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Abstract In this paper, we compute departures in the black hole thermodynamics induced by either geometric or topological corrections to general relativity. Specifically, we analyze the spherically symmetric spacetime solutions of two modified gravity scenarios with Lagrangians $$\mathcal {L}\sim R^{1+\epsilon }$$ L ∼ R 1 + ϵ and $$\mathcal {L}\sim R+\epsilon \, \mathcal {G}^2$$ L ∼ R + ϵ G 2 , where $$\mathcal {G}$$ G is the Euler density in four dimensions, while $$ 0

We investigate the gravitational origin of the Tsallis entropy, characterized by the nonadditive index δ. Utilizing Wald's formalism within the framework of f(R) modified theories of gravity, we evaluate the entropy on the black hole horizon for constant curvature solutions to the spherically symmetric vacuum field equations. In so doing, we demonstrate that the Tsallis entropy can be effectively derived from a generalization of the Lagrangian L∝R1+ϵ, where ϵ=δ−1 quantifies small deviations from general relativity. In conclusion, we examine the physical implications of our findings in light of cosmological observations and elaborate on the possibility of solving the thermodynamic instability of Schwarzschild black holes.

Abstract We address the galaxy rotation curves through the Yukawa gravitational potential emerging as a correction of the Newtonian potential in extended theories of gravity. On the one hand, we consider the contribution of the galactic bulge, galactic disk, and the dark matter halo of the Navarro–Frenk–White profile, in the framework of the standard $$\Lambda $$ Λ CDM model. On the other hand, we use modified Yukawa gravity to show that the rotational velocity of galaxies can be addressed successfully without the need for dark matter. In Yukawa gravity, we recover MOND and show that dark matter might be seen as an apparent effect due to the modification of the law of gravitation in terms of two parameters: the coupling constant $$\alpha $$ α and the characteristic length $$\lambda $$ λ . We thus test our theoretical scenario using the Milky Way and M31 rotation velocity curves. In particular, we place observational constraints on the free parameters of Yukawa cosmology through the Monte Carlo method and then compare our results with the predictions of the $$\Lambda $$ Λ CDM paradigm by making use of Bayesian information criteria. Specifically, we find that $$\lambda $$ λ is constrained to be of the order of kpc, while cosmological data suggest $$\lambda $$ λ of the order of Gpc. To explain this discrepancy, we argue that there is a fundamental limitation in measuring $$\lambda $$ λ due to the role of quantum mechanics on cosmological scales.

Abstract Different astrophysical methods can be combined to detect possible deviations from General Relativity. In this work, we consider a class of f(R) gravity models selected by the existence of Noether symmetries. In this framework, it is possible to determine a set of static and spherically symmetric black hole solutions, encompassing small departures from the Schwarzschild geometry. In particular, when gravity is the only dominating interaction, we exploit the ray-tracing technique to reconstruct the image of a black hole, the epicyclic frequencies, and the black hole shadow profile. Moreover, when matter dynamics is also affected by an electromagnetic radiation force, we take into account the general relativistic Poynting–Robertson effect. In light of the obtained results, the proposed strategy results to be robust and efficient: on the one hand, it allows to investigate gravity from strong to weak field regimes; on the other hand, it is capable of detecting small departures from General Relativity, depending on the current observational sensitivity.

Abstract We show that the Einstein field equations with a negative cosmological constant can admit black hole solutions whose thermodynamics coincides with that of logotropic fluids, recently investigated to heal some cosmological and astrophysical issues. For this purpose, we adopt the Anton–Schmidt equation of state, which represents a generalized version of logotropic fluids. We thus propose a general treatment to obtain an asymptotic anti-de Sitter metric, reproducing the thermodynamic properties of both Anton–Schmidt and logotropic fluids. Hence, we explore how to construct suitable spacetime functions, invoking an event horizon and fulfilling the null, weak, strong and dominant energy conditions. We further relax the strong energy condition to search for possible additional solutions. Finally, we discuss the optical properties related to a specific class of metrics and show how to construct an effective refractive index depending on the spacetime functions and the thermodynamic quantities of the fluid under study. We also explore possible departures with respect to the case without the fluid.

We consider non-local Integral Kernel Theories of Gravity in a homogeneous and isotropic universe background as a possible scenario to drive the cosmic history. In particular, we investigate the cosmological properties of a gravitational action containing the inverse d'Alembert operator of the Ricci scalar proposed to improve Einstein's gravity at both high and low-energy regimes. In particular, the dynamics of a physically motivated non-local exponential coupling is analyzed in detail by recasting the cosmological equations as an autonomous system of first-order differential equations with dimensionless variables. Consequently, we study the phase-space domain and its critical points, investigating their stability and main properties. In particular, saddle points and late-time cosmological attractors are discussed in terms of the free parameters of the model. Finally, we discuss the main physical consequences of our approach in view of dark energy behavior and the ΛCDM model.

We consider gravity mediated by non-metricity, with vanishing curvature and torsion. The gravitational action, including an arbitrary function of the non-metric scalar, is investigated in view of characterizing the dark energy effects. In particular, we present a method to reconstruct the f(Q) action without resorting to a priori assumptions on the cosmological model. To this purpose, we adopt a method based on rational Padé approximations, which provides a stable behaviour of the cosmographic series at high redshifts, alleviating the convergence issues proper of the standard approach. We thus describe how to reconstruct f(Q) through a numerical inversion procedure based on the current observational bounds on cosmographic parameters. Our analysis suggests that the best approximation for describing the accelerated expansion of the universe is represented by a scenario with f(Q)=α+βQn. Finally, possible deviations from the standard ΛCDM model are discussed.

Abstract Background Metabolic Acidosis (MA) is a disturbance of the acid-base balance that can occur in preterm and critically ill term neonates due to different etiologies. Intravenous sodium bicarbonate (SB) has been traditionally used to correct such unbalance, despite the lack of evidence about its safety and efficacy. In literature, reported undesirable effects of treatment with SB in neonates include worsening of intracellular acidosis, impairment of myocardial function, cerebral blood flow fluctuations and intracranial hemorrhage. A national survey was conducted by the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology with the aim to assess and describe attitudes and practices concerning the use of SB, particularly for the treatment of MA in Italian NICUs. Methods A questionnaire regarding treatment of MA and SB prescription habits was sent to the directors of 120 Italian NICUs from June 2017 to March 2018. Results The survey response rate was 97.5% (117/120 centers). Findings showed that in 55% of the surveyed NICUs (64/117 units) it is common practice to correct MA with intravenous SB. On the other hand, the remaining 45% of the units try to solve the metabolic disturbances adopting different approaches (improving perfusion, adjusting ventilation parameters or increasing blood volume). Moreover, to prevent the occurrence of MA, 37.6% of the NICUs (44/117) include buffer salts (lactate, acetate or both) in parenteral nutrition prescriptions. SB is also used as a treatment for other conditions, mainly pathologies with bicarbonate loss and tubular acidosis (respectively in 53.8 and 32.5% of the NICUs). Conclusion This survey showed how SB is a commonly used treatment for MA in more than half of Italian NICUs, with indications and prescription criteria that significantly vary across centers. Based on current knowledge, it is reasonable to suggest that the management of neonatal MA should be firstly directed to identify the underlying disorders. Thus, the use of SB should be reserved only for selected cases, also considering the severity of SB adverse effects and the lack of evidence about its efficacy. Guidance for the management of MA is required to harmonize practices and reduce the use of potentially inappropriate and unsafe treatments.

