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Today, the emergence of social media is helpful for the healthcare system where everyone is closely connected. Large numbers of people can be reached by using seed nodes to provide medical advice, facilities, new changes in the treatment, and any health ministry guidelines. As today’s world is dealing with COVID-19, the main objective is to provide healthcare services to many people irrespective of time and locality. As people suffering from corona are dealing with mental health issues, in order to deal with it, a seed pick framework using machine learning for the influence maximization technique is proposed, which will be helpful to provide pervasive healthcare. For pervasive healthcare, an effectual seed pick framework is required focusing on influence maximization using machine learning. The proposed algorithm Fuzzy-VIKOR is helpful to identify the targeted node to spread information at a high rate. Consequently, the proposed structure effectively addresses different issues related to a large number of patients, and thus, increased influence maximization using seed nodes is helpful for pervasive healthcare. The experiments show that the proposed framework has high precision, accuracy, F1-score, and recall compared to other existing algorithms employed to find influence maximization seeds.

We aimed to determine the rate of postdischarge adverse events (AEs), classify the types of postdischarge AEs, and identify risk factors for postdischarge AEs among neonates admitted to the neonatal intensive care unit (NICU).This was a prospective cohort study of neonates admitted to the NICU from February 2017 through June 2019. We enrolled 170 neonates from a level 4 NICU who were being discharged home and whose parents can speak English and could be contacted after discharge. The main outcome of the study was postdischarge AEs based on structured telephone interviews, health record review, and adjudication by 2 blinded, trained physicians using a previously established methodology.Fourteen percent of 170 neonates admitted to the NICU experienced postdischarge AEs, with 48% being either preventable or ameliorable. Adverse drug events and procedural complications comprised most of the AEs (48%), but most of the preventable and ameliorable AEs were due to management, therapeutic, or diagnostic errors. Seventy-nine percent of neonates who suffered an AE experienced either a readmission to the hospital or an emergency department visit. Neonates admitted to a level 4 NICU from another NICU (level 1, 2, or 3) (adjusted odds ratio, 3.62; 95% confidence interval, 1.27-12.60; P = 0.01) and those 28 to 36 weeks (adjusted odds ratio, 11.38; 95% confidence interval, 1.67-127.98; P = 0.01) had a significantly higher risk of AEs at discharge.Neonates discharged from a level 4 NICU were at high risk for experiencing postdischarge AEs. The identification of AE types and risk factors can be used to guide efforts to develop interventions to improve neonatal patient safety during the postdischarge period.

To compare the pain scores between the two groups, breast milk (BM) and 24% sucrose, in preterm neonates undergoing automated heel lance for the blood draw.The study is designed as a randomized, single-blinded, non-inferiority trial. Infants born between 30 1/7weeks and 36 6/7 weeks of gestation were randomly assigned to receive either 24% sucrose or expressed BM. The Premature Infant Pain Profile-Revised (PIPP-R) was utilized to provide pain scores.No differences were noted in the baseline characteristics between the two groups. The quantile regression estimates for PIPP-R scores during the procedure were statistically non-significant at all percentile levels of distribution (50%ile coefficient 0, 95% CI -0.49 to 0.49).We conclude that BM is not inferior to 24% sucrose in providing analgesia during heel lance in moderate and late preterm infants.This trial was registered at www.gov (identifier NCT04898881).

Among 65 neonates with encephalopathy undergoing cooling, 30 (46.1%) received chest compressions during delivery room resuscitation. Despite differences in encephalopathy severity, early (

Objective The aim of the study is to explore the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on preterm birth at different gestational ages and fetal death in the state of Michigan. Study Design Data on live births and fetal deaths in the state of Michigan from March to November in the years 2017 through 2020 were obtained from Michigan Department of Health and Human Services (MDHHS). Preterm birth rate, fetal death rate (per 1,000 live births) overall and stratified by race and maternal comorbidities during the period of pandemic (March–November 2020) were compared with the same period (March–November) in the prepandemic years (2017–2019). Results Of 328,879 live births and 1,470 fetal deaths during the study period, 77,983 live births and 242 fetal deaths were reported in 2020. Compared with prepandemic years, fetal death rate per 1,000 live births was significantly lower in 2020 (3.1 vs. 4.7 [2017], 5.2 [2018], 4.4 [2019], p-value 42 weeks) between pandemic and prepandemic years on multinomial analysis. Significant associations with preterm birth across all years included African American race, lower level of maternal education, pregnancy-induced hypertension, chronic hypertension, prepregnancy diabetes, congenital anomalies, previous preterm birth, and prolonged rupture of membranes >12 hours. Conclusion Fetal death rate was significantly lower whereas preterm births remained unchanged during pandemic in comparison with prepandemic years in the state of Michigan. Key Points

