Cross-linked phosphorylated RS4 wheat starch reduces glucose and insulin responses after 3 days of pre-feeding in healthy adults: an acute, double-blind, randomized controlled clinical trial.

When this project was designed, there was no evidence that adding resistant starch to available carbohydrate (avCHO) reduced glycaemic and insulinaemic responses (GIR). We compared GIR elicited by a cookie containing cross-linked phosphorylated RS4 wheat starch (Fibersym®) (RS4XL) versus an avCHO-matched control-cookie (CC) after n = 15 adults had consumed RS4XL or CC daily for 3-days using a double-blind, randomised, cross-over design. The difference in glucose iAUC over 0-2 h (primary endpoint) (mmol × min/L) after RS4XL, (mean ± SEM) 106 ± 16, versus CC, 124 ± 16, was not significant (p = 0.087). However, RS4XL reduced 0-90 min glucose iAUC (72 ± 9 vs 87 ± 9, p = 0.022), peak glucose concentration (6.05 ± 0.36 vs 6.57 ± 0.31 mmol/L, p = 0.017) and 0-2 h insulin iAUC (189 ± 21 vs 246 ± 24 nmol × h/L, p = 0.020). These results show that RS4XL reduced postprandial glycaemic and insulinaemic responses when added to avCHO, but do not prove that the products of its colonic fermentation are required for this effect.

Comparison of Postoperative, In-Hospital Outcomes After Complete Repair of Tetralogy of Fallot Between 22q11.2 Deletion Syndrome and Trisomy 21.

22q11.2 deletion syndrome (22q11) and trisomy 21 (T21) are frequently associated with tetralogy of Fallot (TOF). We hypothesized that there are differences in postoperative length of stay (LOS) and occurrence of postoperative interventions after complete repair of TOF when comparing children with 22q11 to those with T21. Using the Pediatric Health Information System, we performed a retrospective cohort study of patients who underwent complete repair of TOF from 2004 to 2019. Three groups were identified: 22q11, T21, and controls (those without a coded genetic syndrome). Outcomes were postoperative LOS and composite occurrence (yes/no) of at least one postoperative intervention. Bivariate and multivariate comparisons were made among groups; odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the control group as the comparator. There were 6924 subjects (n = 493 22q11, n = 455 T21, n = 5976 controls). In bivariate analysis, 22q11 was associated with a longer LOS compared to T21 (OR 2.37 [2.16, 2.60] vs. 1.25 [1.12, 1.39], p < 0.001), and 22q11 more often underwent postoperative intervention (OR 3.42 [CI 2.56, 4.57] vs. 1.38 [CI 0.91, 2.11]; p < 0.001). In multivariate analysis, 22q11 was also associated with longer LOS (adjusted OR 1.35 [1.26, 1.44] vs. 1.12 [1.04, 1.20]; p < 0.001), but there was no difference in the adjusted odds of postoperative intervention. Children with 22q11 are more likely to experience adverse outcomes after repair of TOF compared to those with T21; the differences are most pronounced for LOS.

Preparation and textural properties of white salted noodles made with hard red winter wheat flour partially replaced by different levels of cross-linked phosphorylated RS4 wheat starch.

BACKGROUND: Resistant starch (RS) has health benefits and can be used as a functional ingredient in various food products. Kansas hard red winter (HRW) wheat is conventionally used for bread making and this is attributed to its strong gluten network. To develop Asian white salted noodles with a high RS content, HRW wheat flour was partially replaced with cross-linked phosphorylated RS4 wheat starch. Vital wheat gluten or wheat protein isolate was added to compensate for textural changes due to the addition of RS. RESULTS: The maximum recommended level of RS4 starch to replace HRW wheat flour was 40%. The substitution of 10-40 parts of RS4 for flour did not change hardness in cooked noodles but it did reduce their extensibility, cohesiveness, and springiness, which was probably due to the non-swelling properties of RS4. At 40 parts of RS4 replacement, supplementation of 2-8 parts of vital wheat gluten or wheat protein isolate in the composite flour notably enhanced the hardness and extensibility of cooked noodles, whereas cohesiveness and springiness were minimally affected. Supplemental vital wheat gluten produced a thicker protein network than endogenous protein or added wheat protein isolate, giving cooked noodles greater breaking force and distance. CONCLUSION: RS4 could be used as a functional ingredient to replace up to 40% of hard wheat flour for making Asian noodles while maintaining their hardness after cooking. The extensibility of cooked noodles with high RS4 could be noticeably enhanced by supplementation with vital wheat gluten in the composite flour (RS/flour = 40/60). © 2020 Society of Chemical Industry.

