Reading Philosophy Essay

In order for a child to excel in school they need to be well versed in reading therefore; I believe that it is vital for all children to learn to read. Not only should reading be a fun and enjoyable experience but something that influences the child to succeed in all subject areas. Reading is an integral part of life that needs to be mastered. A child can master the basics of reading in the early years and should be learned at that time due to the aggravation and frustration of learning those skills later on, as he/she gets older. Although there are many children and adults alike that hate to read it is our job to spark an interest in these children so they will find reading enjoyable. All of the aspects of reading should be equal and balanced in order for the child to learn. Although I loved reading when I was younger, I still had to ingrain this behavior into my own children so they could see reading could be enjoyable and that it was an everyday part of life. One must be aware of the IRA standards for reading professionals before they can begin to deal with the actually reading components and these standards state that not only are professionals suppose to demonstrate knowledge of the major components of reading (phonemic awareness, word identification and phonics, vocabulary and background knowledge, fluency, comprehension strategies, and motivation) but also how all of these standards are the very core in fluent reading. Wide ranges of curriculum materials are needed for effective reading instruction to address all learners and their abilities, which is also stated in the IRA standards. In addition, the many cultural and linguistic backgrounds should be addressed for successful learning. Children need to know that later in life reading is a big component in trying to apply for jobs, reading road maps, and state road signs among other things. One component that is vital to reading is comprehension because a child needs to be able to comprehend exactly what they are reading to understand what is required of them. â€Å"Put Reading First† says good readers are purposeful and active which relates to this aspect. A great deal of research has shown that instruction in comprehension can help children understand the text being read, remember the text and be able to restate it, and be able to communicate what they have read to their peers. In our changing world today, we find that there are so many ways to teach children to read. The one approach that makes practical sense to me is the balanced approach because it is my belief that a child has to have several ways to learn the reading material being presented. Phonics and phonemic awareness are great ways to help a child to read along with sight words and repetition. â€Å"Put Reading First† states that children who have phonemic awareness skills are more likely to have an easier time learning to read and spell than those who do not possess these skills. Also, phonics instruction is essential when a child is learning to read for the very first time. Again, research shows us that in order for our children to read and benefit from phonics the child must have phonemic awareness. Fluency is another factor that comes into play because when students struggle to read they have trouble comprehending the text. Fluency is accomplished only when a child practices constantly so he/she can become proficient because it does not come automatically to them. Furthermore, we have to understand that vocabulary instruction plays a key role in fluent reading and comprehension. These children need a solid base to be able to understand what they are reading and having the background knowledge of vocabulary instruction helps enhance reading for them. Just some of these practices are shared book experiences, language experiences, read alouds, invented spellings and environmental print that can provide them with a way to enhance his/her reading ability. Interactive theories, transactive theories and subskill theories are theories that can be beneficial in planning reading instruction. Subskill theories are a set of subskills that students must master and integrate. We need to understand that these skills are significant because beginning readers may read slow and choppy and this decreases comprehension. Next, we have interactive theories, which depict reading as a combination of both reader-based and text-based. It is a process that is good because it allows the reader to make predictions about how to process the material through a process called top-down processing. All of these theories allow the reader to process material about the print and access background knowledge through a process called bottom-up processing. Lastly, transactive theories are based on Rosenblatt’s belief that reading is a transaction. I believe all these theories and components for reading provide the basis for reading instruction. In order for a child to be a good reader one should have a very rigorous background of reading instruction and have a good deal of knowledge of phonemic awareness, phonics, vocabulary, comprehension and fluency so they will become better readers.

Bohemian Rhapsody Lyrics Meaning

Wow. I had no idea there were so many interpretations of this song. For me it's always been clear: the song is about an execution. Please bear with me as I construct a detailed argument for this interpretation. Here's the set-up (all of this is proven later): The narrator has committed murder. He might have done this out of malice, or self-defense, or anything in between; we don't know. The fact is that he killed someone, was caught and sentenced, and is now on Death Row. The man is not an important person, so to speak. He is not famous, nor rich, nor anything of the kind.He has no high-priced lawyers and no â€Å"connections† to help him in his plight. The narrator implies that, if he had higher social status, if he had money or fame or whatever, then he would stand a good chance of escaping death. But alas, he is merely a â€Å"poor boy† (aka ordinary person), and has no such power. His family and friends are attending the execution (or have otherwise heard about it), and are very distressed. Conversely, the family and friends of the dead man want revenge and they can't wait to see the narrator executed.The song takes place just prior to the execution, and involves the narrator talking to (or perhaps just thinking about) his mother, just before he dies. If you're still reading, you have my thanks. Here's the line-by-line analysis: *We start with the narrator's thoughts: â€Å"Is this the real life? Is this just fantasy? † *The narrator is overwhelmed by the idea that he's going to die. He almost wonders whether this is all a nightmare or something. â€Å"Caught in a landslide, No escape from reality† Again, he feels overwhelmed, but he can't really deny that he's about to be killed. Open your eyes, Look up to the skies and see,† Looking up to heaven, wondering about life etc. â€Å"I'm just a poor boy, I need no sympathy Because I'm easy come, easy go, Little high, little low† Here he is quoting the common perspective: he's just a poor man (â€Å"boy†), and he doesn't deserve sympathy. Much of the song is about how no one seems to care for the narrator, even though he seems mournful and regretful for his actions. â€Å"Any way the wind blows doesn't really matter to me, to me† Now that he's going to die, nothing more matters. He has no future, no hopes or dreams or goals.He's going to die within the hour, and there's nothing he can do about it. He feels very hopeless, and from his perspective nothing really matters. â€Å"Mama, just killed a man, Put a gun against his head Pulled my trigger, now he's dead† This part is obvious. He committed murder. I don't he's confessing to his mother here, as surely she would already know by the time of the execution. I think that he's really just sadly reflecting on what he's done, and he mentions this to his mother (or perhaps he's just thinking about her) â€Å"Mama, life had just begunBut now I've gone and thrown it all away† He was a young man, in his 20s perhaps. He had the chance to live a meaningful life, but instead he killed a man, thus causing his own death via execution. The narrator laments, noting that he could have saved his own life by choosing not to murder. But now the deed is done, and the narrator will face justice. â€Å"Mama, ooh, Didn't mean to make you cry If I'm not back again this time tomorrow carry on, carry on as if nothing really matters† Again he's sorry for his actions, and regrets that his mother now weeps for him, as he will soon be killed.The execution will take place within the hour, so if he's not back again this time tomorrow, it will mean that the execution happened on schedule, that he failed to escape it via pardon or other means. The narrator tells his mother that, even if he dies, she should carry on living, almost as if his death didn't matter to her. â€Å"Too late, my time has come† The execution is imminent. â€Å"Sends shivers down my spine, body's aching all the time† These are symptoms of his intense fear. â€Å"Goodbye, ev'rybody, I've got to go† He says a final farewell to his family and friends. Gotta leave you all behind and face the truth† The truth is that he killed a man, and now he faces strict justice. He will die. â€Å"Mama, ooh, I don't want to die I sometimes wish I'd never been born at all† This much is obvious. He doesn't want to be killed, and indeed he wonders if it would have been better never to have been born in the first place. A new voice starts singing; this voice represents his friends and family who are (or have been previously) protesting his execution. â€Å"I see a little silhouetto of a man† The narrator seems so poor and pitiful, â€Å"a shadow of what he once was†, so to speak Scaramouche, Scaramouche, will you do the Fandango† Honestly, I don't know what this means â€Å"Thunderbolt and lightning, very, very fright'ning me† Both he and them are afraid that he'll be killed. The â€Å"lighting† part might indicate that he's to be killed with the electric chair, or it might just be symbolic. â€Å"(Galileo. ) Galileo. (Galileo. ) Galileo, Galileo figaro† Galileo was unfairly persecuted by the authorities of his time. Granted, Galileo didn't commit murder, but the narrator's advocates still draw a parallel, insisting that he doesn't deserve the punishment he's receiving. â€Å"Magnifico.I'm just a poor boy and nobody loves me† The narrator repeats the common belief. â€Å"He's just a poor boy from a poor family Spare him his life from this monstrosity† His friends and family argue that, because he's a poor boy, he deserves sympathy and compassion, not death. â€Å"Easy come, easy go, will you let me go† Here the narrator pleads for his life. He basically says â€Å"You don't seem to care about me; I'm ‘easy come, easy go'. You don't really care if I live or die. So, if you don't re ally care whether I live or die, can't you just let me live? Can't you grant me a pardon or something? â€Å"Then the opposite group, the friends and family of the dead man (and/or the execution authorities) respond to these pleas. â€Å"Bismillah! No, we will not let you go† The other group wants the narrator to be executed. â€Å"(Let him go! ) Bismillah! We will not let you go (Let him go! ) Bismillah! We will not let you go (Let me go. ) Will not let you go (Let me go. ) Will not let you go. (Let me go. ) Ah No, no, no, no, no, no, no. † The two groups have a spirited argument. â€Å"(Oh mama mia, mama mia. ) Mama mia, let me go† Here the chorus of friends and family says â€Å"let me go†, but I really think they mean â€Å"let him go.Don't kill the narrator† â€Å"Beelzebub has a devil put aside for me, for me, for me† Beelzebub means Satan. The narrator feels (or speculates) that Satan is out to torment him by leading him to such a sa d fate. After all, it was probably a devil that tempted him to commit murder in the first place. Likewise, his family feels Satan is tormenting them as well, by killing the narrator to make them feel sad. Perhaps even the dead man's family joins in on this chorus; they feel that it was Satan who told the narrator to commit murder in the first place, and now they insist that execution is the only holy esponse to such a sin. Throughout this, the narrator has been lethargic and morose. But right before the end, he has a sudden burst of passion. â€Å"So you think you can stone me and spit in my eye? So you think you can love me and leave me to die? Oh, baby, can't do this to me, baby Just gotta get out, just gotta get right outta here! † I'm not sure if he's talking to anyone specific here, or if he's just ranting with passion, screaming at everyone and everything involved. As I imagine it, the narrator throws off his guards and fights to escape from his shackles.In the ensuing musical piece, he struggles with the executioners, knocking the room into disarray. The two families watch closely, but everyone knows it's a useless struggle; there's simply no way for the narrator to escape. And the end of the musical piece, he is beaten down and finally subdued. Once again he become morose and dispirited, and the executioners drag him to his place of death (electric chair, perhaps). In his last few moments before death, the narrator resumes his previous state of mind. Nothing really matters, Anyone can see Nothing really matters Nothing really matters to me† Again, because he's about to die, nothing really matters to him. He has no purpose, no hope, nothing. â€Å"Any way the wind blows†¦ † This is an allusion to the begining of the song, where this image was used along with â€Å"nothing really matters† So†¦ yeah. I think that's a pretty thorough interpretation. Bohemian Rhapsody is about a remorseful murderer as he's about to be ex ecuted. Questions? Comments? Did anybody even read all that?

Key Message & Insights to be Gleaned from Babel, the Movie

The two-fold message of Babel, a film by Alejandro Gonzalez Inarritu, is human frailty and interconnectedness of lives. Most individuals tend to think that their actions are inconsequential, and often take people like family — along with other good things happening to them — for granted. In the least expected ways, people’s lives are intertwined. Usually, though, as a culture communicates itself to others, barriers arise, impeding a real connection.The film likewise depicts that there are times when people behave irrationally, which may be part of human nature, and there will always be a point in time when people will experience Murphy’s Law, commonly understood as `Whatever can go wrong will go wrong, and at the worst possible time, in the worst possible way. ’ In such instances, people may be weighed down by misfortunes or tragedy, but in those instances, there are those who cling to each other for support.Notwithstanding the trauma, individuals m ade up of sterner stuff rise to the challenge. Most people, in the end, also own up to their mistakes and take responsibility for their actions as well as for their closest of kin or alliances. Human beings are not infallible, and may sometimes have little control over circumstances unfolding in their lives.Just as the Biblical meaning of the film’s title connotes (the Tower of Babel is referred to as a grandiose structure built by Noah’s descendants for their own glory, but divine intervention muddled up their tongue and they failed to understand one another's speech, and ended up scattered across lands), Babel, the movie, features four interlocking stories where the characters experience some communicative barrier along with a sense of alienation from the rest of humanity, and are pushed to the edge.Every obstacle that the characters encounter, however, is presented as an opportunity to improve on the human condition. As such, Babel showcases how the human spirit can prevail over critical challenges or life-changing hurdles. Hope as a universal thing is clearly expressed. On the other hand, chaos as a constant element in the world is also highlighted. The presence of a gun throughout the movie’s main plot and subplots shows how a shot can create a ripple effect, trigger untold pain, and change the lives of its victims forever.It appears more like a symbolism of how guns can be misused. As each of the movie’s central characters embark on a journey of scars — in a remote setting in Morocco with its grazing lands and desolate tracts, and in another part of the world, Tokyo, with its resplendent yet lonely megalopolis — they see their lives unraveling, yet are unaware of the common thread running through them.In essence, human frailty and disillusionment are exemplified by Babel’s central characters — a couple traveling in Morocco in order to emotionally reconnect; a Mexican nanny who brings their children across the US-Mexican border without the parents’ permission to attend her son’s wedding; a herdsman and his two young boys; and a teenage deaf- mute desperately seeking attention from her father and friends in Tokyo. As fate would have it, a rifle ends up in the possession of a local herdsman who delegates to his young sons the task of guarding the family’s herd from jackals.While playfully testing the rifle’s capacity, the younger son of the herdsman accidentally shoots the lady-tourist, seriously injuring her. The ensuing events find the traveling couple’s nanny facing arrest and deportation for her unauthorized action; and the teenage deaf-mute enduring a dreary existence as social outcast. All these tormented souls attempt to soothe the pain and isolation they encounter as they wrestle with misfortunes and upheavals.The parallel crises take place simultaneously, and as the families deal with their respective hurdles, they pay a high price â₠¬â€œ with their soul, dignity, freedom and life. Overall, it is a good movie that insightfully depicts the human condition and how people will go to great lengths to survive or find elusive happiness or meaning in an imperfect world where actions have impact on others. Reference Inarritu, A. G. (Producer/Director). (2006). Babel. US: Paramount Pictures Corporation.

