Delivery room cuddles for extremely preterm babies and parents: concept, practice, safety, parental feedback

Aim: Following extreme preterm birth, there has traditionally been felt an imperative to rush baby to the neonatal unit for ongoing intensive care. Immediate needs of parents to bond with their babies through direct early physical contact have often been overlooked; many weeks can pass before parents get to hold their babies for the first time. Recognition of the importance of early contact is growing. We aimed to review the safety and value of routinely practising delivery room cuddles for extremely preterm babies. Methods: We reviewed delivery room cuddles in babies born <27 weeks’ gestation in our centre between 2006 and 2017 via case-control. We also conducted a questionnaire survey of mothers who experienced a delivery room cuddle to gain their feedback and perspectives. Results: We found no difference in age or temperatures on neonatal unit admission. There was no case of inadvertent extubation associated with cuddles. Parental feedback was very positive. Conclusion: With appropriate safeguards, delivery room cuddles are feasible and achievable for extremely preterm babies irrespective of birth gestation. Facilitation of the cuddle is an early and very important family-centred care practice which seems much appreciated by parents and which may improve bonding, lactation, and maternal mental health

Fusion of multi-view ultrasonic data for increased detection performance in non-destructive evaluation

State-of-the-art ultrasonic non-destructive evaluation (NDE) uses an array to rapidly generate multiple, information-rich views at each test position on a safety-critical component. However, the information for detecting potential defects is dispersed across views, and a typical inspection may involve thousands of test positions. Interpretation requires painstaking analysis by a skilled operator. In this paper, various methods for fusing multi-view data are developed. Compared with any one single view, all methods are shown to yield significant performance gains, which may be related to the general and edge cases for NDE. In the general case, a defect is clearly detectable in at least one individual view, but the view(s) depends on the defect location and orientation. Here, the performance gain from data fusion is mainly the result of the selective use of information from the most appropriate view(s) and fusion provides a means to substantially reduce operator burden. The edge cases are defects that cannot be reliably detected in any one individual view without false alarms. Here, certain fusion methods are shown to enable detection with reduced false alarms. In this context, fusion allows NDE capability to be extended with potential implications for the design and operation of engineering assets

Pseudomonas aeruginosa arylsulfatase: a purified enzyme for the mild hydrolysis of steroid sulfates

The hydrolysis of sulfate ester conjugates is frequently required prior to analysis for a range of analytical techniques including gas chromatography-mass spectrometry (GC-MS). Sulfate hydrolysis may be achieved with commercial crude arylsulfatase enzyme preparations such as that derived from Helix pomatia but these contain additional enzyme activities such as glucuronidase, oxidase, and reductase that make them unsuitable for many analytical applications. Strong acid can also be used to hydrolyze sulfate esters but this can lead to analyte degradation or increased matrix interference. In this work, the heterologously expressed and purified arylsulfatase from Pseudomonas aeruginosa is shown to promote the mild enzyme-catalyzed hydrolysis of a range of steroid sulfates. The substrate scope of this P. aeruginosa arylsulfatase hydrolysis is compared with commercial crude enzyme preparations such as that derived from H. pomatia. A detailed kinetic comparison is reported for selected examples. Hydrolysis in a urine matrix is demonstrated for dehydroepiandrosterone 3-sulfate and epiandrosterone 3-sulfate. The purified P. aeruginosa arylsulfatase contains only sulfatase activity allowing for the selective hydrolysis of sulfate esters in the presence of glucuronide conjugates as demonstrated in the short three-step chemoenzymatic synthesis of 5α-androstane-3β,17β-diol 17-glucuronide (ADG, 1) from epiandrosterone 3-sulfate. The P. aeruginosa arylsulfatase is readily expressed and purified (0.9 g per L of culture) and thus provides a new and selective method for the hydrolysis of steroid sulfate esters in analytical sample preparation.We thank the Australian Government Anti-Doping Research Pro-gram for financial support

Does magnetic resonance brain scanning at 3.0 Tesla pose a hyperthermic challenge to term neonates?

