World AIDS Day and how to science.

Part of learning “to science” is comparing popular media coverage of original research to the original research itself. This critical thinking exercise is extremely important, but hard to practice without a solid footing in research methods and how science is supposed to work. If you have a hobby-level interest in following science, consider taking one of those free online courses about research methods. It will help you to better understand new breakthroughs, controversial topics (eg. the vaccination debate), and government recommendations.

Inspired by a social media post by the Centers for Disease Control regarding news media spreading misinformation about their recently released data, in addition to World AIDS Day, here is one such paper I submitted in 2012. It has some interesting info on newer HIV research. Perhaps you will find it interesting, perhaps you won’t.  

Comparison of media to scientific data. Plus, bonus information on HIV/AIDS treatment breakthroughs.

Section 1: Media Article Summary

 Bardi, a writer for The University of California- San Francisco website, published an article detailing original research conducted at The University’s affiliate hospital, San Fransisco Veteran’s Memorial Hospital.  The article, titled Fighting Infections: Old Drug Reveals New Tricks and can be read on the University of California-San Fransisco website. The article opens with a short history on the use of interferon as a drug therapy. Interferon is useful in alleviating the symptoms of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)  (Bardi, 2012). It was, therefore, prescribed to HIV patients in the 1980s.  For the past 25 years, the reason interferon relieves HIV symptoms has remained a mystery. As a result, researchers stopped studying interferon as an antiretroviral and began researching other antiretroviral agents. These other antiretroviral agents have a mechanism of action that is clearly understood. However, due to a better understanding of immunobiology, researchers at the San Fransisco Affiliate Hospital have begun studying the mechanism of action for interferon again after two decades. A recent study addresses why in vivo interferon treatment is effective in relieving HIV symptoms.

The 2011 Pillai et al. study observed 20[mas1]  participants in the Swiss HIV Cohort Study. These participants treated both their HIV and diagnosed Hepatitis C (HCV) iinterferon. They were not taking any antiretroviral drugs to treat their HIV. This gave researchers a clear view of how interferon might affect HIV levels.

The study found that interferon increases the effectiveness of restriction factors. Restriction factors are a part of the immune system that act at[mas2]  an intrecellular level. Interferon is a hormone found naturally in host cells which aides in immune response. Antiviral doses of interferon have been shown to increase the effectiveness of the restriction factors APOBEC3[mas3]  and tetherine. APOBEC3 mutates virus particles. These mutations make it impossible for the virus to replicate in other host cells. Tetherine binds to virus particles while maintaining a bond with the host cell. This prevents the virus from invading new cells.

HIV produces two proteins that counter these restriction factors.  The protein, Vpu, acts against tetherin while another protein, Vif, fights APOBEC3. Despite the ability of HIV to fight restriction factors, doses of interferon used to treat HCV effectively lowered HIV levels in patients. This is a major first step in HIV treatment but is far from final.

Section 2:  Scientific Article Summary

             Pillai et al. in conjunction with the Swiss HIV Cohort study investigated why cytokine interferon-alpha (INF-α) is an effective antiviral in their 2011 study. This study was funded by The National Institute of Health and an American Recovery Act supplemental grant. Researchers gathered longitudinal data from a group of HIV/HCV infected participants.  The study plotted data of the HIV viral load in the participant’s blood plasma prior to, during, and post treatment. After analysis, researchers found that plasma viral levels dropped -0.921 log 10 copies/ml while the participant was taking INF-α. Plotting of shifts in CD4+ count showed no correlation between the drop in viral plasma load and a drop in CD4+. This is significant because it suggests that the drop in plasma viral load was probably due to increased restriction factors, rather than an immune response at a multicellular level.  This data is congruent with previous data, suggesting that INF-α prevents viremia, the passage of virus particles in to the blood stream. Prevention of viremia occurs at the cellular level due to restriction factors.

            Three restriction factors are present in the immune response to primate immunodeficiency viruses: apolipoprotein B mRNA editing enzyme, catalytic peptide 3 (APOBEC3), bone marrow stromal cell antigen 2 (BST-2/ tetherine), and Trim5α. In humans trim5α does not inhibit immunodeficiency viruses, however ,APOBEC3 has a profound effect. APOBEC3 protein induces a shift from cytosine to uracil during mRNA synthesis, causing the DNA to be replicated with adenine where guanine should be. This mutation prevents the virus from reproducing. Similarly, BST-2 is a transmembrane protein channel found on the lipid bilayer of cells. As the virons attempt to exit the cell, the BST-2 bonds to them while remaining bonded to the cell membrane, effectively trapping virus particles in the host cell. 