Sensationalism Media Research Paper Example | Topics and Well Written Essays - 750 words

Sensationalism Media - Research Paper Example â€Å"As we all know, the ethical heights journalists set for themselves are not always reached. But, all in all, like politics, it is an honorable profession practiced, for the most part, by people trying to do the right thing.† (Media / Political Bias) Most of the journalists report the news in accordance with their political bias. For example the recent Indo American nuclear agreement has been reported sensationally by most of the Medias in America and India. The American journalists who had soft corner towards the Republicans reported the agreement as a useful one for the American interest while others reported against it. In India also the left supported journalists severely criticized prime minister Man Mohan Singh and his United Progressive Alliance (UPA) government for signing such an agreement with America. They have criticized that the agreement may control the authority of India to conduct further activities in the nuclear energy field. The general public in India and America were confused by the spreading of entirely different interpretations of the agreement. A layman doesn’t know much about the nuclear energy and the agreement and the journalist succeeded in creating confusion among the public. Such sensational journalism may not help the progress of a country and hence it should be controlled by proper means by the government. It is generally accepted that freedom of expression is a basic right. But misuse of even the basic rights must be prevented if it creates harm to the society. Spreading of religious belief is often considered as a basic right in many secular countries. But it should never interfere with other’s beliefs and forceful implementation of such beliefs cannot be accepted in a civilized society. Same way the basic right, freedom of expression should never affect a country’s progress in any circumstances. It should

Segmentation, Targeting and Positioning a comparison of strategies Essay

Segmentation, Targeting and Positioning a comparison of strategies employed by Nivea in the UK and in Thailand now and potential direction for the future - Essay Example Nivea has the ability to appeal to a wide range of consumers. Nivea marketers use market 'Segmentation Strategy' to communicate with consumers. Advertising and promotional activities target consumers' perceived needs. According to Superbrand(2006): "In the UK, four million people use a Nivea Skincare product everyday". Nivea users comprise about 6.8% of UK population. Mintel (2006) argued that the "Potential Consumers" of Nivea products comprise approximately 8% of the population. Mintel (2006) indicated that Nivea is likely to concentrate its marketing on large cities. This target population has a high potential to be loyal buyers of Nivea Skincare products and would most probably buy Nivea products over other products. For example, the major city of London has a population of seven million people and is measured to have 12.2% penetration of the Nivea brand. Nivea marketers target marketing communication generally focuses on women who purchase skincare products for themselves and their families. This target market segment would most probably be readers of advertisements and internet users. In addition, women who are loyal Nivea users would be more willing to try new products under the Nivea brand. Since Nivea launched several innovative new products they have recategorized some of its products. The nourishing, tanning and firming products have been moved into the new and rapidly growing gradual tanning segment. This coincided with the launch of "Nivea Body Sunkissed Skin", a daily moisturizer that helps firms the skin. (Superbrand, 2006) According to IRI sources (2006) "the fastest-growing segment is body care with an annual increase of 29%, mainly attributable to the new gradual tanning segment. Their interest is in the target market that consists of consumers who sun-bathe and those who enjoy adventure sports. It is believed that this target market segment is interested in trying new products related to sunbathing and adventure sports. Age Group & Gender Beiersdorf annual review (2005) indicated that Nivea skincare product users ranged in age between 18-35 years of age. This is about 12 million people in the UK. In 2006 Nivea launched a new sunscreen in the UK. The product advertising states that it provides "immediate protection for children in spray and lotion formulations, forming part of the new Nivea sunscreen for children SPF 50+" (Superbrand, 2006). Nivea has expanded significantly and provides products for younger consumers. They believe that by the time the consumers are over 30 years of age they have become a part of their premium brand consumer market. This transition takes place because this market segment has grown up believing that the Nivea premium brands will help keep their skin young and healthy looking. This market segment looks for products that will help their skin look and feel younger for a longer period of time. This group never stops looking for the best quality products suitable for their age and skin types. (Mintel, 2006) Most male consumers become loyal customers because they are not likely to change their products as often as women do. Income Group Resources indicate that Nivea consumers earn an income from 10K to 35 per month which rates on 'Starting and Basic' of taxable brands. In comparison to other skincare products marketed on the same shelf,

Leadership in Non Profit Organizations Essay Example | Topics and Well Written Essays - 2750 words

Leadership in Non Profit Organizations - Essay Example A preliminary review of the literature has revealed that there is a lack of research on leadership specifically in the context of non-profit organizations. This is noteworthy omission as the non-profit organizations have traditionally made a large impact on the socio-cultural and economic uplift of the people, and governments across the world rely on their partnership and support for welfare activities. As such, it is essential to assess what leadership style may be most suitable in the context of the environment in which non-profit organizations operate. There is however, another difficulty in leadership studies related to non profit organizations. This lies in the fact that leadership effectiveness can not be measured simply in terms of revenues or any other objective economic indicator. As such, it becomes difficult to objectively assess the effectiveness of leadership in non profit organizations. The current research therefore proposes that effective leadership should be able to positively impact on the job satisfaction of the employees, which in turn leads to highly motivated and committed workforce. The proposed research is therefore directed at assessing the leadership styles in the non-profit organizations in the USA and their impact on the satisfaction levels of the employees. The research is expected to provide insights about the leadership styles that are best suited in the context of the non-profit organizations.   2. Literature Review   2.1 Non-profit Organizations: Concept, Growth and Development of Non-Profit Organizations    A non-profit organization can be defined as a group organized for purposes other than generating profit and that does not issue stock shares or distribute its surplus funds  to its members, directors, or officers (Young, 2001). The purpose of Non-Profit organization is to serve the public, and not the owners and the members of the organization. There are a variety of non-profit organizations in different sectors, lik e sports, education, health, social services and artistic groups. Non-profit and non-government organizations are legally comprised entities that work independently from the government. The history of a non-profit sector is embedded in the broader political culture and social improvement of a country or a region, and is also impacted upon by cultural and religious factors. The evolution of US non-profit organizations and non-profit sectors is associated with development of constitution of the US society. In contrast to the US, the non-profit sector development in the Great Britain was closely attached to the changing social needs and political confederacy of the time (Anheier, 2005). Non-profit sector is highly developed in U.S due to its relatively low level of social welfare spending and it seems to be the largest among other countries (Agard, 2011). There are more than 8,00,000 charitable non-profit organizations in the United States, majority of them are Universities, hospitals and churches and these entities make up the major part of the sector in terms of assets and employment (Agard, 2011). According to the John Hopkins’ comparative non-profit sector study, over half of the hospital beds are in the non-profit hospitals, half of all colleges and universities are non-profit institutions, 95% of all orchestras are non-profit organizations, 60% of all social service agencies are non-profit (Salamon, et al, 2003). The non-profit sector has a rich and diverse history in the United States. In USA the non-profit organizations are mainly active in three fields: education, culture and recreation, social service. (Salamon and Anheier, 1996). In the context of European countries as well, the establishment of the voluntary

Progressive Era Essay Example | Topics and Well Written Essays - 500 words

Progressive Era - Essay Example Progressive reforms in states like Wisconsin, Washington and Idaho were becoming the order of the day from 1911 and some of these reforms are still used in nearly half of states in United States of America. Democracy was realized during the era since citizenry was given the mandate to circumvent political bosses and to rule directly. Ballot measure and referendums were also introduced to enable citizens take part in amendments of constitution as it is seen in 1902 by Oregon State and other states (Maureen 13). In 1908, voters were enabled to recall elected officials through state level establishment. Corruption was fully exposed at both the state and local level during the period through the journalists; muckrakers. National medium magazines were handy in exposure of corruption through the media just as journalists today use newspapers, magazines and novels to expose corruption in the world (Alan 25). Journalists could even be nicknamed for inadequate exposure of corruption thus given them a challenge in exposing corruption. This shows the seriousness at which corruption was avoided. Promotion of women’s suffrage was evidently seen in attempt to create pure female votes in the arena. During the period, reformation on social institutions such as churches and schools were carried out. For instance, ‘scientific’ sciences such as political science, economics and history were transformed in to social sciences. Modernization was fully embraced during the period since education, technology, expertise and science were given an upper hand (Alan 27). This led to great improvement in the society of upper industrial. It was also believed that human beings were able to change life’s condition and to improve the environment; human beings were able to intervene in social affairs. This led to roads and railways being reformed to aid efficiency in movement of people, goods and services from one location to the other. The family was

Character Analysis Paper Essay Example | Topics and Well Written Essays - 1000 words

Character Analysis Paper - Essay Example in Single 149). Williams suffers enormous guilt for surviving the familial worries that eventually devastated Rose. Similar to Menagerie’s Tom, Williams also pays remorse for his escape from his family (Single 149). This essay analyzes the character of the matriarch, Amanda Wingfield. Amanda is a selfish, hero mother, with romantic-pragmatic ideas and who created a dysfunctional family by treating her children like a glass menagerie through vanity, arrogance, and control over her family’s life. Amanda is a hopeless romantic. She has been hurt deeply when her husband left through an inconsiderate postcard, and yet she sees her former husband as the personification of romance, connecting him to her earlier life filled with gentleman callers and flirtations (Tischler and Bloom; King and Bloom 85). This is why even if her husband abandoned her, a large picture of him hung in the house. His presence might remind everyone else of his abandonment, but for Amanda, she continues to remember her sweet, youthful, and happy days through this image. Furthermore, she is also ready to leverage and defend her earlier life (Cobbe 50). It is a life of comfort and education she overemphasizes with her children. Whenever Amanda wants to talk about Blue Mountain, a discussion occurs between Tom and Laura: TOM: I know what's coming LAURA: Yes. But let her tell it. TOM: Again? LAURA: She loves to tell it. (Williams scene 1). Amanda enjoys reminiscing her past. It is both her curse and treasure. It is her curse, because she can never reclaim her youth and freedom. She just keeps on replaying it as a narrative, which wears her children out. Her past is, furthermore, her treasure, because her memories remind her and the people around her that she was once a well-coveted and important lady, where she would receive seventeen gentlemen callers in a day. When she is not working at Famous-Barr showing brassieres, she is active in selling subscriptions to a magazine that respond s to female visions of romance (Single 149). Tom uses particular images when describing his mother; one is related to Amanda's romanticized past, and the other is the image found in a glamour magazine cover, which is a superficial image masking their family's dysfunction (Single 149). Williams depicts Amanda as trapped in the past, but pragmatic about the present and the future. As the author describes Amanda, â€Å"She is not paranoiac, but her life is paranoia† (Tischler and Bloom). Amanda is possessed with girlish manners, but she has a pragmatic view of her children’s future. She refuses to know it, but she knows Laura will never marry. She then tries to put Laura in the business world and enrolls her in a school for typing lessons. Unfortunately, Laura is too shy to finish the typing test. Amanda then rallies for the courageous, but bleak, attempt to find a gentleman for Laura. When this fails too, it is a more tragic event for Amanda than Laura. It seems that she has somehow transfixed her dreams of a good life on her daughter. Laura deals with Jim’s rejection quite maturely, which underlines who is more mature in the family. It is not Tom or Amanda, but the one who is considered the most delicate and helpless, Laura. Amanda also pressures her son to work hard for the family. In a quarrel with Tom, she scolds him: â€Å"

Business legal issues. Brandon Burton, Leslie Gaines, Eric Essay

Business legal issues. Brandon Burton, Leslie Gaines, Eric Defrancisco, David Butler, Sanjeev Dube - Essay Example In this case, the mention of his disability as a concern may be construed as prejudice against the physically disabled as a class. The discrimination is made more apparent by the fact that the position being applied for is a managerial one, a job that requires more of mental skills rather than physical capabilities. There may be instances, however, when it is proper to express concern that physical disability may get in the way of the discharge of the duties of the position. When the job requires physical dexterity and the application of manual skills, then clearly the situation of a paraplegic will be a hindrance to the discharge of the function. There are many such instances when the specification of physical attributes for a particular job is accepted as normal and regular, such as requiring airplane attendants to be of a certain minimum height to be able to reach overhead baggage compartments, or ballet dancers to be male to fulfill a particular dance role. Ethnicity or racial or igins may sometimes be necessary for assignment in certain parts of the world, to reduce the threat of personal risk to the individual, or to increase the company’s acceptance in that culture. ... (2012). â€Å"Dallas company sued for disability discrimination.† Retrieved from: http://www.houstonemploymentlawattorney.com/2012/06/dallas-company-sued-for-disability-discrimination.shtml Response to the post of Student 2: Leslie Gaines Reading through the original report of the case, it is mentioned that the company believes the claims to be baseless, â€Å"but will investigate them thoroughly.† What is happening in this case, or at least what the company wants to portray, is that the assignment of non-whites to lower-paid â€Å"back of the house duties† (if it is true) is the decision of the local branch management and is not a policy of top management. In either case, the company has a duty of restitution to the non-whites, not only in monetary terms, but in terms of restoring their dignity and self-esteem. Then if indeed the branch management is culpable, then they should be dealt with by the top executive, together with articulation of a clear statement ag ainst discriminating practices (Daft & Marcic, 2012). It is clear that the company does not claim that the restaurant is trying to maintain a high-end image so it does not assign non-Caucasians as servers; it is the plaintiffs who allege this (Wildeboer, 2012). Had this been the defense of the firm – that it seeks to maintain an image – then it would be tantamount to an admission, and the force of the law should be brought to bear upon it for racial discrimination. Nor does the report say the 26 plaintiffs were qualified. If they are, the firm should be held accountable by the principle of command responsibility. However, it must first be proven that there are and have been absolutely no non-white servers, and that all non-whites, despite being qualified for the front-end, are summarily

Germany 1933-1945 Essay Example | Topics and Well Written Essays - 250 words

Germany 1933-1945 - Essay Example Out of this development, Hitler eventually came to power in 1933 and provided the resources for his own ambitions. From this year until 1938, his government would be preoccupied with anti-Jewish policies and legislations. The so-called â€Å"Jewish question† has been the obsession of the Fuhrer and would remain up to the last moments of his life. As he took the reins of power, Hitler was able to immediately launch a genocidal policy against the Jews. This went unopposed in Germany throughout Hitler’s regime because his philosophy based on volkisch and biological racism was what united Germany under one banner and community. It empowered the state to pursue its aggression and European expansion. The war against the Jews eventually evolved into a multi-dimensional, considered process that embraced different tactics and distinct phases of driving the Jews out of the country, which finally involved the occupation of Europe, as countries refused to accept them as refugees. (Landau, p. 117) From a legal war of attrition against the Jews, it would escalate into a full scale global military conflict lasting from 1939 to

Moral Permissibility of Deriving Stem Cells from Surplus Embryos Essay

Moral Permissibility of Deriving Stem Cells from Surplus Embryos - Essay Example One way to cure this disease is by transplantation of the pancreatic islet cell, the availability of the donated organs is very less for transplant. The stem cells if are induced to differentiate into functional islet cells in the lab, they may form a renewable source for transplantation, allowing this cell-based treatment to become available on a practical scale. (Mastroieni, n.d.) "Recent reports suggest that one of the most promising potential treatments may come from the use of stem cells, undifferentiated cells that can be coaxed into becoming insulin-producing islet-like cells that reduce diabetes symptoms in mice." (Mastroieni, n.d.) Spare embryos, the principal source of embryonic stem cells, are the unavoidably surplus unions of sperm and egg produced in fertility clinics. The embryos are often stored for years and ultimately discarded (Wade, 1999). Then it should not be a problem to use these spare embryos as they will ultimately be discarded anyways. One of the basic arguments for the moral permissibility of the use of these embryos are that the cost of destroying them is far less than the cost of the personal, social and economic costs of the diseases that these stem cells can cure. They can not be equaled to human life, even though they are living things. Some embryos do not even implant after conceived. In some countries it is legal to have an abortion; here the embryo is anyways going to waste. It would be better to utilize these embryos for research and cures rather than just throwing them. Embryonic stem cells can treat a larger number of diseases because they have greater plasticity, and divide more rapidly than adult stem cells. The embryo is taken before the primitive streak is formed. Until then it can be one individual which can separate into two and become twins, or it can be two embryos which can combine and form into one. Thus taking an embryo at this time does not account it as a human being. The number of people affected by diabetes alone is 190 million people around the world. This disease can lead to death and serious complications are common. These stem cells have the ability to cure many diseases not just diabetes. Another thing to keep in mind is that if it were so wrong, the government would never allow research to happen on such things in the first place. Women who give their surplus embryos are not forced into doing so. Rules can be introduced to control the process so that misuse of these embryos does not take place. One such law suggested by Louis M. Guenin is, "The government shall support biomedical research using human embryos that, before or after formation, have been donated to medicine under donor instructions forbidding intrauterine transfer." This way the donor has full control over what happens with the embryos even after it is implanted into another human being. The arguments against the moral permissibility of deriving stem cells from surplus embryos are that some of these embryos may be helpful during research but when used on actual human beings could be dangerous. Apart from this there may be genetic side effects because of manipulation. An example is the recent successes in reprogramming skin cells by fusing them with embryonic stem cells leave scientists wondering whether the genome of the original somatic cell might be 'contaminated' by the embryonic stem cel

The Generation Gap Essay Example for Free

The Generation Gap Essay As generations come and go, they each possess individual values, attitudes, and goals that strike them apart from other generations. A gap has always been noted between the current generation and the others before it. Acting like a barrier, it keeps the different generations distinct. A number of factors play a role in the creation of this barrier. The previous generations have played a big role in shaping the newest generation by offering more help to them. Also, the newest generation seems to have developed a different attitude about and approach to life. My generations attitude about life is very unique compared to the attitudes of other generations. Laziness, selfishness, and greed have infected my generation. Since previous generations have made life so much easier for us, many do not truly appreciate it and take it for granted. Many lack the value of hard work and achievement. Also, they have this mentality that they can do anything they want without consequences or punishment. It seems many members of my generation are under this false illusion. This attitude sets a distinction between my generation and the others. The last key factor that makes my generation different is their open-mindedness. The older generation seems to be more closed minded to different ideas and viewpoints, while my generation seems to embrace them. The previous generations have stricter mindsets about intimacy, homosexuality and interracial relationships, they seem to stay strong to what values they have learned and stick with them no matter what, while my generation seems to question such values and learn to form opinions themselves. All of these elements show how different my generation is compared to other generations that came before us and how it is evolving from the previous ones.

