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Introduction: Contemporary evidence notes the COVID-19 pandemic greatly impacted the utilization of physical and mental health services worldwide. The present study was therefore designed to evaluate the changes in the utilization of mental health services during the first year of the COVID-19 pandemic compared to previous years as well as to estimate the moderating role age had on these changes., Materials and Methods: Psychiatric data was collected from n = 928,044 individuals living in Israel. Rates of receipt of psychiatric diagnoses and purchases of psychotropic medication were extracted for the first year of the COVID-19 pandemic and for two comparison years. The odds of receiving a diagnosis or of purchasing a psychotropic medication during the pandemic were compared to control years using uncontrolled logistic regression models and controlled and logistic regression that accounted for differences between ages., Results: There was a general reduction of about 3-17% in the odds of receiving a psychiatric diagnosis or purchasing psychotropic medications during the pandemic year compared to control years. The bulk of tests conducted showed that reduction in the rates of receiving diagnoses and purchasing medications during the pandemic were evident or more profound in the older age groups. An analysis of a combined measure conclusive of all other measures revealed decreased rates of utilizing any service examined during 2020, with rates decreasing as age increases up to a decrease of 25% in the oldest age group (80-96)., Discussion and Conclusion: Changes in utilization of mental health services reveal the interplay between psychological distress that has been documented to increase during the pandemic and people's reluctance to seek professional assistance. This appears to be especially prominent among the vulnerable elderly, who may have received even less professional help for their emerging distress. The results obtained in Israel are likely to be replicated in other countries as well, given the global impact of the pandemic on adults' mental health and individuals' readiness to utilize mental healthcare services. Future research on the long-term impact of the pandemic on utilization of mental healthcare services is warranted, with an emphasis on the response of different populations to emergency situations., Competing Interests: Declaration of Competing Interest All the authors report no financial relationships with commercial interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Diffuse optical tomography (DOT) is a non-invasive method for detecting breast cancer; however, it struggles to produce high-quality images due to the complexity of scattered light and the limitations of traditional image reconstruction algorithms. These algorithms can be affected by boundary conditions and have a low imaging accuracy, a shallow imaging depth, a long computation time, and a high signal-to-noise ratio. However, machine learning can potentially improve the performance of DOT by being better equipped to solve inverse problems, perform regression, classify medical images, and reconstruct biomedical images. In this study, we utilized a machine learning model called "XGBoost" to detect tumors in inhomogeneous breasts and applied a post-processing technique based on genetic programming to improve accuracy. The proposed algorithm was tested using simulated DOT measurements from complex inhomogeneous breasts and evaluated using the cosine similarity metrics and root mean square error loss. The results showed that the use of XGBoost and genetic programming in DOT could lead to more accurate and non-invasive detection of tumors in inhomogeneous breasts compared to traditional methods, with the reconstructed breasts having an average cosine similarity of more than 0.97 ± 0.07 and average root mean square error of around 0.1270 ± 0.0031 compared to the ground truth.

Pyelectasis, also known as renal pelvic dilatation or hydronephrosis, is frequently found on fetal ultrasound. This study correlated prenatally-detected, moderate pyelectasis with postnatal outcomes. This retrospective, observational study was conducted at a tertiary medical center in Israel. The study group consisted of 54 fetuses with prenatal diagnosis of pyelectasis on ultrasound scan during the second trimester, defined as anteroposterior renal pelvic diameter (APRPD) 6-9.9 mm. Long-term postnatal outcomes and renal-related sequelae were obtained using medical records and telephone-based questionnaires. The control group included 98 cases with APRPD < 6 mm. Results indicate that fetal pyelectasis 6-9.9 mm was more frequent among males (68.5%) than females (51%, p = 0.034). We did not find significant correlations between 6-9.9 mm pyelectasis and other anomalies or chromosomal/genetic disorders. Pyelectasis resolved during the pregnancy in 15/54 (27.8%) cases. There was no change in 17/54 (31.5%) and 22/54 (40.7%) progressed to hydronephrosis Among the study group, 25/54 (46.3%) were diagnosed with neonatal hydronephrosis. There were more cases of renal reflux or renal obstruction in the study group compared to the control group 8/54 (14.8%) vs. 1/98 (1.0%), respectively; p = 0.002. In conclusion, most cases of 6-9.9 mm pyelectasis remained stable or resolved spontaneously during pregnancy. There was a higher rate of postnatal renal reflux and renal obstruction in this group; however, most did not require surgical intervention.

External cephalic version (ECV) is a cost-effective and safe treatment option for breech presentation at term. Following ECV, fetal well-being is assessed via a non-stress test (NST). An alternative option to identify signs of fetal compromise is via the Doppler indices of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV). Inclusion criteria were an uncomplicated pregnancy with breech presentation at term. Doppler velocimetry of the UA, MCA and DV were performed up to 1 h before and up to 2 h after ECV. The study included 56 patients who underwent elective ECV with a success rate of 75%. After ECV, the UA S/D ratio, UA pulsatility index (PI) and UA resistance index (RI) were increased compared to before the ECV ( p = 0.021, p = 0.042, and p = 0.022, respectively). There were no differences in the Doppler MCA and DV before or after ECV. All patients were discharged after the procedure. ECV is associated with changes in the UA Doppler indices that might reflect interference in placental perfusion. These changes are probably short-term and have no detrimental effects on the outcomes of uncomplicated pregnancies. ECV is safe; yet it is a stimulus or stress that can affect placental circulation. Therefore, careful case selection for ECV is important.

Background: Ultrasound is an accurate tool for diagnosing acute appendicitis. Conservative treatment for uncomplicated acute appendicitis is feasible and safe in children. However, no sonographic follow-up results from children with nonoperatively managed acute appendicitis have been reported., Objective: To describe the sonographic appearance of the appendix at follow-up ultrasound and to attempt to identify signs predictive of recurrent acute appendicitis., Materials and Methods: Children diagnosed with uncomplicated acute appendicitis and treated conservatively in our hospital from 2014 to 2019, and who presented for follow-up ultrasound at 3, 6 and 9 months, were included in our study. Clinical, laboratory and ultrasound data were recorded., Results: By the end of follow-up, 29 (14.2%) of 204 children in the cohort had developed recurrent acute appendicitis and 175 had recovered uneventfully. On follow-up ultrasound, appendiceal diameter measured > 6 mm in 56/204 (27.5%) cases at 3 months and in 9/26 (34.5%) at 6 months. After 3 months, 102/204 (50%) children had normal appendiceal diameter on ultrasound. Appendiceal diameter > 6 mm was associated with intraluminal fluid or sludge in the appendiceal lumen at 3- and 6-month follow-up (P < 0.001, P = 0.002, respectively). Comparing cases with and without recurrence, at 3-month follow-up, appendiceal diameter > 6 mm was found in 17/29 (58.6%) cases vs. 39/175 (22.3%), respectively (P < 0.001). Appendiceal diameter returned to normal in 12/19 (63.2%) cases in the nonrecurrent acute appendicitis group compared with 2/7 (28.6%) in the recurrent acute appendicitis group (P = 0.05) at the 6-month follow-up. Intraluminal fluid or sludge was detected more frequently in the recurrent acute appendicitis versus the nonrecurrent acute appendicitis group at 3- (P < 0.001) and 6-month (P = 0.001) follow-up., Conclusion: Progressive normalization of appendiceal diameter was noted on follow-up ultrasound. The prevalence of both appendiceal diameter > 6 mm and intraluminal fluid or sludge were found to be increased in children who later developed recurrent acute appendicitis. Ultrasound appears to be a useful tool for follow-up in children with conservatively treated uncomplicated acute appendicitis and possibly might help predict recurrence., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Several reports regarding the effects of thin meconium on maternal and neonatal outcomes are contradictory. This study evaluated the risk factors and obstetrical outcomes during deliveries complicated with thin meconium. This retrospective cohort study included all women with a singleton pregnancy, who underwent trial of labor >24 weeks of gestation, in a single tertiary center, over a six-year period. Obstetrical, delivery, and neonatal outcomes were compared between deliveries with thin meconium (thin meconium group) to deliveries with clear amniotic fluid (control group). Included in the study were 31,536 deliveries. Among them 1946 (6.2%) were in the thin meconium group and 29,590 (93.8%) were controls. Meconium aspiration syndrome was diagnosed in eight neonates in the thin meconium group and in none of the controls (0.41%, p < 0.001). In multivariate logistic regression analysis, the following adverse outcomes were found to be independently associated with increased odds ratio (OR) for thin meconium: intrapartum fever (OR 1.37, 95% CI 1.1-1.7), instrumental delivery (OR 1.26, 95% CI 1.09-1.46), cesarean delivery for non-reassuring fetal heart rate (OR 2.0, 95% CI 1.68-2.46), and respiratory distress requiring mechanical ventilation (OR 2.06, 95% CI 1.19-3.56). Thin meconium was associated with adverse obstetrical, delivery, and neonatal outcomes that should receive extra neonatal care and alert the pediatrician.

