Hospitalisations from one to six years of age: Effects of Gestational Age and Severe Neonatal Morbidity

Background: To investigate whether the adverse infant health outcomes associated with early birth and severe neonatal morbidity (SNM) persist beyond the first year of life and impact on paediatric hospitalisations for children up to six years of age. Methods: The study population included all singleton live births, >32 weeks gestation in New South Wales, Australia in 2001-2005, with follow-up to six years of age. Birth data were probabilistically linked to hospitalisation data (n=392,964). The odds of hospitalisation, mean hospital length of stay (LOS) and costs, and cumulative LOS were evaluated by gestational age and SNM using multivariable analyses. Results: A total of 74,341 (18.9%) and 41,404 (10.5%) infants were hospitalized once and more than once, respectively. SNM was associated with increased odds of hospitalisation once (adjusted odds ratio (aOR) 1.16 [95% CI 1.10, 1.22]), and more than once (aOR 1.51 [1.42, 1.60]). Decreasing gestational age was associated with increasing odds of hospitalisation more than once from aOR 1.19 at 37-38 weeks to 1.49 at 33-34 weeks. Average LOS and costs per hospital admission were increased with SNM but not with decreasing gestational age. Cumulative LOS was significantly increased with SNM and decreasing gestational age. Conclusions: Adverse effects of SNM and early birth persist between one and six years of age. Strategies to prevent early birth and reduce SNM, and to increase health monitoring of vulnerable infants throughout childhood may help reduce paediatric hospitalisations.NHMRC, NSW Health Population Health and Health Services Gran

Mapping Emotional Attachment as a Measure of Sense of Place to Identify Coastal Restoration Priority Areas

Our applied case study demonstrates how knowledge from community stakeholders about emotional attachment (as a key component of sense of place) can inform and influence future coastal restoration priorities at various scales in the Indian River Lagoon, Florida (USA). We map aggregate measures of emotional attachment from community stakeholders using Geographic Information Systems. We then analyze this human systems level data with kernel density estimation measures at the broader lagoon scale and with inverse distance weighted measures at more localized scales. By connecting these mapped results back to the primary reasons that participants provided for having high or low emotional attachment in a location, we show how varying spatial patterns of emotional attachment as a primary component of sense of place within and across broader geographic regions can be represented, mapped, and visualized to enhance future restoration priorities. We demonstrate how aggregate results gained from community stakeholders can help restoration teams prioritize their science communication and education strategies to align human systems level data with natural systems level data

Synthesis of layered silicon-graphene hetero-structures by wet jet milling for high capacity anodes in Li-ion batteries

While silicon-based negative electrode materials have been extensively studied, to develop high capacity lithium-ion batteries (LIBs), implementing a large-scale production method that can be easily transferred to industry, has been a crucial challenge. Here, a scalable wet-jet milling method was developed to prepare a silicon-graphene hybrid material to be used as negative electrode in LIBs. This synthesized composite, when used as an anode in lithium cells, demonstrated high Li ion storage capacity, long cycling stability and high-rate capability. In particular, the electrode exhibited a reversible discharge capacity exceeding 1763 mAh g−1 after 450 cycles with a capacity retention of 98% and a coulombic efficiency of 99.85% (with a current density of 358 mA g−1). This significantly supersedes the performance of a Si-dominant electrode structures. The capacity fade rate after 450 cycles was only 0.005% per cycle in the 0.05–1 V range. This superior electrochemical performance is ascribed to the highly layered, silicon-graphene porous structure, as investigated via focused ion beam in conjunction with scanning electron microscopy tomography. The hybrid electrode could retain 89% of its porosity (under a current density of 358 mA g−1) after 200 cycles compared with only 35% in a Si-dominant electrode. Moreover, this morphology can not only accommodate the large volume strains from active silicon particles, but also maintains robust electrical connectivity. This confers faster transportation of electrons and ions with significant permeation of electrolyte within the electrode. Physicochemical characterisations were performed to further correlate the electrochemical performance with the microstructural dynamics. The excellent performance of the hybrid material along with the scalability of the synthesizing process is a step forward to realize high capacity/energy density LIBs for multiple device applications