Impact of varied center volume categories on volume-outcome relationship in children receiving ECMO for heart operations.

To study the volume-outcome relationship among children receiving extracorporeal membrane oxygenation (ECMO), different studies from different databases use different volume categories. The objective of this study was to evaluate if different center volume categories impact the volume-outcome relationship among children receiving ECMO for heart operations. We performed a post hoc analysis of data from an existing national database, the Pediatric Health Information System. Centers were classified into five different volume categories using different cut-offs and different variables. Mortality rates were compared between the varied volume categories using a mixed effects logistic regression model after adjusting for patient- and center-level risk factors. Data collection included demographic information, baseline characteristics, pre-ECMO risk factors, operation details, patient diagnoses, and center data. In unadjusted analysis, there was a significant relationship between center volume and mortality, with low-and medium-volume centers associated with higher mortality rates compared to high-volume centers in all volume categories, except the hierarchical clustering volume category. In contrast, there was no significant association between center-volume and mortality among all volume categories in adjusted analysis. We concluded that high-volume centers were not associated with improved outcomes for the majority of the categorization schemes despite using different cut-offs and different variables for volume categorization.

Impact of Timing of ECMO Initiation on Outcomes After Pediatric Heart Surgery: A Multi-Institutional Analysis.

Little is known about the relationship of timing of extracorporeal membrane oxygenation (ECMO) initiation on patient outcomes after pediatric heart surgery. We hypothesized that increasing timing of ECMO initiation after heart surgery will be associated with worsening study outcomes. Patients aged ≤18 years receiving ECMO after pediatric cardiac surgery at a Pediatric Health Information System-participating hospital (2004-2013) were included. Outcomes evaluated included in-hospital mortality, composite poor outcome, prolonged length of ECMO, prolonged length of mechanical ventilation, prolonged length of ICU stay, and prolonged length of hospital stay. Multivariable logistic regression models were fitted to study the probability of study outcomes as a function of timing from cardiac surgery to ECMO initiation. A total of 2908 patients from 42 hospitals qualified for inclusion. The median timing of ECMO initiation after cardiac surgery was 0 days (IQR 0-1 day; range 0-294 days). After adjusting for patient and center characteristics, increasing duration of time from surgery to ECMO initiation was not associated with higher mortality or worsening composite poor outcome. However, increasing duration of time from surgery to ECMO initiation was associated with prolonged length of ECMO, prolonged length of ventilation, prolonged length of ICU stay, and prolonged length of hospital stay. Although this relationship was statistically significant, the odds for prolonged length of ECMO, prolonged length of ventilation, prolonged length of ICU stay, and prolonged length of hospital stay increased by only 1-3 % for every 1-day increase in ECMO that may be clinically insignificant. We did not demonstrate any relationship between timing of ECMO initiation and mortality among the patients of varying age groups, and patients undergoing cardiac surgery of varying complexity. We concluded that increasing duration of time from surgery to ECMO initiation is not associated with worsening mortality. Our results suggest that ECMO is initiated at the appropriate time when dictated by clinical situation among patients of all age groups, and among patients undergoing heart operations of varying complexity.

Safety and efficacy of dexmedetomidine in children with heart failure.

