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Red clover produces isoflavones, including biochanin A, which have been shown to have microbiological effects on the rumen while also promoting growth in beef cattle. The objective was to determine if supplementation of biochanin A via red clover hay would produce similar effects on the rumen microbiota and improve growth performance of lambs. Twenty-four individually-housed Polypay ram lambs (initial age: 114 ± 1 d; initial weight: 38.1 ± 0.59 kg) were randomly assigned to one of three experimental diets (85:15 concentrate:roughage ratio; N = 8 rams/treatment): CON—control diet in which the roughage component (15.0%, w/w, of the total diet) consisted of orchardgrass hay; 7.5-RC—red clover hay substituted for half (7.5%, w/w, of the total diet) of the roughage component; and 15-RC—the entire roughage component (15.0%, w/w, of the total diet) consisted of red clover hay. Feed intake and weight gain were measured at 14-d intervals for the duration of the 56-d trial, and rumen microbiological measures were assessed on days 0, 28, and 56. Red clover supplementation impacted growth performance of ram lambs. Average daily gains (ADG) were greater in ram lambs supplemented with red clover hay (7.5-RC and 15-RC) than for those fed the CON diet (P < 0.05). Conversely, dry matter intake (DMI) was lower in 7.5-RC and 15-RC than for CON lambs (P = 0.03). Differences in ADG and DMI resulted in greater feed efficiency in ram lambs supplemented with red clover hay (both 7.5-RC and 15-RC) compared to CON (P < 0.01). Rumen microbiota were also altered by red clover supplementation. The total viable number of hyper-ammonia-producing bacteria in 7.5-RC and 15-RC decreased over the course of the experiment and were lower than CON by day 28 (P ≤ 0.04). Amylolytic bacteria were also lower in 15-RC than in CON (P = 0.03), with a trend for lower amylolytic bacteria in 7.5-RC (P = 0.08). In contrast, there was tendency for greater cellulolytic bacteria in red clover supplemented lambs than in CON (P = 0.06). Red clover supplementation also increased fiber utilization, with greater ex vivo dry matter digestibility of hay for both 7.5-RC and 15-RC compared to CON by day 28 (P < 0.03). Results of this study indicate that low levels of red clover hay can elicit production benefits in high-concentrate lamb finishing systems through alteration of the rumen microbiota.

BACKGROUND: Invasive species threaten the productivity and stability of natural and managed ecosystems. Predicting the spread of invaders, which can aid in early mitigation efforts, is a major challenge, especially in the face of climate change. While ecological niche models are effective tools to assess habitat suitability for invaders, such models have rarely been created for invasive pest species with rapidly expanding ranges. Here, we leveraged a national monitoring effort from 543 sites over 3 years to assess factors mediating the occurrence and abundance of brown marmorated stink bug (BMSB, Halyomorpha halys), an invasive insect pest that has readily established throughout much of the United States. RESULTS: We used maximum entropy models to estimate the suitable habitat of BMSB under several climate scenarios, and generalized boosted models to assess environmental factors that regulated BMSB abundance. Our models captured BMSB distribution and abundance with high accuracy, and predicted a 70% increase in suitable habitat under future climate scenarios. However, environmental factors that mediated the geographical distribution of BMSB were different from those driving abundance. While BMSB occurrence was most affected by winter precipitation and proximity to populated areas, BMSB abundance was influenced most strongly by evapotranspiration and solar photoperiod. CONCLUSION: Our results suggest that linking models of establishment (occurrence) and population dynamics (abundance) offers a more effective way to forecast the spread and impact of BMSB and other invasive species than simply occurrence-based models, allowing for targeted mitigation efforts. Implications of distribution shifts under climate change are discussed. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. Published version