Objective: Postpartum depression (PPD), a major depressive episode with postpartum onset, develops in 15% of mothers. Although findings suggest sexual minority parents may be at risk for PPD, research among this population is scarce. We evaluated risk factors for PPD in a sample of sexual minority and heterosexual parents., Method: Four hundred and twenty seven heterosexual and one hundred and eleven sexual minority parents responded to a questionnaire distributed via social media that included demographics, the Edinburgh Postnatal Depression Scale, and the Multidimensional Scale of Perceived Social Support., Results: Sexual minority identity was not associated with increased risk for PPD. Pregnancy had no significant effect on the likelihood for PPD. Social support was negatively and significantly associated with probability for PPD., Conclusions: Our data suggest that sexual minority parents are not at increased risk for PPD, contrary to previous findings. The parental role, a psychosocial factor, is a more dominant risk factor than pregnancy itself, in the development of PPD.

Orofacial clefts include cleft lip (CL) and cleft palate (CP). This retrospective study assessed the efficacy of prenatal sonographic diagnosis of isolated and non-isolated cases of CL/CP and the postnatal outcomes of these children. Data regarding patients diagnosed and treated in the tertiary orofacial clinic from 2000 to 2020 were retrieved from electronic medical records and telephone-based questionnaires. Isolated CL was found in 7 cases (7.2%), isolated CP in 51 (53%), and combined CL/CP in 38 (39.5%), and 22 cases (23%) were associated with other anomalies. Among 96 cases, 39 (40.6%) were diagnosed prenatally. Isolated CL was diagnosed in 5/7 (71.5%), combined clefts in 29/38 (76.3%), and CP in 7/51 (13.8%). Prenatal chromosomal analysis performed in 32/39 (82%) cases was normal for all. The rate of surgical intervention in the first year of life was 36/38 (94.7%) for combined clefts, 5/7 (71.4%) for CL, and 20/51 (39%) for isolated CP. Most children had speech therapy (23/38 (60.5%), 3/7 (42.8%), and 41/51 (80.3%), respectively) and psychotherapy (6/38 (15.7%), 3/7 (42.8%) and, 15/51 (29.4%), respectively). The accuracy rate of sonographic prenatal diagnosis is low. Our results emphasize the suggested work-up of fetuses with CL and/or CP and improvements to parental counseling, as well as their understanding and compliance regarding post-natal therapeutic plans.

Social connections have been found to promote wellbeing among older adults. Studies note gender differences in older adults' social network characteristics and aspects of social support. The present study examined gender differences in the association of social network characteristics (number of strong social ties) and perceived tangible support among a sample of elders ( n = 278). Older men reported higher levels of perceived tangible support, while older women had more strong social ties. The number of strong social ties was associated with older women's, but not men's, increased sense of tangible support. Implications for cultivating elders' wellbeing respective of gender particularities are discussed.

Introduction: Conservative antibiotic treatment (CAT) for uncomplicated acute appendicitis (AUA) in children has been proven safe and efficacious. However, as data accumulate, high rates of recurrent appendicitis and subsequent appendectomy have been reported. This prospective longitudinal study evaluated risk-factors for recurrent AUA after CAT in a large cohort, with long-term follow-up., Materials and Methods: Children ages 5 to 16 years admitted to the Department of Pediatric Surgery from 2014 through 2018, diagnosed with AUA were eligible for CAT. We recorded their age, appendix outer diameter, white blood cell counts, C-reactive protein and other related signs and symptoms associated with AUA. Clinical and ultrasonographic follow-up was carried out until follow-up data collection ceased according to the study design (2014-2019)., Results: The cohort included 646 children who were initially treated successfully with CAT. Among them, 180 (28%) were readmitted for recurrent acute appendicitis during the follow-up period and 138 (21%) eventually had appendectomy. Overall success of 79% for CAT was recorded in this cohort. A multivariable model including; age, sex, appendiceal diameter, WBC and CRP, found the factors of older age, larger outer appendiceal diameter and high WBC counts significantly related to appendectomy during the follow-up period. We offer a decision tree model to predict appendectomy probabilities for patients based on their prognostic measurements., Conclusion: CAT in AUA in children should consider older age, larger outer appendiceal diameter and high WBC counts as risk-factors for recurrent AUA and subsequent appendectomy. The proposed decision tree model may help both clinicians and parents before CAT is chosen., Level of Evidence: Level 2., Competing Interests: Declaration of Competing Interest None to declare., (Copyright © 2021. Published by Elsevier Inc.)

6G is already being planned and will employ much higher frequencies, leading to a revolutionary era in communication between people as well as things. It is well known that weather, especially rain, can cause increased attenuation of signal transmission for higher frequencies. The standard methods for evaluating the effect of rain on symbol error rate are based on long-term averaging. These methods are inaccurate, which results in an inefficient system design. This is critical regarding bandwidth scarcity and energy consumption and requires a more significant margin of effort to cope with the imprecision. Recently, we have developed a new and more precise method for calculating communication system performance in case of rain, using the probability density function of rain rate. For high rain rate (above 10 mm/h), for a typical set of parameters, our method shows the symbol error rate in this range to be higher by orders of magnitude than that found by ITU standard methods. Our model also indicates that sensing and measuring the rain rate probability is important in order to provide the required bit error rate to the users. This will enable the design of more efficient systems, enabling design of an adaptive system that will adjust itself to rain conditions in such a way that performance will be improved. To the best knowledge of the authors, this novel analysis is unique. It can constitute a more efficient performance metric for the new era of 6G communication and prevent disruption due to incorrect system design.

