From Efficacy Research to Large-Scale Impact on Undernutrition: The Role of Organizational Cultures

Undernutrition in low-income countries is receiving unprecedented attention at global and national levels due to the convergence of many forces, including strong evidence concerning its magnitude, consequences, and potential solutions and effective advocacy by many organizations. The translation of this attention into large-scale reductions in undernutrition at the country level requires the alignment and support of many organizations in the development and implementation of a coherent policy agenda for nutrition, including the strengthening of operational and strategic capacities and a supportive research agenda. However, many countries experience difficulties achieving such alignment. This article uses the concept of organizational culture to better understand some of the reasons for these difficulties. This concept is applied to the constellation of organizations that make up the “National Nutrition Network” in a given country and some of the individual organizations within that network, including academic institutions that conduct research on undernutrition. We illustrate this concept through a case study involving a middle-income country. We conclude that efforts to align organizations in support of coherent nutrition agendas should do the following: 1) make intentional and sustained efforts to foster common understanding, shared learning, and socialization of new members and other elements of a shared culture among partners; 2) seek a way to frame problems and solutions in a fashion that enables individual organizations to secure some of their particular interests by joining the effort; and 3) not only advocate on the importance of nutrition but also insist that high-level officials hold organizations accountable for aligning in support of common-interest solutions (through some elements of a common culture) that can be effective and appropriate in the national context. We further conclude that a culture change is needed within academic departments if the discipline of nutrition is to play a central role in translating the findings from efficacy trials into large-scale reductions in undernutrition.     

Effect of feeding-tube properties on residual volume measurements in tube-fed patients

BACKGROUND: The effect of feeding tube size and port configuration on the ability to measure gastric residual volume (GRV) is poorly understood. In addition, there is confusion about the need to measure GRVs during feedings into the small bowel. This study sought to (1) compare the volume of gastric contents obtained from small-diameter feeding tubes and large-diameter sump tubes concurrently positioned in the stomach and (2) describe the distribution of GRVs during small-bowel feedings. METHODS: For the first objective, GRV measurements were made from 10-Fr tubes (n = 645) and 14-Fr or 18-Fr sump tubes (n = 645) concurrently present in 62 critically ill patients. Sixty-milliliter syringes were used to measure GRVs from the 10-Fr tubes; the fluid was returned to the stomach and measurements were repeated from the large-diameter sump tubes. To address the second research objective, 890 GRV measurements were made from 14-Fr or 18-Fr gastric sump tubes (not connected to suction) in 75 critically ill patients who were receiving small-bowel feedings. RESULTS: When GRVs were >50 mL, a linear regression equation indicated that volumes obtained from the large-diameter sump tubes were about 1.5 times greater than those obtained from the small-diameter tubes concurrently present in the stomach, p < .001. Gastric volumes > or =100 mL were found in 11.6% of the 890 measurements made in patients receiving small-bowel feedings; volumes > or =150 mL were found in 5.4% of the measurements. CONCLUSIONS: The findings suggest that GRVs obtained from large-diameter sump tubes are about 1.5 times greater than those obtained from 10-Fr tubes. Large GRVs occur in at least 5% of patients receiving postpyloric feedings.     

Identification of new meningococcal serogroup B surface antigens through a systematic analysis of neisserial genomes

The difficulty of inducing an effective immune response against the Neisseria meningitidis serogroup B capsular polysaccharide has lead to the search for vaccines for this serogroup based on outer membrane proteins. The availability of the first meningococcal genome (MC58 strain) allowed the expansion of high-throughput methods to explore the protein profile displayed by N. meningitidis. By combining a pan-genome analysis with an extensive experimental validation to identify new potential vaccine candidates, genes coding for antigens likely to be exposed on the surface of the meningococcus were selected after a multistep comparative analysis of entire Neisseria genomes. Eleven novel putative ORF annotations were reported for serogroup B strain MC58. Furthermore, a total of 20 new predicted potential pan-neisserial vaccine candidates were produced as recombinant proteins and evaluated using immunological assays. Potential vaccine candidate coding genes were PCR-amplified from a panel of representative strains and their variability analyzed using maximum likelihood approaches for detecting positive selection. Finally, five proteins all capable of inducing a functional antibody response vs N. meningitidis strain CU385 were identified as new attractive vaccine candidates: NMB0606 a potential YajC orthologue, NMB0928 the neisserial NlpB (BamC), NMB0873 a LolB orthologue, NMB1163 a protein belonging to a curli-like assembly machinery, and NMB0938 (a neisserial specific antigen) with evidence of positive selection appreciated for NMB0928. The new set of vaccine candidates and the novel proposed functions will open a new wave of research in the search for the elusive neisserial vaccine.