A longitudinal ethnographic study of hospital staff attitudes and experiences of change in nutrition care.

BACKGROUND: Change promotes quality in healthcare, yet adopting change can be challenging. Understanding how change in nutrition care is adopted may support better design and implementation of interventions that aim to address inadequate food intake in hospital. The present study followed the process of change in a healthcare organisation, exploring staff attitudes, beliefs and experiences of the implementation of a mealtime intervention. METHODS: In total, 103 h of fieldwork were conducted in this longitudinal ethnographic study over a 4-month period. Over 170 staff participated, with data captured using observation, interviews and focus groups. Data were analysed using an inductive, thematic approach, informed by implementation theory. RESULTS: Attitudes and experiences of change in nutrition care are described by three themes: (i) staff recognised the inevitability of change; (ii) staff cooperated with the intervention, recognising potential value in the intervention to support patient care, where increased awareness of their mealtime behaviours supported adopting practice changes; and (iii) some staff were able to reflect on their practice after implementing the intervention, whereas others could not. A model illustrating the interconnectedness of factors influencing implementation emerged from the research, guiding future nutrition care intervention design and supporting change. CONCLUSIONS: The requirement to address the underlying perceptions of staff about the need to change should not be underestimated. Increased efforts to market the change message to specific staff groups and physical behavioural reinforcement strategies are needed. Nutrition care in the future should focus on helping staff feel positive about making practice changes.

Systematic review and meta-analysis of the effect of meal intake on postprandial appetite-related gastrointestinal hormones in obese children.

UNLABELLED: Understanding the physiological response to meal intake, of gut-derived appetite and satiety hormone signals, in obese compared with healthy-weight children may assist with informing strategies to help curtail the obesity epidemic. A systematic review and meta-analysis of studies investigating the acute postprandial response of gastrointestinal appetite hormones to meal intake in obese children was undertaken. Systematic searches of databases EMBASE, CINAHL Plus, OVID Medline and the Cochrane Library were performed. INCLUSION CRITERIA: a randomised controlled trial or experimental cross-sectional study following an acute test meal protocol with pre- and postprandial analysis of plasma or serum gastrointestinal hormone concentrations. Database searching retrieved 1001 papers for review. Nine studies met the inclusion criteria, collectively reporting on six appetite hormones yielding a total of 32 test meal-hormone comparisons. Meta-analyses compared the pooled estimate of the mean difference of the postprandial change in total ghrelin and total peptide YY (PYY). Obese compared with healthy-weight children had an attenuated change in ghrelin at 60 min (N=5 studies; n=129 participants) and 120 min postprandial (N=4 studies; n=100 participants) (P<0.05 for both time points). Obese compared with healthy-weight children also had an attenuated PYY response at 60 min (N=5 studies; n=128 participants) and 120 min postprandial (N=4 studies; n=100 participants). Insufficient studies reported on the postprandial time course of other appetite-related hormones, precluding a meta-analysis. Limited evidence notwithstanding, these findings indicate that PYY and ghrelin responses to a meal may be altered in obese children. This review has also identified a major gap in knowledge of hormonal appetite responses in childhood obesity. More comprehensive investigations of the homoeostatic regulation of gut-derived appetite and satiety hormone signals with behavioural and clinical outcomes are warranted to understand if there are consequences of these differences.

The Effect of School Bullying on Pupils' Perceived Stress and Wellbeing During the Covid-19 Pandemic: A Longitudinal Study.

PURPOSE: Establishing how the Covid-19 pandemic and related lockdowns have affected adolescent mental health is a key societal priority. Though numerous studies have examined this topic, few have focused on the wellbeing of pupils who experience school bullying. This is particularly important as pupils who experience bullying represent a vulnerable group at increased risk of mental illness. Therefore, we sought to investigate the relationship between experience of bullying and adolescent wellbeing during lockdown and subsequent re-opening of schools. METHODS: We used the TeenCovidLife dataset to examine the relationship between experience of bullying and pupils' perceived stress and wellbeing across three timepoints. Pupils aged 12-17 (n = 255) completed surveys during the first Covid-19 lockdown (May-July 2020), when they returned to school after the first lockdown (August-October 2020), and during the summer term of 2021 (May-June 2021). RESULTS: Perceived stress was higher in the group of pupils that experienced bullying than in the group that did not, though this difference between groups was smaller during lockdown than when pupils were attending school in person. Pupils who were bullied showed lower wellbeing across all timepoints. For the full sample of pupils, wellbeing was lowest (and perceived stress highest) at Time 3, one year after the first Covid-19 lockdown. CONCLUSION: The findings challenge previous assumptions that Covid-19 lockdowns were associated with a generalised decline in adolescent mental health. Instead, the picture is more nuanced, with perceived stress, though not wellbeing, varying according pupils' experiences of school bullying.

Leukemia evoked with 7,8,12-trimethylbenz(a)anthracene in rat. I. Changes in spleen and thymus.

An early sign of erythroblastic leukemia in rat was nodule formation in the spleen. Hyperplastic foci of stem cells, indistinguishable histologically from leukemic stem cells, were found in the red pulp whereas the malpighian corpuscles were uninvolved. Anemia is a normal phenomenon in immature rats and the spleen of the prepubertal rat possesses considerable hemopoietic potential. Pulse-doses of 7, 8, 12-trimethylbenz(a)anthracene prevented the physiologic hematological development of maturing rats and was associated with subsequent development of leukemic stem cells in the red pulp of the spleen. Significant enzyme changes were observed in leukemic spleens. Compared with the spleens of normal littermates, the concentration of lactate dehydrogenase rose while that of malate dehydrogenase fell; the content of alkaline phosphatase rose whereas acid phosphatase fell. Increased alkaline phosphatase activity in leukemic spleen was attributed to nonleukemic foci of myelopoiesis.

Transformation of fibroblasts by allogeneic and xenogeneic transplants of demineralized tooth and bone.

Xenogeneic transplants of powdered, dehydrated, demineralized matrix of bone and tooth were well tolerated in three species of rodents. Differences between the species were found in competence of fibroblasts to be transformed into cartilage and bone in vivo by these preparations. Rat fibroblasts were most susceptible to transformation of this sort; they were transformed by demineralized dentin of guinea pig, mouse, and rat, and to a limited extent, by a specimen of decalcified human bone.

Hundred day leukemia: preferential induction in rat by pulse-doses of 7,8,12-trimethylbenz(a)anthracene.

A series of pulse-doses of 7, 8, 12-trimethylbenz(a)anthracene-induced leukemia rapidly and consistently in very high yield in rats of Long-Evans (L-E) strain. The predominant type was a diffuse hepatic leukemia of erythroblastic stem cells. Progressive hypothermia and a decline in pituitary function are newly recognized signs of advanced leukemia in rat.

High concentration of injected titanium dioxide in abdominal lymph nodes.

In the rat the greatest accumulation, in any anatomical structure, of titanium dioxide following its intravenous injection was found in two small clusters of lymph nodes in upper abdomen behind the peritoneum. These are the lymph nodes of the liver. This extraordinary quantitative characteristic of the abdominal clusters is attributed to their topography which results in progressive filtration of particulate matter from hepatic lymph.

Endocrine-induced regression of cancers.

Cancer is not necessarily autonomous and intrinsically self-perpetuating. Its growth can be sustained and propagated by hormonal function in the host which is not unusual in kind or exaggerated in rate but which is operating at normal or even subnormal levels. Hormones, or synthetic substances inducing physiologic effects similar thereto, are of crucial significance for survival of several kinds of hormone-responsive cancers in man and animals. Opposite sorts of change of the hormonal status can induce regression and, in some instances, cure such cancers. These modifications are deprivation of essential hormones and hormone interference by giving large amounts of critical compounds. The control of cancer by endocrine methods can be described in three propositions: (i) Some types of cancer cells differ in a cardinal way from the cells from which they arose in their response to change in their hormonal environment. (ii) Certain cancers are hormone-dependent and these cells die when supporting hormones are eliminated. (iii) Certain cancers succumb when large amounts of hormones are administered.

Dentin matrix transformation: rapid induction of alkaline phosphatase and cartilage.