This retrospective observational study aimed to evaluate the safety and efficacy of dexmedetomidine (DEX) for children with heart failure. The study was conducted in the cardiovascular intensive care unit (CVICU) of a single, tertiary care, academic children's hospital. A retrospective review of the charts for all children (up to 18 years of age) with signs and symptoms consistent with congestive heart failure who received DEX in our CVICU between April 2006 and April 2011 was performed. The patients were divided into two groups for study purposes: the DEX group of 21 patients, who received a DEX infusion together with other conventional sedation agents, and the control group of 23 patients, who received conventional sedation agents without the use of DEX. To evaluate the safety of DEX, physiologic data were collected including heart rate, mean arterial pressure (MAP), and inotrope score. To assess the efficacy of DEX, the amount and duration of concomitant sedation and analgesic infusions in both the DEX and control groups were examined. The numbers of rescue boluses for each category before the initiation of sedative infusion and during the sedative infusion also were examined. The baseline characteristics of the patients in the two groups were similar. There was no effect of DEX infusion on heart rate, MAP, or inotrope score at the termination of infusion. The daily amount of midazolam administered was significantly less during the last 24 h of DEX infusion in the DEX group than in the control group (p = 0.04). The daily amount of morphine infusion did not differ between the DEX and control groups during any period. The numbers of sedation and analgesic rescue boluses were lower in DEX group throughout the infusion. No other significant side effects were noted. Two patients in the DEX group had a 50 % or greater drop in MAP compared with baseline in the first 3 h after initiation of DEX infusion, whereas one patient had a 50 % or greater drop in heart rate compared with baseline in the first 3 h after initiation of DEX infusion. Administration of DEX for children with heart failure appears to be safe but should be used cautiously. Furthermore, DEX use is associated with a decreased opiate and benzodiazepine requirement for children with heart failure.

Novel use of an Amplatzer Vascular Occluder II to close an acquired fistula between a reconstructed aortic arch and the left atrial appendage in a patient with hypoplastic left heart syndrome.

An 8-month-old female with hypoplastic left heart syndrome had undergone bidirectional cavopulmonary anastomosis at the age of 4.5 months and presented with a new continuous flow murmur on routine follow-up. Diagnostic catheterization demonstrated a fistula between the left atrial appendage and the neo-aortic arch. The fistula was sealed with an Amplatzer Vascular Occluder II device without complications.

Glycemic and Insulinemic Responses of Healthy Humans to a Nutrition Bar with or without Added Fibersym® RW, a Cross-Linked Phosphorylated RS4-Type Resistant Wheat Starch.

The current study compared postprandial glycemic and insulinemic responses to four nutrition bars containing two different doses of resistant starch type-4. Normoglycemic adults (n = 17) completed six treatments, consuming either 50 g or 30 g digestible carbohydrate as: dextrose beverages (DEX), control puffed wheat bars (PWB), or RS4 test bars (RS4). Glucose (mg/dL) and insulin (µIU/mL) were measured at baseline and 10, 20, 30, 60, 90, and 120 min. There was a main effect of dose and treatment on glucose incremental area under the curve (iAUC, ps < 0.001), such that RS4 (50 g: 941, 95% confidence interval (CI): 501, 1519; 30 g: 481, 95% CI: 186, 914) was lower than PWB (50 g: 1746, 95% CI: 1109, 2528; 30 g: 693, 95% CI: 331, 1188) and DEX (50 g: 1940, 95% CI: 1249, 2783; 30 g:1432, 95% CI: 883, 2114). There was a main effect of dose and treatment on insulin iAUC (ps < 0.001), such that RS4 (50 g: 1993, 95% CI: 1347, 2764; 30 g: 943, 95% CI: 519, 1493) was lower than PWB (50 g: 3501, 95% CI: 2625, 4502; 30 g: 1789, 95% CI: 1193, 256) and DEX (50 g: 3143, 95% CI: 2317, 4095; 30 g: 2184, 95% CI: 1519, 2970). Results demonstrate significantly lower glycemic and insulinemic responses following consumption of nutrition bars containing RS4, regardless of dose, when compared with puffed wheat bars and dextrose.

Long-term outcomes of intraoperative pulmonary artery stent placement for congenital heart disease.