Crisis of Low Morale in Nursing Staff

Crisis of Low Morale in Nursing Staff Introduction of Firm This case study describes Los Rayos a medical center that is in a nurse crisis not only for their high turn over rate but for their low morale among its nursing staff. Although the hospital works diligently to provide quality care to its patients it is failing in many areas due to understaffed and overworked nursing staff. Mandated to keep up government regulations, the hospital understands the importance of not compromising quality even though it has had to minimize quantity in staff. The hospital requires nurses to come up with strategies to be implemented to help improve not only working conditions and quality control but patient care and ideas to help increase personal job performance. Over the last eight years the hospital has enforced some of the changes suggested but it finds itself still with the issue of nurses who feel that they are overextending themselves. Nursing staff is still in the position of trying to keep up with the demand of continuous educational conditioning an d development while performing on the job tasks in addition to extra curricular activities. Overview of Firm Competitive Advantage In order to have a firm competitive advantage an organization has to possess something unique that its competition does not have. What makes one different from another? This question is what separates groups and classes and makes one stand out among the rest. At Los Rayos they have qualified staff just not enough of it. Partnering with another major medical facility was a good business move as it can serve the purpose of showing Los Rayos ways it can improve on its functions within the facility. A normal turnover rate for hospitals is at 14% while Los Rayos is at 21%. Changes in an industry can affect bases and balance among it (Porter, 1985). Job satisfaction will make the difference on the advantage another medical facility will gain when nurses are looking upon where they would like to settle for a career. Some nurses will take a salary cut or drive further in order to work within a medical facility that offers them more than an opportunity to use their credentials. As the medical environment is forever changing one thing that may give a hospital a firm competitive advantage would be their values. Having an expectation of learning within the organization lets nursing staff know that they will be encouraged and required to continue to advance in their field and stay current on all resources and advancements in medicine. Having a competitive advantage means that you make it more difficult for competition and shake up the level playing field. According to Michael Porter (1985), if an organization can achieve and maintain differentiation they will be an above average performer in their industry and exceed competition. In order to be successful in this strategy Los Rayos will have to identify attributes and qualities among their nursing staff that are different from their rivals who are the organizations who benefit from their high turnover rate. They need to identify the factors that contribute the turnovers and come up solutions to keep nursing staff from leavi ng and also keep staff happy on the job. Problem statement The problem with Los Rayos medical facility is management does not resourcefully use staff, which leads to a high number in turnovers. The facility is understaffed and overworked and they promoted housekeepers to health techs and provided no skill training leaving nurses to double work as they would need to perform the patient care tasks that the health techs: were promoted to do. The hospital also dropped moral amongst staff as they took away appreciation events such as the employee picnic and Christmas party that gives staff something to look forward to every year. It is highly noted that when employees feel they are appreciated on the job it reflects in their job performance. The hospital reduced its nursing staff to double patients per nurse and increased shifts from 8 hour to 12 hour. This tedious and exhausting work schedule not only creates a hostile work environment as staff are reluctant to go the extra mile or over achieve for patients and colleagues. The hospital requires a lot from its nursing staff and where a raise or an on the job leisure activity would have compensated for the tedious job detail, management has taken those tokens away. Alternative Solutions/Opportunities a.) Create a rewards system to retain staff -there should be a work environment where staff have materials and training to properly perform tasks and should be awarded for productive performance. Evaluations should be done quarterly on staff to review job performance and adhere to what can be done better but also praise what has been done successfully. During this process not only is staff being rewarded for their accomplishments but also they acquire new knowledge and education that helps expand their skill and personal development. i) Build moral in the workplace ii) Cause discord among staff b.) Regular Shifts- Staff has become overwhelmed by the hours they spend on the job. If they had shorter shifts they would have time to reprogram and detox and come back refreshed eliminating turnover and burnouts i.) Gives staff a chance to unwind from a days work and not have to report right back for duty ii) Staff may call out or take more time off with shorter shifts Decision and Support In order to create a work environment that constantly develops nurses skills so that they can efficiently perform job tasks management needs to create a rewards system to help retain staff. Management has to recognize the nurses core commitment is to provide quality care to their patients and they need to help reduce job related stress by ensuring that supporting staff such as health techs are properly trained and skilled in work related duties. Nurses need to feel important, valued, and appreciated by their organization, as they love their job and they just want working conditions to improve. Action Plan Moving to implement the rewards system and shorter shifts for staff should take place immediately to ensure that staff understands management understands their concerns and have worked to rectify their issues. To implement successful changes, management must play an active role in the entire change process. It is the managers responsibility to understand how to address and put the change into action along with properly overseeing resistance from the staff. It is the managers responsibility to understand how to address and put the change into action along with properly overseeing resistance from the staff. Identifying potential risks, anticipating risks, estimating impact of risks, and managing risks successfully are all accomplishments and work towards building moral and retention. Scundra (2016) explained the importance of leaders understanding how to deal with different people and personalities hence the importance of the quarterly evaluations so management can provide feedback to each nurse and staff member personally. Once nursing staff feels compensated for their diligent work they will be eager to preform on the job and happy to work at Los Rayos now and in the future. REFERENCES Drucker,P. (2009). Management Cases.New York, NY. Harper Collins Publisher Porter, M. E. (1985). Competitive Advantage . Creating and Sustaining Superior Performance , 1-30. Retrieved January 22, 2017. Sacndura, T. A. (2016). Essentials of Organizational Behavior. Thousand Oaks, CA: Sage Publications.

