A systematic review of nursing administration of medication via enteral tubes in adults

Aim. This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults.
Background. Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown.
Design. Systematic review.
Methods. CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data
were presented in a narrative summary.
Results. Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself.
Conclusion. The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication.
Relevance to clinical practice. Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.

Effect of composition on the texture and deformation behaviour of wrought Mg alloys

The microstructure and mechanical response of three extruded magnesium alloys, Mg-3Al-1Zn (AZ31), Mg-1.5Mn (Ml) and Mg-lMn-0.4RE (ME10) are examined. The tensile yield strength of ME10 was nearly half that of AZ31 and Ml. The tensile elongations were 6%, 11% and 19% for Ml, AZ31 and ME10, respectively. This range of properties is large and is attributed to the unique extrusion texture produced in ME10, and the high density of fine particles in Ml.

Effect of microalloying with rare-earth elements on the texture of extruded magnesium-based alloys

A series of alloys have been produced with microalloying additions of rare-earth (RE) elements in the range of 0.1–0.4 wt.%. The alloys have been extruded to produce grain sizes of 23 ± 5 μm. The texture of the extruded alloys was measured, and it was found that the extrusion texture was weakened by the addition of RE elements. The samples with weakened extrusion textures exhibited an increase in the tensile elongation.

Fine grained AZ31 produced by conventional thermo-mechanical processing

The magnesium alloy AZ31 was processed by severe hot rolling and annealing. This processing was optimised to produce recrystallised grain sizes as small as 2.2 μm. The texture of the processed plate was similar to that of the as-received material, with a strong basal alignment in the normal direction. Tensile testing of the fine grained material showed an increase in the strength and elongation compared to the as-received plate. It is  concluded that the improved mechanical properties of the fine grained material results from a refinement in the grain size and the elimination of shear bands that pre-exist in the as-received material.

Pretend play, social competence and involvement in children aged 5-7 years : the concurrent validity of the child-initiated pretend play assessment

Background and aims: The aims of this study were to investigate the relationship between pretend play, social competence and involvement in school-based activities in children aged 5–7 years and to determine whether children's social competence and level of involvement could be inferred from their scores on the Child-Initiated Pretend Play Assessment.
Procedure: The pretend play skills of 41 primary school-aged children aged 5–7 years were assessed on a one-on-one basis. Classroom teachers of the children assessed the children's social competence using the Penn Interactive Peer Play Scale and their involvement in school based activities using the Leuven Involvement Scale for Young Children.
Main findings: Significant positive relationships were found between elaborate pretend play and object substitution scores, involvement scores and peer play interaction scores (P < 0.05, P < 0.01). A significant negative relationship was found between elaborate pretend play scores, and social disconnection and social disruption scores (P < 0.05). Play deficit indicators were significantly negatively related to involvement scores (P < 0.01). This suggests that children with proficient pretend play skills are socially competent with peers and are able to engage in classroom activity. Children who scored poorly on the play assessment were more likely to have difficulty interacting with their peers and engaging in school activities.
Conclusion: Social competence and involvement skills are related to a child's ability to engage in pretend play. A child's social skills and ability to engage in school activities as assessed by teachers can be inferred from their scores on the Child-Initiated Pretend Play Assessment.

The skeletal benefits of calcium- and vitamin D3-fortified milk are sustained in older men after withdrawal of supplementation: an 18 mo follow-up study

Background: In a previous 2-y randomized controlled trial, we showed that calcium- and vitamin D₃–fortified milk stopped or slowed bone loss at several clinically relevant skeletal sites in older men.

Objective: The present study aimed to determine whether the skeletal benefits of the fortified milk were sustained after withdrawal of the supplementation.

Design: One hundred nine men >50 y old who had completed a 2-y fortified milk trial were followed for an additional 18 mo, during which no fortified milk was provided. Bone mineral density (BMD) of the total hip, femoral neck, lumbar spine, and forearm was measured by using dual-energy X-ray absorptiometry.

