What is the HACCP (hazard analysis critical control point) approach and how can it be applied to enteral tube feeding?

The HACCP (hazard analysis critical control point) concept is now widely applied in the food industry and provides a structured and critical approach to the identification and control of hazards that may affect food safety. It has shifted the emphasis for control from retrospective end-product testing to the effective control of raw materials and key processing operations.
This paper discusses how the HACCP approach can be applied to enteral feeding. This involves each unit assembling a multidisciplinary team of personnel involved in enteral feeding. This team will then carry out a detailed analysis of the process from selection of ingredients and feeding systems through to consumption of the feed by the patient by constructing a flow chart that relates specifically to each unit. They can then identify and assess the hazards associated with the handling of the product at each stage in the process. This will enable them to identify the points where control over an identified hazard can be achieved (critical control points, CCP) such as quality of ingredients, design of administration systems, preparation and distribution of the feeds and the procedures involved in the assembly and manipulation of the systems. Control and monitoring procedures can then be specified and implemented at relevant stages in the process. The major strengths of the HACCP procedure are that it entails a team effort from key personnel involved in the full range of activities associated with the product and each detailed analysis is specific to each unit's practices and resources and can be continually reviewed and modified in response to changing circumstances.     

Evaluation of variable line-shape models and prior information in automated 1H spectroscopic imaging analysis.

Analysis of in vivo short TE 1H spectra is complicated by broad baseline signal contributions and resonance line-shape distortions. Although the assumptions of ideal metabolite resonance line-shapes and slowly varying baseline signals can be used to separate these signals, the presence of broad or asymmetric line-shapes can invalidate this model. More complex line-shape models are computationally expensive or difficult to constrain, particularly for the low signal-to-noise commonly found for in vivo MR spectroscopic imaging applications. In this study, two time-domain models for fitting variable spectral line-shapes are examined, one using B-splines and another using summed sinusoids. The methods were verified using both phantom and human data, and Monte Carlo simulations were used to evaluate variations in calculated metabolite amplitudes due to interactions between the baseline and line-shape estimations. Additional studies investigated the use of prior line-shape information, obtained from either a water MRSI measurement or calculations from B(0) maps, to determine parameter starting values or optimization constraints. Both line-shape models showed the ability to fit the variety of line-shapes present in both the phantom and human MRSI data, with similar or improved accuracy over a Gaussian line-shape model; however, this improvement resulted in only minor improvement for the high-SNR phantom data and moderate improvements in regions with asymmetry for the fitted in vivo metabolite images. The use of prior line-shape information was of most benefit when applied toward setting optimization constraints but was of limited benefit when used to define initial starting values.     

一种新的正交参数选优法及其在非线性回归分析中的应用

非线性回归分析是工程中经常采用的一种用来估计数学模型参数的方法，该方法能否顺利运用与参数初始值的选择有极大关系。本研究提出一种新的正交参数选优法——阻尼正交表法，它不仅可以保证非线性回归分析算法的顺利收敛，而且能够显著提高后者的收敛速度，进而极大改善非线性回归分析算法的应用性能。本研究的数值试验及心肌造影超声心动图定量分析应用实例表明，作为对传统正交参数选优法的一种改进，阻尼正交表法在科学与工程计算或信号与信息处理领域有着很好的应用前景。     

Lithium increases slow wave sleep: possible mediation by brain 5-HT2 receptors?

The effect of lithium on slow wave sleep (SWS) was studied in ten normal male volunteers using home based cassette sleep recording and automatic sleep stage analysis. Lithium increased SWS, an effect consisten with a reduction in brain 5-HT₂ receptor function.     

