Era Of Care Research Articles

Is There such a Thing as Post-Viral Depression?: Implications for Precision Medicine.

Viral infections are increasingly recognized as triggers for depressive disorders, particularly following the SARS-CoV-2 pandemic and the rise of long COVID. Viruses such as Herpes Simplex Virus (HSV), Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), and Human Immunodeficiency Virus (HIV) are linked to depression through complex neurobiological mechanisms. These include immune system dysregulation, chronic inflammation, and neurotransmitter imbalances that affect brain function and mood regulation. Viral activation of the immune system leads to the release of pro-inflammatory cytokines, resulting in neuroinflammation and associated depressive symptoms. Furthermore, specific viruses can disrupt neurotransmitter systems, including serotonin, dopamine, and glutamate, all of which are essential for mood stabilization. The unique interactions of different viruses with these systems underscore the need for virus-specific therapeutic approaches. Current broad-spectrum treatments often overlook the precise neurobiological pathways involved in post-viral depression, reducing their efficacy. This review emphasizes the need to understand these virus-specific interactions to create tailored interventions that directly address the neurobiological effects induced by each type of virus. These interventions may include immunomodulatory treatments that target persistent inflammation, antiviral therapies to reduce the viral load, or neuroprotective strategies that restore neurotransmitter balance. Precision medicine offers promising avenues for the effective management of virus-induced depression, providing patient-specific approaches that address the specific biological mechanisms involved. By focusing on the development of these targeted treatments, this review aims to pave the way for a new era in psychiatric care that fully addresses the root causes of depression induced by viral infections.

ASO Author Reflections: Home Recovery After Mastectomy: Embracing a New Era of Postmastectomy Care.

ASO Author Reflections: Home Recovery After Mastectomy: Embracing a New Era of Postmastectomy Care.

"Advances in the Prevention and Treatment of Necrotizing Enterocolitis: A New Era in Neonatal Care"

"Advances in the Prevention and Treatment of Necrotizing Enterocolitis: A New Era in Neonatal Care"

A New Era of Data-Driven Cancer Research and Care: Opportunities and Challenges.

People diagnosed with cancer and their formal and informal caregivers are increasingly faced with a deluge of complex information, thanks to rapid advancements in the type and volume of diagnostic, prognostic, and treatment data. This commentary discusses the opportunities and challenges that the society faces as we integrate large volumes of data into regular cancer care.

The impact of oral oncology drugs in the era of value-based care.

15 Background: Oncology drug expenditures are a significant contributor to increasing total cost of care (TCOC). Oral oncolytics (OO), such as small molecule inhibitors (CDK 4/6 inhibitors, tyrosine kinase inhibitors, etc.), and immunomodulators, have revolutionized the treatment landscape for many cancers. We evaluated the patterns of OO use and spend for Medicare patients over time at a large community oncology practice participating in the Center for Medicare and Medicaid Innovation (CMMI)’s Value-based care (VBC) Program, the Oncology Care Model (OCM), with a focus on the seven cancers that are part of a successor model, the Enhancing Oncology Model. Methods: Using CMMI claims for attributed 6-month OCM episodes, we evaluated drug use and expenditures by performance period (PP) from July 2016 – June 2022 (11 PPs), with an emphasis on OO drugs. We used Part D expenditures as a proxy for OO. Results: From 2016-22, average TCOC per PP increased by 15.5% in the 7 EOM diagnoses (breast, lung, colon, prostate cancer, myeloma, lymphoma, and chronic leukemia). Average drug expenditures per PP grew 33% percent and represented 71% of total cost by PP11, up from 61% in PP1. Average expenditures per episode increased by 11.7% for Part B and 82.6% for Part D drugs (p<0.01). Increase in Part D drug expenditures was partly due to an increase in the number of unique oral drugs which grew by 32% over the evaluation period. The greatest increases in Part D drug expenditures occurred in breast cancer (87%) and lymphoma (153.7%). Table reports average OO expenditures per PP, percent change from PP1 to PP11, and the change in the % Part D drugs contributed to TCOC. Conclusions: Increases in drug expenditures represent the greatest impact on TCOC for cancer patients. OO medicines have an increasing role in the treatment landscape and represent a growing focus in VBC models. Utilization and cost of OO medication have a significant bearing on VBC performance. Diagnosis Avg. OO Expenditures PP1 Avg. OO Expenditures PP11 Avg. OO Expenditures Change Contribution of OO to TCOC Change from PP1 - 11 Breast $4,208 $7,869 87.0% 9.9% Leukemia $25,334 $41,128 62.3% 19.9% CRC $1,206 $2,158 78.9% 3.1% Lung $3,650 $3,625 -0.7% -2.5% Lymphoma $4,193 $10,637 153.7% 13.0% Myeloma $25,109 $39,298 56.5% 6.7% Prostate $18,815 $20,114 6.9% 3.2% Total $8,291 $15,140 82.6% 10.8%

