Initial Criteria Research Articles

Plate-only open-door laminoplasty is associated with durable, significantly improved clinical outcomes and a very low reoperation rate for progressive spondylosis or adjacent segment disease: average 8-year follow-up

Background ContextMultilevel cervical myelopathy is a common cause of spinal cord dysfunction in adults. Surgical intervention via laminoplasty can provide satisfactory clinical outcomes by expansive decompression of the spinal cord. Traditional suture or bone graft techniques have been associated with insufficient fixation, leading to premature closure and subsequent neurological deterioration. In contrast, plated laminoplasty has been shown to provide stable fixation to maintain canal enlargement, but longer-term outcomes are lacking. PurposeTo evaluate longer-term clinical outcomes and reoperations associated with plate-only open-door laminoplasty. Study designRetrospective review of prospectively collected data. Patient SamplePostoperative patients who underwent plate-only open door laminoplasty with minimum 5-year follow up. Outcome Measuresmodified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and 12-item Short Form Health Survey (SF-12). MethodsAll patients at a single academic institution who underwent plate-only open-door cervical laminoplasty from 9/1/2006 to 9/1/2016 were identified to ensure minimum 5 year follow up. Clinical outcomes included the modified Japanese Orthopaedic Association (mJOA) score, the Neck Disability Index (NDI), and the 12-item Short Form Health Survey (SF-12). The occurrence of any repeat operations on the cervical spine was evaluated, as well as its cause. The study team attempted to contact all eligible patients to achieve at least 5 years postoperative follow-up. Pairwise t tests were performed to compare clinical outcomes at preoperative, 6 months, 1-year, and final postoperative follow-up with an α level of 0.05. ResultsA total of 774 met the initial inclusion criteria, of which 157 were included in the study (20.3%). Most common reasons for exclusion included inability to reach after 3 attempts (49.48%), inactive phone numbers (20.28%), and patient declining (3.49%). Included patients had an average age of 60.66±10.63 and an average follow-up time of 8.37±2.57 years (minimum 5 years). mJOA scores (preoperative 11.59±2.16) improved significantly at 6-months (14.57±2.07, p<.001), 1-year (15.19±1.95, p<.001), and final follow-up (14.59±2.63, p<.001). NDI (preoperative 33.89±18.54) improved significantly at 6 months (27.89±19.72, p=.03), 1-year (25.96±19.79, p=.01) and final follow-up (17.88±17.17, p<.001). SF-12 MCS (preoperative 44.73) improved significantly at 6 months (52.01, p=.001), 1-year (51.62, p=.008), and final follow-up (52.32, p<.001). No patient underwent reoperations for plate failure or canal closure with recurrent stenosis. Reoperations for progressive spondylosis during the follow up period were rare and occurred in only three patients for new onset radiculopathy (1.9%) and two patients for myelopathy (1.3%) at an average of 3.2 years postoperative. There were no reoperations performed for adjacent segment disease. ConclusionsAt a minimum of 5 years and an average of more than 8 years postoperative, laminoplasty was associated with significant and sustained improvements in mJOA, NDI, and SF-12 MCS. Importantly, no patients underwent revision surgery for plate failure or recurrent canal closure. Reoperations for new onset radiculopathy and myelopathy were also very rare over the 8-year average follow-up period, with no reoperations for adjacent segment disease. Plate-only laminoplasty is a durable means of treating multilevel myelopathy with excellent longer-term outcomes and a very low risk of reoperation, either for premature closure or the inevitable spondylotic changes that occur over time in patients with similar baseline characteristics to the study population.

Hunting sustainable refrigerants fulfilling technical, environmental, safety and economic requirements

