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Children who survive the pediatric intensive care unit (PICU) are at risk of developing post-intensive care syndrome in pediatrics (PICS-p). PICS-p, defined as new physical, cognitive, emotional, and/or social health dysfunction following critical illness, can affect the child and family. Historically, synthesizing PICU outcomes research has been challenging due to inconsistency in study design and in outcomes measurement. PICS-p risk may be mitigated by implementing intensive care unit best practices that limit iatrogenic injury and by supporting the resiliency of critically ill children and their families.

Interfacial interactions between inorganic surfaces and organic additives are vital to develop new complex nanomaterials. Learning from biosilica materials, composite nanostructures have been developed, which exploit the strength and directionality of specific polyamine additive-silica surface interactions. Previous interpretations of these interactions are almost universally based on interfacial charge matching and/or hydrogen bonding. In this study, we analyzed the surface chemistry of bioinspired silica (BIS) materials using solid-state nuclear magnetic resonance (NMR) spectroscopy as a function of the organic additive concentration. We found significant additional association between the additives and fully condensed (Q4) silicon species compared to industrial silica materials, leading to more overall Q4concentration and higher hydrothermal stability, despite BIS having a shorter synthesis time. We posit that the polyfunctionality and catalytic activity of additives in the BIS synthesis lead to both of these surface phenomena, contrasting previous studies on monofunctional surfactants used in most other artificial templated silica syntheses. From this, we propose that additive polyfunctionality can be used to generate tailored artificial surfaces in situand provide insights into the process of biosintering in biosilica systems, highlighting the need for more in-depth simulations on interfacial interactions at silica surfaces.

AimsThe aim of this study is to develop a core set of outcome domains that should be considered and reported in all future trials of childhood limb fractures.MethodsA four-phase study was conducted to agree a set of core outcome domains. Identification of candidate outcome domains were identified through systematic review of trials, and outcome domains relevant to families were identified through semi-structured interviews with 20 families (parent-child pairing or group). Outcome domains were prioritized using an international three-round Delphi survey with 205 panellists and then condensed into a core outcome set through a consensus workshop with 30 stakeholders.ResultsThe systematic review and interviews identified 85 outcome domains as relevant to professionals or families. The Delphi survey prioritized 30 upper and 29 lower limb outcome domains at first round, an additional 17 upper and 18 lower limb outcomes at second round, and four additional outcomes for upper and lower limb at the third round as important domains. At the consensus workshop, the core outcome domains were agreed as: 1) pain and discomfort; 2) return to physical and recreational activities; 3) emotional and psychosocial wellbeing; 4) complications from the injury and treatment; 5) rturn to baseline activities daily living; 6) participation in learning; 7) appearance and deformity; and 8) time to union. In addition, 9a) recovery of mobility and 9b) recovery of manual dexterity was recommended as a core outcome for lower and upper limb fractures, respectively.ConclusionThis set of core outcome domains is recommended as a minimum set of outcomes to be reported in all trials. It is not an exhaustive set and further work is required to identify what outcome tools should be used to measure each of these outcomes. Adoption of this outcome set will improve the consistency of research for these children that can be combined for more meaningful meta-analyses and policy development.

