Social Distancing During the COVID-19 Pandemic and Neonatal Mortality in the US.

Importance: Neonatal mortality is a major public health concern that was potentially impacted by the COVID-19 pandemic. To prepare for future health crises, it is important to investigate whether COVID-19 pandemic-related interventions were associated with changes in neonatal mortality. Objective: To investigate whether social distancing during the pandemic was associated with a higher neonatal mortality rate. Design, Setting, and Participants: This cohort study examined maternal-linked birth and infant death records from the National Center for Health Statistics, a population-level US database, from 2016 through 2020. The mortality rates were correlated using machine learning-based autoregressive integrated moving average (ARIMA) models with the social distancing index (SDI). The reference period was January 2016 through February 2020, and the pandemic period was March through December 2020. Statistical analysis was performed from March 2023 to May 2024. Exposures: SDI, computed from 6 mobility metrics. Main Outcomes and Measures: The primary outcome was neonatal mortality rate, defined as death at age less than 28 days. Results: The study included 18 011 173 births, of which 15 136 596 were from the reference period (7 753 555 [51.22%] male; 11 643 094 [76.92%] with maternal age of 20 to 34 years) and 2 874 577 were from the pandemic period (1 472 539 [51.23%] male; 2 190 158 [76.19%] with maternal age of 20 to 34 years). Through ARIMA-adjusted analyses, accounting for the declining mortality trend in the reference period, the mortality rates during the pandemic period did not significantly differ from the expected rates. SDI did not exhibit significant correlations with neonatal mortality (unadjusted: correlation coefficient [CC], 0.14 [95% CI, -0.53 to 0.70]; ARIMA adjusted: CC, 0.29 [95% CI, -0.41 to 0.77]), early neonatal mortality (unadjusted: CC, 0.33 [95% CI, -0.37 to 0.79]; ARIMA adjusted: CC, 0.45 [95% CI, -0.24 to 0.84]), and infant mortality (unadjusted: CC, -0.09 [95% CI, -0.68 to 0.57]; ARIMA adjusted: CC, 0.35 [95% CI, -0.35 to 0.80]). However, lag analyses found that SDI was associated with higher neonatal and early neonatal mortality rates with a 2-month lag period, but not with infant mortality rate. SDI was also associated with increases in 22-to-27 weeks' and 28-to-32 weeks' preterm delivery with a 1-month lag period. Conclusions and Relevance: In this population-level study of National Center for Health Statistics databases, neonatal, early neonatal, and infant mortality rates did not increase during the initial COVID-19 pandemic period. However, associations were observed between the pandemic period social distancing measures and higher rates of neonatal and early neonatal mortality, as well as preterm birth rate with a lag period, suggesting the importance of monitoring infant health outcomes following pandemic-related population behavior changes.

Necrotizing Sarcoid Granulomatosis With Hepatic Involvement and Reversible Noncirrhotic Portal Hypertension.

Necrotizing sarcoid granulomatosis falls within the spectrum of sarcoidosis and is characterized by features of necrosis and granulomatous vasculitis. Like classical sarcoidosis, it can affect numerous organ systems, and there is a wide range of disease activity. Few cases of necrotizing sarcoid granulomatosis have been reported in the liver. We present a case of necrotizing sarcoid granulomatosis associated with noncirrhotic portal hypertension.

Feasibility and Advantages of Continuous Synthesis of Bioinspired Silica Using CO2 as an Acidifying Agent.

In this work, we present a method for the continuous synthesis of bioinspired porous silica (BIS) particles using carbon dioxide (CO2) as an acidifying agent. Typical BIS synthesis uses strong mineral acids (e.g., HCl) to initiate the hydrolysis and subsequent condensation reactions. The use of strong acids leads to challenges in controlling the reaction pH. The synthesis approach proposed in this work offers for the first time CO2 as an attractive alternative for the synthesis of BIS and demonstrates the continuous process. The developed method leverages the mild acidic and the self-buffering nature of the CO2 combined with additional options for controlling mass transfer rates to facilitate enhanced control of pH, which is crucial for controlling the properties of synthesized BIS. Proof of concept experiments conducted in continuous mode demonstrated a yield of over 70% and a surface area exceeding 500 m2/g. These results indicate the successful synthesis of BIS using CO2 with properties in the desired range. The enhanced pH control offered by this CO2-based process will facilitate the implementation of a sustainable and robust continuous process for BIS synthesis.

Heart rate characteristics predict risk of mortality in preterm infants in low and high target oxygen saturation ranges.

Background: The Neonatal Oxygenation Prospective Meta-analysis found that in infants <28 weeks gestational age, targeting an oxygen saturation (S pO2 ) range of 85-89% versus 91-95% resulted in lower rates of retinopathy of prematurity but increased mortality. We aimed to evaluate the accuracy of the heart rate characteristics index (HRCi) in assessing the dynamic risk of mortality among infants managed with low and high target S pO2 ranges. Methods: We linked the SUPPORT and HRCi datasets from one centre in which the randomised controlled trials overlapped. We examined the maximum daily HRCi (MaxHRCi24) to predict mortality among patients randomised to the lower and higher target S pO2 groups by generating predictiveness curves and calculating model performance metrics, including area under the receiver operating characteristics curve (AUROC) at prediction windows from 1-60 days. Cox proportional hazards models tested whether MaxHRCi24 was an independent predictor of mortality. We also conducted a moderation analysis. Results: There were 84 infants in the merged dataset. MaxHRCi24 predicted mortality in infants randomised to the lower target S pO2 (AUROC of 0.79-0.89 depending upon the prediction window) and higher target S pO2 (AUROC 0.82-0.91). MaxHRCi24 was an important additional predictor of mortality in multivariable modelling. In moderation analysis, in a model that also included demographic predictor variables, the individual terms and the interaction term between MaxHRCi24 and target S pO2 range all predicted mortality. Conclusions: Associations between HRCi and mortality, at low and high S pO2 target ranges, suggest that future research may find HRCi metrics helpful to individually optimise target oxygen saturation ranges for hospitalised preterm infants.

Controlled Delivery of H2O2: A Three-Enzyme Cascade Flow Reactor for Peroxidase-Catalyzed Reactions.

Peroxidases are promising catalysts for oxidation reactions, yet their practical utility has been hindered by the fact that they require hydrogen peroxide (H2O2), which at high concentrations can cause deactivation of enzymes. Practical processes involving the use of peroxidases require the frequent addition of low concentrations of H2O2. In situ generation of H2O2 can be achieved using oxidase-type enzymes. In this study, a three-enzyme cascade system comprised of a H2O2 generator (glucose oxidase (GOx)), H2O2-dependent enzymes (chloroperoxidase (CPO) or horseradish peroxidase (HRP)), and a H2O2 scavenger (catalase (CAT)) was deployed in a flow reactor. Immobilization of the enzymes on a graphite rod was achieved through electrochemically driven physical adsorption, followed by cross-linking with glutaraldehyde. Modeling studies indicated that the flow in the reactor was laminar (Reynolds number, R e < 2000) and was nearly fully developed at the midplane of the annular reactor. Immobilized CAT and GOx displayed good stability, retaining 79% and 84% of their initial activity, respectively, after three cycles of operation. Conversely, immobilized CPO exhibited a considerable reduction in activity after one use, retaining only 30% of its initial activity. The GOx-CAT-GRE system enabled controlled delivery of H2O2 in a more stable manner with a 4-fold enhancement in the oxidation of indole compared to the direct addition of H2O2. Using CPO in solution coupled with GOx-CAT-GRE yields of 90% for the oxidation of indole to 2-oxyindole and of 93% and 91% for the chlorination of thymol and carvacrol, respectively.

Carbon utilization and storage through rehabilitation of groundwater wells.

According to the Intergovernmental Panel on Climate Change (IPCC) of the United Nations (UN), rise in atmospheric concentration of carbon dioxide (CO 2 ) due to anthropogenic factors is considered as the primary driver for global climate change. With almost every major corporation around the world working towards their "net-zero goals", it is becoming increasingly important to have more technologies that can help reduce carbon footprint. Achieving sequestration of CO 2 in the subsurface through Carbon Capture Utilization and Storage (CCUS) technologies like CO 2 -Enhanced Oil Recovery, CO 2 -Enhanced Geothermal Systems, CO 2 -Enhanced Coal Bed Methane, etc. is well accepted. We introduce yet another attractive CCUS opportunity through well rehabilitation. Aqua Freed® and Aqua Gard® are well-known well rehabilitation and preventive well maintenance technologies that utilize (inject underground) liquid CO 2 for the purpose. The goal of this study was to quantify the storage capacity of Aqua Freed® and Aqua Gard®, and establish their CCUS credentials. Depending on the well being serviced, these technologies can inject up to 40 US tons of CO 2 per well. Based on field data collection and statistical modeling, we estimated that 82-96% (median 90%) of the injected CO 2 remains in the subsurface post injection. Overall, our results and analysis of the US market suggest that using CO 2 for well rehabilitation and maintenance has a storage potential of several megatonnes of CO 2 annually in the US alone.

Acute Hepatitis E Virus Infection Triggering Autoimmune Hepatitis in a Patient With Chronic Liver Disease: Case Report and the Review of the Literature.

Acute viral hepatitis E (HEV) is the most common form of acute viral hepatitis in India. It is associated with self-limiting disease in most cases. However, the chronic form of HEV is also being increasingly recognized. Other viral infections like the hepatitis A virus (HAV) have been implicated in inciting autoimmune hepatitis. HEV infection has been associated with the formation of circulating liver-directed autoantibodies, however autoimmune liver disease following acute HEV infection has been rarely reported. Here we present a case of a 72-year-old diabetic lady who presented to us with an asymptomatic rise of liver enzymes. Investigations suggested metabolic dysfunction associated with steatotic liver disease. After three months of the diagnosis, she developed acute-on-chronic liver failure and her anti-HEV came out positive. She was managed accordingly. Afterwards patient had persistent high liver enzymes, so she underwent a liver biopsy. Her liver biopsy was compatible with autoimmune hepatitis.

Implications of Gender on the Outcome in Patients With Autoimmune Hepatitis.

BACKGROUND: Autoimmune hepatitis (AIH) is uncommon and predominantly affects females. Data on AIH from India are scanty. We retrospectively analyzed the spectrum and outcome of adults with AIH and compared it between male and female patients. METHODS: AIH was diagnosed using a simplified AIH score. For suspected seronegative AIH, the revised score was used. Standard therapies for AIH and portal hypertension were administered and response was assessed at six months. Relapse rates and five-year mortality were also evaluated. RESULTS: Of the 157 patients with AIH, 85 (male: female 25: 60) were included in the study. The median age at diagnosis was 46 (interquartile range (IQR) 32-55.5) years in males vs 45 (IQR 34.2-54) years in females (p=0.91). A similar proportion of male and female patients presented with cirrhosis, acute severe AIH, or AIH-related acute on chronic liver failure (ACLF); Extra-hepatic autoimmune diseases were less common in male patients (16% vs 35.5% p=0.02). Other laboratory and histological features were comparable in both groups. During the median follow-up period of 51 months (IQR 45-67 months). The biochemical and clinical response at six months were seen in 64% of male patients and 63.3% of female patients (p= 0.57). Of patients, 75% relapsed in the male AIH group (12 of 16 patients) after initial remission compared to 42% in the female group (p=0.02). Five-year mortality was 14.1%, and no patient developed hepatocellular carcinoma. CONCLUSION: Male and female patients with AIH have similar clinical, biochemical, and histological profiles. More male patients relapsed after an initial response to therapy.

Dense Oil in Water Emulsions using Vortex-Based Hydrodynamic Cavitation: Effective Viscosity, Sauter Mean Diameter, and Droplet Size Distribution.

Vortex-based hydrodynamic cavitation offers an effective platform for producing emulsions. In this work, we have investigated characteristics of dense oil in water emulsions with oil volume fractions up to 60% produced using a vortex-based cavitation device. Emulsions were prepared using rapeseed oil with oil volume fractions of 0.15, 0.3, 0.45, and 0.6. For each of these volume fractions, the pressure drop as a function of the flow rate of emulsions through the cavitation device was measured. These data were used for estimating the effective viscosity of the emulsions. The droplet size distribution of the emulsions was measured using the laser diffraction technique. The influence of the number of passes through the cavitation device on droplet size distributions and the Sauter mean diameter was quantified. It was found that the Sauter mean diameter (d32) decreases with an increase in the number of passes as n-0.2. The Sauter mean diameter was found to be almost independent of oil volume fraction (αo) up to a certain critical volume fraction (αoc). Beyond αoc, d32 was found to be linearly proportional to a further increase in oil volume fraction. As expected, the turbidity of the produced emulsions was found to be linearly proportional to the oil volume fraction. The slope of turbidity versus oil volume fraction can be used to estimate the Sauter mean diameter. A suitable correlation was developed to relate turbidity, volume fraction, and Sauter mean diameter. The droplet breakage efficiency of the vortex-based cavitation device for dense oil in water emulsions was quantified and reported. The breakage efficiency was found to increase linearly with an increase in oil volume fraction up to αoc and then plateau with a further increase in the oil volume fraction. The breakage efficiency was found to decrease with an increase in energy consumption per unit mass (E) as E-0.8. The presented results demonstrate the effectiveness of a vortex-based cavitation device for producing dense oil in water emulsions and will be useful for extending its applications to other dense emulsions.

Comparative evaluation of remineralization potential of four different remineralization agents on human enamel: An in vitro study.

Aim: The study aimed to assess the remineralizing potential of four different commercially available agents using a Scanning Electron Microscope (SEM), energy dispersive X-ray (EDX) analysis, and Vickers Microhardness (VMH) Test. Materials and Methods: Forty-four specimens (n = 11 per group) were prepared from extracted teeth. A window of 6 mm × 4 mm was made on all the specimens that represented three zones, namely, sound enamel, demineralized enamel, and remineralized enamel. The zone for demineralized enamel was subjected to four different remineralizing agents; casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), tricalcium phosphate fluoride (TCP-F), calcium sucrose phosphate (CSP), and self-assembling peptide (P11-4). Remineralization (REM) was assessed using VMH; the structural changes were assessed using SEM that was analyzed using EDX analysis. The specimens were subjected to a newer regimen of demineralization. One-way ANOVA followed by post hoc Tukey test was used with a level of significance at P ≤ 0.05. Results: There were no significant differences in VMH between the groups for sound enamel (P = 0.472) and demineralized enamel (P = 0.116). VMH was statistically significantly more for P11-4 and the least for CPP-ACPF (P = 0.011). A post hoc analysis revealed higher VMH for P11-4 compared to CPP-ACPF (P = 0.014) and TCP-F (P = 0.035). SEM showed a homogeneous layer of minerals for all groups except CPP-ACPF. TCP-F reported a higher degree of REM, followed by P11-4 as assessed using EDX analysis. Conclusion: Self-assembling peptide (P11-4) exhibited a higher degree of REM than other remineralizing agents followed by CSP.

Degradation of methyl orange using hydrodynamic Cavitation, H2O2, and photo-catalysis with TiO2-Coated glass Fibers: Key operating parameters and synergistic effects.

Advanced oxidation processes (AOPs) are eco-friendly, and promising technology for treating dye containing wastewater. This study focuses on investigating the removal of methyl orange (MO), an azo dye, from a synthetic wastewater through the use of hydrodynamic cavitation (HC), both independently and in combination with hydrogen peroxide (H2O2), as an external oxidant, as well as photocatalysis (PC) employing catalyst coated on glass fibers tissue (GFT). The examination of various operating parameters, including the pressure drop and the concentration of H2O2, was systematically conducted to optimize the degradation of MO. A per-pass degradation modelwas used to interpret and describe the experimental data. The data revealed that exclusive employment of HC using a vortex-based cavitation device at 1.5 bar pressure drop, resulted in a degradation exceeding 96 % after 100 passes, equivalent to 230 min of treatment (cavitation yield of 3.6 mg/kJ for HC), with a COD mineralization surpassing 12 %. The presence of a small amount of H2O2 (0.01 %) significantly reduced the degradation time from 230 min to 36 min (16 passes), achieving a degradation of 99.8 % (cavitation yield of 6.77 mg/kJ for HC) with COD mineralization rate twice as much as HC alone, indicating a synergistic effect of 4.8. The degradation time was further reduced to 21 min by combining HC with PC using TiO2-coated glass fibers and H2O2, (cavitation yield of 11.83 mg/kJ for HC), resulting in an impressive synergistic effect of 9.2 and COD mineralization twice as high as the HC/H2O2 system. The results demonstrate that HC based hybrid AOPs can be very effective for treating and mineralizing azo dyes in water.

Social distancing and extremely preterm births in the initial COVID-19 pandemic period.

HYPOTHESIS: Increased social distancing was associated with a lower incidence of extremely preterm live births (EPLB) during the initial COVID-19 pandemic period. STUDY DESIGN: Prospective study at the NICHD Neonatal Research Network sites comparing EPLB (220/7-286/7 weeks) and extremely preterm intrapartum stillbirths (EPIS) rates during the pandemic period (March-July, weeks 9-30 of 2020) with the reference period (same weeks in 2018 and 2019), correlating with state-specific social distancing index (SDI). RESULTS: EPLB and EPIS percentages did not significantly decrease (1.58-1.45%, p = 0.07, and 0.08-0.06%, p = 0.14, respectively). SDI was not significantly correlated with percent change of EPLB (CC = 0.29, 95% CI = -0.12, 0.71) or EPIS (CC = -0.23, 95% CI = -0.65, 0.18). Percent change in mean gestational age was positively correlated with SDI (CC = 0.49, 95% CI = 0.07, 0.91). CONCLUSIONS: Increased social distancing was not associated with change in incidence of EPLB but was associated with a higher gestational age of extremely preterm births. GOV ID: Generic Database: NCT00063063.

Human alveolar lining fluid from the elderly promotes Mycobacterium tuberculosis intracellular growth and translocation into the cytosol of alveolar epithelial cells.

The elderly population is highly susceptible to developing respiratory diseases, including tuberculosis, a devastating disease caused by the airborne pathogen Mycobacterium tuberculosis (M.tb) that kills one person every 18 seconds. Once M.tb reaches the alveolar space, it contacts alveolar lining fluid (ALF), which dictates host-cell interactions. We previously determined that age-associated dysfunction of soluble innate components in human ALF leads to accelerated M.tb growth within human alveolar macrophages. Here we determined the impact of human ALF on M.tb infection of alveolar epithelial type cells (ATs), another critical lung cellular determinant of infection. We observed that elderly ALF (E-ALF)-exposed M.tb had significantly increased intracellular growth with rapid replication in ATs compared to adult ALF (A-ALF)-exposed bacteria, as well as a dampened inflammatory response. A potential mechanism underlying this accelerated growth in ATs was our observation of increased bacterial translocation into the cytosol, a compartment that favors bacterial replication. These findings in the context of our previous studies highlight how the oxidative and dysfunctional status of the elderly lung mucosa determines susceptibility to M.tb infection, including dampening immune responses and favoring bacterial replication within alveolar resident cell populations, including ATs, the most abundant resident cell type within the alveoli.

A powerful metric for expressive language lateralization in MEG.

Magnetoencephalography (MEG) has proven valuable for presurgical language lateralization. Investigators have established that low-beta (13-23 Hz) event-related desynchrony (ERD), a neuromagnetic signature for increased neuronal firing, maps to critical language centers for expressive language tasks in MEG. The distribution of low-beta ERD is relatively bilateral in early childhood, transitioning to left lateralized by adolescence or early adulthood. Recently, we showed that a complementary signal, low-beta event-related synchrony, thought to reflect neuronal inhibition, becomes increasingly right lateralized across development. Here, we introduce a hybrid laterality index for language derived from both low-beta ERD and ERS. We present findings from a large cohort of children performing verb generation in MEG, and show that inclusion of low-beta ERS provides relatively powerful estimation of language lateralization.

Early and exclusive enteral nutrition in infants born very preterm.

OBJECTIVE: To characterise the effects of early and exclusive enteral nutrition with either maternal or donor milk in infants born very preterm (280/7-326/7 weeks of gestation). DESIGN: Parallel-group, unmasked randomised controlled trial. SETTING: Regional, tertiary neonatal intensive care unit. PARTICIPANTS: 102 infants born very preterm between 2021 and 2022 (51 in each group). INTERVENTION: Infants randomised to the intervention group received 60-80 mL/kg/day within the first 36 hours after birth. Infants randomised to the control group received 20-30 mL/kg/day (standard trophic feeding volumes). MAIN OUTCOME MEASURES: The primary outcome was the number of full enteral feeding days (>150 mL/kg/day) in the first 28 days after birth. Secondary outcomes included growth and body composition at the end of the first two postnatal weeks, and length of hospitalisation. RESULTS: The mean birth weight was 1477 g (SD: 334). Half of the infants were male, and 44% were black. Early and exclusive enteral nutrition increased the number of full enteral feeding days (+2; 0-2 days; p=0.004), the fat-free mass-for-age z-scores at postnatal day 14 (+0.5; 0.1-1.0; p=0.02) and the length-for-age z-scores at the time of hospital discharge (+0.6; 0.2-1.0; p=0.002). Hospitalisation costs differed between groups (mean difference favouring the intervention group: -$28 754; -$647 to -$56 861; p=0.04). CONCLUSIONS: In infants born very preterm, early and exclusive enteral nutrition increases the number of full enteral feeding days. This feeding practice may also improve fat-free mass accretion, increase length and reduce hospitalisation costs. TRIAL REGISTRATION NUMBER: NCT04337710.

Enhancing the Efficiency and Stability of Perovskite Solar Cells through Defect Passivation and Controlled Crystal Growth Using Allantoin.

In this study, we present a robust approach that concurrently manages crystal growth and defect passivation within the perovskite layer through the introduction of a small molecule additive─allantoin. The precise regulation of crystal growth in the presence of allantoin yields perovskite films characterized by enhanced morphology, larger grain size, and improved grain orientation. Notably, the carbonyl and amino groups present in allantoin passivate under-coordinated Pb2+ and I- defects, respectively, through molecular interactions. Trap density in the perovskite layer is measured, and it is 0.39 × 1016 cm-3 for the allantoin-incorporated device and 0.83 × 1016 cm-3 for the pristine device. This reduction in defects leads to reduced trap-assisted nonradiative recombination, as confirmed by the photoluminescence, transient photo voltage, and impedance measurements. As a result, when these allantoin-incorporated perovskite films are implemented as the active layer in solar cells, a noteworthy efficiency enhancement to 20.63% is attained, surpassing the 18.04% of their pristine counterparts. Furthermore, devices with allantoin exhibit remarkable operational stability, maintaining 80% of their efficiency even after 500 h of continuous illumination, whereas the pristine device degraded to 65% of its initial efficiency in 400 h. Also, allantoin-incorporated devices exhibited exceptional stability against high humidity and elevated temperatures.

Novel Machine Learning-Based Method for Estimation of the Surface Area of Porous Silica Particles.

This work reports a novel and quick method to estimate the surface area of porous materials. Conventionally, surface area measurement requires the BET method/N2 adsorption experiment which is time-consuming. In this work, we developed a method based on machine learning (ML) and the adsorption of a conductive dye on porous materials. The rate and quantity of dye adsorption, which is characterized by dynamic measurement of conductivity, provide an indirect measure of surface area and zeta potential. An ML-based soft sensor is developed to relate the measured conductivity profiles with surface area and zeta potential. A phenomenological model on dye adsorption is also developed, validated, and used to augment experimental data for training the soft sensor. The developed method was tested for porous silica particles with a range of surface areas (250-1100 m2/g) and zeta potential (-17 mV: -29 mV). The developed soft sensor was able to estimate the surface area and zeta potential quite well. The developed approach and method reduce overall measurement time for surface area from several hours to a few minutes. The method can potentially be implemented in continuous plants producing porous materials like silica.