Background It is widely believed that septic arthritis poses a risk of joint destruction and long-term adverse outcomes for children if not treated emergently. In the present study, children who had primary confirmed septic arthritis were compared with those who had septic arthritis and adjacent osteomyelitis to evaluate differences that affect the relative risk of adverse outcomes. Methods Children who underwent multidisciplinary treatment for septic arthritis with or without contiguous osteomyelitis between 2009 and 2019 were retrospectively studied. Clinical, laboratory, treatment, and outcome data were compared between cohorts of children with primary confirmed septic arthritis and children with septic arthritis and contiguous osteomyelitis. Results One hundred and thirty-four children had primary confirmed septic arthritis, and 105 children had septic arthritis with contiguous osteomyelitis. Children with osteomyelitis were older (median, 7.4 versus 2.4 years), had higher initial C-reactive protein (median, 15.7 versus 6.4 mg/dL), and had a higher rate of thrombocytopenia (21.0% versus 1.5%). They also had a higher rate of bacteremia (69.5% versus 20.2%) for a longer duration (median, 2.0 versus 1.0 days). Detected pathogens in children with osteomyelitis as compared with those with primary septic arthritis were more likely to be Staphylococcus aureus (77.1% versus 32.1%) and less likely to be Kingella kingae (2.9% versus 32.1%). Children with contiguous osteomyelitis had longer hospitalizations (median, 8.0 versus 4.0 days), a higher rate of intensive care (21.0% versus 1.5%), a higher readmission rate (17.1% versus 5.2%), and a higher complication rate (38.1% versus 0.7%). Conclusions Primary septic arthritis in children is dissimilar to septic arthritis associated with osteomyelitis. The present study demonstrates that long-term adverse outcomes in children with septic arthritis are likely due to the contiguous osteomyelitis. Children with primary septic arthritis are sufficiently distinguishable from those who have contiguous osteomyelitis to guide decisions for magnetic resonance imaging acquisition, duration of antibiotic therapy, and length of outpatient follow-up in order to recognize and address adverse outcomes. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Research demonstrates that exercise acutely reduces appetite by stimulating the secretion of gut-derived satiety hormones. Currently there is a paucity of research examining the impact of postexercise nutrient intake on appetite regulation. The objective of this study was to examine how postexercise fasting versus feeding impacts the postexercise appetite response. In a randomized crossover intervention, 14 participants (body mass index: 26.9 ± 3.5 kg·m−2; age: 26.8 ± 6.7 years) received 1 of 2 recovery beverages: (i) water control (FAST) or (ii) sweetened-milk (FED) after completing a 45-min (65%–70% peak oxygen uptake) evening exercise session (∼1900 h). Energy intake was assessed through a fasted ad libitum breakfast meal and 3-day food diaries. Perceived appetite was assessed using visual analogue scales. Appetite-regulating hormones glucagon-like peptide-1 (GLP-1), peptide tyrosine-tyrosine (PYY), and acyl-ghrelin were assessed pre-exercise, 1 h after exercise, and the morning following exercise. FAST increased subjective hunger compared with FED (P < 0.05). PYY and GLP-1 after exercise were decreased and acyl-ghrelin was increased in FAST, with these differences disappearing the day after exercise (P < 0.05). Ad libitum energy intake at breakfast the following morning did not differ between trials. Overall, in the absence of postexercise macronutrient consumption, there was a pronounced increase in objective and subjective appetite after exercise. The orexigenic effects of postexercise fasting, however, were not observed the morning following exercise. Novelty Postexercise fasting leads to reduced GLP-1 and PYY and increased hunger. Reduced GLP-1 and PYY after exercise is blunted by postexercise nutrient intake. Energy intake the day after exercise is not influenced by postexercise fasting.

