Artificial Formula Research Articles

THE IMPORTANCE OF BREAST MILK IN THE PREVENTION OF NECROTIC ENTEROCOLITIS IN NEWBORNS

Necrotizing enterocolitis (NEC) is one of the most serious conditions affecting preterm infants, associated with a high mortality rate. Breast milk, due to its unique bioactive components, can reduce the risk of NEC by protecting the intestines and supporting healthy microbiota. This article discusses the protective mechanisms of breast milk, its immune and anti-inflammatory properties, and compares it with artificial formula.

Accuracy assessment of artificial intelligence IOL calculation formulae: utilizing the heteroscedastic statistics and the Eyetemis Analysis Tool.

To analyse the accuracy of artificial intelligence (AI)-driven intraocular (IOL) calculation formulae, together with established formulae using the heteroscedastic methodology and the Eyetemis Analysis Tool. Data from 404 eyes who underwent uneventful phacoemulsification with implantation of the SN60WF IOL were retrospectively reviewed. IOL power calculations were performed using the Barrett Universal II (BUII), EVO 2.0, Hoffer QST, K6, Ladas Super Formula (LSF), Nallasamy, PEARL-DGS and RBF 3.0 formulae. The SD of the prediction error (PE), served as the primary metric for accuracy. The mean absolute deviation (MAD) and the predictability rates within intervals from ±0.25 D to ±1.50 D were also evaluated. The Eyetemis Analysis Tool was used for further validation. The SD ranged from 0.468 (Nallasamy) to 0.510 (LSF). The Nallasamy formula had a significantly lower SD than the BUII (0.505, p = 0.025) and K6 (0.489, p = 0.022) formulae. The Nallasamy formula also exhibited the lowest MAD (0.358) with a significant difference compared with the Hoffer QST formula (0.384, p < 0.001). Finally, a significantly higher percentage of eyes achieving ± 0.50 D of the target refraction was seen using the Nallasamy formula (77.19%) compared with the Hoffer QST (71.04%, p = 0.019) and Ladas Super Formula (70.79%, p = 0.030) formulae. The Nallasamy formula, incorporating AI technology, demonstrated superior accuracy according to the analysis guidelines for PE statistics for non-gaussian datasets recommended by Holladay et al. and the online Eyetemis Analysis Tool.

ОЦЕНКА ГОТОВНОСТИ БУДУЩИХ МАМ К ГРУДНОМУ ВСКАРМЛИВАНИЮ

Breastfeeding is the optimal type of child feeding, having a beneficial effect on the health of the child and mother. Objective: to assess the knowledge of expectant mothers about breast milk and the current practice of preparing for breastfeeding in medical organizations. Materials and methods. A one-time study was conducted using a voluntary survey among pregnant and postpartum women in antenatal clinics and obstetric institutions. Results. Despite the readiness of 89% of surveyed respondents to breastfeed their children, there is insufficient commitment of medical personnel to prepare for breastfeeding: only 44% of expectant mothers received information about the benefits of breastfeeding during pregnancy in antenatal clinics and 68% in maternity care institutions, attached to breasts immediately after birth in only 73% of newborns, only 29.6% of postpartum women received help from a breastfeeding consultant in the maternity hospital, 39% of nursing mothers developed cracked nipples on the second or third day from the start of feeding, indicating a violation of breastfeeding technique, and finally, only 33.0% of mothers in the region breastfeed until their children reach 6 months of age. Only 7.3% of respondents know about the reduced risk of developing breast cancer when breastfeeding, 26% believe that children receiving adapted artificial formula are less susceptible to acute intestinal infections. Conclusion. Insufficient knowledge about the benefits of breast milk in expectant mothers requires a change in organizational forms of work to support breastfeeding during pregnancy and in the early postpartum period in medical organizations, as well as large-scale measures to inform the population and create conditions conducive to breastfeeding about its importance.

Risk of Fat Mass- and Obesity-Associated Gene-Dependent Obesogenic Programming by Formula Feeding Compared to Breastfeeding.