The study aims to assess the students’ attitude towards science in selected government and private schools at the secondary level in the Jammu district. A sample comprises 200 students from 5 private and government secondary schools of the Jammu district. The Science Attitude Scale (SAS) developed by Grewal (2012) was used to assess the students’ attitude towards science. The results show that the students in both government and private schools have a positive attitude towards science. This study revealed that secondary school students’ attitudes towards science differ significantly regarding their academic achievement. Female students were found to have a favourable attitude towards science as compared to their male counterparts. Results also showed that students at private schools possess a positive attitude towards science compared to students in government schools. They enjoy science and are ready to pursue their career in science as well.

Objective In this currently evolving coronavirus disease 2019 (COVID-19) pandemic, the evidence is scarce about the impact of COVID-19 infection on women in labor and neonates in an inner city African-Americans (AA) population. The objective of this study was to evaluate the clinical outcomes and placental pathology in mother–infant dyads in COVID-19 cases. Study Design Retrospective chart review was conducted on 34 COVID-19 positive mother–infant dyads to study their baseline characteristics and outcomes. Placental pathology was reviewed by two perinatal pathologists. Results COVID-19 was noted in 3% of pregnant women who delivered in our institution. The majority (82%) of them were asymptomatic. Out of the four mothers who were symptomatic, only three (9%) required supplemental oxygen. None of them required invasive ventilation. All the neonates tested negative for COVID-19 at 24 hours of age. There were no gross or microscopic pathological abnormalities detected that could be definitely associated with any COVID-19 related complications during pregnancy in any of the 34 placentas. Conclusion COVID-19 does not appear to increase morbidity and mortality among pregnant women and their neonates in a predominantly AA population. Our study did not find any evidence of vertical transmission of COVID-19 infection nor any specific findings on placental pathology. Key Points Majority of women infected by coronavirus disease 2019 (COVID-19) during labor were asymptomatic. None of the newborns tested positive for COVID-19 at 24 hours of age. Placental pathology findings were nonspecific in COVID-19 mothers.

To compare the time to full enteral feeds in preterm infants fed exclusive human milk (EHM) - mother's own milk (MOM) fortified with human milk-based fortifier (HMBF), to those who received partial human milk (PHM) - MOM fortified with bovine milk-based fortifier (BMBF), and exclusive formula.A single-center retrospective study of infants with birth weight1250 g from 2013 to 2018. Data on feeding, growth and other short-term neonatal morbidities were collected.On regression analysis, time to full enteral feeds was significantly higher in PHM compared to EHM group (β-coefficient 4.14, 95% CI 0.00-8.29) and formula-fed group compared to EHM (β-coefficient 4.3, 95% CI 0.32-8.20). No significant differences in growth velocity, length of stay and other morbidities were found between the groups.Infants in EHM had better feeding tolerance and reached their enteral feed goals sooner compared to PHM and formula-fed groups.

To evaluate the effect of withholding feeds during transfusion on transfusion associated acute gut injury (TRAGI). Data were collected on 125 preterm infants before and after the practice of withholding feeds for 12–24 h during transfusion was instituted. Logistic regression was used to examine effects of withholding feeds on TRAGI rates. A total of 19 (15%) infants developed NEC; 6/19 (32%) had TRAGI. Postnatal hydrocortisone use was associated with TRAGI (OR 8.97; 95% CI 1.17–68.46, p = 0.034). There was no difference in NEC rates (15.8 vs. 14.7%) and the proportions (22.2 vs. 40%) of TRAGI in the two time periods before and after instituting the standardized feeding regimen and practice of holding feeds during transfusion. No significant decrease was noted in the rates of TRAGI after feeds were withheld during transfusion. Further studies are warranted to explore the relationship between feeds during transfusion and NEC.

