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Objective: Clear outcome reporting in clinical trials facilitates accurate interpretation and application of findings and improves evidence-informed decision-making. Standardized core outcomes for reporting neonatal trials have been developed, but little is known about how primary outcomes are reported in neonatal trials. Our aim was to identify strengths and weaknesses of primary outcome reporting in recent neonatal trials. Methods: Neonatal trials including ≥100 participants/arm published between 2015-2020 with at least one primary outcome from a neonatal core outcome set were eligible. Raters recruited from Cochrane Neonatal were trained to evaluate the trials’ primary outcome reporting completeness using relevant items from CONSORT 2010 and CONSORT-Outcomes 2022 pertaining to the reporting of the definition, selection, measurement, analysis, and interpretation of primary trial outcomes. All trial reports were assessed by 3 raters. Assessments and discrepancies between raters were analyzed. Results: Outcome reporting evaluations were completed for 36 included neonatal trials by 39 raters. Levels of outcome reporting completeness were highly variable. All trials fully reported the primary outcome measurement domain, statistical methods used to compare treatment groups, and participant flow. Yet, only 28% of trials fully reported on minimal important difference, 24% on outcome data missingness, 66% on blinding of the outcome assessor, and 42% on handling of outcome multiplicity. Conclusions: Primary outcome reporting in neonatal trials often lacks key information needed for interpretability of results, knowledge synthesis, and evidence-informed decision-making in neonatology. Use of existing outcome reporting guidelines by trialists, journals, and peer reviewers will enhance transparent reporting of neonatal trials.

Background and Objectives: There is variability in the selection and reporting of outcomes in neonatal trials with key information frequently omitted. This can impact applicability of trial findings to clinicians, families, and caregivers, and impair evidence synthesis. The Neonatal Core Outcomes Set describes outcomes agreed as clinically important that should be assessed in all neonatal trials, and CONSORT-Outcomes 2022 is a new, harmonized, evidence-based reporting guideline for trial outcomes. We reviewed published trials using CONSORT-Outcomes 2022 guidance to identify exemplars of neonatal core outcome reporting to strengthen description of outcomes in future trial publications. Methods: Neonatal trials including >100 participants per arm published between 2015-2020 with a primary outcome included in the Neonatal Core Outcome Set were identified. Primary outcome reporting was reviewed using CONSORT 2010 and CONSORT-Outcomes 2022 guidelines by assessors recruited from Cochrane Neonatal. Examples of clear and complete outcome reporting were identified with verbatim text extracted from trial reports. Results: Thirty-six trials were reviewed by 39 assessors. Examples of good reporting for CONSORT 2010 and CONSORT-Outcomes 2022 criteria were identified and subdivided into three outcome categories: “survival”, “short-term neonatal complications”, and “long-term developmental outcomes” depending on the core outcomes to which they relate. These examples are presented to strengthen future research reporting. Conclusions: We have identified examples of good trial outcome reporting. These illustrate how important neonatal outcomes should be reported to meet the CONSORT 2010 and CONSORT-Outcomes 2022 guidelines. Emulating these examples will improve the transmission of information relating to outcomes and reduce associated research waste.

Importance: Prophylactic cyclooxygenase inhibitors (COX-Is) such as indomethacin, ibuprofen and acetaminophen may prevent morbidity and mortality in extremely preterm infants (born ≤28 weeks’ gestation). However, there is controversy around which COX-I, if any, is the most effective and safest, which has resulted in considerable variability in clinical practice. Objective: To develop rigorous and transparent clinical practice guideline recommendations for the prophylactic use of COX-I drugs for the prevention of mortality and morbidity in extremely preterm infants. Methods: The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence-to-Decision framework for multiple comparisons was used to develop the guideline recommendations. A 12-member panel, including five experienced neonatal care providers, two methods experts, one pharmacist, two parents of former extremely preterm infants and two adults born extremely preterm, was convened. A rating of the most important clinical outcomes was established a priori. Evidence from a Cochrane network meta-analysis, and a cross-sectional mixed-methods study exploring family values and preferences were used as the primary sources of evidence. Recommendations: The panel recommended that prophylaxis with intravenous indomethacin may be considered in extremely preterm infants [conditional recommendation, moderate certainty in estimate of effects]. Shared decision making with parents was encouraged to evaluate their values and preferences prior to therapy. The panel recommended against routine use of ibuprofen prophylaxis in this gestational age group [conditional recommendation, low certainty in the estimate of effects]. The panel strongly recommended against use of prophylactic acetaminophen [strong recommendation, very low certainty in estimate of effects] until further research evidence is available.

Background To undertake a systematic review of studies describing the proportion of children admitted to a paediatric intensive care unit (PICU) for respiratory syncytial virus (RSV) and/or bronchiolitis who were born preterm, and compare their outcomes in PICU with children born at term. Methods We searched Medline, Embase and Scopus. Citations and references of included articles were searched. We included studies published from the year 2000 onwards, from high-income countries, that examined children 0-18 years of age, admitted to PICU from the year 2000 onwards for RSV and/or bronchiolitis. The primary outcome was the percentage of PICU admissions born preterm, and secondary outcomes were observed relative risks of invasive mechanical ventilation and mortality within PICU. We used the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies to assess risk of bias. Results We included 31 studies, from 16 countries, including a total of 18,331 children. Following meta-analysis, the pooled estimate for percentage of PICU admissions for RSV/bronchiolitis who were born preterm was 31% (95% confidence interval: 27% to 35%). Children born preterm had a greater risk of requiring invasive ventilation compared to children born at term (relative risk 1.57, 95% confidence interval 1.25 to 1.97, I2 = 38%). However, we did not observe a significant increase in the relative risk for mortality within PICU for preterm-born children (relative risk 1.10, 95% confidence interval: 0.70 to 1.72, I2 = 0%), although the mortality rate was low across both groups. The majority of studies (n=26, 84%) were at high risk of bias. Conclusions Among PICU admissions for bronchiolitis, preterm-born children are over-represented compared with the preterm birth rate (preterm birth rate 4.4% to 14.4% across countries included in review). Preterm-born children are at higher risk of mechanical ventilation compared to those born at term.