An urgent action to mitigate climate change is the replacement of hydrofluorocarbons used in refrigeration systems, for low-global warming potential (GWP) alternatives, with stringent legislations in place. However, very limited options exist for single-component low-GWP refrigerants with similar technical performance. This work presents an integrated approach for the rational design of low-GWP refrigerant blends, focused on replacing R134a (GWP 1430), and R410A (GWP 2088), used in automotive and domestic air-conditioning, and in high pressure commercial and industrial refrigeration, respectively. A 4 E analysis (energy, exergy, economic and environmental) was employed to select suitable candidates. The molecular polar soft-SAFT theory was used in a predictive manner to fill the gap in thermodynamic data required for evaluating the technical performance based on initial selection criteria including GWP, toxicity, flammability, and degree of azeotropy. Potential candidates from a pool of 432 options were narrowed down and evaluated using a drop-in analysis to replace the working fluids R134a and R410A in today's refrigeration and air conditioning cycles, resulting in seven promising blends. Environmental and cost rate evaluation (geographically dependent based on electricity cost, HFC utilization taxes, and carbon emission factors) quantified the impact associated with their use and emissions, allowing to identify suitable replacements: three blends for replacing R134a: (90/10) wt.% R1243yf + R152a, (90/10) wt.% R1243yf + R134a, and (60/40) wt.% R1243zf + R1234ze(E), and one for replacing R410A: (90/10) wt.% R1123 + R32. This work showcases the importance of using robust thermodynamic models in the search of low-GWP refrigerants blends, considering the 4 E criteria.

A case-control survey study of environmental risk factors for primary hypoadrenocorticism in dogs.

Primary hypoadrenocorticism in dogs is thought to be multifactorial with roles for both genetic and environmental factors. The contributions of environmental factors remain unexplored. Identify environmental and lifestyle exposures associated with primary hypoadrenocorticism in 2 dog breeds with high risk of developing the disease. Animals were not used in this study. Owners of Standard Poodles (STPDs) and Portuguese water dogs (POWDs) participated in a survey. Retrospective case-control study. Dog owners were invited to participate in an online survey through convenience sampling. Questions regarded the demographics, health histories, and indoor/outdoor environments in which their dogs live and play. Responses for dogs with primary hypoadrenocorticism were compared to those without the disease using univariate and multivariate logistic regression models. Five thousand forty-seven responses (358 cases, 4689 controls) met initial inclusion criteria. Significant associations with modest effect size were found for community type, ingestion of canned food, and use of lawn fertilizer in some analysis models. Reproductive (spay/neuter) status exhibited the strongest association with high effect size across all models with adjusted odds ratio (OR) 2.5 (95% confidence interval [CI], 1.4-4.5; P = .003) for spayed females and 6.0 (95% CI, 2.6-13.9; P < .001) for neutered males. The large effect size for reproductive status reflects its high potential clinical relevance, whereas modest effect sizes for other environmental variables suggest lower potential clinical relevance. These findings are associations and do not necessarily imply causation. Before any actionable recommendations are warranted, additional evidence regarding biological mechanisms is needed.

Chronic Rhinosinusitis With Nasal Polyposis Treated With Dupilumab: Real-World Use and Outcomes.

Biologic medications are increasingly incorporated into chronic rhinosinusitis with nasal polyps (CRSwNP) management. However, little is known about prescribing patterns in real-world settings and how this relates to proposed international guidelines and outcomes. To characterize use patterns of dupilumab for CRSwNP better in relation to proposed guidelines and explore real-world outcomes. We used the TriNetX Web-based tool to identify patients who were prescribed dupilumab for CRSwNP. Patients prescribed dupilumab for a CRSwNP indication were included for analysis. Dupilumab initiation criteria were determined via the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS2020). In total, 121 patients were identified who were prescribed dupilumab for a CRSwNP indication. Of these, 86 (71%) met EPOS2020 indications for biologic initiation and 35 (29%) did not. Overall, patients had significant improvements in the 22-item SinoNasal Outcome Test scores (mean improvement of 24.3 points) and nasal polyp scores (mean improvement of 1.0 point). However, 20 patients (30%) did not show meaningful improvement in the 22-item SinoNasal Outcome Test scores. Twenty-one patients (17%) failed a previous biologic attempt. Therapy was discontinued by six patients (5%) due to side effects, and by six (5%) owing to a lack of efficacy. In our experience, patients prescribed dupilumab for CRSwNP frequently may not meet EPOS2020 Guidelines. Over 25% of those who do not meet criteria may not have CRSwNP. Overall, dupilumab use among well-selected patients appears to be safe and effective. Further real-world study of biologic use for CRSwNP will help improve its judicious use and identify populations who benefit most from biologic therapies.