Background: Noise reduction in the Neonatal Intensive Care Unit (NICU) is important for neurodevelopment, but the impact of music therapy on noise is not yet known., Objective: To investigate the effect of music therapy (MT) on noise levels, and whether individual MT (IMT) or environmental MT (EMT) increases meaningful signal-to-noise ratios (SNR)., Study Design: This case-control study was conducted in a level III NICU. Noise levels were recorded simultaneously from two open bay rooms, with a maximum of 10 infants in each room: one with MT and the other without. MT sessions were carried out for approximately 45 min with either IMT or EMT, implemented according to the Rhythm Breath and Lullaby principles. Noise production data were recorded for 4 h on 26 occasions of EMT and IMT, and analyzed using R version 4.0.2 software., Results: Overall average equivalent continuous noise levels (Leq) were lower in the room with MT as compared to the room without MT (53.1 (3.6) vs. 61.4 (4.7) dBA, p = 0.02, d = 2.1 (CI, 0.82, 3.42). IMT was associated with lower overall Leq levels as compared to EMT (51.2 vs. 56.5 dBA, p = 0.04, d = 1.6 (CI, 0.53, 1.97). The lowest sound levels with MT occurred approximately 60 min after the MT started (46 ± 3.9 dBA), with a gradual increase during the remaining recording time, but still significantly lower compared to the room without MT. The SNR was higher (18.1 vs. 10.3 dBA, p = 0.01, d = 2.8 (CI, 1.3, 3.86)) in the room with MT than in the room without MT., Conclusion: Integrating MT modalities such as IMT and EMT in an open bay NICU room helps reduce noise. Both MT modalities resulted in higher SNR compared to the control room, which may indicate that they are meaningful for the neurodevelopment of preterm infants.

Vitamin D plays a key role in regulating calcium and phosphate metabolism. However, whether maternal vitamin D levels affect fetal bone strength is unclear. This study assessed correlations between maternal 25(OH)D status and neonatal bone strength 25(OH)D levels, these were measured in the maternal and infant cord blood of 81 mother−infant dyads. Bone strength was measured using a quantitative ultrasound (QUS) of tibial bone speed of sound (SOS). Maternal vitamin D intake, medical history and lifestyle were evaluated from questionnaires. Maternal 25(OH)D levels were deficient (<25 nmol/L) in 24.7%, insufficient (25−50 nmol/L) in 37% and sufficient (>50 nmol/L) in 38.3%. The maternal and cord blood 25(OH)D levels correlated (r = 0.85, p < 0.001). Cord blood levels (57.9 ± 33.5 nmol/L) were higher than the maternal blood levels (46.3 ± 23.2: p < 0.001). The mean SOS was 3042 ± 130 m/s. The neonatal SOS and 25(OH)D levels were not correlated. The mean bone SOS levels were comparable in the three maternal and cord blood 25(OH)D groups. No correlation was found between the maternal 25(OH)D levels and the neonatal anthropometrics. Although the 25(OH)D levels were higher in Jewish mothers than they were in Muslim mothers (51.1 ± 22.6 nmol/L vs. 24 ± 14.7 nmol/L, respectively: p = 0.002) and in those who took supplemental vitamin D, the bone SOS levels were comparable. In conclusion, maternal vitamin D levels correlate with cord levels but do not affect bone strength or growth parameters.

Importance: Adolescent suicidality (ie, suicidal ideation or attempts) is a major public health concern. Cyberbullying experiences and perpetration have become increasingly prevalent and are associated with mental health burden, but their roles as independent suicidality risk factors remain unclear. Data are needed to clarify their contribution to teen suicidality to inform suicide prevention efforts., Objective: To examine whether cyberbullying experiences and perpetration are distinct stressors divergent from other forms of peer aggression experiences in their association with suicidality in early adolescence., Design, Setting, and Participants: This cross-sectional analysis used data collected between July 2018 and January 2021 from the Adolescent Brain Cognitive Development (ABCD) study, a large, diverse sample of US children aged 10 to 13 years., Exposures: Youth reports of cyberbullying experiences or perpetration., Main Outcomes and Measures: The main outcome was youth-reported suicidality (past or present, as reported in the ABCD 2-year follow-up assessment). Covariates included demographics, established environmental risk and protective factors for youth suicidality, psychopathology, and experiences or perpetration of offline peer aggression., Results: A total of 10 414 ABCD participants were included in this study. Participants had a mean (SD) age of 12.0 (0.7) years and 4962 (47.6%) were female; 796 (7.6%) endorsed suicidality. A total of 930 (8.9%) reported experiencing cyberbullying and 96 (0.9%) reported perpetrating cyberbullying. Of the perpetrators, 66 (69.0%) also endorsed experiencing cyberbullying. Controlling for demographics, experiencing cyberbullying was associated with suicidality (odds ratio [OR], 4.2 [95% CI, 3.5-5.1]; P < .001), whereas perpetrating cyberbullying was not (OR, 1.3 [95% CI, 0.8-2.3]; P = .30). Experiencing cyberbullying remained associated with suicidality when accounting for negative life events, family conflict, parental monitoring, school environment, and racial and ethnic discrimination (OR, 2.5 [95% CI, 2.0-3.0]; P < .001) and when further covarying for internalizing and externalizing psychopathology (OR, 1.8 [95% CI, 1.4-2.4]; P < .001). Both being a target and being a perpetrator of offline peer aggression were associated with suicidality (OR, 1.5 [95% CI, 1.1-2.0] for both), controlling for all covariates described earlier. Cyberbullying experiences remained associated with suicidality (OR, 1.7 [95% CI, 1.3-2.2]; P < .001, controlling for all covariates) when included with offline peer aggression experiences and perpetration., Conclusions and Relevance: In this cross-sectional study, experiencing-but not perpetrating-cyberbullying was associated with suicidality in early adolescence. This association was significant over and above other suicidality risk factors, including offline peer aggression experiences or perpetration. These findings can inform adolescent suicide prevention strategies, and they suggest that clinicians and educational staff working with this population should routinely evaluate for adolescents' experience with cyberbullying.

Introduction: There is no agreement regarding the best method for tube-feeding preterm infants. Few studies, to date, have evaluated the influence of different methods of enteral feeding on intestinal oxygenation. The use of near-infrared spectroscopy (NIRS) has permitted the noninvasive measurement of splanchnic regional oxygenation (rSO 2 S) in different clinical conditions. The aim of this prospective, single-center study was to compare rSO 2 S during continuous versus bolus feeding among stable preterm infants., Methods: Twenty-one preterm infants, less than 32 weeks gestation and appropriate for gestational age, were enrolled. All infants were clinically stable and on full tube feedings. Each infant received a bolus feeding initially (20 min duration), and after 3 h, a continuous feeding (5 h duration). Infants were evaluated 30 min before and 30 min after the bolus and continuous feedings. The regional splanchnic saturation (rSO 2 S) was measured using near-infrared spectroscopy (NIRS) technology and systemic saturation was measured with pulse oximetry. From these measurements, we calculated the splanchnic fractional oxygen extraction ratio (FOES) for each of the four intervals., Results: rSO 2 S decreased after continuous vs. bolus feeding ( p = 0.025), while there was a trend toward decreased SaO 2 after bolus feeding ( p = 0.055). The FOES, which reflects intestinal oxygen extraction, was not affected by the feeding mode ( p = 0.129)., Discussion/conclusion: Continuous vs. bolus feeding decreases rSO 2 S but does not affect oxygen extraction by intestinal tissue; after bolus feeding there was a trend towards decreased systemic saturation.

