Monitoring or estimating the junction temperature of power semiconductor devices is a requirement for degradation monitoring and predictive maintenance of power-electronic converters and usually achieved by online measurement of a temperature-sensitive electrical parameter (TSEP). Many TSEPs rely on switching transients and, thus, depend on the design of a switching cell, driving significant calibration efforts. Instead, utilizing the on-state voltage of a power semiconductor device as TSEP is attractive, as it only depends on the load current and the output characteristic of the device. This independence of the switching cell design enables on-state voltage monitoring circuits to be seamlessly integrated into products that are already mass produced. However, an effective on-state voltage monitoring circuit has to measure small on-state voltages accurately and fast while withstanding high off-state voltages. This article experimentally evaluates three candidate circuits that take on this challenge: a circuit derived from a Wheatstone bridge, a dynamically compensated voltage divider, and a circuit using an auxiliary MOSFET. PCBs are designed, featuring all three circuit concepts, and experiments are carried out to compare the candidate circuits in terms of dynamic performance and resolution. Finally, the potential for integration into commercial products is outlined, illustrated, and discussed.

BackgroundOxytocin is widely used for induction and augmentation of labour, particularly in low- and middle-income countries (LMICs). In this systematic review and meta-analysis, we examined the effect of intra-partum Oxytocin use on neonatal encephalopathy.MethodsThe protocol for this study was registered with PROSPERO (ID: CRD42020165049). We searched Medline, Embase and Web of Science Core Collection databases for papers published between January 1970 and May 2021. We considered all studies involving term and near-term (≥36 weeks’ gestation) primigravidae and multiparous women. We included all randomised, quasi-randomised clinical trials, retrospective studies and non-randomised prospective studies reporting intra-partum Oxytocin administration for induction and/or augmentation of labour. Our primary outcome was neonatal encephalopathy. Risk of bias was assessed in non-randomised studies using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. The RoB 2.0 tool was used for randomised studies. A Mantel-Haenszel statistical method and random effects analysis model were used for meta-analysis. Odds ratios were used to determine effect measure and reported with 95% confidence intervals.ResultsWe included data from seven studies (6 Case-control studies, 1 cluster-randomised trial) of which 3 took place in high-income countries (HICs) and 4 in LMICs. The pooled data included a total of 24,208 women giving birth at or after 36 weeks; 7642 had intra-partum Oxytocin for induction and/or augmentation of labour, and 16,566 did not receive intra-partum Oxytocin. Oxytocin use was associated with an increased prevalence of neonatal encephalopathy (Odds Ratio 2.19, 95% CI 1.58 to 3.04; p < 0.00001).ConclusionsIntra-partum Oxytocin may increase the risk of neonatal encephalopathy. Future clinical trials of uterotonics should include neonatal encephalopathy as a key outcome.

AbstractBackgroundCOVID-19 has restricted singing in communal worship. We sought to understand variations in droplet transmission and the impact of wearing face masks.MethodsUsing rapid laser planar imaging, we measured droplets while participants exhaled, said ‘hello’ or ‘snake’, sang a note or ‘Happy Birthday’, with and without surgical face masks. We measured mean velocity magnitude (MVM), time averaged droplet number (TADN) and maximum droplet number (MDN). Multilevel regression models were used.ResultsIn 20 participants, sound intensity was 71 Decibels (dB) for speaking and 85 dB for singing (p&lt;0.001). MVM was similar for all tasks with no clear hierarchy between vocal tasks or people and &gt;85% reduction wearing face masks. Droplet transmission varied widely, particularly for singing. Masks decreased TADN by 99% (p&lt;0.001) and MDN by 98% (p&lt;0.001) for singing and 86-97% for other tasks. Masks reduced variance by up to 48%. When wearing a mask, neither singing task transmitted more droplets than exhaling.ConclusionsWide variation exists for droplet production. This significantly reduced when wearing face masks. Singing during religious worship wearing a face mask appears as safe as exhaling or talking. This has implications for UK public health guidance during the COVID-19 pandemic.

