Early Activity in Comet C/2014 UN271 Bernardinelli–Bernstein as Observed by TESS

We used long duration observations from the Transient Exoplanet Survey Satellite (TESS) to investigate the behavior of comet C/2014 UN271 Bernardinelli–Bernstein at large heliocentric distances. By combining data from sector 03 (976 30 minute exposures from 2018), and sectors 29 and 30 (3585 and 3410 10 minute exposures, respectively, from 2020), we produced deep coadded images of the comet. A comparison of these results with similarly processed images of inactive Kuiper Belt objects and asteroids reveals that the comet was already exhibiting coma at heliocentric distances 23.8 and 21.2 au, making this one of the most distant comets for which preperihelion activity has been directly detected. A simple syndyne analysis of asymmetries in the coma suggests that activity probably started several years prior to these observations, and likely arose from emission in roughly the sunward direction. The images were used to produce photometric lightcurves, though no rotational variability was detected. We used NEOWISE observations from 2020 November 26–28 to place an upper limit of 2 × 1028 molecules s−1 (3σ) on the CO production rate.

Protocol and statistical analysis plan for the phase 3 randomised controlled Treatment of Invasively Ventilated Adults with Early Activity and Mobilisation (TEAM III) trial

OBJECTIVE: To describe the protocol and statistical analysis plan for the Treatment of Invasively Ventilated Adults with Early Activity and Mobilisation (TEAM III) trial. DESIGN: An international, multicentre, parallel-group, randomised controlled phase 3 trial. SETTING: Intensive care units (ICUs) in Australia, New Zealand, Germany, Ireland, the United Kingdom and Brazil. PATIENTS: 750 adult patients expected to receive mechanical ventilation for more than 48 hours. INTERVENTIONS: Early activity and mobilisation delivered to critically ill patients in an ICU for up to 28 days compared with standard care. MAIN OUTCOME MEASURES: The primary outcome is the number of days alive and out of hospital at 180 days after randomisation. Secondary outcomes include ICU-free days, ventilator-free days, delirium-free days, all-cause mortality at 28 and 180 days after randomisation, and functional outcome at 180 days after randomisation. RESULTS: Recruitment at 46 research sites passed 576 patients in March 2021. Final collection of all 180-day outcome data for the target of 750 patients is anticipated by May 2022. CONCLUSIONS: Consistent with international guidelines, a detailed protocol and prospective analysis plan has been developed for the TEAM III trial. This plan specifies the statistical models for evaluating primary and secondary outcomes, defines covariates for adjusted analyses, and defines methods for exploratory analyses. Application of this protocol and statistical analysis plan to the forthcoming TEAM III trial will facilitate unbiased analyses of the clinical data collected. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03133377.

Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement programme

Early mobilisation following cardiac surgery is vital for improved patient outcomes, as it has a positive effect on a patient’s physical and psychological recovery following surgery. We observed that patients admitted to the cardiothoracic intensive care unit (CTICU) following cardiac surgery had only bed exercises and were confined to bed until the chest tubes were removed, which may have delayed patients achieving functional independence. Therefore, the CTICU team implemented a quality improvement (QI) project aimed at the early mobilisation of patients after cardiac surgery.A retrospective analysis was undertaken to define the current mobilisation practices in the CTICU. The multidisciplinary team identified various practice gaps and tested several changes that led to the implementation of a successful early mobility programme. The tests were carried out and reported using rapid cycle changes. A model for improvement methodology was used to run the project. The outcomes of the project were analysed using standard ‘run chart rules’ to detect changes in outcomes over time and Welch’s t-test to assess the significance of these outcomes.This project was implemented in 2015. Patient compliance with early activity and mobilisation gradually reached 95% in 2016 and was sustained over the next 3 years. After the programme was implemented, the mean hours required for initiating out-of-bed-mobilisation was reduced from 22.77 hours to 11.74 hours. Similarly, functional independence measures and intensive care unit mobility scores also showed a statistically significant (p<0.005) improvement in patient transfers out of the CTICU.Implementing an early mobility programme for post-cardiac surgery patients is both safe and feasible. This QI project allowed for early activity and mobilisation, a substantial reduction in the number of hours required for initiating out-of-bed mobilisation following cardiac surgery, and facilitated the achievement of early ambulation and functional milestones in our patients.

Early Rehabilitation Training Promotes Recovery of Lung Function in Patients with Congenital Heart Disease After Cardiopulmonary Bypass

This article conducts an in-depth study on the recovery of lung function in patients with congenital heart disease after cardiopulmonary bypass through early rehabilitation training, and discusses the effectiveness of early activities after cardiopulmonary bypass in children with congenital heart disease. The children with congenital heart disease who met the criteria were divided into an intervention group and a control group according to the random number table method, and prospective randomized controlled clinical trials were conducted. The control group was given routine clinical care. In addition to routine care, the experimental group increased early active intervention. The intervention content mainly includes preoperative early activity education and postoperative child vital signs to provide early activity guide. The rehabilitation was used as indicators to evaluate the postoperative recovery of the children. Data were collected at the time of discharge and 3 months after discharge, and statistics were performed using SPSS18.0 software analysis. To evaluate the effect of early activity on postoperative recovery in children with congenital heart disease, it improved the heart and lung function in children, improve their quality of life, promotes postoperative recovery of children, and provide a scientific basis for early active intervention in clinical work.

Audiovisual adaptation is expressed in spatial and decisional codes

The brain adapts dynamically to the changing sensory statistics of its environment. The neural circuitries and representations that support this cross-sensory plasticity remain unknown. We combined psychophysics and model-based representational fMRI and EEG to characterize how the adult human brain adapts to misaligned audiovisual signals. We show that audiovisual adaptation moulds regional BOLD-responses and fine-scale activity patterns in a widespread network from Heschl’s gyrus to dorsolateral prefrontal cortices. Crucially, audiovisual recalibration relies on distinct spatial and decisional codes that are expressed with opposite gradients and timecourses across the auditory processing hierarchy. Early activity patterns in auditory cortices encode sounds in a continuous space that flexibly adapts to misaligned visual inputs. Later activity patterns in frontoparietal cortices code decisional uncertainty consistent with these spatial transformations. Our findings demonstrate that regions throughout the auditory processing hierarchy multiplex spatial and decisional codes to adapt flexibly to the changing sensory statistics in the environment.

Anomalous influenza seasonality in the United States and the emergence of novel influenza B viruses

The 2019/2020 influenza season in the United States began earlier than any season since the 2009 H1N1 pandemic, with an increase in influenza-like illnesses observed as early as August. Also noteworthy was the numerical domination of influenza B cases early in this influenza season, in contrast to their typically later peak in the past. Here, we dissect the 2019/2020 influenza season not only with regard to its unusually early activity, but also with regard to the relative dynamics of type A and type B cases. We propose that the recent expansion of a novel influenza B/Victoria clade may be associated with this shift in the composition and kinetics of the influenza season in the United States. We use epidemiological transmission models to explore whether changes in the effective reproduction number or short-term cross-immunity between these viruses can explain the dynamics of influenza A and B seasonality. We find support for an increase in the effective reproduction number of influenza B, rather than support for cross-type immunity-driven dynamics. Our findings have clear implications for optimal vaccination strategies.