High-Resistance Grounding Fault Detection and Line Selection in Resonant Grounding Distribution Network

The detection and selection of fault lines in resonant grounding distribution networks pose challenges due to the lack of sufficient state parameters and data. This paper proposes an approach to overcome these limitations by reconstructing the initial criterion for fault occurrence and fault line selection. Firstly, a combination of 15% of the traditional phase voltage and the sum of the zero-sequence voltage gradient is suggested as the initial criterion for fault occurrence. This improves the speed of the line selection device. Additionally, the transient process of high-resistance grounding in a resonant grounding system is analyzed based on the impedance characteristics of high- and low-frequency lines. The line selection criterion is then established by comparing the current and voltage derivative waveforms on high- and low-frequency lines. To verify the effectiveness of the proposed method, simulations are conducted. The results demonstrate that this method can effectively handle high-resistance grounding faults under complex conditions while meeting the required speed for line selection.

Dynamic Risk Stratification Integrated with ATA Risk System for Predicting Long-Term Outcome in Papillary Thyroid Cancer.

In recent years, there has been a renewed interest in thyroid cancer management paradigms that use individualized risk assessments as the basis for treatment and follow-up recommendations. In this study, we assumed that the long-term follow-up of differentiated thyroid cancer patients might be better tailored by integrating the response to initial therapy with the America Thyroid Association (ATA) risk classes. This retrospective study included low- and intermediate-risk papillary thyroid cancer (PTC) patients followed up for a median time of 8 years and classified according to the response to initial therapy assessed 6-12 months after initial treatment. After a median follow-up of 8 years, in the initial excellent response subgroup of PTC patients (n = 522), the rate of recurrent disease was significantly higher in intermediate-risk patients than in low-risk PTC patients (6.9% versus 1.2%, p = 0.0005). Similarly, in the initial biochemical incomplete response subgroup (n = 82), the rate of excellent response was significantly higher in low-risk PTC patients (58.0%) than in intermediate-risk PTC patients (33.3%) (p = 0.007). Finally, in the initial structural incomplete response subgroup (n = 66), the rate of excellent response was higher in low-risk patients (80.0%) than in intermediate-risk patients (46.4%) (p = 0.08). Moreover, all patients with initial indeterminate response had an excellent response at the last follow-up visit. ATA risk classes were independently associated with long-term outcome in each subgroup of patients classified dynamically after initial therapy and the overall prognostic performance, defined via ROC curve analysis, of response to initial therapy integrated with the ATA risk system (AUC: 0.89; 95% CI: 0.86-0.92) was significantly higher compared to the ATA risk stratification (AUC 0.69; 95% CI: 0.65-0.74, p < 0.001) or the dynamic risk stratification (DRS) systems alone (AUC: 0.86 95% CI: 0.82-0.90, p = 0.007). This study of a large cohort of PTC patients showed that the initial ATA risk criteria may be useful for improving the risk-adapted management of PTC patients based on the response to initial therapy.

"Ordinary days would be extraordinary": The lived experiences of severe and enduring anorexia nervosa.

Approximately 25% of individuals with anorexia nervosa (AN) experience a chronic form of the disorder, referred to as severe and enduring anorexia nervosa (SE-AN). Although the classification of SE-AN remains preliminary, there have been increasing calls for a harm reduction-based, collaborative treatment model for these patients. To provide such care for patients with SE-AN, it is critical to listen to and learn from their lived experiences. Patients (N = 17) admitted to an inpatient eating disorders program who met initial criteria for SE-AN completed semi-structured interviews about the course of their illness and prior treatment episodes. Interviews were audio recorded and transcribed. Data were analyzed using an inductive, reflexive approach to thematic analysis that examined common themes within and across interviews. Three themes were identified focused on (1) the all-encompassing nature of SE-AN, (2) treatment experiences, and (3) living with chronic illness. Within these themes, there were subthemes. Overall, individuals noted clear insight about their condition, both negative and positive experiences with previous treatment, and hope for better quality of life despite their illness. Individuals with SE-AN describe their illness as a chronic condition and hope for a harm reduction-based treatment. Future work, including the lived experiences of individuals with SE-AN, is important to build our understanding of the classification and clinical characteristics of SE-AN and to develop treatment approaches that may best serve these individuals. Many people with anorexia nervosa do not achieve a full recovery despite repeated treatment episodes throughout their lifespan. Understanding the lived experiences of individuals with SE-AN may help to inform future treatment development efforts that could improve eating disorder and quality of life outcomes for these patients.

