Explore the vast range of titles available.

\"This STEM-based set of True Books introduces students to the engineering innovations that can help us reach more environmentally friendly goals\"-- Provided by publisher.

Objective To determine outcomes at age 3 years in babies born before 27 completed weeks’ gestation in 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks’ gestation.Design Prospective national cohort studies, EPICure and EPICure 2.Setting Hospital and home based evaluations, England.Participants 1031 surviving babies born in 2006 before 27 completed weeks’ gestation. Outcomes for 584 babies born at 22-25 weeks’ gestation were compared with those of 260 surviving babies of the same gestational age born in 1995.Main outcome measures Survival to age 3 years, impairment (2008 consensus definitions), and developmental scores. Multiple imputation was used to account for the high proportion of missing data in the 2006 cohort.Results Of the 576 babies evaluated after birth in 2006, 13.4% (n=77) were categorised as having severe impairment and 11.8% (n=68) moderate impairment. The prevalence of neurodevelopmental impairment was significantly associated with length of gestation, with greater impairment as gestational age decreased: 45% at 22-23 weeks, 30% at 24 weeks, 25% at 25 weeks, and 20% at 26 weeks (P<0.001). Cerebral palsy was present in 83 (14%) survivors. Mean developmental quotients were lower than those of the general population (normal values 100 (SD 15)) and showed a direct relation with gestational age: 80 (SD 21) at 22-23 weeks, 87 (19) at 24 weeks, 88 (19) at 25 weeks, and 91 (18) at 26 weeks. These results did not differ significantly after imputation. Comparing imputed outcomes between the 2006 and 1995 cohorts, the proportion of survivors born between 22 and 25 weeks’ gestation with severe disability, using 1995 definitions, was 18% (95% confidence interval 14% to 24%) in 1995 and 19% (14% to 23%) in 2006. Fewer survivors had shunted hydrocephalus or seizures. Survival of babies admitted for neonatal care increased from 39% (35% to 43%) in 1995 to 52% (49% to 55%) in 2006, an increase of 13% (8% to 18%), and survival without disability increased from 23% (20% to 26%) in 1995 to 34% (31% to 37%) in 2006, an increase of 11% (6% to 16%). Conclusion Survival and impairment in early childhood are both closely related to gestational age for babies born at less than 27 weeks’ gestation. Using multiple imputation to account for the high proportion of missing values, a higher proportion of babies admitted for neonatal care now survive without disability, particularly those born at gestational ages 24 and 25 weeks.

Given the well-documented failings in mathematics education in many Western societies, there has been an increased interest in understanding the cognitive underpinnings of mathematical achievement. Recent research has proposed the existence of an Approximate Number System (ANS) which allows individuals to represent and manipulate non-verbal numerical information. Evidence has shown that performance on a measure of the ANS (a dot comparison task) is related to mathematics achievement, which has led researchers to suggest that the ANS plays a critical role in mathematics learning. Here we show that, rather than being driven by the nature of underlying numerical representations, this relationship may in fact be an artefact of the inhibitory control demands of some trials of the dot comparison task. This suggests that recent work basing mathematics assessments and interventions around dot comparison tasks may be inappropriate.

The authors consider the legal and ethical considerations of offering a time-limited trial of a potentially non-beneficial intervention in the setting of patient or surrogate requests to pursue aggressive treatment. The likelihood of an intervention’s success is rarely a zero-sum game, and an intervention’s risk-to-benefit ratio may be indiscernible without further information (often, a matter of time).

Efficient generation of hydrogen from renewable resources requires development of catalysts that avoid deep wells and high barriers. Information about the energy landscape for H₂ production can be obtained by chemical characterization of catalytic intermediates, but few have been observed to date. We have isolated and characterized a key intermediate in 2e⁻ + 2H⁺ → H₂ catalysis. This intermediate, obtained by treatment of Cp*Rh(bpy) (Cp*, η⁵-pentamethylcyclopentadienyl; bpy, κ²-2,2′-bipyridyl) with acid, is not a hydride species but rather, bears [η⁴-Cp*H] as a ligand. Delivery of a second proton to this species leads to evolution of H₂ and reformation of η⁵-Cp* bound to rhodium(III). With suitable choices of acids and bases, the Cp*Rh(bpy) complex catalyzes facile and reversible interconversion of H⁺ and H₂.

ObjectiveAttendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified patient-level factors associated with routine population breast screening attendance.DesignCINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched for studies of any design, published January 1987–June 2019, and reporting attendance in relation to at least one patient-level factor.Data synthesisIndependent reviewers performed screening, data extraction and quality appraisal. OR and 95% CIs were calculated for attendance for each factor and random-effects meta-analysis was undertaken where possible.ResultsOf 19 776 studies, 335 were assessed at full text and 66 studies (n=22 150 922) were included. Risk of bias was generally low. In meta-analysis, increased attendance was associated with higher socioeconomic status (SES) (n=11 studies; OR 1.45, 95% CI: 1.20 to 1.75); higher income (n=5 studies; OR 1.96, 95% CI: 1.68 to 2.29); home ownership (n=3 studies; OR 2.16, 95% CI: 2.08 to 2.23); being non-immigrant (n=7 studies; OR 2.23, 95% CI: 2.00 to 2.48); being married/cohabiting (n=7 studies; OR 1.86, 95% CI: 1.58 to 2.19) and medium (vs low) level of education (n=6 studies; OR 1.24, 95% CI: 1.09 to 1.41). Women with previous false-positive results were less likely to reattend (n=6 studies; OR 0.77, 95% CI: 0.68 to 0.88). There were no differences by age group or by rural versus urban residence.ConclusionsAttendance was lower in women with lower SES, those who were immigrants, non-homeowners and those with previous false-positive results. Variations in service delivery, screening programmes and study populations may influence findings. Our findings are of univariable associations. Underlying causes of lower uptake such as practical, physical, psychological or financial barriers should be investigated.Trial registration numberCRD42016051597.

ObjectiveThere is a paucity of data relating to neurodevelopmental outcomes in infants born late and moderately preterm (LMPT; 32+0–36+6 weeks). This paper present the results of a prospective, population-based study of 2-year outcomes following LMPT birth.Design1130 LMPT and 1255 term-born children were recruited at birth. At 2 years corrected age, parents completed a questionnaire to assess neurosensory (vision, hearing, motor) impairments and the Parent Report of Children's Abilities-Revised to identify cognitive impairment. Relative risks for adverse outcomes were adjusted for sex, socio-economic status and small for gestational age, and weighted to account for over-sampling of term-born multiples. Risk factors for cognitive impairment were explored using multivariable analyses.ResultsParents of 638 (57%) LMPT infants and 765 (62%) controls completed questionnaires. Among LMPT infants, 1.6% had neurosensory impairment compared with 0.3% of controls (RR 4.89, 95% CI 1.07 to 22.25). Cognitive impairments were the most common adverse outcome: LMPT 6.3%; controls 2.4% (RR 2.09, 95% CI 1.19 to 3.64). LMPT infants were at twice the risk for neurodevelopmental disability (RR 2.19, 95% CI 1.27 to 3.75). Independent risk factors for cognitive impairment in LMPT infants were male sex, socio-economic disadvantage, non-white ethnicity, preeclampsia and not receiving breast milk at discharge.ConclusionsCompared with term-born peers, LMPT infants are at double the risk for neurodevelopmental disability at 2 years of age, with the majority of impairments observed in the cognitive domain. Male sex, socio-economic disadvantage and preeclampsia are independent predictors of low cognitive scores following LMPT birth.

Preterm birth (<37 weeks’ gestation) is a risk factor for poor educational outcomes. A dose-response effect of earlier gestational age at birth on poor primary school attainment has been observed, but evidence for secondary school attainment is limited and focused predominantly on the very preterm (<32 weeks) population. We examined the association between gestational age at birth and academic attainment at the end of primary and secondary schooling in England. Data for children born in England from 2000–2001 were drawn from the population-based UK Millennium Cohort Study. Information about the child’s birth, sociodemographic factors and health was collected from parents. Attainment on national tests at the end of primary (age 11) and secondary school (age 16) was derived from linked education records. Data on attainment in primary school was available for 6,950 pupils and that of secondary school was available for 7,131 pupils. Adjusted relative risks (aRRs) for these outcomes were estimated at each stage separately using modified Poisson regression. At the end of primary school, 17.7% of children had not achieved the expected level in both English and Mathematics and this proportion increased with increasing prematurity. Compared to full term (39–41 weeks) children, the strongest associations were among children born moderately (32–33 weeks; aRR = 2.13 (95% CI 1.44–3.13)) and very preterm (aRR = 2.06 (95% CI 1.46–2.92)). Children born late preterm (34–36 weeks) and early term (37–38 weeks) were also at higher risk with aRR = 1.18 (95% CI 0.94–1.49) and aRR = 1.21 (95% CI 1.05–1.38), respectively. At the end of secondary school, 45.2% had not passed at least five General Certificate of Secondary Education examinations including English and Mathematics. Following adjustment, only children born very preterm were at significantly higher risk (aRR = 1.26 (95% CI 1.03–1.54)). All children born before full term are at risk of poorer attainment during primary school compared with term-born children, but only children born very preterm remain at risk at the end of secondary schooling. Children born very preterm may require additional educational support throughout compulsory schooling.

