bluuebunny/crossref_metadata_2025 huggingface dataset:
Two large reciprocal translocations characterized in the disease resistance-rich burmannica genetic group of Musa acuminata
Authors: Dupouy Marion , Baurens Franc-Christophe , Derouault Paco , Hervouet Catherine , Cardi Céline , Cruaud Corinne , Istace Benjamin , Labadie Karine , Guiougou Chantal , Toubi Lyonel , Salmon Frederic , Mournet Pierre , Rouard Mathieu , Yahiaoui Nabila , Lemainque Arnaud , Martin Guillaume , D’Hont Angélique
Published: June 2019

Background and Aims

Banana cultivars are derived from hybridizations involving Musa acuminata subspecies. The latter diverged following geographical isolation in distinct South-east Asian continental regions and islands. Observation of chromosome pairing irregularities in meiosis of hybrids between these subspecies suggested the presence of large chromosomal structural variations. The aim of this study was to characterize such rearrangements.

Methods

Marker (single nucleotide polymorphism) segregation in a self-progeny of the ‘Calcutta 4’ accession and mate-pair sequencing were used to search for chromosomal rearrangements in comparison with the M. acuminata ssp. malaccensis genome reference sequence. Signature segment junctions of the revealed chromosome structures were identified and searched in whole-genome sequencing data from 123 wild and cultivated Musa accessions.

Key Results

Two large reciprocal translocations were characterized in the seedy banana M. acuminata ssp. burmannicoides ‘Calcutta 4’ accession. One consisted of an exchange of a 240 kb distal region of chromosome 2 with a 7.2 Mb distal region of chromosome 8. The other involved an exchange of a 20.8 Mb distal region of chromosome 1 with a 11.6 Mb distal region of chromosome 9. Both translocations were found only in wild accessions belonging to the burmannicoides/burmannica/siamea subspecies. Only two of the 87 cultivars analysed displayed the 2/8 translocation, while none displayed the 1/9 translocation.

Conclusion

Two large reciprocal translocations were identified that probably originated in the burmannica genetic group. Accurate characterization of these translocations should enhance the use of this disease resistance-rich burmannica group in breeding programmes.
Four decades of cultural evolution in House Finch songs
Authors: Ju Chenghui , Geller Frances C , Mundinger Paul C , Lahti David C
Published: June 2019

Bird song is the primary animal model system for cultural evolution. Longitudinal studies of bird song across many generations can provide insights into patterns and mechanisms of change in socially transmitted traits. In this study, we conducted a comparative analysis of songs of the House Finch (Haemorhous mexicanus) across an interval of 37 years (in 1975 and in 2012). Recordings from both years were collected in western Long Island, New York, which is thought to be the initial site of introduction of the House Finch around 1940 from the West Coast. Song types experienced a complete turnover during this period, although half of the syllable types were represented in both samples. Song length, frequency bandwidth and several other spectrographic features were the same in both years, and no structural features predicted recurrence of individual syllables. Consistent with the fact that our study population expanded substantially following a cultural founder effect, song and syllable sharing and similarity between individuals were lower in 2012 than in 1975, reflecting an increase in song diversity at the population level. However, in the more recent sample individual songs had fewer syllables, and were sung with less sequence stereotypy across renditions than in the earlier sample. Syllable prevalence in 2012 was associated both with complexity (as gauged by frequency excursion) and increased minimum frequency. Thus, over nearly 4 decades, Eastern House Finch songs remained structurally similar at the whole-song level, diversified between individuals, but became simpler and less consistent within an individual.
Risk assessment and the use of novel shortcuts in spatial detouring tasks in jumping spiders
Authors: Aguilar-Argüello Samuel , Gerhard Daniel , Nelson Ximena J
Published: June 2019

Selection on individuals that incorporate risk to quickly and accurately make a priori navigational assessments may lead to increased spatial ability. Jumping spiders (Araneae: Salticidae) are characterized by their highly acute vision, which mediates many behaviors, including prey capture and navigation. When moving to a specific goal (prey, nest, a potential mate, etc.), salticids rely on visual cues and spatial memory to orient in 3-dimensional space. Salticid spatial ability has been studied in homing and detour tasks, with Portia being considered one of the most skillful genera in terms of spatial ability in the family. Commonly living in complex environments, salticids are likely to encounter a wide variety of routes that could lead to a goal, and, as selection favors individuals that can accurately make assessments, they may be able to assess alternative route distances to select the most efficient route. Here, we tested whether 2 salticid species (Portia fimbriata and Trite planiceps) can discriminate and assess between different available routes by their length, and riskiness to escape from a stressful scenario. Results suggest that while Portia is more likely to choose the easiest and shortest escape routes, Trite is faster in both decision making about which route to take, and to escape. However, some individuals were able to use novel shortcuts instead of the routes expected, with Portia containing a higher proportion of shortcut-takers than Trite. These differences in spatial ability seem to correspond with the environmental complexity inhabited by each species.
Leaf structure in Amorimia and closely related Neotropical genera and implications for their systematics and leaf evolution in Malpighiaceae
Authors: Mello Ana Caroline Marques Pereira , De Almeida Rafael Felipe , Amorim André Marcio Araújo , Oliveira Denise Maria Trombert
Published: June 2019