Predicting the experience of dentinal caries or restorative dental treatment in adolescents using D1 and D3 visual caries assessments

Standardised epidemiological caries assessments used in oral health surveys have been shown to be poor at predicting whether a tooth surface will be treated restoratively when a patient visits a dentist. However, it has been argued that oral health surveys may be more relevant in determining needs at the level of an individual or groups of individuals. The objective of this study was to determine the discriminatory power of visual caries assessments at two thresholds (D₁ & D₃) in adolescents of average age 12.1 years to predict experience of dentinal caries 3 years later or the experience of restorative treatment (not re‐treatment) during the 3‐year period. The data was derived from a prospective 3‐year longitudinal study in which the dental care provided by 41 dentists for 403 adolescents was monitored. Dental caries experience was monitored by annual standardised assessments of caries undertaken by a single trained examiner. ROC analysis showed that caries assessed visually at the D₁ threshold in 12‐year‐olds was a better predictor (P < 0.001) of experiencing some dentinal caries after 3 years (Az = 0.781) than was caries assessed visually at D₃ threshold in 12‐year‐olds (Az = 0.670). Assessing caries visually at either the D₁ or the D₃ threshold had no discriminatory power for predicting whether an individual would experience some restorative treatment during the ensuing 3‐year period (Az for D₁ = 0.507; Az for D₃ = 0.518).     

Application of median-effect in quantitative analysis of antitumor drugs in vitro

Objective: To analyze quantitatively the synergistic and antagonistic effects of combined oxymatrine (OMT) and 5-fluorouracil (5-GU) on a cell line of human liver cancer (HepG2) with median-effect principle in vitro. Methods: The median-effect principle and MTT method were used in the quantitative analysis of effects of the two drugs. Results: Cytotoxic activity of the individual drugs enhanced as drug concentration increased. As fa=0.41, a CI equal to 1 indicated additivity; fa<0.41, a CI less than 1 indicated synergy; and fa>0.41, a CI greater than 1 indicated antagonism. The sequence of administration did not influence the cytotoxic activity of the combined antitumor drugs. The ratio of drug concentration was a factor that can influence the killing effect. Conclusion: The combined drugs interaction (CI<1) was synergistic at lower concentration and antagonistic at higher concentration. The ratio of drug concentration is a factor that can influence the killing effect. Biography: HE Song(1965–), male, doctor of medicine, associate professor, Chongqing Medical University, majors in gastroenterology.     

The relationship between maternal needs and priorities in a neonatal intensive care environment

AIM: The aim of this study was to investigate the nature and organization of maternal needs and priorities in a neonatal unit. BACKGROUND: The relationship between maternal needs and priorities appears to be an under studied area in neonatal nursing. METHODS: A quantitative survey was carried out based on 209 mothers with premature infants. Two self-assessment schedules were used: critical care maternal needs inventory (J. Leske, Heart and Lung 15, 27-42) and a ranking scale. The data were analysed with multivariate analysis. FINDINGS: Data analysis revealed clear priorities in maternal needs. In particular the need for accurate infant related information was a priority for 93% of the mothers. Good communication practices with professionals were also valued. The mothers displayed altruistic behaviour, and self-related needs took second place. It is proposed that maternal needs demonstrate a hierarchical organization. CONCLUSION: It is important for nurses to consider the individual needs of the mothers, simply because the satisfaction of these needs is essential for maternal well-being.     

药物的定量构效关系的方法学研究——改进的逐步回归算法

在定量的构效关系研究中,多重回归分析选人的参数,多是用穷举所有方程实现的。本文提出一种改进的逐步回归算法,计算实例表明,是个行之有效的方法。     

产后出血159例临床分析及护理

目的　探讨产后出血的原因与影响因素。方法　回顾分析收治的产后出血 15 9例 ,数据处理采用χ2 检验。结果　产后出血发生率 3.5 % ,产后 2小时内出血者 88.6 7% ,出血原因宫缩乏力为 6 6 .6 7% ,影响因素有手术产、流产史、分娩史、妊娠合并症及产程延长等 ,统计学处理P <0 .0 1。结论　重视产后出血的影响因素 ,正确评估出血量及产妇产后 2小时留置产房观察是产后出血早期诊断的关键 ,其预防重点在于早期发现并针对不同原因及时正确处理     

Alternative graphical representations of genotypes in a pedigree

Three representations of the conditional independences due toMendelian segregation of genes in a pedigree are proposed. Thecomputational costs of performing calculations using the techniqueof peeling with each of these representations is compared byconsidering the weights of triangulations of the graph producedby each representation.