UNASSIGNED: Breastfeeding naturally enables the coordination of sucking, swallowing, and respiration patterns for safe feeding. When breastfeeding is not possible a feeding device that releases milk in response to intra-oral vacuum could potentially offer improved coordination of sucking, swallowing, and breathing patterns compared to conventional devices. The aim of the study is to evaluate the effect of a valved infant-bottle with an ergonomic teat compared to a standard infant-bottle.
UNASSIGNED: This unblinded randomized controlled trial focused on late preterm infants fed by bottle for at least three meals over the day, admitted to the Neonatal Unit of Sant\'Anna Hospital (Turin, Italy). Infants were randomized to be fed with a valved infant-bottle with an ergonomic teat (B-EXP arm) or with a standard infant-bottle (B-STD arm). Monitoring included a simultaneous synchronized recording of sucking, swallowing and respiration. The main outcome was the swallowing/breathing ratio.
UNASSIGNED: Forty infants (20 B-EXP arm; 20 B-STD arm) with a median gestational age of 35.0 weeks (IQR 35.0-36.0 weeks) completed the study. Four infants were censored for the presence of artifacts in the polygraphic traces. The median swallowing/breathing ratio was 1.11 (1.03-1.23) in the B-EXP arm and 1.75 (1.21-2.06) in the B-STD (p = .003). A lower frequency of swallowing events during the inspiratory phase of breathing was observed in B-EXP arm compared with B-STD arm (p = 0.013).
UNASSIGNED: The valved infant-bottle with an ergonomic teat improves the coordination of sucking-swallowing-respiration and limits the risk of inhalation reducing the frequency of swallowing during the inspiratory phase.

Objective: This study was completed with the aim of determining the effect of cup feeding (CF), bottle feeding (BF), and syringe feeding (SF) methods on the transition to breastfeeding, breastfeeding success, physiological parameters, weight gain, and discharge duration for preterm neonates in the neonatal intensive care unit (NICU). Materials and Methods: The study was designed to be randomized, controlled, and single blinded. The study was completed with 102 premature neonates between 29-34 gestational weeks abiding by the case selection criteria receiving treatment and care in the NICU. The 1st group comprised premature neonates receiving CF, the second group received BF, and the third group received SF. For collection of data, the Premature Infant Descriptive Information and Monitoring Form, Bristol Breastfeeding Assessment Tool (BBAT), and Infant-Focused Feeding Scales (IFFS) were used. Results: Comparison of mean peak heart rate in the groups found that the BF group was significantly high (p = 0.047) and comparison of mean SO2 found that the SF group was significantly high (p = 0.000). Infants in the SF group were determined to have significantly higher BBAT scores compared to the infants in the BF and CF groups (p = 0.015). In addition, SF infants were determined to transition to full enteral feeding and breastfeeding in a shorter duration (p < 0.05). There were no significant differences between the groups for weight gain and discharge duration (p > 0.05). Conclusions: The SF method was determined to more positively affect breastfeeding success, transition to full breastfeeding duration, and vital signs compared to the CF and BF methods. In line with the results obtained in the study, the use of the SF method may be recommended to increase breastfeeding success of neonates, to shorten the transition to full breastfeeding and for stable physical parameters.

Responsive feeding is currently the recommended feeding style, in which the key principle is reciprocity between the child and the caregiver. The lack of reciprocity characterizes non-responsive feeding styles, which are associated with unhealthy eating behaviors, losses in the regulation of hunger and satiety, and childhood obesity. To assess factors associated with feeding styles between infants aged 6-12 months old, a cross-sectional study with 474 pairs of mothers and infants from 6 to 12 months old was conducted in Public Health Units in the Federal District, Brazil. The questionnaire applied to mothers evaluated four feeding styles from nine subconstructs (Infant Feeding Style Questionnaire), breastfeeding, bottle use, maternal depression and anxiety, household food insecurity (HFI), and prematurity. Multiple linear regression analysis was performed using the automated backward method. Bottle use was positively associated with feeding styles Laissez-faire (Attention) (β:0.56), Pressuring (Cereal) (β:0.58) and Restrictive (Quantity) (β:0.26). Breastfeeding was negatively associated with Laissez-faire (Attention) (β:-0.29) and Pressuring (Cereal) (β:-0.50). Higher maternal education was negatively associated with Pressuring (Cereal) (β:-0.34) and Pressuring (Soothing) (β:-0.36). HFI is positively associated with Restrictive (Quantity) (β:0.25), and Prematurity is negatively associated with Laissez-faire (Attention) (β:-0.33). An important positive association was found between non-responsive styles and both bottle use and HFI, while breastfeeding and higher maternal education exhibited a negative association. Therefore, feeding styles and their associated factors should be considered in the design of interventions that promote a healthy diet for infants.

