The Effectiveness of a Volume-Based Enteral Feeding Protocol to Provide Energy Intake in Hospitalized Critically Ill Adults

Background: Patients determined to be at high nutrition risk are most likely to benefit from early enteral nutrition (EN) therapy. The use of enteral feeding protocols has been associated with significant improvements in nutrition practice and overall nutrition adequacy. The effect of a combined-approach volume-based enteral feeding protocol on the percent of calories received by patients is unknown. Objective: The aim of this study was to determine if a newly implemented combined-approach volume-based enteral feeding (VBF) protocol is more effective in the delivery of EN volume and calories in intensive care unit (ICU) patients compared with the previous rate-based protocol where 88% of patients achieved 85% of their caloric requirements. Participants/setting: Eighteen critically ill adults hospitalized in either the burn or neurological ICU at a large urban hospital. Main outcome measure: The percentage of calories delivered for each patient after a minimum of 7 days of protocol compliance. Results: Ten patients (50% male, 70% Caucasian) received VBF in compliance with protocol for a median of 5.5 days (Interquartile Range; 4.8, 14.0). The percent of goal volume delivered for those who received at least 7 days of treatment (n = 4) was 104.2 ± 7.9. Conclusions: The delivery of goal EN volume using VBF exceeded the average volume provided by the previous rate-based approach in a small sample of critically ill adults. This study supports the use of feeding protocols in order to increase overall percentage of volume delivered. Additional research in a larger patient population is needed to determine the impact of this increase in volume delivery on patient outcomes

A workbook of stories and selected exercises for boys of sixth grade interests and second grade reading ability

Thesis (Ed.M.)--Boston Universit

Predictive response-relevant clustering of expression data provides insights into disease processes

This article describes and illustrates a novel method of microarray data analysis that couples model-based clustering and binary classification to form clusters of ;response-relevant' genes; that is, genes that are informative when discriminating between the different values of the response. Predictions are subsequently made using an appropriate statistical summary of each gene cluster, which we call the ;meta-covariate' representation of the cluster, in a probit regression model. We first illustrate this method by analysing a leukaemia expression dataset, before focusing closely on the meta-covariate analysis of a renal gene expression dataset in a rat model of salt-sensitive hypertension. We explore the biological insights provided by our analysis of these data. In particular, we identify a highly influential cluster of 13 genes-including three transcription factors (Arntl, Bhlhe41 and Npas2)-that is implicated as being protective against hypertension in response to increased dietary sodium. Functional and canonical pathway analysis of this cluster using Ingenuity Pathway Analysis implicated transcriptional activation and circadian rhythm signalling, respectively. Although we illustrate our method using only expression data, the method is applicable to any high-dimensional datasets

Patterns in airborne pollen and other primary biological aerosol particles (PBAP), and their contribution to aerosol mass and number in a boreal forest

We studied variation in concentrations of airborne pollen and other particles of biological origin in a boreal forest in Finland during 2003–2004. The highest concentrations of pollen were observed in late spring and early summer, whereas the peak concentrations of other particles of biological origin (including e.g. fungal spores) occurred in August–September. Although the patterns in concentrations in 2003 and 2004 were similar, the concentration levels were significantly different between the years. The contribution of pollen and other particles of biological origin led to an increase in the measured particulate matter (PM) mass during the pollen season (mass of pollen and other particles of biological origin 5.9 and 0.4 μg m–3, respectively, in respect to PMtotal mass of 9.9 μg m–3) but the effect on total particle number was negligible. The other particles of biological origin constituted the largest fraction of measured primary biological aerosol particle (PBAP) numbers (~99%), whereas pollen showed a higher relative mass fraction (~97%) of PBAP. These results underline the important contribution of PBAP to coarse atmospheric particle mass providing up to 65% of the total mass during the peak pollen season

Is group cognitive behaviour therapy for postnatal depression evidence-based practice? A systematic review

Background: There is evidence that psychological therapies including cognitive behaviour therapy (CBT) may be effective in reducing postnatal depression (PND) when offered to individuals. In clinical practice, this is also implemented in a group therapy format, which, although not recommended in guidelines, is seen as a cost-effective alternative. To consider the extent to which group methods can be seen as evidence-based, we systematically review and synthesise the evidence for the efficacy of group CBT compared to currently used packages of care for women with PND, and we discuss further factors which may contribute to clinician confidence in implementing an intervention. Methods: Seventeen electronic databases were searched. All full papers were read by two reviewers and a third reviewer was consulted in the event of a disagreement on inclusion. Selected studies were quality assessed, using the Cochrane Risk of Bias Tool, were data extracted by two reviewers using a standardised data extraction form and statistically synthesised where appropriate using the fixed-effect inverse-variance method. Results: Seven studies met the inclusion criteria. Meta-analyses showed group CBT to be effective in reducing depression compared to routine primary care, usual care or waiting list groups. A pooled effect size of d = 0.57 (95% CI 0.34 to 0.80, p < 0.001) was observed at 10–13 weeks post-randomisation, reducing to d = 0.28 (95% CI 0.03 to 0.53, p = 0.025) at 6 months. The non-randomised comparisons against waiting list controls at 10–13 weeks was associated with a larger effect size of d = 0.94 (95% CI 0.42 to 1.47, p < 0.001). However due to the limitations of the available data, such as ill-specified definitions of the CBT component of the group programmes, these results should be interpreted with caution. Conclusions: Although the evidence available is limited, group CBT was shown to be effective. We argue, therefore, that there is sufficient evidence to implement group CBT, conditional upon routinely collected outcomes being benchmarked against those obtained in trials of individual CBT, and with other important factors such as patient preference, clinical experience, and information from the local context taken into account when making the treatment decision