Congenital anomalies and predisposition to severe COVID-19 among pediatric patients in the United States.

BACKGROUND AND OBJECTIVE: Congenital heart defects are known to be associated with increased odds of severe COVID-19. Congenital anomalies affecting other body systems may also be associated with poor outcomes. This study is an exhaustive assessment of congenital anomalies and odds of severe COVID-19 in pediatric patients. METHODS: Data were retrieved from the COVID-19 dataset of Cerner® Real-World Data for encounters from March 2020 to February 2022. Prior to matching, the data consisted of 664,523 patients less than 18 years old and 927,805 corresponding encounters with COVID-19 from 117 health systems across the United States. One-to-one propensity score matching was performed, and a cumulative link mixed-effects model with random intercepts for health system and patients was built to assess corresponding associations. RESULTS: All congenital anomalies were associated with worse COVID-19 outcomes, with the strongest association observed for cardiovascular anomalies (odds ratio [OR], 3.84; 95% CI, 3.63-4.06) and the weakest association observed for anomalies affecting the eye/ear/face/neck (OR, 1.16; 95% CI, 1.03-1.31). CONCLUSIONS AND RELEVANCE: Congenital anomalies are associated with greater odds of experiencing severe symptoms of COVID-19. In addition to congenital heart defects, all other birth defects may increase the odds for more severe COVID-19. IMPACT: All congenital anomalies are associated with increased odds of severe COVID-19. This study is the largest and among the first to investigate birth defects across all body systems. The multicenter large data and analysis demonstrate the increased odds of severe COVID19 in pediatric patients with congenital anomalies affecting any body system. These data demonstrate that all children with birth defects are at increased odds of more severe COVID-19, not only those with heart defects. This should be taken into consideration when optimizing prevention and intervention resources within a hospital.

Therapeutic Hypothermia Treatment for an Infant with Hypoxic-Ischemic Encephalopathy and Gastroschisis: A Case Report.

Gastroschisis is a congenital, typically isolated, full-thickness abdominal wall defect in which the abdominal contents, usually only the small intestine, remain outside the abdominal cavity. It is commonly detected on fetal ultrasonography, and has generally excellent survival and outcomes, though these can be decreased in cases of complicated gastroschisis. We present the case of a female infant with a prenatal diagnosis of gastroschisis who required a prolonged and complex resuscitation after delivery. In addition to her gastroschisis, she presented with a history and physical examination consistent with severe hypoxic-ischemic encephalopathy and was treated with therapeutic hypothermia (TH) without further compromise to her bowel. In addition, careful consideration of neuroprotection, fluid status, bowel viability, and hemodynamics were undertaken in her care. She was discharged home on full enteral feeds, with only mild language and gross motor delays at 6 months of age. To our knowledge, there are no reports in the literature of the use of TH in the setting of unrepaired simple gastroschisis.

COVICT: an IoT based architecture for COVID-19 detection and contact tracing.

The world we live in has been taken quite surprisingly by the outbreak of a novel virus namely SARS-CoV-2. COVID-19 i.e. the disease associated with the virus, has not only shaken the world economy due to enforced lockdown but has also saturated the public health care systems of even most advanced countries due to its exponential spread. The fight against COVID-19 pandemic will continue until majority of world's population get vaccinated or herd immunity is achieved. Many researchers have exploited the Artificial intelligence (AI) knacks based IoT architecture for early detection and monitoring of potential COVID-19 cases to control the transmission of the virus. However, the main cause of the spread is that people infected with COVID-19 do not show any symptoms and are asymptomatic but can still transmit virus to the masses. Researcher have introduced contact tracing applications to automatically detect contacts that can be infected by the index case. However, these fully automated contact tracing apps have not been accepted due to issues like privacy and cross-app compatibility. In the current study, an IoT based COVID-19 detection and monitoring system with semi-automated and improved contact tracing capability namely COVICT has been presented with application of real-time data of symptoms collected from individuals and contact tracing. The deployment of COVICT, the prediction of infected persons can be made more effective and contaminated areas can be identified to mitigate the further propagation of the virus by imposing Smart Lockdown. The proposed IoT based architecture can be quite helpful for regulatory authorities for policy making to fight COVID-19.

Single-center comparison of outcomes between laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy.

PURPOSE: Appendectomy is the most common pediatric emergency surgery performed to date. This study compared outcomes between laparoscopic appendectomy (LA) and transumbilical laparoscopic assisted appendectomy (TULAA) for 1154 uncomplicated patients across 5 years at a single institution. Primary outcomes include length of stay (LOS), post-operative complications, pain score, and operating room (OR) time. METHODS: Demographic and clinical data was collected for 1154 eligible patients treated for uncomplicated appendicitis between August 2014-October 2019, with 830 patients in the LA group, and 324 in the TULAA group. Mixed effects modeling procedure using logistic and linear regression examined the effect of surgery type on the four primary outcomes after adjustment for potential clustering effect of surgeon and confounding factors. RESULTS: Of 1154 patients, 62.7% were male, and mean (SD) age was 10.9 (3.6) years. Median [IQR] LOS was 28.0 h [22.0, 36.0], mean (SD) OR time was 29.0 (10.0) minutes, and median [IQR] pain at maximum level was 5.5 (2.7). The complication rate overall was <5.0% and did not differ between TULAA and LA groups (p > 0.05). OR time was reduced by an average of 5.2 min in the TULAA group (p < 0.001), pain did not differ between groups overall (p > 0.05), and patients were more likely to be discharged within 24 h in patients who underwent TULAA (OR = 5.3 [1.6, 17.4], p = 0.007). CONCLUSION: Retrospective analysis of 1154 pediatric appendectomies, found no difference in complications between single- and three-incision laparoscopic procedures (TULAA vs. LA). Findings suggest TULAA is a safe procedure for acute appendicitis in pediatrics. LEVEL OF EVIDENCE: IV.

Electric bicycles (e-bikes) are an increasingly common pediatric public health problem.

Purpose: Electric bicycles (e-bikes) achieve higher speeds than pedal bicycles, but few studies have investigated the impact on injury rates specific to the pediatric population. Utilizing the National Electronic Injury Surveillance System (NEISS), we compared rates of pediatric injury for e-bikes, bicycles, and gas-engine bicycles (mopeds) from 2011 to 2020. Methods: Descriptive and bivariate inferential analyses were performed upon NEISS estimates of e-bike, bicycle, and moped injuries in children aged 2-18 years. Analyses were stratified by patient age and helmet usage. The Mann-Kendall test of trends was used. Results: We identified 3945 e-bike, 23,389 moped, and 2.05 million bicycle injuries. Over time, the incidence of injury increased for e-bikes (Kendall's τ=0.73, p = 0.004), decreased for pedal bicycles (Kendall's τ= - 0.91, p = 0.0003), and did not change for mopeds (Kendall's τ = 0.06, p = 0.85). Males accounted for 82.5 % of e-bike injuries. The age group most commonly affected by e-bike injury (44.3 %) was 10-13 years old. The proportion of injuries requiring hospitalization was significantly higher for e-bikes (11.5 %), compared to moped and bicycle (7.0 and 4.8 %, respectively, p < 0.0001). In cases where helmet use or absence was reported, 97.3 % of e-bike riders were without a helmet at the time of injury, compared to 82.1 % of pedal bicycle riders and 87.2 % of moped riders. Conclusions: The rate of pediatric e-bike injuries increased over the study period. Compared to riders on pedal bicycles or mopeds, children on e-bikes had infrequent helmet use and increased rate of hospitalization. These findings suggest that attention to e-bike safety and increasing helmet usage are important to public health among the pediatric population. Level of evidence: IV.

Distribution of injury in inflatable jumping amusements in the U.S. over the last 20 years.

PURPOSE: To describe the distribution of injuries attributed to inflatable bounce house devices in children 2-18 years old in the United States from 2000 to 2019. METHODS: The National Electronic Injury Surveillance System (NEISS) was used to identify patients <18 years of age with injuries from activities classified as amusements (NEISS Code 1293 and 3219) during the period from 2000 to 2019. RESULTS: A weighted estimate of 159,569 injuries was obtained using NEISS statistical weights. Injury estimates and rate of estimated injury per year showed a continued linear increase from 2000-2019 (p<0.0001). Bounce house-related injuries were more common in males (53.9%) than in females (46.1%). The injuries reported most commonly were fracture (25.8%), muscle strain (25.7%), and contusion (14.5%). The factors associated with bounce house-related injury were compared between "younger" patients ≤6 years of age and "older" patients >6 years of age. In both age groups, the patient's residence was the most prevalent location of injury (≤6 yr, 95.6%; >6 yr, 97.2%), and the lower extremity was the most prevalent anatomic site of injury (≤6 yr, 34.6%, >6 yr 35.3%). Concussion was rare in both groups (≤6 yr, 1.6%; >6 yr, 2.9%); however, concussion was 86% more prevalent in those >6 years of age (p<0.0001). CONCLUSIONS: The frequency and rate of pediatric bounce house injuries has increased steadily since 2000. The most severe injuries occur disproportionately in children > 6 years old.

Entropy Generation Analysis and Radiated Heat Transfer in MHD (Al2O3-Cu/Water) Hybrid Nanofluid Flow.

This research concerns the heat transfer and entropy generation analysis in the MHD axisymmetric flow of Al2O3-Cu/H2O hybrid nanofluid. The magnetic induction effect is considered for large magnetic Reynolds number. The influences of thermal radiations, viscous dissipation and convective temperature conditions over flow are studied. The problem is modeled using boundary layer theory, Maxwell's equations and Fourier's conduction law along with defined physical factors. Similarity transformations are utilized for model simplification which is analytically solved with the homotopy analysis method. The h-curves up to 20th order for solutions establishes the stability and convergence of the adopted computational method. Rheological impacts of involved parameters on flow variables and entropy generation number are demonstrated via graphs and tables. The study reveals that entropy in system of hybrid nanofluid affected by magnetic induction declines for ß while it enhances for Bi, R and λ. Moreover, heat transfer rate elevates for large Bi with convective conditions at surface.

A novel mathematical modeling with solution for movement of fluid through ciliary caused metachronal waves in a channel.

In the present research, a novel mathematical model for the motion of cilia using non-linear rheological fluid in a symmetric channel is developed. The strength of analytical perturbation technique is employed for the solution of proposed physical process using mectachoronal rhythm based on Cilia induced flow for pseudo plastic nano fluid model by considering the low Reynolds number and long wave length approximation phenomena. The role of ciliary motion for the fluid transport in various animals is explained. Analytical expressions are gathered for stream function, concentration, temperature profiles, axial velocity, and pressure gradient. Whereas, transverse velocity, pressure rise per wave length, and frictional force on the wall of the tubule are investigated with aid of numerical computations and their outcomes are demonstrated graphically. A comprehensive analysis for comparison of Perturb and numerical solution is done. This analysis validates the analytical solution.

Integrated intelligent computing application for effectiveness of Au nanoparticles coated over MWCNTs with velocity slip in curved channel peristaltic flow.

Estimation of the effectiveness of Au nanoparticles concentration in peristaltic flow through a curved channel by using a data driven stochastic numerical paradigm based on artificial neural network is presented in this study. In the modelling, nano composite is considered involving multi-walled carbon nanotubes coated with gold nanoparticles with different slip conditions. Modeled differential system of the physical problem is numerically analyzed for different scenarios to predict numerical data for velocity and temperature by Adams Bashforth method and these solutions are used as a reference dataset of the networks. Data is processed by segmentation into three categories i.e., training, validation and testing while Levenberg-Marquart training algorithm is adopted for optimization of networks results in terms of performance on mean square errors, train state plots, error histograms, regression analysis, time series responses, and auto-correlation, which establish the accurate and efficient recognition of trends of the system.

A novel application of Lobatto IIIA solver for numerical treatment of mixed convection nanofluidic model.

The objective of the current investigation is to examine the influence of variable viscosity and transverse magnetic field on mixed convection fluid model through stretching sheet based on copper and silver nanoparticles by exploiting the strength of numerical computing via Lobatto IIIA solver. The nonlinear partial differential equations are changed into ordinary differential equations by means of similarity transformations procedure. A renewed finite difference based Lobatto IIIA method is incorporated to solve the fluidic system numerically. Vogel's model is considered to observe the influence of variable viscosity and applied oblique magnetic field with mixed convection along with temperature dependent viscosity. Graphical and numerical illustrations are presented to visualize the behavior of different sundry parameters of interest on velocity and temperature. Outcomes reflect that volumetric fraction of nanoparticles causes to increase the thermal conductivity of the fluid and the temperature enhances due to blade type copper nanoparticles. The convergence analysis on the accuracy to solve the problem is investigated viably though the residual errors with different tolerances to prove the worth of the solver. The temperature of the fluid accelerates due the blade type nanoparticles of copper and skin friction coefficient is reduced due to enhancement of Grashof Number.

Health hazards, injury problems, and workplace conditions of carpet-weaving children in three districts of Punjab, Pakistan.

Carpet weaving among children is common in rural Pakistan, but little information is available on the health effects of this work. A total of 628 carpet-weaving children and 292 non-working children from 10 rural villages were evaluated with questionnaires and physical exams. Fifty-five home-based and 30 shed-based worksites in these villages were assessed. Girls comprised the majority of working (73%) and non-working (69%) children; the mean age for both boys and girls was 10 years. The mean number of hours worked daily was 7.2 for males and 6.8 for females. Dust exposure in homes was generally higher than in sheds. Working children had significantly greater odds of joint pain (OR = 2.8), dry cough (OR = 2.5), cuts/bruises (OR = 22.1), Phalen's sign (OR = 17.2), and neck/shoulder abnormalities (OR = 14.2). Symptoms and signs of acute and repetitive injury and respiratory symptoms were more common among carpet-weaving children than their non-working peers.

The development of multiorgan dysfunction in CDH-ECMO neonates is associated with the level of pre-ECMO support.

PURPOSE: Congenital diaphragmatic hernia (CDH) is the most common indication for neonatal extracorporeal membrane oxygenation (ECMO), but mortality remains at 50%. Multiorgan failure can occur in 25% and has been linked to worse outcomes. We sought to examine the factors that would increase the risk of multiorgan dysfunction (MOD). METHODS: The Extracorporeal Life Support Organization (ELSO) database was used to identify infants with CDH (2000-2015). The primary outcome was MOD, which was defined as the presence of organ failure in ≥2 organ systems. We used a multivariable logistic regression to examine the effect of demographics, pre-ECMO respiratory status, comorbidities, and therapies on MOD. RESULTS: There were a total of 4374 CDH infants who were treated with ECMO. Overall mortality was 52.4%. The risk models demonstrated that pre-ECMO cardiac arrest (OR 1.458, CI: 1.146-1.861, p = 0.002) and hand-bagging (OR 1.461, CI: 1.094-1.963, p = 0.032) had the strongest association with MOD. In addition, other pre-ECMO indicators of disease severity (pH, HFOV, MAP, 5-min APGAR) and pre-ECMO therapies (bicarb, neuromuscular [NM] blockers) were also associated with MOD. CONCLUSIONS: The level of pre-ECMO support has a significant association with the development of MOD, and initiation of ECMO prior to arrest seems to be critical to avoid complications. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level III.

A novel application of breadth first algorithm for achieving collision free memory mapping.

We are living in the world of handheld smart devices including smart phones, mini computers, tablets, net-books and others communication devices. The telecommunication standards used in these devices includes error correction codes which are integral part of current and future communication systems. To achieve the higher data rate applications, the turbo and Low Density Parity Check (LDPC) codes are decoded on parallel architecture which in turn raises the memory conflict issue. In order to get the good performance, the simultaneous access to the entire memory bank should be performed without any conflict. In this article we present breadth first technique applied on transportation modeling of the problem for solving the collision issue of Turbo decoders in order to get optimized architecture solution.

Use of better designed hand knotting carpet looms and workplace interventions to improve working conditions of adult carpet weavers and to reduce hazardous child labor in carpet weaving in Pakistan.

OBJECTIVE: Children and adults involved in carpet weaving are prone to a number of health and safety problems. This paper describes initial impact of an ergonomically designed loom and work place modifications, to encourage young and adult workers to weave carpets and reduce the hazardous child labor in carpet weaving in the province of Punjab, Pakistan. METHODS: A new carpet loom with improved ergonomic and safety features suitable for adult carpet weavers was designed. Model carpet weaving worksites based on the new loom and better work environment were created in 30 villages. The impact of new loom compared with the traditional looms was assessed through structured questionnaires and health examinations after 24 months. RESULTS: Adolescent (15-17 years) and adult (> 17 years) participants included 75 respondents (males 10.7%, n=8; females 89.3%, n=67) operating under the new conditions and 92 respondents (males 12%, n=11; females 88%, n=81) operating under traditional conditions. Results indicated an improvement of health related complaints among those working in the new conditions, most notable were the differences in joint pain (p=0.002) and respiratory health (p=0.02). Improvement of income was also reported by workers at model workplaces. Also, no children below the age of 14 were found to be working at the new looms. CONCLUSIONS: The results indicate that individuals who adopted new looms and workplace interventions reported less joint pain and better respiratory health than those working with traditional looms in a traditional work environment. By reducing the risks in the workplace, this ergonomic intervention has the potential to reduce or eliminate hazardous child labor from carpet weaving.

Outcomes following neonatal patent ductus arteriosus ligation done by pediatric surgeons: a retrospective cohort analysis.

PURPOSE: Patent Ductus Arteriosus (PDA) ligation in premature infants is an urgent procedure performed by some but not all pediatric surgeons. Proficiency in PDA ligation is not a requirement of Canadian pediatric surgery training. Our purpose was to determine the outcomes of neonatal PDA ligation done by pediatric surgeons. METHODS: We performed a retrospective review of premature infants who underwent PDA ligation by pediatric surgeons in 3 Canadian centers from 2005 to 2009. Outcomes were compared to published controls. RESULTS: The review identified 98 patients with a mean corrected GA and weight at repair of 29 weeks and 1122 g, respectively. There were no intraoperative deaths. The 30-day and inhospital mortality rates were 1% and 5%. Mortality and morbidity were comparable to the published outcomes. CONCLUSIONS: This study documents that a significant number of preterm infant PDA ligations are safely done by pediatric surgeons. To meet the Canadian needs for this service by pediatric surgeons, proficiency in PDA ligation should be considered important in pediatric surgery training programs.

Kinetic study of fission product activity released inside containment under loss of coolant transients in a typical MTR system.

Based on continuous release of fission product (FP) activity from fuel to the coolant and then to the containment, a kinetic model is developed for source term after a LOCA in a typical MTR type system. The time dependent source, re-suspension rate, decay of fission products, leakage, deposition on surfaces, and re-circulation of air through filters are employed with a partial prompt source plus a time varying source. Releases of different FP activities are simulated for various release rates.