AimsThis study evaluates the quality of patient-reported outcome measures (PROMs) reported in childhood fracture trials and recommends outcome measures to assess and report physical function, functional capacity, and quality of life using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standards.MethodsA Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review of OVID Medline, Embase, and Cochrane CENTRAL was performed to identify all PROMs reported in trials. A search of OVID Medline, Embase, and PsycINFO was performed to identify all PROMs with validation studies in childhood fractures. Development studies were identified through hand-searching. Data extraction was undertaken by two reviewers. Study quality and risk of bias was evaluated by COSMIN guidelines and recorded on standardized checklists.ResultsSearches yielded 13,672 studies, which were screened to identify 124 trials and two validation studies. Review of the 124 trials identified 16 reported PROMs, of which two had validation studies. The development papers were retrieved for all PROMs. The quality of the original development studies was adequate for Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility and Upper Extremity and doubtful for the EuroQol Five Dimension Youth questionnaire (EQ-5D-Y). All other PROMs were found to have inadequate development studies. No content validity studies were identified. Reviewer-rated content validity was acceptable for six PROMs: Activity Scale for Kids (ASK), Childhood Health Assessment Questionnaire, PROMIS Upper Extremity, PROMIS Mobility, EQ-5D-Y, and Pediatric Quality of Life Inventory (PedsQL4.0). The Modified Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was shown to have indeterminate reliability and convergence validity in one study and PROMIS Upper Extremity had insufficient convergence validity in one study.ConclusionThere is insufficient evidence to recommend strongly the use of any single PROM to assess and report physical function or quality of life following childhood fractures. There is a need to conduct validation studies for PROMs. In the absence of these studies, we cautiously recommend the use of the PROMIS or ASK-P for physical function and the PedsQL4.0 or EQ-5D-Y for quality of life.Cite this article: Bone Joint J2020;102-B(12):1599–1607.

This article introduces the Seshat: Global History Databank, its potential, and its methodology. Seshat is a databank containing vast amounts of quantitative data buttressed by qualitative nuance for a large sample of historical and archaeological polities. The sample is global in scope and covers the period from the Neolithic Revolution to the Industrial Revolution. Seshat allows scholars to capture dynamic processes and to test theories about the co-evolution (or not) of social scale and complexity, agriculture, warfare, religion, and any number of such Big Questions. Seshat is rapidly becoming a massive resource for innovative cross-cultural and cross-disciplinary research. Seshat is part of a growing trend to use comparative historical data on a large scale and contributes as such to a growing consilience between the humanities and social sciences. Seshat is underpinned by a robust and transparent workflow to ensure the ever growing dataset is of high quality.

Background This study focused on exploring the longer-term participation needs of children and young people with acquired brain injury (CYP-ABI) and their families in one region of the UK and identifying the barriers and facilitators of their participation and well-being to inform the development of a behavioural change intervention for clinical implementation. Methods Qualitative interviews were conducted with CYP-ABI and parents. Focus groups were created with health, education, care and charity stakeholders. The International Classification of Functioning, Disability and Health (ICF) and the Behaviour Change Wheel (BCW) were used to map needs, barriers and facilitators. Results A total of 10 CYP/parent dyads (n = 20) and 17 health, education, care and charity stakeholders were included in this study. Unmet participation needs were mapped to the ICF and barriers/facilitators to the BCW. Significant unmet needs impacting CYP-ABI participation and family well-being were found. Barriers spanned ‘Capability’, ‘Opportunity’ and ‘Motivation’, the greatest being knowledge, skills, social influences, environmental context and resources, social identity and emotion. Facilitators included increasing awareness and understanding, supporting parents, long-term access to specialist assessment and rehabilitation, peer support and integrated collaborative pathways. Conclusion The long-term impact of ABI on CYP and families’ participation and well-being were significant, with barriers spanning every sector and level of society. Implementation of collaborative, cross-sector (education, health and social care) accessible and family-centred care pathways is needed to meet the long-term needs of CYP-ABI and their families, ensuring equity of access. Multi-modal, family-centred, needs-led, theory-based interventions should be co-developed with CYP, families and stakeholders to improve the health and well-being outcomes and the lives of CYP-ABI and their families.

The importance of assessing family satisfaction in paediatric intensive care units (PICUs) is becoming increasingly recognised. The survey, EMpowerment of Parents in THe Intensive Care “EMPATHIC-30”, was designed to assess family satisfaction and has been translated and implemented in several countries but not yet in Japan.

Survival of children with complex medical conditions has increased over time. Around 5% of children admitted to a neonatal unit (NNU) later have an admission to a paediatric intensive care unit (PICU) in early life. No work to date has explored the needs of parents who have a child admitted to both of these healthcare settings.

