Best Practices for Handling and Administration of Expressed Human Milk and Donor Human Milk for Hospitalized Preterm Infants

The importance of human milk for the preterm infant is well established (1–3). However, the feeding of human milk to preterm infants is typically much more complicated than the mere act of breastfeeding (3, 4). The limited oral feeding skills of many preterm infants often results in human milk being administered via an enteral feeding tube (4). In addition, fortification is commonly required to promote optimal growth and development—particularly in the smallest of preterm infants (2, 4, 5). Consequently, a mother's own milk must be pumped, labeled, transported to the hospital, stored, tracked for appropriate expiration dates and times, thawed (if previously frozen), fortified, and administered to the infant with care taken at each step of the process to avoid microbial contamination, misadministration (the wrong milk for the wrong patient), fortification errors, and waste (1–5). Furthermore, the use of pasteurized donor human milk (DHM) for preterm infants when a mother's own milk is not available has been endorsed by many organizations (1). Therefore, appropriate procurement, storage, thawing (if received frozen), fortification, labeling, and administration must occur with the same considerations of preventing contamination and fortification errors while ensuring the correctly prepared final product reaches the correct patient (1). Many professional organizations have published best practices to provide hospitals with guidelines for the safe and accurate handling and preparation of expressed human milk (EHM) and DHM feedings for preterm infants (1–5). These best practices emphasize the importance of preparation location, trained staff, proper identification of human milk to prevent misadministration, and strategies to prevent fortification errors (1–6). The purpose of this mini-review article is to summarize current published best practices for the handling of human milk for preterm infants within the hospital setting (1–6). Emphasis will focus on the use of aseptic technique with proper sanitation and holding times/temperatures to limit microbial growth; use of technology to prevent misadministration of human milk and fortification errors as well as for tracking of expiration dates/times and lot numbers; and workflow strategies to promote safety while improving efficiencies (1–7)

Further work at Kilise Tepe, 2007-11: refining the Bronze to Iron Age transition

The excavations at Kilise Tepe in the 1990s inevitably left a range of research questions unanswered, and our second spell of work at the site from 2007 to 2011 sought to address some of these, relating to the later second and early first millennia. This article gathers the architectural and stratigraphie results of the renewed excavations, presenting the fresh information about the layout and character of the Late Bronze Age North-West Building and the initial phases of the Stele Building which succeeded it, including probable symbolic practices, and describing the complex stratigraphic sequence in the Central Strip sounding which covers the lapse of time from the 12th down to the seventh century. There follow short reports on the analyses of the botanical and faunal materials recovered, a summary of the results from the relevant radiocarbon dating samples and separate studies addressing issues resulting from the continuing study of the ceramics from the different contexts. Taken together, a complex picture emerges of changes in settlement layout, archi¬tectural traditions, use of external space, artefact production and subsistence strategies during the centuries which separate the Level III Late Bronze Age settlement from the latest Iron Age occupation around 700 BC

Mudanças no peso corporal na coorte NutriNet Brasil durante a pandemia de covid-19

Este estudo descreve modificações no peso corporal de participantes da coorte NutriNet Brasil (n = 14.259) ocorridas durante a pandemia de covid-19. Foram analisados dados informados em período anterior ao início da pandemia (26/01/2020 a 18/03/2020) e cerca de 6 meses após (14/09/2020 a 19/10/2020). O ganho de peso ≥ 2 kg alcançou 19,7% dos participantes, mostrando-se diretamente associado ao sexo masculino, à menor escolaridade e à presença prévia de excesso de peso, sendo inversamente associado à idade. A perda de peso ≥ 2kg alcançou 15,2% dos participantes, mostrando-se diretamente associada ao sexo masculino e à presença prévia de excesso de peso, sendo inversamente associada à idade.This study describes body weight changes among participants of the NutriNet Brasil cohort(n = 14,259) during the covid-19 pandemic. We analyzed data reported before the pandemic onset(01/26/2020 to 03/18/2020) and about six months after (09/14/2020 to 10/19/2020). Our resultsshow that 19.7% of the participants gained ≥ 2 kg. Weight gain was directly associated withmale gender, lower education, and previous presence of overweight, and inversely associatedwith age. In turn, 15.2% lost ≥ 2kg, being directly associated with male gender and previouspresence of overweight and inversely associated with age

Machine translation literacy : a panorama of practices at Swiss universities and implications for language teaching

This short paper presents the quantitative results of an online survey of Swiss university students and staff on their use of Machine Translation (MT). The analysis of the 3,713 responses throws light on the context, purposes, degree of successive revisions, and ethical considerations surrounding the use of MT. With regards to language teachers and students, the quantitative data allows us to draw three preliminary conclusions: MT is a well-established but unspoken practice in Swiss universities, MT is not seen as an alternative to language learning, and MT is seen and already being used as a tool to improve language skills