Background: Psychotherapy noncompletion rates for veterans and their families are high. This study sought to (a) measure noncompletion rates of such patients at a university-based treatment center, (b) compare veteran and family member attrition rates, (c) identify dropout predictors, and (d) explore clinicians' perspectives on treatment noncompletion., Method: Using quantitative and qualitative approaches, we analyzed demographic and clinical characteristics of 141 patients (90 military veterans; 51 family members) in a university treatment center. We defined dropout as not completing the time-limited therapy contract. Reviewing semistructured interview data assessing clinicians' perspectives on their patients' dropout, three independent raters agreed on key themes, with interrater coefficient kappa range .74 to 1., Results: Patient attrition was 24%, not differing significantly between veterans and family members. Diagnosis of major depression (MDD) and exposure-based therapies predicted noncompletion, as did higher baseline Hamilton Depression Rating Scale (HDRS) total scores, severe depression (HDRS > 20), lack of Beck Depression Inventory weekly improvement, and history of military sexual trauma. Clinicians mostly attributed noncompletion to patient difficulties coping with intense emotions, especially in exposure-based therapies., Conclusion: Noncompletion rate at this study appeared relatively low compared to other veteran-based treatment centers, if still unfortunately substantial. Patients with comorbid MDD/PTSD and exposure-based therapies carried greater noncompletion risk due to the MDD component, and this should be considered in treatment planning. Ongoing discussion of dissatisfaction and patient discontinuation, in the context of a strong therapeutic alliance, might reduce noncompletion in this at-risk population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Diffuse optical tomography (DOT) is a non-invasive imaging technique utilizing multi-scattered light at visible and infrared wavelengths to detect anomalies in tissues. However, the DOT image reconstruction is based on solving the inverse problem, which requires massive calculations and time. In this article, for the first time, to the best of our knowledge, a simple, regression-based cascaded feed-forward deep learning neural network is derived to solve the inverse problem of DOT in compressed breast geometry. The predicted data is subsequently utilized to visualize the breast tissues and their anomalies. The dataset in this study is created using a Monte-Carlo algorithm, which simulates the light propagation in the compressed breast placed inside a parallel plate source-detector geometry (forward process). The simulated DL-DOT system's performance is evaluated using the Pearson correlation coefficient (R) and the Mean squared error (MSE) metrics. Although a comparatively smaller dataset (50 nos.) is used, our simulation results show that the developed feed-forward network algorithm to solve the inverse problem delivers an increment of ∼30% over the analytical solution approach, in terms of R. Furthermore, the proposed network's MSE outperforms that of the analytical solution's MSE by a large margin revealing the robustness of the network and the adaptability of the system for potential applications in medical settings., Competing Interests: The authors declare no conflict of interest., (© 2022 Optica Publishing Group under the terms of the Optica Open Access Publishing Agreement.)

Objectives: To evaluate short-term effects of music therapy (MT) for premature infants and their caregivers on mother-infant bonding, parental anxiety, and maternal depression., Methods: Parallel, pragmatic, randomized controlled-trial conducted in 7 level III NICUs and 1 level IV NICU in 5 countries enrolling premature infants (<35 weeks gestational age at birth) and their parents. MT included 3 sessions per week with parent-led, infant-directed singing supported by a music therapist. Primary outcome was mother-infant bonding as measured by the Postpartum Bonding Questionnaire (PBQ) at discharge from NICU. Secondary outcomes were parents' symptoms of anxiety measured by General Anxiety Disorder-7 (GAD-7) and maternal depression measured by Edinburgh Postpartum Depression Scale (EPDS). Group differences at the assessment timepoint of discharge from hospital were tested by linear mixed effect models (ANCOVA)., Results: From August 2018 to April 2020, 213 families were enrolled in the study, of whom 108 were randomly assigned to standard care and 105 to MT. Of the participants, 208 of 213 (98%) completed treatment and assessments. Participants in the MT group received a mean (SD) of 10 sessions (5.95), and 87 of 105 participants (83%) received the minimum of 6 sessions. The estimated group effect (95% confidence interval) for PBQ was -0.61 (-1.82 to 0.59). No significant differences between groups were found (P = .32). No significant effects for secondary outcomes or subgroups were found., Conclusions: Parent-led, infant-directed singing supported by a music therapist resulted in no significant differences between groups in mother-infant bonding, parental anxiety, or maternal depression at discharge., Competing Interests: FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose., (Copyright © 2022 by the American Academy of Pediatrics.)

Optical imaging through diffuse media is a challenging issue and has attracted applications in many fields such as biomedical imaging, non-destructive testing, and computer-assisted surgery. However, light interaction with diffuse media leads to multiple scattering of the photons in the angular and spatial domain, severely degrading the image reconstruction process. In this article, a novel method to image through diffuse media using multiple modes of vortex beams and a new deep learning network named "LGDiffNet" is derived. A proof-of-concept numerical simulation is conducted using this method, and the results are experimentally verified. In this technique, the multiple modes of Gaussian and Laguerre-Gaussian beams illuminate the displayed digits dataset number, and the beams are then propagated through the diffuser before being captured on the beam profiler. Furthermore, we investigated whether imaging through diffuse media using multiple modes of vortex beams instead of Gaussian beams improves the imaging system's imaging capability and enhances the network's reconstruction ability. Our results show that illuminating the diffuser using vortex beams and employing the "LGDiffNet" network provides enhanced image reconstruction compared to existing modalities. An enhancement of ~ 1 dB, in terms of PSNR, is achieved using this method when a highly scattering diffuser of grit 220 and width 2 mm (7.11 times the mean free path) is used. No additional optimizations or reference beams were used in the imaging system, revealing the robustness of the "LGDiffNet" network and the adaptability of the imaging system for practical applications in medical imaging., (© 2022. The Author(s).)

While the ecological significance of hyporheic exchange and fine particle transport in rivers is well established, these processes are generally considered irrelevant to riverbed morphodynamics. We show that coupling between hyporheic exchange, suspended sediment deposition, and sand bedform motion strongly modulates morphodynamics and sorts bed sediments. Hyporheic exchange focuses fine-particle deposition within and below mobile bedforms, which suppresses bed mobility. However, deposited fines are also remobilized by bedform motion, providing a mechanism for segregating coarse and fine particles in the bed. Surprisingly, two distinct end states emerge from the competing interplay of bed stabilization and remobilization: a locked state in which fine particle deposition completely stabilizes the bed, and a dynamic equilibrium in which frequent remobilization sorts the bed and restores mobility. These findings demonstrate the significance of hyporheic exchange to riverbed morphodynamics and clarify how dynamic interactions between coarse and fine particles produce sedimentary patterns commonly found in rivers., (© 2021. The Author(s).)

Unbuffered stress levels may negatively influence preterm-infants' autonomic nervous system (ANS) maturation, thus affecting neurobehavior and psycho-emotional development. Music therapy (MT) is an evidence-based treatment modality in neonatal care. When coupled with skin-to-skin care (SSC), it may reduce stress responses in both preterm infants and their parents and enhance family-centered care. Accordingly, we aimed to compare the effects of combined MT and SSC and SSC alone on ANS stabilization in preterm infants. In a single-center, cluster-randomized trial design, ten two-month time-clusters were randomized to either combined MT and SSC or SSC alone. Families of preterm infants were offered two sessions of the allocated condition in the NICU, and a three-month follow up session at home. The primary outcome variable was stabilization of the ANS, defined by change in the high frequency (HF) power of heart rate variability (HRV) during the second session. Secondary outcomes included other HRV measures, parent-infant attachment, and parental anxiety at each session. Sixty-eight families were included. MT combined with SSC improved infants' ANS stability, as indicated by a greater increase in HF power during MT compared to SSC alone (mean difference 5.19 m 2 /Hz, SE = 1.27, p < 0.001) (95% confidence interval 0.87 to 2.05). Most secondary outcomes were not significantly different between the study groups. MT contributes to preterm-infants' autonomic stability, thus laying an important foundation for neuro-behavioral and psycho-emotional development. Studies evaluating longer-term effects of MT on preterm infants' development are warranted.