The future of Cybersecurity in Italy: Strategic focus area

This volume has been created as a continuation of the previous one, with the aim of outlining a set of focus areas and actions that the Italian Nation research community considers essential. The book touches many aspects of cyber security, ranging from the definition of the infrastructure and controls needed to organize cyberdefence to the actions and technologies to be developed to be better protected, from the identification of the main technologies to be defended to the proposal of a set of horizontal actions for training, awareness raising, and risk management

An integrative review of the factors influencing older nurses’ timing of retirement

Aims: To summarise the international empirical literature to provide a comprehensive understanding of older nurses’ decision making surrounding the timing of their retirement. Background: The global nursing shortage is increasing. Amongst some countries it has become an economic imperative to consider raising the state pension age and to extend working lives. Design: An integrative literature review using an integrated design. Data sources: MEDLINE, CINAHL and Business Source Premier databases were searched for studies between January 2007 ‐ October 2019. Review Methods: Quality appraisal of the studies were conducted. Findings were summarised, grouped into categories and themes extracted. Two models were developed for data representation. Results: 132 studies were identified by the search strategy. Of these, 27 articles were included for appraisal and synthesis. 16 papers were quantitative, seven qualitative and four mixed methods. The research took place in 13 different geographical locations. Most studies were of a questionnaire design, followed by interviews and focus groups. The total participant sample was 35,460. Through a synthesis of the studies, four themes were identified: Health, Well‐being and Family factors; Employer factors; Professional factors; Financial factors. Conclusion: This review revealed the heterogeneity of studies on this subject and confirmed previous findings but also established a ranking of criteria that influences nurses’ decision making: age, followed by personal and organisational factors. Four extracted themes of push and pull factors map onto these factors. No ‘one‐size‐fits‐all’ strategy exists to ensure the extension of older nurses’ working lives. Organisations need to foster an environment where older nurses feel respected and heard and where personal and professional needs are addressed

Linkage map saturation, construction, and comparison in four populations of Prunus

One of the objectives of the ISAFRUIT Project was to perform genetic analyses in four populations of Prunus, two of peach (P. persica) and two of apricot (P. armeniaca), in order to identify major genes and quantitative trait loci (QTLs) for characters related to fruit quality. This required the construction of saturated marker maps in each of these populations. Marker maps were available for an intra-specific peach × peach F2, a BC2 peach × P. davidiana (using peach as the recurrent parent), and an apricot × apricot F1. We have further saturated these maps mainly with SSR (simple sequence repeat) markers. A new map, constructed uniquely from SSRs was prepared for a fourth apricot × apricot F1 population. Using anchor markers, we compared these four maps with the reference Prunus map, constructed using an almond × peach F2 population. As previously observed, conservation of synteny and co-linearity were the general rule, providing additional evidence of the high level of similarity between all Prunus genomes. Comparisons of genetic distances between the maps suggested that those involving similar genomes had higher levels of recombination than those with more distant genomes, particularly the inter-specific crosses.The ISAFRUIT Project is funded by the European Commission under Thematic Priority 5 – Food Quality and Safety of the 6th Framework Programme of RTD (Contract No. FP6-FOOD-CT-2006-016279).Peer reviewe

Protocol for a randomised controlled trial of treatment of asymptomatic candidiasis for the prevention of preterm birth [ACTRN12610000607077]

