Direct bilirubin levels observed in prolonged neonatal jaundice: a retrospective cohort study

OBJECTIVE: Prolonged neonatal jaundice is common and usually benign; however, assessment of bilirubin fractions is recommended to determine the need for further assessment for congenital liver disease, particularly biliary atresia. The direct (conjugated) bilirubin thresholds currently used are variable and poorly evidenced. Hence, we aimed to delineate direct bilirubin levels in disease-free neonates with prolonged jaundice. METHODS: We performed a retrospective cohort analysis of split bilirubin levels, and subsequent follow-up, for all neonates initially assessed in our prolonged neonatal jaundice clinic over 2 years. We plotted centile charts for total, direct and direct-total bilirubin ratio levels against age at sampling. The association was assessed using linear regression analysis. RESULTS: Data were collected for 420 neonates (501 blood samples) across an age range of 10-70 days. No significant liver disease was found. For each day of older age, total bilirubin fell by 3.72 µmol/L (95% CI 2.46 to 5.00) and direct bilirubin fell by 0.39 µmol/L (0.18 to 0.59). The ratio between the two did not change significantly (-0.0006 to +0.0034). The 95th centile for direct bilirubin was stable at ~25 µmol/L. Direct-total bilirubin ratio was very variable with some 95th centiles >30%. CONCLUSIONS: In a clinically relevant population of disease-free neonates with prolonged jaundice both the total and the direct bilirubin decreased with age. The absolute direct bilirubin is more useful clinically than the direct-total bilirubin ratio. Our results support National Institute for Health and Care Excellence guidance that conjugated bilirubin >25 µmol/L, or even more stringent criteria, constitutes an appropriate threshold for further investigation for neonatal liver disease

Learning from the past with experiment databases

Thousands of Machine Learning research papers contain experimental comparisons that usually have been conducted with a single focus of interest, and detailed results are usually lost after publication. Once past experiments are collected in experiment databases they allow for additional and possibly much broader investigation. In this paper, we show how to use such a repository to answer various interesting research questions about learning algorithms and to verify a number of recent studies. Alongside performing elaborate comparisons and rankings of algorithms, we also investigate the effects of algorithm parameters and data properties, and study the learning curves and bias-variance profiles of algorithms to gain deeper insights into their behavior

Helping Made Easy: Ease of Argument Generation Enhances Intentions to Help

Previous work has shown that self-generating arguments is more persuasive than reading arguments provided by others, particularly if self-generation feels easy. The present study replicates and extends these findings by providing evidence for fluency effects on behavioral intention in the realm of helping. In two studies, participants were instructed to either self-generate or read two versus ten arguments about why it is good to help. Subsequently, a confederate asked them for help. Results show that self-generating few arguments is more effective than generating many arguments. While this pattern reverses for reading arguments, easy self-generation is the most effective strategy compared to all other conditions. These results have important implications for fostering behavioral change in all areas of life

An Experimental Microarchitecture for a Superconducting Quantum Processor

Quantum computers promise to solve certain problems that are intractable for classical computers, such as factoring large numbers and simulating quantum systems. To date, research in quantum computer engineering has focused primarily at opposite ends of the required system stack: devising high-level programming languages and compilers to describe and optimize quantum algorithms, and building reliable low-level quantum hardware. Relatively little attention has been given to using the compiler output to fully control the operations on experimental quantum processors. Bridging this gap, we propose and build a prototype of a flexible control microarchitecture supporting quantum-classical mixed code for a superconducting quantum processor. The microarchitecture is based on three core elements: (i) a codeword-based event control scheme, (ii) queue-based precise event timing control, and (iii) a flexible multilevel instruction decoding mechanism for control. We design a set of quantum microinstructions that allows flexible control of quantum operations with precise timing. We demonstrate the microarchitecture and microinstruction set by performing a standard gate-characterization experiment on a transmon qubit.Comment: 13 pages including reference. 9 figure

Local balancing of the electricity grid in a renewable municipality; analyzing the effectiveness and cost of decentralized load balancing looking at multiple combinations of technologies

With the integration of Intermitted Renewables Energy (I-RE) electricity production, capacity is shifting from central to decentral. So, the question is if it is also necessary to adjust the current load balancing system from a central to more decentral system. Therefore, an assessment is made on the overall effectiveness and costs of decentralized load balancing, using Flexible Renewable Energy (F-RE) in the shape of biogas, Demand Side Management (DSM), Power Curtailment (PC), and electricity Storage (ST) compared to increased grid capacity (GC). As a case, an average municipality in The Netherlands is supplied by 100% I-RE (wind and solar energy), which is dynamically modeled in the PowerPlan model using multiple scenarios including several combinations of balancing technologies. Results are expressed in yearly production mix, self-consumption, grid strain, Net Load Demand Signal, and added cost. Results indicate that in an optimized scenario, self-consumption of the municipality reaches a level of around 95%, the total hours per year production matches demand to over 90%, and overproduction can be curtailed without substantial losses lowering grid strain. In addition, the combination of balancing technologies also lowers the peak load to 60% of the current peak load in the municipality, thereby freeing up capacity for increased demand (e.g., electric heat pumps, electric cars) or additional I-RE production. The correct combination of F-RE and lowering I-RE production to 60%, ST, and PC are shown to be crucial. However, the direct use of DSM has proven ineffective without a larger flexible demand present in the municipality. In addition, the optimized scenario will require a substantial investment in installations and will increase the energy cost with 75% in the municipality (e.g., from 0.20€ to 0.35€ per kWh) compared to 50% (0.30€ per kWh) for GC. Within this context, solutions are also required on other levels of scale (e.g., on middle or high voltage side or meso and macro level) to ensure security of supply and/or to reduce overall costs

Licenciamento ambiental : herói, vilão ou vítima?

- Divulgação dos SUMÁRIOS das obras recentemente incorporadas ao acervo da Biblioteca Ministro Oscar Saraiva do STJ. Em respeito à lei de Direitos Autorais, não disponibilizamos a obra na íntegra.- Localização na estante: 34:504(81) L698

Sleep, vigilance, and thermosensitivity

The regulation of sleep and wakefulness is well modeled with two underlying processes: a circadian and a homeostatic one. So far, the parameters and mechanisms of additional sleep-permissive and wake-promoting conditions have been largely overlooked. The present overview focuses on one of these conditions: the effect of skin temperature on the onset and maintenance of sleep, and alertness. Skin temperature is quite well suited to provide the brain with information on sleep-permissive and wake-promoting conditions because it changes with most if not all of them. Skin temperature changes with environmental heat and cold, but also with posture, environmental light, danger, nutritional status, pain, and stress. Its effect on the brain may thus moderate the efficacy by which the clock and homeostat manage to initiate or maintain sleep or wakefulness. The review provides a brief overview of the neuroanatomical pathways and physiological mechanisms by which skin temperature can affect the regulation of sleep and vigilance. In addition, current pitfalls and possibilities of practical applications for sleep enhancement are discussed, including the recent finding of impaired thermal comfort perception in insomniacs