Leveraging Generative AI for Personalized Healthcare: Revolutionizing Treatment Plans

This comprehensive article explores the transformative potential of generative artificial intelligence (AI) in healthcare, examining its applications in data analysis, disease outcome prediction, and personalized treatment planning. The article discusses how generative AI systems can process vast amounts of multi-modal patient data to uncover subtle patterns and correlations, leading to more accurate diagnoses and tailored treatment strategies. It highlights successful implementations across various medical specialties, including oncology, chronic disease management, and rare disease diagnosis. The article also addresses the challenges and ethical considerations associated with the deployment of generative AI in healthcare, emphasizing the need for data privacy, algorithmic transparency, and regulatory compliance. By presenting both the opportunities and obstacles, this work provides a balanced view of the role generative AI can play in ushering in a new era of precision medicine and patient-centered care

Artificial intelligence in psychiatric diagnosis: challenges and opportunities in the era of machine learning

The integration of artificial intelligence (AI) into psychiatric diagnosis heralds a new era in mental health care, offering unprecedented opportunities to enhance diagnostic accuracy, personalize treatment, and streamline clinical workflows. A systematic approach was utilized, adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This literature review explores the current state of AI in psychiatric diagnosis, highlighting key technologies such as machine learning, natural language processing, and deep learning. We discuss the application of these technologies across various psychiatric disorders, including depression, anxiety, and schizophrenia. While AI holds immense promise, significant challenges remain, including issues of data privacy, model bias, and the clinical validation of AI tools. Furthermore, ethical and regulatory considerations must be addressed to ensure responsible implementation. This review also examines the potential future directions of AI in psychiatry, emphasizing the importance of collaboration between AI systems and human clinicians. As the field evolves, AI has the potential to transform psychiatric practice, offering new avenues for early detection, personalized care, and therapeutic monitoring.

Validation of a genome-based model for adjusting radiotherapy dose (GARD) in patients with locally advanced rectal cancer

Neoadjuvant radiotherapy is the standard care of locally advanced rectal cancer. Although a majority of patients received the same dose, the curative efficacy varies among individuals. In recent years, cancer treatment has entered the era of precise medical care, and how to identify patients for proper treatment by molecular signature is an important path of individualized therapy. This study aimed to establish and validate a genome-based model for adjusting radiation dose (GARD) for Chinese locally advanced rectal cancer through gene expression microarrays, and to evaluate the response of the GARD model in predicting the efficacy of neoadjuvant radiotherapy. Fresh-frozen primary tumor from 64 patients with locally advanced rectal cancer undergoing neoadjuvant radiotherapy from 2015 to 2018 were included. The gene expression profile was analyzed using Affymetrix 3000Dx gene-chip scanner. The radiosensitivity index (RSI) and GARD were calculated using the pGRT™ algorithm. Neoadjuvant rectal cancer score (NAR) was selected as efficacy evaluation indicators. Patients were divided into high and low NAR scoring groups, and two-sample t-test was used to analyze the differences in GARD values between different NAR subgroups. ROC curves were used to calculate the cut-off values and the area under the curve (AUC) for assessing the validity of the GARD models. The personalized radiation dose ( pGRT dose )can be computed using the formula nd = GARD / (α + βd). Among patients, 1.5% T2, 46.3% T3, and 52.2% T4. Wherein pCR (n = 10; 15.6%) and no pCR (n = 54; 84.4%). The median NAR is 8.43 (rang from 0 to 50.34, IQR 3.75–14.98). NAR > 8.43 (n = 27; 42.2%) and NAR ≤ 8.43 (n = 37; 57.8%), suggesting that there are significant individual differences in clinical efficacy of patients with similar tumor stages and under the same treatment conditions. The median RSI is 0.48 (rang from 0.22 to 0.92, IQR 0.41–0.55). Median GARD was 18.40 rang from (rang from 2.26 to 37.52, IQR 14.94–22.28) within tumor tissue, suggesting individual differences in the efficacy of radiation therapy. The RSI value was significantly lower in the NAR low group (NAR ≤ 8.43) than in NAR high group (NAR > 8.43) (0.44 vs. 0.54, p = 0.0003). The GARD value was significantly higher in the NAR low group (NAR ≤ 8.43) than in NAR high group (NAR > 8.43) (21.01 vs. 15.88, p = 0.0004). Using the Receiver Operating Characteristic (ROC) curve analysis, a GARD threshold of 17 was identified as optimal, covering 37.5% of the 64-patient sample, with an area under the curve (AUC) of 0.75. In the external validation cohort, the high GARD score group demonstrated superior DFS compared to the low GARD score group(p < 0.001). Only 17% of patients had pGRT dose within the guideline recommended dose (45–50 Gy). The differences in NAR values among LARC patients receiving standard neoadjuvant radiotherapy suggest significant individual differences in clinical outcomes among patients with similar tumor stage and the same treatment conditions. Patients with a GARD value exceeding 17 exhibit a more favorable prognosis. Our results suggest that the gene expression-based pGRT™ algorithm has good efficacy prediction performance in preoperative concurrent radiotherapy for locally advanced rectal cancer, suggesting the potential clinical application of this method to guide the designation of individualized radiotherapy doses.

