Significant variations in nutritional supplementation amongst neonates in the UK

Aim Nutritional supplementation in neonates is common in neonatal unit. This study set out to ascertain UK adherence to ESPGHAN guidance. Methods A national cross sectional questionnaire study of neonatal units across England was completed between January and March 2014. All 174 units in the country were attempted to be contacted to complete a telephone survey. This included all level 1,2 and 3 units. They were initially contacted by phone and asking any senior member of the team about their current practice and procedures. The first ten telephone interviews were completed with two researchers present to ensure consistency of approach. If no response was received or no details were available, one further attempt was made to contact the unit. The results were recorded in a proforma and then collated and entered into a spreadsheet for analysis. Comparison to ESPGHAN guidance was completed. Results Response rate was 53%. There was variation in use of all supplements. The survey collected data from 91 neonatal units (53% response rate). It was found that 10% of neonatal units had no fixed policy on supplements. The protocols regarding supplementation involved predominantly folic acid, Vitamin A, Vitamin D and iron, with much variation in doses and regimens. The criteria for prescribing supplements was largely based on age (47%) with only 7% using a weight targets to initiate supplements. Summary data regarding the appropriateness of each nutritional supplement for a variety of different weights are presented, as well as comparison to ESPGHAN guidance which suggests issues with both underdoing of Breast Fed infants and overdosing of infants on several artificial formulas which already contain significant amounts of these nutritional elements. Conclusions There is significant heterogeneity in neonatal policies when prescribing supplements to neonates. National policies which take international guidance into account are recommended

Significant variations in nutritional supplementation amongst neonates in the United Kingdom

AIM: To ascertain United Kingdom adherence to European society of Paediatric Gastroenterology, Hepatology and Nutrition guidance (ESPGHAN). METHODS: A national cross sectional questionnaire study of neonatal units across England was completed between January and March 2014. All 174 units in the country were attempted to be contacted to complete a telephone survey. This included all level 1, 2 and 3 units. They were initially contacted by phone and asking any senior member of the team about their current practice and procedures. The first ten telephone interviews were completed with two researchers present to ensure consistency of approach. If no response was received or no details were available, one further attempt was made to contact the unit. The results were recorded in a proforma and then collated and entered into a spreadsheet for analysis. Comparison to United Kingdom adherence to ESPGHAN guidance was completed. RESULTS: Response rate was 53%. There was variation in use of all supplements. The survey collected data from 91 neonatal units (53% response rate). It was found that 10% of neonatal units had no fixed policy on supplements. The protocols regarding supplementation involved predominantly folic acid, vitamin A, vitamin D and iron, with much variation in doses and regimens. The criteria for prescribing supplements was largely based on age (47%) with only 7% using a weight targets to initiate supplements. Summary data regarding the appropriateness of each nutritional supplement for a variety of different weights are presented, as well as comparison to ESPGHAN guidance which suggests issues with both underdoing of Breast Fed infants and overdosing of infants on several artificial formulas which already contain significant amounts of these nutritional elements. CONCLUSION: There is significant heterogeneity in neonatal policies when prescribing supplements to neonates. National policies which take international guidance into account are recommended

Bowel preparation for elective procedures in Children: A Systematic Review and meta-analysis

Objective Reviews have investigated preparation for colonoscopy, but not for surgery, They are also often limited to patients up to 16 years, despite many paediatric gastroenterologists caring for older patients. We carried out a systematic review investigating the optimum bowel preparation agents for all indications in children and young people. Design A Cochrane format systematic review of randomised controlled trials (RCTs). Data extraction and assessment of methodological quality were performed independently by two reviewers. Methodological quality was assessed using the Cochrane risk of bias tool. Patients Young people requiring bowel preparation for any elective procedure, as defined by the primary studies. Interventions RCTs comparing bowel preparation with placebo or other interventions. Main outcome measures Adequacy of bowel preparation, tolerability and adverse events. Results The search yielded 2124 results and 15 randomised controlled studies (n=1435)but heterogeneity limited synthesis. Meta-analysis of two studies comparing polyethylene glycol (PEG) with sodium phosphate showed no difference in the quality of bowel preparation (risk ratio (RR) 1.27(95% CI 0.66 to 2.44)). Two studies comparing sodium picosulfate/magnesium citrate with PEG found no difference in bowel preparation but significantly higher number of patients needing nasogastric tube insertion in the polyethylene glycol-electrolyte lavage solution (RR 0.04(95% CI 0.01 to 0.18), 45 of 117 in PEG group vs 2 of 121 in sodium picosulfate group). Meta-analysis of three studies (n=241) found no difference between PEG and sennasoids (RR 0.73(95% CI 0.31 to 1.71)). Conclusions The evidence base is clinically heterogeneous and methodologically at risk of bias. There is evidence that all regimens are equally effective. However, sodium picosulfate was better tolerated than PEG. Future research is needed with all agents and should seek to consider safety and tolerability as well as efficacy

Multidisciplinary Design Optimization Approach to Integrated Space Mission Planning and Spacecraft Design

