Total Parenteral Nutrition Catheter Sepsis: Impact of the Team Approach

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141902/1/jpen0642.pd

Association of Parenteral Nutrition Catheter Sepsis with Urinary Tract Infections

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141954/1/jpen0639.pd

Measurement of gut permeability using fluorescent tracer agent technology

Abstract The healthy gut restricts macromolecular and bacterial movement across tight junctions, while increased intestinal permeability accompanies many intestinal disorders. Dual sugar absorption tests, which measure intestinal permeability in humans, present challenges. Therefore, we asked if enterally administered fluorescent tracers could ascertain mucosal integrity, because transcutaneous measurement of differentially absorbed molecules could enable specimen-free evaluation of permeability. We induced small bowel injury in rats using high- (15 mg/kg), intermediate- (10 mg/kg), and low- (5 mg/kg) dose indomethacin. Then, we compared urinary ratios of enterally administered fluorescent tracers MB-402 and MB-301 to urinary ratios of sugar tracers lactulose and rhamnose. We also tested the ability of transcutaneous sensors to measure the ratios of absorbed fluorophores. Urinary fluorophore and sugar ratios reflect gut injury in an indomethacin dose dependent manner. The fluorophores generated smooth curvilinear ratio trajectories with wide dynamic ranges. The more chaotic sugar ratios had narrower dynamic ranges. Fluorophore ratios measured through the skin distinguished indomethacin-challenged from same day control rats. Enterally administered fluorophores can identify intestinal injury in a rat model. Fluorophore ratios are measureable through the skin, obviating drawbacks of dual sugar absorption tests. Pending validation, this technology should be considered for human use

Home Parenteral Nutrition: A Hospital‐Based Program with Commercial Logistic Support

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141442/1/jpen0585.pd

Effect of Enzymatic Tempering of Wheat Kernels on Milling and Baking Performance

This study examined the effect of cell-wall-degrading enzymes added to temper water on wheat milling performance and flour quality. An enzyme cocktail consisting of cellulase, xylanase, and pectinase and five independent variables (enzyme concentration, incubation time, incubation temperature, tempered wheat moisture content, and tempering water pH) were manipulated in a response surface methodology (RSM) central composite design. A single pure cultivar of hard red winter wheat was tempered under defined conditions and milled on a Ross experimental laboratory mill. Some treatment combinations affected flour yield from the break rolls more than that from the reduction rolls. However, a maximum for flour yield was not found in the range of parameters studied. Though treatments did not affect the optimum water absorption for breadmaking, enzyme-treated flours produced dough exhibiting shorter mixing times and slack and sticky textures compared with the control. Regardless of differences in mixing times, specific loaf volumes were not significantly different among treatments. Crumb firmness of bread baked with flour milled from enzyme-treated wheat was comparable to the control after 1 day but became firmer during storage up to 5 days

Rhamnose is superior to mannitol as a monosaccharide in the dual sugar absorption test: A prospective randomized study in children with treatment-naïve celiac disease

BACKGROUND AND AIM: We sought to correlate two different measures of gut permeability [lactulose:mannitol (L:M) and lactulose:rhamnose (L:R)] to the severity of duodenal histopathology in children with and without elevated antibodies to tissue transglutaminase (tTG). A secondary objective was to correlate gut permeability with celiac disease (CD) serology and indices of inflammation and bacterial product translocation. METHODS: We prospectively randomized children undergoing endoscopy with abnormal ( RESULTS: Of the 54 cases with positive celiac serology, 31 and 69% had modified Marsh 0/1 scores or ≥3a, respectively. Circulating tTG IgA correlated with the modified Marsh score ( CONCLUSIONS: L:R, but not L:M, is associated with modified Marsh scores in children undergoing small bowel biopsy for suspected CD. Despite increased intestinal permeability, we see scant evidence of systemic exposure to gut microbes in these children. Gut permeability testing with L:R may predict which patients with abnormal celiac serology will have biopsy evidence for celiac disease and reduce the proportion of such patients undergoing endoscopy whose Marsh scores are ≤1. M should not be used as a monosaccharide for permeability testing in children

Elective Modernism and the Politics of (Bio) Ethical Expertise

In this essay I consider whether the political perspective of third wave science studies – ‘elective modernism’ – offers a suitable framework for understanding the policy-making contributions that (bio)ethical experts might make. The question arises as a consequence of the fact that I have taken inspiration from the third wave in order to develop an account of (bio)ethical expertise. I offer a précis of this work and a brief summary of elective modernism before considering their relation. The view I set out suggests that elective modernism is a political philosophy and that although its use in relation to the use of scientific expertise in political and policy-making process has implications for the role of (bio)ethical expertise it does not, in the final analysis, provide an account that is appropriate for this latter form of specialist expertise. Nevertheless, it is an informative perspective, and one that can help us make sense of the political uses of (bio)ethical expertise

‘Like the stranger at a funeral who cries more than the bereaved’: ethical dilemmas in ethnographic research with children

This article contributes to debates on the practicality and utility of prior ethical review in ethnography and qualitative research using an ethnography of children’s involvement in artisanal gold mining work in Ghana as a case study. Reflecting on dilemmas and obstacles encountered in attempts to employ prescribed institutional ethical guidance modelled for childhood research in the UK during the fieldwork, the discussion brings to attention some of the problems that can arise when ethical guidance is not anchored in the lived realities or value systems of the setting in which fieldwork is conducted. The article seeks to rejuvenate calls for more flexible and socio-culturally responsive ethical review and practice as an alternative to the prescriptive ethical regimes

Small-Scale Extrusion of Corn Masa By-Products

Corn masa by-product streams are high in fiber and are amenable for utilization in livestock feed rations. This approach is a potentially viable alternative to landfilling, the traditional disposal method for these processing residues. Suspended solids were separated from a masa processing waste stream, blended with soybean meal at four levels (0, 10, 20, and 30% wb), and extruded in a laboratory-scale extruder at speeds of 50 rpm (5.24 rad/sec) and 100 rpm (10.47 rad/sec) with temperature profiles of 80-90-100°C and 100-110-120°C. Processing conditions, including dough and die temperatures, drive torque, specific mechanical energy consumption, product and feed material throughput rates, dough apparent viscosity, and dough density, were monitored during extrusion. The resulting products were subjected to physical and nutritional characterization to determine the effects of processing conditions for these blends. Extrudate analysis included moisture content, water activity, crude protein, in vitro protein digestibility, crude fat, ash, product diameter, expansion ratios, unit and true density, color, water absorption and solubility, and durability. All blends were suitable for extrusion at the processing conditions used. Blend ratio had little effect on either processing parameters or extrudate properties; extrusion temperature and screw speed, on the other hand, significantly affected both processing and product properties