OBJECTIVE: Our objective was to examine long-term outcomes of intraoperative pulmonary artery stents and determine risk factors for reintervention BACKGROUND: Short-term outcomes of intraoperative pulmonary artery stents have been reported previously. However, long-term results are unknown. METHODS: We conducted a retrospective review of patients who underwent intraoperative pulmonary artery stent placement for branch pulmonary artery stenosis. RESULTS: Ninety-six stents were implanted intraoperatively in 67 patients. Twenty-seven patients received two or more stents at initial intervention. Median patient age at initial stent placement was 1.8 years. Median post-inflation diameter was 8 mm. At a mean follow-up of 7.6±4.5 years, 49% of stents required reintervention (balloon angioplasty at catheterization in 28 patients and surgical revision in 19 patients). Actuarial freedom from reintervention at 2, 5, and 10 years was 68%, 49%, and 40%, respectively. In univariate analysis of time to first reintervention, age at implantation<2 yrs (P<0.0009) and initial post-inflation stent diameter<10 mm (P<0.0002) were associated with risk for reintervention. Multivariable Cox regression analysis showed age<2 years (P<0.005) and diagnosis of tetralogy of Fallot (p<0.002) or truncus arteriosus (P<0.007) to be significant risk factors for reintervention. CONCLUSION: Intraoperative placement of stents in the pulmonary arteries is an alternative to surgical angioplasty, but is associated with a high incidence of reintervention. Age<2 years and the diagnosis of tetralogy of Fallot or truncus arteriosus are risk factors for reintervention.

Use of near-infrared spectroscopy for estimation of renal oxygenation in children with heart disease.

We evaluated whether near-infrared spectroscopy (NIRS) measurement from the flank correlates with renal vein saturation in children undergoing cardiac catheterization. Thirty-seven patients <18 years of age were studied. A NIRS sensor was placed on the flank, and venous oxygen saturations were measured from the renal vein and the inferior vena cava (IVC). There was a strong correlation between flank NIRS values (rSO(2)) and renal vein saturation (r = 0.821, p = 0.002) and IVC saturation (r = 0.638, p = 0.004) in children weighing ≤ 10 kg. In children weighing > 10 kg, there was no correlation between rSO(2) and renal vein saturation (r = 0.158, p = 0.57) or IVC saturation (r = -0.107, p = 0.67). Regional tissue oxygenation as measured by flank NIRS correlates well with both renal vein and IVC oxygen saturations in children weighing <10 kg undergoing cardiac catheterization, but not in larger children.

Metabolic Responses to Native Wheat Starch (MidsolTM 50) versus Resistant Wheat Starch Type 4 (Fibersym® RW): Standard versus Marketplace Testing Protocols.

BACKGROUND: To investigate the effect of resistant starch (RS) on acute glycemic or insulinemic responses, the FDA indicates that control and RS-enriched foods must contain equivalent amounts of digestible carbohydrate. However, RS-containing foods typically contain less digestible carbohydrate per serving than control foods. Thus, controlling for digestible carbohydrate may yield different responses as compared with controlling for serving size. OBJECTIVE: The aim was to compare the postprandial metabolic responses to native wheat starch (NWS) versus RS type 4 (RS4) using digestible carbohydrate-matched portions compared with weight-matched portions. METHODS: A single-blind, randomized-controlled crossover trial examined glycemic and insulinemic responses over 2 h following consumption of 4 cracker conditions and a dextrose beverage in apparently healthy participants (n = 14). Crackers provided 50 g of digestible carbohydrate using the FDA's meal-intervention protocol or 35 g of carbohydrate by weight for the marketplace substitution method. Crackers differed only by the type of starch additive: NWS (MidsolTM 50; MGP Ingredient, Inc.) or RS4 (Fibersym® RW; MGP Ingredients, Inc.). Glucose concentrations were assessed at baseline and at 15, 30, 45, 60, 90, and 120 min; insulin concentrations were measured at baseline and 30, 60, and 120 min. RESULTS: There were no significant differences between 50 g digestible carbohydrate cracker conditions for glucose or insulin incremental AUC (iAUC). The 35 g carbohydrate by weight conditions were not different for glucose iAUC [mean (95% CI): 35 g NWS: 1317 (677, 2169); 35 g RS4: 701 (262, 1351); P > 0.05]. However, insulin iAUC was lower following 35 g RS4 compared with 35 g NWS [35 g RS4: 92 (1, 259); 35 g NWS: 697 (397, 1080); P < 0.01]. CONCLUSIONS: In healthy adults, consumption of RS4 crackers decreased postprandial insulin responses compared with NWS crackers when using the marketplace substitution method compared with the FDA standard testing method, with similar postprandial glucose responses. Comparisons of the FDA standard testing method and the marketplace substitution method should be investigated further to elucidate differential physiological impacts on consumers.