Next-generation 3-Tesla magnetic resonance (MR) scanners offer improved neonatal neuroimaging, but the greater associated radiofrequency radiation may increase the risk of hyperthermia. Safety data for neonatal 3-T MR scanning are lacking. We measured rectal temperatures continuously in 25 neonates undergoing 3-T brain MR imaging and observed no significant hyperthermic threat

Restorative Justice and Harmful Sexual Behaviour (RJHSB): A commentary

Restorative Justice (RJ) has been practiced around the world in various settings, including criminal justice,for many years (Shapland et al., 2004; 2006). In the UK, there has been a long history of its use with theintent to allow those who have committed offences and victims of crime to interact with one another vialetters or direct meetings (known as a restorative justice conference). These processes enable the personwho has caused the harm to apologise for, or at least acknowledge, the crime they committed, and thevictim-survivor to express what the consequences of the offence were for them. The intention is to achievea constructive outcome from which each party can move forward positively with their life

Parental perceptions of the impact of neonatal unit visitation policies during COVID-19 pandemic

Objectives To ascertain parental perceptions of the impact of restricted visiting policies to neonatal intensive care units during the current COVID-19 pandemic. Design Cross-sectional survey of parents impacted by visitation policies. Setting Six tertiary level neonatal units, four from the UK and two from the USA, participated in the study. Participants Parents and families of infants hospitalised in the participating centres between 1 May 2020 and 21 August 2020. Methods Online-based and/or paper-based survey, querying the visitation policies and their impact on parents' ability to visit, care for and bond with their infants. Results A total of 231 responses were received. Visitation limited to a single visitor with no restrictions on duration was the most frequently reported policy; 140/217 (63%). Visitation policies were perceived as being restrictive by 62% (138/219) of the respondents with 37% (80/216) reporting being able to visit less often than desired, 41% (78/191) reporting being unable to bond enough and 27% (51/191) reporting not being able to participate in their baby's daily care. Mild to severe impact on breast feeding was reported by 36% (75/209) of respondents. Stricter policies had a higher impact on families and were significantly associated with a lack of bonding time, inability to participate in care and an adverse impact on breast feeding. Conclusions Visitation policies during the COVID-19 pandemic varied between centres and over time with stricter restrictions implemented earlier on in the pandemic. Parents reported significant impacts on their ability to visit, care for and bond with their infants with perceived severity of impact worse with stricter restrictions

Identifying gaps in HIV policy and practice along the HIV care continuum: evidence from a national policy review and health facility surveys in urban and rural Kenya.

The last decade has seen rapid evolution in guidance from the WHO concerning the provision of HIV services along the diagnosis-to-treatment continuum, but the extent to which these recommendations are adopted as national policies in Kenya, and subsequently implemented in health facilities, is not well understood. Identifying gaps in policy coverage and implementation is important for highlighting areas for improving service delivery, leading to better health outcomes. We compared WHO guidance with national policies for HIV testing and counselling, prevention of mother-to-child transmission, HIV treatment and retention in care. We then investigated implementation of these national policies in health facilities in one rural (Kisumu) and one urban (Nairobi) sites in Kenya. Implementation was documented using structured questionnaires that were administered to in-charge staff at 10 health facilities in Nairobi and 34 in Kisumu. Policies were defined as widely implemented if they were reported to occur in?>?70% facilities, partially implemented if reported to occur in 30-70% facilities, and having limited implementation if reported to occur in?<?30% facilities. Overall, Kenyan national HIV care and treatment policies were well aligned with WHO guidance. Policies promoting access to treatment and retention in care were widely implemented, but there was partial or limited implementation of several policies promoting access to HIV testing, and the more recent policy of Option B+ for HIV-positive pregnant women. Efforts are needed to improve implementation of policies designed to increase rates of diagnosis, thus facilitating entry into HIV care, if morbidity and mortality burdens are to be further reduced in Kenya, and as the country moves towards universal access to antiretroviral therapy