The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its Origins, Assessment, and Management

Neonatal abstinence syndrome (NAS) refers to a constellation of signs that are present in some newborn infants resulting from the abrupt cessation of passive transfer of maternal opioids used during pregnancy. The classic NAS refers to infants born to mothers who used opioids during pregnancy, but the term has broadened to include infants whose mothers have used or abused other psychoactive substances during pregnancy that contribute to the expression of the syndrome. Pregnant women who use opioids do so illicitly, and/or as medically prescribed for pain relief, and/or as medication assisted treatment for opioid dependence. The first case of NAS in infants and the subsequent treatment (or lack thereof) was reported in 1875 and was called Congenital Morphinism. By 2012, the incidence of NAS increased to more than 30 per 1,000 hospital live births, along with an increase in the number of infants being treated pharmacologically for NAS, resulting in an increase in the length of stay and healthcare expenses. We present historical references on NAS, the various factors and events that led to its increasing prevalence and today\u27s current epidemic. We also review the current tools to assess infants with NAS and treatment options in its management

Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review.

Abstract Objectives This paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs. Design Nestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources. Setting OD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs. Results This report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed. Conclusion There is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some 'best practice' approaches and interventions require extensive efficacy testing before further changes in policy can be implemented

¿Qué caminos existen hacia la calidad de servicio en clubes deportivos de baloncesto? Análisis de orientación emprendedora y nivel de competición

The entrepreneurial orientation (composed of innovation, risk taking and proactivity), is understood as the willingness to face the challenges of the environment and its rivals in an advantageous way, having a growing interest in research and generally related to greater performance in different areas of the organization. This study, carried out with Spanish basketball clubs, analyses the relationship between the Entrepreneurial Orientation, the level of competition of the clubs and the quality of service they provide to their athletes and members/subscribers. In this work, in which the fsQCA analysis methodology has been used, 103 basketball sports clubs have been analysed (61% national and 39% regional). The results show different ways to achieve high levels of Service Quality, with Risk Assumption and the level of national competition standing out as the variables that have the greatest presence in solutions with high levels of Service Quality.La orientación emprendedora (compuesta por innovación, asunción de riesgos y proactividad), es entendida como la disposición para afrontar de forma ventajosa los desafíos del entorno y sus rivales, teniendo creciente interés en la investigación y relacionada generalmente con un mayor rendimiento en distintos ámbitos de la organización. El presente estudio, realizado con clubes de baloncesto españoles, analiza la relación existente entre la Orientación Emprendedora, el nivel de competición de los clubes y la calidad de servicio que prestan a sus deportistas y socios/abonados. En este trabajo, en el que se ha utilizado como metodología de análisis fsQCA se han analizado 103 clubes deportivos de baloncesto (61% de categoría nacional y 39% autonómica). Los resultados muestran diferentes caminos para lograr altos niveles de Calidad de Servicio, destacando Asunción de Riesgos y nivel de competición nacional como variables que mayor presencia tienen en las soluciones de altos niveles de Calidad de servicio.&nbsp

Assessment of fetal corpus callosum biometry by 3D super-resolution reconstructed T2-weighted magnetic resonance imaging.

To assess the accuracy of corpus callosum (CC) biometry, including sub-segments, using 3D super-resolution fetal brain MRI (SR) compared to 2D or 3D ultrasound (US) and clinical low-resolution T2-weighted MRI (T2WS). Fetal brain biometry was conducted by two observers on 57 subjects [21-35 weeks of gestational age (GA)], including 11 cases of partial CC agenesis. Measures were performed by a junior observer (obs1) on US, T2WS and SR and by a senior neuroradiologist (obs2) on T2WS and SR. CC biometric regression with GA was established. Statistical analysis assessed agreement within and between modalities and observers. This study shows robust SR to US concordance across gestation, surpassing T2WS. In obs1, SR aligns with US, except for genu and CC length (CCL), enhancing splenium visibility. In obs2, SR closely corresponds to US, differing in rostrum and CCL. The anterior CC (rostrum and genu) exhibits higher variability. SR's regression aligns better with literature (US) for CCL, splenium and body than T2WS. SR is the method with the least missing values. SR yields CC biometry akin to US (excluding anterior CC). Thanks to superior 3D visualization and better through plane spatial resolution, SR allows to perform CC biometry more frequently than T2WS