Although therapeutic hypothermia (TH) improves outcomes after neonatal encephalopathy (NE), the safety and efficacy of preemptive opioid sedation during cooling therapy is unclear. We performed a secondary analysis of the data from a large multicountry prospective observational study (Magnetic Resonance Biomarkers in Neonatal Encephalopathy [MARBLE]) to examine the association of preemptive morphine infusion during TH on brain injury and neurodevelopmental outcomes after NE. All recruited infants had 3.0 Tesla magnetic resonance imaging and spectroscopy at 1 week, and neurodevelopmental outcome assessments at 22 months. Of 223 babies recruited to the MARBLE study, the data on sedation were available from 169 babies with moderate (n = 150) or severe NE (n = 19). Although the baseline characteristics and admission status were similar, the babies who received morphine infusion (n = 141) were more hypotensive (49% vs. 25%, p = 0.02) and had a significantly longer hospital stay (12 days vs. 9 days, p = 0.009) than those who did not (n = 28). Basal ganglia/thalamic injury (score ≥1) and cortical injury (score ≥1) was seen in 34/141 (24%) and 37/141 (26%), respectively, of the morphine group and 4/28 (14%) and 3/28 (11%) of the nonmorphine group (p > 0.05). On regression modeling adjusted for potential confounders, preemptive morphine was not associated with mean (standard deviation [SD]) thalamic N-acetylaspartate (NAA) concentration (6.9 ± 0.9 vs. 6.5 ± 1.5; p = 0.97), and median (interquartile range) lactate/NAA peak area ratios (0.16 [0.12-0.21] vs. 0.13 [0.11-0.18]; p = 0.20) at 1 week, and mean (SD) Bayley-III composite motor (92 ± 23 vs. 94 ± 10; p = 0.98), language (89 ± 22 vs. 93 ± 8; p = 0.53), and cognitive scores (95 ± 21 vs. 99 ± 13; p = 0.56) at 22 months. Adverse neurodevelopmental outcome (adjusted for severity of encephalopathy) was seen in 26 (18%) of the morphine group, and none of the nonmorphine group (p = 0.11). Preemptive morphine sedation during TH does not offer any neuroprotective benefits and may be associated with increased hospital stay. Optimal sedation during induced hypothermia requires further evaluation in clinical trials.

The Seattle protocol for endoscopic Barrett's esophagus (BE) surveillance samples a small portion of the mucosal surface area, risking a potentially high miss rate of early neoplastic lesions. We assessed whether the new iScan Optical Enhancement system (OE) improves the detection of early BE-associated neoplasia compared with high-definition white-light endoscopy (HD-WLE) in both expert and trainee endoscopists to target sampling of suspicious areas. Such a system may both improve early neoplasia detection and reduce the need for random biopsies. A total of 41 patients undergoing endoscopic BE surveillance from January 2016 to November 2017 were recruited from 3 international referral centers. Matched still images in both HD-WLE (n= 130) and iScan OE (n= 132) were obtained from endoscopic examinations. Two experts, unblinded to the videos and histology, delineated known neoplasia, forming a consensus criterion standard. Seven expert and 7 trainee endoscopists marked 1 position per image where they would expect a target biopsy to identify dysplastic tissue. The same expert panel then reviewed magnification images and, using a previously validated classification system, attempted to classify mucosa as dysplastic or nondysplastic, based on the mucosal and vascular (MV) patterns observed on magnification endoscopy. Diagnostic accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. Improvements in dysplasia detection in HD-WLE versus OE and interobserver agreement were assessed by multilevel logistic regression analysis and Krippendorff alpha, respectively. Improvements in diagnostic performance were expressed as an odds ratio between the odds of improvement in OE compared with the odds of improvement in HD-WLE. Accuracy of neoplasia detection was significantly higher in all trainees who used OE versus HD-WLE (76% vs 63%) and in 6 experts (84% vs 77%). OE improved sensitivity of dysplasia detection compared with HD-WLE in 6 trainees (81% vs 71%) and 5 experts (77% vs 67%). Specificity improved in 6 trainees who used OE versus HD-WLE (70% vs 55%) and in 5 experts (92% vs 86%). PPV improved in both an expert and trainee cohort, but NPV improved significantly only in trainees. By using the MV classification and OE magnification endoscopy compared with HD-WLE, we demonstrated improvements in accuracy (79.9% vs 66.7%), sensitivity (86.3% vs 83.4%), and specificity (71.2% vs 53.6%) of dysplasia detection. PPV improved (62%-76.6%), as did NPV (67.7%-78.5%). Interobserver agreement also improved by using OE from 0.30 to 0.55. iScan OE may improve dysplasia detection on endoscopic imaging of BE as well as the accuracy of histology prediction compared with HD-WLE, when OE magnification endoscopy is used in conjunction with a simple classification system by both expert and non-expert endoscopists.

