Modification and Assessment of the Bedside Pediatric Early Warning Score in the Pediatric Allogeneic Hematopoietic Cell Transplant Population

OBJECTIVES: To determine the validity of the Bedside Pediatric Early Warning Score system in the hematopoietic cell transplant population, and to determine if the addition of weight gain further strengthens the association with need for PICU admission. DESIGN: Retrospective cohort study of pediatric allogeneic hematopoietic cell transplant patients from 2009 to 2016. Daily Pediatric Early Warning Score and weights were collected during hospitalization. Logistic regression was used to identify associations between maximum Pediatric Early Warning Score or Pediatric Early Warning Score plus weight gain and the need for PICU intervention. The primary outcome was need for PICU intervention; secondary outcomes included mortality and intubation. SETTING: A large quaternary free-standing children's hospital. PATIENTS: One-hundred two pediatric allogeneic hematopoietic cell transplant recipients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 102 hematopoietic cell transplant patients included in the study, 29 were admitted to the PICU. The median peak Pediatric Early Warning Score was 11 (interquartile range, 8-13) in the PICU admission cohort, compared with 4 (interquartile range, 3-5) in the cohort without a PICU admission (p < 0.0001). Pediatric Early Warning Score greater than or equal to 8 had a sensitivity of 76% and a specificity of 90%. The area under the receiver operating characteristics curve was 0.83. There was a high negative predictive value at this Pediatric Early Warning Score of 90%. When Pediatric Early Warning Score greater than or equal to 8 and weight gain greater than or equal to 7% were compared together, the area under the receiver operating characteristic curve increased to 0.88. CONCLUSIONS: In this study, a Pediatric Early Warning Score greater than or equal to 8 was associated with PICU admission, having a moderately high sensitivity and high specificity. This study adds to literature supporting Pediatric Early Warning Score monitoring for hematopoietic cell transplant patients. Combining weight gain with Pediatric Early Warning Score improved the discriminative ability of the model to predict the need for critical care, suggesting that incorporation of weight gain into Pediatric Early Warning Score may be beneficial for monitoring of hematopoietic cell transplant patients

A Holder Continuous Nowhere Improvable Function with Derivative Singular Distribution

We present a class of functions $\mathcal{K}$ in $C^0(\R)$ which is variant of the Knopp class of nowhere differentiable functions. We derive estimates which establish \mathcal{K} \sub C^{0,\al}(\R) for 0<\al<1 but no $K \in \mathcal{K}$ is pointwise anywhere improvable to C^{0,\be} for any \be>\al. In particular, all $K$'s are nowhere differentiable with derivatives singular distributions. $\mathcal{K}$ furnishes explicit realizations of the functional analytic result of Berezhnoi. Recently, the author and simulteously others laid the foundations of Vector-Valued Calculus of Variations in $L^\infty$ (Katzourakis), of $L^\infty$-Extremal Quasiconformal maps (Capogna and Raich, Katzourakis) and of Optimal Lipschitz Extensions of maps (Sheffield and Smart). The "Euler-Lagrange PDE" of Calculus of Variations in $L^\infty$ is the nonlinear nondivergence form Aronsson PDE with as special case the $\infty$-Laplacian. Using $\mathcal{K}$, we construct singular solutions for these PDEs. In the scalar case, we partially answered the open $C^1$ regularity problem of Viscosity Solutions to Aronsson's PDE (Katzourakis). In the vector case, the solutions can not be rigorously interpreted by existing PDE theories and justify our new theory of Contact solutions for fully nonlinear systems (Katzourakis). Validity of arguments of our new theory and failure of classical approaches both rely on the properties of $\mathcal{K}$.Comment: 5 figures, accepted to SeMA Journal (2012), to appea

Detection of Gamma Rays of Up to 50 TeV From the Crab Nebula

Gamma rays with energies greater than 7 TeV from the Crab pulsar/nebula have been observed at large zenith angles, using the Imaging Atmospheric Technique from Woomera, South Australia. CANGAROO data taken in 1992, 1993 and 1995 indicate that the energy spectrum extends up to at least 50 TeV, without a change of the index of the power law spectrum. The observed differential spectrum is \noindent $(2.01\pm 0.36)\times 10^{-13}(E/{7 TeV})^{-2.53 \pm 0.18} TeV^{-1}cm^{-2}s^{-1}$ between 7 TeV and 50 TeV. There is no apparent cut-off. The spectrum for photon energies above $\sim$10 TeV allows the maximum particle acceleration energy to be inferred, and implies that this unpulsed emission does not originate near the light cylinder of the pulsar, but in the nebula where the magnetic field is not strong enough to allow pair creation from the TeV photons. The hard gamma-ray energy spectrum above 10 TeV also provides information about the varying role of seed photons for the inverse Compton process at these high energies, as well as a possible contribution of $\pi ^{\circ}$-gamma rays from proton collisions.Comment: 19 pages, 4 figures, LaTeX2.09 with AASTeX 4.0 maros, to appear in Astrophys. J. Let

Mulsemedia: State of the art, perspectives, and challenges

Mulsemedia-multiple sensorial media-captures a wide variety of research efforts and applications. This article presents a historic perspective on mulsemedia work and reviews current developments in the area. These take place across the traditional multimedia spectrum-from virtual reality applications to computer games-as well as efforts in the arts, gastronomy, and therapy, to mention a few. We also describe standardization efforts, via the MPEG-V standard, and identify future developments and exciting challenges the community needs to overcome

