Oral Reading Accuracy (ORA) is an important metric for evaluating a student's reading proficiency, measuring how accurately a reader can read words aloud. Traditional ORA evaluations performed by human assessors often require significant time and labor. This study explores the potential of integrating a speech recognition system into ORA assessments to improve efficiency. We analyzed ORA data from 507 elementary school students across ten passages of different lengths and difficulties. Both human evaluators and AI systems recorded the number of words read correctly. The misclassification rates of these scores are divided into two components: True Positive (correct words are identified as correct), and True Negative (incorrect words are identified as correct). This second study expands upon Method of Moments method to estimate these misclassification rates. We apply Generalized Method of Moments which incorporates additional variance information. To compare the two approaches' accuracy, we apply the m-out-of-n Bootstrap method to estimate their standard errors and compare their reductions in estimator variance. Additionally, we introduce a Contaminated Data Solution to address real-world scenarios where true count data is unavailable and only contaminated observed data is observed.

Sepsis-induced acute kidney injury (S-AKI) is a critical illness that causes decreased kidney function due to infection. With a prevalence of 40-50% of patients in the intensive care unit developing S-AKI, the illness is strongly associated with a higher risk of mortality, longer hospital stays, and increased risk of kidney failure relapse. S-AKI complicates medical nutrition therapy due to altered protein metabolism, increased metabolic demands, fluid imbalances, increased malnutrition risk, and electrolyte imbalances. Goals of nutrition care include close monitoring and evaluation of fluid, meeting estimated protein needs, maintaining electrolyte and vitamin status, and achieving supplemental nutrition tolerance to optimize kidney recovery and prevent malnutrition. Various nutrition interventions, such as individualized protein needs and enteral nutrition (EN), play a role in managing this illness. Evidence-based guidelines for protein recommendations vary based on the type of renal replacement therapy (RRT) and range from 1.2-2.5 g/kg/day. Patients with declining renal function prior to RRT and at risk for chronic kidney disease have a range of 0.8-1.0 g/kg/day to preserve long-term kidney function. Literature indicates initiation of EN within 24 hours is preferred over parenteral nutrition (PN) if oral intake is not feasible to prevent malnutrition. While there are no standardized fluid intake guidelines for S-AKI, continuous multidisciplinary assessment and adjustment to fluid intake are necessary to prevent volume overload. This case report reviews the importance of proactive individualized nutrition interventions to aid in patient recovery including improved nutritional status and AKI resolution.

Background: Research in animals and humans indicate that the gut microbiome plays a significant role in modulating insulin resistance1,2, while animal studies have demonstrated the gut microbiome's direct involvement in regulating body weight3,4. Furthermore, antibiotic use may impair insulin sensitivity and glucose tolerance in individuals with overweight and obesity5-9. However, no studies to date have evaluated the potential factors influencing this metabolic response.

Methods: This is a randomized clinical trial with a within- and between-subjects comparison. Seventy-five individuals aged 18-50 years (BMI 25.0-40.0 kg/m2), with no Diabetes Mellitus diagnosis, and no recent probiotic or antibiotic intake (3 months) were recruited. Participants were allocated to a synbiotic or placebo group for 12 weeks following a 3-day Vancomycin antibiotic intervention (500 mg every 8 hours). Body weight and fasting blood samples (glucose, insulin, HbA1c) were taken at the first (baseline), second (after antibiotic administration), and third visit (after synbiotic/placebo intervention). HOMA-IR was calculated from fasting insulin and glucose levels. Due to lack of normal distribution of independent variables, Mann-Whitney U tests were performed to evaluate within- and between-group changes over time.

Results: Compiled results for all participants were analyzed, although only 60 completed the study. It is important to highlight that the placebo group was significantly heavier at baseline (91.8 ± 18.1 kg) than the synbiotic group (82.8 ± 14.3 kg) (p=0.046), while the latter had a modest weight gain over time (~0.80 kg, p=.056). Neither fasting glucose nor HbA1C changed significantly between groups over time. HbA1c, insulin, and HOMA-IR slightly increased from baseline in all participants (p<.001 each), which could indicate a decreased insulin sensitivity over time, with no significant differences between groups.

Conclusion: Our unadjusted analysis demonstrates that providing a 12-week next-generation synbiotic supplementation posterior to a 3-day antibiotic intervention did not correct the commonly observed detrimental effect of antibiotics on insulin resistance. Furthermore, it seemed to lead to significant weight gain (~0.80 kg, p=.056).

Implications for future research: We are planning on re-running all our statistical analyses controlling for baseline sex and we are also planning on running an independent third group with synbiotic only for comparison purposes.

