What's the best way to control circumcision pain in newborns?

Dorsal penile nerve block (DPNB), ring block (RB), and eutectic mixture of local anesthetics (EMLA) all control pain effectively during neonatal circumcision (strength of recommendation [SOR]: A, systematic review). An RB may provide superior pain relief toDPNB and EMLA (SOR: B, limited-quality evidence). Using a Mogen clamp reduces pain by shortening procedure time (SOR: A, randomized controlled trials [RCTs]). Effective adjuncts to pain relief include nonnutritive sucking (NNS; a pacifier without sucrose), a sucrose pacifier, and use of a padded chair (SOR: A, RCTs)

Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting

Morbidity following CABG (coronary artery bypass grafting) is difficult to predict and leads to increased healthcare costs. We hypothesized that pre-operative CMR (cardiac magnetic resonance) findings would predict resource utilization in elective CABG. Over a 12-month period, patients requiring elective CABG were invited to undergo CMR 1 day prior to CABG. Gadolinium-enhanced CMR was performed using a trueFISP inversion recovery sequence on a 1.5 tesla scanner (Sonata; Siemens). Clinical data were collected prospectively. Admission costs were quantified based on standardized actual cost/day. Admission cost greater than the median was defined as 'increased'. Of 458 elective CABG cases, 45 (10%) underwent pre-operative CMR. Pre-operative characteristics [mean (S.D.) age, 64 (9) years, mortality (1%) and median (interquartile range) admission duration, 7 (6–8) days] were similar in patients who did or did not undergo CMR. In the patients undergoing CMR, eight (18%) and 11 (24%) patients had reduced LV (left ventricular) systolic function by CMR [LVEF (LV ejection fraction) <55%] and echocardiography respectively. LE (late enhancement) with gadolinium was detected in 17 (38%) patients. The average cost/day was $2723. The median (interquartile range) admission cost was$19059 ($10891–157917). CMR LVEF {OR (odds ratio), 0.93 [95% CI (confidence interval), 0.87–0.99]; P=0.03} and SV (stroke volume) index [OR 1.07 (95% CI, 1.00–1.14); P=0.02] predicted increased admission cost. CMR LVEF (P=0.08) and EuroScore tended to predict actual admission cost (P=0.09), but SV by CMR (P=0.16) and LV function by echocardiography (P=0.95) did not. In conclusion, in this exploratory investigation, pre-operative CMR findings predicted admission duration and increased admission cost in elective CABG surgery. The cost-effectiveness of CMR in risk stratification in elective CABG surgery merits prospective assessment

Deep and Transfer Learning Approaches for Pedestrian Identification and Classification in Autonomous Vehicles

Pedestrian detection is at the core of autonomous road vehicle navigation systems as they allow a vehicle to understand where potential hazards lie in the surrounding area and enable it to act in such a way that avoids traffic-accidents, which may result in individuals being harmed. In this work, a review of the convolutional neural networks (CNN) to tackle pedestrian detection is presented. We further present models based on CNN and transfer learning. The CNN model with the VGG-16 architecture is further optimised using the transfer learning approach. This paper demonstrates that the use of image augmentation on training data can yield varying results. In addition, a pre-processing system that can be used to prepare 3D spatial data obtained via LiDAR sensors is proposed. This pre-processing system is able to identify candidate regions that can be put forward for classification, whether that be 3D classification or a combination of 2D and 3D classifications via sensor fusion. We proposed a number of models based on transfer learning and convolutional neural networks and achieved over 98% accuracy with the adaptive transfer learning model.</jats:p

External validation of the LENT and PROMISE prognostic scores for malignant pleural effusion

Background: Accurate survival estimation in malignant pleural effusion is essential to guide clinical management strategies and inform patient discussion. The LENT and PROMISE scores were developed to aid prognostication in malignant pleural effusion, however their uptake in practice has been limited. We aimed to conduct a detailed external validation of the LENT and PROMISE scores to develop recommendations regarding clinical utility, and to highlight factors limiting performance. / Methods: Medical records of patients diagnosed with malignant pleural effusion between 2015–2023 at Oxford University Hospitals were retrospectively reviewed to determine length of survival and the LENT and PROMISE scores at diagnosis. Performance of the scores in predicting overall survival and chance of survival at 3-, 6- and 12-months was assessed using measures of discrimination, calibration and overall model performance. Kaplan-Meier analysis and Cox models were utilised to further investigate individual score variables. / Results: 773 patients with malignant pleural effusion were included. Both scores showed predictive ability for overall survival, however median survival estimates lacked precision. Score performance in predicting survival at 3-, 6- and 12-months was stronger, with C-indices around 0.8 for both at each time-point, and the models appearing well-calibrated. Limited stratification of tumour types and lack of consideration of sensitising mutations were demonstrated to be potential factors restricting performance. / Conclusions: Both scores have ability to prognosticate in malignant pleural effusion, and greater use in practice should be considered. However, areas to improve score performance were also highlighted, and these may aid future model development

External validation of the LENT and PROMISE prognostic scores for malignant pleural effusion

