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Abstract This study evaluates whether exchange traded funds (ETFs) threaten financial market stability by testing two hypotheses relating the growing importance of ETFs to increased market volatility and rising equity valuations. We estimate quantile cointegration models using Standard & Poor's 500 Index (S&P 500) and Chicago Board Options Exchange volatility Index (VIX) data for 1994–2020. We found that an increase in ETFs is positively and significantly related to the long-term valuation of the S&P 500 for quantile values above the median. By contrast, ETFs have only a negative and significant effect on the VIX for quantiles around the median. Ultimately, two novel results were obtained. First, the distortion in the value of the S&P 500 relative to its fundamentals is driven by investor flow into ETFs during a bull market. Second, the impact of equity ETFs on the VIX is only affected when fundamental factors are in play, decreasing it. Therefore, ETFs contribute to forming equity bubbles and support valuation market dynamics. Both regulators and policymakers should consider these conclusions.

Introduction In light of the burden of traumatic brain injury (TBI) in children and the excessive number of unnecessary CT scans still being performed, new strategies are needed to limit their use while minimising the risk of delayed diagnosis of intracranial lesions (ICLs). Identifying children at higher risk of poor outcomes would enable them to be better monitored. The use of the blood-based brain biomarkers glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1) could help clinicians in this decision. The overall aim of this study is to provide new knowledge regarding GFAP and UCH-L1 in order to improve TBI management in the paediatric population.Methods and analysis We will conduct a European, prospective, multicentre study, the BRAINI-2 paediatric study, in 20 centres in France, Spain and Switzerland with an inclusion period of 30 months for a total of 2880 children and adolescents included. To assess the performance of GFAP and UCH-L1 used separately and in combination to predict ICLs on CT scans (primary objective), 630 children less than 18 years of age with mild TBI, defined by a Glasgow Coma Scale score of 13–15 and with a CT scan will be recruited. To evaluate the potential of GFAP and UCH-L1 in predicting the prognosis after TBI (secondary objective), a further 1720 children with mild TBI but no CT scan as well as 130 children with moderate or severe TBI will be recruited. Finally, to establish age-specific reference values for GFAP and UCH-L1 (secondary objective), we will include 400 children and adolescents with no history of TBI.Ethics and dissemination This study has received ethics approval in all participating countries. Results from our study will be disseminated in international peer-reviewed journals. All procedures were developed in order to assure data protection and confidentiality.Trial registration number NCT05413499.

This article studies some algebraic structures known as twisted-skew group rings in the context of public key cryptography. We first present some background related to these structures to then specifically introduce particular twisted-skew group rings and show how to utilize them as the underlying algebraic structure to build cryptographic protocols. We closely follow an incremental-like methodology to construct these protocols by putting parts together. As as result, we first introduce a key-agreement protocol and then generalize it to a group key-agreement protocol. We then proceed to construct a probabilistic public key encryption from our two-party key agreement and, finally, introduce a key-encapsulation mechanism from a well-known generic construction applied to probabilistic public encryption. Furthermore, we provide an in-depth security analysis for each cryptographic construction under new related algebraic assumptions and supply a proof-of-concept implementation for various candidate chosen groups.

Nosocomial infections are a frequent and serious problem in extremely low birth weight (ELBW) infants. Donor human milk (DHM) is the best alternative for feeding these babies when mother’s own milk (MOM) is not available. Recently, a patented prototype of a High-Temperature Short-Time (HTST) pasteurizer adapted to a human milk bank setting showed a lesser impact on immunologic components. We designed a multicentre randomized controlled trial that investigates whether, in ELBW infants with an insufficient MOM supply, the administration of HTST pasteurized DHM reduces the incidence of confirmed catheter-associated sepsis compared to DHM pasteurized with the Holder method. From birth until 34 weeks postmenstrual age, patients included in the study received DHM, as a supplement, pasteurized by the Holder or HTST method. A total of 213 patients were randomized; 79 (HTST group) and 81 (Holder group) were included in the analysis. We found no difference in the frequency of nosocomial sepsis between the patients of the two methods—41.8% (33/79) of HTST group patients versus 45.7% (37/81) of Holder group patients, relative risk 0.91 (0.64–1.3), p = 0.62. In conclusion, when MOM is not available, supplementing during admission with DHM pasteurized by the HTST versus Holder method might not have an impact on the incidence of catheter-associated sepsis.

