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Introdução: A pandemia trouxe inúmeros desafios aos serviços de saúde e isso não foi diferente nos serviços de hemoterapia. O novo cenário exigiu constantes modificações nas rotinas de trabalho de acordo com o que se descobria a respeito da doença e seus impactos na transfusão de sangue. Novas estratégias de captação de doadores, manejo ainda mais criterioso dos estoques de hemocomponentes e adequação da infraestrutura às medidas sanitárias são alguns exemplos das adaptações que ocorreram. Concomitantemente ocorreu uma importante alteração do perfil de pacientes atendidos nos hospitais em geral com redução significativa de pacientes cirúrgicos e elevação do número de atendimentos clínicos, em especial em ambientes de terapia intensiva. Objetivo: Avaliar o volume de transfusões por tipo de hemocomponente antes e depois do início do cenário de pandemia de COVID-19 em uma instituição privada da região sul da cidade de São Paulo. Métodos: Foi realizado estudo descritivo e comparativo através de análise de dados obtidos no sistema informatizado de gerenciamento da agência transfusional. Foram incluídos os dados referentes às transfusões que ocorreram no período abril/2019 a março/2021 classificando-as de acordo com o tipo de hemocomponente diferenciando-se entre componentes eritrocitários, componentes plaquetários e componentes plasmáticos (plasma e crioprecipitado). Resultados: Nos 12 meses que antecederam o início da pandemia foram realizadas 5.613 transfusões, sendo 2.553 concentrados de hemácias (45%), 1.407 concentrados de plaquetas (25%), 1.453 plasmas frescos congelados (26%) e 200 crioprecipitados (4%). Já no período de abril/2020 a março/2021, foram realizadas 6.091 transfusões, sendo 2.599 concentrados de hemácias (43%), 2.614 concentrados de plaquetas (43%), 598 plasmas frescos congelados (10%) e 280 crioprecipitado (4%). Observou-se que no período houve um crescimento do número total de transfusões de 8% em relação ao período pré pandemia, além de uma alteração do perfil de consumo dos hemocomponentes, com expressivo crescimento absoluto e relativo do número de transfusões de componentes plaquetários (25% versus 43%). Conclusões: A pandemia alterou significativamente o perfil de paciente atendido nos hospitais de todo o mundo e isso não foi diferente no hospital estudado. Os pacientes com quadros graves de COVID-19 apresentavam frequentemente quadros de insuficiência respiratória hipoxêmica com necessidade de circulação extracorpórea com membrana de oxigenação (ECMO) além distúrbios de coagulação o que resultou no aumento do consumo de concentrados de plaquetas.

The use of mobile phones has been identified as a potential way to bring the benefits of educational technology to a wider audience, including in low-connectivity settings. This is a topic that has received renewed interest recently as a result of the COVID-19 pandemic and school closures. While a number of recent studies have demonstrated good potential for mobile phones and SMS to be used to support learning, there are also questions about how equitable this medium is in practice. We conducted a telephone survey with learners (n = 122) and their caregivers (n = 124) who use M-Shule, an SMS-based educational platform in Kenya, in order to understand their attitudes towards mobile learning, and the benefits and constraints. In particular, we consider whether there are differences in responses according to gender and/or location, to shed light on whether use is equitable. We find that girls and boys face similar barriers to use, and the technology is perceived to be equally beneficial. We identify some areas for potential further support for all learners through mobile learning.

Parental feeding practices are linked to child disordered eating. Less research has examined these associations in young adult children, particularly college-aged, and studies examining relationships between parent feeding practices and mental health concerns are also limited. Examining these relationships in college students is important because higher education represents a period of marked development and maintenance of maladaptive eating behaviors and mental health concerns. A cross-sectional study with the inclusion of 64 parent-child (i.e., young adult) dyads examined relationships between retrospective parental feeding practices and current disordered eating and mental health concerns in their young adult children. Higher retrospective parental structured feeding practices were associated with lower young adult current disordered eating and mental health concerns. Collegiate health-promotion programs may consider college students' early food environments, particularly structured food environments, as factors that may be associated with adaptive eating behaviors and better mental health outcomes.

