Paediatric intensive care admissions of preterm children born <32 weeks gestation: a national retrospective cohort study using data linkage

Objective: Survival of babies born very preterm (<32 weeks gestational age) has increased, although preterm-born children may have ongoing morbidity. We aimed to investigate the risk of admission to paediatric intensive care units (PICUs) of children born very preterm following discharge home from neonatal care. Design: Retrospective cohort study, using data linkage of National Neonatal Research Database and the Paediatric Intensive Care Audit Network datasets. Setting: All neonatal units and PICUs in England and Wales. Patients: Children born very preterm between 1 January 2013 and 31 December 2018 and admitted to neonatal units. Main outcome measures: Admission to PICU after discharge home from neonatal care, before 2 years of age. Results: Of the 40 690 children discharged home from neonatal care, there were 2308 children (5.7%) with at least one admission to PICU after discharge. Of these children, there were 1901 whose first PICU admission after discharge was unplanned. The percentage of children with unplanned PICU admission varied by gestation, from 10.2% of children born <24 weeks to 3.3% born at 31 weeks. Following adjustment, unplanned PICU admission was associated with lower gestation, male sex (adjusted OR (aOR) 0.79), bronchopulmonary dysplasia (aOR 1.37), necrotising enterocolitis requiring surgery (aOR 1.39) and brain injury (aOR 1.42). For each week of increased gestation, the aOR was 0.90. Conclusions: Most babies born <32 weeks and discharged home from neonatal care do not require PICU admission in the first 2 years. The odds of unplanned admissions to PICU were greater in the most preterm and those with significant neonatal morbidity. Data availability statement: Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. PICANet data may be requested from the data controller, the Healthcare Quality Improvement Partnership (HQIP). A Data Access Request Form can be obtained from https://www.hqip.org.uk/national-programmes/accessing-ncapop-data/%23.XQeml_lKhjU

Characteristics of children requiring admission to neonatal care and paediatric intensive care before the age of 2 years in England and Wales: A data linkage study

\ua9 Author(s) (or their employer(s)) 2024. Objective: To quantify the characteristics of children admitted to neonatal units (NNUs) and paediatric intensive care units (PICUs) before the age of 2 years. Design: A data linkage study of routinely collected data. Setting: National Health Service NNUs and PICUs in England and Wales Patients: Children born from 2013 to 2018. Interventions: None. Main outcome measure: Admission to PICU before the age of 2 years. Results: A total of 384 747 babies were admitted to an NNU and 4.8% (n=18 343) were also admitted to PICU before the age of 2 years. Approximately half of all children admitted to PICU under the age of 2 years born in the same time window (n=18 343/37 549) had previously been cared for in an NNU. The main reasons for first admission to PICU were cardiac (n=7138) and respiratory conditions (n=5386). Cardiac admissions were primarily from children born at term (n=5146), while respiratory admissions were primarily from children born preterm (&lt;37 weeks\u27 gestational age, n=3550). A third of children admitted to PICU had more than one admission. Conclusions: Healthcare professionals caring for babies and children in NNU and PICU see some of the same children in the first 2 years of life. While some children are following established care pathways (eg, staged cardiac surgery), the small proportion of children needing NNU care subsequently requiring PICU care account for a large proportion of the total PICU population. These differences may affect perceptions of risk for this group of children between NNU and PICU teams

The use of oral antibiotics and mechanical bowel preparation in elective colorectal resection for the reduction of surgical site infection.

Surgical site infection (SSI) is a major cause of morbidity following elective colorectal resection worldwide. Reduction in SSI rates can be achieved with the use of SSI reduction bundles. Debate about the role of mechanical bowel preparation and oral antibiotics (MOAB) in reducing SSI has persisted over decades with considerable variation in international practice. This article summarises the arguments for and against the routine use of MOAB in the elective setting, highlighting the areas of controversy and evidence gaps and provides pragmatic suggestions for colorectal practice.This topical debate paper was commissioned by the President and Executive of the Association of Coloproctology of Great Britain and Ireland. ACPGBI also funded the open access publication fee. The authors would like to thank Ms J Pipe for her comments from the patient perspective and Miss N Fearnhead for her support in developing this debate article

