bluuebunny/crossref_metadata_2025 huggingface dataset:
Weight Optimisation of Electric Vehicle through Hybrid Structural Batteries
Authors: Akbar Faraz
Published: January 2021

This paper contributes towards the research and development campaign on the weight reduction of electric vehicles through the technology of structural composite batteries. Batteries are the key component and an integral part of electric vehicles which constitutes a major proportion of the vehicle’s weight. Most of the electric vehicle manufacturers use lithium-ion batteries which are in recent years have gone through a major development. The use of lithium-ion batteries within a carbon reinforced composite structure of the car has given rise to the concept of structural batteries where both the mechanical strength of the structure and the chemistry of the battery to be optimized. Various aspects of design in the formulation of the structural batteries are reviewed including material selection with respect to its electrical and mechanical requirements. In this research work, properties of carbon fiber are utilised which provide mechanical strength to the vehicle whilst be an efficient electrode for the lithium-ion structural batteries. The impacts of lithiation on the strength of the structure and charge time for the batteries are explored. Significant results of weight reduction have been achieved by formulating the structural battery for the roof of a passenger car having a 30 kW-hr battery. At 0.7 mm of active electrode thickness is designed within the roof structure, the roof can store 5.9 kW-hr of energy with the reduction of 56.5 kg in overall weight of the vehicle. The battery pack of 255 kg gets completely replaced by the structural composite battery because of its magnificent specific charge capacity at the active electrode with the thickness of 3.5 mm.
Generalized squared remainder minimization method for solving multi-term fractional differential equations
Authors: Hashemi Mir Sajjad , Inc Mustafa , Hajikhah Somayeh
Published: January 2021

In this paper, we introduce a generalization of the squared remainder minimization method for solving multi-term fractional differential equations. We restrict our attention to linear equations. Approximate solutions of these equations are considered in terms of linearly independent functions. We change our problem into a minimization problem. Finally, the Lagrange-multiplier method is used to minimize the resultant problem. The convergence of this approach is discussed and theoretically investigated. Some relevant examples are investigated to illustrate the accuracy of the method, and obtained results are compared with other methods to show the power of applied method.
Double Hopf bifurcation of a diffusive predator–prey system with strong Allee effect and two delays
Authors: Liu Yuying , Wei Junjie
Published: January 2021

In this paper, we consider a diffusive predator–prey system with strong Allee effect and two delays. First, we explore the stability region of the positive constant steady state by calculating the stability switching curves. Then we derive the Hopf and double Hopf bifurcation theorem via the crossing directions of the stability switching curves. Moreover, we calculate the normal forms near the double Hopf singularities by taking two delays as parameters. We carry out some numerical simulations for illustrating the theoretical results. Both theoretical analysis and numerical simulation show that the system near double Hopf singularity has rich dynamics, including stable spatially homogeneous and inhomogeneous periodic solutions. Finally, we evaluate the influence of two parameters on the existence of double Hopf bifurcation.
Quantized passive filtering for switched delayed neural networks
Authors: Zhou Youmei , Liu Yajuan , Zhou Jianping , Wang Zhen
Published: January 2021

The issue of quantized passive filtering for switched delayed neural networks with noise interference is studied in this paper. Both arbitrary and semi-Markov switching rules are taken into account. By choosing Lyapunov functionals and applying several inequality techniques, sufficient conditions are proposed to ensure the filter error system to be not only exponentially stable, but also exponentially passive from the noise interference to the output error. The gain matrix for the proposed quantized passive filter is able to be determined through the feasible solution of linear matrix inequalities, which are computationally tractable with the help of some popular convex optimization tools. Finally, two numerical examples are given to illustrate the usefulness of the quantized passive filter design methods.
Global dynamics of a stage-structured hantavirus infection model with seasonality
Authors: Liu Junli , Zhang Tailei
Published: January 2021

In this paper, we study a time-periodic model, which incorporates seasonality and host stage-structure. This model describes the propagation of Puumala hantavirus within the bank vole population of Clethrionomys glareolus. The basic reproduction number R0 is obtained. By appealing to the theory of monotone dynamical systems and chain transitive sets, we establish a threshold-type result on the global dynamics in terms of R0, that is, the virus-free periodic solution is globally attractive, and the virus dies out if R0 ≤ 1, while there exists a unique positive periodic solution, which is globally attractive, and the virus persists if R0 > 1. Numerical simulations are given to confirm our theoretical results and to show that cleaning environment and controlling the grow of mice population are essential control strategies to reduce hantavirus infection.
Iterative learning control for multi-agent systems with impulsive consensus tracking
Authors: Cao Xiaokai , Fečkan Michal , Shen Dong , Wang JinRong
Published: January 2021

In this paper, we adopt D-type and PD-type learning laws with the initial state of iteration to achieve uniform tracking problem of multi-agent systems subjected to impulsive input. For the multi-agent system with impulse, we show that all agents are driven to achieve a given asymptotical consensus as the iteration number increases via the proposed learning laws if the virtual leader has a path to any follower agent. Finally, an example is illustrated to verify the effectiveness by tracking a continuous or piecewise continuous desired trajectory.
Projective synchronization analysis for BAM neural networks with time-varying delay via novel control
Authors: Sader Malika , Wang Fuyong , Liu Zhongxin , Chen Zhongxin
Published: January 2021

