diagnostic approaches. To investigate metabolite signals associated with enteric fever we performed two dimensional gas chromatography with time-of-flight mass spectrometry (GCxGC/TOFMS) on plasma from patients with S. Typhi and S. Paratyphi A infections and asymptomatic controls, identifying 695 individual metabolite peaks. Applying supervised pattern recognition, we found highly significant and reproducible metabolite profiles separating S. Typhi cases, S. Paratyphi A cases, and controls, calculating that a combination of six metabolites could accurately define the etiological agent. For the first time we show that reproducible and serovar specific systemic biomarkers can be detected during enteric fever. Our work defines several biologically plausible metabolites that can be used to detect enteric fever, and unlocks the potential of this method in diagnosing other systemic bacterial infections. DOI: http://dx.doi.org/10.7554/eLife.03100.001 PMID:24902583

Document of standardization of enteral nutrition access in adults.

PubMed

Arribas, Lorena; Frías, Laura; Creus, Gloria; Parejo, Juana; Urzola, Carmen; Ashbaugh, Rosana; Pérez-Portabella, Cleofé; Cuerda, Cristina

2014-07-01

The group of standardization and protocols of the Spanish Society of Parenteral and Enteral Nutrition (SENPE) published in 2011 a consensus document SENPE/SEGHNP/ANECIPN/SECP on enteral access for paediatric nutritional support. Along the lines of this document, we have developed another document on adult patients to homogenize the clinical practice and improve the quality of care in enteral access in this age group. The working group included health professionals (nurses, dietitians and doctor) with extensive experience in enteral nutrition and access. We tried to find scientific evidence through a literature review and we used the criteria of the Agency for Health-care Research and Quality (AHRQ) to classify the evidence (Grade of Recommendation A, B or C). Later the document was reviewed by external experts to the group and requested the endorsement of the Scientific and Educational Committee (CCE) and the group of home artificial nutrition (NADYA) of the SENPE. The full text will be published as a monograph number in this journal. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Variation at HLA-DRB1 is associated with resistance to enteric fever

PubMed Central

Dunstan, Sarah J; Hue, Nguyen Thi; Han, Buhm; Li, Zheng; Tram, Trinh Thi Bich; Sim, Kar Seng; Parry, Christopher M; Chinh, Nguyen Tran; Vinh, Ha; Lan, Nguyen Phu Huong; Thieu, Nga Tran Vu; Vinh, Phat Voong; Koirala, Samir; Dongol, Sabina; Arjyal, Amit; Karkey, Abhilasha; Shilpakar, Olita; Dolecek, Christiane; Foo, Jia Nee; Phuong, Le Thi; Lanh, Mai Ngoc; Do, Tan; Aung, Tin; Hon, Do Nu; Teo, Yik Ying; Hibberd, Martin L; Anders, Katherine L; Okada, Yukinori; Raychaudhuri, Soumya; Simmons, Cameron P; Baker, Stephen; de Bakker, Paul I W; Basnyat, Buddha; Hien, Tran Tinh; Farrar, Jeremy J; Khor, Chiea Chuen

2016-01-01

Enteric fever affects more than 25 million people annually and results from systemic infection with Salmonella enterica serovar Typhi or Paratyphi pathovars A, B or C1. We conducted a genome-wide association study of 432 individuals with blood culture–confirmed enteric fever and 2,011 controls from Vietnam. We observed strong association at rs7765379 (odds ratio (OR) for the minor allele = 0.18, P = 4.5 × 10−10), a marker mapping to the HLA class II region, in proximity to HLA-DQB1 and HLA-DRB1. We replicated this association in 595 enteric fever cases and 386 controls from Nepal and also in a second independent collection of 151 cases and 668 controls from Vietnam. Imputation-based fine-mapping across the extended MHC region showed that the classical HLA-DRB1* 04:05 allele (OR = 0.14, P = 2.60 × 10−11) could entirely explain the association at rs7765379, thus implicating HLA-DRB1 as a major contributor to resistance against enteric fever, presumably through antigen presentation. PMID:25383971

DOE Office of Scientific and Technical Information (OSTI.GOV)

Price, Laura L.; Barela, Amanda Crystal; Walkow, Walter M.

An Evaluation and Screening team supporting the Fuel Cycle Technologies Program Office of the United States Department of Energy, Office of Nuclear Energy is conducting an evaluation and screening of a comprehensive set of fuel cycle options. These options have been assigned to one of 40 evaluation groups, each of which has a representative fuel cycle option [Todosow 2013]. A Fuel Cycle Data Package System Datasheet has been prepared for each representative fuel cycle option to ensure that the technical information used in the evaluation is high-quality and traceable [Kim, et al., 2013]. The information contained in the Fuel Cyclemore » Data Packages has been entered into the Nuclear Fuel Cycle Options Catalog at Sandia National Laboratories so that it is accessible by the evaluation and screening team and other interested parties. In addition, an independent team at Savannah River National Laboratory has verified that the information has been entered into the catalog correctly. This report documents that the 40 representative fuel cycle options have been entered into the Catalog, and that the data entered into the catalog for the 40 representative options has been entered correctly.« less

Feeding Tubes

MedlinePlus

... of placement carefully with your physician and surgeon. Methods of Feeding Enteral feeding means the gastrointestinal (digestive) ... unable to absorb nutrients from enteral feeds. This method of feeding requires a central intravenous line. A ...

21 CFR 520.2345d - Tetracycline powder.

Code of Federal Regulations, 2013 CFR

2013-04-01

.... Control and treatment of bacterial enteritis (scours) caused by Escherichia coli and bacterial pneumonia... bacterial enteritis (scours) caused by E. coli and bacterial pneumonia associated with Pasteurella spp., A...

21 CFR 520.2345d - Tetracycline powder.

Code of Federal Regulations, 2014 CFR

2014-04-01

.... Control and treatment of bacterial enteritis (scours) caused by Escherichia coli and bacterial pneumonia... bacterial enteritis (scours) caused by E. coli and bacterial pneumonia associated with Pasteurella spp., A...

21 CFR 520.2345d - Tetracycline powder.

Code of Federal Regulations, 2012 CFR

2012-04-01

.... Control and treatment of bacterial enteritis (scours) caused by Escherichia coli and bacterial pneumonia... bacterial enteritis (scours) caused by E. coli and bacterial pneumonia associated with Pasteurella spp., A...

Acute Pericarditis

MedlinePlus

... and white blood cells to enter the pericardial space. Infection and other conditions that inflame the pericardium ... can cause excess fluid to enter the pericardial space (pericardial effusion). Sometimes, when pericarditis is due to ...

Autonomic innervation of the fish gut.

PubMed

Olsson, Catharina

2009-01-01

The enteric nervous system follows a similar overall arrangement in all vertebrate groups. In fish, the majority of nerve cell bodies are found in the myenteric plexus, innervating muscles, blood vessels and glands. In this review, I describe similarities and differences in size, shape and transmitter content in enteric neurons in different fish species and also in comparison with other vertebrates, foremost mammals. The use of different histological and immunochemical methods is reviewed in a historical perspective including advantages and disadvantages of different methods. Lately, zebrafish have become an important model species for developmental studies of the nervous system, including the enteric nervous system, and this is briefly discussed. Finally, examples of how the enteric nervous system controls gut activity in fish is presented, focussing on the effect on gastrointestinal motility.

Necrotizing enteritis as a cause of mortality in Laysan albatross, Diomedea immutabilis, chicks on Midway Atoll, Hawaii

USGS Publications Warehouse

Work, Thierry M.; Smith, M.R.; Duncan, R.

1998-01-01

A necropsy survey of Laysan albatross, Diomedea immutabilis, chicks on Midway Atoll in June 1993, 1994, and 1995 revealed 54% (21/39), 67% (49/71), and 93% (15/16), respectively, to have enteritis as the most severe pathologic finding. The lesion was limited to the ileum, ceca, and large intestine. We were unable to attribute a single infectious etiology to this lesion. Many birds with enteritis also exhibited renal lesions similar to those encountered in chickens experimentally deprived of water. We propose that enteritis is a significant cause of mortality in Laysan albatross chicks on Midway and that it may be a sequela to dehydration. It is likely that the pathology of dehydration in Laysan albatross differs from that in chickens largely because of diet.

Nursing administration of medication via enteral tubes in adults: a systematic review.

PubMed

Phillips, Nicole M; Nay, Rhonda

Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies. Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug-nutrient interactions or the bioavailability of specific medications. Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary. There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.

Nursing administration of medication via enteral tubes in adults: a systematic review.

PubMed

Phillips, Nicole M; Nay, Rhonda

2007-09-01

Background  Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. Objectives  The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. Search strategy  The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies. Selection criteria  Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug-nutrient interactions or the bioavailability of specific medications. Data collection and analysis  Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary. Results  There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.

21 CFR 520.90f - Ampicillin trihydrate boluses.

Code of Federal Regulations, 2012 CFR

2012-04-01

... enteritis (colibacillosis) caused by E. coli. (ii) Limitations. Treated calves must not be slaughtered for... coli, bacterial enteritis caused by Salmonella spp., and bacterial pneumonia caused by Pasteurella spp...

21 CFR 520.90f - Ampicillin trihydrate boluses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... enteritis (colibacillosis) caused by E. coli. (ii) Limitations. Treated calves must not be slaughtered for... coli, bacterial enteritis caused by Salmonella spp., and bacterial pneumonia caused by Pasteurella spp...

21 CFR 520.90f - Ampicillin trihydrate boluses.

Code of Federal Regulations, 2011 CFR

2011-04-01

... enteritis (colibacillosis) caused by E. coli. (ii) Limitations. Treated calves must not be slaughtered for... coli, bacterial enteritis caused by Salmonella spp., and bacterial pneumonia caused by Pasteurella spp...

[Lupus enteritis as initial manifestation of systemic lupus erythematosus. Report of one case].

PubMed

Barrera O, Manuel; Barrera M, Rodrigo; de la Rivera V, Matías; Vela U, Javier; Mönckeberg F, Gustavo

2017-10-01

Although gastrointestinal symptoms are not rare in Systemic lupus erythematosus, enteritis is an atypical manifestation of the disease. We report a 54 year-old woman who presented acute symptoms of diarrhea, fever and abdominal pain, receiving empiric antibiotic therapy for bacterial enteritis with no response. Computed tomography showed diffuse small intestine inflammation and serositis. Antinuclear antibodies, anti-Ro and anti-La were positive on blood tests. A lupic enteropathy was diagnosed and steroid treatment was initiated, with subsequent clinical improvement.

Endovascular Management of Acute Enteric Bleeding from Pancreas Transplant

DOE Office of Scientific and Technical Information (OSTI.GOV)

Semiz-Oysu, Aslihan; Cwikiel, Wojciech

2007-04-15

Arterioenteric fistula is a rare but serious complication of enteric drained pancreas transplant, which may lead to massive gastrointestinal bleeding. We present 3 patients with failed enteric drained pancreas transplants and massive gastrointestinal bleeding secondary to arterioenteric fistula. One patient was treated by embolization and the 2 others by stent graft placement. Bleeding was successfully controlled in all cases, at follow up of 5 days, 8 months, and 12 months, respectively. One patient died 24 days after embolization, of unknown causes.

Simulation of Finite-Precision Effects in Digital Filters.

DTIC Science & Technology

1991-12-12

the output power due to roundoff noise [13:422][15:3591. To prevent overflow, the filter gains are < 1.0 at branch nodes where the signal enters. This...performed and prevented with a message to the user. A useful check for the user is one when the coefficients are quantized. If a quantized version of a...8217(55) ------------ ALL DONE - WRITE(6,1)’***** PLEASE ENTER NUMBER OR [RET] TO RUN PRGRAM *****’ WRITE(6,1)’ ENTER NUMBER [#]:’ READ(5,38,END=99,ERR

Department of Defense Strategy to Support Multi-Agency Bat Conservation Initiative within the State of Utah

DTIC Science & Technology

2008-02-28

Range, and Section are entered. Datum: Geometric reference surface. Original Site Location datum is defined by user’s map datum; e.g. NAD27...Section are entered. Datum: Geometric reference surface. Original Site Location datum is defined by user’s map datum; e.g. NAD27 Conus or NAD83...Calculated and recorded automatically if the fields UTM_N and UTM_E or Township, Range, and Section are entered. 41 Datum: Geometric reference surface

Nano-Zirconium Tungstate Reinforced Liquid Crystalline Thermosetting Composites with Near Zero Thermal Expansion

DTIC Science & Technology

2015-06-25

5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Washington State University, Pullman...1234. 5c. PROGRAM ELEMENT NUMBER. Enter all program element numbers as they appear in the report, e.g. 61101A. 5d. PROJECT NUMBER. Enter all... project numbers as they appear in the report, e.g. 1F665702D1257; ILIR. 5e. TASK NUMBER. Enter all task numbers as they appear in the report

HARD PAN I Test Series Test and Instrumentation Plans. Volume I. Test Plan

DTIC Science & Technology

1975-12-01

t.jw .y..,,^.,^,. Ä!»,,«-* :,,; .trwev* ’ UNCLASSIFIED SECURITY CLASSIFICATION OF THIS PAGt ’Wh&n Data Entered) J?)REPORT DOCUMENTATION PAGE...to facility-l—> DO ,: FORM A’J 73 1473 EDITION OF 1 NOV 65 15 OBSOLETE UNCLASSIFIED fNW SECURITY CLASSIFICATION OF THIS PAGE (Wfien Data Entered...y^o ... — ppiiw’.^y.-.j-w... v»t \\ UNCLASSIFIED iCURITY CLASSIFICATION CF THIS PAGEfWlon Data Entered) design, modification, and hardness

Attention and curiosity in museums

NASA Astrophysics Data System (ADS)

Koran, John J., Jr.; Morrison, Laura; Lehman, Jeffrey R.; Koran, Mary Lou; Gandara, Luisa

Two hundred and thirty-four museum visitors of all ages were observed as they entered the Object Gallery area of the Florida State Museum. Visitors were observed under conditions where objects were available for close inspection but could not be manipulated (baseline data) and later when the same objects were placed on tables and were available for visitors to touch, move, and use a variety of senses to inspect them (intervention data). Data were recorded on the sex, age, and number of subjects in these areas under each of the above conditions. The results obtained show a significant increase in the number of visitors entering this section of the museum when manipulatable objects were available. Baseline data showed that 58.5% of the people who entered the Object Gallery went into the drawer section. However, when manipulatable objects were made available this increased to 82.3%. Chi-square analysis was used to determine whether the presence of manipulatable objects in the area increased the number of people who entered the area. It did (p < 0.05). Chi-square analysis was also used to determine whether entering the drawer section depended on age or sex. It was found that more children entered the drawer section than adults (p < 0.05) and significantly more female children and female adults entered as a result of intervention (p < 0.05). At the same time, more male children than adults entered after intervention (p < 0.05) than before. These data are supported by considerable curiosity research indicating that both children and adults are attracted to novel as well as complex stimuli which can be manipulated in both formal and free-choice environments. The data also support the growing movement to hands-on exhibits in natural history museums and science centers around the country, as well as hands-on classroom activities from the perspective of their attention attracting and holding power and their curiosity evoking characteristics. Whether these positive factors also lead to increased knowledge or skill development is a question yet to be explored.

