Care When It Counts: Establishing Trauma-Sensitive Care as a Preventative Approach for 0–3-Year-Old Children Suffering from Trauma and Chronic Stress

Adverse childhood experiences are an important societal concern. Children aged 0-3 are particularly vulnerable to unpredictable chronic stress due to the critical period for brain development and attachment. Trauma-sensitive care is a preventative approach to reduce the burden of stressful experiences by committing to positive relationships. Professional caregivers are ideally placed to offer trauma-sensitive care; however, earlier research reveals that the tools they need to consciously apply trauma-sensitive care principles are missing. The current study organized living labs (co-creative research method) to present trauma-sensitive care as a preventative approach aimed at children aged 0-3. Two living labs were organized in Belgium and Hungary, where professional caregivers collaborated to create a protocol that offers guidelines on how to implement trauma-sensitive care. The resulting protocol included a theoretical foundation on trauma as well as a translation of these guidelines into practical recommendations. The protocol was evaluated by incorporating it into a training intervention delivered to 100 professional caregivers from childcare organizations across four European countries. The protocol received positive feedback from participants, with results indicating a self-reported increase in knowledge, attitude and practice of trauma-sensitive care principles. We conclude that this trauma-sensitive care protocol is a promising answer to the needs of professional caregivers working with children aged 0-3

Fuzzy Modeling for Uncertain Nonlinear Systems Using Fuzzy Equations and Z-Numbers

In this paper, the uncertainty property is represented by Z-number as the coefficients and variables of the fuzzy equation. This modification for the fuzzy equation is suitable for nonlinear system modeling with uncertain parameters. Here, we use fuzzy equations as the models for the uncertain nonlinear systems. The modeling of the uncertain nonlinear systems is to find the coefficients of the fuzzy equation. However, it is very difficult to obtain Z-number coefficients of the fuzzy equations. Taking into consideration the modeling case at par with uncertain nonlinear systems, the implementation of neural network technique is contributed in the complex way of dealing the appropriate coefficients of the fuzzy equations. We use the neural network method to approximate Z-number coefficients of the fuzzy equations

Niemann-Pick disease type C

Niemann-Pick C disease (NP-C) is a neurovisceral atypical lysosomal lipid storage disorder with an estimated minimal incidence of 1/120 000 live births. The broad clinical spectrum ranges from a neonatal rapidly fatal disorder to an adult-onset chronic neurodegenerative disease. The neurological involvement defines the disease severity in most patients but is typically preceded by systemic signs (cholestatic jaundice in the neonatal period or isolated spleno- or hepatosplenomegaly in infancy or childhood). The first neurological symptoms vary with age of onset: delay in developmental motor milestones (early infantile period), gait problems, falls, clumsiness, cataplexy, school problems (late infantile and juvenile period), and ataxia not unfrequently following initial psychiatric disturbances (adult form). The most characteristic sign is vertical supranuclear gaze palsy. The neurological disorder consists mainly of cerebellar ataxia, dysarthria, dysphagia, and progressive dementia. Cataplexy, seizures and dystonia are other common features. NP-C is transmitted in an autosomal recessive manner and is caused by mutations of either the NPC1 (95% of families) or the NPC2 genes. The exact functions of the NPC1 and NPC2 proteins are still unclear. NP-C is currently described as a cellular cholesterol trafficking defect but in the brain, the prominently stored lipids are gangliosides. Clinical examination should include comprehensive neurological and ophthalmological evaluations. The primary laboratory diagnosis requires living skin fibroblasts to demonstrate accumulation of unesterified cholesterol in perinuclear vesicles (lysosomes) after staining with filipin. Pronounced abnormalities are observed in about 80% of the cases, mild to moderate alterations in the remainder ("variant" biochemical phenotype). Genotyping of patients is useful to confirm the diagnosis in the latter patients and essential for future prenatal diagnosis. The differential diagnosis may include other lipidoses; idiopathic neonatal hepatitis and other causes of cholestatic icterus should be considered in neonates, and conditions with cerebellar ataxia, dystonia, cataplexy and supranuclear gaze palsy in older children and adults. Symptomatic management of patients is crucial. A first product, miglustat, has been granted marketing authorization in Europe and several other countries for specific treatment of the neurological manifestations. The prognosis largely correlates with the age at onset of the neurological manifestations

The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

On the Evolution of the Central Density of Quiescent Galaxies

We investigate the origin of the evolution of the population-averaged central stellar mass density (Sigma(1)) of quiescent galaxies (QGs) by probing the relation between stellar age and Sigma(1) at z similar to 0. We use the Zurich ENvironmental Study (ZENS), which is a survey of galaxy groups with a large fraction of satellite galaxies. QGs shape a narrow locus in the Sigma(1)-M-star plane, which we refer to as S1 ridgeline. Colors of (B - I) and (I - J) are used to divide QGs into three age categories: young (<2 Gyr), intermediate (2-4 Gyr), and old (>4 Gyr). At fixed stellar mass, old QGs on the Sigma(1) ridgeline have higher Sigma(1) than young QGs. This shows that galaxies landing on the Sigma(1) ridgeline at later epochs arrive with lower Sigma(1), which drives the zeropoint of the ridgeline down with time. We compare the present-day zeropoint of the oldest population at z = 0 with the zeropoint of the quiescent population 4 Gyr back in time, at z = 0.37. These zeropoints are identical, showing that the intrinsic evolution of individual galaxies after they arrive on the Sigma(1) ridgeline must be negligible, or must evolve parallel to the ridgeline during this interval. The observed evolution of the global zeropoint of 0.07 dex over the last 4 Gyr is thus largely due to the continuous addition of newly quenched galaxies with lower Sigma(1) at later times ("progenitor bias"). While these results refer to the satellite-rich ZENS sample as a whole, our work suggests a similar age-Sigma(1) trend for central galaxies

Clumpy galaxies in CANDELS. II. Physical properties of UV-bright clumps at 0.5 ≤ z < 3

Studying giant star-forming clumps in distant galaxies is important to understand galaxy formation and evolution. At present, however, observers and theorists have not reached a consensus on whether the observed "clumps" in distant galaxies are the same phenomenon that is seen in simulations. In this paper, as a step to establish a benchmark of direct comparisons between observations and theories, we publish a sample of clumps constructed to represent the commonly observed "clumps" in the literature. This sample contains 3193 clumps detected from 1270 galaxies at $0.5\leqslant z\lt 3.0$. The clumps are detected from rest-frame UV images, as described in our previous paper. Their physical properties (e.g., rest-frame color, stellar mass (M*), star formation rate (SFR), age, and dust extinction) are measured by fitting the spectral energy distribution (SED) to synthetic stellar population models. We carefully test the procedures of measuring clump properties, especially the method of subtracting background fluxes from the diffuse component of galaxies. With our fiducial background subtraction, we find a radial clump U − V color variation, where clumps close to galactic centers are redder than those in outskirts. The slope of the color gradient (clump color as a function of their galactocentric distance scaled by the semimajor axis of galaxies) changes with redshift and M* of the host galaxies: at a fixed M*, the slope becomes steeper toward low redshift, and at a fixed redshift, it becomes slightly steeper with M*. Based on our SED fitting, this observed color gradient can be explained by a combination of a negative age gradient, a negative E(B − V) gradient, and a positive specific SFR gradient of the clumps. We also find that the color gradients of clumps are steeper than those of intra-clump regions. Correspondingly, the radial gradients of the derived physical properties of clumps are different from those of the diffuse component or intra-clump regions