(B) In Industrial Establishments. Wiring methods of 392.3(A) can be used in accordance with their respective article's requirements. Where only qualified maintenance personnel are available, certain cables are permitted in ladder, ventilated trough, and ventilated channel-type cable trays. Single-conductor cable must be 1/0 AWG or larger and be permitted to be used in cable tray. If the cable is sized 1/0 AWG through 4/0 AWG, it must be installed in ladder-type cable tray with a maximum rung spacing of 9 in. or in ventilated trough cable tray. Welding cable can be installed in accordance with Article 630, Part IV. Equipment grounding single conductors can be insulated, covered, or bare 4 AWG or larger. Multiconductor cable type MV can also be installed as noted above.
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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
In the United States the caesarean section rate continues to rise, reaching 33.1% in 2013 (Mistry et al. 2006). Several studies have demonstrated a difference in the microbiome of infants born via cesarean delivery compared to vaginally delivered neonates. Infants born via the vaginal canal are typically seeded with vaginal flora including Lactobacillus and Prevotella. In contrast, infants born via cesarean section are typically seeded with skin flora (Biasucci et al. 2008). Infants born via cesarean section display delayed onset of colonization of Bifidobacterium and Bacteroides with increased levels of colonization by the Enterobacteriaceae family (Dogra et al. 2015). In 2011 Domingiuez-Bello et al. used sequencing technology to demonstrate that the gastrointestinal microbiota of infants born vaginally were colonized with Lactobacillus, but infants born via cesarean delivery were colonized by bacteria typically found in skin and hospitals such as Staphylococcus and Acinetobacter (Dominguez-Bello et al. 2011). They later demonstrated that exposing neonates delivered via cesarean section to maternal vaginal fluids at birth could redirect the microbiome, making it similar to neonates delivered vaginally (Dominguez-Bello et al. 2016). Large numbers of epidemiologic studies have demonstrated compelling evidence suggesting a link between cesarean delivery and increased risk of obesity, asthma, allergies, immune deficiencies, and other atopic disease (Thavagnanam et al. 2008; Pistiner et al. 2008; Huh et al. 2012; Sevelsted et al. 2015). However, to date, a direct link between delivery by cesarean and NEC has not been found. Prognostic studies indicate that cesarean section is a risk factor for NEC but this is likely correlated not causative (Samuels et al. 2017).
Given the link between dysbiosis and NEC, altering the microbiome is a promising target for future therapies (Vongbhavit and Underwood 2016). A 2014 Cochrane review of randomized and quasi-randomized trials found that enteral supplementation of probiotics prevents severe NEC and all cause mortality in preterm infants (Robinson 2014). In 2016 Denkel et al. found that dual-strain probiotics reduced NEC and mortality in preterm infants in a German NICU (Denkel et al. 2016). However, the evidence regarding probiotics is difficult to interpret. Although the meta-analyses of probiotics usage have shown a beneficial effect, not all individual randomized control trials have demonstrated the same. Trials are difficult to generalize as many use a different study design, differing probiotics, and differing infant diets and feeding times (Patel et al. 2017). The strain of probiotics used is likely to be important. The PiPs trial did not demonstrate any benefit with routine administration of Bifidobacterium breve (Costeloe et al. 2016). Furthermore, there are conflicting opinions regarding giving live bacteria to particular vulnerable preterm neonates.
Research over the last decade has demonstrated the importance of the gut microbiome on human health and disease. Microbiome alterations have been associated with a vast array of diseases ranging from cardiovascular disease to colorectal cancer, obesity, diabetes, and rheumatoid arthritis (Shreiner et al. 2015). Furthermore, microbiome manipulation has already proven beneficial in the treatment of clostridium difficile infection (Brandt 2012) and has demonstrated promising results in the treatment of inflammatory bowel disease (Hansen and Sartor 2015) and in experimental models of obesity (Jayasinghe et al. 2016). The above review demonstrates the link between gut dysbiosis and necrotizing enterocolitis. It is logical then, that future prevention and treatment of the disease will also include a component of microbiome manipulation.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated. 2ff7e9595c
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