Aim To undertake a systematic review and meta-analysis exploring school-aged neurodevelopmental outcomes of children after low-grade intraventricular haemorrhage (IVH). Methods The published and grey literature was extensively searched to identify observational comparative studies exploring neurodevelopmental outcomes after IVH grade 1-2. Our primary outcome was neurodevelopmental impairment after 5 years of age, which included cognitive, motor, speech and language, behavioural, hearing or visual impairments. Results This review included 12 studies and over 2,036 preterm infants with low grade IVH. Studies used 30 different neurodevelopmental tools to determine outcomes. There was conflicting evidence of the composite risk of neurodevelopmental impairment after low-grade IVH. There was evidence of an association between low-grade IVH and lower IQ at school age -4.23 95% CI (-7.53, -0.92) I2=0% but impact on school performance was unclear. Studies reported an increased crude risk of cerebral palsy after low-grade IVH OR 2.92 95%CI (1.95, 4.37) I2=41%. No increased risk of speech and language impairment or behavioural impairment was found. Few studies addressed hearing and visual impairment. Interpretation This review presents evidence that low-grade IVH is associated with specific neurodevelopmental impairments at school age, lending support to the theory that low-grade IVH is not a benign condition.

Importance: Inequalities in preterm infant mortality exist between population subgroups within the US. Objective: To characterise trends in preterm infant mortality by maternal race and socioeconomic status to assess how inequalities in preterm mortality rates have changed over time. Design, setting, and participants: This was a retrospective longitudinal descriptive study using the US National Centre for Health Statistics Birth Infant/Death Dataset of 12,256,303 preterm infant births over 26 years, between 1995 and 2020. Exposures: Maternal characteristics including race, smoking status, educational attainment, antenatal care, and insurance status were used as reported on an infants’ US birth certificate. Main outcomes and measures: Preterm infant mortality rate was calculated for each year between 1995-2020 for all subgroups, with a trend regression coefficient calculated to describe the rate of change in preterm mortality. Results: The average US preterm infant mortality rate (IMR) decreased from 33.71 (95% CI, 33.71 to 34.04) per 1000 preterm births per year between 1995-1997, to 23.32 (95% CI 23.05 to 23.58) between 2018-2020. Black Non-Hispanic infants were more likely to die following preterm birth than White Non-Hispanic and Hispanic infants however once born extremely prematurely Black and Hispanic infants had a narrow survival advantage. The rate of decrease in preterm IMR was higher in Black infants (-0.015) than in White (-0.013) and Hispanic infants (-0.010); however, the relative risk of preterm IMR among Black infants compared to White infants remained the same between 1995-1997 vs 2018-2020 (RR 1.40, 95% CI 1.38 to 1.44, vs 1.43, 95% CI 1.39 to 1.46). The rate of decrease in preterm IMR was higher in non-smokers compared to smokers (-0.015 vs -0.010), in those with high levels of education compared to those with intermediate or low (-0.016 vs – 0.010, -0.011), and in those who had received adequate antenatal care compared to those who did not (-0.014 vs -0.012, -0.013). Overtime, the relative risk of preterm mortality widened within each of these subgroups. Conclusions and relevance: Between 1995 and 2020, US preterm infant mortality has improved amongst all categories of prematurity. Inequalities in preterm infant mortality based on a mother’s race have remained constant whilst socioeconomic disparities have widened over time.

Background: Using routinely collected clinical data for observational research is becoming a popular method for data collection, especially for outcomes that are rare events. The POOL study was commissioned to evaluate the safety of waterbirth in the UK using routine maternity and neonate clinical data. This paper sets out the design rationale, set-up and data collection pilot for this bespoke data linkage study. Methods: Wellbeing Software®, provider of the Euroking® information system was selected to add new variables to their information system, extract study data from participating NHS sites and transfer data for matching with the National Neonatal Research Database (NNRD). The data extraction, linkage and cleaning was piloted with the first NHS site set-up to confirm data could be linked to the NNRD, identify steps for data management and cleaning, assess data completeness for new and key data fields and develop a plan for a risk classification algorithm. Results: Twenty six sites were set-up over a # months. Twenty-four thousand records were extracted from the pilot NHS site, pertaining to the period from January 2015 to March 2019. Data field completeness for maternal and neonatal primary outcomes were assessable, although some data fields’ completion had been identified as less than adequate. Data flowed to the NNRD enabling matching and linkage between maternal and neonate data. Discussion: Piloting the data extraction and linkage has been a useful exercise which highlighted the need for additional documentation, training and processes to ensure data quality and confidentiality are upheld for the remainder of the study. Accessing such data on scale, is possible, but continues to be a time consuming and a technically challenging exercise.

We present a new study of jet interactions in the quark-gluon plasma created in high-energy heavy-ion collisions, using a multistage event generator within the JETSCAPE framework. We focus on medium-induced modifications in the rate of inclusive jets and high transverse momentum (high-$p_{\mathrm{T}}$) hadrons. Scattering-induced jet energy loss is calculated in two stages: A high virtuality stage based on the MATTER model, in which scattering of highly virtual partons modifies the vacuum radiation pattern, and a second stage at lower jet virtuality based on the LBT model, in which leading partons gain and lose virtuality by scattering and radiation. Coherence effects that reduce the medium-induced emission rate in the MATTER phase are also included. The TRENTo model is used for initial conditions, and the (2+1)dimensional VISHNU model is used for viscous hydrodynamic evolution. Jet interactions with the medium are modeled via 2-to-2 scattering with Debye screened potentials, in which the recoiling partons are tracked, hadronized, and included in the jet clustering. Holes left in the medium are also tracked and subtracted to conserve transverse momentum. Calculations of the nuclear modification factor ($R_{\mathrm{AA}}$) for inclusive jets and high-$p_{\mathrm{T}}$ hadrons are compared to experimental measurements at the BNL Relativistic Heavy Ion Collider (RHIC) and the CERN Large Hadron Collider (LHC). Within this framework, we find that with one extra parameter which codifies the transition between stages of jet modification -- along with the typical parameters such as the coupling in the medium, the start and stop criteria etc. -- we can describe these data at all energies for central and semicentral collisions without a rescaling of the jet transport coefficient $\hat{q}$., Comment: 34 pages, 23 figures

