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Objective: Nurses provide parental support and education in the neonatal intensive care unit (NICU), but it is unknown if satisfaction and expectations about nursing care differ between racial groups. Study Design: A prospective cohort was constructed of families with a premature infant presenting to primary care between 1 January 2010 and 1 January 2013 ( N =249, 52% white, 42% black). Responses to questions about satisfaction with the NICU were analyzed in ATLAS.ti using the standard qualitative methodology. Results: One hundred and twenty (48%) parents commented on nursing. Fifty-seven percent of the comments were positive, with black parents more negative (58%) compared with white parents (33%). Black parents were most dissatisfied with how nurses supported them, wanting compassionate and respectful communication. White parents were most dissatisfied with inconsistent nursing care and lack of education about their child. Conclusions: Racial differences were found in satisfaction and expectations with neonatal nursing care. Accounting for these differences will improve parental engagement during the NICU stay.

Objective: Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome experienced by opioid-exposed infants. There is no standard treatment for NAS and surveys suggest wide variation in pharmacotherapy for NAS. Our objective was to determine whether different pharmacotherapies for NAS are associated with differences in outcomes and to determine whether pharmacotherapy and outcome vary by hospital. Study Design: We used the Pediatric Health Information System Database from 2004 to 2011 to identify a cohort of infants with NAS requiring pharmacotherapy. Mixed effects hierarchical negative binomial models evaluated the association between pharmacotherapy and hospital with length of stay (LOS), length of treatment (LOT) and hospital charges, after adjusting for socioeconomic variables and comorbid clinical conditions. Result: Our cohort included 1424 infants with NAS from 14 children’s hospitals. Among hospitals in our sample, six used morphine, six used methadone and two used phenobarbital as primary initial treatment for NAS. In multivariate analysis, when compared with NAS patients initially treated with morphine, infants treated with methadone had shorter LOT (incidence rate ratio (IRR)=0.55; P <0.0001) and LOS (IRR=0.60; P <0.0001). Phenobarbital as a second-line agent was associated with increased LOT (IRR=2.09; P <0.0001), LOS (IRR=1.78; P <0.0001) and higher hospital charges (IRR=1.84; P <0.0001). After controlling for case-mix, hospitals varied in LOT, LOS and hospital charges. Conclusion: We found variation in hospital in treatment for NAS among major US children's hospitals. In analyses controlling for possible confounders, methadone as initial treatment was associated with reduced LOT and hospital stay.

We use genetic programming (GP), a type of machine learning (ML) approach, to predict the total and infragravity swash excursion using previously published data sets that have been used extensively in swash prediction studies. Three previously published works with a range of new conditions are added to this data set to extend the range of measured swash conditions. Using this newly compiled data set we demonstrate that a ML approach can reduce the prediction errors compared to well-established parameterizations and therefore it may improve coastal hazards assessment (e.g. coastal inundation). Predictors obtained using GP can also be physically sound and replicate the functionality and dependencies of previous published formulas. Overall, we show that ML techniques are capable of both improving predictability (compared to classical regression approaches) and providing physical insight into coastal processes.

BackgroundThe prevalence of opioid use during pregnancy is increasing. Two downstream effects are neonatal abstinence syndrome (NAS), a postnatal withdrawal syndrome, and long-term prenatal opioid exposure (LTPOE) without documented withdrawal symptoms in the infant. Mental health characteristics of mothers of infants with NAS and LTPOE have not been described.MethodsUsing linked maternal and infant Medicaid claims and birth certificate data, we analyzed 15,571 infants born to Medicaid-insured women 15–24 years old in a mid-Atlantic city from 2007 to 2010. Pairwise comparisons with multinomial logistic regression, adjusting for maternal and infant covariates, were performed. We compared four mental health conditions among mothers of infants with NAS, infants with LTPOE without NAS, and controls: depression, anxiety, bipolar disorder, and schizophrenia.ResultsThe prevalence of depression among mothers of infants with NAS, infants with LTPOE, and controls was 26, 21.1, and 5.5% respectively. Similar results were found for anxiety. In multivariable analysis, mothers of infants with NAS and LTPOE had approximately twice the depression risk as controls, while mothers of infants with LTPOE had 2.2 times the bipolar disorder risk and 4.6 times the schizophrenia risk as controls. The overall risk of mental health conditions in mothers of infants with NAS and LTPOE was similar.DiscussionMothers of infants with LTPOE who did not develop NAS are at similarly high risk for mental health conditions as mothers of infants with NAS, and both are at higher risk than controls. Therefore, those mothers of infants who did not develop symptoms of NAS despite LTPOE may be a vulnerable population that needs additional mental health support in the post-partum period.

In this paper, we derive a nonlinear strain gradient theory of thermoelastic materials with microtemperatures taking into account micro-inertia effects as well. The elastic behaviour is assumed to be consistent with Mindlin’s Form II gradient elasticity theory, while the thermal behaviour is based on the entropy balance of type III postulated by Green and Naghdi for both temperature and microtemperatures. The work is motivated by increasing use of materials having microstructure at both mechanical and thermal levels. The equations of the linear theory are also obtained. Then, we use the semigroup theory to prove the well-posedness of the obtained problem. Because of the coupling between high-order derivatives and microtemperatures, the obtained equations do not have exponential decay. A frictional damping for the elastic component, whose form depends on the micro-inertia, is shown to lead to exponential stability for the type III model.

This paper relates to the development of an improved gasket product by the use of a controlled moduli foam material. This material is based on a foamed nitrile rubber and its modulus is controlled through compositional changes and curing conditions. Steel or aluminum sheets coated with this material have been tested for gasket application and data obtained on its characterization and properties are presented.

Accounting for the diversity in El Niño Southern Oscillation (ENSO)'s spatial pattern, with the novel ENSO longitudinal index (ELI), we evaluate the simulation of its teleconnections to US winter precipitation extremes by seven global high‐resolution (HR) Earth System Models (ESM). Six (four) HR ESMs simulate the observed increase in precipitation extremes over Southwest US (Southeast US) during ELI‐defined El Niño events better than their low‐resolution counterparts, which are low‐biased. The stronger ENSO‐dependence over the Southwest US and Southeast US in those models is associated with an improved simulation of moisture flux into the regions and/or storm track activity there. HR ESMs, however, generally overestimate the increase in precipitation extremes over the Pacific‐Northwest during La Niña events. Model bias there is associated with bias in moisture transport into the region during La Niña events, which is amplified by the enhanced vertical mass fluxes in HR. Plain Language Summary El Niño Southern Oscillation (ENSO) comes in many flavors with diverse spatial pattern of ocean warming and associated heavy tropical rainfall over the deep tropical Pacific. This ENSO diversity is one of the major reasons behind our limited understanding and prediction of its global impacts, particularly on climate extremes. A recent approach to characterize the full spectrum of ENSO using a simple index shows promise in improving our understanding. Here, we use this new index to evaluate if new state‐of‐the‐art high resolution Earth System Models can capture the remote impacts of ENSO on US precipitation extremes in the winter. We find that some of these models can credibly simulate these ENSO teleconnections, across its many flavors, over the SE‐US and SW‐US, and generally improve upon their low resolution model counterparts. Key Points We evaluate seven high‐resolution (HR) Earth System Models' simulation of diverse El Niño Southern Oscillation (ENSO) teleconnections to US winter precipitation extremes Simulation of ENSO‐dependent Southwest‐US (Southeast‐US) precipitation extremes is improved in six (four) models with resolution increase This is due to improvements in ENSO dependent moisture transport, storm track activity, and vertical mass fluxes in HR models

In this paper, we derive a nonlinear strain gradient theory of thermoelastic materials with microtemperatures taking into account micro-inertia effects as well. The elastic behaviour is assumed to be consistent with Mindlin’s Form II gradient elasticity theory, while the thermal behaviour is based on the entropy balance of type III postulated by Green and Naghdi for both temperature and microtemperatures. The work is motivated by increasing use of materials having microstructure at both mechanical and thermal levels. The equations of the linear theory are also obtained. Then, we use the semigroup theory to prove the well-posedness of the obtained problem. Because of the coupling between high-order derivatives and microtemperatures, the obtained equations do not have exponential decay. A frictional damping for the elastic component, whose form depends on the micro-inertia, is shown to lead to exponential stability for the type III model.

ObjectiveDetermine impact of using delivery criteria to initiate antibiotics among very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.Study designSingle site cohort study from 01/01/2009 to 01/31/2020. After 04/2017, infants delivered by Cesarean section, without labor or membrane rupture were categorized as low-risk for early-onset infection and managed without empiric antibiotics. We determined effect of this guideline by pre-post, and interrupted time-series analyses.ResultsAfter 04/2017, antibiotic initiation ≤3 days decreased among low-risk VLBW (62% vs. 13%, p < 0.001) and low-risk ELBW (88% vs. 21%, p < 0.001) infants. In time series analysis, guideline was associated with decreased initiation among low-risk ELBW infants. In contrast, low-risk VLBW infants demonstrated decreased antibiotic initiation throughout study period. Incidence of confirmed infection, death, or transfer ≤7 days age was unchanged.ConclusionDelivery criteria may be used to optimize early antibiotic initiation among preterm infants without short-term increase in adverse outcomes.

OBJECTIVE:To quantify the contribution of acute versus postacute care factors to survival and functional outcomes after hip fracture. DESIGN, SETTING, AND PARTICIPANTS:Retrospective cohort study using Medicare data; subjects included previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009. METHODS:We used logistic regression to measure the associations of hospital and nursing home factors with functional and survival outcomes at 30 and 180 days among patients discharged to a nursing facility; we quantified the contribution of hospital versus nursing home factors to outcomes by the ω statistic. RESULTS:Among 45,996 hospitalized patients, 1814 (3.9%) died during hospitalization. A total of 42,781 (93%) were discharged alive to a nursing home. Of these, 12,126 (28%) died within 180 days and 20,479 (48%) died or were newly unable to walk within 180 days. Hospital characteristics were not consistently associated with outcomes. Multiple nursing home characteristics predicted 30- and 180-day outcomes, including bed count, chain membership, and performance on selected quality measures. Nursing home factors explained 3 times more variation in the odds of 30-day mortality than did hospital factors [ω, hospital vs. nursing home0.32; 95% confidence interval (CI), 0.11, 0.96], 7 times more variation in the odds of 180-day mortality (ω0.15; 95% CI, 0.04, 0.61), and 8 times more variation in the odds of 180-day death or new dependence in locomotion (ω0.12; 95% CI, 0.05, 0.31). CONCLUSIONS:Nursing home factors explain a larger proportion of the variation in clinical outcomes following hip fracture than do hospital factors.