To determine feasibility of providing a concentrated emulsified long-chain polyunsaturated fatty acids (LCPUFA) supplement to very low birth weight infants, and to evaluate blood LCPUFA concentrations at 2 and 8weeks of study supplementation. This prospective, randomized, double-blind, placebo-controlled trial randomized infants to receive (1) LCPUFA-120 (a supplement of 40mg/kg/day docosahexaenoic acid [DHA] and 80mg/kg/day arachidonic acid [ARA]; DHAARA at 12 ratio), (2) LCPUFA-360 (a supplement of 120mg/kg/day DHA and 240mg/kg/day ARA), or (3) sunflower oil (placebo control). Infants received supplement daily for 8weeks or until discharge, whichever came first. Whole blood LCPUFA levels (wt%; g/100g) were measured at baseline, 2weeks, and 8weeks. Infants were 28weeks of gestation (IQR, 27-30weeks of gestation) and weighed 1040g (IQR, 910-1245g). At 2weeks, the change in blood DHA (wt%) from baseline differed significantly among groups (sunflower oil, n=6; -0.63 [IQR, -0.96 to -0.55]; LCPUFA-120 n=12; -0.14 [IQR, -0.72 to -0.26]; LCPUFA-360, n=12; 0.46 [IQR, 0.17-0.81]; P=.002 across groups). Change in blood ARA (wt%) also differed by group (sunflower oil -2.2 [IQR, -3.9 to -1.7]; LCPUFA-120 0.1 [IQR, -2.1 to 1.1] vs LCPUFA-360 2.9 IQR, 1.5 to 4.5]; P=.0002). Change from baseline to 8weeks significantly differed between groups for DHA (P=.02) and ARA (P=.003). Enteral LCPUFA supplementation supported higher blood DHA by 2weeks. LCPUFA supplementation at 360mg of combined DHA and ARA is likely necessary to reduce declines as well as allow increases in whole blood concentrations in the first 8weeks of life. Clinicaltrials.gov NCT03192839.Clinicaltrials.gov NCT03192839. To determine if implementation of an automated sepsis screening algorithm with low positive predictive value led to inappropriate resource utilization in emergency department (ED) patients as evidenced by an increased proportion of children with false-positive sepsis screens receiving intravenous (IV) antibiotics. Retrospective cohort study comparing children <18years of age presenting to an ED who triggered a false-positive sepsis alert during 2 different 5-month time periods a silent alert period when alerts were generated but not visible to clinicians and an active alert period when alerts were visible. Primary outcome was the proportion of patients who received IV antibiotics. find more Secondary outcomes included proportion receiving IV fluid boluses, proportion admitted to the hospital, and ED length of stay (LOS). Of 1457 patients, 1277 triggered a false-positive sepsis alert in the silent and active alert periods, respectively. In multivariable models, there were no changes in the proportion administered IV antibiotics (27.0% vs 27.6%, aOR 1.1 [0.9,1.3]) or IV fluid boluses (29.7% vs 29.1%, aOR 1.0 [0.8,1.2]). Differences in ED LOS and proportion admitted to the hospital were not significant when controlling for similar changes seen across all ED encounters. An automated sepsis screening algorithm did not lead to changes in the proportion receiving IV antibiotics or IV fluid boluses, department LOS, or the proportion admitted to the hospital for patients with false-positive sepsis alerts.An automated sepsis screening algorithm did not lead to changes in the proportion receiving IV antibiotics or IV fluid boluses, department LOS, or the proportion admitted to the hospital for patients with false-positive sepsis alerts. Although quality improvement interventions for acute heart failure have been studied in high-income countries, none have been studied in low- or middle-income country settings where quality of care can be lower. We evaluated the effect of a quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized for acute heart failure in 8 hospitals in Kerala, India utilizing an interrupted time series design from February 2018 to August 2018. The quality improvement toolkit included checklists, audit-and-feedback reports, and patient education materials. The primary outcome was rate of discharge guideline-directed medical therapy for patients with heart failure with reduced ejection fraction. We used mixed effect logistic regression and interrupted time series models for analysis. Among 1400 participants, mean (SD) age was 66.6 (12.2) years, and 38% were female. Mean (SD) left ventricular ejection fraction was 35.2% (9.7%). The primary outcome was observed in 41.3% of parries. Bilateral carpal tunnel syndrome (CTS), particularly in male individuals with left ventricular hypertrophy (LVH), has been recognized as a red flag for transthyretin cardiac amyloidosis (TTR-CA). Nonetheless, the opportunity of screening CTS patients for TTR has yet to be determined. Medical records of 1689 CTS surgeries performed at our institution between 2008 and 2018 were reviewed. Eighty-three males who underwent bilateral CTS surgery were considered eligible for the study, and offered a screening examination including electrocardiography and echocardiography. Individuals with LVH (diastolic septal wall thickness>12mm) were offered second-line diagnostic testing including blood testing and bone scintigraphy. Study population consisted of 53 bilateral CTS male patients, with median age of 73years. LVH was found in 6 (11%) individuals. None of them had monoclonal gammopathy or reported CTS occupational risk factors. Two declined to undergo further testing, whereas 2 had negative and 2 had positive bone scintigraphy (both Perugini 2 uptake) and tested negative for TTR gene mutations (wild-type TTR-CA). Prevalence of TTR-CA in the entire study population was 4%, but among bilateral CTS patients with LVH peaked at 33%. In this latter population, screening for TTR-CA appeared feasible and effective.Prevalence of TTR-CA in the entire study population was 4%, but among bilateral CTS patients with LVH peaked at 33%. In this latter population, screening for TTR-CA appeared feasible and effective.Cells associated with an abnormal (cancerous) growth exchange flows, morph freely and grow hand-in-glove with their immediate environment, the extracellular matrix (ECM). The cell structure experiences two mass flows in counterflow. Flowing into the structure are nutrients and flowing out is refuse from the metabolically active biomass within. The physical effect of the evolution of the cell and extracellular structure is more flow and mixing in that space, that is, more mixing than in the absence of a biological growth in that space. The objective of the present theory is to predict the increase in the size of the cell cluster as a function of its structure, and also to predict the critical cluster sizes that mark the transitions from one distinct cluster configuration to the next. This amounts to predicting the timing and the main features of the transitions from single cell to clusters with two, four, eight and more cells, including larger clusters with cells organized on its outer surface. The predicted evolution of the size and configuration of the cell cluster is validated successfully by comparison with measurements from several independent studies of cancerous and non-cancerous growth patterns.