In this paper, we investigate the cosmological viability of a double scalar field model motivated by warm inflation. To this end, we first set up the theoretical framework in which dark energy, dark matter and inflation are accounted for in a triple unification scheme. We then compute the overall dynamics of the model, analyzing the physical role of coupling parameters. Focussing on the late-time evolution, we test the model against current data. Specifically, using the low-redshift Pantheon Supernovae Ia and Hubble cosmic chronometers measurements, we perform a Bayesian analysis through the Monte Carlo Markov Chains method of integration on the free parameters of the model. We find that the mean values of the free parameters constrained by observations lie within suitable theoretical ranges, and the evolution of the scalar fields provides a good resemblance to the features of the dark sector of the universe. Such behaviour is confirmed by the outcomes of widely adopted selection criteria, suggesting a statistical evidence comparable to that of the standard ΛCDM cosmology. We finally discuss the presence of large uncertainties over the free parameters of the model and we debate about fine-tuning issues related to the coupling constants.

Abstract Background Despite regionalization of perinatal care provides for the “in utero” transfer of high-risk pregnancies, there will always be a number of neonates who undergo acute inter-facility transport. The presence of a well-organized Neonatal Emergency Transport Service (NETS) can prevent and reduce risks of transportation, especially for very preterm infants, and is therefore mandatory for any program of regionalization of perinatal care. Italian National Health System is highly decentralized and Regions are autonomous to structure, plan and delivery their regional health services. Consequently, organization models and resources available vary widely and significant regional differences in access and quality of health services have been reported in the past years. A national survey was conducted in 2015 by the neonatal transport study group of the Italian Society of Neonatology with the aim to describe neonatal transfer practices and to assess the Neonatal Emergency Transport Services (NETS) status in the 20 Italian regions. Methods A questionnaire regarding neonatal transfer practices and NETS activity for the previous year (2014) was sent to the 44 NETS operating in the 20 Italian regions. Demographic data were obtained from the Italian National Statistical Institute (ISTAT). Results The overall survey response rate was 100%. In 2014, only 12 (60%) of the 20 Italian regions were fully covered by NETS, 3 (15%) regions were partially covered, while neonatal transport was not available in 5 (25%) regions. Overall, in 2014, the 44 NETS operating in Italy transported a total of 6387 infants, including 522 (8.17%) having a gestational age

Abstract We study extended classes of logotropic fluids as unified dark energy models. Under the hypothesis of the Anton–Schmidt scenario, we consider a universe obeying a single fluid model with a logarithmic equation of state. We investigate the thermodynamic and dynamical consequences of an extended version of the Anton–Schmidt cosmic fluids. Specifically, we expand the Anton–Schmidt pressure in the infrared regime. The low-energy case becomes relevant for the universe as regards acceleration without any cosmological constant. We therefore derive the effective representation of our fluid in terms of a Lagrangian depending on the kinetic term only. We analyze both the relativistic and the non-relativistic limits. In the non-relativistic limit we construct both the Hamiltonian and the Lagrangian in terms of density $$\rho $$ ρ and scalar field $$\vartheta $$ ϑ , whereas in the relativistic case no analytical expression for the Lagrangian can be found. Thus, we obtain the potential as a function of $$\rho $$ ρ , under the hypothesis of an irrotational perfect fluid. We demonstrate that the model represents a natural generalization of logotropic dark energy models. Finally, we analyze an extended class of generalized Chaplygin gas models with one extra parameter $$\beta $$ β . Interestingly, we find that the Lagrangians of this scenario and the pure logotropic one coincide in the non-relativistic regime.

In Cosmology and in Fundamental Physics there is a crucial question like: where the elusive substance that we call Dark Matter is hidden in the Universe and what is it made of? that, even after 40 years from the Vera Rubin seminal discovery [1] does not have a proper answer. Actually, the more we have investigated, the more this issue has become strongly entangled with aspects that go beyond the established Quantum Physics, the Standard Model of Elementary particles and the General Relativity and related to processes like the Inflation, the accelerated expansion of the Universe and High Energy Phenomena around compact objects. Even Quantum Gravity and very exotic Dark Matter particle candidates may play a role in framing the Dark Matter mystery that seems to be accomplice of new unknown Physics. Observations and experiments have clearly indicated that the above phenomenon cannot be considered as already theoretically framed, as hoped for decades. The Special Topic to which this review belongs wants to penetrate this newly realized mystery from different angles, including that of a contamination of different fields of Physics apparently unrelated. We show with the works of this ST that this contamination is able to guide us into the required new Physics. This review wants to provide a good number of these “paths or contamination” beyond/among the three worlds above; in most of the cases, the results presented here open a direct link with the multi-scale dark matter phenomenon, enlightening some of its important aspects. Also in the remaining cases, possible interesting contacts emerges. Finally, a very complete and accurate bibliography is provided to help the reader in navigating all these issues.

The ability of metabolomics to provide a snapshot of an individual’s metabolic state makes it a very useful technique in neonatology for investigating the complex relationship between nutrition and the state of health of the newborn. Through an 1H-NMR metabolomics analysis, we aimed to investigate the metabolic profile of newborns by analyzing both urine and milk samples in relation to the birth weight of neonates classified as AGA (adequate for the gestational age, n = 51), IUGR (intrauterine growth restriction, n = 14), and LGA (large for gestational age, n = 15). Samples were collected at 7 ± 2 days after delivery. Of these infants, 42 were exclusively breastfed, while 38 received mixed feeding with a variable amount of commercial infant formula (less than 40%) in addition to breast milk. We observed a urinary spectral pattern for oligosaccharides very close to that of the corresponding mother’s milk in the case of exclusively breastfed infants, thus mirroring the maternal phenotype. The absence of this good match between the infant urine and human milk spectra in the case of mixed-fed infants could be reasonably ascribed to the use of a variable amount of commercial infant formulas (under 40%) added to breast milk. Furthermore, our findings did not evidence any significant differences in the spectral profiles in terms of the neonatal customize centile, i.e., AGA (adequate for gestational age), LGA (large for gestational age), or IGUR (intrauterine growth restriction). It is reasonable to assume that maternal human milk oligosaccharide (HMO) production is not or is only minimally influenced by the fetal growth conditions for unknown reasons. This hypothesis may be supported by our metabolomics-based results, confirming once again the importance of this approach in the neonatal field.

Introduction: In the last years the uncritical attitude towards cesarean section (CS) has been associated with the fast emergence of ‘modern’ diseases such as early pediatric obesity, asthma, type 2 diabetes mellitus and dermatitis. Increasing evidence shows that babies born at term by vaginal delivery (VD) have a different physiology at birth, with subsequent influence on adult health. In relation to these short-term physiological changes, in the present study we aimed at assessing the influence of the mode of delivery in term newborns on the first 24 hours metabolism of neonates. Material and methods: This study was carried out on urine samples from 42 patients admitted to the Neonatal Intensive Unit and Neonatal Pathology of “S. Giovanni Calibita” Hospital Fatebenefratelli (Rome, Italy). According to the type of delivery, term neonates with similar gestational age and birthweight were divided in two groups: (1) born by spontaneous VD, (2) born by elective CS. Urine samples, collected at birth by a non-invasive method, were subjected to proton Nuclear Magnetic Resonance spectroscopy. Results: CS newborns showed lower fatty acid omega oxidation, as evidenced by lower urinary excretion of dicarboxylic acids. This metabolic signature supports current evidence that babies delivered by CS have lower body temperature and perturbed thermogenesis. CS associates also with hypoglycaemia and altered endocrine profile, which linked to changes in central energy metabolic pathways (Krebs and Cori Cycles). Lung function may be reduced in infants born by CS, primarily due to delayed clearance of lung liquid, and surfactant insufficiency, which might be reflected in different urinary excretion of myo-inositol and choline – two intermediates in lung surfactant metabolism. Conclusion: Non-invasive urine metabolic phenotyping of children born by different mode of delivery provides relevant readouts to assess metabolic requirements associated with major physiological functions during this critical period of metabolic adaptation.

In this paper, we describe QUBIC, an experiment that will observe the polarized microwave sky with a novel approach, which combines the sensitivity of state-of-the-art bolometric detectors with the systematic effects control typical of interferometers. QUBIC’s unique features are the so-called “self-calibration”, a technique that allows us to clean the measured data from instrumental effects, and its spectral imaging power, i.e., the ability to separate the signal into various sub-bands within each frequency band. QUBIC will observe the sky in two main frequency bands: 150 GHz and 220 GHz. A technological demonstrator is currently under testing and will be deployed in Argentina during 2019, while the final instrument is expected to be installed during 2020.

Introduction: The admittance of a baby in NICU is a chocking and stressful experience for parents that need support to comprehend and accept circumstances and help to start the relation with their baby. Expressive Laboratory (EL) is a counseling activity that offers parents the possibility to explore their emotional experience by participating with other parents in meetings with a counselor and a psychologist. Materials and method: The EL includes a set of nine meetings, planned in three moments: pre-contact, contact and post-contact, each meeting is focusing on a particular theme and at the end parents fill out an anonymous feedback form where they can show their appreciation of the activities performed, the benefit obtained and the emotions experienced. Results: From May 2009 to September 2010 seven sets of meetings were organized in which 142 parents participated and they filled out 286 feedback forms. The main results from this descriptive study concerned feelings as: sharing the experience, ability to express oneself, finding resources. Some comments go beyond the activities of EL. Conclusions: The major benefits of EL reported by the parents are the sharing of the experience; not to feel lonely during the hospital stay. The experience to share allows a full understanding of the stories, promoting the creation of a support net that lasts even after the discharge of the baby with self-aid groups.

This manuscript describes the experience of our team in developing a flow-triggered nasal respiratory support for the neonate and its related clinical applications. Although mechanical ventilation (MV) via an endotracheal tube has undoubtedly led to improvement in neonatal survival in the last 40 years, the prolonged use of this technique may predispose the infant to the development of many possible complications, first of all, bronchopulmonary dysplasia (BPD). Avoiding mechanical ventilation is thought to be a critical goal, and different modes of non invasive respiratory support may reduce the intubation rate: nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV) and its more advantageous form, synchronized nasal intermittent positive pressure ventilation (SNIPPV). SNIPPV was initially performed by a capsule placed on the baby’s abdomen. To overcome the disadvantages of the abdominal capsule, our team decided to create a flow-sensor that could be interposed between the nasal prongs and the Y piece. Firstly we developed a hot-wire flow-sensor to trigger the ventilator and we showed that flow-SNIPPV can support the inspiratory effort in the post-extubation period more effectively than NCPAP. But, although accurate, the proper functioning of the hot-wire flow-sensor was easily compromised by secretions or moisture, and therefore we started to use as flow-sensor a simpler differential pressure transducer. In a following trial using the new device, we were able to demonstrate that flow-SNIPPV was more effective than conventional NCPAP in decreasing extubation failure in preterm infants who had been ventilated for respiratory distress syndrome (RDS). More recently we used flow-SNIPPV as the primary mode of ventilation, after surfactant replacement, reducing MV need and favorably affecting short-term morbidities of treated premature infants. We also successfully applied SNIPPV to treat apnea of prematurity (AOP). Finally, we developed a new shaped flow-sensor, which is smaller and lighter of the previous one and its reliability was tested using a simulated neonatal model. Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy) · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research

In this paper, we review the main features of modified theories of gravity containing higher-order curvature invariants in the action. After summarizing the main features of these theories, we consider their applications to cosmology, pointing out the differences with respect to general relativity that can eventually solve issues exhibited by the latter at low and high energy scales. Specifically, we explore a gravitational action that incorporates both the Ricci scalar R and the topological Gauss–Bonnet term, denoted as . Our investigation revolves around the cosmological properties of a specific category of modified gravity theories, chosen upon symmetry considerations. Within the framework of a spatially flat, homogeneous and isotropic cosmic background, we demonstrate that it is possible to account for the presently observed acceleration of the Universe by means of the extra geometric terms carried by the selected f (R ,) model. This approach offers a way to address the issues associated with the cosmological constant. To achieve this, we first examine the energy conditions and find that, under certain choices for the values of the cosmographic parameters, these conditions are all violated. In the second part of the work, to assess the feasibility of the selected f (R ,) model, we place observational constraints on its free parameters through a Bayesian Monte Carlo technique applied to late-time cosmic data. Our findings reveal that the f (R ,) model can effectively reproduce observations at low redshifts, providing an alternative to the standard Λ CDM scenario. [ABSTRACT FROM AUTHOR]

We modify the symmetric-teleparallel dark energy through the addition of a further Yukawa-like term, in which the non-metricity scalar, Q, is non-minimally coupled to a scalar field Lagrangian where the phion acts as quintessence, describing dark energy. We investigate regions of stability and find late-time attractors. To do so, we conduct a stability analysis for different types of physical potentials describing dark energy, namely the power-law, inverse power-law, and exponential potentials. Within these choices, we furthermore single out particular limiting cases, such as the constant, linear and inverse potentials. For all the considered scenarios, regions of stability are calculated in terms of the signs of the coupling constant and the exponent, revealing a clear degeneracy among coefficients necessary to ensure stability. We find that a generic power-law potential with α > 0 is not suitable as a non-minimal quintessence potential and we put severe limits on the use of inverse potential, as well. In addition, the equations of state of each potential have been also computed. We find the constant potential seems to be favored than other treatments, since the critical point appears independent of the non-minimal coupling. [ABSTRACT FROM AUTHOR]

We address the galaxy rotation curves through the Yukawa gravitational potential emerging as a correction of the Newtonian potential in extended theories of gravity. On the one hand, we consider the contribution of the galactic bulge, galactic disk, and the dark matter halo of the Navarro–Frenk–White profile, in the framework of the standard Λ CDM model. On the other hand, we use modified Yukawa gravity to show that the rotational velocity of galaxies can be addressed successfully without the need for dark matter. In Yukawa gravity, we recover MOND and show that dark matter might be seen as an apparent effect due to the modification of the law of gravitation in terms of two parameters: the coupling constant α and the characteristic length λ . We thus test our theoretical scenario using the Milky Way and M31 rotation velocity curves. In particular, we place observational constraints on the free parameters of Yukawa cosmology through the Monte Carlo method and then compare our results with the predictions of the Λ CDM paradigm by making use of Bayesian information criteria. Specifically, we find that λ is constrained to be of the order of kpc, while cosmological data suggest λ of the order of Gpc. To explain this discrepancy, we argue that there is a fundamental limitation in measuring λ due to the role of quantum mechanics on cosmological scales. [ABSTRACT FROM AUTHOR]

We here propose a new model-independent technique to overcome the circularity problem affecting the use of gamma-ray bursts (GRBs) as distance indicators through the use of E p−Eiso correlation. We calibrate the E p −E iso correlation and find the GRB distance moduli that can be used to constrain dark energy models. We use observational Hubble data to approximate the cosmic evolution through Bézier parametric curve obtained through the linear combination of Bernstein basis polynomials. In doing so, we build up a new data set consisting of 193 GRB distance moduli. We combine this sample with the supernova JLA data set to test the standard ΛCDM model and its w CDM extension. We place observational constraints on the cosmological parameters through Markov Chain Monte Carlo numerical technique. Moreover, we compare the theoretical scenarios by performing the Akaike and Deviance Information statistical criteria.the 2σ level, while for the w CDM model we obtain |$\Omega _m=0.34^{+0.13}_{-0.15}$| and |$w=-0.86^{+0.36}_{-0.38}$| at the 2σ level. Our analysis suggests that ΛCDM model is statistically favoured over the w CDM scenario. No evidence for extension of the ΛCDM model is found. [ABSTRACT FROM AUTHOR]

In the framework of metric-affine gravity, we consider the role of the boundary term in Symmetric Teleparallel Gravity assuming f(Q, B) models where f is a smooth function of the non-metricity scalar Q and the related boundary term B. Starting from a variational approach, we derive the field equations and compare them with respect to those of f(Q) gravity in the limit of B → 0 . It is possible to show that f (Q , B) = f (Q - B) models are dynamically equivalent to f(R) gravity as in the case of teleparallel f (B ~ - T) gravity (where B ≠ B ~ ). Furthermore, conservation laws are derived. In this perspective, considering boundary terms in f(Q) gravity represents the last ingredient towards the Extended Geometric Trinity of Gravity, where f(R), f (T , B ~) , and f(Q, B) can be dealt under the same standard. In this perspective, we discuss also the Gibbons–Hawking–York boundary term of General Relativity comparing it with B in f(Q, B) gravity. [ABSTRACT FROM AUTHOR]

Different astrophysical methods can be combined to detect possible deviations from General Relativity. In this work, we consider a class of f(R) gravity models selected by the existence of Noether symmetries. In this framework, it is possible to determine a set of static and spherically symmetric black hole solutions, encompassing small departures from the Schwarzschild geometry. In particular, when gravity is the only dominating interaction, we exploit the ray-tracing technique to reconstruct the image of a black hole, the epicyclic frequencies, and the black hole shadow profile. Moreover, when matter dynamics is also affected by an electromagnetic radiation force, we take into account the general relativistic Poynting–Robertson effect. In light of the obtained results, the proposed strategy results to be robust and efficient: on the one hand, it allows to investigate gravity from strong to weak field regimes; on the other hand, it is capable of detecting small departures from General Relativity, depending on the current observational sensitivity. [ABSTRACT FROM AUTHOR]

Patients with progressive supranuclear palsy (PSP) often have blinking abnormalities. In this study we examined the kinematic features of voluntary, spontaneous and reflex blinking in 11 patients with PSP and healthy control subjects. Patients were asked to blink voluntarily as fast as possible; spontaneous blinking was recorded during two 60 s rest periods; reflex blinking was evoked by electrical stimulation of the supraorbital nerve. Eyelid movements were recorded with the SMART analyzer motion system. During voluntary blinking the closing and opening phases lasted longer in patients than in healthy subjects. Furthermore, the peak velocity of the closing phase of voluntary blinking was lower in patients than healthy subjects. During spontaneous blinking the blink rate was markedly lower in patients than in control subjects. Patients recordings also showed kinematic abnormalities of spontaneous (reduced peak velocity of both closing and opening phases) and reflex (reduced peak velocity and increased duration of the opening phase) blinking. Recordings during reflex blinking disclosed an enhanced excitability of the interneuronal pool mediating the closing and opening blink phases. Finally, the pause, a neurophysiological marker of the switching processes between the closing and opening phases, was prolonged in all the three types of blinking. The abnormal kinematic variables correlated with patients’ clinical and kinematic features. Abnormal voluntary, spontaneous and reflex blinking in patients with PSP reflects the widespread cortical, subcortical and brainstem degeneration related to this disease. [ABSTRACT FROM AUTHOR]

In this paper, we consider a gravitational action containing a combination of the Ricci scalar, R, and the topological Gauss-Bonnet term, G. Specifically, we study the cosmological features of a particular class of modified gravity theories selected by symmetry considerations, namely the f (R , G) = R n G 1 - n model. In the context of a spatially flat, homogeneous and isotropic background, we show that the currently observed acceleration of the Universe can be addressed through geometry, hence avoiding de facto the shortcomings of the cosmological constant. We thus present a strategy to numerically solve the Friedmann equations in presence of pressureless matter and obtain the redshift behavior of the Hubble expansion rate. Then, to check the viability of the model, we place constraints on the free parameters of the theory by means of a Bayesian Monte Carlo method applied to late-time cosmic observations. Our results show that the f(R, G) model is capable of mimicking the low-redshift behavior of the standard Λ CDM model. Finally, we investigate the energy conditions and show that, under suitable choices for the values of the cosmographic parameters, they are all violated when considering the mean value of n obtained from our analysis, as occurs in the case of a dark fluid. [ABSTRACT FROM AUTHOR]

We heal the cosmological constant problem by means of a cancellation mechanism that adopts a phase transition during which quantum fluctuations are eliminated. To this purpose, we propose that a generalized scalar (dark) matter field with a non-vanishing pressure term can remove the vacuum energy contribution, if its corresponding thermodynamics is written in terms of a quasi-quintessence representation. In such a picture, pressure differs from quintessence as it shows a zero kinetic contribution. Using this field, we investigate a metastable transition phase, in which the Universe naturally passes through an inflationary phase. To reach this target, we single out a double exponential potential, describing the metastable inflationary dynamics by considering suitable boundaries and thermodynamic conditions. We analyze stability investigating saddle, stable and unstable points and we thus predict a chaotic inflation that mimics the Starobinsky exponential potential. Consequently, the role of the proposed dark matter field is investigated throughout the overall Universe evolution. To do so, we provide a physical explanation on unifying the dark sector with inflation by healing the cosmological constant problem. [ABSTRACT FROM AUTHOR]