            The HIV evolved defenses to counteract these restriction factors. It uses 16-kDa viral protein U (Vpu) to counteract the BST-2 response. Vpu removes the BST-2 from the lipid bilayer. The decrease in BST-2 allows more virions to escape the host cell. HIV has also evolved a defense mechanism against APOBEC3. 23-kDa protein virion infectivity factor (Vif) destroys APOBEC3[mas4] .

Section 3: Critical Analysis

            The media article is written for leisure reading. It is a summary of a complicated research study.  Therefore, the audience for this article would include adults with an interest in health science. The majority of the audience probably does not have a vast knowledge of virology and immunology.  The media article effectively summarized the scientific article and can be used by an audience with limited scientific knowledge.

            Bardi did not make any claims beyond the original research; therefore, a novice reader could use this article to aid in the understanding of the original research. Or, since the article is quite accurate, a leisure reader can believe all the claims made in the media article, instead of having to consult the original research. Finally, the media article can be used to educate HIV/AIDS patients, in a quick and concise format, on a new treatment option.  

            The media article did not include information on the shortcomings of the study. For example, 20 participants is a very limited sample size.  Larger studies are generally more accurate. Also, an ideal study would examine how interferon works in patients who do not also have HVC. Without a discussion of the shortcomings of a study, the information can be misleading. Since this article is written for an audience without a vast scientific knowledge, it can be assumed that some of the readers may not know how to preform research These readers may not realize that 20 subjects is typically a pilot study and that more research should be done before any theories are created.   

Section 4: Applications

            Currently, there are few effective antivirals on the market. The antivirals we do have typically slightly decrease the duration and severity of the viral infection (CDC.Gov, 2012). A very important application for this data set is the development of a more effective antiviral. The mechanism of action for interferon can be applied to many other viruses.   A shorter duration of viral illness decreases the infectivity rate of the illness. Doctors and public health officials could use interferon to slow the spread of viral epidemics, including influenza. In an era where so many citizens are afraid to get vaccinated, public health officials will have to find other means of preventing disease transmission. Antivirals may be the key to supplementing the low vaccination rate.

While interferon cannot cure long-term viruses, like HIV,HCV, or herpes, it can drop the viral load to a low enough level that the patient no longer experience symptoms. Furthermore, a low viral load decreases the chances of spreading the virus. For example, if the blood viral load of HIV is low there is a decreased probability that the patient’s sexual partner will be exposed to the virus (Anema, Wood, & Montaner ,2008).

Public health officials can use interferon on both an epidemiological scale and a personal scale.  In the case of HIV and HCV, interferon can be used to decrease the rate of new infections. The ideal plan to decrease the infection rate would include three components: 1.education regarding HIV and HCV. 2.services for HIV and HCV infected individuals including needle exchanges and free condoms. 3 antiretroviral treatments capable of dropping the viral load below the rate that is high enough to spread the virus.

A drop in my viral load is associated with a decrease in symptoms. Therefore, interferon can be used to improve personal wellness by dropping the patient’s viral load. There are several antiretroviral treatments that drop the patient’s viral load already on the market. However, the HIV is constantly evolving defense mechanisms against antiretroviral treatments; therefore, we need a wide range of antiretroviral agents. Furthermore, the combination of several antiretroviral drugs is capable of decreasing the viral load further than if the patient uses only one drug at a time. Understanding how interferon works will make combining the drug with other drugs safer.  The addition of interferon to our arsenal of antiretroviral drugs is a public health break through.

Of course, all of these applications are only viable with more research on interferon. The Pillia et al. study was a great pilot study. Perhaps, with further study the researchers will find a way to combine interferon with a drug that inhibits Vpu and Vif. This combination would further increase the effectiveness of the restriction factors, APOBEC3 and BST-2. I am optimistic for the future of interferon.

Fraudlent Claims made by Dr. Oz and Marketers of Garcinia Cambogia Supplements: An Exercise in the Scientific Method

Plenty of people admire Dr.Oz. He’s charismatic, entertaining, and a damn good transplant surgeon at a very respectable hospital. His face graces magazine covers and millions of people watch him on TV every day. What most people don’t know is that he’s actually very greedy and unethical. He uses his prestige to sell under researched products for weight loss. What’s worse is that he makes false medical claims regarding the efficacy of these products.

