Temporal Trends in Severe Brain Injury and Associated Outcomes in Very Preterm Infants.

INTRODUCTION: Severe brain injury (SBI), including severe intraventricular haemorrhage (sIVH) and cystic periventricular leukomalacia, poses significant challenges for preterm infants, yet recent data and trends are limited. METHODS: Analyses were conducted using the Australian and New Zealand Neonatal Network data on preterm infants born <32 weeks' gestation admitted at Monash Children's Hospital, Australia, from January 2014 to April 2021. The occurrence and trends of SBI and sIVH among preterm infants, along with the rates and trends of death and neurodevelopmental impairment (NDI) in SBI infants were assessed. RESULTS: Of 1,609 preterm infants, 6.7% had SBI, and 5.6% exhibited sIVH. A total of 37.6% of infants with SBI did not survive to discharge, with 92% of these deaths occurring following redirection of clinical care. Cerebral palsy was diagnosed in 65.2% of SBI survivors, while 86.4% of SBI survivors experienced NDI. No statistically significant differences were observed in the temporal trends of SBI (adjusted OR [95% CI] 1.08 [0.97-1.20]; p = 0.13) or sIVH (adjusted OR [95% CI] 1.09 [0.97-1.21]; p = 0.11). Similarly, there was no statistically significant difference noted in the temporal trend of the composite outcome, which included death or NDI among infants with SBI (adjusted OR [95% CI] 0.90 [0.53-1.53]; p = 0.71). CONCLUSION: Neither the rates of SBI nor its associated composite outcome of death or NDI improved over time. A notable proportion of preterm infants with SBI faced redirection of care and subsequent mortality, while most survivors exhibited adverse neurodevelopmental challenges. The development of better therapeutic interventions is imperative to improve outcomes for these vulnerable infants.

High Flow Nasal Cannula for Weaning Nasal Continuous Positive Airway Pressure in Preterm Infants: A Systematic Review and Meta-Analysis.

INTRODUCTION: The aim of this study was to systematically review the benefits and harms of using a high-flow nasal cannula (HFNC) for weaning continuous positive airway pressure (CPAP) support in preterm infants. METHODS: Cochrane Central, EMBASE, Medline, and Web of Science were searched from inception to July 15, 2023. Randomised clinical trials (RCTs) comparing weaning CPAP using HFNC versus weaning CPAP alone and evaluating predefined outcomes were included. Two authors independently performed data extraction and methodological quality assessment. Meta-analysis was conducted using a random-effects model, and the certainty of evidence was assessed using Cochrane GRADE. RESULTS: Among 843 identified records, seven RCTs involving 781 preterm infants were eligible for analysis. The meta-analysis found no statistically significant difference in duration of respiratory support when using HFNC for weaning compared to weaning CPAP alone (mean difference (95% confidence interval) 3.52 (-0.02, 7.05); 5 RCTs; participants = 488; I2 = 29%). The evidence certainty was downgraded to low due to study limitations and imprecision. There were no significant differences in secondary outcomes, except for a lower occurrence of nasal trauma with HFNC for weaning CPAP compared to weaning CPAP alone (relative risk (95% confidence interval) 0.61 (0.38, 0.99); 4 RCTs; participants = 335; I2 = 0%). The evidence certainty for the secondary outcomes was low to very low. CONCLUSION: Low certainty of evidence suggests using HFNC for weaning CPAP in preterm infants may not impact the duration of respiratory support. Caution is advised when considering HFNC for weaning CPAP, especially in extremely preterm infants, until additional supportive evidence on its safety becomes available.

Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia.

Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights. Materials and Methods: We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother's age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI). Results: A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62-7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46-0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67-8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24-8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32-0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively. Conclusions: Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions.

Influence of Alloying Materials Al, Cu, and Ca on Microstructures, Mechanical Properties, And Corrosion Resistance of Mg Alloys for Industrial Applications: A Review.

Magnesium is renowned for its favorable low-density attributes, rendering it a viable choice for commercial engineering applications in which weight has substantial design implications. Magnesium (Mg) stands as a readily obtainable metallic element, exhibiting robustness, efficient heat dissipation, and excellent damping properties. The utilization of pure magnesium remains infrequent due to its susceptibility to instability under high temperatures and pronounced vulnerability to corrosion within humid environments. Hence, the incorporation of magnesium alloys into the design process of aircraft, automotive, and biomedical applications assumes paramount importance. This Review presents a comprehensive review of research endeavors and their resultant achievements concerning the advancement of magnesium alloys. Specifically focusing on aerospace, automotive, and biomedical applications, the Review underscores the pivotal role played by alloying constituents, namely aluminum (Al), copper (Cu), calcium (Ca), and PEO coatings, in influencing the microstructural attributes, mechanical potency, and resistance to corrosion.

