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Introduction: This retrospective observational study was designed to examine early vs. late steroid use and if there was an impact on the incidence of bronchopulmonary dysplasia (BPD) and growth in our NICU. Methods: Between July 2019 and August 2021, 175 infants <30 weeks gestational age and/or 1500 grams at birth were enrolled in our retrospective observational study. Infants were classified into three cohorts based on initial steroid exposure and timing: no exposure, ≤21 days of life (DOL), and >21 DOL. We classified BPD using support-based criteria at 36 weeks and evaluated differences between the steroid groups using a chi-square test. Results: There were no statistical differences observed in infants who began steroids before or after DOL 21 concerning BPD or support required at discharge. ΔZ-scores from birth to DOL 42 demonstrated similar growth velocity between all cohorts (P=0.199). Conclusions: No significant difference was found in BPD outcomes when comparing early (≤21) vs. late postnatal steroid initiation (>21 days). Growth velocities were not adversely impacted by steroid exposure. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the indications for maternal TORCH (Toxoplasma gondii, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV)) serology, with a focus on the yield in isolated fetal growth restriction (FGR). Materials and Methods: A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. TORCH testing ordered for pregnancy losses and stillbirth was excluded. Results: Medical records of 718 pregnancies were reviewed, representing 760 fetuses. Isolated FGR was the indication for TORCH screening in 71.2% of pregnancies. Screens ordered for isolated FGR were positive in 7.4% (95% CI 5.5–10.0%). There were 49 positive maternal immunoglobulin M (CMV = 34, Toxoplasma = 15). Two acute maternal infections during pregnancy were diagnosed (CMV = 1, Toxoplasma = 1), with both screens ordered to assess symptomatic maternal illness. There was one neonatal CMV infection, born to a woman with symptomatic primary CMV. No maternal or neonatal rubella or HSV infections were identified. We found a diagnostic yield of TORCH screening for isolated FGR of 0.0% (95% CI 0.00–0.8%). An estimated AUD$64 269.75 was expended on maternal TORCH screens in this study. Conclusion: Maternal TORCH testing for isolated FGR is of no diagnostic yield and should be abandoned. [ABSTRACT FROM AUTHOR]

BackgroundAltered coagulation function after trauma can contribute to development of venous thromboembolism (VTE). Severe trauma impairs coagulation function, but the trajectory for recovery is not known. We hypothesized that enhanced, early recovery of coagulation function increases VTE risk in severely injured trauma patients.Study designSecondary analysis was performed on data from the Pragmatic Randomized Optimal Platelet and Plasma Ratio (PROPPR) trial, excluding patients who died within 24 hours or were on pre-injury anticoagulants. Patient characteristics, adverse outcomes, and parameters of platelet function and coagulation (thromboelastography) were compared from admission to 72 hours between VTE (n = 83) and non-VTE (n = 475) patients. A p value < 0.05 indicates significance.ResultsDespite similar patient demographics, VTE patients exhibited hypercoagulable thromboelastography parameters and enhanced platelet function at admission (p < 0.05). Both groups exhibited hypocoagulable thromboelastography parameters, platelet dysfunction, and suppressed clot lysis (low clot lysis at 30 minutes) 2 hours after admission (p < 0.05). The VTE patients exhibited delayed coagulation recovery (a significant change compared with 2 hours) of K-value (48 vs 24 hours), α-angle (no recovery), maximum amplitude (24 vs 12 hours), and clot lysis at 30 minutes (48 vs 12 hours). Platelet function recovery mediated by arachidonic acid (72 vs 4 hours), ADP (72 vs 12 hours), and collagen (48 vs 12 hours) was delayed in VTE patients. The VTE patients had lower mortality (4% vs 13%; p < 0.05), but fewer hospital-free days (0 days [interquartile range 0 to 8 days] vs 10 days [interquartile range 0 to 20 days]; p < 0.05) and higher complication rates (p < 0.05).ConclusionsRecovery from platelet dysfunction and coagulopathy after severe trauma were delayed in VTE patients. Suppressed clot lysis and compensatory mechanisms associated with altered coagulation that can potentiate VTE formation require additional investigation.