An interaction between levodopa and enteral nutrition resulting in neuroleptic malignant-like syndrome and prolonged ICU stay.

PubMed

Bonnici, André; Ruiner, Carola-Ellen; St-Laurent, Lyne; Hornstein, David

2010-09-01

To describe a probable interaction between enteral feeds and levodopa leading to neuroleptic malignant-like syndrome (NMLS) in a polytrauma patient with Parkinson's disease (PD). A 63-year-old morbidly obese male polytrauma patient with PD and type 2 diabetes mellitus was admitted to our intensive care unit postoperatively. Enteral feeds were administered per nasogastric tube and provided 0.88 g /kg/day of protein based on ideal body weight (IBW). His PD medications (pramipexole, entacapone, and immediate-release levodopa/carbidopa 100 mg/25 mg, 1.5 tablets 4 times daily) were administered via nasogastric tube. To achieve better glycemic control, his enteral feeds were changed to a formula that provided 1.8 g/kg/day of protein based on IBW. In the following 24 hours, the patient's mental status deteriorated and he was reintubated. He developed a high fever (40.5 degrees C), leukocytosis, elevated serum creatine kinase (CK) (480-1801 units/L), and acute renal impairment. His enteral nutrition was changed to decrease protein intake to 1.0 g/kg/day based on IBW and he was given bromocriptine 5 mg 3 times daily via nasogastric tube. Within 24 hours, the patient's mental status improved, his temperature and CK decreased, and his renal function began to improve; the values returned to baseline levels on the 18th day of admission. Withdrawal or dose reduction of levodopa in patients with PD has been reported to precipitate NMLS, which is potentially fatal. Because dietary protein can decrease the absorp0tion of levodopa, a potential for an interaction between levodopa and enteral feedings exists, although published reports of such an interaction are limited. In this patient, the likelihood that a drug-nutrient interaction occurred between levodopa and enteral feedings is considered to be probable based on the Naranjo probability scale and the Horn Drug Interaction Probability Scale. Health-care professionals should be aware of the interaction between levodopa and protein content of enteral nutrition to avoid the occurrence of NMLS in patients with PD.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Han, Young-Min; Kim, Chan-Young; Yang, Doo-Hyun

Purpose. To evaluate the feasibility and effectiveness of feeding tube insertion and enteral feeding for the treatment of postoperative gastrointestinal anastomotic obstruction and leakage. Materials and Methods. From June 1999 to June 2002, thirty-four cases of postoperative gastrointestinal anastomotic obstruction and leakage after surgery for gastric carcinoma were treated by insertion of a feeding tube under fluoroscopic guidance. Twenty-one patients were male and 13 were female. The patients' ages ranged from 39 to 74 years (mean age: 61 years). All the patients experienced vomiting, and 15 patients had anastomotic site or duodenal stump leakage. We evaluated the feasibility of feedingmore » tube insertion for enteral feeding to improve the obstruction and facilitate leakage site closure, and the patients' nutritional benefit was also evaluated by checking the serum albumin level between pre- and post-enteral feeding via the feeding tube.Results. Thirty-two patients (94%) were successfully managed by feeding tube insertion, but the remaining two were not managed, and this was due to severe angulations at the anastomotic site. The procedure times for feeding tube insertion ranged from 15 to 60 minutes (mean time: 45 minutes). Twenty-eight patients experienced symptomatic relief of gastrointestinal obstruction, and they were able to resume a normal regular diet after feeding tube removal. Three patients underwent stent insertion due to recurrent symptoms, and one patient underwent jejunostomy feeding due to the presence of a persistent leakage site. Eleven patients achieved leakage site closure after enteral feeding via a feeding tube. The serum albumin level was significant, increased from pre-enteral feeding (2.65 {+-} 0.37 g/dL) to the post-enteral feeding (3.64 {+-} 0.58 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from one to 53 months (mean: 23 months). Conclusion. The insertion of a feeding tube for enteral feeding under fluoroscopic guidance is safe, and it provides effective relief from gastrointestinal anastomotic site obstruction and leakage after gastric surgery. Moreover, our findings indicate that feeding tube insertion for enteral feeding may be used as the primary procedure to treat postoperative anastomotic obstruction and leakage.« less

American Society for Parenteral & Enteral Nutrition

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69. Vice President Ford entering SAC command post, February, 1974 ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

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19 CFR 10.38 - Exportation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... exportation entry. In such cases Customs Form 3495 shall be filed in triplicate. Articles entered under a... samples were entered under subheading 9813.00.20, HTSUS, or professional equipment or tools of trade were...

Hepatitis C: Treatment

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Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants.

PubMed

Morgan, Jessie; Young, Lauren; McGuire, William

2014-01-01

The introduction of enteral feeds for very preterm (less than 32 weeks' gestation) or very low birth weight (VLBW; less than 1500 g) infants is often delayed for several days or longer after birth due to concern that early introduction may not be tolerated and may increase the risk of necrotising enterocolitis (NEC). However, delaying enteral feeding could diminish the functional adaptation of the gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks. To determine the effect of delayed introduction of progressive enteral feeds on the incidence of NEC, mortality and other morbidities in very preterm or VLBW infants. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 8), MEDLINE (1966 to September 2014), EMBASE (1980 to September 2014), CINAHL (1982 to September 2014), conference proceedings and previous reviews. We included randomised or quasi-randomised controlled trials that assessed the effect of delayed (more than four days after birth) versus earlier introduction of progressive enteral feeds on the incidence of NEC, mortality and other morbidities in very preterm or VLBW infants. Two review authors independently assessed trial eligibility and risk of bias and undertook data extraction. We analysed the treatment effects in the individual trials and reported the risk ratio (RR) and risk difference for dichotomous data and mean difference for continuous data, with respective 95% confidence intervals (CI). We used a fixed-effect model in meta-analyses and explored the potential causes of heterogeneity in sensitivity analyses. We identified nine randomised controlled trials in which 1106 infants participated. Few participants were extremely preterm (less 28 weeks' gestation) or extremely low birth weight (less than 1000 g). The trials defined delayed introduction of progressive enteral feeds as later than four to seven days after birth and early introduction as four days or less after birth. Meta-analyses did not detect statistically significant effects on the risk of NEC (typical RR 0.93, 95% CI 0.64 to 1.34; 8 trials; 1092 infants) or all-cause mortality (typical RR 1.18, 95% CI 0.75 to 1.88; 7 trials; 967 infants). Four of the trials restricted participation to growth-restricted infants with Doppler ultrasound evidence of abnormal fetal circulatory distribution or flow. Planned subgroup analyses of these trials found no statistically significant effects on the risk of NEC or all-cause mortality. Infants who had delayed introduction of enteral feeds took longer to establish full enteral feeding (reported median differences two to four days). The evidence available from randomised controlled trials suggested that delaying the introduction of progressive enteral feeds beyond four days after birth did not reduce the risk of developing NEC in very preterm or VLBW infants, including growth-restricted infants. Delaying the introduction of progressive enteral feeds resulted in a few days' delay in establishing full enteral feeds but the clinical importance of this effect was unclear. The applicability of these findings to extremely preterm or extremely low birth weight was uncertain. Further randomised controlled trials in this population may be warranted.

Early-life enteric infections: relation between chronic systemic inflammation and poor cognition in children

PubMed Central

Murray-Kolb, Laura E.; Scharf, Rebecca J.; Pendergast, Laura L.; Lang, Dennis R.; Kolling, Glynis L.; Guerrant, Richard L.

2016-01-01

The intestinal microbiota undergoes active remodeling in the first 6 to 18 months of life, during which time the characteristics of the adult microbiota are developed. This process is strongly influenced by the early diet and enteric pathogens. Enteric infections and malnutrition early in life may favor microbiota dysbiosis and small intestinal bacterial overgrowth, resulting in intestinal barrier dysfunction and translocation of intestinal bacterial products, ultimately leading to low-grade, chronic, subclinical systemic inflammation. The leaky gut–derived low-grade systemic inflammation may have profound consequences on the gut–liver–brain axis, compromising normal growth, metabolism, and cognitive development. This review examines recent data suggesting that early-life enteric infections that lead to intestinal barrier disruption may shift the intestinal microbiota toward chronic systemic inflammation and subsequent impaired cognitive development. PMID:27142301

Evaluation of human enteric viruses in surface water and drinking water resources in southern Ghana.

PubMed

Gibson, Kristen E; Opryszko, Melissa C; Schissler, James T; Guo, Yayi; Schwab, Kellogg J

2011-01-01

An estimated 884 million people worldwide do not have access to an improved drinking water source, and the microbial quality of these sources is often unknown. In this study, a combined tangential flow, hollow fiber ultrafiltration (UF), and real-time PCR method was applied to large volume (100 L) groundwater (N = 4), surface water (N = 9), and finished (i.e., receiving treatment) drinking water (N = 6) samples for the evaluation of human enteric viruses and bacterial indicators. Human enteric viruses including norovirus GI and GII, adenovirus, and polyomavirus were detected in five different samples including one groundwater, three surface water, and one drinking water sample. Total coliforms and Escherichia coli assessed for each sample before and after UF revealed a lack of correlation between bacterial indicators and the presence of human enteric viruses.

The Mother’s Perspective: Factors Considered When Choosing to Enter a Stay-at-Home Father and Working Mother Relationship

PubMed Central

Rushing, Cassie; Sparks, Misti

2017-01-01

A qualitative study was conducted to examine the decision-making factors of entering a stay-at-home father and working mother relationship based on the mother’s perspective. A total of 20 married, heterosexual, working mothers with biological children aged 1 to 4 years were asked questions regarding how they decided to enter a stay-at-home father and working mother relationship as well as contributing factors to this decision. The findings presented in this article were part of a larger study that examined mothers’ overall perspectives of the working mother stay-at-home father dynamics. The themes that emerged regarding how the decision was made to enter this kind of relationship were creating a work–family life balance, utilizing the cost-benefit ratio, and applying personality/trait strengths. PMID:28198208

The Mother's Perspective: Factors Considered When Choosing to Enter a Stay-at-Home Father and Working Mother Relationship.

PubMed

Rushing, Cassie; Sparks, Misti

2017-07-01

A qualitative study was conducted to examine the decision-making factors of entering a stay-at-home father and working mother relationship based on the mother's perspective. A total of 20 married, heterosexual, working mothers with biological children aged 1 to 4 years were asked questions regarding how they decided to enter a stay-at-home father and working mother relationship as well as contributing factors to this decision. The findings presented in this article were part of a larger study that examined mothers' overall perspectives of the working mother stay-at-home father dynamics. The themes that emerged regarding how the decision was made to enter this kind of relationship were creating a work-family life balance, utilizing the cost-benefit ratio, and applying personality/trait strengths.

[THE ROLE OF FOOD OBJECTS AND ENTERAL MICROBIOTA PROTEASES IN NUTRITIVE AND TEMPERATURE ADAPTATIONS OF THE DIGESTIVE SYSTEM IN FISH].

PubMed

Kuz'mina, V V

2015-01-01

The review presents data on the activity and some temperature characteristics of proteases in the potential food objects of fishes and some enteral microbiota representatives that provide induced autolysis and symbiotic digestion. It is shown that during the active feeding period the total protease activity in the prey tissues exceeds the total protease activity in the fish gastric mucosa by 5-10 times. At low temperature, the relative activity of the prey tissue lysosomal hydrolases (20-35%) and the enteral microbiota enzymes (up to 45%) may exceed that of proteases synthesized by the hepatopancreas and functioning in the consumers' intestinal mucosa (less than 10% maximal activity). The data presented indicate the important role of proteases of food objects and enteral microbiota in nutritive adaptations of the fish digestive system.

