Inhuman shields — children caught in the crossfire of domestic violence

Background. Child abuse is a worldwide scourge. One of its most devastating manifestations is non-accidental head injury (NAHI). Methods. This is a retrospective chart review of children presenting to the Red Cross Children’s Hospital trauma unit with a diagnosis of NAHI over a 3-year period. Results. Sixty-eight children were included in the study and 2 different groups were identified. Fifty-three per cent of the children were deliberately injured (median age 2 years), while 47% were allegedly not the intended target of the assailant (median age 9 months). The assailant was male in 65% of the intentional assaults and male in 100% of the unintentional assaults, with the intended adult victim female in 85% of the latter cases. Overall, 85% of the assaults were committed in the child’s own home. Conclusions. The high proportion of cases in which a young child was injured unintentionally suggests that these infants effectively become shields in assaults committed by adults. In this context any attempts to deal with child abuse must also address the concurrent intimate partner violence

Development and evaluation of a patient decision aid for patients considering ongoing medical or surgical treatment options for ulcerative colitis using a mixed-methods approach : protocol for DISCUSS study

Introduction: Approximately 20%–30% of patients with ulcerative colitis (UC) require surgery, the majority of these being elective due to chronic symptoms refractory to medical treatment. The decision for surgery is difficult and dependent on patient preferences. Current resources for patients considering surgery have been found not to meet minimum international standards. The overall aim of the ‘DISCUSS’ study is to develop and evaluate a new patient decision aid (PtDA) for patients considering surgery for UC created in line with international minimum standards. Methods and analysis: This is a prospective mixed-methods study of adults (18+ years) who are considering surgical intervention for UC across two regional centres in Yorkshire, UK. This study is in three stages. In stage 1 we will develop the PtDA and its content via systematic reviews and a patient questionnaire. In stage 2 we will assess the face validity of the PtDA using mixed-methods on key stakeholders using both semistructured interviews and questionnaires, following which the PtDA will be refined. In stage 3 we will assess the acceptability of using the PtDA in clinical practice. This will use a mixed-methods approach on clinicians and patients who are considering undergoing elective surgery. Questionnaires including the Preparation for Decision-Making Scale, a measure of anxiety and decisional conflict will be analysed at two timepoints using paired sample t-tests and CIs. Interviews with patients and clinicians will be analysed using thematic analysis. Ethics and dissemination: Research ethics approval from North East–Tyne & Wear South Research Ethics Committee (Ref: 19/NE/0073) and Health Research Authority approval (Ref: 257044) have been granted. Results will be published in open access peer-reviewed journals, presented in conferences and distributed through the Crohn’s and Colitis UK charity. External endorsement will be sought from the International Patient Decision Aid Standards Collaboration inventory of PtDAs

A survey of patient informational preferences when choosing between medical and surgical therapy for ulcerative colitis:a sub‐study from the DISCUSS project

Aim: People living with ulcerative colitis (UC) have two broad treatment avenues, namely medical or surgical therapy. The choice between these can depend on patient preference as well as the receipt of relevant information. The aim of this study was to define the informational needs of patients with UC.Method: A postal survey was designed to capture respondent demographics, treatment experienced within the previous 12 months and informational preferences by rating a long list of items. It was delivered through two hospitals that provide tertiary inflammatory bowel disease services. Descriptive analyses were performed to describe demographics and experiences. Principal component analysis was carried out using a varimax rotation to investigate informational needs.Results: A total of 101 responses were returned (20.1% response rate). The median age of respondents was 45 years and the median time since diagnosis was 10 years. Control preferences skewed towards shared (42.6%) or patient-led but clinician-informed (35.6%). Decision regret was low for the population (median 12.5/100, range 0–100). Key informational needs related to medical therapy were benefits and risks of long-term therapy, burden of hospital attendance, reproductive health, need for steroid treatment and impact on personal life. For surgery, these were stoma information, effect on daily life, effect on sexual and reproductive health, risks and benefits and disruption of life due to surgery.Conclusion: This study has identified key areas for discussion when counselling patients about treatment decisions around medical therapy and surgery for UC

Relaxation Methods for Mixed-Integer Optimal Control of Partial Differential Equations

We consider integer-restricted optimal control of systems governed by abstract semilinear evolution equations. This includes the problem of optimal control design for certain distributed parameter systems endowed with multiple actuators, where the task is to minimize costs associated with the dynamics of the system by choosing, for each instant in time, one of the actuators together with ordinary controls. We consider relaxation techniques that are already used successfully for mixed-integer optimal control of ordinary differential equations. Our analysis yields sufficient conditions such that the optimal value and the optimal state of the relaxed problem can be approximated with arbitrary precision by a control satisfying the integer restrictions. The results are obtained by semigroup theory methods. The approach is constructive and gives rise to a numerical method. We supplement the analysis with numerical experiments

