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Background: There is variability in the use of sedatives and analgesics in neonatal intensive care units (NICUs). We aimed to investigate the use of analgesics and sedatives and the management of neonatal pain and distress. Methods: This was a global, prospective, cross-sectional study. A survey was distributed May–November 2022. The primary outcome of this research was to compare results between countries depending on their socio-sanitary level using the sociodemographic index (SDI). We organized results based on geographical location. Results: The survey collected 1304 responses, but we analyzed 924 responses after database cleaning. Responses from 98 different countries were analyzed. More than 60% of NICUs reported having an analgosedation guideline, and one-third of respondents used neonatal pain scales in more than 80% of neonates. We found differences in the management of sedation and analgesia between NICUs on different continents, but especially between countries with different SDIs. Countries with a higher SDI had greater availability of and adherence to analgosedation guidelines, as well as higher rates of analgosedation for painful or distressing procedures. Countries with different SDIs reported differences in analgosedation for neonatal intubation, invasive ventilation, and therapeutic hypothermia, among others. Conclusions: Socio-economic status of countries impacts on neonatal analgosedation management. Impact:

There is significant variability in the pain management practices in neonates.

There is a lack of knowledge related to how neonatal pain management practices differ between regions.

Sociodemographic index is a key factor associated with differences in neonatal pain management practices across global regions.

User mobility prediction can be exploited in cellular networks for different purposes, such as enhancing the handover process, proactive resource allocation, proactive load balancing, etc., in order to improve the network performance. While many works aimed for the prediction of the next cell visited by the User Equipment (UE), the prediction of future UE locations has received less attention. In fact, only a few works deal with the prediction of the next UE location while other few works aim to predict the future direction of UEs arriving at a crossroad. This paper presents a methodology for the prediction of the trajectory followed by the UEs inside the cell. First, UE trajectory patterns are learnt by means of an off-line clustering of historical UE trajectories. Then, the obtained trajectory patterns are used for on-line prediction of the UE trajectory inside the cell, the prediction of the next cell that the UE will visit and an estimation of the time to reach this new cell. A dataset with UE trajectories moving around a large real-life cellular network has been considered.

(Abstracted from JAMA2023;330:2096–2105)Bilateral renal agenesis is a congenital anomaly of the fetal urinary tract that results in the absence of amniotic fluid by the second trimester. This occurs in roughly 1 in 3000 births and often results in depressurization of fetal airways, impaired pulmonary development, and lethal pulmonary hypoplasia at birth.vvvvvv

As part of a marine ecology study aimed to discover the diversity of fish parasites, we described a new species representing Magnanchorn. gen. and provided new and supplementary morphometric information for Mexicana bychowskyi, both monogenoidean species collected from the gill lamellae of the humpback grunt Microlepidotus brevipinnis(Haemulidae) from the Pacific coast of Mexico. The new genus is proposed for its unique species, M. rarisn. sp. which is characterized in having overlapping gonads (testis posterodorsal to the germarium), a copulatory complex consisting of counterclockwise coils of the copulatory organ that is unarticulated to the accessory piece, a haptor armed with two pairs of anchors (each with broad base and well differentiated roots), dorsal and ventral bars, a dextral vaginal aperture, and 6 pairs of hooks with uniform shank and upright acute thumb. Data on morphological and biometric variability of the six species of Mexicana(including illustrations of the haptoral structures of the present specimens of M. bychowskyi) previously described and/or reported parasitizing different haemulid hosts from the Pacific and Atlantic oceans in the Tropics are also provided. Due to the morphological similarities among the amphiamerican species of Mexicana, they could represent sister-species pairs in the Tropics. Magnanchor rarisn. sp. and M. bychowskyi(type species of the genus) are the first dactylogyrids described and/or reported on M. brevipinnis.