Enteral Nutrition Support to Treat Malnutrition in Inflammatory Bowel Disease

PubMed Central

Altomare, Roberta; Damiano, Giuseppe; Abruzzo, Alida; Palumbo, Vincenzo Davide; Tomasello, Giovanni; Buscemi, Salvatore; Lo Monte, Attilio Ignazio

2015-01-01

Malnutrition is a common consequence of inflammatory bowel disease (IBD). Diet has an important role in the management of IBD, as it prevents and corrects malnutrition. It is well known that diet may be implicated in the aetiology of IBD and that it plays a central role in the pathogenesis of gastrointestinal-tract disease. Often oral nutrition alone is not sufficient in the management of IBD patients, especially in children or the elderly, and must be combined with oral supplementation or replaced with tube enteral nutrition. In this review, we describe several different approaches to enteral nutrition—total parenteral, oral supplementation and enteral tube feeding—in terms of results, patients compliance, risks and and benefits. We also focus on the home entaral nutrition strategy as the future goal for treating IBD while focusing on patient wellness. PMID:25816159

White paper on guidelines concerning enteric nervous system stem cell therapy for enteric neuropathies⋆

PubMed Central

Burns, Alan J.; Goldstein, Allan M.; Newgreen, Donald F.; Stamp, Lincon; Schäfer, Karl-Herbert; Metzger, Marco; Hotta, Ryo; Young, Heather M.; Andrews, Peter W.; Thapar, Nikhil; Belkind-Gerson, Jaime; Bondurand, Nadege; Bornstein, Joel C.; Chan, Wood Yee; Cheah, Kathryn; Gershon, Michael D.; Heuckeroth, Robert O.; Hofstra, Robert M.W.; Just, Lothar; Kapur, Raj P.; King, Sebastian K.; McCann, Conor J.; Nagy, Nandor; Ngan, Elly; Obermayr, Florian; Pachnis, Vassilis; Pasricha, Pankaj J.; Sham, Mai Har; Tam, Paul; Berghe, Pieter Vanden

2016-01-01

Over the last 20 years, there has been increasing focus on the development of novel stem cell based therapies for the treatment of disorders and diseases affecting the enteric nervous system (ENS) of the gastrointestinal tract (so-called enteric neuropathies). Here, the idea is that ENS progenitor/stem cells could be transplanted into the gut wall to replace the damaged or absent neurons and glia of the ENS. This White Paper sets out experts’ views on the commonly used methods and approaches to identify, isolate, purify, expand and optimize ENS stem cells, transplant them into the bowel, and assess transplant success, including restoration of gut function. We also highlight obstacles that must be overcome in order to progress from successful preclinical studies in animal models to ENS stem cell therapies in the clinic. PMID:27059883

Evaluation of Human Enteric Viruses in Surface Water and Drinking Water Resources in Southern Ghana

PubMed Central

Gibson, Kristen E.; Opryszko, Melissa C.; Schissler, James T.; Guo, Yayi; Schwab, Kellogg J.

2011-01-01

An estimated 884 million people worldwide do not have access to an improved drinking water source, and the microbial quality of these sources is often unknown. In this study, a combined tangential flow, hollow fiber ultrafiltration (UF), and real-time PCR method was applied to large volume (100 L) groundwater (N = 4), surface water (N = 9), and finished (i.e., receiving treatment) drinking water (N = 6) samples for the evaluation of human enteric viruses and bacterial indicators. Human enteric viruses including norovirus GI and GII, adenovirus, and polyomavirus were detected in five different samples including one groundwater, three surface water, and one drinking water sample. Total coliforms and Escherichia coli assessed for each sample before and after UF revealed a lack of correlation between bacterial indicators and the presence of human enteric viruses. PMID:21212196

The survival and inactivation of enteric viruses on soft surfaces: A systematic review of the literature.

PubMed

Yeargin, Thomas; Buckley, David; Fraser, Angela; Jiang, Xiuping

2016-11-01

Worldwide, enteric viruses are the main cause of acute gastroenteritis. In humans, these viruses spread via person-to-person contact, food, water, and/or the environment. Their survival and inactivation on hard surfaces have been extensively studied; however, nonlaunderable soft surfaces, such as upholstery and carpet, have received little attention. The aim of this systematic review was to determine factors that influence the survival and inactivation of enteric viruses on nonlaunderable soft surfaces. EBSCO and Web of Science were searched for experimental studies published between 1965 and 2015 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methods. Titles and abstracts were screened using 3 eligibility criteria. The quality of all study methods was also assessed. Our search yielded 12 articles. Viruses survived between 0 hours and 140 days depending on surface and environment conditions. Virus survival was influenced by temperature, relative humidity, organic content, and deposition method. A variety of chemistries were tested across studies and were shown to have a varied effect on enteric viruses. Chlorine, glutaraldehyde, vaporous ozone, and hydrogen peroxide were the most efficacious against enteric viruses (> 3-log reduction). Environmental factors, such as temperature and relative humidity, can influence survival of enteric viruses on nonlaunderable soft surfaces. The efficacy of liquid and vaporous chemistries are associated with surface and virus type. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Surgery and transplantation – Guidelines on Parenteral Nutrition, Chapter 18

PubMed Central

Weimann, A.; Ebener, Ch.; Holland-Cunz, S.; Jauch, K. W.; Hausser, L.; Kemen, M.; Kraehenbuehl, L.; Kuse, E. R.; Laengle, F.

2009-01-01

In surgery, indications for artificial nutrition comprise prevention and treatment of catabolism and malnutrition. Thus in general, food intake should not be interrupted postoperatively and the re-establishing of oral (e.g. after anastomosis of the colon and rectum, kidney transplantation) or enteral food intake (e.g. after an anastomosis in the upper gastrointestinal tract, liver transplantation) is recommended within 24 h post surgery. To avoid increased mortality an indication for an immediate postoperatively artificial nutrition (enteral or parenteral nutrition (PN)) also exists in patients with no signs of malnutrition, but who will not receive oral food intake for more than 7 days perioperatively or whose oral food intake does not meet their needs (e.g. less than 60–80%) for more than 14 days. In cases of absolute contraindication for enteral nutrition, there is an indication for total PN (TPN) such as in chronic intestinal obstruction with a relevant passage obstruction e.g. a peritoneal carcinoma. If energy and nutrient requirements cannot be met by oral and enteral intake alone, a combination of enteral and parenteral nutrition is indicated. Delaying surgery for a systematic nutrition therapy (enteral and parenteral) is only indicated if severe malnutrition is present. Preoperative nutrition therapy should preferably be conducted prior to hospital admission to lower the risk of nosocomial infections. The recommendations of early postoperative re-establishing oral feeding, generally apply also to paediatric patients. Standardised operative procedures should be established in order to guarantee an effective nutrition therapy. PMID:20049072

Enteric Viruses in Raw Vegetables and Groundwater Used for Irrigation in South Korea▿

PubMed Central

Cheong, Sooryun; Lee, Cheonghoon; Song, Sung Won; Choi, Weon Cheon; Lee, Chan Hee; Kim, Sang-Jong

2009-01-01

Raw vegetables irrigated with groundwater that may contain enteric viruses can be associated with food-borne viral disease outbreaks. In this study, we performed reverse transcription-PCR (RT-PCR) and cell culture-PCR to monitor the occurrence of enteric viruses in groundwater samples and in raw vegetables that were cultivated using that groundwater in South Korea. Samples were collected 10 times from three farms located in Gyeonggi Province, South Korea. RT-PCR and cell culture-PCR were performed to detect adenoviruses (AdVs), enteroviruses (EVs), noroviruses (NoVs), and rotaviruses, followed by sequence analyses of the detected strains. Of the 29 groundwater samples and the 30 vegetable samples, five (17%) and three (10%) were positive for enteric viruses, respectively. AdVs were the most frequently detected viruses in four groundwater and three vegetable samples. EVs and NoVs were detected in only one groundwater sample and one spinach sample, respectively. The occurrence of enteric viruses in groundwater and vegetable samples was not correlated with the water temperature and the levels of indicator bacteria, respectively. Phylogenetic analysis indicated that most of the detected AdVs were temporally distributed, irrespective of sample type. Our results indicate that raw vegetables may be contaminated with a broad range of enteric viruses, which may originate from virus-infected farmers and virus-contaminated irrigation water, and these vegetables may act as a potential vector of food-borne viral transmission. PMID:19854919

Flies and their bacterial loads in greyhound dog kennels in Kansas.

PubMed

Urban, J E; Broce, A

1998-03-01

Breeders of greyhound dogs traditionally feed racing animals and nursing bitches raw meat, and that meat generally is obtained frozen from commercial renderers. Previous studies have shown that the rendered meat is frequently contaminated with enteric bacteria, including Salmonella spp., and that during thawing the rendered meat is exposed to filth flies common in dog kennels. Nursing greyhound pups tend to experience a high morbidity and mortality from intestinal infections, and we attempted to determine in this study whether enterics could be spread to pups through contaminated flies. At intervals during 1995 and 1996, flies were trapped or were net-collected from 10 dog breeding kennels in the region around Abilene, KS. Trapped flies were identified and counted to determine population numbers, and netted flies were cultured in tetrathionate broth and streaked to medium selecting for Salmonella sp. and other lactose-negative Gram (-) bacteria. The relative numbers of different fly species varied with the sampling method, but traps and sweep nets produced similar proportions of the different fly species. Blow flies were twice as likely to be contaminated with enteric bacteria as any other fly. The most common enteric bacteria found were Proteus spp., followed by Providencia spp., Pseudomonas spp., and Salmonella spp. The incidence of Salmonella and Proteus spp. seemed to correlate more with accessibility of flies to dog excrement than to rendered meat. The apparent high incidence of enteric contamination of filth flies clearly implicates them as vectors of enteric diseases in kennels.

Efficacy of a Creon delayed-release pancreatic enzyme protocol for clearing occluded enteral feeding tubes.

PubMed

Stumpf, Janice L; Kurian, Rebecca M; Vuong, Jennifer; Dang, Kimberlyn; Kraft, Michael D

2014-04-01

Alkalinized Viokase pancreatic enzyme tablets restored patency to 71.9% of occluded Dobhoff tubes in a prospective study. After removal of Viokase tablets from the US market, the hospital protocol for unclogging enteral feeding tubes was adapted to use Creon pancreatic enzyme delayed-release capsules, despite the lack of published data. To evaluate the effectiveness of a Creon-based protocol to clear occluded enteral feeding tubes. This retrospective study included all adult and pediatric patients seen in the emergency department or in an inpatient setting who received Creon 12 000 units lipase delayed-release capsule dissolved in a solution of sodium bicarbonate 650 mg and sterile water for clearing occluded enteral feeding tubes between May 1 and November 30, 2010. The Creon protocol was deemed effective if tube clearance was documented in the medical record or if enteral feedings were resumed with no note regarding tube replacement. Alkalinized Creon delayed-release capsules were administered to 83 patients with a total of 118 clogged tubes. Three poorly documented cases and 5 tubes with mechanical clogs were excluded from data analysis. Patency was restored to 53 of 110 (48.2%) occluded tubes. More than 1 treatment course was attempted in 5 cases, with success in 3. An alkalinized Creon pancreatic enzyme protocol was effective in clearing approximately half of the occluded enteral feeding tubes in this retrospective study, an efficacy rate much less than that previously reported in the literature with a Viokase-based protocol.

Tubing misconnections: normalization of deviance.

PubMed

Simmons, Debora; Symes, Lene; Guenter, Peggi; Graves, Krisanne

2011-06-01

Accidental connection of an enteral system to an intravenous (IV) system frequently results in the death of the patient. Misconnections are commonly attributed to the presence of universal connectors found in the majority of patient care tubing systems. Universal connectors allow for tubing misconnections between physiologically incompatible systems. The purpose of this review of case studies of tubing misconnections and of current expert recommendations for safe tubing connections was to answer the following questions: In tubing connections that have the potential for misconnections between enteral and IV tubing, what are the threats to safety? What are patient outcomes following misconnections between enteral and IV tubing? What are the current recommendations for preventing misconnections between enteral and IV tubing? Following an extensive literature search and guided by 2 models of threats and errors, the authors analyzed case studies and expert opinions to identify technical, organizational, and human errors; patient-related threats; patient outcomes; and recommendations. A total of 116 case studies were found in 34 publications. Each involved misconnections of tubes carrying feedings, intended for enteral routes, to IV lines. Overwhelmingly, the recommendations were for redesign to eliminate universal connectors and prevent misconnections. Other recommendations were made, but the analysis indicates they would not prevent all misconnections. This review of the published case studies and current expert recommendations supports a redesign of connectors to ensure incompatibility between enteral and IV systems. Despite the cumulative evidence, little progress has been made to safeguard patients from tubing misconnections.

Presence and fate of coliphages and enteric viruses in three wastewater treatment plants effluents and activated sludge from Tunisia.

PubMed

Jebri, Sihem; Jofre, Juan; Barkallah, Insaf; Saidi, Mouldi; Hmaied, Fatma

2012-07-01

The role of water in the transmission of infectious diseases is well defined; it may act as a reservoir of different types of pathogens. Enteric viruses can survive and persist for a long time in water, maintaining infectivity in many instances. This suggests the need to include virus detection in the evaluation of the microbiological quality of waters. In this study, enteric viruses (enteroviruses and hepatitis A virus (HAV)) were investigated by RT-PCR and coliphages (known as indicators of viral contamination) were enumerated with the double-layer technique agar in effluents and sewage sludge from three Tunisian wastewater treatment plants. The molecular detection of enteric viruses revealed 7.7% of positive activated sludge samples for enteroviruses. None of the samples was positive for HAV. Molecular virus detection threshold was estimated to be 10(3) PFU/100 ml. All samples contained high concentrations of coliphages except those of dry sludge. Reductions in the concentrations of bacteriophages attained by the wastewater treatment plants are of the order of magnitude as reductions described elsewhere. Peak concentrations in raw wastewater were associated with winter rains and suspended materials rate in analysed samples. Our data which is the first in North Africa showed that similar trends of coliphages distribution to other studies in other countries. No clear correlation between studied enteric viruses and coliphages concentration was proved. Coliphages abundance in collected samples should raise concerns about human enteric viruses transmission as these residues are reused in agricultural fields.

Role of central nervous system glucagon-like Peptide-1 receptors in enteric glucose sensing.