To characterize behavior of 2-year-old children based on the severity of bronchopulmonary dysplasia (BPD).We studied children born at 22-26 weeks of gestation and assessed at 22-26 months of corrected age with the Child Behavior Checklist (CBCL). BPD was classified by the level of respiratory support at 36 weeks of postmenstrual age. CBCL syndrome scales were the primary outcomes. The relationship between BPD grade and behavior was evaluated, adjusting for perinatal confounders. Mediation analysis was performed to evaluate whether cognitive, language, or motor skills mediated the effect of BPD grade on behavior.Of 2310 children, 1208 (52%) had no BPD, 806 (35%) had grade 1 BPD, 177 (8%) had grade 2 BPD, and 119 (5%) had grade 3 BPD. Withdrawn behavior (P .001) and pervasive developmental problems (P .001) increased with worsening BPD grade. Sleep problems (P = .008) and aggressive behavior (P = .023) decreased with worsening BPD grade. Children with grade 3 BPD scored 2 points worse for withdrawn behavior and pervasive developmental problems and 2 points better for externalizing problems, sleep problems, and aggressive behavior than children without BPD. Cognitive, language, and motor skills mediated the effect of BPD grade on the attention problems, emotionally reactive, somatic complaints, and withdrawn CBCL syndrome scales (P values .05).BPD grade was associated with increased risk of withdrawn behavior and pervasive developmental problems but with decreased risk of sleep problems and aggressive behavior. The relationship between BPD and behavior is complex. Cognitive, language, and motor skills mediate the effects of BPD grade on some problem behaviors.

Formal learning has shifted from the confines of institutional walls to our home computers and even to our mobiles. It is often felt that the concept of e-learning can be successfully applied to theoretical subjects but when it comes to teaching of science subjects like chemistry where hands on practical training is must, it is inadequate. This chapter presents a hybrid approach (amalgamation of concepts of machine learning technique with soft computing paradigm) to develop an intelligent virtual chemistry laboratory (IVCL) tool for simulating chemical experiments online. Tool presents an easy to use web based interface, which takes as input the reactants and presents results in the form of - type of reaction occurred and the list of possible products. Technically, the IVCL tool utilizes naïve bayes algorithm to classify the type of reactions and then applies genetic algorithm inspired approach to generate the products. Subsequently it employs system of equations method to balance the reactions. Experimental evaluations reveal that proposed IVCL tool runs with 95% accuracy.

Objective To investigate if magnetic resonance imaging (MRI) is an accurate predictor for death or moderate-severe disability at 18-22 months of age among infants with neonatal encephalopathy in a trial of cooling initiated at 6-24 hours. Study design Subgroup analysis of infants ≥36 weeks of gestation with moderate-severe neonatal encephalopathy randomized at 6-24 postnatal hours to hypothermia or usual care in a multicenter trial of late hypothermia. MRI scans were performed per each center's practice and interpreted by 2 central readers using the Eunice Kennedy Shriver National Institute of Child Health and Human Development injury score (6 levels, normal to hemispheric devastation). Neurodevelopmental outcomes were assessed at 18-22 months of age. Results Of 168 enrollees, 128 had an interpretable MRI and were seen in follow-up (n = 119) or died (n = 9). MRI findings were predominantly acute injury and did not differ by cooling treatment. At 18-22 months, death or severe disability occurred in 20.3%. No infant had moderate disability. Agreement between central readers was moderate (weighted kappa 0.56, 95% CI 0.45-0.67). The adjusted odds of death or severe disability increased 3.7-fold (95% CI 1.8-7.9) for each increment of injury score. The area under the curve for severe MRI patterns to predict death or severe disability was 0.77 and the positive and negative predictive values were 36% and 100%, respectively. Conclusions MRI injury scores were associated with neurodevelopmental outcome at 18-22 months among infants in the Late Hypothermia Trial. However, the results suggest caution when using qualitative interpretations of MRI images to provide prognostic information to families following perinatal hypoxia–ischemia. Trial registration Clinicaltrials.gov: NCT00614744 .