Amorimia (Malpighiaceae) was recently segregated from the polyphyletic Mascagnia and placed in the malpighioid clade; identifying new characters based on leaf structure is among the first steps towards a proper generic delimitation of these segregates of Mascagnia. A comprehensive study describing and testing the relevance of leaf-structure characters in the evolution of Amorimia and related Neotropical genera is presented. We sampled all 15 Amorimia spp. and, as outgroups, eight species from the closely related Neotropical genera (Diplopterys, Ectopopterys, Mascagnia, Peixotoa and Stigmaphyllon). We scored 85 structural characters and mapped them on the most recent phylogenetic tree recovered for the genera. The presence of druses in the palisade parenchyma, the position of fibres alongside the vascular bundle and the occurrence of fibre blocks near the margin of the leaf blade were recovered as anatomical synapomorphies for Amorimia. Our results are a first step towards recovering anatomical and macromorphological synapomorphies for newly identified lineages of Malpighiaceae, such as Amorimia.
Along-strike variation in slab geometry at the southern Mariana subduction zone revealed by seismicity through ocean bottom seismic experiments
Authors: Zhu Gaohua , Yang Hongfeng , Lin Jian , Zhou Zhiyuan , Xu Min , Sun Jinlong , Wan Kuiyuan
Published: June 2019

We have conducted the first passive Ocean Bottom Seismograph (OBS) experiment near the Challenger Deep at the southernmost Mariana subduction zone by deploying and recovering an array of 6 broad-band OBSs during December 2016–June 2017. The obtained passive-source seismic records provide the first-ever near-field seismic observations in the southernmost Mariana subduction zone. We first correct clock errors of the OBS recordings based on both teleseismic waveforms and ambient noise cross-correlation. We then perform matched filter earthquake detection using 53 template events in the catalogue of the US Geological Survey and find >7000 local earthquakes during the 6-month OBS deployment period. Results of the two independent approaches show that the maximum clock drifting was ∼2 s on one instrument (OBS PA01), while the rest of OBS waveforms had negligible time drifting. After timing correction, we locate the detected earthquakes using a newly refined local velocity model that was derived from a companion active source experiment in the same region. In total, 2004 earthquakes are located with relatively high resolution. Furthermore, we calibrate the magnitudes of the detected earthquakes by measuring the relative amplitudes to their nearest relocated templates on all OBSs and acquire a high-resolution local earthquake catalogue. The magnitudes of earthquakes in our new catalogue range from 1.1 to 5.6. The earthquakes span over the Southwest Mariana rift, the megathrust interface, forearc and outer-rise regions. While most earthquakes are shallow, depths of the slab earthquakes increase from ∼100 to ∼240 km from west to east towards Guam. We also delineate the subducting interface from seismicity distribution and find an increasing trend in dip angles from west to east. The observed along-strike variation in slab dip angles and its downdip extents provide new constraints on geodynamic processes of the southernmost Mariana subduction zone.
Psychological effects of outdoor activity in type 2 diabetes: a review
Authors: Fraser Matthew , Polson Robert , Munoz Sarah-Anne , MacRury Sandra
Published: June 2019

Previous research has shown individuals living with type 2 diabetes are more likely to experience depression, anxiety and reduced quality of life (QoL) in comparison to those without the disease. Physical activity has been highlighted as an important factor in improving physiological and psychological parameters in this population. Previous systematic reviews have found mixed results regarding the effects of exercise on psychological problems. Green exercise is an emerging research area with mounting evidence demonstrating positive effects on mental health. Objectives of the current review investigated whether conducting physical activity in outdoor environments had any effect on psychological problems in individuals with type 2 diabetes. Methods such as PubMed, Medline, PsycINFO, Scopus, Cochrane library, CINAHL, SPORTDiscus and Google Scholar databases were searched. The databases were searched for articles which used an outdoor exercise intervention and investigated psychological problems in individuals with type 2 diabetes. Results from the 1467 retrieved articles, 4 studies were included in the systematic review, consisting of 231 participants. All four studies investigated QoL, one study looked at depression and one investigated general wellbeing. Mixed results were found regarding QoL, no significant effect was found for depression. However, general wellbeing was improved. Due to the limited number of studies eligible for inclusion and the heterogeneity of outcome measures, it was difficult to draw firm conclusions. This systematic review acts as a starting point for future investigations into the use of green exercise in improving the mental health of individuals living with type 2 diabetes.

