Bliss

ObjectiveTo quantify the characteristics of children admitted to neonatal units (NNUs) and paediatric intensive care units (PICUs) before the age of 2 years.DesignA data linkage study of routinely collected data.SettingNational Health Service NNUs and PICUs in England and WalesPatientsChildren born from 2013 to 2018.InterventionsNone.Main outcome measureAdmission to PICU before the age of 2 years.ResultsA total of 384 747 babies were admitted to an NNU and 4.8% (n=18 343) were also admitted to PICU before the age of 2 years. Approximately half of all children admitted to PICU under the age of 2 years born in the same time window (n=18 343/37 549) had previously been cared for in an NNU.The main reasons for first admission to PICU were cardiac (n=7138) and respiratory conditions (n=5386). Cardiac admissions were primarily from children born at term (n=5146), while respiratory admissions were primarily from children born preterm (<37 weeks’ gestational age, n=3550). A third of children admitted to PICU had more than one admission.ConclusionsHealthcare professionals caring for babies and children in NNU and PICU see some of the same children in the first 2 years of life. While some children are following established care pathways (eg, staged cardiac surgery), the small proportion of children needing NNU care subsequently requiring PICU care account for a large proportion of the total PICU population. These differences may affect perceptions of risk for this group of children between NNU and PICU teams.

Stroke is a leading cause of long-term disability and death in the united states. The development of new therapies for stroke are sorely needed. There is great hope that stem cell therapy will create a paradigm shift in the treatment of stroke patients. A barrier to ensuring clinical success of stem cell therapy is the paucity of understanding of the mechanisms by which stem cells exert their beneficial effects. Using a novel mRNA purification method, we identified 50 genes encoding extracellular space proteins, expressed by human neural stem cells (hNSCs) whose expression positively correlated with functional recovery. In this study, we focus on one of the paracrine factors from grafted hNSCs that correlated best with functional recovery, to investigate its therapeutic potential in promoting recovery after stroke. Male nude rats underwent stroke using the distal middle cerebral artery occlusion (dMCAo) model. One week following stroke, osmotic pumps were prepared and loaded with recombinant MTN-2. The osmotic pumps were inserted into the peri-infarct area and infused recombinant MTN-2 for 5 days. Post-stroke, animals were assessed for functional recovery for 5 weeks using both the Montoya staircase test and the whisker-paw reflex test to assess for forelimb function, dexterity, side bias, and placing deficits. After 5 weeks, brain tissue was isolated to assess glial cell morphology. Brain sections were stained with GFAP and IBA1 to visualize astrocytes and microglia, respectively. Confocal images were processed and analyzed using the Bitplane Imaris image analysis software. Output measurements of number of cells/mm2, cell volume, cell branching, and process length and thickness were obtained to characterize the changes in astrocytic and microglial response to injury and paracrine factor treatment. By identifying paracrine factors that are responsible for the regeneration of brain tissue following implantation of hNSCs in stroke brain, this work will increase the likelihood of successful clinical translation of stem cell therapy for stroke. Moreover, elucidating these molecular pathways important for brain recovery may ultimately identify novel therapeutic targets and offer hope to millions of Americans who live with the devastating effects of stroke.

Introduction. As students and faculty are increasingly becoming more comfortable with technology, physical therapy programs are using the flipped classroom (FC) to provide an environment more conducive to active and problem-based learning. Most literature on students in graduate level health care professional programs rely on subjective student report. To our knowledge, no studies have compared objective actual student consumption of online content to subjective student perception of online content consumption. Nor have studies explored the relationship between actual online content consumption and classroom performance. In this study, we compared estimated and actual online content consumption as well as its relationship to student performance. We hypothesized that students would inaccurately estimate online content viewing amounts and that a positive correlation would exist between online content consumption and student performance. Methods. Upon completion of a patient mobility training course, 46 year-one physical therapist students estimated their weekly online content consumption. In this cross-sectional study design, we compared these estimations with student usage data provided by an online learning management system. Additionally, we compared examination grades and overall course grades to average weekly viewing times. A Pearson's product moment correlation assessed the relationship between weekly viewing time and student performance. Discriminant ability of weekly viewing time was assessed with receiver operating characteristic curve analyses. Results. At least 40% of the students overestimated their online consumption. Students overestimated their weekly viewing by 63.2%. Weekly viewing time was correlated with percentile class ranks. Discussion and Conclusion. Students chronically overestimated online content consumption. Physical therapy faculty should be aware of discrepancies between objective actual and subjective perceived consumption of online content and may consider implementing an open feedback loop relative to actual preparation for the FC since this study also found a positive relationship between weekly viewing time and student performance.