Immunoparesis (IP) in multiple myeloma (MM) patients can be measured by classic assessment of immunoglobulin (Ig) levels or by analysis of the uninvolved heavy/light chain pair of the same immunoglobulin (uHLC) by the Hevylite® assay. In this study we evaluate the prognostic value of recovery from IP measured by classic total Ig and uHLC assessment in newly diagnosed MM transplant-eligible (NDMM-TE) patients with intensive treatment and its association with minimal residual disease (MRD). Patients were enrolled and treated in the PETHEMA/GEM2012MENOS65 trial and continued in the PETHEMA /GEM2014MAIN trial. Total Ig (IgG, IgA and IgM) and uHLC were analyzed in a central laboratory at diagnosis, after consolidation treatment and after the first year of maintenance. MRD was analyzed by next-generation flow cytometry after consolidation (sensitivity level 2x10-6). We found no differences in progression-free survival (PFS) between patients who recovered and patients who didn’t recover from IP after consolidation when examining classic total Ig and uHLC. However, after the first year of maintenance, in contrast to patients with classic IP, patients with recovery from uHLC IP had longer PFS than patients without recovery, with hazard ratio of 0.42 (95% confidence interval [CI]: 0.21-0.81; P=0.008). Multivariate analysis with Cox proportional-hazards regression models confirmed recovery from uHLC IP after the first year of maintenance as an independent prognostic factor for PFS, with an increase in C-statistic of 0.05 (95% CI: -0.04 to 0.14; P

The objective of this study was to evaluate the application of hot water treatment to tomato fruits (Solanum lycopersicum cv. TA234) genetically modified with silencing of the TomloxB gene. Unmodified and genetically modified tomato fruits were immersed in water at 40°C for 10, 20 and 30 seconds. Subsequently, fruits were stored at 25°C for 18 days. Physiology was assessed and electrolyte leakage, lipoxygenase and polygalacturonase activities were monitored. Treatment applied to the genetically modified tomatoes at 40°C for 30 seconds, resulted in slower ripening, decreased metabolic activity and maintained the attributes in optimal conditions for longer time, increased the postharvest life of the genetically modified tomatoes until 18 days. Lipoxygenase and polygalacturonase activities were partially inhibited.

Introduction Two blood brain-derived biomarkers, glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), can rule out intracranial lesions in patients with mild traumatic brain injury (mTBI) when assessed within the first 12 hours. Most elderly patients were excluded from previous studies due to comorbidities. Biomarker use in elderly population could be affected by increased basal levels. This study will assess the performance of an automated test for measuring serum GFAP and UCH-L1 in elderly patients to predict the absence of intracranial lesions on head CT scans after mTBI, and determine both biomarkers reference values in a non-TBI elderly population.Methods and analysis This is a prospective multicentre observational study on elderly patients (≥65 years) that will be performed in Spain, France and Germany. Two patient groups will be included in two independent substudies. (1) A cohort of 2370 elderly patients (1185

Objective: To identify the use of social media as an influencing factor of the orthodontic patient’s preferences regarding the lip profile protrusion. Methods: A two-part cross-sectional questionnaire was distributed to orthodontic patients in Spain and The Netherlands. The first part collected general data and frequency of use of different social media. The second part consisted of a series of modified female and male silhouettes presenting different lip profile positions. Each participant was required to choose both the (male and female) most attractive silhouette and the least attractive one.Student t-test, one-way ANOVA and Chi-square test were performed. Effect sizes were calculated to express the magnitude of differences between samples. Results: The Spanish sample resulted in a moderate higher tendency (R2 = 0.060) to choose protrusive lips as the most attractive lip profile for females, on subjects with more frequent use of social media. A medium tendency (R2=0,26) was observed as result of low users of social media choosing and ideal lip profile for men.The Dutch sample showed that high users of social media tended to choose as attractive a more protrusive female lip profile versus low users (p

Introduction Digital technologies can be used as part of paediatric motor rehabilitation to remediate impairment, promote recovery and improve function. However, the uptake of digital technologies in this clinical field may be limited.The aim of this study is to describe and explain digital technology use for paediatric motor rehabilitation. The specific objectives will be: (1) to describe the access to, acceptance of and use of digital technologies as a function of individual factors related to professionals practicing motor rehabilitation with children, and of environmental factors related to paediatric rehabilitation practice and (2) to explain digital technology use with a causal model based on the ‘unified theory of acceptance and use of technology’.Methods and analysis RehaTech4child (Rehabilitation Technologies For children) is a cross-sectional study involving an online survey, that is sponsored by the European Academy of Childhood Disability (EACD). The survey protocol follows the Strengthening the Reporting of Observational Studies in Epidemiology and CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines. The survey includes 43 questions about (1) respondents’ individual and environmental characteristics; (2) the ease of access to digital technologies, and the frequency, type and purpose of use of those technologies and (3) acceptance of technologies and barriers to their use. The survey is intended for professionals involved in paediatric motor rehabilitation. It is disseminated across Europe by the EACD network in 20 languages. Participation is anonymous and voluntary. We aim to include 500 respondents to ensure sufficient precision for the description of study outcomes and to perform stratified analyses by the main determinants.Ethics and dissemination Ethics approval was waived by the Brest CHRU Institutional Review Board. The study is conducted according to current French legislation (loi Jardé (n°2012-300)) and the survey is GDPR compliant. Study findings will be presented at national and international meetings and submitted for publication in a peer-reviewed journal.Trial registration number NCT05176522.