Objectives We involved public and professional stakeholders to assess a novel data interrogation tool, the Neonatal Health Intelligence Tool, for a National Data Asset, the National Neonatal Research Database. Methods We recruited parents, preterm adults, data managers, clinicians, network managers and researchers (trialists and epidemiologists) for consultations demonstrating a prototype tool and semi-structured discussion. A thematic analysis of consultations is reported by stakeholder group. Results We held nine on-line consultations (March–December 2021), with 24 stakeholders: parents (n=8), preterm adults (n=2), data managers (n=3), clinicians (n=3), network managers (n=2), triallists (n=3) and epidemiologists (n=3). We identified four themes from parents/preterm adults: struggling to consume information, Dads and data, bring data to life and yearning for predictions; five themes from data managers/clinicians/network managers: benchmarking, clinical outcomes, transfers and activity, the impact of socioeconomic background and ethnicity, and timeliness of updates and widening availability; and one theme from researchers: interrogating the data. Discussion Other patient and public involvement (PPI) studies have reported that data tools generate concerns; our stakeholders had none. They were unanimously supportive and enthusiastic, citing visualisation as the tool’s greatest strength. Stakeholders had no criticisms; instead, they recognised the tool’s potential and wanted more features. Parents saw the tool as an opportunity to inform themselves without burdening clinicians, while clinicians welcomed an aid to explaining potential outcomes to parents. Conclusion All stakeholder groups recognised the need for the tool, praising its content and format. PPI consultations with all key groups, and their synthesis, illustrated desire for additional uses from it.

Shower development dynamics for a jet traveling through the quark-gluon plasma (QGP) is a multiscale process, where the heavy flavor mass is an important scale. During the high virtuality portion of the jet evolution in the QGP, emission of gluons from a heavy flavor is modified owing to heavy quark mass. Medium-induced radiation of heavy flavor is sensitive to microscopic processes (e.g. diffusion), whose virtuality dependence is phenomenologically explored in this study. In the lower virtuality part of shower evolution, i.e. when the mass is comparable to the virtuality of the parton, scattering and radiation processes of heavy quarks differ from light quarks. The effects of these mechanisms on shower development in heavy flavor tagged showers in the QGP is explored here. Furthermore, this multiscale study examines dynamical pair production of heavy flavor (via virtual gluon splittings) and their subsequent evolution in the QGP, which is not possible otherwise. A realistic event-by-event simulation is performed using the JETSCAPE framework. Energy-momentum exchange with the medium proceeds using a weak coupling recoil approach. Using leading hadron and open heavy flavor observables, differences in heavy versus light quark energy-loss mechanisms are explored, while the importance of heavy flavor pair production is highlighted along with future directions to study., Comment: 6 pages, 3 figures, contribution to the Hard Probes 2023 proceedings

Introduction. Methodologically robust clinical trials are required to improve neonatal care and reduce unwanted variations in practice. Previous neonatal research prioritisation processes have identified important research themes rather than specific research questions amenable to clinical trials. Practice-changing trials require well defined research questions, commonly organised using the Population, Intervention, Comparison, Outcome (PICO) structure. By narrowing the scope of research priorities to those which can be answered in clinical trials and by involving a wide range of different stakeholders, we aim to provide a robust and transparent process to identify and prioritise research questions answerable within the NHS to inform future practice-changing clinical trials. Methods and Analysis. A steering group comprising parents, doctors, nurses, allied health professionals, researchers, and representatives from key organisations (Neonatal Society (NS), British Association of Perinatal Medicine (BAPM), Neonatal Nurses Association (NNA) and Royal College of Paediatrics and Child Health (RCPCH)) was identified to oversee this project. We will invite submissions of research questions formatted using the PICO structure from the following stakeholder groups using an online questionnaire: parents, patients, healthcare professionals and academic researchers. Unanswered, non-duplicate research questions will be entered into a three round eDelphi survey of all stakeholder groups. Research questions will be ranked by mean aggregate scores. Ethics and Dissemination. The final list of prioritised research questions will be disseminated through traditional academic channels, directly to key stakeholder groups through representative organisations and on social media. The outcome of the project will be shared with key research organisations such as the National Institute for Health Research (NIHR). Research ethics committee approval is not required. Registration Details. Not registered.

[Abstract] Aims. This study aimed to assess age‐ and sex‐related differences in management and 1‐year risk for all‐cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results. Of 16 354 patients included in the European Society of Cardiology Heart Failure Long‐Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline‐directed medical therapy (GDMT) were high (angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, beta‐blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P ≤ 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1‐year follow‐up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all‐cause mortality were lower in women than in men (7.1% vs. 8.7%; P = 0.015), as were rates of all‐cause hospitalization (21.9% vs. 27.3%; P < 0.001) and there were no differences in causes of death. All‐cause mortality and all‐cause hospitalization increased with greater age in both sexes. Sex was not an independent predictor of 1‐year all‐cause mortality (restricted to patients with LVEF ≤45%). Mortality risk was significantly lower in patients of younger age, compared to patients aged >75 years. Conclusions. There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all‐cause mortality in patients with LVEF ≤45%.