Additionally to the fragments of manuscripts, which now belong to the collection of Freiburg University Library, Hartmut Beckers had some others, which since early 2017 are kept at the Berlin Library. These fragments contain parts of the (Ia.) ʻRennewart’ Ulrichs von Türheim and (Ib.) the ʻArabel’ Ulrich’s von dem Türlin, both belong to a well-known Codex discissus, furthermore parts of the (II.) ʻChristherre-Chronik’ and (III.) a versified Schachzabelbuch. All pieces are shortly introduced to the reader.

The combination of emerging new communication technologies, economic growth, and current limitations on the amount of available dedicated spectrum necessitate sharing spectrum dynamically between incumbent (primary) users and opportunistic (secondary) users. This paper builds upon the seminal “spectrum jails” paradigm — a mathematical model for light-handed ex-post enforcement. Analyzing this as a Stackelberg game, we examine what kinds of rights for primaries and secondaries we can credibly enforce. While the primary cannot possibly be made to trust that secondaries will always be honest, it can trust that it will be protected from too much harmful interference and we show how the enforcer can set the ex-post enforcement parameters to do this no matter which secondary user becomes capable of using the band. Similarly, it is impossible to give a universal guarantee to all secondary users that the primary will never make false reports (“cry wolf”) against them. However, it is possible to show that “compatible” secondary users will trust that the primary user will not make false reports against them when the spectrum opportunity is sufficiently attractive for them to use.

ObjectiveTo assess parents' experiences and satisfaction with care during very preterm birth and to identify domains associated with positive and negative experiences of care.DesignQualitative study using semi-structured interviews.SettingThree neonatal units in tertiary care hospitals in South-East England.PopulationThirty-two mothers and seven fathers who had a baby born before 32 weeks of gestation and spoke English well.MethodsSemi-structured interviews were conducted. Results were analysed using thematic analysis.Main outcome measuresParticipants' experiences and satisfaction with care during the birth of their preterm baby.ResultsOverall, 80% of participants were extremely satisfied with the care during the birth of their preterm baby, seven were generally satisfied but felt some things could be improved and one was dissatisfied. Four key determinants of experiences of care were identified: staff professionalism, which included information and explanation, being calm in a crisis, appearing confident and in control, and conversely not listening to the woman; staff empathy, which included caring and emotional support, and encouragement and reassurance; involvement of the father; and birth environment.ConclusionsAlthough the determinants of experiences of care are generally consistent with previous research on term births, unique factors to preterm birth were identified. These were the importance of the staff appearing calm during the birth, and the staff portraying confidence and taking control during the birth. Women valued being listened to, and both they and their partners valued staff helping fathers to feel involved during the birth.

A survey by the charity Bliss of the 213 hospitals in the UK with neonatal units (response rate 92%) found a serious shortage of neonatal nurses. Minimum nurse staffing ratios recommended by the British Association of Perinatal Medicine (BAPM) were not being met, especially in neonatal intensive care units (NICUs). Only one in five neonatal units reported meeting the BAPM standard. Cot occupancy rates in NICUs exceeded the recommended 70% on occasions. Fifty-five per cent of units had to close to new admissions at some point during the survey period 1 April to 1 September 2007; the average duration for closure was two weeks. Staff shortages and 100% cot occupancy resulted in babies having to be transported to other units, sometimes long distances away. As well as clinical considerations, shortfalls in staffing and service capacity added to parents' difficulties at a stressful time in their lives. The one to one campaign being spearheaded by Bliss with endorsement from several professional bodies is actively promoting the recommended 1:1 nurse-to-cot ratio in NICUs. In England, the need for action on this issue has been acknowledged by the National Audit Office, the House of Commons Public Accounts Committee and the Healthcare Commission.