In this paper, the projective synchronization of BAM neural networks with time-varying delays is studied. Firstly, a type of novel adaptive controller is introduced for the considered neural networks, which can achieve projective synchronization. Then, based on the adaptive controller, some novel and useful conditions are obtained to ensure the projective synchronization of considered neural networks. To our knowledge, different from other forms of synchronization, projective synchronization is more suitable to clearly represent the nonlinear systems’ fragile nature. Besides, we solve the projective synchronization problem between two different chaotic BAM neural networks, while most of the existing works only concerned with the projective synchronization chaotic systems with the same topologies. Compared with the controllers in previous papers, the designed controllers in this paper do not require any activation functions during the application process. Finally, an example is provided to show the effectiveness of the theoretical results.
A variational principle, coupled fixed points and market equilibrium
Authors: Kabaivanov Stanimir , Zlatanov Boyan
Published: January 2021

We present a possible kind of generalization of the notion of ordered pairs of cyclic maps and coupled fixed points and its application in modelling of equilibrium in oligopoly markets. We have obtained sufficient conditions for the existence and uniqueness of coupled fixed in complete metric spaces. We illustrate one possible application of the results by building a pragmatic model on competition in oligopoly markets. To achieve this goal, we use an approach based on studying the response functions of each market participant, thus making it possible to address both Cournot and Bertrand industrial structures with unified formal method.We show that whenever the response functions of the two players are identical, then the equilibrium will be attained at equal levels of production and equal prices. The response functions approach makes it also possible to take into consideration different barriers to entry. By fitting to the response functions rather than the profit maximization of the payoff functions problem we alter the classical optimization problem to a problem of coupled fixed points, which has the benefit that considering corner optimum, corner equilibrium and convexity condition of the payoff function can be skipped.
On a singular Riemann–Liouville fractional boundary value problem with parameters
Authors: Tudorache Alexandru , Luca Rodica
Published: January 2021

We investigate the existence of positive solutions for a nonlinear Riemann–Liouville fractional differential equation with a positive parameter subject to nonlocal boundary conditions, which contain fractional derivatives and Riemann–Stieltjes integrals. The nonlinearity of the equation is nonnegative, and it may have singularities at its variables. In the proof of the main results, we use the fixed point index theory and the principal characteristic value of an associated linear operator. A related semipositone problem is also studied by using the Guo–Krasnosel’skii fixed point theorem.
Best proximity point theorems for cyclic p-contractions with some consequences and applications
Authors: Aslantas Mustafa , Sahin Hakan , Altun Ishak
Published: January 2021

In this paper, we introduce the concept of cyclic p-contraction pair for single-valued mappings. Then we present some best proximity point results for such mappings defined on proximally complete pair of subsets of a metric space. Also, we provide some illustrative examples that compared our results with some earliest. Finally, by taking into account a fixed point consequence of our main result we give an existence and uniqueness result for a common solution of a system of second order boundary value problems.
Concise review: The role of cancer-derived exosomes in tumorigenesis and immune cell modulation
Authors: Thao Huynh Nhi , Duy Pham Khuong , Chau Truong Nhat
Published: January 2021

Exosomes are subcellular entities which were first discovered in the 1980s. Over the past decade, scientists have discovered that they carry components of genetic information that allow for cell-cell communication and cell targeting. Exosomes secreted by cancer cells are termed cancer-derived exosomes (CDEs), and play an important role in tumor formation and progression. Specifically, CDEs mediate the communication between cancer cells, as well as between cancer cells and other cells in the tumor microenvironment, including cancer-associated fibroblasts, endothelial cells, mesenchymal stem cells, and effector immune cells. Additionally, through the vascular system and body fluids, CDEs can modulate response to drugs, increase angiogenesis, stimulate proliferation, promote invasion and metastasis, and facilitate escape from immune surveillance. This review will discuss the relationship between cancer cells and other cells (particularly immune cells), as mediated through CDEs, as well as the subsequent impact on tumorigenesis and immunomodulation. Understanding the role of CDEs in tumorigenesis and immune cell modulation will help advance their utilization in the diagnosis, prognosis, and treatment of cancer.
Factors Associated With Parental Participation in Family-Centered Rounds
Authors: Glick Alexander F. , Goonan Michael , Kim Chan , Sandmeyer Diana , Londoño Kevin , Gold-von Simson Gabrielle
Published: January 2021

OBJECTIVES:

Although families positively perceive family-centered rounds (FCR), factors associated with engagement have been examined in few studies. Our objective for this study was to test the hypothesis that inviting the parent to speak and nurse presence are associated with parent engagement during FCR.

METHODS:

We conducted a cross-sectional study with English-speaking parents (N = 199) of inpatients on the pediatric hospital medicine service at an academic medical center. We used a standardized checklist to record outcomes of engagement (number of questions asked and participation occurrences), predictor variables (team invited parent to speak, nurse presence), and other encounter-related variables. Parents were surveyed to assess parent and child characteristics and experiences during FCR. We examined parent, child, and encounter characteristic associations with the above outcomes using bivariate analyses and (for those associated in bivariate analyses) Poisson regressions.

RESULTS:

Inviting the parent to speak was independently associated with the number of questions asked (incident rate ratio [IRR] 1.4; 95% confidence interval [CI] 1.1–1.7). Trusting the medical team was inversely associated with questions asked (IRR 0.8; 95% CI 0.6–0.97). Factors associated with total participation included invitation for the parent to speak (IRR 1.5; 95% CI 1.3–1.6), nurse presence (IRR 1.3; 95% CI 1.1–1.5), white race (IRR 1.2; 95% CI 1.1–1.4), clerkship student presentation (IRR 1.2; 95% CI 1.03–1.3), and parent inclusion in rounding arrangement (IRR 1.5; 95% CI 1.05–2).