The routine measurement of gastric residual volume to guide the initiation and delivery of enteral feeding is widespread in paediatric intensive care and neonatal units, but has little underlying evidence to support it.To answer the question: is a trial of no gastric residual volume measurement feasible in UK paediatric intensive care units and neonatal units?A mixed-methods study involving five linked work packages in two parallel arms: neonatal units and paediatric intensive care units. Work package 1: a survey of units to establish current UK practice. Work package 2: qualitative interviews with health-care professionals and caregivers of children admitted to either setting. Work package 3: a modified two-round e-Delphi survey to investigate health-care professionals' opinions on trial design issues and to obtain consensus on outcomes. Work package 4: examination of national databases to determine the potential eligible populations. Work package 5: two consensus meetings of health-care professionals and parents to review the data and agree consensus on outcomes that had not reached consensus in the e-Delphi study.Parents of children with experience of ventilation and tube feeding in both neonatal units and paediatric intensive care units, and health-care professionals working in neonatal units and paediatric intensive care units.Baseline surveys showed that the practice of gastric residual volume measurement was very common (96% in paediatric intensive care units and 65% in neonatal units). Ninety per cent of parents from both neonatal units and paediatric intensive care units supported a future trial, while highlighting concerns around possible delays in detecting complications. Health-care professionals also indicated that a trial was feasible, with 84% of staff willing to participate in a trial. Concerns expressed by junior nurses about the intervention arm of not measuring gastric residual volumes were addressed by developing a simple flow chart and education package. The trial design survey and e-Delphi study gained consensus on 12 paediatric intensive care unit and nine neonatal unit outcome measures, and identified acceptable inclusion and exclusion criteria. Given the differences in physiology, disease processes, environments, staffing and outcomes of interest, two different trials are required in the two settings. Database analyses subsequently showed that trials were feasible in both settings in terms of patient numbers. Of 16,222 children who met the inclusion criteria in paediatric intensive care units, 12,629 stayed for 3 days. In neonatal units, 15,375 neonates 32 weeks of age met the inclusion criteria. Finally, the two consensus meetings demonstrated 'buy-in' from the wider UK neonatal communities and paediatric intensive care units, and enabled us to discuss and vote on the outcomes that did not achieve consensus in the e-Delphi study.Two separate UK trials (one in neonatal units and one in paediatric intensive care units) are feasible to conduct, but they cannot be combined as a result of differences in outcome measures and treatment protocols, reflecting the distinctness of the two specialties.Current Controlled Trials ISRCTN42110505.This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inNurses looking after babies and children on intensive care units in the UK usually pass a tube and aspirate whatever food or fluid is in the baby’s stomach before they give a feed. The idea is to ensure that the stomach is not overdistended with food and prevent the baby vomiting or, worse, aspirating food into the lungs. However, there is little justification for this practice. It is rarely done in many other countries. It may not be pleasant for the child and perhaps is unnecessary. Some experts have suggested that the policy should be evaluated in a randomised controlled trial. This would mean allocating a large number of children at random to either have the stomach aspirated before feeds, or not. Such a trial would be a major undertaking and we are unsure if parents or staff would be willing to allow children to participate. The aim of this study was to see if it is possible to conduct such a large trial in the UK. Two surveys (of 119 units) showed us that regularly measuring the stomach contents when starting and increasing feeds is common practice for both newborn and older children in UK intensive care units. However, in some countries, such as France, this practice is rarely done. We asked 31 parents and 51 health-care professionals about a future study. Overall, parents were supportive of a trial if it was explained to them well by a knowledgeable and caring professional, and if they were approached at the right time. Some concerns were expressed about not picking up complications early if gastric residual volume was not measured. Health-care professionals were also mainly positive about a future trial, but mentioned similar concerns about not picking up complications early and the difficulty of changing a long-standing routine practice. Parents suggested study outcomes that were important to them. These, along with other outcomes, were voted on in a further survey of 106 professionals and at face-to-face meetings involving 41 participants. Overall, our findings suggest that a trial is feasible to perform and acceptable to parents. However, because of differences in both treatments and important outcomes between children’s intensive care units and newborn baby intensive care units, two trials would be needed, one in each type of intensive care unit. These two trials will test whether or not the benefits of not measuring gastric residual volume (e.g. improved calorie intake) outweigh the potential harms (e.g. delayed diagnosis of complications).

During 2015 and early 2016, the cultural application of Com- putational Creativity research and practice took a big leap for- ward, with a project where multiple computational systems were used to provide advice and material for a new musical theatre production. Billed as the world’s first ‘computer mu- sical ... conceived by computer and substantially crafted by computer’, Beyond The Fence was staged in the Arts Theatre in London’s West End during February and March of 2016. Various computational approaches to analytical and genera- tive sub-projects were used to bring about the musical, and these efforts were recorded in two 1-hour documentary films made by Wingspan Productions, which were aired on Sky Arts under the title Computer Says Show. We provide de- tails here of the project conception and execution, including details of the systems which took on some of the creative re- sponsibility in writing the musical, and the contributions they made. We also provide details of the impact of the project, including a perspective from the two (human) writers with overall control of the creative aspects the musical.

[Abstract] Aims. Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results. We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66±13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion. Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease.

We report a new determination of q, the jet transport coefficient of the quark-gluon plasma. We use the JETSCAPE framework, which incorporates a novel multistage theoretical approach to in-medium jet evolution and Bayesian inference for parameter extraction. The calculations, based on the Matter and Lbt jet quenching models, are compared to experimental measurements of inclusive hadron suppression in Au+Au collisions at the BNL Relativistic Heavy Ion Collider (RHIC) and Pb+Pb collisions at the CERN Large Hadron Collider (LHC). The correlation of experimental systematic uncertainties is accounted for in the parameter extraction. The functional dependence of q on jet energy or virtuality and medium temperature is based on a perturbative picture of in-medium scattering, with components reflecting the different regimes of applicability of Matter and Lbt. In the multistage approach, the switch between Matter and Lbt is governed by a virtuality scale Q0. Comparison of the posterior model predictions to the RHIC and LHC hadron suppression data shows reasonable agreement, with moderate tension in limited regions of phase space. The distribution of q/T3 extracted from the posterior distributions exhibits weak dependence on jet momentum and medium temperature T, with 90% credible region (CR) depending on the specific choice of model configuration. The choice of Matter+Lbt, with switching at virtuality Q0, has 90% CR of 240 GeV/c. The value of Q0, determined here for the first time, is in the range 2.0-2.7 GeV.