Evaluating Goldberger's triad as a marker of congestive heart failure: A systematic review and retrospective study

BackgroundIn 1982, Drs. Barold and Goldberger described an ECG triad associated with left ventricular dysfunction (LVD) consisting of high precordial QRS voltage, low limb lead voltage, and poor precordial R wave progression. Studies have since attempted to replicate the originally reported sensitivity (70%), specificity (>99%), and positive predictive value (PPV, 100%) of Goldberger's triad (GT) with variable results. PurposeTo assess sensitivity, specificity and PPV of GT as a screening tool for LVD in the current era. MethodsWe performed: (1) A systematic review of the published studies; (2) Searched our hospital ECG database (GE MUSE) for diagnoses of “low limb-voltage” and “left ventricular hypertrophy” from 2017 to 2022; identified ECGs were analyzed for GT criteria and their medical records were screened for LVD. (3) ECG analysis of patients with known idiopathic LVD for the GT. ResultsA total of 11,115 patients from 8 studies were included in the systematic review of published studies and showed widely varying sensitivity, specificity and PPV. A total of 4576 ECGs (in GE MUSE) from 372 patients met initial screening criteria of low limb lead voltage and LVH; only 12 patients had ECGs that satisfied GT. Of these 12, only 1 patient had evidence of LVD, yielding a PPV of 8%. Finally, of the 40 patients with known LVD, only 1 met the ECG criteria for GT, resulting in a sensitivity of 2.5%. ConclusionOur literature review does not support the original results of GT. ECGs from our database that met GT (searched by low limb-voltage and left ventricular hypertrophy) over a span of 5 years were rare. When present, the PPV of GT was 8%. In patients with established LVD, the sensitivity was 2.5%. These data do not validate GT as tool to identify LVD in the current era.

The concept of a set in the theory and practice of designing

The concept of a set is one of the key concepts in mathematics and not only. To further the discussion, assessments of the significance of sets in designing, generated by large language models, are given as a kind of generalized take on the importance of this concept. An analysis of the concepts of a set and a class in mathematics and engineering is provided. The multiplicity of their interpretations and the difference in various fields of application directly related to the concept of “element of the set”, are shown. In designing, the concept of a set is considered in various aspects and is filled with different content. First of all, it is a set of needs that continuously arise, and the design activity, accompanied by a multitude of design subjects participating in it, is aimed at satisfying them. It is also a set of precedents (already created artifacts), which are analogues and prototypes for the designer, but for one reason or another do not satisfy the emerging needs of the subjects. There are sets of: design parameters and design variables of the object being developed; criteria for evaluating a new artifact; background assumptions, data and conditions, including limitations; models describing the designed object; decision-making methods and, finally, a variety of design decisions. An objectively existing set of values of initial data and evaluation criteria in designing can be and is considered as an uncertainty (uncertain set), and as a given that must be revealed, narrowing the range of solutions and lowering the power of sets. In designing practice (removal of uncertainty, degeneration of the multiplicity of possible values of design parameters, etc.) one always strives for a singleton (a set with a single element), i.e. to the design solution that will be embodied in a design, technology or system.

A Hot Cracking Initiation Criterion Based on Solidification Liquid Film Characteristic and Microstructure

A Hot Cracking Initiation Criterion Based on Solidification Liquid Film Characteristic and Microstructure

Perioperative opioids and survival outcomes in resectable head and neck cancer: A systematic review.

Opioids are a mainstay in pain control for oncologic surgery. The objective of this systematic review is to evaluate the associations of perioperative opioid use with overall survival (OS) and disease-free survival (DFS) in patients with resectable head and neck cancer (HNC). A systematic review of PubMed, SCOPUS, and CINAHL between 2000 and 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating perioperative opioid use for patients with HNC undergoing surgical resection and its association with OS and DFS were included. Three thousand three hundred seventy-eight studies met initial inclusion criteria, and three studies representing 562 patients (intraoperative opioids, n = 463; postoperative opioids, n = 99) met final exclusion criteria. One study identified that high intraoperative opioid requirement in oral cancer surgery was associated with decreased OS (HR = 1.77, 95% CI 0.995-3.149) but was not an independent predictor of decreased DFS. Another study found that increased intraoperative opioid requirements in treating laryngeal cancer was demonstrated to have a weak but statistically significant inverse relationship with DFS (HR = 1.001, p = 0.02) and OS (HR = 1.001, p = 0.02). The last study identified that patients with chronic opioid after resection of oral cavity cancer had decreased DFS (HR = 2.7, 95% CI 1.1-6.6) compared to those who were not chronically using opioids postoperatively. An association may exist between perioperative opioid use and OS and DFS in patients with resectable HNC. Additional investigation is required to further delineate this relationship and promote appropriate stewardship of opioid use with adjunctive nonopioid analgesic regimens.