Funding Source: Pendulum® and TCU Dean’s Opportunity Grant

References
1. Sergeev IN, Aljutaily T, Walton G, Huarte E. Effects of Synbiotic Supplement on Human Gut Microbiota, Body Composition and Weight Loss in Obesity. Nutrients. Jan 15 2020;12(1)doi:10.3390/nu12010222
2. Wu Z, Zhang B, Chen F, et al. Fecal microbiota transplantation reverses insulin resistance in type 2 diabetes: A randomized, controlled, prospective study. Front Cell Infect Microbiol. 2022;12:1089991. doi:10.3389/fcimb.2022.1089991
3. Ridaura VK, Faith JJ, Rey FE, et al. Gut microbiota from twins discordant for obesity modulate metabolism in mice. Science. Sep 6 2013;341(6150):1241214. doi:10.1126/science.1241214
4. Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. Dec 21 2006;444(7122):1027-31. doi:10.1038/nature05414
5. Del Fiol FS, Balcão VM, Barberato-Fillho S, Lopes LC, Bergamaschi CC. Obesity: A New Adverse Effect of Antibiotics? Front Pharmacol. 2018;9:1408. doi:10.3389/fphar.2018.01408
6. Klancic T, Laforest-Lapointe I, Wong J, et al. Concurrent Prebiotic Intake Reverses Insulin Resistance Induced by Early-Life Pulsed Antibiotic in Rats. Biomedicines. Jan 12 2021;9(1)doi:10.3390/biomedicines9010066
7. Park SJ, Park YJ, Chang J, et al. Association between antibiotics use and diabetes incidence in a nationally representative retrospective cohort among Koreans. Sci Rep. Nov 4 2021;11(1):21681. doi:10.1038/s41598-021-01125-5
8. Yuan J, Hu YJ, Zheng J, et al. Long-term use of antibiotics and risk of type 2 diabetes in women: a prospective cohort study. Int J Epidemiol. Oct 1 2020;49(5):1572-1581. doi:10.1093/ije/dyaa122
9. Zhou J, Lin Y, Liu Y, Chen K. Antibiotic exposure and risk of type 2 diabetes mellitus: a systematic review and meta-analysis. Environ Sci Pollut Res Int. Dec 2021;28(46):65052-65061. doi:10.1007/s11356-021-16781-3

Medical nutrition therapy is necessary for individuals at risk of impaired wound healing, such as those with malnutrition, poor circulation, or advanced age. During the acute inflammatory response from wounds, the body enters a catabolic state, increasing energy and protein needs. For those with malnutrition or at risk for malnutrition, calories should be provided at 30-35 kcal/kg body weight and protein at 1.25-1.5 g/kg body weight. Along with increased energy needs, the assessment and management of vitamins and minerals such as vitamins A, vitamin C, vitamin K, and zinc enhance the synthesis of fibroblasts needed for tissue formation. Early diagnosis and intervention for malnourished patients with chronic wounds are critical steps in providing effective patient care. Oral intake is monitored to ensure calorie and protein intake is adequate and oral nutrition supplements may be provided if indicated. For those unable to tolerate oral feeds, enteral nutrition is the next preferred method. If enteral nutrition is contraindicated then parenteral nutrition can be initiated to provide adequate calories and protein. This case report analyzes the care of a 74-year-old female with a non-healing surgical wound with a history of bariatric surgery who has been diagnosed with malnutrition.

Essential fatty acid deficiency (EFAD) is a condition that can occur when the body does not have adequate fats from the diet. EFAD can develop in as quick as 10 days and can present with symptoms such as itchy and flaky skin, poor wound healing, elevated liver function tests, and increased susceptibility to infection. EFAD rarely occurs in individuals who eat a balanced diet with a variety of foods and fat sources and is seen most often in patients unable to eat by mouth or tolerate tube feedings. Patients with prolonged poor nutrition are at increased risk of EFAD due to insufficient fat intake. Risk factors of EFAD are inflammatory bowel disease, pancreatic insufficiency, extreme diet restriction, and long-term parenteral nutrition support with limited fat emulsion supplementation. Preventing EFAD through awareness and proactive measures is essential in medical nutrition therapy. Since clinical markers are challenging to assess in the acute care setting, physical signs and symptoms are used for identifying and treating EFAD. For patients on parenteral nutrition support with no fat, supplementing with 500 mL intralipids per week is recommended to prevent EFAD. This case report reviews the current nutritional guidelines related to EFAD and parenteral nutrition and highlights a patient at risk for EFAD due to her poor intake, who was receiving long-term parenteral nutrition with supplemental oral intake.