It is the purpose of this review to compare differences in postnatal epigenetic programming at the level of DNA and RNA methylation and later obesity risk between infants receiving artificial formula feeding (FF) in contrast to natural breastfeeding (BF). FF bears the risk of aberrant epigenetic programming at the level of DNA methylation and enhances the expression of the RNA demethylase fat mass- and obesity-associated gene (FTO), pointing to further deviations in the RNA methylome. Based on a literature search through Web of Science, Google Scholar, and PubMed databases concerning the dietary and epigenetic factors influencing FTO gene and FTO protein expression and FTO activity, FTO's impact on postnatal adipogenic programming was investigated. Accumulated translational evidence underscores that total protein intake as well as tryptophan, kynurenine, branched-chain amino acids, milk exosomal miRNAs, NADP, and NADPH are crucial regulators modifying FTO gene expression and FTO activity. Increased FTO-mTORC1-S6K1 signaling may epigenetically suppress the WNT/β-catenin pathway, enhancing adipocyte precursor cell proliferation and adipogenesis. Formula-induced FTO-dependent alterations of the N6-methyladenosine (m6A) RNA methylome may represent novel unfavorable molecular events in the postnatal development of adipogenesis and obesity, necessitating further investigations. BF provides physiological epigenetic DNA and RNA regulation, a compelling reason to rely on BF.

Choosing the formula for calculating optical power of intraocular lens on "short" eyes using the potential of artificial intelligence

Objective: to carry out a comparative analysis of IOL fitting accuracy in patients with eye length less than 22.0 mm using Barrett Universal II, Kane, Hoffer Q and artificial intelligence formulas. Material and methods. The results of 88 phacoemulsification cataract operations with implantation of monofocal lOLs were analyzed. Preoperative biometry and IOL calculations were performed on the IOL Master 700. The accuracy of IOL fitting was also determined using the LensCalc program, which is based on artificial intelligence (DecisionTreeClassifier). Results. The eye length of the patients ranged from 19.8 to 22 mm. The prediction of the target refraction hit was the most accurate when using Barrett Universal II formulas as opposed to Hoffer Q (Z=2.12; p=0.034). The mean value of the target refraction hit error was not different when using the Barrett Universal II formula compared to the Kane formula (p&gt;0.05). Using artificial intelligence it was found that higher accuracy in the results of IOL optical power determination was achieved when using the Barrett Universal II formula. Conclusion. Based on a comparative analysis of the study results and assessment of IOL fitting accuracy using artificial intelligence, it was found that the Barrett Universal II formula (4th generation) is more accurate in determining the optical power of lOLs in "short" eyes than the Hoffer Q formula (3rd generation). The results obtained using the Barrett Universal II formula, in contrast to the Hoffer Q formula, do not differ from the data calculated using the Kane formula (5th generation), which, according to the results of most studies, is the most accurate IOL selection formula at present (p&gt;0.05).

Inconsistent reproductive cycles and postnatal growth between captive and wild Chinese pangolins and its conservation implications

Captive breeding and reintroduction are crucial to the conservation of endangered species and restoring their populations in the wild. Previous research has primarily focused on behavioral changes and adaptations in captive-bred animals prior to release; few studies have examined changes in reproductive traits and postnatal development in captivity. The Chinese pangolin, Manis pentadactyla, is Critically Endangered because its population has substantially declined in the wild due to poaching for sale in the traditional medicine and luxury food markets. Nevertheless, success in captive breeding in Taiwan may provide a pathway to the recovery of wild populations. This study combined records on captive individuals and field observations on wild Chinese pangolins over a period from 1997 to 2023 to determine (i) mating season, (ii) birth timing, (iii) body mass and total length of newborns, and (iv) postnatal growth patterns prior to weaning. The present study suggests that mating and birth timings for captive Chinese pangolins are not seasonal, as they are in the wild. Captive-born infants are significantly longer and heavier at birth than wild-born infants. Remarkably, captive-born pangolins also experience more rapid weight gain, nearly doubling in size compared with their wild counterparts by 25 weeks of age, even before they are weaned. This rapid growth is likely attributable to the high nutritional content of captive diets. This study suggests artificial feed formulas should be aligned more closely with wild pangolins’ diets to reduce the risk of obesity. Additionally, reproductive parameters and postnatal growth rates in Chinese pangolins cannot be based on observations of captive individuals alone; wild populations must also be considered. We conclude that Chinese pangolins exhibit physiological flexibility in reproduction and growth in response to environmental changes, providing insights for captive pangolin management and reintroduction programs.

The acceptability of a donor human milk bank and donated human milk among mothers in Limpopo Province, South Africa.