Youth physical activity (PA) levels are a central focus for physical educators and health professionals worldwide. This study (a) examined the PA levels of children during structured and unstructured PA lessons of an after-school program (ASP) and (b) described the children's perceptions of structured and unstructured PA. Participants were 31 children, M[subscript age] (10.37 ± 1.4 yrs.), BMI percentile (79.86 ± 28.01), who actively participated in an ASP. Activity measurements examined mean steps per minute, percentage of MVPA, and percentage of activity time during unstructured and structured PA opportunities. Children accumulated higher mean steps per minute and percentage of activity time during unstructured PA; however, they had a higher mean percentage of MVPA during structured PA. There were statistically significant differences between mean steps per minute and mean percentage activity time. The findings suggest that implementation of forms of unstructured PA may increase the daily PA of youth and help them to meet recent national recommendations.

* Context.--Automated analyzers have advanced the field of clinical hematology, mandating updated complete blood count (CBC) reference intervals (RIs) to be clinically useful. Contemporary newborn CBC RI publications are mostly retrospective, which some authors have cited as one of their cardinal limitations and recommended future prospective studies. Objective.--To prospectively establish accurate hematologic RIs for normal healthy term newborns at 24 hours of life given the limitations of the current medical literature. Design.--This prospective study was conducted at an academic tertiary care center, and hematology samples were collected from 120 participants deemed to be normal healthy term newborns. Distributions were assessed for normality and tested for outliers. Reference intervals were values between the 2.5th percentile and 97.5th percentile. Results.--The novel RIs obtained for this study population are as follows: absolute immature granulocyte count, 80/[micro]L to 1700/[micro]L; immature granulocyte percentage, 0.6% to 6.1%; reticulocyte hemoglobin equivalent, 31.7 to 38.4 pg; immature reticulocyte fraction, 35.9% to 52.8%; immature platelet count, 4.73 * [10.sup.3]/[micro]L to 19.72 * [10.sup.3]/[micro]L; and immature platelet fraction, 1.7% to 9.8%. Conclusions.--This prospective study has defined hematologic RIs for this newborn population, including new advanced clinical parameters from the Sysmex XN-1000 Automated Hematology Analyzer. These RIs are proposed as the new standard and can serve as a strong foundation for continued research to further explore their value in diagnosing and managing morbidities such as sepsis, anemia, and thrombocytopenia. (Arch Pathol Lab Med. 2021;145:66-74; doi: 10.5858/arpa.2019-0444-OA), Laboratory tests leverage 60% to 70% of medical decisions and one of the most often ordered and impactful tests is the complete blood count (CBC). (1,2) These decisions require that [...]

Youth physical activity (PA) levels are a central focus for physical educators and health professionals worldwide. This study (a) examined the PA levels of children during structured and unstructured PA lessons of an after-school program (ASP) and (b) described the children's perceptions of structured and unstructured PA. Participants were 31 children, Mage (10.37 [+ or -] 1.4 yrs.), BMI percentile (79.86 [+ or -] 28.01), who actively participated in an ASP. Activity measurements examined mean steps per minute, percentage of MVPA, and percentage of activity time during unstructured and structured PA opportunities. Children accumulated higher mean steps per minute and percentage of activity time during unstructured PA; however, they had a higher mean percentage of MVPA during structured PA. There were statistically significant differences between mean steps per minute and mean percentage activity time. The findings suggest that implementation of forms of unstructured PA may increase the daily PA of youth and help them to meet recent national recommendations., An estimated 32% of U.S. youth are considered overweight or obese, and the prevalence of extreme obesity varies by ethnic and age groups (Durstine, Gordon, Wang, & Luo, 2013; Koebnick [...]

Poetry therapy is an arts-based psychotherapeutic intervention, often delivered in groups. This paper argues that the process and benefits of poetry therapy may be particularly suited to clients recovering from anorexia, as an adjunct to other treatments. Poetry therapy and its history are described briefly, and the relevance of poetry therapy for clients recovering from anorexia is outlined. After one client contributes her experience of this treatment for illustration, the paper offers a review of the evidence base for poetry therapy for eating disorders, and argues that, while research is limited, further research is warranted. Finally, a description of one form of clinical application is offered, to enable replication.