Background: To evaluate in vitro antimicrobial activity of orange peel extract, 0.2% chlorhexidine (CHX) and saline against dental biofilm-forming bacteria and their effect on plaque structure under SEM. Methods: Present study included 3 groups; Group A: Orange peel extract; Group B: 0.2% CHX and Group C: Saline. MIC of each group was determined by broth and well diffusion method. Reference strains of Porphyromonas gingivalis ( P.g. ), Prevotella intermedia ( P.i. ) and Aggregatibacter actinomycetemcomitans ( A.a.) were selected as being colonizers in dental biofilm. For SEM analysis, plaque retained orthodontic e-chains were subjected to each group for 60s and studied under SEM. Results: The MIC of Group A by broth diffusion method is 66.66 µg/ml for P. intermedia , 75 µg/ml for P. gingivalis and 33.33 µg/ml for A.a. MIC of Group B was 14.58 µg/ml for P.i., 7.29 µg/ml for P.g. and 20.83 µg/ml for A.a. MIC of Group C was 83.33 µg/ml for A.a. while P.i. and P.g. showed resistance to Group C. The determination of MIC by well diffusion showed increase in clear zone diameter with increasing concentrations. Greater zone of inhibition was seen in Group B with statistical significance for all 3 microorganisms. Morphologic changes in the SEM study showed maximum change in the surface characteristics and loss of adhesion of the clusters of microorganisms subjected to Group B. Conclusions: CHX and orange peel extract exhibited notable anti-microbial activity against biofilm organisms, but at varying concentrations. The plaque samples subjected to orange peel extract showed slightly shrunken and coarse form indicating its ability to disrupt the plaque biofilm.

Objective To assess outcomes following post-hemorrhagic ventricular dilatation (PHVD) among infants born at ≤26 weeks of gestation. Study design Observational study of infants born April 1, 2011, to December 31, 2015, in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and categorized into 3 groups: PHVD, intracranial hemorrhage without ventricular dilatation, or normal head ultrasound. PHVD was treated per center practice. Neurodevelopmental impairment at 18-26 months was defined by cerebral palsy, Bayley Scales of Infant and Toddler Development, 3rd edition, cognitive or motor score Results Of 4216 infants, 815 had PHVD, 769 had hemorrhage without ventricular dilatation, and 2632 had normal head ultrasounds. Progressive dilatation occurred among 119 of 815 infants; the initial intervention in 66 infants was reservoir placement and 53 had ventriculoperitoneal shunt placement. Death or impairment occurred among 68%, 39%, and 28% of infants with PHVD, hemorrhage without dilatation, and normal head ultrasound, respectively; aOR (95% CI) were 4.6 (3.8-5.7) PHVD vs normal head ultrasound scan and 2.98 (2.3-3.8) for PHVD vs hemorrhage without dilatation. Death or impairment was more frequent with intervention for progressive dilatation vs no intervention (80% vs 65%; aOR 2.2 [1.38-3.8]). Death or impairment increased with parenchymal hemorrhage, intervention for PHVD, male sex, and surgery for retinopathy; odds decreased with each additional gestational week. Conclusions PHVD was associated with high rates of death or impairment among infants with gestational ages ≤26 weeks; risk was further increased among those with progressive ventricular dilation requiring intervention.

Imaging has many uses, but in cases of suspected child abuse, radiographs and CT scans are vital in identifying fractures and head injury that may not be clinically obvious. There are growing concerns about the small but potential adverse effects of radiation, including cancer, in the paediatric population as a result of imaging. The vast majority of general paediatricians undertaking child abuse assessments request skeletal surveys and CT scans, subjecting children to significant amounts of radiation. Informed consent must be taken from parents for these procedures and therefore this paper aims to look at evidence of the dangers of radiation in children and raise awareness among paediatricians.

To determine a) factors associated with the need for cardiopulmonary resuscitation (CPR) in the delivery room (DR) or, beyond day 1, in the Neonatal Intensive Care Unit (NICU) and b) whether DR-CPR and NICU-CPR predict mortality and major morbidities in neonates of varying gestational ages (GA). We analyzed admissions at < 30 days of age in the Kids …

Objective To evaluate genetic disease among children referred to a community paediatric clinic. Design Retrospective cohort study. Setting Community paediatric clinic, Tower Hamlets, London. Patients All patients seen for first time in the Child Development Team (CDT) clinic between 1999 and 2013. Interventions Clinical notes were reviewed. Genetic test results were obtained. Exploratory Excel analysis was performed. Patients without an identified genetic disorder were labelled ‘more likely genetic cause’ if they had at least two out of three risk factors: developmental delay, congenital abnormality or parental consanguinity, and ‘unlikely genetic cause’ if they had one or no risk factors, or an obvious alternative cause. Main outcome measures Prevalence of genetic diagnoses and parental consanguinity, undertaking of genetic tests, predicted likelihood of a genetic cause among unsolved patients. Results 749 patients were included. 404 (53.9%) had undergone genetic testing and 158 of those tested (39.1%) had a confirmed genetic diagnosis. Parental relatedness was documented in 461 patients, of which 128 (27.8%) had first-cousin parents. The number of patients undergoing genetic testing increased over time. Aneuploidies and syndromic/Mendelian disorders were most common. Of the 591 patients without a genetic diagnosis, 29.9% were classified ‘more likely genetic cause’. Patients with consanguineous parents were significantly more likely to have a diagnosed genetic disorder than those with non-consanguineous parents (43/128 vs 72/333), particularly an autosomal recessive condition (27/43 vs 6/72). Conclusions Genetic disease was common and genetic testing is important in evaluating children in this clinic. Consanguinity increases the likelihood of autosomal recessive disease.