Many of us are unhappy with our body composition, and the idea of taking a pill to become thin is extremely alluring. We are bombarded with ads for supplements that are regarded as miracle plants. We are duped in to thinking that these supplements will make us thin without any work on our part. We mistakenly believe that these products are safe because they are natural. Indeed, the FDA classifies supplements as foods. But, this does not guarantee safety or efficacy. In fact, these compounds are not considered drugs because there has much research in to whether or not they will kill us. Drugs are rigorously tested for safety and efficacy. This process is extremely expensive for companies, so supplement distributors forgo applying to be designated as a drug. Furthermore, drugs must be prescription for a period of time. This is a safety net for compounds that don’t have much research. Doctors can monitor how their patient’s bodies respond to the compound and provide intervention before too much damage occurs. Doctors may also chose not to prescribe a drug to a patient if their case does not warrant the use. Distributors of these shady supplements would prefer to directly market and sell products to the public.

I am not saying the supplements are inherently evil. I take calcium, folate, and melatonin on a regular basis. Some supplements are not drugs because they cannot be patented, so no companies want to invest the money and time in to research and development. Most supplements are harmless, and may actually do some really great things. I’m also not saying that drug companies are benevolent gods. They do awful things as well (eg. direct marketing, falsifying of data, and price gouging). And the compounds classified as drugs have done far more damage than most supplements. I’m just attempting to point out that certain supplement companies are acting unethically in order to get your hard earned money.

I did a little research on GC after seeing a slew of Facebook pages designed to sell this supplement. These pages had normal sounding titles like “I love Yoga” or “Fitness Club”, however they were run by the supplement company. They were designed to trick consumers in to believing that other consumers were writing positive reviews of a specific GC product. In reality, a marketing professional employed by the company was generating fake countless fake Facebook accounts and writing all of the reviews. I researched the claims found in these pages and on the company’s website. Here are my findings: 

Citing Claims/ Fraudenlent Claims:
The author claimed to have "poured through mountains research", but did not care to share any of her sources. I actually did a little meta-analysis on the current data. Here is a link to an article in The Journal of the American Medical association: http://goo.gl/M08b8. The conclusion section in the abstract is one line long and reads: "Garcinia cambogia failed to produce significant weight loss and fat mass loss beyond that observed with placebo (Hemysfeild et al.,1998)."

Of course that was just one study. Another study found in the journal "Phytotherapy Research" found that GC demonstrates lipid lowering activity in lab rats (Koshy et al.,2001). http://goo.gl/kjcmu

A more recent study from 2011, can be cited as saying, "To date, there is little clinical evidence to support [weight loss supplement, including GC] use. More data is necessary to determine the efficacy and safety of these supplements. Healthcare providers should assist patients in weighing the risks and benefits of dietary supplement use for weight loss(Egras et al., 2011)." http://goo.gl/o0OKa

I did find a 2011 study that substantiates GC claims using a biochemical approach. This study is cited as saying, "Clerodendron glandulosum.Coleb extract prevents adipocyte differentiation and visceral adiposity by down regulation of PPARγ-2 related genes and Lep expression thus validating its traditional therapeutic use in controlling obesity(Jadja et al., 2011)"

I found two articles in Lipids in Health and Disease, the journal cited by the manufacturer as claiming "subjects taking Miracle Garcinia Cambogia lost an average of 19.3 pounds in 28 days without diet or exercise(Prima Lite Nutrition).  
The first study addressed the role high fat diets with relation to brain oxidative stress and metabolic disturbances. CG was investigated as an antiobesity agent. This study, which utilized lab rats, found that CG was effective in lowering blood cholesterol, and in weight management (Amin et al., 2011). Though it made no mention of a 19.83 pound fat loss in 28 days. The authors describe this data as novel, meaning far more data is needed to fully substantiate claims.http://goo.gl/Mkf4H

The second study addressed renal oxidative stress from high fat, high sugar diets. The study's findings concurred with the previous study. Again, this data is described as novel and took place on lab rats(Amin et al., 2011). Still no mention of 19.3 pounds in 28 days. http://goo.gl/CUWMv

Finally, I found a study that evaluated the safety of GC. This study can be cited as saying, "[Clinical studies on GC] support its safety demonstrating a wide margin of safety for human consumption. Recent animal and clinical toxicology studies have shown that G. cambogia/HCA is generally safe and is classified as NOAEL up to 1240 mg/kg/day(Chaun et al.,2011)" However, the study was short-term random trials. The authors have identified a need for studies addressing the long term effects of the supplement. http://goo.gl/uh8x6

Conclusion:
Based on the data gathered in this meta-analysis, I suspect that the manufacturer is making fraudulent claims to sell a supplement. However, with more research, CG may be a very effective antiobesity agent. There is some biochemical basis for the use of CG in oxidation prevention and weight management. There has to be human trials before an respectable claims about the effectiveness in humans can be made. 

