Search

There has been little exploration of acute myocarditis trends in children despite notable advancements in care over the past decade. We explored trends in pediatric hospitalizations for acute myocarditis from 2007 to 2016 in the United States (US). This was a retrospective, serial cross-sectional study of the National Inpatient Sample database from 2007 to 2016, identifying patients ≤18 years hospitalized with acute myocarditis. Patient demographics and incidence trends were examined. Other relevant clinical and resource utilization outcomes were also explored. Out of 60,390,000 weighted pediatric hospitalizations, 6371 were related to myocarditis. The incidence of myocarditis increased from 0.7 to 0.9 per 100,000 children (p0.0001) over the study period. The mortality decreased from 7.5% to 6.1% (p = 0.02). A significant inflation-adjusted increase by $4,574 in the median hospitalization cost was noted (p = 0.02) while length of stay remained stable (median 6.1 days). Tachyarrhythmias were identified as the most common type of associated arrhythmia. The occurrence of congestive heart failure remained steady at 27%. In conclusion, in-hospital mortality associated with pediatric acute myocarditis has decreased in the United States over years 2007 to 2016 with a concurrent rise in incidence. Despite steady length of stay, hospitalization costs have increased. Future studies investigating long-term outcomes relating to acute myocarditis are warranted.

OBJECTIVE To determine the trends in tracheostomy placement and resource use in preterm infants less than or equal to 30 weeks gestational age (GA) with bronchopulmonary dysplasia (BPD) in the United States from 2008 to 2017. STUDY DESIGN This was a retrospective, serial cross-sectional study using data from the NIS. Inclusion criteria were: GA less than or equal to 30 weeks, hospitalization at less than or equal to 28 days of age, assignment of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) or ICD10-CM codes for BPD and tracheostomy. Trends in tracheostomy and resource utilization were assessed using Jonckheere-Terpstra test. p-value

Decades of research for an ideal sedative agent that could provide both sedation and analgesia with minimal side effects to the patients has failed to find one. Research was then shifted to finding combination of drugs which could suffice the ideal sedative agent. Of these Ketofol showed promising results.Aim of this study is to “Assess the efficacy and safety of propofol and ketamine amalgamation (ketofol) and comparing the superiority over ketamine and midazolam combination for procedural sedation”. In this prospective randomized single blind study, 50 patients between 15 to 60 years of both males and females, ASA Grade I and Grade II were allocated into two groups. Patients in group 1 received ketofol and group 2 patients received ketamine and midazolam. The comparison between the two groups was done using Two-Sample T-Test, With the help of SPSS version 15.0 Statistical calculator, sample size calculated = 5 to 17, and actual power calculated with this sample size was 0.990 to 0.997 which shows significance of the study.: The study showed statistically significant (p Ketofol is safe and efficient sedative combination which can be utilized in emergency department, daycare and OT settings with comfort, ease and without any complications. It is close to ideal sedative agent.

Background The incidence rate and economic burden of neonatal abstinence syndrome (NAS) are increasing in the United States (US). We explored the link between the length of stay (LOS) and hospitalization cost for neonatal abstinence syndrome in 2018. Methods This was a cross-sectional analysis of the 2018 national inpatient sample database. Newborn hospitalizations with neonatal abstinence syndrome and their accompanying comorbid conditions were identified using the International Classification of Diseases, 10th Edition diagnostic codes. Logistic regression was used to determine the impact of length of stay and the co-morbidities on inflation-adjusted hospital costs. Results The incidence of neonatal abstinence syndrome was 7.1 per 1000 births (95% CI 6.8-7.3) in 2018. The majority had Medicaid (84.1%), with a neonatal abstinence syndrome incidence of 13.2 (95% CI: 12.8-13.6). In adjusted analysis, every one-day increase in length of stay increased the hospital cost by $1,685 (95% CI: 1,639-1,731). Neonatal abstinence syndrome hospitalizations with Medicaid had a longer length of stay by 1.8 days (95% CI: 0.5-3.1). Co-morbidities further increased the length of stay: seizures: 13.8 days; sepsis: 4.1 days; respiratory complications: 4.4 days; and feeding problems: 5.8 days. Those at urban teaching hospitals had a longer length of stay by 7.3 days (95% CI: 5.8-8.8). Co-morbidities increased hospital cost as follows: seizures: $71,380; sepsis: $12,837; respiratory complications: $8,268; feeding problems: $7,737. The cost of hospitalization at large bed-size hospitals and urban teaching was higher by $5,243 and $12,005, respectively. Conclusion The incidence rate of neonatal abstinence syndrome remained high and was resource-intensive in 2018. Co-morbid conditions and hospitalization at urban teaching hospitals were major contributors to increased length of stay and hospital costs.

OBJECTIVES Although a growing body of evidence suggests that early transition to oral antimicrobial therapy is equally efficacious to prolonged intravenous antibiotics for treatment of acute pediatric osteomyelitis, little is known about the pediatric trends in peripherally inserted central catheter (PICC) placements. Using a national database, we examined incidence rates of pediatric hospitalizations for acute osteomyelitis in the United States from 2007 through 2016, as well as the trends in PICC placement, length of stay (LOS), and cost associated with these hospitalizations. METHODS This was a retrospective, serial cross-sectional study of the National Inpatient Sample database from 2007 through 2016. Patients ≤18 years of age with acute osteomyelitis were identified by using appropriate diagnostic codes. Outcomes measured included PICC placement rate, LOS, and inflation-adjusted hospitalization costs. Weighted analysis was reported, and a hierarchical regression model was used to analyze predictors. RESULTS The annual incidence of acute osteomyelitis increased from 1.0 to 1.8 per 100 000 children from 2007 to 08 to 2015 to 16 (P < .0001), whereas PICC placement rates decreased from 58.8% to 5.9% (P < .0001). Overall, changes in LOS and inflation-adjusted hospital costs were not statistically significant. PICC placements and sepsis were important predictors of increased LOS and hospital costs. CONCLUSIONS Although PICC placement rates for acute osteomyelitis significantly decreased in the face of increased incidence of acute osteomyelitis in children, LOS and hospital costs for all hospitalizations remained stable. However, patients receiving PICC placements had longer LOS. Further studies are needed to explore the long-term outcomes of reduced PICC use.