PubMed

Knauf, Claude; Cani, Patrice D; Kim, Dong-Hoon; Iglesias, Miguel A; Chabo, Chantal; Waget, Aurélie; Colom, André; Rastrelli, Sophie; Delzenne, Nathalie M; Drucker, Daniel J; Seeley, Randy J; Burcelin, Remy

2008-10-01

Ingested glucose is detected by specialized sensors in the enteric/hepatoportal vein, which send neural signals to the brain, which in turn regulates key peripheral tissues. Hence, impairment in the control of enteric-neural glucose sensing could contribute to disordered glucose homeostasis. The aim of this study was to determine the cells in the brain targeted by the activation of the enteric glucose-sensing system. We selectively activated the axis in mice using a low-rate intragastric glucose infusion in wild-type and glucagon-like peptide-1 (GLP-1) receptor knockout mice, neuropeptide Y-and proopiomelanocortin-green fluorescent protein-expressing mice, and high-fat diet diabetic mice. We quantified the whole-body glucose utilization rate and the pattern of c-Fos positive in the brain. Enteric glucose increased muscle glycogen synthesis by 30% and regulates c-Fos expression in the brainstem and the hypothalamus. Moreover, the synthesis of muscle glycogen was diminished after central infusion of the GLP-1 receptor (GLP-1Rc) antagonist Exendin 9-39 and abolished in GLP-1Rc knockout mice. Gut-glucose-sensitive c-Fos-positive cells of the arcuate nucleus colocalized with neuropeptide Y-positive neurons but not with proopiomelanocortin-positive neurons. Furthermore, high-fat feeding prevented the enteric activation of c-Fos expression. We conclude that the gut-glucose sensor modulates peripheral glucose metabolism through a nutrient-sensitive mechanism, which requires brain GLP-1Rc signaling and is impaired during diabetes.

Interplay among gut microbiota, intestinal mucosal barrier and enteric neuro-immune system: a common path to neurodegenerative diseases?

PubMed

Pellegrini, Carolina; Antonioli, Luca; Colucci, Rocchina; Blandizzi, Corrado; Fornai, Matteo

2018-05-24

Neurological diseases, such as Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis (ALS) and multiple sclerosis, are often associated with functional gastrointestinal disorders. These gastrointestinal disturbances may occur at all stages of the neurodegenerative diseases, to such an extent that they are now considered an integral part of their clinical picture. Several lines of evidence support the contention that, in central neurodegenerative diseases, changes in gut microbiota and enteric neuro-immune system alterations could contribute to gastrointesinal dysfunctions as well as initiation and upward spreading of the neurologic disorder. The present review has been intended to provide a comprehensive overview of the available knowledge on the role played by enteric microbiota, mucosal immune system and enteric nervous system, considered as an integrated network, in the pathophysiology of the main neurological diseases known to be associated with intestinal disturbances. In addition, based on current human and pre-clinical evidence, our intent was to critically discuss whether changes in the dynamic interplay between gut microbiota, intestinal epithelial barrier and enteric neuro-immune system are a consequence of the central neurodegeneration or might represent the starting point of the neurodegenerative process. Special attention has been paid also to discuss whether alterations of the enteric bacterial-neuro-immune network could represent a common path driving the onset of the main neurodegenerative diseases, even though each disease displays its own distinct clinical features.

Characterization of the duck enteritis virus UL55 protein

PubMed Central

2011-01-01

Background Characteration of the newly identified duck enteritis virus UL55 gene product has not been reported yet. Knowledge of the protein UL55 can provide useful insights about its function. Results The newly identified duck enteritis virus UL55 gene was about 561 bp, it was amplified and digested for construction of a recombinant plasmid pET32a(+)/UL55 for expression in Escherichia coli. SDS-PAGE analysis revealed the recombinant protein UL55(pUL55) was overexpressed in Escherichia coli BL21 host cells after induction by 0.2 mM IPTG at 37°C for 4 h and aggregated as inclusion bodies. The denatured protein about 40 KDa named pUL55 was purified by washing five times, and used to immune rabbits for preparation of polyclonal antibody. The prepared polyclonal antibody against pUL55 was detected and determined by Agar immundiffusion and Neutralization test. The results of Wstern blotting assay and intracellular analysis revealed that pUL55 was expressed most abundantly during the late phase of replication and mainly distributed in cytoplasm in duck enteritis virus infected cells. Conclusions In this study, the duck enteritis virus UL55 protein was successfully expressed in prokaryotic expression system. Besides, we have prepared the polyclonal antibody against recombinant prtein UL55, and characterized some properties of the duck enteritis virus UL55 protein for the first time. The research will be useful for further functional analysis of this gene. PMID:21609474

Comparison of clinical characteristics and laboratory findings of malaria, dengue, and enteric fever in returning travelers: 8-year experience at a referral center in Tokyo, Japan.

PubMed

Kutsuna, Satoshi; Hayakawa, Kayoko; Kato, Yasuyuki; Fujiya, Yoshihiro; Mawatari, Momoko; Takeshita, Nozomi; Kanagawa, Shuzo; Ohmagari, Norio

2015-07-01

Without specific symptoms, diagnosis of febrile illness in returning travelers is challenging. Dengue, malaria, and enteric fever are common causes of fever in returning travelers and timely and appropriate treatment is important. However, differentiation is difficult without specific diagnostic tests. A retrospective study was conducted at the National Centre for Global Health and Medicine (NCGM) from April 2005 to March 2013. Febrile travelers returning from overseas who were diagnosed with dengue, malaria, or enteric fever were included in this study. Clinical characteristics and laboratory findings were compared for each diagnosis. During the study period, 86 malaria, 85 dengue, and 31 enteric fever cases were identified. The mean age of the study cohort was 33.1 ± 12 years and 134 (66.3%) study participants were male. Asia was the most common area visited by returning travelers with fevers (89% of dengue, 18.6% of malaria, and 100% of enteric fever cases), followed by Africa (1.2% of dengue and 70.9% of malaria cases). Clinical characteristics and laboratory findings were significantly different among each group with each diagnosis. Decision tree models revealed that returning from Africa and CRP levels < 10 mg/L were factors specific for diagnosis of malaria and dengue fever, respectively. Clinical manifestations, simple laboratory test results, and regions of travel are helpful to distinguish between dengue, malaria, and enteric fever in febrile returning travelers with non-specific symptoms.

Enteric Fever in a Tertiary Paediatric Hospital: A Retrospective Six-Year Review.

PubMed

Ahmad Hatib, Nur Adila; Chong, Chia Yin; Thoon, Koh Cheng; Tee, Nancy Ws; Krishnamoorthy, Subramania S; Tan, Natalie Wh

2016-07-01

Enteric fever is a multisystemic infection which largely affects children. This study aimed to analyse the epidemiology, clinical presentation, treatment and outcome of paediatric enteric fever in Singapore. A retrospective review of children diagnosed with enteric fever in a tertiary paediatric hospital in Singapore was conducted from January 2006 to January 2012. Patients with positive blood cultures for Salmonella typhi or paratyphi were identified from the microbiology laboratory information system. Data was extracted from their case records. Of 50 enteric fever cases, 86% were due to Salmonella typhi, with 16.3% being multidrug resistant (MDR) strains. Sixty-two percent of S. typhi isolates were of decreased ciprofloxacin susceptibility (DCS). Five cases were both MDR and DCS. The remaining 14% were Salmonella paratyphi A. There were only 3 indigenous cases. Ninety-four percent had travelled to typhoid-endemic countries, 70.2% to the Indian subcontinent and the rest to Indonesia and Malaysia. All patients infected with MDR strains had travelled to the Indian subcontinent. Anaemia was a significant finding in children with typhoid, as compared to paratyphoid fever (P = 0.04). Although all children were previously well, 14% suffered severe complications including shock, pericardial effusion and enterocolitis. None had typhoid vaccination prior to their travel to developing countries. Enteric fever is largely an imported disease in Singapore and has contributed to significant morbidity in children. The use of typhoid vaccine, as well as education on food and water hygiene to children travelling to developing countries, needs to be emphasised.

Options for addressing exocrine pancreatic insufficiency in patients receiving enteral nutrition supplementation.

PubMed

Freedman, Steven D

2017-07-01

Patients with exocrine pancreatic insufficiency (EPI) have suboptimal secretion of pancreatic digestive enzymes and experience a range of clinical symptoms related to the malabsorption of fat. In patients with EPI unable to meet their nutritional requirements, enteral nutrition (EN) support is used to augment nutritional status. In addition to protein and carbohydrate, EN formulas contain fats as a calorie source, as well as vitamins and minerals to help prevent nutritional deficiencies related to malabsorption. Semielemental enteral nutrition formulas are advantageous as they contain hydrolyzed protein, shorter chain carbohydrates, and may contain medium chain triglycerides as a fat source. However, severely pancreatic insufficient patients may be unable to absorb complex long-chain triglycerides provided by EN formulas due to insufficient pancreatic lipase; replacement pancreatic enzyme products are recommended for these patients. Currently, none of the FDA-approved pancreatic enzyme replacement therapy (PERT) products are indicated for use in patients receiving enteral nutrition and administration of enzymes by mixing into enteral nutrition formula is not supported by guidelines as this route is associated with risks. RELiZORB (immobilized lipase) is a novel in-line digestive cartridge that has been designed to address the unmet need for PERT in patients receiving enteral nutrition. RELiZORB efficacy and compatibility with a range of commercially available polymeric and semielemental formulas with varying nutrient, caloric content, and triglyceride chain lengths have been demonstrated. In most formulas, RELiZORB efficiently hydrolyzed greater than 90% of fats within the formula into absorbable fatty acids and monoglycerides.

Effects of different doses, enteric-coated preparation of aspirin, and sex on urinary 11-dehydrothromboxane B2 in healthy volunteers.

PubMed

Dharmasaroja, Pornpatr A; Sae-Lim, Suvaraporn

2010-10-01

There is scarce information about the effects of different doses and enteric-coated preparation of aspirin on platelet function, especially in Asian people, evaluated by the measurement of urinary 11-dehydrothromboxane B2 (dTXB2). The objective of the present study was to assess the effects of different doses, enteric-coated preparation of aspirin, sex and also the effects of timing of urine collection on urinary dTXB2 level in healthy volunteers. Thirty healthy volunteers were included. Each volunteer took three preparations of aspirin (aspirin 81 mg, enteric-coated aspirin 300 mg and aspirin 300 mg) for 7 days. Urine dTXB2 level was measured at baseline, day 3, and day 7 after taking each preparation of aspirin. There was no significant difference in the effects of different doses of aspirin (81 vs. 300 mg, 50.7 vs. 61.8 ng/mmol creatinine, P = 0.248), preparations (enteric-coated vs. nonenteric-coated aspirin, 61.8 vs. 67.9 ng/mmol creatinine, P = 0.527) and time of urine collection (day 3 vs. day 7, 51.7 vs. 49.9 ng/mmol creatinine, P = 0.448). Female volunteers showed a trend to have higher urinary dTXB2 than male volunteers at baseline and after taking aspirin. This study showed no significant difference in urinary dTXB2 level after taking different doses and enteric-coated preparation of aspirin in healthy volunteers.

Ionized and total magnesium concentrations in blood from dogs with naturally acquired parvoviral enteritis.

PubMed

Mann, F A; Boon, G D; Wagner-Mann, C C; Ruben, D S; Harrington, D P

1998-05-01

To determine whether pretreatment total and ionized blood magnesium concentrations were associated with outcome for dogs with parvoviral enteritis and whether ionized magnesium concentration was related to total magnesium concentration or other laboratory values. Prospective cohort study. 61 healthy dogs and 72 dogs with parvoviral enteritis. Total, ionized, and pH-normalized ionized magnesium concentrations, ionized and pH-normalized ionized calcium concentrations, pH, sodium and potassium concentrations, and Hct were measured prior to treatment. chi 2 Analyses were used to test for associations between outcome and age and between outcome and treatment with antiendotoxin antibody. Pearson's correlation coefficients were calculated to determine whether ionized magnesium concentration was linearly associated with other laboratory values. Total and ionized magnesium concentrations were not significantly different between healthy dogs and dogs with parvoviral enteritis or between dogs surviving and those not surviving parvoviral enteritis. The only laboratory value strongly correlated with ionized magnesium concentration was pH-normalized ionized magnesium concentration. Of the factors tested, none were significantly associated with outcome, except that dogs 16 weeks old or less treated with antiendotoxin antibody were significantly more likely to die than were dogs 16 weeks old or less that were not treated with antiendotoxin antibody. Total and ionized blood magnesium concentrations cannot be used to consistently predict outcome for dogs with parvoviral enteritis. Antiendotoxin antibody should be used with caution in dogs 16 weeks old or less.

Assessing Health Professional Students' Cultural Competence Using a Global Perspective.

PubMed

Jones, Sophia; Pinto-Zipp, Genevieve

2017-01-01

The United States has become a diverse society, and healthcare professionals must view culture from a global perspective. The purpose of this study was to determine cultural competence levels of entering and exiting health science students within and across differing professional programs using the Global Worldview Cultural Competence Survey (GWCCS). 196 students participated in the study: 146 were entering students and 59 were exiting students. From the 146 entering students, 138 surveys were usable in the data analysis, and 58 of the 59 exiting were usable. Two separate cohorts of health professional students completed the GWCCS. Cohort 1 completed the GWCCS during the first 2 weeks of their academic program, and Cohort 2 completed the GWCCS in their final-year post-clinical experience. A significant difference in GWCCS total score was observed between entering and exiting students in health sciences, with the exiting students being more culturally competent. Although this study did not utilize a longitudinal study design, the findings demonstrate that the exiting cohort of health science students was more culturally competent than the entering cohort of health science students as determined by the GWCCS. However, neither cohort of students reached the level of proficiency.

Factors related to nursing students' readiness to enter working life - A scoping literature review.

PubMed

Järvinen, Tiina; Eklöf, Niina; Salminen, Leena

2018-03-01

The aim of this scoping literature review was to identify the factors related to nursing students' readiness to enter working life. The literature search was carried out in autumn 2017 in PubMed and CINAHL databases. The studies selected for this review (n = 17) were analyzed thematically with inductive content analysis. Four subthemes that were combined into two main factors related to nursing students' readiness to enter working life were found. The main factors found were 1) educational factors and 2) personal factors. Educational factors consisted of professional competence and clinical practice, while personal factors consisted of nursing students' background and feelings. Some nursing students tend to feel insecure about entering working life as a newly graduated nurse. This literature review also supports the importance of clinical practice periods in nursing education and for readiness for working life. Nurse education needs to ensure clinical practice periods which support nursing students' professional growth. Further research is needed on how the factors related to nursing students' readiness to enter working life correlate with each other. Particularly, the association between competence, readiness and positive feelings towards graduation needs further investigation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Survival of the Fittest: How Bacterial Pathogens Utilize Bile To Enhance Infection

PubMed Central

Sistrunk, Jeticia R.; Nickerson, Kourtney P.; Chanin, Rachael B.; Rasko, David A.