Twenty-five elements, including the most essential and toxic metals, were determined in fifty beer samples stored in cans and bottles by Inductively Coupled Plasma Mass Spectrometry (ICP-MS), Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) and Cold Vapor Atomic Absorption Spectroscopy (CVAAS) techniques. The packaging material was analyzed using the Scanning Electron Microscopy with Energy Dispersive Spectroscopy (SEM-EDS) technique. The control of the level of individual metals is necessary, not only to maintain the organoleptic properties of the product, but also to fulfill the standards regarding the permissible maximum concentrations. Metals can originate from different sources, including the brewing water, malt grains, hops, adjuncts, fruits, and spices. They may also come from contamination from the brewery equipment, i.e., vessels and tanks, including beer packing, storing and transporting (kegs, casks, cans). Discriminant analysis revealed that the differentiation of three types of beer (Lager, Ale, Craft) was possible, based on elemental concentrations, for the reduced data set after their selection using the Kruskal-Wallis test. The analysis of the impact of the packaging material (can or bottle) proved that when this parameter was used as a differentiating criterion, the difference in the content of Na, Al, Cu and Mn can be indicated. The risk assessment analysis showed that the consumption of beer in a moderate quantity did not have any adverse effect in terms of the selected element concentrations, besides Al. However, in the case of Al, the risk related to consumption can be considered, but only for the beer stored in cans produced from aluminum.

Young children often present at the emergency department (ED) with foreign bodies in their mouths, including the occasional bottles and cans. Previous reports of tongue entrapment have presented cases where bottles were mostly made of glass or metal. A 4-year-old girl presented to the ED with her tongue entrapped in a uniquely designed plastic bottle. Attempts at conservative methods of removal such as gentle traction, breaking of the vacuum seal and use of lubricants were unsuccessful. The child was brought to the operating theatre for further management. Anaesthesia induction with a facemask was not possible as the plastic bottle was protruding from the tongue and would not allow an adequate seal around the nose and mouth. To overcome such challenges of a shared airway and workspace, the child was placed under intravenous propofol sedation initially until the prompt removal of foreign body allowed subsequent mask placement and oral intubation. The foreign body was eventually removed by sectioning the inflexible plastic into two pieces with a water-cooled high speed dental diamond bur. The child remained stable intra-operatively and subsequent post-operative recovery was uneventful. This report highlights the importance of multidisciplinary coordination to reduce delays when liberating the entrapped tongue so as to minimize potential complications from the injury.

Packaging ecodesign can contribute to improve the environmental performance of pharmaceutical products. The main goal of this article is to present an ecodesign approach based on Life Cycle Assessment (LCA) for pharmaceutical packaging, assessing opportunities to improve the packaging environmental performance, and providing ecodesign recommendations to the pharmaceutical sector. The proposed ecodesign approach consists of five phases. I) The most representative packaging of medicines in the market (blister, bottle, and sachet), with different sizes, materials and weights, were investigated. II) Three ecodesign strategies were selected to analyze with LCA: i) weight and/or volume reduction, ii) alternative types of packaging, and iii) transportation with less environmental impact. III-IV) A cradle-to-gate life cycle model has been implemented, including transport to pharmacies. Alternative transportation modes (truck, train, airplane, and ship) and different packaging production locations have been considered. Thirteen environmental categories have been analyzed. V) Ecodesign recommendations for improving the environmental performance of pharmaceutical packaging are presented in two stages: i) specific recommendations based on LCA, illustrated in sheets with examples of ecodesign, quantifying the environmental impact reduction of an ecodesign solution compared to the original; and ii) generic recommendations for different packaging life cycle phases. Ecodesign recommendations highlight the use of smaller-size packaging, avoiding superfluous elements and empty spaces, which reduces material and production costs, and transportation impacts; the selection of modes of transportation with less environmental impact, considering the packaging production location; and the use of electric vehicles for pharmacy distribution. This ecodesign approach based on LCA allows quantifying environmental impacts robustly to support the incorporation of environmental information from the design, material selection, and packaging production to distribution till the final consumer. This article emphasizes the importance of developing specific packaging ecodesign based on LCA to improve environmental performance and provide more informed recommendations to stakeholders.