OBJECTIVES: Infantile hypertrophic pyloric stenosis (IHPS) is the most common reason for abdominal surgery in infants; however, national-level data on incidence rate and resource use are lacking. We aimed to examine the national trends in hospitalizations for IHPS and resource use in its management in the United States from 2012 to 2016. METHODS: We performed a retrospective serial cross-sectional study using data from the National Inpatient Sample, the largest health care database in the United States. We included infants aged ≤1 year assigned an International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, code for IHPS who underwent pyloromyotomy or pyloroplasty. We examined the temporal trends in the incidence rate (cases per 1000 live births) according to sex, insurance status, geographic region, and race. We examined resource use using length of stay (LOS) and hospital costs. Linear regression was used for trend analysis. RESULTS: Between 2012 and 2016, there were 32 450 cases of IHPS and 20 808 149 live births (incidence rate of 1.56 per 1000). Characteristics of the study population were 82.7% male, 53% white, and 63.3% on Medicaid, and a majority were born in large (64%), urban teaching hospitals (90%). The incidence of IHPS varied with race, sex, socioeconomic status, and geographic region. In multivariable regression analysis, the incidence rate of IHPS decreased from 1.76 to 1.57 per 1000 (adjusted odds ratio 0.93; 95% confidence interval 0.92–0.93). The median cost of care was $6078.30, whereas the median LOS was 2 days, and these remained stable during the period. CONCLUSIONS: The incidence rate of IHPS decreased significantly between 2012 and 2016, whereas LOS and hospital costs remained stable. The reasons for the decline in the IHPS incidence rate may be multifactorial.

OBJECTIVES:We examined the trends in the rate of Henoch-Schönlein purpura (HSP) hospitalizations and the associated resource use among children in the United States from 2006 through 2014.METHODS:Pediatric hospitalizations with HSP were identified by using International Classification of Diseases, Ninth Revision, code 287.0 from the National Inpatient Sample. HSP hospitalization rate was calculated by using the US population as the denominator. Resource use was determined by length of stay (LOS) and hospital cost. We used linear regression for trend analysis.RESULTS:A total of 16 865 HSP hospitalizations were identified, and the HSP hospitalization rate varied by age, sex, and race. The overall HSP hospitalization rate was 2.4 per 100 000 children, and there was no trend during the study period. LOS remained stable at 2.8 days, but inflation-adjusted hospital cost increased from $2802.20 in 2006 to $3254.70 in 2014 (P < .001).CONCLUSIONS:HSP hospitalization rate in the United States remained stable from 2006 to 2014. Despite no increase in LOS, inflation-adjusted hospital cost increased. Further studies are needed to identify the drivers of increased hospitalization cost and to develop cost-effective management strategies.

To examine the temporal trends in the incidence and outcomes of neonatal herpes simplex infections (NHSV) in the United States. We conducted a retrospective study using the National Inpatient Sample (NIS). Neonates ≤28 days old with ICD-9 codes for NHSV (054.xx) from 2003 to 2014 were included. Trends in the incidence, mortality, length of stay (LOS), and hospital cost were analyzed using Jonckheere–Terpstra test. NHSV increased from 7.9 to 10 per 100,000 live births from 2003–05 to 2012–14 (P = 0.04). Hospital costs increased from $21,650 to $27,843; P

BACKGROUND The management practices of Respiratory Distress Syndrome (RDS) in the newborn have changed over time. We examine the trends in the epidemiology, resource utilization, and outcomes (mortality and bronchopulmonary dysplasia [BPD]) of RDS in preterm neonates ≤34 weeks gestational age (GA) in the United States. METHODS In this retrospective serial cross-sectional study, we used ICD-9 codes to classify preterm infants GA ≤34 weeks between 2003 and 2014 from the National Inpatient Sample as having RDS or not. Trends in the prevalence of infants defined as RDS by ICD-9 code (ICD9-RDS), length of stay, BPD, and mortality were analyzed using Cochran-Armitage and Jonckheere-Terpstra tests and multivariable logistic regression. RESULTS Of 1 526 186 preterm live births with GA ≤34 weeks, 554 409 had ICD9-RDS (260 cases per 1000 live births) with the prevalence increasing from 170 to 361 (Ptrend 96 h (60.4 to 56.6%; Ptrend

International audience

Background: Acute hematogenous osteomyelitis is a frequent cause of hospitalization and current literature suggests that early transition to oral antibiotics may be equally as effective as long-term intravenous antimicrobial administration. Our aim was to explore contemporary trends in acute osteomyelitis hospitalizations, resource utilization, and central/peripherally inserted central catheter (PICC) line placement among hospitalized children with osteomyelitis in the United States. Methods: This was a retrospective, serial cross-sectional study using data from the 2007-2016 editions of the National Inpatient Sample, the largest healthcare database in the United …

Classical meta-absorber designs usually have a tradeoff between bandwidth, efficiency, and thickness. Here, we introduce the concept of a nonlocal acoustic metasurface absorber by using a bridge structure connecting resonating unit cells to improve the performances of the meta-absorber. By utilizing the coupling effect between the adjacent unit cells, ultrabroadband sound absorption is achieved with deep-wavelength thickness. The physical mechanism of the nonlocal acoustic metasurface absorber is investigated and uncovered by developing analytical models. We theoretically and numerically study the nonlocal metasurface with a connecting bridge and the traditional metasurface without a bridge. The nonlocality can introduce three specific effects: the optimization of effective acoustic impedances, the shift of Fabry-Perot resonant frequencies, and the enhancement of the coupling effects between adjacent unit cells. These effects contribute to improve the bandwidth and the efficiency of the acoustic meta-absorber. We numerically and experimentally achieve an average absorption coefficient larger than 0.9 within the ultrabroadband bandwidth extending from about 600 to 2600 Hz, with a metasurface of 6.8 cm, viz., \ensuremath{\lambda}/9 for the lowest frequency. Our finding demonstrates the advantage of nonlocal acoustic metasurface to conceive a subwavelength sound meta-absorber.