Issues and Problems Affecting Post-Disaster Reconstruction Activities in Indonesia

Efforts to mitigate the danger of disasters continue. Both long-term and short-term Disaster Risk Reduction (DRR) activities have been undertaken by governments and International Organizations. One type of long-term post-disaster activity is rehabilitation and reconstruction, which are an important part of the catastrophe recovery phase Long-term reconstruction activities are activities that have uncertainty. The reconstruction necessitates the integration of long-term development plans that account for various catastrophic risks and the possibility of mitigating future dangers. Based on past research, uncertainty variables show a problem with the activity of reconstruction activities. Numerous countries, including Malaysia, Nepal, America, and Estonia, have conducted research on the challenges and issues associated with construction activity. This research variable was developed from several studies conducted in several countries to obtain more comprehensive variables for study in the disaster-prone. Assessment instruments were developed using questionnaires distributed to a sample of respondents who met the initial criteria. Relative importance index (RII) is used in data processing procedures, and this paper examines the concerns and difficulties experienced during the reconstruction process. The data analysis found that the most dominant aspect that influences the construction period is the delay in project completion. With the value of the Relative Importance Index (RII) at the High-Medium (H–M) level (0.6 RI 0.8) with a value of 0.769 and all research variables are included in the High-Medium (H–M), namely (0.6 ≤ RI ≤ 0.8).

An elastoplastic constitutive model for frozen soil considering fracture of cryostructure and propagation of cracks

The natural frozen soil is formed in long-term geological processes under complex climatic conditions, and the special cryogenic structures are engendered in it. Investigation on the mechanical model of frozen soil with cryostructure can provide reliable measures to control and dispose the deformation of engineering foundations in cold regions. In this research, the crack initiation criterion and propagation path of frozen soil containing ice lens were studied based on available laboratory results. For the frozen soil containing ice lenses, the failure was formed by the propagation and penetration of the wing cracks at tip of ice lens. According to the fracture mechanics and strain energy theory, the structural damage variable of frozen soil was established, the effects of ice lens geometric parameters on the damage variable were analyzed. The elastoplastic tensor of frozen soil with cryostructure was modified using the damage variable which considering fracture of cryostructure and propagation of cracks, and an elastoplastic model was established. The PDE module in COMSOL was adopted to redevelop the proposed model, the rationality of the model was verified and the mechanical properties of natural frozen soil was investigated.

Critical Decay Time Model for Direct Detonation Initiation Energy in Gaseous Mixtures

A critical decay time (CDT) model is developed to predict the critical energy of direct detonation initiation in gaseous mixtures. It is based on the global initiation criterion that the energy deposit should allow the decaying shock speed to stay in a specific range below the Chapman–Jouguet (CJ) speed at least for a critical decay time. The speed range is estimated with the sub-CJ Zel’dovich–von Neumann–Döring (ZND) simulations. The critical decay time is calculated as the minimum time to reach unity Mach number in the sub-CJ ZND simulations. The lower-speed bound is taken as a characteristic extinction speed below (which means the lower-speed bound) which the direct initiation should fail. This speed is calibrated using one-dimensional simulations for hydrogen (H2)–oxygen (O2)–argon (Ar) mixtures. The calibrated CDT model is then applied to estimate the critical initiation energy with the point-blast theory. The model yields better agreement with experimental data for hydrogen-fueled mixtures such as H2─O2─Ar and H2─air mixtures than the well-known critical decay rate model. For small hydrocarbon-fueled mixtures such as acetylene (C2H2)─O2─Ar, methane (CH4)–air, ethylene (C2H4)–air, and ethane (C2H6)─air mixtures, the predicted critical energies also agree well with experimental results. The CDT model provides an efficient tool to evaluate the detonability of fuel–oxidizer mixtures, which could be beneficial for ignition initiation in propulsion and power devices such as rotating detonation engines.