Results: Comparison of the mean changes from baseline between the groups (adjusted for baseline age, BMD, total calcium intake, and change in weight) showed that the net beneficial effects of fortified milk on femoral neck and ultradistal radius BMD at the end of the intervention (1.8% and 1.5%, respectively; P < 0.01 for both) were sustained at 18-mo follow-up (P < 0.05 for both). The nonsignificant between-group differences at the total hip (0.8%; P = 0.17) also persisted at follow-up (0.7%; P = 0.10), but there were no lasting benefits at the lumbar spine. The average total dietary calcium intake in the milk supplementation group at follow-up approximated recommended amounts for Australian men >50 y old (1000 mg/d) but did not differ significantly from that in the control subjects (1021 versus 890 mg/d).

Conclusion: Supplementation with calcium- and vitamin D₃–fortified milk for 2 y may provide some sustained benefits for BMD in older men after withdrawal of supplementation.

Diet of common diving-petrels (Pelecanoides Urinatrix Urinatrix) in Southeastern Australia during chick rearing

Unlike conspecifics in the subantarctic region, which typically begin breeding in mid-spring to summer, Common Diving-petrels Pelecanoides urinatrix urinatrix in southeastern Australia (towards the northern limit of the species' distribution) commence breeding mid winter. Knowledge of the foraging ecology of this species is crucial to understanding the factors that influence its timing of breeding in the region, yet there is currently little information available. Analysis of 43 stomachs of breeding adults, collected opportunistically after they were killed in a fire which burned through their colony, indicated that their diet was dominated by two taxa: a euphausiid Nyctiphanes australis which comprised 87% of the diet by number; and a hyperiid amphipod Themisto australis which constituted a further 12.5%. Mean lengths (±SE) of N. australis (n = 39) and T. australis (n = 41) were 12 mm (±0.3) and 5.2 mm (±0.2), respectively. The importance of N. australis in the diet of Common Diving-petrels is discussed in relation to their timing of breeding and the euphausiid's potential role in the Bass Strait pelagic ecosystem.

NDRG2, a novel regulator of myoblast proliferation, is regulated by anabolic and catabolic factors

Skeletal muscle tissue undergoes adaptive changes in response to stress and the genes that control these processes are incompletely characterised. NDRG2 (N-myc downstream-regulated gene 2), a stress- and growth-related gene, was investigated in skeletal muscle growth and adaption. While NDRG2 expression levels were found to be up-regulated in both differentiated human and mouse myotubes compared with undifferentiated myoblasts, the suppression of NDRG2 in C2C12 myoblasts resulted in slowed myoblast proliferation. The increased expression levels of the cell cycle inhibitors, p21 Waf1/Cip1 and p27 Kip1, and of various muscle differentiation markers in NDRG2-deficient myoblasts indicate that a lack of NDRG2 promoted cell cycle exiting and the onset of myogenesis. Furthermore, the analysis of NDRG2 regulation in C2C12 myotubes treated with catabolic and anabolic agents and in skeletal muscle from human subjects following resistance exercise training revealed NDRG2 gene expression to be down-regulated during hypertrophic conditions, and conversely, up-regulated during muscle atrophy. Together, these data demonstrate that NDRG2 expression is highly responsive to different stress conditions in skeletal muscle and suggest that the level of NDRG2 expression may be critical to myoblast growth and differentiation.

Generation of mutant leukaemia inhibitory factor (LIF)-IgG heavy chain fusion proteins as bivalent antagonists of LIF