Objective: Extrauterine growth restriction (EUGR) among very preterm infants is related to poor neurodevelopment, but lack of consensus on EUGR measurement constrains international research. Our aim was to compare EUGR prevalence in a European very preterm cohort using commonly used measures.Design: Population-based observational study.Setting: 19 regions in 11 European countries.Patients: 6792 very preterm infants born before 32 weeks' gestational age (GA) surviving to discharge.Main Outcome Measures: We investigated two measures based on discharge-weight percentiles with (1) Fenton and (2) Intergrowth (IG) charts and two based on growth velocity (1) birth weight and discharge-weight Z-score differences using Fenton charts and (2) weight-gain velocity using Patel's model. We estimated country-level relative risks of EUGR adjusting for maternal and neonatal characteristics and associations with population differences in healthy newborn size, measured by mean national birth weight at 40 weeks' GA.Results: About twofold differences in EUGR prevalence were observed between countries for all indicators and these persisted after case-mix adjustment. Discharge weight <10th percentile using Fenton charts varied from 24% (Sweden) to 60% (Portugal) and using IG from 13% (Sweden) to 43% (Portugal), while low weight-gain velocity ranged from 35% (Germany) to 62% (UK). Mean term birth weight strongly correlated with both percentile-based measures (Spearman's rho=-0.90 Fenton, -0.84 IG, p<0.01), but not Patel's weight-gain velocity (rho: -0.38, p=0.25).Conclusions: Very preterm infants have a high prevalence of EUGR, with wide variations between countries in Europe. Variability associated with mean term birth weight when using common postnatal growth charts complicates international benchmarking. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the variation in neurodevelopmental disability rates between populations persists after adjustment for demographic, maternal and infant characteristics for an international very preterm (VPT) birth cohort using a standardised approach to neurodevelopmental assessment at 2 years of age.Design: Prospective standardised cohort study.Setting: 15 regions in 10 European countries.Patients: VPT births: 22+0-31+6 weeks of gestation.Data Collection: Standardised data collection tools relating to pregnancy, birth and neonatal care and developmental outcomes at 2 years corrected age using a validated parent completed questionnaire.Main Outcome Measures: Crude and standardised prevalence ratios calculated to compare rates of moderate to severe neurodevelopmental impairment between regions grouped by country using fixed effects models.Results: Parent reported rates of moderate or severe neurodevelopmental impairment for the cohort were: 17.3% (ranging 10.2%-26.1% between regions grouped by country) with crude standardised prevalence ratios ranging from 0.60 to 1.53. Adjustment for population, maternal and infant factors resulted in a small reduction in the overall variation (ranging from 0.65 to 1.30).Conclusion: There is wide variation in the rates of moderate to severe neurodevelopmental impairment for VPT cohorts across Europe, much of which persists following adjustment for known population, maternal and infant factors. Further work is needed to investigate whether other factors including quality of care and evidence-based practice have an effect on neurodevelopmental outcomes for these children. [ABSTRACT FROM AUTHOR]

Background Hospitalized neonates receive the highest number of drugs compared to all other age groups, but consumption rates vary between studies depending on patient characteristics and local practices. There are no large-scale international studies on drug use in neonatal units. Objective We aimed to describe drug use in European neonatal units and characterize its associations with geographic region and gestational age. Setting A one-day point prevalence study was performed as part of the European Study of Neonatal Exposure to Excipients from January to June 2012. Method All neonatal prescriptions and demographic data were registered in a web-based database. The impact of gestational age and region on prescription rate were analysed with logistic regression. Main outcome measure The number and variety of drugs prescribed to hospitalized neonates in different gestational age groups and geographic regions. Results In total, 21 European countries with 89 neonatal units participated. Altogether 2173 prescriptions given to 726 neonates were registered. The 10 drugs with the highest prescription rate were multivitamins, vitamin D, caffeine, gentamicin, amino acids for parenteral nutrition, phytomenadione, ampicillin, benzylpenicillin, fat emulsion for parenteral nutrition and probiotics. The six most commonly prescribed ATC groups (alimentary tract and metabolism, blood and blood-forming organs, systemic anti-infectives, nervous, respiratory and cardiovascular system) covered 98% of prescriptions. Gestational age significantly affected the use of all commonly used drug groups. Geographic region influenced the use of alimentary tract and metabolism, blood and blood-forming organs, systemic anti-infectives, nervous and respiratory system drugs. Conclusion While gestational age-dependent differences in neonatal drug use were expected, regional variations (except for systemic anti-infectives) indicate a need for cooperation in developing harmonized evidence-based guidelines and suggest priorities for collaborative work. [ABSTRACT FROM AUTHOR]

2051Cosmography can be considered as a sort of a model-independent approach to tackle the dark energy/modified gravity problem. In this review, the success and the shortcomings of the Λ CDM model, based on General Relativity (GR) and standard model of particles, are discussed in view of the most recent observational constraints. The motivations for considering extensions and modifications of GR are taken into account, with particular attention to f (R) and f (T) theories of gravity where dynamics is represented by curvature or torsion field, respectively. The features of f (R) models are explored in metric and Palatini formalisms. We discuss the connection between f (R) gravity and scalar–tensor theories highlighting the role of conformal transformations in the Einstein and Jordan frames. Cosmological dynamics of f (R) models is investigated through the corresponding viability criteria. Afterwards, the equivalent formulation of GR (Teleparallel Equivalent General Relativity (TEGR)) in terms of torsion and its extension to f (T) gravity is considered. Finally, the cosmographic method is adopted to break the degeneracy among dark energy models. A novel approach, built upon rational Padé and Chebyshev polynomials, is proposed to overcome limits of standard cosmography based on Taylor expansion. The approach provides accurate model-independent approximations of the Hubble flow. Numerical analyses, based on Monte Carlo Markov Chain integration of cosmic data, are presented to bound coefficients of the cosmographic series. These techniques are thus applied to reconstruct f (R) and f (T) functions and to frame the late-time expansion history of the universe with no a priori assumptions on its equation-of-state. A comparison between the Λ CDM cosmological model with f (R) and f (T) models is reported. [ABSTRACT FROM AUTHOR]