Breastfeeding is a crucial public health approach that reduces infant morbidity and mortality by providing essential nutrients and antibodies, and breast milk is easily digested. Breastfeeding and donated milk serve as a preventative measure against necrotising enterocolitis. Additionally, they protect against viruses and nosocomial sepsis. When a birthing parent's own milk is unavailable, alternative enteral nutrition for preterm or low-birth-weight infants is either donor human milk (DHM) or artificial formula. This study aimed to understand mothers' acceptance of the donor human milk bank (DHMB) and DHM. A qualitative phenomenological study was conducted in Limpopo Province, South Africa. The study used purposive sampling to select 23 mothers in postnatal and neonatal wards. Data collection was via in-depth interviews using a semistructured interview guide. Manual data analysis using an interpretative phenomenological analysis (IPA) framework was used to coding. Concepts were grouped to generate themes. Three themes and nine subthemes were generated: (1) DHMBs (2) cultural perspective of DHMB, and (3) health considerations of DHM. Participants were unaware of the DHMB. Hesitancy in accepting DHM due to fear of contracting HIV was observed. Cultural beliefs are an influencing factor for use, while donation was driven by altruistic reasons, preventing waste, helping othersand having previously benefited from DHM. The study found that mothers are willing to donate human milk. Willingness to donate can be increased by raising awareness about DHMB and addressing cultureand safety concerns at antenatal clinics.

A Review of Intraocular Lens Power Calculation Formulas Based on Artificial Intelligence.

The proper selection of an intraocular lens power calculation formula is an essential aspect of cataract surgery. This study evaluated the accuracy of artificial intelligence-based formulas. Systematic review. This review comprises articles evaluating the exactness of artificial intelligence-based formulas published from 2017 to July 2023. The papers were identified by a literature search of various databases (Pubmed/MEDLINE, Google Scholar, Crossref, Cochrane Library, Web of Science, and SciELO) using the terms "IOL formulas", "FullMonte", "Ladas", "Hill-RBF", "PEARL-DGS", "Kane", "Karmona", "Hoffer QST", and "Nallasamy". In total, 25 peer-reviewed articles in English with the maximum sample and the largest number of compared formulas were examined. The scores of the mean absolute error and percentage of patients within ±0.5 D and ±1.0 D were used to estimate the exactness of the formulas. In most studies the Kane formula obtained the smallest mean absolute error and the highest percentage of patients within ±0.5 D and ±1.0 D. Second place was typically achieved by the PEARL DGS formula. The limitations of the studies were also discussed. Kane seems to be the most accurate artificial intelligence-based formula. PEARL DGS also gives very good results. Hoffer QST, Karmona, and Nallasamy are the newest, and need further evaluation.

Modern baby breastfeeding trends

Breastfeeding is a critical aspect of infant care that provides numerous benefits for both infants and mothers. The socio-cultural changes of the 21st century require optimisation of this practice and research into the physiological stages of milk secretion, including the hormonal regulation of lactation and factors that influence breast secretion, which is crucial for supporting breastfeeding and improving the overall well-being of infants and mothers. The purpose of the work was to investigate current views on breastfeeding support through a comprehensive review of the existing literature, with a particular focus on studies on the physiological stages of milk secretion during pregnancy and breastfeeding. We used bibliographic, analytical and regulatory search methods. The review contributes to the deepening of knowledge and understanding of breastfeeding, emphasising its importance for newborn care and maternal well-being. The material covers a wide range of factors that influence lactation as a physiological process and breastfeeding as a social practice. The findings highlight the physiological basis of the lactation process: the key role of prolactin and oxytocin in initiating and maintaining milk secretion, internal (hormonal imbalances, breast anatomy and surgery), and external factors such as the mother’s somatic condition, including gestational diabetes and polycystic ovary syndrome. The positive aspects of breastfeeding for both the child and the mother are analysed. The various positive effects of this practice on the child are considered, including the most favourable balance of nutrients in the mother’s milk, the formation of passive immunity and the maintenance of a healthy intestinal microbiota. Particular attention is paid to the changing views on infant feeding in light of social and economic changes in the early 21st century, including the growing role of artificial formula and the challenges of natural feeding in the workplace. Practical implications: it provides a basis for developing evidence-based interventions to improve the breastfeeding experience and well-being of both infants and mothers while informing healthcare professionals, policymakers, and support groups.