Purpose: This research was aimed at studying the evolution and roles of the Israeli physicians' professional social network as perceived by the members of the network., Methodology: The research examined a case study of RAMBAM/KEHILA professional networks, applying both qualitative and quantitative methods for establishing a grounded theory., Findings: Physicians want to be part of their professional community and consider the network as a place where the "wisdom of the crowd" exists. They seek approval for their initial line of reasoning regarding their clinical cases but will consider other approaches if such are suggested by persons of professional repute or if answers are based on evidence-based medicine. The evolved network constitutes an a-political space which has gained the trust of the community and enables physicians of various ranks to share experiences and thoughts. Moreover, the network fosters learning opportunities and the network dynamics have impact on physicians' professional development., Discussion: This unique ten-year longitudinal research examined the evolution of a professional social network. The research findings have practical and social implications. Practically, the study shows the values of professional network as an instrument for clinicians' lifelong learning and professional development. Socially, the study presents the professional network social role in facilitating social interactions when the network participants are involved in determining its roles and gain trust by avoiding any political or commercial interference., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: As veterans have high rates of posttraumatic stress disorder (PTSD) and historically poor treatment outcomes and high attrition, alternative treatments have gained much popularity despite lack of rigorous research. In this study, a recently developed and manualized 8-session group Equine-Assisted Therapy for PTSD (EAT-PTSD) was tested in an open trial to assess its preliminary feasibility, acceptability, and outcomes for military veterans., Methods: The study was conducted from July 2016 to July 2019. Sixty-three treatment-seeking veterans with PTSD enrolled. PTSD diagnosis was ascertained using the Structured Clinical Interview for DSM-5 , Research Version (SCID-5-RV) and confirmed using the Clinician-Administered PTSD Scale (CAPS-5). Mean age was 50 years, and 23 patients (37%) were women. Clinician and self-report measures of PTSD and depression were assessed at pretreatment, midtreatment, and posttreatment and at a 3-month follow-up. An intent-to-treat analysis and a secondary analysis of those who completed all 4 clinical assessments were utilized., Results: Only 5 patients (8%) withdrew from treatment, 4 before midtreatment and 1 afterward. Posttreatment assessment revealed marked reductions in both clinician-rated and self-reported PTSD and depression symptoms, which persisted at 3-month follow-up. Specifically, mean (SD) CAPS-5 scores fell from 38.6 (8.1) to 26.9 (12.4) at termination. Thirty-two patients (50.8%) showed clinically significant change (≥ 30% decrease in CAPS-5 score) at posttreatment and 34 (54.0%) at follow-up., Conclusions: Manualized EAT-PTSD shows promise as a potential new intervention for veterans with PTSD. It appears safe, feasible, and clinically viable. These preliminary results encourage examination of EAT-PTSD in larger, randomized controlled trials., Trial Registration: ClinicalTrials.gov identifier: NCT03068325., (© Copyright 2021 Physicians Postgraduate Press, Inc.)

Neonatal music therapy (MT) has become more accessible worldwide. Previous research suggests multiple benefits of MT for preterm infants and their caregivers; however, far too little attention has been paid to understanding the mechanisms of change in previous Neonatal Intensive Care Unit (NICU)-MT research so far. This perspective article describes potential mechanisms of MT interventions exposed during kangaroo mother care on the preterm infant's response (behavioral and physiological outcomes) and the mother-infant relationship. The paper focuses on the hypothalamic-pituitary-adrenal axis' role in stabilization of behavioral state, the autonomic nervous system's role in stabilization of physiologic state, as well as co-regulation as a potential mechanism for the developing of the parent-infant relationship. Mechanisms play a pivotal role in understanding variables related to the therapy course and well as in generating new knowledge regarding treatment susceptibility and optimizing resources. Understanding of the mechanisms of how interventions may lead to specific outcomes plays an important role in addressing the issue of improvement of currently available approaches of MT used in the NICU.

Objective: Military service members and veterans have high rates of posttraumatic stress disorder (PTSD), as do military family members. Exposure-based, cognitive-behavioral approaches have received ample research, but other PTSD therapies require further empirical attention. Interpersonal psychotherapy (IPT) targets affective awareness, life circumstances, and social support. IPT has shown efficacy for civilians with PTSD but awaits rigorous testing among military personnel; only two small military pilot studies and two case reports have been published. Military family members have received minimal attention from clinical outcomes research. Addressing these gaps, this open trial examined IPT for PTSD among veterans, service members, and family members, including a patient subset with comorbid PTSD and depression., Methods: Fifty U.S. military service members, veterans, and family members (age ≥18 years) were offered 14 sessions of IPT for PTSD. Individuals with psychosis, bipolar disorder, moderate or severe substance use disorders, or high suicide risk were excluded. PTSD and depressive symptoms were assessed at baseline, midtreatment, posttreatment, and 3-month follow-up., Results: Clinician-assessed PTSD (Clinician-Administered PTSD Scale) and depression (Hamilton Depression Rating Scale) symptoms decreased over time in the full sample and the comorbid PTSD/depression subset (p<0.05). Service members, veterans, and family members had similar treatment responses., Conclusions: Patients receiving IPT showed reductions in PTSD and depressive symptoms. These open trial findings provide preliminary support for the utility of IPT in reducing PTSD symptoms among veterans and family members. This largest IPT trial to date for PTSD in military patients also bolsters the literature on treating military family members.

(1) Background: This study investigated parents' motives for enrolling preterm infants into music therapy intervention studies during Neonatal Intensive Care hospitalization. (2) Methods: We surveyed Israeli parents of preterm infants after they consented or refused to participate in such studies. The pre-piloted questionnaires evaluated attitudes toward research and music therapy intervention studies. The study included 116 (57%) parents who agreed to participate in music therapy studies and 87 (43%) who declined. (3) Results: Infants of those who agreed to participate were younger (17 ± 2.3 vs. 28 ± 4.7 days old, p = 0.03) and sicker (Clinical Risk Index for Babies score 6.1 ± 2.7 vs. 3.68 ± 4.1, p = 0.04). More single-parent families declined to participate ( p = 0.05). Parents agreed to participate because they thought the study might help their child, would improve future care of preterm infants and increase medical knowledge (all p < 0.05). In addition, they perceived music as beneficial for brain development, thought it might improve bonding, and routinely listened to music daily. (4) Conclusions: When recruiting parents and preterm infants for music therapy intervention studies, one should highlight potential contributions to the child's health, future children's health and medical knowledge. Stressing music as a potential tool for brain development and augmenting bonding is important. The best time to recruit is when improvements are still anticipated.

Transport processes that lead to exchange of mass between surface water and groundwater play a significant role for the ecological functioning of aquatic systems, for hydrological processes and for biogeochemical transformations. In this study, we present a novel integral modeling approach for flow and transport at the sediment-water interface. The model allows us to simultaneously simulate turbulent surface and subsurface flow and transport with the same conceptual approach. For this purpose, a conservative transport equation was implemented to an existing approach that uses an extended version of the Navier-Stokes equations. Based on previous flume studies which investigated the spreading of a dye tracer under neutral, losing and gaining flow conditions the new solver is validated. Tracer distributions of the experiments are in close agreement with the simulations. The simulated flow paths are significantly affected by in- and outflowing groundwater flow. The highest velocities within the sediment are found for losing condition, which leads to shorter residence times compared to neutral and gaining conditions. The largest extent of the hyporheic exchange flow is observed under neutral condition. The new solver can be used for further examinations of cases that are not suitable for the conventional coupled models, for example, if Reynolds numbers are larger than 10. Moreover, results gained with the integral solver provide high-resolution information on pressure and velocity distributions at the rippled streambed, which can be used to improve flow predictions. This includes the extent of hyporheic exchange under varying ambient groundwater flow conditions., (© 2021 The Authors. Groundwater published by Wiley Periodicals LLC on behalf of National Ground Water Association.)