CONCLUSIONS:

Parents present during FCR are more engaged when invited to speak. Nurse presence was associated with total parent participation. Future studies to inform interventions to optimize engagement are warranted.
Physiometric Response to High-Flow Nasal Cannula Support in Acute Bronchiolitis
Authors: Sochet Anthony A. , Nunez Miranda , Maamari Mia , McKinley Scott , Morrison John M. , Nakagawa Thomas A.
Published: January 2021

OBJECTIVES:

To describe the rate of high-flow nasal cannula (HFNC) nonresponse and paired physiometric responses (changes [∆] in heart rate [HR] and respiratory rate [RR]) before and after HFNC initiation in hospitalized children with bronchiolitis.

METHODS:

We performed a single-center, prospective descriptive study in a PICU within a quaternary referral center, assessing children aged ≤2 years admitted for bronchiolitis on HFNC from November 2017 to March 2020. We excluded for cystic fibrosis, airway anomalies, pulmonary hypertension, tracheostomy, neuromuscular disease, congenital heart disease, or preadmission intubation. Primary outcomes were paired ∆ and %∆ in HR and RR before and after HFNC initiation. Secondary outcomes were HFNC nonresponse rate (ie, intubation or transition to noninvasive positive pressure ventilation). Analyses included χ2, Student’s t, Wilcoxon rank, and paired testing.

RESULTS:

Of the 172 children studied, 56 (32.6%) experienced HFNC nonresponse at a median of 14.4 (interquartile range: 4.8–36) hours and 11 (6.4%) were intubated. Nonresponders had a greater frequency of bacterial pneumonia, but otherwise no major differences in demographics, comorbidities, or viral pathogens were noted. Responders experienced reductions in both %ΔRR (−17.1% ± 15.8% vs +5.3% ± 22.3%) and %ΔHR (−6.5% ± 10.5% vs 0% ± 10.9%) compared with nonresponders.

CONCLUSIONS:

In this prospective, observational cohort study, we provide baseline data describing expected physiologic changes after initiation of HFNC for children admitted to the PICU for bronchiolitis. In our descriptive analysis, patients with comorbid bacterial pneumonia appear to be at additional risk for subsequent HFNC nonresponse.
Characteristics of Afebrile Infants ≤60 Days of Age With Invasive Bacterial Infections
Authors: Wang Marie E. , Neuman Mark I. , Nigrovic Lise E. , Pruitt Christopher M. , Desai Sanyukta , DePorre Adrienne G. , Sartori Laura F. , Marble Richard D. , Woll Christopher , Leazer Rianna C. , Balamuth Fran , Rooholamini Sahar N. , Aronson Paul L.
Published: January 2021

OBJECTIVES:

To describe the characteristics and outcomes of afebrile infants ≤60 days old with invasive bacterial infection (IBI).

METHODS:

We conducted a secondary analysis of a cross-sectional study of infants ≤60 days old with IBI presenting to the emergency departments (EDs) of 11 children’s hospitals from 2011 to 2016. We classified infants as afebrile if there was absence of a temperature ≥38°C at home, at the referring clinic, or in the ED. Bacteremia and bacterial meningitis were defined as pathogenic bacterial growth from a blood and/or cerebrospinal fluid culture.

RESULTS:

Of 440 infants with IBI, 78 (18%) were afebrile. Among afebrile infants, 62 (79%) had bacteremia without meningitis and 16 (20%) had bacterial meningitis (10 with concomitant bacteremia). Five infants (6%) died, all with bacteremia. The most common pathogens were Streptococcus agalactiae (35%), Escherichia coli (16%), and Staphylococcus aureus (16%). Sixty infants (77%) had an abnormal triage vital sign (temperature <36°C, heart rate ≥181 beats per minute, or respiratory rate ≥66 breaths per minute) or a physical examination abnormality (ill appearance, full or depressed fontanelle, increased work of breathing, or signs of focal infection). Forty-three infants (55%) had ≥1 of the following laboratory abnormalities: white blood cell count <5000 or >15 000 cells per μL, absolute band count >1500 cells per μl, or positive urinalysis. Presence of an abnormal vital sign, examination finding, or laboratory test result had a sensitivity of 91% (95% confidence interval 82%–96%) for IBI.

CONCLUSIONS:

Most afebrile young infants with an IBI had vital sign, examination, or laboratory abnormalities. Future studies should evaluate the predictive ability of these criteria in afebrile infants undergoing evaluation for IBI.
Smoking Behaviors Among Tobacco-Using Parents of Hospitalized Children and Association With Child Cotinine Level
Authors: Wilson Karen M. , Moss Angela , Lowary Michelle , Gambino Jessica , Klein Jonathan D. , Kerby Gwendolyn S. , Hovell Melbourne , Winickoff Jonathan P.
Published: January 2021

OBJECTIVES:

Understanding patterns of parental tobacco use and their association with child exposure can help us target interventions more appropriately. We aimed to examine the association between parental smoking practices and cotinine levels of hospitalized children.

METHODS:

This is a secondary analysis of data collected from parents of hospitalized children, recruited for a cessation intervention randomized controlled trial. Smoking parents were identified by using a medical record screening question. Parent-reported demographics and smoking habits were compared to child urine cotinine by using geometric means and log-transformed cotinine levels in multivariable linear regression analyses.