The therapeutic benefits of acupoint injection of vitamin K in spleen-6 (SP6) for the treatment of primary dysmenorrhea have been observed in limited clinical settings. However, menadione, the form of vitamin K most studied for treating dysmenorrhea, is not routinely used in clinical practice in North America. As part of a larger clinical trial among women aged 18-25 years with primary dysmenorrhea, we conducted a substudy to test the plasma concentration of phylloquinone (vitamin K1). We collected blood samples from four women before and 24-48 hours after an acupoint injection of phylloquinone in SP6. Despite the rapid turnover of phylloquinone observed in previous studies, we found that the plasma phylloquinone concentrations increased significantly from preinjection to 1-2 days after the injection. Interestingly, higher phylloquinone concentrations were correlated with less pain intensity among women with dysmenorrhea. Additional research is needed to understand the association between vitamin K and menstrual pain, including the role of vitamin K deficiency in inflammation and pain, and on the possible mechanisms of acupoint injection of vitamin K for the treatment of primary dysmenorrhea.

ContextDysmenorrhea, the occurrence of painful menstrual cramping of the uterus, is a major cause of activity restriction and absences from school and work among young women. Standard pharmaceuticals used to treat dysmenorrhea are not effective for all women and have side effects that limit their use. Studies elsewhere have shown beneficial effects for use of vitamin K1 as an acupoint treatment, but the acceptability of this treatment to women in the United States has been unknown.ObjectiveThe study intended to examine the feasibility, acceptability, and preliminary effects of acupuncture point injection of vitamin K1 as an alternative treatment for primary dysmenorrhea among US women.DesignThe research team conducted a pilot study using a blinded, randomized, crossover trial design.SettingThe study took place at the University of California, San Francisco (UCSF).ParticipantsThe study was conducted in the San Francisco Bay Area among women 18 to 25 y of age who had been diagnosed with primary dysmenorrhea. Fourteen women completed all of the study's visits.InterventionWomen with primary dysmenorrhea were randomized into 2 groups to receive bilateral injections of vitamin K1 in the Spleen-6 (SP-6) acupuncture point at the start of menstruation and then, following a 2-mo washout period, saline in a nonacupuncture point at the start of menstruation. One group received the vitamin K1 injection first, while the other group received the saline injection first.Outcome measureDysmenorrhea pain intensity was measured using a 0-10 numeric rating scale (NRS), before and after injections.ResultsWomen had an average 2.5-point decrease in pain after a vitamin K1 injection in the SP-6 acupoint (P < .001), as compared with a 1.8-point decrease after a saline injection (P < .001). Change scores for vitamin K1, as compared with a saline injection, approached statistical significance (P < .10). Intensity and duration of menstrual symptoms, as measured by the Cox retrospective symptom scale, also decreased following injections. After participating, 94% of the women remained agreeable to receiving the injection therapy, and 77% reported they would come every month were the treatment available.ConclusionsFindings suggested high acceptability for an acupuncture point injection of vitamin K1 as treatment for primary dysmenorrhea among young women in San Francisco. Pain decreased with both treatments, with a trend toward greater pain reduction for the vitamin K1/SP-6 injection. This finding is consistent with outcomes from the Obstetrics and Gynecology Hospital in Shanghai, China, where the protocol was developed.

