Obesity has reached pandemic proportions in the last few decades. The global increase in obesity has contributed to an increase in the number of pregnant women with pre-pregnancy obesity or with ...excessive gestational weight gain. Obesity during pregnancy is associated with higher incidence of maternal co-morbidities such as gestational diabetes and hypertension. Both obesity during pregnancy and its associated complications are not only associated with immediate adverse outcomes for the mother and their newborns during the perinatal period but, more importantly, are linked with long-term morbidities in the offsprings. Neonates born to women with obesity are at higher risk for cardiac complications including cardiac malformations, and non-structural cardiac issues such as changes in the microvasculature, e.g., elevated systolic blood pressure, and overt systemic hypertension. Pulmonary diseases associated with maternal obesity include respiratory distress syndrome, asthma during childhood and adolescence, and adulthood diseases, such as chronic obstructive pulmonary disease. Sequelae of short-term complications compound long-term outcomes such as long-term obesity, hypertension later in life, and metabolic complications including insulin resistance and dyslipidemia. Multiple mechanisms have been proposed to explain these adverse outcomes and are related to the emerging knowledge of pathophysiology of obesity in adults. The best investigated ones include the role of obesity-mediated metabolic alterations and systemic inflammation. There is emerging evidence linking metabolic and immune derangements to altered biome, and alteration in epigenetics as one of the intermediary mechanisms underlying the adverse outcomes. These are initiated as part of fetal adaptation to obesity during pregnancy which are compounded by rapid weight gain during infancy and early childhood, a known complication of obesity during pregnancy. This newer evidence points toward the role of specific nutrients and changes in biome that may potentially modify the adverse outcomes observed in the offsprings of women with obesity.
Limited observations hinder understanding of turbulent characteristics in mountainous terrain resulting from heating or cooling of slopes, wind, vertical motions, and heat or moisture advection, ...which disperse aerosols and other pollutants over the region. In this study, the 1290 MHz radar wind profiler data are utilized to compute the boundary layer height (BLH), the refractive index structure constant (
C
n
2
), and the energy dissipation rate (
ɛ
) over the central Himalayan site for the period of November 2011 to March 2012, from the intense Ganges Valley Aerosol Experiment (GVAX) field measurements. The radar wind profiler (RWP) based estimation of BLH and ɛ is validated against the radiosonde, representing the effectiveness of the datasets for further investigation. The strong seasonal variation of log
C
n
2
and log
ɛ,
with average values of ≈ -12 m
−2/3
and -2 m
2
s
−3
, respectively, is associated with the mountain-induced local circulations and stability in the atmospheric boundary layer. The weak stratification during weak flow is found to be responsible for deep mixing, particularly in the nocturnal boundary layer in spring. Furthermore, the level of cloud cover significantly impacts the strength of turbulence, with the highest cloud cover resulting in a substantial increase in log
C
n
2
(approximately -11 m
−2/3
) due to intense updraft and downdraft motions compared to clear skies. Additionally, the distribution of aerosol loading across the site, coupled with the behavior of BLH, atmospheric stability, and orographic-induced circulations, implies distinctive seasonal mechanisms for transporting aerosols toward the mountains. This study offers valuable insights into the diurnal and seasonal patterns of turbulent mixing and the mechanisms behind the transport of pollutants through boundary layer processes over the region.
We evaluated the epidemiology of fluid balance (FB) over the first postnatal week and its impact on outcomes in a multi-center cohort of premature neonates from the AWAKEN study.
Retrospective ...analysis of infants <36 weeks' gestational age from the AWAKEN study (N = 1007). FB was defined by percentage of change from birth weight.
Mechanical ventilation (MV) at postnatal day 7.
One hundred and forty-nine (14.8%) were on MV at postnatal day 7. The median peak FB was 0% (IQR: -2.9, 2) and occurred on postnatal day 2 (IQR: 1,5). Multivariable models showed that the peak FB (aOR 1.14, 95% CI 1.10-1.19), lowest FB in first postnatal week (aOR 1.12, 95% CI 1.07-1.16), and FB on postnatal day 7 (aOR 1.10, 95% CI 1.06-1.13) were independently associated with MV on postnatal day 7. In a similar analysis, a negative FB at postnatal day 7 protected against the need for MV at postnatal day 7 (aOR 0.21, 95% CI 0.12-0.35).
Positive peak FB during the first postnatal week and more positive FB on postnatal day 7 were independently associated with MV at postnatal day 7. Those with a negative FB at postnatal day 7 were less likely to require MV.
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•Vibrational spectra of neutral and ionized vinyl-PAHs are reported.•The possibility of vinyl-PAHs in interstellar medium is analyzed.•Composite spectral model show new features that ...match some observed astrophysical bands.•Data suitable for emission models along proto planetary nebulae type cool objects.
