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

TESS Giants Transiting Giants. II. The Hottest Jupiters Orbiting Evolved Stars

Giant planets on short-period orbits are predicted to be inflated and eventually engulfed by their host stars. However, the detailed timescales and stages of these processes are not well known. Here, we present the discovery of three hot Jupiters (P < 10 days) orbiting evolved, intermediate-mass stars (M ⋆ ≈ 1.5 M ⊙, 2 R ⊙ < R ⋆ < 5 R ⊙). By combining TESS photometry with ground-based photometry and radial velocity measurements, we report masses and radii for these three planets of between 0.4 and 1.8 M J and 0.8 and 1.8 R J. TOI-2337b has the shortest period (P = 2.99432 ± 0.00008 days) of any planet discovered around a red giant star to date. Both TOI-4329b and TOI-2669b appear to be inflated, but TOI-2337b does not show any sign of inflation. The large radii and relatively low masses of TOI-4329b and TOI-2669b place them among the lowest density hot Jupiters currently known, while TOI-2337b is conversely one of the highest. All three planets have orbital eccentricities of below 0.2. The large spread in radii for these systems implies that planet inflation has a complex dependence on planet mass, radius, incident flux, and orbital properties. We predict that TOI-2337b has the shortest orbital decay timescale of any planet currently known, but do not detect any orbital decay in this system. Transmission spectroscopy of TOI-4329b would provide a favorable opportunity for the detection of water, carbon dioxide, and carbon monoxide features in the atmosphere of a planet orbiting an evolved star, and could yield new information about planet formation and atmospheric evolution

Understanding family dynamics in a cross-cultural sample: a multi-national study

The Family Systems Circumplex Model posits that balanced levels of cohesion and adaptability are associated with positive familial outcomes, whereas extremely high or low levels of these factors are associated with deleterious outcomes. Despite the popularity and utility of this model in Western cultures, there is a dearth of empirical data supporting its use in more culturally diverse contexts. The current, preregistered study assessed the Family Circumplex Model, cultural factors, and emerging adult outcomes across seven countries (i.e., China, Iran, Nigeria, Switzerland, Turkey, the United Kingdom, and the United States). Participants were N = 3,593 emerging adults, mostly self-identifying as women (71.3%). Collaborators were participants in Psi Chi’s Network for International Collaborative Exchange (NICE) and administered measures related to family dynamics and cultural orientation to participants in a random order. Results indicated that the Family Circumplex Model did not fit cross-culturally. As such, a new model was adapted, the Expanded Circumplex Model, which demonstrated invariance across samples and between women and men. The Expanded Circumplex Model retained 6 constructs with differences regarding the separation of disengagement into 2 variables and the combining of adaptive flexibility and cohesion. The current study suggests that the cultural context in which family dynamics occur should be taken into consideration when conceptualizing family dynamics theory and measurement. Future work should seek to replicate and further apply the Expanded Circumplex Model to familial outcomes