Objective Since the global outbreak of the novel coronavirus disease 2019 (COVID-19), there have been increasing reports of children developing a croup-like cough associated with concurrent COVID-19 infection. Currently, there is not much information available regarding newborn infants and COVID-19 infection and the incidence of vertical transmission is thought to be rare. This novel case report depicts a term newborn infected at the time of birth with COVID-19 and includes details about the course of their complicated hospitalization. Study Design A term infant, found to be infected at birth with COVID-19, developed respiratory distress resulting in transfer to our neonatal intensive care unit. Due to the increasing respiratory support requirements, endotracheal intubation was required on day of life (DOL) 7. Later, when the infant was extubated, on DOL 21, a croup-like cough developed. Results Despite respiratory treatment with albuterol, budesonide, racemic epinephrine, lidocaine, dornase alfa, and a 10-day course of dexamethasone, the cough persisted. A prolonged hospitalization was required and eventually the infant was discharged home on 0.4 L/minute of oxygen via nasal cannula on DOL 95. Conclusion As the COVID-19 virus mutates over time, there are some seemingly different presentations in both the pediatric and adult populations. The hypervigilance and sharing of new findings among providers are paramount in the treatment of infants with COVID-19 disease. Key Points Term infant with COVID-19 developed a croup-like cough. Usual respiratory treatment not effective with croup-like cough and COVID-19. COVID-19 present at birth later requiring intubation. [ABSTRACT FROM AUTHOR]

Mothers are currently under‐represented in the literature on anorexia, including research on treatment, with most research focussed on female adolescents. This raises questions about how adult women and particularly those who are mothers, experience eating disorder treatment. This study provides a phenomenological exploration of lived experiences of seeking and receiving professional help and interactions with health professionals for six white heterosexual mothers who experienced anorexia while raising their children. Four themes are reported that capture the women's diverse experiences of seeking and receiving support for anorexia: (1) conflict between mothering and seeking help; (2) experiences of feeling blamed, poorly treated or misunderstood by health professionals; (3) positive experiences of seeking and receiving support; and (4) the importance of ongoing support. The women's experiences suggest that healthcare professionals should adopt a more holistic approach that acknowledges the subjective reality of the client (including their mother status) when working with mothers experiencing anorexia. [ABSTRACT FROM AUTHOR]

In order to better understand faculty perceptions of group work, a survey was deployed to online teaching instructors. Results suggest that most faculty find student socialization (e.g., being supportive, caring about each other), communication, reliability, and dependability important in the group process. However, very few faculty rated the development of deeper interpersonal relationships as very important. Finally, most faculty said it was important for group members to have a role, though most suggested group roles were decided upon by group members. Implications for group project implementation are discussed.

Focus group interviews with university instructors (tenured, tenure-track, and adjunct) were conducted to explore perceptions of online group work. Results indicated that instructors believe that group work is an essential tool for students' future lives and, therefore, a key component of the online classroom. They believe that professional development should be offered to distance instructors to encourage the use of best practice teaching (including group work) in online courses. Specific strategies for the successful implementation of online group projects were shared. Implications for practice related to faculty development, supporting outstanding teachers, and successful implementation of online group projects are presented.

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Objective The study aimed to evaluate the validity of transcutaneous bilirubin (TcB) measurements at three sites in premature infants born at 23 0/7 to 34 6/7 weeks' gestational age (GA) compared with total serum bilirubin (TSB) measurements. Study Design A prospective study was conducted at Banner – University Medical Center Phoenix, where informed consent was obtained from the infant's parent or legally authorized representative. Cohort A was comprised of infants 23 0/7 to 28 6/7 weeks' GA and Cohort B contained subjects 29 0/7 to 34 6/7 weeks' GA. Baseline TSB measurements were collected at approximately 24 hours of life, as the standard of care and the TcB measurements were obtained from the sternum, interscapular, and buttock areas at approximately ± 30 minutes from collection of the TSB. Statistical analysis of measurements including sensitivity, specificity, positive, and negative predictive values, and the area under the receiver operator characteristic curve (AUROC) were performed. Results A total of 166 infants were included in the study population. Cohort A consisted of 41 subjects and Cohort B contained 125 subjects. The results showed that baseline TcB measurements from the interscapular area were the most sensitive and specific with TSB levels >5.0 mg/dL in Cohort A. Baseline TcB measurements from the sternum demonstrated greatest sensitivity and specificity when the TSB level was >8.0 mg/dL in Cohort B. In general, each of the three sites in both cohorts demonstrated excellent AUROCs and negative predictive values. Conclusion The use of a TcB meter in preterm infants can be a reliable noninvasive screening tool for hyperbilirubinemia, and it may be beneficial in decreasing painful stimuli and iatrogenic blood loss when used as an adjunct to TSB monitoring. Key Points Interscapular TcB is sensitive/specific in 23 to 29 weeks' GA. Sternal TcB is sensitive/specific in 29 to 35 weeks' GA. TcB readings are reliable in preterm infants. TcB is reliable when serum bilirubin is >5.0 mg/dL. [ABSTRACT FROM AUTHOR]