Medicalized Aesthetic Uses of Exosomes and Cell Culture-Conditioned Media: Opening an Advanced Care Era for Biologically Inspired Cutaneous Prejuvenation and Rejuvenation

Recent advancements in aesthetic medicine offer innovative cosmetic solutions to enhance patient skin quality and appearance. Advanced treatment options enable practitioners to effectively address skin aging signs, pigmentation imbalance, and loss of elasticity in ambulatory and home-based care regimens. Exosomes (nanoscale cell-derived vesicles) transport a variety of biomolecules and are pivotal in physiological intercellular communication. Importantly, exosomes have recently emerged as key endogenous players in tissular regeneration. More broadly (from an active ingredient purity standpoint), exosomes, stem cell secretomes, and cell culture-conditioned media have been clinically proven to exert multifaceted beneficial topical effects (anti-inflammatory, antioxidant, anti-aging, skin rejuvenation). Therefore, human, animal, and plant-derived exosomes or other refined sub-cellular biological fractions are gaining substantial interest within the aesthetic and cosmetic industries. Notably, such approaches are thought to be among the most promising novel contenders for advanced, biologically inspired skin prejuvenation and rejuvenation care. The present narrative review summarizes the latest clinically oriented research on exosomes and cell culture-conditioned media, highlighting their mechanisms of action in various topical applications. Furthermore, it explores the innovation landscape and currently commercially available products on the global cosmetic market and discusses the potential future applications of advanced, biologically inspired ingredients in the medical aesthetic industry.

Cutting-edge developments in acute myeloid leukaemia: innovations in diagnosis and treatment

Acute Myeloid Leukaemia (AML) is a fast-growing hematologic malignancy that is distinguished by the clonal proliferation of myeloid progenitors in bone marrow. Recent advances in molecular biology and genomic technology have altered the landscape of AML diagnosis and therapy, resulting in more tailored and successful therapeutic approaches. This study reviews recent innovations in the diagnosis and treatment of AML, focusing on genomic profiling, next-generation sequencing (NGS), and novel targeted therapies. Data was collected from recent clinical trials, peer-reviewed journals, and case studies. Comparative analysis was conducted to evaluate the efficacy of emerging diagnostic tools and treatments. NGS and MRD monitoring have greatly improved diagnosis accuracy and therapy customization. Targeted medicines have enhanced remission rates and decreased recurrence rates in individuals with certain genetic alterations. Immunotherapies have showed long-term efficacy and controllable safety profiles. Combining modern diagnostic technologies with customized medicines ushers in a new era of AML care, enhancing prognosis and quality of life. Ongoing research and clinical trials are critical for improving these therapies and expanding their advantages to a larger patient group.

Patients' Expectations of Doctors' Clinical Competencies in the Digital Health Care Era: Qualitative Semistructured Interview Study Among Patients.

Digital technologies have impacted health care delivery globally, and are increasingly being deployed in clinical practice. However, there is limited research on patients' expectations of doctors' clinical competencies when using digital health care technologies (DHTs) in medical care. Understanding these expectations can reveal competency gaps, enhance patient confidence, and contribute to digital innovation initiatives. This study explores patients' perceptions of doctors' use of DHTs in clinical care. Using Singapore as a case study, it examines patients' expectations regarding doctors' communication, diagnosis, and treatment skills when using telemedicine, health apps, wearable devices, electronic health records, and artificial intelligence. Findings were drawn from individual semistructured interviews with patients from outpatient clinics. Participants were recruited using purposive sampling. Data were analyzed qualitatively using thematic analysis. Twenty-five participants from different backgrounds and with various chronic conditions participated in the study. They expected doctors to be adept in handling medical data from apps and wearable devices. For telemedicine, participants expected a level of assessment of their medical conditions akin to in-person consultations. In addition, they valued doctors recognizing when a physical examination was necessary. Interestingly, eye contact was appreciated but deemed nonessential by participants across all age bands when electronic health records were used, as they valued the doctor's efficiency more than eye contact. Nonetheless, participants emphasized the need for empathy throughout the clinical encounter regardless of DHT use. Furthermore, younger participants had a greater expectation for DHT use among doctors compared to older ones, who preferred DHTs as a complement rather than a replacement for clinical skills. The former expected doctors to be knowledgeable about the algorithms, principles, and purposes of DHTs such as artificial intelligence technologies to better assist them in diagnosis and treatment. By identifying patients' expectations of doctors amid increasing health care digitalization, this study highlights that while basic clinical skills remain crucial in the digital age, the role of clinicians needs to evolve with the introduction of DHTs. It has also provided insights into how DHTs can be integrated effectively into clinical settings, aligning with patients' expectations and preferences. Overall, the findings offer a framework for high-income countries to harness DHTs in enhancing health care delivery in the digital era.

A new era for primary care is ahead of us

A new era for primary care is ahead of us

Definitions of pulmonary exacerbation in people with cystic fibrosis: a scoping review

BackgroundPulmonary exacerbations (PExs) are clinically important in people with cystic fibrosis (CF). Multiple definitions have been used for PEx, and this scoping review aimed to identify the different definitions reported...

The Current Regulatory Environment for Software Used in Medical Devices: A Need for Refined International Strategies

In the fast-evolving landscape of healthcare technology, Software as a Medical Device (SaMD) has emerged as a transformative force, redefining how medical functionalities are delivered and accessed. From diagnostic algorithms to treatment monitoring applications, SaMD has ushered in a new era of innovation and patient care[1]. As this field continues to burgeon, regulatory frameworks play a pivotal role in ensuring the safety, efficacy, and reliability of these digital health solutions[2]. In this editorial, we delve into the dynamic regulatory landscape of SaMD in both the BRICS (Brazil, Russia, India, China, and South Africa) nations and the United States (US), exploring the nuances and challenges that underscore the need for more refined strategies. By examining the regulatory intricacies and aligning them with technological advancements, we aim to shed light on the imperative of adaptive regulatory approaches that can harness the full potential of SaMD while safeguarding public health. A remarkable role of "software as a medical device" (SaMD) in contemporary healthcare software that is intended to be used for medical purposes but is not a component of a hardware medical device is referred to as "software as a medical device" (SaMD)[3]. SaMD is essential to contemporary healthcare since it makes it possible to use software applications for a variety of medical functions, diagnoses, treatments, and monitoring [4].

Impact of Discontinuing Both Hypertonic Saline and Dornase Alfa After Elexacaftor/Tezacaftor/Ivacaftor in Cystic Fibrosis.

