Perspectives on non-emergent neonatal intensive care unit to pediatric intensive care unit care transfers in the United States

BACKGROUND There is a substantial population of long-stay patients who non-emergently transfer directly from the neonatal intensive care unit(NICU)to the pediatric intensive care unit(PICU)without an interim discharge home.These infants are often medically complex and have higher mortality relative to NICU or PICUonly admissions.Given an absence of data surrounding practice patterns for nonemergent NICU to PICU transfers,we hypothesized that we would encounter a broad spectrum of current practices and a high proportion of dissatisfaction with current processes.AIM To characterize non-emergent NICU to PICU transfer practices across the United States and query PICU providers’evaluations of their effectiveness.METHODS A cross-sectional survey was drafted,piloted,and sent to one physician representative from each of 115 PICUs across the United States based on membership in the PARK-PICU research consortium and membership in the Children’s Hospital Association.The survey was administered via internet(REDCap).Analysis was performed using STATA,primarily consisting of descriptive statistics,though logistic regressions were run examining the relationship between specific transfer steps,hospital characteristics,and effectiveness of transfer.RESULTS One PICU attending from each of 81 institutions in the United States completed the survey(overall 70%response rate).Over half(52%)indicated their hospital transfers patients without using set clinical criteria,and only 33%indicated that their hospital has a standardized protocol to facilitate non-emergent transfer.Fewer than half of respondents reported that their institution’s nonemergent NICU to PICU transfer practices were effective for clinicians(47%)or patient families(38%).Respondents evaluated their centers’transfers as less effective when they lacked any transfer criteria(P=0.027)or set transfer protocols(P=0.007).Respondents overwhelmingly agreed that having set clinical criteria and standardized protocols for non-emergent transfer were important to the patient-family experience and patient safety.CONCLUSION Most hospitals lacked any clinical criteria or protocols for non-emergent NICU to PICU transfers.More positive perceptions of transfer effectiveness were found among those with set criteria and/or transfer protocols.

Three-Stage Transfer Learning with AlexNet50 for MRI Image Multi-Class Classification with Optimal Learning Rate

In radiology,magnetic resonance imaging(MRI)is an essential diagnostic tool that provides detailed images of a patient’s anatomical and physiological structures.MRI is particularly effective for detecting soft tissue anomalies.Traditionally,radiologists manually interpret these images,which can be labor-intensive and time-consuming due to the vast amount of data.To address this challenge,machine learning,and deep learning approaches can be utilized to improve the accuracy and efficiency of anomaly detection in MRI scans.This manuscript presents the use of the Deep AlexNet50 model for MRI classification with discriminative learning methods.There are three stages for learning;in the first stage,the whole dataset is used to learn the features.In the second stage,some layers of AlexNet50 are frozen with an augmented dataset,and in the third stage,AlexNet50 with an augmented dataset with the augmented dataset.This method used three publicly available MRI classification datasets:Harvard whole brain atlas(HWBA-dataset),the School of Biomedical Engineering of Southern Medical University(SMU-dataset),and The National Institute of Neuroscience and Hospitals brain MRI dataset(NINS-dataset)for analysis.Various hyperparameter optimizers like Adam,stochastic gradient descent(SGD),Root mean square propagation(RMS prop),Adamax,and AdamW have been used to compare the performance of the learning process.HWBA-dataset registers maximum classification performance.We evaluated the performance of the proposed classification model using several quantitative metrics,achieving an average accuracy of 98%.

