A multifaceted approach to addressing feeding intolerance in the preterm infant

In 2013, 11.4% of births in the United States occurred preterm.1 Due to the immaturity of the gastrointestinal tract, these infants are at increased risk of feeding intolerance and necrotizing enterocolitis (NEC). NEC is the most common surgical emergency among infants and proves fatal for 25-33% those diagnosed.2,3 Effective early detection of these conditions,4 combined with targeted therapies to promote intestinal adaptation and weaning from parenteral nutrition (PN), represent an important opportunity to improve infant outcomes. To this end, the following studies were conducted. 1. The safety and efficacy of teduglutide, an analog of human glucagon-like peptide-2 (GLP-2) approved for use only in adults, in reducing PN requirements was assessed via a systematic review.5 Fourteen reports met the inclusion criteria. Teduglutide reduced PN requirements vs. placebo regardless of PN dependence duration, whereas adverse event incidence was similar between groups (number needed to treat to benefit [NNTB] = 3-4; number needed to treat to harm [NNTH] = 24-187). 2. Teduglutide-stimulated intestinal adaptation, potential synergies with partial enteral nutrition (PEN), and distinct temporal markers of adaptation were investigated in a neonatal piglet model of short bowel syndrome (SBS). Teduglutide improved (P < 0.05) mucosal surface area (villus height: duodenum, jejunum, ileum; crypt depth: ileum, colon; proliferation: duodenum, jejunum, ileum, colon; apoptosis: jejunum, ileum, colon) and acute nutrient processing capacity (glucose: duodenum, jejunum, ileum; glutamine: duodenum, jejunum). PEN complimented and synergistically enhanced these effects. Structural adaptation preceded functional adaptation, but crypt depth was a strong indicator of adaptation, regardless of time. 3. A novel feeding intolerance and NEC risk scoring tool was implemented in the University of Illinois-affiliated Carle Foundation Hospital (CFH) level III neonatal intensive care unit (NICU). During the study period, 499 tools were completed on the 133 enrolled infants. Indices of feeding intolerance included days with emesis, abdominal distention, or gastric residuals > 50% of previous feeding volume, and NEC. Anonymous surveys (n = 42) indicated nurses’ positive attitudes toward the tool (ease of use of 6.9 [SD 1.9] on 10-point scale). Estimated tool completion time was 4.2 minutes (range 1-10). Error rate (9.2%), Cronbach’s alpha (0.71), the intraclass correlation coefficient (ICC; 0.99), and Fleiss’ kappa (1.00) were in acceptable ranges. Gestational age at birth, hypoxia/asphyxia at birth, red blood cell (RBC) transfusion, and congenital heart disease/patent ductus arteriosis (PDA) were significantly associated with all four outcome measures. Total optimized tool score was also associated with all four outcome measures, with area under the ROC curve (AUC) and diagnostic odds ratio (OR) estimates [95% CI] of: emesis, AUC = 0.69 and OR = 1.14 [1.06, 1.23]; abdominal distention, AUC = 0.82 and OR = 1.28 [1.18, 1.41]; gastric residuals > 50% of previous feeding volume, AUC = 0.64 and OR = 1.11 [1.04, 1.20]; NEC, AUC = 0.90 and OR = 1.29 [1.12, 1.56]. Scores of infants who did and did not develop each of the four outcome measures were significantly (P < 0.05) different, and an “at-risk” threshold of 9 points was established. The tool represents a clinically feasible means to discriminate infants at risk of feeding intolerance and NEC. Further refinement will improve its clinical utility and identify infants who may benefit from targeted therapies, including teduglutide and/or PEN, to promote gastrointestinal maturation and improve feeding tolerance.   REFERENCES 1. Martin J, Hamilton B, Osterman M, Curtin S, Mathews T. Births: final data for 2013. Natl Vital Stat Rep 2015;64(1):1-65. 2. Henry M, Moss R. Current issues in the management of necrotizing enterocolitis. Semin Perinatol 2004;28:221-233. 3. Lin P, Stoll B. Necrotising enterocolitis. Lancet 2006;368:1271-1283. 4. Neu J, Walker W. Necrotizing enterocolitis. N Engl J Med 2011;364:255-264. 5. Higgins J, Green S (eds). Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. The Cochrane Collaboration 2011

Square patterns in Rayleigh-Benard convection with rotation about a vertical axis

We present experimental results for Rayleigh-Benard convection with rotation about a vertical axis at dimensionless rotation rates in the range 0 to 250 and upto 20% above the onset. Critical Rayleigh numbers and wavenumbers agree with predictions of linear stability analysis. For rotation rates greater than 70 and close to onset, the patterns are cellular with local four-fold coordination and differ from the theoretically expected Kuppers-Lortz unstable state. Stable as well as intermittent defect-free square lattices exist over certain parameter ranges. Over other ranges defects dynamically disrupt the lattice but cellular flow and local four-fold coordination is maintained.Comment: ReVTeX, 4 pages, 7 eps figures include

The components for a quantum computer based on surface state electrons on liquid helium

