Method of Food Preparation Influences Blood Glucose Response to a High-Carbohydrate Meal: A Randomised Cross-over Trial.

The aim of this study was to establish the blood glucose response to different cooking methods of pasta. Participants consumed three identical meals in a random order that were freshly cooked (hot), cooled and reheated. Blood glucose concentrations were assessed before, and every 15 min after ingestion of each meal for 120 min. There was a significant interaction between temperature and time (F ( 8.46 - 372.34 ) = 2.75, p = 0.005), with the reheated (90 min) condition returning to baseline faster than both cold (120 min) and hot conditions. Blood glucose area under the curve (AUC) was significantly lower in the reheated (703 ± 56 mmol·L-1·min-1) than the hot condition (735 ± 77 mmol·L-1·min-1, t ( 92 ) = -3.36, pbonferroni = 0.003), with no significant difference with the cold condition (722 ± 62 mmol·L-1·min-1). To our knowledge, the current study is the first to show that reheating pasta causes changes in post-prandial glucose response, with a quicker return to fasting levels in both the reheated and cooled conditions than the hot condition. The mechanisms behind the changes in post-prandial blood glucose seen in this study are most likely related to changes in starch structure and how these changes influence glycaemic response.

Outcomes of adding acute care nurse practitioners to a Level I trauma service with the goal of decreased length of stay and improved physician and nursing satisfaction.

BACKGROUND: The trauma service experienced preventable delays caused by an Accreditation Council for Graduate Medical Education work restrictions and a 16% increase in patient census. Furthermore, nurses needed a consistently accessible provider for the coordination of care. We hypothesized that using experienced acute care nurse practitioners (ACNPs) on the stepdown unit would improve throughput and decrease length of stay (LOS) and hospital charges. Moreover, we hypothesized that adding ACNPs would improve staff satisfaction. On December 1, 2011, the Vanderbilt University Medical Center Division of Trauma reassigned ACNPs to the stepdown area 5 days a week for a pilot program. METHODS: LOS data from December 1, 2011 through December 1, 2012 was compared with data from the same months from the previous two years and estimated hospital charges and patient days were extrapolated. Physician and nursing surveys were performed. Data from 2010 (n = 2,559) and 2011 (n= 2,671) were averaged and the mean LOS for the entire trauma service was 7.2 days. After adding an experienced ACNP, the average LOS decreased to 6.4 days, a 0.8 day reduction. Per patient, there was a $ 9,111.50 savings in hospital charges, for a reduction of $27.8 million dollars in hospital charges over the 12 month pilot program. RESULTS: A confidential survey administered to attending physicians showed that 100% agreed that a nurse practitioner in the stepdown area was beneficial and helped throughput. Dayshift nurses were surveyed, and 100% agreed or strongly agreed that the ACNPs were knowledgeable about the patient's plan of care, experienced in the care of trauma patients, and improved patient care overall. CONCLUSION: The addition of experienced ACNPs resulted in the decrease of overall trauma service LOS, saving almost $9 million in hospital charges. LEVEL OF EVIDENCE: Economic/decision study, level III.

Verbesina alternifolia Tolerance to the Holoparasite Cuscuta gronovii and the Impact of Drought.

Holoparasites are nonphotosynthetic plants that acquire all resources from hosts. The holoparasite Cuscuta gronovii is native to much of the US with a broad host range including Verbesina alternifolia, an understory perennial. Both species grow in moderate to moist soils and occur in habitats that may experience prolonged or episodic drought. We applied the Wise-Abrahamson Limiting Resource Model (LRM) developed for plant-herbivore relations to examine the effects of pattern of drought stress on tolerance of V. alternifolia to parasitism by C. gronovii. Individual plants were assigned one of six treatments that were combinations of parasite (none or addition of parasite) and drought stress (well-watered, continuously-stressed, or pulse-stressed). After pulse-stressed plants had experienced two wet-dry cycles all plants were harvested. Parasitism strongly reduced both shoot and root mass and well-watered hosts exhibited the greatest decline, indicating reduced tolerance to parasitism when water was readily available. This is consistent with the LRM if parasitism limits photosynthates available to the host. However, parasitism increased allocation to shoot and this effect did not differ between well-watered and drought-stressed plants, indicating equal tolerance. This outcome is in accord with an alternative prediction of the LRM if hosts are not carbon limited. Total pot productivity was reduced by parasitism and drought stress, and this effect was greater for pulse-stressed than for continuously-stressed hosts. We discuss the applicability of the LRM for understanding the effects of drought on tolerance to parasitism.