Given the lack of protective structural barriers and advanced restraints, motorcyclists are vulnerable road users. In 2020 in the United States, motorcycle-involved fatalities occurred 28 times more frequently per vehicle mile traveled than passenger car occupant fatalities, causing 5,579 motorcycle-related fatalities—the highest number of motorcyclists killed since 1975. By identifying patterns and relationships between key contributing factors, strategies for reducing motorcycle crashes can be developed. In addition to current efforts, additional research must be conducted using innovative avenues, with increased funding. Bayesian networks can better discover the relationships between potential speed compliance variables. This study used six years (2014 to 2019) of motorcycle crash data in Louisiana to determine the conditional probabilities of the influential factors. In addition to the high contribution of alcohol involvement, two-way undivided roadways, 35 to 44 year-old drivers involved in improper driving behaviors, and crash types are the underlying factors associated with a considerable increase in motorcycle crash severity. The findings of this study can also be used for decision making and strategy development for motorcycle safety.

Single-phase ac to dc converters for computers and related applications have requirements that are difficult to meet while achieving both high-power density and high efficiency: wide input voltage range, large voltage step down, galvanic isolation, harmonic current limits, and hold-up requirements. This article explores a circuit architecture and topology that is structured to facilitate operation at multi-MHz frequencies in order to address this challenge. We present a 250 W, 24 V output, universal input power factor correction converter prototype that leverages the proposed approach to achieve a power density of 34.9 W/in3 while meeting the 80 PLUS Platinum efficiency standard, EN61000-3-2 line harmonic requirements and half-cycle holdup. The converter operates at variable switching frequencies in the range of 1–4 MHz; the measured efficiency at 230 Vac rms, 60 Hz input is 95.33% at full load, and 84.57% at 8% load.

Background Long-term care facilities (LTCFs) including assisted living facilities (ALFs) are hubs for high transmission and poor prognosis of COVID-19 among the residents who are more susceptible due to old age and comorbidities.Aim Houston Health Department conducted assessments of ALFs within the City of Houston to determine preparedness and existing preventive measures at the facilities.Methods Onsite assessments were conducted at ALFs using a modified CDC Infection Control Assessment and Response (ICAR) Tool. Data was obtained on IPC measures, training, testing, vaccination etc. Data was analyzed, frequencies generated, and bivariate associations determined.Results A total of 118 facilities were assessed and categorized into small scale 46 (39%), medium scale 47 (40%), and large scale 25 (21%). The facilities had 2431 residents and 2290 staff. Thirty-one (26%) facilities reported an outbreak in 2020, while 14 (12%) had an ongoing outbreak. Twenty-three (97%) large-scale and 12 (26%) small-scale facilities had COVID-19 testing program. Vaccination coverage among residents ranged from 99% in large-scale to 40% in small-scale facilities but was smaller among staff at 748 (45%) in large scale, 71 (36%) in small scale, and 193 (45%) in medium scale. While 24 (96%) large-scale and 34 (77%) of small-scale facilities conducted staff training staff on IPC practices, 22 (92%) of large-scale and 19 (56%) of small-scale facility staff demonstrated capacity (p= 0.01), respectively. Visitor screening was done at 100% of large-scale and 80% of small-scale and the medium-scale ALFs.Discussion Assisted living facilities within the city of Houston are at various levels of preparedness and interventions with respect to COVID-19 response.

ABSTRACTAlthough engaging fathers effectively can bolster and sustain treatment outcomes, fathers participate in their children’s treatment at lower rates than mothers and have been left out of the literature on caregiver engagement. Because provider attitudes and behaviors shape the course of treatment, therapist perspectives on father attendance and engagement should be investigated. A mixed-method study design examined rates and predictors of father attendance in treatment and therapist perspectives on father engagement in Parent-Child Interaction Therapy (PCIT). Quantitative data were gathered through a survey distributed to PCIT therapists (n = 267) to identify the effects of: 1) therapist and caseload characteristics, 2) therapist confidence working with fathers, 3) therapist use of father engagement strategies, and 4) organizational practices for engaging fathers, on father attendance rates. Qualitative interviews with 23 therapists were thematically analyzed to expand upon therapist experiences engaging fathers. Therapists reported that on average, 60.97% of cases with a father available had regular session attendance by the father. Only frequency of therapist use of father engagement strategies predicted father attendance rate. Qualitative interviews expanded on the many barriers therapists face to engaging fathers and the variety of strategies they employ to engage fathers. Rates of father attendance in PCIT are higher than what has been previously reported in the literature but still show room for improvement. Despite barriers, therapists remain dedicated to developing solutions to elicit father engagement. Future research should evaluate whether therapist-reported engagement strategies effectively increase father participation and can be more widely disseminated.

