Parents' experiences of caring for their infant following surgery in the neonatal period: A literature review

Previous research with parents of preterm and low-birth weight infants admitted to the Neonatal Intensive Care Unit (NICU) has indicated the following: (i) parents are at risk of experiencing stress associated with the NICU environment; (ii) parents are at risk of short- and longer-term psychological distress; and (iii) the family is at risk of longer-term stress and strain. However, parents of infants admitted to the NICU for surgery are an under-researched population. This paper provides an overview of the current literature in relation to this issue. The results highlight the paucity of research conducted with parents of infants admitted to the NICU for surgery. A number of gaps and limitations were also identified in the current literature, including a lack of examination why some parents cope better than others, and a focus solely on parents of preterm and low birth weight infants. To conclude, further research with parents of infants who had surgery in the first few weeks of life is needed. Such information could help inform clinicians caring for these infants and their families, and would enable identification of those parents and families most at risk.

Human Parechovirus Infection in Neonatal Intensive Care

Background: Approximately 5-6% of all infective episodes in NICU are of viral origin. Previous studies suggest that human parechovirus (HPeV) infection presents most commonly in term infants, as a sepsis-like syndrome in which meningoencephalitis is prominent. Our aim was to study the infection rate and associated features of HPeV.

Methods: Blood samples were taken from NICU babies greater than 48 hours old, who were being investigated for late onset sepsis. Clinical and laboratory data were collected at the time of the suspected sepsis episode. Samples were tested using universal primers and probe directed at the 5'-untranslated region of the HPeV genome by reverse transcriptase PCR. Results were confirmed by electrophoresis and DNA sequencing.

Results: HPeV was detected in 11 of 84 samples (13%). These infants had a mean (interquartile range, IQR) gestational age of 28.9 (26.9 - 30.6) weeks and mean birth weight of 1.26 (SD = 0.72) kg. The median day of presentation was 16 (IQR: 11-27). These characteristics were similar to the infants without positive viral detection. Six infants presented with respiratory signs. One infant presented with signs of meningitis. Six of the 11 episodes of HPeV infection occurred during the winter months (December - February). No HPeV positive infants had abnormal findings on their 28-day cranial ultrasound examination.

Conclusions: We found a HPeV infection rate of 13% in infants being tested for late onset sepsis. HPeV should be considered as a possible cause of sepsis-like symptoms in preterm infants.

Later prehistoric vegetation dynamics and Bronze Age agriculture at Hobbister, Orkney, Scotland

The Bronze Age in Britain was a time of major social and cultural changes, reflected in the division of the landscape into field systems and the establishment of new belief systems and ritual practices. Several hypotheses have been advanced to explain these changes, and assessment of many of them is dependent on the availability of detailed palaeoenvironmental data from the sites concerned. This paper explores the development of a later prehistoric landscape in Orkney, where a Bronze Age field system and an apparently ritually-deposited late Bronze Age axe head are located in an area of deep blanket peat from which high-resolution palaeoenvironmental sequences have been recovered. There is no indication that the field system was constructed to facilitate agricultural intensification, and it more likely reflects a cultural response to social fragmentation associated with a more dispersed settlement pattern. There is evidence for wetter conditions during the later Bronze Age, and the apparent votive deposit may reflect the efforts of the local population to maintain community integrity during a time of perceptible environmental change leading to loss of farmland. The study emphasises the advantages of close integration of palaeoenvironmental and archaeological data for interpretation of prehistoric human activity. The palaeoenvironmental data also provide further evidence for the complexity of prehistoric woodland communities in Orkney, hinting at greater diversity than is often assumed. Additionally, differing dates for woodland decline in the two sequences highlight the dangers of over-extrapolation from trends observed in a single pollen profile, even at a very local scale.

Particle-in-cell simulation study of the interaction between a relativistically moving leptonic micro-cloud and ambient electrons

Context. The jets of compact accreting objects are composed of electrons and a mixture of positrons and ions. These outflows impinge on the interstellar or intergalactic medium and both plasmas interact via collisionless processes. Filamentation (beam-Weibel) instabilities give rise to the growth of strong electromagnetic fields. These fields thermalize the interpenetrating plasmas. 