A Very Scientifc Explaination Possibly Describing Why Neurodiverse Children are Often Picky Eaters

I am a huge fan of the neurodiversity movement. This movement empowers people with autism and other differences in behavior that are thought to be related to how the brain works. The movement asks neurotypicals (such as myself) to view people with autism or pervasive development disorder as human beings who simply do things a little differently. These people are not victims, and the current act of glorifying people who do "nice" things for the "poor helpless special kid at school" (see the quarterback who takes the down syndrome girl to the prom because he's like soooo nice) actually have a negative emotional impact on them.

But, I digress. As mentioned before, the brains of the neurodiverse do things a little differently than those of neurotypicals, and we should ALL (neurodiverse included) have an understanding of these differences. Perhaps you have stumbled upon this post because you are neurodiverse and were doing research on why you perceive certain things in certain ways. Maybe you are looking for information on how to deal with sensory overstimulation in order to live more comfortably.  Maybe you’re the parent of a neurodiverse kid who is at their wits end about why their child is so bothered by seemingly insignificant things. Or perhaps, you just really like science and have an interest in learning about the latest data out there, regardless of what category you fall in to.

I wrote this piece using data gathered via metanalysis for a poster session I did in grad school. The topic is a fascinating look in to the human mind. If you are a parent of a neurodiverse kid who is an incredibly picky eater, this topic is very important for you. It is imperative for your child’s health and wellbeing that you understand what is at the root of this “annoying behavior”. The sensory stimuli differences that cause your child to be a picky eater are actually extremely uncomfortable. This behavior is markedly different than a neurotypical child who refuses to eat certain foods because they are “yucky”. You can convince a child who does not have sensory processing child to eat, and eventually enjoy, broccoli. A child with sensory processing disorder who experiences extreme physical discomfort (eg. nausea, physical pain, ect) from eating broccoli cannot be coaxed out of this. Furthermore, to force them to eat broccoli is cruel. It is your job to take all the necessary steps to ensure that your child will not become malnourished. There are plenty of things that you can do to help them eat a balanced diet.

If you an older neurodiverse person who is interested in using therapies to be able to eat a more diverse diet (perhaps because you would like to try new foods, or because you have developed a health ailment related to your diet), I urge you to talk to your doctor and find therapists who are educated in this area. It would be most beneficial to find a doctor or therapist who also has sensory processing disorder, as their personal experience with the condition is worth more than most textbook education on the topic.

Though I am neurotypical, I have sensory processing disorder. That’s why I am so interested in the topic.

DISCLAIMER: I am not a prescribing provider, occupational therapist, or registered dietitian. This information is provided by a graduate student who is not yet allowed to practice. This information is in no way medical advice, and is not intended to diagnose or treat any condition. It is merely for entertainment. If you would like more information on this topic, please seek medical advice from a doctor or midlevel practitioner who can provide you with a diagnosis. 

Introduction

Sensory processing disorder (SPD), formerly sensory integration disorder, is a neurological disorder affecting the perception of sensory stimuli perception.¹ SPD patients may experience overstimulation in certain sensory receptors, as well as under stimulation in other sensory receptors. Furthermore, SPD patients may exhibit crossed sensory paths, such as the nausea and vomiting from hearing certain sounds that should not be expected to cause vomiting. SPD commonly co-occurs with autism spectrum disorder (ASD) and other pervasive development disorders (PDD).²

Thesis

Children diagnosed with SPD are at an increased risk of malnourishment due to malfunctioning sensory input. All children with an ASD or PDD diagnosis should be monitored for SPD signs. Furthermore, all children with an SPD diagnosis should be monitored for signs of poor nutritional status.

Pervasive Development Disorder, Specifically Autism

PDD is a broad diagnosis that includes autism, Asperger’s, Rett’s syndrome, childhood disintegrative disorder, and PDD-not otherwise specified.³ PDD is generally characterized in developmental delay, failure, or regression.

One in sixty-eight US children fall somewhere on the autism spectrum.⁴ ASD is characterized by a regression of normal development between ages 1-3 years old. ASD toddlers may suddenly stop making eye contact or speaking after a period of normal development. The spectrum ranges from “high autism-low functioning” to “low autism-high functioning”. Patients on the “high autism-low functioning” area of the range are generally unable to walk, speak, feed, or clothe themselves. High functioning autistics have relatively few developmental disabilities, and can lead fairly average lives. The hallmark signs of autism are obsessive fixation on a particular topic, avoidance of eye contact, inability to read social cues, and unusual interaction with peers. Young children with autism may prefer to organize toys, rather than act out in an imaginative fashion.⁵ ASD can occur with or without a deficit in intelligence quotient.

The cause of ASD is currently unknown, however, there is thought to be a genetic component.⁶ ASD occurs commonly in siblings, particularly identical twins. An environmental activation of genes is the leading theory on the development of the condition.

