Defining Fluid Restriction in the Management of Infants Following Cardiac Surgery and Understanding the Subsequent Impact on Nutrient Delivery and Growth Outcomes

Adequacy of nutritional intake during the postoperative period, as measured by a change in weight-for-age z-scores from surgery to the time of discharge, was evaluated in infants (n = 58) diagnosed with a congenital heart defect and admitted for surgical intervention at Miami Children’s Hospital using a prospective observational study design. Parental consent was obtained for all infants who participated in the study. Forty patients had a weight available at hospital discharge. The mean preoperative weight-for-age z-score was -1.3 ±1.43 and the mean weight-for-age z-score at hospital discharge was -1.89 ±1.35 with a mean difference of 0.58 ±0.5 (P Nutritional intake during the postoperative period was inadequate based on a decrease in weight-for-age z-scores from the time of surgery until discharged home. Our findings suggested that limited fluid volume for nutrition likely contributes to suboptimal nutritional delivery during the postoperative period; however, inadequate nutrition prescription may also be an important contributing factor. Development of a nutrition protocol for initiation and advancement of nutrition support may reduce the delay in achieving patient’s nutritional goals and may attenuate the observed decrease in z-scores during the postoperative period.

Defining fluid restriction in the management of infants following cardiac surgery and understanding the subsequent impact on nutrient delivery and growth outcomes

Adequacy of nutritional intake during the postoperative period, as measured by a change in weight-for-age z-scores from surgery to the time of discharge, was evaluated in infants (n = 58) diagnosed with a congenital heart defect and admitted for surgical intervention at Miami Children’s Hospital using a prospective observational study design. Parental consent was obtained for all infants who participated in the study. ^ Forty patients had a weight available at hospital discharge. The mean preoperative weight-for-age z-score was -1.3 ±1.43 and the mean weight-for-age z-score at hospital discharge was -1.89 ±1.35 with a mean difference of 0.58 ±0.5 (P = 0.2).^ Nutritional intake during the postoperative period was inadequate based on a decrease in weight-for-age z-scores from the time of surgery until discharged home. Our findings suggested that limited fluid volume for nutrition likely contributes to suboptimal nutritional delivery during the postoperative period; however, inadequate nutrition prescription may also be an important contributing factor. Development of a nutrition protocol for initiation and advancement of nutrition support may reduce the delay in achieving patient’s nutritional goals and may attenuate the observed decrease in z-scores during the postoperative period.^

Comparison of Common Field/Clinical Measures to Standard Laboratory Measures of Hydration Status

Context: Accurately determining hydration status is a preventative measure for exertional heat illnesses (EHI). Objective: To determine the validity of various field measures of urine specific gravity (Usg) compared to laboratory instruments. Design: Observational research design to compare measures of hydration status: urine reagent strips (URS) and a urine color (Ucol) chart to a refractometer. Setting: We utilized the athletic training room of a Division I-A collegiate American football team. Participants: Trial 1 involved urine samples of 69 veteran football players (age=20.1+1.2yr; body mass=229.7+44.4lb; height=72.2+2.1in). Trial 2 involved samples from 5 football players (age=20.4+0.5yr; body mass=261.4+39.2lb; height=72.3+2.3in). Interventions: We administered the Heat Illness Index Score (HIIS) Risk Assessment, to identify athletes at-risk for EHI (Trial 1). For individuals “at-risk” (Trial 2), we collected urine samples before and after 15 days of pre-season “two-a-day” practices in a hot, humid environment(mean on-field WBGT=28.84+2.36oC). Main Outcome Measures: Urine samples were immediately analyzed for Usg using a refractometer, Diascreen 7® (URS1), Multistix® (URS2), and Chemstrip10® (URS3). Ucol was measured using Ucol chart. We calculated descriptive statistics for all main measures; Pearson correlations to assess relationships between the refractometer, each URS, and Ucol, and transformed Ucol data to Z-scores for comparison to the refractometer. Results: In Trial 1, we found a moderate relationship (r=0.491, p<.01) between URS1 (1.020+0.006μg) and the refractometer (1.026+0.010μg). In Trial 2, we found marked relationships for Ucol (5.6+1.6shades, r=0.619, p<0.01), URS2 (1.019+0.008μg, r=0.712, p<0.01), and URS3 (1.022+0.007μg, r=0.689, p<0.01) compared to the refractometer (1.028+0.008μg). Conclusions: Our findings suggest that URS were inconsistent between manufacturers, suggesting practitioners use the clinical refractometer to accurately determine Usg and monitor hydration status.