Introduction: Pomegranate is considered “A pharmacy unto itself”. Hydrolysable tannins called punicalagins which have free scavenging properties are the most abundant polyphenols found in pomegranate-containing mouthwash. Aim: To evaluate antimicrobial effect of pomegranate- containing mouthwash on oral biofilm-forming bacteria. Materials and Methods: The mouthwashes used were divided into three groups- Group A: Chlorhexidine mouthwash (Hexidine); Group B: Herbal Mouthwash (Hiora) and Group C: Pomegranatecontaining Mouthwash (Life-extension). Each mouthwash was diluted to five different concentrations. Reference strains of Streptococcus mutans (S.mutans) (ATCC 25175), Streptococcus salivarius (S.salivarius) (ATCC 7073), and Aggregatibacter actinomycetemcomitans (A.a) (NCTC 9710) were selected as being colonizers in dental biofilm formation. On each culture plate, five wells of 5mm were prepared and mouthwashes with different concentrations were added, followed by incubation in a CO2 jar for 24 hours at 37°C. Inhibition zone diameters were measured using a digital caliper. Results: Chlorhexidine (0.12%) presented a zone of inhibition between 38.46% to 96.15% for all the three organisms, while Hiora presented zone of inhibition ranging from 33.33% to 69.23% but was resistant at

o r Nasal deformity is associated with unilateral cleft lip and alveolus with or without cleft palate and involves skeletal and soft tissue structures. Most of this deformity can be corrected at the time of primary repair. Primary lip and nasal reconstruction during the first operation has now become the expected standard of care for infants with complete unilateral cleft lip and palate. The key to correction of the cleft nasal defority is translocation of the alar cartilage with its ttached vestibular lining into a normal position, hich establishes the normal vault and shape of the artilage. However, postoperatively, there is some elapse in the position of the alar cartilage, which is ttributed to the scar contracture or tissue memory. Postoperative maintenance of the corrected shape is indispensable for achieving a symmetric and wellproportioned nose in patients with cleft nasal deformity. To correct the cleft lip-nose deformity, esecially in Asian patients, sustaining the shape of the epaired nose after corrective surgery is extremely mportant. Because the nose in Asian patients has nderdeveloped, thin alar cartilage and thick skin, the orrected nose is prone to relapse after surgery. Long-term benefits of a nasal retainer that sustains the corrected nasal cavity for several months after surgical repair of cleft lip-nose deformity have been shown by Yeow et al.

'Common childhood illnesses can present with findings suggestive of sexual abuse' Key Practitioner Messages * Common childhood illnesses should always be considered/ruled out in all cases of suspected abuse. * When faced with clinical presentations commonly found in cases of child abuse, all doctors should keep an open mind and formulate a differential diagnosis with abuse being one of the possibilities. * When requesting an opinion from paediatricians, it is the duty of the referring clinician to be open with parents and inform them that abuse is one of the differential diagnoses. Language: en

Periodontitis is an inflammatory disease which manifests clinically as loss of supporting periodontal tissues including periodontal ligament, cementum, and alveolar bone, and periodontal therapy is aimed at achieving complete regeneration of these structures. To date, this goal has been tried to accomplish using various bone grafts, growth factors, and barrier membranes. Stem cells are the most fascinating area of biology today and have been used clinically in the field of medicine to treat many incurable diseases. Various human and animal studies have confirmed the presence of stem cells in dental tissues including periodontal ligament. This has opened new avenues aiming toward complete periodontal regeneration using cell-based therapies. This review provides an overview of various types of stem cells in medicine and dentistry and their potential uses especially pertaining to periodontal regeneration.