PD-1/PD-L1 pathway plays a role in inhibiting immune response. Therapeutic antibodies aimed at blocking the PD-1/PD-L1 interaction have entered clinical development and have been approved for a variety of cancers. However, the clinical benefits are reduced to a group of patients. The research in combined therapies, which allow for a greater response, is strongly encouraging. We previously characterized a polyphenol-rich extract from Caesalpinia spinosa (P2Et) with antitumor activity in both melanoma and breast carcinoma, as well as immunomodulatory activity. We hypothesize that the combined treatment with P2Et and anti-PD-L1 can improve the antitumor response through an additive antitumor effect. We investigated the antitumor and immunomodulatory activity of P2Et and anti-PD-L1 combined therapy in B16-F10 melanoma and 4T1 breast carcinoma. We analyzed tumor growth, hematologic parameters, T cell counts, cytokine expression, and T cell cytotoxicity. In the melanoma model, combined P2Et and anti-PD-L1 therapy has the following effects: decrease in tumor size; increase in the number of activated CD4 + and CD8 + T cells; decrease in the number of suppressor myeloid cells; increase in PD-L1 expression; decrease in the frequency of CD8 + T cell expressing PD-1; improvement in the cytotoxic activity of T cells; and increase in the IFN γ secretion. In the breast cancer model, P2Et and PD-L1 alone or in combination show antitumor effect with no clear additive effect. This study shows that combined therapy of P2Et and anti-PD-L1 can improve antitumor response in a melanoma model by activating the immune response and neutralizing immunosuppressive mechanisms.

The purpose of this article is to examine the literature on risk management in projects and to provide a robust and structured literature review on risk sources in project management. We developed a systematic review and we found 817 articles on the data bases. We selected 68 articles. Results show 538 sources of risk in projects. We categorized these sources on 25 constructs. This research helps project managers to identify risks prior to the start of the project; and allows to develop appropriate measures to reduce or mitigate risks at an early stage of a project. O objetivo deste artigo é examinar a literatura sobre gerenciamento de riscos em projetos e for-necer uma revisão de literatura robusta e estruturada sobre fontes de risco no gerenciamento de projetos. Foi realizada uma revisão sistemática da literatura e encontrados 817 artigos. 68 artigos foram seleciona-dos. Os resultados mostram que existem 538 fontes de risco em projetos. Essas fontes foram agrupadas em 25 categorias. Esta pesquisa auxilia os gerentes de projetos a estimar os riscos antes do início de um projeto e permite desenvolver medidas adequadas para diminuir ou mitigar os riscos em um estágio inicial de um projeto.

Background: Intracranial hemorrhage (ICH) is a rare but severe complication in patients with immune thrombocytopenia (ITP). We aimed to examine the incidence and outcomes of ICH among ITP hospitalizations and factors associated with it. Additionally, we studied resource utilization for these hospitalizations. Methods: Using National (Nationwide) Inpatient Sample, International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM/ICD-10-CM) codes, we studied ITP hospitalizations with occurrence of ICH between 2007 and 2016. Result: Out of 348,906 weighted ITP hospitalizations, ICH occurred in 3,408 encounters (incidence 1.1 ± 0.04%). The incidence remained stable over time (2007-2008: 1.01%, 2015-2016: 1.20%; P = 0.3). People with age ≥25 years, especially those aged ≥65 years (odds ratio [OR] 3.69, 95% confidence interval [CI] 2.34-5.84), or those with gastrointestinal bleed (OR 1.60, 95% CI 1.18-2.16) were significantly more likely to develop ICH. Female gender (OR 0.81, 95% CI 0.68-0.97) had lower odds for developing ICH. Overall mortality in ITP hospitalizations with ICH was 26.7%. Length of stay (LOS) was longer (4.8 vs. 2.6 days) and costs of hospitalization (COH) were higher ($20,081 vs. $8,355) in ICH hospitalizations compared to non-ICH ITP hospitalizations. Increasing age and comorbidities such as gastrointestinal bleed, hematuria, and other bleeding were also associated with longer LOS and higher COH. Conclusion: Although rare, ICH in ITP was associated with a high mortality and increased resource utilization. Clinicians should be cognizant of factors associated with risk of ICH in ITP, and future studies should reassess the ICH trends to study the impact of novel therapeutic options such as thrombopoietin receptor agonists.

Background: Air or barium enema reduction is becoming increasingly common and safer for pediatric intussusception. However, little is known about trends of pediatric intussusception requiring surgical intervention in the United States. Methods: National Inpatient Sample database was analyzed from 2005-2014 to identify pediatric (≤18 years) intussusceptions along with procedures such as enema and/or surgical intervention. Trends in the rates of surgical intervention were examined according to encounter-level (age, gender, race, comorbidities) and hospital-level (hospital census region, teaching status) characteristics. Outcomes of pediatric intussusception requiring surgical intervention were analyzed in terms of length of stay and cost of hospitalization. Factors associated with surgical intervention were also analyzed. P value of < 0.05 was considered significant. Results: Out of 21,835 intussusception hospitalizations requiring enema or surgical intervention, 14,415 (66%) had surgical intervention; 90% of which (12,978) had no preceding enema. Surgical intervention rates among intussusception hospitalizations varied by age (highest < 1 year), gender (male > females) and race (Hispanics > Whites and Blacks). During the study period, overall surgical intervention rate remained stable (2.2 to 1.7, P=0.07) although it declined in those under 1 year of age. Children with severe disease, gastrointestinal comorbidities over the age of 4 years had increased odds of surgical intervention, whereas hospitalization in large and urban teaching hospitals had decreased odds of surgical intervention. Length of stay and hospital cost remained stable from 2005-2014. Conclusion: The rates of surgical intervention and resource utilization for pediatric intussusception remained stable from 2005-2014, however they declined significantly in infants. The proportion of intussusception hospitalization requiring surgery remains high and further studies are needed to explore the possible factors.