Anterior prefrontal cortex (PFC, Brodmann area 10) activations are often, but not always, found in neuroimaging studies investigating deception, and the precise role of this area remains unclear. To explore the role of the PFC in face-to-face deception, we invited pairs of participants to play a card game involving lying and lie detection while we used functional near infrared spectroscopy (fNIRS) to record brain activity in the PFC. Participants could win points for successfully lying about the value of their cards or for detecting lies. We contrasted patterns of brain activation when the participants either told the truth or lied, when they were either forced into this or did so voluntarily and when they either succeeded or failed to detect a lie. Activation in the anterior PFC was found in both lie production and detection, unrelated to reward. Analysis of cross-brain activation patterns between participants identified areas of the PFC where the lead player’s brain activity synchronized their partner’s later brain activity. These results suggest that during situations that involve close interpersonal interaction, the anterior PFC supports processing widely involved in deception, possibly relating to the demands of monitoring one’s own and other people’s behaviour.

Funding Acknowledgements Type of funding sources: None. Background Left atrial (LA) dysfunction is associated with poorer outcomes in many disease processes. Left atrial strain (LAS) is a novel two-dimensional (2D) quantitative analysis of LA function. Cardiac transplantation directly involves the LA during implantation of the donor heart. Traditional echocardiographic indices after transplantation have demonstrated value in correlating with acute cellular rejection (ACR), morbidity and mortality over short- and long-term follow-up. The prognostic value of LA strain has not been previously investigated in this cohort. Purpose We hypothesized that incrementally impaired LA strain in post cardiac transplant patients with varying degrees of ACR may be prognostic of poorer outcomes on long term follow-up. Methods 87 Heart transplant patients, assessed between 2009 and 2015, underwent transthoracic echocardiography and endomyocardial biopsy. 2D strain analysis on the LV and LA were performed along with traditional echocardiographic parameters. Patients were grouped according to peak LAS (PALS) tertiles and rejection burden history was assessed and grouped according to ACR burden at a median of 12 (±5.4) months post transplantation. The primary endpoint was all-cause mortality at follow-up. Results 12 patients met the primary endpoint over a median follow-up of 66 ± 51 months. The mean LA PALS was significantly different across the tertiles (lowest tertile 12.29 ± 2.5% vs middle tertile 17.89 ± 1.1% vs highest tertile 24.54 ± 4.2%; p Conclusions Lower LA PALS is significantly associated with poorer long-term outcomes in cardiac transplant patients with ACR. Non-invasive LA PALS may be a useful predictor of long-term outcome in patients post cardiac transplantation. Abstract Figure. Survival curves for LA PALS tertiles

BACKGROUND There is uncertainty involved in the evaluation and treatment of children suspected to have septic arthritis particularly when no causative pathogen is confirmed. This study evaluates children with primary septic arthritis to refine the processes of evaluation and treatment and improve the rate of pathogen confirmation. METHODS Children suspected to have septic arthritis from 2009 to 2019 were retrospectively studied. Diagnosis of primary septic arthritis, defined as hematogenous joint infection without associated osteomyelitis, was established by clinical evaluation, radiology and laboratory results, including joint fluid analysis. Excluded cases were categorized by etiology. Children with primary septic arthritis were divided into confirmed and presumed cohorts for statistical comparison. RESULTS A total of 355 children (average age 4.4 y, range 0.05 to 18 y) were initially treated as septic arthritis. Eighty-seven (24.5%) were excluded due to other conditions, including 34 (9.6%) with noninfectious conditions. Among 268 children with primary septic arthritis, 134 were confirmed and 134 were presumed. A higher rate of 16S polymerase chain reaction (PCR) acquisition (71.6% vs. 45.5%) occurred in the confirmed cohort. Overall yield for various methods of pathogen identification were 27 of 239 (11.3%) by blood culture, 83 of 268 (31.0%) by joint fluid culture and 85 of 157 (54.1%) by PCR. PCR identified a pathogen in 87.5% of children with confirmed septic arthritis. Antibiotic pretreatment was associated with a lower rate of joint fluid culture positivity. Pathogens aggregated within specific age groups. The 4 to 9-year-old age group displayed the widest spectrum of pathogens with limited predictability. CONCLUSIONS This study emphasizes the need for systematic processes of evaluation and treatment for children suspected to have primary septic arthritis, including minimization of antibiotic pretreatment, age-based empiric antibiotic selection, and sufficient follow-up to ensure noninfectious conditions are distinguished in culture-negative cases. Extended observation, before intervention, may be appropriate for some children. LEVEL OF EVIDENCE Level III-retrospective control study.