BackgroundMany patients with axSpA experience work disability (WD: not working due to axSpA) which is preceded by impairment whilst working (presenteeism), absenteeism, and overall work productivity loss (WPL). Studies addressing these and health-related factors are few, with only one done in a UK sample.ObjectivesTo determine key factors associated with absenteeism, presenteeism, WPL, and daily activity impairment (other than employed work) in UK patients with axSpA using standardized measures.MethodsIn a cross-sectional, observational study, during visits to the Royal National Hospital for Rheumatic Diseases axSpA clinic, 490 patients completed validated questionnaires for: (1) Work productivity using the Work Productivity and Impairment questionnaire (WPAI) which produces 4 measures: absenteeism, presenteeism, WPL and activity impairment; (2) Health-related disease factors using: BASDAI, BASFI, BASMI, Jenkins Sleep scale, Patient Global Assessment (PGA) for disease activity, back pain at night, back pain at any time, EQ-5D for mobility, self-care ability, usual daily activities, pain/discomfort, anxiety/depression, EQ-VAS for Health State Today, FACIT for fatigue in the last week scale, and the Margolis Pain Diagram. Statistics package STATA V. 13.1 was used for analyses. Univariate and multivariate linear and logistic regression were applied to determine associations between WPAI measures and health-related factors.ResultsOf 490 patients, 301 (61%) provided WPAI measurements, 261 (53%) were in employment, 76% were male, 87% HLA-B27+, mean (±SD) years (i) age of first symptoms 21.5 (8.8), (ii) age at diagnosis 30.8 (11.7), (iii)disease duration 21.7 (13.0), and 29% were receiving biologics. Mean scores: BASDAI 3.8 (2.2), BASFI 4.0 (2.7), BASMI 3.8 (2.1), Jenkins 13.0 (2.7), PGA 3.9 (2.6), PGA night pain 3.3 (2.6), PGA pain anytime 3.6 (2.6), FACIT 34 (12), EQ-VAS 63 (22), Margolis pain 8.7 (6.9). Mean WPAI scores for absenteeism were=5.1% (19.2), presenteeism=22% (24.3), WPL=23.2% (25.7), activity impairment=34.8% (27.3).WPAI outcomeNVariable*OR/Coefficient (95% CI)P*Absenteeism301FACIT−0.68 (0.56, 0.82)<0.001Smoking – Non10.07 Smoking – Ex0.82 (0.24, 2.74)<0.001 Smoking – Current2.86 (1.07, 7.64)Category – Radiographic1 Category – Non6.07, (1.83, 20.1)Presenteeism301FACIT−3.1 (−4.7, −1.6)<0.001BASDAI3.0 (1.1, 5.0)0.002BASFI1.6 (0.0, 3.3)0.04Duration diagnosis (yrs)−2.0 (−4.2, 0.3)0.08WPL301FACIT−3.9 (−5.5, −2.3)<0.001BASDAI3.0 (1.0, 4.9)0.003BASFI1.6 (0.1, 3.2)0.05Activity Impairment301FACIT−3.9 (−4.7, −3.1)<0.001Smoking – Non00.02 Smoking – Ex−4.4 (−7.6, −1.2)<0.001 Smoking – Current−0.8 (−4.8, 3.2)0.003BASFI4.4 (3.6, 5.2)<0.001EQ-VAS−1.2 (−2.0, −0.4)PGA disease activity1.7 (0.8, 2.5)ConclusionsWork productivity and activity impairment are associated with fatigue, disease activity, and functional ability in UK patients with axSpA. The strong association of fatigue with work disability and activity impairment emphasize the need to measure and better understand the impact of fatigue in axSpA.Disclosure of InterestNone declared

To make informed choices, patients need information about negative as well as positive effects of treatments. There is little information about negative effects of psychological interventions. To determine the prevalence of and risk factors for perceived negative effects of psychological treatment for common mental disorders. Cross-sectional survey of people receiving psychological treatment from 184 services in England and Wales. Respondents were asked whether they had experienced lasting bad effects from the treatment they received. Of 14 587 respondents, 763 (5.2%) reported experiencing lasting bad effects. People aged over 65 were less likely to report such effects and sexual and ethnic minorities were more likely to report them. People who were unsure what type of therapy they received were more likely to report negative effects (odds ratio (OR) = 1.51, 95% CI 1.22-1.87), and those that stated that they were given enough information about therapy before it started were less likely to report them (OR = 0.65, 95% CI 0.54-0.79). One in 20 people responding to this survey reported lasting bad effects from psychological treatment. Clinicians should discuss the potential for both the positive and negative effects of therapy before it starts.