Trends in Pediatric Hospital Admissions Caused or Contributed by SARS-CoV-2 Infection in England

Objective: To investigate the changing characteristics of SARS-CoV-2 related pediatric hospital admissions over time. // Study design: A national, observational cohort study from 1, July 2020, to August 31, 2023, using English population-linked electronic health records. We identified 45,203 children under 18 years old in whom SARS-CoV-2 either caused or contributed to hospitalization, excluding those admitted with “incidental” infection. Studied outcomes were types of hospitalization and severe hospitalizations involving either critical care or PIMS-TS. // Results: There were 45,920 SARS-CoV-2 related hospitalizations in children: 34,870 (75.9%) due to COVID-19; 1,845 (4.0%) due to pediatric inflammatory multisystem syndrome – temporally associated with SARS-CoV-2 (PIMS-TS); 8,330 (18.1%) with SARS-CoV-2 as contributor to admission; and 875 (1.9%) acquired nosocomial SARS-CoV-2 infection. The most notable changes between the first three waves (March 2020 through November 2021) and the omicron era (December 2021 onwards) were: a fall in PIMS-TS from 1,575 of 14,020 (11.2%) to 270 of 31,905 (0.8%); a reduction in critical care use from 1,175 of 14,020 (8.4%) to 1,390 of 31,905 (4.4%); a fall in mortality rate among those hospitalized from 521 per 100,000 to 249 per 100,000; and a drop in the median age of hospitalized children from 4.7 (IQR 0.6,12.3) to 1.1 (IQR 0.3,6.4) years. Of children hospitalized, infants, 10.2% of whom had a recorded underlying health condition, comprised 4,225 of 14,020 (30.1%) admissions 2020 through 2021 and 15,555 of 31,900 (48.8%) since 2022. (p<0.001 for all comparisons). // Conclusions: Infants are now the most affected age group by SARS-CoV2, at least partially related to having the least immunity to the virus, and are most vulnerable to respiratory illnesses. Among 11.9 million children and adolescents resident in England,1 we previously studied hospital admissions related to SARS-CoV-2 infection, between July 2020 when the testing program had been set up and February 2022;2 finding that this infection was causal or a contributory factor in the hospitalization of 21,000 individuals.2 Since February 2022, children’s SARS-CoV-2 exposure histories,3 relevant SARS-CoV-2 testing and health protection policies,4 and variant dominance5 have evolved. In England, over 90% of school age children had detectable SARS-CoV-2 antibodies in March 2022.6 This was largely due to infection, especially in younger children; by October 2023, at least one dose of COVID-19 vaccine had been received in only 9% of 5-11 year-olds; 42% of 12-15 year-olds and 61% of 16 to 17 year-olds.7 For children in England under 5 years old, only those with significant underlying health conditions have ever been eligible for COVID-19 vaccination. Since 2023, only children with significant underlying health conditions are eligible for any SARS-CoV-2 vaccines across all age groups.8 Increased SARS-CoV-2 immunity from previous infection or vaccination may be responsible for the noted drop in incidence of pediatric inflammatory multisystem syndrome in children temporally associated with COVID-19(PIMS-TS) (also known as multisystem inflammatory syndrome in children in some countries, MIS-C) ,9 however, the wider impacts of evolving complex inter-related factors upon changes in the phenotypes of pediatric SARS-CoV-2 related hospital admissions are unclear. We used population-based electronic healthcare record (EHR) data to describe trends in hospital admissions caused or contributed to by SARS-CoV-2 infection among children and adolescents resident in England. Our study objectives were to explore any changes over time in the characteristics of hospital admissions caused or contributed to by SARS-CoV-2, including severe admissions involving critical care10 and in the demographics of affected children

18S rRNA is a reliable normalisation gene for real time PCR based on influenza virus infected cells