Brown marmorated stink bug, Halyomorpha halys (Stål), is an invasive species in the United States that attacks a wide variety of agricultural commodities including fruits, vegetables, agronomic crops, and ornamental plants. Populations of H. halys adults were collected from four and six states in 2017 and 2018, respectively, and tested using topical applications to establish baseline levels of susceptibility to two commonly used insecticides, bifenthrin and thiamethoxam. A Probit-estimated (95% fiducial limits) LD50 and LD99 of 2.64 g AI/L (1.2–3.84 g AI/L) and 84.96 g AI/L (35.76–716.16 g AI/L) for bifenthrin, and a LD50 and LD99 of 0.05 g AI/liter (1.14E-5–0.27 g AI/L) and 150.11 g AI/L (27.35–761,867 g AI/L) for thiamethoxam, respectively. These baseline levels can be used for future insecticide resistance monitoring in H. halys.

Background Cardiac telemetry monitoring is widely utilized for a variety of clinical indications, yet indication‐specific event rates for monitored patients are seldomly reported. Hypothesis High‐risk hospitalized patients for clinical deterioration can be identified using standardized telemetry monitoring indications. Methods Adjudicated data from events triggering emergency response team (ERT) activation were systematically characterized at the Cleveland Clinic from among standardized telemetry indications ordered over a 13‐month period. Results Among 72 199 orders created for telemetry monitored patients, ERT activation occurred in 2677 patients (3.7%), of which 1326 (49.5%) were cardiac‐related. Patients with deep venous thrombosis or pulmonary embolism (DVT/PE) demonstrated the highest overall event rate (ERT: n = 41 of 593 pts [6.9%]; 25/41 cardiac related [61%]). Cardiac‐related events were proportionally highest among patients with coronary disease awaiting revascularization (ERT: n = 19 of 847 patients [2.2%]; 13/19 cardiac‐related [68.4%]). Arrhythmia‐specific events were highest among patients who underwent cardiac surgery (n = 78 of 193 cardiac‐related ERT [40.4%]), and patients with known or suspected tachyarrhythmias (n = 318 of 788 cardiac‐related ERT [40.4%]). Bubble plot analysis identified patients hospitalized with DVT/PE, drug or alcohol exposures, and acute coronary syndrome as among the highest overall and cardiac‐related events while identifying patients with respiratory disorder monitoring indications as carrying the highest noncardiac event rate. Conclusion High‐risk hospitalized patients can be identified by telemetry indication and prioritized according to concerns for cardiac, arrhythmia‐specific and noncardiac clinical deterioration. This is particularly useful when monitored bed resources are constrained.

PFOS is a persistent, fluorosurfactant used in multiple products. Murine Cyp2b's are induced by PFOS and high-fat diets (HFD) and therefore we hypothesized that human CYP2B6 may alleviate PFOS-induced steatosis. Cyp2b-null and hCYP2B6-Tg mice were treated with 0, 1, or 10 mg/kg/day PFOS by oral gavage for 21-days while provided a chow diet (ND) or HFD. Similar to murine Cyp2b10, CYP2B6 is inducible by PFOS. Furthermore, three ND-fed hCYP2B6-Tg females treated with 10 mg/kg/day PFOS died during the exposure period; neither Cyp2b-null nor HFD-fed mice died. hCYP2B6-Tg mice retained more PFOS in serum and liver than Cyp2b-null mice presumably causing the observed toxicity. In contrast, serum PFOS retention was reduced in the HFD-fed hCYP2B6-Tg mice; the opposite trend observed in HFD-fed Cyp2b-null mice. Hepatotoxicity biomarkers, ALT and ALP, were higher in PFOS-treated mice and repressed by a HFD. However, PFOS combined with a HFD exacerbated steatosis in all mice, especially in the hCYP2B6-Tg mice with significant disruption of key lipid metabolism genes such as Srebp1, Pparg, and Hmgcr. In conclusion, CYP2B6 is induced by PFOS but does not alleviate PFOS toxicity presumably due to increased retention. CYP2B6 protects from PFOS-mediated steatosis in ND-fed mice, but increases steatosis when co-treated with a HFD.

