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Background Intestinal failure-associated liver disease (IFALD) occurs in ≤85% of neonates receiving prolonged parenteral nutrition. Strategies for treatment of IFALD include alternative lipid therapies, such as Smoflipid (Fresenius Kabi). In this study, we reviewed our institutional Smoflipid use, including predictors of patient response and safety concerns. Methods This is a retrospective chart review of all pediatric patients who received Smoflipid therapy over a 2-year period at Riley Hospital for Children. Forty-two patients (89%) had cholestasis at the start of Smoflipid therapy and were included in group analysis. We compared patients based on response to Smoflipid therapy, identifying associations and predictors of patient response. We also documented patient safety concerns, including essential fatty acid deficiency (EFAD), rapid infusion, and compatibility/access issues. Results Sixteen patients (38%) with cholestasis had resolution with Smoflipid. Those patients with resolution were older at initiation (58 vs 33.5 days; P = .010), treated with Smoflipid for longer (85.5 vs 41 days; P = .001), and had lower direct bilirubin at the start of Smoflipid therapy (3.7 vs 5.2 mg/dL; P = .035). We identified multiple safety concerns, including EFAD (54%), rapid infusion (17%), and missed doses (51%). No patient characteristics were found to correlate with Smofllpid therapy and diagnosis of EFAD. Conclusion In our patient population, Smoflipid therapy led to cholestasis resolution in patients with lower direct bilirubin or less-severe IFALD. Use of Smoflipid is also associated with significant safety concerns, and its use should be coupled with close monitoring in pediatric patients, particularly in neonates.

Background Children are more at risk of medication errors than adults. Predisposing factors include: dosing by weight/age; multitude of dose strengths available; use of off license prescribing. The GMC and BMA encourage open, honest admission to families when errors occur. Aims To evaluate families views on how they would like to be informed about medication errors. Methods We devised a parental questionnaire asking if their child used medication and if they had experienced an error. Three scenarios for medication errors with; no/low/significant harm were presented along with 4 options as to how to be told: Tell them over the phone immediately If we can’t contact them, leave an answer phone message that there is a problem Tell them face to face when they return Wouldn’t want to be informed Their preference for who would inform them was sought. Parents of any children attending/resident in hospital were eligible. Results We asked 100 parents: 85 mothers and 15 fathers; 52 inpatients and 48 outpatients. 53% of the children were taking regular medications and 7% had experienced a medication error. Parents preferred to be told by: a doctor 54%, nurse 10%, either doctor or nurse 32% and 4% did not mind. Several specified that this would depend on the severity of the error and who was most available. Conclusions Most parents would like to be informed about a medication error by a doctor as soon as it is identified. If they are not present they would prefer to be contacted by telephone, although not via an answering machine message. Where no harm is expected, waiting until parents are present was generally acceptable to them (table 1). Trust between families and healthcare professionals is encouraged by honesty and openness. Best practice should be to provide information as soon as possible; however this may present logistical challenges to meet these expectations.

Over the past decades metabolic balance studies have been extensively used for the purpose of determining the retention rates of nutrients ingested by neonates. Traditionally, data derived from these studies have been used to estimate nutritional requirements in both full-term and premature infants. This article provides a historical review of the methodology used in classic metabolic balance studies performed in neonates since 1955. In addition, descriptions of new methodologies that improve the reliability and reproducibility of metabolic balance studies conducted in premature infants that include: (1) the recognition that an acclimation period of steady and sufficient energy intake is necessary prior to the initiation of the balance study; (2) the use of a minimum period of 72 hours for the total duration of balance study; and (3) the use of stool markers to time the period. Also described in this article are the retention rates of calcium and fat that were measured in premature infants by means of metabolic balance studies conducted with the use of recommended methodology.

Demand for the commercial use of genetically modified (GM) crops has been increasing in light of the projected growth of world population to nine billion by 2050. A prerequisite of paramount importance for regulatory submissions is the rigorous safety assessment of GM crops. One of the components of safety assessment is molecular characterization at DNA level which helps to determine the copy number, integrity and stability of a transgene; characterize the integration site within a host genome; and confirm the absence of vector DNA. Historically, molecular characterization has been carried out using Southern blot analysis coupled with Sanger sequencing. While this is a robust approach to characterize the transgenic crops, it is both time- and resource-consuming. The emergence of next-generation sequencing (NGS) technologies has provided highly sensitive and cost- and labor-effective alternative for molecular characterization compared to traditional Southern blot analysis. Herein, we have demonstrated the successful application of both whole genome sequencing and target capture sequencing approaches for the characterization of single and stacked transgenic events and compared the results and inferences with traditional method with respect to key criteria required for regulatory submissions.