Sustainable Breastfeeding: A State-of-the Art Review.

Disparities in breastfeeding rates and exclusivity exist across regions and countries despite multifaceted breastfeeding promotion efforts in recent decades. Markets for artificial milk formula continue to grow as its substitution for breastfeeding is common. A new approach is needed for breastfeeding promotion strategies. This state-of-the-art review aimed to describe the implications of not-breastfeeding on the environment within the context of food system sustainability. A total of 19 peer-reviewed articles within a 20-year timeframe were included in this review. Authors searched five databases for articles including Science Direct, GreenFILE, Springer Link, ProQuest, and PubMed. The demand for artificial milk formula production as a replacement for breastfeeding results in increased greenhouse gas emissions, water pollution, and waste, thereby aggravating problems with freshwater scarcity. A short duration of breastfeeding and limited exclusivity have been associated with close birth spacing and contributing to global population growth. Breastfeeding is a healthy, sustainable diet, and a culturally acceptable first food. It advances health equity and food security. Exclusive breastfeeding for the first 6 months of life can be promoted with emphasis on total carbon footprint reduction, prevention of waterway degradation, and natural birth spacing, thereby sustaining food systems at large. It is important to reform food, nutrition, and environmental policies to protect exclusive breastfeeding while decarbonizing artificial milk formula production. More research is needed to provide directions for new breastfeeding promotion strategies connecting breastfeeding with environmental stewardship.

Accuracy of Seven Modern Online IOL Formulas in Eyes With Axial Lengths Longer Than 30 mm.

To evaluate the accuracy of newer online intraocular lens (IOL) formulas in extremely elongated eyes (axial length > 30 mm). This retrospective case series study included 236 patients (236 eyes). Postoperative refractive outcomes of the Barrett Universal II (BU II), Cooke K6 (K6), Emmetropia Verifying Optical (EVO) 2.0, Hoffer QST (HQST), Kane, Pearl-DGS, and Radial Basis Function (RBF) 3.0 formulas were compared. Subgroup analysis was performed in the extreme myopia group 1 (30 < axial length ≤ 32 mm), extreme myopia group 2 (32 < axial length ≤ 35 mm), and meniscus IOL group. The root mean square absolute prediction error (RMSAE) and proportions of eyes of prediction errors within ±0.50 diopters (D) were calculated for statistical analysis. For the extreme myopia group 1, RBF 3.0 achieved the lowest RMSAE (0.361) and EVO 2.0 showed the highest proportion of eyes within ±0.50 diopters (85.06%). For the extreme myopia group 2, the RMSAE of the K6 (0.442) and EVO 2.0 (0.475) was significantly lower than the BU II (0.610), Kane (0.641), and HQST (0.759, P ≤ .016) formulas. In the meniscus IOL group, the K6 formula showed the lowest RMSAE (0.402) and the highest percentage within ±0.50 diopters (84.31%). The EVO 2.0 and K6 formulas are recommended for IOL power calculation in eyes with extreme myopia. Modern artificial intelligence-based formulas should be used cautiously when the axial length is longer than 32 mm or meniscus IOLs are implanted. [J Refract Surg. 2023;39(10):705-710.].

Intraocular Lens Power Calculation Formulas-A Systematic Review.

The proper choice of an intraocular lens (IOL) power calculation formula is an important aspect of phacoemulsification. In this study, the formulas most commonly used today are described and their accuracy is evaluated. This review includes papers evaluating the accuracy of IOL power calculation formulas published during the period from January 2015 to December 2022. The articles were identified by a literature search of medical and other databases (PubMed/MEDLINE, Crossref, Web of Science, SciELO, Google Scholar, and Cochrane Library) using the terms "IOL formulas," "Barrett Universal II," "Kane," "Hill-RBF," "Olsen," "PEARL-DGS," "EVO," "Haigis," "SRK/T," and "Hoffer Q." Twenty-nine of the most recent peer-reviewed papers in English with the largest samples and largest number of formulas compared were considered. Outcomes of mean absolute error and percentage of predictions within ±0.5 D and ±1.0 D were used to evaluate the accuracy of the formulas. In most studies, Barrett achieved the smallest mean absolute error and PEARL-DGS the highest percentage of patients with ±0.5 D in short eyes, while Kane obtained the highest percentage of patients with ±0.5 D in long eyes. The third- and fourth-generation formulas are gradually being replaced by more accurate ones. The Barrett Universal II among vergence formulas and Kane and PEARL-DGS among artificial intelligence-based formulas are currently most often reported as the most precise.