Registration: PROSPERO: CRD42018088212
Introduction to the Symposium: Stress Phenotype: Linking Molecular, Cellular, and Physiological Stress Responses to Fitness
Authors: Heidinger Britt J , Wada Haruka
Published: June 2019

Although most organisms respond to environmental and social stressors by initiating a stress response that is expected to increase fitness, we currently lack information about how the stress response is integrated across levels of biological organization. Organismal biologists and physiological ecologists have tended to focus on questions related to how the glucocorticoid stress response varies across ecological contexts and is related to fitness, whereas, molecular and cellular biologists have typically investigated the fundamental underlying mechanisms. However, it is becoming increasingly clear that a comprehensive understanding of the evolution of the stress response will require integrative studies that span levels of analyses. This information will be critical for predicting how selection will influence the expression of this complex phenotype at the organismal level, as well as how the integration of the underlying mechanisms will influence the evolutionary response to selection. As diverse organisms are expected to experience rising stress exposure in the face of anthropogenic disturbance and climate change, this information is becoming increasingly urgent. The overarching goals of this symposium were to bring together researchers that study the stress response across levels of organization in diverse organisms to identify important gaps in knowledge and novel research approaches that could be used to advance the field.
Venoarterial extracorporeal membrane oxygenation with or without simultaneous intra-aortic balloon pump support as a direct bridge to heart transplantation: results from a nationwide Spanish registry
Authors: Barge-Caballero Gonzalo , Castel-Lavilla María A , Almenar-Bonet Luis , Garrido-Bravo Iris P , Delgado Juan F , Rangel-Sousa Diego , González-Costello José , Segovia-Cubero Javier , Farrero-Torres Marta , Lambert-Rodríguez José Luis , Crespo-Leiro María G , Hervás-Sotomayor Daniela , Portolés-Ocampo Ana , Martínez-Sellés Manuel , De la Fuente-Galán Luis , Rábago-Juan-Aracil Gregorio , González-Vílchez Francisco , Mirabet-Pérez Sonia , Muñiz Javier , Barge-Caballero Eduardo
Published: June 2019

OBJECTIVES

To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT).

METHODS

We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n = 73) were compared to a control group of patients without IABP support (n = 96).

RESULTS

There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P = 0.17), death during VA-ECMO support (20.6% vs 14.6%, P = 0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P = 0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P = 0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P = 0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02–4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P = 0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P = 0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56–1.58).

CONCLUSIONS

In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.
Sepsis surveillance: an examination of parameter sensitivity and alert reliability
Authors: Amland Robert C , Burghart Mark , Overhage J Marc
Published: June 2019

Objective

To examine performance of a sepsis surveillance system in a simulated environment where modifications to parameters and settings for identification of at-risk patients can be explored in-depth.

Materials and Methods

This was a multiple center observational cohort study. The study population comprised 14 917 adults hospitalized in 2016. An expert-driven rules algorithm was applied against 15.1 million data points to simulate a system with binary notification of sepsis events. Three system scenarios were examined: a scenario as derived from the second version of the Consensus Definitions for Sepsis and Septic Shock (SEP-2), the same scenario but without systolic blood pressure (SBP) decrease criteria (near SEP-2), and a conservative scenario with limited parameters. Patients identified by scenarios as being at-risk for sepsis were assessed for suspected infection. Multivariate binary logistic regression models estimated mortality risk among patients with suspected infection.

Results

First, the SEP-2-based scenario had a hyperactive, unreliable parameter SBP decrease >40 mm Hg from baseline. Second, the near SEP-2 scenario demonstrated adequate reliability and sensitivity. Third, the conservative scenario had modestly higher reliability, but sensitivity degraded quickly. Parameters differed in predicting mortality risk and represented a substitution effect between scenarios.

Discussion

Configuration of parameters and alert criteria have implications for patient identification and predicted outcomes.

Conclusion

Performance of scenarios was associated with scenario design. A single hyperactive, unreliable parameter may negatively influence adoption of the system. A trade-off between modest improvements in alert reliability corresponded to a steep decline in condition sensitivity in scenarios explored.
A T-capsulotomy provides increased hip joint visualization compared with an extended interportal capsulotomy
Authors: Cvetanovich Gregory L , Levy David M , Beck Edward C , Weber Alexander E , Kuhns Benjamin D , Khair Mahmoud M , Nho Shane J
Published: June 2019

The purpose of this study was to compare the cross-sectional area (CSA) of joint visualization between extended interportal and T-capsulotomies. Twenty fresh-frozen cadaveric hips were dissected to their capsuloligamentous complexes and fixed in a custom apparatus in neutral hip position. Ten hips underwent sequential interportal capsulotomies at lengths of 2, 4, 6, and 8 cm. Ten hips underwent sequential T-capsulotomies starting from a 4 cm interportal capsulotomy, creating a 2 cm T-capsulotomy (Half-T), and finally a 4 cm T-capsulotomy (Full-T). Following each sequential capsule change in both groups, a high-resolution digital photograph was taken to measure the visualized intra-articular cross-sectional area (CSA). Independent t-test was used to compare CSA interportal and T-capsulotomy groups. Analysis demonstrated a statistically significant increase in CSA visualization with each sequential increase in interportal capsulotomy length up to 6 cm (2cm: 0.6 ± 0.2 cm2; 4cm: 2.1 ± 0.5 cm2 (p<0.001); 6cm: 3.6 ± 1.0 cm2 (p=0.001)), and no difference at 8cm (4.2 ± 1.2 cm2 (p=0.20)). For the T-capsulotomy group the average CSA visualization significantly increased from 3.2 ± 0.9 cm2 for the Half-T to 7.1 ± 1.0 cm2 for the Full-T (p<0.001). The Half-T CSA visualization was not statistically different from the 6 cm capsulotomy (p=0.4) and the 8cm capsulotomy (p=0.05). The Full-T had significantly superior CSA visualization area as compared to the 6 cm and 8 cm interportal capsulotomies (p<0.001 for both). In conclusion, T-capsulotomy resulted in improved cross-sectional area of joint visualization compared to an extended (8cm) interportal capsulotomy in a cadaveric model. Surgeons must weigh the benefits of greater visualization from T-capsulotomy that may help to avoid residual FAI while ensuring to completely repair the capsulotomy to avoid iatrogenic instability.
Biology and Management of Clover Root Curculio (Coleoptera: Curculionidae)
Authors: Rim Kaitlin , Price Steven J , Wenninger Erik J , Long Rachael , Ramirez Ricardo A
Published: June 2019