Background: One requisite of quantitative reverse transcription PCR (qRT-PCR) is to normalise the data with an internal reference gene that is invariant regardless of treatment, such as virus infection. Several studies have found variability in the expression of commonly used housekeeping genes, such as beta-actin (ACTB) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH), under different experimental settings. However, ACTB and GAPDH remain widely used in the studies of host gene response to virus infections, including influenza viruses. To date no detailed study has been described that compares the suitability of commonly used housekeeping genes in influenza virus infections. The present study evaluated several commonly used housekeeping genes [ACTB, GAPDH, 18S ribosomal RNA (18S rRNA), ATP synthase, H+ transporting, mitochondrial F1 complex, beta polypeptide (ATP5B) and ATP synthase, H+ transporting, mitochondrial Fo complex, subunit C1 (subunit 9) (ATP5G1)] to identify the most stably expressed gene in human, pig, chicken and duck cells infected with a range of influenza A virus subtypes. Results: The relative expression stability of commonly used housekeeping genes were determined in primary human bronchial epithelial cells (HBECs), pig tracheal epithelial cells (PTECs), and chicken and duck primary lung-derived cells infected with five influenza A virus subtypes. Analysis of qRT-PCR data from virus and mock infected cells using NormFinder and BestKeeper software programmes found that 18S rRNA was the most stable gene in HBECs, PTECs and avian lung cells. Conclusions: Based on the presented data from cell culture models (HBECs, PTECs, chicken and duck lung cells) infected with a range of influenza viruses, we found that 18S rRNA is the most stable reference gene for normalising qRT-PCR data. Expression levels of the other housekeeping genes evaluated in this study (including ACTB and GPADH) were highly affected by influenza virus infection and hence are not reliable as reference genes for RNA normalisation

Coronal X-Ray Emission from Nearby, Low-Mass, Exoplanet Host Stars Observed by the MUSCLES and Mega-MUSCLES HST Treasury Survey Projects

The high energy X-ray and ultraviolet (UV) radiation fields of exoplanet host stars play a crucial role in controlling the atmospheric conditions and the potential habitability of exoplanets. Major surveys of the X-ray/UV emissions from late-type (K and M spectral type) exoplanet hosts have been conducted by the MUSCLES and Mega-MUSCLES Hubble Space Telescope (HST) Treasury programs. These samples primarily consist of relatively old, ``inactive'', low mass stars. In this paper we present results from X-ray observations of the coronal emission from these stars obtained using the Chandra X-ray Observatory, the XMM-Newton Observatory, and the Neil Gehrels Swift Observatory. The stars effectively sample the coronal activity of low-mass stars at a wide range of masses and ages. The vast majority (21 of 23) of the stars are detected and their X-ray luminosities measured. Short-term flaring variability is detected for most of the fully-convective (M $\leq$ 0.35 M$_{\odot}$) stars but not for the more massive M dwarfs during these observations. Despite this difference, the mean X-ray luminosities for these two sets of M dwarfs are similar with more massive (0.35 M$_{\odot}$ $\leq$ M $\leq$ 0.6 M$_{\odot}$) M dwarfs at $\sim$5 $\times$ 10$^{26}$ erg s$^{-1}$ compared to $\sim$2 $\times$ 10$^{26}$ erg s$^{-1}$ for fully-convective stars older than 1 Gyr. Younger, fully-convective M dwarfs have X-ray luminosities between 3 and 6 $\times$ 10$^{27}$ erg s$^{-1}$.The coronal X-ray spectra have been characterized and provide important information that is vital for the modeling of the stellar EUV spectra.Comment: 39 pages, 15 figures. Accepted for publication in The Astronomical Journa

Evaluating annual severe coral bleaching risk for marine protected areas across Indonesia

Coral reefs face an uncertain future under global climate change, with thermal-induced bleaching increasing in frequency such that corals will soon experience annual severe bleaching (ASB). Marine Protected Areas (MPAs) are therefore becoming increasingly important as a conservation tool. Here we evaluate (i) Indonesia’s coral reefs’ spatial variation in ASB, (ii) whether reefs projected to have a later onset of ASB (i.e. possible climate refugia) are protected within MPAs, and (iii) the ASB risk profiles for reefs related to MPAs receiving priority investments. Our results highlight considerable variability across Indonesia’s reefs being at risk of ASB. The ASB risk before 2028 is greater for coral reefs protected by MPAs versus those outside MPA boundaries. The ASB risk before 2025 is greater for coral reefs protected by priority MPAs versus those protected by non-priority MPAs. Overall, our results show that only ∼45% of the coral reef areas that are currently located within MPAs will likely act as thermal refugia (ASB > 2044). This is unsurprising given that the MPA network in Indonesia has been established over many decades, with most MPAs designated before suitable bleaching risk projections were available to inform MPA placement. Our results highlight the scope to further incorporate potential climate refugia for reefs into new MPA designations. This study also provides strategic information, which can support the development of Indonesia’s long-term MPA and coral reef conservation strategy to effectively manage, mitigate, and adapt to the impacts of climate change on coral reefs