Unravelling the molecular-level mechanisms that lead to the formation of mesoscale-ordered porous materials is a crucial step towards the goal of computational material design. For silica templated by alkylamine surfactants, a mechanism based on hydrogen-bond interactions between neutral amines and neutral silicates in solution has been widely accepted by the materials science community, despite the lack of conclusive evidence to support it. We demonstrate, through a combination of experimental measurements and multi-scale modelling, that the so-called “neutral templating route” does not represent a viable description of the synthesis mechanism of hexagonal mesoporous silica (HMS), the earliest example of amine-templated porous silica. Instead, the mesoscale structure of the material is defined by charge-matching of ionic interactions between amines and silicates. This has profound implications for the synthesis of a wide range of templated porous materials, and may shed new light on developing sustainable and economical routes to high value porous materials.

Inorganic nanomaterials are widely used in e.g. healthcare, electronics and energy sectors (worth several billion $), but their manufacturing is highly wasteful and hence unsustainable. This review highlights the key reasons that make these manufacturing routes unsustainable. We present alternatives, with special emphasis on bottom-up techniques. Biological and bioinspired routes feature as emerging solutions that can be sustainable yet with the ability to produce high-value nanomaterials. Finally, the review identifies future challenges in developing these routes such that they become commercially attractive manufacturing methods.

With the growing number of children and young people with complex care needs or life-limiting conditions, alternative routes for nutrition have been established (such as gastrostomy feeding). The conditions of children and young people who require such feeding are diverse but could relate to problems with swallowing (dysphagia), digestive disorders or neurological/muscular disorders. However, the use of a blended diet as an alternative to prescribed formula feeds for children fed via a gastrostomy is a contentious issue for clinicians and researchers. From a rapid review of the literature, we identify that current evidence falls into three categories: (1) those who feel that the use of a blended diet is unsafe and substandard; (2) those who see benefits of such a diet as an alternative in particular circumstances (eg, to reduce constipation) and (3) those who see merit in the blended diet but are cautious to proclaim potential benefits due to the lack of clinical research. There may be some benefits to using blended diets, although concerns around safety, nutrition and practical issues remain.

For the past decade, motorcycle fatalities have risen while other motor vehicle fatalities have declined. Many motorcycle fatalities occurred within intersections after a driver failed to see a motorcyclist. However, little is known about the behavior of motorcyclists when they negotiate an intersection. A study was undertaken to compare the behavior at intersections of an experienced group of motorcyclists when they were operating a motorcycle with their behavior when they were driving a car. Each participant navigated a course through low-volume, open roads. Participants wore eye-tracking equipment to record eye-glance information, and the motorcycle and car were instrumented with an onboard accelerometer and Global Positioning System apparatus. Results showed that participants were more likely to make last glances toward the direction of the most threatening traffic before they made a turn when they were driving a car than when they were riding a motorcycle. In addition, motorcyclists were less likely to come to a complete stop at a stop sign than car drivers. These results suggested that motorcyclists were exposing themselves to unnecessary risk. Specifically, motorcyclists frequently failed to make proper glances and practice optimal riding techniques. The behavior of the motorcyclists was compared with the current Motorcycle Safety Foundation curriculum. The results suggested that threat-response and delayed-apex techniques should be added to the training curriculum.

For the past decade, motorcycle fatalities have risen while other motor vehicle fatalities have declined. Many motorcycle fatalities occurred within intersections after a driver failed to see a motorcyclist. However, little is known about the behavior of motorcyclists when they negotiate an intersection. A study was undertaken to compare the behavior at intersections of an experienced group of motorcyclists when they were operating a motorcycle with their behavior when they were driving a car. Each participant navigated a course through low-volume, open roads. Participants wore eye-tracking equipment to record eye-glance information, and the motorcycle and car were instrumented with an onboard accelerometer and Global Positioning System apparatus. Results showed that participants were more likely to make last glances toward the direction of the most threatening traffic before they made a turn when they were driving a car than when they were riding a motorcycle. In addition, motorcyclists were less likely to come to a complete stop at a stop sign than car drivers. These results suggested that motorcyclists were exposing themselves to unnecessary risk. Specifically, motorcyclists frequently failed to make proper glances and practice optimal riding techniques. The behavior of the motorcyclists was compared with the current Motorcycle Safety Foundation curriculum. The results suggested that threat-response and delayed-apex techniques should be added to the training curriculum.