Until now children's attention to the beliefs of people they wish to persuade has been examined experimentally via tasks that were artificial in important respects. To determine whether such research has underestimated children's psychological perspective taking, two studies that manipulated task elements pertinent to ecological validity were conducted. Children in three age groups (3, 4/5, and 6/7 years) were asked (forced-choice and open-ended formats) how best to persuade puppets and people, with differing beliefs, to pet and play with various toy animals. Children offered as many or more belief-relevant arguments in response to forced-choice as to open-ended questions. Only the oldest group attended to beliefs more when persuading a person compared with a puppet. Even on more realistic tasks, significant improvement with age across task formats confirmed a developmental trajectory in line with extant reports of children's belief reasoning. The findings support the idea that enhanced social competence corresponds specifically to children's increasing attention to beliefs in social interactions such as persuasion.

Trust between group members has been suggested as an important part of small group work in online classrooms. Developing interpersonal relationships with group members may promote a sense of trust among them; however, research shows mixed results. The current study explored how students' perceptions of the importance of interpersonal relationships in online groups affected their perceptions of trust and experiences within the group. Students enrolled in online classes that incorporated a group project were surveyed about their experiences with online group projects. Participants did not find interpersonal relationships as necessary in trust development. However, student gender and type (i.e., distance versus on-campus) were important factors in determining the type of experiences students had within their online groups. Males reported more negative experiences than females, and distance education students desired relationships with group members more than on-campus students. (Contains 4 tables.)

Bedtime struggles are some of the most common childhood behavior problems. These disruptions are associated with children's daytime misbehavior, impaired social functioning, poorer school performance, and even an increased risk of child abuse. These problems also have a number of negative consequences for members of the child's family. Of the evidence-based treatments for bedtime noncompliance in young children, graduated extinction is the most widely used by clinicians. A number of studies have demonstrated its efficacy. The present study is the first to examine the efficacy of graduated extinction with children from ethnic minority or low socioeconomic backgrounds. Additionally, this is one of the first studies to examine the effects of graduated extinction when it is delivered in a group format. In an interrupted time-series design, five parents of children enrolled at a Head Start preschool site participated in one of two groups that received instruction on the use of graduated extinction. According to visual inspection as well as single case and multilevel statistical analyses, parents reported that at posttest their children experienced large reductions in both bedtime and daytime behavior problems. Parents also reported that their own levels of depression and stress declined during this period. At two-month follow-up, gains in the children's bedtime behavior were maintained. Parents also reported high levels of satisfaction with the intervention. These results suggest that graduated extinction for bedtime noncompliance is effective for a wide range of parents and can be successfully administered in a group setting.

