A Retrospective Observational Study of Maximal Enteral Nutrition Rates in a Burn Patient Population

Enteral nutrition (EN) is frequently interrupted in the critically ill patient, which can lead to nutritional deficits and severe weight and lean body mass loss. Increased EN rates are being used more frequently to account for these interruptions. This study examined the maximum hourly EN rate (MAX rate) received by each subject and evaluated outcomes and tolerance in an effort to determine if there is a maximum threshold for the EN rate in this population. This retrospective observational study was conducted on an adult population admitted to a major burn center during a three year period who received EN and had ≥20% total body surface area (TBSA) burned requiring excision. Demographics, treatment, and outcomes data were collected during the MAX rate that each subject received and were analyzed with descriptive and comparative statistics. The gastrointestinal (GI) intolerance data examined included emesis, residuals ≥500 mL, aspiration, ≥1 L stool output in 24 hours, and necrotic bowel during or after MAX rate. IRB approval was obtained. Data were collected on 151 subjects with 48% ± 18% TBSA burn who were 33 ± 14 years old and met the inclusion criteria. The average MAX rate ordered and received was 154 ± 45 mL/hr. The factors that predicted mortality in this study were burn size (p =22=0.01). Pressor agents running during the MAX rate in 15% of the subjects (n=23). Subjects who were on pressors during the MAX rate had significantly higher residuals [445 (143, 525) mL vs. 140 (0,340) mL] than subjects who were not on pressors during the MAX rate. The total number of GI intolerance symptoms experienced per subject was a predictor of mortality, but the MAX rate was not associated with increased GI intolerance symptoms. Pressor use during MAX rate was associated with the total number of different types of GI intolerance symptoms experienced per subject and with mortality. There were no strong correlation between increase in MAX rate and incidence of negative outcomes, therefore a definitive MAX rate could not be established

Japanese-Brazilian Return Migration: Pushes, Pulls, and Prospects

Japan’s economic situation and need for foreign labor present challenges when attracting and incorporating an influx of newcomers, which in turn poses questions relevant to previously established theories of migration. By examining public policies and the experiences of Japanese-Brazilians or Brazilian nikkeijin—migrants of Japanese descendants born in Brazil—I argue that Japan’s immigration policy is a key determinant in their migration to Japan and, subsequently, that this policy plays an integral role in shaping the Japanese-Brazilians’ environment in the host society. Building on Portes and Borocz’s theory of host country receptivity, I consider how determinants of migration influence the immigrants’ incorporation. Japanese immigration policy essentially recruits Brazilian nikkeijin for immigration by extending admission to them on the basis of Japanese descent; following their immigration, this policy results in a generally low-level reception of Brazilian nikkeijin into the dominant society as evidenced by government policy, public opinion, and Japanese-Brazilian ethnic communities in Japan. Specifically, the Japanese government has created an immigration policy that both supports a perception of Japanese-Brazilians as possessing a high-level of “Japaneseness,” and yet continues to view these immigrants as “others” or foreigners (Tsuda 2003). As a result, Japanese immigration policy encourages Brazilian nikkeijin to immigrate and meet Japan’s needs for foreign laborers, but once in the country, Japanese-Brazilians face political restrictions and negative public sentiment stemming from their emergent cultural and ethnic differences. This case reveals how policy plays a significant role in shaping migration flows and illuminates possible motives behind and inconsistencies between pre- and post-migration policies

The Stage and the Dance in Medias Res: An Ethnographic Study of Ideologies Associated with Tradition and Continuity in a French Ballet Academy in the United States

The anthropological study of dance is particularly relevant to scholars who work on theories of embodiment and social practice, as well as those concerned with the production of history and ideologies, for dance concerns the deliberate movement of the body across space and in time, and within a particular socio-cultural context. Based on a year and a half of ethnographic research at a pre-professional ballet school in New York City that specializes in teaching the "classical French" form, this study applies an anthropological understanding of ideologies and processes in education to classical forms of ballet. Its analysis of how the ideological system associated with the aesthetics of ballet is created and recreated, in relation to shifting concepts of tradition, suggests that the process of establishing and maintaining institutional boundaries and "sculpting" the bodies of students in the classroom frames the ways that students are related to, and develop relationships with, the ideologies that they encounter. Both the school, as an institution, and individual students are able to navigate and position themselves within the landscape formulated by these ideologies through the development of social networks, the formulation of individual institutional genealogies, and the development and presentation of choreography in selected venues. These processes illustrate the ways in which ideological systems are articulated, developed, and altered in relation to understandings of the human body