Fluid Ounces Research Articles

Effect of Varying Amounts of a Liquid Nutritional Supplement on the Pharmacokinetics of Posaconazole in Healthy Volunteers

The aim of this single-center, phase 1, randomized, 5 by 5 crossover, open-label study was to determine the effects of varying amounts of a nutritional supplement (Boost Plus) on the pharmacokinetics of posaconazole in 30 healthy volunteers. After an overnight fast, subjects were administered a single dose of 400 mg posaconazole oral suspension alone or following Boost Plus (8 fluid ounces [oz] [240 ml], 4 oz [120 ml], 2 oz [60 ml], or 1 oz [30 ml]). Subjects were randomized to receive all five treatments in different sequences, with a 14-day washout between treatments. Primary pharmacokinetic variables--area under the concentration-time curve from time zero to the time of the final quantifiable sample (AUC(tf)), maximum observed plasma concentration (C(max)), time to C(max) (T(max)), and relative bioavailability--were assessed up to 5 days postdose. Safety assessments included testing for adverse events, clinical laboratory tests, measurement of vital signs, physical examinations, and electrocardiograms. Posaconazole bioavailability increased almost linearly with increasing amounts of Boost Plus. Based on log-transformed data, the relative bioavailabilities (AUCs) of posaconazole were 35% (fasting), 48% (1 oz), 60% (2 oz), and 77% (4 oz) of the level reached in the presence of 8 oz Boost Plus, whereas T(max) was unaffected. Compared with the levels reached under fasting conditions, posaconazole C(max) and AUC values increased 3.5- and 2.9-fold, respectively, when given with 8 oz Boost Plus. Single doses of posaconazole at 400 mg alone and with 1, 2, 4, or 8 oz Boost Plus were safe and well tolerated in healthy subjects.

Change in plasma carotenoids in response to a 3‐week carrot juice intervention among breast cancer survivors

Evidence suggests that breast cancer recurrence may be reduced among women with higher plasma carotenoid levels post‐treatment (Rock 2005). Convenient dietary approaches to increase plasma carotenoids to protective levels are needed. Breast cancer survivors (n=33) participated in a randomized, controlled trial in which they consumed 8 fl.oz of fresh carrot juice daily for 3 weeks. Subjects were randomized to purple (n=23) or orange (n=10) carrots (Daucus carota) to test the hypothesis that daily juice intake would be associated with a significant rise in plasma total carotenoids and a‐ and β‐carotene. Mean baseline carotenoid levels were 1.24±0.73 umol/L for total carotenoids and 0.11±0.12 umol/L and 0.39±0.38 umol/L for a‐ and β‐carotene, respectively. Post‐feeding, levels increased significantly (p<0.001) to 4.80±1.91 umol/L, 1.52±0.75 umol/L, and 2.03±1.05 umol/L, for total carotenoids, α‐ and β‐carotene. Analysis by carrot type showed that mean change in carotenoids was not significantly different between the two carrot types (p=0.78). Mean total plasma carotenoids post‐feeding reached levels previously shown to be protective against breast cancer recurrence (4.19 umol/L). Daily consumption of 8 fluid ounces of carrot juice may represent an effective and simple dietary strategy to enhance survival among breast cancer survivors. Funded by: USDA‐CSREES, TAES 06‐118409, Texas A&M‐VFIC.

Testing the effect of specific orders to provide oral liquid nutritional supplements to nursing home residents: a quality improvement project.

To improve nursing home (NH) staff delivery of oral liquid nutritional supplements between meals to residents with a history of weight loss. Pre-Post intervention study. Two skilled nursing homes. Eighteen long term care residents. At baseline all participants had a non-specific physician's order to receive a nutritional supplement. The intervention consisted of specifying the physician's order as follows: "Give 4 oz high protein supplement at 10 am, 2 pm, and 7 pm". Research staff conducted direct observations for two days during and between meals for a total of 4 days, or 12 possible observation periods per participant before and one week following the intervention. Research staff documented NH staff delivery of snacks (including high protein supplements) and amount consumed (fluid ounces) for the high protein supplements using a standardized protocol during each observation period. Before the specific order was written participants were offered any type of snack an average of 1.82 times per day and a high protein supplement 0.59 times per day. After the specific order was written participants were offered any type of snack an average of 1.59 times per day and a high protein supplement 0.91 times per day. There were no statistically significant differences in the average number of times snacks or supplements were offered before and after the specific order was written. The proportion of snacks offered that were high protein supplements did increase after the specific order was written (p<0.001). When a high protein supplement was provided, most residents consumed 100% of it. Oral liquid nutritional supplements were not provided consistent with orders in NH practice. The specificity of the order related to type of supplement and time of delivery did not influence when and how often supplements are provided to residents but it did influence the type of nutritional supplement offered.