Abstract Background This study evaluates the particle dispersion involved in dental procedures carried out during orthodontic treatments. Variants such as temperature and relative humidity in the dental cabinet were considered. Methods Using a particle counter, a pilot study was conducted, in which 98 consecutive recordings were made during appointments of patients undergoing orthodontic treatments. Temperature, relative humidity and particles present at the beginning (AR) and during the appointment (BR) were recorded. A control record (CR) of temperature, relative humidity and particles present was made before the start of the clinical activity. In addition to conventional statistics, differential descriptive procedures were used to analyse results, and the influence of relative humidity on particle concentration was analysed by statistical modelling with regression equations. Results The number of particles present, regardless of their size, was much higher in AR than in CR (p

In this paper we define and study rank metric codes endowed with a Hermitian form. We analyze the duality for $\mathbb {F}_{q^{2}}$ -linear matrix codes in the ambient space $(\mathbb {F}_{q^{2}})_{n,m}$ and for both $\mathbb {F}_{q^{2}}$ -additive codes and $\mathbb {F}_{q^{2m}}$ -linear codes in the ambient space $\mathbb {F}_{q^{2m}}^{n}$ . Similarly, as in the Euclidean case we establish a relationship between the duality of these families of codes. For this we introduce the concept of $q^{m}$ -duality between bases of $\mathbb {F}_{q^{2m}}$ over $\mathbb {F}_{q^{2}}$ and prove that a $q^{m}$ -self dual basis exists if and only if $m$ is an odd integer. We obtain connections on the dual codes in $\mathbb {F}_{q^{2m}}^{n}$ and $(\mathbb {F}_{q^{2}})_{n,m}$ with the corresponding inner products. In particular, we study Hermitian linear complementary dual, Hermitian self-dual and Hermitian self-orthogonal codes in $\mathbb {F}_{q^{2m}}^{n}$ and $(\mathbb {F}_{q^{2}})_{n,m}$ . Furthermore, we present connections between Hermitian $\mathbb {F}_{q^{2}}$ -additive codes and Euclidean $\mathbb {F}_{q^{2}}$ -additive codes in $\mathbb {F}_{q^{2m}}^{n}$ .

Antibiotic burden is a critical issue in neonatal intensive care units (NICU) and antibiotic use is considered a quality indicator of neonatal care. Our aim was to optimize antibiotic use through a quality improvement (QI) initiative that included revision of departmental protocols and implementation of a surveillance system based on process indicators.MethodsThis is descriptive study of a cohort of all very low birth weight (VLBW) infants admitted to the NICU from 2014 to 2019. A series of QI interventions were made during the study period and included departmental protocols and the implementation of a surveillance system based on process indicators. The primary outcome was the percentage of VLBW infants who had received early antibiotics (ampicillin, gentamicin, or cefotaxime on the day of birth or day 1 or 2 after birth), antibiotics for longer than 3 days (despite negative blood culture), or no antibiotics.ResultsDuring the study period, a significant relative reduction was seen in the proportion of VLBW infants administered early antibiotics (46%; p < 0.01) and in infants provided antibiotics for longer than 3 days (90%; p < 0.01). Additionally, the percentage of VLBW with “no antibiotics” during their NICU stay increased fivefold (6 to 30%; p < 0.001).ConclusionsIn our NICU, the implementation of a QI initiative that is based on affordable methods to track process indicators and evaluate the results led into a significant reduction in antibiotic exposure in VLBW infants. This approach is easy to implement in other NICUs as well.