Sensory Processing Disorder

SPD is a malfunction of the sensory system. This condition affects both ascending and descending neurological pathways.⁵ SPD is not currently recognized as occurring as a standalone condition, however emerging research is suggesting that SPD can occur in the absence of PDD. 90% of ASD patients experience SPD, and 5-16% of the general population experience SPD.

According to adult self-report data and observational data of children, the overstimulation that results from SPD is extremely uncomfortable.⁷ Simple everyday experiences, such as television viewing or teeth brushing, can be unbearable for SPD patients. As a result, patients will actively avoid stimuli that they know to be unpleasant. Avoidance of unpleasant stimuli is perfectly normal, but becomes a problem when the unpleasant stimuli is hard to avoid.

SPD also involves some degree of understimulation.⁸ In cases of understimulation, it is unclear whether the ascending path way, the cortex, or the descending pathway are responsible for the inappropriate stimuli response. It is also unclear why some stimuli causes overstimulation, while other stimuli goes almost unnoticed.

Sensory Processing Disorder’s Effect on Feeding

SPDs can interfere greatly with mealtimes, as mealtimes are generally filled with stimuli.² There is a wide range of smells and colors in foods. This provides olfactory and optical stimuli. Eating is generally a social activity, this provides auditory stimuli. The texture of foods ranges from soft and mushy to hard and crunchy. Utensils can be cold, metallic, and sharp or they can be plastic and flimsy. This provides both oral tactile stimulation and digital tactile stimulation. Finally, there is a wide array of food flavor combinations. This provides gustatory stimulation.

Patients with ASD may gag or vomit when they attempt to eat certain foods, as a result of inappropriate signaling from the brain that the food should be expelled via emesis. They may feel physical pain from the sound of a fork scraping against a plate. They may feel an indescribable discomfort from having a grape explode in their mouth.

Sensory Processing Disorder, Food Selectivity, and Malnourishment

SPD patients actively seek to avoid eating foods that cause them discomfort. Older children and adults may flat out refuse to eat certain foods and food groups, while younger children throw tantrums and dodge the feeding spoon⁷. Children with ASD are more likely to refuse foods, and have a smaller bank of acceptable foods relative to their non-ASD peers.⁹

Omission of foods and refusal to eat put SPD patients at risk for malnourishment.¹⁰ The majority of studied SPD patients consume adequate kilocalories, but favor carbohydrates over lipids and proteins. SPD patients generally demonstrate normal anthropometric values due to acceptable kcal intake. However, they tend to favor refined carbohydrates as their primary source of kcals. A lack of lipid, fat, and plant based carbohydrate intake results in micronutrient deficiencies. Most SPD patients do not consume the recommended daily intake (RDI) levels of vitamins A,D, and K. Their intake also lacks calcium, choline, fiber, magnesium, phosphorous, and potassium. Furthermore, excess consumption of specific foods results in intakes above the upper limit (UL) of copper, retinol (despite low intakes of vitamin A overall),folic acid, zinc, and manganese. Most B vitamin and iron levels are adequate.

Interventions for Sensory Processing Disorder Related Malnourishment

Anthropometric values and blood values for micronutrients should be measured by a prescribing provider during annual checkups.¹⁰ Additionally, the patient should be monitored for signs and symptoms of nutrient deficiencies. Access to a dietitian should be recommended at the first sign of malnourishment. Occupational therapists (OTs) should be utilized from the beginning of the SPD diagnosis. OTs can help the patient learn to effectively cope with overstimulation. They can also provide insight on how to limit stimuli that is not absolutely essential to feeding. Stimulation is compounded by all of the stimuli in the environment, therefore, it is beneficial to limit stimuli during feeding. Dimming lights, reducing noises, and using utensils that the patient does not have a strong reaction to can help them adequately cope with food specific overstimulation. Foods that cause overstimulation can be hidden in foods that the patient does not have difficulty with. This practice can help provide needed nutrients without causing a reaction in the patient. Finally, supplementation via nutritional formulas can be beneficial to the patient. In the rare case that kcal requirements can not being met through interventions, total parenteral nutrition (TPN) and enteral nutrition (EN) can be used.

Conclusion

SPD is a condition that often co-occurs with PDD. SPD is over or under stimulation resulting from environmental stimulation. The condition becomes a problem when it interferes with the life of the patient in a profoundly negative way. SPD affects nutritional status due to the stimuli filled nature of feeding. A multi-disciplinary therapeutic approach can provide relief of SPD symptoms for patients. This team should include prescribing providers, dietitians, and occupational therapists. SPD patients should be monitored for malnutrition and below average anthropometric values. 