BackgroundAccurate survival estimation in malignant pleural effusion is essential to guide clinical management strategies and inform patient discussion. The LENT and PROMISE scores were developed to aid prognostication in malignant pleural effusion; however their uptake in practice has been limited. We aimed to conduct a detailed external validation of the LENT and PROMISE scores to develop recommendations regarding clinical utility, and to highlight factors limiting performance.MethodsMedical records of patients diagnosed with malignant pleural effusion between 2015-2023 at Oxford University Hospitals were retrospectively reviewed to determine length of survival and the LENT and PROMISE scores at diagnosis. Performance of the scores in predicting overall survival and chance of survival at 3, 6 and 12 months was assessed using measures of discrimination, calibration and overall model performance. Kaplan-Meier analysis and Cox models were utilised to further investigate individual score variables.Results773 patients with malignant pleural effusion were included. Both scores showed predictive ability for overall survival; however median survival estimates lacked precision. Score performance in predicting survival at 3, 6 and 12 months was stronger, with C-indices around 0.8 for both at each time point, and the models appearing well calibrated. Limited stratification of tumour types and lack of consideration of sensitising mutations were demonstrated to be potential factors restricting performance.ConclusionsBoth scores have the ability to prognosticate in malignant pleural effusion, and greater use in practice should be considered. However, areas to improve score performance were also highlighted, and these may aid future model development

Removal of mesh track on an upland blanket peatland leads to changes in vegetation composition and structure

Mesh tracks on peatlands are often granted permits on a temporary basis under the presumption that the tracks are either removed at the end of their permitted use or remain unused in situ. However, the fragility of peatland habitats and poor resilience of the specialist plant communities within them, mean that these linear disturbances may persist post-abandonment or post-removal. We removed sections of mesh track, abandoned five years earlier, from a blanket peatland using two different removal treatment methods (mown and unprepared) and studied a third treatment with sections left in place over a period of 19 months. On abandoned tracks, invasive species including Campylopus introflexus and Deschampsia flexulosa had established, while track removal led to extensive loss of Sphagnum species. Loss of surficial nanotopographic vegetation structures during track removal was extensive, and micro-erosion features were prevalent in both removal treatments. Abandoned sections of track performed comparably better across all metrics than removed sections. However, similarity between the vegetation assemblage of the abandoned track and the controls was <40% at the study outset, with NMDS (Non-metric Multidimensional Scaling) highlighting divergences. There was a mean species loss of 5 per quadrat for the removed sections. Bare peat was present in 52% of all track quadrats by the finish of the study. Our findings suggest that mesh tracks left in situ and track removal both present significant barriers to recovery and additional conservation interventions may be required after peatland tracks are abandoned

Blanket bogs exhibit significant alterations to physical properties as a result of temporary track removal or abandonment

Temporarily consented tracks made from high-density polyethylene (HDPE) mesh have been used to mitigate both the physical and ecological impacts on peatlands from low-frequency vehicle usage. However, the impacts of mesh track removal or abandonment at the end of the consented period remain poorly understood. Over a 2-year period, we studied replicate sections of abandoned mesh track which, at the start of the experiment, had been unused for approximately 5 years, on a UK blanket bog. Some sections were removed (using two treatment methods – vegetation mown and unprepared), whereas others were left in situ. Metrics were compared both between treatments and to undisturbed reference areas. Significant differences in surface soil moisture were found between abandoned and removed tracks depending on season. Control areas had higher volumetric soil moisture than track locations. Compaction was significantly higher across all track locations in comparison to controls (p < 0.001), but rarefaction was not recorded post-removal, suggesting long-term deformation. Overland flow events were recorded in rut sections for a mean of 16% of the time, compared to <1% in control areas. Sediment traps on the tracks collected 0.406 kg compared to 0.0048 kg from the control traps, equating to a per trap value of 7.3 g from track samplers and 0.17 g from control samplers. Erosion and desiccation features occurred on both removed and abandoned track sections. Both abandonment and removal of mesh tracks have a wide range of impacts on the physical properties of peatlands, suggesting that only where access is a necessity should such a track be installed

Surface structure on abandoned upland blanket peatland tracks

Temporary permissions are often granted for track use on peatlands. However, even when peatland track designs attempt to minimise environmental impacts via use of mesh systems, such linear disturbances may have persistent impacts. We evaluated the surface peatland structure of five abandoned tracks (four with a mesh surface, one unsurfaced) with varying past usage frequencies, at an upland site in northern England. Simplification of the surface nanotopography was found on all tracks compared to surrounding control areas, with increased micro-erosion patterns in rutted areas, and invasive species on some treatments. The frequency of previous usage was not found to be a significant factor controlling nano-topographic loss. Edge effects and hillslope position were influential in places, but these effects were not consistent across treatments. Nano-topographic recovery was found to be inhibited when track usage commenced within a short time frame after track construction. Mesh tracks appear to create a spatial constraint leading to poor development of plants and a reduced ability to form characteristic structures which are integral to mire function