BackgroundDuring early skin-to-skin contact (ESSC), alterations in peripheral oxygen saturation (SpO2) and heart rate (HR) have been frequently observed.ObjectivesThis study aimed to determine the incidence of cardiorespiratory events (CREs) during ESSC in healthy term newborns (HTNs) and estimate the association of maternal and neonatal prognostic factors with the risk of CREs.MethodsA pooled analysis of the cohort from a clinical trial involving healthy mother–child dyads during ESSC was performed. Pulse oximetry was employed to continuously monitor SpO2 and HR within 2 h after birth. The individual and combined prognostic relevance of the demographic and clinical characteristics of dyads for the occurrence of a CRE (SpO2 180 bpm) was analyzed through logistic regression models.ResultsOf the 254 children assessed, 169 [66.5%; 95% confidence interval (95% CI), 60.5–72.5%] had at least one CRE. The characteristics that increased the risk of CRE were maternal age ≥35 years (odds ratio, 2.21; 95% CI, 1.19–4.09), primiparity (1.96; 1.03–3.72), gestational body mass index (BMI) >25 kg/m2 (1.92; 1.05–3.53), and birth time between 09:00 p.m. and 08:59 a.m. (2.47; 1.02–5.97).ConclusionCREs were more frequent in HTNs born during nighttime and in HTNs born to first-time mothers, mothers ≥35 years, and mothers with a gestational BMI >25 kg/m2. These predictor variables can be determined during childbirth. Identification of neonates at higher risk of developing CREs would allow for closer surveillance during ESSC.

Abstract Background Patients with cancer have been shown to have a higher risk of clinical severity and mortality compared to non-cancer patients with COVID-19. Patients with hematologic malignancies typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections than patients with solid tumors. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterize disease severity and mortality and evaluate potential prognostic factors for mortality. Methods In this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult patients with hematologic malignancies and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centers between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age, sex, comorbidities, hematologic malignancy and recent active cancer therapy. Results Of 833 patients reported, 697 were included in the analyses. Median age was 72 years (IQR 60–79), 413 (60%) patients were male and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age ≥ 60 years (hazard ratios 3.17–10.1 vs 2 comorbidities (1.41 vs ≤ 2), acute myeloid leukemia (2.22 vs non-Hodgkin lymphoma) and active antineoplastic treatment with monoclonal antibodies (2·02) were associated with increased mortality; conventional chemotherapy showed borderline significance (1.50 vs no active therapy). Conversely, Ph-negative myeloproliferative neoplasms (0.33) and active treatment with hypomethylating agents (0.47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20). Conclusions In this series of patients with hematologic malignancies and COVID-19, mortality was associated with higher age, more comorbidities, type of hematological malignancy and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk stratification.

Abstract Background Assessment of interobserver reproducibility and interocular symmetry using optical coherence tomography (OCT)–based measurements of the macular ganglion cell complex (GCC) in healthy children facilitates interpretation of OCT data. We assessed the interobserver reproducibility and interocular symmetry of GCC and evaluated candidate determinants. Methods This was a cross-sectional study performed in a primary and tertiary health-care setting. A total of 126 healthy participants aged 5 to 18 years were eligible. GCC scans were performed by 4 operators using the Topcon 3D OCT-2000 device. Intraclass correlation coefficients (ICCs) were used to estimate reproducibility and symmetry. Cut-off points for symmetry were defined as the 95th percentile of the absolute interocular difference for 6 GCC parameters. Percentile distributions of interocular difference were generated based on age and difference in absolute interocular spherical equivalent (SE). Results The reproducibility ICC ranged from 0.96 to 0.98 for all 6 GCC parameters. Cut-off points for interocular symmetry of the superior and inferior quadrants and total macular retinal nerve fibre layer thickness (mRNFL) and macular ganglion cell layer-inner plexiform layer thickness were 3.5, 4.5, 3.0, 3.0, 2.5, and 2.5 μm respectively. A positive association was observed between the absolute interocular difference of SE and superior and total mRNFL symmetry values (p = 0.047 and p = 0.040, respectively). Conclusions OCT measurements of GCC in healthy children show excellent reproducibility. Interocular differences in SE should be assessed when mRNFL differences exceed the 95% cut-off. These findings can contribute to establish reference values for interocular symmetry in paediatric GCC parameters.