Both bone mass by densitometry and speed of sound (SOS) from quantitative ultrasound of the bone (QUS) are directly related to bone strength. However, reports of lower bone mass but higher SOS in neonates with intrauterine growth deficit lead to apparent contradictory conclusions on bone strength. Three groups of infants were studied: small for gestation (SGA) with birth weights ≤10th percentile for gestation and 2 control groups with appropriate birth weights (11th to 90th percentile) for gestation (AGA): matched to SGA group for gestation and birth weight, respectively. SOS was measured with a commercial QUS instrument (Sunlight Omnisense 7000, Sunlight Medical Ltd, Tel Aviv, Israel) and 2 manufacturer supplied ultrasound probes (CS and CR) for small bones. The SGA group had significantly (p0.01) higher SOS compared with weight matched but gestational less matured control group by an average of 54m/s with the CS probe and 80m/s with the CR probe but not significantly different from gestation-matched AGA group. SOS values from both probes were significantly correlated (r=0.71-0.91) but were significantly different between probes. Probe failure occurred with both probes. We conclude that QUS SOS values in SGA neonates are a reflection of a continuum of intrauterine maturation of the skeleton.

Objectives To describe the frequency and extent of delivery room resuscitation and evaluate the association of delivery room resuscitation with neonatal outcomes in moderately preterm (MPT) infants. Study design This was an observational cohort study of MPT infants delivered at 290/7 to 336/7 weeks' gestational age (GA) enrolled in the Neonatal Research Network MPT registry. Infants were categorized into 5 groups based on the highest level of delivery room intervention: routine care, oxygen and/or continuous positive airway pressure, bag and mask ventilation, endotracheal intubation, and cardiopulmonary resuscitation including chest compressions and/or epinephrine use. The association of antepartum and intrapartum risk factors and discharge outcomes with the intensity of resuscitation was evaluated. Results Of 7014 included infants, 1684 (24.0%) received routine care and no additional resuscitation, 2279 (32.5%) received oxygen or continuous positive airway pressure, 1831 (26.1%) received bag and mask ventilation, 1034 (14.7%) underwent endotracheal intubation, and 186 (2.7%) received cardiopulmonary resuscitation. Among the antepartum and intrapartum factors, increasing GA, any exposure to antenatal steroids and prolonged rupture of membranes decreased the likelihood of receipt of all levels of resuscitation. Infants who were small for GA (SGA) had increased risk of delivery room resuscitation. Among the neonatal outcomes, respiratory support at 28 days, days to full oral feeds and length of stay were significantly associated with the intensity of delivery room resuscitation. Higher intensity of resuscitation was associated with increased risk of mortality. Conclusions The majority of MPT infants receive some level of delivery room resuscitation. Increased intensity of delivery room interventions was associated with prolonged respiratory and nutritional support, increased mortality, and a longer length of stay.

Soft computing techniques such as nature-inspired algorithms have always been a great source of inspiration for researchers in developing intelligent systems. One of the prominent nature inspired algorithms is firefly algorithm. The algorithm simulates the attraction approach of real fireflies where each firefly has specific agenda and coordinates with other fireflies in the group (swarm) to achieve the same. The presented work employs this attraction mechanism of firefly algorithm for product promotion at global scale through social networking sites. The algorithm is strategically employed to capture the user interest toward product features and explore the social network of prospective consumers to identify the best initial seeds for efficient product promotion. The strategy is divided into three phases. In the first phase, the market analysis phase, the often changing market demands for a product feature and user preferences for the same are captured. Based on these preferences users are grouped into homogeneous segments in the second phase, i.e., market segmentation. Thereafter, for targeted product promotion the most potential segment(s) with respect to the product to be promoted is selected in the third phase, i.e., targeted product promotion. Experimental studies are conducted to evaluate the performance of each phase individually and subsequently overall strategy is evaluated on epinion dataset. The results reveal the supremacy of firefly algorithm-based approach over other algorithms and substantiate the potential of presented plan to target wide and right range of audience by employing small fraction of advertising budget.

In a retrospective review of infants with neonatal herpes simplex virus disease (n = 29), we found bilateral multilobar (n = 8), pontine (n = 3), thalamic (n = 6), and internal capsule and corticospinal tract (n = 5) involvement on magnetic resonance imaging (MRI). Diffusion-weighted imaging (n = 6) performed early revealed additional involvement than detected by conventional MRI. Neurodevelopmental sequelae were correlated with MRI abnormalities. Our findings demonstrate that MRI, including diffusion-weighted imaging, is a valuable prognostic adjunct in neonatal herpes simplex virus disease.