ABSTRACTEngaging caregivers in their children’s mental health treatment is critical for delivering high quality, evidence-based care, particularly for young children with externalizing behaviors. Lay health workers (LHWs), including peer providers and promotoras de salud, have been identified as important workforces in addressing structural and stigma-related barriers to engagement in mental health services. Importantly, research has suggested that LHWs may be integral in efforts to address engagement disparities in evidence-based behavioral parent training programs (BPTs) for Latinx caregivers. The purpose of the study was to understand how different LHW workforces engage caregivers within their usual services, in order to inform strategies that improve access to and engagement in BPTs. Qualitative interviews were conducted with two different LHW workforces: volunteer LHWs (i.e., promotoras de salud) (n= 14), who were part of a community-embedded network, and paid LHWs (i.e., parent support partners, home visitors) (n= 9) embedded within children’s mental health agencies. Participants were predominately Latinx (79%) and female (96%). Qualitative analyses revealed three primary themes related to engagement strategies used by LHWs to address barriers to care: 1.) Building Trust, 2.) Empowerment, 3.) Increasing Access. Although the majority of themes and sub-themes were consistent across the two LHW workforces, agency-embedded LHWs often discussed having the means to provide resources through their organizations, whereas community-embedded LHWs discussed acting as a bridge to services by providing information and conducting outreach. Findings have implications for partnering with different workforces of LHWs to increase equity in access to BPTs.

Nuclear factor I-C (NFIC) belongs to a family of NFI transcription factors that binds to DNA through CAATT-boxes and are involved in cellular differentiation and stem cell maintenance. Here we show NFIC protein is significantly overexpressed in 69% of acute myeloid leukemia patients. Examination of the functional consequences of NFIC overexpression in HSPCs showed that this protein promoted monocytic differentiation. Single-cell RNA sequencing analysis further demonstrated that NFIC overexpressing monocytes had increased expression of growth and survival genes. In contrast, depletion of NFIC through shRNA decreased cell growth, increased cell cycle arrest and apoptosis in AML cell lines and AML patient blasts. Further, in AML cell lines (THP-1), bulk RNA sequencing of NFIC knockdown led to downregulation of genes involved in cell survival and oncogenic signaling pathways including mixed lineage leukemia-1 (MLL-1). Lastly, we show that NFIC knockdown in an ex vivo mouse MLL::AF9 pre-leukemic stem cell model, decreased their growth and colony formation and increased expression of myeloid differentiation markers Gr1 and Mac1. Collectively, our results suggest that NFIC is an important transcription factor in myeloid differentiation as well as AML cell survival and is a potential therapeutic target in AML.

The growth of the city's population and the COVID-19 crisis has increased the need to improve last-mile logistics in transportation. Many stakeholders such as policymakers, logistics operators and shippers have to collaborate to improve environmental, economic, and social performance indicators. This paper investigates the opportunities in last-mile logistics and the benefits that can be achieved by balancing all the city stakeholders' needs using Digital Twins technology. To that end, we focused on the Madrid Living Lab that sets up an Urban Consolidation Centre (UCC) located in underground public parking in the city centre, surrounded by the Madrid Low Emissions Zone (LEZ). Madrid defines cases and scenarios to understand business policies and improve decisions, such as shifting the UCC's location and defining new Low Emission Zones.

Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia.