Abstract The blood–brain barrier (BBB) presents a significant challenge for targeted drug delivery. A proposed method to improve drug delivery across the BBB is focused ultrasound (fUS), which delivers ultrasound waves to a targeted location in the brain and is hypothesized to open the BBB. Furthermore, stem cell-derived exosomes have been suggested as a possible anti-inflammatory molecule that may have neural benefits, if able to pass the BBB. In the present study, transcranial low-intensity focused ultrasound (LIFU), without the use of intravenous microbubbles, was assessed for both (1) its ability to influence the BBB, as well as (2) its ability to increase the localization of intravenously administered small molecules to a specific region in the brain. In vivo rat studies were conducted with a rodent-customized 2 MHz LIFU probe (peak pressure = 1.5 MPa), and injection of labeled stem cell-derived exosomes. The results suggested that LIFU (without microbubbles) did not appear to open the BBB after exposure times of 20, 40, or 60 min; instead, there appeared to be an increase in transcytosis of the dextran tracer. Furthermore, the imaging results of the exosome study showed an increase in exosome localization in the right hippocampus following 60 min of targeted LIFU.

Purpose: Retinopathy of prematurity (ROP) is one of the leading causes of blindness in children. Although the role of oxygen in the pathophysiology of ROP is well established, a precise understanding of the dynamic relationship between oxygen exposure ROP incidence and severity is lacking. The purpose of this study was to evaluate the correlation between time-dependent oxygen variables and the onset of ROP. Design: Retrospective cohort study. Participants: Two hundred thirty infants who were born at a single academic center and met the inclusion criteria were included. Infants are mainly born between January 2011 and October 2022. Methods: Patient data were extracted from electronic health records (EHRs), with sufficient time-dependent oxygen data. Clinical outcomes for ROP were recorded as none/mild or moderate/severe (defined as type II or worse). Mixed-effects linear models were used to compare the 2 groups in terms of dynamic oxygen variables, such as daily average and the coefficient of variation (COV) fraction of inspired oxygen (FiO2). Support vector machine (SVM) and long-short-term memory (LSTM)-based multimodal models were trained with fivefold cross-validation to predict which infants would develop moderate/severe ROP. Gestational age (GA), birth weight, and time-dependent oxygen variables were used to develop predictive models. Main Outcome Measures: Model cross-validation performance was evaluated by computing the mean area under the receiver operating characteristic (AUROC) curve, precision, recall, and F1 score. Results: We found that both daily average and COV of FiO2 were associated with more severe ROP (adjusted P

This review paper describes the energy-upgraded Continuous Electron Beam Accelerator Facility (CEBAF) accelerator. This superconducting linac has achieved 12 GeV beam energy by adding 11 new high-performance cryomodules containing 88 superconducting cavities that have operated cw at an average accelerating gradient of 20 MV/m. After reviewing the attributes and performance of the previous 6 GeV CEBAF accelerator, we discuss the upgraded CEBAF accelerator system in detail with particular attention paid to the new beam acceleration systems. In addition to doubling the acceleration in each linac, the upgrade included improving the beam recirculation magnets, adding more helium cooling capacity to allow the newly installed modules to run cold, adding a new experimental hall, and improving numerous other accelerator components. We review several of the techniques deployed to operate and analyze the accelerator performance and document system operating experience and performance. In the final portion of the document, we present much of the current planning regarding projects to improve accelerator performance and enhance operating margins, and our plans for ensuring CEBAF operates reliably into the future. For the benefit of potential users of CEBAF, the performance and quality measures for the beam delivered to each of the experimental halls are summarized in the Appendix.