It has been proposed in literature that a quantum computer can be made utilizing the electronic states of electrons bound to the surface of liquid helium. One can model a single electron on the surface as a 1d hydrogenic atom, providing a set of quantum electronic states which are easily tunable, with an untuned energy gap of 0.488\,meV (̃120 GHz) between the ground state and the first excited state, and it is these two energy levels that are proposed as the 0 and 1 state of a qubit. To that end, three microfabricated devices are needed: a low temperature electron source of low energy electrons, a detector capable of detecting single electrons, and a microstructure capable of trapping and Stark shifting the energy levels of individual electrons in proximity close enough to perform multiple qubit operations. This dissertation contains a description of the devices microfabricated for these purposes. An electron source based on porous silicon was fabricated, tested, and proven to provide low energy electrons. Other more conventional techniques based on a thoriated tungsten filament were also explored. For electron detection, we have fabricated a transition edge superconducting microbolometer. Tests have shown it is capable of detecting a few eV of energy. For the microstructure, we fabricated a series of columns 200 nm in diameter, 1.5[mu]m in height, separated by 500 nm. For later tests, a microelectrode exposed through a 10[mu]m diameter hole in a ground plane was used. Initial experiments describing bolometer designs and electron confinement are discussed, as well as proposed microfabrication redesign to continue this work. Numerical time series computations of both single (NOT, PHASE) and two qubit (SWAP, [square root]SWAP, CNOT) gates are also presente

DEFECT CLUSTERING AND RELAXATION PHENOMENA IN RARE-EARTH DOPED CRYSTALS.

Abstract not availabl

Some Aspects of Recovery of Interblock Information.

In the analysis of an incomplete block design under the usual additive model for block and treatment effects, if the block effects are considered to be r and om, one can obtain information about the treatment effects by considering contrasts of observations both within and between blocks. The information obtained from contrasts within blocks is called intrablock information and that obtained from contrasts between blocks is called interblock information. In this dissertation, various aspects of recovery of interblock information are studied for several designs. First, the cross-validatory choice of weights proposed by Jensen and Stone (1976) for combining intrablock and interblock information in balanced incomplete block designs is investigated. By expressing these weights in a much simpler form, their similarity to other weights suggested in the literature is demonstrated and their properties are examined. In addition, it is shown how Jensen and Stone's cross-validatory procedure for obtaining the weights in balanced incomplete block designs can be extended to other binary incomplete block designs. Second, weights suggested in the literature for binary incomplete block designs are reformulated for use in n-ary incomplete block designs. The properties of the resulting combined estimates are also examined. Third, since methods have been given for constructing second order rotatable response surface designs with nonorthogonal blocking, and these designs require fewer design points than the corresponding orthogonal designs, it is shown how interblock information can be recovered in such designs to increase the precision of the response surface coefficients. Finally, for symmetric factorial designs, the estimation of treatment contrasts formed from orthogonal polynomials is considered, with and without interblock information. It is shown that the use of trigonometric factor levels introduced by Bailey (1982) may lead to more precise estimates for those treatment contrasts of interest than the use of the more common equally spaced factor levels.Ph.D.BiostatisticsUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/160043/1/8412255.pd

Health care costs matter: a review of nutrition economics &ndash; is there a role for nutritional support to reduce the cost of medical health care?

Jane K Naberhuis,1 Vivienne N Hunt,2 Jvawnna D Bell,3 Jamie S Partridge,3 Scott Goates,3 Mark JC Nuijten4 1Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA; 2Abbott Nutrition, Research and Development, Singapore; 3Abbott Nutrition, Research and Development, Columbus, OH, USA; 4A2M (Ars&nbsp;Accessus Medica), Amsterdam,&nbsp;The&nbsp;Netherlands Background and aims: As policy-makers assess the value of money spent on health care, research in the field of health economics is expanding rapidly. This review covers a period of 10 years and seeks to characterize the publication of papers at the intersection of health economics and nutrition. Methods: Relevant publications on nutrition care were identified in the medical literature databases using predetermined search criteria. These included nutritional interventions linked to health economic terms with inclusion criteria requiring original research that included clinical outcomes and cost analyses, subjects&rsquo; ages &ge;18 years, and publications in English between January 2004 and October 2014. Results: Of the 5,646 publications identified in first-round searches, 274 met the specified inclusion criteria. The number of publications linking nutrition to economic outcomes has increased markedly over the 10-year period, with a growing number of studies in both developed and developing countries. Most studies were undertaken in Europe (39%) and the USA and Canada (28%). The most common study setting was hospital (62%) followed by community/noninstitutional care (30%). Of all the studies, 12% involved the use of oral nutritional supplements, and 13% involved parenteral nutrition. The economic outcomes consistently measured were medical care costs (53% of the studies), hospital length of stay (48%), hospital readmission rates (9%), and mortality (25%). Conclusion: The number of publications focused on the economics of nutrition interventions has increased dramatically in recent years. Studies have demonstrated that malnutrition can increase the costs of care and length of hospital stay while corresponding studies show that nutrition interventions can help lower the cost of health care by decreasing the incidence of complications and speeding recovery. As populations age, policies that lead to wider adoption of screening, assessment, and treatment of malnutrition will be important to improve health economic outcomes. Keywords: economics of nutrition interventions, reducing health care costs through nutritio