Research background. TomloxB is the main isoform of lipoxygenase associated with ripening and senescence of fruits. On the other hand, ethylene, a gaseous hormone, is essential for the regulation of ripening in climacteric fruits like tomatoes. However, the relationship between TomloxB and ethylene production has not been thoroughly studied. Therefore, we aim to assess the effect of exogenous ethylene in transgenic tomatoes that contain a silenced TomloxB gene, and subsequently evaluate lipoxygenase activity, 1-aminocyclopropane-1-carboxylic acid oxidase and ethylene production; as well as to quantify the expression of the genes encoding 1-aminocyclopropane-1-carboxylic acid oxidase and TomloxB. Experimental approach. To investigate the effect of lipoxygenase and 1-aminocyclopropane-1-carboxylic acid oxidase activity, fruits harvested at the stages of break, turning and pink were used. Tomatoes at break stage collected from transgenic and wild type plants were used to determine ethylene production and gene expression. Genetically modified and wild type tomato fruits were exposed to 100 μL/L exogenous ethylene. Lipoxygenase activity was measured spectrophotometrically. Activity of 1-aminocyclopropane-1-carboxylic acid oxidase and ethylene production were determined by gas chromatography. Oligonucleotides for differentially expressed genes: 1-aminocyclopropane-1-carboxylic acid oxidase and TomloxB were used to determine gene expression by real-time PCR. Results and conclusions. The data showed that silencing of TomloxB caused a reduction in lipoxygenase activity and ethylene production in tomato fruits, and also reduced 1-aminocyclopropane-1-carboxylic acid oxidase activity. Hence, the addition of exogenous ethylene increased lipoxygenase activity in all treatments and 1-aminocyclopropane-1-carboxylic acid oxidase activity only in transgenic lines at break stage, consequently there was a positive regulation between TomloxB and ethylene, as increasing the amount of ethylene increased the activity of lipoxygenase. The results suggest that lipoxygenase may be a regulator of 1-aminocyclopropane-1-carboxylic acid oxidase and production of ethylene at break stage. Novelty and scientific contribution. These results lead to a better understanding of the metabolic contribution of TomloxB in fruit ripening and how it is linked to the senescence-related process, which can lead to a longer shelf life of fruits. Understanding this relationship between lipoxygenase and ethylene can be useful for better post-harvest handling of tomatoes.

Actuator Fault Estimation (FE) and Fault Tolerant Control (FTC) strategies designed with model-based observers for Vertical Take-Off and Landing (VTOL) aerial vehicles are proposed and validated experimentally in this paper. Three observers are considered for FE: a nonlinear adaptive observer and a linear Proportional-Integral Observer (PIO) applied to a Planar VTOL and a quasi-Linear Parameter Varying (qLPV) PIO applied to a quadcopter vehicle. The fault detection is done by comparing the fault estimation signal with a predefined threshold. Fault isolation is achieved by analyzing the sign of the fault estimation signal. The Available Control Authority Index (ACAI) method is used to analyze the controllability properties of the vehicles under actuator faults. The main contribution of this work is the design and the experimental validation of complete active FTC schemes by using the proposed FE systems in order to accommodate a soft actuator fault and reconfigure an aggressive fault, even when the vehicle is flying in a non-hover position. Finally, the proposed FTC schemes are validated in different cases of flight tests for illustrating the effectiveness of the strategies.

Background and AimsThe provision of coordinated and multidisciplinary rehabilitation programs that adapt to the individual with cerebral palsy (CP) evolving rehabilitation needs throughout the different phases of life is highly challenging for healthcare systems. The aim of this study was to report the changes in motor rehabilitation (MR) environmental factors, service use and patient outcomes between children and adults with cerebral palsy and to identify if changes took place earlier or later than the standard division between pediatric and adult healthcare systems at 18 years.MethodsWe used data from the French ESPaCe survey to select a set of indicators for MR environmental factors, service use and patient outcomes, highlighted by patients and families in previous studies. We then compared the distribution of the indicator data between children and adults, as well as between four transition age groups: children under 12, adolescents up to 17 years, young adults, and adults over 25 years of age. We estimated odds ratios adjusted for motor involvement, associated impairments and informant type.ResultsA total of 997 respondents over 2 years of age were included in this study (484 children and 513 adults). Finding an available physiotherapist was very difficult for almost half of the children, and a greater proportion of adolescents and adults. Physiotherapy was provided in a private outpatient practice for twice as many adults over 25 years as children and adolescents. The weekly amount of physical therapy decreased as outpatient practice increased. Multidisciplinary rehabilitation decreased sharply from adolescence and was halved at adulthood. Satisfaction with the MR program decreased from childhood into adolescence and adulthood. Perceived impact of physiotherapy on people with CP and their main carers were less positive in adolescents.ConclusionsHealthcare policies should focus on accessibility issues at all ages, consider adolescents as a specific population, consider a wide transition phase (12–25 yo) and maintain a multidisciplinary approach at adulthood. There is a strong need for national rehabilitation strategies for individuals with CP.

Introduction: Heart transplant (HT) survival has barely improved in the last decades, which is unsatisfactory for many HT recipients. The development of anti-human leukocyte antigen (anti-HLA) antibodies in HT patients is associated with a cardiac allograft dysfunction. The mechanisms leading to this damage are unclear. The Multimodality Evaluation Of Antibody-Mediated Injury In Heart Transplantation (LEONE-HT) study aimed to thoroughly describe the damage inflicted on the myocardium by anti-HLA antibodies. Methods and analysis: The LEONE-HT study is a cohort study with a cross-sectional approach in which HT patients with positive anti-HLA antibodies are compared with coetaneous HT patients with negative anti-HLA antibodies. All patients will undergo a state-of-the-art multimodal assessment, including imaging techniques, coronary anatomy and physiology evaluations and histological and immunological analyses. The individual and combined primary outcomes of structural graft injuries and longitudinal secondary outcomes are to be compared between the exposed and non-exposed groups with univariate and multivariable descriptive analyses. Ethics and dissemination: The LEONE-HT study is carried out in accordance with the principles set out in the Declaration of Helsinki and the International Conference on Harmonization guidelines for good clinical practice and following national laws and regulations. The study design, objectives and participant centers have been communicated to clinicaltrials.gov (NCT05184426). The LEONE-HT study counts on the support of patient associations to disseminate the objectives and results of the research. This study was funded by the Spanish Ministry of Science and Innovation and the Spanish Society of Cardiology.