2016-01-01

SUMMARY Bacterial pathogens have coevolved with humans in order to efficiently infect, replicate within, and be transmitted to new hosts to ensure survival and a continual infection cycle. For enteric pathogens, the ability to adapt to numerous host factors under the harsh conditions of the gastrointestinal tract is critical for establishing infection. One such host factor readily encountered by enteric bacteria is bile, an innately antimicrobial detergent-like compound essential for digestion and nutrient absorption. Not only have enteric pathogens evolved to resist the bactericidal conditions of bile, but these bacteria also utilize bile as a signal to enhance virulence regulation for efficient infection. This review provides a comprehensive and up-to-date analysis of bile-related research with enteric pathogens. From common responses to the unique expression of specific virulence factors, each pathogen has overcome significant challenges to establish infection in the gastrointestinal tract. Utilization of bile as a signal to modulate virulence factor expression has led to important insights for our understanding of virulence mechanisms for many pathogens. Further research on enteric pathogens exposed to this in vivo signal will benefit therapeutic and vaccine development and ultimately enhance our success at combating such elite pathogens. PMID:27464994

Experimental study of the embryogenesis of gastrointestinal duplication and enteric cyst.

PubMed

Emura, Takaki; Hashizume, Kohei; Asashima, Makoto

2003-05-01

The theory of gastrointestinal duplication and enteric cyst embryogenesis was verified by examining the developmental process of this experimentally induced anomaly. In Cynopus pyrrhogaster (amphibian) embryos (stage 18), the dorsal midline structures (including the neural plate and notochord) were split regionally to induce partial separation of the notochord and gut anlage endoderm herniation between the split elements of the notochord. Following this procedure, the embryonic development was traced morphologically and histologically. Control embryos were cultured without the procedure. Following the incubation and breeding period, gastrointestinal duplication and enteric cysts were observed with vertebral anomaly, spina bifida, split cord malformation and subcutaneous manifestations in the mature animals. The combination of anomalies that was observed in these experimental animals is consistent with that found in "split notochord syndrome." No abnormal morphology or histology was observed in the control group. The embryogenetic theory of gastrointestinal duplication and enteric cysts was thus verified by simulating the partial separation of the notochord, which induced split notochord syndrome in laboratory animals. The results indicate that gastrointestinal duplication and enteric cysts may arise through a process of herniation of the gut anlage endoderm between split elements of the notochord.

Enteric pathogen-plant interactions: molecular connections leading to colonization and growth and implications for food safety.

PubMed

Martínez-Vaz, Betsy M; Fink, Ryan C; Diez-Gonzalez, Francisco; Sadowsky, Michael J

2014-01-01

Leafy green vegetables have been identified as a source of foodborne illnesses worldwide over the past decade. Human enteric pathogens, such as Escherichia coli O157:H7 and Salmonella, have been implicated in numerous food poisoning outbreaks associated with the consumption of fresh produce. An understanding of the mechanisms responsible for the establishment of pathogenic bacteria in or on vegetable plants is critical for understanding and ameliorating this problem as well as ensuring the safety of our food supply. While previous studies have described the growth and survival of enteric pathogens in the environment and also the risk factors associated with the contamination of vegetables, the molecular events involved in the colonization of fresh produce by enteric pathogens are just beginning to be elucidated. This review summarizes recent findings on the interactions of several bacterial pathogens with leafy green vegetables. Changes in gene expression linked to the bacterial attachment and colonization of plant structures are discussed in light of their relevance to plant-microbe interactions. We propose a mechanism for the establishment and association of enteric pathogens with plants and discuss potential strategies to address the problem of foodborne illness linked to the consumption of leafy green vegetables.

Clinical and economic evaluation of BBL CHROMagar Salmonella (CHROMSal) versus subculture after selenite broth enrichment to CHROMSal and Hektoen enteric agars to detect enteric Salmonella in a large regional microbiology laboratory.

PubMed

Church, Deirdre L; Emshey, Diana; Lloyd, Tracie; Pitout, Johann

2010-09-01

Stool culture for enteric pathogens is one of the most labor-intensive clinical microbiology procedures. Direct plating of stool to BBL CHROMagar Salmonella (CHROMSal) (BD Diagnostics, Sparks, MD) versus subculture after selenite broth enrichment (Sel) to CHROMSal (Sel-CHROMSal) and Hektoen enteric agar (Sel-Hek) (PML Microbiologicals, Eugene, OR) to detect Salmonella were compared. The number of colony picks and biochemical/serotyping tests per plate was recorded. A cost comparison was done. Fifty-one of 2999 (1.7%) stools yielded Salmonella sp., and 80% of isolates grew on CHROMSal by 24 h. CHROMSal demonstrated much less false-positive growth compared to Sel-Hek (P < 0.0001), which reduced biochemical and serotyping tests by 85% and 20%, respectively. Sel-CHROMSal and CHROMSal versus Sel-Hek improved enteric Salmonella detection when compared to a true positive "gold standard" (i.e., recovery by any culture method) with a sensitivity, specificity, positive predictive value, and negative predictive value of 100% and 94.12%, 100% and 99.97%, 100% and 97.96%, and 100% and 99.90%, respectively. CHROMSal use would result in substantial cost and labor savings.

Enteric fever burden in North Jakarta, Indonesia: a prospective, community-based study.

PubMed

Punjabi, Narain H; Agtini, Magdarina D; Ochiai, R Leon; Simanjuntak, Cyrus H; Lesmana, Murad; Subekti, Decy; Oyofo, Buhari A; von Seidlein, Lorenz; Deen, Jacqueline; Shin, Seonghye; Acosta, Camilo; Wangsasaputra, Ferry; Pulungsih, Sri P; Saroso, Santoso; Suyeti, Suyeti; R, Suharno; Sudarmono, Pratiwi; Syarurachman, Agus; Suwandono, Agus; Arjoso, Sumarjati; Beecham, H James; Corwin, Andrew L; Clemens, John D

2013-11-15

We undertook a prospective community-based study in North Jakarta, Indonesia, to determine the incidence, clinical characteristics, seasonality, etiologic agent, and antimicrobial susceptibility pattern of enteric fever. Following a census, treatment centre-based surveillance for febrile illness was conducted for two-years. Clinical data and a blood culture were obtained from each patient. In a population of 160,261, we detected 296 laboratory-confirmed enteric fever cases during the surveillance period, of which 221 (75%) were typhoid fever and 75 (25%)  were paratyphoid fever.  The overall incidence of typhoid and paratyphoid cases was 1.4, and 0.5 per thousand populations per year, respectively. Although the incidence of febrile episodes evaluated was highest among children under 5 years of age at 92.6 per thousand persons per year, we found that the burden of typhoid fever was greatest among children between 5 and 20 years of age. Paratyphoid fever occurred most commonly in children and was infrequent in adults. Enteric fever is a public health problem in North Jakarta with a substantial proportion due to paratyphoid fever. The results highlight the need for control strategies against enteric fever.

Do we still need to collect stool? Evaluation of visualized fatty acid absorption: experimental studies using rats.

PubMed

Chiba, T; Ohi, R

1998-01-01

Short-gut syndrome is likely to impair enteric fat utilization. This study was undertaken to develop a clinical test of lipid absorption without fecal collection. The absorption of enterally fed radioactive long-chain fatty acid, beta-methyl-p-(123I)-iodophenylpentadecanoic acid was investigated with continuous chyle collection in rats. The changes in excretion and time-dependent biodistribution of radioactivity of the enterally fed agent were assessed in normal control animals. Similarly, sequential urinary excretion and biodistribution were studied along with scintigraphy using sham-operated and short-gut animals. Approximately 64% of the enterally fed radioactivity was recovered in the collected chyle (24 hours). A comparison of normal control, sham-operated, and short-gut animals showed significantly less urinary and greater fecal excretions of radioactivity in short-gut animals. With the use of sequential scintigraphy, the small intestine, whole-body soft tissues, and urinary bladder were well visualized in sham-operated animals, whereas the large intestine and feces were demonstrated earlier in short-gut animals. Our results suggest that enteral feeding of the agent might be feasible for determining lipid absorption from the the dynamic changes of radioactivity in visualized abdominal organs and in urine.

The nature of catecholamine-containing neurons in the enteric nervous system in relationship with organogenesis, normal human anatomy and neurodegeneration.

PubMed

Natale, G; Ryskalin, L; Busceti, C L; Biagioni, F; Fornai, F

2017-09-01

The gastrointestinal tract is provided with extrinsic and intrinsic innervation. The extrinsic innervation includes the classic vagal parasympathetic and sympathetic components, with afferent sensitive and efferent secretomotor fibers. The intrinsic innervations is represented by the enteric nervous system (ENS), which is recognized as a complex neural network controlling a variety of cell populations, including smooth muscle cells, mucosal secretory cells, endocrine cells, microvasculature, immune and inflammatory cells. This is finalized to regulate gastrointestinal secretion, absorption and motility. In particular, this network is organized in several plexuses each one providing quite autonomous control of gastrointestinal functions (hence the definition of "second brain"). The similarity between ENS and CNS is further substantiated by the presence of local sensitive pseudo- unipolar ganglionic neurons with both peripheral and central branching which terminate in the enteric wall. A large variety of neurons and neurotransmitters takes part in the ENS. However, the nature of these neurons and their role in the regulation of gastrointestinal functions is debatable. In particular, the available literature reporting the specific nature of catecholamine- containing neurons provides conflicting evidence. This is critical both for understanding the specific role of each catecholamine in the gut and, mostly, to characterize specifically the enteric neuropathology occurring in a variety of diseases. An emphasis is posed on neurodegenerative disorders, such as Parkinson's disease, which is associated with the loss of catecholamine neurons. In this respect, the recognition of the nature of such neurons within the ENS would contribute to elucidate the pathological mechanisms which produce both CNS and ENS degeneration and to achieve more effective therapeutic approaches. Despite a great emphasis is posed on the role of noradrenaline to regulate enteric activities only a few reports are available on the anatomy and physiology of enteric dopamine neurons. Remarkably, this review limits the presence of enteric noradrenaline (and adrenaline) only within extrinsic sympathetic nerve terminals. This is based on careful morphological studies showing that the only catecholamine-containing neurons within ENS would be dopaminergic. This means that enteric pathology of catecholamine neurons should be conceived as axon pathology for noradrenaline neurons and whole cell pathology for dopamine neurons which would be the sole catecholamine cell within intrinsic circuitries affecting gut motility and secretions.The gastrointestinal tract is provided with extrinsic and intrinsic innervation. The extrinsic innervation includes the classic vagal parasympathetic and sympathetic components, with afferent sensitive and efferent secretomotor fibers. The intrinsic innervations is represented by the enteric nervous system (ENS), which is recognized as a complex neural network  controlling a variety of cell populations, including smooth muscle cells, mucosal secretory cells, endocrine cells, microvasculature, immune and inflammatory cells. This is finalized to regulate gastrointestinal secretion, absorption and motility. In particular, this network is organized in several plexuses each one providing quite autonomous control of gastrointestinal functions (hence the definition of "second brain"). The similarity between ENS and CNS is further substantiated by the presence of local sensitive pseudounipolar ganglionic neurons with both peripheral and central branching which terminate in the enteric wall. A large variety of neurons and neurotransmitters takes part in the ENS. However, the nature of these neurons and their role in the regulation of gastrointestinal functions is debatable. In particular, the available literature reporting the specific nature of catecholamine-containing neurons provides conflicting evidence. This is critical both for understanding the specific role of each catecholamine in the gut and, mostly, to characterize specifically the enteric neuropathology occurring in a variety of diseases. An emphasis is posed on neurodegenerative disorders, such as including Parkinson's disease, which is associated with the loss of catecholamine neurons. In this respect, the recognition of the nature of such neurons within the ENS would contribute to elucidate the pathological mechanisms which produce both CNS and ENS degeneration and to achieve more effective therapeutic approaches. Despite a great emphasis is posed on the role of noradrenaline to regulate enteric activities only a few reports are available on the anatomy and physiology of enteric dopamine neurons. Remarkably, this review limits the presence of enteric noradrenaline (and adrenaline) only within extrinsic sympathetic nerve terminals. This is based on careful morphological studies showing that the only catecholamine-containing neurons within ENS would be dopaminergic. This means that enteric pathology of catecholamine neurons should be conceived as axon pathology for noradrenaline neurons and whole cell pathology for dopamine neurons which would be the sole catecholamine cell within intrinsic circuitries affecting gut motility and secretions.

32 CFR 1806.3 - Procedures governing acceptance of service of process.

Code of Federal Regulations, 2011 CFR

2011-07-01

... physically located, process servers generally will not be allowed to enter CIA Headquarters for the purpose... sole discretion of the Director, NACIC, process servers will generally not be permitted to enter NACIC...

32 CFR 635.29 - Domestic violence and protection orders.

Code of Federal Regulations, 2013 CFR

2013-07-01

... COPS, and entered into NCIC. Violations of a military Protection Order may be violations of Article 92... order. Violations of a civilian Protection Order must be reported on DA Form 3975, entered into COPS...

32 CFR 635.29 - Domestic violence and protection orders.

Code of Federal Regulations, 2014 CFR

2014-07-01

... COPS, and entered into NCIC. Violations of a military Protection Order may be violations of Article 92... order. Violations of a civilian Protection Order must be reported on DA Form 3975, entered into COPS...