Chronic Obstructive Pulmonary Disease Case Study

Chronic Obstructive Pulmonary Disease Case Study CASE STUDY : COPD This piece of work will explore the comprehensively physical examination, differential diagnosis and various diagnostic tests to confirm the disease condition that is CHRONIC OBSTRUCTIVE PULMONARY DISEASE. It will then move further to discover the comprehensive treatment plan and present a argument on an excellent method to treat the disease condition on the basis of current evidenced based studies. The actual name of the patient is replaced with another name so as to retain confidentiality (Dimond, 2002). Mr.X is a 58 year retired office manager came to the emergency ward with his son. He had chief complaints of difficulty in breathing, severe cough, weakness and was feeling discomfort. Patient general appearance shows that he is weak, sitting in high fowlers position, respiring through pursed lips. Suggest that this type of breathing is the indication of emphysema. Pursed lip breathing helps in emitting the air which is trapped in the lungs and limits the force for taking breath (Rik Gosselink, 2003). History taking and proper investigations are the two main components for confirming the disease condition. Complete history is essential to determine the exact etiology of shortness of breath that includes past history of asthmatic attack, family history of asthma, occupational history, present history of smoking, alcohol intake, medication history, episodes of cough whether it is productive or not, presence of any heart problems (Walsh, 2008). COPD develops due to the lack of alpha one antitrypsin hereditary factor. Furthermore the occupational hazards along with genetic factor deteriorate the condition. So detail history collection including all the aspects is significant (Yohannes and Hardy, 2003). History of patient reveals that patient was a chronic smoker from the past 20 years and consume near about twenty cigarettes every day, although patient left smoking 6 months ago his smoking history provides estimation of 20 packs a year. Moreover COPD is more prevalent in patient who consume 20 packs of cigarettes in one year (Georgios et al, 2004). However there are various other diseases that occur due to cigarette smoking such as cancer, heart diseases, pulmonary diseases, influenza, pneumococcal, meningococcal, tuberculosis etc (Arcavi and Benowitz, 2004). Also patient is not able to perform daily activities due to shortness of breath and cough with sputum production. These symptoms are quite common in carcinoma of bronchus, however difficulty in breathing, cough and sputum production are also main clinical symptom of COPD (Pauwels and Rabe, 2004). Moreover, history of the client indicates that plentiful production of sputum for more than three months for two years which shows t he presence of chronic bronchitis (GOLD, 2008). Patient is also not able to sleep during night. Awakening during night which occurs by shortness of breath reveal presence of congestive heart failure or asthma (Price, 2010). Complaints of patient we loss of weight, fatigue, chest tightness due to severe episodes of cough, disturbance in sleep. Dietary history shows that patient is non vegetarian, family history does not provide any significant data. Client having age more than 40 and have sign and symptom such as formation of sputum, difficulty in breathing, history of cigarette smoking and any inhalation of noxious fumes and chances of occurrence of COPD is more at the age above 40 ,therefore patient is believed to have COPD (Vestbo, 2010). Although all the sign and symptom of the client signify that patient is suffering from COPD still functional diagnosis is necessary to confirm the exact diagnosis and proper physical assessment is necessary to confirm the diagnosis (Ferrara, 2011). In high risk cases of COPD proper cardinal sign, body mass index, height and weight of the patient is to be notified as component of assessment (Stockle, 2007). The vital sign of patient are blood pressure:124/76mmHg, height: 174cm, rate of respiration: 20/minute, temperature: 98.2F, Weight: 56kg and body mass index is 19kg/m2. During inspection it is observed that shape of chest of patient is barrel and patient respire with the help of accessory muscle which indicates presence of emphysema (Smeltzer et al, 2009). This less amount of air in the lungs causes disturbance in breathing pattern (Celli, 2007). This alteration in shape of chest shape occur due to the decrease in flexibility of lungs muscles and therefore extra energy is required for this forceful type of breathing as a result client is not able to eat in adequate manner and loosen the weight (Smeltzer et al, 2009). Percussion indicate presence of tympanic resonance that occur because of less motion of diaphragm and presence of wheezing sounds indicating COPD (Celli, 2007). Auscultation indicate that there is extended forced expiratory pattern due to the decrease in air in the lungs. Congestive heart failure or lung fibrosis is differentiated from COPD on the basis of wheezing sound and presence of ronchi. Club shape finger of patient may indicate the presence of other disease condition such as cancer of lungs, bronchiectasis, and pulmonary fibrosis. The skin mucosa of the client is bluish which signify that less of oxygen in blood (American thoracic society, 2004) . Physical assessment of respiratory system does not provide the relevant and valid information for the detection of disease condition but related co morbid state and differential diagnosis are well judged with the help of thorough examination (Mcivor et al, 2004). However the decrease in flow of air in lungs is not predicted with the help of history collection and general assessment. Therefore pulmonary functional test such as spirometry is useful in diagnosing COPD (Travers et al, 2007). Furthermore for identification and confirmation of the COPD and its progress level can be easily identify with the help of spirometry (Stoloff, 2011). COPD is well detected with the help of satandarized device that is spirometry however this device is inconsistent in clinical area (Gold, 2008). Spirometry reading of patient reveals that FEV1/FVC is 56% , this value is less than 70% and it is categorize as stage two that is moderate. However spirometry is not believed to be valid tool for the evaluati on of broad category of airflow obstruction diseases (Borg, 2010, American Thoracic Society, 2004, GOLD, 2008). But provision of bronchodilators are beneficial in diagnosis of asthma and COPD and determine the limit of flow of air that is not reversible fully. Still the exact value of reversibility that helps in judging the patient asthmatic or COPD pdiseases is not known. However differential diagnosis of COPD can be clinically evaluated and also can determine by various non invasive procedures (Vestbo, 2010). Chest radiography is useful technique in excluding various differential diagnosis such as pneumothorax, chronic heart disease, pneumonia (Man et al, 2004). Therefore, to clear out the differential diagnosis, a proper clinical examination and simple investigations including chest radiography could resolve uncertainty if any (Vestbo, 2010). Radiography of chest mostly exhibit clear interstitial markings in patient with chronic bronchitis however there is no particular outcomes that provide evidence that radiography is beneficial for the diagnosis of COPD or Chronic bronchitis (Kane Graham, 2004). In the patient, chest radiography reveals that lung field is hyper distensded, diaphragms are flattened and retrosternal space is more which is the sign of emphysema. Moreover determination of various changes in lungs in case of emphysema can be determined with the help of superior type of chest film (Vestbo, 2010). However with the help of chest x ray it is not possible to detect initial stages of COPD (Gold, 2008). Therefore high resolution Computed tomography is used for identifying emphysema in the initial stages. Moreover the lesions in the lungs can be identifying with the help of high resolution computed tomography (HRCT) without any trouble (Gold, 2008). There are various other diagnostic test which are helpful in COPD confirmation with more accuracy such as arterial blood gas analysis, cardio pulmonary exercise test (GOLD, 2008). The presence of pulmonary emphysema and various other alternative diseases such as asthma and other minor airway diseases can be determined by the value of total lung capacity and diffusing capacity for carbon monoxide(Vandevoorde, 2006) suggest that through examination of blood gas, saturation of oxygen in blood, blood perfusion is determined (Smeltzer et al, 2009). (also supported that arterial blood analysis in moderate and severe cases of COPD should be performed (Vestbo, 2010). However this test is not is not a reliable test to confirm COPD but in high risk cases of emphysema this test is helpful to know hypoxemia (Travers et al, 2010). Value of ABG analysis of patient was PH-7.30, Pao2-84mmHg, Paco2-48mmHg, HCO3-25mg/dl and Sao2 94% Haemoglobin level of patient was 13.4 mg/dl . Chronic Obstructive Pulmonary Disease is the disease of respiratory system that causes non reversible and progressive decrease in pulmonary function (Higginson, 2010). The air flow is not proper in lungs due to this reduction of lung function. The diseases it includes are bronchitis, asthma and emphysema. It effect more than three million people in England. (Jones, 2001) In the Western World, the main cause of COPD is smoking, smoking is related with over 90% of this disease, however COPD occurs in merely 10% to 20% of chronic chain smokers. (Beyer et al, 2008)Respiratory illness is also occurred by passive smoking. (Higginson, 2010) Genetic factor is also responsible for yhe occurrence of COPD however there is only one genetic factor alpha antitrypsin that involes in causing this disease. The lack of this genetic factor is the single major risk factor for the occurrence of this disease. Though determine in only one percemt cases of COPD. Contact with noxious substances is the most c ommon cause of COPD. (Yohannes and Hardy, 2003) There are various diseases in childhood such as pneumonia and whooping cough prior to the age of 12 year are considered to be the risk factor of bronchiectasis and bronchiolitis. Females are at high risk of COPD than man however argues that there is no difference in occurrence of COPD in male and females (Lindberg, 2006). The progress of the disease inside body is mostly described by the inflammation that involve central and peripheral airways. By the inhalation of the noxious substances or irritants , inflammation occurs in the central airway. Due to this soreness , there is more secretion of mucus that damage the ciliary clearance. As a result the glands of the mucus turn into large size and therefore more production of mucus take place due to more amount of goblet cells. This increase production of mucus provides an brilliant medium for the growth of microorganism cause the impairment of airway. Repeated infection causes damage to cilliary body and further inflammation. This progression leads to constriction of airway . Following obstruction trapping of air inside lungs occurs that result in hyperinflation, difficulty in breathing and less tolerance to exercise. The chronic obstruction diseases are chronic bronchitis, emphysema (Higginson, 2010). For the appropriate management of COPD, holistic approach must be taken in account (Paul, 2004). Individually management plan must be made that covers the essential components such as termination of smoking, dietary management and function of lungs should be maintained by medication therapy. Instant treatment in emergency unit is started with the provision of oxygen and sometime bronchodilator may be beneficial to find out reaction to the treatment (Gold, 2008). Moreover administration of oxygen helps in treating hypoxemia and hence improves breathing problem (Downs Appel, 2007). However excess utilization of oxygen may lead to withholding of carbon dioxide level in lungs. So it should be provided with cautious (Kevin, 2007). Patient was provided with oxygen therapy for short duration, the partial pressure of oxygen of the patient is 74% so there is no requirement of oxgen for long term (Gold, 2008). Drug therapy is beneficial for the treatment of COPD and it is provided according to the seriousness level of disease condition (Incalzi et al, 2006). In mild COPD cases, short acting beta 2 adrenoceptor agonists is advised whereas in moderate and severe cases long acting beta 2 adrenoreceptor agonist are recommended. Moreover anti cholinergic is beneficial and easily bearable in older people. Pharmacotherapy is essential in relieving the various symptoms however there is no medication that reveals long lasting improvement of lung function (Gold, 2004). Suggest that with the combination of different drug therapy can give better result and reduce the harmful effects as compared to large amount of single dosage. The preference of different bronchodilators depends upon, accomplishment of desired reaction and ill effects (Downs Appel, 2007). Suggest that due to very few harmful effects and less dosage requirement, inhalation route is chosen for treatment (American thoracic society, 2004) . The widely used short acting beta agonist are salbutamol, terbutaline, pirbut erol and salmeterol, formoterol are the long acting beta agonist also methylxanthines such as theophylline , antichollinergic and inhaled corticosteroid are commonly used that are beneficial in reducing m mucus secretion in airway (Nazir and Erbland, 2009). Pharmacotherapy in the patient was begin with the administration of combined therapy of salbutamol of dose 50Â µg with ipratropium 20Â µg. these are the bronchodilators which is provided with the help of inhaled and injection of theophyllin also administered through intra muscular route. There are some other drugs that are beneficial in severe stage such as antioxidants and immunoregulators (Gold, 2008) Improper nutrition in COPD patient is quite general and it has harmful influence on the pulmonary functioning. So helping the client in maintenance of adequate nutrition level is important and beneficial in improving the respiratory functioning (Shepherd, 2010). Moreover the client whose BMI is less than 21 kg/m2 should be given supplementary diet in order to improve condition of client further (Vermeeren et al, 2001). However age associated alteration in structure, height, muscular changes and if value of BMI is more than also malnutrition cannot be identified (Shepherd, 2010). In patient BMI is in normal category instead patient is advised to take adequate calories, carbhohydrate and proteins in diet. Patient is also advised to avoid caffeine, restrict sodium and taking more milk. The other preventive measure is vaccination of influenza. It has much influence in prevention of various acute respiratory illnesses along with COPD. This type of vaccination must be advised to each patient suffering from COPD (Wongsurakiat, 2004) . Patient who is moderate or severe deterioration of lung function then pulmonary rehabilitation is beneficial to gain maximum functioning to manage with disease condition. Patients are motivated to do different types of exercise to keep body healty Such as steps up, walking , various arm exercises, self handling of various activites such as taking medication, that helps in keeping the function of different system appropriately. Also exercise for decreasing hyperinflation and manage dyspnoea such as deep breathing and pursed lip is advised to the patient (Barnett, 2008). Moreover advantages of rehabilitation of lung fuction maintain for numerous months even after the end of this program (O` Donell, 2007) . COPD is the most prevalent problem that effect mostly elderly people. The mai symptom of COPD is shortness of breath, production of cough with sputum. The main cause of occurrence of this disease is cigarette smoking. History taking and physical examination is beneficial in excluding all the differential diagnosis. Through spirometry diagnosis of COPD can be made. Pharmacology is helpful in controlling the further spread of disease but medication does not provide efficient result in long term care. CASE STUDY ON SPINAL CORD INJURY This case study will throw light on the complete physical examination and diagnostic test and a range of laboratory investigation to confirm the diagnosis. It will then undergo detail treatment plan along with differential diagnosis to explain the appropriate intervention on the basis of present evidence sources. Also it will explore the recent issues regarding care of spinal cord injured patent. The actual name of the patient is changed in the study so that data cannot be recognized (Dimond, 2002). Mr. Malik Aggarwal is a 21 year old student studying in University of Greenwich doing mastering in marketing. During summer break in France, Malik was struck with an motorbike accident. During accident he fall harshly on the footpath from his bike and was lying towards his abdomen . This accident was witnessed by the policeman and he quickly gave call for first aid management. Ambulance was arrived soon and emergency staff identify the severity of Malik injury, they protect the neck of the victim with the help of strong board and immobilize the part before transferring him to the emergency department of the closest hospital. Patient was awake and also familiarized with current date, day and location. He was also replying in well manner. After reaching hospital, he complained of loss of feeling on his both legs, severe pain in neck, mild pain on his back and all extremities, patient was not able to move his neck and lower extremities properly. The assessment was carried out by the eme rgency specialist staff, and found that there were contusions and lesions present on his trunk and lower extremities, the restriction of the neck was rapidly maintained by the staff with the help of firm cervical collar. In order to limit further deterioration of condition, patient was supported with cervical traction and head was also supported with motion restricted devices that are helpful in maintaining proper alignment (Grubb, 2006) . The cardinal signs were checked and indicate that patient has Blood pressure of 100/70, pulse rate: 90/minute, respiration: 20/mt, temperature: 98.4 F and oxygen saturation was 90%. During history collection main emphasis should be given on complete mechanism that how the injury took place, this data is confirmed from the witness and also who is present at the time of accident to so as to proceed accurately towards confirmation of diagnosis (Schreiber, 2009). Other physical and social factors should be noticed that may interfere with the proper assessment of pain (Cruz-Almeida, 2007). Moreover complete history plays an important role in knowing possible etiology of different symptoms and also helps in excluding differential diagnosis. Proper pharmacological history , family history and dietary history should be taken because it might be beneficial in knowing the disease (Cox, 2008) . History collection of patient reveals that patient was anxious and had complaint of pain at the site of neck. The constant pain occur due to the contraction of muscles of neck muscls. There were presence of mild lesions on the trunk and extremities. Therefore it might be the case of injury on cervical cord because continual pain is the indication of spinal cord injury (Lee and Ostrander, 2003) . The exact cause of injury is the extreme flexion of head towards the chest that is due to hyperflexion. Moreover if the main reason of spinal cord injury is hyperflexion or hyperextension then it might be the case of spinal cord injury (ElFaramawy, 2009). Client gave appropriate reaction to each question during history taking , this shows that patient has good level of consciousness. As patient vital sign indicate that patient has hypotension, low respiratory rate and decrease in temperature. The one reason for the occurrence of hypotension might be the interference of vagal and symphathetic vascular tone (Karlet 2001). The client symptoms of hypotension, bradycardia indicates that it might be due to neurogenic shock (McLeod, 2004). After the collection of data it is essential to carry out physical assessment by covering all the aspects. Adequate Physical assessment is the basis in determining the injury related to spinal cord (Bono and Lee, 2004). Moreover physical examination especially of neurological system is beneficial in gathering the baseline data. The main section in neurological examination include will be cranial nerves, sensory and motor function and also reflexes (Noah, 2004). Assessment take place by mkaintaing proper interpersonal relationship with patient. While doing inspection assess for the mental condition, intellectual and cognitive response of the patient (Crimlisk, Grande 2004). Assess for the posture of the patient, if posture maintained by patient is decerebrate thenit may indicate trauma in the midbrain. With the help of Glasgow coma scale, level of consciousness should be assessed and also this scale is beneficial in determining the sensory, motor and verbal response. However the response through this scale is not satisfactory in determing the verbal function (Iyer, 2009). Assess for the extremities for spasticity, presence of weakness, flaccidity as these are the significant mark of damage to neurologic system and also assess for the pronator drift which signify hemiparesis (Crimlisk and Grande, 2004). In the patient, level of consciousness through Glasgow coma is assessed and it is found to be 13 which is normal(Iyer, 2009). Inspection of the patient indicates that there is presence of abrasions on the body and he has difficulty in breathing which is indicated from the use of accessory muscles. This data may be crucial in determine that damage occur in between C3 and C5 vertebrae (Walker, 2009). Neck and trunk should be properly palpated as it is helpful in determine any kind of defect in the neurological system. Palpation should be done in an appropriate manner starting from the cranium and regularly descending along the vertebral disc. On palpation of patient there is feeling of rigidity of muscles of cervical and tenderness. So there are chances of cervical injury (Noah, 2004). Diagnosis of spinal cord injury is based not just on history collection and examination infact complete neurological examination and radiographic studies are essential for the confirmation of diagnosis (Berney, et al 2011) . Spinal nerve assessment should be done with the help of hammer that should be strike beneath the knee. Striking causing sending of nerve impulse and thigh muscles contracted due to this flow of nerve impulse. If there is no contraction of muscles then it indicates there is distruption in the pathway and some sensory or motor deficit. In patient there was mild contraction of muscle fibre indicate neurological deficit(Cox, 2008). After that cranial nerves should be assessed by various method such as recognization of smell, assessment of the vision through snellen chart, assess for speech ,facial expression, assess for optic fundi with the help of opthalmoscope, if there is presence of papilloedema it may be the case of increase intracranial pressure. In patient all the cranial nerves are intact and also no papilloedema is present which exclude the diagnosis of increased intracranial pressure (Cox, 2008) . Patient motor and sensory function is determined by the American Spinal Injury Association (AISA) impairment scale. In this scale sensory deficit and motor impairment is recognized with the help of broad categorization. In the patient the strength of elbows, wrist was normal, the stretch of the biceps and triceps was also normal. The response of the patient towards light touch and pin prick was normal up to the inguinal area however due to weakness of lower limbs, the response of lower extremities was not adequate indicate sensory deficit due to spinal cord trauma (Dodwell, 2010) . However the proper alignment of the vertebrae and recognizing of fracture cannot be possible with such scale so for that radiography is essential (Sheerin, 2005). The radiography is beneficial in determine the fracture of thoracic vertebrae, it gives reliable information but it is not useful in case of cervical vertebrae as these vertebrae are to small to be visible appropriately in radiography (Jorge, 2009). Radiography of the patient provide inadequate data as the film was not properly clear. The deep examination of displacement of bone segments and fractures is possible with the help of computed tomography. The CT scan is beneficial in visualization of the image in different cross section (Jorge, 2009). It is possible to get exact information regarding injury of bone with the help of CT scan and radiography films however the injury to the soft tissue on the cord, intervertebral disc then these diagnostic test does not provide complete information regarding soft tissues (Sheerin, 2005). The CT scan of patient exhibit that injury take place at the level of C5 spine. Magnetic Resonance Imaging is helpful in visualization of injury that occurs on soft tissues by providing well clarify image. The further deterioration and injury that occur due to soft tissues is clearly recognized with the help of MRI (Sheerin, 2005). The MRI of patient shows that there is no soft tissue injury. Functional studies such as positron emission tomography, electromyograms are not of use in case of conscious client. They are only essential in patients who are not cooperative (McDonald and Sadowsky, 2002). From the above history collection, physical assessment, various diagnostic test it is clear that client has cervical injury at the level of 5 intercostals vertebra. Spinal cord is the basic part of central nervous system. It consists of thirty one segments. However due to the fusion of coccygeal bones there are 30 segments in vertebral column (Sheerin, 2004). Spinal cord has two region that is cervical and lumber and it is consist of grey matter (Sheerin, 2004). Approximation of 500 to 700 people each year suffers from traumatic spinal cord injury in UK. The main aetiology of spinal cord injury is straight mechanical injury and injury develops due to the compression on cord (Pellatt, 2010). This compression develops from traumatic and non traumatic reason (McDonald Sandusky, 2002). Due to this overstress of cord, intense flexion, extension or rotation develops. If injury develops due to direct force then within little duration discharge of enzymes from cells and vasoactive substance take place. After that neutrophills and macrophages infilterate in that region. The amount of potassium in extracellular fluid boost up and cells become depolarized and result in hypoxic conditions. Where as in case of indirect cause, vascular system compromised causing lack of blood supply in tissues. Which further leads to development of various haemorrhages, due to this haemorrhages the endothelium of blood vessels become disrupted. Further development of aneurysms occurs causing thrombi development in blood vessels. Due to stimulation of vagus nerve, imbalance thermoregulation develops and because of dermal blood vessel dilatation various life threatening sign and symptoms are developed such as neurogenic shock due to vasodilatation (McDonald and Sadowsky, 2002). There are also development of various syndrome such as anterior cord syndrome which occurs due to the injury to the two third of spinal cord in the anterior side, and next is the posterior cord syndrome that occurs due to the injury to the two third of spinal cord in the posterior side (Bailes et al, 200) . Central cord syndrome mainly occupies the cervical part of spinal cord. This syndrome usually influence elderly people and develop cervical spondylosis due to hyperextension. This spondylosis and hyperextension injury together put compression on the anterior and posterior side of cord. Due to which ligament turn towards inner side and put force on the anterior horn cells. This will further causes development of oedema (Bailes et al, 200) . Management of the patient begins from the site of the accident. First priority of the management is the maintenance of the airway, breathing and circulation. Oxygen therapy helps to prevent hypoxic conditions along with that oxygen therapy stop secondary injury that occurs due to the hypoxic conditions. For maintain airway jaw thrust method should be used chin lift method should be avoided as this may deteriorate the neck by extension (Pellatt, 2010). Immediately stabilization of spine must be maintain with the help of stiff cervical colour. The client must be positioned on hard board so as to maintain proper alignment. If there is requirement of intubation then it should be maintained with the help of three people without mobilizing the patient. However immobilization is not as important as the oxygen therapy because death of the patient may take place due to development of encephalopathy in hypoxic condition (Sheerin, 2005). After the confirmation of diagnosis, drug therapy should be started without any delay. Currently this drug therapy is recognized as basic treatment and helps in limiting secondary damage due to hypoxic condition. Steroid treatment must be started immediately. Methylprednisolone is more preferable. The amount needed for this drug is 30mg/kg in 15minutes, subsequently 5.44mg/kg/hr within 24 hours. Steroid treatment helps in improving neurologic deficit through blood flow toward central nervous system. However this drug is helps in only protection of neurological function and also use of elevated amount this drug result in side effects such as gastric bleeding and infection of wound (Weant, 2008). Further supporting, this drug is usually beneficial within 8 hours of injury. Also in the study organized by the researcher in random controlled trial to see the impact of nimodipine and methylprednisolone on patient with spinal cord injury in acute phase is that both the drugs produce side e ffects and these drugs are not of much beneficial (Pointillart, 2000). Also respiratory and cardiovascular function should be adequately maintained in spinal cord injury. Excessive damage if occur by spinal cord injury has remarkable effect on respiratory system. Mostly colloidal solutions maintain pulmonary wedge pressure. (Nockels, 2001) Moreover due to spinal cord injury the tidal volume generated by accessory muscles is not adequate and result in further damage to pulmonary function so there is need of maintainence of respiratory function. Also hypotension may develop in patient as a result of neurogenic shock. Therefore it is essential to check blood pressure and average arterial pressure should be more than 85mmHg. However if blood pressure is too low than it can be managed with the help of vasopressin agent such as dopamine (Sheerin, 2005). Mr. Malik was provided oxygen about 2 litres/min so as to maintain proper perfusion. Pulse oxymetry was continued and part

Genetic Engineering and Developing Countries Essays -- Biotechnology S

The genetic engineering of foods has been the subject of much controversy since its first appearance in the mid 1980’s. As scientists began to learn more about genetically engineered foods and the benefits of such foods, their potential also began to be realized. Developing countries, because of poor nutrition, would benefit the most from modified foods. Millions of people in developing countries die each year form lack of nutrition and hundreds of thousands go blind. Overpopulation is another problem facing developing countries and without food and nutrients survival will be tough. Alternately, there exist genetically modified foods, which can supply these poor nations with the proper nutrients and agricultural knowledge to prevent any nutritional and overpopulation problems from occurring. Many benefits can come from genetically engineered foods on top of aiding developing countries. Humans need to get over the fear f genetically engineered foods and start to utilize biot echnology in everyday life. One suggested use of genetically engineered foods would be to aid developing countries that are struggling because of a lack of proper nutrients in their diets and overpopulation. A shocking statistic is that over 13% of the worlds population does not receive enough nutrients to prevent malnutrition and vitamin A deficiencies. Another horrifying statistic is that by the year 2020 the world population will exceed 7.5 billion people with 98% of the increase coming from less developed countries (Mary Arends-Kuenning and Flora Makundi â€Å"Agricultural biotechnology†). Supplying enough food to not only feed the growing number of people but to also provide tem with enough nutrients might seem impossible, but with the use of genetic en... ...esistant genes, scientists can enable farmers to flourish on land considered to be not farmable. Humans need to embrace biotechnology in order to secure their future. By implementing this policy an effort will be made to ensure that all future food and nutrition needs will be met. Also, healthier, faster growing foods will benefit, not only less developed countries, but also the developed world. This technology has not yet been introduced to most crops but hundreds of millions of people need this technology now and can no longer wait for regulations and speculations. As Neal C. Stewart et. al. state, â€Å"the key is to determine the importance of the risks as weighed against the benefits†(836). Undeniably, the benefits certainly outweigh the risks. Humans must not fear genetics and must also embrace this technology, which is the future of all food production.

Antigone :: Free Essay Writer

Antigone The characters in the play Antigone all suffer a downfall of some sort. The major characters suffer the most, though. In this short essay, I will document on how the two main characters, Creon and Antigone, both inevitably become tragic heroes. The first example that I observed in Antigone was her self-righteous plight to bury her brother. She believes that what she is doing is right, and that she will do it no matter what the consequences, because he was her brother, her blood. This establishes the first part of a tragic hero, the part about doing something for the good of someone else, rather for than the greater glory of doing it. The first impression that Creon made upon me was his stern, ironclad manner and ethical code. When the reader is first introduced to Creon, his or her first impression is that Creon will eventually die, as the villain does in nearly any play, movie, novel, etc. But in actuality, Creon suffers the most of all, losing his one key to immortality, his son. I ruled out that Antigone probably was a tragic hero to a lesser extent, however, when she started to question her actions. A real hero of any sort always does what they think is right. Since Creon still hadn't changed his mind at that point, I was perplexed on who would become the one who regretted their actions later, and was eventually going to experience a catharsis. Haimon was the "silent" tragic hero of the play, suffering at the hands of his strict father. Haimon remained loyal up to a certain point, until the question of whether Creon's decision was possibly the right one. Haimon established himself as a tragic hero when he tried to kill Creon in revenge for Antigone's suicide. Haimon not only lost Antigone's love, he lost his life. Earlier, I mentioned Antigone's self-righteousness. Creon had an egotistical point of view as well. Antigone thought at first that her actions were justified and righteous when it came to the question of morals and ethics. Creon was not at all different, believing that his way was the "right" way, or the way the "Gods" would have chosen. Both realized the mistake they made, and regretted it later, when it was too late. Creon certainly suffered the most, losing three of his immediate family, the unmentioned being his wife. But to say that Creon is the only tragic hero in the play is extremely naive and shortsighted.