Aims. Hitherto, the effects imposed by a spatial non-uniformity on filamentation instabilities have remained unexplored. We examine the interaction between spatially uniform background electrons and a minuscule cloud of electrons and positrons. The cloud size is comparable to that created in recent laboratory experiments and such clouds may exist close to internal and external shocks of leptonic jets. The purpose of our study is to determine the prevalent instabilities, their ability to generate electromagnetic fields and the mechanism, by which the lepton micro-cloud transfers energy to the background plasma. 

Methods. A square micro-cloud of equally dense electrons and positrons impinges in our particle-in-cell (PIC) simulation on a spatially uniform plasma at rest. The latter consists of electrons with a temperature of 1 keV and immobile ions. The initially charge- and current neutral micro-cloud has a temperature of 100 keV and a side length of 2.5 plasma skin depths of the micro-cloud. The side length is given in the reference frame of the background plasma. The mean speed of the micro-cloud corresponds to a relativistic factor of 15, which is relevant for laboratory experiments and for relativistic astrophysical outflows. The spatial distributions of the leptons and of the electromagnetic fields are examined at several times. 

Results. A filamentation instability develops between the magnetic field carried by the micro-cloud and the background electrons. The electromagnetic fields, which grow from noise levels, redistribute the electrons and positrons within the cloud, which boosts the peak magnetic field amplitude. The current density and the moduli of the electromagnetic fields grow aperiodically in time and steadily along the direction that is anti-parallel to the cloud's velocity vector. The micro-cloud remains conjoined during the simulation. The instability induces an electrostatic wakefield in the background plasma. 

Conclusions. Relativistic clouds of leptons can generate and amplify magnetic fields even if they have a microscopic size, which implies that the underlying processes can be studied in the laboratory. The interaction of the localized magnetic field and high-energy leptons will give rise to synchrotron jitter radiation. The wakefield in the background plasma dissipates the kinetic energy of the lepton cloud. Even the fastest lepton micro-clouds can be slowed down by this collisionless mechanism. Moderately fast charge- and current neutralized lepton micro-clouds will deposit their energy close to relativistic shocks and hence they do not constitute an energy loss mechanism for the shock.

Microneedles: an innovative platform for gene delivery

The advent of microneedle (MN) technology has provided a revolutionary platform for the delivery of therapeutic agents, particularly in the field of gene therapy. For over 20 years, the area of gene therapy has undergone intense innovation and progression which has seen advancement of the technology from an experimental concept to a widely acknowledged strategy for the treatment and prevention of numerous disease states. However, the true potential of gene therapy has yet to be achieved due to limitations in formulation and delivery technologies beyond parenteral injection of the DNA. Microneedle-mediated delivery provides a unique platform for the delivery of DNA therapeutics clinically. It provides a means to overcome the skin barriers to gene delivery and deposit the DNA directly into the dermal layers, a key site for delivery of therapeutics to treat a wide range of skin and cutaneous diseases. Additionally, the skin is a tissue rich in immune sentinels, an ideal target for the delivery of a DNA vaccine directly to the desired target cell populations. This review details the advancement of MN-mediated DNA delivery from proof-of-concept to the delivery of DNA encoding clinically relevant proteins and antigens and examines the key considerations for the improvement of the technology and progress into a clinically applicable delivery system.

The effect of heating temperature on the properties of vermiculites from Tanzania with respect to potential agronomic applications

This study was carried out to assess the properties of vermiculites from Tanzania with respect to the temperature used to expand them. Vermiculites from five locations in the Mozambique Belt of Tanzania were sampled and heated at 15, 200, 400, 600 and 800 °C in a muffle furnace. Palabora Europe Ltd provided one sample for comparison from their South Africa deposit which provides vermiculite used worldwide as a soil amendment. Water release characteristic, cation exchange capacity, pH, mass loss, and bulk density were among the properties assessed. All six vermiculites responded differently on heating, and had a significant variation in their agronomic properties. Water release characteristic varied with the degree of exfoliation and phase composition. Although vermiculites from Tanzania expanded on heating, their capacity to retain plant available water was relatively low as compared to vermiculite from Palabora. Disintegration on heating and the presence of a high amount of iron could be among the factors affecting their water release characteristic. Loss of hydroxyl water was higher in vermiculites than in hydrobiotites. Dehydroxylation enhanced the availability of exchangeable K⁺ and reduced significantly the cation exchange capacity of vermiculites. The optimum exchangeable K⁺ was obtained on heating at a temperature of 600 °C. The pH was unaffected by heating to a temperature of less than 600 °C. At higher temperature, the pH increased in some samples and was accompanied by substantial amounts of exchangeable Mg²⁺. Thus, it was concluded that initial characterization of vermiculites is essential prior to potential agricultural applications in order to optimize their agronomic potential. © 2008 Elsevier B.V. All rights reserved.

