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The early abnormal pulmonary vasoreactivity observed in babies at risk of Bronchopulmonary dysplasia (BPD) increases the pulmonary vascular resistance. This can be assessed non-invasively using Time to Peak Velocity:Right Ventricular Ejection Time ratio (TPV:RVET) measured from pulmonary artery Doppler waveform obtained using echocardiogram. We postulate that screening for this early can predict BPD in this cohort. The objective of the study was to determine the utility of TPV:RVET in early prediction of BPD in Extremely Low Birth Weight (ELBW) babies born less than 1250grams Birth Weight.This was a single-center retrospective cohort study of ELBW babies born29 weeks over 4 year period who had echocardiogram between 7-21 days of life. TPV:RVET ratio was measured from pulmonary artery Doppler waveform obtained using echocardiogram. The main outcome was BPD at 36 weeks corrected gestation. The predictive ability of TPV:RVET (cut off 0.34) for subsequent development of BPD was analyzed using ROC.Of 589 ELBW29 weeks, 207 babies were eligible. BPD was found in 60.4%. The TPV:RVET at 0.34 had sensitivity 76.8% (95%CI 68.4-83.9), specificity 85.4% (95%CI 75.8-92.2), positive predictive value 88.9% (95%CI 81.4-94.1), negative predictive value 70.7% (95%CI 60.7-79), and ROC area 0.811 (95%CI 0.757-0.864). Odds ratio of having BPD for TPV:RVET at 0.34 was 19.9 (95%CI 8.19-48.34) and increased by 1.07 (95%CI 1.05-1.09) with every additional days of mechanical ventilation. TPV:RVET ratio had 92.75% inter-observer agreement with kappa 0.83.TPV:RVET ratio is a good and reliable early screening tool for subsequent development of BPD in ELBW babies with substantial inter-observer agreement.

To examine patient characteristics, hospital course, and medical outcomes of neonatal tracheostomy at a single center.Retrospective cohort study.Level III neonatal intensive care units (NICUs) in Edmonton, Canada.Infants admitted to NICU who underwent tracheostomy between January 2013 and December 2017 inclusive.Hospital course, discharge, and 3-year post-tracheostomy outcomes were compared between preterm infants29 weeks gestation and infants with congenital anomalies.Forty-three infants were identified; seven were lost to follow-up and excluded. Of the 36 analyzed, 86% survived to discharge. At discharge, 13% were decannulated, 36% required no mechanical ventilation, and 52% required mechanical ventilation. Median hospitalization was 295 days. At 3 years post-tracheostomy, 97% were alive. Proportions of infants with tracheostomy in situ was 80%, 73%, and 60% at 1, 2, and 3 years post tracheostomy. Tracheostomy incidence was 2.7% for preterm infants29 weeks gestational age with 55% for subglottic stenosis. All preterm infants received postnatal steroids. Preterm infants underwent tracheostomy at later chronological age (123 vs. 81 days, p 0.001), but similar corrected gestational age (42 + 5 vs. 51 + 2 weeks, p = 0.095). Preterm infants had more intubation attempts (17 vs. 4, p 0.001), total extubations (8 vs. 2, p 0.001), and days on ventilation before tracheostomy (100 vs. 78, p 0.001).Infants who underwent tracheostomy in a Canadian public healthcare setting demonstrated decreasing tracheostomy dependence and high survival post tracheostomy, despite prolonged hospitalization. Preterm infants had more intubation and extubation events which may have contributed to airway injury.

Hospital and community healthcare providers have expressed concerns around the continuity and quality of care for infants with neonatal abstinence syndrome (NAS) during hospitalization and transition home. This qualitative study explored the experiences of hospital and community-based healthcare providers and identified themes related to the management of NAS for mothers and infants. Healthcare providers that cared for women with substance use disorders and/or cared for newborns with NAS in a large urban setting in Canada met inclusion criteria for this study and were interviewed in groups or as individuals. Interview transcripts were reviewed iteratively using inductive thematic analysis to identify an overarching theme linked with primary themes. In total, 45 healthcare providers were interviewed. Qualitative analysis of their experiences derived the overarching theme of hope with five primary themes being: mother/infant, mental health, system, judgement, and knowledge. The study identified gaps in NAS care including fear, stigma, and language. This research demonstrates that programs and interventions that work with mothers and newborns with NAS must foster hope in mothers, families, and in the extended care provider team and improve communication between hospital and community networks.

Spectroscopy of Earth-like exoplanets and ultra-faint galaxies are priority science cases for the coming decades. Here, broadband source flux rates are measured in photons per square meter per hour, imposing extreme demands on detector performance, including dark currents lower than 1 e-/pixel/kilosecond, read noise less than 1 e-/pixel/frame, and large formats. There are currently no infrared detectors that meet these requirements. The University of Hawaii and industrial partners are developing one promising technology, linear mode avalanche photodiodes (LmAPDs), using fine control over the HgCdTe bandgap structure to enable noise-free charge amplification and minimal glow. Here we report first results of a prototype megapixel format LmAPD operated in our cryogenic testbed. At 50 Kelvin, we measure a dark current of about 3 e-/pixel/kilosecond, which is due to an intrinsic dark current consistent with zero (best estimate of 0.1 e-/pixel/kilosecond) and a ROIC glow of 0.08 e-/pixel/frame. The read noise of these devices is about 10 e-/pixel/frame at 3 volts, and decreases by 30% with each additional volt of bias, reaching 2 e- at 8 volts. Upcoming science-grade devices are expected to substantially improve upon these figures, and address other issues uncovered during testing., To be published in Proc. SPIE 12191, X-Ray, Optical, and Infrared Detectors for Astronomy X, 12191-34 (July 18, 2022)

Unilateral pulmonary vein atresia (UPVA) is a rare congenital vascular malformation with obliteration of the pulmonary vein. We present a case series of three siblings with variable presentation of UPVA. We suggest a dominant genetic cause based on different paternity. Identifying genetic etiology would contribute to early diagnosis and screening.

Purpose: To evaluate the change in the severity of hypoxic-ischemic encephalopathy (HIE) and associated morbidities between pre-and during COVID-19 pandemic periods in Canada. Methods: We conducted a retrospective cohort study extracting the data from level-3 NICUs participating in Canadian Neonatal Network (CNN). The primary outcome was a composite of death in the first week after birth and/or stage 3 HIE (Sarnat and Sarnat). Secondary outcomes included rate and severity of HIE among admitted neonates, overall mortality, brain injury on magnetic resonance imaging (MRI), neonates requiring resuscitation, organ dysfunction, and rates of therapeutic hypothermia (TH) usage. We included 1591 neonates with gestational age ≥36 weeks with HIE during the specified periods: pandemic cohort April 1st to December 31st of 2020; pre-pandemic cohort between April 1st to December 31st of 2017, 2018, and 2019. We calculated the odds ratio (OR) and confidence intervals (CI).Results: We observed no difference in the primary outcome (15% vs. 16%; OR 1.08; 95%CI 0.78-1.48), mortality in the first week of life (6% vs. 6%; OR 1.10, 95%CI 0.69-1.75), overall mortality, neonates requiring resuscitation, organ dysfunction, TH usage, and rate of brain injury. In the ad-hoc analysis, per 1000 live births, there was an increase in the rate of infants with HIE and TH use. Conclusions: Severity of HIE, associated morbidities and mortality were not significantly different during the pandemic compared to a pre-pandemic period in Canada. Anticipated risks and difficulties in accessing healthcare have not increased the mortality and morbidities in neonates with HIE in Canada.

BackgroundComprehensive multidisciplinary assessment of neurodevelopmental outcomes of high-risk neonates may have significant challenges in low- and middle-income countries, in addition to socio-cultural barriers. We aimed to compare the time to diagnosis of neurodevelopmental impairment (NDI) and cerebral palsy (CP) in preterm neonates (MethodsAll eligible surviving very preterm neonates born at ResultsThe rates of NDI and CP were not different in two epochs [NDI: 12 (50%) vs. 12 (41%); CP: 3 (12%) vs. 2 (7%) of 24 and 29 surviving infants assessed in conventional and MDAC clinics, respectively]. Infants in the MDAC clinic were diagnosed with NDI and CP earlier than those in the pre-MDAC epoch (6 vs. 14 months corrected age, respectively, P < 0.05).ConclusionHigh-risk preterm neonates can be followed more effectively in a family-centered, child-friendly multidisciplinary clinic, leading to an earlier diagnosis of NDI and CP. Early counseling and interventions could be implemented accordingly.

The abundance of embedded systems and smart devices increases the risk of physical memory disclosure attacks. One such classic noninvasive attack exploits dynamic RAM’s temperature-dependent ability to retain information across power cyclesÐknown as a cold boot attack. When exposed to low temperatures, DRAM cells preserve their state for a short time without power, mimicking nonvolatile memories in that time frame. Attackers exploit this physical phenomenon to gain access to a system’s secrets, leading to data theft from encrypted storage. To prevent cold boot attacks, programmers hide secrets on-chip in Static Random-Access Memory (SRAM); by construction, on-chip SRAM is isolated from external probing and has little intrinsic capacitance, making it robust against cold boot attacks. While it is the case that SRAM protects against traditional cold boot attacks, we show that there is another way to retain information in on-chip SRAM across power cycles and software changes. This paper presents Volt Boot, an attack that demonstrates a vulnerability of on-chip volatile memories due to the physical separation common to modern system-on-chip power distribution networks. Volt Boot leverages asymmetrical power states (e.g., on vs. off) to force SRAM state retention across power cycles, eliminating the need for traditional cold boot attack enablers, such as low-temperature or intrinsic data retention time. Using several modern ARM Cortex-A devices, we demonstrate the effectiveness of the attack in caches, registers, and iRAMs. Unlike other forms of SRAM data retention attacks, Volt Boot retrieves data with 100% accuracyÐwithout any complex post-processing. Published version

Electronic devices are increasingly the subject of inspection by authorities. While encryption hides secret messages, it does not hide the transmission of those secret messages - in fact, it calls attention to them. Thus, an adversary, seeing encrypted data, turns to coercion to extract the credentials required to reveal the secret message. Steganographic techniques hide secret messages in plain sight, providing the user with plausible deniability, removing the threat of coercion. This paper unveils Invisible Bits a new steganographic technique that hides secret messages in the analog domain of Static Random Access Memory (SRAM) embedded within a computing device. Unlike other memory technologies, the power-on state of SRAM reveals the analog-domain properties of its individual cells. We show how to quickly and systematically change the analog-domain properties of SRAM cells to encode data in the analog domain and how to reveal those changes by capturing SRAM’s power-on state. Experiments with commercial devices show that Invisible Bits provides over 90% capacity - two orders-of-magnitude more than previous on-chip steganographic approaches, while retaining device functionality - even when the device undergoes subsequent normal operation or is shelved for months. Experiments also show that adversaries cannot differentiate between devices with encoded messages and those without. Lastly, we show how to layer encryption and error correction on top of our message encoding scheme in an end-to-end demonstration. Published version

There have been no significant breakthroughs in infrared imagery since the hybridization of III-V or II-VI narrow-bandgap semiconductors on complementary metal-oxide semiconductor (CMOS) read-out integrated circuits (ROICs). The development of third-generation, linear-mode avalanche photodiode arrays (LmAPDs) using mercury cadmium telluride (MCT) has resulted in a significant sensitivity improvement for short-wave infrared (SWIR) imaging. The first dedicated LmAPD device, called SAPHIRA (320x256/24 microns), was designed by Leonardo UK Ltd specifically for SWIR astronomical applications. In the past decade there has been a significant development effort to make larger LmAPD arrays for low-background astronomy. Larger LmAPD formats for ultra-low noise/flux SWIR imaging, currently under development at Leonardo include a 512 x 512 LmAPD array funded by ESO, MPE and NRC Herzberg, a 1k x 1k array funded by NASA and a 2K x 2K device funded by ESA for general scientific imaging applications. The 2048x2048 pixel ROIC has a pitch of 15 microns, 4/8/16 outputs and a maximum frame rate of 10 Hz. The ROIC characterization is scheduled in the third quarter of 2022, while the first arrays will be fabricated by end-2022. The hybridized arrays will be characterized during end-2022. At this time, First Light Imaging will start the development of an autonomous camera integrating this 2Kx2K LmAPD array, based on the unique experience from the C-RED One camera, the only commercial camera integrating the SAPHIRA SWIR LmAPD array.The detector will be embedded in a compact high vacuum cryostat cooled with low vibration pulse at 50-80K which does not require external pumping. Sub-electron readout noise is expected to be achieved with high multiplication gain. Custom cold filters and beam aperture cold baffling will be integrated in the camera., Comment: 9 pages

Coverage-guided fuzzing's aggressive, high-volume testing has helped reveal tens of thousands of software security flaws. While executing billions of test cases mandates fast code coverage tracing, the nature of binary-only targets leads to reduced tracing performance. A recent advancement in binary fuzzing performance is Coverage-guided Tracing (CGT), which brings orders-of-magnitude gains in throughput by restricting the expense of coverage tracing to only when new coverage is guaranteed. Unfortunately, CGT suits only a basic block coverage granularity -- yet most fuzzers require finer-grain coverage metrics: edge coverage and hit counts. It is this limitation which prohibits nearly all of today's state-of-the-art fuzzers from attaining the performance benefits of CGT. This paper tackles the challenges of adapting CGT to fuzzing's most ubiquitous coverage metrics. We introduce and implement a suite of enhancements that expand CGT's introspection to fuzzing's most common code coverage metrics, while maintaining its orders-of-magnitude speedup over conventional always-on coverage tracing. We evaluate their trade-offs with respect to fuzzing performance and effectiveness across 12 diverse real-world binaries (8 open- and 4 closed-source). On average, our coverage-preserving CGT attains near-identical speed to the present block-coverage-only CGT, UnTracer; and outperforms leading binary- and source-level coverage tracers QEMU, Dyninst, RetroWrite, and AFL-Clang by 2-24x, finding more bugs in less time., CCS '21: Proceedings of the 2021 ACM SIGSAC Conference on Computer and Communications Security

Background Many studies have demonstrated empathy decline in medical students over the course of training. Burnout negatively affects academic or professional performance and has been negatively correlated with empathy. Neither empathy nor burnout has been previously studied in naturopathic medical students. Objective The aims of this cross-sectional study were to (1) compare empathy at different levels of training, (2) describe the prevalence of burnout, and (3) identify correlations between empathy and burnout, in naturopathic medical students. Methods This cross-sectional study used the Interpersonal Reactivity Index and Maslach Burnout Inventory to measure empathy and burnout, respectively, in an online survey of current naturopathic medical students at one institution. Results 1) There was no significant difference in empathy between any cohorts or between those in internship versus those not in internship. 2) Among burnout outcomes, 42% of participants met criteria for emotional exhaustion, 19% for depersonalization, and 64% for low sense of personal accomplishment. 3) Cognitive empathy was positively correlated with affective empathy and a higher sense of personal accomplishment and negatively correlated with emotional exhaustion and depersonalization. Conclusions While a longitudinal study would provide more definitive evidence, this study suggests that empathy in naturopathic medical students is relatively stable over the course of training. It also demonstrates that burnout is prevalent in this population and has an inverse relationship with empathy. Interventions to prevent burnout and increase empathy are discussed.

In an ideal world, it would be possible to build a provably correct and secure processor. However, the complexity of today's processors puts this ideal out of reach. The complete verification of a modern processor remains intractable. Statically verifying even a simple security property -for example, "hardware privilege escalation never occurs" -remains beyond the state of the art in formal verification. Testing can complement formal verification methods, yet testing is incomplete and bugs in the hardware that leave it vulnerable continue to elude test suites. Further, a crafty malicious actor can evade typical testing coverage metrics. Recent efforts, including that of three of the authors, have explored the use of static analysis on the design files (e.g., hardware description level source code or gate-level netlists) to find suspicious circuitry." These techniques rely on heuristics to define patterns that indicate a likely trojan and then search for instances in the design that match the pattern. However, malicious circuitry that does not match the pattern will be missed, as will inadvertent bugs that open vulnerabilities. By the time the weakness is uncovered, the hardware is already in the end user's hands and vulnerable to attack. In the absence of a full proof of correctness, what is needed is a final filter: a runtime verification technique that works-postdeployment-to detect and respond to security property violations as they occur during execution. In this article, we make the case for final filters using our tool, FinalFilter, as a case study.

Background Neurodevelopment involves sensory-motor, cognitive, and social-emotional domains, which can be influenced by biological and psychosocial factors. Poor neurodevelopment can result in missing developmental milestones and neurodevelopmental disorders (NDs) that translate into negative consequences for long-term health and well-being. Indigenous children in countries with similar colonial histories face a disproportionate burden of infant mortality, chronic diseases, injuries, and disability compared to non-Indigenous children. However, there is no consensus on the prevalence of NDs among Indigenous children around the world. Objectives This systematic review (PROSPERO 2021 CRD42021238669) synthesized current evidence on the prevalence of NDs among Indigenous children in Australia, Canada, New Zealand, and the USA. Design/Methods Comprehensive searches of five databases from 2005 to Feb 15, 2021 were conducted to identify cohort and cross-sectional studies that assessed the objective. Two independent reviewers conducted study selection, data extraction/analysis, and risk of bias assessment. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort and ecological studies (adapted), and the Quality Assessment Tool for Prevalence Studies by Hoy et al. for cross-sectional studies. Prevalence odds ratios (pOR) with 95% confidence intervals (CI) were calculated in random-effects meta-analyses for each ND outcome if there were two or more studies of the same study design. Results Of the 864 studies identified, 25 studies met the inclusion criteria. Twelve studies were conducted in Australia, one in Canada, four in New Zealand, and eight in the USA. Four studies evaluated attention-deficit/hyperactivity disorder (ADHD) prevalence, 13 for autism spectrum disorder (ASD), 10 for intellectual disability (ID), and five for motor disorders (MD). Most cohort studies (10/17) had high risk of bias. All cross-sectional studies (n=8) had low risk of bias. The prevalence of ADHD, ASD, ID, and MD for Indigenous children ranged from 2.7-3.9%, 0.07-3.0%, 1.1-3.9%, and 0.18-0.47%, respectively. Prevalence in non-Indigenous children ranged from 1.6-5.6%, 0.31-3.3%, 0.87-2.3%, and 0.22-0.37%. In cross-sectional studies, Indigenous children had decreased odds of ASD (three studies; pOR=0.80; 95% CI: 0.71-0.89) compared to non-Indigenous children. In cohort studies, higher odds of MD (two studies; pOR=1.57; 95%CI: 1.35-1.84) and lower odds of ASD (four studies; pOR=0.46; 95% CI: 0.28-0.76) were found in Indigenous children compared to non-Indigenous children. Conclusion Prevalence rates are greater in Indigenous children for MD and lower for ASD compared to their non-Indigenous counterparts. Differences in NDs prevalence between Indigenous and non-Indigenous children may be due to differences in access to health care services/assessment.

Background In 2016, the Academic Medical Center Neonatal Encephalopathy Task Force recommended therapeutic hypothermia (TH) as the standard-of-care for hypoxic ischemic encephalopathy (HIE). However, not all infants who meet the criteria for TH receive this treatment. The purpose of this study was to compare the risk of mortality for infants with HIE who did and did not receive TH, after accounting for confounders associated with receipt of TH. Methods A retrospective cohort study was conducted using the 2016 National Inpatient Sample (NIS), which contains 20% of all hospital discharges in the United States. Infants were included if they were diagnosed with HIE and were eligible for TH. Nearest-neighbor propensity score-matching (1:1) without replacement was performed prior to logistic regression analysis. The average treatment effect of TH was calculated to estimate the odds of mortality. Results There were 211 infants with HIE who received TH, which is an estimated proportion of 24.8% (95% CI: 20.9-29.1%). Infants who received TH were more likely to have a seizure (p Conclusions Receipt of TH varied across patient groups and was associated with clinical risk factors. The odds of in-hospital mortality were lower in infants who received TH. Key messages Infants who received TH had a decreased risk of in-hospital mortality compared to infants who did not receive TH.

Energy harvesting systems support the deployment of low-power microcontrollers untethered by constant power sources or batteries, enabling long-lived deployments in a variety of applications previously limited by power or size constraints. However, the limitations of harvested energy mean that even the lowest-power microcontrollers operate intermittently---waiting for the harvester to slowly charge a buffer capacitor and rapidly discharging the capacitor to support a brief burst of computation. The challenges of the intermittent operation brought on by harvested energy drive a variety of hardware and software techniques that first enabled long-running computation, then focused on improving performance. Many of the most promising systems demand dynamic updates of available energy to inform checkpointing and mode decisions. Unfortunately, existing energy monitoring solutions based on analog circuits (e.g., analog-to-digital converters) are ill-matched for the task because their signal processing focus sacrifices power efficiency for increased performance---performance not required by current or future intermittent computation systems. This results in existing solutions consuming as much energy as the microcontroller, stealing energy from useful computation. To create a low-power energy monitoring solution that provides just enough performance for intermittent computation use cases, we design and implement Failure Sentinels, an on-chip, fully-digital energy monitor. Failure Sentinels leverages the predictable propagation delay response of digital logic gates to supply voltage fluctuations to measure available energy. Our design space exploration shows that Failure Sentinels provides 30--50mV of resolution at sample rates up to 10kHz, while consuming less than 2μA of current. Experiments show that Failure Sentinels increases the energy available for software computation by up to 77%, compared to current solutions. We also implement a RISC-V-based FPGA prototype that validates our design space exploration and shows the overheads of incorporating Failure Sentinels into a system-on-chip.

To cope with ever-increasing design complexities, integrated circuit designers increase both the size of their design teams and their reliance on third-party intellectual property (IP). Both come at the expense of trust: it is computationally infeasible to exhaustively verify that a design is free of all possible malicious modifications (i.e., hardware Trojans). Making matters worse, unlike software, hardware modifications are permanent: there is no "patching" mechanism for hardware; and powerful: they serve as a foothold for subverting software that sits above.To counter this threat, prior work uses both static and dynamic analysis techniques to verify hardware designs are Trojan-free. Unfortunately, researchers continue to reveal weaknesses in these "one-size-fits-all", heuristic-based approaches. Instead of attempting to detect all possible hardware Trojans, we take the first step in addressing the hardware Trojan threat in a divide-and-conquer fashion: defining and eliminating Ticking Timebomb Trojans (TTTs), forcing attackers to implement larger Trojan designs detectable via existing verification and side-channel defenses. Like many system-level software defenses (e.g., Address Space Layout Randomization (ASLR) and Data Execution Prevention (DEP)), our goal is to systematically constrict the hardware attacker’s design space.First, we construct a definition of TTTs derived from their functional behavior. Next, we translate this definition into fundamental components required to realize TTT behavior in hardware. Using these components, we expand the set of all known TTTs to a total of six variants—including unseen variants. Leveraging our definition, we design and implement a TTT-specific dynamic verification toolchain extension, called Bomber-man. Using four real-world hardware designs, we demonstrate Bomberman’s ability to detect all TTT variants, where previous defenses fail, with

Primary Subject area Neonatal-Perinatal Medicine Background Stage III necrotizing enterocolitis (NEC-III) is a serious intestinal inflammatory disease in neonates, with high case fatality rate and significant morbidities including need for surgical intervention. Research focusing on risk factors for the development of NEC-III are lacking. Objectives To determine the risk factors for NEC-III and its outcomes among neonates born under 33 weeks gestational age (GA). Design/Methods This was a single-centre retrospective case-control study of preterm neonates born under 33 weeks GA who were admitted to Stollery Children’s Hospital neonatal intensive care unit (NICU), Edmonton, Alberta, between January 2015 and December 2018. NEC-III cases were compared with Stage II NEC (NEC-II) and matched with 2-4 non-NEC controls by GA ± 1 week and date of birth within 3 months. Univariate and multivariate analysis compared the risk factors for NEC-III, adjusting for GA, birth weight, and sex. Results Out of 1360 babies born There was a trend towards lower Apgar score Conclusion In this case-control study of neonates born under 33 weeks GA, after adjustment for known confounders, duration of UAC and prolonged rupture of membranes were significantly associated with increased incidence of NEC-III. Composite outcome of mortality or short bowel syndrome were higher in NEC-III.

SAPHIRA (320x256/24μm) is the first of a family of HgCdTe APD infrared sensors for NIR/SWIR sensing in low flux conditions for scientific applications. The paper will present the status of the latest developments of detectors suitable for a range of ground and space applications including wavefront sensing, low flux imaging, Lidar and high speed optical communications. The next generation SAPHIRA (512x512/24μm) array has an architecture specific to pyramid wavefront sensors, supported by a consortium comprising European Southern Observatory, Max Planck Institute, NRC Herzberg Institute and Potsdam University. A 1kx1k/15μm, 3-side buttable sensor called Ike Pono after the Hawaiian for ‘far-vision’ is aimed at extreme, low-flux imaging, supported by NASA through the University of Hawaii, Institute of Astronomy. A large area device suitable for LIDAR and supported by NASA also demonstrates a performance suitable for high speed optical communication applications. Most recently the development of a 2k x 2k/ 15μm device for scientific imaging has started with the support of ESA.

OBJECTIVE To compare neurodevelopmental outcomes of large and appropriate for gestational age (LGA, AGA) infants

Introduction/Background Health care providers in neonatal intensive care units (NICU) experience critical or distressing events that can overwhelm their usual coping skills and lead to significant stress. Ineffective support for health care providers dealing with critical incidents can lead to poor unit resilience, staff burnout and compromised patient care behaviours. A formalized peer program and process to address critical workplace incidents and support care providers, “Critical Incident Stress Management (CISM)” is used in many first responder professions. While there is growing interest in implementing peer CISM teams in critical care units, there is a lack of research describing the impact of CISM in NICU. Objectives This study examined the effect of implementing a multidisciplinary NICU health care provider peer CISM team on resilience, burnout, and team/safety culture in a tertiary NICU. Design/Methods Multidisciplinary team members were peer selected and formally CISM trained. Change management strategies were employed to introduce CISM to the NICU. All health care providers were invited to complete an anonymous online or paper survey before and 1 year after NICU CISM team implementation. The survey contained validated measures of resilience, burnout, and team/safety culture that were analyzed pre and post intervention. Results The response rate pre-intervention was 66% (114/172 staff) and 32% post (60/186 staff). Stress recognition significantly improved as fewer staff reported being less effective at work when feeling stressed post incident (74% vs 61%, pre and post CISM respectively, p Conclusion Implementation of a peer CISM team led to improved NICU care provider resilience, stress recognition, and team culture, all of which can mitigate the effects of increased patient load. Findings from this research and knowledge gained from the CISM implementation process should be shared with other health care environments.

Despite improved survival of preterm infants, there has not been an equivalent improvement in long-term neurodevelopmental outcomes. Adverse neurodevelopmental outcome rates and severity are inversely related to the degree of prematurity, but only 1.6% are born very preterm and the motor, cognitive, behavioral, and psychiatric disabilities in the large moderate and late preterm population have a greater impact. The disability-free preterm adult has a lower educational achievement and income but similar health-related quality of life to term controls. Reducing the long-term neurodevelopmental impact of prematurity is the next frontier of neonatal care.

While the move to smaller transistors has been a boon for performance it has dramatically increased the cost to fabricate chips using those smaller transistors. This forces the vast majority of chip design companies to trust a third party---often overseas---to fabricate their design. To guard against shipping chips with errors (intentional or otherwise) chip design companies rely on post-fabrication testing. Unfortunately, this type of testing leaves the door open to malicious modifications since attackers can craft attack triggers requiring a sequence of unlikely events, which will never be encountered by even the most diligent tester. In this paper, we show how a fabrication-time attacker can leverage analog circuits to create a hardware attack that is small (i.e., requires as little as one gate) and stealthy (i.e., requires an unlikely trigger sequence before affecting a chip's functionality). In the open spaces of an already placed and routed design, we construct a circuit that uses capacitors to siphon charge from nearby wires as they transit between digital values. When the capacitors are fully charged, they deploy an attack that forces a victim flip-flop to a desired value. We weaponize this attack into a remotely controllable privilege escalation by attaching the capacitor to a controllable wire and by selecting a victim flip-flop that holds the privilege bit for our processor. We implement this attack in an OR1200 processor and fabricate a chip. Experimental results show that the purposed attack works. It eludes activation by a diverse set of benchmarks and evades known defenses.

The processors that drive embedded systems are getting smaller; meanwhile, the batteries used to provide power to those systems have stagnated. If we are to realize the dream of ubiquitous computing promised by the Internet of Things, processors must shed large, heavy, expensive, and high maintenance batteries and, instead, harvest energy from their environment. One challenge with this transition is that harvested energy is insufficient for continuous operation. Unfortunately, existing programs fail miserably when executed intermittently. This paper presents Clank: lightweight architectural support for correct and efficient execution of long-running applications on harvested energy---without programmer intervention or extreme hardware modifications. Clank is a set of hardware buffers and memory-access monitors that dynamically maintain idempotency. Essentially, Clank dynamically decomposes program execution into a stream of restartable sub-executions connected via lightweight checkpoints. To validate Clank's ability to correctly stretch program execution across frequent, random power cycles, and to explore the associated hardware and software overheads, we implement Clank in Verilog, formally verify it, and then add it to an ARM Cortex M0+ processor which we use to run a set of 23 embedded systems benchmarks. Experiments show run-time overheads as low as 2.5%, with run-time overheads of 6% for a version of Clank that adds 1.7% hardware. Clank minimizes checkpoints so much that re-execution time becomes the dominate contributor to run-time overhead.

Introduction/Background BPD is a chronic lung disease that affects ELBW babies and contributes significantly to their morbidity and mortality. The early abnormal vasoreactivity observed in babies at risk of BPD increases the pulmonary vascular resistance and can be assessed non-invasively using Time to Peak Velocity: Right Ventricular Ejection Time ratio (TPV: RVET) that is calculated from pulmonary artery doppler waveform. We postulate that screening for this condition early may be useful to predict BPD in this cohort, which may provide prognostic information as well as early clinical management of the ELBW at risk of developing BPD and therefore can potentially present a window of opportunity for therapeutic intervention. Objectives 1. To determine utility of TPV/RVET ratio in predicting the risk for BPD in ELBW babies in a tertiary center. 2. To determine utility of TPV/RVET(c) ratio in predicting the risk for BPD in ELBW babies in a tertiary center. Design/Methods This is a retrospective cohort study of ELBW babies Results Out of 589 ELBW babies Conclusion TPV/RVET and its corrected ratio are good and reliable early screening tools for subsequent development of BPD in ELBW babies with substantial inter-observer agreement. Two variable model namely TPV/RVET

To develop and validate an itemized costing algorithm for in-patient neonatal intensive care unit (NICU) costs for infants born prematurely that can be used for quality improvement and health economic analyses.We sourced patient resource use data from the Canadian Neonatal Network database, with records from infants admitted to 30 tertiary NICUs in Canada. We sourced unit cost inputs from Ontario hospitals, schedules of benefits, and administrative sources. Costing estimates were generated by matching patient resource use data to the appropriate unit costs. All cost estimates were in 2017 Canadian dollars and assigned from the perspective of a provincial public payer. Results were validated using previous estimates of inpatient NICU costs and hospital case-cost estimates.We assigned costs to 27 742 infants born prematurely admitted from 2015 to 2017. Mean (SD) gestational age and birth weight of the cohort were 31.8 (3.5) weeks and 1843 (739) g, respectively. The median (IQR) cost of hospitalization before NICU discharge was estimated as $20 184 ($9739-51 314) for all infants; $11 810 ($6410-19 800) for infants born at gestational age of 33-36 weeks; $30 572 ($16 597-$51 857) at gestational age of 29-32 weeks; and $100 440 ($56 858-$159 3867) at gestational age of29 weeks. Cost estimates correlated with length of stay (r = 0.97) and gestational age (r = -0.65). The estimates were consistent with provincial resource estimates and previous estimates from Canada.NICU costs for infants with preterm birth increase as gestation decreases and length of stay increases. Our cost estimates are easily accessible, transparent, and congruent with previous cost estimates.

The Afghan National Army Special Operations Command (ANASOC) uses several documents for casualty reporting. By analyzing these documents from a period of March to December 2018, the authors demonstrate the predominance of gunshot fatalities within ANASOC at approximately 63% of combat deaths and a high rate of prehospital death at approximately 97% of combat deaths. The data also demonstrate relatively few cases of long-term disability from ANASOC soldiers wounded in action. The authors used these conclusions to create a Combined Joint Special Operations Task Force-Afghanistan (CJSOTF-A) working group that recommended changes to the medical curriculum at the ANASOC School of Excellence. These recommendations centered on an increased emphasis on bleeding control to prevent death from hemorrhagic shock.

To examine rates and determinants of mother's own milk (MOM) feeding at hospital discharge in a cohort of infants born very preterm within the Canadian Neonatal Network (CNN).This was a population-based cohort study of infants born at33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2015, and December 31, 2018. We examined the rates and determinants of MOM use at discharge home among the participating NICUs. We used multivariable logistic regression analysis to identify independent determinants of MOM feeding.Among the 6404 infants born very preterm and discharged home during the study period, 4457 (70%) received MOM or MOM supplemented with formula. Rates of MOM feeding at discharge varied from 49% to 87% across NICUs. Determinants associated with MOM feeding at discharge were gestational age 29-32 weeks compared with26 weeks (aOR 1.56, 95% CI 1.25-1.93), primipara mothers (aOR 2.12, 95% CI 1.86-2.42), maternal diabetes (aOR 0.79, 95% CI 0.66-0.93), and maternal smoking (aOR 0.27, 95% CI 0.19-0.38). Receipt of MOM by day 3 of age was the major predictor of breast milk feeding at discharge (aOR 3.61, 95% CI 3.17-4.12).Approximately two-thirds of infants born very preterm received MOM at hospital discharge, and rates varied across NICUs. Supporting mothers to provide breast milk in the first 3 days after birth may be associated with improved MOM feeding rates at discharge.

Background One of the controversies in the management of twin gestations relates to mode of delivery, especially when the second twin is in a nonvertex presentation (Vertex/nonVertex pairs) and birth is imminent at extremely low gestation. Objective We hypothesized that, for Vertex/nonVertex twins born before 28 weeks’ gestation, cesarean delivery would be associated with a lower risk of adverse neonatal outcomes than trial of vaginal delivery. Our aim was to test this hypothesis by comparing the neonatal outcomes of Vertex/nonVertex twins born before 28 weeks’ gestation by mode of delivery using a large national cohort. Study Design This work is a retrospective cohort study of all twin infants born at 240/7 to 276/7 weeks’ gestation and admitted to level III neonatal intensive care units participating in the Canadian Neonatal Network (2010–2017). Exposure is defined a trial of vaginal delivery for Vertex/nonVertex twins. Nonexposed (control) groups are defined as cases where both twins were delivered by cesarean delivery, either in vertex or nonvertex presentation (control group 1) or owing to the nonvertex presentation of the first twin (control group 2). Outcome measures are defined as a composite of neonatal death, severe neurologic injury, or birth trauma. Results A total of 1082 twin infants (541 twin pairs) met the inclusion criteria: 220 Vertex/nonVertex pairs, of which 112 had a trial of vaginal delivery (study group) and 108 had cesarean delivery for both twins (control group 1); 170 pairs with the first twin in nonvertex presentation, all of which were born by cesarean delivery (control group 2); and 151 pairs with both twins in vertex presentation (vertex or nonvertex). In the study group, the rate of urgent cesarean delivery for the second twin was 30%. The rate of the primary outcome in the study group was 42%, which was not significantly different compared with control group 1 (37%; adjusted relative risk, 0.93; 95% confidence interval, 0.71–1.22) or control group 2 (34%; adjusted relative risk, 1.20; 95% confidence interval, 0.92–1.58). The findings remained similar when outcomes were analyzed separately for the first and second twins. Conclusion For preterm Vertex/nonVertex twins born at

Of coverage-guided fuzzing's three main components: (1) testcase generation, (2) code coverage tracing, and (3) crash triage, code coverage tracing is a dominant source of overhead. Coverage-guided fuzzers trace every testcase's code coverage through either static or dynamic binary instrumentation, or more recently, using hardware support. Unfortunately, tracing all testcases incurs significant performance penalties---even when the overwhelming majority of testcases and their coverage information are discarded because they do not increase code coverage. To eliminate needless tracing by coverage-guided fuzzers, we introduce the notion of coverage-guided tracing. Coverage-guided tracing leverages two observations: (1) only a fraction of generated testcases increase coverage, and thus require tracing; and (2) coverage-increasing testcases become less frequent over time. Coverage-guided tracing works by encoding the current frontier of code coverage in the target binary so that it self-reports when a testcase produces new coverage---without tracing. This acts as a filter for tracing; restricting the expense of tracing to only coverage-increasing testcases. Thus, coverage-guided tracing chooses to tradeoff increased coverage-increasing-testcase handling time for the ability to execute testcases initially at native speed. To show the potential of coverage-guided tracing, we create an implementation based on the static binary instrumentor Dyninst called UnTracer. We evaluate UnTracer using eight real-world binaries commonly used by the fuzzing community. Experiments show that after only an hour of fuzzing, UnTracer's average overhead is below 1%, and after 24-hours of fuzzing, UnTracer approaches 0% overhead, while tracing every testcase with popular white- and black-box-binary tracers AFL-Clang, AFL-QEMU, and AFL-Dyninst incurs overheads of 36%, 612%, and 518%, respectively., To appear in the 40th IEEE Symposium on Security and Privacy, May 20--22, 2019, San Francisco, CA, USA

We used the Green Bank Telescope to detect molecular lines observed toward Mid-Infrared (MIR) bubbles N62, N65, N90, and N117. The bubbles were selected from Watson et al. (2016) who detected non-Gaussian CS (1-0) emission lines toward the bubbles. Two of the bubbles are adjacent to infrared dark clouds (IRDCs); we examined these sources for evidence of interaction between the bubble rim and IRDC. The other two bubbles contain YSOs interior to the bubble rim; in these sources we observed the gas near the YSOs. We detect CS (1-0) emission toward all of the sources, and in several pointings the CS emission shows non-Gaussian line shapes. HC$_3$N (5-4), C$^{34}$S (1-0), CH$_3$OH (1-0), and SiO (v=0) (1-0) were also detected in some pointings. We calculate column densities and abundances for the detected molecules. We compare the velocity of optically-thick CS emission with the velocity of the other, optically thin lines to look for evidence of infall. We find that even in pointings with non-Gaussian CS emission, our detections do not support an infall model. We interpret the kinematics of the gas in N62, N65, and N117 as likely evidence of multiple clouds along the line of sight moving at slightly offset velocities. We do not detect evidence of bubble rims interacting with IRDCs in N62 or N90. The gas interior to bubbles appears more disrupted than the gas in the IRDCs. N65 shows significantly stronger emission lines than the other sources, as well as the most complicated non-Gaussian line shapes.

Ensuring the integrity and security of the memory system is critical. Recent studies have shown serious security concerns due to "rowhammer" attacks, where repeated accesses to a row of memory cause bit flips in adjacent rows. Recent work by Google's Project Zero has shown how to leverage rowhammer-induced bit-flips as the basis for security exploits that include malicious code injection and memory privilege escalation. Being an important security concern, industry has attempted to defend against rowhammer attacks. Deployed defenses employ two strategies: (1) doubling the system DRAM refresh rate and (2) restricting access to the CLFLUSH instruction that attackers use to bypass the cache to increase memory access frequency (i.e., the rate of rowhammering). We demonstrate that such defenses are inadequte: we implement rowhammer attacks that both avoid using the CLFLUSH instruction and cause bit flips with a doubled refresh rate. Our next-generation CLFLUSH-free rowhammer attack bypasses the cache by manipulating cache replacement state to allow frequent misses out of the last-level cache to DRAM rows of our choosing. To protect existing systems from more advanced rowhammer attacks, we develop a software-based defense, ANVIL, which thwarts all known rowhammer attacks on existing systems. ANVIL detects rowhammer attacks by tracking the locality of DRAM accesses using existing hardware performance counters. Our detector identifies the rows being frequently accessed (i.e., the aggressors), then selectively refreshes the nearby victim rows to prevent hammering. Experiments running on real hardware with the SPEC2006 benchmarks show that ANVIL has less than a 1% false positive rate and an average slowdown of 1%. ANVIL is low-cost and robust, and our experiments indicate that it is an effective approach for protecting existing and future systems from even advanced rowhammer attacks.

Motivation: Metabolite databases provide a unique window into metabolome research allowing the most commonly searched biomarkers to be catalogued. Omic scale metabolite profiling, or metabolomics, is finding increased utility in biomarker discovery largely driven by improvements in analytical technologies and the concurrent developments in bioinformatics. However, the successful translation of biomarkers into clinical or biologically relevant indicators is limited. Results: With the aim of improving the discovery of translatable metabolite biomarkers, we present search analytics for over one million METLIN metabolite database queries. The most common metabolites found in METLIN were cross-correlated against XCMS Online, the widely used cloud-based data processing and pathway analysis platform. Analysis of the METLIN and XCMS common metabolite data has two primary implications: these metabolites, might indicate a conserved metabolic response to stressors and, this data may be used to gauge the relative uniqueness of potential biomarkers. Availability and implementation. METLIN can be accessed by logging on to: https://metlin.scripps.edu Contact: siuzdak@scripps.edu Supplementary information: Supplementary data are available at Bioinformatics online.

Processor implementation errata remain a problem, and worse, a subset of these bugs are security-critical. We classified 7 years of errata from recent commercial processors to understand the magnitude and severity of this problem, and found that of 301 errata analyzed, 28 are security-critical. We propose the SECURITY-CRITICAL PROCESSOR ER- RATA CATCHING SYSTEM (SPECS) as a low-overhead solution to this problem. SPECS employs a dynamic verification strategy that is made lightweight by limiting protection to only security-critical processor state. As a proof-of- concept, we implement a hardware prototype of SPECS in an open source processor. Using this prototype, we evaluate SPECS against a set of 14 bugs inspired by the types of security-critical errata we discovered in the classification phase. The evaluation shows that SPECS is 86% effective as a defense when deployed using only ISA-level state; incurs less than 5% area and power overhead; and has no software run-time overhead.

A hidden dimension of software and hardware security is secret-revealing information disseminated through side channels. Even the most secure systems tend to reveal their secrets through secret-dependent computation. Secret-dependent computation is detectable by monitoring a system's time, power, outputs, and electromagnetic signature. Common defenses to side channel emanations include adding noise to the channel or making algorithmic changes to eliminate specific side channels. Unfortunately, existing solutions are either, not automatic, not comprehensive, and/or not practical.We propose an isolation-based approach for eliminating power and timing side-channels that is automatic, comprehensive, and practical. Our approach eliminates side channels by leveraging energy harvesting techniques to isolate trusted computation from the rest of the system. Software has the ability to request a fixed-power and fixed-time quantum of isolated computation. By discretizing power and time, our approach controls the granularity of side channel leakage; the only burden on programmers is to ensure that all secret-dependent execution differences converge within a single power/time quantum.We design and implement three approaches to power/time-based quantization and isolation: a wholly-digital version, a hybrid version that uses capacitors for time tracking, and a full-custom version. A key insight we leverage is that capacitors act as resource efficient, workload and environment independent time trackers. We explore the trade-offs of the three designs and look at the challenges ahead.

In the continual battle between malware attacks and antivirus technologies, both sides strive to deploy their techniques at always lower layers in the software system stack. The goal is to monitor and control the software executing in the levels above their own deployment, to detect attacks or to defeat defenses. Recent antivirus solutions have gone even below the software, by enlisting hardware support. However, so far, they have only mimicked classic software techniques by monitoring software clues of an attack. As a result, malware can easily defeat them by employing metamorphic manifestation patterns. With this work, we propose a hardware-monitoring solution, SNIFFER, which tracks malware manifestations in system-level behavior, rather than code patterns, and it thus cannot be circumvented unless malware renounces its very nature, that is, to attack. SNIFFER leverages in-hardware feature monitoring, and uses machine learning to assess whether a system shows signs of an attack. Experiments with a virtual SNIFFER implementation, which supports 13 features and tests against five common network-based malicious behaviors, show that SNIFFER detects malware nearly 100% of the time, unless the malware aggressively throttle its attack. Our experiments also highlight the need for machine-learning classifiers employing a range of diverse system features, as many of the tested malware require multiple, seemingly disconnected, features for accurate detection.

Virus-like particles are unique platforms well suited for the construction of nanomaterials with broad-range applications. The research presented here describes the development of a modular approach for the covalent attachment of protein domains to the exterior of the versatile bacteriophage P22 virus-like particle (VLP) via a sortase-mediated ligation strategy. The bacteriophage P22 coat protein was genetically engineered to incorporate an LPETG amino acid sequence on the C-terminus, providing the peptide recognition sequence utilized by the sortase enzyme to catalyze peptide bond formation between the LPETG-tagged protein and a protein containing a polyglycine sequence on the N-terminus. Here we evaluate attachment of green fluorescent protein (GFP) and the head domain of the influenza hemagglutinin (HA) protein by genetically producing polyglycine tagged proteins. Attachment of both proteins to the exterior of the P22 VLP was found to be highly efficient as judged by SDS-PAGE densitometry. These results enlarge the tool kit for modifying the P22 VLP system and provide new insights for other VLPs that have an externally displayed C-terminus that can use the described strategy for the modular modification of their external surface for various applications.

Hicks, M., Tough, S., Johnston, D., Siever, J., Clarke, M., Sauve, R., Brant, R., & Lyon, A. (2014). T-ACE and predictors of self-reported alcohol use during pregnancy in a large, population-based urban cohort. The International Journal Of Alcohol And Drug Research, 3(1), 51-61 . doi:10.7895/ijadr.v3i1.117 Aims: To determine 1) the relationship between T-ACE score and maternal self-reported alcohol use prior to and during pregnancy, and 2) the relationship between T-ACE score and maternal demographics, mental health and life circumstances. Design: Prospective, population-based cohort study. Setting: Three urban maternity clinics in Calgary, Canada. Participants: 1,929 pregnant women attended by family physicians at low-risk maternity clinics. Measures: Women completed three standardized questionnaires over the telephone in the first and third trimesters and eight weeks post-delivery, including the T-ACE and questions about drug and alcohol use, demographics, mental health and life circumstances. Findings: 43.6% of subjects had a positive T-ACE score at intake (score 2 or greater). A positive T-ACE score was predictive of alcohol use throughout pregnancy, although most women reported no alcohol after the first trimester (93.1%). Multivariate analysis indicated that a positive T-ACE score was significantly associated with being less than 30 years of age; being Caucasian; smoking during pregnancy; having an income of less than $80,000 per annum; having a history of depression; having a history of alcohol use and binge drinking during a previous pregnancy; lower social support; and poor network orientation. Conclusions: There was a positive association between the T-ACE score and maternal self-report of alcohol use, poor mental health and poor social support. Routine use of the T-ACE to assess for risk of an alcohol-exposed pregnancy may also help identify women with complex needs who could benefit from additional prenatal support.

Outer membrane protein A (OmpA) is a key outer membrane protein found in Gram‐negative bacteria that contributes to several crucial processes in bacterial virulence. In Porphyromonas gingivalis, OmpA is predicted as a heterotrimer of OmpA1 and OmpA2 subunits encoded by adjacent genes. Here we describe the role of OmpA and its individual subunits in the interaction of P. gingivalis with oral cells. Using knockout mutagenesis, we show that OmpA2 plays a significant role in biofilm formation and interaction with human epithelial cells. We used protein structure prediction software to identify extracellular loops of OmpA2, and determined these are involved in interactions with epithelial cells as evidenced by inhibition of adherence and invasion of P. gingivalis by synthetic extracellular loop peptides and the ability of the peptides to mediate interaction of latex beads with human cells. In particular, we observe that OmpA2‐loop 4 plays an important role in the interaction with host cells. These data demonstrate for the first time the important role of P. gingivalis OmpA2 extracellular loops in interaction with epithelial cells, which may help design novel peptide‐based antimicrobial therapies for periodontal disease.