Gastroschisis is a severe congenital anomaly associated with a significant morbidity and mortality. There are limited temporal trend data on incidence, mortality, length of stay, and hospital cost of gastroschisis. Our aim was to study these temporal trends using the National Inpatient Sample (NIS). We identified all neonatal admissions with a diagnosis of gastroschisis within the NIS from 2010 through 2014. We limited admission age to ≤ 28 days and excluded all those transferred to other hospitals. We estimated gastroschisis incidence, mortality, length of hospital stay, and cost of hospitalization. For continuous variables, trends were analyzed using survey regression. Cochrane–Armitage trend test was used to analyze trends for categorical variables. P

Background: The American Academy of Pediatrics reissued its guidelines on the management of jaundice in newborns born at ≥35 weeks gestation in 2004. The impact of this on the management of jaundice and the incidence of kernicterus in the United States (US) is unknown Objective: To examine the trends in hospitalization for neonatal jaundice and kernicterus and their associated resource utilization in the United States from 2006 to 2017 Design/Methods: This was a retrospective, serial cross-sectional study using data …

The fisheries management policy shift towards resource user participation in Malawi in the early 1990s resulted in mixed benefits among small-scale fishers, with many applauding the changes. This paper considers the impacts of these policy changes on government and within the fishing communities around Lake Chiuta whose fisheries co-management experience is considered successful. Benefits to the communities range from gaining government support in excluding non-local fishers using destructive fishing gear to increased household incomes and improved livelihoods, while benefits to government range from taking credit for establishing a sustainable fishery and co-management arrangements to reduced resource management costs. Community costs include financial resources and time spent by resource user representative organisations in enforcing fishing regulations. These findings enable a more balanced assessment of neoliberal claims about the benefits of delegating management responsibilities and downloading costs of management onto fishing communities and organisations.

International audience; We theoretically and experimentally propose two designs of broadband low-frequency acoustic metasurface coiled absorbers (Sample I/Sample II) for the frequency ranges of 460 Hz–972 Hz and 232 Hz–494 Hz (larger than 1 octave), with absorption larger than 0.8 (average is 0.87), and having the ultra-thin thickness of 4.5 cm and 9 cm respectively (λ/17 for the lowest working frequency and λ/8 for the highest frequency). The designed supercell consists of 16 different unit cells corresponding to 16 eigen frequencies for resonant absorptions. The coupling between multiple resonances leads to broadband absorption effect in the full range of the targeted frequency spectrum. In addition, the coiling structure lead to the ultra-thin thickness of the metasurface absorbers. Our conceived ultra-thin low-frequency broadband absorbers may lead to pragmatic implementations and applications in noise control field.

Hyperoxia plays a key role in the development of bronchopulmonary dysplasia (BPD), a chronic lung disease of preterm infants. Infants with BPD often have brain injury that leads to long-term neurodevelopmental impairment, but the underlying mechanisms that control BPD-induced neurodevelopmental impairment remain unclear. Our previous studies have shown that hyperoxia-induced BPD in rodents is associated with lung inflammasome activation. Here, we tested the hypothesis that hyperoxia-induced lung and brain injury is mediated by inflammasome activation, and that inhibition of caspase-1, a key component of the inflammasome, attenuates hyperoxia-induced lung and brain injury in neonatal mice. C57/BL6 mouse pups were randomized to receive daily intraperitoneal injections of Ac-YVAD-CMK, an irreversible caspase-1 inhibitor, or placebo during exposure to room air or hyperoxia (85% O2) for 10 days. We found that hyperoxia activated the NLRP1 inflammasome, increased production of mature IL-1β, and upregulated expression of p30 gasdermin-D (GSDMD), the active form of GSDMD that is responsible for the programmed cell death mechanism of pyroptosis in both lung and brain tissue. Importantly, we show that inhibition of caspase-1 decreased IL-1β activation and p30 GSDMD expression, and improved alveolar and vascular development in hyperoxia-exposed lungs. Moreover, caspase-1 inhibition also promoted cell proliferation in the subgranular zone and subventricular zone of hyperoxia-exposed brains, resulting in lessened atrophy of these zones. Thus, the inflammasome plays a critical role in hyperoxia-induced neonatal lung and brain injury, and targeting this pathway may be beneficial for the prevention of lung and brain injury in preterm infants.

Script identification is an essential task especially in India because of existence of 13 different scripts for writing 22 languages. Major applications of script identification are document sorting, automatic translation, selecting of OCR (Optical Character Recognition) and text area identification. Traditionally, researchers have used feature based methods for script identification but it can be automated through deep learning techniques to reduce comprehensive time. Moreover, CNN (Convolutional Neural Network) based deep learning approaches are less explored for script identification problem. Intention behind this survey on script identification is to make researchers more perceived about the usefulness of deep learning techniques and more specifically, the significance of CNN to deal with script identification problem. This paper contains a useful survey on both feature-based and deep learning based domains on popular foreign and Indian scripts. We have shown comparative analysis between both domains which clearly concludes that deep learning methods could be more useful as compared to feature based methods. In addition, limitations and usefulness of CNN based best practices are also presented.

We introduce a multi-coiled acoustic metasurface providing a quasi-perfect absorption (reaching 99.99% in experiments) at extremely low-frequency of 50 Hz, and simultaneously featuring an ultrathin thickness down to {\lambda}/527 (1.3 cm). In contrast to the state of the art, this original conceived multi-coiled metasurface offers additional degrees of freedom capable to tune the acoustic impedance effectively without increasing the total thickness. We provide analytical derivation, numerical simulation and experimental demonstrations for this unique absorber concept, and discuss its physical mechanism which breaks the quarter-wavelength resonator theory. Furthermore, based on the same conceptual approach, we propose a broadband lowfrequency metasurface absorber by coupling unit cells exhibiting different properties.