Bank Failures of the 1990s::An Exploratory Analysis

Past research has frequently attributed the incidence of bank failures to macroeconomic cycles and/or downturns in the regional economy. More recent analyses have suggested that the incidence and severity of bank failures can be linked to governance failures, which may be preventable through more stringent disclosure and auditing requirements. Using data on bank failures during the years 1991 to 1997, for the US, Canada, the UK and Germany, this study examines the relationship between institutional characteristics of national legal and auditing systems and the incidence of bank failures. In the second part of our analysis we then examined the relationship between the same institutional variables and the severity of bank failures.
The first part of our study notes a significant correlation between the law and order tradition (‘rule of law’) of a national legal system and the incidence of bank failures. Nations which were assigned high 'rule of law’ scores by country risk guides appear to have been less likely to experience bank failures. Another variable which appears to impact on bank failure rates is the ‘risk of contract repudiation’. Countries with a greater ‘risk of contract repudiation’ appear to be more likely to experience bank failures. We suggest that this may be due to a greater ex ante protection of stakeholders in countries where contract enforcement is more stringent.
The results of the second part of our study are less clear cut. However, there appears to be a significant correlation between the amount paid out by national deposit insurers (our proxy for the severity of bank failures) and the macroeconomic variable 'GDP change'. Here our findings follow the conventional wisdom; with greater amounts of deposit insurance funds being paid during economic downturns (i.e. low or negative GDP 'growth' correlates with high amounts of deposit insurance being paid out). A less pronounced relationship with the severity of bank failures can also be established for the institutional variables ' accounting standards' as well as 'risk of contract repudiation'. Countries with more stringent ‘accounting standards’ and a low ‘risk of contract repudiation’ appear to have been less prone to severe bank failures.

Protocolized versus non-protocolized weaning for reducing the duration of invasive mechanical ventilation in newborn infants: review

Background
Mechanical ventilation is a life-saving intervention for critically ill newborn infants with respiratory failure admitted to a neonatal intensive care unit (NICU). Ventilating newborn infants can be challenging due to small tidal volumes, high breathing frequencies, and the use of uncuffed endotracheal tubes. Mechanical ventilation has several short-term, as well as long-term complications. To prevent complications, weaning from the ventilator is started as soon as possible. Weaning aims to support the transfer from full mechanical ventilation support to spontaneous breathing activity.

Objectives
To assess the efficacy of protocolized versus non-protocolized ventilator weaning for newborn infants in reducing the duration of invasive mechanical ventilation, the duration of weaning, and shortening the NICU and hospital length of stay. To determine efficacy in predefined subgroups including: gestational age and birth weight; type of protocol; and type of protocol delivery. To establish whether protocolized weaning is safe and clinically effective in reducing the duration of mechanical ventilation without increasing the risk of adverse events.

Search methods
We searched the Cochrane Central Register of Controlled trials (CENTRAL; the Cochrane Library; 2015, Issue 7); MEDLINE In-Process and other Non-Indexed Citations and OVID MEDLINE (1950 to 31 July 2015); CINAHL (1982 to 31 July 2015); EMBASE (1988 to 31 July 2015); and Web of Science (1990 to 15 July 2015). We did not restrict language of publication. We contacted authors of studies with a subgroup of newborn infants in their study, and experts in the field regarding this subject. In addition, we searched abstracts from conference proceedings, theses, dissertations, and reference lists of all identified studies for further relevant studies.

Selection criteria
Randomized, quasi-randomized or cluster-randomized controlled trials that compared protocolized with non-protocolized ventilator weaning practices in newborn infants with a gestational age of 24 weeks or more, who were enrolled in the study before the postnatal age of 28 completed days after the expected date of birth.

Data collection and analysis
Four authors, in pairs, independently reviewed titles and abstracts identified by electronic searches. We retrieved full-text versions of potentially relevant studies.