Hydrogen molecules have attracted attention as a new antioxidant, but are left to be confirmedly verified whether the oral administration is highly safe or not, concurrently with retention of abundant hydrogen. When electrolysis was performed for 10 minutes using a direct-current electrolytic hydrogen-water generating bottle with tap water, \"residual free chlorine\" concurrently upon the production of molecular hydrogen (444 μg/L) could be appreciably decreased from 0.18 mg/L to 0.12 mg/L as quantified by a N,N-diethyl-p-phenylenediamine-dye colorimetric method. Moreover, the total chlorine concentration (residual bound chlorine plus free chlorine) was estimated to be decreased from 0.17 mg/L to 0.11 mg/L. Although a merit of electrolytic hydrogen-generating bottles exists in electrolysis for periods as short as 10 minutes, the 30-minute electrolysis brought about the more abundant hydrogen (479 μg/L) together with an oxidation-reduction potential of -245 mV; even upon this long-term electrolysis, the gross amounts of chlorine, hypochlorous acid and chloramine were shown not to be increased (0.09-0.10 mg/L from 0.11 mg/L for tap water) as detected by orthotolidine colorimetry. Above-mentioned levels of diverse-type chlorines might fulfill the World Health Organization guideline for drinking water below 5 mg/L. In addition, the dissolved ozone upon electrolytic generation of hydrogen-water was below the detection limit (< 0.05 mg/L) or undetectable, which fulfilled the official safety standards in Japan and the USA for drinking water below 0.1 mg/L, as evaluated by three methods such as an electrode-type ozone checker, indigo dye-utilizing ozone detector capillaries and potassium iodide-based colorimetry. Importantly, even when half the amount of tap water was poured into the tank of the apparatus and electrolyzed, both the residual chlorine and ozone concentrations measured were also below the safety standard. Thus, major potently harmful substances, such as residual free/bound chlorine, or hypochlorous-acid/chloramine, respectively, and dissolved ozone, as the drinking hydrogen-water was direct-current-electrolytically generated, were estimated to be repressed within safety concentration ranges with achievements of abundant hydrogen generation.

OBJECTIVE: Portion size influences energy intake and is an important factor when developing weight management strategies. The effect of tableware on food intake is less clear, especially in children. To date, the relationship between the body weight of individuals and the tableware used in their households has not been investigated. The aim of this study was to analyze the sizes of tableware in households of children and adolescents with obesity (OBE) in comparison to participants with normal-weight matched for age and gender (NW).
METHODS: 60 OBE (32 female, 26 male) and 27 NW (12 female, 15 male) aged between 9 and 17 years participated in a structured interview on the tableware used at home. Responses were standardized based on the selection of different sizes of tableware and everyday objects presented to the children.
RESULTS: In households of NW, larger plates and bowls were used during meals and desserts compared to OBE. OBE drank out of larger bottles. Shapes and sizes of drinkware, the number of children drinking out of bottles and the cutlery used during dessert did not differ between the groups.
CONCLUSIONS: Drinking out of large bottles may be an unfavourable habit of OBE if they contain sugar-rich liquids. The use of smaller plates and bowls of OBE may result in multiple helpings being consumed and so contribute to an overall increased portion size.
METHODS: Level V, Descriptive study.

This is the first reported case of ocular trauma caused by a plastic bottle cap occurring accidentally without misuse. The mechanism involved an un-emptied plastic bottle containing orange juice being thrown away with other rubbish. The combination of this minor impact and the pressure built up within the bottle through fermentation caused expulsion of the cap at high velocity. This cap caused severe ocular trauma requiring urgent ophthalmic assessment and intervention. Our simple recommendation is that plastic bottles have their caps removed and are emptied before being thrown away.

OBJECTIVE: To investigate microbial contamination of canine plasma eye drops when used clinically and to compare the effect of two different eyedropper bottles on contamination rate.
METHODS: Forty-six bottles containing plasma were randomly dispensed for use on 42 dogs with ulcerative keratitis. Of these, 23 were standard eyedropper bottles and 23 were Novelia® bottles designed to prevent contamination. After use for up to 2 weeks, samples for bacterial culture were obtained from a drop of plasma, the bottle tip, the plasma inside the bottle, and the corneal surface. Fungal culture was performed from a drop of plasma.
RESULTS: The overall microbial contamination rate was 17.4% (8/46 bottles); however, only one bottle had growth from the plasma inside the bottle. There was a lower contamination rate of Novelia® bottles (3/23 = 13.0%) compared to standard bottles (5/23 = 21.7%), but this difference was not statistically significant (P = .57). There were also no significant differences in contamination rate of bottles used greater than 7 days compared to less than or equal to 7 days, or in bottles used greater than 4 times daily compared to 4 times daily or less. Three corneal samples (6.5%) had bacterial growth, but none matched contamination from the bottles.
CONCLUSIONS: Novelia® bottles may decrease contamination of plasma eye drops used clinically. However, while microbial contamination of plasma bottles was documented, no clinically relevant complications were observed. This study supports safe use of plasma eye drops for up to 2 weeks when refrigerated and dispensed from either Novelia® or standard eyedropper bottles.