Simulation of Intermetallic Solidification using Phase-Field Techniques

We present current ideas towards developing a phase-field model appropriate to the solidification of intermetallic phases. Such simulation presents two main challenges (i) dealing with faceted interfaces and (ii) the complex sub-lattice models used to describe the thermodynamics of such phases. Although models are already existent for the simulation of faceted crystals, some of these can be shown to produce highly unrealistic Wulff shapes. The model present here uses a parameterization of the Wulff shape as a direct input to the model, allowing the simulation of arbitrary crystal shapes. In addition, an anti-trapping current that can be used with arbitrary (including sub-lattice) thermodynamics is presented. Such antitrapping currents are vital in the simulation of intermetallic phases where the steep liquidus slope means small deviations in solute partitioning behaviour can translate to a significant change in tip undercooling

Ubiquitous velocity fluctuations throughout the molecular interstellar medium

The density structure of the interstellar medium (ISM) determines where stars form and release energy, momentum, and heavy elements, driving galaxy evolution. Density variations are seeded and amplified by gas motion, but the exact nature of this motion is unknown across spatial scale and galactic environment. Although dense star-forming gas likely emerges from a combination of instabilities, convergent flows, and turbulence, establishing the precise origin is challenging because it requires quantifying gas motion over many orders of magnitude in spatial scale. Here we measure the motion of molecular gas in the Milky Way and in nearby galaxy NGC 4321, assembling observations that span an unprecedented spatial dynamic range ($10^{-1}{-}10^3$ pc). We detect ubiquitous velocity fluctuations across all spatial scales and galactic environments. Statistical analysis of these fluctuations indicates how star-forming gas is assembled. We discover oscillatory gas flows with wavelengths ranging from $0.3{-}400$ pc. These flows are coupled to regularly-spaced density enhancements that likely form via gravitational instabilities. We also identify stochastic and scale-free velocity and density fluctuations, consistent with the structure generated in turbulent flows. Our results demonstrate that ISM structure cannot be considered in isolation. Instead, its formation and evolution is controlled by nested, interdependent flows of matter covering many orders of magnitude in spatial scale

The effects of integrated care: a systematic review of UK and international evidence

BACKGROUND: Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS: The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS: One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS: Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION: Prospero registration number: 42016037725

Mapping the Deep Blue Oceans

The ocean terrain spanning the globe is vast and complex—far from an immense flat plain of mud. To map these depths accurately and wisely, we must understand how cartographic abstraction and generalization work both in analog cartography and digital GIS. This chapter explores abstraction practices such as selection and exaggeration with respect to mapping the oceans, showing significant continuity in such practices across cartography and contemporary GIS. The role of measurement and abstraction—as well as of political and economic power, and sexual and personal bias—in these sciences is illustrated by the biographies of Marie Tharp and Bruce Heezen, whose mapping of the Mid-Atlantic Ridge precipitated a paradigm shift in geology

Voices of the hungry: a qualitative measure of household food access and food insecurity in South Africa

South Africa is rated a food secure nation, but large numbers of households within the country have inadequate access to nutrient-rich diverse foods. The study sought to investigate households’ physical and economic access and availability of food, in relation to local context which influences households’ access to and ability to grow food which may affect the dietary quality. We sought to understand self-reported healthy diets, food insecurity from the perspective of people who experienced it, barriers to household food security and perceptions and feelings on food access as well as strategies households use to cope with food shortages and their perceptions on improving household food security

Effect of national guidance on survival for babies born at 22 weeks' gestation in England and Wales: population based cohort study

OBJECTIVES: To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks' gestation in England and Wales. DESIGN: Population based cohort study. SETTING: England and Wales, comprising routine data for births and hospital records. PARTICIPANTS: Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021. MAIN OUTCOME MEASURES: Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21. RESULTS: For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at <500g weight; 19% to 31% at 22 weeks+0 days to 22 weeks+3 days). CONCLUSIONS: A change in national guidance to recommend a risk based approach was associated with a threefold increase in 22 weeks' gestation babies receiving survival focused care. The number of babies being admitted to neonatal units and those surviving to discharge increased