Clover root curculio (Sitona hispidulus (F.)) (CRC) has become an economically important pest of alfalfa since the regulatory phase-out of carbofuran, methyl bromide, and other synthetic soil fumigants. Native to temperate Europe, the Middle East, and Asia, CRC was introduced to North America in the early 1900s and is now widespread across the U.S. Adult foliar herbivory is not typically economically important. However, severe root damage by larvae can result in secondary plant pathogen infections, leading to losses in forage quality, yield, and stand life. Monitoring efforts include sweep netting adults and soil sampling around the crown and roots of plants for eggs and larvae. Relationships between CRC densities and root damage as well as economic thresholds have yet to be established. Although several pyrethroids have been registered for use against CRC adults, they are not recommended due to potential non-target effects. Chemical controls have not been registered for use against the cryptic larval stage. This review discusses CRC identification, life history, biology, and ecology. Potential ecological management strategies (e.g., crop rotation, planting dates, resistant host varieties), biological control agents, and insecticide options are also described as key components of an integrated pest management program against CRC in U.S. alfalfa.
Chechen Refugees in Poland on ‘Tolerated Stay’: Different Perspectives of Hospitality in the Context of Theatrical Action in a Private Apartment
Authors: Izdebska Karolina
Published: June 2019

Many researchers show that the medium of the theatre can be an effective tool for collecting and analysing data and designing learning processes, especially when it comes to issues relevant to communities. Art-based research methods offer different ways of thinking, perceiving and researching social problems. The analysed theatrical play, ‘Tolerated Stay’, addresses the issues of hospitality in the context of refugees. The starting point is the history of a Chechen family with whom the artists worked and who stayed in Poland under a tolerated-stay permit. The play was realized in a private apartment. The convention of a meeting at a table opens the field for debate on the themes of the emigration and hospitality. In the analysis, three perspectives of hospitality were distinguished (of refugees, artists and participants). Following the principle of triangulation, different methods from theatre activity were supplemented by qualitative methods.
Miracles in Dark Times: Hannah Arendt and Refugees as ‘Vanguard’
Authors: Horst Cindy , Lysaker Odin
Published: June 2019

The radical uncertainty that refugees face because of war, flight and exile often dramatically shapes their participation in society. Violent conflict and human rights abuses are not just disproportionately experienced by, but can also create, political subjects. Such life events can transform the motivations, sense of responsibility and political actions of individuals with refugee backgrounds. In this article, we explore the links between civil–political engagement and the life stories of such individuals, analysing our empirical data through themes in the work of Hannah Arendt. We make three central points. First, we highlight the possibility of refugees as ‘vanguard’, playing a leading role in the struggle against dark times. Second, we illustrate the importance of expanding the idea of ‘the political’ through Arendt’s understanding of political action as narrative. And, third, we explore the political freedom and hope that stem from the possibility of ‘new beginnings’.
The role of water in Earth's mantle
Authors: Ohtani Eiji
Published: June 2019

Geophysical observations suggest that the transition zone is wet locally. Continental and oceanic sediment components together with the basaltic and peridotitic components might be transported and accumulated in the transition zone. Low-velocity anomalies at the upper mantle–transition zone boundary might be caused by the existence of dense hydrous magmas. Water can be carried farther into the lower mantle by the slabs. The anomalous Q and shear wave regions locating at the uppermost part of the lower mantle could be caused by the existence of fluid or wet magmas in this region because of the water-solubility contrast between the minerals in the transition zone and those in the lower mantle. δ-H solid solution AlO2H–MgSiO4H2 carries water into the lower mantle. Hydrogen-bond symmetrization exists in high-pressure hydrous phases and thus they are stable at the high pressures of the lower mantle. Thus, the δ-H solid solution in subducting slabs carries water farther into the bottom of the lower mantle. Pyrite FeO2Hx is formed due to a reaction between the core and hydrated slabs. This phase could be a candidate for the anomalous regions at the core–mantle boundary.
Near-infrared imaging polarimetry toward M 17 SWex
Authors: Sugitani Koji , Nakamura Fumitaka , Shimoikura Tomomi , Dobashi Kazuhito , Nguyen-Luong Quang , Kusune Takayoshi , Nagayama Takahiro , Watanabe Makoto , Nishiyama Shogo , Tamura Motohide
Published: June 2019