Background A maternal postpartum six-week check (SWC) with a General Practitioner (GP) is now considered an essential service in England, a recent policy change intended to improve women’s health. We aimed to provide an up-to-date snapshot of the prevalence of SWC prior to the policy change as a baseline, and to explore factors associated with having a late or no check. Methods We conducted a cohort study using primary care records in England (Clinical Practice Research Datalink (CPRD)). 34,337 women who gave birth between 1st July 2015 and 30th June 2018 and had ≥12 weeks of follow-up postpartum, were identified in the CPRD Pregnancy Register. The proportion who had evidence of a SWC with a GP was calculated, and regression analysis was used to assess the association between women’s characteristics and risks of a late or no check. Results Sixty-two percent (95%CI: 58%-67%) of women had a SWC recorded at their GP practice within 12 weeks postpartum, another 27% had other consultations. Forty percent had a SWC at the recommended 6-8 weeks, 2% earlier and 20% later. A late or no check was more common among younger women, mothers of preterm babies, or those registered in more deprived areas. Conclusions Nearly 40% of women did not have a postpartum SWC recorded. Provision or uptake was not equitable; younger women and those in more deprived areas were less likely to have a record of such check, suggesting postpartum care in general practice may be missing some women who need it most.

Using combined data from the Relativistic Heavy Ion and Large Hadron Colliders, we constrain the shear and bulk viscosities of quark-gluon plasma (QGP) at temperatures of ∼150-350 MeV. We use Bayesian inference to translate experimental and theoretical uncertainties into probabilistic constraints for the viscosities. With Bayesian model averaging we propagate an estimate of the model uncertainty generated by the transition from hydrodynamics to hadron transport in the plasma's final evolution stage, providing the most reliable phenomenological constraints to date on the QGP viscosities.

Objective To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. Design Observational cohort study with propensity score matching. Setting National health service neonatal care in England; population data held in the National Neonatal Research Database. Participants Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. Main outcome measures Death, severe brain injury, and survival without severe brain injury. Results 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). Conclusions In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.

Correction to the following report: https://doi.org/10.25561/87336

Background: There is limited evidence to inform feeding during neonatal therapeutic hypothermia; practice is variable. We aimed assess the association between feeding during therapeutic hypothermia and clinically important outcomes. Methods: Retrospective, population-based cohort study using the National Neonatal Research Database. We included all babies admitted to NHS neonatal units in England, Scotland or Wales, 1 January 2010 – 31 December 2017, that received therapeutic hypothermia for 72 hours or died during treatment. We formed matched groups for analysis using propensity scores and compared outcomes in babies fed during therapeutic hypothermia to those that were not. The primary outcome was severe necrotising enterocolitis confirmed at surgery or causing death; we also described pragmatically defined necrotising enterocolitis including lower severity disease, infection, survival, hypoglycaemia, parenteral nutrition and central line days, measures of breastmilk feeding, length of stay and weight. Pre-registered ISRCTN47404296. Findings: 6030 babies received therapeutic hypothermia and 1873 (31%) were fed during hypothermia. Seven babies (0·1%) were diagnosed with severe necrotising enterocolitis. 3236 babies were selected for the matched feeding analysis (1618 pairs) and good balance was achieved for all recorded background variables. Pragmatically defined necrotising enterocolitis was rare both fed and not fed groups (0·6% and 1·1% respectively). Higher survival to discharge (difference 5·2%; 95% CI: 3·9, 6·6; p

We present a new determination of $\hat{q}$, the jet transport coefficient of the quark-gluon plasma. Using the JETSCAPE framework, we use Bayesian parameter estimation to constrain the dependence of $\hat{q}$ on the jet energy, virtuality, and medium temperature from experimental measurements of inclusive hadron suppression in Au-Au collisions at RHIC and Pb-Pb collisions at the LHC. These results are based on a multi-stage theoretical approach to in-medium jet evolution with the MATTER and LBT jet quenching models. The functional dependence of $\hat{q}$ on jet energy, virtuality, and medium temperature is based on a perturbative picture of in-medium scattering, with components reflecting the different regimes of applicability of MATTER and LBT. The correlation of experimental systematic uncertainties is accounted for in the parameter extraction. These results provide state-of-the-art constraints on $\hat{q}$ and lay the groundwork to extract additional properties of the quark-gluon plasma from jet measurements in heavy-ion collisions., Comment: contribution to the 2021 QCD session of the 55th Recontres de Moriond

Additional file 1. Association of multimorbidity and changes in health related quality of life following myocardial infarction: A UK multicentre longitudinal patient-reported outcomes study. Figure S1-[Number of patients who enrolled in EMMACE 3 and 4]. Figure S2-[Normal probability plots for level 1 and level 2 residuals for (A) EQVAS and (B) EQ5D models]. Table S1-[latent class analysis model selection goodness of fit statistics]. Table S2-[Proportions of latent class based on their most likely latent class membership]. Table S3-[Class conditional probabilities of responses to the 7 comorbidities]. Table S4-[Comparison of baseline characteristics between respondent and non-respondents at 12 months]. Table S5-[Adjusted parameter estimates from multilevel modelling of EQ-5D scores and multi-morbidity classes, regression coefficient and 95% confidence intervals].

The JETSCAPE framework is a modular and versatile Monte Carlo software package for the simulation of high energy nuclear collisions. In this work we present a new tune of JETSCAPE, called PP19, and validate it by comparison to jet-based measurements in p+p collisions, including inclusive single jet cross sections, jet shape observables, fragmentation functions, charged hadron cross sections, and dijet mass cross sections. These observables in p+p collisions provide the baseline for their counterparts in nuclear collisions. Quantifying the level of agreement of JETSCAPE results with p+p data is thus necessary for meaningful applications of JETSCAPE to A+A collisions. The calculations use the JETSCAPE PP19 tune, defined in this paper, based on version 1.0 of the JETSCAPE framework. For the observables discussed in this work calculations using JETSCAPE PP19 agree with data over a wide range of collision energies at a level comparable to standard Monte Carlo codes. These results demonstrate the physics capabilities of the JETSCAPE framework and provide benchmarks for JETSCAPE users.