The Effect of Humour in Galloway’s the Cellist of Sarajevo

People of all ages and cultures respond to humour. Riddles and jokes have been told for centuries to make light of situations and to make people laugh. Humour is the tendency of particular experiences to provoke laughter and provide amusement. People are able to be amused, laugh, or smile at something funny, and therefore they are considered to have a sense of humour. To find something humourous depends on the person and their taste in humour and there are many instances when humour does not result in laughter because of the mood of the surroundings or the context. Humour is an emotion that enables us to experience joy even when faced with adversity. It can be seen that in Galloway’s The Cellist of Sarajevo, humour is used in a dark way to lighten the mood. This is done so that the readers have glimpses of light in a dreary time. Humour helps people, in this case the characters, carry on their lives in times of adversity. Galloway uses the lives of Kenan and Dragan to exemplify how humour, in the slightest form, can make a dreary day a little more pleasant. Through examining the life of Kenan, a middle aged man, it will be proven that humour has an important role in his daily life. Kenan has the duty of carrying canisters to the brewery to bring clean, filtered water for his family and Mrs. Ristovski, the neighbour. Before the war, Kenan was a clerical assistant at an accounting firm. His journey to the brewery is very risky because at any point he may be shot; therefore, humour has a huge impact in the way Kenan presently lives his life. Before Kenan leaves his house his wife and him joke about their clothes: â€Å"Would you like me to get you some shoes?†¦ No, she says. But I’ll take a hat if you have time†¦ Of course, he says. I would assume you would like mink? † (Galloway, 26). At a time of war, fancy clothes will not benefit either of them, but he leaves his wife in a good mood. Amila and Kenan use light humour to make a dark situation a little easier to bear. Another example in which Kenan uses his humour to make his grey, dreary journey a little more pleasant is when he walks across an older man fishing for pigeons: â€Å"How’s the fishing today? Kenan asks, †¦ They’re biting well, the man says, †¦ Do you need a licence this time of year? e asks, smiling so the man understands it’s a joke† (Galloway, 64). Seeing the man fishing for pigeons was a brief distraction for Kenan and also a window of hope; with seeing the man, Kenan felt that if he could finish his mission of collecting water for his family, he could also fish for pigeons to help his family. The humour is light; it makes the reader pause, and makes the characters forget about th eir surroundings and just smile. Kenan made slight of the situations he faced so that he can smile, and make it seem that life will carry on with the war. Just as Kenan used humour in his life, Dragan, previously a baker does the same to fill the void of his missing son and wife who left on the last bus to Italy. Dragan now lives with his sister and her family, and to have his space he goes to collect bread from the bakery for the family. While on his journey he has seen many men and women running to cross roads so that the snipers have less probability of hitting them. Dragan likes to see the running as a game: â€Å"The man runs in a straight line. He’s fast. A new world record? Maybe. Perhaps they will have to notify the people at Guinness† (Galloway, 230). Dragan uses sarcasm to make an almost dangerous situation seem funny since the civilian has survived. Dragan likes to see things for what they are, and to make the most of a situation. There is no need to focus on the bad when there is also much to be grateful for. Just like Kenan, Dragan does face a lot of danger and hardships with dealing with the loss of his family, but his humour and sarcasm seem to help him push through and carry on with his life. Dragan uses his wit make it through the tough and challenging times, especially since he has no one by his side. Although Galloway’s The Cellist of Sarajevo is about a devastating, tragic time in history, he manages to use humour in the characters to lighten the mood of the book. By examining how Kenan and Dragan use humour, it has been shown that humour assists in fighting adversity. No matter what situation the character was faced with, they still had their humour, and as long as their sense of humour was alive, their sense of hope would live. As the humour helps the characters in the novel, it also makes the readers have something to tone down the darkness and despair of reality of the war. All persons are different and have appeal to a different sense of humour, but as long as there is something to put a smile on one’s face, then there is something worth fighting for. Works Cited Galloway, Steven. The Cellist of Sarajevo. Toronto, Vintage Canada, 2008 â€Å"Humour. † Wikipedia: The Free Encyclopedia. Wikimedia Foundation, n. d. Web. January 30, 2010

A Review of the Role of Soluble Fiber in Health with Specific Reference to Wheat Dextrin