The South Texas Sand Sheet (STSS) consists predominantly of medium- to fine-grain eolian sand deposits and sand dunes. STSS covers over six counties with an area of approximately 9.15 × 103km2with thickness ranging between less than a meter and over 10 m. Groundwater contamination is of particular concern as groundwater resources are the principal water source in this area. The preliminary conceptual hydro-geologic model implies that the STSS is a significant hydrologic component for shallow groundwater flow and can be potential storage and/or significant environmental flow input into nearby hypersaline Lower Laguna Madre (LLM). Water (fresh/brackish) held in the STSS should be taken into consideration when accounting for regional water balance/budget, e.g., groundwater recharge and storage, flood control, and discharge to coastal areas. The geospatial analysis was conducted using geographic information systems (GIS) spatial analysis tools with well logs from Texas Water Development Board (TWDB) groundwater database and preliminary drilling in the field. A DRASTIC model developed within a GIS framework was applied to evaluate the groundwater vulnerability of the STSS. DRASTIC modeling suggested that STSS with high risk to pollution is mainly located in the eastern portions of the STSS where factors, i.e., high hydraulic conductivity and high-water table, allow easy access for contaminants to reach the shallow groundwater aquifer. The assessment found that around 94% of the unconfined aquifer in STSS has moderate to high vulnerability to contamination. The sensitivity analysis of DRASTIC model showed that the removal of hydraulic conductivity, topography, and soil media parameters caused an increase in groundwater vulnerability to pollution. Moreover, single-parameter sensitivity analysis results suggested that the net recharge rate, hydraulic conductivity, and soil media parameters were more effective in determining the groundwater vulnerability than the DRASTIC model assumed. Results of this study suggest that the groundwater vulnerability in STSS is high and assessment maps can be used to evaluate possible environmental and economic impacts to ecosystems on the adjacent Lower Laguna Madre.

Syncope is a common complaint evaluated in the emergency department (ED). Differentials for syncope include cardiac and neurological etiologies. A 12-lead electrocardiogram (ECG) can help identify possible cardiac etiologies for the syncopal episode. Brugada syndrome falls under cardiovascular etiologies for syncope. This syndrome has specific ECG findings such as coved or saddleback ST-segment morphology and elevation with normal QRS width, although they may vary by subtype. Prompt identification of Brugada and cardiology evaluation are essential steps to help prevent life-threatening arrhythmias. Nurse practitioners in the ED must accurately identify signs, symptoms, risk factors, and ECG findings associated with Brugada syndrome.

Posterior micropthalmos is characterized by a disproportionately small posterior segment and multiple retinal abnormalities including papillomacular fold and high hyperopia. We report two siblings with amblyopia, severe bilateral hypermetropia, and ocular abnormalities suggesting a diagnosis of posterior microphthalmos. The unique optical coherence tomography and optical coherence tomography angiography findings are presented.

This study was conducted to re-examine the geographic distribution and update the existing maps and distribution data of the two Greater Luzon Philippine malkohas (Lepidogrammus cumingiand Dasylophus superciliosus) derived from museum specimens and online anecdotes. Precise locality of each skin specimen from various museum collections and recent field accounts from various online platforms on the occurrence of these malkohas were collected, plotted, and compared with the existing distribution maps from the BirdLife International using the Quantum Geographic Information System (QGIS) software. Results showed that the data collected on the locations of the two endemic Philippine malkohas revealed that L. cumingiand D. superciliosusexhibited broader range on their distributions compared to the existing BirdLife International distribution data. Furthermore, the collected distribution data also revealed that the subspecies D. s. cagayanensisis not restricted in the northeast region of Cagayan province but also occurs in its southern regions as well as in the provinces of Benguet and Nueva Vizcaya. The updated and generated maps of the distribution of these birds constitutes a significant range extension that will serve as additional information in the proper implementation of conservation management plan of the Philippine Malkohas.

This is a case study describing a young woman with a chief complaint of low back pain (LBP) symptoms. Initially, she was evaluated and treated for LBP. Her back pain worsened over the course of 16 weeks, and she eventually developed chills and fever. Knowledge of the presentation, assessment, and differentials in patients with LBP is essential to quickly identifying, diagnosing, treating, and referring patients with uncommon etiologies.