Simplification of the Finnegan Neonatal Abstinence Scoring System: Retrospective Study of Two Institutions in the USA

Objective To develop a simplified Finnegan Neonatal Abstinence Scoring System (sFNAS) that will highly correlate with scores ≥ 8 and ≥12 in infants being assessed with the FNAS. Design, setting and participants This is a retrospective analysis involving 367 patients admitted to two level IV neonatal intensive care units with a total of 40 294 observations. Inclusion criteria included neonates with gestational age ≥ 37 0/7 weeks, who are being assessed for neonatal abstinence syndrome (NAS) using the FNAS. Infants with a gestational age \u3c 37 weeks were excluded. Methods A linear regression model based on the original FNAS data from one institution was developed to determine optimal values for each item in the sFNAS. A backward elimination approach was used, removing the items that contributed least to the Pearson’s correlation. The sFNAS was then cross-validated with data from a second institution. Results Pearson’s correlation between the proposed sFNAS and the FNAS was 0.914. The optimal treatment cut-off values for the sFNAS were 6 and 10 to predict FNAS scores ≥ 8 and ≥ 12, respectively. The sensitivity and specificity of these cut-off values to detect FNAS scores ≥ 8 and ≥ 12 were 0.888 and 0.883 for a cut-off of 6, and 0.637 and 0.992 for a cut-off of 10, respectively. The sFNAS cross-validation resulted in a Pearson’s correlation of 0.908, sensitivity and specificity of 0.860 and 0.873 for a cut-off of 6, and 0.525 and 0.986 for a cut-off of 10, respectively. Conclusion The sFNAS has a high statistical correlation with the FNAS, and it is cross-validated for the assessment of infants with NAS. It has excellent specificity and negative predictive value for identifying infants with FNAS scores ≥ 8 and ≥ 12

Critical Dynamics of a Vortex Loop Model for the Superconducting Transition

We calculate analytically the dynamic critical exponent $z_{MC}$ measured in Monte Carlo simulations for a vortex loop model of the superconducting transition, and account for the simulation results. In the weak screening limit, where magnetic fluctuations are neglected, the dynamic exponent is found to be $z_{MC} = 3/2$. In the perfect screening limit, $z_{MC} = 5/2$. We relate $z_{MC}$ to the actual value of $z$ observable in experiments and find that $z \sim 2$, consistent with some experimental results

Correction: Absence of Zika virus among pregnant women in Vietnam in 2008.

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Temperature and magnetic-field dependence of the conductivity of YBaCuO films in the vicinity of superconducting transition: Effect of Tc-inhomogeneity

Temperature and magnetic field dependences of the conductivity of YBaCuO films in the transition region are analyzed taking into account spatial inhomogeneity in transition temperature, Tc. (i) An expression for the superconducting contribution to conductivity, \sigma_s(T,H,Tc), of a homogeneous superconductor for H<<Hc2(T=0) is obtained using the solution of the Ginzburg-Landau equation in form of perturbation expansions [S.Ullah, A.T.Dorsey, PRB 44, 262 (1991)]. (ii) The error in \sigma_s(T,H,Tc) occurring due to the presence of Tc-inhomogeneity is calculated and plotted on an H-T plane diagram. These calculations use an effective medium approximation and a Gaussian distribution of Tc. (iii) Measuring the temperature dependences of a voltage, induced by a focused electron beam, we determine spatial distributions of the critical temperature for YBaCuO microbridges with a 2 micron resolution. A typical Tc-distribution dispersion is found to be approximately 1K. For such dispersion, error in \sigma_s(T,H,Tc) due to Tc-inhomogeneity exceeds 30% for magnetic fields H < 1 T and temperatures |T-Tc| < 0.5 K. (iv) Experimental R(T,H) dependences of resistance are well described by a numerical solution of a set of Kirchoff equations for the resistor network based on the measured spatial distributions of Tc and the expression for \sigma_s(T,H,Tc).Comment: REVTeX, 12 pages including 7 figures, resubmitted to Phys. Rev.