Pyrodextrins from waxy and normal tapioca starches: Molecular structure and in vitro digestibility.

Pyrodextrins were prepared from acidified waxy and normal tapioca starches (pH∼3) at 3 temperatures (130, 150 and 170 °C) and 3 times (1, 2 and 4 h) to determine their in vitro digestibility and molecular structure. Pyrodextrin from waxy tapioca starch produced at 170 °C/4 h had 5% higher total indigestible carbohydrate than pyrodextrin from normal tapioca starch (45.2 % and 40.4 %, respectively) as determined by a modified AOAC Method 2011.25. The low-molecular weight indigestible carbohydrate content at this condition was also higher for waxy tapioca starch than normal tapioca starch (40.6 % and 34.9 %, respectively). Gel permeation chromatography and nuclear magnetic resonance spectroscopy were used to study changes in molecular structure and correlate with digestibility of the pyrodextrins. Molecular size distribution indicated that waxy tapioca starch underwent thermal modification more readily than normal tapioca starch. Non α-1,4/α-1,6 glucosidic linkages were increased in the pyrodextrins with increasing in indigestible carbohydrate content.

Intrahospital transport of children on extracorporeal membrane oxygenation: indications, process, interventions, and effectiveness.

OBJECTIVE: To evaluate indications, process, interventions, and effectiveness of patients undergoing intrahospital transport. Critically ill patients supported with extracorporeal membrane oxygenation are transported within the hospital to the radiology suite, cardiac catheterization suite, operating room, and from one intensive care unit to another. No studies to date have systematically evaluated intrahospital transport for patients on extracorporeal membrane oxygenation. DESIGN: Retrospective cohort analysis. SETTING: Cardiac intensive care unit in a tertiary care children's hospital. PATIENTS: All patients on extracorporeal membrane oxygenation who required intrahospital transport between January 1996 and March 2007 were included and analyzed. MEASUREMENTS AND MAIN RESULTS: A total of 57 intrahospital transports for cardiac catheterization and head computed tomography scans were analyzed. In 14 (70%) of 20 of patients with cardiac catheterization, a management change occurred as a result of the diagnostic cardiac catheterization. In ten (59%) of 17 patients, bedside echocardiography was of limited value in defining the critical problem. In the interventional group, the majority of transports were for atrial septostomy. In the head computed tomography group, significant pathology was identified, which led to management change. No major complications occurred during these intrahospital transports. CONCLUSIONS: Although transporting patients on extracorporeal membrane oxygenation is labor intensive and requires extensive logistic support, it can be carried out safely in experienced hands and it can result in important therapeutic and diagnostic yields. To our knowledge, this is the first study designed to evaluate safety and efficacy of intrahospital transport for patients receiving extracorporeal membrane oxygenation support.

Percutaneous coronary intervention using drug-eluting stents in pediatric heart transplant recipients.