This study investigated the racial/ethnic differences in COVID-19-related worry amongst family caregivers of adults with intellectual and developmental disabilities (IDD) living in Texas using the COVID-Related Thoughts and Behavioral Symptoms-Adult Version (COV-TaBS-A) questionnaire. Two hundred and six caregivers completed the survey. Compared to White caregivers, Latino caregivers were more likely to be very concerned about having enough food and supplies (adj OR 3.41, 95% CI [1.50, 7.74]) when adjusting for being that sole caregiver and using provider services. In free text questions, caregivers described feeling overwhelmed by additional responsibilities, disruptions in home health services, and concerns about their loved ones' wellness. Study findings can be used to strategize support for caregivers of adults with IDD during pandemic/emergency situations. [ABSTRACT FROM AUTHOR]

This study tested the feasibility and initial efficacy of a cognitive-behavioral summer treatment (summerMAX[superscript yc]) for high-functioning young children, ages 4-6 years, with ASD (HFASD; without intellectual disability). The treatment was conducted 5 days per week, 6 h per day, over 5 weeks in the summer and included skills instruction and therapeutic activities targeting social/social-communication skills, facial-emotion recognition, and interest expansion. Skills instruction sessions and therapeutic activities utilized direct instruction, modeling, role-play, performance feedback, and repeated practice. A behavioral system was also implemented to increase skills development and reduce ASD symptoms and disruptive behaviors, and parents participated in weekly parent training. Feasibility was supported in high levels of treatment fidelity and child, parent, and staff clinician satisfaction, and there was no attrition or adverse events/responses. Results of the primary outcome measure (coding of the children's social performance by naïve raters) indicated that 10 of the 12 children were treatment responders (d = 1.76). Significant post-treatment improvements were also found on secondary measures (parent and staff clinician ratings) of social/social-communication skills and ASD symptoms, as well as a range of adaptive behaviors (effect sizes in the medium and large ranges). Results supported the feasibility of the treatment and suggested that it may yield positive outcomes for 4-6 year olds with HFASD. Recommendations for ongoing testing are provided.

Purpose: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness related to oxygen exposure in premature infants. Since oxygen monitoring protocols have reduced the incidence of treatment-requiring ROP (TR-ROP), it remains unclear whether oxygen exposure remains a relevant risk factor for incident TR-ROP and aggressive ROP (A-ROP), a severe, rapidly progressing form of ROP. The purpose of this proof-of-concept study was to use electronic health record (EHR) data to evaluate early oxygen exposure as a predictive variable for developing TR-ROP and A-ROP. Design: Retrospective cohort study. Participants: Two hundred forty-four infants screened for ROP at a single academic center. Methods: For each infant, oxygen saturations and fraction of inspired oxygen (FiO2) were extracted manually from the EHR until 31 weeks postmenstrual age (PMA). Cumulative minimum, maximum, and mean oxygen saturation and FiO2 were calculated on a weekly basis. Random forest models were trained with 5-fold cross-validation using gestational age (GA) and cumulative minimum FiO2 at 30 weeks PMA to identify infants who developed TR-ROP. Secondary receiver operating characteristic (ROC) curve analysis of infants with or without A-ROP was performed without cross-validation because of small numbers. Main Outcome Measures: For each model, cross-validation performance for incident TR-ROP was assessed using area under the ROC curve (AUC) and area under the precision-recall curve (AUPRC) scores. For A-ROP, we calculated AUC and evaluated sensitivity and specificity at a high-sensitivity operating point. Results: Of the 244 infants included, 33 developed TR-ROP, of which 5 developed A-ROP. For incident TR-ROP, random forest models trained on GA plus cumulative minimum FiO2 (AUC = 0.93 ± 0.06; AUPRC = 0.76 ± 0.08) were not significantly better than models trained on GA alone (AUC = 0.92 ± 0.06 [P = 0.59]; AUPRC = 0.74 ± 0.12 [P = 0.32]). Models using oxygen alone showed an AUC of 0.80 ± 0.09. ROC analysis for A-ROP found an AUC of 0.92 (95% confidence interval, 0.87–0.96). Conclusions: Oxygen exposure can be extracted from the EHR and quantified as a risk factor for incident TR-ROP and A-ROP. Extracting quantifiable clinical features from the EHR may be useful for building risk models for multiple diseases and evaluating the complex relationships among oxygen exposure, ROP, and other sequelae of prematurity.