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Maternal obesity is an established risk factor for poor infant neurodevelopmental outcomes; however, the link between maternal weight and fetal development in utero is unknown. We investigated whether maternal obesity negatively influences fetal autonomic nervous system (ANS) development. Fetal heart rate variability (HRV) is an index of the ANS that is associated with neurodevelopmental outcomes in the infant. Maternal–fetal magnetocardiograms were recorded using a fetal biomagnetometer at 36 weeks (n = 46). Fetal HRV was represented by the standard deviation of sinus beat-to-beat intervals (SDNN). Maternal weight was measured at enrollment (12–20 weeks) and 36 weeks. The relationships between fetal HRV and maternal weight at both time points were modeled using adjusted ordinary least squares regression models. Higher maternal weight at enrollment and 36 weeks were associated with lower fetal HRV, an indicator of poorer ANS development. Further study is needed to better understand how maternal obesity influences fetal autonomic development and long-term neurodevelopmental outcomes.
Prolactin (PRL) data from adolescents treated with olanzapine are presented.
Data from 454 adolescents (13-18, mean=15.9 yrs) with schizophrenia or bipolar mania were pooled from 4 olanzapine (2.5-20.0mg/day) studies (4-32 weeks; 2 double-blind, placebo-controlled studies [combined for acute phase endpoint PRL levels] with open-label extensions; 2 open-label studies). Age- and sex-specific Covance reference ranges defined normal PRL; categorical increases were based on multiples of the upper limit of normal (ULN). Baseline-to-endpoint PRL changes in adolescents were compared with data pooled from 84 olanzapine clinical trials in adults with schizophrenia or bipolar disorder.
Olanzapine-treated adolescents had mean PRL increases at both the acute (11.4μg/L) and open-label endpoints (4.7μg/L). Of those patients with normal PRL levels at baseline (N=311), high PRL occurred in 54.7% at anytime; 32.2% at endpoint. The percentage of patients in which PRL levels shifted from normal-to-abnormal was smaller at endpoint than at anytime during treatment; 26.7% shifted to a higher category. Among patients with normal baseline PRL, 32.7% remained <=1X ULN; 32.3% increased to 1¬<=2X; 6.0%, >2-<=3X; and 1.2%, >3X at anytime; 4.6% had at >=1 potentially PRL-related adverse event. Adolescents had significantly higher mean changes at endpoint (p=.004), and a greater incidence of high PRL levels at anytime during olanzapine treatment (p<.001) versus adults.
Incidence of high PRL was significantly higher, and mean increases in PRL were significantly greater in adolescents versus adults. Mean increases and high PRL incidence were lower at the open-label compared with the acute phase endpoint.
The changes in metabolic parameters in olanzapine-treated adolescents were examined.
Data from 454 adolescents (13–18, mean=15.9 years) with schizophrenia or bipolar I disorder were pooled from 4 olanzapine (2.5–20.0mg/day) studies (4–32 weeks). Changes in metabolic parameters in adolescents were compared with those of olanzapine-treated adults (pooled from 84 clinical trials); changes in weight and BMI were compared with US age- and sex-adjusted standardized growth curves.
Olanzapine-treated adolescents had significant increases from baseline-to-endpoint in fasting glucose (p=.021); total cholesterol, LDL, and triglycerides (p<.001); and significant decreases in HDL (p<.001). Significantly more adolescents gained >=7% of their baseline weight versus adults (65.1% vs. 35.6%, p<.001); mean change from baseline-to-endpoint in weight was significantly greater in adolescents (7.0 vs. 3.3kg, p<.001). Adolescents had significantly lower mean changes from baseline-to-endpoint in fasting glucose (0.3 vs. 0.1mmol/L, p=.002) and triglycerides (0.3 vs. 0.2mmol/L, p=.007) versus adults. Significantly more adults experienced treatment-emergent normal-to-high changes at anytime in fasting glucose (4.8% vs. 1.2%, p=.033), total cholesterol (6.9% vs. 1.1%, p=.001), LDL (5.8% vs. 1.5%, p=.014), and triglycerides (25.7% vs. 17.4%, p=.030). Compared with standardized growth curves, olanzapine-treated adolescents had greater increases from baseline-to-endpoint in weight (1.0 vs. 7.1kg, p<.001), height (0.5 vs. 0.7cm, p<.001), and BMI (0.2 vs. 2.2kg/m2, p<.001).
