To date there have been no complete reports of the nutrient intakes of persons with Type I diabetes mellitus who use continuous subcutaneous insulin infusion (CSII) pumps. The purpose of this study was to describe the sample population and to determine the nutrient intake of adult Type I diabetics from the Salt Lake City, Utah area, who use CSII. Seven male and 15 female CSII users, ages 25 to 53, completed a questionnaire and a three-day diet record as instructed. Diet records were coded and household measurements of foods were converted to gram weights for computerized nutrient analysis. Nutrient intake is reported as group mean and standard deviation for sex and age. The average duration of diabetes was 17 years. The average length of CSII use was l.6 years. Review of the medical charts revealed that weight gain since beginning CSII averaged 5.5 pounds irrespective of the duration of pump use. The dietary intake of protein, calcium, phosphorus, vitamin A, thiamin, riboflavin, niacin, vitamin B12 , and ascorbic acid met or exceeded the Recommended Dietary Allowances (RDA) for both men and women. For males, mean nutrient intakes were below the RDA for zinc (82.7%), folate (82.2%), and vitamin 86 (69.0%). For females, intakes were also below the RDA for zinc (64.0%), folate (58.3%), and vitamin 86 (69.0%), as well as for iron (58.5%) and magnesium (88.0%). The average percent of kilocalories from protein, carbohydrate and fat, (approximately 17%, 43%, and 40%) was similar for both the males and females. The day-to-day variation in carbohydrate intake for both sexes was not significantly different. Intake of added sugar in the diet was 6.6% and 5.8% of total kilocalories (14.8% and 13.9% of the carbohydrate kilocalories) for males and females, respectively. In conclusion, dietary intake for this small group of CSII users was adequate in most nutrients . Of concern is the apparent inadequate intakes of zinc, folate, vitamin s6 and iron for women, as compared to the current RDA standards. The distribution of kilocalories from protein, carbohydrate and fat approaches the 1979 recommendations by the American Diabetes Association. Weight gain may be a problem for some CSII pump users, and should be monitored.

UNIVERZITA KARLOVA Lékařská fakulta v Plzni Dizertační práce Endothelial glycocalyx - diagnostic approach and intervention assessment MUDr.Jiří Pouska ABSTRACT Endothelial glycocalyx (EG) is fine structure on the surface of endothelium. After extensive research in past years, revisited Starling principle was finally formulated. It describes fluid physiology in capillaries precisely. EG has pivotal role in keeping endothelium semipermeable and thus avoiding extensive filtration of fluids to interstitium. Assessment of EG is clinically difficult. Many pathological conditions lead to damage of EG (sepsis etc.). Intravenous fluid therapy is mainstay of treatment of such conditions. Our aim was to determine the changes of EG integrity depending on the choice of intravenous fluid and its infusion time in physiological and pathological conditions. Key words: Endothelial glycocalyx, infusion therapy, anaesthesia, sepsis, microcirculation.

The potential for enhancing oleic acid (cis-18:1) and linoleic acid (18:2) content and lowering medium chain fatty acid (MCFA) content of bovine milk was investigated by abomasal infusion or dietary supplementation of oils. In experiment 1, olive oil, sesame oil, sunflower oil, or fish oil was abomasally infused (155 to 219 g/d) into Jersey cows during the last 6 d of each of four 14-d periods. In experiment 2, canola oil, olive oil, high-oleic sunflower oil, or distilled water (control) was abomasally infused (342 to 371 g/d) into three Holsteins and three Jerseys during the last 5 d of each of four 10-d periods. The intestinal digestibility and concentration of cis-18:1 and 18:2 in milk were proportional to flow of these fatty acids to the duodenum. Also, greater concentration of cis-18:1 in milk was associated with lowered yield of MCFA. During olive oil or sesame oil infusion in experiment 1, for each 100 g of cis-18:1 infused into the abomasum, milk cis-18:1 yield was increased by an average of 47 g, and MCFA yield was reduced by 42 g. The yield of 18:2 in milk was increased by approximately 46 g for each 100 g of infused 18:2 during olive oil or sesame oil infusion. Milk produced during sesame oil infusion, however, had an off-flavor when evaluated by a taste panel. In experiment 2, each 100 g of cis-18:1 infused daily increased milk cis-18:1 yield in Holsteins and Jerseys by 41 and 39 g/d, respectively, whereas recovery of infused 18:2 was 34 g/d for Jerseys and 42 g/d for Holsteins. In experiment 3, 22 Jersey cows were fed a basal diet, or the basal diet supplemented with 3.5% high-oleic canola oil, 3.5% soybean oil, or 1.75% high-oleic canola oil plus 1.75% soybean oil for 5 wk. Dietary canola oil supplementation increased conjugated linoleic acid (CLA) percentage in milk to a moderate level without raising trans-18:1 percentage, whereas feeding either supplement containing soybean oil raised both CLA and trans-18:1 percentages. Concentrations of trans-18:1 and CLA in milk apparently reflected the extent of unsaturated fatty acid biohydrogenation in the rumen. Dietary supplementation with canola oil increased yield of cis-18:1 in milk by 21 g for each 100 g of supplemental cis-18:1 intake. Yield of 18:2 in milk was raised by 3 g for each 100 g of supplemental 18:2 intake by cows fed soybean oil. Using abomasal infusion as an indicator of the maximum potential for apparent recovery of cis-18:1 in milk (39 to 49%), cis-18:1 recovery in response to supplemental cis-18:1 in the diet was approximately half of the potential response due to partial biohydrogenation in the rumen. The apparent recovery of dietary 18:2 in milk was reduced to only one-tenth of the potential yield (31 to 47%) indicated by abomasal infusion of seed oils. Results indicated that the fatty acid profile of bovine milk was altered in a manner that would be beneficial to human health when cows were fed supplemental oleic acid, but further research should focus on safe and economical methods to protect dietary unsaturated fatty acids from biohydrogenation. / Ph. D.

No description available.

No description available.

Objective: Establish and validate an experimental pain model that will create pain for at least 20-minutes and then use the model to determine if: 1) cryotherapy decreases experimentally induced pain, 2) experimentally induced pain contributes to arthrogenic muscle inhibition, and 3) cold application influences pain or arthrogenic muscle inhibition. To answer these questions we conducted two experiments, the results of which are presented in two manuscripts. Methods: Seventy (n = 30 for experiment I and n = 40 for experiment II), physically active healthy male subjects participated. Interventions: Independent variables used for experiment I were condition (5% hypertonic saline infusion/cryotherapy, no-saline infusion/cryotherapy, 5% hypertonic saline infusion/sham) and time (precondition, every minute during a condition, and 10 minutes following each condition). For experiment II, independent variables were treatment (saline infusion, saline infusion/cryotherapy, saline infusion/sham, and no-saline infusion) and time (pretreatment, posttreatment, and 30-minutes posttreatment). Dependent variables measured were pain perception, knee surface and ambient temperatures, and Hmax, and Mmax measures (experiment II only). Results: Saline caused more pain than no-saline at minutes 3, 4, and 5 during infusion. Pain caused by saline and sham application remained constant from 4 minutes during application through 1 minute following application. Cold application decreased pain for 16 minutes. Pain resulted in arthrogenic muscle inhibition following and 30 minutes following saline infusion. Cryotherapy removed inhibition following but not 30 minutes following application. Pain for the saline groups increased following infusion as measured with the pain rating index and visual analogue scale. According to pain rating index, cryotherapy did not decrease pain; however, cryotherapy decreased pain as measured with the visual analogue scales. No change in temperature occurred during the non-cooling conditions. Ambient temperatures fluctuated less than 1°C. Conclusion: Saline infusion caused anterior knee pain for over 20 minutes and resulted in arthrogenic muscle inhibition. Cryotherapy disinhibited the quadriceps motoneuron pool and reduced pain as measured with visual analogue scales. Cryotherapy did not decrease pain as measured with the McGill pain questionnaire.

OBJECTIVE: To measure clinical and qualitative outcomes in patients with diabetes mellitus transitioning from intensive insulin therapy using multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII) initiated and managed by clinical pharmacists under a collaborative practice agreement in a primary care setting without an endocrinologist. RESEARCH DESIGN AND METHODS: This study was a retrospective and cross-sectional analysis of data from an electronic medical record (EMR) and patient survey at a large primary care private practice. Patients with type 1 or type 2 diabetes who were ≥18 years old, started on CSII between 2007 and 2010, and had at least one follow-up visit post-CSII were analyzed. Mean HbA1c results were stratified across 3-month intervals post-CSII initiation and compared to pre-CSII levels. Body mass index (BMI), the number of diabetes-related clinic visits with the primary care physician (PCP), and non-insulin diabetes medication use was compared pre- and post-CSII initiation. Paper-based questionnaires were used to assess patient satisfaction with CSII vs MDI and pharmacist-led services. RESULTS: Twenty-five patients were included in the analysis. HbA1c decreased from 8.69 to 7.52% pre and post-CSII, respectively (p < 0.001). HbA1c also decreased across all 3-month intervals post-CSII. BMI decreased from 33.0 to 32.3 kg/m(2) pre- and post-CSII, respectively (p = 0.085). Fewer diabetes-related PCP visits were completed post-CSII (5.09 vs 3.78 visits/year, p = 0.009), and less non-insulin diabetes medications were prescribed post-CSII (p < 0.001). Patients felt more comfortable controlling glycemic excursions and resultant insulin adjustments with CSII compared to MDI (p < 0.001). CONCLUSIONS: Pharmacist-led CSII services appear to improve diabetes control in patients requiring intensive insulin therapy. Patients report greater comfort using CSII and strong confidence in the abilities of the pharmacist. Physician-pharmacist collaboration in the management of intensive insulin therapy in the primary care setting should be further explored.

The subject of this project is to study spun cellulose fibers made by Spinnova Oy inFinland. The fibers are spun using an environmentally friendly spinning process withoutuse of harsh chemicals.The spun filaments and the yarn based on these filaments were characterized and usedas reinforcement in polylactic acid biopolymer (PLA) and in biobased epoxy resin. Acomprehensive mechanical and morphological characterization of the single filamentsand their yarn was conducted. It was found that the single filaments are flat with a largewidth/thickness ratio, they are porous especially on one side and some cellulosemicrofibril orientation is observed on the filament surface. The single filaments are stiffand strong if compared to commercial regenerated cellulose filaments but are difficultto handle as they are very small and extremely light. The yarn showed to have lowermechanical properties but is easier to handle during the process of compositemanufacturing. Unidirectional fiber-reinforced composites were made using theSpinnova-yarn and PLA polymer applying film-stacking processing method. Thecomposite mechanical properties were studied and the results showed that themechanical performance of the PLA was significantly improved. The strength improvedfrom 54 MPa of the neat PLA to 95 MPa and the stiffness from 3.4 to 8.6 GPa withaddition of 22 wt% Spinnova-yarn.The main challenge of the project was handling the single filaments and their yarn todevelop a suitable manufacturing process which allows to exploit the potential of themto obtain a homogeneous fiber “preform” and to achieve good impregnation with the PLA matrix.

INTRODUCTION: Acute infusion reactions from antineoplastic agents can include hypersensitivity reactions, anaphylaxis, and cytokine release infusion reactions. Severe acute infusion reactions happen in about 5% of the oncology patient population and nurses are responsible for assessment and management of the reaction. This is a high-stress task for a nurse magnified by the lack of exposure. This project explores nursing knowledge and perceived comfort level of acute infusion reactions caused by antineoplastic agents. METHODOLOGY: An original survey was created to test nursing knowledge and assess comfort level. Nursing knowledge was broken down into six subscales: general knowledge of acute infusion reactions, signs and symptoms of hypersensitivity, anaphylaxis, and cytokine release infusion reaction, and drugs most likely to cause hypersensitivity and anaphylactic reactions and cytokine release infusion reactions. Comfort questions were asked on a 6-point Likert scale from extremely uncomfortable to extremely comfortable. There was an additional section in the survey related to nurses’ distress and support in situations with acute infusion reactions. The questions were presented using a 6-point Likert scale ranging from strongly disagree to strongly agree. There were two open-ended questions that were designed to allow the nurses to share any additional information about their experiences with acute infusion reactions. Oncology nurses working with adults and pediatric populations were invited to participate. Descriptive statistics were used to analyze the survey results. T tests were used to compare groups and Pearson R statistics were used to examine relationships between total knowledge, knowledge subscale score, and comfort level. RESULTS: 20 nurses completed the survey. 12 were from the adult nurse population and 8 were from the pediatric nurse population. The typical participant was forty-four years of age, had sixteen years experience as a Registered Nurse, and thirteen years experience in the oncology setting. The average total knowledge score was a 56% based on 84 possible points. The basic knowledge section and the anaphylactic signs and symptoms were the highest scoring subscales, both scoring a 62%. Cytokine release infusion reaction signs and symptoms was the lowest scoring subscale with a 45%. There were no significant differences in knowledge between groups. The nurses chose an overwhelming agree/strongly agree when asked to choose the signs and symptoms related to each type of infusion reaction. The total comfort level score indicated that nurses were very comfortable managing acute reactions. There was no significant difference between the adult and pediatric setting comfort level scores. There was no statistically significant relationship between total knowledge score and total comfort level score. DISCUSSION: The knowledge score showed knowledge deficits while the comfort score indicated confidence in management of acute infusion reactions. The high frequency of agree/strongly agree for all three subscales of signs and symptoms indicates that the nurses at least know what to look for even if they cannot assign the specific sign and symptom to the type of infusion reaction. Knowledge about signs of specific types of drug reactions may not be necessary as long as a basic understanding of what to look for and how to manage a reaction is present.

No description available.