Objective: To determine whether usage of the Neonatal Early-Onset Sepsis (EOS) Calculator decreases sepsis evaluations, antibiotic administration, length of stay (LOS), and resource utilization when caring for newborns whose mothers were diagnosed with confirmed chorioamnionitis (CAM). Study Design: This retrospective cohort study enrolled 236 dyads of mothers and newborns (= 35 weeks gestation). De-identified data, including newborn antibiotic usage, complete blood counts (CBC), blood cultures, and LOS, were collected one year before and after the 2019 implementation of the EOS calculator. To summarize the data for all study variables, descriptive statistics were utilized. All categorical variables were compared using the Fisher exact or X2 test, and the Wilcoxon Rank Sum test was applied for continuous variables. Results: A significant reduction was seen in the incidence of sepsis evaluations (P < 0.001) and antibiotic use (P < 0.001) after the implementation of the EOS calculator. An Arizona Medicare reimbursement rate estimation revealed that the median expense of EOS-related care decreased by $257.89 in infants whose mothers were diagnosed with confirmed CAM (P < 0.0001). Conclusion: The frequency of sepsis evaluations and antibiotic utilization in newborns of mothers diagnosed with confirmed CAM was significantly reduced with the use of the EOS calculator, resulting in decreased resource utilization. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the conservative management versus medical/surgical treatment of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants leads to improved morbidity, mortality, and length of stay (LOS). Study Design: A cohort observational study was conducted on infants born October 31, 2017, through June 30, 2021, weighing = 1000 grams with a confirmed PDA by echocardiogram. Median growth rate, LOS, ventilator days, need for oxygen at NICU discharge, major comorbidities, mortality, and the type of PDA treatment were collected. Subjects were divided into those who received only conservative management (Cohort 1) and those who received medical and/or surgical treatment to close the ductus (Cohort 2). Chi-square and Mann-Whitney U tests were used to compare baseline demographics and to determine any statistical significance in outcomes between the two cohorts. Results: 225 patients met the inclusion criteria, with 79 (35%) in Cohort 1 and 146 (65%) in Cohort 2. Upon comparison, demographics were similar among the two groups. There were no significant differences in weight gain, LOS, or ventilator days, nor in need for oxygen at NICU discharge, rates of necrotizing enterocolitis, bronchopulmonary dysplasia, or mortality (P > .05). Conclusion: The management of ELBW infants with a PDA proved varied, with more than half receiving a medical and/or surgical intervention. This study failed to demonstrate significant improvement in several important outcomes or common comorbidities in Cohort 2. This suggests that while treating a PDA may benefit an infant's day-to-day clinical course, it may not improve their outcomes at NICU discharge. Further research is needed to increase statistical power and obtain generalizable results. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the effect of a single dose of prophylactic vancomycin prior to the removal of a peripherally inserted central catheter (PICC) in decreasing sepsis evaluations, positive cultures, and antibiotic usage in neonates. METHODS A retrospective review was conducted from December 1, 2015, through November 30, 2019, to evaluate outcomes of sepsis evaluations, positive cultures, and antibiotic usage in neonates not receiving prophylactic vancomycin prior to the discontinuation of a PICC as compared with those receiving prophylaxis vancomycin in a neonatal intensive care unit (NICU). RESULTS Of the 138 neonates enrolled in the study, 82 did not receive vancomycin prophylaxis (Cohort 1), and 56 did (Cohort 2). Both cohorts were similar in sex distribution, gestational age, and PICC days. The frequency of sepsis evaluations, positive cultures, and the need for antibiotics was not found to be significant (p = 0.404, 0.703, 0.808) (Table 2). CONCLUSIONS The results did not show a statistically significant improvement in the incidence of sepsis in neonates who received prophylactic vancomycin prior to PICC discontinuation. However, there were lower percentages of sepsis evaluations, positive cultures, and antibiotics administered in the Cohort 2 patients. Although the advantage of implementing this antibiotic policy is uncertain based on this study, further research across multiple centers including a larger number of subjects may provide more conclusive results. ABBREVIATIONS NICU, neonatal intensive care unit; PICC, peripherally inserted central catheter; TPN, total parenteral nutrition. [ABSTRACT FROM AUTHOR]

Introduction  The long-term effects of prenatal coronavirus disease 2019 (COVID-19) infection on the fetal brain are mostly unknown at this time; however, there is increasing evidence being published. Case Report  Two cases of severe ventriculomegaly, neurological dysfunction, and seizures were found in neonates with prenatal exposure to COVID-19 infection during the first and third trimesters of pregnancy. Conclusion  Inflammation during the prenatal and neonatal periods may be associated with neurological disorders or injury. Despite the presumed lack of vertical transmission, post-COVID-19 syndrome and its associated inflammation may have an impact on the unborn fetus. Hyper-vigilance and dissemination of adverse findings are of significant importance as we navigate through this evolving pandemic and its effects. Key Points Prenatal exposure to COVID-19 may affect the fetal brain. There is a possibility of neonatal neurological sequelae from maternal COVID-19. Does maternal COVID-19 infection cause infantile seizures? [ABSTRACT FROM AUTHOR]