Riverine ecosystems can be conceptualized as 'bioreactors' (the riverine bioreactor) which retain and decompose a wide range of organic substrates. The metabolic performance of the riverine bioreactor is linked to their community structure, the efficiency of energy transfer along food chains, and complex interactions among biotic and abiotic environmental factors. However, our understanding of the mechanistic functioning and capacity of the riverine bioreactor remains limited. We review the state of knowledge and outline major gaps in the understanding of biotic drivers of organic matter decomposition processes that occur in riverine ecosystems, across habitats, temporal dimensions, and latitudes influenced by climate change. We propose a novel, integrative analytical perspective to assess and predict decomposition processes in riverine ecosystems. We then use this model to analyse data to demonstrate that the size-spectra of a community can be used to predict decomposition rates by analysing an illustrative dataset. This modelling methodology allows comparison of the riverine bioreactor's performance across habitats and at a global scale. Our integrative analytical approach can be applied to advance understanding of the functioning and efficiency of the riverine bioreactor as hotspots of metabolic activity. Application of insights gained from such analyses could inform the development of strategies that promote the functioning of the riverine bioreactor across global ecosystems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. All authors agreed on its publication in the current form., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Coronary calcifications are an obstacle for successful percutaneous treatment of coronary artery disease patients. The optimal method for delineating calcifications extent is coronary optical coherence tomography (OCT). To identify calcification on OCT and subsequently tailor the appropriate treatment, requires expertise in both image acquisition and interpretation. Image acquisition consists from system calibration, blood clearance by a contrast agent along with synchronization of the pullback process. Accurate interpretation demands careful review by the operator of a segment of 50-75 mm of the coronary vessel at steps of 5-10 frames per mm accounting for 375-540 images in each OCT run, which is time consuming and necessitates some expertise in OCT analysis. In this paper we developed a new deep learning algorithm to assist the physician to identify and quantify coronary calcifications promptly, efficiently and accurately. Our algorithm achieves an accuracy of 0.9903 ± 0.009 over the test set at size of 1500 frames and even managed to find calcifications that were not recognized manually by the physician. For the best knowledge of the authors our algorithm achieves high accuracy which was never achieved in the past.

Preterm infants with severe brain injury are at high risk for poor outcomes and, therefore, may benefit from developmental care modalities such as music therapy (MT). In this prospective, randomized intervention, preterm infants with severe brain injury (grade 3 or 4 intraventricular hemorrhage or periventricular leukomalacia) who underwent skin-to-skin contact (SSC) with or without maternal singing during MT were evaluated for physiological responses, including autonomic nervous system stability (low frequency (LF)/high frequency (HF) power), heart rate, respiratory rate, oxygen saturation, and behavioral state. Maternal anxiety state and physiological data were also evaluated. A total of 35 preterm infants with severe brain injuries were included in the study analysis. Higher mean ± standard deviation (SD) LF/HF ratio (1.8 ± 0.7 vs. 1.1 ± 0.25, p = 0.01), higher mean ± SD heart rate (145 ± 15 vs. 132 ± 12 beats per minute, p = 0.04), higher median (interquartile range) infant behavioral state (NIDCAP manual for naturalistic observation and the Brazelton Neonatal Behavioral Assessment) score (3 (2-5) vs. 1 (1-3), p = 0.03), and higher mean ± SD maternal anxiety (state-trait anxiety inventory) score (39.1 ± 10.4 vs. 31.5 ± 7.3, p = 0.04) were documented in SSC combined with maternal singing during MT, as compared to SSC alone.Conclusion: Maternal singing during MT for preterm infants with severe brain injury induces physiological and behavioral instability and increases maternal anxiety during NICU hospitalization. A unique MT intervention should be designed for preterm infants with severe brain injury and their mothers. What is Known: • Preterm infants with severe brain injury are at high risk for poor outcomes. • Music therapy benefits brain development of preterm infants without severe brain injury, however it is unknown whether maternal singing during music therapy for preterm infants with severe brain injury is beneficial. What is New: • Maternal singing during music therapy for preterm infants with severe brain injury induces physiological and behavioral instability and increases maternal anxiety during NICU hospitalization. • A unique music therapy intervention should be designed for preterm infants with severe brain injury and their mothers.

Background: While effective treatments for posttraumatic stress disorder (PTSD) exist, many individuals, including military personnel and veterans fail to respond to them. Equine-assisted therapy (EAT), a novel PTSD treatment, may complement existing PTSD interventions. This study employs longitudinal neuro-imaging, including structural magnetic resonance imaging (sMRI), resting state-fMRI (rs-fMRI), and diffusion tensor imaging (DTI), to determine mechanisms and predictors of EAT outcomes for PTSD., Method: Nineteen veterans with PTSD completed eight weekly group sessions of EAT undergoing multimodal MRI assessments before and after treatment. Clinical assessments were conducted at baseline, post-treatment and at 3-month follow-up., Results: At post-treatment patients showed a significant increase in caudate functional connectivity (FC) and reduction in the gray matter density of the thalamus and the caudate. The increase of caudate FC was positively associated with clinical improvement seen immediately at post-treatment and at 3-month follow-up. In addition, higher baseline caudate FC was associated with greater PTSD symptom reduction post-treatment., Conclusions: This exploratory study is the first to demonstrate that EAT can affect functional and structural changes in the brains of patients with PTSD. The findings suggest that EAT may target reward circuitry responsiveness and produce a caudate pruning effect from pre- to post-treatment., (© 2021 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.)

A major challenge in use of the optical spectrum for communication and imaging applications is the scattering of light as it passes through diffuse media. Recent studies indicate that light beams with orbital angular momentum (OAM) can penetrate deeper through diffuse media than simple Gaussian beams. To the best knowledge of the authors, in this paper we describe for the first time an experiment examining transmission of OAM beams through biological tissue with thickness of up to a few centimeters, and for OAM modes reaching up to 20. Our results indicate that OAM beams do indeed show a higher transmittance relative to Gaussian beams, and that the greater the OAM, the higher the transmittance also up to 20, Our results extend measured results to highly multi scattering media and indicate that at 2.6 cm tissue thickness for OAM of order 20, we measure nearly 30% more power in comparison to a Gaussian beam. In addition, we develop a mathematical model describing the improved permeability. This work shows that OAM beams can be a valuable contribution to optical wireless communication (OWC) for medical implants, optical biological imaging, as well as recent innovative applications of medical diagnosis.

Optical interrogation of tissues is broadly considered in biomedical applications. Nevertheless, light scattering by tissue limits the resolution and accuracy achieved when investigating sub-surface tissue features. Light carrying optical angular momentum or complex polarization profiles, offers different propagation characteristics through scattering media compared to light with unstructured beam profiles. Here we discuss the behaviour of structured light scattered by tissue-mimicking phantoms. We study the spatial and the polarization profile of the scattered modes as a function of a range of optical parameters of the phantoms, with varying scattering and absorption coefficients and of different lengths. These results show the non-trivial trade-off between the advantages of structured light profiles and mode broadening, stimulating further investigations in this direction.