32 CFR 635.29 - Domestic violence and protection orders.

Code of Federal Regulations, 2011 CFR

2011-07-01

... COPS, and entered into NCIC. Violations of a military Protection Order may be violations of Article 92... order. Violations of a civilian Protection Order must be reported on DA Form 3975, entered into COPS...

78 FR 66984 - U.S. National Commission for UNESCO; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-07

..., and Cultural Organization (UNESCO) will take place on Monday, December 16, 2013, at the U.S... to validate the identity of individuals who enter Department facilities. The data will be entered...

2. CONFLUENCE POOL, DETAIL OF TUNNEL PORTAL WITH WATER ENTERING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. CONFLUENCE POOL, DETAIL OF TUNNEL PORTAL WITH WATER ENTERING FROM SANTA ANA RIVER. VIEW TO NORTHEAST. - Santa Ana River Hydroelectric System, Bear Creek Diversion Dam & Confluence Pool, Redlands, San Bernardino County, CA

22 CFR 181.7 - Transmittal to the Congress.

Code of Federal Regulations, 2013 CFR

2013-04-01

... section 12 of the Taiwan Relations Act (22 U.S.C. 3311), any agreement entered into between the American Institute in Taiwan and the governing authorities on Taiwan, or any agreement entered into between the...

22 CFR 181.7 - Transmittal to the Congress.

Code of Federal Regulations, 2014 CFR

2014-04-01

... section 12 of the Taiwan Relations Act (22 U.S.C. 3311), any agreement entered into between the American Institute in Taiwan and the governing authorities on Taiwan, or any agreement entered into between the...

22 CFR 181.7 - Transmittal to the Congress.

Code of Federal Regulations, 2012 CFR

2012-04-01

... section 12 of the Taiwan Relations Act (22 U.S.C. 3311), any agreement entered into between the American Institute in Taiwan and the governing authorities on Taiwan, or any agreement entered into between the...

22 CFR 181.7 - Transmittal to the Congress.

Code of Federal Regulations, 2011 CFR

2011-04-01

... section 12 of the Taiwan Relations Act (22 U.S.C. 3311), any agreement entered into between the American Institute in Taiwan and the governing authorities on Taiwan, or any agreement entered into between the...

Get More TVDG Info

Science.gov Websites

FAX number: (necessary if you want our information package) Enter your E-Mail address: Use this input area to enter any comments or questions: Thanks for your input. Request Info Clear lampline Go to TVDG

32 CFR 644.448 - Limits on government obligation to restore.

Code of Federal Regulations, 2010 CFR

2010-07-01

... they were in at the time of entering into possession, reasonable and ordinary wear and tear, and... the condition that existed at time of entering into possession, reasonable and ordinary wear and tear...

6. DOUBLE METAL DOORS ON WEST SIDE WITH CABLES ENTERING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. DOUBLE METAL DOORS ON WEST SIDE WITH CABLES ENTERING GROUND AT NORTH END OF BUILDING. - Chollas Heights Naval Radio Transmitting Facility, Helix House, 6410 Zero Road, San Diego, San Diego County, CA

Pettit enters data in a laptop computer

NASA Image and Video Library

2012-03-13

ISS030-E-142862 (13 March 2012) --- NASA astronaut Don Pettit, Expedition 30 flight engineer, enters data in a computer while working with Robonaut 2 humanoid robot in the Destiny laboratory of the International Space Station.

Cut at eastern approach, with portal obscured by train entering ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Cut at eastern approach, with portal obscured by train entering tunnel, looking NNW. - Philadelphia & Reading Railroad, Black Rock Tunnel, Beneath Black Rock Hill, southwest of Black Rock Dam, Phoenixville, Chester County, PA

Enteric viruses

USDA-ARS?s Scientific Manuscript database

Characteristic clinical signs associated with viral enteritis in young poultry include diarrhea, anorexia, litter eating, ruffled feathers, and poor growth. Intestines may have lesions; intestines are typically dilated and are filled with fluid and gaseous contents. The sequela to clinical disease...

OCCURRENCE OF ENTERIC VIRUSES IN SURFACE WATERS

EPA Science Inventory

Human enteric viruses cause a number of diseases when individuals are exposed to contaminated drinking & recreational waters. Vaccination against poliovirus has virtually eliminated poliomyelitis from the planet. Other members of enterovirus group cause numerous diseases. Hepatit...

Voyager 1 Entering Interstellar Space Artist Concept

NASA Image and Video Library

2013-09-12

This artist concept depicts NASA Voyager 1 spacecraft entering interstellar space. Interstellar space is dominated by the plasma, or ionized gas, that was ejected by the death of nearby giant stars millions of years ago.

Theory of Tumbling Bodies Entering Planetary Atmospheres with Application to Probe Vehicles and the Australian Tektites

NASA Technical Reports Server (NTRS)

Tobak, Murray; Peterson, Victor L.

1964-01-01

The tumbling motion of aerodynamically stable bodies entering planetary atmospheres is analyzed considering that the tumbling, its arrest, and the subsequent oscillatory motion are governed by the equation for the fifth Painleve' transcendent. Results based on the asymptotic behavior of the transcendent are applied to study (1) the oscillatory behavior of planetary probe vehicles in relation to aerodynamic heating and loads and (2) the dynamic behavior of the Australian tektites on entering the Earth's atmosphere, under the hypothesis that their origin was the Moon.

Gas gangrene of the abdominal wall due to late-onset enteric fistula after polyester mesh repair of an incisional hernia.

PubMed

Moussi, A; Daldoul, S; Bourguiba, B; Othmani, D; Zaouche, A

2012-04-01

The occurrence of enteric fistulae after wall repair using a prosthetic mesh is a serious but, fortunately, rare complication. We report the case of a 66-year-old diabetic man who presented with gas gangrene of the abdominal wall due to an intra-abdominal abscess caused by intestinal erosion six years after an incisional hernia repair using a polyester mesh. The aim of this case report is to illustrate the seriousness of enteric fistula after parietal repair using a synthetic material.

Data on metals (Zn, Al, Sr, and Co) and metalloid (As) concentration levels of ballast water in commercial ships entering Bushehr port, along the Persian Gulf.

PubMed

Soleimani, Farshid; Dobaradaran, Sina; Hayati, Abdolreza; Khorsand, Maryam; Keshtkar, Mozhgan

2016-12-01

In this article, we determined the concentration levels of metals including Zn, Al, Sr, and Co and metalloid of As of ballast water in commercial ships entering Bushehr port, along the Persian Gulf. Ballast water samples were taken from commercial ships entering Bushehr port from 34 ports around the world during 15 February and 25 August 2016. The concentration levels of metals and metalloid were determined by using a graphite furnace absorption spectrometer (AAS).

Nothing New Under the Sun: Benefiting from the Great Lessons of History to Develop a Coherent Cyberspace Deterrence Strategy

DTIC Science & Technology

2012-05-12

LESSONS OF HISTORY TO DEVELOP A COHERENT CYBERSPACE DETERRENCE STRATEGY 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHDR!SI 5d. PROJECT ...AFOSR-82-1234. 5c. PROGRAM ELEMENT NUMBER. Enter all program element numbers as they appear in the report, e.g. 61101 A. 5d. PROJECT NUMBER...Enter all project numbers as they appear in the report, e.g. 1F665702D1257; ILIR. 5e. TASK NUMBER. Enter all task numbers as they appear in the

Nutritional assessment using stable isotope ratios of carbon and nitrogen in the scalp hair of geriatric patients who received enteral and parenteral nutrition formulas.

PubMed

Hayasaka, M; Ogasawara, H; Hotta, Y; Tsukagoshi, K; Kimura, O; Kura, T; Tarumi, T; Muramatsu, H; Endo, T

2017-12-01

The δ 13 C and δ 15 N values in the scalp hair of geriatric patients in Japan who received the enteral or parenteral nutrition formula were measured to assess nutritional status. The relations among δ 13 C, δ 15 N, calorie intake, BMI, albumin concentration, total cholesterol (T-CHO) and geriatric nutritional risk index (GNRI) in the patients were investigated. Furthermore, the enrichment of δ 13 C and δ 15 N from the nutrients to the hair was investigated. The δ 13 C values in the hair of patients who received enteral nutrition decreased with decreases in the calories received, while the δ 15 N values increased, suggesting malnutrition in some patients with a low calorie intake due to a negative nitrogen balance. The distribution of patients with a low calorie intake (below 20 kcal/kg/day) when δ 13 C was plotted against δ 15 N differed from that of control subjects, but the distribution of patients with a high calorie intake (above 20 kcal/kg/day) was similar to that of control subjects. No significant differences were observed in BMI, albumin concentration, T-CHO or GNRI between the low and high calorie groups. The enrichment of δ 13 C and δ 15 N from the enteral nutrients to the hair were inversely correlated with the δ 13 C and δ 15 N in the enteral nutrients. The enrichment levels of δ 13 C and δ 15 N tended to be higher and lower, respectively, in the high calorie group. On the other hand, the δ 13 C and δ 15 N values in the hair of patients who received parenteral nutrition were higher and lower than those in the control subjects and in the patients who received enteral nutrition, respectively, reflecting the higher δ 13 C and lower δ 15 N contents of the parenteral nutrients. The δ 13 C and δ 15 N values in the hair of patients who received enteral nutrition may be effective indicators for evaluating the long-term nutritional status of geriatric patients. A calorie intake of 20 kcal/kg/day may be a cut-off value for malnutrition in Japanese geriatric patients receiving enteral nutrition. However, caution is necessary when dealing with patients switching from parental nutrition as parenteral nutrition resulted in different changes in δ 13 C and δ 15 N. The enrichment levels of δ 13 C and δ 15 N from the enteral nutrients to the hair may be inversely correlated with the δ 13 C and δ 15 N values of enteral nutrients and vary according to the calorie intake. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Quantitative risk assessment to compare the risk of rabies entering the UK from Turkey via quarantine, the Pet Travel Scheme and the EU Pet Movement Policy.

PubMed

Ramnial, V; Kosmider, R; Aylan, O; Freuling, C; Müller, T; Fooks, A R

2010-08-01

Rabies was eradicated from the UK in 1922 through strict controls of dog movement and investigation of every incident of disease. Amendments were made to the UK quarantine laws and the Pet Travel Scheme (PETS) was subsequently introduced in 2000 for animals entering the UK from qualifying listed countries. European Regulation 998/2003 on the non-commercial movement of pet animals initiated the European Union Pet Movement Policy (EUPMP) in July 2004. The introduction of EUPMP harmonized the movement of pet animals within the EU (EUPMP(listed)) but raised the possibility of domestic animals entering the UK from a non-EU state where rabies is endemic (EUPMP(unlisted)). A quantitative risk assessment was developed to estimate the risk of rabies entering the UK from Turkey via companion animals that are incubating the disease and enter through PETS or EUPMP compared to quarantine. Specifically, the risk was assessed by estimating the annual probability of rabies entering the UK and the number of years between rabies entries for each scheme. The model identified that the probability of rabies entering the UK via the three schemes is highly dependent on compliance. If 100% compliance is assumed, PETS and EUPMP(unlisted) (at the current level of importation) present a lower risk than quarantine, i.e. the number of years between rabies entry is more than 170 721 years for PETS and 60 163 years for EUPMP(unlisted) compared to 41 851 years for quarantine (with 95% certainty). If less than 100% compliance is assumed, PETS and EUPMP(unlisted) (at the current level of importation) present a higher risk. In addition, EUPMP(listed) and EUPMP(unlisted) (at an increased level of importation) present a higher risk than quarantine or PETS at 100% compliance and at an uncertain level of compliance.

A systematic review of zoonotic enteric parasitic diseases among nomadic and pastoral people

PubMed Central

Davaasuren, Anu; Baasandagva, Uyanga; Gray, Gregory C.

2017-01-01

Introduction Zoonotic enteric parasites are ubiquitous and remain a public health threat to humans due to our close relationship with domestic animals and wildlife, inadequate water, sanitation, and hygiene practices and diet. While most communities are now sedentary, nomadic and pastoral populations still exist and experience unique exposure risks for acquiring zoonotic enteric parasites. Through this systematic review we sought to summarize published research regarding pathogens present in nomadic populations and to identify the risk factors for their infection. Methods Using systematic review guidelines set forth by PRISMA, research articles were identified, screened and summarized based on exclusion criteria for the documented presence of zoonotic enteric parasites within nomadic or pastoral human populations. A total of 54 articles published between 1956 and 2016 were reviewed to determine the pathogens and exposure risks associated with the global transhumance lifestyle. Results The included articles reported more than twenty different zoonotic enteric parasite species and illustrated several risk factors for nomadic and pastoralist populations to acquire infection including; a) animal contact, b) food preparation and diet, and c) household characteristics. The most common parasite studied was Echinococcosis spp. and contact with dogs was recognized as a leading risk factor for zoonotic enteric parasites followed by contact with livestock and/or wildlife, water, sanitation, and hygiene barriers, home slaughter of animals, environmental water exposures, household member age and sex, and consumption of unwashed produce or raw, unprocessed, or undercooked milk or meat. Conclusion Nomadic and pastoral communities are at risk of infection with a variety of zoonotic enteric parasites due to their living environment, cultural and dietary traditions, and close relationship to animals. Global health efforts aimed at reducing the transmission of these animal-to-human pathogens must incorporate a One Health approach to support water, sanitation, and hygiene development, provide education on safe food handling and preparation, and improve the health of domestic animals associated with these groups, particularly dogs. PMID:29190664

Enteral tranexamic acid attenuates vasopressor resistance and changes in α1-adrenergic receptor expression in hemorrhagic shock.