The objective of this study was to produce an evidence base of what works, for whom, and in what context when implementing the ICU Liberation Bundle into the paediatric intensive care unit (PICU).

Abstract: is a new programming language with the unique property that the average running time of its programs can be (semi-)automatically deduced in a modular way by a static analysis of the program code. This is based on the fact that to each action there corresponds an operation on partial orders, which associates with each partial order a sequence of partial orders. All programs in use a special data structure and an associated suite of operations. This data structure consists of a pair , where is a finite poset and is a bijection from X to a totally ordered set of labels , satisfying the condition . Central to the analysis of programs is the set of all such pairs for a given and a given ; this set is called a random structure. The corresponding set of order-preserving bijections is called a random structuring. This paper establishes a fundamental equivalence by showing that each poset is uniquely characterised by its associated random structuring, and derives algorithms to reconstruct a poset from its random structuring and to test if an arbitrary set of bijections forms a random structuring. It then develops some consequences of the previous results, and in particular a first characterisation of cardinalities of random structurings. These results open the way to the study of the representation of recursive sets of lists as random structures. This study is closely related to the implementation of list manipulation algorithms in . [Copyright &y& Elsevier]

Abstract: A high-level overview of the MOQA language is presented. The representation of its data structure, a labeled series-parallel partial order, is shown along with some of the functions allowed upon this data structure. The combination of MOQA''s data structure and its functions capture the required calculus to statically obtain the average-case time of algorithms written in this language. The implementation of these concepts is discussed and algorithms written in this implementation are presented. A detailed analysis of one of these implemented algorithms, quicksort, critically compares its average-case time in MOQA against the average-case time of standard quicksort. While the asymptotic average of quicksort in MOQA remains unchanged, extra constant costs are incurred by the MOQA method. It is shown that these costs result from molding the algorithm around the MOQA data structure and functions versus the general approach of choosing the data structure and functions that best match the algorithm. This limitation is balanced against an approach that aims to obtain the average-case time of algorithms statically. [Copyright &y& Elsevier]

A task designed to estimate the impact of communication channel performance on individual and collaborative human performance in distributed, shared, virtual environments was evaluated. The 'Fitts-like' task required participants to press buttons as fast as they could in a three-dimensional virtual workspace. In addition, in the collaborative task the 2 participants were required to press the buttons simultaneously. The size of the buttons, the distance between buttons, and the delay between movement and visual feedback were manipulated. The results were well described by Fitts' law. Movement Time increased with increases in Index of Difficulty and delay. The Index of Performance decreased with delay and was lower in the collaborative task. Overall, orderly changes inperformance were observed with manipulation of task parameters, suggestingthat future studies to examine more complicated manipulations of networkperformance and multisensory displays are appropriate.

A method is presented to obtain normalized high resolution slant path transmittance spectra of the atmosphere. Sample spectra are presented. The spectra are of use in remote sensing applications for various types of atmospheric physics and atmospheric photochemistry research, for validating line parameter compilations, and for modeling slant path radiative transfer. The sample spectra are used to demonstrate improved accuracy of line-by-line transmission models when recently reported water vapor line parameters are substituted for those in the 1986 AFGL line parameter compilation in the region near 1 μm.

n-Nonyl throughn-octadecyl thiol esters of lauric, myristic, palmitic, and stearic acids are being reported for the first time. The four series of thiol esters show an alternation of melting points. The melting points of the even members fall on a single ascending curve. The melting points of the odd members fall on two separate ascending curves.

Summary: n-Nonyl throughn-octadecyl thiol esters of lauric, myristic, palmitic, and stearic acids are being reported for the first time. The four series of thiol esters show an alternation of melting points. The melting points of the even members fall on a single ascending curve. The melting points of the odd members fall on two separate ascending curves.

Discusses health and medical insurance developments in the United States. Increase of disability claims filed by physicians in the United States; Insurance industry's response to said claims; Changes in health and medical insurance; Factors to consider in the purchase of health insurance.