RESULTS:

A total of 213 patients had complete baseline parent-interview and urine cotinine data. The median age was 4 (interquartile range: 1–9); 57% were boys; 56% were white, 12% were Black, and 23% were multiracial; 36% identified as Hispanic. Most families (54%) had 1 smoker in the home; 36% had 2, and 9% had ≥3. Many (77%) reported having a ban on smoking in the home, and 86% reported smoking only outside. The geometric mean cotinine level of the cohort was 0.98 ng/mL. Higher cotinine levels were associated with more smokers in the home (ratio of 2.99) and smoking inside the house (ratio of 4.11).

CONCLUSIONS:

Having more smokers in the home and parents who smoke inside are associated with increased smoke exposure; however, even children whose families who smoke only outside the home have significant levels of cotinine, a marker for toxin exposure.
Variations in Sedated Echocardiography and Association With Repeat Echocardiography in Nonrefractory Kawasaki Disease
Authors: Clark Nicholas A. , Richardson Troy , Schuster Jennifer E. , Parthiban Anitha , Puls Henry T.
Published: January 2021

OBJECTIVES:

Echocardiography performed under sedation allows for better coronary artery visualization in children with Kawasaki disease. We sought to describe hospital-level variability in the percentage of sedated echocardiography (SE) among children with nonrefractory Kawasaki disease (NRKD) and then test its association with repeat echocardiography, length of stay (LOS), and costs.

METHODS:

We identified children in the Pediatric Health Information System <36 months of age hospitalized with NRKD from March 2010 to February 2017. Hospital-level percentage of SE was the primary outcome. Secondary outcomes were repeat echocardiography during the same hospitalization, LOS, and costs. We used χ2 and Wilcoxon rank tests to compare differences in repeat echocardiography between SE and nonsedated echocardiography. Pearson correlation was used to test associations between SE and repeat echocardiography, LOS, and costs.

RESULTS:

There were 2887 NRKD hospitalizations from 40 children’s hospitals. Initial SE varied from 0.0% to 87.0% (median 5.9%; interquartile range 1.4%–21.1%). Of initial echocardiographies, 22.4% were sedated and 10.1% of all hospitalizations had a repeat echocardiography. Use of SE at the hospital level was associated with a lower likelihood for repeat echocardiography (r = −0.32; 95% confidence interval −0.58 to −0.01; P = .042). Absolute risk reduction was 3.5% and the number needed to sedate was 29. Initial SE was not associated with LOS or hospital-level costs but was associated with increased patient-level costs.

CONCLUSIONS:

Significant variation exists in the use of SE for children <36 months of age with NRKD at children’s hospitals. Our results suggest that determination of SE should not be driven by concern for repeat echocardiography or LOS considerations.
Maternal Smoking in Pregnancy and Child’s Hospital Use up to 5 Years of Age in a Data Linkage Birth Cohort
Authors: Ezegbe Chigozie , Neil Amanda L. , Magnussen Costan G. , Chappell Katherine , Judd Fiona , Wagg Fiona , Gall Seana
Published: January 2021

OBJECTIVES:

To examine if exposure to maternal smoking during pregnancy is associated with emergency department (ED) presentation and admission through the ED in children up to 5 years after birth.

METHODS:

Antenatal records of all children up to 5 years of age who were born in Tasmania, Australia, between July 2008 and June 2014 were linked to health service use (ED presentations and hospital admissions). Negative binomial regression was used to estimate the incidence rate ratio (IRR) and 95% confidence intervals (CIs) at ≤1 year and ≤5 years for ED presentations and admissions to the hospital through the ED for any reason and by 9 major disease categories for children exposed versus children not exposed to maternal smoking during pregnancy. Models were adjusted for sex, socioeconomic position, maternal age at birth, and region of residence. Presentations and admissions for poisoning and injuries were used as a negative control.

RESULTS:

Among 36 630 infants, 21% were exposed to maternal smoking during pregnancy. Exposed children had a 26% higher rate of presentation to the ED (IRRadjusted 1.26; 95% CI 1.23–1.29) and a 45% higher rate of admission (IRRadjusted 1.45; 95% CI 1.39–1.51) at up to 5 years of age. Compared with the negative control, higher presentation and admission rates were evident in respiratory; eyes, ears, nose, and throat; psychosocial; and infectious disease categories.

CONCLUSIONS:

Higher health care service use was observed in children exposed to maternal smoking during pregnancy for a range of conditions associated with exposure to smoking. The findings reinforce the need to reduce smoking among people in their childbearing years.
Trends in Incidence of Nicotine Use Disorder Among Adolescents in the Pediatric Hospital, 2012–2019
Authors: Masonbrink Abbey , Richardson Troy , Hall Matt , Catley Delwyn , Wilson Karen
Published: January 2021

OBJECTIVES:

To assess trends in the incidence of nicotine use disorder (NUD) and describe associated factors among adolescents in the pediatric emergency department (ED) and inpatient settings.

METHODS:

We conducted a retrospective cohort study of all adolescents (11–18 years) with a hospital encounter (inpatient, observation, or ED) in the Pediatric Health Information System between January 1, 2012, and September 30, 2019. After excluding adolescents with a previous International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, NUD diagnosis in the past 2 years, adolescents with new NUD diagnosis (ie, NUD incidence) were identified. A multivariable generalized liner mixed model was used to assess adjusted NUD incidence and investigate the relationship of NUD with patient characteristics and any interactions between characteristics and time. Spearman’s correlation coefficient was used to assess the correlation between NUD incidence and e-cigarette use reported among youth.