The mid infrared emission features observed in various astrophysical sources are attributed to polycyclic aromatic hydrocarbon (PAH) molecules. The models of emission spectra from a collection of PAHs show uncertainty in matching the 6.2μm feature. This indicates the need to consider a larger variety of PAHs and PAH derivatives. Chemical pathways towards formation of PAHs in the astrophysical environments involve vinyl substituted PAHs as intermediate products. Vibrational spectroscopic study of vinyl-PAHs is reported in the present work. The vinyl group is substituted at similar positions in eight different PAHs. The obtained optimized structures show that vinyl substitution at 2 position in acenes gives planar geometry, while all other vinyl-PAHs are non-planar. Infrared spectra is simulated for neutrals as well as for cations. The results are compared with the spectra of corresponding plain PAHs and analyzed for possible match with astrophysical observations. New features, due to vinyl group in the composite spectra, identified at 6.64, 6.92, 7.27, 8.77 and 10.35μm fall close to some sub features of the observed emission spectra. The paper provides data that may be used in the emission models particularly along proto planetary nebulae type cool objects.
The dynamical and microphysical aspects of two different precipitating systems have been investigated using the ARIES Stratosphere‐Troposphere Radar (ASTRad) facility and further substantiated by ...Weather Research Forecasting (WRF) model over Manora Peak. The first event (Case‐I) is associated with the southwest Indian summer monsoon that occurred on 4 August 2020, with a vertical extension of 10–12 km and leads to liquid phase precipitation. The second event (Case‐II) linked to the winter western disturbance occurred on 5 February 2021. This precipitating system was developed with a vertical extension of 6–7 km, resulting in both liquid and solid phase precipitation. Such distinct vertical extension of the systems is found to be associated with the thermodynamical conditions and prevailed large‐scale circulations. By analyzing the vertical structure of these systems using three Doppler moments estimated from the ASTRad (equivalent Reflectivity dBZe, Doppler velocity, and Spectral width), maximum dBZe (∼60 dB) is observed in Case‐II, while higher spectral width (>2 m s−1) is associated to Case‐I. The microphysical processes assessed by the WRF model pointed out that Case‐I involved snow accretion on supercooled droplets, leading to graupel and raindrop formation, while in Case–II, solid and liquid precipitation resulted from ice processes, including accretion or autoconversion. These findings highlight the significance of integrating radar and modeling data to understand the dynamical and microphysical evolution of precipitation under the influence of orography in the Himalayan region.
Plain Language Summary
This study examined two different weather events in the Himalayan region. The first event occurred during the monsoon season and mostly involved liquid precipitation, while the second event took place in winter and had both solid and liquid precipitation. To understand how these weather patterns formed in the context of their dynamical and microphysical processes, we analyzed the data obtained from ASTRad technology and the WRF model. The radar data played a crucial role in observing and analyzing the vertical structure and temporal evolution of the precipitation systems. The modeling data provided valuable insights of the orographic effects and microphysical processes behind the formation of solid and liquid phase precipitation. Understanding these processes is essential for predicting weather in the Himalayan region, especially the influence of mountains on liquid and solid precipitation.
Key Points
Two distinct precipitation systems, one associated with monsoon and the other with western disturbance are investigated over the central Himalaya
These systems show distinct characteristics in terms of synoptic meteorological conditions, cloud processes, and spatio‐temporal scales
Integrated radar and model data emphasize the importance of understanding the precipitation evolution influenced by orography over the region
Background
There is increased use of early nasal continuous positive airway pressure (NCPAP) to manage respiratory distress in preterm infants but optimal methods and factors associated with ...successful wean are not well defined. A systematic review was performed to define the corrected gestational age (CGA), weight to wean NCPAP and the methods associated with successful weaning of the NCPAP among preterm infants, along with factors affecting it.
Methods
Searches were made of PubMed using the keywords-NCPAP, CPAP, weaning, withdrawal, preterm, and infants from its inception to January 1st, 2014, for studies in all languages but limited to humans. Previous reviews (including cross references) were also searched. We included all randomized and quasi-randomized controlled trials where preterm neonates were randomized to different NCPAP weaning strategies. Details of CGA, weight and methods used for weaning NCPAP were extracted along with factors which affect its withdrawal.
Results
Seven studies met the search criteria. The successful wean was at 32 to 33 weeks CGA and at 1600 g. Three different methods were used for weaning were sudden, gradual pressure wean and gradual graded time off wean. Criteria for readiness, success and failure to wean were defined. Factors affecting successful weaning were intubation, anemia, infection and gastro-esophageal reflux.
Conclusions
The successful wean was at 32 to 33 weeks CGA and 1600 g. Criteria for readiness, success and failure to wean are well defined. Sudden weaning may be associated with a shorter weaning time. Future trials are needed comparing weaning methods using defined criteria for readiness and success of NCPAP wean and stratify the results by gestational age and birth weight.
Management of severe acute respiratory Syndrome corona virus-2 (SARS-CoV-2) infected pregnant women at time of delivery presents a unique challenge. The variability in the timing and the method of ...delivery, ranging from normal vaginal delivery to an emergent cesarean section, adds complexity to the role of the health care providers in the medical care of the patient and in the interactions, they have with other providers. These variations are further influenced by the availability of isolation rooms in the facility and adequacy of personal protective equipment. The protocols already set in place can be further challenged when the facility reaches its capacity to manage the patients.To fulfill the goal of providing adequate management to the SARS-CoV-2 infected pregnant women and their infants, avoid variation from suggested guidelines, and decrease risk of exposure of the health care workers, the health care provider team needs to review the variations regularly. While familiarity can be achieved by reviewing the guidelines, clinical case simulations provide a more hands-on approach.Using case-based simulations and current guidance from the Center for Disease Control, American Academy of Pediatrics, and recent reviews, we discuss a management guideline developed at our institution to facilitate provision of care to SARS-CoV-2 infected pregnant women during delivery and to their infants, while protecting health care providers from exposure, and in keeping with the local facility logistics. KEY POINTS: · Simulation of delivery of SARS-CoV-2 positive pregnant women can minimize the risk of exposure to healthcare professionals.. · Four common scenarios of delivery as described can be adapted for the evolving guidelines for the management of SARS-CoV-2 positive pregnant women.. · Integrating simulations of management of SARS-CoV-2 positive pregnant women is feasible in daily clinical routine..
High resolution infrared imaging observations of the young planetary nebulae (PNe) NGC 7027 and BD +30° 3639, taken with the newly installed TIFR near infrared camera-II (TIRCAM2) on 3.6 m Devasthal ...optical telescope (DOT), ARIES, Nainital, are being reported. The images are acquired in J, H, K, polycyclic aromatic hydrocarbon (PAH) and narrow-band L (nbL) filters. The observations show emission from warm dust and PAHs in the circumstellar shells. The imaging of the two objects are among the first observations in PAH and nbL bands using TIRCAM2 on DOT. The NGC 7027 images in all bands show similar elliptical morphology with
∼
6
″
.7 and
∼
4
″
.5 semi-major and semi-minor axes. Considering size up to 10% of peak value the nebula extends upto 8
″
from the central star revealing a multipolar evolution. The relatively cooler BD +30° 3639 shows a rectangular-ring shaped nebula. In J and H bands it shows an angular diameter of
∼
8
″
, while a smaller
∼
6
″
.9 size is observed in K, PAH and nbL bands. The 3.28
μ
m emission indicates presence of PAHs at about 6000 and 5000 AU from the central stars in NGC 7027 and BD +30° 3639 respectively. Analysis suggests domination of neutral PAHs in BD +30° 3639, while in NGC 7027 there is higher ionization and more processed PAH population.
Studies in adults showed a relationship between low hemoglobin (Hb) and acute kidney injury (AKI). We performed this study to evaluate this association in newborns.
We evaluated 1891 newborns from ...the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database. We evaluated the associations for the entire cohort and 3 gestational age (GA) groups: <29, 29-<36, and ≥36 weeks' GA.
Minimum Hb in the first postnatal week was significantly lower in neonates with AKI after the first postnatal week (late AKI). After controlling for multiple potential confounders, compared to neonates with a minimum Hb ≥17.0 g/dL, both those with minimum Hb ≤12.6 and 12.7-14.8 g/dL had an adjusted increased odds of late AKI (aOR 3.16, 95% CI 1.44-6.96, p = 0.04) and (aOR 2.03, 95% CI 1.05-3.93; p = 0.04), respectively. This association was no longer evident after controlling for fluid balance. The ability of minimum Hb to predict late AKI was moderate (c-statistic 0.68, 95% CI 0.64-0.72) with a sensitivity of 65.9%, a specificity of 69.7%, and a PPV of 20.8%.
Lower Hb in the first postnatal week was associated with late AKI, though the association no longer remained after fluid balance was included.
The current study suggests a possible novel association between low serum hemoglobin (Hb) and neonatal acute kidney injury (AKI). The study shows that low serum Hb levels in the first postnatal week are associated with increased risk of AKI after the first postnatal week. This study is the first to show this relationship in neonates. Because this study is retrospective, our observations cannot be considered proof of a causative role but do raise important questions and deserve further investigation. Whether the correction of low Hb levels might confer short- and/or long-term renal benefits in neonates was beyond the scope of this study.
Investigate relationship between management of patent ductus arteriosus (PDA) and acute kidney injury (AKI) in very low birthweight neonates.
Retrospective cohort study of neonates, <1500 g, admitted ...to 24 NICUs, 1/1/14 - 3/31/14. AKI diagnosed using the neonatal modified KDIGO definition; diagnosis and treatment of PDA extracted from the medical record. Demographics, clinical characteristics, and AKI stage compared using chi-square and analysis of variance. A general estimating equation logistic regression used to estimate adjusted odds ratios.
Of 526 neonates with sufficient data to diagnose AKI, 157 (30%) had PDA (61 conservative management, 62 pharmacologic treatment only, 34 surgical ligation). In analyses adjusted for sex, birthweight, gestational age, caffeine, nephrotoxin exposure, vasopressor and mechanical ventilation use, with conservative management as reference, there were no differences among treatment cohorts in the odds of AKI.
The underlying physiology of PDA, not management strategy, may determine the likelihood of AKI in neonates <1500 g.
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