© AIAASpace mission planning and spacecraft design are tightly coupled and need to be considered together for optimal performance; however, this integrated optimization problem results in a large-scale mixed-integer nonlinear programming (MINLP) problem, which is challenging to solve. In response to this challenge, this paper proposes a new solution approach to this problem based on decomposition-based optimization via augmented Lagrangian coordination. The proposed approach leverages the unique structure of the problem that enables its decomposition into a set of coupled subproblems of different types: a mixed-integer quadratic programming (MIQP) subproblem for mission planning, and one or more nonlinear programming (NLP) subproblem(s) for spacecraft design. Because specialized MIQP or NLP solvers can be applied to each subproblem, the proposed approach can efficiently solve the otherwise intractable integrated MINLP problem. An automatic and effective method to find an initial solution for this iterative approach is also proposed so that the optimization can be performed without a user-defined initial guess. The demonstration case study shows that, compared to the state-of-the-art method, the proposed formulation converges substantially faster and the converged solution is at least the same or better given the same computational time limit.This material is based upon work supported by the National Science Foundation under Grant No. 1942559

A pre-embedding immunogold approach reveals localization of myosin VI at the ultrastructural level in the actin cones that mediate Drosophila spermatid individualization

Stable actin structures play important roles in the development and specialization of differentiated cells. How these structures form, are organized, and are used to mediate physiological processes is not well understood in most cases. In Drosophila testis, stable actin structures, called actin cones, mediate spermatid individualization, a large-scale cellular remodeling process. These actin cones are composed of two structural domains, a front meshwork and a rear region of parallel bundles. Myosin VI is an important player in proper actin cone organization and function. Myosin VI localizes to the cones\u27 fronts and its specific localization is required for proper actin cone formation and function during individualization. To understand how these structures are organized and assembled, ultrastructural studies are important to reveal both organization of actin and the precise localization of actin regulators relative to regions with different filament organizations. In the present work, we have developed a novel pre-embedding immunogold-silver labeling method for high-resolution analysis of protein distribution in actin structures which allowed both satisfactory antibody labeling and good ultrastructural preservation. Electron microscopic studies revealed that myosin VI accumulated at the extreme leading edge of the actin cone and preferentially localized throughout the front meshwork of the cone where branched actin filaments were most concentrated. No myosin VI labeling was found adjacent to the membranes along the length of the cone or connecting neighboring cones. This method has potential to reveal important information about precise relationships between actin-binding proteins, membranes, and different types of actin structures

A Survey on the Actual Use of and Reasons for Heated Tobacco Products in Patients with Rheumatoid Arthritis

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THE EFFECT OF WARM-UP SESSIONS WITH KNOB-LOADED, CENTER-LOADED, AND BARREL-LOADED BASEBALL BATS ON BAT SPEED IN COLLEGIATE BASEBALL PLAYERS

The purpose of this study was to examine the effect of warm-up with a knob-loaded, center-loaded, and barrel-loaded baseball bat on swinging velocity when compared to a normal baseball bat in Division I collegiate baseball hitters. Middle Tennessee State University Baseball hitters (N=9) participated in the study. The velocity was the highest in warm-up with a normal baseball bat. There was no significant difference in swing velocity between a game bat, knob-loaded, center-loaded, and barrel-loaded bat warm-ups. While no significant effect was found, the changing of the location of weight on baseball bat can alter bat speed when switched to a normal baseball bat in game situation

Cultural differences in ant-dipping tool length between neighbouring chimpanzee communities at Kalinzu, Uganda.

Cultural variation has been identified in a growing number of animal species ranging from primates to cetaceans. The principal method used to establish the presence of culture in wild populations is the method of exclusion. This method is problematic, since it cannot rule out the influence of genetics and ecology in geographically distant populations. A new approach to the study of culture compares neighbouring groups belonging to the same population. We applied this new approach by comparing ant-dipping tool length between two neighbouring communities of chimpanzees (Pan troglodytes schweinfurthii) in the Kalinzu Forest, Uganda. Ant-dipping tool length varies across chimpanzee study sites in relation to army ant species (Dorylus spp.) and dipping location (nest vs. trail). We compared the availability of army ant species and dipping tool length between the two communities. M-group tools were significantly longer than S-group tools, despite identical army ant target species availabilities. Moreover, tool length in S-group was shorter than at all other sites where chimpanzees prey on epigaeic ants at nests. Considering the lack of ecological differences between the two communities, the tool length difference appears to be cultural. Our findings highlight how cultural knowledge can generate small-scale cultural diversification in neighbouring chimpanzee communities

Coiled-coil-mediated dimerization is not required for myosin VI to stabilize actin during spermatid individualization in Drosophila melanogaster

Myosin VI is a pointed-end-directed actin motor that is thought to function as both a transporter of cargoes and an anchor, capable of binding cellular components to actin for long periods. Dimerization via a predicted coiled coil was hypothesized to regulate activity and motor properties. However, the importance of the coiled-coil sequence has not been tested in vivo. We used myosin VI\u27s well-defined role in actin stabilization during Drosophila spermatid individualization to test the importance in vivo of the predicted coiled coil. If myosin VI functions as a dimer, a forced dimer should fully rescue myosin VI loss of function defects, including actin stabilization, actin cone movement, and cytoplasmic exclusion by the cones. Conversely, a molecule lacking the coiled coil should not rescue at all. Surprisingly, neither prediction was correct, because each rescued partially and the molecule lacking the coiled coil functioned better than the forced dimer. In extracts, no cross-linking into higher molecular weight forms indicative of dimerization was observed. In addition, a sequence required for altering nucleotide kinetics to make myosin VI dimers processive is not required for myosin VI\u27s actin stabilization function. We conclude that myosin VI does not need to dimerize via the predicted coiled coil to stabilize actin in vivo