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IntroductionPediatric obesity threatens the efficacy of medications given intramuscularly. In anaphylactic patients, epinephrine auto-injector needle lengths are potentially too short to reach the muscle compartment in patients with elevated body habitus. The objective of the study was to determine needle-length requirements for intramuscular injections in pediatric patients.MethodsWe used ultrasound to measure the distance from skin to muscle compartment of the thigh in 200 pediatric patients of various weight and body mass index who presented to the emergency department.ResultsPatients with higher body mass index had an increased distance to muscle and bone. If current recommendations were followed, 5% of patients within the EpiPen adult weight category and 11% of patients within the Centers for Disease Control and Prevention weight category would have potentially used a needle inadequate in length for intramuscular injections.ConclusionWith the increase in childhood obesity, needle lengths may be too short to effectively deliver medications to the intramuscular compartment. Needle length should be evaluated to accommodate pediatric patients with increased skin to muscle distance.

Malignantsmall round cell tumor of the abdomen is a newly described clinicopathologic entity.

The Amazon Basin currently hosts the world’s largest pool of terrestrial biodiversity and prior to European colonization of the Americas there were large human communities living in parkland ecosystems. We examine the formation of archaeological sites in the northeast sector of the Caxiuanã National Forest (CNF) using light stable isotopes of nitrogen and carbon, total carbon and nitrogen and Optically Stimulated Luminescence to characterize long-term human landscape management practices. Previous research in the CNF has documented differences in pH, calcium, total organic carbon (TOC) and nitrogen (TN) between terra preta and terra marrom contexts as well as different forest structures based on remote sensing analysis. Therefore, we adopt a comparative approach, examining the formation processes of on-site (terra preta), near-site (terra marrom) and offsite (latosol) contexts. TOC and TN values obtained in our study augment and support previous research demonstrating significantly higher on-site values relative to near-site and off-site. However, the stable isotopes (δ13C, δ15N) assayed from terra preta, terra marrom and latosols show statistically overlapping values, indicating the persistence of closed canopy in off-site and near-site contexts and the use of this canopy in the formation of on-site soils (terra preta). Our results corroborate the hypothesis that closed canopy ecosystems and human settlements persisted in the Amazon for thousands of years and formed the foundation of the region’s rich biodiversity.