We derive the weak field limit for a gravitational Lagrangian density L g = (R + a 0 R 2 + ∑ k = 1 p a k R □ k R) − g , where higher-order derivative terms in the Ricci scalar R are taken into account. The interest for this kind of effective theories comes out from the consideration of the infrared and ultraviolet behaviors of gravitational field and, in general, from the formulation of quantum field theory in curved spacetimes. Here, we obtain solutions in weak field regime both in vacuum and in the presence of matter and derive gravitational waves considering the contribution of R □ k R terms. By using a suitable set of coefficients a k , it is possible to find up to (p + 2) normal modes of oscillation with six polarization states with helicity 0 or 2. Here p is the higher-order term in the □ operator appearing in the gravitational Lagrangian. More specifically: the mode ω 1 , with k 2 = 0 , has transverse polarizations 𝜖 μ ν (+) and 𝜖 μ ν (×) with helicity 2; the (p + 1) modes ω m , with k 2 ≠ 0 , have transverse polarizations 𝜖 μ ν (1) and non-transverse ones 𝜖 μ ν (TT) , 𝜖 μ ν (TS) , 𝜖 μ ν (L) with helicity 0. [ABSTRACT FROM AUTHOR]

We propose a model-independent formalism to numerically solve the modified Friedmann equations in the framework of f( T) teleparallel cosmology. Our strategy is to expand the Hubble parameter around the redshift $$z=0$$ up to a given order and to adopt cosmographic bounds as initial settings to determine the corresponding $$f(z)\equiv f(T(H(z)))$$ function. In this perspective, we distinguish two cases: the first expansion is up to the jerk parameter, the second expansion is up to the snap parameter. We show that inside the observed redshift domain $$z\le 1$$ , only the net strength of f( z) is modified passing from jerk to snap, whereas its functional behavior and shape turn out to be identical. As first step, we set the cosmographic parameters by means of the most recent observations. Afterwards, we calibrate our numerical solutions with the concordance $$\Lambda $$ CDM model. In both cases, there is a good agreement with the cosmological standard model around $$z\le 1$$ , with severe discrepancies outer of this limit. We demonstrate that the effective dark energy term evolves following the test-function: $$f(z)={\mathcal {A}}+{\mathcal {B}}{z}^2e^{{\mathcal {C}}{z}}$$ . Bounds over the set $$\left\{ {\mathcal {A}}, {\mathcal {B}}, {\mathcal {C}}\right\} $$ are also fixed by statistical considerations, comparing discrepancies between f( z) with data. The approach opens the possibility to get a wide class of test-functions able to frame the dynamics of f( T) without postulating any model a priori. We thus re-obtain the f( T) function through a back-scattering procedure once f( z) is known. We figure out the properties of our f( T) function at the level of background cosmology, to check the goodness of our numerical results. Finally, a comparison with previous cosmographic approaches is carried out giving results compatible with theoretical expectations. [ABSTRACT FROM AUTHOR]

In this study, a gas-chromatography mass spectrometry (GC-MS) metabolomics study was applied to examine urine metabolite profiles of different classes of neonates under different nutrition regimens. The study population included 35 neonates, exclusively either breastfed or formula milk fed, in a seven-day timeframe. Urine samples were collected from intrauterine growth restriction (IUGR), large for gestational age (LGA), and appropriate gestational age (AGA) neonates. At birth, IUGR and LGA neonates showed similarities in their urine metabolite profiles that differed from AGA. When neonates started milk feeding, their metabolite excretion profile was strongly characterized by the different diet regimens. After three days of formula milk nutrition, urine had higher levels of glucose, galactose, glycine and myo-inositol, while up-regulated aconitic acid, aminomalonic acid and adipic acid were found in breast milk fed neonates. At seven days, neonates fed with formula milk shared higher levels of pseudouridine with IUGR and LGA at birth. Breastfed neonates shared up-regulated pyroglutamic acid, citric acid, and homoserine, with AGA at birth. The role of most important metabolites is herein discussed. [ABSTRACT FROM AUTHOR]

Purpose: The use of medicines among newborns admitted to intensive care units is characterized by a high prevalence of off-label/unlicensed use and a wide variability in the absence of international guidelines. A prospective cross-sectional study was organized with the aim to analyse drug prescriptions among all 107 Italian level III neonatal intensive care units. Methods: An online questionnaire was used to collect detailed information for each newborn, and a classification was made about the license status of all prescriptions. In addition, prescriptions were analysed taking into account a practical guide prepared by the Italian Society of Neonatology (ISN). Results: The 1-day survey (May-July 2014) regarded 220 newborn infants admitted to 36/107 Italian neonatal intensive care units: 191 prematures and 29 born at term. In total, 720 prescriptions (corresponding to 79 different drugs) were analysed: 191 (26.5 %) followed the terms of the product license, 529 (73.5 %) were off-label or unlicensed: 193/220 newborns (87.7 %) received at least one off-label/unlicensed prescription. Antiinfectives were the most common medicine used, followed by respiratory drugs and antianaemics; in an off-label manner, the most common was cardiovascular and central nervous system (CNS) drugs, gastrointestinals and antiinfectives. The most common categories of off-label use were age (34.4 %) and dosing frequency (20.6 %). Compared to ISN practical guide, prescriptions adhered more frequently to indications (100 % for ampicillin/sulbactam, >80 % for ampicillin, fluconazole, fentanyl, ranitidine and vancomicin). Conclusions: Our results confirm the high prevalence of off-label/unlicensed drug use in the neonatal population and underline a better adherence to indications based on clinical practice, suggesting the need to update information contained in the data sheets of medicines. [ABSTRACT FROM AUTHOR]

Objectives We aimed to describe administration of eight potentially harmful excipients of interest (EOI)-- parabens, polysorbate 80, propylene glycol, benzoates, saccharin sodium, sorbitol, ethanol and benzalkonium chloride--to hospitalised neonates in Europe and to identify risk factors for exposure. Methods All medicines administered to neonates during 1 day with individual prescription and demographic data were registered in a web-based point prevalence study. Excipients were identified from the Summaries of Product Characteristics. Determinants of EOI administration (geographical region, gestational age (GA), active pharmaceutical ingredient, unit level and hospital teaching status) were identified using multivariable logistical regression analysis. Results Overall 89 neonatal units from 21 countries participated. Altogether 2095 prescriptions for 530 products administered to 726 neonates were recorded. EOI were found in 638 (31%) prescriptions and were administered to 456 (63%) neonates through a relatively small number of products (n=142; 27%). Parabens, found in 71 (13%) products administered to 313 (43%) neonates, were used most frequently. EOI administration varied by geographical region, GA and route of administration. Geographical region remained a significant determinant of the use of parabens, polysorbate 80, propylene glycol and saccharin sodium after adjustment for the potential covariates including anatomical therapeutic chemical class of the active ingredient. Conclusions European neonates receive a number of potentially harmful pharmaceutical excipients. Regional differences in EOI administration suggest that EOI-free products are available and provide the potential for substitution to avoid side effects of some excipients. [ABSTRACT FROM AUTHOR]