Bone quantitative ultrasound generated speed of sound (SOS) is a marker of bone strength. However, critical evaluation of its validity for use in small bones is extremely limited, and SOS data may not be consistent with data obtained from dual energy x ray absorptiometry, another marker of bone strength. We report the SOS values pre and postinjection of s.c. fat using a chicken bone model; and in large for gestation and appropriate for gestation neonates to determine the influence of s.c. fat. Average SOS were lowered for the chicken bones postfat injection by 36 m/s (CS probe) and 58 m/s (CR probe), and in large for gestation group by 75 m/s (CS probe) and 51 m/s (CR probe) (p = 0.03-0.004 paired t test) although SOS measurements from each probe are significantly correlated within the large (r = 0.78) and appropriate (r = 0.83) for gestation group. Failed SOS measurements occurred significantly more frequently in the postinjection studies regardless of the probe used in the chicken bone model and for the CS probe in large for gestation neonates. The lowered bone quantitative ultrasound measurements in large for gestation neonates is likely a measurement artifact from increased s.c. fat.

Objectives To evaluate the change in physiologic stability of very low-birth-weight (VLBW) infants following transport using TRIPS (transport risk index of physiologic stability) score as a measure of physiologic stability and compare changes in TRIPS score in groups of VLBW infants who underwent shorter versus longer transport. Study Design Retrospective chart review. Results Our cohort of 106 infants, 44 (41%) of whom were females, had a mean birth weight of 777 g (standard deviation [SD] 159) and median gestational age of 26 weeks (range 23 to 32 weeks). Mean weight at transfer was 1,610 g (SD 924) and mean postnatal age at transfer was 56 days (SD 45). Median time on transport was 15 minutes (range 10 to 85 minutes). All 106 transports were ground transports. Of the 106 infants, 57 (54%) had deterioration, 20 (19%) had improvement, and 29 (27%) had no change in their physiologic status during transport. Comparison of the two transport duration groups based on median transport time as a cutoff point (i.e., ≤ 15 minutes and > 15 minutes) revealed a higher proportion of infants with deterioration in their physiologic status in the prolonged transport (>15 minutes) group (65% versus 45%; p = 0.03). Temperature change, either alone or in combination with other indices, was responsible for change in TRIPS score (deterioration or improvement) in 79% of these infants. Conclusions Interhospital transport of VLBW infants may cause deterioration in their physiologic status, the likelihood of which is increased with longer duration of transport. Better temperature regulation during interhospital transport may decrease the chances of deterioration in physiologic status of VLBW infants.

Objective: To reduce the incidence of hypothermia (admission temperatures Study design: We conducted a multi-intervention QI initiative to reduce hypothermia (admission temperatures χ 2, and logistic regression as appropriate. Results: In our cohort of 209 patients, baseline characteristics were comparable in the three periods except for a reduction in the need for surfactant doses in the 3rd period. Temperature on admission to the neonatal intensive care unit was significantly higher, with a reduction in hypothermia in the 3rd period. There was no patient with a temperature of ≥37.5°C. On logistic regression, with gestational age, 5-min Apgar score, and mode of delivery as covariates, time period 3 was significantly associated with a reduction in the incidence of hypothermia (P=0.02). Conclusion: A concerted QI approach improved admission temperature in ELBW neonates, with more neonates in the euthermic range, without increasing the risk for hyperthermia. Such an approach could be associated with improved outcomes in this population.

A preterm (33 weeks) male neonate was born to a 34-year-old mother by caesarean section. The mother had a history of chronic hypertension, type 1 diabetes mellitus, stroke and asthma. Her medications included enoxaparin, insulin, nifedipine, methyldopa, inhaled albuterol and inhaled corticosteroids. She received regular prenatal care. The obstetric ultrasound done at 21 weeks of gestation revealed an occipital encephalocele, measuring ∼3.3×2.0×2.5 cm in size and protruding through a 0.95 cm cranial defect in the occipital area. The baby had a spontaneous cry at birth with Apgar score of 9 and 9 at …

We describe a monozygotic twin discordant for VATER association with single dysplastic kidney and cloacal anomaly, who had no pulmonary hypoplasia. This twin probably had little or no urine output in utero, but still had normal lung development due to production of adequate amniotic fluid by the healthy twin preventing pulmonary hypoplasia. The discordance between monozygotic twins for VATER association indicates that factors other than inherited genetic ones may have a role in the causation of this association.