PubMed

Santamaria, Marco Henry; Aletti, Federico; Li, Joyce B; Tan, Aaron; Chang, Monica; Leon, Jessica; Schmid-Schönbein, Geert W; Kistler, Erik B

2017-08-01

Irreversible hemorrhagic shock is characterized by hyporesponsiveness to vasopressor and fluid therapy. Little is known, however, about the mechanisms that contribute to this phenomenon. Previous studies have shown that decreased intestinal perfusion in hemorrhagic shock leads to proteolytically mediated increases in gut permeability, with subsequent egress of vasoactive substances systemically. Maintenance of blood pressure is achieved in part by α1 receptor modulation, which may be affected by vasoactive factors; we thus hypothesized that decreases in hemodynamic stability and vasopressor response in shock can be prevented by enteral protease inhibition. Rats were exposed to experimental hemorrhagic shock (35 mm Hg mean arterial blood pressure for 2 hours, followed by reperfusion for 2 hours) and challenged with phenylephrine (2 μg/kg) at discrete intervals to measure vasopressor responsiveness. A second group of animals received enteral injections with the protease inhibitor tranexamic acid (TXA) (127 mM) along the small intestine and cecum 1 hour after induction of hemorrhagic shock. Blood pressure response (duration and amplitude) to phenylephrine after reperfusion was significantly attenuated in animals subjected to hemorrhagic shock compared with baseline and control nonshocked animals and was restored to near baseline by enteral TXA. Arteries from shocked animals also displayed decreased α1 receptor density with restoration to baseline after enteral TXA treatment. In vitro, rat shock plasma decreased α1 receptor density in smooth muscle cells, which was also abrogated by enteral TXA treatment. Results from this study demonstrate that experimental hemorrhagic shock leads to decreased response to the α1-selective agonist phenylephrine and decreased α1 receptor density via circulating shock factors. These changes are mitigated by enteral TXA with correspondingly improved hemodynamics. Proteolytic inhibition in the lumen of the small intestine improves hemodynamics in hemorrhagic shock, possibly by restoring α1 adrenergic functionality necessary to maintain systemic blood pressure and perfusion.

Caring for patients on home enteral nutrition: Reported complications by home carers and perspectives of community nurses.

PubMed

Lim, Mei Ling; Yong, Bei Yi Paulynn; Mar, Mei Qi Maggie; Ang, Shin Yuh; Chan, Mei Mei; Lam, Madeleine; Chong, Ngian Choo Janet; Lopez, Violeta

2018-07-01

To explore the experiences of community nurses and home carers, in caring for patients on home enteral nutrition. The number of patients on home enteral nutrition is on the increase due to advancement in technology and shift in focus of providing care from acute to community care settings. A mixed-method approach was adopted. (i) A face-to-face survey design was used to elicit experience of carers of patients on home enteral nutrition. (ii) Focus group interviews were conducted with community nurses. Ninety-nine carers (n = 99) were recruited. Patient's mean age that they cared for was aged 77.7 years (SD = 11.2), and they had been on enteral feeding for a mean of 29 months (SD = 23.0). Most were bed-bound (90%) and required full assistance with their feeding (99%). Most were not on follow-up with dietitians (91%) and dentists (96%). The three most common reported gastrointestinal complications were constipation (31%), abdominal distension (28%) and vomiting (22%). Twenty community nurses (n = 20) were recruited for the focus group interviews. Four main themes emerged from the analysis: (i) challenge of accessing allied health services in the community; (ii) shorter length of stay in the acute care setting led to challenges in carers' learning and adaptation; (iii) transition gaps between hospital and home care services; and (iv) managing expectations of family. To facilitate a better transition of care for patients, adequate training for carers, standardising clinical practice in managing patients with home enteral nutrition and improving communication between home care services and the acute care hospitals are needed. This study highlighted the challenges faced by community home care nurses and carers. Results of this study would help to inform future policies and practice changes that would improve the quality of care received by patients on home enteral nutrition. © 2018 John Wiley & Sons Ltd.

Home Enteral Nutrition therapy: Difficulties, satisfactions and support needs of caregivers assisting older patients.

PubMed

Jukic P, Nikolina; Gagliardi, Cristina; Fagnani, Donata; Venturini, Claudia; Orlandoni, Paolo

2017-08-01

The purpose of this study was to comprehend and describe the views, experiences and adaptations of caregivers who assist older patients treated with Home Enteral Nutrition. The objective was to gather empirical evidence to improve the delivery of Home Enteral Nutrition for old patients taking into account the caregivers' support needs. A qualitative methodology with focus groups as data collection method was used to collect the testimonies of 30 informal and formal caregivers of older patients treated with Home Enteral Nutrition by the Clinical Nutrition Service of INRCA (Ancona) during 2014. Quantitative methodology was used to collect socio-demographic data. Partially modified Silver's "Home Enteral Nutrition Caregiver Task Checklist" was used to identify training needs. The constant comparison method was used to code and categorize data and to develop themes of focus groups. Simple descriptive statistics were used to summarize questionnaires. Five main themes were identified from focus groups: acceptance of the therapy, skill acquisition process, need for psychological and practical support at home from healthcare professionals, lifestyle adaptation, affirmation of life and family. All caregivers testified the initial fear and refusal to manage the nutrition pump and the therapy. They expressed the need to be trained gradually, starting during a patient's hospitalization, and continuing in the community. With reference to their overall QoL, it emerged that informal caregivers suffered mostly from the reduction of their free time while formal caregivers suffered social isolation and psychological burden. For both groups the monthly home visit was the most important element of the HEN service. Informal caregivers highlighted the importance of having their loved ones at home. Unsatisfied training needs were identified by the modified Silver's "Home Enteral Nutrition Caregiver Task Checklist". This qualitative study underlined the challenges and adaptations of caregivers who assist older patients treated with Home Enteral Nutrition, which should be considered when defining clinical protocols and supporting caregivers. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Equine grass sickness, but not botulism, causes autonomic and enteric neurodegeneration and increases soluble N-ethylmaleimide-sensitive factor attachment receptor protein expression within neuronal perikarya.

PubMed

McGorum, B C; Scholes, S; Milne, E M; Eaton, S L; Wishart, T M; Poxton, I R; Moss, S; Wernery, U; Davey, T; Harris, J B; Pirie, R S

2016-11-01

Equine grass sickness (EGS) is of unknown aetiology. Despite some evidence suggesting that it represents a toxico-infection with Clostridium botulinum types C and/or D, the effect of EGS on the functional targets of botulinum neurotoxins, namely the soluble N-ethylmaleimide-sensitive factor attachment receptor (SNARE) proteins, is unknown. Further, while it is commonly stated that, unlike EGS, equine botulism is not associated with autonomic and enteric neurodegeneration, this has not been definitively assessed. To determine: 1) whether botulism causes autonomic and enteric neurodegeneration; and 2) the effect of EGS on the expression of SNARE proteins within cranial cervical ganglion (CCG) and enteric neuronal perikarya. Descriptive study. Light microscopy was used to compare the morphology of neurons in haematoxylin-eosin stained sections of CCG and ileum from 6 EGS horses, 5 botulism horses and 6 control horses. Immunohistochemistry was used to compare the expression of synaptosomal-associated protein-25, synaptobrevin (Syb) and syntaxin within CCG neurons, and of Syb in enteric neurons, from horses with EGS, horses with botulism and control horses. The concentrations of these SNARE proteins in extracts of CCG from EGS and control horses were compared using quantitative fluorescent western blotting. EGS, but not botulism, was associated with autonomic and enteric neurodegeneration and with increased immunoreactivity for SNARE proteins within neuronal perikarya. Quantitative fluorescent western blotting confirmed increased concentrations of synaptosomal-associated protein-25, Syb and syntaxin within CCG extracts from EGS vs. control horses, with the increases in the latter 2 proteins being statistically significant. The occurrence of autonomic and enteric neurodegeneration, and increased expression of SNARE proteins within neuronal perikarya, in EGS but not botulism, suggests that EGS may not be caused by botulinum neurotoxins. Further investigation of the aetiology of EGS is therefore warranted. © 2015 EVJ Ltd.

Differences in perception of dysentery and enteric fever and willingness to receive vaccines among rural residents in China.

PubMed

Chen, Xinguang; Stanton, Bonita; Wang, Xuanyi; Nyamette, Andrew; Pach, Alfred; Kaljee, Linda; Pack, Robert; von Seidlein, Lorenz; Clemens, John; Gong, Youlong; Mao, Rong

2006-01-30

Enteric diseases including dysentery and enteric fever remain significant public health problems in China. While vaccines offer great potential in controlling these diseases, greater understanding of factors influencing acceptance of vaccines is needed to create effective enteric disease control programs in rural China. Cross-sectional quantitative study with randomly sampled households from two sites in China, one experiencing high rates of shigellosis (Zengding) and the other of typhoid/paratyphoid (Lingchuan). Sociobehavioral survey data were collected through face-to-face interviews from 501 respondents (56% female) in Zhengding regarding dysentery and 624 in Lingchuan (51% female) regarding enteric fever. Vaccine acceptability was measured by expressed need for vaccination and willingness to pay. Comparative and associative analyses were conducted to assess disease perception, vaccination service satisfaction, likelihood of improvements in water and sanitation, and vaccine acceptability. Nearly all respondents in Lingchuan considered enteric fever to be prevalent in the community, while only one half of the respondents in Zhengding considered dysentery to be problematic (p < 0.01). Nevertheless, more respondents in Zhengding were fearful that a household member would acquire dysentery than were Lingchuan respondents worried that a household member would acquire enteric fever (p < 0.01). Perceived vulnerability of specific subgroups (odds ratios ranging from 1.6 to 8.1), knowing someone who died of the disease (odds ratio reached infinity) and satisfaction with past vaccination services (odds ratios reached infinity) were consistently associated with perceived need for vaccines of target populations of all age groups while the association between perception of sanitary improvement and vaccine need was limited. Perceived need for a vaccine was associated with willingness to pay for the vaccine. Perceptions of enhanced vulnerability of specific subgroups to a disease and satisfactory experiences with vaccination services may increase the perceived need for a vaccine, leading to increased willingness to pay for vaccine. Vaccines are not perceived as important for the elderly.

Early enteral nutrition prevents intra-abdominal hypertension and reduces the severity of severe acute pancreatitis compared with delayed enteral nutrition: a prospective pilot study.

PubMed

Sun, Jia-Kui; Li, Wei-Qin; Ke, Lu; Tong, Zhi-Hui; Ni, Hai-Bin; Li, Gang; Zhang, Lu-Yao; Nie, Yao; Wang, Xin-Ying; Ye, Xiang-Hong; Li, Ning; Li, Jie-Shou

2013-09-01

To investigate the effects of early enteral nutrition (EEN) on intra-abdominal pressure (IAP) and disease severity in patients with severe acute pancreatitis (SAP). Enteral nutrition (EN) was started within 48 h after admission in the EEN group and from the 8th day in the delayed enteral nutrition (DEN) group. The IAP and intra-abdominal hypertension (IAH) incidence were recorded for 2 weeks. The caloric intake and feeding intolerance (FI) incidence were recorded daily after EN was started. The severity markers and clinical outcome variables were also recorded. Sixty patients were enrolled to this study. No difference about IAP was found. The IAH incidence of the EEN group was significantly lower than that of the DEN group from the 9th day (8/30 versus 18/30; P = 0.009) after admission. The FI incidence of the EEN group was higher than that of the DEN group during the initial 3 days of feeding (25/30 versus 12/30; P = 0.001; 22/30 versus 9/30; P = 0.001; 15/30 versus 4/30; P = 0.002). Patients with an IAP <15 mmHg had lower FI incidence than those with an IAP ≥15 mmHg on the 1st day (20/22 versus 17/38; P < 0.001), the 3rd day (11/13 versus 8/47; P < 0.001), and the 7th day (3/5 versus 3/55; P = 0.005) of feeding. The severity markers and clinical outcome variables of the EEN group were significantly improved. Early enteral nutrition did not increase IAP. In contrast, it might prevent the development of IAH. In addition, EEN might be not appropriate during the initial 3-4 days of SAP onset. Moreover, EN might be of benefit to patients with an IAP <15 mmHg. Early enteral nutrition could improve disease severity and clinical outcome, but did not decrease mortality of SAP.

Evaluation of an electricity-free, culture-based approach for detecting typhoidal Salmonella bacteremia during enteric fever in a high burden, resource-limited setting.

PubMed

Andrews, Jason R; Prajapati, Krishna G; Eypper, Elizabeth; Shrestha, Poojan; Shakya, Mila; Pathak, Kamal R; Joshi, Niva; Tiwari, Priyanka; Risal, Manisha; Koirala, Samir; Karkey, Abhilasha; Dongol, Sabina; Wen, Shawn; Smith, Amy B; Maru, Duncan; Basnyat, Buddha; Baker, Stephen; Farrar, Jeremy; Ryan, Edward T; Hohmann, Elizabeth; Arjyal, Amit

2013-01-01

In many rural areas at risk for enteric fever, there are few data on Salmonella enterica serotypes Typhi (S. Typhi) and Paratyphi (S. Paratyphi) incidence, due to limited laboratory capacity for microbiologic culture. Here, we describe an approach that permits recovery of the causative agents of enteric fever in such settings. This approach involves the use of an electricity-free incubator based upon use of phase-change materials. We compared this against conventional blood culture for detection of typhoidal Salmonella. Three hundred and four patients with undifferentiated fever attending the outpatient and emergency departments of a public hospital in the Kathmandu Valley of Nepal were recruited. Conventional blood culture was compared against an electricity-free culture approach. Blood from 66 (21.7%) patients tested positive for a Gram-negative bacterium by at least one of the two methods. Sixty-five (21.4%) patients tested blood culture positive for S. Typhi (30; 9.9%) or S. Paratyphi A (35; 11.5%). From the 65 individuals with culture-confirmed enteric fever, 55 (84.6%) were identified by the conventional blood culture and 60 (92.3%) were identified by the experimental method. Median time-to-positivity was 2 days for both procedures. The experimental approach was falsely positive due to probable skin contaminants in 2 of 239 individuals (0.8%). The percentages of positive and negative agreement for diagnosis of enteric fever were 90.9% (95% CI: 80.0%-97.0%) and 96.0% (92.7%-98.1%), respectively. After initial incubation, Salmonella isolates could be readily recovered from blood culture bottles maintained at room temperature for six months. A simple culture approach based upon a phase-change incubator can be used to isolate agents of enteric fever. This approach could be used as a surveillance tool to assess incidence and drug resistance of the etiologic agents of enteric fever in settings without reliable local access to electricity or local diagnostic microbiology laboratories.