Rationale Evaluating approaches to reduce treatment burden is a research priority among people with CF (pwCF) on highly effective modulators including elexacaftor/tezacaftor/ivacaftor (ETI). Objective To evaluate the impact of discontinuing both hypertonic saline (HS) and dornase alfa (DA) versus continuing both therapies among a subgroup of participants in the SIMPLIFY study who sequentially participated in trials evaluating the independent clinical effects of discontinuing HS and DA. Methods SIMPLIFY participants ≥12 years old on ETI and comprising a subgroup using both HS and DA at study entry were randomized to the HS or DA trial, and then randomized 1:1 to continue or discontinue the applicable therapy for 6 weeks. After completion of the first trial, eligible participants could enroll in the second trial beginning with a 2-week run in. Study outcomes were compared across the duration of SIMPLIFY participation between a cohort remaining on both therapies during SIMPLIFY versus a cohort that sequentially discontinued both as a result of trial randomizations. Multivariable regression models were used to estimate treatment differences, adjusted for time between trials, trial order, baseline age, sex at birth and percent predicted forced expiratory volume in one second (ppFEV1) at study entry. Results There were 43 participants who discontinued both therapies by the end of SIMPLIFY and 63 who remained on both, with overall average ppFEV1 at study entry 96.7% and average duration of follow up from beginning of the first trial to completion of the second trial 3.9 months, including time between trials. No clinically meaningful difference in the change in ppFEV1 from baseline to completion of the second trial was observed between those who discontinued versus remained on both therapies (difference: 0.22% Off-On, 95% CI: -1.60,2.03). Changes in LCI2.5, patient reported, and safety outcomes were also comparable. Patient reported treatment burden, as measured by a CFQ-R subscale, significantly decreased in those discontinuing both therapies. Conclusions SIMPLIFY participants who sequentially discontinued both HS and DA experienced no meaningful changes in clinical outcomes and reported decreased treatment burden as compared to those who remained on both therapies. These data continue to inform a new era of post-modulator care of pwCF.

A New Paradigm in the Management of Knee Osteoarthritis and Arthroplasty with Dynamic Patient-source Outcome Measures: Comprehensive Clinical Review of the Knee Kinesiography Exam with the KneeKG® System

While knee disorders, and more specifically knee osteoarthritis, account for a significant portion of the orthopedic visits to health care providers, there are still clinical gaps that need to be addressed to achieve effective management of this disease. The absence of functional tools to objectively assess knee function in motion and weight-bearing conditions poses a challenge for clinicians to hindering their ability to design individualized conservative and surgical treatment plans aimed at achieving better patient outcomes. The Knee Kinesiography exam with the KneeKG® system provides accurate, reliable, three-dimensional, and real-time information about dynamic knee malalignment and joint dysfunction during weight-bearing activities through the assessment of kinematic biomechanical markers. This work presents a comprehensive clinical review of the materials related to this exam which have been published since its validation in 2012. The aim is to summarize literature evidence on how the Knee Kinesiography exam may enhance both non-surgical and surgical management of knee osteoarthritis and arthroplasty. The access to objective patient-source outcome measures from this exam, directly associated with both patient-reported outcomes and osteoarthritis onset and progression before and after total knee arthroplasty, can allow clinicians to identify mechanisms behind knee pain, dysfunction, and dissatisfaction. In the era of orthopedic value-based care, such patient-source data may help clinicians better understand the condition of the knee and thus assist them in their decision-making to establish the best personalized care plan possible throughout the continuum of care, from diagnosis to post-surgery management.

Phoenix: an R package and Python module for calculating the Phoenix pediatric sepsis score and criteria.

The publication of the Phoenix criteria for pediatric sepsis and septic shock initiates a new era in clinical care and research of pediatric sepsis. Tools to consistently and accurately apply the Phoenix criteria to electronic health records (EHRs) is one part of building a robust and internally consistent body of research across multiple research groups and datasets. We developed the phoenix R package and Python module to provide researchers with intuitive and simple functions to apply the Phoenix criteria to EHR data. The phoenix R package and Python module enable researchers to apply the Phoenix criteria to EHR datasets and derive the relevant indicators, total scores, and sub-scores. The transition to the Phoenix criteria marks a major change in the conceptual definition of pediatric sepsis. Applicable across differentially resourced settings, the Phoenix criteria should help improve clinical care and research. The phoenix R package and Python model are freely available on CRAN, PyPi, and GitHub. These tools enable the consistent and accurate application of the Phoenix criteria to EHR datasets.