The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and has spread rapidly. COVID-19 was declared a pandemic by the WHO on 12 March 2020. Robust, population-based data describing COVID-19 during pregnancy and the neonatal period are critical to understand and manage this global threat in these groups. There are three key ways that SARS-CoV-2 could affect neonates: 1. Vertical transmission of SARS-CoV-2 from mother to infant, which may lead to neonatal COVID-19. 2. Horizontal transmission of SARS-CoV-2 in the neonatal period, potentially leading to neonatal COVID-19; this may occur from family contacts or nosocomial transmission in healthcare settings, such as neonatal units. 3. Indirect effects on the newborn following maternal COVID-19 that impact pregnancy or labour and birth, leading to complications, such as preterm birth. This will include situations where the neonate is affected by, but does not contract, SARS-CoV-2. The impact of COVID-19 on neonates, as well as the importance of these different potential mechanisms of exposure, remains unclear. Vertical transmission of SARS-CoV-2 has yet to be definitively established; neonatal infection with the virus has been detected in the first days after birth to mothers with COVID-191; however, this could represent early horizontal transmission. Support for vertical transmission comes from serological testing following maternal COVID-19, which found SARS-CoV-2 IgM in umbilical cord blood2; however, SARS-CoV-2 viral RNA was not detected in these newborns, and the validity of current serological tests remains to be established.3 Nevertheless, neonates can be symptomatic with COVID-19 regardless of the mechanism of transmission. Although initial data indicated that the disease was less severe in children,4 approximately 10% of neonates and infants with COVID-19 develop severe or critical disease, a higher proportion than that in …

The dynamics of shower development for a jet traveling through the QGP involves a variety of scales, one of them being the heavy quark mass. Even though the mass of the heavy quarks plays a subdominant role during the high virtuality portion of the jet evolution, it does affect longitudinal drag and diffusion, stimulating additional radiation from heavy quarks. These emissions partially compensate the reduction in radiation from the dead cone effect. In the lower virtuality part of the shower, when the mass is comparable to the transverse momenta of the partons, scattering and radiation processes off heavy quarks differ from those off light quarks. All these factors result in a different nuclear modification factor for heavy versus light flavors and thus for heavy-flavor tagged jets. In this study, the heavy quark shower evolution and the fluid dynamical medium are modeled on an event by event basis using the JETSCAPE Framework. We present a multi-stage calculation that explores the differences between various heavy quark energy-loss mechanisms within a realistically expanding quark-gluon plasma (QGP). Inside the QGP, the highly virtual and energetic portion of the shower is modeled using the MATTER generator, while the LBT generator models the showers induced by energetic and close-to-on-shell heavy quarks. Energy-momentum exchange with the medium, essential for the study of jet modification, proceeds using a weak coupling recoil approach. The JETSCAPE framework allows for transitions, on the level of individual partons, from one energy-loss prescription to the other depending on the parton's energy and virtuality and the local density. This allows us to explore the effect and interplay between the different regimes of energy loss on the propagation and radiation from hard heavy quarks in a dense medium., Comment: arXiv admin note: substantial text overlap with arXiv:2002.06643

Multistage models based on relativistic viscous hydrodynamics have proven successful in describing hadron measurements from relativistic nuclear collisions. These measurements are sensitive to the shear and the bulk viscosities of QCD and provide a unique opportunity to constrain these transport coefficients. Bayesian analyses can be used to obtain systematic constraints on the viscosities of QCD, through methodical model-to-data comparisons. In this manuscript, we discuss recent developments in Bayesian analyses of heavy ion collision data. We highlight the essential role of closure tests in validating a Bayesian analysis before comparison with measurements. We discuss the role of the emulator that is used as proxy for the multistage theoretical model. We use an ongoing Bayesian analysis of soft hadron measurements by the JETSCAPE Collaboration as context for the discussion., Comment: 4 pages, 1 figure, contribution to the Quark Matter 2019 proceedings

We study the medium response to jet evolution in the quark-gluon plasma within the JETSCAPE framework. Recoil partons' medium response in the weakly coupled description is implemented in the multi-stage jet energy-loss model in the framework. As a further extension, the hydrodynamic description is rearranged to include in-medium jet transport based on a strong-coupling picture. To interface hydrodynamics with jet energy-loss models, the hydrodynamic source term is modeled by a causal formulation employing the relativistic diffusion equation. The jet shape and fragmentation function are studied via realistic simulations with weakly coupled recoils. We also demonstrate modifications in the medium caused by the hydrodynamic response., Comment: 4 pages, 2 figures, contribution to the Quark Matter 2019 proceedings

"Hybrid Hadronization" is a new Monte Carlo package to hadronize systems of partons. It smoothly combines quark recombination applicable when distances between partons in phase space are small, and string fragmentation appropriate for dilute parton systems, following the picture outlined by Han et al. [PRC 93, 045207 (2016)]. Hybrid Hadronization integrates with PYTHIA 8 and can be applied to a variety of systems from $e^++e^-$ to $A+A$ collisions. It takes systems of partons and their color flow information, for example from a Monte Carlo parton shower generator, as input. In addition, if for $A+A$ collisions a thermal background medium is provided, the package allows sampling thermal partons that contribute to hadronization. Hybrid Hadronization is available for use as a standalone code and is also part of JETSCAPE since the 2.0 release. In these proceedings we review the physics concepts underlying Hybrid Hadronization and demonstrate how users can use the code with various parton shower Monte Carlos. We present calculations of hadron chemistry and fragmentation functions in small and large systems when Hybrid Hadronization is combined with parton shower Monte Carlos MATTER and LBT. In particular, we discuss observable effects of the recombination of shower partons with thermal partons., Comment: 4 pages, 3 figures, Proceedings of Hard Probes 2020, 1-6 June 2020, Austin, Texas; Updated Author list

We present a jet quenching model within a unified multi-stage framework and demonstrate for the first time a simultaneous description of leading hadrons, inclusive jets, and elliptic flow observables which spans multiple centralities and collision energies. This highlights one of the major successes of the JETSCAPE framework in providing a tool for setting up an effective parton evolution that includes a high-virtuality radiation dominated energy loss phase (MATTER), followed by a low-virtuality scattering dominated (LBT) energy loss phase. Measurements of jet and charged-hadron $R_{AA}$ set strong constraints on the jet quenching model. Jet-medium response is also included through a weakly-coupled transport description., Comment: 4 pages, 4 figures, contribution to the Quark Matter 2019 proceedings

