Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Assessing blended and online-only delivery formats for teacher professional development in Kenya

AbstractThe present study compared the learning and experiences of Kenyan teachers randomly assigned to either an online or a blended 12-week intensive teacher professional development program (TPD). The TPD addressed the fundamentals of early literacy development as well as how to use early literacy software to support students learning. TPD outcomes were assessed through surveys, course performance and discussion elements. Teachers demonstrated pre- to post-test gains in domain knowledge, lesson plan construction and comfort teaching early literacy skills. Few differences were observed between the online versus blended formats. However, teachers endorsed a blended instructional format over online-only or in-person formats. Challenges regarding resources and infrastructure were identified as barriers to technology integration within the classroom. Some cultural challenges were identified as potential barriers for young learners using software developed in Western countries. Overall, both online and blended formats appear to be effective TPD delivery systems for Kenyan teachers, however, findings highlighted challenges that need to be addressed to optimize learning when using technology. Future research recommendations include broadening the teacher sample to assess potential differences due to regionalism, associated differences in access to resources, and further examination of teaching experience on learning in the two types of online formats

A Curated Debate

Publisher Copyright: © The Author(s) 2022.One of the raging debates in organization study concerns the use of “templates” in qualitative research. This curated debate brings together many of the players in that debate, who make statements of position relative to the issues involved and trade accusations and counter-accusations about statements they have made that in their view have been misinterpreted or misconstrued. Overall, it is quite a lively debate that reveals positions, points of tension and grounds for disagreement. Denny Gioia wrote the triggering essay that prompted other players to weigh in with their personal and professional views.Peer reviewe

Astrometric Accelerations as Dynamical Beacons: A Giant Planet Imaged inside the Debris Disk of the Young Star AF Lep

We present the direct-imaging discovery of a giant planet orbiting the young star AF Lep, a 1.2 M _⊙ member of the 24 ± 3 Myr β Pic moving group. AF Lep was observed as part of our ongoing high-contrast imaging program targeting stars with astrometric accelerations between Hipparcos and Gaia that indicate the presence of substellar companions. Keck/NIRC2 observations in $L^{\prime}$ with the vector vortex coronagraph reveal a point source, AF Lep b, at ≈340 mas, which exhibits orbital motion at the 6 σ level over the course of 13 months. A joint orbit fit yields precise constraints on the planet’s dynamical mass of ${3.2}_{-0.6}^{+0.7}$ M _Jup , semimajor axis of ${8.4}_{-1.3}^{+1.1}$ au, and eccentricity of ${0.24}_{-0.15}^{+0.27}$ . AF Lep hosts a debris disk located at ∼50 au, but it is unlikely to be sculpted by AF Lep b, implying there may be additional planets in the system at wider separations. The stellar inclination ( i _* = ${54}_{-9}^{{+11}^{\circ}}$ ) and orbital inclination ( i _o = ${50}_{-12}^{{+9}^{\circ}}$ ) are in good agreement, which is consistent with the system having spin–orbit alignment. AF Lep b is the lowest-mass imaged planet with a dynamical mass measurement and highlights the promise of using astrometric accelerations as a tool to find and characterize long-period planets

Adolescent Screen Time and Rules to Limit Screen Time in the Home

PURPOSE: To investigate associations among adolescent screen time behaviors and screen time rules and electronic media in adolescents’ bedrooms. METHODS: Parents and adolescents (N = 160 dyads) from Boston, Cincinnati and San Diego completed demographic, screen time rules, availability of media devices, and screen time behavior questions. Separate multiple regression models for adolescent report and parent report tested correlates of adolescent TV watching, video game play, and computer use for entertainment. RESULTS: Data from adolescents indicated that rules for TV, computer use, and total number of screen time rules were significant correlates of time spent watching TV (ß = −.22, p < .01), playing video or computer games (ß = −.18, p < .05), and using the internet/computer for entertainment (ß = −.18, p < .05), respectively. Data from parents indicated that TV rules were significantly associated with lower TV viewing, and parent/adolescent agreement on rules strengthened this relationship. Both parent and adolescent data indicated that having a TV in the bedroom was positively associated with TV viewing time (ß = .18 and .24, p < .05, respectively). Adolescent data indicated a positive association between having at least one video game system in the bedroom with time spent playing video games (ß = .19, p < .05). CONCLUSION: Having clear rules, setting limits on screen time, and not having screen-based media in the bedroom were associated with fewer hours of screen time for adolescents

A systematic review of help-seeking interventions for depression, anxiety and general psychological distress

<p>Abstract</p> <p>Background</p> <p>Depression and anxiety are treatable disorders, yet many people do not seek professional help. Interventions designed to improve help-seeking attitudes and increase help-seeking intentions and behaviour have been evaluated in recent times. However, there have been no systematic reviews of the efficacy or effectiveness of these interventions in promoting help-seeking. Therefore, this paper reports a systematic review of published randomised controlled trials targeting help-seeking attitudes, intentions or behaviours for depression, anxiety, and general psychological distress.</p> <p>Methods</p> <p>Studies were identified through searches of PubMed, PsycInfo, and the Cochrane database in November 2011. Studies were included if they included a randomised controlled trial of at least one intervention targeting help-seeking for depression or anxiety or general psychological distress, and contained extractable data on help-seeking attitudes or intentions or behaviour. Studies were excluded if they focused on problems or conditions other than the target (e.g., substance use, eating disorder).</p> <p>Results</p> <p>Six published studies of randomised controlled trials investigating eight different interventions for help-seeking were identified. The majority of trials targeted young adults. Mental health literacy content was effective (<it>d</it> = .12 to .53) in improving help-seeking attitudes in the majority of studies at post-intervention, but had no effect on help-seeking behaviour (<it>d</it> = −.01, .02). There was less evidence for other intervention types such as efforts to destigmatise or provide help-seeking source information.</p> <p>Conclusions</p> <p>Mental health literacy interventions are a promising method for promoting positive help-seeking attitudes, but there is no evidence that it leads to help-seeking behaviour. Further research investigating the effects of interventions on attitudes, intentions, and behaviour is required.</p