Consumption of ultra-processed foods and its association with sociodemographic factors in the adult population of the 27 Brazilian state capitals (2019)

OBJETIVO: Descrever a magnitude do consumo de alimentos ultraprocessados na população adulta (≥ 18 anos) das capitais das 27 unidades federativas do Brasil e sua associação com variáveis sociodemográficas. MÉTODOS: Os dados utilizados neste estudo provêm dos participantes (n = 52.443) da onda 2019 do inquérito anual do “Sistema nacional de vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico” (Vigitel). O consumo de alimentos ultraprocessados foi descrito com base em escore correspondente à somatória de respostas positivas para questões sobre o consumo no dia anterior de treze subgrupos de alimentos ultraprocessados frequentemente consumidos no Brasil. Modelos de regressão de Poisson foram utilizados para descrever as associações bruta e ajustada do alto consumo de alimentos ultraprocessados (escores ≥ 5) com sexo, faixa etária e nível de escolaridade. RESULTADOS: A frequência de alto consumo de alimentos ultraprocessados foi 18,2% (IC95% 17,4–19,0). Com ou sem o ajuste para as demais variáveis sociodemográficas, essa frequência foi significativamente menor no sexo feminino e diminuiu linearmente com a idade. Na análise bruta, evidenciou-se aumento na frequência de alto consumo do nível inferior para o nível intermediário de escolaridade e diminuição desse consumo do nível intermediário para o superior. Na análise ajustada por sexo e idade, a frequência de alto consumo de alimentos ultraprocessados foi significativamente menor no nível superior de escolaridade (12 ou mais anos de estudo), não havendo diferenças entre os demais níveis. CONCLUSÃO: Alimentos ultraprocessados são consumidos com alta frequência na população brasileira adulta das 27 capitais da federação. Pertencer ao sexo masculino, ser mais jovem e ter escolaridade inferior à universitária são condições que aumentam, de forma independente, o consumo desses alimentos.OBJECTIVE: To describe the magnitude of consumption of ultra-processed foods in the adult population (≥ 18 years old) in the capitals of the 27 federative units of Brazil, as well as its association with sociodemographic variables. METHODS: Data used in this study stem from participants (n = 52,443) of the 2019 wave of the annual survey of the “National surveillance system for risk and protective factors for chronic diseases by telephone survey” (Vigitel). The consumption of ultra-processed foods was described based on a score, corresponding to the sum of positive responses to questions about consumption on the previous day of thirteen subgroups of ultra-processed foods frequently consumed in Brazil. Poisson regression models were used to describe the crude and adjusted associations between high consumption of ultra-processed foods (scores ≥ 5) and sex, age group, and level of education. RESULTS: The frequency of high consumption of ultra-processed foods was 18.2% (95% CI 17.4–19.0). With or without adjustment for other sociodemographic variables, this frequency was significantly lower in females and decreased linearly with age. In the crude analysis, there was an increase in the frequency of high consumption from the lower level to the intermediate level of education and a decrease in this consumption from the intermediate level to the upper level. In the analysis adjusted for sex and age, the frequency of high consumption of ultra-processed foods was significantly lower at the higher level of education (12 or more years of study), with no differences between the other levels. CONCLUSION: Ultra-processed foods are consumed with high frequency in the adult Brazilian population in the 27 capitals of the federation. Being male, younger and having less education than university are conditions that increase, independently, the consumption of these foods

A rapid, simple, and low-blank pumped ion-exchange column chromatography technique for boron purification from carbonate and seawater matrices

Funding: This work is supported by the European Research Council under the European Union's Horizon 2020 research and innovation program (Grant 805246) to J.W.B.R., H.J., a Natural Environmental Research Council (NERC)-IAPETUS2 Doctoral Training Programme (DTP) Studentship to NE/S007431/1 C.X., a NERC-IAPETUS DTP Studentship NE/RO12253/1 to M.T., a Leverhulme Trust Early Career Fellowship ECF-2023-199 to H.J., a NERC UK IODP grant NE/P000878/1 to S.B. and S.N., and a Taiwanese MOST Grant 111-2116M-002-032-MY3 to S.N.Boron isotope ratios (δ11B) are used across the Earth Sciences and are increasing analyzed by Multi-Collector Inductively Coupled Plasma Mass Spectrometry (MC-ICPMS). Accurate δ11B MC-ICPMS analysis requires boron purification from the sample matrix using ion-exchange column chromatography. However, the traditional gravity-drip column method is time-consuming and prone to airborne contamination due to its long duration and open resin surface. To address these issues, we designed a novel, simple, and reliable column chromatography technique called “peri-columns.” This method uses a peristaltic pump to generate vacuum on a commonly used column set up. This method uses sealed collection beakers and does not require solutions to pass through pump tubing, minimizing contamination. The duration is reduced by eight-fold, processing 12 samples in just 1.5 hr. It also yields low and consistent total procedural blanks, averaging 11 pg. The efficiency and efficacy of this method were tested by repeated boron purification from calcium carbonate and high-sodium matrices with international and in-house reference materials. The results matched those obtained using the gravity column method and fell within our laboratory long-term and international certified values. The mean δ11B and 2SD (standard deviation) of repeatedly processed NIST 8301f were 14.57 ± 0.26‰ (n = 31), NIST 8301c was 24.19 ± 0.33‰ (n = 10), STAiG-F1 was 16.20 ± 0.26‰ (n = 13), and seawater was 39.52 ± 0.32‰ (n = 10). All the components of our techniques are commercially available, and it is easily adaptable to other laboratories and isotope systems.Publisher PDFPeer reviewe

