Does enternal nutrition affect clinical outcome? A systematic review of the randomized trials

Background: Both parenteral nutrition (PN) and enteral nutrition (EN) are widely advocated as adjunctive care in patients with various diseases. A systematic review of 82 randomized controlled trials (RCTs) of PN published in 2001 found little, if any, effect on mortality, morbidity, or duration of hospital stay; in some situations, PN increased infectious complication rates. Objective: To assess the effect of EN or volitional nutrition support (VNS) in individual disease states from available randomized controlled trials (RCTs). Design: We conducted a systematic review. RCTs comparing EN or VNS to untreated controls, or comparing EN to PN, were identified and separated according to the underlying disease state. Meta-analysis was performed when at least 3 RCTs provided data. The evidence from the RCTs was summarized into one of five grades. A or B indicated the presence of strong or weak (low quality RCTs) evidence supporting the use of the intervention. C indicated a lack of adequate evidence to make any decision about efficacy. D indicated that limited data could not support the intervention. E indicated either that strong data found no effect, or that either strong or weak data suggested that the intervention caused harm. Patients and settings: RCTs could include either hospitalized or non-hospitalized patients. The EN or VNS had to be provided as part of a treatment plan for an underlying disease process. Interventions: The RCT had to compare recipients of either EN or VNS to controls not receiving any type of artificial nutrition or had to compare recipients of EN with recipients of PN. Outcome measures: Mortality, morbidity (disease-specific), duration of hospitalization, cost, or interventional complications. Summary of grading: A – No indication was identified. B – EN or VNS in the perioperative patient or in patients with chronic liver disease; EN in critically ill patients or low birth weight infants (trophic feeding); VNS in malnourished geriatric patients. (The low quality trials found a significant difference in survival favoring the VNS recipients in the malnourished geriatric patient trials; two high quality trials found non-significant differences that favored VNS as well.) C – EN or VNS in liver transplantation, cystic fibrosis, renal failure, pediatric conditions other than low birth weight infants, well-nourished geriatric patients, non-stroke neurologic conditions, AIDS; EN in acute pancreatitis, chronic obstructive pulmonary disease, non-malnourished geriatric patients; VNS in inflammatory bowel disease, arthritis, cardiac disease, pregnancy, allergic patients, preoperative bowel preparation D – EN or VNS in patients receiving non-surgical cancer treatment or in patients with hip fractures; EN in patients with inflammatory bowel disease; VNS in patients with chronic obstructive pulmonary disease E – EN in the first week in dysphagic, or VNS at any time in non-dysphagic, stroke patients who are not malnourished; dysphagia persisting for weeks will presumably ultimately require EN. Conclusions: There is strong evidence for not using EN in the first week in dysphagic, and not using VNS at all in non-dysphagic, stroke patients who are not malnourished. There is reasonable evidence for using VNS in malnourished geriatric patients. The recommendations to consider EN/VNS in perioperative/liver/critically ill/low birth weight patients are limited by the low quality of the RCTs. No evidence could be identified to justify the use of EN/VNS in other disease states

Comparative Effectiveness Trial of an Obesity Prevention Intervention in EFNEP and SNAP-ED: Primary Outcomes

There is a need to disseminate evidence-based childhood obesity prevention interventions on a broader scale to reduce obesity-related disparities among underserved children. The purpose of this study was to test the comparative effectiveness of an evidence-based obesity prevention intervention, Hip-Hop to Health (HH), delivered through Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) versus the standard curriculum delivered by the programs (Standard Nutrition Education (NE)). A nonequivalent control group design was delivered to compare the effectiveness of HH to NE on weight gain prevention and health behavior outcomes at EFNEP and SNAP-Ed sites. One hundred and fifty-three caregiver–child dyads (n = 103 in the HH group; n = 50 in the NE group) participated in the study. HH is an evidence-based dietary and physical activity intervention for low-income preschool children. The NE curriculum provided lessons for children that are consistent with the Dietary Guidelines for Americans 2010. Data were collected on demographics, anthropometrics, and behavioral variables for parent–child dyads at baseline and postintervention. Mixed model methods with random effects for site and participant were utilized. No differences in child or caregiver diet, physical activity, or screen time by group were found. No between-group differences in child BMI z-score were found; however, caregivers in the HH group lost significantly more weight than those in the NE group. Results from this trial can inform future dissemination efforts of evidenced-based programs for underserved families

Clinical Rounds With Nutrition Support Services

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68406/2/10.1177_011542659400900273.pd