Does core strength training influence kinetic efficiency, lower extremity stability, and 5000m performance in runners?

Context: Core strength training (CST) has been popular in the fitness industry for a decade. Although strong core muscles are believed to enhance athletic performance, only few scientific studies have been conducted to identify the effectiveness of CST on improving athletic performance. Objective: Identify the effects of a 6-wk CST on running kinetics, lower extremity stability, and running performance in recreational and competitive runners. Design and Setting: A test-retest, randomized control design was used to assess the effect of CST and no CST on ground reaction force (GRF), lower extremity stability scores, and running performance. Participants: Twenty-eight healthy adults (age, 36.9+9.4yrs, height, 168.4+9.6cm, mass, 70.1+15.3kg) were recruited and randomly divided into two groups. Main outcome Measures: GRF was determined by calculating peak impact vertical GRF (vGRF), peak active vGRF, duration of the breaking or horizontal GRF (hGRF), and duration of the propulsive hGRF as measured while running across a force plate. Lower extremity stability in three directions (anterior, posterior, lateral) was assessed using the Star Excursion Balance Test (SEBT). Running performance was determined by 5000 meter run measured on selected outdoor tracks. Six 2 (time) X 2 (condition) mixed-design ANOVA were used to determine if CST influences on each dependent variable, p < .05. Results: No significant interactions were found for any kinetic variables and SEBT score, p>.05. But 5000m run time showed significant interaction, p < .05. SEBT scores improved in both groups, but more in the experimental group. Conclusion: CST did not significantly influence kinetic efficiency and lower extremity stability, but did influence running performance.

The effects of cross -age peer tutoring on writing and reading comprehension skills and attitudes and self -perceptions as writers of third and fourth grade students

The purpose of this study was to investigate the effects of cross-age peer writing response groups on the writing and reading achievement of third and fourth grade students. Students' attitudes about writing and their perceptions of themselves as writers were also measured at the end of the study. ^ One hundred and twenty-two third and fourth grade students enrolled in a public school in a middle-class, multi-cultural neighborhood participated in the study. Four existing classes of students were randomly assigned to either the experimental condition (EC) or the control condition (CC). Both groups were pretested and posttested for writing and reading achievement. The intervention, cross-age peer writing groups, met for eleven weeks. ^ Three hypotheses were examined in this study: (a) writing improvement score, (b) reading comprehension improvement score, and (c) students' attitudes toward writing and their perception of themselves as writers based on the five scales measured on the Writer Self-Perception Scale. ^ ANOVAs were done on the pretests and posttests for writing and the Stanford Achievement Test reading comprehension subtest scores for the year of the study and the previous year. ANOVAs were also done for the five areas of the Writer Self-Perception Scale. Cross-tabulations were also used to compare improvement level verses treatment group, and grade level. ^ Analysis of the data revealed that there was no evidence that the tutoring (EC) groups made more progress than the non-tutoring (CC) groups in writing and reading. There was evidence of growth in writing, especially by the fourth graders. Most importantly, the fourth grade tutors, the experimental group, had the most positive feelings about writing and themselves as writers. ^

Acculturation and Diabetes Self-management of Cuban Americans: Is Age a Protective Factor?

Migration to the United States has been linked to obesity and poor diet quality. We investigated the relationship among diabetes self-management, diet, age and acculturation factors for 182 Cuban-Americans (Females = 110, Males = 72) with type 2 diabetes recruited from a randomized mailing list in South Florida. Inadequate glycemic control (β = 0.257), BMI (β = 0.251), total fat intake (β = 0.251), and smoking (β = 0.200), were positively associated, while understanding of overall diabetes care (β = -0.165), was negatively associated with migration (N = 162, adj.R2 = 0.286, F = 14.65, p < 0.001). These associations suggest that effective diabetes education targeting acculturation issues is lacking.