Enteral nutrition in patients with acute renal failure.

PubMed

Fiaccadori, Enrico; Maggiore, Umberto; Giacosa, Roberto; Rotelli, Carlo; Picetti, Edoardo; Sagripanti, Sibilla; Melfa, Luigi; Meschi, Tiziana; Borghi, Loris; Cabassi, Aderville

2004-03-01

Systematic studies on safety and efficacy of enteral nutrition in patients with acute renal failure (ARF) are lacking. We studied enteral nutrition-related complications and adequacy of nutrient administration during 2525 days of artificial nutrition in 247 consecutive patients fed exclusively by the enteral route: 65 had normal renal function, 68 had ARF not requiring renal replacement therapy, and 114 required renal replacement therapy. No difference was found in gastrointestinal or mechanical complications between ARF patients and patients with normal renal function, except for high gastric residual volumes, which occurred in 3.1% of patients with normal renal function, 7.3% of patients with ARF not requiring renal replacement therapy, 13.2% of patients with ARF on renal replacement therapy (P= 0.02 for trend), and for nasogastric tube obstruction: 0.0%, 5.9%, 14%, respectively (P < 0.001). Gastrointestinal complications were the most frequent cause of suboptimal delivery; the ratio of administered to prescribed daily volume was well above 90% in all the three groups. Definitive withdrawal of enteral nutrition due to complications was documented in 6.1%, 13.2%. and 14.9% of patients, respectively (P= 0.09 for trend). At regimen, mean delivered nonprotein calories were 19.8 kcal/kg (SD 4.6), 22.6 kcal/kg (8.4), 23.4 kcal/kg (6.5); protein intake was 0.92 g/kg (0.21), 0.87 g/kg (0.25), and 0.92 g/kg (0.21), the latter value being below that currently recommended for ARF patients on renal replacement therapy. Median fluid intake with enteral nutrition was 1440 mL (range 720 to 1960), 1200 (720 to 2400), and 960 (360 to 1920). Enteral nutrition is a safe and effective nutritional technique to deliver artificial nutrition in ARF patients. Parenteral amino acid supplementation may be required, especially in patients with ARF needing renal replacement therapy.

A systematic review of zoonotic enteric parasitic diseases among nomadic and pastoral people.

PubMed

Barnes, Amber N; Davaasuren, Anu; Baasandagva, Uyanga; Gray, Gregory C

2017-01-01

Zoonotic enteric parasites are ubiquitous and remain a public health threat to humans due to our close relationship with domestic animals and wildlife, inadequate water, sanitation, and hygiene practices and diet. While most communities are now sedentary, nomadic and pastoral populations still exist and experience unique exposure risks for acquiring zoonotic enteric parasites. Through this systematic review we sought to summarize published research regarding pathogens present in nomadic populations and to identify the risk factors for their infection. Using systematic review guidelines set forth by PRISMA, research articles were identified, screened and summarized based on exclusion criteria for the documented presence of zoonotic enteric parasites within nomadic or pastoral human populations. A total of 54 articles published between 1956 and 2016 were reviewed to determine the pathogens and exposure risks associated with the global transhumance lifestyle. The included articles reported more than twenty different zoonotic enteric parasite species and illustrated several risk factors for nomadic and pastoralist populations to acquire infection including; a) animal contact, b) food preparation and diet, and c) household characteristics. The most common parasite studied was Echinococcosis spp. and contact with dogs was recognized as a leading risk factor for zoonotic enteric parasites followed by contact with livestock and/or wildlife, water, sanitation, and hygiene barriers, home slaughter of animals, environmental water exposures, household member age and sex, and consumption of unwashed produce or raw, unprocessed, or undercooked milk or meat. Nomadic and pastoral communities are at risk of infection with a variety of zoonotic enteric parasites due to their living environment, cultural and dietary traditions, and close relationship to animals. Global health efforts aimed at reducing the transmission of these animal-to-human pathogens must incorporate a One Health approach to support water, sanitation, and hygiene development, provide education on safe food handling and preparation, and improve the health of domestic animals associated with these groups, particularly dogs.

Crashworthiness testing of a portable maintenance work-zone barrier.

DOT National Transportation Integrated Search

2008-12-01

Barrier and shadow vehicles generally provide Caltrans maintenance workers protection from errant vehicles entering the work zones, from the upstream direction of traffic flow. This type of protection does not protect workers from vehicles entering t...

Carbon Nanotubes and Human Cells?

ERIC Educational Resources Information Center

King, G. Angela

2005-01-01

Single-walled carbon nanotubes that were chemically altered to be water soluble are shown to enter fibroblasts, T cells, and HL60 cells. Nanoparticles adversely affect immortalized HaCaT human keratinocyte cultures, indicating that they may enter cells.

Crude glycerol combustion: Particulate, acrolein, other volatile organic emissions

EPA Science Inventory

This STICS entry is for the presentation materials for a peer-reviewed journal manuscript entry by the same title (ORD-000108) previously entered an approved. A Product Description / Abstract for ORD-000108 was previously entered.

2. CANAL BOAT ENTERING THE DELAWARE CANAL FROM OF THE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. CANAL BOAT ENTERING THE DELAWARE CANAL FROM OF THE LEHIGH RIVER. BOATS COULD BE FERRIED ACROSS THE DELAWARE RIVER TO THE MORRIS CANAL BY A CABLE SUPPORTED TROLLEY. - Morris Canal, Phillipsburg, Warren County, NJ

OCCURRENCE OF ENTERIC VIRUSES IN WATERS

EPA Science Inventory

A number of different types of human enteric viruses cause waterborne outbreaks when individuals are exposed to contaminated drinking and recreational waters. Vaccination against poliovirus has virtually eliminated poliomyelitis from the planet, but other members of the enterovi...

31. LOOKING SOUTHEAST. AS THE TRAM ENTERED THE GRAVITY TRAM ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

31. LOOKING SOUTHEAST. AS THE TRAM ENTERED THE GRAVITY TRAM LINE, IT CROSSED THIS CUT-STONE BRIDGE AND WAS CONTROLLED BY THE SWITCHING PLATFORM IN THE BACKGROUND - Independent Coal & Coke Company, Kenilworth, Carbon County, UT

Pumps, feed and sets: is procurement limiting outcomes?

PubMed

Ojo, Omorogieva

This article aims to review the unique ways in which enteral feed, ancillary items and pumps are procured in the UK and to evaluate whether these are inhibiting innovation and reducing the choices of patients. There are a number of models that have been developed across the UK for the procurement of enteral feed, feeding accessories and pump. The two most common are the hospital-based nutrition support team, which may have an overarching role in the community, and the home enteral nutrition (HEN) team, a multidisciplinary community-based team with skilled health professionals dedicated to the delivery of the enteral nutrition service. While the HEN service has its advantages over other models in the community, it is primarily driven by its clinical role. The lack of significant opportunity for clinical audits and research within the service limits the prospects for service improvement, innovation and patients' choices.

A High Burden of Asymptomatic Gastrointestinal Infections in Traditional Communities in Papua New Guinea.

PubMed

Horwood, Paul F; Soli, Kevin W; Maure, Tobias; Naito, Yuichi I; Morita, Ayako; Natsuhara, Kazumi; Tadokoro, Kiyoshi; Baba, Jun; Odani, Shingo; Tomitsuka, Eriko; Igai, Katsura; Larkins, Jo-Ann; Siba, Peter M; Pomat, William; McBryde, Emma S; Umezaki, Masahiro; Greenhill, Andrew R

2017-12-01

Stool samples were collected from 148 healthy adults living a traditional subsistence lifestyle in Papua New Guinea and screened for enteric pathogens using real-time RT-PCR/PCR assays. Enteric pathogens were detected in a high proportion (41%) of individuals. Clear differences were observed in the detection of pathogens between highland and lowland communities. In particular, there was a marked difference in detection rates of norovirus GII (20% and 0%, respectively) and Shigella sp. (15% and 0%, respectively). Analysis of the relationship between enteric pathogen carriage and microbial community composition of participants, using box plots to compare specific normal flora population numbers, did not suggest that gut microbial composition was directly associated with pathogen carriage. This study suggests that enteric pathogens are common in healthy individuals in Papua New Guinean highland communities, presumably acting as a reservoir of infection and thus contributing to a high burden of gastrointestinal illnesses.

[Intestinal occlusion by persistence of the omphalo-enteric conduct in a 10-year old child].

PubMed

Filip, F; Goţia, D G; Aprodu, S G; Vlad, A; Savu, A; Savu, B; Bejenaru, T

2000-01-01

The persistence of the omphalo-enteric conduct is a rare, but possible, cause of pathology in children. Haemorrhage and intestinal occlusion are the most frequent clinical presentations, usually in infants. We describe the case of a 10 year old boy, who was admitted in our department for what seemed first to be an acute appendicitis. During hospitalization, the clinical picture turned on to an intestinal occlusion, and the patient finally required surgery. We performed exploratory laparotomy and we discovered a mechanical occlusion by persistence of the omphalo-enteric conduct, which was treated according to standard protocols. The post-operative course was good, and the child was discharged 8 days after surgery. This case emphasizes that the persistence of the omphalo-enteric conduct should be sought as the source of symptoms in any child presenting with intestinal occlusion.

Endothelial binding of beta toxin to small intestinal mucosal endothelial cells in early stages of experimentally induced Clostridium perfringens type C enteritis in pigs.

PubMed

Schumacher, V L; Martel, A; Pasmans, F; Van Immerseel, F; Posthaus, H

2013-07-01

Beta toxin (CPB) is known to be an essential virulence factor in the development of lesions of Clostridium perfringens type C enteritis in different animal species. Its target cells and exact mechanism of toxicity have not yet been clearly defined. Here, we evaluate the suitability of a neonatal piglet jejunal loop model to investigate early lesions of C. perfringens type C enteritis. Immunohistochemically, CPB was detected at microvascular endothelial cells in intestinal villi during early and advanced stages of lesions induced by C. perfringens type C. This was first associated with capillary dilatation and subsequently with widespread hemorrhage in affected intestinal segments. CPB was, however, not demonstrated on intestinal epithelial cells. This indicates a tropism of CPB toward endothelial cells and suggests that CPB-induced endothelial damage plays an important role in the early stages of C. perfringens type C enteritis in pigs.

Variable protection against experimental broiler necrotic enteritis after immunization with the C-terminal fragment of Clostridium perfringens alpha-toxin and a non-toxic NetB variant.

PubMed

Fernandes da Costa, Sérgio P; Mot, Dorien; Geeraerts, Sofie; Bokori-Brown, Monika; Van Immerseel, Filip; Titball, Richard W

2016-06-01

Necrotic enteritis toxin B (NetB) is a pore-forming toxin produced by Clostridium perfringens and has been shown to play a key role in avian necrotic enteritis, a disease causing significant costs to the poultry production industry worldwide. The aim of this work was to determine whether immunization with a non-toxic variant of NetB (NetB W262A) and the C-terminal fragment of C. perfringens alpha-toxin (CPA247-370) would provide protection against experimental necrotic enteritis. Immunized birds with either antigen or a combination of antigens developed serum antibody levels against NetB and CPA. When CPA247-370 and NetB W262A were used in combination as immunogens, an increased protection was observed after oral challenge by individual dosing, but not after in-feed-challenge.

Enteric Micromotor Can Selectively Position and Spontaneously Propel in the Gastrointestinal Tract.

PubMed

Li, Jinxing; Thamphiwatana, Soracha; Liu, Wenjuan; Esteban-Fernández de Ávila, Berta; Angsantikul, Pavimol; Sandraz, Elodie; Wang, Jianxing; Xu, Tailin; Soto, Fernando; Ramez, Valentin; Wang, Xiaolei; Gao, Weiwei; Zhang, Liangfang; Wang, Joseph

2016-09-22

The gastrointestinal (GI) tract, which hosts hundreds of bacteria species, becomes the most exciting organ for the emerging microbiome research. Some of these GI microbes are hostile and cause a variety of diseases. These bacteria colonize in different segments of the GI tract dependent on the local physicochemical and biological factors. Therefore, selectively locating therapeutic or imaging agents to specific GI segments is of significant importance for studying gut microbiome and treating various GI-related diseases. Herein, we demonstrate an enteric micromotor system capable of precise positioning and controllable retention in desired segments of the GI tract. These motors, consisting of magnesium-based tubular micromotors coated with an enteric polymer layer, act as a robust nanobiotechnology tool for site-specific GI delivery. The micromotors can deliver payload to a particular location via dissolution of their enteric coating to activate their propulsion at the target site toward localized tissue penetration and retention.

Fitness levels and physical activity among class A drug users entering prison.

PubMed

Fischer, Jan; Butt, Christine; Dawes, Helen; Foster, Charlie; Neale, Joanne; Plugge, Emma; Wheeler, Carly; Wright, Nat

2012-12-01

Physical activity could benefit drug users' physiological and mental health. Previous research has suggested that physical activity levels change when drug users enter prison. Twenty-five class A drug users who were new to prison answered physical activity and drug use cross-sectional questionnaires, took a submaximal fitness test and wore a pedometer for 1 week. Participants' mean aerobic capacity was estimated as 49 mls O2/kg/min (±12 SD). Their mean self-reported walking distance outside of prison was 4.67 miles on an average day (±4.14 SD). Pedometer data suggest they walked a mean of 1.8 miles/day in prison. Many class A drug users entering prison had high levels of fitness and physical activity before admission, often gained from walking. Walking activity reduced when they entered prison, posing a challenge to maintaining healthy activity levels.