Objectives: To explore differences in approaches to supporting lactation and breastfeeding for very preterm infants in neonatal intensive care units (NICU) in 3 European regions. Design: Qualitative cross-sectional study carried out by means of face-to-face semistructured interviews. Verbatim transcripts were coded using a theoretical framework derived from the literature and supplemented by data-driven concepts and codes. Setting: 4 purposively selected NICUs in each of 3 European regions in 2010 (Ile-de-France in France, Lazio in Italy, and the former Trent region in the UK). Participants: NICU staff members (n=22). Results: Policies and practices for managing mother's own milk for very preterm babies differed between regions, and were much more complex in Ile-de-France than in the Trent or Lazio regions. Staff approaches to mothers to initiate lactation differed by region, with an emphasis on the nutritional and immunological value of human milk in the Trent region and on the 'normalising' effect of breastfeeding on the mother-child relationship in Lazio. French and English staff expressed conflicting opinions about the use of bottles, which was routine in Italy. Italian informants stressed the importance of early maternal milk expression and feeding, but also mentioned discharging infants home before feeding at the breast was established. In Ile-de-France and Trent, successful feeding from the breast was achieved before discharge, although this was seen as a factor that could prolong hospitalisation and discourage continued breastfeeding for some women. Conclusions: Targeted health promotion policies in the NICU are necessary to increase the number of infants receiving their mother's milk and to support mothers with transfer of the infant to the breast. Integrating knowledge about the different approaches to lactation and breastfeeding in European NICUs could improve the relevance of recommendations in multiple cultural settings. [ABSTRACT FROM AUTHOR]

Background: Antibiotic dosing in neonates varies between countries and centres, suggesting suboptimal exposures for some neonates. We aimed to describe variations and factors influencing the variability in the dosing of frequently used antibiotics in European NICUs to help define strategies for improvement. Methods: A sub-analysis of the European Study of Neonatal Exposure to Excipients point prevalence study was undertaken. Demographic data of neonates receiving any antibiotic on the study day within one of three two-week periods from January to June 2012, the dose, dosing interval and route of administration of each prescription were recorded. The British National Formulary for Children (BNFC) and Neofax were used as reference sources. Risk factors for deviations exceeding ±25% of the relevant BNFC dosage recommendation were identified by multivariate logistic regression analysis. Results: In 89 NICUs from 21 countries, 586 antibiotic prescriptions for 342 infants were reported. The twelve most frequently used antibiotics - gentamicin, penicillin G, ampicillin, vancomycin, amikacin, cefotaxime, ceftazidime, meropenem, amoxicillin, metronidazole, teicoplanin and flucloxacillin - covered 92% of systemic prescriptions. Glycopeptide class, GA <32 weeks, 5th minute Apgar score <5 and geographical region were associated with deviation from the BNFC dosage recommendation. While the doses of penicillins exceeded recommendations, antibiotics with safety concerns followed (gentamicin) or were dosed below (vancomycin) recommendations. Conclusions: The current lack of compliance with existing dosing recommendations for neonates needs to be overcome through the conduct of well-designed clinical trials with a limited number of antibiotics to define pharmacokinetics/pharmacodynamics, efficacy and safety in this population and by efficient dissemination of the results. [ABSTRACT FROM AUTHOR]

Extrauterine growth retardation (EUGR) seriously affects premature newborns and is related to the impairment of growth during childhood. There are very limited data available concerning the growth outcome of EUGR children. Our aim was to assess the growth outcome in a cohort of children born before 34 weeks of gestation with severe EUGR. This was a retrospective multicenter study, performed in outpatient endocrinology clinic. A total of 103 premature children with weight and/or length below −2 standard deviation score (SDS) of 'intrauterine' growth expectation at the time of discharge from hospital (within 42 weeks of postmenstrual age) were included in the study. The study participants underwent a thorough anthropometric assessment at a mean age of 3.9 years ± 1.7 SD. Of the EUGR children, 12.6 % showed a height below −2 SDS and 7.7 % even below −2.5 SDS. Growth impairment was more common in males than in females (17 vs. 8 %). The prevalence of subnormal weight (below −2 SDS) was 13.6 %, being higher in males than in females (17 vs. 10 %). BMI values below −2 SDS were found in 18.4 % of our study population (22.7 % in males and 12 % in females). The 19.6 % of EUGR children did not catch up in head circumference during early childhood. Length at term was the major predictor of height in childhood ( P < 0.001). Conclusion: A significant proportion of children born prematurely with severe EUGR show growth retardation in childhood thus suggesting the need for a close clinical follow-up to determine their growth potential and implement effective intervention strategies. [ABSTRACT FROM AUTHOR]

1H-NMR spectroscopy coupled with multivariate statistical analysis was used for the first time to compare the urinary NMR metabolic profiles of neonates with intrauterine growth retardation (IUGR) and large for gestational age (LGA). For the sake of comparison, infants who were adequate for gestational age (AGA) were also analyzed. Pattern recognition methods, including Principal Component Analyses (PCA), Partial Least Squares Discriminant Analysis (PLS-DA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA), were used to analyze NMR data. Clear differences among the metabolic profiles of AGA, IUGR and LGA were observed. The main metabolites responsible for these differentiations were identified as myo-inositol, creatinine, creatine, citrate, urea and glycine. In particular, among these, myo-inositol may be a potential biomarker of an altered glucose metabolism during fetal development both in IUGR and LGA. This study highlights the applicability of NMR-based metabolomics for improving the understanding of the relations among nutrition, integrated metabolism and health in neonatology. [ABSTRACT FROM AUTHOR]

Background: Estimates of prevalence are known to be affected by the design of cross-sectional studies. A pan-European study provided an opportunity to compare the effect of two cross-sectional study designs on estimates of medicines use. Methods: A Service evaluation survey (SES) and a web-based point-prevalence study (PPS) were conducted as part of a European study of neonatal exposure to excipients. Neonatal units from all European Union countries plus Iceland, Norway, Switzerland and Serbia were invited to participate. All medicines prescribed to neonates were recorded during three-day and one-day study periods in the SES and PPS, respectively. In the PPS individual demographic and prescription data were also collected. To compare the probabilities that a particular medicine would be reported by each study multilevel mixed effects logistic regression models with crossed random effects were applied. The relationship between medicines exposure at the unit and individual levels in the PPS data was assessed using polynomial regression with square root transformation. Results: Of 31 invited countries 20 and 21 with 115 and 89 units joined the SES and PPS, respectively. Out of 5,572,859 live births in invited countries in 2010 a higher proportion was covered by units participating in the SES compared to the PPS (11% vs 6%, respectively; OR 1.89; 95% CI 1.87-1.89). A greater number of active pharmaceutical ingredients (API), manufacturers and trade names were registered in the SES compared to the PPS. High correlation between the two studies in frequency of use for each specified API was seen (R2= 0.86). The average probability of a department to use a given API was greater in the SES compared to the PPS (OR 2.36; 95% CI 2.05-2.73) with higher frequency of use and longer average duration of prescription further increasing the difference. The polynomial regression model described the correlation between APIs exposure on unit and individual level well (R2= 0.93). Conclusion: The simple data structure and longer study period of the SES resulted in improved recruitment and higher likelihood of capture for a given API. The frequency of use at the unit level appears a good surrogate of individual exposure rates. [ABSTRACT FROM AUTHOR]

People who the author would like to thank for their assistance in the creation of the 2013 issue of the journal "BMC Medical Informatics and Decision Making" are mentioned.

