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1.
Front Chem ; 12: 1414996, 2024.
Article in English | MEDLINE | ID: mdl-38721009

ABSTRACT

[This corrects the article DOI: 10.3389/fchem.2024.1358417.].

2.
Health Aff Sch ; 2(1): qxad092, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38756406

ABSTRACT

Parental perceptions of school meals can affect student participation and overall support for school meal policies. Little is known about parental school meal perceptions under universal free school meals (UFSM) policies. We assessed California parents' perceptions of school meals during the COVID-19 emergency response with federally funded UFSM and whether perceptions differed by race/ethnicity. Among 1110 California parents of K-12 students, most reported school meals benefit their families, saving them money (81.6%), time (79.2%), and stress (75.0%). Few reported that their child would be embarrassed to eat school meals (11.7%), but more parents of White students than Hispanic students reported this. Many parents reported that their child likes to eat lunch to be with friends (64.7%); about half felt their child has enough time to eat (54.2%). Fewer parents perceived school lunches to be of good quality (36.9%), tasty (39.6%), or healthy (44.0%). Parents of Hispanic and Asian students had less favorable perceptions of school meal quality, taste, and healthfulness than parents of White students. Parents report that school meals benefit their families, but policy efforts are needed to ensure schools have the resources needed to address cultural appropriateness. Schools should address parental perceptions of meals to optimize participation, nutrition security, and health.

3.
J Acad Nutr Diet ; 2024 May 10.
Article in English | MEDLINE | ID: mdl-38735530

ABSTRACT

BACKGROUND: In response to the COVID-19 pandemic, the United States Congress authorized the United States Department of Agriculture to waive a variety of school meal regulations and funded school meals daily for all students at no charge regardless of family income. Since federal Universal Free School Meals (UFSM) ended with the 2021-2022 school year, several states, including California and Maine, adopted state-level UFSM policies. OBJECTIVE: This study aimed to understand parent perceptions of school meals and the federal and new state UFSM policies in California and Maine, including potential challenges and benefits to students and households. DESIGN: A mixed methods study design was used. A quantitative cross-sectional survey was administered, and semi-structured interviews were conducted in English and Spanish during the 2021-2022 school year. PARTICIPANTS/SETTING: The quantitative survey was administered to parents of students in elementary, middle, and high schools in rural, suburban, and urban communities in California (n=1,110) and Maine (n=80). Qualitative interviews were then conducted with a subset of these parents in California (n=46) and Maine (n=20) using ZoomTM. Most survey participants (708 out of 1,190; 59.5%) and interviewees (40 out of 66; 60.6%) were parents of students who were eligible for free or reduced-price meals (FRPM). MAIN OUTCOME MEASURES: Parents' perceptions of UFSM, school meal quality, and experiences applying for FRPM were examined. ANALYSES PERFORMED: Tests of proportions were used to analyze survey data. Using grounded theory, interview transcripts were analyzed qualitatively by 2 trained research assistants, applying principles of content analysis to identify themes and domains. Inter-rater reliability was conducted. RESULTS: Parents perceived that school meals and UFSM saved families money and time, as parents had fewer meals to purchase and prepare for their children. Additionally, UFSM reduced parents' stress and reduced stigma for children and for parents, who described feelings of embarrassment when they previously filled out paperwork for FRPM. While parent perceptions of school meal quality and healthfulness were mixed, most parents reported feeling grateful for school meals. CONCLUSIONS: Parents had mixed opinions on the quality and healthfulness of school meals, but believed UFSM saved them money and time and reduced their stress. Parents also felt UFSM reduced stigma for families.

5.
Front Chem ; 12: 1358417, 2024.
Article in English | MEDLINE | ID: mdl-38650673

ABSTRACT

Net zero targets have resulted in a drive to decarbonise the transport sector worldwide through electrification. This has, in turn, led to an exponentially growing battery market and, conversely, increasing attention on how we can reduce the environmental impact of batteries and promote a more efficient circular economy to achieve real net zero. As these batteries reach the end of their first life, challenges arise as to how to collect and process them, in order to maximise their economical use before finally being recycled. Despite the growing body of work around this topic, the decision-making process on which pathways batteries could take is not yet well understood, and clear policies and standards to support implementation of processes and infrastructure are still lacking. Requirements and challenges behind recycling and second life applications are complex and continue being defined in industry and academia. Both pathways rely on cell collection, selection and processing, and are confronted with the complexities of pack disassembly, as well as a diversity of cell chemistries, state-of-health, size, and form factor. There are several opportunities to address these barriers, such as standardisation of battery design and reviewing the criteria for a battery's end-of-life. These revisions could potentially improve the overall sustainability of batteries, but may require policies to drive such transformation across the industry. The influence of policies in triggering a pattern of behaviour that favours one pathway over another are examined and suggestions are made for policy amendments that could support a second life pipeline, while encouraging the development of an efficient recycling industry. This review explains the different pathways that end-of-life EV batteries could follow, either immediate recycling or service in one of a variety of second life applications, before eventual recycling. The challenges and barriers to each pathway are discussed, taking into account their relative environmental and economic feasibility and competing advantages and disadvantages of each. The review identifies key areas where processes need to be simplified and decision criteria clearly defined, so that optimal pathways can be rapidly determined for each end-of-life battery.

7.
Behav Sci Law ; 2024 Apr 07.
Article in English | MEDLINE | ID: mdl-38583136

ABSTRACT

With its firm establishment as a neuropsychology subspecialty, forensic neuropsychological assessment is integral to many criminal and civil forensic evaluations. In addition to evaluating cognitive deficits, forensic neuropsychologists can provide reliable information regarding symptom magnification, malingering, and other neurocognitive and psychological issues that may impact the outcome of a particular legal case. This article is an overview and introduction to neuropsychological assessment in the forensic mental health context. Major issues impacting the current practice of forensic neuropsychology are summarized, and several examples from case law are highlighted.

8.
J Immunother Cancer ; 12(4)2024 Apr 10.
Article in English | MEDLINE | ID: mdl-38599660

ABSTRACT

With an increasing number of patients eligible for immune checkpoint inhibitors, the incidence of immune-related adverse events (irAEs) is on the rise. Dermatologic immune-related adverse events (D-irAEs) are the most common and earliest to manifest, often with important downstream consequences for the patient. Current guidelines lack clarity in terms of diagnostic criteria for D-irAEs. The goal of this project is to better define D-irAE for the purposes of identification, diagnosis, and future study of this important group of diseases.The objectives of this project were to develop consensus guidance for an approach to D-irAEs including disease definitions and severity grading. Knowing that consensus among oncologists, dermatologists, and irAE subspecialists would be critical for usability, we formed a Dermatologic irAE Disease Definition Panel. The panel was composed of 34 experts, including oncologists, dermatologists, a rheumatologist, and an allergist/immunologist from 22 institutions across the USA and internationally. A modified Delphi consensus process was used, with two rounds of anonymous ratings by panelists and two virtual meetings to discuss areas of controversy. Panelists rated content for usability, appropriateness, and accuracy on 9-point scales in electronic surveys and provided free text comments. A working group aggregated survey responses and incorporated them into revised definitions. Consensus was based on numeric ratings using the RAND/UCLA Appropriateness Method with prespecified definitions.Following revisions based on panelist feedback, all items received consensus in the second round of ratings. Consensus definitions were achieved for 10 core D-irAE diagnoses: ICI-vitiligo, ICI-lichen planus, ICI-psoriasis, ICI-exanthem, ICI-bullous pemphigoid, ICI-Grover's, ICI-eczematous, ICI-eruptive atypical squamous proliferation, ICI-pruritus without rash, and ICI-erosive mucocutaneous. A standard evaluation for D-irAE was also found to reach consensus, with disease-specific exceptions detailed when necessary. Each disorder's description includes further details on disease subtypes, symptoms, supportive exam findings, and three levels of diagnostic certainty (definite, probable, and possible).These consensus-driven disease definitions standardize D-irAE classification in a useable framework for multiple disciplines and will be the foundation for future work. Given consensus on their accuracy and usability from a representative panel group, we anticipate that they can be used broadly across clinical and research settings.


Subject(s)
Exanthema , Oncologists , Humans , Consensus , Immune Checkpoint Inhibitors/adverse effects , Radioimmunotherapy
9.
J Nutr Educ Behav ; 56(4): 230-241, 2024 04.
Article in English | MEDLINE | ID: mdl-38583880

ABSTRACT

OBJECTIVE: To evaluate if parent perceptions of school meals influence student participation. DESIGN: In May 2022, an online survey was used to evaluate parents' perceptions of school meals and their children's participation. PARTICIPANTS: A total of 1,110 California parents of kindergarten through 12th-grade students. MAIN OUTCOME MEASURES: Student participation in school lunch and breakfast. ANALYSIS: Principal component analysis and Poisson regression models. RESULTS: Three groups of parental perceptions were identified: (1) positive perceptions (eg, liking school meals and thinking that they are tasty and healthy), (2) perceived benefits to families (eg, school meals save families money, time, and stress), and (3) negative (eg, concerns about the amount of sugar in school meals and stigma). More positive parental perceptions about school meals and their benefits to families were associated with greater student meal participation. In contrast, more negative parental perceptions were associated with reduced student participation in school meals (P < 0.05). CONCLUSION AND IMPLICATIONS: Parent perceptions of school meals may affect student participation in school meal programs. Working to ensure parents are familiar with the healthfulness and quality of school meals and the efforts schools are making to provide high-quality, appealing meals may be critical for increasing school meal participation rates.


Subject(s)
Food Services , Child , Humans , Meals , Breakfast , Lunch , Students , Parents
10.
J Neurooncol ; 167(3): 515-522, 2024 May.
Article in English | MEDLINE | ID: mdl-38443692

ABSTRACT

PURPOSE: Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder which commonly causes neoplasms leading to disfigurement or dysfunction. Mitogen-activated protein kinase inhibitors (MEKi) are generally well-tolerated treatments which target neural tumor progression in patients with NF1. However, cutaneous adverse events (CAEs) are common and may hinder patients' abilities to remain on treatment, particularly in children. We aim to characterize CAEs secondary to MEKi treatment in pediatric and young adult patients with NF1. METHODS: We reviewed institutional medical records of patients under 30 years with a diagnosis of "NF1," "NF2," or "other neurofibromatoses" on MEKi therapy between January 1, 2019 and June 1, 2022. We recorded the time-to-onset, type, and distribution of CAEs, non-cutaneous adverse events (AEs), AE management, and tumor response. RESULTS: Our cohort consisted of 40 patients with NF1 (median age, 14 years). Tumor types included low-grade gliomas (51%) and plexiform neurofibromas (38%). MEKi used included selumetinib (69%), trametinib (25%), and mirdametinib (6%). A total of 74 CAEs occurred, with 28 cases of acneiform rash (38%). Other common CAEs were paronychia, seborrheic dermatitis, eczema, xerosis, and oral mucositis. The most common treatments included oral antibiotics and topical corticosteroids. Most patients had clinical (stable or improved) tumor response (71%) while 29% had tumor progression while on a MEKi. There was no significant association between CAE presence and tumor response (p = 0.39). CONCLUSIONS: Improvement in characterization of MEKi toxicities and their management is important to develop treatment guidelines for pediatric and young adult patients with NF1 on MEKi therapy.


Subject(s)
Neurofibromatosis 1 , Protein Kinase Inhibitors , Humans , Neurofibromatosis 1/drug therapy , Female , Male , Adolescent , Child , Young Adult , Adult , Protein Kinase Inhibitors/adverse effects , Retrospective Studies , Child, Preschool , Neurofibroma, Plexiform/drug therapy , Neurofibroma, Plexiform/pathology , Follow-Up Studies , Drug Eruptions/etiology , Prognosis
11.
J Dermatolog Treat ; 35(1): 2328180, 2024 Dec.
Article in English | MEDLINE | ID: mdl-38493799

ABSTRACT

Purpose: Trichodysplasia spinulosa (TS) is a rare, disfiguring skin condition which presents with widespread asymptomatic or pruritic, skin-colored papules with white protruding keratin spiculations in immunocompromised individuals. Due to its rarity, there is little data to guide treatment decisions. The purpose of this article is to report a case of TS that completely resolved after treatment with topical cidofovir.Materials and methods: A 19-year-old immunosuppressed female presented with widespread painful, itchy bumps on the nose and face. Upon examination, there were erythematous papules with hyperkeratinized spicules affecting the central face. Biopsy of the lesions was consistent with TS which was confirmed via PCR analysis. The tenderness of this patient's eruption was highly atypical for TS. Once daily topical application of compounded 1% cidofovir cream was prescribed.Results: The patient's symptoms resolved completely after 4 weeks of therapy with topical cidofovir 1% cream, without reduction of immunosuppression.Conclusions: Topical cidofovir 1% cream may be a valuable treatment for this rare disease.


Subject(s)
Polyomavirus Infections , Skin Diseases , Female , Humans , Young Adult , Cidofovir/therapeutic use , Immunocompromised Host , Polyomavirus Infections/diagnosis , Polyomavirus Infections/pathology , Polyomavirus Infections/therapy , Pruritus , Skin Diseases/pathology
12.
Eur Radiol ; 2024 Mar 15.
Article in English | MEDLINE | ID: mdl-38488970

ABSTRACT

BACKGROUND: The Paris classification categorises colorectal polyp morphology. Interobserver agreement for Paris classification has been assessed at optical colonoscopy (OC) but not CT colonography (CTC). We aimed to determine the following: (1) interobserver agreement for the Paris classification using CTC between radiologists; (2) if radiologist experience influenced classification, gross polyp morphology, or polyp size; and (3) the extent to which radiologist classifications agreed with (a) colonoscopy and (b) a combined reference standard. METHODS: Following ethical approval for this non-randomised prospective cohort study, seven radiologists from three hospitals classified 52 colonic polyps using the Paris system. We calculated interobserver agreement using Fleiss kappa and mean pairwise agreement (MPA). Absolute agreement was calculated between radiologists; between CTC and OC; and between CTC and a combined reference standard using all available imaging, colonoscopic, and histopathological data. RESULTS: Overall interobserver agreement between the seven readers was fair (Fleiss kappa 0.33; 95% CI 0.30-0.37; MPA 49.7%). Readers with < 1500 CTC experience had higher interobserver agreement (0.42 (95% CI 0.35-0.48) vs. 0.33 (95% CI 0.25-0.42)) and MPA (69.2% vs 50.6%) than readers with ≥ 1500 experience. There was substantial overall agreement for flat vs protuberant polyps (0.62 (95% CI 0.56-0.68)) with a MPA of 87.9%. Agreement between CTC and OC classifications was only 44%, and CTC agreement with the combined reference standard was 56%. CONCLUSION: Radiologist agreement when using the Paris classification at CT colonography is low, and radiologist classification agrees poorly with colonoscopy. Using the full Paris classification in routine CTC reporting is of questionable value. CLINICAL RELEVANCE STATEMENT: Interobserver agreement for radiologists using the Paris classification to categorise colorectal polyp morphology is only fair; routine use of the full Paris classification at CT colonography is questionable. KEY POINTS: • Overall interobserver agreement for the Paris classification at CT colonography (CTC) was only fair, and lower than for colonoscopy. • Agreement was higher for radiologists with < 1500 CTC experience and for larger polyps. There was substantial agreement when classifying polyps as protuberant vs flat. • Agreement between CTC and colonoscopic polyp classification was low (44%).

13.
Am J Clin Pathol ; 2024 Mar 21.
Article in English | MEDLINE | ID: mdl-38513285

ABSTRACT

OBJECTIVES: Cutaneous diseases that disproportionately affect patients with darker pigmentation and their histologic features are historically understudied and undertreated. This review article aims to highlight the key clinical features, histopathology, and diagnostic pearls of several cutaneous diseases that commonly present in patients with darker pigmentation. METHODS: A literature search was conducted, and a list of cutaneous diseases that frequently affect patients with darker pigmentation was compiled. A group of experts expounded upon those that were most common or misdiagnosed according to scientific evidence and clinical practice. RESULTS: The diseases were divided into hypopigmented disorders, hyperpigmented disorders, scarring disorders, and alopecic disorders. Within each category, the etiology, clinical features, histopathology, and key histologic differential diagnoses are described and discussed. CONCLUSIONS: As many clinicians are taught that there are no effective treatment options or that these diseases are considered "cosmetic" in nature, patients often do not get a thorough medical workup or skin biopsy. This article aims to decrease the knowledge gap and serve as a resource for anyone involved in the care of patients with these cutaneous conditions.

14.
J Natl Compr Canc Netw ; : 1-8, 2024 Jan 08.
Article in English | MEDLINE | ID: mdl-38190801

ABSTRACT

Immune checkpoint inhibitors (ICIs) have transformed the treatment paradigm for many cancer types. The clinical use of ICIs is increasing rapidly, including in combinations associated with increased risk of toxicities, termed "immune-related adverse events" (irAEs). Therefore, MD Anderson Cancer Center (MDACC) in Houston, Texas has proactively responded by developing a priority endeavor known as the Immuno-Oncology Toxicity (IOTOX) initiative. This strategic initiative aims to facilitate the seamless integration of key domains: (1) standardized clinical practice and innovative decision toolsets; (2) patient and provider education; and (3) a comprehensive clinical and translational research platform. The ultimate goal of this initiative is to develop and disseminate clinical best practices and biologic insights into irAEs to improve outcomes of patients with irAEs at MDACC and in the wider oncology community.

15.
Public Health Rep ; : 333549231192471, 2023 Sep 04.
Article in English | MEDLINE | ID: mdl-37667618

ABSTRACT

OBJECTIVES: Reports of unsafe school drinking water in the United States highlight the importance of ensuring school water is safe for consumption. Our objectives were to describe (1) results from our recent school drinking water sampling of 5 common contaminants, (2) school-level factors associated with exceedances of various water quality standards, and (3) recommendations. METHODS: We collected and analyzed drinking water samples from at least 3 sources in 83 schools from a representative sample of California public schools from 2017 through 2022. We used multivariate logistic regression to examine school-level factors associated with lead in drinking water exceedances at the American Academy of Pediatrics (AAP) recommendation level (1 part per billion [ppb]) and state action-level exceedances of other contaminants (lead, copper, arsenic, nitrate, and hexavalent chromium). RESULTS: No schools had state action-level violations for arsenic or nitrate; however, 4% had ≥1 tap that exceeded either the proposed 10 ppb action level for hexavalent chromium or the 1300 ppb action level for copper. Of first-draw lead samples, 4% of schools had ≥1 tap that exceeded the California action level of 15 ppb, 18% exceeded the US Food and Drug Administration (FDA) bottled water standard of 5 ppb, and 75% exceeded the AAP 1 ppb recommendation. After turning on the tap and flushing water for 45 seconds, 2%, 10%, and 33% of schools exceeded the same standards, respectively. We found no significant differences in demographic characteristics between schools with and without FDA or AAP exceedances. CONCLUSIONS: Enforcing stricter lead action levels (<5 ppb) will markedly increase remediation costs. Continued sampling, testing, and remediation efforts are necessary to ensure drinking water meets safety standards in US schools.

16.
Pediatrics ; 152(3)2023 09 01.
Article in English | MEDLINE | ID: mdl-37545466

ABSTRACT

BACKGROUND AND OBJECTIVE: Drinking water promotion and access shows promise for preventing weight gain. This study evaluated the impact of Water First, a school-based water promotion and access intervention on changes in overweight. METHODS: Low-income, ethnically diverse elementary schools in California's Bay Area were cluster-randomized to intervention and control groups. Water First includes classroom lessons, water stations, and schoolwide water promotion over 1 school year. The primary outcome was overweight prevalence (BMI-for-age-and-sex ≥85th percentile). Students (n = 1249) in 56 fourth-grade classes in 18 schools (9 intervention, 9 control) from 2016 to 2019 participated in evaluation at baseline, 7, and 15 months. Data collection was interrupted in 8 additional recruited schools because of coronavirus disease 2019. RESULTS: Of 1262 students from 18 schools, 1249 (47.4% girls; mean [SD] age, 9.6 [0.4] years; 63.4% Hispanic) were recruited. From baseline to 7 months, there was no significant difference in changes in overweight prevalence in intervention schools (-0.2%) compared to control schools (-0.4%) (adjusted ratio of odds ratios [ORs]: 0.7 [confidence interval (CI): 0.2-2.9] P = 0.68). From baseline to 15-months, increases in overweight prevalence were significantly greater in control schools (3.7%) compared to intervention schools (0.5%). At 15 months, intervention students had a significantly lower change in overweight prevalence (adjusted ratio of ORs: 0.1 [CI: 0.03-0.7] P = .017) compared to control students. There were no intervention effects for obesity prevalence. CONCLUSIONS: Water First prevented increases in the prevalence of overweight, but not obesity, in elementary school students.


Subject(s)
COVID-19 , Drinking Water , Female , Humans , Child , Male , Overweight/epidemiology , Overweight/prevention & control , Health Promotion , Obesity/epidemiology , School Health Services
17.
Melanoma Res ; 33(5): 406-416, 2023 10 01.
Article in English | MEDLINE | ID: mdl-37534686

ABSTRACT

For patients with locally advanced or metastatic melanoma who have BRAF V600 activating mutations, combination therapy with BRAF and MEK inhibitors is now the standard of care. The combination of encorafenib, a highly selective adenosine triphosphate-competitive BRAF inhibitor, plus binimetinib, a potent, selective, allosteric, non-adenosine triphosphate-competitive MEK1/2 inhibitor, was approved by the US Food and Drug Administration for unresectable or metastatic melanoma with BRAF V600E or V600K mutations based on data from the phase III COLUMBUS study (NCT01909453). Clinical data evaluating BRAF and MEK inhibitor combinations in advanced melanoma indicate a specific profile of adverse events that includes serious retinopathy, skin disorders, and cardiovascular toxicities. Here we provide an overview of the rationale for combining BRAF and MEK inhibitors for the treatment of melanoma, long-term safety results from COLUMBUS, and guidance on managing the most common adverse events associated with this combination based on clinical experience. Proactive and appropriate management of adverse events can allow for longer treatment durations and may result in better treatment outcomes.


Subject(s)
Melanoma , Skin Neoplasms , Humans , Melanoma/drug therapy , Melanoma/genetics , Melanoma/pathology , Skin Neoplasms/drug therapy , Skin Neoplasms/genetics , Skin Neoplasms/pathology , Proto-Oncogene Proteins B-raf/genetics , Proto-Oncogene Proteins B-raf/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Protein Kinase Inhibitors/adverse effects , Mutation , Mitogen-Activated Protein Kinase Kinases
18.
JMIR Dermatol ; 6: e46620, 2023 Aug 16.
Article in English | MEDLINE | ID: mdl-37585241

ABSTRACT

BACKGROUND: Alternative bibliometrics or altmetrics, is a measure of an academic article's impact on social media outlets, which is quantified by the Altmetric Attention score (AAS). Given a lack of data for altmetric trends during the COVID-19 pandemic, we conducted a comprehensive, multivariable analysis of top dermatology manuscripts published during this time period. OBJECTIVE: We aim to assess (1) the relationship between traditional bibiliometrics and Altmetrics and (2) factors associated with high AAS. METHODS: All abstracted articles published in the top-5 (ranked by SCImago Journal Rankings) peer-reviewed dermatology journals published in 2021 were included in our study. We collected AAS as the dependent variable and categorical predictor variables included journal title, whether a conflict of interest existed, open access status, whether the article was related to COVID-19 or skin-of-color research, and the type of research (eg, clinical, basic science, review, etc). Numerical predictor variables consisted of the impact factor of journal, total citations, and number of authors. Multivariable linear or logistic regression models were used. RESULTS: The relationship between AAS and citation number was significant by multivariable analysis during the COVID-19 pandemic (P<.001). Numerous factors, including studies related to COVID-19, whether the article was open access, title of the journal, and journal impact factor were also independently related to higher AAS (P<.002). CONCLUSIONS: Our results validate the use of altmetrics as a complement to traditional bibliometrics, especially in times of widespread scientific interest. Despite existing in a complex realm of bibliometrics, there are also discernable patterns associated with higher AAS. This is especially relevant in the era of growing technologic importance and utility to assess the impact of scientific works within the general public.

19.
ACS Appl Mater Interfaces ; 15(36): 42470-42480, 2023 Sep 13.
Article in English | MEDLINE | ID: mdl-37646541

ABSTRACT

Solid-state batteries (SSBs) are promising alternatives to the incumbent lithium-ion technology; however, they face a unique set of challenges that must be overcome to enable their widespread adoption. These challenges include solid-solid interfaces that are highly resistive, with slow kinetics, and a tendency to form interfacial voids causing diminished cycle life due to fracture and delamination. This modeling study probes the evolution of stresses at the solid electrolyte (SE) solid-solid interfaces, by linking the chemical and mechanical material properties to their electrochemical response, which can be used as a guide to optimize the design and manufacture of silicon (Si) based SSBs. A thin-film solid-state battery consisting of an amorphous Si negative electrode (NE) is studied, which exerts compressive stress on the SE, caused by the lithiation-induced expansion of the Si. By using a 2D chemo-mechanical model, continuum scale simulations are used to probe the effect of applied pressure and C-rate on the stress-strain response of the cell and their impacts on the overall cell capacity. A complex concentration gradient is generated within the Si electrode due to slow diffusion of Li through Si, which leads to localized strains. To reduce the interfacial stress and strain at 100% SOC, operation at moderate C-rates with low applied pressure is desirable. Alternatively, the mechanical properties of the SE could be tailored to optimize cell performance. To reduce Si stress, a SE with a moderate Young's modulus similar to that of lithium phosphorous oxynitride (∼77 GPa) with a low yield strength comparable to sulfides (∼0.67 GPa) should be selected. However, if the reduction in SE stress is of greater concern, then a compliant Young's modulus (∼29 GPa) with a moderate yield strength (1-3 GPa) should be targeted. This study emphasizes the need for SE material selection and the consideration of other cell components in order to optimize the performance of thin film solid-state batteries.

20.
JAMA Netw Open ; 6(8): e2331011, 2023 08 01.
Article in English | MEDLINE | ID: mdl-37642965

ABSTRACT

Importance: Thermoregulation is a key component of well-newborn care. There is limited epidemiologic data on hypothermia in late preterm and term infants admitted to the nursery. Expanding on these data is essential for advancing evidence-based care in a population that represents more than 3.5 million births per year in the US. Objective: To examine the incidence and factors associated with hypothermia in otherwise healthy infants admitted to the newborn nursery following delivery. Design, Setting, and Participants: A retrospective cohort study using electronic health record data from May 1, 2015, to August 31, 2021, was conducted at a newborn nursery at a university-affiliated children's hospital. Participants included 23 549 infants admitted to the newborn nursery, from which 321 060 axillary and rectal temperature values were analyzed. Exposures: Infant and maternal clinical and demographic factors. Main Outcomes and Measures: Neonatal hypothermia was defined according to the World Health Organization threshold of temperature less than 36.5 °C. Hypothermia was further classified by severity (mild: single episode, temperature 36.0-36.4 °C; moderate/severe: persistent or recurrent hypothermia and/or temperature <36.0 °C) and timing (early: all hypothermic episodes occurred within the first 24 hours after birth; late: any episode extended beyond the first 24 hours). Results: Of 23 549 included infants (male, 12 220 [51.9%]), 5.6% were late preterm (35-36 weeks' gestation) and 4.3% were low birth weight (≤2500 g). The incidence of mild hypothermia was 17.1% and the incidence of moderate/severe hypothermia was 4.6%. Late hypothermia occurred in 1.8% of infants. Lower birth weight and gestational age and Black and Asian maternal race and ethnicity had the highest adjusted odds across all classifications of hypothermia. The adjusted odds ratios of moderate/severe hypothermia were 5.97 (95% CI 4.45-8.00) in infants with a birth weight less than or equal to 2500 vs 3001 to 3500 g, 3.17 (95% CI 2.24-4.49) in 35 week' vs 39 weeks' gestation, and 2.65 (95% CI 1.78-3.96) in infants born to Black mothers and 1.94 (95% CI 1.61-2.34) in infants born to Asian mothers vs non-Hispanic White mothers. Conclusions and Relevance: In this cohort study of infants in the inpatient nursery, hypothermia was common, and the incidence varied by hypothermia definition applied. Infants of lower gestational age and birth weight and those born to Black and Asian mothers carried the highest odds of hypothermia. These findings suggest that identifying biological, structural, and social determinants of hypothermia is essential for advancing evidence-based equitable thermoregulatory care.


Subject(s)
Hypothermia , Child , Infant , Infant, Newborn , Female , Humans , Male , Hypothermia/epidemiology , Incidence , Birth Weight , Cohort Studies , Retrospective Studies , Mothers
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