We conducted near-infrared ($\mathit {JHK}_{\rm s}$) imaging polarimetry toward the infrared dark cloud (IRDC) M 17 SWex, including almost all of the IRDC filaments as well as its outskirts, with the polarimeter SIRPOL on the IRSF 1.4 m telescope. We revealed the magnetic fields of M 17 SWex with our polarization-detected sources that were selected by some criteria based on their near-IR colors and the column densities toward them, which were derived from the Herschel data. The selected sources indicate not only that the ordered magnetic field is perpendicular to the cloud elongation as a whole, but also that at both ends of the elongated cloud the magnetic field appears to be bent toward its central part, i.e., a large-scale hourglass-shaped magnetic field perpendicular to the cloud elongation. In addition to this general trend, the elongations of the filamentary subregions within the dense parts of the cloud appear to be mostly perpendicular to their local magnetic fields, while the magnetic fields of the outskirts appear to follow the thin filaments that protrude from the dense parts. The magnetic strengths were estimated to be ∼70–$300\, \mu$G in the subregions, of which the lengths and average number densities are ∼3–9 pc and ∼2–7 × 103 cm−3, respectively, by the Davis–Chandrasekhar–Fermi method with the angular dispersion of our polarization data and the velocity dispersion derived from the C18O (J = 1–0) data obtained by the Nobeyama 45 m telescope. These field configurations and our magnetic stability analysis of the subregions imply that the magnetic field has controlled the formation/evolution of the M 17 SWex cloud.
Gravity analog model of non-equilibrium thermodynamics
Authors: Aibara Noriaki , Fujimoto Naoaki , Katagiri So , Saitou Mayumi , Sugamoto Akio , Yamamoto Takashi , Yumibayashi Tsukasa ,   The OUJ Tokyo Bunkyo Field Theory Collaboration
Published: June 2019

The non-equilibrium thermodynamics of Onsager and Machlup and of Hashitsume is reformulated as a gravity analog model, in which thermodynamic variables, kinetic coefficients, and generalized forces form, respectively, coordinates and metric tensor and vector fields in a space of thermodynamic variables. The relevant symmetry of the model is the general coordinate transformation. Then, the entropy production is classified into three categories, when a closed path is depicted as a thermodynamic cycle. One category is time-reversal odd, and is attributed to the number of lines of magnetic flux passing through the closed path, having the monopole as a source. There are two time-reversal-even categories, one of which is attributed to the space curvature around the path, having the gravitational instanton as a source, which dominates for a rapid operation of the cycle. The last category is the usual one, which remains even for the quasi-equilibrium operation. It is possible to extend the model to include non-linear responses. In introducing new terms, dimensional counting is important, using two parameters, the temperature and the relaxation time. The effective action, being induced by the non-equilibrium thermodynamics, is derived. This is a candidate for the action that controls the dynamics of kinetic coefficients and thermodynamic forces. An example is given in a chemical oscillatory reaction in a solvent of van der Waals type. The fluctuation–dissipation theorem is examined à la Onsager, and a derivation of the gravity analog thermodynamic model from quantum mechanics is sketched, based on an analogy to the resonance problem.
A Case of Fasciolosis in a 11-Year-Old Syrian Immigrant Boy
Authors: Velev V , Vutova K , Pavlova M , Mangarov Iliya
Published: June 2019

Fasciolosis is a chronic parasitic disease caused by two species of liver trematodes, Fasciola hepatica and Fasciola gigantica, which infest ruminants and rarely humans. The disease is spread all over the world, but more common in Asia in areas with extensive livestock farming and can be imported cases in Europe and America. In this case, we describe imported infection with F. hepatica in Bulgaria from 11-year-old Syrian immigrant boy.
Tuberculosis control activities in the private and public health sectors of Kenya from 2013 to 2017: how do they compare?
Authors: Mailu Eunice W , Owiti Philip , Ade Serge , Harries Anthony D , Manzi Marcel , Omesa Eunice , Kiende Polly , Macharia Stephen , Mbithi Irene , Kamene Maureen
Published: June 2019

Background

Large numbers of tuberculosis (TB) patients seek care from private for-profit providers. This study aimed to assess and compare TB control activities in the private for-profit and public sectors in Kenya between 2013 and 2017.

Methods

We conducted a retrospective cross-sectional study using routinely collected data from the National Tuberculosis, Leprosy and Lung Disease Program.

Results

Of 421 409 patients registered and treated between 2013 and 2017, 86 894 (21%) were from the private sector. Data collection was less complete in the private sector for nutritional assessment and follow-up sputum smear examinations (p<0.001). The private sector notified less bacteriologically confirmed TB (43.1% vs 52.6%; p<0.001) and had less malnutrition (body mass index <18.5 kg/m2; 36.4% vs 43.3%; p<0.001) than the public sector. Rates of human immunodeficiency virus (HIV) testing and antiretroviral therapy initiation were >95% and >90%, respectively, in both sectors, but more patients were HIV positive in the private sector (39.6% vs 31.6%; p<0.001). For bacteriologically confirmed pulmonary TB, cure rates were lower in the private sector, especially for HIV-negative patients (p<0.001). The private sector had an overall treatment success of 86.3% as compared with the public sector at 85.7% (p<0.001).