We present a multi-stage model for jet evolution through a quark-gluon plasma within the JETSCAPE framework. The multi-stage approach in JETSCAPE provides a unified description of distinct phases in jet shower contingent on the virtuality. We demonstrate a simultaneous description of leading hadron and integrated jet observables as well as jet $v_n$ using tuned parameters. Medium response to the jet quenching is implemented based on a weakly-coupled recoil prescription. We also explore the cone-size dependence of jet energy loss inside the plasma., Comment: 4 pages, 4 figures, Proceedings of Hard Probes 2020, 1-6 June 2020, Austin, Texas

© 2017 Royal College of Obstetricians and Gynaecologists Background: Standardising outcome collection and reporting in pre-eclampsia trials requires an appraisal of current outcome reporting. Objectives: To map maternal and offspring outcome reporting across randomised trials evaluating therapeutic interventions for pre-eclampsia. Search strategy: Randomised trials were identified by searching bibliographical databases from inception to January 2016. Selection criteria: Randomised controlled trials. Data collection and analysis: We systematically extracted and categorised outcome reporting. Main results: Seventy-nine randomised trials, reporting data from 31 615 maternal participants and 28 172 of their offspring, were included. Fifty-five different interventions were evaluated. Included trials reported 119 different outcomes, including 72 maternal outcomes and 47 offspring outcomes. Maternal outcomes were inconsistently reported across included trials; for example, 11 trials (14%) reported maternal mortality, reporting data from 12 422 participants, and 16 trials (20%) reported cardiovascular morbidity, reporting data from 14 963 maternal participants. Forty-three trials (54%) reported fetal outcomes and 23 trials (29%) reported neonatal outcomes. Twenty-eight trials (35%) reported offspring mortality. There was poor reporting of childhood outcomes: six trials (8%) reported neurodevelopmental outcomes. Less than half of included trials reported any relevant information regarding harms for maternal participants and their offspring. Conclusions: Most randomised trials evaluating interventions for pre-eclampsia are missing information on clinically important outcomes, and in particular have neglected to evaluate efficacy and safety in the offspring of participants. Developing and implementing a minimum data set, known as a core outcome set, in future pre-eclampsia trials could help to address these issues. Tweetable abstract: Future #preeclampsia research requires a core outcome set to reduce #research waste. @coreoutcomes @jamesmnduffy. International Prospective Register of Systematic Reviews: CRD42015015529; www.crd.york.ac.uk/PROSPERO/display_record.aspID=CRD42015015529.

Aims The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI. Methods and results Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission. Conclusion The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Socio-economic position (SEP) is a multi-dimensional construct reflecting (and influencing) multiple socio-cultural, physical, and environmental factors. Previous genome-wide association studies (GWAS) using household income as a marker of SEP have shown that common genetic variants account for 11% of its variation. Here, in a sample of 286,301 participants from UK Biobank, we identified 30 independent genome-wide significant loci, 29 novel, that are associated with household income. Using a recently-developed method to meta-analyze data that leverages power from genetically-correlated traits, we identified an additional 120 income-associated loci. These loci showed clear evidence of functional enrichment, with transcriptional differences identified across multiple cortical tissues, in addition to links with GABAergic and serotonergic neurotransmission. We identified neurogenesis and the components of the synapse as candidate biological systems that are linked with income. By combining our GWAS on income with data from eQTL studies and chromatin interactions, 24 genes were prioritized for follow up, 18 of which were previously associated with cognitive ability. Using Mendelian Randomization, we identified cognitive ability as one of the causal, partly-heritable phenotypes that bridges the gap between molecular genetic inheritance and phenotypic consequence in terms of income differences. Significant differences between genetic correlations indicated that, the genetic variants associated with income are related to better mental health than those linked to educational attainment (another commonly-used marker of SEP). Finally, we were able to predict 2.5% of income differences using genetic data alone in an independent sample. These results are important for understanding the observed socioeconomic inequalities in Great Britain today.

The JETSCAPE Collaboration has recently announced the first release of the JETSCAPE package that provides a modular, flexible, and extensible Monte Carlo event generator. This innovative framework makes it possible to perform a comprehensive study of multi-stage high-energy jet evolution in the Quark-Gluon Plasma. In this work, we illustrate the performance of the event generator for different algorithmic approaches to jet energy loss, and reproduce the measurements of several jet and hadron observables as well as correlations between the hard and soft sector. We also carry out direct comparisons between different approaches to energy loss to study their sensitivity to those observables.

Background While the associations between personality traits and self-reported physical activity are well replicated, few studies have examined the associations between personality and device-based measures of both physical activity and sedentary behaviour. Low levels of physical activity and high levels of sedentary behaviour are known risk factors for poorer health outcomes in older age. Methods We used device-based measures of physical activity and sedentary behaviour recorded over 7 days in 271 79-year-old participants of the Lothian Birth Cohort 1936. Linear regression models were used to assess whether personality traits were cross-sectionally associated with step count, sedentary time, and the number of sit-to-stand transitions. Personality traits were entered one at a time, and all-together, controlling for age and sex in Model 1 and additionally for BMI and limiting long-term illness in Model 2. Results None of the associations between personality traits and measures of physical activity and sedentary behaviours remained significant after controlling for multiple-comparisons using the False Discovery Rate test (all ps > .07). Conclusions We found no evidence that personality traits are associated with device-based measures of physical activity or sedentary behaviour in older age. More studies are needed to replicate and examine the nature of these relationships.