This paper introduces skew dihedral group rings and their applications for public-key cryptography. We present a specific skew group ring that is the underlying algebraic platform for our cryptographic constructions. We then build a two-party key exchange protocol and present an analysis of its security. We then exploit it to derive a group key agreement protocol, a probabilistic public-key scheme, and a key encapsulation mechanism. In addition to the security analysis of our cryptographic constructions, we present a proof-of-concept implementation.

Abstract Background Early mother–child skin-to-skin contact (SSC) in the first 2 h postpartum is highly beneficial for both mother and child. However, cases have been reported of newborns who have experienced apparently life-threatening events (ALTEs) or sudden death during this procedure. The causes of these events are unknown. Newborn’s prone position could influence the onset of these events but there is very little evidence to support any recommendation. We hypothesize that newborns’ breathing obstruction episodes increase as mothers lie more horizontally. The main objective of this study is to compare the occurrence of desaturation and bradycardia episodes as a function of mother’s bed incline. The study is designed as a randomized, controlled, assessor blind, multicenter, superiority trial with two parallel groups and 1:1 allocation ratio. Methods The study participants will be full-term healthy mother–newborn dyads from ten hospitals in Spain. Participants will be randomly assigned to one of two study arms defined by mother’s bed inclination (45° or 15°). The planned sample size is 5866. Centralized permuted blocks randomization and assessor blinding will be implemented. The newborns will be monitored remotely with pulse oximetry, from 10 min to 2 h after delivery. We established SO2 and heart rate (HR) limit alarms, as well as an action protocol in the event of alarm activation. The primary outcome is the number of healthy newborns who undergo episodes of SO2 ≤ 90%. Secondary outcomes are the mean SO2 level, the number of newborns who experience episodes of SO2 ≤ 85%, the time to SSC discontinuation due to abnormal SO2 or HR, and episodes of HR 180 bpm. Subgroups and pooled analysis will be performed to identify if breast-feeding and mother and child positions favor the occurrence of desaturation or bradycardia episodes. Discussion A simple intervention such as modifying mother’s bed angle of inclination while in SSC with her child during the first 2 h postpartum could favor newborn’s hemodynamic and respiratory stabilization and thus contribute to reducing the onset of ALTEs. Trial registration ClinicalTrials.gov, NCT02585492. Registered on 22nd October 2015. Protocol version 2 (30th June 2015).

Today, there are new technologies to produce bioethanol: one of them is the Pressure Swing Adsorption (PSA) process. This process has displaced other separation technologies due to the use of natural adsorbents and its methodology to obtain high purities with a lower energy cost. The aim of this work focuses on the optimization of the PSA process (experimental case) to obtain a higher recovery and production of bioethanol using lower energy consumption. The results are favorable since the energy cost is reduced to a range of 60% and 62%, obtaining purities above 99% wt of ethanol and recovery between 75% and 77.41%. The bioethanol produced and purified in the different scenarios meets international standards to be used as a fuel or oxygenating additive.

Background: Cerebral palsy (CP) is a disorder of movement and posture and every child with CP has a unique composition of neurological symptoms, motor severity, and associated impairments, constituting the functional profile. Although not part of the CP definition, magnetic resonance imaging (MRI) sheds light on the localization, nature, and severity of brain compromise. The MRI classification system (MRICS), developed by the Surveillance of Cerebral Palsy in Europe (SCPE), describes typical MRI patterns associated with specific timing of vulnerability in different areas of the brain. The classification has proven to be reliable and easy to use.Aims: The aim of this study is to apply the MRICS on a large dataset and describe the functional profile associated with the different MRI patterns of the MRICS.Materials and Methods: Data on children with CP born in 1999–2009 with a post-neonatal MRI from 20 European registers in the JRC-SCPE Central Registry was included. The CP classification and the MRICS was applied, and The Gross Motor Function Classification (GMFCS) and the Bimanual Fine Motor Function (BFMF) classification were used. The following associated impairments were documented: intellectual impairment, active epilepsy, visual impairment, and hearing impairment. An impairment index was used to characterize severity of impairment load.Results: The study included 3,818 children with post-neonatal MRI. Distribution of CP type, motor, and associated impairments differed by neuroimaging patterns. Functional profiles associated with neuroimaging patterns were described, and the impairment index showed that bilateral findings were associated with a more severe outcome both regarding motor impairment and associated impairments than unilateral compromise. The results from this study, particularly the differences in functional severity regarding uni- and bilateral brain compromise, may support counseling and service planning of support of children with CP.