Risotto alla Milanese

1 Bring the chicken stock to a simmer. 2 Heat 3 ounces (90 grams) of the butter in a large, heavy saucepan. Add the onions and saute until translucent. 3 Add the rice to the onions and butter. Stir well to coat the grains with butter, but do not allow the rice to brown. Add the wine and stir until it is completely absorbed. 4 Add the saffron. Add the simmering stock, 4 fluid ounces (120 milliliters) at a time, stirring frequently. Wait until the stock is absorbed before adding the next 4-fluid-ounce (120-milliliter) portion. 5 After approximately 18 to 20 minutes, all the stock should be incorporated and the rice should be tender. Remove from the heat and stir in the remaining 1 ounce (30 grams) of butter and the grated cheese. Serve immediately.

Leber Hereditary Optic Neuropathy Presenting in a 75-Year-Old Man

We recently examined a white man who developed Leber hereditary optic neuropathy (LHON) at age 75. The patient was referred to us with bilateral visual failure of presumed psychogenic nature. He had presented to his local eye unit 6 months earlier with visual blurring initially in his left eye. Within 6 weeks visual acuity had dropped to counting fingers in the right eye and hand movements in the left eye. No ophthalmoscopic abnormalities were noted, findings from his neurological examination were normal except for well-controlled hypertension, and his medical history was unremarkable. He was a lifelong non-smoker, and for several years he had been drinking 48 to 96 fluid ounces of beer per day. Brain MRI was normal, and extensive investigation at the time had failed to identify an underlying cause for his visual loss. When we first examined him, visual acuities were unchanged; there was no afferent pupillary defect, but bilateral optic disc pallor and large central scotomas were evident. On closer questioning, he gave a clear family history of five other affected family members having experienced poor vision in their 20s to 40s, and some of them were registered as blind with social services. This prompted mitochondrial genetic analysis, which identified a G3460A primary LHON mutation. He was homoplasmic for the mutation, belonged to the mtDNA haplogroup H, and genotyping revealed the DXS8090(160)-DXS1068(256) X-chromosomal haplotype at the Xp21.1 locus. This man is one of the oldest reported individuals to have LHON. More than 95% of carriers become affected by age 50 (1-3). What are the possible precipitants of visual loss in these late cases? The predominance of affected males has been linked to an X-linked nuclear modifier gene and we have recently identified a high-risk haplotype at Xp21.1, DXS8090(166)-DXS1068(268), which increases the risk of visual failure 35-fold for the G11778A and T14484C LHON mutations but not for G3460A (4). Our patient did not harbor this visual loss susceptibility haplotype, but he did have a high alcohol intake. Although it is tempting to link this in some way, there are conflicting data regarding the strength of the association between excessive alcohol consumption and a higher risk of developing visual symptoms in LHON (5,6). Furthermore, there is no suggestion that he had been exposed to other exogenous toxins that have previously been reported to precipitate visual loss among LHON carriers (2,3). The secondary factors influencing disease expression in LHON still need to be clarified and our patient highlights the difficulties of genetic counseling in this condition. Patrick Yu-Wai-Man, MRCOphth Department of Ophthalmology, Royal Victoria Infirmary, Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom, [email protected] David E. Bateman, FRCP Department of Neurology, Cumberland Infirmary, Carlisle, United Kingdom Gavin Hudson, PhD Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom Philip G. Griffiths, FRCOphth Department of Ophthalmology, Royal Victoria Infirmary, Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom Patrick F Chinnery, FRCP Mitochondrial Research Group, The Medical School, Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, United Kingdom