Targeting the LOX/hypoxia axis reverses many of the features that make pancreatic cancer deadly: inhibition of LOX abrogates metastasis and enhances drug efficacy

Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer‐related mortality. Despite significant advances made in the treatment of other cancers, current chemotherapies offer little survival benefit in this disease. Pancreaticoduodenectomy offers patients the possibility of a cure, but most will die of recurrent or metastatic disease. Hence, preventing metastatic disease in these patients would be of significant benefit. Using principal component analysis (PCA), we identified a LOX/hypoxia signature associated with poor patient survival in resectable patients. We found that LOX expression is upregulated in metastatic tumors from Pdx1‐Cre KrasG12D/+ Trp53R172H/+ (KPC) mice and that inhibition of LOX in these mice suppressed metastasis. Mechanistically, LOX inhibition suppressed both migration and invasion of KPC cells. LOX inhibition also synergized with gemcitabine to kill tumors and significantly prolonged tumor‐free survival in KPC mice with early‐stage tumors. This was associated with stromal alterations, including increased vasculature and decreased fibrillar collagen, and increased infiltration of macrophages and neutrophils into tumors. Therefore, LOX inhibition is able to reverse many of the features that make PDAC inherently refractory to conventional therapies and targeting LOX could improve outcome in surgically resectable disease

Impaired reward-related learning signals in remitted unmedicated patients with recurrent depression

One of the core symptoms of major depressive disorder is anhedonia, an inability to experience pleasure. In patients with major depressive disorder, a dysfunctional reward-system may exist, with blunted temporal difference reward-related learning signals in the ventral striatum and increased temporal difference-related (dopaminergic) activation in the ventral tegmental area. Anhedonia often remains as residual symptom during remission; however, it remains largely unknown whether the abovementioned reward systems are still dysfunctional when patients are in remission. We used a Pavlovian classical conditioning functional MRI task to explore the relationship between anhedonia and the temporal difference-related response of the ventral tegmental area and ventral striatum in medication-free remitted recurrent depression patients (n = 36) versus healthy control subjects (n = 27). Computational modelling was used to obtain the expected temporal difference errors during this task. Patients, compared to healthy controls, showed significantly increased temporal difference reward learning activation in the ventral tegmental area (PFWE,SVC = 0.028). No differences were observed between groups for ventral striatum activity. A group × anhedonia interaction [t(57) = -2.29, P = 0.026] indicated that in patients, higher anhedonia was associated with lower temporal difference activation in the ventral tegmental area, while in healthy controls higher anhedonia was associated with higher ventral tegmental area activation. These findings suggest impaired reward-related learning signals in the ventral tegmental area during remission in patients with depression. This merits further investigation to identify impaired reward-related learning as an endophenotype for recurrent depression. Moreover, the inverse association between reinforcement learning and anhedonia in patients implies an additional disturbing influence of anhedonia on reward-related learning or vice versa, suggesting that the level of anhedonia should be considered in behavioural treatments

Lack of trust in maternal support is associated with negative interpretations of ambiguous maternal behavior

Attachment theory assumes that children who lack trust in maternal availability for support are more inclined to interpret maternal behavior in congruence with their expectation that mother will remain unavailable for support. To provide the first test of this assumption, early adolescents (9-13 years old) were asked to assess whether ambiguous interactions with mother should be interpreted in a positive or a negative way. In our sample (n = 322), results showed that early adolescents' lack of trust in their mother's availability for support was related to more negative interpretations of maternal behavior. The associations remained significant after controlling for depressive mood. The importance of these findings for our understanding of attachment theory, attachment stability, and clinical practice are discussed

An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial

Objective To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae. Design Pragmatic, parallel group, cluster randomised controlled trial. Setting 228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom. Participants 1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012. Intervention Targeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment. Main outcome measures Primary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points. Results 64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval −0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. Conclusions This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies