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Little is known about the frequency of conflict between clinicians and families at the time of pediatric clinical ethics consultation (CEC) and what factors are associated with the presence of conflict. We conducted a retrospective cohort study at a single, tertiary urban US pediatric hospital that included all hospitalized patients between January 2008 and December 2019 who received CEC. Utilizing the hospital's CEC database that requires documentation of the presence of conflict by the consultant at the time of CEC, we determined the frequency and types of perceived conflict between families and clinicians. We also assessed the bivariable association between conflict and patient age, patient- or family-reported race/ethnicity, language for care, insurance status, clinical setting, and consultant involvement. Perceived conflict between clinicians and families was present in 44% (91/209) of CEC. We observed a higher occurrence of clinician-family conflict within certain consult topics than others, in particular, informed consent/parental permission (69%), cultural considerations (67%), benefit/harm assessment (58%), and limitation of life-sustaining treatment (58%). We found no other significant associations between the presence of perceived conflict and patient sociodemographic factors or CEC factors. Conflict between healthcare teams and families appears common in CEC, particularly with certain consult topics. Further study is needed to better understand conflict types, causes of conflicts, management and mediation strategies, and outcomes. [ABSTRACT FROM AUTHOR]

In this paper, the distributed optimal consensus problem is investigated for a class of continuous-time nonlinear multi-agent systems with input saturation. Non-quadratic cost functions are introduced to handle input constraints and a novel distributed optimal consensus protocol is derived based on event-triggered adaptive dynamic programming method. An online implement scheme is designed under actor-critic network framework in order to obtain the solutions of Hamilton-Jacobi-Bellman equations online. The computation and communication loads are effectively reduced since the weight estimation vectors and controllers are updated only at event-triggered instants. Detailed analysis is presented based on Lyapunov stability theory which guarantees that the weight estimation errors and local consensus errors are uniformly ultimately bounded. Furthermore, it proves that Zeno behaviour can be effectively avoided. Finally, the simulation examples are presented to validate the proposed strategy. [ABSTRACT FROM AUTHOR]

Capsaicinoids are pungent components in hot peppers, which have been detected in waste cooking oil. However, trace analysis of capsaicinoids in edible and crude vegetable oils is a challenging task due to the complex matrix. In this study, a simple liquid-liquid extraction and solid phase extraction (SPE) coupled with RP-UPLC-ESI-MS/MS method was developed for the quantification of capsaicinoids in edible and crude vegetable oils to screen the adulteration with waste cooking oil. This method was used to simultaneously determine 3 capsaicinoids (capsaicin, dihydrocapsaicin, and nordihydrocapsaicin) with capsaicin-d3, and dihydrocapsaicin-d3 as internal standards. This method allows the complete analysis of a sample in only an hour, even including sample preparation and chromatographic separation. The linear range of 3 capsaicinoids ranged between 0.5 and 40 µg/kg. The limit of detection (LOD) and limit of quantification (LOQ) for capsaicinoids were calculated as 0.15 and 0.5 µg/kg, respectively. Quantitative recoveries ranging from 92.9% to 105% were obtained by the analysis of spiked oil. The relative standard deviations were less than 5% (n = 6). The established method can potentially overcome the interference of triacylglycerols and fatty acids in edible and crude vegetable oils, and have been successfully applied to analyse real oil samples. This method provided a rapid and reliable method for the detection of adulteration of vegetable oils with waste cooking oils. [ABSTRACT FROM AUTHOR]

In this research, firstly astaxanthin (ASX)-loaded nanoemulsions (NEs) were produced using a convenient low-energy emulsion phase inversion method. The optimised ASX-NEs were prepared in the presence of Cremophor®EL and Labrafil®M 1944 CS, with a surfactant-to-oil ratio of 4:6. The ASX-NE droplets were spherical with a mean droplet diameter below 100 nm and a small negative surface charge. The system was stable without alteration of mean droplet diameter for three months. Then, the ASX-NE was functionalised with carboxymethyl chitosan (CMCS) through direct CMCS (0.02%) incorporation during the preparation process. The ASX chemical stability and skin permeability increased in the following order: ASX solution control < ASX-NE < CMCS-ASX-NE. Cell viability assays on L929 cells revealed low cytotoxicity of blank NE, ASX-NE and CMCS-ASX-NE in the range from 5 to 500 μg mL−1. In conclusion, the CMCS-ASX-NE might be a promising delivery vehicle in dermal and transdermal products. [ABSTRACT FROM AUTHOR]

A novel integrated design scheme of average dwell time scheduling strategy, dynamic bandwidth allocation policy and quantised control for a collection of networked control systems (NCSs) with time delay and communication constraints is proposed in this paper. A scheduling policy is presented to accommodate the limitation of communication capacity which depends on the convergence rate of closed-loop system and divergence rate of open-loop plant. Linear programming technique is adopted to dynamically allocate bit rate for each node and the strategy is used to make trade-offs between the network utilisation and the control performance which provides an effective way of optimising the quality of control (QoC) and the quality of service (QoS) for NCSs. Mid-tread uniform quantisers update the quantisation rules according to the assignment of the bit rate and convert the quantised state into a kind of input saturation with bounded disturbances. Taking into account the effect of dual scheduling strategy and quantisation, the NCSs are modelled as discrete-time switched systems with bounded disturbances. Furthermore, a scheduling and quantised feedback control co-design procedure is proposed for the simultaneous stabilisation of the collection of networked subsystems. Finally, a simulation example is given to illustrate the effectiveness of the proposed method. [ABSTRACT FROM AUTHOR]

Pile safety has received increasing attention in marine engineering, especially in the field of local scour. In this paper, a finite element numerical model is established for local scour around a cylinder in steady currents. The flow is described by unsteady Reynolds–averaged Navier–Stokes equations with a traditional k − ε turbulent closure model. The proposed scour model takes bed load into account. The Exner equation is solved to determine the bed variation and the moving mesh approach is used to capture the evolution of the bed. When the resulting slope exceeds the angle of repose, a novel sand-slide model based on Rodrigues' rotation formula is used to prevent simulation distortion. All the equations are discretized by the two-step Taylor–Galerkin algorithm, and the resulting approach is fast to implement with second-order accuracy in space. The numerical results are found to be in good agreement with the experimental data. [ABSTRACT FROM AUTHOR]

Severe fever with thrombocytopenia syndrome virus (SFTSV) nonstructural protein (NSs) is an important viral virulence factor that sequesters multiple antiviral proteins into inclusion bodies to escape the antiviral innate immune response. However, the mechanism of the NSs restricting host innate immunity remains largely elusive. Here, we found that the NSs induced complete macroautophagy/autophagy by interacting with the CCD domain of BECN1, thereby promoting the formation of a BECN1-dependent autophagy initiation complex. Importantly, our data showed that the NSs sequestered antiviral proteins such as TBK1 into autophagic vesicles, and therefore promoted the degradation of TBK1 and other antiviral proteins. In addition, the 8A mutant of NSs reduced the induction of BECN1-dependent autophagy flux and degradation of antiviral immune proteins. In conclusion, our results indicated that SFTSV NSs sequesters antiviral proteins into autophagic vesicles for degradation and to escape antiviral immune responses. [ABSTRACT FROM AUTHOR]

Our aim is to evaluate initial efficacy, safety, and durable response of eltrombopag in the treatment of Chinese children with chronic immune thrombocytopenia (cITP). This was a retrospective, single-center cohort study including 30 pediatric patients with cITP administered eltrombopag between 1 July 2017 and 1 January 2019. Patients with at least 12 weeks of eltrombopag treatment and available follow-up data were included. Initial response rate, durable response rate, bleeding events, and adverse events were assessed during the follow-up period. The median duration of eltrombopag administration was 6 months (range 3–8 months). The initial response rate was 73.3%. Patients with megakaryocyte count ≥100/slide or Treg <4.5% were more likely to achieve initial response. The median follow-up period was 10 months (range 6–20 months). A total of 53.2% of pediatric patients had a durable response of up to 20 months. Patients with megakaryocyte count ≥100/slide and Treg<4.5% had more than 60% durable response rates compared with individuals with megakaryocyte count<100/slide and Treg≥4.5%, respectively. No serious bleeding events or serious adverse events occurred during the study period. Eltrombopag not only shows excellent initial response but also has continued efficacy and safety. Patients with megakaryocyte count ≥100/slide and Treg<4.5% achieve increased initial response and more frequent durable response. [ABSTRACT FROM AUTHOR]

Background: Adolescents who undergo major surgery experience high rates of disabling acute and chronic postsurgical pain (CPSP). However, little is known about the subacute period when acute to chronic pain transition occurs. Aims: The aims of this study were to examine feasibility of electronic daily monitoring of pain and opioid use in adolescents during the first 30 days at home following major surgery and identify target features of subacute pain curves associated with CPSP at 4 months. Methods: Twenty-five youth (10–18 years) undergoing major musculoskeletal surgery reported daily pain severity, interference, and opioid use on the Brief Pain Inventory each evening for 30 days after hospital discharge to form short time series trajectories. At 4 months, youth reported on pain intensity and health-related quality of life. Characteristics of subacute pain severity and interference curves were compared by 4-month CPSP status. Results: At 4 months, 20.8% of youth met criteria for CPSP. During the 30-day monitoring period, youth who went on to develop CPSP reported high pain severity on 45.9% of days compared to 2.9% of days in youth who recovered (P = 0.005) and high pain interference on 49.4% of days vs. 9.7% in youth who recovered (P = 0.01). Pain variability and rate of change were not significantly associated with CPSP in our pilot sample. Conclusions: We found it feasible to collect daily pain data in youth recovering at home after major surgery. Pilot findings suggest that daily electronic monitoring may identify early recovery problems at home after surgery. Larger studies are needed to validate subacute pain trajectory features to identify risk for CPSP. [ABSTRACT FROM AUTHOR]

Purpose: To compare walking activity of children with and without cerebral palsy (CP) between the Netherlands and the United States. Methods: A cross-sectional analysis on walking activity data from an international retrospective comparison study including a convenience sample of 134 walking children aged 7-12 years with spastic CP, classified as Gross Motor Function Classification System (GMFCS) level I ( N = 64), II ( N = 49) or III ( N = 21), and 223 typically developing children (TDC) from the Netherlands and the United States. Walking activity was assessed during a one-week period using a StepWatch™ activity monitor. Outcomes were the daily number of strides, daily time being inactive and spent at low (0-15 strides/min), moderate (16-30 strides/min) and high stride rate (31-60 strides/min). Walking activity was compared between countries using multiple linear regression analyses. Results: Walking activity of TDC was not significantly different between countries. Compared to their American counterparts, Dutch children in GMFCS level I and II showed less walking activity ( p < 0.05), whereas Dutch children in GMFCS level III showed more walking activity ( p < 0.05). Conclusion: The absence of differences in walking activity between Dutch and American TDC, and the presence of differences in walking activity between Dutch and American children with CP suggest that between-country differences affect walking activity differently in children with CP. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for concussive symptoms ≥ 1 week. Methods: Retrospective cohort study of concussions in the RIO™ database 2006-2009 ( n = 1412) analysing risk factors for concussive symptoms ≥ 1 week. This study examined athlete's age, sex, weight, history of concussion, number of symptoms and specific symptoms. Data were stratified by football vs. non-football and analysed using Poisson regression to calculate relative risks and 95% confidence intervals. Results: Presenting with four or more symptoms was associated with double the risk for concussive symptoms ≥1 week for both football (95% CI = 1.3-3.5) and non-football players (95% CI = 1.4-4.6). History of prior concussion was associated with double the risk for concussive symptoms ≥1 week in football players only (95% CI = 1.3-3.5). Several symptoms were associated with concussive symptoms ≥1 week in all athletes: drowsiness, nausea and concentration difficulties. Sensitivity to light and noise was associated with concussive symptoms ≥1 week in non-football players only. Amnesia was associated with concussive symptoms ≥1 week in males, but not females. Loss of consciousness was not significant. Conclusions: Risk factors for concussive symptoms ≥1 week are identifiable and can potentially be used to prognosticate for athletes and design evidence-based return-to-play guidelines. [ABSTRACT FROM AUTHOR]

Objective: To investigate the role of stomatin-like protein 2 ( SLP-2), a novel cancer-related gene, in pulmonary squamous cell carcinoma (PSCC) and its implications. Methods: Immunohistochemical detection of SLP-2 was performed on 96 cases of PSCC with a tissue microarray. Results: SLP-2 was overexpressed in lung cancer compared with normal lung tissue ( p <0.001). High-level SLP-2 expression was significantly correlated with distant metastasis ( p = 0.025), decreased overall survival ( p = 0.018) and disease-free survival ( p = 0.017). SLP-2 overexpression was an independent prognostic factor in multivariate analysis using the Cox regression model ( p <0.05). Conclusion: SLP-2 overexpression is associated with tumour distant metastasis and poor prognosis in PSCC. SLP-2 could be regarded as a new significant prognostic biomarker for patients with PSCC. [ABSTRACT FROM AUTHOR]