International Society of Sports Nutrition position stand: Nutrient timing

Position Statement: The position of the Society regarding nutrient timing and the intake of carbohydrates, proteins, and fats in reference to healthy, exercising individuals is summarized by the following eight points: 1.) Maximal endogenous glycogen stores are best promoted by following a high-glycemic, high-carbohydrate (CHO) diet (600 – 1000 grams CHO or ~8 – 10 g CHO/kg/d), and ingestion of free amino acids and protein (PRO) alone or in combination with CHO before resistance exercise can maximally stimulate protein synthesis. 2.) During exercise, CHO should be consumed at a rate of 30 – 60 grams of CHO/hour in a 6 – 8% CHO solution (8 – 16 fluid ounces) every 10 – 15 minutes. Adding PRO to create a CHO:PRO ratio of 3 – 4:1 may increase endurance performance and maximally promotes glycogen re-synthesis during acute and subsequent bouts of endurance exercise. 3.) Ingesting CHO alone or in combination with PRO during resistance exercise increases muscle glycogen, offsets muscle damage, and facilitates greater training adaptations after either acute or prolonged periods of supplementation with resistance training. 4.) Post-exercise (within 30 minutes) consumption of CHO at high dosages (8 – 10 g CHO/kg/day) have been shown to stimulate muscle glycogen re-synthesis, while adding PRO (0.2 g – 0.5 g PRO/kg/day) to CHO at a ratio of 3 – 4:1 (CHO: PRO) may further enhance glycogen re-synthesis. 5.) Post-exercise ingestion (immediately to 3 h post) of amino acids, primarily essential amino acids, has been shown to stimulate robust increases in muscle protein synthesis, while the addition of CHO may stimulate even greater levels of protein synthesis. Additionally, pre-exercise consumption of a CHO + PRO supplement may result in peak levels of protein synthesis. 6.) During consistent, prolonged resistance training, post-exercise consumption of varying doses of CHO + PRO supplements in varying dosages have been shown to stimulate improvements in strength and body composition when compared to control or placebo conditions. 7.) The addition of creatine (Cr) (0.1 g Cr/kg/day) to a CHO + PRO supplement may facilitate even greater adaptations to resistance training. 8.) Nutrient timing incorporates the use of methodical planning and eating of whole foods, nutrients extracted from food, and other sources. The timing of the energy intake and the ratio of certain ingested macronutrients are likely the attributes which allow for enhanced recovery and tissue repair following high-volume exercise, augmented muscle protein synthesis, and improved mood states when compared with unplanned or traditional strategies of nutrient intake.

Concentrations of 17β-Estradiol in Holstein Whole Milk

Some individuals have expressed concern about estrogens in food because of their potential to promote growth of estrogen-sensitive human cancer cells. Researchers have reported concentrations of estrogen in milk but few whole milk samples have been analyzed. Because estrogen associates with the fat phase of milk, the analysis of whole milk is an important consideration. The objectives of this study, therefore, were to quantify 17β-estradiol (E2) in whole milk from dairy cows and to determine whether E2 concentrations in milk from cows in the second half of pregnancy were greater than that in milk from cows in the first half of pregnancy or in nonpregnant cows. Milk samples and weights were collected during a single morning milking from 206 Holstein cows. Triplicate samples were collected and 2 samples were analyzed for fat, protein, lactose, and somatic cell counts (SCC); 1 sample was homogenized and analyzed for E2. The homogenized whole milk (3mL) was extracted twice with ethyl acetate and once with methanol. The extract was reconstituted in benzene:methanol (9:1, vol/vol) and run over a Sephadex LH-20 column to separate E2 from cholesterol and estrone before quantification using radioimmunoassay. Cows were classified as not pregnant (NP, n=138), early pregnant (EP, 1 to 140 d pregnant, n=47), or midpregnant (MP, 141 to 210 d pregnant, n=21) at the time of milk sampling based on herd health records. Mean E2 concentration in whole milk was 1.4±0.2 pg/mL and ranged from nondetectable to 22.9 pg/mL. Milk E2 concentrations averaged 1.3, 0.9, and 3.0 pg/mL for NP, EP, and MP cows, respectively. Milk E2 concentrations for MP cows were greater and differed from those of NP and EP cows. Milk composition was normal for a Holstein herd in that log SCC values and percentages of fat, protein, and lactose averaged 4.9, 3.5, 3.1, and 4.8, respectively. Estradiol concentration was significantly correlated (r=0.20) with percentage fat in milk. Mean milk yield was 18.9±0.6kg for the morning milking. The mean E2 mass accumulated in the morning milk was 23.2±3.4 ng/cow. Likewise, using the overall mean concentration for E2 in milk, the mean E2 mass in 237mL (8 fluid ounces) of raw whole milk was 330 pg. The quantity of E2 in whole milk, therefore, is low and is unlikely to pose a health risk for humans.