Introduction Mild traumatic brain injury (mTBI) is a common cause of clinical consultation in the emergency department. Patients with mTBI may undergo brain CT scans based on clinical criteria. However, the proportion of patients with brain lesions on CT is very low. Two serum biomarkers, glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), have been shown to discriminate patients regarding the presence or absence of brain lesions on initial CT scan when assessed within the first 12 hours after TBI. However, the current technique for measuring serum concentrations of GFAP and UCH-L1 is manual and time consuming, which may hinder its use in routine clinical practice. This study assesses the diagnostic accuracy of an automated assay for the measurement of serum GFAP and UCH-L1 in a cohort of patients with mTBI who received a CT scan as the standard of care.Methods and analysis This is a prospective multicentre observational study of 1760 patients with mTBI recruited in France and Spain across 16 participating sites. Adult patients with an initial Glasgow Coma Scale score of 13–15 and a brain CT scan underwent blood sampling within 12 hours after TBI. The primary outcome measure is the diagnostic performance of an automated assay measuring serum concentrations of GFAP and UCH-L1 for discriminating between patients with positive and negative findings on brain CT-scans. Secondary outcome measures include the performance of these two biomarkers in predicting the neurological status and quality of life at 1 week and 3 months after the trauma.Ethics and dissemination Ethics approval was obtained by the Institutional Review Board of Sud-Ouest Outre Mer III in France (Re#2019-A01525-52) and Hospital 12 de Octubre in Spain (Re#19/322). The results will be presented at scientific meetings and published in peer-reviewed publications.Trial registration number ClinicalTrials.gov: NCT04032509.

Small wind turbines (SWTs) have been a common option for rural electrification during recent decades. Recently, an application for connecting these devices to the grid was proposed. This requires an AC-coupled configuration, which brings the need for a power converter necessary for connection to the AC bus. This publication analyzes the requirements and commercial availability of such power converters, coming first to a conclusion on the lack of existing electronic power converters for SWTs, mainly in the lowest power range (

Aim: This study aimed to compare the esthetic perceptionof profile silhouette of pictures of class II patients before andafter treatment (extractions or mandibular advancement),according to a visual analog scale (VAS) among orthodontists,general dentists and lay people. Methods: A presentation of 18class II adult patients silhouette was shown to three groups ofparticipants (25 orthodontists, 25 general dentists, and 25 laypeople) in two phases in an cross-sectional survey study. An initialpresentation pre-treatment and a second one post-treatment,one month later. The presentation consisted of nine pictures offour extractions orthodontic cases (two maxillary premolars andtwo mandibular premolars): five males, four females, and othernine pictures with a dentoalveolar mandibular advance (Forsus®and/or class II elastics): four males, five females. To comparepre and post-treatment scores, an ANOVA test was performed.Independent variables studied were: sex, age, and previousor present orthodontic treatment of participants. Results:A total of 75 of evaluators scored 18 patient profiles beforeand after treatment. In the three groups, the post treatmentsilhouette scored significantly higher. Advancement treatmentscored significantly higher than extractions, especially amonglay people. Orthodontist gave the lowers score regardless oftreatment. No differences were found between male and femalescoring (p>0.05). The participants between 30-39 years old gavehigher scores than other age groups(p

Nowadays, the global energy system is in a transition phase, in which the integration of renewable energy is among the main requirements for attenuating climate change. Wind power is a major alternative to supply clean energy; hence, its widespread penetration is being pursued in all end-use sectors. In particular, it is currently noteworthy to analyze the feasibility of deploying small-scale wind power technology to provide cleaner and cheaper energy in the residential sector. As a first step, a technical assessment must be carried out to provide crucial information to intensive energy consumers, providers of small-scale wind power technology, electric energy distribution utilities, and any other party, to help them decide whether or not to deploy small-scale wind turbines. With this aim, we propose to perform such an analysis using a suitable probabilistic paradigm to solve complex decision-making problems with uncertainty, namely Bayesian Intelligence, since wind resources and energy demands are intermittent variables, properly characterized by probability distribution functions. Then, the problem of determining the technical feasibility can be formulated as an investigation into whether or not small-scale wind turbine technology can produce enough energy to cover the excess demand of intensive energy residential consumers to get off high-priced tariffs. For this purpose, we introduce a novel model based on probabilistic reasoning to assess the suitability of small-scale wind turbine technology to produce the said energy, taking into consideration the availability of wind resources and the energy pricing structure. To demonstrate the usefulness and performance of the proposed model, we consider a case study of deploying 5 and 10 kW wind turbines and analyze the feasibility of their implementation in Mexico, where the energy pricing structure and scattered wind resource availability pose difficult challenges.