Objective  This study was aimed to evaluate the effect of human milk protein fortifier (HMPF) versus bovine milk protein fortifier (BMPF) on feeding tolerance defined as the time to reach full feeds and necrotizing enterocolitis (NEC) in premature very low birth weight (VLBW) infants. Study Design  A retrospective review using the BabySteps Database included 493 infants born ≤33 weeks of gestational age and ≤1,250 g (g) birth weight. A total of 218 infants fed a human milk diet (HMD) with BMPF were compared with 275 infants fed an HMD with HMPF. Results  Full feeds were reached significantly sooner in the HMPF group (median: 14 vs. 16 days, p  = 0.04). Weight at full feeds was significantly lower in the HMPF group (1,060 vs. 1110 g, p  = 0.03). Conclusion  Using HMPF to provide an exclusively HMD allowed VLBW infants to achieve full feeds sooner, but did not affect rate of NEC compared with using a BMPF with an HMD. Key Points Human milk fortifiers with human milk are better than bovine human milk protein fortifiers. Full feeds are reached sooner with a human milk protein fortifier. The incidence of NEC did not change with the use of Prolacta. [ABSTRACT FROM AUTHOR]

Background: Neonatal sepsis is a serious condition caused largely by group B Streptococcus (GBS), Escherichia coli (E. Coli), and Listeria monocytogenes. Prenatal screenings have decreased the incidence of GBS infections; however, it remains a leading cause of early-onset sepsis (EOS). Gram-positive organisms are often the cause of late-onset sepsis (LOS). While EOS is usually attributed to vertical transmission from mother to infant, LOS is secondary to pathogen exposure during delivery or hospi-talization. We sought to identify the prevalent organisms in positive blood cultures in our NICU. Methods: A retrospective chart review was completed from July 2009 to December 2019. If an organism was identified, a positive culture was included, and five or more days of antibiotics were administered. Infection occurring in the first three days of life was considered EOS, while LOS was any time after. Variables were evaluated using Fisher's exact and Wilcoxon rank-sum tests. Results: Over ten years, there were 89 positive blood cultures. Of these, 28% of the cases were EOS, and 72% were LOS. Interestingly, the median birth weight for infants with EOS was significantly larger at 1810g compared to 1021g for LOS (P=0.004). The median gestational age for EOS cases was 31 5/7 weeks compared to 27 2/7 weeks for LOS (P=0.086). Conclusions: Approximately half of EOS-causing organisms were GBS or E.Coli. Coagulase-negative staphylococcus and methicillin-susceptible Staphylococcus aureus were most prevalent in LOS. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ctim.2006.07.003 Byline: Francesco Cardini (a), Christine Wade (b), Anna Laura Regalia (c), Suiqi Gui (d), Wang Li (d), Roberto Raschetti (a), Fredi Kronenberg (b) Keywords: Traditional medicine; Clinical research; Methods; Priorities; Pragmatic trials Abstract: This paper explores the challenges and opportunities associated with the evaluation of treatments arising from traditional medical systems (TMS). Globalization and popular consumer-and industry-driven market forces contribute to the spread of traditional treatments, techniques and technologies, but do not necessarily ensure their usefulness or safety. The international scientific community is obliged to evaluate the safety and efficacy of these treatments because of their potential impact on global public health. Clinical evaluations of traditional treatments, however, have complex methodological and practical challenges, depending on the goals of the research and the audience for the results (country of origin; or new host countries and new patient populations). To address these challenges, the authors offer the following recommendations to identify and prioritize treatments to study and how to design study protocols. Evaluations of traditional treatments are best addressed first by collaborative, international, pragmatic studies. Protocols for observational, prospective, pragmatic pilot study (randomized and controlled, when feasible) should be designed collaboratively and executed simultaneously in the culture of origin and in new contexts. This, in turn, could determine the acceptability, usefulness and feasibility of larger randomized controlled trials (RCTs). International multicentre RCTs would have the potential benefits of evaluating safety and effectiveness and also assessing the transferability of a traditional treatment across social and cultural contexts. Author Affiliation: (a) Istituto Superiore di Sanita, Rome, Italy (b) The Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine, Department of Rehabilitation Medicine, College of Physicians & Surgeons, Columbia, University, New York, NY, USA (c) Obstetrics & Gynecology Department, Hospital S. Gerardo (Monza), Milano Bicocca University, Milan, Italy (d) Obstetrics & Gynecology Hospital, Fudan University, Shanghai, People's Republic of China Article Note: (footnote) [star] This work was supported in part by the ISS Non-Conventional Therapies Project, and NIH/NCCAM Planning Grant for a Center for TCM Research in Women's Health (R21 AT001957).