DNA methylation and gene expression changes in mouse mammary tissue during successive lactations: part I – the impact of inflammation

ABSTRACT Mastitis is among the main reasons women cease breastfeeding, which leads to them supplementing breast milk with artificial formula. In farm animals, mastitis results in significant economic losses and the premature culling of some animals. Nevertheless, researchers do not know enough about the effect of inflammation on the mammary gland. This article discusses the changes to DNA methylation in mouse mammary tissue caused by lipopolysaccharide-induced inflammation (4 h post-injection of lipopolysaccharide). We analysed the expression of some genes related to mammary gland function, epigenetic regulation, and the immune response. The analysis focused on three comparisons: inflammation during the first lactation, inflammation during second lactation with no history of inflammation, and inflammation during second lactation with previous inflammation. We identified differentially methylated cytosines (DMCs), differentially methylated regions (DMRs), and some differentially expressed genes (DEGs) for each comparison. The three comparisons shared some DEGs; however, few DMCs and only one DMR were shared. These observations suggest that inflammation is one of several factors affecting epigenetic regulation during successive lactations. Furthermore, the comparison between animals in second lactation with and without inflammation, with no inflammation history during first lactation showed a different pattern compared to the other conditions in this experiment. This indicates that inflammation history plays an important role in determining epigenetic changes. The data presented in this study suggest that lactation rank and previous inflammation history are equally important when explaining mammary tissue gene expression and DNA methylation changes. Abbreviations: RRBS, reduced representation bisulfite sequencing; RT–qPCR, real-time quantitative polymerase chain reaction; MEC, mammary epithelial cells; TSS, transcription start site; TTS, transcription termination site; UTR, untranslated region; SINE, short interspersed nuclear element; LINE, long interspersed nuclear element; CGI, CpG island; DEG, differentially expressed gene; DMC, differentially methylated cytosine; DMR, differentially methylated region; GO term, gene ontology term; MF, molecular function; BP, biological process

The Zhu-Lu formula: a machine learning-based intraocular lens power calculation formula for highly myopic eyes

BackgroundTo develop a novel machine learning-based intraocular lens (IOL) power calculation formula for highly myopic eyes.MethodsA total of 1828 eyes (from 1828 highly myopic patients) undergoing cataract surgery in our hospital were used as the internal dataset, and 151 eyes from 151 highly myopic patients from two other hospitals were used as external test dataset. The Zhu-Lu formula was developed based on the eXtreme Gradient Boosting and the support vector regression algorithms. Its accuracy was compared in the internal and external test datasets with the Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO) 2.0, Kane, Pearl-DGS and Radial Basis Function (RBF) 3.0 formulas.ResultsIn the internal test dataset, the Zhu-Lu, RBF 3.0 and BUII ranked top three from low to high taking into account standard deviations (SDs) of prediction errors (PEs). The Zhu-Lu and RBF 3.0 showed significantly lower median absolute errors (MedAEs) than the other formulas (all P < 0.05). In the external test dataset, the Zhu-Lu, Kane and EVO 2.0 ranked top three from low to high considering SDs of PEs. The Zhu-Lu formula showed a comparable MedAE with BUII and EVO 2.0 but significantly lower than Kane, Pearl-DGS and RBF 3.0 (all P < 0.05). The Zhu-Lu formula ranked first regarding the percentages of eyes within ± 0.50 D of the PE in both test datasets (internal: 80.61%; external: 72.85%). In the axial length subgroup analysis, the PE of the Zhu-Lu stayed stably close to zero in all subgroups.ConclusionsThe novel IOL power calculation formula for highly myopic eyes demonstrated improved and stable predictive accuracy compared with other artificial intelligence-based formulas.

