Preterm cranial ultrasound scanning is both feasible and effective in a middle-income country

© 2016 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.Aim Cranial ultrasound is seldom used in middle-income countries, and the burden of preterm brain injury and its relationship to perinatal data is unknown. We assessed cranial ultrasound abnormalities in very low-birthweight (VLBW) infants and correlated the findings with perinatal data. Methods VLBW Armenian infants receiving neonatal intensive care in 2012 were scanned from birth to term-equivalent age (TEA). Clinical data were collected prospectively. Results We studied 100 VLBW infants with a median gestation of 30 weeks. Periventricular white matter echogenicity (PVE) lasting more than two weeks was seen in 34 infants, grade III intraventricular haemorrhage (IVH) in 10, haemorrhagic parenchymal infarction (HPI) in seven and cystic periventricular leukomalacia in two. Caudothalamic notch echogenicity appeared in 36 infants after two to three weeks, with cystic transformation in 22. At TEA, 17 infants had persisting PVEs and 55 had increased basal ganglia/thalamic (BGT) echogenicity. Lack of antenatal steroids was significantly associated with IVH and HPI and intubation at birth with IVH. Late BGT echogenicity was generally seen in infants without perinatal problems. Conclusion Our study demonstrated that cranial ultrasound can be used effectively in a middle-income country to identify high-risk infants and monitor quality of care

Hybridising heuristics within an estimation distribution algorithm for examination timetabling

This paper presents a hybrid hyper-heuristic approach based on estimation distribution algorithms. The main motivation is to raise the level of generality for search methodologies. The objective of the hyper-heuristic is to produce solutions of acceptable quality for a number of optimisation problems. In this work, we demonstrate the generality through experimental results for different variants of exam timetabling problems. The hyper-heuristic represents an automated constructive method that searches for heuristic choices from a given set of low-level heuristics based only on non-domain-specific knowledge. The high-level search methodology is based on a simple estimation distribution algorithm. It is capable of guiding the search to select appropriate heuristics in different problem solving situations. The probability distribution of low-level heuristics at different stages of solution construction can be used to measure their effectiveness and possibly help to facilitate more intelligent hyper-heuristic search methods

Use of fractional exhaled nitric oxide to guide the treatment of asthma an official american thoracic society clinical practice guideline

Background: The fractional exhaled nitric oxide (FENO) test is a point-of-care test that is used in the assessment of asthma.Objective: To provide evidence-based clinical guidance on whether FENO testing is indicated to optimize asthma treatment in patients with asthma in whom treatment is being considered.Methods: An international, multidisciplinary panel of experts was convened to form a consensus document regarding a single question relevant to the use of FENO. The question was selected from three potential questions based on the greatest perceived impact on clinical practice and the unmet need for evidencebased answers related to this question. The panel performed systematic reviews of published randomized controlled trials between 2004 and 2019 and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework to develop recommendations. All panel members evaluated and approved the recommendations.Main Results: After considering the overall low quality of the evidence, the panel made a conditional recommendation for FENO-based care. In patients with asthma in whom treatment is being considered, we suggest that FENO is beneficial and should be used in addition to usual care. This judgment is based on a balance of effects that probably favors the intervention; the moderate costs and availability of resources, which probably favors the intervention; and the perceived acceptability and feasibility of the intervention in daily practice.Conclusions: Clinicians should consider this recommendation to measure FENO in patients with asthma in whom treatment is being considered based on current best available evidence. </p

Fairness in examination timetabling: student preferences and extended formulations

Variations of the examination timetabling problem have been investigated by the research community for more than two decades. The common characteristic between all problems is the fact that the definitions and data sets used all originate from actual educational institutions, particularly universities, including specific examination criteria and the students involved. Although much has been achieved and published on the state-of-the-art problem modelling and optimisation, a lack of attention has been focussed on the students involved in the process. This work presents and utilises the results of an extensive survey seeking student preferences with regard to their individual examination timetables, with the aim of producing solutions which satisfy these preferences while still also satisfying all existing benchmark considerations. The study reveals one of the main concerns relates to fairness within the students cohort; i.e. a student considers fairness with respect to the examination timetables of their immediate peers, as highly important. Considerations such as providing an equitable distribution of preparation time between all student cohort examinations, not just a majority, are used to form a measure of fairness. In order to satisfy this requirement, we propose an extension to the state-of-the-art examination timetabling problem models widely used in the scientific literature. Fairness is introduced as a new objective in addition to the standard objectives, creating a multi-objective problem. Several real-world examination data models are extended and the benchmarks for each are used in experimentation to determine the effectiveness of a multi-stage multi-objective approach based on weighted Tchebyceff scalarisation in improving fairness along with the other objectives. The results show that the proposed model and methods allow for the production of high quality timetable solutions while also providing a trade-off between the standard soft constraints and a desired fairness for each student

Neonatal airway management training using simulation-based educational methods and technology

Airway management is a fundamental component of neonatal critical care and requires a high level of skill. Neonatal endotracheal intubation (ETI), bag-mask ventilation, and supraglottic airway management are complex technical skills to acquire and continually maintain. Simulation training has emerged as a leading educational modality to accelerate the acquisition of airway management skills and train interprofessional teams. However, current simulation-based training does not always replicate neonatal airway management needed for patient care with a high level of fidelity. Educators still rely on clinical training on live patients. In this article, we will a) review the importance of simulation-based neonatal airway training for learners and clinicians, b) evaluate the available training modalities, instructional design, and challenges for airway procedural skill acquisition, especially neonatal ETI, and c) describe the human factors affecting the transfer of airway training skills into the clinical environment