Background: Respiratory support in very preterm infants is often a life-saving procedure and several techniques are available. There is lack of data on the current use of these techniques. Methods and aim: We analyzed a cohort of infants <30 weeks gestation or < 1501 g birth weight, enrolled in the Italian Neonatal Network in 2009 and 2010 ( n = 8297, mean gestation = 29.3 weeks, mean birth weight = 1089 g) to ascertain the use of several techniques. We also conducted a questionnaire survey of all neonatal units adhering to the Italian Neonatal Network, inquiring about preferred methods of respiratory support. Results: Conventional ventilation was used in 53% of these infants, high frequency ventilation in 15.8%, CPAP in 71.6%, and surfactant in 56.2%. Huge variations were observed between hospitals for all techniques studied. The survey of centres showed that all respondents considered non-invasive ventilation the first-intention treatment for these infants. In case of need of tracheal intubation and mechanical ventilation, two hospitals said they used IPPV/IMV; 20 synchronized IPPV/IMV; 25 'volume guarantee'; and 10 hospitals used HFV as a first intention treatment (in five hospital for all infants, and in other five hospitals, depending upon birth weight/gestation. Conclusions: This study provides large scale, up to date results of the current methods of respiratory support in very preterm infants in Italy. Huge variations between hospitals, only partly explained by the paucity of evidence-based data, are apparent. These differences point to the possibility of implementing 'potentially better practices' with the aim of reducing unwanted, physician-related variation. [ABSTRACT FROM AUTHOR]

Background: A considerable local variability in the rate of bronchopulmonary dysplasia (BPD) has been recorded previously. Objectives: The objectives of the present study were to describe regional differences in the rate of BPD in very preterm neonates from a European population-based cohort and to further delineate risk factors. Methods: 4,185 survivors to 36 weeks' postmenstrual age of 4,984 live-born infants born at 24+0-31+6 weeks' gestation in 2003 (the MOSAIC cohort) in 10 European regions were enrolled using predefined structured questionnaires. Results: Overall median gestational age of preterms without BPD was 30 weeks (range 23-31), median birth weight 1,320 g (range 490-3,150) compared with 27 weeks (23-31) and 900 g (370-2,460) in those with BPD. The region-specific crude rate of BPD ranged from 10.2% (Italian region) to 24.8% (UK Northern region). Maternal hypertension, immaturity, male gender, small for gestational age, Apgar <7 and region of care were associated with an increased incidence of BPD on multivariate analysis. Conclusion: A wide variability of BPD between European regions may be explained by different local practices; the strongest association however was with degree of immaturity. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Although synaptic plasticity in the human cerebral cortex is governed by metaplasticity, whether a similar mechanism operates at brainstem level is unknown. In this study in healthy humans we examined the effects and interactions induced by pairing supraorbital nerve high-frequency electrical stimulation (HFS) protocols on the R2 component of the trigeminal blink reflex [Mao, J.B. & Evinger, C (2001) J Neurosci., 21:RC151(1-4)]. Changes in the R2 component were tested by pairing three different priming stimulation protocols inducing long-term potentiation (LTP)-like or long-term depression (LTD)-like effects (LTP-HFS and LTD-HFS), or no change (CONTROL-HFS) with a subsequent test LTP-HFS. Additionally, to examine changes in the R2 component induced by nonspecific factors, two CONTROL-HFS sessions were paired. Priming LTP-, LTD- or CONTROL-HFS potentiated, inhibited or left unchanged the area of the R2 component. Regardless of the type of priming LTP-, LTD- or CONTROL-HFS, the test LTP-HFS induced negligible differences in the R2 component. When two CONTROL-HFS sessions were paired, the test CONTROL-HFS increased the latency and markedly reduced the duration and area of the R2 component. The analysis of the normalized data across the first three experimental sessions, corrected for the inhibitory effects found in the fourth experiment, showed that the test LTP-HFS potentiated the R2 component area of the trigeminal blink reflex only when preceded by a priming LTD-HFS. We propose that homosynaptic metaplasticity might operate in the brainstem circuitry of the blink reflex. [ABSTRACT FROM AUTHOR]

Theta-burst stimulation (TBS) is currently used for inducing long-lasting changes in primary motor cortex (M1) excitability. More information is needed on how M1 is involved in early motor learning (practice-related improvement in motor performance, motor retention and motor consolidation). We investigated whether inhibitory continuous TBS (cTBS) is an effective experimental approach for modulating early motor learning of a simple finger movement in healthy humans. In a short task, 11 subjects practised 160 movements, and in a longer task also testing motor consolidation ten subjects practised 600 movements. During both experiments subjects randomly received real or sham cTBS over the left M1. Motor evoked potentials were tested at baseline and 7 min after cTBS. In the 160-movement experiment to test motor retention, 20 movements were repeated 30 min after motor practice ended. In the 600-movement experiment motor retention was assessed 15 and 30 min after motor practice ended, motor consolidation was tested by performing 20 movements 24 h after motor practice ended. Kinematic variables – movement amplitude, peak velocity and peak acceleration – were measured. cTBS significantly reduced the practice-related improvement in motor performance of finger movements in the experiment involving 160 movements and in the first part of the experiment involving 600 movements. After cTBS, peak velocity and peak acceleration of the 20 movements testing motor retention decreased whereas those testing motor consolidation remained unchanged. cTBS over M1 degrades practice-related improvement in motor performance and motor retention, but not motor consolidation of a voluntary finger movement. [ABSTRACT FROM AUTHOR]

The ability of metabolomics to provide a snapshot of an individual's metabolic state makes it a very useful technique in neonatology for investigating the complex relationship between nutrition and the state of health of the newborn. Through an 1H-NMR metabolomics analysis, we aimed to investigate the metabolic profile of newborns by analyzing both urine and milk samples in relation to the birth weight of neonates classified as AGA (adequate for the gestational age, n = 51), IUGR (intrauterine growth restriction, n = 14), and LGA (large for gestational age, n = 15). Samples were collected at 7 ± 2 days after delivery. Of these infants, 42 were exclusively breastfed, while 38 received mixed feeding with a variable amount of commercial infant formula (less than 40%) in addition to breast milk. We observed a urinary spectral pattern for oligosaccharides very close to that of the corresponding mother's milk in the case of exclusively breastfed infants, thus mirroring the maternal phenotype. The absence of this good match between the infant urine and human milk spectra in the case of mixed-fed infants could be reasonably ascribed to the use of a variable amount of commercial infant formulas (under 40%) added to breast milk. Furthermore, our findings did not evidence any significant differences in the spectral profiles in terms of the neonatal customize centile, i.e., AGA (adequate for gestational age), LGA (large for gestational age), or IGUR (intrauterine growth restriction). It is reasonable to assume that maternal human milk oligosaccharide (HMO) production is not or is only minimally influenced by the fetal growth conditions for unknown reasons. This hypothesis may be supported by our metabolomics-based results, confirming once again the importance of this approach in the neonatal field. [ABSTRACT FROM AUTHOR]