An acid-insoluble fraction of rat dentin rapidly initiates a chain reaction in mesenchyma after allogeneic transplantation to the subcutaneous tissues. The tooth matrix induced alkaline phosphatase activity within 24 hours; cartilage appeared within 5 days; bone and bone marrow formed within 14 days. The induced cartilage disappeared within 5 weeks, but bone persisted at least 1 year.

Functional and metabolic remodelling in GLUT4-deficient hearts confers hyper-responsiveness to substrate intervention.

Impaired glucose uptake is associated with both cardiac hypertrophy and contractile dysfunction, but whether there are common underlying mechanisms linking these conditions is yet to be determined. Using a 'gene dose' Cre-Lox GLUT4-deficient murine model, we examined the effect of suppressed glucose availability on global myocardial gene expression and glycolysis substrate bypass on the function of isolated perfused hearts. Performance of hearts from 22- to 60-week-old male GLUT4 knockout (KO, >95% reduction in GLUT4), GLUT4 knockdown (KD, 85% reduction in cardiac GLUT4) and C57Bl/6 wild-type (WT) controls was measured ex vivo in Langendorff mode perfusion. DNA microarray was used to profile mRNA expression differences between GLUT4-KO and GLUT4-KD hearts. At 22 weeks, GLUT4-KO hearts exhibited cardiac hypertrophy and impaired contractile function ex vivo, characterized by a 40% decrease in developed pressure. At 60 weeks, dysfunction was accentuated in GLUT4-KO hearts and evident in GLUT4-KD hearts. Exogenous pyruvate (5 mM) restored systolic pressure to a level equivalent to WT (GLUT4-KO, 176.8+/-13.2 mmHg vs. WT, 146.4+/-9.56 mmHg) in 22-week-old GLUT4-KO hearts but not in 60-week-old GLUT4-KO hearts. In GLUT4-KO, DNA microarray analysis detected downregulation of a number of genes centrally involved in mitochondrial oxidation and upregulation of other genes indicative of a shift to cytosolic beta-oxidation of long chain fatty acids. A direct link between cardiomyocyte GLUT4 deficiency, hypertrophy and contractile dysfunction is demonstrated. These data provide mechanistic insight into the myocardial metabolic adaptations associated with short and long-term insulin resistance and indicate a window of opportunity for substrate intervention and functional 'rescue'.

Influence of prolactin on carcinogen-induced leukemogenesis in Long-Evans rats.

Hypophysectomy of rats bearing 7,12-dimethylbenzanthracene-induced leukemia has been reported to result in a prompt and persistent regression of the leukemia. The purpose of this study was to determine whether or not marked alterations in prolactin secretion would influence this neoplastic process. To determine this, immature male and female Long-Evans rats were divided into three groups: Group 1, controls; Group 2, pituitary grafted (hyperprolactinemia); and Group 3, 2-bromo-alpha-ergocryptine-treated (hypoprolactinemia). Two weeks after the initial treatment and at 2-week intervals thereafter (6 total), each rat was given a single intragastric intubation of 7,12-dimethylbenzanthracene (10 mg/rat). Two months after the initial carcinogen treatment and at 2- to 3-week intervals thereafter, all rats had liver biopsies for the identification of leukemia. Results clearly show that despite nearly 10-fold difference in mean serum prolactin levels in the three groups of female rats and nearly a 20-fold difference in the level of this hormone in male rats, no significant differences in the magnitude of this leukemogenic process could be detected. Thus, striking changes in prolactin secretion do not appear to influence significantly this leukemogenic process.

How does nutritional state change during a subacute admission? Findings and implications for practice.

BACKGROUND/OBJECTIVES: Nutritional status influences patients' clinical and functional outcomes. The aims were to identify changes in nutritional state during subacute care and associated participant characteristics. SUBJECTS/METHODS: A longitudinal study was undertaken with consecutive patients admitted to subacute care wards during a 3-month period. Participants were recruited under a waiver of consent to reflect the usual demographic. Change in classification (malnourished, at risk of malnutrition, well nourished) of the full Mini Nutritional Assessment (full MNA) between admission and discharge was the primary outcome. Weight (kg), mid-arm and calf circumference (cm) change were secondary outcomes. Hand grip strength (kg) and fat-free mass (kg) (assessed using bioelectrical impedance analysis) were measured for a consenting subgroup. RESULTS: Participants (n=248, 36.7% male) had a median age of 80 years and a length of stay of 17 days. On admission, 29.1% were classified as malnourished. By discharge, nutritional classification remained stable for 62.0% of participants (n=132), declined for 10.3% (n=22) and improved for 27.7% (n=59, including 52.5% malnourished on admission). Impaired cognition (odds ratio (OR)=0.169, P=0.002) and higher full MNA score at admission (OR=0.870, P=0.001) reduced odds of improvement in full MNA. There was no change in hand grip strength (n=46), but there was a decline in mean fat-free mass (-1.1 kg, 95% confidence interval: -0.1 to -2.2 kg, P=0.043, n=24). CONCLUSIONS: Multidisciplinary care supports the nutritional state of most patients admitted to subacute care. Those with cognitive impairments or at risk of malnutrition were less likely to demonstrate improvement and may benefit from more intensive or tailored nutritional care.

Intermittent energy restriction and weight loss: a systematic review.

BACKGROUND/OBJECTIVES: Intermittent energy restriction (IER) is an eating pattern of regular daily periods of restricted energy intake followed by periods of unrestricted energy intake. This is gaining prominence as an alternative weight-loss strategy to daily energy restriction (DER). The aim of this systematic review was to determine the effectiveness of IER on weight loss in overweight and obese adults and compare this with DER. SUBJECTS/METHODS: A systematic literature search was conducted using the CINAHL, Embase, Medline, PsycINFO, Cochrane and Scopus databases. Eight studies that assigned overweight or obese adults to IER or to a DER 'control' were deemed eligible for inclusion. RESULTS: All studies reported significant weight loss for IER groups. Average weight loss was approximately 0.2-0.8 kg per week. IER resulted in comparable weight loss to DER when overall energy restriction remained similar between diets. The majority of studies that reported body composition outcomes have shown equal efficacy for fat mass, fat-free mass and waist circumference. CONCLUSIONS: Weight loss was achieved in overweight and obese adults following IER and this loss was comparable to a DER diet. IER may be an effective alternative strategy for health practitioners to promote weight loss for selected overweight and obese people.

Effect of solution non-ideality on erythrocyte volume regulation.

A non-ideal, hydrated, non-dilute pseudo-binary salt-protein-water solution model of the erythrocyte intracellular solution is presented to describe the osmotic behavior of human erythrocytes. Existing experimental activity data for salts and proteins in aqueous solutions are used to formulate van Laar type expressions for the solvent and solute activity coefficients. Reasonable estimates can therefore be made of the non-ideality of the erythrocyte intracellular solution over a wide range of osmolalities. Solution non-ideality is shown to affect significantly the degree of solute polarization within the erythrocyte intracellular solution during freezing. However, the non-ideality has very little effect upon the amount of water retained within erythrocytes cooled at sub-zero temperatures.

Can the Mini Nutritional Assessment (MNA) Be Used as a Nutrition Evaluation Tool for Subacute Inpatients over an Average Length of Stay?

OBJECTIVE: The prevalence of malnutrition in subacute inpatient settings has been reported to be 30-50%. While there are a number of nutrition evaluation tools which have been validated to diagnose malnutrition, the use of a validated nutrition evaluation tool to measure changes in nutritional status during an average length of stay for a subacute inpatient has not yet been tested. This study aims to determine the potential of the full MNA (full Mini Nutritional Assessment) and MNA (Mini Nutritional Assessment Short Form) scores to measure change in nutritional status over an average subacute inpatient stay (21 days). DESIGN: A prospective observational study. SETTING: The study was performed in three Rehabilitation and Geriatric Evaluation and Management (GEM) wards of the Kingston Centre, Monash Health, Melbourne, Australia. PARTICIPANTS: All patients ≥65 years admitted to these wards with an expected length of stay of at least 14 days were considered for inclusion in this study. MEASUREMENTS: Nutritional status was assessed on admission using the full MNA as part of usual dietetic care and patients were provided with nutrition intervention/diet therapy based on full MNA classification. Full MNA score (0-30), MNA score (0-14), anthropometry (weight and height) and nutritional biochemistry (serum albumin, transthyretin and C-reactive protein) were compared between admission and day 20.5 ± 2.4. RESULTS: Mean age (± SD) of 83 ± 7 years, n=114. For those patients diagnosed at risk of malnutrition or malnourished (n=103), there were significant increases in full MNA score (1.8 ± 2.4, p<0.001), MNA score (0.9 ± 1.7, p<0.001), weight (0.6 ± 2.5 kg, p=0.017) and serum albumin (1.4 ± 4.4 g/L, p=0.003) over the study period. All four of the full MNA domain sub-scores, also increased significantly in those patients diagnosed at risk of malnutrition or malnourished (n=103): anthropometric assessment (p<0.001), dietary assessment (p<0.001), general status assessment (p=0.019) and self-perceived health and nutrition states (p=0.033). CONCLUSION: Both the MNA and full MNA can be used to evaluate nutrition progress within the subacute inpatient setting over a three week time period, thereby providing clinicians with feedback on a patient's nutrition progress and assisting with ongoing care planning. Due to its ease of use and shorter time required to complete, the MNA may be the preferred nutrition evaluation tool in this setting.

Threshold effects of glucose transporter-4 (GLUT4) deficiency on cardiac glucose uptake and development of hypertrophy.

The aim of this study was to investigate the metabolic and structural consequences of a decrease in glucose transporter-4 (GLUT4) levels on the heart. The CreLoxP system was utilised to delete GLUT4 in muscle tIssue including heart. The presence of the PGK-neoR cassette in the GLUT4-Lox mice resulted in reduced expression in all tIssues to levels 15-30% of wild-type control mice. In mice expressing Cre recombinase, there was a further reduction of GLUT4 in cardiac tIssue to almost undetectable levels. Cardiac glucose uptake was measured basally and during a euglycaemic/hyperinsulinaemic clamp using 2-deoxy-[1-(14)C]glucose. Insulin-stimulated glucose uptake was normal in hearts expressing 15% of normal GLUT4 levels but markedly reduced in mice with more profound reduction in GLUT4. Cardiac enlargement occurred only when GLUT4 levels were less than 5% of normal values. In heart there is a threshold level of GLUT4 above which insulin-stimulated glucose uptake is maintained. As little as 5% of normal GLUT4 levels expressed in heart is sufficient to prevent the development of cardiac hypertrophy.

Permanent cell culture lines of rat erythroleukemia and growth inhibition by dexamethasone in vitro.

Four erythroleukemia cell lines were established in vitro from rats with primary leukemias induced by a set of intravenous injections of 7,8,12-trimethylbenz[a] anthracene (TMBA). These cell lines were grown in Dulbecco's medium with 20% inactivated fetal calf serum; they were characterized by specific consistent chromosome abnormalities, related to No. 2 chromosome, which were maintained in culture for more than 1 year. Addition of dexamethasone prevented the cell growth of 2 of the cell lines in this medium but failed to alter the growth rate of the other 2 cell lines. These findings are correlated with karyotype abnormalities involving chromosome No. 2.

A new experimental model for colorectal carcinogenesis in the rat.

A total of 130 rats were used in various experiments to prepare a new model for colorectal carcinogenesis. The experiments resulted in the development of a surgical technique that creates a subcutaneous cecal hernia, which allows the direct injection of the promoting substance, human bile from percutaneous biliary drainage, into the bowel of the rat. The method permits a direct, complete, and very easy access of a specific amount of the substance to be tested onto the colonic mucosa. The results have proven to be uniformly effective and easily reproducible and to ensure safe management of the animal.

Using case management with clinical plans to improve patient outcomes.

A case-management approach using clinical plans was developed to enhance outcomes. Patients with congestive heart failure (CHF) who were admitted to home care and case managed by nurses specially trained in cardiovascular nursing, case management, and the use of a clinical plan, had improved outcomes with fewer visits than patients with CHF managed with traditional care practices. Quality management and cost-effectiveness of patient care may be positively affected when using this approach.