Nursing Home Staff Delivery of Oral Liquid Nutritional Supplements to Residents at Risk for Unintentional Weight Loss

To describe nursing home (NH) staff delivery of oral liquid nutritional supplements to residents with an order to receive supplementation. Descriptive. Six skilled NHs. One hundred thirty-two long-stay residents. Research staff conducted direct observations for 2 days during and between meals and documented NH staff delivery of supplements, amount consumed (fluid ounces), and amount of assistance (minutes) provided by staff to encourage consumption. Eighty-eight percent had an order to receive a supplement one to three times daily (mode = 3); 12% had an order to receive a supplement four to six times daily. Fewer than 10% received the supplement consistent with their orders during the 2 observation days. On average, NH staff provided a supplement less than once per participant per day during or between meals. When a supplement was provided, residents consumed an average+/-standard deviation of 4.91+/-2.19 fluid ounces during meals with 6.16+/-7.46 minutes of staff assistance and 3.98+/-2.60 fluid ounces between meals with less than 1 minute of staff assistance. Participants with orders that specified time of delivery received the supplement at a significantly higher frequency between meals. Oral liquid nutritional supplements are not provided consistent with orders in NH practice. Staff spends little time promoting supplement consumption during or between meals. The specificity of the order related to time of delivery may influence when and how often supplements are provided to residents.

It's Time to Throw Out Old-Fashioned Latin Abbreviations

It's Time to Throw Out Old-Fashioned Latin Abbreviations

Human Exposure to Mosquito-Control Pesticides—Mississippi, North Carolina, and Virginia, 2002 and 2003

Public health officials weigh the risk for mosquito-borne diseases against the risk for human exposure to pesticides sprayed to control mosquitoes. Response to outbreaks of mosquito-borne diseases has focused on vector control through habitat reduction and application of pesticides that kill mosquito larvae. However, in certain situations, public health officials control adult mosquito populations by spraying ultra-low volume (ULV) (<3 fluid ounces per acre [oz/acre]) mosquito-control (MC) pesticides, such as naled, permethrin, and d-phenothrin. These ULV applications generate aerosols of fine droplets of pesticides that stay aloft and kill mosquitoes on contact while minimizing the risk for exposure to persons, wildlife, and the environment. This report summarizes the results of studies in Mississippi, North Carolina, and Virginia that assessed human exposure to ULV naled, permethrin, and d-phenothrin used in emergency, large-scale MC activities. The findings indicated ULV application in MC activities did not result in substantial pesticide exposure to humans; however, public health interventions should focus on the reduction of home and workplace exposure to pesticides.

Using hierarchical soft computing method to discriminate microcyte anemia

Anemia is the most common hematological disorder. The complete blood count (CBC) is used to identify anemia and others disorder relative to hematology. However, discriminating both of iron deficiency anemias (IDA) and thalassemia (THA) depend on the mean cell volume (MCV) less than 80fL (fluid ounces) that is imprecision and uncertain. Recently, more literatures applied soft computing methods to solved problem of classification under imprecision and uncertainty. This paper proposes a new approach which derived from soft computing, and rule-based, namely, hierarchical soft computing (HSC). HSC is fitting for discriminating microcyte anemia, which evaluated the performance of microcyte anemia diagnosis after ANFIS pruning rule found: (1) The 96% accuracy is inferred by ANFIS with 50 patterns, that is more accurate than traditional experience. (2) Both sensitivity (90.1%) and specificity (95.8%) are higher than discriminant function which has only higher either sensitivity or specificity. (3) The area under receiver operating characteristics curve (AUC) is 0.954 means that the accuracy is 95.4% when inference value is revised to 13.6. The HSC has been improved the performance of discriminant function to discriminate microcyte.