This research aimed to find main users, frequent utilized tasks, major usability problems, and the context of use of a neonatal incubator (NI) present in a neonatal intensive care unit from a Brazilian hospital and to find out the problems faced by a new user. The chosen methods were the heuristics analysis, contextual investigation, and usability test (UT). Nurses and technicians are the main users of NIs. The predominant contexts of use are the admission of newborns and the replacement of the equipment. Eight selected tasks were performed in the UT, and the most significant problems refer to alarms and configuration of the Air and Skin Modes, because the interface is not intuitive to novice users. Therefore, mitigating errors should be an investment in human factor engineering methods from the beginning of the product development process to the training of the main users.

To assess the trends of inpatient resource use and mortality in pediatric hospitalizations for fever with neutropenia in the US from 2007 to 2014.Using National (Nationwide) Inpatient Sample (NIS) and International Classification of Diseases, Ninth Revision, Clinical Modification codes, we studied pediatric cancer hospitalizations with fever with neutropenia between 2007 and 2014. Using appropriate weights for each NIS discharge, we created national estimates of median cost, length of stay, and in-hospital mortality rates.Between 2007 and 2014, there were 104 315 hospitalizations for pediatric fever with neutropenia. The number of weighted fever with neutropenia hospitalizations increased from 12.9 (2007) to 18.1 (2014) per 100 000 US population. A significant increase in fever with neutropenia hospitalizations trend was seen in the 5- to 14-year age group, male sex, all races, and in Midwest and Western US hospital regions. Overall mortality rate remained low at 0.75%, and the 15- to 19-year age group was at significantly greater risk of mortality (OR 2.23, 95% CI 1.36-3.68, P = .002). Sepsis, pneumonia, meningitis, and mycosis were the comorbidities with greater risk of mortality during fever with neutropenia hospitalizations. Median length of stay (2007: 4 days, 2014: 5 days, P .001) and cost of hospitalization (2007: $8771, 2014: $11 202, P .001) also significantly increased during the study period.Our study provides information regarding inpatient use associated with fever with neutropenia in pediatric hospitalizations. Continued research is needed to develop standardized risk stratification and cost-effective treatment strategies for fever with neutropenia hospitalizations considering increasing costs reported in our study. Future studies also are needed to address the greater observed mortality in adolescents with cancer.

To determine trends in neonatal extracorporeal membrane oxygenation (ECMO) utilization from 2002–2011. Using the Nationwide inpatient sample (NIS), we conducted a population-based retrospective cohort study to identify ECMO utilization among neonates. Incidence of ECMO utilization, length of stay (LOS), cost and mortality were estimated. In all, 33,367,146 neonates were identified of which 7603 (18 per 100,000 live births) underwent ECMO. Neonatal ECMO increased from 12 to 23 runs per 100,000 live births. Mortality was 48.4%, decreasing from 47.5 to 41.9% between 2002 and 2011. On multivariate analysis, mortality was significantly higher for infectious indications (OR 4.1; CI 1.1–16.0), E-CPR (OR 3.8; CI 1.4–10.7) and cardiac indications (OR 2.0; CI 1.5–2.8). On hierarchical regression, LOS increased by 1.6 days each year (p = 0.02) and cost of hospitalization increased by $14,033 each year (p

Objective: the present study aimed to investigate whether dental wear depth perception has influence on the final quality of aesthetic direct restorations in the pre-clinical setting. Material and Methods: eighty one participants were assigned to one of three groups (n=27): G1, beginning dentistry students; G2, intermediate dentistry students; and G3, advanced dentistry students. All groups were required to prepare a tooth for facet of 1mm in depth. Subsequently, teeth were restored with opaque or translucent composite resin. Results: dental wear was different among the groups (p 0.05). Conclusion: technical training and clinical experience contribute to the better dental wear depth perception of undergraduate dental students. No direct correlation between the dental wear depth perception and the quality of shade matching of restored artificial teeth could be performed in the pre-clinical environment. Keywords: Dental education; Motor skills; Color; Dental Aesthetics