Solar absorption plants are renewable energy systems with a special advantage: the cooling demand follows the solar energy source. The problem is that this plant presents solar intermittency, phenomenological complexity, and nonlinearities. That results in a challenge for control and energy management. In this context, this paper develops a Digital Twin of an absorption chiller High Temperature Generator (HTG) seeking accuracy and low computational efort for control and management purposes. A neuro-fuzzy technique is applied to describe HTG, internal Lithium-Bromide temperature, and water outlet temperature. Two Adaptative Neuro-Fuzzy Inference Systems (ANFIS) are trained considering real data of eight days of operation. Then, the obtained model is validated considering two days of real data. The validation shows a RMSE of 1.65e−2for the internal normalized temperature, and 2.05e−2for the outlet normalized temperature. Therefore, the obtained Digital Twin presents a good performance capturing the dynamics of the HTG with adaptive capabilities considering that each day can update the learning step.

During aging, hematopoietic stem cell (HSC) function wanes with important biological and clinical implications for benign and malignant hematology, and other comorbidities, such as cardiovascular disease. However, the molecular mechanisms regulating HSC aging remain incompletely defined. GATA2 haploinsufficiency driven clinical syndromes initially result in primary immunodeficiencies and routinely evolve into hematologic malignancies on acquisition of further epigenetic mutations in both young and older patients. Using a conditional mouse model of Gata2 haploinsufficiency, we discover that during aging Gata2 promotes HSC proliferation, monocytosis, and loss of the common lymphoid progenitor. Aging of Gata2 haploinsufficient mice also offsets enhanced HSC apoptosis and decreased granulocyte-macrophage progenitor number normally observed in young Gata2 haploinsufficient mice. Transplantation of elderly Gata2 haploinsufficient HSCs impairs HSC function with evidence of myeloid bias. Our data demonstrate that Gata2 regulates HSC aging and suggest the mechanisms by which Gata2 mediated HSC aging has an impact on the evolution of malignancies in GATA2 haploinsufficiency syndromes.

During aging, hematopoietic stem cell (HSC) function wanes with important biological and clinical implications for benign and malignant hematology, and other comorbidities, such as cardiovascular disease. However, the molecular mechanisms regulating HSC aging remain incompletely defined. GATA2haploinsufficiency driven clinical syndromes initially result in primary immunodeficiencies and routinely evolve into hematologic malignancies on acquisition of further epigenetic mutations in both young and older patients. Using a conditional mouse model of Gata2haploinsufficiency, we discover that during aging Gata2promotes HSC proliferation, monocytosis, and loss of the common lymphoid progenitor. Aging of Gata2haploinsufficient mice also offsets enhanced HSC apoptosis and decreased granulocyte-macrophage progenitor number normally observed in young Gata2haploinsufficient mice. Transplantation of elderly Gata2haploinsufficient HSCs impairs HSC function with evidence of myeloid bias. Our data demonstrate that Gata2regulates HSC aging and suggest the mechanisms by which Gata2mediated HSC aging has an impact on the evolution of malignancies in GATA2haploinsufficiency syndromes.

Poly(3,4-ethylenedioxythiophene) (PEDOT) is one of the most important conductive polymers utilized in a variety of applications in organic electronics and bioelectronics and energy storage. PEDOT chains are believed to be rather short, but detailed knowledge of their length is missing because of the challenges in its experimental determination due to insolubility of PEDOT films. Here, we report a molecular dynamics (MD) study of in situ oxidative chemical polymerization and simultaneous crystallization of molecularly doped PEDOT focusing on the determination of its chain lengths at different polymerization temperatures. We find the average chain length to be 6, 7, and 11 monomers for 298, 323 and 373 K, respectively. At the same time, the length distribution is rather broad, for example, between 2 and 16 monomer units for T= 323 K. We demonstrate that the limiting factor determining the chain length is the diffusivity of the reactants (PEDOT monomers and oligomers). We also study the polymer film formation during solvent evaporation, and we find that although crystallization starts and proceeds already during the polymerization and doping phases, it mostly occurs during the evaporation phase. Finally, we believe that our results providing the oligomer chain length and polymerization and crystallization mechanisms obtained by means of MD “computational microscopy” provide an important insight into the morphology of PEDOT that cannot be obtained by other means.