Nutrition Risk Classification: A Reproducible and Valid Tool for Nurses

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141661/1/ncp0020.pd

Aqueous batteries as grid scale energy storage solutions

Energy storage technologies are required to make full use of renewable energy sources, and electrochemical cells offer a great deal flexibility in the design of energy systems. For large scale electrochemical storage to be viable, the materials employed and device production methods need to be low cost, devices should be long lasting and safety during operation is of utmost importance. Energy and power densities are of lesser concern. For these reasons, battery chemistries that make use of aqueous electrolytes are favorable candidates where large quantities of energy need to be stored. Herein we describe several different aqueous based battery chemistries and identify some of the research challenges currently hindering their wider adoption. Lead acid batteries represent a mature technology that currently dominates the battery market, however there remain challenges that may prevent their future use at the large scale. Nickel–iron batteries have received a resurgence of interest of late and are known for their long cycle lives and robust nature however improvements in efficiency are needed in order to make them competitive. Other technologies that use aqueous electrolytes and have the potential to be useful in future large-scale applications are briefly introduced. Recent investigations in to the design of nickel–iron cells are reported with it being shown that electrolyte decomposition can be virtually eliminated by employing relatively large concentrations of iron sulfide in the electrode mixture, however this is at the expense of capacity and cycle life

Adaptation and dissemination of an evidence-based obesity prevention intervention: Design of a comparative effectiveness trial

Low-income youth are at increased risk for excess weight gain. Although evidence-based prevention programs exist, successful adaptation to provide wide dissemination presents a challenge. Hip-Hop to Health (HH) is a school-based obesity prevention intervention that targets primarily preschool children of low-income families. In a large randomized controlled trial, HH was found to be efficacious for prevention of excessive weight gain. The Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) are USDA-funded nutrition education programs offered to low-income families, and may provide an ideal platform for the wide dissemination of evidence-based obesity prevention programs. A research–practice partnership was established in order to conduct formative research to guide the adaptation and implementation of HH through EFNEP and SNAP-Ed. We present the design and method of a comparative effectiveness trial that will determine the efficacy of HH when delivered by peer educators through these programs compared to the standard EFNEP and SNAP-Ed nutrition education (NE) curriculum. Results from this trial will inform larger scale dissemination. The dissemination of HH through government programs has the potential to increase the reach of efficacious obesity prevention programs that target low-income children and families

Comparative Effectiveness Trial of an Obesity Prevention Intervention in EFNEP and SNAP-ED: Primary Outcomes

There is a need to disseminate evidence-based childhood obesity prevention interventions on a broader scale to reduce obesity-related disparities among underserved children. The purpose of this study was to test the comparative effectiveness of an evidence-based obesity prevention intervention, Hip-Hop to Health (HH), delivered through Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) versus the standard curriculum delivered by the programs (Standard Nutrition Education (NE)). A nonequivalent control group design was delivered to compare the effectiveness of HH to NE on weight gain prevention and health behavior outcomes at EFNEP and SNAP-Ed sites. One hundred and fifty-three caregiver−child dyads (n = 103 in the HH group; n = 50 in the NE group) participated in the study. HH is an evidence-based dietary and physical activity intervention for low-income preschool children. The NE curriculum provided lessons for children that are consistent with the Dietary Guidelines for Americans 2010. Data were collected on demographics, anthropometrics, and behavioral variables for parent−child dyads at baseline and postintervention. Mixed model methods with random effects for site and participant were utilized. No differences in child or caregiver diet, physical activity, or screen time by group were found. No between-group differences in child BMI z-score were found; however, caregivers in the HH group lost significantly more weight than those in the NE group. Results from this trial can inform future dissemination efforts of evidenced-based programs for underserved families

Effect of Variable Energy Served on 24-Hour Energy Intake in 16 Preschools, Chicago, Illinois, 2007

IntroductionThe effect of varying portion size in a natural environment on the self-regulation of 24-hour energy intake has not been evaluated. We studied students at 16 preschools in Chicago to determine the effect of meals with variable energy and macronutrients on the amount consumed over a 24-hour period (ie, at preschool and outside of preschool).MethodsThe food items and portion sizes served at 16 preschools in the Chicago Public Schools early childhood education programs were observed for 3 to 8 days. Children were assessed for total energy and selected macronutrients consumed at preschool and outside of preschool for a 24-hour period; their data were pooled and reported by school.ResultsThe students were predominantly African American (96%); on average, 32 students (range, 21-38) participated at each of the 16 preschools, and the age range of students was 4.0 to 4.5 years. The energy served at preschools ranged from 48% to 90% of the daily recommended energy allowance (REA). The mean energy intake at school was significantly higher (39% of REA) at 2 preschools, including 1 that served 90% of the REA. Mean energy consumption outside of preschool and total 24-hour energy consumption did not differ by preschool, adjusting for body mass index z score and sex.ConclusionThe preschools served meals that widely varied by portion size and energy; however, this variation did not result in differences in mean 24-hour nutrient intakes for the students attending these schools