Olanzapine-treated adolescents may gain significantly more weight compared with adults, but may have smaller changes in other metabolic parameters. Clinicians may want to consider both efficacy and changes in metabolic parameters when selecting treatment options for individual adolescent patients.
According to the World Health Organization (WHO) mental and substance use disorders will surpass all physical diseases as the major cause of disability by the year 2020. The abuse of alcohol results in 2.5 million deaths annually, including 320,000 young people between the age of 15 and 29, and at least 15.3 million people have drug use disorders (WHO, 2013). The Indiana University Center for Health Policy studied the economic impact of substance abuse in Indiana and found that substance abuse and addiction have a powerful impact on all sectors of our society including education, criminal justice, health, workforce and public safety. Total cost for the state in 2008 was $7.3 billion and the professional capacity for nurturing the health of our citizens is woefully inadequate. With funding from the Substance Abuse and Mental Health Services Administration, faculty at Indiana University's Schools of Nursing, Social Work, and Medicine integrated Screening Brief Intervention and Referral to Treatment (SBIRT) into our health care education systems in order to improve the health of the large number of adolescents and adults at risk for one or more substance use disorders. SBIRT training was incorporated in select courses in each of the three schools using tailored webbased educational modules and face-to-face motivational interview (MI) training to prepare participants' for clinical practica. Innovative curricular materials will be presented as well as preliminary data on participants' knowledge, skills and attitudes related to training.
Alcohol and other substance use contribute to a major, preventable, international healthcare burden. The evidentiary bases for screening, brief intervention, and referral to treatment (SBIRT) for alcohol are well-established, while research on SBIRT for other substance use is ongoing. In the United States, funding for SBIRT education among medical professionals recently has expanded beyond physicians to include other healthcare providers such as nurses and social workers.
This brief study measured characteristics of nurses, social workers, and physicians at the beginning of the first year of graduate education (nurses, social workers) or post-graduate year 1 (physician residents) to assess potential baseline differences in knowledge, attitudes, beliefs, and behaviors related to SBIRT.
The aim of this study was to inform targeted modification of SBIRT education programs based on baseline differences between professions.
Participants (n = 81 [16 physicians, 27 nurses, 38 social workers]) completed a 36-item assessment of baseline behaviors (modified from Hettema et al., 2012) and knowledge, beliefs, and attitudes predictive of SBIRT performance (Gassman et al., 2003). Differences between groups were assessed using ANOVA and the Tukey or Games-Howell post-hoc test (contingent on homogeneity of variance).
The study identified differences among professionals for 13 of 36 measured variables across several domains: SBIRT behaviors, beliefs about time utilization, satisfaction working with at-risk clients, self-efficacy, and perceived organizational resources.
Preliminary data suggest that SBIRT training for medical professionals might be improved by attending to specific differences among nurses, physicians, and social workers in several key areas.
The Vaigat Iceberg-Microbial Oil Degradation and Archaeological Heritage Investigation (VIMOA) project records the results of archaeological survey of five sites in Greenland that are threatened by extreme weather conditions related to climate change. The project demonstrates the advantages of collaboration between archaeologists and natural scientists, and provides a repository of data to help preserve the archaeological record.
Recent European studies suggest that fathers’ leave-taking may contribute to parental relationship stability. Paternity leave-taking may signal a commitment by fathers toward a greater investment in family life, which may reduce the burden on mothers and strengthen parental relationships. This study uses longitudinal data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) to analyze the association between paternity leave-taking and relationship stability in the United States. Results indicate that paternity leave-taking, and taking relatively short leaves (i.e. two weeks or less) in particular, is associated with greater relationship stability. These findings increase our understanding of the potential benefits of paternity leave, and can inform policy decisions that aim to increase family stability.
Sugarbeet growers only recently have combined ethofumesate, S-metolachlor, and dimethenamid-P in a weed control system for waterhemp control. Sugarbeet plant density, visible stature reduction, root yield, percent sucrose content, and recoverable sucrose were measured in field experiments at five environments between 2014 and 2016. Sugarbeet stand density and stature reduction occurred in some but not all environments. Stand density was reduced with PRE application of S-metolachlor at 1.60 kg ai ha–1 and S-metolachlor at 0.80 kg ha–1 + ethofumesate at 1.68 kg ai ha–1 alone or followed by POST applications of dimethenamid-P at 0.95 kg ai ha–1. Sugarbeet visible stature was reduced when dimethenamid-P followed PRE treatments. Stature reduction was greatest with ethofumesate at 1.68 or 4.37 kg ha–1 PRE and S-metolachlor at 0.80 kg ha–1 + ethofumesate at 1.68 kg ha–1 PRE followed by dimethenamid-P at 0.95 kg ha–1 POST. Stature reduction ranged from 0 to 32% 10 d after treatment (DAT), but sugarbeet recovered quickly and visible injury was negligible 23 DAT. Although root yield and recoverable sucrose were similar across herbicide treatments and environments, we caution against the use of S-metolachlor at 0.80 kg ha–1 + ethofumesate at 1.68 kg ai ha–1 PRE followed by dimethenamid-P at 0.95 kg ha–1 in sugarbeet.
Hyperventilation during cardiopulmonary resuscitation (CPR) negatively affects cardiopulmonary physiology. Compression-adjusted ventilations (CAVs) may allow providers to deliver ventilation rates more consistently than conventional ventilations (CVs). This study sought to compare ventilation rates between these two methods during simulated cardiac arrest.
That CAV will not result in different rates than CV in simulated CPR with metronome-guided compressions.
Volunteer Basic Life Support (BLS)-trained providers delivered bag-valve-mask (BVM) ventilations during simulated CPR with metronome-guided compressions at 100 beats/minute. For the first 4-minute interval, volunteers delivered CV. Volunteers were then instructed on how to perform CAV by delivering one breath, counting 12 compressions, and then delivering a subsequent breath. They then performed CAV for the second 4-minute interval. Ventilation rates were manually recorded. Minute-by-minute ventilation rates were compared between the techniques.
A total of 23 volunteers were enrolled with a median age of 36 years old and with a median of 14 years of experience. Median ventilation rates were consistently higher in the CV group versus the CAV group across all 1-minute segments: 13 vs 9, 12 vs 8, 12 vs 8, and 12 vs 8 for minutes one through four, respectively (P <.01, all). Hyperventilation (>10 breaths per minute) occurred 64% of the time intervals with CV versus one percent with CAV (P <.01). The proportion of time which hyperventilation occurred was also consistently higher in the CV group versus the CAV group across all 1-minute segments: 78% vs 4%, 61% vs 0%, 57% vs 0%, and 61% vs 0% for minutes one through four, respectively (P <.01, all).
In this simulated model of cardiac arrest, CAV had more accurate ventilation rates and fewer episodes of hyperventilation compared with CV.
Nikolla DA, Kramer BJ, Carlson JN. A cross-over trial comparing conventional to compression-adjusted ventilations with metronome-guided compressions. Prehosp Disaster Med. 2019;34(2):220–223
This Research Communication describes an investigation of the nutritional depletion of total mixed rations (TMR) by pest birds. We hypothesized that species-specific bird depredation of TMR can alter the nutritional composition of the ration and that these changes can negatively impact the performance of dairy cows. Blackbirds selected the high energy fraction of the TMR (i.e., flaked corn) and reduced starch, crude fat and total digestible nutrients during controlled feeding experiments. For Holsteins producing 37·1 kg of milk/d, dairy production modeling illustrated that total required net energy intake (NEI) was 35·8 Mcal/d. For the reference TMR unexposed to blackbirds and the blackbird-consumed TMR, NEI supplied was 41·2 and 37·8 Mcal/d, and the resulting energy balance was 5·4 and 2·0 Mcal/d, respectively. Thus, Holsteins fed the reference and blackbird-consumed TMR were estimated to gain one body condition score in 96 and 254 d, and experience daily weight change due to reserves of 1·1 and 0·4 kg/d, respectively. We discuss these results in context of an integrated pest management program for mitigating the depredation caused by pest birds at commercial dairies.
The bow and arrow is thought to be a unique development of our species, signalling higher-level cognitive functioning. How this technology originated and how we identify archaeological evidence for it are subjects of ongoing debate. Recent analysis of the putative bone arrow point from Sibudu Cave in South Africa, dated to 61.7±1.5kya, has provided important new insights. High-resolution CT scanning revealed heat and impact damage in both the Sibudu point and in experimentally produced arrow points. These features suggest that the Sibudu point was first used as an arrowhead for hunting, and afterwards was deposited in a hearth. Our results support the claim that bone weapon tips were used in South African hunting long before the Eurasian Upper Palaeolithic.
Many preschool-age children meet criteria for psychiatric disorders, and rates approach those observed in later childhood and adolescence. However, there is a paucity of longitudinal research examining the outcomes of preschool diagnoses.
Families with a 3-year-old child (N = 559) were recruited from the community. Primary caregivers were interviewed using the Preschool Age Psychiatric Assessment when children were 3 years old (n = 541), and, along with children, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version when children were 9 and 12 years old.