journal of international checkup look into http//imr. s advancepub. com/ A round of the character reference of disintegrable eccentric in health with Specific Reference to stalk Dextrin JL Slavin, V Savarino, A Pargondes-Diaz and G Fotopoulos Journal of housemanational Medical Re take c ar 2009 37 1 DOI 10. 1177/147323000903700101 The online version of this article tin stinkpot be engraft at http//imr. sagepub. com/ substance/37/1/1 publish by http//www. sagepublications. com Additional services and nurture for Journal of interneational Medical reticuloendothelial systemearch sess be found at Email Alerts http//imr. agepub. com/cgi/alerts Subscriptions http//imr. sagepub. com/subscriptions Reprints http//www. sagepub. com/journalsReprints. nav Permissions http//www. sagepub. com/journalsPermissions. nav Version of Record Feb 1, 2009 What is This? Down hinderanceed from imr. sagepub. com by knob on March 27, 2013 The Journal of International Medical reticuloendothe lial systemearch 2009 37 1 17 A review of the region of spicy- dis meltable roughage in Health with Specific Reference to chaff Dextrin JL SLAVIN1, V SAVARINO2, A PAREDES-DIAZ3* 1 AND G FOTOPOULOS4Depart manpowert of sustenance Science and victuals, University of Minnesota, St Paul, Minnesota, the States 2 Depart handst of Internal practice of medicine, Gastroenterology Unit, Genoa, Italy 3Novartis Consumer Health, Parsippany, pertly Jersey, the States 4Novartis Consumer Health, Nyon, Switzerland dextrin, based on a search of PubMed. The read suggests that meltable characters inspection and repair to regularize the digestive corpse, whitethorn growing micro aliwork forcetary submersion, arouse course glucose and low-spiriteder blood serum lipids, whitethorn prevent several botch uptrointestinal disorders, and seduce an veritable intention in the ginmill of cardiovascular indisposition.It is concluded that accessory with disintegrable graphemes (e. g. straw dextrin) whitethorn be efficacious in individuals at seek of a move than recommended regimenetic persona expenditure. ACIDS f aretic case is widely recognized to eat a near use of right-hand(a)s and services in e realplace every last(predicate) health, moreover only at adequate levels (25 38 g/ twenty-four hour period for powerful adults). Wheat dextrin in situation is a fat- water supply- meltable quality that batch easily be added to the food and is widely used in the food industry. in that location is close to debate about whether affix inhalation of dis alcohol- dissolvable graphic symbols trains to health benefits.This writing look backwards the secernate regarding the physiological do and authorization health benefits of the addition of fat- alcohol-soluble nourishmentetical roughages, with detail reference to straw key fruit WORDS SOLUBLE FIBER stubble DEXTRIN SHORT-CHAIN FATTY PHYSIOLOGICAL fixS swellheadness BENEFITS PREBIOTICS Introduction fictitious character, the indigestible part of limits such(prenominal) as grains, fruits and vegetables (Table 1), has a fundamental role in the regulation of the digestive system and whitethorn abet to prevent hard disorders such as damage,1 3 dissipation4 6 and vexatious gut syndrome. 9 Fiber may in any case dish to charm the assimilation of micronutrients,3,10,11 stabilize glucose12 14 and cholesterin levels,15 17 be fork over a role in cardiovascular health18 20 and perchance table service to prevent some miscellanys of tail assemblycer. 21 23 *Current address 90 Possum Way, tonic Provilairce, NJ 07974, USA. numerous sustainment and healthcargon professionals use the name soluble and insoluble references for viands labeling. 24 27 meltable references usher out in water and usu tout ensembley form a gel.They ar every twenty-four hour periodly fermented by bacterium in the write down intestine, but they are ind igestible and hence non absorb into the linestream. 24,28 Soluble parts likewise ferment to form all of a sudden-chain bufflehead harshs (SCFAs) such as butyrate, ethanoate and propionate (Table 2). 17,29 34 Short-chain butterball social sicknesss ingredientrate roughly 1 2 kcal/g of ingested fictional character, so are used as an vitality author by the intestinal Down pointed from imr. sagepub. com by lymph node on March 27, 2013 1 JL Slavin, V Savarino, A Paredes-Diaz et al.The health benefits of soluble role remit 1 compartmentalisation systems for persona based on quaternion different vul washbasinized fount characteristics viandsary references Lignin (polyphenolic compound, in cell walls of woody plants and seeds) Cellulose (glucose polymer, in all plant cell walls) ? -Glucans (glucose polymers, in oats, barley) Hemicelluloses (polysaccharides, in plant cell walls) Pectins ( muggy polysaccharides, in fruits and berries) Gums (viscous polysaccharides, in seeds e. g. uar mutter tree) Inulin and oligofructose (mixture of fructose chains, in plants such as onions) reticuloendothelial systemistant starch (starch in plant cell walls inaccessible to serviceman digestive enzymes often found in bananas and le put ones may withal be formed by food processing) Soluble theatrical roles Wheat dextrin ? -Glucans Gums (e. g. cluster bean chewing glue, in fulfilly hydrolyzed cluster bean gum) Mucilages (e. g. fleawort) Pectins Fructo-oligosaccharides whatever hemicelluloses Sources oat products, legumes (dry beans, peas, lentils) fermentable graphemes Wheat dextrin Pectins ? Glucans cluster bean gum part hydrolyzed guar gum Inulin and oligofructose Sources oats, barley, fruits, vegetables Viscous theatrical roles Pectins ? -Glucans Some gums (e. g. guar gum) Mucilages (e. g. fleawort) Functional roles reticuloendothelial systemistant dextrins (e. g. chaff berry dextrin) (indigestible polysaccharides formed when starch is heated and hard-boi guide with enzymes includes resistant maltodextrins) Psyllium (viscous mucilage, isolated from stalkings of psyllium seeds as well known as ispaghula husk) Chitin and chitosan (nondigestible scratch from exoskeletons of crustaceans, e. . crabs, lobsters deacetylation of chitin gives chitosan, a nondigestible glucosamine polymer) Fructo-oligosaccharides (FOS, short semisynthetic fructose) Polydextrose and polyols (synthetic polysaccharides used as bulking agents and peag substitutes in foods) Insoluble roles Cellulose Lignin Some pectins Some hemicelluloses Sources pale yellow bran, some vegetables Non-fermentable characters Cellulose Lignin Sources cereal references rich in cellulose (e. g. husk bran)Non-viscous fictional characters Cellulose Lignin Some hemicelluloses mucosa and are absorbed through the colonic wall, where they are metabolized to produce nix or transported into the agentral circulation. 29 SCFAs also harass epithelial cell differ entiation and proliferation. 29 Soluble vulcanized lineaments can also promote the ontogeny of colonic Downloaded from imr. sagepub. com by leaf node on March 27, 2013 2 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble graphic symbolTABLE 2 Short-chain roly-poly caustics (SCFA) produced by fermentable, soluble grapheme17,29 34 Butyrate widely recognized as the near perspicuousiary acid in terms of its record rigs in the colon The best-loved nutrient for the cells lining the colonic epithelium, in particular the distal colon and rectum The preferred substratum for colonocytes Positive nubs on colonic mucosal growth, crypt cell proliferation, and early- solvent gene expression Acetate A give the sack for skeletal and cardiac muscle, kidney and the brain A substrate for fertile acid and cholesteroid alcohol synthesis Propionate Metabolized by the colored further SCFA that can be a major source of glucose (after transfiguration, used for postcode getup signal) whitethorn bleed a role in cholesterin cut downing bacteriuml phytology (prebiotic assemble). 35 37 Insoluble character references, on the former(a) and, do not dissolve in water, are slackly less(prenominal) fermentable by colonic microflora and are indigestible,26 so pass through the intestines almost intact. Insoluble fibers take a leak passive water-attracting properties that suspensor to familiarize mountainous gut thing by acting like a sponge, pulling water into the fanny and make it easier to pass. 38 They may also return intestinal transit judgment of conviction, extend faecal load through bulk litigate, live on glucose compactness and encourage to hold and sense of balance the pH in the intestines. 39,40 In the USA, the fooling inhalation recommended by the American fodderetic tie (ADA) is 20 35 g fiber/ call back solar mean solar twenty-four hour period for healthy adults, and age plus 5 g/ daytime for childr en. 6 The sphere Health judicature (WHO) recommends 25 g/day,41 speckle the British fodder Foundation recommends 12 24 g/day for healthy adults. 42 The victuals and nourishment Board of the shew of Medicine established the Adequate usance (AI) recommendation for fiber (both soluble and insoluble),24 which ranges from 19 to 38 g/day for children, depending on age, and from 25 to 38 g/day for healthy adults. The majority of people, however, do not seem to achieve the recommended day-to-day uptake of fiber, and women in commonplace seem to call for put down cores than men. 43,44 Wheat dextrin is a soluble fiber that has been widely used in the food industry because it has a low viscosity and so has a good consistency when added to water, beverages or yielding food. 4 It is formed by heating pale yellow starch at graduate(prenominal) temperature, followed by enzymatic (amylase) treatment to form a resistant starch. 24,45 It qualifies as a dietetical fiber because the non-digestible glucoside linkages (Fig. 1) lead to incomplete hydrolysation, so that only a downcast character of straw dextrin is absorbed in the micro intestine and the rest is windyly fermented in the overlarge intestine. 3 This go over aims to assess the evidence regarding the physiological personal sums and latent health benefits of supplementing the diet with soluble fibers, with specific reference to wheat dextrin. Data source The PubMed database (US depicted object Library Downloaded from imr. sagepub. om by client on March 27, 2013 3 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber CH2OH O OH O OH O CH2OH O OH HO O CH2 O OH O OH O OH CH2OH O OH O OH CH2OH O OH OH O OH OH O OH O OH HO 12 flummox O O CH2OH O OH CH2OH O O OH OH O OH 13 bond CH2OH O OH O CH2 O OH O HO CH2OH O OH 16 bond O CH2 O H2 C O O CH2OH O CH2OH O OH O HO OH see to it 1 Chemical structure of wheat dextrin of Medicine, National Institutes of Health, Bethesda, MD , USA) was searched (to July 2007) using the terms wheat dextrin and soluble fiber, and studies were selected based on whether they evaluated the physiological or clinical outlets of soluble fibers.Although this non-systematic approach limits the go over in that a numerical analysis was not performed, it does furnish a general and potentially expedient overview of the effects of appurtenance with soluble fibers. physiologic effects of soluble fibers FERMENTABILITY In vitro fermenting of wheat dextrin, inulin and part hydrolysed guar gum (PHGG), and analysis of the sequeling SCFA production over a 24-h period17 revealed that all three fibers demo perceptible fermentability. Acetate was the main SCFA produced by all fibers, accounting for about 50% of the core SCFA. Over 24 h, wheat dextrin produced advantageously more than constitutional SCFA, propionate and butyrate than PHGG, which systematically showed tear down fermentability at all time points (Fig. 2A 2C).To n ullify gunslinger production (which can be socially undesirable and cause awkward bloating), extensive zymolysis at 24 h is desirable, small-arm fast zymosis (e. g. full(prenominal) nourishs at 4 h) may be undesirable. The sum message amount of SCFA produced by wheat dextrin at 4 h was just over half(a) the amount produced by glucose Downloaded from imr. sagepub. com by knob on March 27, 2013 4 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber A assiduousness (mol/ml) long hundred nose candy 80 60 40 20 0 B immersion (mol/ml) 16 14 12 10 8 6 4 2 0 0 4 8 12 quantify since run of fermentation (h) 24 0 4 8 12 Time since bug out of fermentation (h) 24 C Concentration (mol/ml) 45 40 35 30 25 20 15 10 5 0 0 4 8 12 Time since start of fermentation (h) 24 Wheat dextrin PHGG Inulin F97 GlucoseFIGURE 2 Analysis of short-chain fatty acid (SCFA) production following in vitro fermentation of wheat dextrin, partly hydrolysed guar gum (PHGG) inul in and glucose ( substantiating aver) over 24 h (A) do SCFA production (B) butyrate production and (C) propionate production17 (positive control) and almost half the amount produced by inulin at the same time point (Fig. 2A). The fermentation of wheat dextrin, therefore, occurred tardily over 24 h, so its inspiration was less likely to response in the gas production that can occur as a impart of rapid fiber fermentation. composition towards a more full distribution. 17,46 For example, the consumption of fructo-oligosaccharides led to an add in faecal bifidobacteria,36,47,48 tour inlet of polydextrose resulted in a dosedependent drop in bacteriodes and an change magnitude in beneficial lactobacilli and bifidobacteria. 49 Administration of PHGG for 3 hebdomads qualifying magnitude the Lactobacillus spp count in feces. 0 usance of wheat dextrin led to a lower colonic pH, an amplification in the faecal concentration of glucosidases, a statistically crucial increase in the beneficial lactobacilli people and a statistically monumental light in pathogenic Clostridium perfringens. 35 In an early(a) memorise, wheat dextrin change magnitude the faecal concentration of glucosidase45,51 change magnitude glucosidase use is considered beneficial to the host and is linked to substrate fermentation guide to more SCFAs and lactic acid production. PREBIOTIC EFFECT The SCFAs produced by soluble fermentable fibers are moderately muscular acids (pK 4. 8)29 and so they lower colonic pH. heavy the pH in the large ntestine may body forth the growth of bifidobacteria and lactobacilli because they have a strong intrinsic resistance to acid and the lower pH may help to prevent the growth of pH-sensitive pathogenic bacteria such as clostridia. 30 umpteen soluble fermentable fibers have process a prodigious prebiotic effect and deviate the intestinal microflora Downloaded from imr. sagepub. com by invitee on March 27, 2013 5 JL Slavin, V Savarino, A Pa redes-Diaz et al. The health benefits of soluble fiber EFFECT ON LAXATION AND REGULARITY The establishment of SCFAs helps to purify shitting and order by increasing faecal bulk and pitching and increasing the waterholding capacity (and thus the hydration) of feces. 0,46 The increase in fecal bulk and metric exercising weight unit results from the presence of fiber, the water that the fiber holds and the partial fermentation of the fiber, which increases the amount of bacteria in the feces. 52 Studies have actualizeed that consumption of the soluble fibers inulin or oligofructose result in an increase in fecal weight,53 musical composition inulin helped to abbreviate constipation2 and polydextrose change magnitude fecal push-down store and sometimes raft absolute absolute oftenness. 49,54 Consumption of psyllium world-shakingly change magnitude stool frequency and stool weight, change magnitude stool water content, change stool consistency, change magnitude th e frequency of intestine movements and minify pain on defecation. 55 59 Wheat dextrin significantly change magnitude dry fecal outfit by 70% (P 0. 02) and nonsensical fecal yield by 45% (P 0. 05) (Fig. 3). The increase in wet fecal rig was due to increased dry motion produce (38%) and increased water output (62%). IMPROVED NUTRIENT/MINERAL assiduousness Although dietetic fibers are traditionally suasion to devolve mineral ducking, animal models and valet de chambre studies have show that soluble fermentable fibers come to the fore to increase the absorption of received minerals. 3,10,60 62 For example, soluble fibers may increase calcium absorption through the increased production of SCFAs, with an increase in the villus crypt height, effect of epithelial cells per crypt, cecal vein period and mucosal-to-serosal calcium fluxes and stimulation of the expression of calbindinD9K, thereby enhancing the active calcium transport route. 3 Soluble fibers may also incre ase the absorption of other minerals such as milligram, surface and exhort. 3,10,11 Studies in rats showed that the absorption of calcium, magnesium and/or zinc may be enhanced by guar gum,64 inulin,10,65 oligofructose65 and PHGG. 11 In healthy men supplemented with both wheat dextrin or dextrose (100 g/day), wasting ailment of wheat dextrin significantly increased magnesium apparent absorption (50. 9%, P = 0. 001) and computer storage (30. 9 mg/day, P = 0. 024) and tended 80 P 0. 02 70 60 Increase (%) 50 40 30 20 10 0 Wet fecal output FIGURE 3 aftermath of wheat dextrin on fecal output3 Dry fecal output P 0. 05 45% 70% Downloaded from imr. sagepub. om by guest on March 27, 2013 6 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber (not statistically significant) to increase calcium apparent absorption (37. 4%) and memory board (111 mg/day) (Table 3). 3 prandial germ plasm glucose concentrations (13 mg, P = 0. 04) and a significant diminutio n in the urinary excretory product of glucose (P = 0. 008) compared with the low-fiber diet. 13 In fact, the effects of fiber on glucose concentrations are most evident in individuals with diabetes mellitus and it has been suggested that diabetics should toss off 25 50 g/day of dietetic fiber, with ? 55% of their calorie divine guidance coming from carbohydrate. 4 To assess the effect of fiber on the try for diabetes, more than 65 000 women (40 65 years of age) were followed for 6 years it was found that dietetic glycemic index and glycemic load were positively associated with the development of grapheme 2 diabetes, and dietetical fiber was inversely associated. 75 beyond the effects of fiber on post-prandial glucose and insulin, fiber alters the responses and actions of the gut hormones gastric inhibitory peptide,76 glucagon-like peptide177 and cholecystokinin (CCK). 78 CCK is a peptide hormone and neurotransmitter that regulates gut motility, irritate bladder contractio n and pancreatic enzyme secretion and may mediate the post-prandial glycemic and insulinemic response to viscous fibers. A direct correlation has been inform mingled with post-prandial CCK and internal satiety haemorrhoid following ingestion of foods with varying amounts of fiber. 79,80 trim GLYCEMIA AND INSULINEMIAThrough the production of SCFAs, soluble fibers can stimulate pancreatic insulin release and affect liver-colored control of glycogen breakdown,66,67 and so may be effective in lessen kind glucose and insulin levels and improving glycemic and insulinemic indices. 68 Guar gum,69,70 inulin12 and dextrin71 were all found to break postprandial glycemia. In healthy subjects, the glycemic index of wheat dextrin was 25% compared with dextrose and the insulin response with wheat dextrin was also low at 13% compared with dextrose. 14 Resistant dextrins led to trim down blood glucose concentrations and insulin secretion in rats after sucrose or maltose loading,72,73 rock -bottom the post-prandial blood glucose concentrations in healthy men and women,13 and significantly trim down self-restraint blood glucose concentrations in type 2 diabetics. 6 In patients with type 2 diabetes given a diet overlord (25 g soluble plus 25 g insoluble fiber) or low (8 g soluble plus 16 g insoluble fiber) in totality fiber, the mellowed-fiber diet resulted in significantly lower pre- TABLE 3 onus of wheat dextrin supplementation (100 g/day) on the absorption and retention of magnesium and calcium in healthy men3 Dextrose diet Calcium unmixed absorption, mean, mg/day (%) Retention, mean, mg/day Magnesium Apparent absorption, mean, mg/day (%) Retention, mean, mg/day 187 (28. 8) 39. 3 65 (30. 4) 0. 3 Wheat dextrin diet 269 (37. 4) 111 117 (50. 9) 30. 9 Statistical significance (P-value) 0. 093 0. 122 0. 001 0. 024 Downloaded from imr. sagepub. com by guest on March 27, 2013 7 JL Slavin, V Savarino, A Paredes-Diaz et al.The health benefits of soluble fiber REDUCE D CHOLESTEROL LEVELS The SFCAs can quash cholesterin synthesis by the liver and may suppress serum levels of curio lipoprotein cholesterin (LDL-C) and triglycerides. 81 Soluble, viscous fibers are also intellection process to exert their hypo cholesterinemic action by increasing fecal sterol excretion and stimulating hepatic insolence acid synthesis. 82,83 In a metaanalysis of 67 controlled trials, consumption of 2 10 g/day of fiber (i. e. pectin, oat bran, guar gum, psyllium) cut total cholesterol by 4% and LDL-C by 7% compared with placebo. 