The Prevalence of Sarcopenia in Patients With Respiratory Failure Classified as Normally Nourished Using Computed Tomography and Subjective Global Assessment

Nazio Batuek 2015an onartu zituzten Garapen Iraunkorrerako 17 helburuetako bostgarrena Genero-berdintasun eraginkorra lortzean datza. Eta helburu hori negozioen alorrean ere sustatu behar da. Bestetik, Gizarte Erantzukizun Korporatiboaren (GEK) eremuan, erakundeen jarduerak sortzen dituzten eraginei buruzko eta beren gobernuari buruzko gardentasun eskaria handituz doa. Artikulu honek enpresa eta bestelako erakundeetako berdintasun politikei buruzko informazioa ematearen normalizazioak aurrera egiteko ematen ari diren ekimen nagusiak berrikusten ditu. Batez ere, 2017ko uztailean Europako Batzordeak onartutako Komunikazioa (CE, 2017b), enpresei laguntzeko, 2018an 2014/95/EB Zuzentaraua lehen aldiz jarraitu beharko dutenean. Edonola ere, gida hori borondatezkoa den neurrian, bere aplikazioa ez dago bermatuta. Bestetik, Accounting for Sustainability finantza zuzendaritzaren lidergorako sareak argitaratutako gida (A4S, 2017) ere berrikusten da. Hemen, genero aniztasun politikei buruzko informazioa emateko lider gisa jardun dezaketen enpresek eskaintzen dituzten adibideak oraindik oso urriak direla ikusi da. Beraz, uste dugu lan gehiago egin behar dela arlo honetan ez baita jorratu nahikoa, ez kontabilitate literaturan ez eta enpresen praktikan ere.The number five of the 17 Sustainable Development Goals that the United Nations approuved in 2015 wants to achieve an effective gender equality. It is an objective that should also be promoted in the business world. On the other hand, there is a growing demand for transparency regarding the impacts generated by the activity of organizations and their own governance, as part of Corporate Social Responsibility (CSR). In this context, this article reviews the main initiatives that are being taken to advance the standardization of the disclosure of equality policies in organizations. Especially the Communication of the European Commission (CE, 2017b), to help the companies that must apply Directive 2014/95/EU for the first time in 2018. Although to the extent that the application of the guide will be voluntary, its application by companies is not guaranteed. The guide published by the Accounting for Sustainability CFO leadership network (A4S, 2017) is also reviewed. As a result it is noted that the examples offered by companies that can act as leaders in the disclosure of gender diversity policies are still very scarce. Therefore, we believe that it is necessary to continue working in this area that has not been sufficiently addressed, neither in the accounting literature nor in the practice of the companies.El número cinco de los 17 Objetivos de Desarrollo Sostenible (ODS) de las Naciones Unidas, que se aprobaron en 2015, consiste en lograr una igualdad de género efectiva, objetivo que debe promoverse también en el ámbito empresarial. Por otra parte, cada vez es mayor la demanda de transparencia sobre los impactos que genera la actividad de las organizaciones y sobre la propia gobernanza de éstas, como parte de la Responsabilidad Social Corporativa (RSC). Este artículo revisa las principales iniciativas que se están dando para avanzar en la normalización de la divulgación sobre políticas de igualdad en las organizaciones, especialmente, la Comunicación de la Comisión Europea (CE, 2017b), de directrices o guía para ayudar a las empresas que deban aplicar la Directiva 2014/95/EU por primera vez en 2018. Si bien, en la medida en que la aplicación de la guía será voluntaria, no está garantizada su aplicación por parte de las empresas. También se revisa la guía publicada por la red para liderazgo de la dirección financiera Accounting for Sustainability (A4S, 2017). Como resultado se constata que los ejemplos que ofrecen las empresas que pueden actuar como líderes en la divulgación de políticas de diversidad de género son aún muy escasos. Por lo tanto, creemos que es necesario seguir trabajando en este área que, hasta el presente, no se ha abordado suficientemente, ni en la literatura contable ni en la práctica de las empresas