Conclusions

The private sector is performing well in Kenya although there are programmatic challenges that need to be addressed.
The Effects of Family Functioning on the Development of Posttraumatic Stress in Children and Their Parents Following Admission to the PICU*
Authors: Nelson Lara P. , Lachman Sage E. , Li Sara W. , Gold Jeffrey I.
Published: June 2019

Objectives:

To report the rate of acute stress and posttraumatic stress among children and parents following PICU admission and the relation between family function and posttraumatic stress.

Design:

Prospective, longitudinal, multi-informant observational study. Pediatric patients (n = 69) and parents were recruited in the ICU. They completed measures evaluating acute stress and posttraumatic stress during their hospitalization and at 3-month follow-up. Parents completed measures of family functioning during the hospitalization. Pearson correlations and multiple regression models were used to examine the relations between family functioning and acute stress and posttraumatic stress.

Setting:

An academic, urban, pediatric hospital in California.

Patients:

Children, 8–17 years old, admitted to the PICU for greater than 24 hours and their English- or Spanish-speaking parents.

Interventions:

None.

Measurements and Main Results:

All children endorsed acute stress during their PICU admission, with 51% meeting criteria for acute stress disorder. At 3-month follow-up, 53% of the children continued to endorse posttraumatic stress with 13% meeting criteria for posttraumatic stress disorder. Among parents, 78% endorsed acute stress during admission with 30% meeting criteria for acute stress disorder, and at follow-up, 35% endorsed posttraumatic stress with 10% meeting criteria for posttraumatic stress disorder. In multiple linear regression modeling, child acute stress significantly predicted child posttraumatic stress (β = 0.36; p < 0.01). In the parent model, parent acute stress (β = 0.29; p < 0.01) and parent education (β = 0.59; p < 0.00) positively predicted parent’s posttraumatic stress. Family function was not a predictor of either’s posttraumatic stress.

Conclusions:

Both children and parents have alarmingly high rates of acute stress and posttraumatic stress following the child’s PICU admission. Although family function did not emerge as a predictor in this study, further understanding of the influence of the family and the interplay between child and parent posttraumatic stress is needed to improve our understanding of the model of development of posttraumatic stress in this population to inform the intervention strategies.
Antidepressant Use by Youth with Minimal or Mild Depression: Evidence from 3 Health Systems
Authors: Penfold Robert B. , Stewart Christine , Simon Gregory E. , Shortreed Susan M. , Johnson Eric , Rossom Rebecca C. , Operskalski Belinda , Beck Arne
Published: June 2019

Background:

There is concern about the prevalence of prescribing antidepressant medications to youth without appropriate diagnoses or who have subthreshold (mild) depression.

Methods:

Electronic records data from 3 large healthcare systems identified youth aged ≤21 years starting a new episode of antidepressant treatment between January 1, 2009, and December 31, 2013. For those with a diagnosis of depression, Patient Health Questionnaire (PHQ9) scores at the time of treatment initiation were used to examine the distribution of symptom severity and patients' demographic and clinical characteristics.

Results:

Of the 15,460 episodes of treatment, a depression diagnosis was recorded in 95% of the cases. PHQ9 scores were available for 4,329 youth with a diagnosis of depression. Younger age, sex, previous treatment, co-occurring anxiety, treatment setting, concurrent psychotherapy, and site were significant predictors of completing a PHQ9. Among youth with a baseline score, 87% reported moderate or severe symptoms (PHQ9 score ≥ 10) and 13% reported mild or minimal symptoms (PHQ9 < 10). The proportion reporting PHQ9 < 10 when starting treatment decreased with age, ranging from 19% in those aged 13–14 years and 12% in those aged 18–21 years. Patients treated by psychiatrists were 1.54 times (95% Confidence Interval [CI], 1.21–1.97) more likely to have PHQ9 scores < 10 compared with primary care physicians. Patients with prior treatment history (odds ratio = 1.76; 95% CI, 1.45–2.13) and concurrent psychotherapy (odds ratio = 1.24; 95% CI, 1.02–1.52) were more likely to have PHQ9 < 10.

Conclusions:

In these health systems, prescribing of antidepressant medication to adolescents for minimal or mild depression is much less common than previous reported.
Implementation of an Outcome Measure in Pediatric Behavioral Health: A Process Improvement Initiative
Authors: Butz Catherine , Valleru Jahnavi , Castillo Anthony , Butter Eric M.
Published: June 2019

Introduction:

Efforts to monitor outcomes in pediatric behavioral health are becoming a quality, financial, and regulatory imperative. The implementation of a broad-based measure to assess patient functioning at the start of pediatric psychology services, as well as at subsequent visits, has not been demonstrated. This article describes the systematic implementation of a measure of health-related quality of life (HRQOL) to assess functional impairment across an entire clinic population using quality improvement science and methodologies.

Methods:

The Pediatric Quality of Life Inventory Generic Core 4.0 (PedsQL) was administered at initial and subsequent visits for all patients seeking treatment at a large, tertiary care pediatric psychology clinic in an academic pediatric medical center (Nationwide Children’s Hospital, Columbus, Ohio). The goal of this project was to design a process change to support a 90% completion rate of this measurement tool by all clinicians.

Results:

Within 16 months, the completion rate of the PedsQL increased from a baseline of 39% to the identified goal of 90%. This process change was within control limits (over 80%) for over 12 months.