Heritability and impact of environmental effects during pregnancy on antral follicle count in cattle

peer-reviewedPrevious studies have documented that ovarian antral follicle count (AFC) is positively correlated with number of healthy follicles and oocytes in ovaries (ovarian reserve), as well as ovarian function and fertility in cattle. However, environmental factors (e.g., nutrition, steroids) during pregnancy in cattle and sheep can reduce AFC in offspring. The role that genetic and environmental factors play in influencing the variability in AFC and, correspondingly, the size of the ovarian reserve, ovarian function, and fertility, are, however, poorly understood. The present study tests the hypothesis that variability in AFC in offspring is influenced not only by genetic merit but also by the dam age and lactation status (lactating cows vs. nonlactating heifers) and milk production during pregnancy. Antral follicle count was assessed by ultrasonography in 445 Irish Holstein-Friesian dairy cows and 522 US Holstein-Friesian dairy heifers. Heritability estimates for AFC (± standard error) were 0.31 ± 0.14 and 0.25 ± 0.13 in dairy cows and heifers, respectively. Association analysis between both genotypic sire data and phenotypic dam data with AFC in their daughters was performed using regression and generalized linear models. Antral follicle count was negatively associated with genetic merit for milk fat concentration. Also, AFC was greater in offspring of dams that were lactating (n = 255) compared with nonlactating dams (n = 89) during pregnancy and was positively associated with dam milk fat concentration and milk fat-to-protein ratio. In conclusion, AFC in dairy cattle is a moderately heritable genetic trait affected by age or lactation status and milk quality but not by level of dam’s milk production during pregnancy

The Use of a Kinetic Therapy Rotational Bed in Pediatric Acute Respiratory Distress Syndrome: A Case Series

Patients with acute respiratory distress syndrome (ARDS) commonly have dependent atelectasis and heterogeneous lung disease. Due to the heterogenous lung volumes seen, the application of positive end expiratory pressure (PEEP) can have both beneficial and deleterious effects. Alternating supine and prone positioning may be beneficial in ARDS by providing more homogenous distribution of PEEP and decreasing intrapulmonary shunt. In pediatrics, the pediatric acute lung injury and consensus conference (PALICC) recommended to consider it in severe pediatric ARDS (PARDS). Manually prone positioning patients can be burdensome in larger patients. In adults, the use of rotational beds has eased care of these patients. There is little published data about rotational bed therapy in children. Therefore, we sought to describe the use of a rotational bed in children with PARDS. We performed a retrospective case series of children who utilized a rotational bed as an adjunctive therapy for their PARDS. Patient data were collected and analyzed. Descriptive statistical analyses were performed and reported. Oxygenation indices (OI) pre- and post-prone positioning were analyzed. Twelve patients with PARDS were treated with a rotational bed with minimal adverse events. There were no complications noted. Three patients had malfunctioning of their arterial line while on the rotational bed. Oxygenation indices improved over time in 11 of the 12 patients included in the study while on the rotational bed. Rotational beds can be safely utilized in pediatric patients. In larger children with PARDS, where it may be more difficult to perform a manual prone position, use of a rotational bed can be considered a safe alternative

Charged Vortices in High Temperature Superconductors Probed by NMR

We report a first experimental evidence that a vortex in the high temperature superconductors (HTSC) traps a finite electric charge from the high resolution measurements of the nuclear quadrupole frequencies. In slightly overdoped YBa_2Cu_3O_7 the vortex is negatively charged by trapping electrons, while in underdoped YBa_2Cu_4O_8 it is positively charged by expelling electrons. The sign of the trapped charge is opposite to the sign predicted by the conventional BCS theory. Moreover, in both materials, the deviation of the magnitude of the charge from the theory is also significant. These unexpected features can be attributed to the novel electronic structure of the vortex in HTSC.Comment: 6 pages, 7 figures, to be published in Phys Rev.

Hairs on the cosmological horizon

We investigate the possibility of having hairs on the cosmological horizon. The cosmological horizon shares similar properties of black hole horizons in the aspect of having hairs on the horizons. For those theories admitting haired black hole solutions, the nontrivial matter fields may reach and extend beyond the cosmological horizon. For Q-stars and boson stars, the matter fields cannot reach the cosmological horizon. The no short hair conjecture keeps valid, despite the asymptotic behavior (de Sitter or anti-de Sitter) of black hole solutions. We prove the no scalar hair theorem for anti-de Sitter black holes. Using the Bekenstein's identity method, we also prove the no scalar hair theorem for the de Sitter space and de Sitter black holes if the scalar potential is convex.Comment: Revtex, no figures, 16 page

Comprehensive phenotypic analysis of the Dp1Tyb mouse strain reveals a broad range of down syndrome-related phenotypes

Down syndrome (DS), trisomy 21, results in many complex phenotypes including cognitive deficits, heart defects and craniofacial alterations. Phenotypes arise from an extra copy of human chromosome 21 (Hsa21) genes. However, these dosage-sensitive causative genes remain unknown. Animal models enable identification of genes and pathological mechanisms. The Dp1Tyb mouse model of DS has an extra copy of 63% of Hsa21-orthologous mouse genes. In order to establish if this model recapitulates DS phenotypes, we comprehensively phenotyped Dp1Tyb mice using 28 tests of different physiological systems and found that 468 out of 1800 parameters were significantly altered. We show that Dp1Tyb mice have wide-ranging DS-like phenotypes including aberrant erythropoiesis and megakaryopoiesis, reduced bone density, craniofacial changes, altered cardiac function, a pre-diabetic state and deficits in memory, locomotion, hearing and sleep. Thus, Dp1Tyb mice are an excellent model for investigating complex DS phenotype-genotype relationships for this common disorder