Nutrition support in critical patients: A review of enteral and parenteral nutrition in patients exhibiting multiple organ dysfunction, hypermetabolism and hypercatabolism

Caitlin Swartz

April 30^th, 2014

Introduction

Nutrition support for critically ill patients encompasses both enteral and parenteral feeding in order to aide in patient survival following life threatening events. Nutrition support is generally practiced by a team of registered dietitian nutritionists, intensive care physicians, nurses, and pharmacists (Association of Parenteral and Enteral Support (A.S.P.E.N), 2014).  Nutrition support practitioners maintain a Nutrition Support Certification through the National Board for Nutrition Support Certification.

Enteral nutrition (EN) is broadly defined as any form of feeding where nutrients pass through the gastrointestinal (GI) system (A.S.P.E.N, 2014). EN in the focus of nutrition support uses catheters to bypass certain areas on the GI system. Nasogastric catheters are inserted in to the stomach via the nasal passages. This form of EN is preferable because it is associated with the lowest risk of complications in addition to using the greatest portion of the GI tract (Mosier, Pham, Klein, Gibran, Arnoldo, Gamelli, Tompkins, & Herndon, 2011). Complications from nasogastric catheters are limited to localized irritation and accidental aspiration that occasionally leads to pneumonia. Jejunostomy is a catheter that is placed directly in to the small intestine via an access point on the patient’s abdomen (A.S.P.E.N, 2014). Bowel strangulation, physical obstruction of blood flow to the bowel caused by the catheter wrapping around the bowel (Merck Manual, 2014), is a rare, but serious complication of jejunostomies (Gerristen, Besselink, Cieslak, Vriens, Steenhagen, van Hillegersberg, Borel Rinkes, & Molenaar, 2012). Complications from EN are generally in the form of intestinal regurgitation resulting from gastroparesis or paralytic ileus. Though, this complication can be avoided with early onset EN (Dissanaike, Pham, Shalhub, Warner, Hennessy, Moore, Maier, O’Keefe, & Cushieri, 2008).

Parenteral nutrition (PN) support is the extraintestinal insertion of a catheter in to a vein (A.S.P.E.N, 2014). A solution of substrates ie. simple carbohydrates, amino acids, short chain fatty acids, vitamins, and minerals is supplied directly to the bloodstream. The use of total parenteral nutrition (TPN) is indicated in patients who cannot tolerate EN. A combination of PN and EN can be used in patients who cannot reach a neutral or positive energy balance via EN alone (Thibault, Pichard, Wernerman, & Bendjelid, 2010).  PN is associated with serious complications including: gut atrophy, sepsis, electrolyte imbalances, hyperglycemia, overfeeding, uremia, metabolic acidosis, and immunosuppression (Varga, Griffiths, Chiolero, Nitenberg, Leverve, Pertkiewicz, Roth, Wernerman, Pichard, & Preiser, 2006). The risks associated with PN outweigh the risks associated with fasting and starvation in cases with a short duration. Therefore, ASPEN recommends delaying PN until eight days following the patient’s admission to the intensive care unit (ICU) (Cove & Pinskey, 2011). Furthermore, EN is always preferred over PN in patients who can tolerate GI feeding (Varga et al., 2006).

The purpose of this paper is to explain the need for nutrition support in ICUs by examining the pathology of multiple organ dysfunction syndrome (MODS), hypermetabolism, and hypercatabolism in patients suffering from severe burns, heart and respiratory failure requiring the use of extracorporeal therapy, and following trauma and major surgery.

Multiple Organ Dysfunction Syndrome Pathology

            There are several factors contributing to the small intestine’s role in MODS. In critically ill patients, the mucosa of the in small intestine begins to atrophy as a result of fasting. In non-critical individuals, the brush boarder secrets intestinal alkaline phosphatase (IAP). IAP neutralizes bacterial lipopolysaccharide (LPS). LPS is an endotoxin which harms human cells. As the mucosa deteriorates in fasting patients, the brush boarder does not regenerate. The excess LPS initiates an immune response from the complement system. Macrophages secret inflammatory interleukins 1 and 6, and tumor necrosis factor alpha. This cytokine action increases GI permeability.

Increased GI permeability leads to bacterial translocation, the movement of normal intestinal bacteria to surrounding sterile mesenteric organs (Berg, 1999). The mesenteric organs include the liver, kidneys, spleen, and mesenteric lymph node complex (MLNC). The liver and MLNC spread bacteria throughout the circulatory system resulting in sepsis.

The small intestine contains the highest concentration of immune tissue relative to the rest of the system. As the GI undergoes atrophy, the immune tissue does not regenerate. This results in an overall decrease in immune function. The patient experiences a decrease in the ability to fight the systemic infection due to a decrease in immunoglobin A secretion.