RESULTS:

Of 3 963 754 adolescents, 15 376 (0.4%) had a new diagnosis of NUD. Between 2012 and 2019, NUD incidence increased from 0.3% to 0.4% (P < .001). Findings from the time interaction effect analysis revealed increasing NUD incidence among certain subpopulations, including boys, those with a commercial or other insurance type, adolescents seen in the ED, those from the lowest and highest median household income quartile, and those in the South and West US Census regions. The correlation between NUD incidence and e-cigarette use among high school students was ρ = 0.884 (P = .006).

CONCLUSIONS:

The incidence of NUD among adolescents is increasing. Efforts to increase the screening and treatment of NUD among adolescents in the hospital, particularly among the at-risk populations identified, are needed.
Roseville Protocol for the Management of Febrile Infants 7–60 Days
Authors: Nguyen Tran H.P. , Young Beverly R. , Poggel Laura E. , Alabaster Amy , Greenhow Tara L.
Published: January 2021

OBJECTIVES:

The Roseville Protocol modifies the Rochester Protocol by adding a high-risk temperature criterion of >38.5°C for infants 7 to 28 days old and by allowing febrile infants 29 to 60 days old with abnormal urinalysis but reassuring complete blood cell counts to be discharged home on oral antibiotics without receiving a lumbar puncture (LP). In this study, we define the Roseville Protocol test characteristics to detect invasive bacterial infection (IBI) and retrospectively compare its performance to that of the Rochester, Philadelphia, and Boston protocols.

METHODS:

In this retrospective study, we examine all cases of fever in infants aged 7 to 60 days presenting to a large health maintenance organization from 2007 to 2016 and having requisite laboratory tests for protocol analysis. The 4 protocols were retrospectively applied to this cohort to calculate each protocol’s sensitivity and specificity to detect IBI. Protocols were compared regarding recommended LPs, admissions, and parenteral antibiotics.

RESULTS:

In 627 infants 7 to 28 days old, the Roseville Protocol had a sensitivity of 96.7% and a negative predictive value of 99.5%. It identified 2 IBIs missed by the Rochester Protocol but recommended an absolute increase of 19% in LPs and admissions. In 1176 infants 29 to 60 days old, the Roseville Protocol had a sensitivity of 91.4% and a negative predictive value of 99.6%. There was an absolute reduction in LPs by 18% to 44% compared to the Rochester Protocol and by 74% to 100% compared to the Philadelphia and Boston protocols. There was an absolute reduction in admissions by 18% to 44% compared to the Rochester Protocol, by 25% to 51% compared to the Philadelphia Protocol, and by 10% to 36% compared to the Boston Protocol.

CONCLUSIONS:

The Roseville Protocol has sensitivity and specificity comparable to that of existing protocols for IBI in febrile infants 7 to 60 days old, while allowing for fewer invasive procedures and hospitalizations in infants ≥29 days old.
A Cost Comparison of Infliximab Versus Intravenous Immunoglobulin for Refractory Kawasaki Disease Treatment
Authors: Johnson Scarlett Carmen , Williams Daniel Clay , Brinton Daniel , Chew Marshall , Simpson Annie , Andrews Annie Lintzenich
Published: January 2021

BACKGROUND AND OBJECTIVES:

In 10% to 20% of cases, Kawasaki disease is refractory to intravenous immunoglobulin (IVIg), an expensive medication under a national shortage. Data suggest that infliximab is a viable alternative to a second dose of IVIg, with similar efficacy and safety. We compared the cost of a second IVIg dose to that of infliximab in the treatment of refractory Kawasaki disease (rKD).

METHODS:

A decision analysis model was used to compare rKD treatments: a second dose of IVIg at 2 g/kg versus infliximab at 10 mg/kg. Infliximab monitoring times were 24, 36, and 48 hours. Direct hospital costs beginning at rKD diagnosis were estimated by using 2016–2017 Truven MarketScan data. Redbook was used for drug costs. Calculations were applied to 3 hypothetical cohorts of 100 patients aged 2 (12.5 kg), 4 (16 kg), and 8 years (25.5 kg). Indirect costs included parental missed workdays.

RESULTS:

The total direct cost for children receiving IVIg was $1 677 801, $1 791 652, and $2 100 675 for the 2-, 4-, and 8-year-old cohorts. The direct cost of infliximab with 24 hours of monitoring was $853 042, $899 096, and $1 024 101, respectively. A 20% bidirectional sensitivity analysis revealed stability of our model, with overall cost savings with use of infliximab. With monitoring 48 hours after infliximab treatment, 20% changes in length of stay (LOS) tipped the balance for the 2- and 4-year-old cohorts. Overall, IVIg and infliximab LOS had the most influence on our model.

CONCLUSIONS:

Infliximab has potential to yield shorter LOS and significant cost savings in the treatment of rKD. Infliximab treatment, followed by 24 hours of monitoring, nearly halved hospital costs, regardless of age.
Protection of the Newborn Through Vaccination in Pregnancy
Authors: Abu-Raya Bahaa , Maertens Kirsten
Published: January 2021

Newborns and infants are at risk for severe infections with some pathogens (eg, Bordetella pertussis, influenza, respiratory syncytial virus, group B Streptococcus) during early life. To decrease this window of high susceptibility to some infections during early life and protect young infants, vaccination in pregnancy against some vaccine-preventable diseases (eg, influenza, pertussis, tetanus) has been recommended in an increasing number of countries with notable success. In addition, recent advances have been made in developing vaccines for pregnant women with the aim of reducing the respiratory syncytial virus and group B Streptococcus burden in infancy. In this article, we review the vaccines currently recommended during pregnancy and their benefits to newborns and infants. We also discuss progress made in the development of other vaccines that are expected to be evaluated in pregnant women in the near future.
Neonatal Dermatology: The Normal, the Common, and the Serious
Authors: Goodarzi Heidi , Wu Tiffany T. , Wang Jami , Teng Joyce M.
Published: January 2021

