Despite ambient heat being a well-known risk to workers' health, this study's findings indicate ambient heat contributed to work-related ED hyperthermia visits in these five states Used alone, existing OSHA heat-risk levels for ambient temperatures did not appear to successfully communicate workers' risk for hyperthermia in this study Findings should inform future heat-alert communications and policies, heat prevention efforts, and heat-illness prevention research for workers in the southeastern United States
  Pelvic fluid collections PFCs are frequent adverse events of abdominal surgery or inflammatory conditions A percutaneous approach to deep PFCs could be challenging and result in a longer, painful recovery The transvaginal approach has been considered easy but is limited by the difficulty of leaving a stent in place The transrectal approach has been described, but issues related to fecal contamination were hypothesized Data on EUS-guided transrectal drainage EUS-TRD with lumen-apposing metal stents LAMSs are few and suggest unsatisfactory outcomes The aim of this study was to evaluate the safety and efficacy of EUS-TRD with LAMSs in patients with PFCs
 
  A retrospective analysis of a prospectively maintained database on therapeutic EUS was conducted All EUS-TRD procedures were included
 
  Five patients 2 male, age 44-89 years were included Four patients had postoperative PFCs, and 1 presented with a pelvic abscess complicating acute diverticulitis Two of 5 had fecal diversion; the remaining 3ows rapid PFC resolution EUS-TRD could be performed not only in patients with fecal diversion but also in cases of unaltered anatomy
  Definitive treatment options for refractory dysphagia due to cricopharyngeal bar are limited We aimed to demonstrate a novel adaptation of peroral endoscopic myotomy to treat this condition cricopharyngeal peroral endoscopic myotomy [c-POEM]
 
  The approach to c-POEM is similar to that in the distal esophagus for the treatment of achalasia A submucosal injection and overlying mucosal incision are performed, ideally 15 to 2 cm upstream of the upper esophageal sphincter, and then a submucosal tunnel is extended beyond the level of the cricopharyngeus The target muscle is then transected before closure of the mucosotomy
 
  In 3 cases of refractory cricopharyngeal bar, c-POEM was successfully performed Although no major adverse events occurred, significant postprocedural edema at the level of the upper esophageal sphincter prolonged hospitalization in 2 of the 3 patients After recovery, all patients reported complete resolution of dysphagia and tolerated an unrestricted diet
 
  C-POEM allows reliable and complete muscular division in patients with refractory cricopharyngeal bar who have limited treatment options
 C-POEM allows reliable and complete muscular division in patients with refractory cricopharyngeal bar who have limited treatment options
  Evidence is emerging that surgery in the neonatal period is associated with increased risk of suboptimal neurodevelopmental outcomes SNDO The aim of this study was to describe neurodevelopmental outcomes at 1 year of neonatal surgery for congenital gastrointestinal surgical conditions CGSC and to explore risk factors
 
  Retrospective study 2005-2014 of infants born ≥34 weeks gestation with CGSC and admitted to the surgical neonatal intensive care unit of Perth Children's Hospital, Western Australia Clinical details and 1-year developmental outcomes based on Griffiths Mental Developmental Assessment Scales were collated from the database and by reviewing the medical records of study infants SNDO was defined as one or more of the following a general quotient less than 88 ie, gt;1 SD below mean, cerebral palsy, blindness or sensorineural deafness Univariable and multivariable logistic regression analyses were carried out to explore risk factors for SNDO A total of 413 infants were included, of which 13 died Median gestation was 376 weeks IQR 364-391 Information on developmental outcomes was available from 262 out of 400 survivors A total of 43/262 164 had SNDO On univariable analysis, lower z scores for birth weight, prolonged duration of antibiotics, increased episodes of general anaesthesia and prolonged duration of hospital stay were associated with SNDO On multivariable analysis, lower z scores for birth weight and prolonged hospital stay were associated with increased risk of SNDO
 
  Late preterm and term infants undergoing neonatal surgery for CGSC may be at risk for SNDO Studies with longer duration of follow-up are needed to further evaluate the role of potentially modifiable risk factors on their neurodevelopmental outcomes
 Late preterm and term infants undergoing neonatal surgery for CGSC may be at risk for SNDO Studies with longer duration of follow-up are needed to further evaluate the role of potentially modifiable risk factors on their neurodevelopmental outcomesDog bite injuries are a significant public health problem and many are sustained by children These injuries can be complex, both physically and psychologically, and in rare cases fatal This paper will review current evidence-based approaches to treatment, explore identified patterns in biting incidents and discuss the effectiveness of prevention strategies Safe management of these patients requires a comprehensive approach Physical injuries need to be accurately assessed with a high index of suspicion for underlying injuries, particularly in younger children less able to communicate Treatment depends on severity and location, but all bites must be irrigated to reduce the risk of infection but may not always require prophylactic antibiotic use Careful exploration of the circumstances in which the bite occurred is essential to make safeguarding decisions and prevent future bites Reducing the incidence of paediatric dog bites requires education of both children and parents that any dog can bite, regardless of breed, and all *****-dog interactions must be highly supervised However, education alone is unlikely to prevent dog bites Policies that support environmental changes need to be developed such as provision of pet dogs less likely to bite or bite as severely, through breeding for temperament and appropriate socialisation Additionally, investment in psychological support for bite victims and their families is required to reduce the long-term impacts of being bitten
  Optimal feeding of very low birthweight VLBW lt;1500 g/very preterm gestation lt;32 weeks infants in resource-limited settings in sub-Saharan Africa sSA is critical to reducing high mortality and poor outcomes
 