Effect of silicon carbide on kerf convergence and irregularity of the surface during abrasive water jet machining of fiber-metal hybrid composites.

The traditional way to machine hybrid composites is hard because they tend to break, have a high retraction, have a high service temperature, and have an uneven surface irregularity. For high-strength fiber/metal composite constructions, alternative machining methods have drawn interest as a solution to these problems. Current research focuses on enhancing the Abrasive Water Jet Machining process by optimizing its variables using a composite material of epoxy reinforced with silicon carbide, stainless steel wire mesh, and Kevlar. The variables assessed are the Nozzle-to-substrate gap (S), the Abrasive discharge molding and different percentages of silicon carbide (SiC) filler (0%, 3%, and 6% by weight), three different types of hybrid laminates (H1, H2, and H3) were produced. The response surface method (RSM) was utilized in this learning, specifically on a central composite design, to calculate and optimize machining variables based on the Kerf convergence ratio (Kt) and Surface irregularity (Ra) as responses. According to the results, the traverse feed velocity, Abrasive discharge proportion, and Nozzle-to-substrate gap are the critical factors in determining Surface irregularity and Kerf convergence width (H1 laminate) for a fiber/metal laminate with 0%, 3% and 6% weight fraction. In the case of a 3% weight fraction H2 laminate, the traverse feed velocity was identified as the primary factor affecting the Kerf convergence ratio. In contrast, traverse feed velocity and Nozzle-to-substrate gap had the most significant influence on Surface irregularity. The findings also indicated that S, followed by Abrasive discharge proportion and traverse feed velocity, are the variables that have the most significant influence when cutting 6 wt% SiC filler particle fiber/metal laminate (H3 laminate). For Surface irregularity, the combination of traverse feed velocity and Nozzle-to-substrate gap had the most significant impact. To validate the optimization results, confirmatory tests was conducted, and the findings were very similar to the experimental values, indicating the accuracy and effectiveness of the optimization process. To better understand the manufacturing processes, a scanning electron microscope was used to examine the morphological features of the machined surfaces, such as delamination, fibre breakage, and fibre pull-out.

Experimental Investigation and Characterization of Friction Stir Spot-Welded Dissimilar Aluminum Copper Metallic Lap Joints.

Due to their contrasting physical properties, joining materials like copper and aluminum has always proven difficult. The disadvantages of traditional joining methods include additional weight, solidification problems, and energy waste. Friction stir spot-welding (FSSW) was utilized for joining copper and aluminum in order to get around these difficulties. This study illustrates that friction stir spot-welding (FSSW) produces joints between incompatible copper and aluminum alloys with better mechanical and electrical properties. The numerous FSSW parameters play an important role in deciding how well the welded joint performs. Tool rotational speed (TRS), plunge rate (PR), and dwell duration (DT) are the study parameters. During manufacture, a case-hardened H13 tool was used to lap-joint AA 6061 T6 hot-rolled aluminum flat strips with C11000 copper strips while operating at three different levels of TRS, PR and DT. SEM analysis was utilized to investigate the interface region and bimetallic interface of the joints. In order to demonstrate modifications in the grain-related characteristics, the joints were examined for electrical conductivity, mechanical strength (lap shear, bending, and microhardness test), and analysis of the microstructure at the weld zones. The outcome demonstrates that other factors, such as plunge rate, dwell time, and tool rotation speed, had the greatest impact on the joints' electrical conductivity, mechanical strength, and microstructure.

Elastoplastic Analysis of Metallic Parts Employing a Meshless Method.