Theory of Scanning Tunneling Spectroscopy of Magnetic-Field-Induced Discrete Nodal States in a D-Wave Superconductor

In the presence of an external magnetic field, the low lying elementary excitations of a d-wave superconductor have quantized energy and their momenta are locked near the node direction. It is argued that these discrete states can most likely be detected by a local probe, such as a scanning tunneling microscope. The low temperature local tunneling conductance on the Wigner-Seitz cell boundaries of the vortex lattice is predicted to show peaks spaced as $\pm \sqrt{n}, n ={0,1,2, ...}$. The $n=0$ peak is anomalous, and it is present only if the superconducting order parameter changes sign at certain points on the Fermi surface. Away from the cell boundary, where the superfluid velocity is nonzero, each peak splits, in general, into four peaks, corresponding to the number of nodes in the order parameter.Comment: RevTeX 3.0, 4 pages, 3 figures (included

Association of a Simplified Finnegan Neonatal Abstinence Scoring Tool With the Need for Pharmacologic Treatment for Neonatal Abstinence Syndrome

Importance: Observer-rated scales, such as the Finnegan Neonatal Abstinence Scoring Tool (FNAST), are used to quantify the severity of neonatal abstinence syndrome (NAS) and guide pharmacologic therapy. The FNAST, a comprehensive 21-item assessment tool, was developed for research and subsequently integrated into clinical practice; a simpler tool, designed to account for clinically meaningful outcomes, is urgently needed to standardize assessment. Objectives: To identify FNAST items independently associated with the decision to use pharmacologic therapy and to simplify the FNAST while minimizing loss of information for the treatment decision. Design, Setting, and Participants: This multisite cohort study included 424 neonates with opioid exposure who had a gestational age of at least 36 weeks with follow-up from birth to hospital discharge in the derivation cohort and 109 neonates with opioid exposure from the Maternal Opioid Treatment: Human Experimental Research Study in the validation cohort. Neonates in the derivation cohort were included in a medical record review at the Universities of Louisville and Kentucky or in a randomized clinical trial and observational study conducted at Tufts University (2014-2018); the Maternal Opioid Treatment: Human Experimental Research was conducted from 2005 to 2008. Data analysis was conducted from May 2017 to August 2019. Exposures: Prenatal opioid exposure. Main Outcomes and Measures: All FNAST items were dichotomized as present or not present, and logistic regression was used to identify binary items independently associated with pharmacologic treatment. The final model was validated with an independent cohort of neonates with opioid exposure. Results: Among 424 neonates (gestational age, ≥36 weeks; 217 [51%] female infants), convulsions were not observed, and high-pitched cry and hyperactive Moro reflex had extremely different frequencies across cohorts. Therefore, these 3 FNAST items were removed from further analysis. The 2 tremor items were combined, and 8 of the remaining 17 items were independently associated with pharmacologic treatment, with an area under the curve of 0.86 (95% CI, 0.82-0.89) compared with 0.90 (95% CI, 0.87-0.94) for the 21-item FNAST. External validation of the 8 items resulted in an area under the curve of 0.86 (95% CI, 0.79-0.93). Thresholds of 4 and 5 on the simplified scale yielded the closest agreement with FNAST thresholds of 8 and 12 (weighted κ = 0.55; 95% CI, 0.48-0.61). Conclusions and Relevance: The findings of this study suggest that 8 signs of NAS may be sufficient to assess whether a neonate meets criteria for pharmacologic therapy. A focus on these signs could simplify the FNAST tool and may enhance its clinical utility