Background: Intracranial hemorrhage (ICH) is a rare but severe complication in patients with immune thrombocytopenia (ITP). It is unclear whether the incidence of ICH has changed over time. We aimed study the incidence of ICH among ITP hospitalizations and factors associated with its occurrence from 2007-2016. Additionally, we examined the outcomes of ITP hospitalizations with ICH and resource utilization (length of stay, cost of hospitalization) during this time period. Methods: We used data from the National Inpatient Sample (NIS) database from 2007-2016. ITP hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code '287.31' and ICD-10-CM code 'D69.3'. Pertinent ICD-9-CM and ICD-10-CM codes were used to identify ICH. Baseline characteristics of ITP hospitalizations with and without ICH were compared using chi-square test and Wilcoxon rank-sum test for categorical and continuous variables, respectively. For trend analysis, chi-square test of trend for proportions was used with Cochrane Armitage test. Survey logistic regression was used to analyze factors associated with the occurrence of ICH and mortality in ITP hospitalizations with ICH. To account for the complex design of NIS, hierarchical regression was used to analyze the factors associated with of length of stay (LOS) and cost of hospitalization (COH). Beta coefficient and 95% confidence intervals (CI) were reported. P-value Results: Between 2007 and 2016, 348,906 ITP hospitalizations were identified. The incidence of ICH was 0.98% (n=3,408). Median age of patients with reported ICH was significantly higher than those without ICH [63.4 (range 47.1-76.7) vs. 51.6 (28.6-70.0), P While the overall incidence of ICH remained stable during the study period (P=0.3), it varied by age, gender, and hospital region. Incidence significantly decreased in age ≤24 years (0.7% to 0.4%). On the contrary, it significantly increased among those ≥65 years (1.5% to 1.9%), females (0.9% to 1.1%), and hospitalizations in Northeast region (0.9% to 1.1%). Similarly, trend of mortality in hospitalizations with ICH increased from 28.1% in 2007-08 to 34.6% in 2015-16 (P On multivariate regression analysis, factors associated with higher likelihood of ICH were (Table 1): age 25-64 years [odds ratio (OR) 2.23; 95% CI 1.51-3.31], ≥65 years (OR 3.69; 95% CI 2.34-5.84), gastrointestinal (GI) bleed (OR 1.60; 95% CI 1.18-2.16), other bleed (OR 1.69; 95% CI 1.19-2.42), hospitalization in the West region (OR 1.62; 95% CI 1.26-2.08), in a medium (OR 1.64; 95% CI 1.08-2.47) or large hospital (OR 2.42; 95% CI 1.65-3.55) and in an urban-teaching hospital (OR 2.73; 95% CI 1.80-4.13). Female gender (OR 0.81; 95% CI 0.68-0.97) was associated with lower likelihood of ICH. Similarly, factors were associated with higher likelihood of mortality in ICH hospitalizations were: age 25-64 years (OR 6.73; 95% CI 4.11-11.03), ≥ 65 years (OR 16.94; 95% CI 10.14-28.30), GI bleed (OR 3.13; 95% CI 2.72-3.60), other bleeds (OR 1.66; 95% CI 1.31-2.10), hospitalizations at a large hospital (OR 1.17; 95% CI 1.00-1.37), and an urban teaching hospital (OR 1.23; 95% CI 1.02-1.48). Increasing age was associated with longer LOS, which also translated into higher COH (Table 2). Comorbidities such as GI bleed (2.5 days, 95% CI 2.1-2.9; $9,391, 95% CI 8,210-10,572), hematuria (1.1 days, 95% CI 0.6-1.6; $3,586, 95% CI 1,941-5,230), and other bleeding (1.1 days, 95% CI 0.7-1.5; $5,931, 95% CI 4,565-7,296) were also associated with longer LOS and higher COH. LOS decreased from 2007 to 2016 [-0.2 days, 95% CI (-0.3)-(-0.1)], however, the COH did not change. Conclusion: The overall incidence of ICH among ITP hospitalizations is low and remained stable from 2007-2016, which is reassuring. Nonetheless, a quarter of these hospitalizations resulted in mortality. ICH also significantly increased healthcare utilization in ITP hospitalizations through high LOS and COH. Older age and male gender were associated with higher ICH incidence and mortality. Future studies should reassess the ICH trends to study the impact of novel therapeutic options such as thrombopoietin receptor agonists. Disclosures No relevant conflicts of interest to declare.

Dalam memenuhi kebutuhan pangan nasional, tanaman padi merupakan komoditas utama yang diupayakan setiap tahun agar produksinya terus meningkat. Karakteristik wilayah yang berbeda-beda sangat mempengaruhi produksi padi yang dihasilkan. Tujuan yang ingin dicapai dalam penelitian ini adalah untuk mengelompokkan provinsi-provinsi di Indonesia dengan melakukan penerapan analisis gerombol deret waktu (clustering time series analysis). Penerapan analisis gerombol deret waktu dilakukan berdasarkan perkembangan data produksi padi setiap provinsi di Indonesia pada periode tahun 1968 – 2015. Clustering time series analysis dengan metode hierarki dan tidak berhierarki menghasilkan distribusi anggota gerombol yang sama pada 3 gerombol optimal. Secara rata-rata dari 3 gerombol yang terbentuk menghasilkan nilai koefisien silhouette sebesar 0.64 atau terkategori Good Classification. Kata kunci: deret waktu, gerombol, padi, silhouette

To determine the temporal trends in the epidemiology of acute disseminated encephalomyelitis (ADEM) and hospitalization outcomes in the US from 2006 through 2014.Pediatric (≤18 years of age) hospitalizations with ADEM discharge diagnosis were identified from the National (Nationwide) Inpatient Sample (NIS) for years 2006 through 2014. Trends in the incidence of ADEM with respect to age, sex, race, and region were examined. Outcomes of ADEM in terms of mortality, length of stay (LOS), cost of hospitalization, and seasonal variation were analyzed. NIS includes sampling weight. These weights were used to generate national estimates. P value of .05 was considered significant.Overall incidence of ADEM associated pediatric hospitalizations from 2006 through 2014 was 0.5 per 100 000 population. Between 2006 through 2008 and 2012 through 2014, the incidence of ADEM increased from 0.4 to 0.6 per 100 000 (P-trend.001). Black and Hispanic children had a significantly increased incidence of ADEM during the study period (0.2-0.5 per 100 000 population). There was no sex preponderance and 67% of ADEM hospitalizations were in patients9 years old. From 2006 through 2008 to 2012 through 2014 (1.1%-1.5%; P-trend 0.07) and median LOS (4.8-5.5 days; PIn this large nationwide cohort of ADEM hospitalizations, the incidence of ADEM increased during the study period. Mortality and LOS have remained stable over time, but inflation adjusted cost of hospitalizations increased.

Objective. To determine if a positive result on pneumography, diagnosis of gastroesophageal reflux disease (GERD), or nontreatment of those diagnosed with GERD with antireflux medications predicts an increased recurrence risk of apparent life-threatening event (ALTE) over the first 4 weeks of follow-up. Methods. Secondary analysis of a prospective, observational study of 300 infants diagnosed with ALTE. Results. The relative risk of recurrent ALTE was 1.26 (95% confidence interval = 0.47-3.38) among infants with an abnormal versus normal result on pneumography, 1.98 (1.02-3.86) among those diagnosed with GERD versus those not, and 0.46 (0.20-1.03) among those with GERD and started on antireflux medications versus those not started on such medications. Conclusions. Positive pneumography for apnea or reflux does not predict an increase in recurrence rate of an ALTE. Infants diagnosed with GERD are more likely to have recurrent ALTE; treatment with antireflux medications may reduce this risk.