The use of finite element method-based approaches has been popular in studying the elastoplastic behavior of metal parts. However, there has been a growing demand for meshless methods. In response, researchers have developed a meshless solution for 2D elastoplastic evaluation of metal components. This approach obtains the locally symmetric weak form of the governing elastoplastic integral equations at each node throughout the problem area and boundary. The elastoplastic constitutive relationships consider a small deformation rate independent associative flow theory applicable to isotropic hardening materials. The proposed solution algorithm can handle loading, unloading, and reverse loading. Numerical results were computed using Gaussian and spline weight functions, and the presented meshless solution proved to be robust and accurate for conducting the elastoplastic investigation of metallic parts. Furthermore, the Gaussian weight function was found to be more robust than the spline weight function. In conclusion, this paper presents a reliable meshless solution for elastoplastic analysis and highlights the advantages of using Gaussian weight functions.

Influence of Graphite Particles on the Mechanical and Wear Characterization of Al6082 Alloy Composites.

In the current study, a two-stage stir cast process was used to produce Al6082 reinforced with sized graphite particulates, and the material's mechanical and tribological properties were analyzed. The graphite content in the Al6082 alloy was increased from 2 to 6% in steps of 2 wt %. The impact of graphite addition to Al6082 was evaluated using microstructural micrographs, hardness test, tensile test, and wear test outcomes. The matrix alloy's microstructure and particle distribution were analyzed using scanning electron microscopy and energy-dispersive spectroscopy. The microstructure of Al6082 shows that the reinforcement particles are evenly distributed throughout the matrix. Although the hardness of metal-matrix composites was slightly reduced when graphite was added at concentrations of up to 6 wt %, the material's tensile strength and wear resistance were significantly improved. Micrographs taken by a microscope were used to examine the fractured surfaces of tensile test specimens. Wear experiments were performed using a conventional pin-on-disc tribometer to examine the tribological properties of both unreinforced matrix and graphite composites. With the addition of 2, 4, and 6 wt % of graphite particles, the composites' wear resistance was significantly improved. Wear of alloys and their composites was analyzed to determine how load and sliding speed impacted wear loss.

Allogeneic Cell Therapy Applications in Neonates: A Systematic Review.

BACKGROUND: Neonatal cell therapy applications are increasing; however, data on allogeneic cell therapy are limited. OBJECTIVE: To summarize evidence on allogeneic cell therapy in term and preterm neonates. METHODS: Cochrane Central Register of Controlled Trials, Embase, Ovid Medline, and various registries were searched for studies investigating the safety, feasibility, and efficacy of allogeneic cell therapy in neonates. Two authors independently selected the articles, extracted data, and assessed the risk of bias. RESULTS: Twelve published (153 infants) and 21 ongoing studies were included. These studies predominantly sourced allogeneic cells from umbilical cord blood (UCB). Mesenchymal stromal cells (MSCs) were the main cell type used (134 of 153 infants); others included UCB-derived total nucleated cells (TNCs) and human amnion epithelial cells (hAECs). Applications included bronchopulmonary dysplasia (BPD; 113 infants), Krabbe disease (13 infants), intraventricular haemorrhage (10 infants), perinatal arterial ischemic stroke (10 infants), hypoxic-ischaemic encephalopathy (6 infants), and necrotizing enterocolitis (1 infant). Nine out of 12 studies did not report any serious adverse events (SAEs) related to cell administration. Three studies reported SAEs, such as graft versus host disease (GVHD) in 5 infants (UCB-derived TNCs for Krabbe disease); and transient cardiorespiratory compromise in 1 infant (hAECs for BPD). Data on efficacy outcomes were limited. CONCLUSION: The safety and feasibility of allogeneic cell therapy applications in neonates are available, mainly from the use of MSCs. Further safety data for other cell types are required, and the risk of GVHD in different settings needs to be determined. Efficacy studies are largely lacking for all cell types. PROTOCOL REGISTRATION: The protocol was registered with PROSPERO (registration number CRD42023397876), the international prospective register for systematic reviews (https://www.crd.york.ac.uk/PROSPERO).

Impact of Boron Carbide Particles and Weight Percentage on the Mechanical and Wear Characterization of Al2011 Alloy Metal Composites.

Micron-sized B4C addition to the Al2011 alloy was investigated for its impact on mechanical and wear performance. The stir-casting method was used to manufacture the Al2011 alloy metal matrix composites reinforced with varying percentages of B4C particulates (2, 4, and 6). The microstructural, mechanical, and wear properties of the synthesized composites were tested. scanning electronic microscope (SEM) microscopy and XRD patterns were used to characterize the microstructure of the samples that were obtained. The XRD patterns confirmed the presence of B4C particles. The addition of B4C reinforcement increased the metal composite's hardness, tensile strength, and compressive strength. Incorporating the reinforcement resulted in a decrease in elongation for the Al2011 alloy composite. The wear behavior of the prepared samples was examined under various load and speed conditions. In terms of wear resistance, the microcomposites were far superior. SEM observations of the Al2011-B4C composites revealed numerous fracture and wear mechanisms.

Glass Fiber-Epoxy Composites with Carbon Nanotube Fillers for Enhancing Properties in Structure Modeling and Analysis Using Artificial Intelligence Technique.

Hybrid composite materials are a form of material that incorporates more than one type of reinforcement into a matrix to attain enhanced qualities. This usually includes the use of nanoparticle fillers in classic advanced composites with fiber reinforcements such as carbon or glass. In the current investigation, the impact of carbon nanopowder filler on the wear and thermal performance of the chopped strand mat E-glass fiber-reinforced epoxy composite (GFREC) were analyzed. Multiwall carbon nanotube (MWCNT) fillers were used; they react with the resin system to contribute a significant improvement of properties in the polymer cross-linking web. The experiments were carried out employing the central composite method of design of experiment (DOE). A polynomial mathematical model was created using response surface methodology (RSM). To forecast the wear rate of composites, four machine learning (ML) regression models were built. The study's findings indicate that the addition of carbon nanopowder has a substantial impact on the wear behavior of composites. This is mostly owing to the homogeneity created by the carbon nanofillers in uniformly dispersing the reinforcements in the matrix phase. Results revealed that a load of 1.005 kg, a sliding velocity of 1.499 m/s, a sliding distance of 150 m, and 15 wt % of filler were found to be the optimal parameters for the efficient reduction of specific wear rate. Composites with 10 and 20% carbon contents exhibit lower thermal expansion coefficients than plain composites. These composites' coefficients of thermal expansion fell by 45 and 9%, respectively. If the carbon proportion increases beyond 20%, so will the thermal coefficient of expansion.

Preparation of purified vaccine from local isolate of foot and mouth disease virus and its immune response in bovine calves.

Foot and Mouth Disease (FMD) is globally pandemic which badly affect the economics of livestock based countries like Pakistan. There are different types of Foot and Mouth Disease Virus (FMDV) among these types O is most prevalent in Pakistan. Recently Pakistan is producing approximately fifteen million doses of non-purified FMD vaccine against the demand of 160 million doses annually. More over the Pakistan is still striving for the development and optimization of concentration as well as purification of FMDV. The present project was designed to develop the technology for the purification of FMDV indigenously. The locally isolated and adapted FMDV type O virus was propagated on adherent culture of BHK-21cells to get final volume of virus one liter. This virus suspension was concentrated by peggylation as well as ultra-filtration method. The purification and quantification of concentrated virus was done by size exclusion chromatography. The results showed that peggylation is better method of concentration up to 603.75 µg/ml with 82.80 % recovery rate than ultra-filtration with 43.90 % followed by chromatography for purification. The PD50 was calculated in bovines at 24, 12, 6, 3 and 1.5 µg of FMDV Ag/dose and it revealed that antigen load of 1.98 µg is the dose, where the 50 % of inoculated animals showed the protective antibody level based upon percent inhibition through antibody detecting ELISA. According to the British pharmacopeia, the vaccine should contain 3PD50 which found equivalent to our findings about 6 µg/dose. The group of animal injected with 6/dose (3.23PD50) showed protective titer up to 20th week post priming.

Impact of Bonding Temperature on Microstructure, Mechanical, and Fracture Behaviors of TLP Bonded Joints of Al2219 with a Cu Interlayer.

The present study aims at producing transient liquid phase (TLP) bonded Al2219 joints with pure Cu (copper) as an interlayer. The TLP bonding is carried out at the bonding temperatures in the range of 480 to 520 °C while keeping the bonding pressure (2 MPa) and time (30 min.) constant. Reaction layers are formed at the Al-Cu interface with a significant increase in diffusion depth with the increase in the bonding temperature. The microstructural investigations are carried out using scanning electron microscopy and energy-dispersive spectroscopy. X-ray diffraction study confirms the formation of CuAl2, CuAl, and Cu9Al4 intermetallic compounds across the interface of the bonded specimens. An increase in microhardness is observed across the bonding zone with the increase in the bonding temperature, and a maximum hardness value of 723 Hv is obtained on the diffusion zone of the specimen bonded at 520 °C. Furthermore, the fractography study of the bonded specimens is carried out, and a maximum shear strength of 18.75 MPa is observed on the joints produced at 520 °C.

