Survey of Nutrition Management Practices in Centers for Pediatric Intestinal Rehabilitation

Background: Nutrition management of pediatric intestinal failure (IF) requires interdisciplinary coordination of parenteral nutrition (PN) and enteral nutrition (EN) support. Nutrition strategies used by specialists in pediatric intestinal rehabilitation to promote gut adaptation and manage complications have not been previously summarized. Methods: A practice survey was distributed to members of the dietitian subgroup of the American Society for Parenteral and Enteral Nutrition Pediatric Intestinal Failure Section. The survey included 24 open‐ended questions related to PN and enteral feeding strategies, nutrition management of PN‐associated liver disease, and laboratory monitoring. Results: Dietitians from 14 centers completed the survey. Management components for patients at risk for cholestasis were consistent and included fat minimization, trace element modification, avoiding PN overfeeding, and providing EN. Parenteral amino acid solutions designed for infants/young children are used in patients <1 or 2 years of age. Trace minerals are dosed individually in 10 of 14 centers. Eleven centers prescribe a continuous infusion of breast milk or elemental formula 1–2 weeks after resection while 3 centers determine the formula type by the extent of resection. Most (86%) centers do not have a protocol for initiating oral/motor therapy. Laboratory panel composition varied widely by center. The selection and frequency of use depended on clinical variables, including cholestatic status, exclusive vs partial PN dependence, postrepletion verification vs routine monitoring, intestinal anatomy, and acuity of care. Conclusion: EN and PN management strategies are relatively consistent among U.S. centers. Collaborative initiatives are necessary to define better practices and establish laboratory monitoring guidelines.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145220/1/ncp10040_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145220/2/ncp10040.pd

Geology, geochemistry and earthquake history of Lō`ihi Seamount, Hawai`i

Author Posting. © The Authors, 2005. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Chemie der Erde - Geochemistry 66 (2006): 81-108, doi:10.1016/j.chemer.2005.09.002.A half century of investigations are summarized here on the youngest Hawaiian volcano, Lō`ihi Seamount. It was discovered in 1952 following an earthquake swarm. Surveying in 1954 determined it has an elongate shape, which is the meaning of its Hawaiian name. Lō`ihi was mostly forgotten until two earthquake swarms in the 1970’s led to a dredging expedition in 1978, which recovered young lavas. This led to numerous expeditions to investigate the geology, geophysics, and geochemistry of this active volcano. Geophysical monitoring, including a realtime submarine observatory that continuously monitored Lō`ihi’s seismic activity for three months, captured some of the volcano’s earthquake swarms. The 1996 swarm, the largest recorded in Hawai`i, was preceded by at least one eruption and accompanied by the formation of a ~300-m deep pit crater, renewing interest in this submarine volcano. Seismic and petrologic data indicate that magma was stored in a ~8-9 km deep reservoir prior to the 1996 eruption. Studies on Lō`ihi have altered conceptual models for the growth of Hawaiian and other oceanic island volcanoes and led to a refined understanding of mantle plumes. Petrologic and geochemical studies of Lō`ihi lavas showed that the volcano taps a relatively primitive part of the Hawaiian plume, producing a wide range of magma compositions. These compositions have become progressively more silica-saturated with time reflecting higher degrees of partial melting as the volcano drifts towards the center of the hotspot. Seismic and bathymetric data have highlighted the importance of landsliding in the early formation of an ocean island volcano. Lō`ihi’s internal structure and eruptive behavior, however, cannot be fully understood without installing monitoring equipment directly on the volcano. The presence of hydrothermal activity at Lō`ihi was initially proposed based on nontronite deposits on dredged samples that indicated elevated temperatures (31oC), and on the detection of water temperature, methane and 3He anomalies, and clumps of benthic micro-organisms in the water column over the volcano in 1982. Submersible observations in 1987 confirmed a low temperature system (15-30oC) prior to the 1996 formation of Pele’s Pit. The sulfide mineral assemblage (wurtzite, pyrrhotite, and chalcopyrite) deposited after the pit crater collapsed are consistent with hydrothermal fluids >250oC. Vent temperatures have decreased to ~60oC during the 2004 dive season indicating the current phase of hydrothermal activity may be waning.This work was supported by a NSF grant to M. Garcia (OCE 97-29894)

ASPEN safe practices for enteral nutrition therapy [formula: see text]

Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN