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• Nursing homes lacked adequate resources and staff during the COVID-19 pandemic. • Advice to prevent and manage facility outbreaks was rapidly changing, often conflicting. • Nursing homes should be considered in discussions of medical supply allocation. • Nursing homes are an integral piece of the national healthcare system. Nursing home (NH) populations have borne the brunt of morbidity and mortality of COVID-19. We surveyed Michigan NHs to evaluate preparedness, staffing, testing, and adaptations to these challenges. Interpandemic survey responses were collected May 1-12, 2020. We used Pearson's Chi-squared test, Fisher's exact test, and logistic regression to evaluate relationships. Of 452 Michigan NHs contacted via e-mail, 145 (32.1%) opened the survey and of these, 143 (98.6%) responded. Sixty-eight percent of respondents indicated their response plan addressed most issues. NHs reported receiving rapidly changing guidance from many sources. Two-thirds reported shortages of personal protective equipment and other supplies. Half (50%) lacked sufficient testing resources with only 36% able to test residents and staff with suspected COVID-19. A majority (55%) experienced staffing shortages. Sixty-three percent experienced resignations, with front-line clinical staff more likely to resign, particularly in facilities caring for COVID-19 patients (P <.001). Facilities adapted quickly, creating COVID-19 units (78%) to care for patients on site. To reduce isolation, NHs facilitated communication via phone calls (98%), videoconferencing (96%), and window visits (81%). A majority continued to provide requisite therapies (90%). NHs experienced shortages of resources, testing supplies, and staffing challenges. COVID-19 in the facility was a key predictor of staff resignations. Facilities relied on rapidly changing, often conflicting advice from multiple sources, suggesting high-yield areas of improvement. [ABSTRACT FROM AUTHOR]

Background Low-calorie diet (LCD)–induced weight loss demonstrates response heterogeneity. Physiologically, a decrease in energy expenditure lower than what is predicted based on body composition (metabolic adaptation) and/or an impaired capacity to increase fat oxidation may hinder weight loss. Understanding the metabolic components that characterize weight loss success is important for optimizing weight loss strategies. Objectives We tested the hypothesis that overweight/obese individuals who had lower than expected weight loss in response to a 28-d LCD would be characterized by 1) impaired fat oxidation and 2) whole-body metabolic adaptation. We also characterized the molecular mechanisms associated with weight loss success/failure. Methods This was a retrospective comparison of participants who met their predicted weight loss targets [overweight/obese diet sensitive (ODS), n  = 23, females = 21, males = 2] and those that did not [overweight/obese diet resistant (ODR), n  = 14, females = 12, males = 2] after a 28-d LCD (900–1000 kcal/d). We used whole-body (energy expenditure and fat oxidation) and tissue-specific measurements (metabolic proteins in skeletal muscle, gene expression in adipose tissue, and metabolites in serum) to detect metabolic properties and biomarkers associated with weight loss success. Results The ODR group had greater mean ± SD metabolic adaptation (−175 ± 149 kcal/d; +119%) than the ODS group (−80 ± 108 kcal/d) after the LCD (P  = 0.030). Mean ± SD fat oxidation increased similarly for both groups from baseline (0.0701 ± 0.0206 g/min) to day 28 (0.0869 ± 0.0269 g/min; P  < 0.001). A principal component analysis factor comprised of serum 3-hydroxybutyric acid, citrate, leucine/isoleucine, acetyl-carnitine, and 3-hydroxylbutyrlcarnitine was associated with weight loss success at day 28 (std. β = 0.674, R 2 = 0.479, P  < 0.001). Conclusions Individuals who achieved predicted weight loss targets after a 28-d LCD were characterized by reduced metabolic adaptation. Accumulation of metabolites associated with acetyl-CoA excess and enhanced ketogenesis was identified in the ODS group. This trial was registered at clinicaltrials.gov as NCT01616082. [ABSTRACT FROM AUTHOR]

This study evaluated the validity and utility of antigen-detection rapid diagnostic tests (Ag-RDTs) for SARS-CoV-2 in elite sports. The data on utility, ease of use and application for Ag-RDTs as a new testing format were positive from players and staff. This evaluation was limited by the low prevalence of SARS-CoV-2 circulating within the three squads. This study highlights the need for continued service evaluations for SARS-CoV-2 Ag-RDTs in elite sport settings. [ABSTRACT FROM AUTHOR]

Background: Postprandial hypotension (PPH) occurs frequently, particularly in older people and those with type 2 diabetes, and is associated with increased morbidity and mortality. The magnitude of the decrease in blood pressure (BP) induced by carbohydrate, fat, and protein appears to be comparable and results from the interaction of macronutrients with the small intestine, including an observed stimulation of mesenteric blood flow. It is not known whether artificial sweeteners, such as sucralose, which are widely used, affect BP. Objective: The aim of this study was to evaluate the effects of intraduodenal sucralose on BP and superior mesenteric artery (SMA) blood flow, compared with intraduodenal glucose and saline (control), in healthy older subjects. Design: Twelve healthy subjects (6 men, 6 women; aged 66-79 y) were studied on 3 separate occasions in a randomized, double-blind, crossover design. After an overnight fast, subjects had concurrent measurements of BP and heart rate (HR; automated device), SMA blood flow (Doppler ultrasound), and blood glucose (glucometer) during intraduodenal infusion of 1) glucose (25% wt:vol, ~1400 mOsmol/L), 2) sucralose (4 mmol/L, ~300 mOsmol/L), or 3) saline (0.9% wt:vol, ~300 mOsmol/L) at a rate of 3 mL/min for 60 min followed by intraduodenal saline for a further 60 min. Results: There was a decrease in mean arterial BP (P < 0.001) during intraduodenal glucose [baseline (mean ± SEM): 91.7 ± 2.6 mm Hg compared with t = 60 min: 85.9 ± 2.8 mm Hg] but not during intraduodenal saline or intraduodenal sucralose. The HR (P < 0.0001) and SMA blood flow (P < 0.0001) also increased during intraduodenal glucose but not during intraduodenal saline or intraduodenal sucralose. As expected, blood glucose concentrations increased in response to glucose (P < 0.0001) but not saline or sucralose. Conclusions: In healthy older subjects, intraduodenal administration of the artificial sweetener sucralose was not associated with changes in BP or SMA blood flow. Further studies are therefore warranted to determine the potential role for artificial sweeteners as a therapy for PPH. This trial was registered at http://www.ANZCTR.org.au as ACTRN12617001249347. [ABSTRACT FROM AUTHOR]

Background: Protein- and energy-rich supplements are used widely for the management of malnutrition in the elderly. Information about the effects of protein on energy intake and related gastrointestinal mechanisms and whether these differ between men and women is limited.Objective: We determined the effects of whey protein on energy intake, appetite, gastric emptying, and gut hormones in healthy older men and women.Design: Eight older women and 8 older men [mean ± SEM age: 72 ± 1 y; body mass index (in kg/m²): 25 ± 1] were studied on 3 occasions in which they received protein loads of 30 g (120 kcal) or 70 g (280 kcal) or a flavored water control drink (0 kcal). At regular intervals over 180 min, appetite (visual analog scales), gastric emptying (3-dimensional ultrasonography), and blood glucose and plasma gut-hormone concentrations [insulin, glucagon, ghrelin, cholecystokinin, gastric inhibitory polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and peptide tyrosine tyrosine (PYY)] were measured, and ad libitum energy intake was quantified from a buffet meal (180-210 min; energy intake, appetite, and gastric emptying in the men have been published previously). Results: Energy intake at the buffet meal was ~80% higher in older men than in older women (P < 0.001). Energy intake was not suppressed by protein compared with the control in men or women (P > 0.05). There was no effect of sex on gastric emptying, appetite, gastrointestinal symptoms, glucose, or gut hormones (P > 0.05). There was a protein load-dependent slowing of gastric emptying, an increase in concentrations of insulin, glucagon, cholecystokinin, GIP, GLP-1, and PYY, and an increase in total energy intake (drink plus meal: 12% increase with 30 g and 32% increase with 70 g; P < 0.001). Energy intake at the buffet meal was inversely related to the stomach volume and area under the curve of hormone concentrations (P < 0.05).Conclusion: In older men and women, whey-protein drinks load-dependently slow gastric emptying and alter gut hormone secretion compared with a control but have no suppressive effect on subsequent ad libitum energy intake. This trial was registered at www.anzctr.org.au as ACTRN12612000941864. [ABSTRACT FROM AUTHOR]

The effects of teacher feedback on children's preferences and perceptions of a target child with behavior problems were studied.

Background Obtaining a specimen for urine culture is a key element in evaluating for catheter-associated urinary tract infections (CAUTIs). Evaluating nurses' knowledge regarding appropriate reasons and methods to obtain urine culture specimens are the first steps to improving practice. Methods Nurses at 5 hospitals completed a 40-question survey regarding their knowledge, training, and practices of appropriate reasons for obtaining urine cultures. The survey included different scenarios of patients with urinary catheters and when they would expect to obtain urine cultures. A 12-point scoring system calculated responses regarding urine collection appropriateness. Results There were 394 nurses who responded to the survey. Of them, 76.1% reported receiving education on CAUTI risk reduction within the last 12 months. Although 327 (83%) of all nurses surveyed reported that they never collect urine samples by draining directly from the drainage bag, only 58.4% viewed others to be fully compliant with that standard ( P < .001). Nurses who considered their knowledge to be above average to excellent had similar knowledge assessment scores (out of 12 points) for triggers to obtain urine cultures (mean score, 4.9 ± 1.72) compared with those that reported average to poor knowledge (mean score, 4.64 ± 1.78; P = .15). Conclusions Important opportunities exist for nurses to optimize the decisions to obtain urine cultures and the process for obtaining them. Addressing nurses' knowledge and practice may lead to more appropriate use of urine cultures. [ABSTRACT FROM AUTHOR]

Background: Resveratrol has been reported to lower glycemia in rodent models of type 2 diabetes associated with the stimulation of glucagon-like peptide 1 (GLP-1), which is known to slow gastric emptying, stimulate insulin secretion, and suppress glucagon secretion and energy intake. Objective: We evaluated the effects of 5 wk of resveratrol treatment on GLP-1 secretion, gastric emptying, and glycemic control in type 2 diabetes. Design: Fourteen patients with diet-controlled type-2 diabetes [mean ± SEM glycated hemoglobin (HbA1c): 6.4 ± 0.2% (46.4 ± 2.2 mmol/mol)] received resveratrol (500 mg twice daily) or a placebo over two 5-wk intervention periods with a 5-wk washout period in between in a double-blind, randomized, crossover design. Before and after each intervention period (4 visits), body weight and HbA1c were measured, and patients were evaluated after an overnight fast with a standardized mashed-potato meal labeled with 100 µg 13C-octanoic acid to measure blood glucose and plasma GLP-1 concentrations and gastric emptying (breath test) over 240 min. Daily energy intake was estimated from 3-d food diaries during the week before each visit. Results: Fasting and postprandial blood glucose and plasma total GLP-1 as well as gastric emptying were similar at each assessment, and the change in each variable from weeks 0 to 5 did not differ between resveratrol and placebo groups. Similarly, changes in HbA1c, daily energy intake, and body weight after 5 wk did not differ between the 2 treatments. Conclusions: In patients with diet-controlled type 2 diabetes, 5 wk of twice-daily 500 mg-resveratrol supplementation had no effect on GLP-1 secretion, glycemic control, gastric emptying, body weight, or energy intake. Our observations do not support the use of resveratrol for improving glycemic control. This trial was registered at www.anzctr.org.au as ACTRN12613000717752. [ABSTRACT FROM AUTHOR]