Two leukaemia inhibitory factor (LIF) mutants, designated MH35-BD and LIF05, have been shown to have a capacity to inhibit the biological activities of not only human LIF (hLIF) but also other interleukin-6 (IL-6) subfamily cytokines such as human oncostatin M (hOSM). These cytokines share the same receptor complex in which the glycoprotein 130 (gp130) subunit is a common constituent. However, at low concentrations and in their monomeric forms, such molecules have a relatively short plasma half-life due to rapid clearance from the kidneys. Here, to prolong their serum half-lives, we have used a multi-step polymerase chain reaction (PCR) to fuse each of the LIF05 and MH35-BD cDNA fragments to a sequence encoding the Fc portion, and the hinge region, of the human immunoglobulin G (hIgG) heavy chain. The linking was achieved through an oligomer encoding a thrombin-sensitive peptide linker thus generating MH35-BD:Fc and LIF05:Fc, respectively. Both Fc fusion constructs were expressed in insect cell Sf21 and the proteins were purified by two successive affinity chromatography steps using nickel–nitrilotriacetic acid (Ni–NTA) agarose and protein A beads. The Ba/F3 cell-based proliferation assay was used to confirm that the proteins were biologically active. In addition, preliminary pharmacokinetics indicates that the Fc fusion constructs have a longer serum half-life compared to their non-fusion counterparts.

International well-being index : the Austrian version

The International Well-being Index (IWI) measures both personal and national well-being. It comprises two subscales: the Personal Well-being Index (PWI) and the National Well-being Index (NWI). The aim of this paper is to test the psychometric properties (validity and reliability) of the translated scale in Austria. Convergent validity is assessed using the Scales of Psychological Well-Being, the Satisfaction with Life Scale and the Positive and Negative Affect Scale. In addition, a Visual–Analog Scales capturing “satisfaction with life as a whole” was applied. The participants were 581 students of the Medical University Innsbruck (female: 47.7%; age: 23.2 ± 3.7). Internal consistency (Cronbach’s α) of the IWI was for both scales > .70 (PWI: .85; NWI: .83). The exploratory factor analysis of the IWI identified a 2-factor-structure identical with the two scales of the IWI explaining 54.2% of the variance. The convergent validity hypotheses were confirmed, construct validity was partly confirmed for the PWI being a deconstruction of a first factor called “satisfaction with life” (38.1% explained variance). Happy participants scored higher on the PWI (84.3 ± 7.9 vs. 68.7 ± 13.7; p < .001) and NWI (64.3 ± 15.8 vs. 57.9 ± 15.1; p < .001) scores than unhappy participants. It is concluded that the Austrian version of the IWI is a reliable and valid instrument to assess personal and national well-being. Further studies including a representative sample should be carried out on a recurring basis to use the IWI as an indicator for social science research in Austria.

Stimulation of calcineurin Aα activity attenuates muscle pathophysiology in mdx dystrophic mice

Calcineurin activation ameliorates the dystrophic pathology of hindlimb muscles in mdx mice and decreases their susceptibility to contraction damage. In mdx mice, the diaphragm is more severely affected than hindlimb muscles and more representative of Duchenne muscular dystrophy. The constitutively active calcineurin A transgene (CnA) was overexpressed in skeletal muscles of mdx (mdx CnA*) mice to test whether muscle morphology and function would be improved. Contractile function of diaphragm strips and extensor digitorum longus and soleus muscles from adult mdx CnA* and mdx mice was examined in vitro. Hindlimb muscles from mdx CnA* mice had a prolonged twitch time course and were more resistant to fatigue. Because of a slower phenotype and a decrease in fiber cross-sectional area, normalized force was lower in fast- and slow-twitch muscles of mdx CnA* than mdx mice. In the diaphragm, despite a slower phenotype and a 35% reduction in fiber size, normalized force was preserved. This was likely mediated by the reduction in the area of the diaphragm undergoing degeneration (i.e., mononuclear cell and connective and adipose tissue infiltration). The proportion of centrally nucleated fibers was reduced in mdx CnA* compared with mdx mice, indicative of improved myofiber viability. In hindlimb muscles of mdx mice, calcineurin activation increased expression of markers of regeneration, particularly developmental myosin heavy chain isoform and myocyte enhancer factor 2A. Thus activation of the calcineurin signal transduction pathway has potential to ameliorate the mdx pathophysiology, especially in the diaphragm, through its effects on muscle degeneration and regeneration and endurance capacity.