Background To assess the clinical service provision of neonatal follow-up services in the UK in line with UK National Institute for Health and Care Excellence (NICE) guideline NG72, ‘Developmental follow-up of children and young people born preterm’. Methods Design: Online survey. Setting: Neonatal units in England, Scotland and Wales ( n  = 187) in July– September 2022. Participants: Lead neonatal clinicians for neurodevelopmental follow-up. Results Responses were received from 154 neonatal units, representing 82% of the total. This included 52 out of 58 (89%) Neonatal Intensive Care Units, 68 out of 86 (79%) Local Neonatal Units, and 34 out of 43 (79%) Special Care Baby Units. In total, 136 units (88%) provided neurodevelopmental follow-up for infants born before 30 weeks’ gestation, and 75 units (51%) did so for those born before 32 weeks’ gestation. Out of 145 responses, 134 units (92%) offered follow-up to infants with brain injury requiring cooling therapy. A 2-year neurodevelopmental face-to-face appointment was available for infants born before 30 weeks’ gestation in 129 units (83%), while only ten units (6%) provided a 4-year assessment for those born before 28 weeks’ gestation. Additionally, just 13 units (9.6%) directed families to peer support services. Conclusions The structure and content of neonatal neurodevelopmental follow-up vary widely. Notably, there is a lack of 4-year assessments for infants born preterm, representing a missed opportunity to support school readiness. Key Messages What is already known on this topic? Neonatal neurodevelopmental follow-up is a vital aspect of care for early detection of difficulties, timely access to intervention, promotion of long-term health and wellbeing and data collection to contribute to parental counselling. Delivery of neonatal follow-up in line with UK clinical guidelines has not been evaluated. What this study hopes to add. There is wide variation in the inclusion criteria, content, and duration of neonatal neurodevelopmental follow-up in the UK. Only 6.8% of services reported offering infants born < 28 weeks’ gestation a face-to-face appointment at four years of age. Recognition that the informational needs of parents may be conflated with the data requirements of clinicians, and this may contribute to suboptimal clinical service provision and limited reliable outcome data. How this study might affect research, practice, or policy. This study highlights the lack of neurodevelopmental surveillance and support for children born < 28 weeks’ gestation at four years of age. These data provide evidence for Operational Delivery Networks (ODNs) to understand how neonatal neurodevelopmental follow-up is delivered within their area. This will help inform families about available services, facilitate joint work, and deliver more equitable neonatal follow-up in the UK. Clinicians could improve information sharing with families by signposting to trusted local, community, online, or third-sector support. Further research is necessary to comprehensively understand neonatal and paediatric developmental services from a parent/caregiver perspective and a systems and processes perspective. Clinical policy and guidelines should provide further clarity regarding which services are most appropriate and responsible for delivering this care.

Anthropogenic climate change and ecosystem disturbances can detrimentally affect habitats and species. Areas with concentrated biodiversity, such as aridland riparian zones, often yield the greatest number of vulnerable species. A better understanding of ecological and environmental relationships can guide more effective conservation strategies. We used both visual transects and external (tape) radio telemetry to study the behavioral and spatial ecology of black-necked gartersnakes ( Thamnophis cyrtopsis ; n = 81)—a dietary generalist yet aquatic habitat specialist—in a heterogenous aridland riparian zone of lower Sabino Canyon, Tucson, Arizona, between 2018 and 2021. Our objectives were to (1) understand how extrinsic conditions influence population ecology dynamics, including immediately prior to and after major disturbances and environmental extremes; (2) analyze behavioral activity and microhabitat usage in relation to environmental factors; and (3) assess the efficacy of a less-invasive telemetry strategy. Between late spring 2020 and early summer 2021, ecosystem disturbances included near-record heat and drought, wildfire, and low overwinter precipitation. Many aquatic habitats either completely dried or were spatially disjunct; gartersnake prey species were noticeably sparse. Extreme drought rapidly shifted to excessive flooding during the 2021 monsoon that brought above-average streamflow magnitude and duration. Between 2019 and 2021, we observed a dramatic decline in T. cyrtopsis ; odds of detection reduced by 92.8% (CI [56.0–99.1%]). Strong spatiotemporal links relative to the extent and timing of available surface water appear important. Prior to the onset of monsoonal stream recharge in early summer, shallow and drying aquatic habitats are used as parturition sites and foraging grounds; all age classes took advantage to corral fishes trapped in isolated and shrinking pools. Ambient conditions had varying effects on gartersnake behaviors. Variation in microhabitat assemblages occurred with distance from water, activity level, and developmental age class. Interestingly, associations remained consistent across seasons and years, which suggests a reliance on heterogenous habitat structure. Sampling techniques complemented each other, however, bioclimatic parameters rendered limitations and should be considered in methodological decisions. Overall, disadvantageous responses to major disturbances and climatic extremes by a presumably adaptable generalist like T. cyrtopsis are concerning. Insights from long-term monitoring of responses by common yet environmentally sensitive species such as T. cyrtopsis may serve to more broadly highlight demographic challenges that other taxa with similar semi-aquatic life histories may face in changing systems. Such information could inform more effective conservation management strategies in warming and drying ecosystems.