Body weight status, dietary habits, and physical activity levels of middle school-aged children in rural Mississippi.

Obesity and cardiovascular diseases are more prevalent in the Southeast as compared with other geographic regions of the United States. However, few investigations have addressed health disparities among children in rural Southeastern areas. The purpose of this investigation was to determine the risk of overweight and obesity in middle school-aged children residing in a racially diverse rural community, and to characterize their dietary and physical activity habits. Two hundred and five middle school children from Scott County, Mississippi were enrolled in this investigation. Measurements included height, weight, body mass index, dietary intake using a 24-hour recall, and physical activity level using pedometers. Of the 205 children studied, 54% were "overweight" or "at risk for overweight" according to a body mass index-for-age sex-specific percentile. Intake of saturated fat and sodium exceeded recommended levels, whereas intake of calcium, fruits, and vegetables was inadequate. One third of the sample consumed 12 fluid ounces or more of soda on the day of the recall. Physical activity level was below that previously reported for children in this age range, and knowledge of the importance of diet and physical activity in the prevention of cardiovascular disease was poor, particularly among African-American children. The children in our sample are at increased risk for overweight and obesity. Factors that may be targeted for intervention include a reduction in dietary intake of fat, saturated fat, sodium, and soft drinks, and an increased intake of fruits and vegetables. Physical activity should be encouraged. Many of these factors could be improved through changes within the school environment.

Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect.

Moderate to heavy levels of prenatal alcohol exposure have been associated with alterations in child behavior, but limited data are available on adverse effects after low levels of exposure. The objective of this study was to evaluate the dose-response effect of prenatal alcohol exposure for adverse child behavior outcomes at 6 to 7 years of age. Beginning in 1986, women attending the urban university-based maternity clinic were routinely screened at their first prenatal visit for alcohol and drug use by trained research assistants from the Fetal Alcohol Research Center. All women reporting alcohol consumption at conception of at least 0.5 oz absolute alcohol/day and a 5% random sample of lower level drinkers and abstainers were invited to participate to be able to identify the associations between alcohol intake and child development. Maternal alcohol, cigarette, and illicit drug use were prospectively assessed during pregnancy and postnatally. The independent variable in this study, prenatal alcohol exposure, was computed as the average absolute alcohol intake (oz) per day across pregnancy. At each prenatal visit, mothers were interviewed about alcohol use during the previous 2 weeks. Quantities and types of alcohol consumed were converted to fluid ounces of absolute alcohol and averaged across visits to generate a summary measure of alcohol exposure throughout pregnancy. Alcohol was initially used as a dichotomous variable comparing children with no prenatal alcohol exposure to children with any exposure. To evaluate the effects of different levels of exposure, the average absolute alcohol intake was relatively arbitrarily categorized into no, low (>0 but <0.3 fl oz of absolute alcohol/day), and moderate/heavy (>/=0.3 fl oz of absolute alcohol/day) for the purpose of this study. Six years later, 665 families were contacted. Ninety-four percent agreed to testing. Exclusions included children who missed multiple test appointments, had major congenital malformations (other than fetal alcohol syndrome), possessed an IQ >2 standard deviations from the sample mean, or had incomplete data. The Achenbach Child Behavior Checklist (CBCL) was used to assess child behavior. The CBCL is a parent questionnaire applicable to children ages 4 to 16 years. It is widely used in the clinical assessment of children's behavior problems and has been extensively used in research. Eight syndrome scales are further grouped into Externalizing or undercontrolled (Aggressive and Delinquent) behavior and Internalizing or overcontrolled (Anxious/Depressed, Somatic Complaints, and Withdrawn) behaviors. Three syndromes (Social, Thought, and Attention Problems) fit neither group. Higher scores are associated with more problem behaviors. Research assistants who were trained and blinded to exposure status independently interviewed the child and caretaker. Data were collected on a broad range of control variables known to influence childhood behavior and/or to be associated with prenatal alcohol exposure. These included perinatal factors of maternal age, education, cigarette, cocaine, and other substances of abuse and the gestational age of the baby. Postnatal factors studied included maternal psychopathology, continuing alcohol and drug use, family structure, socioeconomic status, children's whole blood lead level, and exposure to violence. Data were collected only from black women as there was inadequate representation of other racial groups. Statistical analyses were performed using the SPSS statistical package. Frequency distribution, cross-tabulation, odds ratio, and chi(2) tests were used for analyzing categorical data. Continuous data were analyzed using t tests, analyses of variance (ANOVAs) with posthoc tests, and regression analysis. Testing was available for 501 parent-children dyads. Almost one fourth of the women denied alcohol use during pregnancy. Low levels of alcohol use were reported in 63.8% and moderate/heavy use in 13% of pregnancies. Increasing prenatal alcohol exposure was associated with lower birth weight and gestational age, higher lead levels, higher maternal age, and lower education level, prenatal exposure to cocaine and smoking, custody changes, lower socioeconomic status, and paternal drinking and drug use at the time of pregnancy. Children with any prenatal alcohol exposure were more likely to have higher CBCL scores on Externalizing (Aggressive and Delinquent) and Internalizing (Anxious/Depressed and Withdrawn) syndrome scales and the Total Problem Score. The odds ratio of scoring in the clinical range for Delinquent behavior was 3.2 (1.3-7.6) in children with any prenatal exposure to alcohol compared with nonexposed controls. The threshold dose was evaluated with the 3 prenatal alcohol exposure groups. One-way ANOVA revealed a significant between group difference for Externalizing (Aggressive and Delinquent) and the Total Problem Score. (ABSTRACT TRUNCATED)