PCI has been used for palliation of CAV in adults, but there are limited data available in children. We sought to evaluate our experience with PCIs for CAV in pediatric heart transplant recipients. Retrospective review of the medical records of all four patients who were diagnosed with CAV, including demographic data and catheterization reports was performed. Of the 149 pediatric heart transplant recipients followed at our institution, 10 were identified with CAV. Four of these 10 underwent 12 PCI procedures for CAV. One donor heart had documented coronary artery disease. Two patients had significant risk factors for coronary artery disease including morbid obesity, hyperlipidemia, and systemic hypertension. PCI involved deployment of bare metal stents (n = 2), paclitaxel-eluting stent (n = 6), and sirolimus-eluting stents (n = 4) with procedural success in all and no early or late mortality. One procedure was complicated by coronary dissection that was successfully treated with stent placement. One patient has been re-transplanted while the other three are not candidates for re-transplantation and have remained asymptomatic as palliation with PCI. PCI using coronary stents is a safe and effective palliative measure for CAV in pediatric heart transplant recipients.

Cesium-induced QT-interval prolongation in an adolescent.

Alternative medicine is becoming increasingly popular, especially with terminally ill patients. Most alternative remedies have not been adequately studied or proven effective for the diseases for which they are promoted. In the worst cases, these therapies are harmful. We describe a 16-year-old girl with metastatic hepatocellular carcinoma who experienced cesium-induced QT-interval prolongation after the start of a cesium chloride-based alternative treatment regimen. She had received seven courses of chemotherapy, with a cumulative doxorubicin dose of 500 mg/m(2) over 5 months, resulting in minimal tumor regression. Against the advice of her oncologist, she abandoned traditional therapy and started an alternative regimen that included cesium chloride supplements. Two weeks later, the patient went to a local emergency department after experiencing two brief syncopal episodes. An electrocardiogram revealed occasional premature ventricular contractions, a QTc interval of 683 msec (normal range for females 450-460 msec), and R on T phenomenon. She was admitted to the hospital and later experienced monomorphic ventricular tachycardia, which resolved spontaneously. Lidocaine therapy was started, and the patient was transferred to a cardiac intensive care unit at our hospital. Her plasma cesium level was 2400 microg/dl (normal < 1 microg/dl), and her family was told to stop her alternative treatment regimen. On hospital day 5, as no additional arrhythmias had occurred, lidocaine was discontinued. Two days later, the patient's QTc interval had decreased to 546 msec, and she was discharged home. Two months later, at a follow-up visit, her serum cesium level was 1800 microg/dl, and her QTc interval was 494 msec. According to the Naranjo adverse drug reaction probability scale, cesium was the probable cause of the patient's arrhythmia. In animal models, cesium chloride has induced cardiac arrhythmias, including torsade de pointes. It inhibits delayed rectifier potassium channels in the myocardium, causing delayed repolarization and QT-interval prolongation. Patients with cancer should be aware that alternative remedies may be harmful and ineffective. Because patients may be unlikely to self-report alternative remedies, health care providers should specifically ask their patients about any alternative treatments they may be taking and should be knowledgeable about their toxicities.

Determination of secondary structural changes in gluten proteins during mixing using Fourier transform horizontal attenuated total reflectance spectroscopy.

Fourier transform horizontal attenuated total reflectance (FT-HATR) was used to examine changes in the secondary structure of gluten proteins in a flour-water dough system during mixing. Midinfrared spectra of mixed dough revealed changes in four bands in the amide III region associated with secondary structure in proteins: 1317 (alpha-helix), 1285 (beta-turn), 1265 (random coil), and 1242 cm (-1) (beta-sheet). The largest band, which also showed the greatest change in second derivative band area (SDBA) during mixing, was located at 1242 cm (-1). The bands at 1317 and 1285 cm (-1) also showed an increase in SDBA over time. Conversely, the band at 1265 cm (-1) showed a corresponding decrease over time as the doughs were mixed. All bands reached an optimum corresponding to the minimum mobility of the dough as determined by the mixograph. Increases in alpha-helix, beta-turn, and beta-sheet secondary structures during mixing suggest that the dough proteins assume a more ordered conformation. These results demonstrate that it is possible, using infrared spectroscopic techniques, to relate the rheological behavior of developing dough in a mixograph directly to changes in the structure of the gluten protein system.