Conclusion:

This study demonstrates the implementation of a systematic process for collection of outcome measures in a pediatric behavioral health care setting. Successful administration of an outcome measure at multiple time points during the care of children and adolescents in a large psychology clinic can allow for quantitative assessment of treatment progress and identify a pathway for administration of additional measures.
SAFEST: Use of a Rubric to Teach Safety Reporting to Pediatric House Officers
Authors: Keefer Patricia , Helms Lauren , Warrier Kavita , Vredeveld Jennifer , Burrows Heather , Orringer Kelly
Published: June 2019

Background:

Among the many modalities of error detection in academic pediatric hospitals, patient safety reporting is an important component, particularly for unexpected events. Residents recognize the importance of reporting but cite some barriers to doing so. A rubric was developed to guide resident reporting and streamline information gathering in patient safety reports. The rubric used the acronym SAFEST as a reminder to include 6 key elements:

1. Staff involved in the incident.

2. Actual event description.

3. Follow-up initiated.

4. Effect on patient.

5. Standard of care described.

6. To-do/suggestions for improvement.

Objectives:

This study was designed to determine if the addition of this educational rubric into a standard quality improvement curriculum improves the consistency of information documented in patient safety reports as a subset of a larger quality improvement project aimed at improving safety reporting.

Methods:

A team of faculty members analyzed individual resident error reports for adherence to the 6 tenets of the SAFEST mnemonic.

Results:

From April to October of 2014, 2015, and 2016, a convenience sample of 131, 110, and 132 reports, respectively, were extracted and analyzed. For the rates of reporting “staff involved” and “standard of care,” the differences over time were significant, both with P values < 0.001. After training, residents were 2.2 times more likely to report on the “staff involved” in the error and 1.8 times more likely to report the “standard of care.”

Discussion:

These results describe successful education on a rubric designed to improve the content of patient safety reports.
Increasing Patient Portal Activation in a Pediatric Subspecialty Clinic
Authors: Ratliff-Schaub Karen , Valleru Jahnavi
Published: June 2019

Background:

Online patient portals are not widely used, despite their advantages for efficient communication, especially for patients with chronic conditions. A hospital-based group practice of Developmental-Behavioral Pediatricians initiated this quality improvement (QI) project with a goal to increase the percentage of patients with an active MyChart (Epic Systems Corporation’s patient portal) account and ultimately improve efficiency of communication between families and clinical staff.

Methods:

Using QI methodology, we identified staff commitment, workflow issues, and family awareness as gaps and implemented progressive Plan, Do, Study, Act cycles aimed at developing standard processes for activating families on MyChart. We tracked our project measures with statistical process control methodology and sustained our progress with improving awareness and regular feedback.

Results:

Patient portal activations increased from 1.8% to 30% in a 6-month time period. Highly successful interventions included development and implementation of a standard process for activation, staff education to ensure comfort and commitment, having families opt out instead of opt in, and completed activation of accounts before families leaving clinic.

Conclusions:

Patient portal activation can be significantly increased through systematic application of QI methodology to address staff training and workflow in a busy subspecialty clinic. Engagement of operations staff and completion of the activation process while the family is still in clinic seemed to be effective in getting families activated in MyChart. It is possible to improve patient portal activation with minimal impact to workflow.
Impact of Implementing a Pediatric Early Warning System (PEWS) in a Pediatric Oncology Hospital
Authors: Agulnik Asya , Johnson Sherry , Wilkes Regina , Faughnan Lane , Carrillo Angela , Morrison R. Ray
Published: June 2019

Background:

Hospitalized pediatric oncology and hematopoietic stem cell transplant (HSCT) patients have frequent clinical deterioration requiring transfer to the Pediatric Intensive Care Unit (PICU). Pediatric Early Warning Systems (PEWS) can aid early identification of clinical deterioration and improve outcomes in these patients.

Objectives:

Describe the impact of PEWS implementation in a dedicated pediatric hematology-oncology/HSCT hospital.

Methods:

A PEWS tool and escalation algorithm were implemented between August and October 2016 (Fig. 1). Implementation quality was evaluated by measuring errors in PEWS calculation, omissions, and algorithm activation. Frequency of emergency activations and method of unplanned PICU transfer were compared before and after PEWS implementation.

Results:

Random monitoring of PEWS scores demonstrated 12.7% calculation errors, 3.8% omissions, and 1.7% algorithm errors. Omissions and algorithm errors decreased over time following implementation (P < 0.0001 and P = 0.005, respectively). Frequency of Rapid Response Team (RRT) activations increased after PEWS implementation from 1.3 to 12.2/1,000-inpatient-days (P < 0.0001), without an increase in Code Blue activations (1.2 to 0.97/1,000-inpatient-days, P = 0.49, Fig. 2) and no change in frequency of unplanned PICU transfers (5.7/1,000-inpatient-days before and after PEWS implementation). Unplanned PICU transfers arriving via RRT increased from 11.5% to 60.5% of admissions (P < 0.0001, Fig. 3).