Background: In healthy individuals, intraduodenal whey protein load-dependently modulates gastrointestinal motor and hormonal functions and suppresses energy intake. The effect of oral whey, particularly the impact of load, has not been evaluated. Objective: The purpose of this study was to quantify gastric emptying of 30 and 70 g of oral whey protein loads and their relation to gastrointestinal hormone, glycemic, and appetitive responses. Design: On 3 separate occasions in a randomized, double-blind order, 18 lean men [mean ± SEM age: 24.8 ± 1.4 y; body mass index (in kg/m ): 21.6 ± 0.5] received iso-osmolar, equally palatable drinks (~450 mL) containing 30 g pure whey protein isolate (L), 70 g pure whey protein isolate (H), or saline (control). Gastric emptying (with the use of 3-dimensional ultrasound), plasma cholecystokinin, glucagon-like peptide 1, glucose-dependent in-sulinotropic peptide, insulin, glucagon, total amino acids, and blood glucose were measured for 180 min after consumption of the drinks, and energy intake at a buffet-style lunch was quantified. Results: Gastric emptying of the L and H drinks was comparable when expressed in kilocalories per minute (L: 2.6 ± 0.2 kcal/min; H: 2.9 ± 0.3 kcal/min) and related between individuals (r = 0.54, P < 0.01). Gastrointestinal hormone, insulin, and glucagon responses to the L and H drinks were comparable until ~ 45-60 min after ingestion, after which time the responses became more differentiated. Blood glucose was modestly reduced after the H drink between t = 45 and 150 min when compared with the L drink (all P < 0.05). Energy intake was suppressed by both L and H drinks compared with control (P < 0.05) (control: 1174 ± 91 kcal; L: 1027 ± 81 kcal; and H: 997 ± 71 kcal). Conclusion: These findings indicate that, in healthy lean men, the rate of gastric emptying of whey protein is independent of load and determines the initial gastrointestinal hormone response. This study was registered at www.anzctr.org.au as 12611000706976. [ABSTRACT FROM AUTHOR]

Summary Background & aims Enteral nutrition is important in critically ill patients and is usually administered via a nasogastric tube. As gastric emptying is frequently delayed, and this compromises the delivery of nutrient, it is important that the emptying rate can be quantified. Methods A comprehensive search of MEDLINE/PubMed, of English articles, from inception to 1 July 2014. References of included manuscripts were also examined for additional studies. Results A number of methods are available to measure gastric emptying and these broadly can be categorised as direct- or indirect-test and surrogate assessments. Direct tests necessitate visualisation of the stomach contents during emptying and are unaffected by liver or kidney metabolism. The most frequently used direct modality is scintigraphy, which remains the ‘gold standard’. Indirect tests use a marker that is absorbed in the proximal small intestine, so that measurements of the marker, or its metabolite measured in plasma or breath, correlates with gastric emptying. These tests include drug and carbohydrate absorption and isotope breath tests. Gastric residual volumes (GRVs) are used frequently to quantify gastric emptying during nasogastric feeding, but these measurements may be inaccurate and should be regarded as a surrogate measurement. While the inherent limitations of GRVs make them less suitable for research purposes they are often the only technique that is available for clinicians at the bedside. Conclusions Each of the available techniques has its strength and limitations. Accordingly, the choice of gastric emptying test is dictated by the particular requirement(s) and expertise of the investigator or clinician. [ABSTRACT FROM AUTHOR]

Prolactin (PRL) is hypothesized to stimulate follicular growth through a physiological action at the ovary. Immunohistochemistry was used to identify PRL receptors (PRLrs) within the equine ovary. Prolactin receptors were detected in anestrous (n = 3), winter cycling (n = 2), summer follicular (n = 3), and luteal phase (n = 3) ovaries. Prolactin receptors were detected in follicles of all stages, in corpus luteum and on oocytes. Staining intensity did not differ ( P > .05) between primordial and preantral follicles but was greater ( P < .001) in antral follicles than in primordial or preantral follicles. Greater PRLr staining ( P < .001) occurred in winter cycling primordial follicles (1.58 ± 0.09) than anestrous (0.67 ± 0.10) and summer luteal phase primordial follicles (1.16 ± 0.12; P < .01) but not in primordial follicles during the summer follicular phase ( P > .05). Prolactin receptor staining in preantral follicles during anestrus was lower ( P < .05) than for all other reproductive states. Winter cycling and summer luteal phase preantral follicles stained most intensely, and both had greater PRLr staining than preantral follicles from anestrous ovaries ( P < .001) or summer follicular phase ovaries ( P < .001). Prolactin receptor staining of antral follicles was the most intense of all follicular sizes and did not vary ( P > .10) between reproductive states. Prolactin receptor staining was also detected in luteal tissue. In conclusion, PRLrs were detected in all stages of follicular growth with staining intensity highest in large antral follicles, indicating a possible mechanistic role for PRL during late stage follicular growth and perhaps ovulation. [ABSTRACT FROM AUTHOR]