Cassava starch was hydrolyzed with 2.2 M hydrochloric acid for different periods of time. The soluble starches obtained were subsequently used for microsphere preparation by a water-in-water emulsion crosslinking technique. The average chain lengths of starches hydrolyzed for 6, 12, 24, 36, and 48 h were 122.0, 106.3, 65.4, 33.2, and 28.3, respectively. Starches hydrolyzed for 6 and 12 h did not form regular shaped microspheres, while those hydrolyzed for 24, 36, and 48 h mostly formed separate spherical-shaped microparticles with average particle sizes of 14.6, 10.1, and 10.4 μm, respectively. The swelling power of starch microspheres (SMs) produced from 24 h hydrolyzed starch was 6.5-7.0 g/g, whereas those of SMs from 36 and 48 h hydrolyzed starch were higher and comparable (8.0-9.0 g/g). All the SMs were stable against high temperature (>140 °C). Susceptibility of the SMs to α-amylase hydrolysis decreased when the degree of starch hydrolysis increased., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Cortisol is a stress response marker. During pregnancy and delivery, cortisol levels are elevated, especially in complicated deliveries. Blood cortisol levels can increase 17-hydroxyprogesterone (17-OHP) levels in the mother during delivery, however this effect was not elucidate in newborn infants., Objectives: To investigate whether there is a correlation between umbilical cord cortisol and 17-OHP levels in the newborn, leading to false results in the newborn screening tests., Methods: Umbilical cord cortisol levels together with maternal delivery data were analyzed at Meir Medical Center during 2015-2016. The newborn screening test was performed in all newborns at 36 to 72 hours after birth, and data on 17-OHP levels were recorded. A correlation between mode of delivery, umbilical cord cortisol level and 17-OH- P levels of the newborn screening tests was conducted., Results: A total of 122 newborn infants were included in the study. The mean cord cortisol levels were 12.3±4.1 mcg/dL. Vacuum extraction deliveries were associated with the higher cord cortisol level compared to unplanned cesarean section deliveries, planned cesarean sections and vaginal deliveries (all p<0.03). Unplanned cesarean sections had higher umbilical cord cortisol levels compared to planned cesarean section and vaginal delivery ( all p<0.05). All infants had 17-OHP levels within normal limits (<35 nM), with no correlation to umbilical cord cortisol levels (r=0.012, p=0.26)., Conclusions: Vacuum extraction deliveries are associated with the highest cord cortisol level compared to unplanned cesarean section deliveries and to vaginal deliveries, however, these levels are not associated with high levels of 17-OHP of the newborn screening test. Therefore, our data does not support the hypothesis that stressful deliveries are associated with high false positive 17-OHP levels in the newborn screening test.

Introduction: Equine-assisted therapy (EAT) for post-traumatic stress disorder (PTSD) has attracted great interest despite lacking empirical support, a manual, and a standardized protocol. Our team of experts in EAT and PTSD developed an eight-session group EAT treatment protocol for PTSD (EAT-PTSD) and administered it to two pilot groups of military veterans to assess initial effects., Materials and Methods: We describe the development of the treatment manual, which was used with two pilot groups of veterans. Protocol safety, feasibility, and acceptability were assessed by reported adverse events, treatment completion rates, and self-rated patient satisfaction. Preliminary data on PTSD, depressive, and anxiety symptoms and quality of life were collected pretreatment, midpoint, post-treatment, and at 3-month follow up., Results: No adverse events were recorded. All patients completed treatment, reporting high satisfaction. Preliminary data showed decreases in clinician-assessed PTSD and depressive symptoms from pre to post-treatment and follow-up (medium to large effect sizes, d = .54-1.8), with similar trends across self-report measures (d = 0.72-1.6). In our pilot sample, treatment response and remission varied; all patients showed some benefit post-treatment, but gains did not persist at follow-up., Conclusions: This article presents the first standardized EAT protocol. Highly preliminary results suggest our new manualized group EAT-PTSD appears safe, well-regarded, and well-attended, yielding short-term benefits in symptomatology and quality of life if unclear length of effect. Future research should test this alternative treatment for PTSD more rigorously., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Music therapy (MT) interventions and skin-to-skin care (SSC) both aim to address the varied needs of preterm infants, including sensory regulation and stress reduction, inclusion of parents in their infant's care, support of parents' emotional state, and enhancing the parent-infant attachment process. Few studies have investigated the combination of both modalities through randomized controlled trials. Evidence of longer-term effects is missing. This article presents a study protocol that will investigate the effects of combined family-centered MT intervention and SSC on preterm-infants' autonomic nervous system (ANS) stability, parental anxiety levels, and parent-infant attachment quality. 12 clusters with a total of 72 preterm infants, with their parents, will be randomized to one of two conditions: MT combined with SSC or SSC alone. Each parent-infant dyad will participate in 3 sessions (2 in the hospital and a 3-month follow-up). The primary outcome of preterm infants' ANS stability will be measured by the high frequency power of their heart rate variability. Secondary outcomes will be physiological measures and behavioral states in infants and anxiety and attachment levels of parents. This trial will provide important, evidence-based knowledge on the use of the "First Sounds: Rhythm, Breath, and Lullaby" model of MT in neonatal care, through an intervention that is in line with the Newborn Individualized Developmental Care and Assessment Program model for supportive developmental care of preterm infants and their parents. Ethical approval (no. 0283-15) was granted from the local Institutional Review Board in April 2017. This trial is registered in ClinicalTrials.gov, NCT03023267., (© American Music Therapy Association 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Separation anxiety disorder (SAD) comprises one aspect of attachment dysregulation or insecurity. Although SAD aggravates posttraumatic stress disorder (PTSD) risk, no clinical research has tracked how many patients with PTSD have SAD, its clinical associations, or its response to PTSD treatment. Our open trial of interpersonal psychotherapy (IPT) for veterans with PTSD assessed these SAD domains., Methods: Twenty-nine veterans diagnosed with chronic PTSD on the Clinician-Administered PTSD Scale were assessed for SAD using the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), and for Symptom-Specific Reflective Function (SSRF), another dysregulated-attachment marker capturing patients' emotional understanding of their symptoms. Patients received 14 IPT sessions for PTSD with assessments at baseline, Week 4 (SCI-SAS and SSRF), and termination for SAD, PTSD, and depression., Results: At baseline, 69% of patients met SAD criteria. Separation anxiety did not correlate with baseline PTSD severity, depressive severity, or age when traumatized; patients with and without SAD had comparable PTSD and depression severity. Patients with baseline comorbid SAD who completed IPT (N = 17) reported significantly improved adult separation anxiety (p = .009). Adult SAD improvements predicted depressive improvement (p = .049). Patients with SAD showed a stronger relationship between early SSRF gains and subsequent adult SAD improvement (p = .021) compared with patients without SAD., Discussion: This first exploration of dysregulated/insecure attachment features among patients with PTSD found high SAD comorbidity and adult SAD improvement among patients with SAD following IPT. Highly impaired attachment patients normalized attachment posttreatment: 14-session IPT improved attachment dysregulation. This small study requires replication but begins to broaden clinical understanding of separation anxiety, attachment dysregulation, and PTSD., (© 2020 Wiley Periodicals, Inc.)