<p>Abstract</p> <p>Background</p> <p>Prevention of preterm birth remains one of the most important challenges in maternity care. We propose a randomised trial with: a simple <it>Candida </it>testing protocol that can be easily incorporated into usual antenatal care; a simple, well accepted, treatment intervention; and assessment of outcomes from validated, routinely-collected, computerised databases.</p> <p>Methods/Design</p> <p>Using a prospective, randomised, open-label, blinded-endpoint (PROBE) study design, we aim to evaluate whether treating women with asymptomatic vaginal candidiasis early in pregnancy is effective in preventing spontaneous preterm birth. Pregnant women presenting for antenatal care <20 weeks gestation with singleton pregnancies are eligible for inclusion. The intervention is a 6-day course of clotrimazole vaginal pessaries (100 mg) and the primary outcome is spontaneous preterm birth <37 weeks gestation.</p> <p>The study protocol draws on the usual antenatal care schedule, has been pilot-tested and the intervention involves only a minor modification of current practice. Women who agree to participate will self-collect a vaginal swab and those who are culture positive for Candida will be randomised (central, telephone) to open-label treatment or usual care (screening result is not revealed, no treatment, routine antenatal care). Outcomes will be obtained from population databases.</p> <p>A sample size of 3,208 women with <it>Candida </it>colonisation (1,604 per arm) is required to detect a 40% reduction in the spontaneous preterm birth rate among women with asymptomatic candidiasis from 5.0% in the control group to 3.0% in women treated with clotrimazole (significance 0.05, power 0.8). Analyses will be by intention to treat.</p> <p>Discussion</p> <p>For our hypothesis, a placebo-controlled trial had major disadvantages: a placebo arm would not represent current clinical practice; knowledge of vaginal colonisation with <it>Candida </it>may change participants' behaviour; and a placebo with an alcohol preservative may have an independent affect on vaginal flora. These disadvantages can be overcome by the PROBE study design.</p> <p>This trial will provide definitive evidence on whether screening for and treating asymptomatic candidiasis in pregnancy significantly reduces the rate of spontaneous preterm birth. If it can be demonstrated that treating asymptomatic candidiasis reduces preterm births this will change current practice and would directly impact the management of every pregnant woman.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trials Registry <a href="http://www.anzctr.org.au/ACTRN12610000607077.aspx">ACTRN12610000607077</a></p

Roadmap on Li-ion battery manufacturing research

Growth in the Li-ion battery market continues to accelerate, driven primarily by the increasing need for economic energy storage for electric vehicles. Electrode manufacture by slurry casting is the first main step in cell production but much of the manufacturing optimisation is based on trial and error, know-how and individual expertise. Advancing manufacturing science that underpins Li-ion battery electrode production is critical to adding to the electrode manufacturing value chain. Overcoming the current barriers in electrode manufacturing requires advances in materials, manufacturing technology, in-line process metrology and data analytics, and can enable improvements in cell performance, quality, safety and process sustainability. In this roadmap we explore the research opportunities to improve each stage of the electrode manufacturing process, from materials synthesis through to electrode calendering. We highlight the role of new process technology, such as dry processing, and advanced electrode design supported through electrode level, physics-based modelling. Progress in data driven models of electrode manufacturing processes is also considered. We conclude there is a growing need for innovations in process metrology to aid fundamental understanding and to enable feedback control, an opportunity for electrode design to reduce trial and error, and an urgent imperative to improve the sustainability of manufacture

Regional block versus general anaesthesia for caesarean section and neonatal outcomes: a population-based study

<p>Abstract</p> <p>Background</p> <p>Anaesthesia guidelines recommend regional anaesthesia for most caesarean sections due to the risk of failed intubation and aspiration with general anaesthesia. However, general anaesthesia is considered to be safe for the foetus, based on limited evidence, and is still used for caesarean sections.</p> <p>Methods</p> <p>Cohorts of caesarean sections by indication (that is, planned repeat caesarean section, failure to progress, foetal distress) were selected from the period 1998 to 2004 (<it>N </it>= 50,806). Deliveries performed under general anaesthesia were compared with those performed under spinal or epidural, for the outcomes of neonatal intubation and 5-minute Apgar (Apgar5) <7.</p> <p>Results</p> <p>The risk of adverse outcomes was increased for caesarean sections under general anaesthesia for all three indications and across all levels of hospital. The relative risks were largest for low-risk planned repeat caesarean deliveries: resuscitation with intubation relative risk was 12.8 (95% confidence interval 7.6, 21.7), and Apgar5 <7 relative risk was 13.4 (95% confidence interval 9.2, 19.4). The largest absolute increase in risk was for unplanned caesareans due to foetal distress: there were five extra intubations per 100 deliveries and six extra Apgar5 <7 per 100 deliveries.</p> <p>Conclusion</p> <p>The infants most affected by general anaesthesia were those already compromised <it>in utero</it>, as evidenced by foetal distress. The increased rate of adverse neonatal outcomes should be weighed up when general anaesthesia is under consideration.</p