15 No significant effect was observed on serum high-density lipoprotein cholesterol (HDL-C) and triacylglycerol concentrations.A greater reduction in serum total cholesterol and triacylglycerol concentrations was also noted in type 2 diabetics who consumed 60 g/day resistant dextrin compared with type 2 diabetics or healthy adults who consumed 30 g/day. 16 No difference was observed in the concentration of HDL-C. A diet high in total f iber (25 g soluble plus 25 g insoluble fiber) led to significantly trim back plasm total cholesterol (P = 0. 02), very-low-density lipoprotein cholesterol (VLDL-C) (P = 0. 01) and triglyceride (P = 0. 02) concentrations compared with a low-fiber diet, indicating that high fiber divine guidance, specially soluble fiber, improves plasma lipid profile. 3 It has also been proposed that soluble fermentable fibers may lead to a reduction of cholesterol levels via the increased amounts of propionate produced during their fermentation by the commensal bacteria, because propionate may inhibit cholesterol biosynthesis. 84 Fibers producing high amounts of SCFAs (particularly propionate), such as wheat dextrin, may help to sustain cholesterol levels within the normal range. 17 The cholesterol-lowering effects of wheat dextrin have been demonstrated in animal trials. 85 The findings suggest that its cholesterol-lowering effect is likely to be related to go downd cholesterol and cheekiness s alt absorption. However, not all soluble fibers are hypocholesterolemic agents for example, oat bran has been shown to lower serum lipids while wheat bran did not. 81 IMMUNE FUNCTIONIt is possible that SCFAs help to improve immune procedure, as they stimulate the production of T helper cells, antibodies, leukocytes and splenocyte cytokines, all of which have a crucial role in immune protection. 86,87 In addition, SCFAs improve the obstacle properties of the colonic mucosal layer, thus inhibiting inflammatory and adhesion irritants. 88 90 Lactic-acid-forming bacteria competitively inhibit and/or mortify the growth of pathogenic bacteria, and may have a positive influence on immune suffice. 91,92 WEIGHT REDUCTION corpulency is associated with increased energy ambition and come down consumption of fiberrich foods,93 while fiber brainchild is inversely associated with be weight and consistence fat. 94 97 Increasing cursory fiber dream is an effective expressive style of providing a satiating effect. 8 dietetic fiber also strikes gastric emptying and/or slows energy and nutrient absorption (a fiber-rich meal, which is also usually richer in micronutrients, is processed more belatedly and nutrient absorption occurs over a greater period of time99), confidential information to lower post-prandial glucose and lipid levels. Furthermore, addition of dietetical fiber to a low-calorie diet has been shown to lead to a significantly greater weight release (8. 0 kg) compared with placebo (5. 8 kg). 100 When post-menopausal women consumed higher fiber diets, this was associated with significant weight loss. 101 A high Downloaded from imr. sagepub. com by guest on March 27, 2013 8 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber carbohydrate diet consumed ad libitum (i. e. elf-regulating), without energy restriction or change in energy brainchild, caused significant form weight and body fat losses in older men and wome n, with a significant decrease in thigh fat area (P = 0. 003). 102 A review of the effects of increased fiber (high-fiber foods or supplementation) on smart, satiety, energy inhalation and body weight revealed that controlled energy ambition with increased dietetic fiber led to an increase in post-meal satiety and a decrease in subsequent yearning. 103 With ad libitum energy intake, increased dietetic fiber (14 g/day) resulted in an middling 10% decrease in energy intake and 1. 9 kg weight loss over 3. 8 months of disturbance. The effects of increasing dietary fiber were reported to be greater in rotund individuals.When evaluating the effects of 1 week of supplementation with soluble fiber (guar gum, 40 g/day) on hunger, satiety rating and energy intake, mean day-by-day energy intake change magnitude significantly from 6. 7 to 5. 4 MJ, while hunger and satiety scores did not change. 104 long (4 5 weeks) judgment of wheat dextrin (30 or 45 g/day) supplementation demonst rated a trend towards better weight maintenance compared with baseline, body weight was increased in the control group supplemented with unmixed absorbable maltodextrin (+0. 87 kg P = 0. 07), whereas body weight remained stable in the wheat dextrin-treated groups (+0. 0 kg). 35 sometimes stool frequency. 9,54 Psyllium significantly increased stool frequency and stool weight, increased stool water content, ameliorate stool consistency, increased the frequency of bowel movements and reduced pain on defecation. 55 59 Administration of PHGG for 3 weeks increased the frequency of defecation (+0. 17 /day), increased fecal moisture (+5%) and decreased fecal pH. 50 Supplementation with PHGG also helped to reduce the use of evacuants (from an average of 2. 0 to 0. 2 doses/day). 105 Wheat dextrin (100 g/day) had a positive effect on fecal output in healthy men,3 with an average 45% increase in wet fecal weight (P 0. 05) and 70% increase in dry fecal output (P 0. 02) (Fig. 3). DIARRHEA I ncreased intake of soluble fiber may enhance recovery and improve stool consistency in play. ,5,106 109 Persistent diarrhea resolved in more children taking PHGG (84%) compared with those on the control diet (62%) (odds ratio 3. 12), while the term of diarrhea was reduced and there was a trend towards reduction in free-and-easy stool weight that reached significance on days 4 7. 6 Compared with non-fiber control in children, PHGG significantly reduced the mean frequency of diarrhea (8. 8% versus 32. 0% P = 0. 001), resulted in significantly less days with diarrhea per total nourishment days (10. 8% versus 31. 5% P 0. 001) and led to a significantly lower mean diarrhea score (4. 8 versus 9. 4 P 0. 001). 110 PHGG also suppressed diarrhea caused by the ingestion of high levels of non-digestible sugar substitutes. 11 In remote patients with diarrhea, 4-week supplementation with soluble dietary fiber (7 g/day) significantly reduced the water content of feces (P 0. 01), the fe cal pH (P 0. 05) and the frequency of nonchalant bowel movements (P 0. 05). 5 In addition, the fecal characteristics improved The role of soluble fiber in complaint CONSTIPATION Increased daily fiber intake can remediate constipation. 40,49,52 59 Consumption of inulin or oligofructose was shown to increase fecal weight,53 inulin reduced constipation2 and polydextrose increased fecal mass and Downloaded from imr. sagepub. com by guest on March 27, 2013 9 JL Slavin, V Savarino, A Paredes-Diaz et al.The health benefits of soluble fiber and the total level of SCFAs increased significantly (P 0. 05). 5 In patients with fecal incontinence, significantly a few(prenominal) incontinent stools were observed in those who consumed dietary fiber (psyllium or gum arabic) than those receiving placebo. 4 Improvements in fecal incontinence or stool consistency did not appear to be related to unfermented dietary fiber. However, the effects of increased soluble fiber on diarrhea are inconclus ive, as a meta-analysis of randomized, controlled trials found no evidence that dietary fiber was effective in treating diarrhea. 112 randomized studies would be useful to confirm the potentially beneficial effects of soluble fiber in IBS.DIVERTICULOSIS A diet low in fiber is thought to play a role in the pathogenesis of diverticular unsoundness. 114 Increasing dietary fiber produces bulky, soft stools, facilitating defecation and reducing intracolonic blackmail. 114 Increased fiber also helps to promote regular bowel function and is of import in imperious and minimizing diverticular illness. 115 117 Non-viscous soluble fiber is associated with a decreased run a take chances of diverticular disease and an expediency of bowel pain. 115 In patients with diverticulosis, it is recommended that patients consume 20 35 g/day of fiber either through the diet or supplementation. 118 IRRITABLE BOWEL SYNDROMETreatment for ill-natured bowel syndrome (IBS) is aimed at alleviating symp toms. In patients with batty symptoms, fiber supplementation (particularly non-gelling soluble fibers) may help to relieve the severity and frequency of IBS symptoms, including abdominal pain, spasms or distension/tension, bowel dysfunction (e. g. fluctuation between constipation and diarrhea) and flatulence. 8,9,113 PHGG was better tolerated than wheat bran and more pronto accepted by IBS patients, resulting in an improved quality of life during the treatment period. 113 PHGG also had a positive effect on evacuation frequency with a decrease in the frequency of IBS symptoms such as flatulence, abdominal tension and abdominal spasm. 13 Based on its physiological properties, wheat dextrin may also help to allay gastrointestinal symptoms associated with IBS through increased fecal output,3 enhanced prebiotic capabilities35,45 and significant but slow fermentation in the lower intestine, producing high concentrations of SCFAs but lower amounts of gas, which could be an important aspe ct in relieving the discomfort caused by IBS. 17 However, double- cheat, HEMORRHOIDS A low-fiber diet is thought to contribute to the etiology of hemorrhoids. 119 Increasing the fiber content in the diet can have a beneficial effect in the treatment of symptomatic hemorrhoids. 120,121 A recent meta-analysis demonstrated that increased fiber reduced the endangerment of bleeding and decreased the rate of recurrence of hemorrhoids,120 while a Cochrane review found that the risk of not improving hemorrhoids and having persisting symptoms decreased by 53% with increased intake of fiber, with a significant reduction in bleeding. 121CARDIOVASCULAR complaint A number of studies have consistently found that a fiber-enriched diet (14 g fiber/1000 kcal energy) is associated with a significant reduction (16 33%) in the risk of coronary spirit disease (CHD). 19,20,122 126 A pooled analysis of studies evaluating dietary fiber Downloaded from imr. sagepub. com by guest on March 27, 2013 10 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber intake in the USA and Europe indicated that each 10 g/day increase in total fiber intake was associated with a 14% decrease in the risk of coronary events (e. g. myocardial infarction), and a 24% decrease in deaths from CHD. 9 A count on the relationship between dietary fiber and risk of cardiovascular disease (CVD) among women over a 10-year period showed that the ageadjusted copulation risk for major CVD was 0. 53 for women devour the highest amount of fiber (22. 9 g/day) compared with those on the lowest fiber intake (11. 5 g/day). 125 Although few interventional studies have specifically assessed fiber intake on the risk of CVD, increased fiber has been shown to ameliorate some of the risk factors for CVD (e. g. high cholesterol levels, high blood wedge, corpulency and diabetes). For example, fiber can significantly reduce blood cholesterol levels and so may be important to cardiovascular health . 5,16,81,127 devour foods rich in viscous soluble fibers has been shown to reduce blood levels of LDL-C by 10 15%, with an expected reduction in CVD events of 10 15%, and it has been stated that a diet including 5 10 g/day of viscous soluble fiber reduces CVD events and death independent of baseline risk. 18 Although the cholesterol-lowering effect of soluble ( in particular viscous) fibers probably contributes the most to its cardioprotective effects, other mechanisms are likely to play a role. As part of a lifestyle accommodation chopine, fiber can help to reduce blood insisting significantly,128 supporting research that found that highfiber intake was inversely associated with the risk of high blood pressure or high blood pressure. 129,130 Two intervention trials found that increased fiber intake resulted in significant reductions in blood pressure compared with placebo. 31,132 In an analysis of the connectedness between nutrient intake and risk of stroke, dietary fiber was inversely gibe to the relative incidence of stroke, a relationship that was stronger in hypertensive than normotensive men. 133 Fiber is also effective at reducing the risk of diabetes and, thus, the risk of developing CVD, and can improve glycemic and insulinemic indices12,14,69 71 and decrease blood glucose and insulin levels. 13,16,72 Lowfiber, high-glycemic load diets are associated with higher serum triglyceride levels and lower HDL-C levels, which are risk factors for CVD. 134,135 Increased fiber consumption may also help control body weight and support a weight reduction program by helping to reduce obesity and, possibly, the associated risk of CVD. 94 104 Safety aspects of fiber supplementationReduced absorption of trace elements has traditionally been proposed as a potential negative effect of dietary fiber intake136,137 however, it is unbelievable that healthy adults who consume fiber in amounts within the recommended ranges will have problems with nutrient absor ption. In fact, clinical data demonstrate that soluble fibers (e. g. inulin, fructo-oligosaccharides, wheat dextrin) may positively affect the absorption of definite minerals. 3,10,11,64,65 excitement of dietary fiber by anaerobic bacteria in the large intestine produces gas (including hydrogen, methane and carbon dioxide), which may be related to complaints of distention or flatulence, especially with high intakes of fiber. An increase in dietary fiber should also be accompanied by an increase in facile intake, and fiber should be increased in stages to allow the gastrointestinal tract time to adapt.Normal laxation may be achieved with relatively small amounts of dietary Downloaded from imr. sagepub. com by guest on March 27, 2013 11 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber fiber, and the smallest intake that results in normal laxation should be used. 138 Nevertheless, wheat dextrin has been shown to be well tolerated even up to the re latively high intake of 45 g/day. 51 Higher daily intakes (60 and 80 g) resulted in greater flatulence (P 0. 05) and some bloating compared with placebo, but no intake resulted in diarrhea. fiber can have beneficial effects on constipation, diarrhea and the symptoms of IBS.Soluble fiber also has additional positive effects on cardiovascular health, tip to a significant risk reduction of CHD. Thus, this review of the physiological effects and subsequent health benefits of soluble fibers suggests that daily fiber supplementation could be beneficial in those individuals who are at risk of inadequate fiber in their diet. Most servings of common foods contain between 1 and 3 g of dietary fiber so it may be difficult to consume the recommended amounts of fiber. dietary assessment programs can estimate fiber intake for different population groups, allowing the identification of groups that have deficient fiber intake.At an individual level, fiber intake can be generally estimated based o n servings of fruits, vegetables and whole grains having 2 g of dietary fiber per serving, and servings of legumes having 5 g of dietary fiber per serving. get a line from high-fiber cereals or fiber supplements can be added to these totals. Wheat dextrin is one example of a soluble fiber supplement that has been shown to help normalize bowel function and is well tolerated, even at large intakes. It is slowly but extensively fermented, leading to a significantly high production of SCFAs, while its slow fermentation profile could help minimize the undesirable effects of gas production and flatulence. Wheat dextrin has also demonstrated enhanced prebiotic capabilities when used at an intake of 30 45 g/day.Based on its physiological properties, supplementation with wheat dextrin should be useful in individuals that need to complete their dietary intake with a fiber in order to achieve the daily recommended dietary levels of fiber. Conclusion Review of the evidence indicates that sol uble, fermentable fibers, including wheat dextrin, have positive physiological effects that may help to improve bowel regularity and result in some health benefits. Soluble fibers are fermented in the large intestine, leading to the production of SCFAs that lower colonic pH and result in a significant prebiotic effect in which the growth of beneficial intestinal microflora (e. g. ifidobacteria, lactobacilli) and fecal glucosidase concentrations are increased, while the growth of pH-sensitive pathogenic bacteria (e. g. clostridia) is prevented or suppressed. In this way, SCFAs could promote normal bowel regularity and may help to reduce serum glucose and cholesterol levels. SCFAs also positively influence the absorption and retention of accepted micronutrients (e. g. calcium, magnesium, zinc), and may improve immune function by stimulating the production of immunoprotective factors (e. g. T helper cells, antibodies) and improving the barrier properties of the colonic mucosal layer. Soluble fibers that are slowly yet extensively fermented in the large intestine (e. g. heat dextrin) are tolerated more easily than those that ferment quickly, as the last mentioned can produce larger amounts of gas in a shorter period of time, leading to bloating and flatulence. By improving digestive balance, regularity and hydration in the gut, soluble Downloaded from imr. sagepub. com by guest on March 27, 2013 12 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber Acknowledgments Editorial support was given by Deborah Nock, DPP-Cordell Ltd, Saxthorpe, UK. Funding for the review was provided by Novartis Consumer Health, Nyon, Switzerland. Conflicts of absorb Alberto Paredes-Diaz and Grigorios Fotopoulos were Novartis Consumer Health, employees at the time of manuscript preparation.The other authors had no conflicts of interest to declare in relation to this article. Received for publication 8 September 2008 Accepted subject to revision 9 Septem ber 2008 Revised accepted 11 December 2008 Copyright 2009 business line House Publishing LLP References 1 cummings JH The effect of dietary fiber on fecal weight and composition. In CRC vade mecum of dietetic Fiber in forgiving feed (Spiller GA, ed), 2nd edn. Boca Raton CRC Press, 1993 pp 263 349. 2 Kleessen B, Sykura B, Zunft HJ, et al make of inulin and lactose on fecal microflora, microbial occupation, and bowel habit in elderly constipated persons. Am J Clin Nutr 1997 65 1397 1402. Vermorel M, Coudray C, Wils D, et al Energy value of a low-digestible carbohydrate, NUTRIOSEFB, and its impact on magnesium, calcium, and zinc apparent absorption and retention in healthy young men. Eur J Nutr 2004 43 344 352. 4 Bliss DZ, Guenter PA, Settle RG defining and reporting diarrhea in tube- ply patients what a mess Am J Clin Nutr 1992 55 753 759. 5 Nakao M, Ogura Y, Satake S, et al Usefulness of soluble dietary fiber for the treatment of diarrhea during enteral nutrition in eld erly patients. Nutrition 2002 18 35 39. 6 Alam NH, Sarker SA, Bardhan PK, et al partly hydrolysed guar gum supplemented comminuted chicken diet in resolved diarrhoea randomised controlled trial. flex Dis nipper 2005 90 195 199. Giaccari S, Grasso G, Tronci S, et al Partially hydrolyzed guar gum a fiber as coadjuvant in the irritable colon syndrome. Clin Ter 2001 152 21 25. 8 Bijkerk CJ, Muris JW, Knottnerus JA, et al Systematic review the role of different types of eccentric in the treatment of irritable bowel syndrome. nutrify Pharmacol Ther 2004 19 245 251. 9 Aller R, de Luis DA, Izaola O, et al personal effects of a high-fiber diet on symptoms of irritable bowel syndrome a randomized clinical trial. Nutrition 2004 20 735 737. 10 Coudray C, Rambeau M, Feillet-Coudray C, et al dietetic inulin intake and age can significantly affect intestinal absorption of calcium and magnesium in rats a stable isotope approach. Nutr J 2005 4 29. 1 de Cassia Freitas K, Amancio OM, Ferre ira Novo M, et al Partially hydrolyzed guar gum increases intestinal absorption of iron in growing rats with iron wishing anemia. Nutrition 2003 19 549 552. Jackson KG, Taylor GRJ, Clohessy AM, et al The effect of the daily intake of inulin fasting lipid, insulin and glucose concentrations in middle-aged men and women. Br J Nutr 1999 82 23 30. Chandalia M, Garg A, Lutjohann D, et al Beneficial effect of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med 2000 342 1392 1398. Donazzolo Y, Pelletier X, Cristiani I, et al Glycaemic and insulinaemic indexes of NUTRIOSE FB in healthy subjects. dietary Fiber 18 21 May 2003 abstract.Brown L, Rosner B, Willett WW, et al Cholesterol-lowering effects of dietary fiber a meta-analysis. Am J Clin Nutr 1999 69 30 42. Ohkuma K, Wakabayashi S Fibersol-2 A soluble, non-digestible, starch derived dietary quality. In Advanced dietary fictitious character Technology (McCleary B, Prosky L, eds). Oxford Blackwell Scie nce, 2001 pp 510 523. Stewart ML, Savarino V, Slavin JL Assessment of dietary fiber fermentation effect of Lactobacillus reuteri and reproducibility of shortchain fatty acid concentrations. Mol Nutr Food Res 2009 53 DOI 10. 