Role of dietary polyphenols in non-communicable chronic disease prevention, and interactions in food systems: An overview.

Polyphenols is a major group of non-nutrients, considering their diversity, occurrence, and biological properties. Polyphenols play essential roles in the prevention of chronic diseases through the mitigation of inflammation, commonly referred to as meta-flammation. Inflammation is the most common feature of chronic diseases such as cancers, cardiovascular disorders, diabetes, and obesity. This aim of this review was to present a wide spectrum of literature data, including the current understanding of the role of polyphenols in the prevention and management of chronic diseases and their ability to interact with other food compounds in food systems. The publications cited are based on animal models, cohort studies, case controls, and feeding experiments. The significant effects of dietary polyphenols in cancers and cardiovascular diseases are evaluated. The interactive possibilities of dietary polyphenols with other dietary food compounds in food systems and their effects are also presented. However, despite several works, estimation of dietary intake is still inconclusive and a major challenge.

Early neurodevelopmental outcomes of extreme preterm infants exposed to paracetamol: a retrospective cohort study.

BACKGROUND: Paracetamol is commonly used for analgesia and patent ductus arteriosus (PDA) treatment in preterm infants. We aimed to evaluate early neurodevelopmental outcomes of extreme preterm infants exposed to paracetamol during their neonatal admission. METHODS: This retrospective cohort study included surviving infants born at <29 weeks gestation, or with a birth weight of <1000 grams. Neurodevelopmental outcomes studied were early cerebral palsy (CP) or high risk of CP diagnosis, Hammersmith Infant Neurological Examination (HINE) score and Prechtl General Movement Assessment (GMA) at 3-4 months corrected age. RESULTS: Two hundred and forty-two infants were included, of which 123 were exposed to paracetamol. After adjusting for birth weight, sex and chronic lung disease, there were no significant associations between paracetamol exposure and early CP or high risk of CP diagnosis (aOR 1.46, 95% CI 0.61, 3.5), abnormal or absent GMA (aOR 0.82, 95% CI 0.37, 1.79) or HINE score (adjusted ß -0.19, 95% CI -2.39, 2.01). Subgroup analysis stratifying paracetamol exposure into <180 mg/kg or ≥180 mg/kg cumulative dose found that neither had significant effects on outcomes. CONCLUSIONS: In this cohort of extreme preterm infants, no significant association was found between exposure to paracetamol during the neonatal admission and adverse early neurodevelopment. IMPACT: Paracetamol is commonly used in the neonatal period for analgesia and patent ductus arteriosus treatment in preterm infants, although prenatal paracetamol use has been associated with adverse neurodevelopmental outcomes. Exposure to paracetamol during the neonatal admission was not associated with adverse early neurodevelopment at 3-4 months corrected age in this cohort of extreme preterm infants. The findings from this observational study is consistent with the small body of literature supporting the lack of association between neonatal paracetamol exposure and adverse neurodevelopmental outcomes in preterm infants.

Al2014-Alumina Aerospace Composites: Particle Size Impacts on Microstructure, Mechanical, Fractography, and Wear Characteristics.

An Al2014-alumina (Al2O3) composite's characteristics are significantly influenced by the reinforcement particle size variation. Therefore, this study examines the microstructure, mechanical, fractography, and wear performance of an Al2014-Al2O3p composite made using a unique two-stage stir casting method and various alumina weight fractions (9, 12, and 15 wt %). Three categories of alumina particle size are used, i.e., fine particle size (FPS, 8 µm), intermediate particle size (IPS, 53 µm), and coarse particle size (CPS, 88 µm). The shapes of the composites were characterized using scanning electron microscopy. According to scanning electron microscopic analyses of the microstructure, the FPS dispersion was more uniform than IPS and CPS, whereas CPS causes agglomeration. Additionally, the studies show that the FPS composite outperformed CPS and IPS composites in terms of mechanical characteristics and wear performance. The fractography study shows conical and equiaxed dimple failure in the Al2014 matrix and the circular cavities.

Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates: A Systematic Review and Meta-analysis.

Importance: Interventions to reduce severe brain injury risk are the prime focus in neonatal clinical trials. Objective: To evaluate multiple perinatal interventions across clinical settings for reducing the risk of severe intraventricular hemorrhage (sIVH) and cystic periventricular leukomalacia (cPVL) in preterm neonates. Data Sources: MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception until September 8, 2022, using prespecified search terms and no language restrictions. Study Selection: Randomized clinical trials (RCTs) that evaluated perinatal interventions, chosen a priori, and reported 1 or more outcomes (sIVH, cPVL, and severe brain injury) were included. Data Extraction and Synthesis: Two co-authors independently extracted the data, assessed the quality of the trials, and evaluated the certainty of the evidence using the Cochrane GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Fixed-effects pairwise meta-analysis was used for data synthesis. Main Outcomes and Measures: The 3 prespecified outcomes were sIVH, cPVL, and severe brain injury. Results: A total of 221 RCTs that assessed 44 perinatal interventions (6 antenatal, 6 delivery room, and 32 neonatal) were included. Meta-analysis showed with moderate certainty that antenatal corticosteroids were associated with small reduction in sIVH risk (risk ratio [RR], 0.54 [95% CI, 0.35-0.82]; absolute risk difference [ARD], -1% [95% CI, -2% to 0%]; number needed to treat [NNT], 80 [95% CI, 48-232]), whereas indomethacin prophylaxis was associated with moderate reduction in sIVH risk (RR, 0.64 [95% CI, 0.52-0.79]; ARD, -5% [95% CI, -8% to -3%]; NNT, 20 [95% CI, 13-39]). Similarly, the meta-analysis showed with low certainty that volume-targeted ventilation was associated with large reduction in risk of sIVH (RR, 0.51 [95% CI, 0.36-0.72]; ARD, -9% [95% CI, -13% to -5%]; NNT, 11 [95% CI, 7-23]). Additionally, early erythropoiesis-stimulating agents (RR, 0.68 [95% CI, 0.57-0.83]; ARD, -3% [95% CI, -4% to -1%]; NNT, 34 [95% CI, 22-67]) and prophylactic ethamsylate (RR, 0.68 [95% CI, 0.48-0.97]; ARD, -4% [95% CI, -7% to 0%]; NNT, 26 [95% CI, 13-372]) were associated with moderate reduction in sIVH risk (low certainty). The meta-analysis also showed with low certainty that compared with delayed cord clamping, umbilical cord milking was associated with a moderate increase in sIVH risk (RR, 1.82 [95% CI, 1.03-3.21]; ARD, 3% [95% CI, 0%-6%]; NNT, -30 [95% CI, -368 to -16]). Conclusions and Relevance: Results of this study suggest that a few interventions, including antenatal corticosteroids and indomethacin prophylaxis, were associated with reduction in sIVH risk (moderate certainty), and volume-targeted ventilation, early erythropoiesis-stimulating agents, and prophylactic ethamsylate were associated with reduction in sIVH risk (low certainty) in preterm neonates. However, clinicians should carefully consider all of the critical factors that may affect applicability in these interventions, including certainty of the evidence, before applying them to clinical practice.

Slow Heat-Based Hybrid Simulated Annealing Algorithm in Vehicular Ad Hoc Network.

Vehicular ad hoc networks (VANETs) using reliable protocols of routing have become crucial in identifying the changes to topology on a continuous basis for a large collection of vehicles. For this purpose, it becomes important to identify an optimal configuration of these protocols. There are several possible configurations that have been preventing the configuration of efficient protocols that do not make use of automatic and intelligent design tools. It can further motivate using the techniques of metaheuristics like the tools, which are well-suited to be able to solve these problems. The glowworm swarm optimization (GSO), simulated annealing (SA), and slow heat-based SA-GSO algorithms have been proposed in this work. The SA is a method of optimization, which imitates the manner in which the thermal system has been frozen down to its lowest state of energy. In the GSO, there is guidance to the rules of feasibility, where the swarm converges to its feasible regions very fast. Additionally, for overcoming any premature convergence, there is a local search strategy that is based on the SA and is used for making a search that is near to its true optimum solutions. Finally, this sluggish temperature-based SA-GSO algorithm will be employed to solve routing problems and problems of heat transfer. There is a hybrid slow heat SA-GSO algorithm with a faster speed of convergence and higher precision of computation that is more effective in solving problems of constrained engineering.