Diabetes Retinopathy prediction Using Machine Learning

Diabetes mellitus is a persistent condition that affects a variety of body organs of body featuring the retina. Diabetic person Retinopathy (DR) arises from Diabetes Mellitus (DM). In literary works a variety of artificial intelligence formulas have been related to the diagnosis of DR. This includes pair of steps; Including removal and also Category. This study testimonials a variety of approaches utilized for spotting DR based upon the attributes like capillary, microaneurysms, haemorrhages and so on. In the majority of the experiments, retinal fundus graphics were utilized through which photos of the retina were recorded through a fundus video cam. This evaluation bifurcates the diagnosis of DR into pair of approaches; Capillary segmentation and also Recognition of sores. This study matches up the speculative results of a variety of artificial intelligence approaches based upon specifications like level of sensitivity, specificity,AUC, Precision. The results are likewise compared to the deep-seated neural systems and also evaluation of the greatest procedure was offered.

Integrated multiple-omics reveals the regulatory mechanism underlying the effects of artificial feed and grass feeding on growth and muscle quality of grass carp (Ctenopharyngodon idellus)

The muscle quality of farmed fish has attracted widespread public attention. To understand a comprehensive molecular mechanism underlying the effects of artificial formula feed- (AF) and grass-feeding (GF) on muscle quality and growth of grass carp (Ctenopharyngodon idellus), muscular transcriptomics and proteomics of GF and AF C. idellus were characterized. A total of 834 DEGs (484 up-, 350 down-regulated genes) and 487 DEPs (271 up- and 216 down-regulations) were identified between groups. Then, the functional enrichment analysis of DEGs & DEPs (DEs) and the integration of multiple-Omics (SDFs), further reflected that the stronger myofiber differentiation and protein synthesis capacities are likely the main strategy of more muscle mass gain in AF C. idellus, while the muscle growth in GF C. idellus is consequent to the stronger muscle cell proliferation and hypertrophy. Secondly, there was a significant difference in muscle fiber types between GF and AF groups, this has a noticeable effect on muscle tenderness and quality. In combination with previously metabolic results, we established DEG-DEP-SDM interaction network, which validated that the slow-MyHC-I fiber, dense in AF C. idellus muscles, accumulated more glycogen and exhibited more powerful glycolytic activity. Meanwhile, the suppressed activity of eIF2α in AF C. idellus muscles promoted protein synthesis, the “Ubiquitin mediated proteolysis” was simultaneously restrained. However, the activities of TCA cycle and fatty acid oxidation were significantly enhanced in GF muscles (rich in fast-MyHC-IIb). Accordingly, the up-regulated ACSL1, ACADS, ppara, etc. were quantified in GF C. idellus samples with stronger fatty acids β-oxidation activity, then led to the reduction of cellular triglycerides and lipid droplet formation. Additionally, our results also provide key information for further understanding of the molecular mechanisms (e.g. MAPK and PI3K signaling pathways, Necroptosis and so on) of C. idellus under dietary treatments. In summary, the grass-feeding could effectively alleviate the negative effects of AF on fish, namely, reducing fat deposition, improving nutrients, flavor and texture of muscle, relieving insulin resistance and stress tolerance, finally lead to better nourishing and healthy C. idellus.

Exclusive breastmilk pumping: A concept analysis.

AimTo analyze and examine the concept of exclusive breast pumping (EP).BackgroundBreastmilk is the ideal nutrition for infants, yet when breastfeeding is unsuccessful, parents resort to informal breastmilk sharing, artificial formula feeding, or EP. A growing proportion of families exclusively pump yet they often receive guidance from social media rather than healthcare providers because healthcare providers are uninformed about this feeding method.Data SourceCumulative Index of Nursing and Allied Health Literature, PubMed, and Google Scholar databases were searched using the following keywords: human milk express*, breast express*, breast milk express, breastmilk express*, exclusive pump, exclusive breast pumping, and exclusive expression.Review MethodsConcept analysis design using Walker and Avant's method.ResultsThree defining attributes of (1) absence of direct breastfeeding, (2) breastmilk expression, (3) and an enduring infant feeding pattern of feeding expressed breastmilk only via a bottle were identified. All three attributes are required to confirm the presence of the concept of exclusive pumping. Definitions, antecedents, consequences, and empirical referents are described. Model and contrary cases are discussed.ConclusionThis exclusive pumping concept analysis allows for consistency in terminology in practice and research. EP is a feeding method which can increase the proportion of infants who are fed breastmilk and may reduce the risks that arise from artificial formula feeding.