The objective of this review is to help practitioners of neonatal and pediatric medicine become more familiar with diagnosing and managing neonatal skin conditions. This article will discuss normal neonatal skin care and benign and common rashes, as well as some of the serious dermatologic conditions that require specialists for further evaluation and/or treatment.
Support Services for Young Adults With Substance Use Disorders
Authors: Xuan Ziming , Choi Jasmin , Lobrutto Lara , Cunningham Tiffany , Castedo de Martell Sierra , Cance Jessica , Silverstein Michael , Yule Amy M. , Botticelli Michael , Holleran Steiker Lori
Published: January 2021

In summarizing the proceedings of a longitudinal meeting of experts in substance use disorders (SUDs) among young adults, this special article reviews principles of care concerning recovery support services for this population. Young adults in recovery from SUDs can benefit from a variety of support services throughout the process of recovery. These services take place in both traditional clinical settings and settings outside the health system, and they can be delivered by a wide variety of nonprofessional and paraprofessional individuals. In this article, we communicate fundamental points related to guidance, evidence, and clinical considerations about 3 basic principles for recovery support services: (1) given their developmental needs, young adults affected by SUDs should have access to a wide variety of recovery support services regardless of the levels of care they need, which could range from early intervention services to medically managed intensive inpatient services; (2) the workforce for addiction services for young adults benefits from the inclusion of individuals with lived experience in addiction; and (3) recovery support services should be integrated to promote recovery most effectively and provide the strongest possible social support.
Principles of Care for Young Adults With Co-Occurring Psychiatric and Substance Use Disorders
Authors: Spencer Andrea E. , Valentine Sarah E. , Sikov Jennifer , Yule Amy M. , Hsu Heather , Hallett Eliza , Xuan Ziming , Silverstein Michael , Fortuna Lisa
Published: January 2021

Over 50% of young adults (defined as individuals aged 18–25 years) with substance use disorders (SUDs) have at least 1 co-occurring psychiatric disorder, and the presence of co-occurring disorders worsens SUD outcomes. Treatment of both co-occurring psychiatric disorders and SUDs in young adults is imperative for optimal treatment, yet many barriers exist to achieving this goal. We present a series of evidence-informed principles of care for young adults with co-occurring psychiatric disorders derived by a workgroup of experts convened by Boston Medical Center’s Grayken Center for Addiction. The 3 principles are as follows: (1) young adults should receive integrated mental health and addiction care across treatment settings; (2) care should be responsive to the needs of young adults exposed to trauma and other adverse childhood experiences; and (3) treatment programs should regularly assess and respond to the evolving mental health needs, motivations, and treatment goals of young adults with co-occurring disorders. Our guidance for each principle is followed by a review of the evidence supporting that principle, as well as practice considerations for implementation. More research among young adults is critical to identify effective treatments and service systems for those with co-occurring disorders.
The Justice System and Young Adults With Substance Use Disorders
Authors: Siringil Perker Selen , Chester Lael E. H.
Published: January 2021

Young adults’ heightened vulnerability to substance use disorders (SUD) corresponds with their disproportionate representation in the criminal justice system. It is paramount that the justice system systemically recognize young adults as a group with distinct developmental needs and align reform efforts with advancements made in medical and public health fields to better address the needs of justice-involved young adults with SUD. This article warns against reliance on the justice system for engaging young adults with SUD in treatment and presents 4 principles that were developed by a workgroup participating in a longitudinal meeting of experts sponsored by Boston Medical Center’s Grayken Center for Addiction. The goal of the principles is to support and guide policy and practice initiatives for developmentally appropriate justice responses to young adults with SUD. The article also reviews the evidence that underlies these principles and offers policy and practice considerations for their implementation.
A Survivor-Derived Approach to Addressing Trafficking in the Pediatric ED
Authors: Wallace Carmelle , Schein Yvette , Carabelli Gina , Patel Heta , Mehta Needhi , Dowshen Nadia , Kassam-Adams Nancy , Ginsburg Kenneth , Mollen Cynthia
Published: January 2021

OBJECTIVES:

Our objective was to elicit the perspectives of survivors of child trafficking on addressing trafficking in the pediatric emergency department (ED) and, secondarily, to provide a survivor-derived framework to help pediatric emergency medicine (PEM) providers discuss trafficking with their patients.

METHODS:

We conducted in-depth, semistructured interviews with young adults who experienced trafficking as children and/or as adolescents. In the interviews, we employed a novel video-elicitation method designed by the research team to elicit detailed participant feedback and recommendations on the pediatric ED through an interactive, immersive discussion with the interviewer. A grounded theory approach was employed.

RESULTS:

Seventeen interviews were conducted revealing the following themes, which we present in an integrated framework for PEM providers: (1) fear is a significant barrier; (2) participants do want PEM providers to ask about trafficking, and it is not harmful to do so; (3) PEM providers should address fear through emphasizing confidentiality and privacy and encouraging agency; (4) PEM providers should approach the patient in a direct, sensitive, and nonjudgmental manner; and (5) changes to the ED environment may facilitate the conversation. Suggested wordings and tips from survivors were compiled.