Rates of disruptive behavior disorders (DBD) decreased from preschool to middle childhood and early adolescence, whereas rates of attention-deficit/hyperactivity disorder (ADHD) increased. Rates of any psychiatric disorder and depression increased from preschool to early adolescence only. Preschoolers with a diagnosis were over twice as likely to have a diagnosis during later periods. Homotypic continuity was present for anxiety disorders from preschool to middle childhood, for ADHD from preschool to early adolescence, and for DBD through both later time points. There was heterotypic continuity between preschool anxiety and early adolescent depression, and between preschool ADHD and early adolescent DBD. Dimensional symptom scores showed homotypic continuity for all diagnostic categories and showed a number of heterotypic associations as well.
Results provide moderate support for the predictive validity of psychiatric disorders in preschoolers. Psychopathology in preschool is a significant risk factor for future psychiatric disorders during middle childhood and early adolescence.
Background: Perinatal stroke is the most common cause of hemiparetic cerebral palsy. Post-stroke plasticity is well studied in adults, but mechanisms in children are poorly understood. To better understand the relationship between functional connectivity and disability, we used rsfMRI to compare connectivity with sensorimotor dysfunction. Methods: Subjects with periventricular venous infarction were compared to controls. Resting-state BOLD signal was acquired on 3T MRI and analyzed using SPM12. Functional connectivity was computed between S1 and M1 of the left/non-lesioned and right/ lesioned hemisphere. Primary outcome was connectivity expressed as a Pearson correlation coefficient. Motor function was measured using the Assisting Hand Assessment (AHA), and Melbourne Assessment (MA). Proprioceptive function was measured using a robotic position matching task (VarXY). Results: Subjects included 17 PVI and 21 controls. AHA and MA in patients were negatively correlated with connectivity (increased connectivity=poorer performance). Correlations between AHA and connectivity between non-lesioned M1 to bilateral S1s were significant. VarXY in PVI was inversely correlated with connectivity (increased connectivity=improved performance), significantly between non-lesioned S1 and bilateral M1s. Control VarXY was positively correlated with connectivity between non-dominant S1 to bilateral M1s. Conclusions: We demonstrated significant correlations between connectivity and motor/sensory function in PVI patients. Greater insight into understanding reorganization of brain networks following perinatal stroke may facilitate personalized rehabilitation.
To describe the frequency of urine cultures performed in inpatients without additional testing for pyuria
Retrospective cohort study
A 1,250-bed academic tertiary referral center
This study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures.
During the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37–3.34).
Isolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.
With European Laser Facilities such as the Extreme Light Infrastructure (ELI) and the Helmholtz International Beamline for Extreme Fields (HIBEF) scheduled to come online within the next couple of years, General Atomics, as a major supplier of targets and target components for the High Energy Density Physics community in the United States, is gearing up to meet their demand for large numbers of low cost targets. Using the production of a subassembly for the National Ignition Facility’s fusion targets as an example, we demonstrate that through automation of assembly tasks, the design of targets and their experimental setup can be fairly complex while keeping the assembly time and cost as a minimum. A six-axis Mitsubishi robot is used in combination with vision feedback and a force–torque sensor to assemble target subassemblies of different scales and designs with minimal change of tooling, allowing for design flexibility and short assembly setup times. Implementing automated measurement routines on a Nikon NEXIV microscope further reduces the effort required for target metrology, while electronic data collection and transfer complete a streamlined target production operation that can be adapted to a large variety of target designs.
During the Quaternary, the hominin evolutionary tree can be best characterised as bushy. Fossil discoveries in recent decades have shown that different hominin taxa co-existed more than was previously thought when Homo habilis was first deemed the earliest member of genus Homo. Such phylogenetic complexity at the origin of Homo is indicative of an adaptive radiation, in this case often attributed to a palaeoclimatic drying trend in Africa. Establishing evolutionary relationships amongst different taxa at the origins of Homo, and ultimately with the descendent species of one of them, Homo erectus, is made difficult by their mosaic of primitive and derived morphological characteristics. Linking these morphologies with coeval environmental change is made difficult by conflicting signals between regional palaeoclimate indicators. By the end of the Quaternary, hominin behavioural and cognitive changes arguably become more evident in the ‘evolving’ archaeological record of southern Africa than in its fossil record. New discoveries and new types of morphological analyses are clearly needed for sharpening phylogenetic resolution, particularly early in the Quaternary.