The rise for innovation in the electrical industry is strongly driven by development of new materials. Features of new materials are changing design paradigms for engineers. In this paper, the electrical properties of films of cellulose nanocrystals were measured. It was found that humidity affects the dielectric strength on the cellulose nanocrystals (CNCs). The dielectric strength was similar to the value of the industrial dielectric paper. The addition of plasticizer improved the flexibility of the material but lowered the dielectric strength. The films of CNC had an ordered arrangement, as suggested by the iridescence shown by them. The humidity content of the films was measured by thermogravimetric analysis. The CNC film was used for assembling a capacitor and compared to a capacitor assembled with dielectric paper.

In this paper, all extremal Type I and Type III codes of length 60 with an automorphism of order 29 are classified up to equivalence. In both cases, it has been proven that there are three inequivalent codes. In addition, a new family of self-dual codes over non-binary fields is presented.

Objectives: The aim of this retrospective study was to evaluate the prevalence of hypodontia in a sample of dental patients, aged between seven and eleven years at University Alfonso X in Madrid (Spain). Materials and Methods: The number of hypodontia cases and the most affected teeth were evaluated in 2500 panoramic radiographs in a random sample of dental patients consisting of 1235 females and 1265 males. We divided them according to age, number of hypodontia resent in each patient (multiple or single), each side, each quadrant either in the upper jaw or in the mandible. The chi-square test (P 0.05). Conclusion: The percentage of total agenesis of 2500 patients studied was 3.48%.

Abstract Objective We performed a cohort study in seven hospitals in Spain to determine the clinical characteristics of incident patients with bladder cancer, the diagnostic process, and the conditions that might affect health care interval times. Results 314 patients with bladder cancer were included, 70.3 (Standard Deviation [SD] 11.2) years old and 85.0% male. Clinical stage was T1 in 45.9% of patients. The median interval time between first consultation and diagnosis was of 104.0 days (Inter quartile range [IQR]:112.0; range from 0 to 986), being shorter for those patients who attended a hospital for their first consultation. The median interval time between diagnosis and first treatment was of 0.0 days (IQR: 0.0; range from 0 to 366), being longer when the patient had a pathologic tumor stage ≥ T2a.

Given the imminent threats of climate change, it is urgent to boost the use of clean energy, being wind energy a potential candidate. Nowadays, deployment of wind turbines has become extremely important and long-term estimation of the produced power entails a challenge to achieve good prediction accuracy for site assessment, economic feasibility analysis, farm dispatch, and system operation. We present a method for long-term wind power forecasting using wind turbine properties, statistics, and genetic programming. First, due to the high degree of intermittency of wind speed, we characterize it with Weibull probability distributions and consider wind speed data of time intervals corresponding to prediction horizons of 30, 25, 20, 15 and 10 days ahead. Second, we perform the prediction of a wind speed distribution with genetic programming using the parameters of the Weibull distribution and other relevant meteorological variables. Third, the estimation of wind power is obtained by integrating the forecasted wind velocity distribution into the wind turbine power curve. To demonstrate the feasibility of the proposed method, we present a case study for a location in Mexico with low wind speeds. Estimation results are promising when compared against real data, as shown by MAE and MAPE forecasting metrics.

Lactobacillus reuteri and Bifidobacterium bifidum were inoculated (2.8·10^8 and 4.7·10^8 CFU/mL, respectively) into reconstituted whey containing sucrose and pectin in order to prepare a fermented probiotic product. Inoculation levels were: 0.5, 1 or 2 % for Lactobacillus reuteri and 0.5 or 1 % for Bifidobacterium bifidum. The treatment with the highest bacterial counts and sensory scores was selected and stored at 4 °C for 30 days. Microbial counts, changes in pH values, titratable acidity and both triangle test and sensory attributes were monitored on the stored product. The beverage fermented for approx. 11 h and prepared with 2 % Lactobacillus reuteri and 0.5 % Bifidobacterium bifidum met the probiotic criterion by maintaining both bacterial populations at counts greater than 10^6 CFU/mL for the whole storage period. Titratable acidity and pH values as well as sensory properties did not change appreciably during the first 14 days of storage. At the end of the storage period (30 days), slight acidification was detected, although the beverage still retained an acceptable flavour.