Finally, during times of metabolic stress, the body adapts by redirecting blood flow to the vital organs including the brain, heart, and lungs. This redirection of blood flow results in bowel ischemia.

EN prevents the initial bowel atrophy by providing activity for intestinal muscles. 

Conditional Racism.

Apparently this is a real product?
Image Credit:http://images.fileferrets.org/vv2008/

t's not okay to be racist conditionally. It's not okay to use a racial slur to refer to a person whom you don't like or respect. It's not okay to make a satire ad for Obama Waffles, even if you think he is failing at his job. It's not okay to superimpose Condoleeza Rice's face on Aunt Jemima's face just because you think her participation in The Bush Administration sets both women and blacks back. It's not okay to refer to an entire grassroots organization as "white crackers", even if you believe this organization to be the very same people who were against the civil rights movement (ignoring the fact that the Tea Party platform never mentions race, anywhere. And ignoring the fact that this organization is made up of people who represent a multitude of races and ethnicities and a wide range of ages ie too young to be part of protests against the civil rights movement) 

It's also not okay to throw around the labels -ist, bigot, or anti- just because someone doesn't agree with you. There are very valid reasons to dislike world leaders, regardless of race. Being pro-Pakistan

A racist caricature of Condoleeza Rice
Image Credit: ZenComix.Com

does not necessarily make you anti-Semitic, being pro-Isreal does not necessarily make you anti-Muslim. 

Lastly, it's not okay to excuse the autonomous actions of a particular group that segregates themselves along racial or religious lines, while berating another group for doing the exact same thing. Eg supporting whites who disallow marriage to anyone other than another white, while shaming blacks who disallow marriage between a black person and anyone who is any other color. 

Stop running from the debates that have the power to advance society. Stop using the name calling shield. Most controversial views have valid supporting ideals. Effective compromise will make the world a better place, but this compromise cannot happen if we continue to act like kindergarteners. Use logic, not emotion.

With Regard to Agressive Atheists.

Side note: I am not okay with the claim that always science endorses
atheism. The scientific method cannot apply to spirituality because
there is no observable data on the topic.
Logically, science would endorse agnosticism. The openness to all
ideas about who we are, where we came from, and what might be out there.
 Scientific evidence counters things in the bible ie. the literal
translation of creation and the idea that heaven is in the sky. But, this
limited data has little impact on the expanse of spirituality.
Photo Credit: PSNT.net

I'd like to rant for a minute, if that's okay.
To the atheists of the Internet: I've noticed that you feel that you are victimized quite often. I've noticed that a few of you are quite defensive about your choice. So much so that you attack anyone you perceive to not agree with you.

Maybe this emotional reaction stems from how people close to you view your choice. But, to millions of strangers, your choice is insignificant. Much like the choice to be religious by other interneters is insignificant. Perhaps, you are defensive because your religious parents are upset with your choice. Or maybe you are defensive because you feel that the religion you grew up with has been a controlling sham that you resent for dictating so much of your life.

I applaud your ability to think for yourself. Your ability to use critical thinking to reach an important life decision. It's okay to be atheist. It really is. It's not okay to insult and attack those who are not atheist. If they are insulting or attacking you for your decision, by all means, tell them that it is your choice, and they have no right to tell you how to live your life.

But there cannot be a double standard. If you expect people to respect your decision and show it by not attempting to belittle you or convert you, you cannot belittle or attempt to convert others.

An example of the kind of rude behavior this post is about.
Photo Credit: Un-Learning.Org

If a discussion about faith arises, politely explain how you reached your decision. This may mean pointing out the flaws you perceive religion and spirituality to have. If, once you have made your case in a rational and reasonable fashion, the dissenting party continues to tell you that you are a sinner who is going to Hell just give up. This debate is not worth your time.

It is okay to discuss your perceived downsides of religion, but it must be done in a polite, logical, and civil debate.

I have reached the conclusion, entirely on my own, that religion is not right for me. But, since we cannot be certain that there is no higher power, I have chosen to remain spiritual. I find great comfort in the idea of an afterlife. I cannot imagine grieving for a lost love one with out the idea of an afterlife. I like using prayer to guide my life. But, I pray to whomever is listening, not necessarily an all powerful, all knowing man in the sky.

This is my decision. I, much like you, have reached it using critical thinking. I respect your decision, and I expect you to respect mine.

The world is changing. Not being religious is more widely accepted than many of you understand. So please be more confident in your choice to deny religion.