Conclusions/Implications:

PEWS can be successfully implemented in a pediatric hematology-oncology/HSCT hospital with improvement in accuracy over time. Implementation of PEWS resulted in increased use of the RRT system and more patients with clinical deterioration arriving to the PICU via an organized escalation pathway, representing standardization of care and improvement in the culture of safety in the hospital.
Early Recognition of Sepsis among Inpatients in Pediatric Critical Care and Acute Care Areas
Authors: Brown Terri L. , Jeppesen Amy , Kancharla Venkatesh , Macias Charles
Published: June 2019

Project Aim:

Develop, test, and implement inpatient clinical decision support tools (Best Practice Alerts; BPA) for early recognition of sepsis to improve time from physiologic sepsis to recognition, and timeliness of evidence-based care, with the ultimate goals of reducing mortality and morbidity.

Background:

No valid and reliable sepsis screening tools for hospitalized children exist. The Pediatric Septic Shock collaborative, focused on Emergency Centers, demonstrated reduced mortality with early intervention and improved adherence to evidence-based care bundles. Setting: large quaternary children’s hospital, average monthly severe sepsis volume: 148 children, 6 deaths.

Methods:

Existing pediatric sepsis screens were identified via literature review, Epic UserWeb, and Children’s Hospital Association Improving Pediatric Sepsis Outcomes Collaborative website. Our Emergency Center sepsis screen was selected as the base for our inpatient tools. Separate scoring criteria were developed for use in the Critical Care areas and Acute Care/Hematology-Oncology/Bone Marrow Transplant areas (Fig. 1).

Results:

The sepsis screening algorithms were implemented in the background of the electronic medical record, allowing performance testing in our populations before becoming visible to the end-user. Initial results of a 3-day test period of screening with 8-hour lockout are in Table 1.

Discussion:

The number of activations were not excessive. Multiple revisions to the BPA build were required due to the paucity of component details in the reporting for population analysis; however, these enriched data are pending.
Impact of a Hands-free Wireless Communication Device on Communication and Clinical Outcomes in a Pediatric Intensive Care
Authors: Cooney Hannah J. , Banbury Hannah E. , Plunkett Adrian C.
Published: June 2019

Introduction:

Timely communication is essential in the intensive care environment. Delays may occur if communication relies on identification of individuals through line of sight, or use of telephones and pagers. We measured communication delays, staff perceptions, and clinical outcomes before and after implementation of a hands-free wireless communication device (HWCD) in a pediatric intensive care unit (PICU).

Methods:

Single-center study comprising 3 components: observational study of verbal communication among PICU staff; staff survey regarding perceptions of communication delays; analysis of clinical data (length of stay, risk adjusted mortality, emergency events). All components were conducted before and after implementation of the HWCD.

Results:

Four hundred sixteen hours of staff working time were observed (210 pre- and 206 postimplementation). These data showed significant reduction in communication delays—most notably among roaming staff [median time to response to verbal queries before and after implementation 120 seconds (interquartile range, 6–255) and 9 seconds (interquartile range, 7–30), respectively: P < 0.001]. The results of the staff survey showed significant improvements in staff perceptions of communication delays in all roaming staff groups utilizing the HWCD. The survey response rate was 205/361: 56.8%. There were no differences in clinical outcomes from the routinely collected clinical data. There was a significant reduction in emergency event rate—emergency summoning of assistance to bedside (per 100 bed-days)—before and after implementation, 2.17 and 1.69, respectively: rate ratio = 0.78 (95% confidence interval, 0.63–0.95; P < 0.05).

Conclusions:

Implementation of a HWCD was associated with significant reduction in communication delays among roaming staff members in PICU.
Standardized Process for Early Recognition and Treatment of Hypotension in Pediatric Oncology Patients Reduces Clinical Deterioration and Shock
Authors: Rutman Lori , Wilkes Jennifer , Stimpson Megan , Masse Elizabeth , Barry Dwight , Roberts Joan
Published: June 2019

Introduction:

Pediatric oncology patients are a high-risk population for septic shock. These patients often screen positive for sepsis during hospitalization, making it difficult to discern when care escalations are warranted. This poses challenges to timely clinical decision-making, which can result in extended periods of hypotension and increased risk for clinical deterioration. The aim of this project was to decrease the frequency of “rescue events” (hypotension for 2 hours before initiation of vasoactive medications) in pediatric oncology patients by 25% within 6 months of implementing standardized hypotension [mean arterial pressure (MAP)] thresholds on a septic shock pathway.

Methods:

A key driver diagram was developed (Fig. 1). Age-based MAP norms were integrated into the electronic medical record. Critical MAP thresholds for provider evaluation were included in a revised septic shock pathway. Rescue events were measured over time.

Results:

The revised septic shock pathway was implemented in December 2016. Baseline data from 10/1/15 to 12/30/16 showed 10 rescue events (0.7 events per 1,000 patient days), with reduction to 2 rescue events from 1/1/17 to 6/30/17 (0.3 events per 1,000 patient days). This represents a 60% reduction in events, and 56% reduction in the rate of events. The distribution of days between rescue events shifted considerably after implementation (Fig. 2); median days between events increased from 16 days (interquartile range, 7–22) to 37 days (interquartile range, 27–56).

Conclusion:

Integration of simple, actionable blood pressure thresholds in a standardized pathway for sepsis led to a reduction of preventable harm (rescue events) among pediatric oncology patients.