Transfer RNA-derived small RNA serves as potential non-invasive diagnostic marker and a novel therapeutic target for acute pancreatitis

Transfer RNA(tRNA)-derived fragments,a new type of tRNA-derived small RNA(tsRNA),can be cleaved from tRNA by enzymes to regulate target gene expression at the transcriptional and translational levels.tsRNAs are not only degradation fragments but also have biological functions,including those in immune inflammation,metabolic disorders,and cell death.tsRNA dysregulation is closely associated with multiple diseases,including various cancers and acute pancreatitis(AP).AP is a common gastrointestinal disease,and its incidence increases annually.AP development is associated with tsRNAs,which regulate cell injury and induce inflammation,especially pyroptosis and ferroptosis.Notably,serum tRF36 has the potential to serve as a non-invasive diagnostic biomarker and leads to pancreatic acinar cell ferroptosis causing inflammation to promote AP.We show the characteristics of tsRNAs and their diagnostic value and function in AP,and discuss the potential opportunities and challenges of using tsRNAs in clinical applications and research.

Brachioradialis tendon transfer and palmaris longus tendon graft for thumb avulsion:A case report and review of literature

BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.

Intermolecular Vibrational Energy Transfers in Melts and Solutions

Resonant and nonresonant intermolecular vibrational energy transfers in Gdm- SCN/KSCN=1/1, GdmSCN/KS^13CN=1/1 and GdmSCN/KS^13C^15N=1/1 mixed crystals in melts and in aqueous solutions are studied with the two dimensional infrared spectroscopy. The energy transfers in the samples are slower with a larger energy donor/acceptor gap, independent of the Raman spectra. The energy gap dependences of the nonresonant energy transfers cannot be described by the phonon compensation mechanism. Instead, the experi- mental energy gap dependences can be quantitatively described by the dephasing mechanism. Temperature dependences of resonant and nonresonant energy transfer rates in the melts are also consistent with the prediction of the dephasing mechanism. The series of results suggest that the dephasing mechanism can be dominant not only in solutions, but also in melts （pure liquids without solvents）, only if the molecular motions （translations and rotations） are much faster than the nonresonant energy transfer processes.

Influence of Blastocysts Morphological Score on Pregnancy Outcomes in Frozen-thawed Blastocyst Transfers: a Retrospective Study of 741 Cycles

The influence of inner cell mass （ICM） and trophectoderm （TE） score on pregnancy out- comes in frozen-thawed blastocyst transfer cycles was analyzed. A retrospective analysis of 741 cycles of frozen-thawed blastosysts transfer was performed. All cycles were divided into four groups based on the number and morphological score of blastocysts： S-ICM B/TE B group （n=91）, the single blastocyst transfer oflCM B and TE B; D-ICM B/TE B group （n=579）, double blastocysts transfer oflCM B/TE B; D-1CM B/TE C group （n=35）, double blastocysts transfer of ICM B/TE C; and D-ICM C/TE B group （n=36）, double blastocysts transfer ofTE B/ICM C. The pregnancy outcomes were compared among the four groups. As compared with D-ICM B/TE C group, the clinical pregnancy rate, implantation rate and multiple pregnancy rate were increased in D-ICM B/TE B group （74.96% vs. 57.14%, 57.43% vs. 37.14%, and .48.62% vs. 25%, respectively, P〈0.05 for all）. Clinical pregnancy rate and implantation rate in D-ICM B/TE B group were also higher than in D-ICM C/TE B group （74.96% vs. 50%, and 57.43% vs. 33.33%, both P〈0.05）. Multivariable Logistic regression analysis indicated that ICM score was a better predictive parameter for clinical pregnancy （OR=3.05, CI 1.70-5.46, P〈0.001）, while the trophectoderm score was a better one for early abortion （OR=0.074, CI 0.03-0.19, P〈0.001）. Clinical pregnancy rate and multiple pregnancy rate in S-ICM B/TE B group were significantly lower than those in D-ICM B/TE B group （46.15% vs. 74.96%, and 2.38% vs. 48.62%, both P〈0.05）, but there was no si~,,niflcant difference in the implantation rate between the two groups. It was suggested that the higher score of ICM and TE may be indicative of the better pregnancy outcomes. The ICM score is a better predictor of clinical pregnancy than TE, while TE score is a better one in predicting early abortion. Sin- gle ICM B/TE B blastocyst transfer in frozen-thawed cycles can also get satisfactory pregnancy out- comes.

Time Optimization of Multiple Knowledge Transfers in the Big Data Environment

In the big data environment, enterprises must constantly assimilate big dataknowledge and private knowledge by multiple knowledge transfers to maintain theircompetitive advantage. The optimal time of knowledge transfer is one of the mostimportant aspects to improve knowledge transfer efficiency. Based on the analysis of thecomplex characteristics of knowledge transfer in the big data environment, multipleknowledge transfers can be divided into two categories. One is the simultaneous transferof various types of knowledge, and the other one is multiple knowledge transfers atdifferent time points. Taking into consideration the influential factors, such as theknowledge type, knowledge structure, knowledge absorptive capacity, knowledge updaterate, discount rate, market share, profit contributions of each type of knowledge, transfercosts, product life cycle and so on, time optimization models of multiple knowledgetransfers in the big data environment are presented by maximizing the total discountedexpected profits (DEPs) of an enterprise. Some simulation experiments have beenperformed to verify the validity of the models, and the models can help enterprisesdetermine the optimal time of multiple knowledge transfer in the big data environment.

Sperm DNA fragmentation does not affect the clinical outcomes in the cumulative transfers of an ICSI cycle along with blastocyst transfers in couples with normozoospermic male patients

Objective:To know whether sperm DNA fragmentation(SDF)affects the clinical outcomes in the cumulative transfers of an intracytoplasmic sperm injection(ICSI)cycle along with blastocyst transfers in couples with normozoospermic males.Methods:The study included 252 couples who underwent their first ICSI cycles along with blastocyst transfer and whose male partner semen samples were normozoospermic according to the World Health Organization 2010 criteria.All the couples were classified into two groups based on the SDF:the low SDF group(SDF≤30%,n=162)and the high SDF group(SDF>30%,n=90).Clinical as well as laboratory outcomes were correlated between the two groups.Sperm DNA fragmentation was assessed on the post-wash semen samples by acridine orange test.The main outcome measures were the live birth rate and miscarriage rate.Results:A significant decrease in the live birth rates was observed in the high SDF group compared to the low SDF group in fresh embryo transfer cycles(P<0.05).However,no significant difference was observed in the clinical outcomes either in the frozen embryo transfer cycles or in the overall cumulative transfer cycles(P>0.05).No significant difference was observed in the laboratory outcomes between the two SDF groups.A remarkable decrease in sperm motility was observed in the high SDF group compared to the low SDF group(P<0.05).Conclusions:Sperm DNA fragmentation does not affect the clinical outcomes in the cumulative transfers of an ICSI cycle along with blastocyst transfers in couples with normozoospermic males.

Consideration of Size and Dimension in the Evaluation of Transfers during Convective Drying of Sweet Potato

This work is interested in solving the complex problem of understanding mass transfers in biological media. The contribution of the initial sample size is taken into account. Transfers are established more efficiently in small samples. Thus, from the first 50 minutes, the cubic sample at 1 cm stop is already at 50% while the sample at 4 cm edge is at about 90% of its initial water content. Likewise the shape is combined with the size. But it is revealed that if we fix similar characteristic dimensions, we can bypass the notion of initial shape. Thus the cubic samples 4 cm of edges. 4 cm diameter of spherical shape, 4 cm × 4 cm height-diameter cylindrical one, all dry identically.

Towards electrochemical hydrogen storage in liquid organic hydrogen carriers via proton-coupled electron transfers

Green hydrogen is identified as one of the prime clean energy carriers due to its high energy density and a zero emission of CO_(2).A possible solution for the transport of H_(2)in a safe and low-cost way is in the form of liquid organic hydrogen carriers(LOHCs).As an alternative to loading LOHC with H_(2)via a two-step procedure involving preliminary electrolytic production of H_(2)and subsequent chemical hydrogenation of the LOHC,we explore here the possibility of electrochemical hydrogen storage(EHS)via conversion of proton of a proton donor into a hydrogen atom involved in covalent bonds with the LOHC(R)via a protoncoupled electron transfer(PCET)reaction:2nH^(+)+2ne^(-)+Rox■n H_(2)^(0)Rred.We chose 9-fluorenone/fluorenol(Fnone/Fnol)conversion as such a model PCET reaction.The electrochemical activation of Fnone via two sequential electron transfers was monitored with in-situ and operando spectroscopies in absence and in presence of different alcohols as proton donors of different reactivity,which enabled us to both quantify and get the mechanistic insight on PCET.The possibility of hydrogen extraction from the loaded carrier molecule was illustrated by chemical activation.

Inter-hospital transfers and door-to-balloon times for STEMI: a single centre cohort study

Background Key performance indices such as door-to-balloon times have long been recognized as quality metrics in reducing time to care for patients with acute coronary syndromes(ACS). In the situation where patients do not present to a facility capable of 24/7 percutaneous coronary interventions(PCI) delays in time to therapy can exceed the recommendation of 90 min or less. This study aimed to evaluate the impact of transfers on performance indices for patients diagnosed with ST-segment elevation myocardial infarction(STEMI). Methods Over a seven month collection period, all patients presenting with symptoms suggestive of ACS and admitted for PCI were studied. Patients were divided into dichotomous groups of direct presentations or transfers from a secondary non-PCI capable hospital with key times recorded, including symptom-onset, first hospital and PCI-capable hospital arrival and balloon inflation times to evaluate time of treatment for STEMI patients. Results Of the 87 patients diagnosed with STEMI, transferred patients experienced statistically significant delays in symptom-onset to the PCI-capable hospital(PCI-H) arrival(215 vs. 95 min, P < 0.001), symptom-onset to balloon inflation(225 vs. 160 min, P = 0.009) and first hospital arrival to balloon inflation times(106 vs. 56 min, P < 0.001). Only 28%(n = 9) of transferred patients underwent balloon inflation within 90 min from first hospital arrival, while 60%(n = 19) did within 120 min, although all received balloon inflation within 90 min from arrival at the PCI-H. After controlling for confounding factors of socio-economic status, presentation date/time and diagnostic category, transferred patients experienced an average 162% longer delays from symptom-onset to PCI-H door arrival, and 98% longer delays in symptom-onset to balloon inflation;compared to patients who present directly to the PCI-H. No statistically significant differences were noted between transferred and direct patients when measured from PCI-H door-to-balloon times. Conclusions This study shows that transferred patients experience a greater overall system delay, compared to patients who present directly for PCI, significantly increasing their time to treatment and therefore infarct times. Despite the majority of transfers experiencing pre-hospital activation, their treatment hospital arrival to balloon times are no less than direct presenters after controlling for confounding factors, further compounding the overall delay to therapy.

NUMERICAL SIMULATION OF HEAT,MASS AND MOMENTUM TRANSFERS IN METALLIC INGOTS AND PREDICTION OF MACROSEGREGATION

A continuum model and numerical methods were established for description of heat,mass and momentum transfers as well as macrosegregation formations in metallic ingots.Numerical simulation of temperature,composition and liquid flow fields during the solidification of an Al-4.5% Cu ingot were performed on an IBM personal computer.The model and numerical methods were verified through two experiments.

Reconstruction of thumb together with the first metacarpus of 10 cases using the modified method of free transfers of second toe and composite tissue

in the paper the results of reconstruction of thumb and first matacarpus of 10 cases are reported. All the 10 transplantations were successful and revealed fine recovery of function and appearance.It was considered that the method of simultaneous removal of the second toe and metatarsus,first web space of the foot and the dorsal pedis flap for reconstruction of thumb and metacarpus to be superior to traditional methods in many aspects.Revascularization by anastomosis between the dorsalis pedis artery and the proximal end of the radial artery and that between the first plantar metatarsal artery and the distal end of the radial artery is effective to overcome ischemia of transplants because of variation of the first dorsal metatarsal artery.

Multiple Energy Transfers in Rare Earth Complex-Doped SiO_2 Spheres

Silica spheres doped with Eu （TTFA）3 and/or Sm（TTFA）3 were synthesized by using the modified Stober method. The transmission electron microscope image reveals that the hybrid spheres have smooth surfaces and an average diameter of about 210 nm. Fluorescence spectrometer was used to analyze the fluorescence properties of hybrid spheres. The results show that multiple energy transfer processes are simultaneously achieved in the same samples co-doped with Eu （TTFA）3 and Sm（TTFA）3, namely between the ligand and Eu^3＋ ion, the ligand and Sm^3＋ ion, and Sm^3＋ ion and Eu^3＋ ion. Energy transfer of Sm^3＋→Eu^3＋ in the hybrid spheres leads to fluorescence enhancement of Eu^3＋ emission by approximately an order of magnitude. The lifetimes of the hybrid spheres were also measured.

IDS-INT:Intrusion detection system using transformer-based transfer learning for imbalanced network traffic

A network intrusion detection system is critical for cyber security against llegitimate attacks.In terms of feature perspectives,network traffic may include a variety of elements such as attack reference,attack type,a subcategory of attack,host information,malicious scripts,etc.In terms of network perspectives,network traffic may contain an imbalanced number of harmful attacks when compared to normal traffic.It is challenging to identify a specific attack due to complex features and data imbalance issues.To address these issues,this paper proposes an Intrusion Detection System using transformer-based transfer learning for Imbalanced Network Traffic(IDS-INT).IDS-INT uses transformer-based transfer learning to learn feature interactions in both network feature representation and imbalanced data.First,detailed information about each type of attack is gathered from network interaction descriptions,which include network nodes,attack type,reference,host information,etc.Second,the transformer-based transfer learning approach is developed to learn detailed feature representation using their semantic anchors.Third,the Synthetic Minority Oversampling Technique(SMOTE)is implemented to balance abnormal traffic and detect minority attacks.Fourth,the Convolution Neural Network(CNN)model is designed to extract deep features from the balanced network traffic.Finally,the hybrid approach of the CNN-Long Short-Term Memory(CNN-LSTM)model is developed to detect different types of attacks from the deep features.Detailed experiments are conducted to test the proposed approach using three standard datasets,i.e.,UNsWNB15,CIC-IDS2017,and NSL-KDD.An explainable AI approach is implemented to interpret the proposed method and develop a trustable model.

Heat and Mass Transfers in a Two-Phase Stratified Turbulent Fluid Flow in a Geothermal Pipe with Chemical Reaction

This research focused on the study of heat and mass transfers in a two-phase stratified turbulent fluid flow in a geothermal pipe with chemical reaction. The derived non-linear partial differential equations governing the flow were solved using the Finite Difference Method. The effects of various physical parameters on the concentration, skin friction, heat, and mass transfers have been determined. Analysis of the results obtained indicated that the coefficient of skin friction decreased with an increase in Reynolds number and solutal Grasholf number, the rate of heat transfer increased with an increase in Eckert number, Prandtl number, and angle of inclination, and the rate of mass transfer increased with increase in Reynolds number, Chemical reaction parameter and angle of inclination. The findings would be useful to engineers in designing and maintaining geothermal pipelines more effectively.

Causal Analysis Between Rice Growth and Cadmium Accumulation and Transfer under Arbuscular Mycorrhizal Inoculation