Nursing home (NH) infection prevention and control (IPC) programs struggled before the COVID-19 pandemic. As the pandemic began, NHs were challenged with frequently changing directives including isolation, testing, visitation, and reporting. Within a larger research project, we compared changes in the infection preventionist (IP) role pre-COVID (before March 2020) and during the pandemic. 78 Michigan NHs participated in a 12-month program to reduce healthcare-associated infections from 2018-2021. A 36-question survey on IPC characteristics was sent before starting each of four cohorts. Surveys were completed by IPs, nursing directors, or NH administrators. We compared IPC characteristics pre- and intra-COVID using Fisher's exact test and Wilcoxon Rank Sum to assess significance in categorical and continuous descriptors, respectively. 74 (94.8%) NHs completed the survey, 56 pre-COVID (before March 2020) and 18 during COVID (> one year after COVID was identified in Michigan). Full-time equivalent (FTE) for the IP role was similar between the two groups, but hours worked per week increased significantly from an average 20 to 38 hours per week (p< 0.001). Half of respondents in 2021 reported working 40 hours or more on IPC activities. Despite the additional workload, the IP did not have a significant decrease in their non-IP responsibilities (e.g., staff educator, employee health). Pre-COVID, 21.8% of NHs were enrolled in CDC's National Health Safety Network (NHSN). As mandatory COVID reporting into NHSN began mid-2021, its use contributed to an average of five additional hours per week. Inter-facility notification of resident infections was done by a variety of methods, with facility-to-facility telephone calls increasing during COVID. COVID-19 has dramatically added to the IP workload in NH settings with no reduction in their other non-IP responsibilities. With reporting requirements unlikely to decrease soon, investment into staffing is needed to reduce staff burnout, maintain quality of care, and resident safety. [ABSTRACT FROM AUTHOR]

Background: Peripheral venous catheters (PVCs) can be associated with serious complications. We evaluated the effect of education and feedback on processes related to PVC placement. Methods: We implemented an educational intervention in a 72-bed Emergency Department (ED) over 12 months (4 periods, each a quarter). During preimplementation period, we evaluated PVC placement, condition, accurate documentation, and demonstration of aseptic steps for medication infusion. With implementation, ED nurses had formal education, with direct observations and feedback. For post- implementation periods 1 and 2, we continued direct observations and feedback, reducing the number of audits per week. Results: Of 2,568 PVCs evaluated in the ED, accurate documentation on dressing improved from S3 of 803 (10.3%) preimplementation to 300 of 476 (63%) at the end of the study (P < .0001). Correct docu- mentation in ED records improved from 498 of 803 (62%) preimplementation to 409 of 476 (85.9%) at the end of study (P < .0001). We observed 273 attempts to place PVC; of them, 220 (80.6%) were completed. The overall compliance with the procedure steps was very poor preimplementation (n = 3/63, 4.8%) and improved in implementation (n = 17/55, 30.9%) and postimplementation periods 1 (n = 19/60, 31.7%) and 2 (n = 14/42, 33.3%, P < .0001). ED health care workers showed significant improvement in knowledge with education. Conclusion: Education and real-time feedback to ED health care workers are associated with an increased and sustained compliance with processes to reduce the risk of infection from PVCs. [ABSTRACT FROM AUTHOR]

Background: Macronutrient "preloads" can stimulate glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), slow gastric emptying, and reduce postprandial glycemic excursions. After sweet preloads, these effects may be signaled by sodium-glucose cotransporter-1 (SGLT1), sweet taste receptors, or both. Objective: We determined the effects of 4 sweet preloads on GIP and GLP-1 release, gastric emptying, and postprandial glycemia. Design: Ten healthy subjects were studied on 4 separate occasions each. A preload drink containing 40 g glucose, 40 g tagatose/isomalt mixture (TIM), 40 g 3-O-methylglucose (3OMG; a nonmetabolized substrate of SGLT1), or 60 mg sucralose was consumed 15 min before a 13C-octanoic acid-labeled mashed potato meal. Blood glucose, plasma total GLP-1 and GIP, serum insulin, and gastric emptying were determined. Results: Both glucose and 3OMG stimulated GLP-1 and GIP release in advance of the meal (each P < 0.05), whereas TIM and sucralose did not. The overall postprandial GLP-1 response was greater after glucose, 3OMG, and TIM than after sucralose (P < 0.05), albeit later after TIM than the other preloads. The blood glucose and insulin responses in the first 30 min after the meal were greatest after glucose (each P < 0.05). Gastric emptying was slower after both 3OMG and TIM than after sucralose (each P < 0.05). Conclusions: In healthy humans, SGLT1 substrates stimulate GLP-1 and GIP and slow gastric emptying, regardless of whether they are metabolized, whereas the artificial sweetener sucralose does not. Poorly absorbed sweet tastants (TIM), which probably expose a greater length of gut to nutrients, result in delayed GLP-1 secretion but not in delayed GIP release. These observations have the potential to optimize the use of preloads for glycemic control. [ABSTRACT FROM AUTHOR]

Abstract: Background: Given the elevated potential for primary or transmitted drug resistance (TDR) among newly HIV-infected individuals, there is a need for a deeper understanding of the baseline resistance patterns present in young men of color who have sex with men. Methods: Genotypic data were collected for participants aged 13–24 who were enrolled from seven sites. Univariate and bivariate methods were used to describe the prevalence of TDR and characteristics associated with TDR. Results: Of the 296 individuals participating in the substudy, 145 (49%) had baseline genotypes. The majority of the individuals were African American (65%) and gay-identified (70%). There was significant variation in genotype availability by site (p < .001). Major surveillance drug resistance mutations were present in 28 subjects (19.3%); the majority were non-nucleoside reverse transcriptase inhibitor mutations (12.4%). Subjects with TDR were less likely to have used alcohol on 1 or more days in the prior 2 weeks. Location was not associated with acquisition of TDR. Conclusions: There was a high rate of TDR in a geographically and racially diverse sample of HIV-infected young men of color who have sex with men. This represents a serious public health concern given the young age of this sample and the potential need for long-term antiretroviral therapy. These findings underscore the critical roles of both early case identification and secondary prevention. [Copyright &y& Elsevier]

Postprandial glycaemia is now recognised as the major determinant of average glycaemic control in type 2 diabetes, as assessed by glycated haemoglobin. Therefore, an understanding of the factors influencing both the rise in blood glucose and insulin secretion after a meal is fundamental to the development of dietary and pharmacological approaches to optimise glycaemic control. The gastrointestinal tract regulates the rate at which carbohydrate and other nutrients are absorbed and is the source of regulatory peptides that stimulate pancreatic insulin secretion in the setting of elevated blood glucose levels. This article highlights the importance of the gastrointestinal tract in insulin secretion and glucose homeostasis and discusses potential strategies directed at modification of gastrointestinal function in order to improve glycaemic control in the management of diabetes. [Copyright &y& Elsevier]

This study measured the impact of teacher professional development (PD), designed to support grades 3–5 integrated science activities in Indiana, United States and enhance mathematics and language arts learning experiences. To determine whether students of the Indiana Science Initiative (ISI) teachers benefitted, we conducted a matched comparison study of 1546 classrooms using multi-level modeling to identify the effect of teachers on their students' science, English Language Arts, and math state assessment scores. Results show that when teachers participated in multiple years of ISI and attended PD recently, their students had statistically higher standardized test scores than the comparison group in science as well as mathematics and ELA. • Evidenced-based, job-embedded PD results in positive student learning outcomes. • Elementary teacher PD supports integration of science and mathematics and ELA. • Three summers of professional development positively impact student outcomes. • Recency of professional development has a strong influence on student outcomes. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to identify factors predicting risk of aortic arch recoarctation after the Norwood procedure. Methods: Patient records were reviewed retrospectively for consecutive patients who underwent the Norwood procedure from 1996 to 2005. Preoperative and intraoperative parameters were identified for analysis. Aortic arch recoarctation was defined by the need for catheter or surgical reintervention. Data were analyzed using survival analysis, with freedom from intervention as the outcome. Factors predicting need for reintervention were analyzed using Cox proportional hazards regression. Results: Thirty-five recoarctations were observed in 117 patients (30%). Freedom from aortic arch reintervention at six months, one, three, and five years were 72%, 63%, 56%, and 52%, respectively. The majority of arch reinterventions occurred in the first six months (63%), involving either surgical (43%) or catheter (57%) techniques. The use of bovine pericardium showed the greatest risk for potential recoarctation (hazard ratio = 1.81 [0.90–3.64], p = 0.09). Age, gender, weight, ascending aortic diameter, ventricular morphology, primary anatomic diagnosis, and coarctation shelf resection were not found to be predictors of recoarctation. Conclusions: Most interventions for aortic arch recoarctation after the Norwood procedure occur within the first six months of life. The type of patch material used for arch reconstruction appears to influence, most strongly, the long-term risk of aortic arch recoarctation. [Copyright &y& Elsevier]

Background & Aims: The effects of fat on gastric emptying (GE), gut hormones, and energy intake are dependent on digestion to free fatty acids (FFAs). In animals, small intestinal oleic acid inhibits energy intake more potently than the triacylglyceride (TG) triolein, but there is limited information about the comparative effects of FFA and TG in human beings. We compared the effects of FFA and TG on GE, gut hormone secretion, appetite, and energy intake in healthy males. Methods: Nine men (age, 23 ± 2 y; body mass index, 22 ± 1 kg/m2) were studied on 3 occasions to evaluate the effects of (1) 40 g oleic acid (FFA, 1830 kJ), (2) 40 g macadamia oil (TG, 1856 kJ; both 600-mL oil-in-water emulsions stabilized with 4% milk protein and labeled with 15 MBq 123I), or (3) 600 mL 4% milk protein (control, 352 kJ), administered intragastrically, on GE, plasma cholecystokinin (CCK) and peptide-YY (PYY) levels, appetite perceptions, and subsequent energy intake. Results: GE of FFA was much slower than that of TG (P < .05), with greater retention of FFA, than TG, in the proximal stomach (P < .001). Hunger was less (P < .05), and fullness was greater (P < .05), after FFA when compared with control and TG. Increases in plasma CCK and PYY levels were greater after FFA than TG or control (P < .05). Energy intake tended to be less after FFA compared with TG (control, 4754 ± 610 kJ; TG, 5463 ± 662 kJ; FFA, 4199 ± 410 kJ). Conclusions: FFAs empty from the stomach more slowly, but stimulate CCK and PYY and suppress appetite more potently than TG in healthy human beings. [Copyright &y& Elsevier]

The pharmacokinetics (PK) and hepatic extraction (EH) of human PTH (1–34), hPTH (1–34), were characterized in rat, dog, and monkey, following intraportal (IPO) and intravenous (IV) bolus administration. hPTH (1–34) was administered to Sprague–Dawley rats (2, 10, 100 µg/kg), beagle dogs (3, 6 µg/kg), and rhesus monkeys (6, 30 µg/kg). Serum concentrations of immunoreactive hPTH (1–34) were used to derive PK parameters. IPO bioavailability (FIPO) was determined by comparing dose-normalized serum exposure (i.e., AUCIPO/AUCIV). EH was estimated as 1-FIPO. In all species, greater than dose-proportional increases in exposure (i.e., Cmax and AUC) were observed for both routes. Dose-dependent disposition (i.e., time-average clearance (CL) and half-life (t½) were observed in all three species. In rats, EH values of 71% (2 µg/kg), 35% (10 µg/kg), and <1% (100 µg/kg) were obtained. In dogs, EH values of 90% (3 µg/kg) and 66% (6 µg/kg) were obtained. In monkeys, EH values of 25% (6 µg/kg) and <1% (30 µg/kg) were observed. In conclusion, hPTH (1–34) is subject to hepatic first pass extraction in rat, dog, and monkey with evidence of saturation in the rat. Saturable hepatic extraction in dog and monkey is inconclusive due to the limited dose range investigated. © 2006 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 95:2499–2506, 2006 [ABSTRACT FROM AUTHOR]

Abstract: Since the first “blue baby operation,” dramatic diagnostic and therapeutic advances have improved survival for most infants born with cyanotic heart defects. In the current decade, most infants with cyanotic congenital heart disease will undergo vital palliative or corrective surgery in the first months of life. In this article, the anatomy and clinical features of selected cyanotic heart defects, including tetralogy of Fallot, transposition of the great arteries, truncus arteriosus, tricuspid atresia, and pulmonary atresia, will be reviewed, with discussion of current treatment strategies and nursing implications. [Copyright &y& Elsevier]

Background: Gastric distension reduces food intake, and antral, rather than proximal, gastric distension may be the dominant mechanism in the induction of appetite-related sensations. Healthy aging is associated with reduced appetite. Objective: We examined the effects of different energy preloads on appetite, plasma cholecystokinin, antral area, and subsequent energy intake in healthy older and young subjects. Design: On 3 separate days, 12 young and 12 older subjects consumed 400 mL of a drink containing either 0 kcal (water), 250 kcal, or 750 kcal 70 min before a buffet-style meal. Results: Hunger was less in the older than in the young subjects (P < 0.001). Both nutrient preloads reduced hunger and increased fullness more than did water (P < 0.02), and older subjects were more full than were the young (P < 0.05). Antral area was greater after the nutrient preloads than after water (P = 0.001) and greater in theolderthan in theyoung subjects (P = 0.005). In both groups, food intake was suppressed in an energy-dependent manner (P = 0.008). Plasma cholecystokinin was greater in the older than in the young subjects (P = 0.003). Immediately before the meal, hunger (r = -0.59) and energy intake (r = -0.90) were inversely related and fullness (r= 0.66) was directly related to antral area (all: P < 0.001). Antral area, but not plasma cholecystokinin, was a predictor of subsequent energy intake. Conclusion: In healthy young and older subjects, the suppression of subsequent energy intake by a liquid preload is nutrient dependent and comparable, and both satiation and satiety are related to antral area and (presumably) antral distension. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility, reliability and validity of the pediatric quality of life inventory (PedsQL™) in children with heart disease. Participants and setting: The study sample was comprised of parents of children with heart disease between the ages of 2 and 18 years including 250 child-respondents 5–18 years of age followed at a large, hospital-based pediatric cardiology clinic. Procedure/design: Parents and children completed the PedsQL™ 4.0 Generic Core Scales and the newly developed PedsQL™ 3.0 Cardiac Module during a pediatric cardiology outpatient visit. Child and parent scores on the PedsQL™ Generic Core Scales were compared to known healthy children/parents. Measurement properties were computed for the PedsQL™ Cardiac Module Scales. Cross-informant variance between children and parents was assessed. Results: The percentage of missing item responses was less than 2% for both parent and child-respondents, supporting the feasibility of PedsQL™ administration in the outpatient setting. Comparisons between all PedsQL™ Generic Core Scales for healthy children and children with heart disease revealed a significant difference (P<0.001) between the groups, except on the child self-report physical functioning subscale (P=0.114). There was a significant difference in self-reported physical functioning between children with complex heart disease and the healthy sample (P<0.05). All internal consistency reliability coefficients for PedsQL™ cardiac module scales exceeded the minimum reliability standard for group comparisons, ranging from 0.72 to 0.96, except in the young child 5- to 7-year-old age group. Hypothesized correlations between cardiac module and core scales were statistically significant, ranging from 0.36 to 0.78. Conclusions: Results support the feasibility, reliability and validity of the PedsQL™ Generic Core Scales and Cardiac Module to assess health-related quality of life in children with heart disease. [Copyright &y& Elsevier]