Many investigators over the past three decades have successfully conducted traditional metabolic balance studies in efforts to determine the retention rates of key nutrients important to the optimal growth of preterm infants. Differences in methodologies discussed in this review may explain the inconsistent results of balance studies reported for some nutrients, particularly calcium. These methodologic differences include (1) variability in nutrient intake and nutritional course prior to the balance period, (2) differences in the method of stool collection (with and without markers), (3) use of single versus repeated balance periods, and (4) different durations of balance periods. The data presented here suggest that the variability of net fat absorptions among VLBW infants was decreased when an acclimation period of nutrient intake supportive of growth was provided prior to a metabolic balance study. In addition, the use of markers affected the estimates of net calcium absorption but not fat absorption. Additional factors that may influence net calcium absorption and methods for the estimation of calcium absorption in VLBW infants warrant further investigation. This review describes the methods of specimen collection for metabolic balance studies in VLBW preterm infants that demonstrated reproducible data. The recent application of stable isotope methodology to metabolic balance studies can be extremely advantageous in identifying the rates of nutrient absorption versus endogenous secretion in the GI tract.

To measure simultaneously blood volume, altered vascular permeability, and leukocyte extravasation in ocular inflammation in rabbits at various times and in different anatomic locations after intravitreal endotoxin (lipopolysaccharide [LPS]).Nuclides of different emission and decay were used for labeling and then injected intravenously. Ocular blood volumes were measured with technetium 99m, altered vascular permeability with I-125 albumin, and polymorphonuclear leukocyte or mononuclear cell extravasation after labeling with Indium 111. Eyes were divided into anterior eye section, iris-ciliary body, aqueous, and vitreous and posterior eye sections, and measurements were made at 3, 6, 9, 18, and 24 hours after intravitreal LPS injection. Blood volume measurements made it possible to estimate the amount of extravascular protein and the number of extravascular leukocytes.Blood volumes were consistently elevated at all times, usually by approximately 50% and predominantly in the anterior segment. Altered vascular permeability was present at 3 hours, increased at 6 hours, decreased at 9 hours, and was elevated at 18 to 24 hours, predominantly in the anterior eye. Leukocytes in iris-ciliary body appeared in small numbers at 6 hours, increased at 9 hours, and continued to extravasate at 18 and 24 hours. Mononuclear cells were as numerous as polymorphonuclear leukocytes at each time measured.The quantitation of multiple parameters of ocular inflammation in this experimental model has been helpful in defining when and in what tissue changes occur. Leukocytes are primarily within tissues, particularly in the iris-ciliary body region. Mononuclear leukocytes are a prominent feature at all times and add further support to the concept that the mononuclear phagocyte plays a pivotal role in reactions to LPS.

Summary The paper describes the water well drilling methods currently in use throughout the world and explains the operation, tooling, and application of each system. Notable developments are reviewed and the problems which fostered them are examined. While the main systems of drilling are dealt with, mention is made of the less common methods, some of which may be selected for areas where local conditions warrant their use. Cable-tool (percussion), rotary and other types of drilling are discussed and also the use of clay-based and organic polymer muds, air-flush, and foam.

Sym. Trinitrobenzol kann exakt an seinem rotfarbigen Komplex mit Natriumaethylat in benzolischer Losung colorimetriert werden. m-Dinitrobenzol last sich ebenfalls in benzolischer Losung durch Colorimetrieren im ultravioletten Licht quantitativ bestimmen. Fur eine Bestimmung beider Stoffe nebeneinander ist eine chromatographische Abtrennung notwendig, die an frisch aktiviertem Magnesiumoxyd in benzolischer Losung gelingt.

Durch Einschaltung einer geeigneten mit Mesgut gefullten Messtrecke in das Ruckkopplungsnetzwerk eines RC-Generators ist es moglich, aus der Frequenzanzeige dieses Generators Aussagen uber die elektrischen Eigenschaften des Mesgutes zu gewinnen. Im 1. Teil werden die Frequenz- und Ruckkopplungsbeziehungen fur ein arbeitsfahiges Gerat abgeleitet. Neben dem Aufbau des RC-Gerates und der Ausgestaltung des Ruckkopplungsvierpols als frequenzbestimmendem Teil werden die Empfindlichkeit und die Grenzen der Anwendbarkeit aufgezeigt. In dem Leitfahigkeitsbereich von 10−12Ω−1 cm−1 bis 10 Ω−1 cm−1 gestattet die Methode eine kontinuierliche unverzugliche Registrierung. Das Gerat ist auch als Dekameter verwendbar. Im 2. Teil wird die Gestaltung der Meszelle diskutiert, abschliesend werden im 3. Teil Anwendungen der Methode beschrieben. By inserting a suitable test section, containing samples, into the feedback network of an RC generator it is possible to make statements about the electrical properties of the samples from the frequency indication of this generator. In Part 1 the frequency and feedback relations for a practicable apparatus are deduced. The design of the RC equipment and the layout of the four-pole feedback system as the frequency determining part are outlined as well as the sensitivity and the limits of applicability. Within the conductivity range of 10−12Ω−1cm−1 to 10 Ω−1cm−1 the method permits immediate and continuous recording. The apparatus can also be used as a decameter. In Part 2 the design of the measuring cell is discussed, while the applications of the method are described in Part 3.