An alternative to standard drinks as a measure of alcohol consumption.

Despite the field's longstanding concern with underreporting of alcohol consumption, traditional survey questions encourage error because respondents often must calculate their number of drinks based on standard drink sizes that often do not match their own drinking style. This study considered how often respondents' self-defined drink sizes matched a 'standard' drink size based on approximately 12 g of ethanol for six different beverages. We also studied whether respondents could accurately judge the size of their drinks. Subjects were recruited and interviewed at urban prenatal clinics, health clinics, and via snowball referrals and community outreach in Los Angeles and the San Francisco Bay Area. Because of the urgency of accurate measurement of consumption during pregnancy, urban pregnant women from the groups most at risk for Fetal Alcohol Syndrome, Native Americans (n = 102) and African Americans (185), were targeted. A small comparison group of urban pregnant white women (n = 34) was included. One-hour in-person interviews were conducted. Self-defined drink sizes were determined for each beverage consumed, using models and photographs of vessels. Frequent drinkers and the majority of women who reported drinking higher alcohol content beverages reported drinking larger-than-standard drink sizes. The median size of a malt liquor drink among the daily drinkers was almost three times as large as the standard, their fortified wine drinks were four times the standard, and their spirits drinks were six times the standard size. The majority of drinkers of each beverage were unable to accurately judge the size of their drinks, underestimating the number of fluid ounces by about 30%. Although the vessels methodology used here must be refined and tested further on other populations (e.g., men, nonpregnant women, and all ethnic groups), results suggest that determination of risk levels should be based on survey data that takes into consideration the beverage mix and the actual size of respondents' alcohol drinks.

The Effect of Alcohol on Blood Pressure

The pathogenesis of hypertension, a major risk factor for cardiovascular disease, is multifactorial. Alcohol consumption has been identified as one important modulator of blood pressure; many epidemiological, clinical, and interventional studies have shown a linear relationship between alcohol intake and blood pressure. These studies have also found that the absolute amount of alcohol consumed is more significant than the beverage type; recent alcohol intake is more influential than past alcohol intake; the hypertensive effect of alcohol is more pronounced in frequent drinkers and in females; and upon cessation or reduction of alcohol intake, blood pressure declines. Many different mechanisms, including alcohol's effects on the central nervous system and the vessel wall, may be responsible; however, a single mechanism has yet to be identified. Any patient with resistant hypertension without secondary hypertension should reduce alcohol intake as a nonpharmacological strategy to lower blood pressure. Daily consumption should be avoided and the upper limit of alcohol intake in one day should be 20 g (0.7 fluid ounce) for women and 30 g (1 fluid ounce) for men. Whenever possible, alcohol should be consumed with food.

Infant acceptance and effectiveness of a new oral liquid medication delivery system.

A medication acceptance scale (MAS) for pediatric oral liquids was developed and used to evaluate effectiveness and infant acceptance of a medication delivery system. The MAS incorporated five behavioral elements associated with pediatric drug administration: cry, facial expression, body movement or level of agitation, reaction to placement of medication in the mouth, and swallowing. A score of 1-10 was possible, with 10 indicating the highest level of infant acceptance. Preliminary field testing was conducted. In an open-label clinical study, a single dose of acetaminophen was administered to 20 infants with approximately one fluid ounce of infant formula or apple juice by pediatric nurses using the Rx medibottle (The Medicine Bottle Company). Past medication acceptance was rated on an infant global acceptance scale. The intended dose, the amount consumed, and the time taken to administer the dose were recorded. Infant acceptance was independently scored by a nurse and two pharmacists. A high preliminary estimate of internal consistency reliability of the MAS was found. Interrater reliability was high, with the highest correlation between the two pharmacists. Sixteen (80%) of the infants received 100% of the intended dose; it took 0.5-9 minutes to administer these doses. The median MAS score was 9 for each of the three raters. Mean MAS scores for the three raters were 7.85 and 7.45 (pharmacists) and 8.50 (nurse). There was a strong correlation between MAS scores and infant global acceptance scale scores. A pediatric oral liquid MAS that had content validity, concurrent validity, high internal consistency reliability, and high interrater reliability was developed; the Rx medibottle was an effective oral liquid medication delivery system and had a high level of infant and rater acceptance.

Absorption of Dietary and Supplemental Folate in Women with Prior Pregnancies with Neural Tube Defects and Controls

Background: The Public Health Service of the United States recommends that all women capable of childbearing consume .4 mg (400 μg) folic acid per day to decrease the risk of having a pregnancy affected by a neural tube defect such as spina bifida or anencephaly. Three strategies are available to women to achieve this goal: use of dietary supplements; use of fortified foods; and/or increased intake of naturally occurring folate from foods. Identification of the most effective vehicle for delivery of folate to all women is critical in order to prevent these devastating congenital defects.Objective: To investigate the difference in response to an oral load of folate both from naturally occurring food sources and synthetic supplements among women with prior pregnancies affected by neural tube defects and controls.Methods: We compared the absorption of test doses of 400 μg pteroylglutamic acid (unconjugated or synthetic folic acid found in supplements) and 400 μg pteroylpolyglutamic acid (conjugated or food folate) in 10 women with a history of neural tube defect affected pregnancies and eight controls with normal birth outcomes. The folate test dose was given as either 32 fluid ounces of orange juice or a folic acid single supplement pill. All participants received each test dose at separate clinic visits. The response to each test dose was measured by constructing an area under the curve (AUC) from the serum folate levels at 1, 2 and 3 hours post dose and applying a t-test to compare within and between cases and controls. We also compared red cell folate, vitamin B12, zinc and homocysteine between cases and controls.Results: Within group comparisons showed that the area under the curve was significantly greater for the pteroylglutamic acid dose compared to the pteroylpolyglutamic acid dose for both cases and controls (p=0.02 and p=0.03, respectively). In a between group comparison, control women had a greater serum folate response to both forms of the vitamin compared to the case women, but the difference reached statistical significance only for the pteroylglutamic acid dose (p=0.02). Other measured nutrients differed between cases and controls, but did not reach statistical significance.Conclusion: We conclude that for all women synthetic folic acid as supplements or fortified foods may be the best way to increase acute folate levels in the blood, and thus delivery to the developing embryo. Further, since case women had a diminished response to both forms of the vitamin, and some case women had almost no response, we speculate that women with prior affected pregnancies may need a larger dose of folate to elicit a plasma response equivalent to the general population.