Objectives. We studied the use of complementary and alternative medicine (CAM) among women in 4 racial/ethnic groups: non-Hispanic Whites, African Americans, Mexican Americans, and Chinese Americans. Methods. We obtained a nationally representative sample of women aged 18 years and older living in the United States in 2001. Oversampling obtained 800 interviews in each group, resulting in a sample of 3068 women. Results. Between one third and one half of the members of all groups reported using at least 1 CAM modality in the year preceding the survey. In bivariate analyses, overall CAM use among Whites surpassed that of other groups; however, when CAM use was adjusted for socioeconomic factors, use by Whites and Mexican Americans were equivalent. Despite the socioeconomic disadvantage of African American women, socioeconomic factors did not account for differences in CAM use between Whites and African Americans. Conclusions. CAM use among racial/ethnic groups is complex and nuanced. Patterns of CAM use domains differ among groups, and multivariate models of CAM use indicate that ethnicity plays an independent role in the use of CAM modalities, the use of CAM practitioners, and the health problems for which CAM is used. (doi:10.2105/AJPH.2004.047688)

Key message: Persistent productive cough despite appropriate treatment warrants consideration of flexible bronchoscopy to obtain bronchial specimens for culture. Endobronchial examination of airways may reveal signs of infection in the form of purulent secretions, sputum plugs or in this case, an unexpected finding of a calcified broncholithiasis secondary to Nocardia infection.Nocardia is generally regarded as an opportunistic infection, affecting immunocompromised patients but case reports have been described in immunocompetent patients. Endobronchial nocardiosis is a rare manifestation of pulmonary nocardiosis. Persistent productive cough despite appropriate treatment warrants suspicion of pulmonary nocardiosis such as in this case, which resulted in an unexpected finding of a calcified broncholithiasis secondary to Nocardia infection. [ABSTRACT FROM AUTHOR]

Abstract Background We previously reported early tissue injury, increased serum and tissue inflammatory cytokines and decreased grip in young rats performing a moderate demand repetitive task. The tissue cytokine response was transient, the serum response and decreased grip were still evident by 8 weeks. Thus, here, we examined their levels at 12 weeks in young rats. Since aging is known to enhance serum cytokine levels, we also examined aged rats. Methods Aged and young rats, 14 mo and 2.5 mo of age at onset, respectfully, were trained 15 min/day for 4 weeks, and then performed a high repetition, low force (HRLF) reaching and grasping task for 2 hours/day, for 12 weeks. Serum was assayed for 6 cytokines: IL-1alpha, IL-6, IFN-gamma, TNF-alpha, MIP2, IL-10. Grip strength was assayed, since we have previously shown an inverse correlation between grip strength and serum inflammatory cytokines. Results were compared to naïve (grip), and normal, food-restricted and trained-only controls. Results Serum cytokines were higher overall in aged than young rats, with increases in IL-1alpha, IFN-gamma and IL-6 in aged Trained and 12-week HRLF rats, compared to young Trained and HRLF rats (p < 0.05 and p < 0.001, respectively, each). IL-6 was also increased in aged 12-week HRLF versus aged normal controls (p < 0.05). Serum IFN-gamma and MIP2 levels were also increased in young 6-week HRLF rats, but no cytokines were above baseline levels in young 12-week HRLF rats. Grip strength declined in both young and aged 12-week HRLF rats, compared to naïve and normal controls (p < 0.05 each), but these declines correlated only with IL-6 levels in aged rats (r = -0.39). Conclusion Aging enhanced a serum cytokine response in general, a response that was even greater with repetitive task performance. Grip strength was adversely affected by task performance in both age groups, but was apparently influenced by factors other than serum cytokine levels in young rats.