Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control Study

Nutrition is essential in critically ill patients, but translating caloric prescriptions into adequate caloric intake remains challenging. Caloric prescriptions (P), effective intake (I), and caloric needs (N), calculated with modified Harris-Benedict formulas, were recorded during seven consecutive days in ventilated patients. Adequacy of prescription was estimated by P/N ratio. I/P ratio assessed accuracy of translating a prescription into administered feeding. I/N ratio compared delivered calories with theoretical caloric needs. Fifty patients were prospectively studied in a mixed medicosurgical ICU in a teaching hospital. Basal and total energy expenditure were, respectively, 1361 ± 171 kcal/d and 1649 ± 233 kcal/d. P and I attained 1536 ± 602 kcal/d and 1424 ± 572 kcal/d, respectively. 24.6% prescriptions were accurate, and 24.3% calories were correctly administered. Excessive calories were prescribed in 35.4% of patients, 27.4% being overfed. Caloric needs were underestimated in 40% prescriptions, with 48.3% patients underfed. Calculating caloric requirements by a modified standard formula covered energy needs in only 25% of long-term mechanically ventilated patients, leaving many over- or underfed. Nutritional imbalance mainly resulted from incorrect prescription. Failure of “simple” calculations to direct caloric prescription in these patients suggests systematic use of more reliable methods, for example, indirect calorimetry

Bilateral proximal tibia fracture

A bilateral fracture of the proximal tibia is rare in children. We describe a girl with a bilateral fracture just distal of the epiphyseal plate after minimal trauma

A global review of capacity building organizations in water sanitation, and hygiene for developing countries

Although capacity building is increasingly emphasized in the water, sanitation and hygiene (WASH) sector, many WASH implementing organizations still lack capacity to effectively and sustainably provide WASH services. This study attempts to review the global capacity building efforts in the WASH sector by identifying the major capacity building organizations, understanding their focus and activities, comparing their efforts, and assessing potential gaps in capacity building services. A review of 72 water and sanitation networks identified 104 organizations providing capacity building services to other organizations. These capacity builders are mostly European Non-Governmental Organizations giving trainings on technical subjects with frequent duplication of services. Capacity building services were found to be concentrated in capital cities with rural and remote areas receiving less capacity building services. A lack of long-term client tracking and support was also found. By addressing these gaps and increased communication between these organizations, capacity could be built much more efficiently

Calculations of the Knight Shift Anomalies in Heavy Electron Materials

We have studied the Knight shift $K(\vec r, T)$ and magnetic susceptibility $\chi(T)$ of heavy electron materials, modeled by the infinite U Anderson model with the NCA method. A systematic study of $K(\vec r, T)$ and $\chi(T)$ for different Kondo temperatures $T_0$ (which depends on the hybridization width $\Gamma$) shows a low temperature anomaly (nonlinear relation between $K$ and $\chi$) which increases as the Kondo temperature $T_0$ and distance $r$ increase. We carried out an incoherent lattice sum by adding the $K(\vec r)$ of a few hundred shells of rare earth atoms around a nucleus and compare the numerically calculated results with the experimental results. For CeSn_3, which is a concentrated heavy electron material, both the ^{119}Sn NMR Knight shift and positive muon Knight shift are studied. Also, lattice coherence effects by conduction electron scattering at every rare earth site are included using the average-T matrix approximation. Also NMR Knight shifts for YbCuAl and the proposed quadrupolar Kondo alloy Y_{0.8}U_{0.2}Pd_{3} are studied.Comment: 31 pages of RevTex, 22 Postscript figures, submmitted to PRB, some figures are delete

Management of trichobezoar: case report and literature review

Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. We present our experience with four patients and provide a review of the recent literature. According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. In addition, psychiatric consultation is necessary to prevent relapses

Visuospatial Integration: Paleoanthropological and Archaeological Perspectives

The visuospatial system integrates inner and outer functional processes, organizing spatial, temporal, and social interactions between the brain, body, and environment. These processes involve sensorimotor networks like the eye–hand circuit, which is especially important to primates, given their reliance on vision and touch as primary sensory modalities and the use of the hands in social and environmental interactions. At the same time, visuospatial cognition is intimately connected with memory, self-awareness, and simulation capacity. In the present article, we review issues associated with investigating visuospatial integration in extinct human groups through the use of anatomical and behavioral data gleaned from the paleontological and archaeological records. In modern humans, paleoneurological analyses have demonstrated noticeable and unique morphological changes in the parietal cortex, a region crucial to visuospatial management. Archaeological data provides information on hand–tool interaction, the spatial behavior of past populations, and their interaction with the environment. Visuospatial integration may represent a critical bridge between extended cognition, self-awareness, and social perception. As such, visuospatial functions are relevant to the hypothesis that human evolution is characterized by changes in brain–body–environment interactions and relations, which enhance integration between internal and external cognitive components through neural plasticity and the development of a specialized embodiment capacity. We therefore advocate the investigation of visuospatial functions in past populations through the paleoneurological study of anatomical elements and archaeological analysis of visuospatial behaviors