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Background: Early skin-to-skin contact (SSC) at birth has been shown to improve neonatal outcomes due to enhanced cardiorespiratory stability, thermoregulation and breastfeeding success., Local Problem: The practice of early SSC was virtually non-existent in our delivery room (DR)., Methods and Interventions: The study was conducted in a newly established tertiary care teaching hospital in Western Rajasthan, India. We aimed to improve the median duration of early SSC from 0 min to at least 60 min over 24 weeks in our DR. A quality improvement (QI) team was formed, and all inborn infants ≥35 weeks born vaginally from 9 March 2017 were included. Using the tools of point-of-care QI, we found the lack of standard operating procedure, lack of knowledge among nursing staff regarding early SSC, routine shifting of all infants to radiant warmer, the practice of prioritising birthweight documentation and vitamin K administration as the major hindrances to early SSC. Various change ideas were implemented and tested sequentially through multiple plan-do-study-act (PDSA) cycles to improve the duration of early SSC. Interventions included framing a written policy for SSC, sensitising the nursing staff and resident doctors, actively delaying the alternate priorities, making early SSC a shared responsibility among paediatricians, obstetricians, nursing staff and family members, and continuing SSC in the recovery area of the DR complex., Results: The duration of early SSC increased from 0 to 67 min without any additional resources. The practice of SSC got well established in the system as reflected by a sustained improvement of 63 min and 72 min, respectively, at the end of 2 months and 4 years after study completion., Conclusion: Using the QI approach, we established and sustained the practice of early SSC for more than 60 min in our unit by using system analysis and testing change ideas in sequential PDSA cycles., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Collateral arteries act as natural bypasses which reroute blood flow to ischemic regions and facilitate tissue regeneration. In an injured heart, neonatal artery endothelial cells orchestrate a systematic series of cellular events, which includes their outward migration, proliferation, and coalescence into fully functional collateral arteries. This process, called artery reassembly, aids complete cardiac regeneration in neonatal hearts but is absent in adults. The reason for this age-dependent disparity in artery cell response is completely unknown. In this study, we investigated if regenerative potential of coronary arteries is dictated by their ability to dedifferentiate., Methods: Single-cell RNA sequencing of coronary endothelial cells was performed to identify differences in molecular profiles of neonatal and adult endothelial cells in mice. Findings from this in silico analyses were confirmed with in vivo experiments using genetic lineage tracing, whole organ immunostaining, confocal imaging, and cardiac functional assays in mice., Results: Upon coronary occlusion, neonates showed a significant increase in actively cycling artery cells and expressed prominent dedifferentiation markers. Data from in silico pathway analyses and in vivo experiments suggested that upon myocardial infarction, cell cycle reentry of preexisting neonatal artery cells, the subsequent collateral artery formation, and recovery of cardiac function are dependent on arterial VegfR2 (vascular endothelial growth factor receptor-2). This subpopulation of dedifferentiated and proliferating artery cells was absent in nonregenerative postnatal day 7 or adult hearts., Conclusions: These data indicate that adult artery endothelial cells fail to drive collateral artery development due to their limited ability to dedifferentiate and proliferate., Competing Interests: Disclosures None.

In this work, we benchmark non-idealities and variations in the two-dimensional graphene sheet. We have simulated more than two hundred graphene-based devices structure. We have simulated distorted graphene sheets and have included random, inhomogeneous, asymmetric out-of-plane surface corrugation and in-plane deformation corrugation in the sheet through autocorrelation function in the non-equilibrium Green's function (NEGF) framework to introduce random distortion in flat graphene. These corrugation effects inevitably appear in the graphene sheet due to background substrate roughness or the passivation encapsulation material morphology in the transfer step. We have examined the variation in density of state, propagating density of transmission modes, electronic band structure, electronic density, and hole density in those device structures. We have observed that the surface corrugation increases the electronic and hole density distribution variation across the device and creates electron-hole charge puddles in the sheet. This redistribution of microscopic charge in the sheet is due to the lattice fields' quantum fluctuation and symmetry breaking. Furthermore, to understand the impact of scattered charge distribution on the sheet, we simulated various impurity effects within the NEGF framework. The study's objective is to numerically simulate and benchmark numerous device design morphology with different background materials compositions to elucidate the electrical property of the sheet device., (© 2022. The Author(s).)