The role of the gastroenterologist in the provision of artificial nutrition support

Background:Nutrition support is required for the prevention or treatment of malnutrition in patients with intestinal failure and those who are unable to eat.Aims:To determine the demands upon gastroenterologists for nutrition support, the available resources, and compliance with the British Society of Gastroenterology (BSG) guidelines.Method:A questionnaire was circulated to all 483 consultant physician members of the BSG.Results:There were 336 (70%) replies. Fifty?three per cent of respondents reported malnutrition in 20% or more of their patients. Seventy?nine per cent of consultants supervised patients on enteral feeding, and 64% supervised parenteral feeding. Feeding jejunostomy was used by 61% of Teaching Hospital (TH) consultants but only 38% of District General Hospital (DGH) consultants (P

Output of selenium in milk, urine, and feces is proportional to selenium intake in dairy cows fed a total mixed ration supplemented with selenium yeast

Fifteen rumen fistulated Holstein cows in late lactation and fed a total mixed ration offered ad libitum were supplemented with Se yeast to provide 0, 11, 20, 30, or 42 mg of supplemental Se/day to test the hypothesis that amounts of Se secreted in milk, excreted in urine and feces, and apparently retained in tissues would increase in direct proportion to Se intake. One-half of the yeast supplement was placed directly into the rumen through the fistula of each cow just before milking in the morning and again in the evening, and estimates of average daily excretion of Se were made using total collections of urine and feces from 25 to 31 d after treatments commenced. Amounts of Se secreted daily in milk and apparently retained in tissues increased linearly with average daily intake of Se. The amount of Se excreted in feces and total excretion of Se in urine plus feces increased curvilinearly with Se intake, such that proportionately less Se was excreted as the amount of Se fed increased. On average, total Se excretion accounted for 66%, Se secretion in milk accounted for 17%, and Se apparently retained in tissues accounted for 17% of total Se intake by cows. Thus, in herds fed large amounts of Se yeast, most of the Se will be excreted and retained on-farm. High concentrations of Se will be found where urine and feces accumulate (e.g., yards and effluent ponds), and effluent management practices must be tailored to avoid environmental issues

Selenium levels in cows fed pasture and concentrates or a total mixed ration and supplemented with selenized yeast to produce milk with supra-nutritional selenium concentrations

Seventy multiparous Holstein-Friesian cows were fed different amounts of pasture and concentrates, or a total mixed ration (TMR), for 42 d in mid-lactation to test the hypothesis that the concentration of Se in milk would depend on the amount of Se consumed, when the Se is primarily organic in nature, regardless of the diet of the cows. Of the 70 cows, 60 grazed irrigated perennial pasture at daily allowances of either 20 or 40 kg of dry matter (DM)/cow. These cows received 1 of 3 amounts of concentrates, either 1, 3, or 6 kg of DM/cow per day of pellets, and at each level of concentrate feeding, the pellets were formulated to provide 1 of 2 quantities of Se from Se yeast, either about 16 or 32 mg of Se/d. The other 10 cows were included in 2 additional treatments where a TMR diet was supplemented with 1 kg of DM/d of pellets formulated to include 1 of the 2 quantities of supplemental Se. Total Se intakes ranged from 14.5 to 35.9 mg/d, and of this, the Se-enriched pellets provided 93, 91, and 72% of the Se for cows allocated 20 and 40 kg of pasture DM/d or the TMR, respectively. No effects of the amount of Se consumed on any milk production variable, or on somatic cell count, body weight, and body condition score, for either the pasture-fed or TMR-fed cows were found. Milk Se concentrations responded quickly to the commencement of Se supplementation, reaching 89% of steady state levels at d 5. When milk Se concentrations were at steady state (d 12 to 40), each 1 mg of Se eaten increased the Se concentration of milk by 5.0 μg/kg (R2 = 0.97), and this response did not seem to be affected by the diet of the cows or their milk production. The concentration of Se in whole blood was more variable than that in milk, and took much longer to respond to change in Se status, but it was not affected by diet at any time either. For the on-farm production of Se-enriched milk, it is important to be able to predict milk Se concentration from Se input. In our study, type of diet did not affect this relationship

Natural phenomena hazards evaluation of equipment and piping of Gaseous Diffusion Plant Uranium Enrichment Facility

In support of the Gaseous Diffusion Plant Safety Analysis Report Upgrade program (GDP SARUP), a natural phenomena hazards evaluation was performed for the main process equipment and piping in the uranium enrichment buildings at Paducah and Portsmouth gaseous diffusion plants. In order to reduce the cost of rigorous analyses, the evaluation methodology utilized a graded approach based on an experience data base collected by SQUG/EPRI that contains information on the performance of industrial equipment and piping during past earthquakes. This method consisted of a screening walkthrough of the facility in combination with the use of engineering judgment and simple calculations. By using these screenings combined with evaluations that contain decreasing conservatism, reductions in the time and cost of the analyses were significant. A team of experienced seismic engineers who were trained in the use of the DOE SQUG/EPRI Walkdown Screening Material was essential to the success of this natural phenomena hazards evaluation

Producing milk with uniform high selenium concentrations on commercial dairy farms

Six herds on five commercial dairy farms were involved in the production of high selenium (Se) milk. The farms had a range of herd sizes, herd structures, feeding systems and milk production per cow. On all farms, pelleted concentrate supplements containing Se yeast were fed twice daily in the dairy for 16 days. The objectives were to: (1) produce milk with Se concentrations exceeding 225 mu g/kg on the five farms for pilot-scale production of a high protein milk powder; (2) validate a predictive relationship between Se intake and milk Se concentration developed in research; and (3) examine the time taken from the introduction of Se yeast to steady-state concentrations of Se in milk under a range of commercial farming conditions. We hypothesised that the relationship between Se intake and its concentration in milk found in research would apply on commercial farms. Daily Se intake, which was primarily from Se yeast in the pelleted concentrates, varied from 35 to 51 mg Se/cow. Grazed pasture and conserved forage contributed less than 1 mg Se/cow on all farms. The time taken from the introduction of pellets containing Se yeast to steady-state milk Se concentrations was 4-7 days. The steady-state Se concentrations in milk varied from 166 to 247 mu g/kg, but these concentrations were only 55-72% of predicted values. All the milk produced from the five farms on the last 2 days of feeding of Se-enriched pellets was used to produce a milk protein concentrate with a Se concentration of 5.4 mg/kg. Factors that might have affected Se incorporation into milk and the implications of these results for commercial production of high Se milk or milk products are discussed