  To review evidence on feeding of VLBW/very preterm infants relevant to sSA
 
  We searched the Cochrane Database of Systematic Reviews, Embase, PubMed and Cumulative Index to Nursing and Allied Health Literature CINAHL from inception to July 2019 to identify reviews of randomised and quasi-randomised controlled trials of feeding VLBW/very preterm infants We focused on interventions that are readily available in sSA Primary outcomes were weight gain during hospital stay and time to achieve full enteral feeds 120 mL/kg/day Secondary outcomes were growth, common morbidities, mortality, duration of hospital stay and cognitive development Quality of evidence QOE was assessed using the Measurement Tool to Assess Systematic Reviews AMSTAR2
 
  Eight systematic reviews were included Highr these highly vulnerable infants
 
  CRD42019140204
 CRD42019140204
  Despite little evidence, the practice of routine gastric residual volume GRV measurement to guide enteral feeding in neonatal units is widespread Due to increased interest in this practice, and to examine trial feasibility, we aimed to determine enteral feeding and GRV measurement practices in British neonatal units
 
  An online survey was distributed via email to all neonatal units and networks in England, Scotland and Wales A clinical nurse, senior doctor and dietitian were invited to collaboratively complete the survey and submit a copy of relevant guidelines
 
  95/184 516 approached units completed the survey, 81/95 853 reported having feeding guidelines and 28 guidelines were submitted for review The majority of units used intermittent 90/95 gastric feeds as their primary feeding method 42/95 units reported specific guidance for measuring and interpreting GRV 20/90 units measured GRV before every feed, 39/90 at regular time intervals most commonly four to six hourly 35/39 and 26/90 when felt to be clinically indicated Most units reported uncertainty on the utility of aspirate volume for guiding feeding decisions; 13/90 reported that aspirate volume affected decisions 'very much' In contrast, aspirate colour was reported to affect decisions 'very much' by 37/90 of responding units Almost half, 44/90, routinely returned aspirates to the stomach
 
  Routine GRV measurement is part of standard practice in British neonatal units, although there was inconsistency in how frequently to measure or how to interpret the aspirate Volume was considered less important than colour of the aspirate
 Routine GRV measurement is part of standard practice in British neonatal units, although there was inconsistency in how frequently to measure or how to interpret the aspirate Volume was considered less important than colour of the aspirate
  How did coronavirus disease 2019 COVID-19 impact on medically assisted reproduction MAR services in Europe during the COVID-19 pandemic March to May 2020
 
  MAR services, and hence treatments for infertile couples, were stopped in most European countries for a mean of 7 weeks
 
  With the outbreak of COVID-19 in Europe, non-urgent medical care was reduced by local authorities to preserve health resources and maintain social distancing Furthermore, ESHRE and other societies recommended to postpone ART pregnancies as of 14 March 2020
 
  A structured questionnaire was distributed in April among the ESHRE Committee of National Representatives, followed by further information collection through email
 
  The information was collected through the questionnaire and afterwards summarised and aligned with data from the European Centre for Disease Control on the number of COVID-19 cases per country
 
  By aligning the data for each country with respective epidemiological data, we show a large variation in the timto disclose
 There was no funding for the study, apart from technical support from ESHRE The authors had no COI to discloseClinical trials are a fundamental tool used to evaluate the efficacy and safety of new drugs and medical devices and other health system interventions The traditional clinical trials system acts as a quality funnel for the development and implementation of new drugs, devices and health system interventions The concept of a "digital clinical trial" involves leveraging digital technology to improve participant access, engagement, trial-related measurements, and/or interventions, enable concealed randomized intervention allocation, and has the potential to transform clinical trials and to lower their cost In April 2019, the US National Institutes of Health NIH and the National Science Foundation NSF held a workshop bringing together experts in clinical trials, digital technology, and digital analytics to discuss strategies to implement the use of digital technologies in clinical trials while considering potential challenges This position paper builds on this workshop to describe the current state of the art for digital clinical trials including 1 defining and outlining the composition and elements of digital trials; 2 describing recruitment and retention using digital technology; 3 outlining data collection elements including mobile health, wearable technologies, application programming interfaces APIs, digital transmission of data, and consideration of regulatory oversight and guidance for data security, privacy, and remotely provided informed consent; 4 elucidating digital analytics and data science approaches leveraging artificial intelligence and machine learning algorithms; and 5 setting future priorities and strategies that should be addressed to successfully harness digital methods and the myriad benefits of such technologies for clinical research