Streamflow dynamics are often ignored when studying biogeochemical processes in the hyporheic zone. We explored the interactive effects of unsteady streamflow and groundwater fluxes on the delivery and consumption of oxygen within the hyporheic zone using a recirculating flume packed with natural sandy sediments. The flume was equipped with a programmable streamflow control and drainage system that was used to impose losing and gaining fluxes. Tracer tests were used to measure hyporheic exchange flux and a planar optode was used to measure subsurface oxygen concentration patterns. It was found that the volume of the oxic zone decreased when the losing flux declined, and was drastically decreased when gaining conditions were applied. It was also found that unsteady streamflow led to a slight increase in the average volume of the oxic zone, compared to the average volume of the oxic zone under steady streamflow. However, the average oxygen consumption rates were significantly higher under unsteady streamflow compared to steady streamflow under all groundwater conditions with the exception of the highest losing flux. The present study provides the first insight into the interactions between streamflow unsteadiness and losing/gaining fluxes and improve understanding of their impact on microbial metabolism in the hyporheic zone.

Introduction: Preterm birth has major medical, psychological and socioeconomic consequences worldwide. Music therapy (MT) has positive effects on physiological measures of preterm infants and maternal anxiety, but rigorous studies including long-term follow-up are missing. Drawing on caregivers' inherent resources, this study emphasises caregiver involvement in MT to promote attuned, developmentally appropriate musical interactions that may be of mutual benefit to infant and parent. This study will determine whether MT, as delivered by a qualified music therapist during neonatal intensive care unit (NICU) hospitalisation and/or in home/municipal settings following discharge, is superior to standard care in improving bonding between primary caregivers and preterm infants, parent well-being and infant development. METHODS AND ANALYSIS: Design: international multicentre, assessor-blind, 2×2 factorial, pragmatic randomised controlled trial; informed by a completed feasibility study. Participants: 250 preterm infants and their parents. Intervention: MT focusing on parental singing specifically tailored to infant responses, will be delivered during NICU and/or during a postdischarge 6-month period. Primary outcome: changes in mother-infant bonding at 6-month corrected age (CA), as measured by the Postpartum Bonding Questionnaire. Secondary outcomes : mother-infant bonding at discharge and at 12-month CA; child development over 24 months; and parental depression, anxiety and stress, and infant rehospitalisation, all over 12 months., Ethics and Dissemination: The Regional Committees for Medical and Health Research Ethics approved the study (2018/994/REK Nord, 03 July 2018). Service users were involved in development of the study and will be involved in implementation and dissemination. Dissemination of findings will apply to local, national and international levels., Trial Registration Number: NCT03564184., Competing Interests: Competing interests: ŁB, CGh and CGo conceived the study, developed the study design, and drafted the manuscript. JA developed the study design, provided statistical expertise in clinical trial design and is conducting the primary statistical analysis. IK, MH, RR, ME, SA, BV and TG contributed to the study design, with IK and MH contributing in particular the definition of outcomes. All authors contributed to refinement of the study protocol and approved the final manuscript., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In this paper, the free-space optics (FSO) quantum backscatter communication (QBC), inspired by the quantum illumination concept, is described. In this method, the transmitter generates entangled photon pairs. The signal photon is transmitted in the direction of the modulated retro reflector (MRR) or the tag antenna, and the idler photon is moved to the receiver. The MRR communicates by modulating the received photon and retro-reflecting it back to the receiver. QBC could provide performance improvement in comparison to conventional backscatter communications. In this work, a mathematical model of the FSO QBC systems is derived. In an FSO system, the pointing direction jitter is a stochastic process that reduces the communication performance. In this paper, optimization of FSO QBC performance is proposed to minimize the error probability. This could be done by adapting the telescope gain to jitter a standard deviation amplitude.

Treated wastewater (TWW) constitutes a sustainable water resource and has been used for fish culture in some countries around the world, although there are no comprehensive data on the effect of TWW on fish growth and health in the context of aquaculture production. Our objectives were to examine how fish culture in TWW affected fish growth and fitness, as well as compliance with the international standards for safe consumption. Guppy (Poecilia reticulata) fingerlings were reared in 0%, 50% and 100% tertiary TWW (TTWW), from the age of five days, for a period of four months. In water analyses, 33 out of 67 tested organic micropollutants (OMPs) were detected in the TTWW samples at least once, at concentrations that are typically reported in domestic TTWW. Fish survival ranged between 77-80% and did not differ between treatment groups. Fish growth and mortality following challenge infection with Tetrahymena sp. (which ranged between 64-68%), were similar among treatment groups. Of tested immunological parameters, lysozyme and anti-protease was similar among treatments while complement activity was highest in the 50% TTWW-reared fish. No abnormalities were observed in the histopathological analysis. Levels of heavy metals, polychlorinated-biphenyls (PCBs) and organochlorines (OCs) in fish were below the detection limit and below the Food and Agriculture Organization of the United Nations (FAO) and the European Union EU maximal permitted levels in food fish. Results suggest that the yield of fish grown in TTWW is potentially similar to that in freshwater, and the produced fish comply with the standards of consumer safety. The results are in line with previous studies that examined the feasibility of TWW-fed aquaculture., Competing Interests: The authors have declared that no competing interests exist.

Climate change and human pressures are changing the global distribution and the extent of intermittent rivers and ephemeral streams (IRES), which comprise half of the global river network area. IRES are characterized by periods of flow cessation, during which channel substrates accumulate and undergo physico-chemical changes (preconditioning), and periods of flow resumption, when these substrates are rewetted and release pulses of dissolved nutrients and organic matter (OM). However, there are no estimates of the amounts and quality of leached substances, nor is there information on the underlying environmental constraints operating at the global scale. We experimentally simulated, under standard laboratory conditions, rewetting of leaves, riverbed sediments, and epilithic biofilms collected during the dry phase across 205 IRES from five major climate zones. We determined the amounts and qualitative characteristics of the leached nutrients and OM, and estimated their areal fluxes from riverbeds. In addition, we evaluated the variance in leachate characteristics in relation to selected environmental variables and substrate characteristics. We found that sediments, due to their large quantities within riverbeds, contribute most to the overall flux of dissolved substances during rewetting events (56%-98%), and that flux rates distinctly differ among climate zones. Dissolved organic carbon, phenolics, and nitrate contributed most to the areal fluxes. The largest amounts of leached substances were found in the continental climate zone, coinciding with the lowest potential bioavailability of the leached OM. The opposite pattern was found in the arid zone. Environmental variables expected to be modified under climate change (i.e. potential evapotranspiration, aridity, dry period duration, land use) were correlated with the amount of leached substances, with the strongest relationship found for sediments. These results show that the role of IRES should be accounted for in global biogeochemical cycles, especially because prevalence of IRES will increase due to increasing severity of drying events., (© 2019 The Authors. Global Change Biology Published by John Wiley & Sons Ltd.)

The Military Family Wellness Center at Columbia University Irving Medical Center provides cost-free, confidential mental health services to military service members, veterans, and their families in a nongovernmental setting, with an emphasis on addressing gaps in available care. Partnerships with academic institutions and collaboration with veteran organizations, regional stakeholders, and local Veterans Administration centers facilitate cross-site referrals, enhance knowledge and expertise, and advance shared goals. This article describes the development of these relationships, focusing on key priorities, barriers overcome, and lessons learned. Future directions are discussed.

Multiple-pulse position modulation (MPPM) is an advanced modulation method for optical wireless communication (OWC), which could provide better performance when channel information is not available. We consider the evaluation of a symbol error rate (SER) expression for MPPM applied within OWC. In the proposed model, MPPM is realized by spectral-amplitude coding (SAC) with non-uniform spectral slot energies. The derived fading channel SER expression is applicable for an arbitrary fading distribution, which may be due to either atmospheric turbulence or transceiver pointing error. A detailed theoretical analysis of the SER is provided and the resulting SER expression is verified by simulation.