Cadmium(Cd)contamination in rice has been a serious threat to human health.To investigate the effects of arbuscular mycorrhizal fungi(AMF)on the Cd translocation in rice,a controlled pot experiment was conducted.The results indicated that AMF significantly increased rice biomass,with an increase of up to 40.0%,particularly in root biomass by up to 68.4%.Notably,the number of prominent rice individuals also increased,and their plasticity was enhanced following AMF inoculation.AMF led to an increase in the net photosynthetic rate and antioxidant enzyme activity of rice.In the AMF treatment group,the Cd concentration in the rice roots was significantly higher(19.1%‒68.0%)compared with that in the control group.Conversely,the Cd concentration in the rice seeds was lower in the AMF treatment group,indicating that AMF facilitated the sequestration of Cd in rice roots and reduced Cd accumulation in the seeds.Path coefficients varied across different treatments,suggesting that AMF inoculation reduced the direct impact of soil Cd concentration on the total Cd accumulation in seeds.The translocation of Cd was consistently associated with simultaneous growth dilution and compensatory accumulation as a result of mycorrhizal effects.Our study quantitatively analyzed this process through path analysis and clarified the causal relationship between rice growth and Cd transfer under the influence of AMF.

Robust Information Hiding Based on Neural Style Transfer with Artificial Intelligence

This paper proposes an artificial intelligence-based robust information hiding algorithm to address the issue of confidential information being susceptible to noise attacks during transmission.The algorithm we designed aims to mitigate the impact of various noise attacks on the integrity of secret information during transmission.The method we propose involves encoding secret images into stylized encrypted images and applies adversarial transfer to both the style and content features of the original and embedded data.This process effectively enhances the concealment and imperceptibility of confidential information,thereby improving the security of such information during transmission and reducing security risks.Furthermore,we have designed a specialized attack layer to simulate real-world attacks and common noise scenarios encountered in practical environments.Through adversarial training,the algorithm is strengthened to enhance its resilience against attacks and overall robustness,ensuring better protection against potential threats.Experimental results demonstrate that our proposed algorithm successfully enhances the concealment and unknowability of secret information while maintaining embedding capacity.Additionally,it ensures the quality and fidelity of the stego image.The method we propose not only improves the security and robustness of information hiding technology but also holds practical application value in protecting sensitive data and ensuring the invisibility of confidential information.

Generation of mitochondrial replacement monkeys by female pronucleus transfer

Mutations in mitochondrial DNA(mtDNA)are maternally inherited and have the potential to cause severe disorders.Mitochondrial replacement therapies,including spindle,polar body,and pronuclear transfers,are promising strategies for preventing the hereditary transmission of mtDNA diseases.While pronuclear transfer has been used to generate mitochondrial replacement mouse models and human embryos,its application in non-human primates has not been previously reported.In this study,we successfully generated four healthy cynomolgus monkeys(Macaca fascicularis)via female pronuclear transfer.These individuals all survived for more than two years and exhibited minimal mtDNA carryover(3.8%–6.7%),as well as relatively stable mtDNA heteroplasmy dynamics during development.The successful establishment of this nonhuman primate model highlights the considerable potential of pronuclear transfer in reducing the risk of inherited mtDNA diseases and provides a valuable preclinical research model for advancing mitochondrial replacement therapies in humans.

Effects of projectile parameters on the momentum transfer and projectile melting during hypervelocity impact

The effects of projectile/target impedance matching and projectile shape on energy,momentum transfer and projectile melting during collisions are investigated by numerical simulation.By comparing the computation results with the experimental results,the correctness of the calculation and the statistical method of momentum transfer coefficient is verified.Different shapes of aluminum,copper and heavy tungsten alloy projectiles striking aluminum,basalt,and pumice target for impacts up to 10 km/s are simulated.The influence mechanism of the shape of the projectile and projectile/target density on the momentum transfer was obtained.With an increase in projectile density and length-diameter ratio,the energy transfer time between the projectile and targets is prolonged.The projectile decelerates slowly,resulting in a larger cratering depth.The energy consumed by the projectile in the excavation stage increased,resulting in lower mass-velocity of ejecta and momentum transfer coefficient.The numerical simulation results demonstrated that for different projectile/target combinations,the higher the wave impedance of the projectile,the higher the initial phase transition velocity and the smaller the mass of phase transition.The results can provide theoretical guidance for kinetic impactor design and material selection.