A billboard created by a Christian minister.
The rude, childish, overly emotional,
hate occurs in theists as well.
Photo Credit: GodDiscussion.Com

** Of course, there are many overly defensive, hypercritical religious people out there. Merely changing the word atheist to the name of any religion would hold the same meaning. Because every group has some members who are guilty of these actions. I just chose atheism because that is what I am most exposed to via the internet. I often see atheists attacking religious people when unprovoked. Or attacking an imaginary person when no one has said anything despairing or dissenting towards atheism. If you are atheist, and you feel that I am wrong in generating this post, I hope you will approach me in a civilized manner. Though, all of my atheist friends are mature, reasonable, pleasant people. So, I doubt this will be an issue. This was directed at the few, hateful, aggressive atheists that make their presence so well known on the internet.

*** Last note: An agnostic is a person who chooses to not accept or deny the existance of a higher power because sufficient evidence is lacking. Agnostic is the label I most identify with. To be clear, I am not an offended Christian, Muslim, or Jew ranting about the wrongs of atheism. I am just a person who fully believes in tolerance and acceptance of all reasonable thought processes.

A comic about agnosticism. I just love these guys.
Photo Credit: Cyanide and Happiness

Thank you for reading this. Any discourse that may result regarding this that is not mature and civilized will be removed. So, if you would like to comment, please act your age

Scientific Research and the General Population

My father, mother, and I were discussing the Aaron Swartz case, and we reached some interesting conclusions. I know he comes up a lot, but what he was doing was very important to me. I have been in the academic science field for around 8 years now. I had to take two research methods classes as an undergrad, and I'm set to take one at the graduate level in the coming year. An important part of science is the ability to analyze original research. You are presented with a document that ideally tells you how to recreate the experiment on your own. The authors draw their own conclusions about what the data indicates, but they must present the data uninterpreted in their journal articles.

My parents both hold masters degrees, one in chemistry, and the other in education. My dad attended college in the late 60s and early 70s, my mother attended in the 70s. Obviously, the ability to access scholarly sources has changed quite a bit in the past decades. My parents went to college during a time when any schmuck could walk in to a university library and pull a journal off of the stacks. My dad and his peers used xerox machines to copy the articles that they needed. I believe this violates copyright laws, or at least the signs posted on all university copiers lead me to believe this. My dad stated, "I don't know how the students in the 50s survived without the ability to xerox these papers." Indeed, I must frequently reread and annotate technical writing in order to fully understand the content. Not sure if everyone is like this, though I score high on reading comprehension tests.

My mother said that she continued to access the latest research, via academic journals, throughout her career. She used her own interpretation of original data to offer parents advice on how to deal with atypical learners. But, this was the 80s and 90s, just prior to widespread electronic databases. We tell doctors and dietitians to review original research when consulting patients. Entire units are focused on giving med and dietetics students the skills to effectively analyze research.

We use original research to generate laws that affect the public, yet the public does not have reasonable access to original research. If you are not affiliated with academia, it's very expensive to access these journals. Something like $30 per article. It could be argued that it is expensive to access these journals if you are affiliated with academia, because the cost is reflected in tuition, and the ability to pay university employees.

In the US, and other places I'm sure, tax dollars are used to fund scientific studies. So, we are all paying to fund these studies. Why doesn't every single citizen have reasonable access to this research?

Aaron understood this. He took action, and in the end he raised awareness for the open science movement. I whole heartedly wish things had gone differently. I would trade the gains that he afforded the movement for him to still be alive. But, since that isn't going to happen, let's use his work to further the movement.

My father loves to play devil's advocate, and in doing so we reached a nice compromise. Publishers don't have to offer everything at a loss. But, they could accept a decrease in profit margins, by lowering the cost of access. What if access to an article cost $1.50? Would that be reasonable? With the advent of electronic databases and PDF, publishers don't have to foot the costs of ink, paper, and press production. The user has the right to print the article, but they pay for ink, paper, and printer access. In my experience, this tacks on around $0.75 to the cost. It wouldn't hurt to limit the amount of unneeded paper use to print physical journals. Trees probaby aren't an unlimited resource.

If you are a researcher, consider making your articles open access. Use a platform that allows for this. Figshare is great! http://figshare.com/. You worked hard on your research, you spent hours in LaTeX writing, so share it with the world.

As scientists, we are asked to reference original data. Yet, in the current system, we ask the public to rely on journalist's intereptation of the origninal research. I'm sure, during your undergrad career, you were asked to do an assignment comparing a scientific popular culture article to the original research. I'm sure you know that this system can be misleading. Let's fix this.

I would be quite pleased to see intelligent, civilized discourse on the matter. Please comment with your views. You may alter the views of your peers. If you have a good argument in defense of the current system, this blog would love to hear it.

Disclaimer: The views presented in this blog do not necessarily represent the views of the individuals or organizations mentioned in this blog. If any individual, deceased individual's family or friends, or organization would like their reference removed from this post, please contact me.