Growth in preterm infants is compromised during the transition phase of nutrition, when parenteral nutrition (PN) volumes are weaned with advancing enteral nutrition (EN) feeds, likely due to suboptimal nutrient intakes during this time. We implemented new PN guidelines designed to maintain optimal nutrient intakes during the transition phase and compared growth outcomes of this cohort with a control group.A chart review was conducted on infants born32 weeks' gestation, before (control group) and after (study group) a new transition PN protocol was implemented in the neonatal intensive care unit. Weight parameters and nutrient intakes were calculated for the transition phase and compared between the 2 groups.Demographic and clinical characteristics of the 2 groups were comparable except for higher rates of sepsis in control group. Weight-for-age z scores at birth, at 1 week of life, and at the start of the transition phase were similar. At the end of the transition phase, infants in the study group had significantly higher z scores compared with the control group, even when corrected for sepsis, a difference that persisted at 35 weeks' gestation. During the transition phase, study infants gained 16.1 ± 4.6 g/kg/d compared with 13.2 ± 5.4 g/kg/d in control group ( P.001). Similar results were observed in the subset of expressed breastmilk-only fed infants (15.9 ± 4.6 g/kg/d in the study group compared with 13.2 ± 5.4 g/kg/d in the control group, P.004).Optimizing nutrition by the use of concentrated PN during the transition phase to maintain appropriate nutrient intakes improves growth rates in preterm infants.

A numerical study of stepped conical shaped nanoantennae as elements of silicon transmissive metasurfaces for operation in the visible wavelength bands is presenteD.Improved transmissivity in comparison to simple cylindrical geometries is observed., by Krupali D. Donda and Ravi S. Hegde

In this article we analyze co-management arrangements in Malawi through the lenses of the concept of power. We focus the analysis at the local level where most of the more important actors operate. These include the fishing communities and the Department of Fisheries, but also the traditional leaders and the new local management entities created through co-management reforms—the so-called beach village committees. Our analysis, based on decentralization and power frameworks, shows that co-management arrangements are characterized by unequal power distribution among these different actors, often resulting in the marginalization of the fishers themselves. In this new institutional landscape the role of the perceived key partners including the traditional leaders and the Department of Fisheries remains unclear, with a combination of both positive and negative outcomes.

After publication of this article [1], it was noticed that 3 authors were missed from the author list.

"A random sample attitude survey concluded a ten-year research effort on fisheries co-management that was carried out in Malawi, Mozambique and Zambia. The survey responses were analysed using a two-level hierarchical model that allowed conclusions about village-level institutions to be based on individual-level survey responses. The present paper describes the surveys background,methodology, and conclusions. Three of these conclusions are very clear from the survey results. The first is that co-management that is more responsive to the community is more effective. The second is that co-management institutions made up mainly of fishers are more effective than ones that incorporate a broad range of stakeholders. The third is that local conservation efforts being seen as making a positive contribution to village life is unrelated to their being seen as rule enforcement mechanisms."

BACKGROUND Splenectomy is considered an effective treatment for immune thrombocytopenia (ITP) with 70-80% response rate. However, its current use is limited in children with ITP. It is unclear if the rates of splenectomy have changed over time. Using a large nationally representative database, we aimed to study the trends of splenectomy in pediatric hospitalizations with ITP, and the factors associated with splenectomy during these encounters. METHODS Using National (Nationwide) Inpatient Sample (NIS), and international classification of diseases (9th revision), clinical modification (ICD-9-CM) codes, we studied pediatric ITP hospitalizations with occurrence of total splenectomy between 2005 and 2014. RESULTS Out of 37,844 weighted ITP hospitalizations from 2005 to 2014; total splenectomy was performed in 954 encounters. Splenectomy rate declined over time (3.4% [2005-2006] to 1.6% [2013-2014], P

The EU Geocapacity Project aims to obtain an estimation of the potential capacity of CO2 storage in deep saline aquifers, depleted hydrocarbon fields and coal beds in Europe. Prior to this project, the availability of data to calculate the storage capacity differed very much in each country. Some of them have already provided estimations for CO2 storage capacities in the framework of previous projects (e.g. GESTCO (FP5) and CASTOR (FP6)), while other countries have not been evaluated at all. Therefore, an important part of the work performed in the frame of the GeoCapacity project has been to homogenise estimation methodologies and reliability of data. Emphasis has been placed on the study of saline aquifers, as this type of geological formation, was until now, the less studied and most poorly understood compared to the depleted oil and gas fields. The work activities were organized in geographical groups to make them easier to manage. The Group South is composed of four Mediterranean countries: Spain, Italy, Slovenia and Croatia plus Bosnia–Herzegovina. Specific methodologies were adopted in order to achieve different goals: • Creation of maps of regional storage potential • Collection of geological information of storage sites • Estimation of storage capacities • Elaboration of databases to be inserted into GIS • Detailed analysis of case studies and scenarios for economic evaluation • Integration of the storage capacity data with emission sources and pipeline infrastructure Each of the countries belonging to Group South worked and continue to work in order to achieve such goals, despite of their different geological settings. The initial phase of such analyses included mapping of regional aquifers and locations of possible storages and seals described using data from hydrocarbon or water exploration, represented by borehole data and seismic surveys. Later on, structures contained in these aquifers were studied and CO2 storage capacity estimated with a higher precision. The two most promising or best defined structures in every country have been selected for a more detailed study. As a result of this project, it can be observed that CCS can play an important role in Mediterranean countries, as part of their strategy to mitigate GHG emission. Storage efficiency factor determination is the key issue, and also further exploration for new data.