Update and understanding of optical biometer

With advances in technology that allow for more accurate measurement of ocular biometric characteristics and the availability of sophisticated methods for calculating intraocular lens (IOL) power, cataract surgery has evolved into a refractive operation. Patient expectations have been raised as a result of this, as well as free and simple access to information about the latest technology. After cataract surgery, there is a greater demand than ever for life without spectacles. Newer advances in optical biometry, such as swept-source optical coherence tomography, combined with the availability of highly accurate IOL power calculation formulae, including artificial intelligence-based formulae, have the potential to enable surgeons to achieve near-perfect outcomes in the majority of their patients. Understanding the benefits and limitations of currently available cutting-edge technologies and equations and applying them to the cataract surgical practice is required to hit the bull’s eye in terms of goal refraction.

Obesity and overweight in Children below 5 years of age: Environmental, Behavioural and Social Factors and Their Active Use in Prevention and Management

Introduction: Early childhood is a critical time for obesity prevention. Children are developing taste preferences, learning to walk and play. They eagerly mimick both the healthy and unhealthy behavior of their parents, siblings and caregivers. Obesity during early childhood is a major health concern of the developed world and is steadily affecting many low- and middle-income countries, particularly in urban settings. Unfortunately, overweight, and obese children often stay obese into adulthood and more likely to develop many non-communicable diseases at a younger age. Important environmental and socioeconomic factors play a significant role in the initiation and progression of early childhood obesity. In this minireview, we try to shed light on the published data exploring various relevant issues, including possible etiologic factors in this target population at risk (children below 5 years) that may enable the initiation of early and effective policy and tactics for the prevention and management of this problem, particularly in high-risk communities.&#x0D; Methods: We examined the English language literature (Pubmed, Google scholar, and Cochrane library ) on the environmental and socioeconomic factors that appeared to be important in the pathogenesis of early obesity in children for the past 20 years. Inclusion criteria were obesity and overweight in young children below 5 years of age. &#x0D; Results: Education, income, and urbanization, food environments and increased energy intake through consumption of fatty foods and a high sugar diet as well as parental effects through conveying their behaviors, attitudes, and feeding styles to their children appear to be among the most important factors that contribute to the initiation and progression of obesity in young children. Overfeeding preterms and small for gestational age infants, using artificial milk formula, and early addition of solid foods play a considerable share in inducing early obesity. In addition, lack of health education to parents and children, poor health care, and scarcity of access to physical activity are important risk factors in poor populations.&#x0D; Conclusions: Many important social and environmental factors can actively contribute to the production and progression of early childhood obesity. These factors differ considerably among different populations. Understanding these factors is essential for appropriate and early prevention as well as management of early childhood obesity, especially in high risk communities.&#x0D;

The impact of a multifaceted quality improvement program on the incidence of necrotizing enterocolitis in very low birth weight infants

Necrotizing enterocolitis (NEC) is a multifactorial gastrointestinal disease which mostly occurs in very low birth weight (VLBW) infants. In addition to decreasing gestational age (GA) or birth weight (BW), artificial formula, delayed initiation or rapidly advanced feeding, severe anemia and systemic infections were associated with NEC. Several studies demonstrated that breast milk, standardized feeding advancement regimens and treatment of anemia are associated with less incidence of NEC. It is not known if including all these interventions in one multifaceted program will lead to significant reduction in NEC. The NICU team at The George Washington University Hospital created a multifaceted interdisciplinary quality improvement project to tackle several aspects of NEC prevention that addressed researched risk factors for NEC. The program was made of four quality improvement protocols: 1) Standardized Structured Feeding Program, 2) Feeding Intolerance Management Algorithm, 3) Enteral Osmolality Control Tool, and 4) Packed Red Blood Cell (RBC) Standardized Transfusion Protocol. This time-series, quasi experimental study design examined the differences in the incidence of NEC between infants with BW < 1500g who were admitted to the GW Hospital NICU before and after the program implementation. Data from 408 VLBW infants were included in the study. Although not statistically significant, there was a decreasing trend of NEC incidence in the post-implementation group (n=199) compared to the pre-implementation group (n=209), (3.5% vs. 5.3%, p=0.88). The trend in the incidence of NEC declined further after the introduction of RBC transfusion protocol which was introduced ten month after starting the other elements of the program. Integration of the multifaceted quality improvement program may be associated with a decline in the occurrence of NEC. Further analysis with a larger sample size is required to determine if the changes seen are statistically significant.