Characteristics and Fate of Pediatric Heart Disease Abstracts Presented at National Meetings.

BACKGROUND: This study evaluated the characteristics and publication outcomes of pediatric heart disease abstracts presented in national meetings. METHODS: Three years of abstracts (2012-2014) were evaluated from five national meetings: Society of Thoracic Surgeons (STS), American Association of Thoracic Surgeons (AATS), American College of Cardiology (ACC), American Academy of Pediatrics (AAP), and American Heart Association (AHA). Each abstract was assessed for publication in a peer-reviewed scientific journal, time to publication, impact factor of the journal, and number of citations associated with the publication. RESULTS: A total of 1145 abstracts qualified for inclusion. The majority of the abstracts originated from North America (80.8%) and were single institutional (85.7%), clinical (92.5%), and retrospective (77.9%) studies. A total of 767 abstracts (66.9%) were published in peer-reviewed journals as full-length articles. More than 90% of the abstracts presented at the surgical meetings were published as manuscripts in peer-reviewed journals. In contrast, 68.8% of ACC abstracts 53.7% AAP abstracts and 61.4% of AHA abstracts were published as manuscripts in a peer-reviewed journal. The median time to publication was shortest for STS abstracts (10 months) and longest for AHA abstracts (29 months). The median impact factor for published manuscripts varied between 3.0 and 3.5 for AATS abstracts, STS abstracts, ACC abstracts, and AHA abstracts. Manuscripts from AATS abstracts had the highest number of citations. CONCLUSIONS: Our data indicate that the national cardiology and cardiac surgery meetings have become a forum for presenting high-quality research, with >90% of the abstracts presented in these meetings culminating in publication.

Settling volume and morphology changes in cross-linked and unmodified starches from wheat, waxy wheat, and waxy maize in relation to their pasting properties.

Normal wheat, waxy wheat and waxy maize starches were cross-linked with 0.01, 0.03 and 0.06% (sb) phosphorus oxychloride. The objective of this study was to correlate the morphology changes and settling volume to the pasting properties of those cross-linked and unmodified starches. Pasting and microscopic data for waxy maize starch and its cross-linked products was similar to waxy wheat starch, except changes occurred at ∼5 °C higher in temperature. At 6% solids, waxy wheat starch cross-linked with 0.01% POCl3 had a greater settling volume and a higher pasting viscosity than the cross-linked waxy maize starch, but at 7 and 8% solids, waxy maize starch cross-linked with 0.03% and 0.06% POCl3 had a higher pasting viscosity. At 6% starch solids, particle volume fraction appeared to be the dominant factor controlling consistency, but at higher starch solids contents, the deformability (rigidity) of swollen granules became important in controlling viscosity.

Is Magnet® recognition associated with improved outcomes among critically ill children treated at freestanding children's hospitals?

PURPOSE: With increasing emphasis on high-quality care, we designed this study to evaluate the relationship between Magnet® recognition and patient outcomes in pediatric critical care. MATERIALS AND METHODS: Post hoc analysis of data from an existing administrative national database. We used inverse probability of treatment weighting and multivariate models to compare outcomes between two study groups after adjusting for confounding variables. RESULTS: A total of 823,634 pediatric patients from 41 centers were included. Of these, 454,616 patients (55.2%) were treated in 23 Magnet hospitals. The majority of baseline characteristics did not vary significantly among the two study groups. In adjusted models, there was no difference in mortality between the two groups (Magnet vs. non-Magnet; odds ratio: 0.92, 95% confidence interval: 0.77-1.11). When stratified by various subgroups, such as cardiac, non-cardiac, ECMO, cardiac arrest, respiratory failure, use of nitric oxide, genetic abnormality etc., Magnet status of the hospital did not confer a survival advantage. In a sensitivity analysis on patients from crossover hospitals only, attainment of magnet status was associated with increased hospital charges. CONCLUSIONS: This large observational study calls into question the utility of the Magnet Recognition Program among children with critical illness, at least among the freestanding children's hospitals.