Both obesity and hypertension are associated with left ventricular hypertrophy (LVH) in children. Our objective was to compare the prevalence of LVH in obese and nonobese subjects with casual hypertension who underwent ambulatory blood pressure monitoring (ABPM). Untreated children (aged 6-20 years) underwent 24-hour ABPM, and left ventricular mass index (LVMI) was measured. Subjects were classified into three groups: white coat hypertension (WCH), prehypertension (pre-HT), and hypertension (HT). The prevalence of LVH was compared between obese and nonobese subjects among the groups. Of 69 children who underwent ABPM, thirty-two patients (46%) had WCH, 13 (19%) had pre-HT, and 24 (35%) had HT. Mean age, BMI, and LVMI were similar in the groups (P = not significant [NS]). In all, 22 patients (32%) had LVH, with no difference among WCH versus pre-HT versus HT (37.5% vs. 46% vs. 16.7%, P = NS). Twenty-seven subjects (39%) were obese. The ratio of LVH in obese to nonobese was 55.5% to 16.6% (P = .001). In both pre-HT and WCH, patients with LVH had a significantly higher BMI z score (P = .02 and P = .01, respectively). LVMI correlated strongly with BMI z score (P = .0001) but not with any blood pressure parameter. Almost half of children with casual HT have WCH. LVH is prevalent in a third of children with HT, pre-HT, and WCH. In both pre-HT and WCH, patients with LVH were more likely to be obese. More than half of all the obese subjects had LVH. Obese children in all three groups may be at a greater risk for end organ damage.

We introduce the use of timing channels for digital watermarking of embedded hardware and software components. In addition to previous side channel watermarking schemes, timing analysis offers new perspectives for a remote verification of mobile and embedded products. Timing channels make it possible to detect the presence of a watermark solely by measuring program execution times.

High-transmissivity all-dielectric metasurfaces have recently attracted attention toward the realization of ultracompact optical devices and systems. Silicon-based metasurfaces, in particular, are highly promising considering the possibility of monolithic integration with complementary metal–oxide–semiconductor very large scale integration circuits. Realization of silicon-based metasurfaces operational in the visible wavelengths, however, remains a challenge. A numerical study of bilayered truncated-cone shaped nanoantenna elements is presented. Metasurfaces based on the proposed stepped conical geometry can be designed for operation in the 700- to 800-nm wavelength window and can achieve full-cycle phase response (0 to 2π) with an improved transmittance in comparison with the previously reported cylindrical geometry. A systematic parameter study of the influence of various geometrical parameters on the achievable amplitude and phase coverage is reported.

While scientists are paying increasing attention to the seismicity potentially induced by hydrocarbon exploitation, so far, little is known about the reverse problem, i.e. the impact of active faulting and earthquakes on hydrocarbon reservoirs. The 20 and 29 May 2012 earthquakes in Emilia, northern Italy (Mw 6.1 and 6.0), raised concerns among the public for being possibly human-induced, but also shed light on the possible use of gas wells as a marker of the seismogenic potential of an active fold and thrust belt. We compared the location, depth and production history of 455 gas wells drilled along the Ferrara-Romagna arc, a large hydrocarbon reserve in the southeastern Po Plain (northern Italy), with the location of the inferred surface projection of the causative faults of the 2012 Emilia earthquakes and of two pre-instrumental damaging earthquakes. We found that these earthquake sources fall within a cluster of sterile wells, surrounded by productive wells at a few kilometres' distance. Since the geology of the productive and sterile areas is quite similar, we suggest that past earthquakes caused the loss of all natural gas from the potential reservoirs lying above their causative faults. To validate our hypothesis we performed two different statistical tests (binomial and Monte Carlo) on the relative distribution of productive and sterile wells, with respect to seismogenic faults. Our findings have important practical implications: (1) they may allow major seismogenic sources to be singled out within large active thrust systems; (2) they suggest that reservoirs hosted in smaller anticlines are more likely to be intact; and (3) they also suggest that in order to minimize the hazard of triggering significant earthquakes, all new gas storage facilities should use exploited reservoirs rather than sterile hydrocarbon traps or aquifers.

Background Therapeutic cancer vaccines aim to boost the natural immunity against transformed cancer cells, and a series of adjuvants and co-stimulatory molecules have been proposed to enhance the immune response against weak self-antigens expressed on cancer cells. For instance, a peptide/CpG-based cancer vaccine has been evaluated in several clinical trials and was shown in pre-clinical studies to favor the expansion of effector T versus Tregs cells, resulting in a potent antitumor activity, as compared to other TLR ligands. Alternatively, the adjuvant activity of CD1d-restricted invariant NKT cells (iNKT) on the innate and adaptive immunity is well demonstrated, and several CD1d glycolipid ligands are under pre-clinical and clinical evaluation. Importantly, additive or even synergistic effects have been shown upon combined CD1d/NKT agonists and TLR ligands. The aim of the present study is to combine the activation and tumor targeting of activated iNKT, NK and T cells. Methods Activation and tumor targeting of iNKT cells via recombinant α-galactosylceramide (αGC)-loaded CD1d-anti-HER2 fusion protein (CD1d-antitumor) is combined or not with OVA peptide/CpG vaccine. Circulating and intratumoral NK and H-2Kb/OVA-specific CD8 responses are monitored, as well as the state of activation of dendritic cells (DC) with regard to activation markers and IL-12 secretion. The resulting antitumor therapy is tested against established tumor grafts of B16 melanoma cells expressing human HER2 and ovalbumin. Results The combined CD1d/iNKT antitumor therapy and CpG/peptide-based immunization leads to optimized expansion of NK and OVA-specific CD8 T cells (CTLs), likely resulting from the maturation of highly pro-inflammatory DCs as seen by a synergistic increase in serum IL-12. The enhanced innate and adaptive immune responses result in higher tumor inhibition that correlates with increased numbers of OVA-specific CTLs at the tumor site. Antibody-mediated depletion experiments further demonstrate that in this context, CTLs rather than NK cells are essential for the enhanced tumor inhibition. Conclusions Altogether, our study in mice demonstrates that αGC/CD1d-antitumor fusion protein greatly increases the efficacy of a therapeutic CpG-based cancer vaccine, first as an adjuvant during T cell priming and second, as a therapeutic agent to redirect immune responses to the tumor site. Electronic supplementary material The online version of this article (doi:10.1186/s40425-014-0039-8) contains supplementary material, which is available to authorized users.