We conclude that diabetic patients undergoing major cardiovascular or abdominal surgery have an increased risk of infection that is further exacerbated by early postoperative hyperglycemia. The high rate of nosocomial infection observed in diabetic patients with poor glucose control suggests that hyperglycemia itself may be an independent risk factor for the development of infection. Efforts to improve perioperative glucose homeostasis in diabetic patients may reduce the incidence of nosocomial infection and thereby improve outcome.

Objective To measure the changes in whole blood fatty acid levels in premature infants and evaluate their association with neonatal morbidities. Study design Retrospective cohort study of 88 infants born at < 30 weeks of gestation. Serial fatty acid profiles during the first postnatal month and infant outcomes, including chronic lung disease (CLD), retinopathy of prematurity (ROP), and late-onset sepsis, were analyzed. Regression modeling was applied to determine the association between fatty acid levels and neonatal morbidities. Results DHA and AA levels declined rapidly in the first postnatal week with a concomitant increase in linoleic acid (LA) levels. Decreased DHA levels were associated with an increased risk of CLD (OR 2.5; 95% CI 1.3 – 5.0). Decreased AA levels were associated with an increased risk of late-onset sepsis (hazard ratio 1.4; 95% CI 1.1 – 1.7). The balance between fatty acids was also a predictor of CLD and late-onset sepsis. An increased LA:DHA ratio was associated with an increased risk of CLD (OR 8.6; 95% CI 1.4 – 53.1) and late-onset sepsis (hazard ratio 4.6; 95% CI 1.5 – 14.1). Conclusion Altered postnatal fatty acid levels in premature infants are associated with an increased risk of CLD and late-onset sepsis.

Two experiments explored the integration of animated agents into multimedia environments in the context of R. E. Mayer's (2001) cognitive theory of multimedia learning. Experiment 1 was a 3 (agent properties: agent only, agent with gesture, no agent) ϫ 3 (picture features: static picture, sudden onset, animation) design. Agent properties produced no significant effects. Both sudden onset and animation conditions facilitated performance relative to the static-picture condition. In Experiment 2, we explored the effects of printed text, spoken narration, and spoken narration with the printed text, in a multimedia environment that included an agent, to investigate effects of redundancy. The spoken-narration-only condition outperformed the other 2, with no differences between printed text and printed text with spoken narration.

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Lipid injectable emulsions have been routinely used in patients worldwide for over 40 years as a nutritional supplement in patients requiring parenteral nutrition. They can be given as a separate infusion or added into total parenteral nutrition admixtures. Despite such broad use, no pharmacopeial standards exist with respect to the optimal pharmaceutical characteristics of the formulation. Several attempts to establish standard physical and chemical attributes have been attempted by various pharmacopeias around the world, but without success largely due to technical issues regarding the creation of globule size limits. Recently, the United States Pharmacopeia has revised its previous efforts and developed two methods and criteria (under Chapter <729>) to measure the mean droplet size (Method I), and the large-diameter tail > 5 mum (Method II) of the globule size distribution to verify the stability of lipid injectable emulsions. Importantly, it is the latter size limits of Method II that have the greatest implications for infusion safety. The major safety issues involving lipid injectable emulsions include impairments in plasma clearance in susceptible patients, and the infusion of an unstable emulsion containing large quantities of potentially embolic fat globules. Recent animal studies investigating the toxicity from the infusion of unstable lipid injectable emulsions have shown evidence of oxidative stress and tissue damage to the liver when recommended globule size limits determined by Method II of the USP are exceeded. Adoption of Chapter <729> of the USP seems appropriate at this time.