Coaching culture: an evidence review and framework for future research and practice

ABSTRACT Given the colossal interest in creating ‘coaching cultures’, we update the 2014 literature review by Gormley and van Nieuwerburgh and extend this work by applying a Systematic Literature Review (SLR) methodology. In doing so, we detangle definitions and the conditions under which ‘coaching cultures’ can be developed. We also explore contemporary interventions, report on organisational level outcomes, and comment on how progress is measured and evaluated. In total, 1453 papers were identified using a systematic search, of which 42 met our initial screening criteria and nine were eligible for inclusion in our final review. Findings show that we remain with an unclear understanding of ‘coaching culture’; there is still no agreed definition and the building blocks (i.e., the foundational elements, interventions, outcomes, and measures) remain ambiguous. We recommend a framework for future research and practice and highlight a gap in our understanding of stakeholders’ behavioural and cultural patterns vis-à-vis the design and development of coaching culture programmes.

Incidence and prognosis of acute kidney injury versus acute kidney disease among 71041 inpatients.

Acute kidney disease (AKD) defines patients with acute kidney injury (AKI) or subacute loss of kidney function lasting for >7days. Little is known about the prognosis of AKD in hospitalized patients. The aim of this study was to investigate the risk factors and prognosis of AKD and to compare different types of acute/subacute renal impairment among Chinese inpatients. Complete data were available for 71041 patients for a range of 5-63months. AKI and AKD were diagnosed based on the Acute Disease Quality Initiative criteria of 2017. Of 71041 inpatients, 16098 (22.7%) patients developed AKI or AKD; 5895 (8.3%) AKI patients recovered within 7days, 5623 (7.9%) AKI patients developed AKD and 4580 (6.4%) patients developed AKD without AKI. Mortality was proportional to stages of AKI and AKD (P<.05), while AKI followed by AKD was associated with a higher risk of long-term mortality [hazard ratio (HR) 4.51] as compared with AKD without AKI (HR 2.25) and recovery from AKI (HR 1.18). The AKD criteria were robustly associated with overall survival [area under the receiver operating characteristic curve (AUROC) 0.71] and de novo CKD (AUROC 0.71), while the AKI criteria showed a relatively lower ability to fit the risk of overall survival (AUROC 0.65) and CKD (AUROC 0.63). AKD and AKD stages are useful clinical definitions for clinical practice, as they predict unfortunate clinical outcomes such as overall long-term mortality and CKD. Research activities should focus on AKD.

Current Patterns of Probiotic Use in U.S. Neonatal Intensive Care Units: A Multi-Institution Survey.

Probiotic supplementation is associated with health benefits in preterm infants. The 2021 American Academy of Pediatrics (AAP) statement on probiotic use advised caution, citing heterogeneity and absence of federal regulation. We assessed the impact of the AAP statement and current institution-wide patterns of probiotic use across neonatal intensive care units (NICU) across the United States. A cross-sectional web-based institutional survey using REDCap was emailed to 430 Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group institutions. The survey captured data on probiotic formulations, supplementation, initiation and cessation criteria, reasons for discontinuation, interest in initiating, and AAP statement's impact. Ninety-five (22.1%) hospitals, including 42/46 (91%) CHNC and 53/384 (14%) Pediatrix institutions, completed the survey. Thirty-seven (39%) currently use probiotics. Fourteen different probiotic formulations were reported. The common criteria for initiation were birth weight <1,500 g and gestational age <32 weeks. Parental consent or assent was obtained at only 30% of institutions. Five hospitals (11%) with prior probiotic use discontinued solely due to the AAP statement. Overall, 23 (24%) of hospitals indicated that the AAP statement significantly influenced their decision regarding probiotic use. Nineteen of 51 nonusers (37%) are considering initiation. Probiotic use in preterm infants is likely increasing in NICUs across the United States, but significant variability exists. The 2021 AAP statement had variable impact on NICUs' decision regarding probiotic use. The growing interest in adopting probiotics and the significant interhospital variability highlight the need for better regulation and consensus guidelines to ensure standardized use. · Probiotic use in preterm infants is likely increasing in U.S. NICUs, but clinical variability exists.. · The AAP statement on probiotic use in preterm infants had a modest impact on current practices.. · There's a need for better product regulation and consensus guidelines to ensure standardized use..

A Critical Review on Working Capital Management and Financial Distress in Chartered Public Universities in Kenya

Working capital management is a matter of concern in public universities in Kenya, with the main challenge being how to prudently manage assets in order to achieve financial self-sufficiency. Working capital management impacts the financial health of an organisation. Both public and private sector entities are prone to mismanagement of some kind, not only in Kenya but also regionally and globally. The PRISMA guidelines were adopted in the systematic review process, where 55 articles were narrowed down to the final 11 articles. From the reviewed papers, poor management of the components of working capital management was concluded to have caused financial distress. Other aspects, like funding and government policy, are other contributing factors. The reviewed literature on working capital management is the major one. The reviewed literature was anchored on several theories, which include financial distress theory, working capital management theory, free cash flow theory, cash conversion cycle theory, and Altman's Z score model. The study topics were tested using the initial inclusion criteria by analysing the key words used in the studies. The key words sought were working capital, working capital management, and financial distress. Most of the data used in the reviewed studies was secondary. The reviewed literature was for a period of ten years, ranging from 2013 to 2022, as published in journals and full papers. The data was organised by panel data technique, and financial ratios were computed using the three-statement model, which is basically an integrated financial statement model that comprises a balance sheet, income statement, and cash flow statement linked together. Content analysis has been used for the analysis. The results revealed that few studies have been conducted in public universities, while the majority were done in Kenya’s manufacturing sector. The studies reported mixed results on the relationship between financial distress and working capital management. The outcome becomes more confounded when more than two measures are used to conceptualise working capital management. Therefore, further studies ought to be conducted in public universities in Kenya by blending both secondary and primary data and also considering other research designs with the inclusion of a moderating variable such as government policies.

Transition metal embedded in two‐dimensional bi‐BN as high activity single atom electrocatalyst for oxygen reduction reactions

AbstractSearching for stable, highly effective and cost‐efficient catalysts for the oxygen reduction reaction (ORR) is important to addressing the energy crisis and environmental issues. A single atom embedded in two‐dimensional boron nitride materials is a viable candidate for the ORR to replace Pt‐based catalysts. Herein, by making use of density functional theory (DFT) simulations, we systematically study a novel two‐dimensional boron nitride materials (bi‐BN) embedded by 23 kinds of transition metal (TM) atoms ranging from Ti to Au as high activity single atom electrocatalyst for the ORR. According to the initial screening criteria (−4.92 eV &lt; ΔGO* &lt; 0 eV), 13 kinds of TM‐bi‐BN (TM = Ti, V, Cr, Mn, Fe, Co, Ni, Ru, Rh, Pd, Ag, Pt, Au) meet the criteria and are selected to study their ORR performance in this work. Our calculations indicate that Au‐bi‐BN has the most superior ORR performance with the lowest overpotential (0.43 V), which was lower than that of Pt (0.45 V) as ORR catalyst. The origin of the catalytic activity of the ORR is studied by the linear correlation between these oxygen‐containing intermediates, the volcanic curve, the d‐band center and the crystal orbital Hamilton populations. Ab Initio Molecular Dynamics simulation suggests that Au‐bi‐BN is thermodynamically stable at 300 K. Our results not only offer valuable insights into the utility of boron‐nitride materials as catalysts for ORR, but also facilitate the development of novel catalysts for ORR through improved comprehension of the material properties.

Quality Improvement to Reduce High-Flow Nasal Cannula Overuse in Children With Bronchiolitis.

High-flow nasal cannula oxygen therapy (HFNC) is increasingly used to treat bronchiolitis. However, HFNC has not reduced time on supplemental oxygen, length of stay (LOS), or ICU admission. Our objective was to reduce HFNC use in children admitted for bronchiolitis from 41% to 20% over 2 years. Using quality improvement methods, our multidisciplinary team formulated key drivers, including standardization of HFNC use, effective communication, knowledgeable staff, engaged providers and families, data transparency, and high-value care focus. Interventions included: (1) standardized HFNC initiation criteria, (2) staff education, (3) real-time feedback to providers, (4) a script for providers to use with families about expectations during admission, (5) team huddle for patients admitted on HFNC to discuss necessity, and (6) distribution of a bronchiolitis toolkit. We used statistical process control charts to track the percentage of children with bronchiolitis who received HFNC. Data were compared with a comparison institution not actively involved in quality improvement work around HFNC use to ensure improvements were not secondary to the COVID-19 pandemic alone. Over 10 months of interventions, we saw a decrease in HFNC use for patients admitted with bronchiolitis from 41% to 22%, which was sustained for >12 months. There was no change in HFNC use at the comparison institution. The overall mean LOS for children with bronchiolitis decreased from 60 to 45 hours. We successfully reduced HFNC use in children with bronchiolitis, improving delivery of high-value and evidence-based care. This reduction was associated with a 25% decrease in LOS.