Effects of Center Based vs. Telerehabilitation using an Interval and Continuous Aerobic Training among Post-Coronary Revascularization Patients-A Randomized Controlled Trial

Background: This investigation used continuous aerobic and high-intensity interval training to compare the differences between centre-based and telerehabilitation. This study seeks to identify the most efficient rehabilitation strategy positioned to empower patients on their path to recovery and well-being in the contemporary era of cardiac care. Methodology: The study was a single-blinded, randomized controlled trial involving 80 patients who had undergone coronary revascularization procedures, were enrolled in the cardiac rehabilitation department, and were eligible for Phase-III CR. Patients were divided into Group A, receiving centre-based Continuous Moderate-Intensity Aerobic Exercise, 3–4 days a week, at 50%-70% of MHR. Group B received high-intensity interval-based training for 3–4 days and at four subsequent intervals. Telerehabilitation was conducted with Group C following the same protocol as Group A and Group D following the same protocol as Group B, while each group had n=20 participants. Results: The within-group analysis showed significant improvements in the 6-Minute Walk Test (6MWT) and Self-reported Seven-Day Physical Activity Questionnaire (PAR) across all groups (p&lt;0.001). Significant improvements in the Rate of Perceived Exertion (RPE) were found in Groups A and B (p&lt;0.05). ANOVA results indicated that centre-based rehabilitation was significantly more effective than telerehabilitation in improving 6MWT and RPE scores (p&lt;0.05). Conclusion: Centre-based intervention is more effective than telerehabilitation in Phase-III Cardia Rehabilitation patients. However, high-intensity interval-based training was more effective in centre-based, while continuous moderate-intensity aerobic exercise was effective in telerehabilitation. Keywords: Aerobic Exercises, Cardiac Rehabilitation, Coronary Artery, Physical Activity.

Significance of Triazole in Medicinal Chemistry: Advancement in Drug Design, Reward and Biological Activity.

One of the triazole tautomers, 1,2,4-triazole derivatives, has a wide range of biological activities that suggest its potential therapeutic utility in medicinal chemistry. These actions include anti-inflammatory, anti-cancer, anti-bacterial, anti-tuberculosis, and anti-diabetic effects. Using computational simulations and models, we investigate the structure-activity relationships of 1,2,4-triazoles, showing how various modifications to the triazole core yield a variety of clinical therapeutic benefits. The review highlights the anti-inflammatory effect of 1,2,4-triazoles in relation to their ability to disrupt significant inflammatory mediators and pathways. We present in-silico data that illuminate the triazoles' capacity to inhibit cell division, encourage apoptosis, and stop metastasis in a range of cancer models. This review looks at the bactericidal and bacteriostatic properties of 1,2,4-triazole derivatives, with a focus on their potential efficacy against multi-drug resistant bacterial infections and their usage in tuberculosis therapy. In order to better understand these substances' potential anti-diabetic benefits, this review also looks at how they affect glucose metabolism regulation and insulin responsiveness. Coordinated efforts are required to translate the efficacy of 1,2,4-triazole compounds in preclinical models into practical therapeutic benefits. Based on the information provided, it can be concluded that 1,2,4-triazole derivatives are a promising class of diverse therapeutic agents with potential utility in a range of disorders. Their development and improvement might herald a new era of medical care that will be immensely advantageous to both patients and the medical community as a whole. This comprehensive research, which is further reinforced by in-silico investigations, highlights the great medicinal potential of 1,2,4-triazoles. Additionally, this study encourages more research into these substances and their enhancement for use in pharmaceutical development.

Standardizing clinician training and patient care in the neonatal neurocritical care: A step-by-step guide

Neonatal neurocritical care (NNCC) has emerged as an important specialty to address neurological conditions affecting newborns including a wide spectrum of brain injuries and developmental impairment. Despite the discipline's growth, variability in NNCC service delivery, patient care, and clinical training poses significant challenges and potentially adversely impacts patient outcomes. Variations in neuroprotective strategies, postnatal care, and training methodologies highlight the urgent need for a unified approach to optimize both short- and long-term neurodevelopmental outcomes for these vulnerable population. This paper presents strategic blueprints for establishing standardized NNCC clinical care and training programs focusing on collaborative effort across medical and allied health professions. By addressing these inconsistencies, the paper proposes that standardizing NNCC practices can significantly enhance the quality of care, streamline healthcare resource utilization, and improve neurodevelopmental outcome, thus paving the way for a new era of neonatal neurological care.