Ethical dilemmas in artificial nutrition and hydration: food for thought.
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Biomedical subjects
Publications and source records attributed to J C Hall.
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Surveys have shown that malnutrition is present in approximately 50% of all hospitalized patients. With the continued reduction in length of stay in acute care facilities, it is critical that ALL patients receive a nutrition screen and, when appropriate, a comprehensive nutritional assessment. Once the nutrition evaluation has been completed, the next step is to determine the most appropriate route of nutrition intervention. This article provides some guidelines that can be used to determine the type of nutritional support to be implemented. It also contains information on access routes, benefits, and complications with interventions for both enteral tube feeding and parenteral nutrition.
Cyclohexanedione herbicides inhibit monocotyledonous acetyl coenzyme-A carboxylase (ACCase; E.C. 6.4.1.2.), which catalyzes the first committed step in fatty acid biosynthesis. Although the target site has been identified, little is known about the mechanisms involved in herbicide binding. An immunological study was undertaken to create a model to better characterize the herbicide-enzyme interaction. Cyclohexanedione-specific antiserum was raised in New Zealand white rabbits by immunizing them with a cyclohexanedione analog-bovine serum albumin conjugate. Two indirect enzyme-linked immunosorbent assays (ELISA) were developed using 2 different cyclohexanedione analogs conjugated to ovalbumin as coating conjugates. Nineteen cyclohexanedione analogs, 13 active ACCase inhibitors, and 6 inactive analogs were tested for their ability to compete with both coating conjugates for antiserum binding. All active ACCase inhibitors were observed to compete with both coating conjugates, whereas all inactive analogs failed to compete with at least one coating conjugate. On the basis of these results, the immunological model could be used to distinguish all active ACCase inhibitors from inactive analogs using the 2 ELISAs sequentially.
An enriched plasma membrane fraction was isolated from caput, corpus, and cauda rat spermatozoa and analyzed for lipid and protein content, thermal phase transition temperature using electron paramagnetic resonance spectroscopy (EPR), and enzymatic assays of calcium-dependent ATPase activity. Based on sperm concentration, total membrane phospholipid, cholesterol, and protein content declined as sperm passed through the epididymis. A more refined analysis of the bulk plasma membrane phospholipid revealed that approximately 56% of the phospholipid consisted of choline (PC) and ethanolamine (PE) phosphoglycerides; the remainder consisted of sphingomyelin (SM), phosphatidylserine (PS), and diphosphatidylglycerol (DPG). The mole percent of PE increased in sperm proceeding from the caput to the corpus epididymis and then declined from the corpus to the cauda epididymis. The phospholipid-bound fatty acids consisted primarily of palmitate (C16:0) and stearate (C18:0), with a significant increase in the mole percent of the docosapentenoyl acyl group (C22:5) in cauda sperm. Arrhenius' plots of the EPR peak height signals using the lipid soluble spin label, 5-doxyldecane, and the calcium-dependent ATPase activity as a function of temperature demonstrated a change in the apparent fluidity of the membrane and energy of activation of the calcium-dependent ATPase associated with the three sperm membrane preparations. These data suggest that the apparent fluidity and biochemical composition of the sperm membrane change during epididymal maturation.
Case management traditionally has been performed by occupational health nurses and rehabilitation professionals. The rapid growth of managed care was the impetus for defined standards and formal credentialing.