Main results
Our search yielded 1752 records. We removed duplicates (1062) and irrelevant studies (843). We did not find any randomized, quasi-randomized or cluster-randomized controlled trials conducted on weaning from mechanical ventilation in newborn infants. Two randomized controlled trials met the inclusion criteria on type of study and type of intervention, but only included a proportion of newborns. The study authors could not provide data needed for subgroup analysis; we excluded both studies.

Authors' conclusions
Based on the results of this review, there is no evidence to support or refute the superiority or inferiority of weaning by protocol over non-protocol weaning on duration of invasive mechanical ventilation in newborn infants.

Spatial and temporal influences of in-stream factors on the chemistry and epilithic biomasses of upland stream metal deposits

The density and composition of stream bed metal deposits are affected by physical, chemical and biological processes. In this paper we investigate the importance of these processes and their relation to algal and non-photosynthetic detrital (NPD) biomass in a set of upland streams in Northern Ireland. Deposit density and Fe, Mn, Al and P concentrations varied with stream pH across sites but not seasonally. No effects of stream bed erosion or photoreduction were detected on deposit densities. Seasonal variation in stream water metal concentrations was correlated with rainfall. NPD biomass was a significant predictor of both spatial and seasonal variation in deposit concentrations. There were strong, non-linear, relations between NPD biomass and deposit metal concentrations, with Fe and Mn becoming relatively more important and algal biomass declining above threshold deposit/NPD densities. The results suggest that NPD biomass influences deposit density and reduces the biomass of photosynthetic autotrophs above a threshold deposit density.

International Coordination in Cross-Border Bank Bail-ins: Problems and Prospects

Bail-in is quickly becoming a predominant approach to banking resolution. The EU Bank Recovery Resolution Directive and the US Federal Deposit Insurance Corporation’s single point of entry strategy envisage creditors’ recapitalisations
to resolve a failing financial institution. However, this legislation focuses on the domestic aspects of bail-in, leaving the question of how it is applied
to a cross-border banking group open. Cross-border banking resolution has been historically subject to coordination failures, which have resulted in disorderly resolutions with dangerous systemic effects. The goal of this article is to assess whether bail-in is subject to the same coordination problems that affect other resolution tools, and to discuss the logic of international legal cooperation in bail-in policies. We demonstrate that, in spite of the evident benefit in terms of fiscal sustainability, bail-in suffers from complex coordination problems which, if not addressed, might lead to regulatory arbitrage and lengthy court battles, and, ultimately, may disrupt resolutions. We argue that only a binding legal regime can address those problems. In doing so, we discuss the recent Financial Stability
Board’s proposal on cross-border recognition of resolution action, and the role of international law in promoting cooperation in banking resolution.

Polybius’ ‘previous landslide’: Proof that Hannibal’s invasion route crossed the col de la traversette

Both Polybius and Livy described a landslide/landslip that blocked the Punic Army’s exfiltration from a high col on the water divide in the Western Alps. The landslide, more aptly termed rockfall, has been a source of contention amongst classicists for centuries despite the fact that only two cols—Clapier and Traversette—exhibit rockfall debris on the lee side of the Alps. While the Clapier rockfall is too small and too young to have provided blockage, the Traversette debris is nearly as Polybius described it when he retraced the invasion route some 60 years after the event. His ‘two-tier’ description of the deposit, a doublet of younger and older rock rubble, including measurements of width and volume are close to modern measurements and prove that he knew, in advance, the route Hannibal had followed. It would take a practiced eye to correctly identify the stratigraphic complexity inherent in the Traversette Rockfall. Here we present weathering ratios, soil stratigraphic, mineral, chemical and microbiological evidence in support of Polybius’ observations as a considerable background database for future geoarchaeological exploration.

Effect of reinforcement and heat treatment on elevated temperature sliding of electroless Ni–P/SiC composite coatings

The investigation is focused on the wear behaviour at elevated test temperature of composite Ni–P/SiC deposit, with varying concentration of the reinforcing SiC particles. The phase evolution measured by X-ray diffraction suggests slight crystallisation during wear testing at 200 °C. In coating without reinforcing particles, adhesive wear is accompanied by microcracks. The thermal heat generated and the cyclic loading could have induced sub-surface microcracks. Owing to the effective matrix-ceramics system in composite coatings, fine grooves, abrasive polishing and uniform wearing are observed. Reinforcing particles in the matrix hinder microcrack formation and significantly reduce the wear rate. Triboxidation is confirmed from energy dispersive X-ray spectrometry.