Alcohol Use and Pregnancy: Improving Identification

Objective: To test the effectiveness of a four-item prenatal-alcohol-use, self-administered screening questionnaire that asks about tolerance to alcohol, being annoyed by other’s comments about drinking, attempts to cut down, and having a drink first thing in the morning (“eye-opener”) (T-ACE) in an ethnically and socioeconomically diverse sample. Methods: Two hundred fifty T-ACE–positive and 100 T-ACE–negative women completed a comprehensive assessment of their alcohol use after initiating prenatal care at the Brigham and Women’s Hospital in Boston, Massachusetts. This comprehensive assessment, which included the Alcohol Use Disorders Identification Test and the Short Michigan Alcoholism Screening Test as comparisons to the T-ACE, generated three criterion standards: Diagnostic and Statistical Manual of Mental Disorders, Third Ed., Revised (DSM-III-R), lifetime alcohol diagnoses, risk drinking (regularly having more than one fluid ounce of alcohol per drinking day before pregnancy), and current drinking. Results: T-ACE–positive pregnant women were more likely than T-ACE–negative women to satisfy DSM-III-R criteria for lifetime alcohol diagnoses (40% versus 14%, P < .001) and risk drinking (39% versus 8%, P < .001) and to have current alcohol consumption (43% versus 13%, P < .001). In contrast, obstetric staff members documented only 33 (9%) women as using alcohol at any time, even though nearly all subjects (96%) were asked about drinking upon initiation of prenatal care. Conclusion: The T-ACE was the most sensitive screen for lifetime alcohol diagnoses, risk drinking, and current alcohol consumption. It outperformed obstetric staff assessment of any alcohol use by pregnant women enrolled in the study.

A seven year follow-up of treating rumination with dietary satiation

”Fred“, a man with profound mental retardation who was 24 years old at the beginning of this study, was referred for treatment of rumination. A number of minimally restrictive interventions, including administration of Zantac, extra fluids, and delivery of peanut butter after meals, had been used without success. In April of 1989 Fred began a satiation diet with ad libitum access to starchy foods or to fruits and vegetables, in addition to his regular meals. His baseline weight was 82 pounds and he ruminated during 58% of 10 s intervals measured during 20 min post-meal observations. During the first month of the satiation diet, Fred's ruminating declined to 6% of measured intervals, he consumed a mean of 163 fluid ounces of extra food per day, and his weight increased to 90 pounds. After 4 months' treatment, Fred's ruminating had declined to zero, his food consumption had stabilized at approximately 65 extra ounces of food per day, and his weight had stabilized at about 120 pounds. Starting in August 1990, in an effort to minimize weight gain, extra food was limited to 50% of Fred's ad libitum food consumption (averaged over the previous 6 weeks). Fred's weight gradually declined to about 100 pounds with zero rumination over the next two years. In August 1992 Fred's ruminating accelerated to 17% of intervals and he was again offered ad libitum food access. Over the next 7 months, rumination declined to zero and his weight increased slightly to about 105 pounds. This study shows that rumination that had not responded to less restrictive procedures was suppressed for 7 years via dietary satiation. Although dietary satiation is not without some risk, Fred has suffered no adverse effects from the procedure, other than gaining approximately one-third of his baseline weight. © 1997 John Wiley & Sons, Ltd.

Effect of Labels on Risk Perceptions of Consumer Products

Previous studies have shown many individuals do not know the meanings of terms often used as stand-alone descriptions of hazards. Leonard and Digby (1992) found subjects rated the danger associated with different products very differently despite being given the same hazard description. One possibility for the differences in ratings is that substances are experienced in very different quantities. While gasoline is usually seen in multigallon amounts, fingernail polish remover is seen in quantities of a few fluid ounces. An alternative explanation is that people's experiences (direct or vicarious) with the substances have given them different concepts of the characteristics of the substances. This study examined these alternatives by asking 88 subjects to rate the risk of a dangerous event occurring with the same specific quantity of each substance. Mean ratings over all subgroups indicated that they perceived less risk from certain substances than from others, although the substances are equally dangerous. Evidence for an experiential component of risk assessment was provided by differences between older and younger subjects on specific items. The importance of presenting information about the consequences of hazards in warnings was discussed.