The interaction of heavy flavor with the quark-gluon plasma (QGP) in relativistic heavy-ion collisions is studied using JETSCAPE, a publicly available software package containing a framework for Monte Carlo event generators. Multi-stage (and multi-model) evolution of heavy quarks within JETSCAPE provides a cohesive description of heavy flavor quenching inside the QGP. As the parton shower develops, a model becomes active as soon as its kinematic region of validity is reached. Two combinations of heavy-flavor energy-loss models are explored within a realistic QGP medium, using parameters which were tuned to describe {\it light-flavor} partonic energy-loss., 4 pages, 2 figures, contribution to the Quark Matter 2019 proceedings

The central Appalachian Piedmont lies in the critical juncture between the northern and southern Appalachians, portions of the orogen with distinct middle to late Paleozoic accretionary histories. Orogen-scale compilation maps link the central and southern Appalachians, but until recently, limited geochronological data prevented robust tectonic comparisons between high-grade metamorphic rocks in different parts of the orogen. We report the results of in situ U-Th-total Pb monazite geochronology that date significant deformation and metamorphism as middle Silurian (~425 Ma) through middle Devonian (~385 Ma) and demonstrate the diachronous nature of orogen development. The Rosemont Shear Zone is identified as a major tectonic boundary in southeastern Pennsylvania and northern Delaware separating the rifted Laurentian margin from younger rock units that formed in a magmatic arc setting. The Laurentian margin rocks occur in a series of nappes in which the metamorphic grade decreases from the structurally highest nappe to the lowest. The in situ monazite ages show that maximum temperature in the lowest nappe may have been attained some 15 million years after maximum temperature in the highest nappe. We interpret this to be the result of successive nappe emplacement, with the warmer overriding sheets contributing heat to lower levels. Combining geochronologic and thermobarometric results with the geometry of deformation results in a new picture of the tectonic development of the central Appalachian Piedmont that further links the evolution of the southern and northern Appalachians. For the Laurentian margin rocks, tectonism resulted from the approach and collision of peri-Gondwanan terranes during the Silurian to early Devonian in a dominantly sinistral, transpressive tectonic regime. This portion of the Pennsylvania-Delaware Piedmont inboard of the Rosemont Shear Zone is contiguous with comparable rocks in the southern Appalachians. In contrast, arc-related rock units outboard of the Rosemont Shear Zone experienced primarily thermal metamorphism in the Silurian, while crustal thickening and associated regional metamorphism is middle Devonian in age and likely the result of the accretion of Avalonia during the Acadian orogeny. These arc-related and younger rocks probably originated to the north of their present location as part of the northern Appalachians. They were ultimately emplaced in a right-lateral transcurrent regime sometime after the middle Devonian. Thus, it is in this portion of the central Appalachian Piedmont that the northern and southern Appalachians are joined.

Objective Multiple outcomes can be measured in infants that receive neonatal care. It is unknown whether outcomes of importance to parents and patients differ from those of health professionals. Our objective was to systematically map neonatal care outcomes discussed in qualitative research by patients, parents and healthcare professionals and test whether the frequency with which outcomes are discussed differs between groups. Design Systematic review of qualitative literature. The following databases were searched: Medline, CINAHL, EMBASE, PsycINFO and ASSIA from 1997 to 2017. Publications describing qualitative data relating to neonatal care outcomes, reported by former patients, parents or healthcare professionals, were included. Narrative text was analysed and outcomes grouped thematically by organ system. Permutation testing was applied to assess an association between the outcomes identified and stakeholder group. Results Sixty-two papers containing the views of over 4100 stakeholders were identified; 146 discrete outcomes were discussed; 58 outcomes related to organ systems and 88 to other more global domains. Permutation testing provides evidence that parents, former patients and health professionals reported outcomes with different frequencies (p=0.037). Conclusions Parents, patients and health professionals focus on different outcomes when discussing their experience of neonatal care. A wide range of neonatal care outcomes are reported in qualitative research; many are global outcomes relating to the overall status of the infant. The views of former patients and parents should be taken into consideration when designing research; the development of a core outcomes set for neonatal research will facilitate this.

The modification of jet substructure in relativistic heavy-ion collisions is studied using JETSCAPE, a publicly available software package containing a framework for Monte Carlo event generators. Multi-stage jet evolution in JETSCAPE provides an integrated description of jet quenching by combining multiple models, with each becoming active at a different stage of the parton shower evolution. Jet substructure modification due to different aspects of jet quenching is studied using jet shape and jet fragmentation observables. Various combinations of jet energy loss models are exploed, with medium background provided by (2 + 1)-D VISHNU with TRENTo+freestreaming initial conditions. Results reported here are from simulations performed within JETSCAPE framework., Comment: 4 pages, 3 figures, Proceedings of Hard Probes 2018, 30 September-5 October, Aix-Les-Bains, France

Background Standardising outcome collection and reporting in pre-eclampsia trials requires an appraisal of current outcome reporting. Objectives To map maternal and offspring outcome reporting across randomised trials evaluating therapeutic interventions for pre-eclampsia. Search strategy Randomised trials were identified by searching bibliographical databases from inception to January 2016. Selection criteria Randomised controlled trials. Data collection and analysis We systematically extracted and categorised outcomes reporting. Main results Seventy-nine randomised trials, reporting data from 31,615 maternal participants and 28,172 of their offspring, were included. Fifty-five different interventions were evaluated. Included trials reported 119 different outcomes, including 72 maternal outcomes and 47 offspring outcomes. Maternal outcomes were inconsistently reported across included trials, for example, 11 (14%) trials reported maternal mortality, reporting data from 12,422 participants (39%), and 16 (20%) trials reported cardiovascular morbidity, reporting data from 14,963 maternal participants (43%). Forty-three (54%) trials reported fetal outcomes and 23 (29%) trials reported neonatal outcomes. Twenty-eight trials (35%) reported offspring mortality. There was poor reporting of childhood outcomes: six trials (8%) reported neurodevelopmental outcomes. Less than half of included trials reported any relevant information regarding harms for maternal participants and their offspring. Conclusions Most randomised trials evaluating interventions for pre-eclampsia are missing information on clinically important outcomes and in particular have neglected to evaluate efficacy and safety in the offspring of participants. Developing and implementing a minimum core data set, known as a core outcome set, in future pre-eclampsia trials could help to address these issues.