1002/mnfr. 200700523. Shamliyan TA, Jacobs DR Jr, Raatz SK, et al be your patients with risk of CVD getting the viscous soluble fiber they need? J Fam Pract 2006 55 761 769.Pereira MA, OReilly E, Augustsson K, et al dietetical fiber and risk of coronary heart disease a pooled analysis of cohort studies. Arch Intern Med 2004 164 370 376. Mozaffarian D, Kumanyika SK, Lemaitre RN, et al Cereal, fruit, and vegetable fiber intake and the risk of cardiovascular disease in elderly individuals. JAMA 2003 289 1659 1666. Wakai K, Date C, Fukui M, et al Dietary fiber and risk of colorectal crabmeat in the Japan collaborative cohort study. Cancer Epidemiol Biomarkers Prev 2007 16 668 675. Bingham SA, solar day NE, Luben R, et al Dietary part in food and protection against colorectal cancer in the European future investigating into Cancer and Nutrition (EPIC) an observational study. fishgig 2003 361 1496 1501. 12 13 14 15 16 7 18 19 20 21 22 Downloaded from imr. sagepub. com by guest on March 27, 2013 13 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber 23 Pelucchi C, Talamini R, Galeone C, et al type intake and prostate cancer risk. Int J Cancer 2004 109 278 280. 24 Institute of Medicine Dietary, functional, and total fiber. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, superfatted Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Washington, DC National Academies Press, 2005 pp 339 421. 25 Shikany JM, White GL Dietary guidelines for chronic disease prevention. South Med J 2000 93 1157 1161. 6 Marlett JA, McBurney MI, Slavin JL set up of the American Dietetic connexion health implications of dietary fiber. J Am Diet Assoc 2002 102 993 1000. 27 US Food and Drug Administ ration Health claims soluble fiber from certain foods and risk of heart diseases. Code of Federal Regulations 2001 21 101. 81. 28 Cho SS, Dreher ML (eds) Handbook of Dietary Fiber. New York Marcel Dekker, 2001. 29 cummings JH, Rombeau JL, Sakata T (eds) Physiological and Clinical Aspects of Short-Chain Fatty Acids. Cambridge Cambridge University Press, 2004. 30 Topping DL, Clifton PM Short-chain fatty acids and humankind colonic function roles of resistant starch and nonstarch polysaccharides. Physiol Rev 2001 81 1031 1064. 1 Wong JM, de Souza R, Kendall CW, et al Colonic health fermentation and short chain fatty acids. J Clin Gastroenterol 2006 40 235 243. 32 Drozdowski LA, Dixon WT, McBurney MI, et al Cellular proliferation and gene expression. J Parenter Enteral Nutr 2002 26 one hundred forty-five 150. 33 Vogt JA, Wolever TM Fecal acetate rayon is inversely related to acetate absorption from the human rectum and distal colon. Hum Nutr Metab Res Comm 2003 133 3145 3148. 34 K hattak MMAK Physiological effects of dietary complex carbohyd place and its metabolites role in certain diseases. Pak J Nutr 2002 1 161 168. 35 Pasman W, Wils D, Saniez M-H, et al Long term gastrointestinal margin of NUTRIOSEFB in healthy men. Eur J Clin Nutr 2006 60 1024 1034. 6 Tuohy KM, Kolida S, Lustenberger AM, et al The prebiotic effects of biscuits containing part hydrolysed guar gum and fructooligosaccharides a human volunteer study. Br J Nutr 2001 86 341 348. 37 Okubo T, Ishihara N, Takahashi H, et al set up of partially hydrolyzed guar gum intake on human intestinal microflora and its metabolism. Biosci Biotechnol Biochem 1994 58 1364 1369. 38 American Dietetic Association Position of the American Dietetic Association health implications of dietary fiber. J Am Diet Assoc 1997 97 1157 1159. 39 Gibson GR, Roberfroid MB Dietary modulation of the human colonic microbiota introducing the theory of prebiotics. J Nutr 1995 125 1401 1412. 40 Stephen AM, Cummings JH Mech anism of action of dietary fibre in the human colon. Nature 1980 284 283 284. 1 World Health Organization Diet, nutrition and the prevention of chronic diseases. traverse of a Joint FAO/WHO Expert Consultation. 2003. Geneva, WHO, WHO expert Report Series 916. 42 British Nutrition Foundation Nutrient Requirements and Recommendations, 2004. Available at http//www. nutrition. org. uk/ upload/Nutritient%20Requirements%20and %20recommendations%20pdf(1). pdf accessed 22 September 2008. 43 Elmadfa I, Weichselbaum E (eds) Energy and nutrient intake in the European Union. European Nutrition and Health Report 2004. Forum Nutr. Basel Karger, 2005, Vol 58, pp 19 46. 44 Variyam JN Factors affecting the macronutrient intake of US adults.Washington DC US Department of Agriculture, Technical Bulletin Number 1901, April 2003. 45 vanguard den Heuvel EGHM, Wils D, Pasman WJ, et al Dietary supplementation of different doses of NUTRIOSE FB, a fermentable dextrin, alters the activity of faecal enzym es in healthy men. Eur J Nutr 2005 44 445 451. 46 Giannini EG, Mansi C, Dulbecco P, et al Role of partially hydrolyzed guar gum in the treatment of irritable bowel syndrome. Nutrition 2006 22 334 342. 47 Bouhnik Y, Vahedi K, Achour L, et al Shortchain fructo-oligosaccharide disposition dose-dependently increases fecal bifidobacteria in healthy humans. J Nutr 1999 129 113 116. 8 Buddington RK, Williams CH, Chen S-C, et al Dietary supplementation of neosugar alters the fecal flora and decreases activities of some reductive enzymes in human subjects. Am J Clin Nutr 1996 63 709 716. 49 Jie Z, Bang-Yao L, Ming-Jie X, et al Studies on the effects of polydextrose intake on physiologic functions in Chinese people. Am J Clin Nutr 2000 72 1503 1509. 50 Takahashi H, Wako N, Okubo T, et al Influence of partially hydrolyzed guar gum on constipation in women. J Nutr Sci Vitaminol (Tokyo) 1994 40 251 259. 51 train den Heuvel EGHM, Wils D, Pasman WJ, et al Short-term digestive security dep osit of different doses of NUTRIOSEFB, a food dextrin, in adult men. Eur J Clin Nutr 2004 58 1046 1055. 2 Kurasawa S, Haack VS, Marlett JA Plant residue and bacteria as bases for increased stool weight accompany consumption of higher dietary fiber diets. J Am Coll Nutr 2000 19 426 433. 53 Gibson GR, Beatty ER, Wang X, et al Selective stimulation of bifidobacteria in the human colon by oligofructose and inulin. Gastroenterology 1995 108 975 982. 54 Tomlin J, Read NW A relative study of Downloaded from imr. sagepub. com by guest on March 27, 2013 14 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber 55 56 57 58 59 60 61 62 63 64 65 66 67 68 the effects on colon function caused by feeding ispaghula husk and polydextrose. viands Pharmacol Ther 1988 2 513 519.Ashraf W, Park F, Lof J, et al Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. commissariat Pharmacol Ther 1995 9 639 647. McRorie JW, Daggy BP, Morel JG, et al Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther 1998 12 491 497. Burton R, Manninen V Influence of psylliumbased fibre preparation on faecal and serum parameters. Acta Med Scand Suppl 1982 668 91 94. Dettmar PW, Sykes J A multi-centre, general practice comparability ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Curr Med Res Opin 1998 14 227 233. Prior A, Whorwell PJ Double blind study of ispaghula in irritable bowel syndrome. Gut 1987 28 1510 1513.Holloway L, Moynihan S, Abrams SA, et al Effects of oligofructose-enriched inulin on intestinal absorption of calcium and magnesium and bone turnover markers in postmenopausal women. Br J Nutr 2007 97 365 372. Abrams SA, Griffin IJ, Hawthorne KM, et al A junto of prebiotic short- and long-chain inulin-type fructans enhances calcium absorption and bone mineralization in young adolescents. A m J Clin Nutr 2005 82 471 476. Tahiri M, Tressol JC, Arnaud J Five-week intake of short-chain fructo-oligosaccharides increases intestinal absorption and status of magnesium in postmenopausal women. J Bone Miner Res 2001 16 2152 2160. Scholz-Ahrens KE, Schrezenmeir J Inulin, oligofructose and mineral metabolism experimental data and mechanism. Br J Nutr 2002 87(suppl 2) S179 S186.Hara H, Suzuki T, Kasai T, et al Ingestion of guar gum hydrolysates, a soluble fiber, increases calcium absorption in totally gastrectomized rats. J Nutr 1999 129 39 45. Raschka L, Daniel H Mechanisms underlying the effects of inulin-type fructans on calcium absorption in the large intestine of rats. Bone 2005 37 728 735. Katoh K, Tsuda T Effects of acetylcholine and short-chain fatty acids on acinous cells of the exocrine pancreas in sheep. J Physiol 1984 356 479 489. Mineo H, Hashizume Y, Hanaki Y Chemical specificity of short-chain fatty acids in stimulating insulin and glucagon secretion in sheep . Am J Physiol Endocrinol Metab 1994 267 E234 E241. Wolever TM, Jenkins DJ Effect of dietary fiber and foods on carbohydrate metabolism.In CRC Handbook of Dietary Fiber in Human Nutrition (Spiller GA, ed), 2nd edn. Boca Raton CRC Press, 1993 pp 111 152. 69 Williams JA, Lai C, Corwin H, et al inclusion body of guar gum and alginate into a tender bar improves postprandial glycemia in humans. J Nutr 2004 134 886 889. 70 Prieto PG, Cancelas J, Villanueva-Penacarrillo ML, et al Short-term and long-term effects of guar on postprandial plasma glucose, insulin and glucagon-like peptide 1 concentration in healthy rats. Horm Metab Res 2006 38 397 404. 71 Asp ML, Hertzler SR, Chow J, et al Gammacyclodextrin lowers postprandial glycemia and insulinemia without carbohydrate malabsorption in healthy adults. J Am Coll Nutr 2006 25 49 55. 2 Wakabayashi S, Ueda Y, Matsuoka A Effects of indigestible dextrin on blood glucose and insulin levels after various sugar loads in rats. J Jpn Soc Nutr Food Sci 1993 46 131 137. 73 Wakabayashi S, Kishimoto Y, Matsuoka A Effects of indigestible dextrin on glucose tolerance in rats. J Endocrinol 1995 144 533 538. 74 Anderson JW, Randles KM, Kendall CW, et al Carbohydrate and fiber recommendations for individuals with diabetes a quantitative assessment and meta-analysis of the evidence. J Am Coll Nutr 2004 23 5 17. 75 Salmeron J, Manson JE, Stampfer MJ, et al Dietary fiber, glycemic load, and risk of noninsulin-dependent diabetes mellitus in women. JAMA 1997 277 472 477. 6 Tseng CC, Kieffer TJ, Jarboe LA, et al Postprandial stimulation of insulin releases by glucose-dependent insulinotropic polypeptide (GIP) effect of a specific glucose-dependent insulinotropic polypeptide receptor opposition in the rat. J Clin Invest 1996 98 2440 2445. 77 Van Dijk G, Thiele TE Glucagon-like peptide-I (7-36) amide a central regulator of satiety and interoceptive stress. Neuropeptides 1999 33 406 414. 78 Bourdon I, Olson B, Rackus R, et al Beans , as a source of dietary fiber, increase cholecystokinin and apolipoprotein B48 response to test meals in men. J Nutr 2001 131 1485 1490. 79 Burton-Freeman B, Davis PA, Schneeman BO Plasma cholecystokinin is associated with subjective measures of satiety in women. Am J Clin Nutr 2002 76 659 667. 0 Bourdon I, Yokoyama W, Davis P, et al Postprandial lipid, glucose, insulin, and cholecystokinin responses in men fed barley pasta enriched with ? -glucan. Am J Clin Nutr 1999 69 55 63. 81 Anderson JW, Gilinsky NH, Deakins DA, et al Lipid responses of hypercholesterolemic men to oat-bran and wheat-bran intake. Am J Clin Nutr 1991 54 678 683. 82 Marlett JA Dietary fiber and cardiovascular disease. In Handbook of Dietary Fiber (Cho SS, Dreher ML, eds). New York Marcel Dekker, 2001 pp 17 30. 83 Trautwein EA, Kunath-Rau A, Erbersdobler HF Downloaded from imr. sagepub. com by guest on March 27, 2013 15 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber 84 85 8 6 87 88 89 90 91 92 93 94 95 96 97 98Increased fecal bile acid excretion and changes in the travel bile acid pool are involved in the hypocholesterolemic and gallstone-preventive actions of psyllium in hamsters. J Nutr 1999 129 896 902. Anderson JW, Deakins DA, Bridges SR Soluble fiber hypocholesterolemic effects and proposed mechanisms. In Dietary Fibre Chemistry, Physiology, and Health Effects (Kritchevsky D, Bonfield C, Anderson JW, eds). New York Plenum Press, 1990 pp 339 363. Juhel C, Tosini F, Steib M, et al Cholesterollowering effect of non-viscous soluble dietary fiber Nutriose FB in hypercholesterolemic hamsters. Ann Nutr Metab 2007 15(suppl 1) 259.Pratt VC, Tappenden KA, McBurney MI, et al Short-chain fatty acid-supplemented total parenteral nutrition improves nonspecific immunity after intestinal resection in rats. JPEN J Parenter Enteral Nutr 1996 20 264 271. Sanderson IR Short chain fatty acid regulation of signaling genes expressed by the intestinal epithelium. J Nutr 2004 134 2450S 2454S. Roediger WE Utilization of nutrients by isolated epithelial cells of rat colon. Gastroenterology 1982 83 424 429. Koruda MJ, Rolandelli RH, Bliss DZ, et al Parenteral nutrition supplemented with shortchain fatty acids effect on the small bowel mucosa in normal rats. Am J Clin Nutr 1990 51 685 689. Mariadason JM, Barkla DH, Gibson PR Effect of short-chain fatty acids on paracellular permeableness in Caco-2 intestinal epithelium model.Am J Physiol 1997 272 G705 G712. Blum S, Schiffrin EJ Intestinal microflora and homeostasis of the mucosal immune response implications for probiotic bacteria? Curr Issues Intest Microbiol 2003 4 53 60. Schiffrin EJ, Rochat F, Link-Amster H, et al Immunomodulation of human blood cells following the ingestion of lactic acid bacteria. J dairy farm Sci 1995 78 491 497. Lissner L, Lindroos AK, Sjostrom L Swedish obese subjects (SOS) an obesity intervention study with a nutritional perspective. Eur J Clin Nutr 1998 52 316 3 22. Kimm S The role of dietary fiber in the development and treatment of childhood obesity. Pediatr 1995 96 1010 1014. AlfieriM, Pomerleau J, Grace DM, et al Fiber intake of normal weight, moderately obese and hard obese subjects. Obes Res 1995 3 541 547. Nelson LH, expel LA Diet composition related to body fat in a multivariate study of 293 men. J Am Diet Assoc 1996 96 771 777. Kromhout D, Bloemberg B, Seidell JC, et al corporeal activity and dietary fiber determine population body fat levels the cardinal Countries Study. Int J Obes Relat Metab Disord 2001 25 301 306. Slavin J, Green H Dietary fibre and satiety. Nutr Bull 2007 32 32 42. 99 Jenkins DJ, Wolever TM, Rao AV, et al Effect on blood lipids of very high intakes of fiber in diets low in saturated fat and cholesterol. N Engl J Med 1993 329 21 26. 00 Birketvedt GS, Aaseth J, Florholmen JR, et al Long-term effect of fibre supplement and reduced energy intake on body weight and blood lipids in overweight subjects. Act a Medica (Hradec Kralove) 2000 43 129 132. 101 Mueller-Cunningham WM, Quintana R, Kasim-Karakas SE An ad libitum, very low-fat diet results in weight loss and changes in nutrient intakes in postmenopausal women. J Am Diet Assoc 2003 103 1600 1606. 102 hay NP, Starling RD, Liu X, et al Effects of an ad libitum low-fat, high-carbohydrate diet on body weight, body composition, and fat distribution in older men and women. Arch Intern Med 2004 164 210 217. 103 Howarth NC, Saltzman E, Roberts SB Dietary fiber and weight regulation. Nutr Rev 2001 59 129 139. 04 Pasman WJ, Saris WHM, Wauters MAJ, et al Effect of one week of fibre supplementation on hunger and satiety ratings and energy intake. Appetite 1997 29 77 78. 105 Patrick PG, Gohman SM, Marx SC, et al Effect of supplements of partially hydrolyzed guar gum on the occurrence of constipation and use of laxative agents. J Am Diet Assoc 1998 98 912. 106 Schiller LR Chronic diarrhea. Curr Treat Options Gastroenterol 2005 8 259 266. 1 07 Meier R, Burri E, Steuerwald M The role of nutrition in diarrhea syndromes. Curr Opin Clin Nutr Metab Care 2003 6 563 567. 108 Alam NH, Meier R, Schneider H, et al Partially hydrolyzed guar gum-supplemented oral rehydration solution in the treatment of acute diarrhea in children. J Pediatr Gastroenterol Nutr 2000 31 503 507. 09 Homann HH, Kemen M, Fuessenich C, et al drop-off in diarrhea incidence by soluble fiber in patients receiving total or supplemental enteral nutrition. JPEN J Parenter Enteral Nutr 1994 18 486 490. 110 Spapen H, Diltoer M, Van Malderen C, et al Soluble fiber reduces the incidence of diarrhea in septic patients receiving total enteral nutrition a potential, double-blind, randomized, and controlled trial. Clin Nutr 2001 20 301 305. 111 Nakamura S, Hong R, Moji M, et al Suppressive effect of partially hydrolyzed guar gum on short-lived diarrhea induced by ingestion of maltitol and lactitol in healthy humans. Eur J Clin Nutr 2007 61 1086 1093. 12 Yang G , Wu X-T, Zhou Y, et al finishing of dietary fiber in clinical enteral nutrition a meta-analysis of randomized, controlled trials. World J Gastroenterol 2005 11 3935 3938. 113 Parisi GC, Zilli M, Miani MP, et al High-fiber diet supplementation in patients with irritable bowel syndrome (IBS) a multicenter, randomized, open trial comparison between Downloaded from imr. sagepub. com by guest on March 27, 2013 16 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber wheat bran diet and partially hydrolyzed guar gum (PHGG). Dig Dis Sci 2002 47 1696 1704. 114 Deckmann RC, Cheskin LJ Diverticular disease in the elderly. J Am Geriatr Soc 1993 41 986 993. 15 Aldoori WH, Giovannucci EL, Rockett HR, et al A prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr 1998 128 714 719. 116 Smits BJ, Whitehead AM, Prescott P Lactulose in the treatment of symptomatic diverticular disease a comparative study with high-fibre diet. Br J Clin Pract 1990 44 314 318. 117 Brodrib AJ Treatment of symptomatic diverticular disease with a high-fibre diet. Lancet 1977 i 664 668. 118 Marlett JA, McBurney MI, Slavin JL Position of the American Dietetic Association health implications of dietary fiber. J Am Diet Assoc 2002 102 933 1000. 119 Burkitt DP Varicose veins, cryptic vein thrombosis and haemorrhoids epidemiology and suggested aetiology. Br Med J 1972 2 556 561. 20 Alonso-Coello P, Mills E, Heels-Ansdell D, et al Fiber for the treatment of hemorrhoids complications a systematic review and metaanalysis. Am J Gastroenterol 2006 101 181 188. 121 Alonso-Coello P, Guyatt G, Heels-Ansdell D, et al Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev 2005, Issue 4 Art No CD004649. DOI 10. 1002/ 14651858. CD004649. pub2. 122 Khaw KT, Barrett-Connor E Dietary fiber and reduced ischaemic heart disease mortality rates in men and women a 12-year prospective study. Am J Epidemiol 1987 126 1093 1102. 123 Ri mm EB, Ascherio A, Giovannucci E, et al Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease among men. JAMA 1996 275 447 451. 24 Todd S, Woodward M, Tunstall-Pedoe H, et al Dietary antioxidant vitamins and fiber in the etiology of cardiovascular disease and allcauses mortality results from the Scottish Heart Health Study. Am J Epidemiol 1999 150 1073 1080. 125 Wolk A, Manson JE, Stampfer MJ, et al Longterm intake of dietary fiber and decreased risk of coronary heart disease among women. JAMA 1999 281 1998 2004. 126 Bazzano LA, He J, Ogden LG, et al Dietary fiber intake and reduced risk of coronary heart disease in US men and women the National Health and Nutrition exam Survey I Epidemiologic carry through Study. Arch Intern Med 2003 163 1897 1904. 27 Jenkins DJA, Vuksan V, Kendall CWC, et al Physiological effects of resistant starches on fecal bulk, short chain fatty acids, blood lipids and glycemic index. J Am Coll Nutr 1998 17 609 616. 128 Elmer PJ , Obarzanek E, Vollmer WM Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control 18-month results of a randomized trial. Ann Intern Med 2006 144 485 495. 129 Ascherio A, Rimm EB, Giovannucci EL, et al A prospective study of nutritional factors and hypertension among US men. Circulation 1992 86 1475 1484. 130 Ascherio A, Hennekens C, Willett WC, et al Prospective study of nutritional factors, blood pressure, and hypertension among US women. Hypertension 1996 27 1065 1072. 31 Keenan JM, Pins JJ, Frazel C, et al Oat ingestion reduces systolic and diastolic blood pressure in patients with mild-mannered or borderline hypertension a pilot trial. J Fam Pract 2002 51 369. 132 He J, Streiffer RH, Muntner P, et al Effect of dietary fiber intake on blood pressure a randomized, double-blind, placebo-controlled trial. J Hypertens 2004 22 73 80. 133 Ascherio A, Rimm EB, Hernan MA, et al Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation 1998 98 1198 1204. 134 crossing ES, Liu S Glycemic index and serum high-density lipoprotein cholesterol concentration among US adults. Arch Intern Med 2001 161 572 576. 35 Liu S, Manson JE, Stampfer MJ, et al Dietary glycemic load assessed by food-frequency questionnaire in relation to plasma highdensity-lipoprotein cholesterol and fasting plasma triacylglycerols in postmenopausal women. Am J Clin Nutr 2001 73 560 566. 136 Walker AR Dietary fibre and mineral metabolism. Mol Aspects Med 1987 9 69 87. 137 Torre M, Rodriguez AR, Saura-Calixto F Effects of dietary fiber and phytic acid on mineral availability. Crit Rev Food Sci Nutr 1991 30 1 22. 138 Slavin JL, Greenberg NA Partially hydrolyzed guar gum clinical nutrition uses. Nutrition 2003 19 549 552. conditions address for correspondence Dr Joanne L Slavin Department of Food Science and Nutrition, University of Minnesota,1334 Eckles Avenue, St Paul, MN 55108, USA. E-mail emailprote cted edu Downloaded from imr. sagepub. com by guest on March 27, 2013 17