Atopic dermatitis is a notoriously itchy condition that has profound effects on patient quality of life. The pathophysiology of this disease involves immune dysregulation, genetics, and environmental triggers contributing to barrier dysfunction characteristic of this disease. With advances in knowledge of atopic dermatitis pathophysiology, novel drugs have changed the lives of many patients. Furthermore, as dermatologic diseases are often a large component of primary care, it is important for the nurse practitioner to be aware of updates in management. The purpose of this article is to provide an updated review on the treatment of atopic dermatitis including novel therapies.

Characterizing genetic influences on DNA methylation (DNAm) provides an opportunity to understand mechanisms underpinning gene regulation and disease. In the present study, we describe results of DNAm quantitative trait locus (mQTL) analyses on 32,851 participants, identifying genetic variants associated with DNAm at 420,509 DNAm sites in blood. We present a database of >270,000 independent mQTLs, of which 8.5% comprise long-range (trans) associations. Identified mQTL associations explain 15–17% of the additive genetic variance of DNAm. We show that the genetic architecture of DNAm levels is highly polygenic. Using shared genetic control between distal DNAm sites, we constructed networks, identifying 405 discrete genomic communities enriched for genomic annotations and complex traits. Shared genetic variants are associated with both DNAm levels and complex diseases, but only in a minority of cases do these associations reflect causal relationships from DNAm to trait or vice versa, indicating a more complex genotype–phenotype map than previously anticipated.

We report on the thermally activated delayed fluorescence (TADF) properties of a novel iodine-bridged CuIdimeric complex and its structurally related monomer. The chemical environment around the copper centers is identical in both complexes, providing a clean comparison to understand the effect of nuclearity in CuIemitters. Efficient room-temperature TADF (≈80% of the total emission) is observed in both compounds. Similar singlet–triplet splittings were found for the monomer and the dimer (554 and 583 cm–1, respectively), while the dimer triplet lifetime (90.0 μs) was longer than that of the monomer (46.0 μs). Experimental findings were rationalized by time-dependent density functional theory and complete active space self-consistent field calculations, identifying key structural factors determining TADF properties such as the key role of iodine in spin–orbit coupling mixing and the importance of near degeneracies in donor and acceptor orbitals for promoting state mixing. Unavoidable modifications associated with a change in nuclearity (e.g. intermolecular interactions, molecular charge, or modification of some binding motifs) can be also designed to promote TADF performance.

Conocer la epidemiología y evolución al alta de los pacientes oncológicos que precisan ingreso en UCI.

Simultaneous heart‐kidney transplant (sHK) has enabled the successful transplantation of patients with end‐stage heart disease and concomitant kidney disease, with non‐inferior outcomes to heart transplant (HT) alone. The decision for sHK is challenged by difficulties in differentiating those patients with a significant component of reversible kidney injury due to cardiorenal syndrome who may recover kidney function after HT, from those with intrinsic advanced kidney disease who would benefit most from sHK. A consensus conference on sHK took place on June 1, 2019 in Boston, Massachusetts. The conference represented a collaborative effort by experts in cardiothoracic and kidney transplantation from centers across the United States to explore the development of guidelines for the interdisciplinary criteria for kidney transplantation in the sHK candidate, to evaluate the current allocation of kidneys to follow the heart for sHK, and to recommend standardized care for the management of sHK recipients. The conference served as a forum to unify criteria between the different specialties and to forge a pathway for patients who may need dual organ transplantation. Due to the continuing shortage of available donor organs, ethical problems related to multi‐organ transplantation were also debated. The findings and consensus statements are presented. This article contains the proceedings of a collaborative effort by experts in heart and kidney transplantation to explore the development of interdisciplinary criteria for kidney transplantation in the heart‐kidney transplant candidate, to evaluate the current allocation of kidneys to follow the heart, and to recommend standardized care for the management of heart‐kidney transplant recipients. See Johnson and Nadim's editorial on page 2323.

This case challenge describes the presentation of an unexplained rash in the summertime. The diagnosis of pathology is not always straightforward in the emergency department. This case challenge is designed to allow practitioners to familiarize with the person’s presenting history and apply clinical knowledge, examination techniques, and serologic testing that will aid diagnosis.