CONCLUSIONS:

Trafficking survivors feel that the pediatric ED can be a place where they can be asked about trafficking, and that when done in private, it is not harmful or retraumatizing. Fear is a major barrier to disclosure in the pediatric ED setting, and PEM providers can mitigate this by emphasizing privacy and confidentiality and increasing agency by providing choices. PEM providers should be direct, sensitive, and nonjudgmental in their approach to discussing trafficking.
PENGARUH METODE PEMASAKAN TERHADAP NILAI SENSORI DAN PROFIL ASAM AMINO CAKALANG (Katsuwonus pelamis) MASAK
Authors: Sumandiarsa Ketut , Siregar Resmi R , Dewi Kadek Ayu Sastra
Published: January 2021

Asam amino merupakan suatu zat penyusun protein yang saling berikatan membentuk ikatan peptida. Jumlah asam amino setelah pemasakan akan mempengaruhi sifat dan kandungan kimia produk. Penelitian ini bertujuan untuk mengetahui pengaruh metode pemasakan terhadap nilai sensori dan profil asam amino pada cakalang masak. Cara pemasakan dibedakan atas Kukus, Presto dan Steam precooked yang menggunakan suhu dan waktu yang sama yaitu 100° C selama 45 menit. Rancangan penelitian menggunakan rancangan acak lengkap (RAL) satu faktor terhadap perlakuan cara pemasakan dan selanjutnya menggunakan analisis keragaman (ANOVA) uji lanjut dengan uji Duncan serta  uji Kruskal Wallis terhadap kesukaan. Hasil penelitian menyatakan panelis lebih menyukai cakalang presto dengan nilai rata-rata kenampakan 7.1 ± 0.94; bau 7.4 ± 0.71; dan tekstur 7.2 ± 0.96. Hasil uji sensori menunjukkan yang terbaik adalah cakalang presto dengan nilai rata-rata kenampakan 7.4±1.1; bau 8.7±0.05 dan tekstur 8.1±0.17. Asam amino cakalang segar menunjukkan asam glutamate merupakan yang terbesar yaitu 3.16% dan terkecil adalah Serin sebesar 0.51% dengan total asam amino adalah 20.30%. Berdasarkan cara memasak, asam amino tertinggi terdapat pada Kukus yang diikuti oleh Presto dan Steam cooked dengan masing-masing 24.85%; 24.10%; dan 21.01%. Cara pemasakan tidak berpengaruh nyata terhadap kuantitas asam amino namun karakteristik bau dan tekstur secara signifikan dipengaruhi oleh cara masak yang berbeda (Sig (0.000) < (α = 0.05)).
KINERJA DAN ANALISIS FINANSIAL BUDIDAYA UDANG VANAME (Litopenaeus vannamei) DI PT. NOERWY AQUA FARM KAB. SUKABUMI PROV. JAWA BARAT
Authors: Kayandi Eka Desri , Thaib Effi Athfiyani , Djunaidah Iin Siti , Rachmad Basuki
Published: January 2021

Tujuan penelitian ini untuk menganalisis kinerja budidaya udang vaname dan menghitung analisis finansial usaha budidaya udang vaname. Penelitian dilakukan mulai dari tanggal 02 Maret 2020 sampai 15 Mei 2020 di PT. Noerwy Aqua Farm yang berada di Desa Cipeundeuy, Kecamatan Surade, Kabupaten Sukabumi, Provinsi Jawa Barat. Metode penelitian yang dilakukan adalah metode observasi dengan pola magang. Tujuh petak tambak dipergunakan dan pemeliharaan secara  intensif dengan padat tebar 184 ekor/m2. Kinerja budidaya yang diperoleh selama penelitian yaitu Average Daily Growth 0,17 gram/hari sampai 0,72 gram/hari, Survival Rate 72-83%, efektivitas penggunaan pakan dihitung dengan nilai Feed Conversion Ratio 1,1-1,5 dan produktivitas antara 32,09-38,19 ton/ha. Hasil produksi selama penelitian menghasilkan keuntungan sebesar Rp.7.892.873.428 pertahun dengan Revenue Cost Ratio 1,86, Break Even Point sebesar Rp.3.976.500.424 dan Payback Period selama 2,41 tahun. Kinerja budidaya yang dihasilkan dapat dikatakan baik dan berdasarkan analisis finansial usaha budidaya layak untuk dilakukan.
The 'Siege of the Badonic Mountain'
Authors: Higham N. J.
Published: January 2021

Gildas's brief and somewhat opaque reference to the siege of Badon provides us with one of the very few events that we can be reasonably sure occurred in Britain during the century following the ending of Roman rule. Close attention to the way that he used this conflict within his text
allows us to establish that it was included primarily as a means of fixing the year in which God's weighing up of His people ended and Gildas's present began. It was not a final battle that brought the Britons victory; on the contrary, it was the Saxons who had had the greater success in the
war. That this 'not the least' conflict was sufficiently memorable 44 years later may, though, mean that it was comparatively local both to Gildas himself and the intended recipients of his letter.
Genealogia Brittonum: revisiting the textual tradition of the Historia Brittonum
Authors: Fitzpatrick-Matthews Keith J.
Published: January 2021

The Historia Brittonum remains a textual puzzle because of its variant recensions; printed editions generally present conflated versions of the text. The Harleian Recension is usually thought to represent the version closest to the original. The present approach to its textual
history uses cladistics to recognise characteristics shared between recensions. These determine those of ancestral groups and indicate the points at which different recensions split off, demonstrating that the work grew by accretion. The Harleian Recension is shown to be a late development.
All existing printed editions of the work are defective: every reading must be based on judging the position of all witnesses on the cladogram. Where the readings of the Chartres and Edmundine Recensions agree against the others, they take precedence. The earliest recoverable form of the text
is the recension of 829×30, here termed 'Merminian'.
Las flores de Myrtillocactus geometrizans (Cactaceae): morfología y artrópodos visitadores en un gradiente geográfico
Authors: Islas-Barrios Yanin , Serrato-Díaz Alejandra , Zavala-Hurtado J. Alejandro , Octavio-Aguilar Pablo , Callejas-Chavero Alicia , Cornejo-Romero Amelia
Published: January 2021

Antecedentes: Las flores son elementos reproductivos costosos que presentan balances costo/beneficio en sus estructuras. La diversidad de éstas se ha atribuido a factores bióticos como las interacciones con sus visitadores florales y abióticos como las características del ambiente.

Preguntas: ¿La morfología floral de M. geometrizans está relacionada con los tipos de vegetación? ¿La comunidad de artrópodos visitadores florales se relaciona con la morfología floral y/o el tipo de vegetación? ¿La morfología floral y la comunidad de artrópodos tendrán relación con la perturbación del ambiente?

Especie de estudio: Myrtillocactus geometrizans (Mart. ex Pfeiff.) Console

Sitio de estudio y fecha: Selva Baja Caducifolia y Matorral Xerófilo en las Reservas de la Biosfera Tehuacán-Cuicatlán, Puebla Barranca de Metztitlán, Hidalgo. México. Marzo 2017.

Métodos: En los cuatro sitios (dos días por sitio), durante el pico de floración de M. geometrizans, se calculó el índice de disturbio, se recolectaron 30 flores (N = 120) y los artrópodos visitadores florales. Se determinaron la morfología floral y los artrópodos.

Resultados: Los sitios de la Barranca de Metztitlán presentaron el mayor índice de disturbio, las flores más chicas y mayor número de estructuras florales. Los visitadores florales fueron más abundantes en los matorrales xerófilos, particularmente en el sitio más perturbado donde el grupo funcional más relevante fue el de los polinizadores.

Conclusiones: Se encontraron diferencias significativas en la morfología floral de M. geometrizans relacionadas a los tipos de vegetación y ubicación geográfica. Se reportó una compensación entre tamaño y producción de estructuras florales.
Growth, reproduction and weediness: testing four related species on a gradient of synanthropy
Authors: Hanan-Alipi Ana María , Vibrans Heike , Vega-Frutis Rocío , Juárez-Rosete Cecilia Rocío , Valdivia-Bernal Roberto , Velázquez-Fernández Jesús
Published: January 2021

Background . The ability of weeds to thrive in the stressful environments created by human disturbance has been explained mainly by a set of life history traits, such as short life cycles, generalist habits, as well as early and sustained reproduction. However, the evidence that these traits are better represented in weeds than in related species of other environments is mixed. To explore the relationship between weeds and the life history traits, we used the fact that plants are weedy to different degrees because of the heterogeneous nature of environments produced by disturbance. In a group of four congeners, we studied some growth and reproduction parameters in relation to the degree of synanthropy of the species, determined previously.

Methods. In a common garden experiment, we compared relative growth rate, time to flowering, and biomass distribution between four species of the genus Melampodium (Asteraceae) that are weedy to different degrees.

Results. The most synanthropic species, M. divaricatum , stood out for its steady growth rate, but not for assigning more resources to reproduction, nor for early flowering. In general, we found no association between growth and reproductive parameters studied in the four Melampodium species and the degree to which they are weeds.

Conclusions. Results suggest that traits such as fast growth and early reproduction may not be essential for life as a weed. Rather, weedy species exhibit a complex pattern of growth traits that could be affected by conditions independent of anthropogenic disturbance.
Development of SSR markers and their application to genetic diversity analysis of Curcuma alismatifolia varieties
Authors: Mao Lihui , Liu Jianxin , Ding Huaqiao , Zou Qingcheng , Tian Danqing
Published: January 2021

Background: Curcuma alismatifolia is an ornamental cultivar with several varieties introduced into China from Thailand within the past fifteen years. Curcuma alismatifolia is widely used as cut flowers and potted flowers and is also used in flower beds.

Questions and/or Hypotheses: However, limited genetic and genomic information is available for this species, which has impeded studies on the enhancement of its ornamental value and stress resistance.

Studied species Curcuma alismatifolia

Study site and dates: Zhejiang, 2018  

Methods: single-cell sequencing technology of PCR and polyacrylamide gel electrophoresis  

Results: (A/T)n accounted for 43.6 % of the SSRs, the maximum proportion, and mononucleotide and trinucleotide repeats were the two most abundant repeat types. A total of 3,637 primer pairs flanking SSR sequences were successfully designed, and 70 sets of primers were randomly selected for validation in 10 varieties. Forty-one (59 %) of the 70 primer pairs successfully amplified alleles, of which 35 were identified as polymorphic markers and used to assess the level of genetic diversity and genetic relationships among the 10 varieties. The genetic diversity analysis showed that the number of alleles (Na) at each locus ranged from 2 to 8, with an average of 3.97, and that PIC had a mean of 0.524 and ranged from 0.095 to 0.795.

Conclusions: The genetic distance between 10 varieties varied from 0.30 to 0.96, and the dendrogram clustered all varieties into three groups.