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)

Increasing levels of the endocannabinoid 2-AG is neuroprotective in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine mouse model of Parkinson's disease

Date of Acceptance: 28/07/2015 The authors are grateful to the staff of the Medical Research Facility for their help with the animal care. This work was supported by the NHS Endowment fund 09/03 and the Wellcome Trust (WT080782MF). We thank Merck & Co. Inc., Rathway NJ, USA for the supply of DFU.Peer reviewedPublisher PD

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

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

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

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

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

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

Molecular Epidemiology of Escherichia coli Producing CTX-M and pAmpC β-Lactamases from Dairy Farms Identifies a Dominant Plasmid Encoding CTX-M-32 but No Evidence for Transmission to Humans in the Same Geographical Region

Third-generation cephalosporin resistance (3GC-R) in Escherichia coli is a rising problem in human and farmed-animal populations. We conducted whole-genome sequencing analysis of 138 representative 3GC-R isolates previously collected from dairy farms in southwest England and confirmed by PCR to carry acquired 3GC-R genes. This analysis identified bla(CTX-M) (131 isolates encoding CTX-M-1, -14, -15, -and 32 and the novel variant CTX-M-214), bla(CMY-2) (6 isolates), and bla(DHA-1) (1 isolate). A highly conserved plasmid was identified in 73 isolates, representing 27 E. coli sequence types. This novel ∼220-kb IncHI2 plasmid carrying bla(CTX-M-32) was sequenced to closure and designated pMOO-32. It was found experimentally to be stable in cattle and human transconjugant E. coli even in the absence of selective pressure and was found by multiplex PCR to be present on 26 study farms representing a remarkable range of transmission over 1,500 square kilometers. However, the plasmid was not found among human urinary E. coli isolates we recently characterized from people living in the same geographical location, collected in parallel with farm sampling. There were close relatives of two bla(CTX-M) plasmids circulating among eight human and two cattle isolates, and a closely related bla(CMY-2) plasmid was found in one cattle and one human isolate. However, phylogenetic evidence of recent sharing of 3GC-R strains between farms and humans in the same region was not found. IMPORTANCE Third-generation cephalosporins (3GCs) are critically important antibacterials, and 3GC resistance (3GC-R) threatens human health, particularly in the context of opportunistic pathogens such as Escherichia coli. There is some evidence for zoonotic transmission of 3GC-R E. coli through food, but little work has been done examining possible transmission via interaction of people with the local near-farm environment. We characterized acquired 3GC-R E. coli found on dairy farms in a geographically restricted region of the United Kingdom and compared these with E. coli from people living in the same region, collected in parallel. While there is strong evidence for recent farm-to-farm transmission of 3GC-R strains and plasmids—including one epidemic plasmid that has a remarkable capacity to be transmitted—there was no evidence that 3GC-R E. coli found on study farms had a significant impact on circulating 3GC-R E. coli strains or plasmids in the local human population

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) &#60;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