Brown marmorated stink bug, Halyomorpha halys, is native to Asia and has invaded North America and Europe inflicting serious agricultural damage to specialty and row crops. Tools to monitor the spread of H. halys include traps baited with the two-component aggregation pheromone (PHER), (3S,6S,7R,10S)-10,11-epoxy-1-bisabolen-3-ol and (3R,6S,7R,10S)-10,11-epoxy-1-bisabolen-3-ol, and pheromone synergist, methyl (2E,4E,6Z)-decatrienoate (MDT). Here, an international team of researchers conducted trials aimed at evaluating prototype commercial lures for H. halys to establish relative attractiveness of: 1) low and high loading rates of PHER and MDT for monitoring tools and attract and kill tactics; 2) polyethylene lure delivery substrates; and 3) the inclusion of ethyl (2E,4E,6Z)-decatrieonate (EDT), a compound that enhances captures when combined with PHER in lures. In general, PHER loading rate had a greater impact on overall trap captures compared with loading of MDT, but reductions in PHER loading and accompanying lower trap captures could be offset by increasing loading of MDT. As MDT is less expensive to produce, these findings enable reduced production costs. Traps baited with lures containing PHER and EDT resulted in numerically increased captures when EDT was loaded at a high rate, but captures were not significantly greater than those traps baited with lures containing standard PHER and MDT. Experimental polyethylene vial dispensers did not outperform standard lure dispensers; trap captures were significantly lower in most cases. Ultimately, these results will enable refinement of commercially available lures for H. halys to balance attraction and sensitivity with production cost. USDA-NIFA-SCRI [2016-51181-25409]; Hungarian Ministry for Innovation and Technology within the framework of the Higher Education Institutional Excellence Program [NKFIH-1159-6/2019]; scope of plant breeding and plant protection research of Szent Istvan University Published version We thank Chris Hott, Lee Carper, Anthony Rugh, Nate Brandt, Carson Wise John Cullum, and Erica Rudolph for excellent technical assistance. This research was supported by USDA-NIFA-SCRI 2016-51181-25409. This research was also supported by the Hungarian Ministry for Innovation and Technology within the framework of the Higher Education Institutional Excellence Program (NKFIH-1159-6/2019) in the scope of plant breeding and plant protection research of Szent Istvan University. Mention of commercial trade names is for the purposes of providing scientific information only and does not imply endorsement by the U.S. Department of Agriculture. The U.S. Department of Agriculture is an equal opportunity employer. Public domain – authored by a U.S. government employee

BACKGROUND: The clinical characteristics and outcomes associated with non–intensive care unit (non-ICU) hospitalizations for coronavirus disease 2019 (COVID-19) outside disease epicenters remain poorly characterized. METHODS: Systematic analysis of all non-ICU patient hospitalizations for COVID-19 completing discharge between March 13 and May 1, 2020, in a large US health care system utilizing off-site central monitoring. Variables of interest were examined in relation to a composite event rate of death, ICU transfer, or increased oxygen requirement to high-flow nasal cannula, noninvasive ventilation, or mechanical ventilation. RESULTS: Among 350 patients (age, 64 ± 16 years; 55% male), most (73%) required 3 L/min or less of supplemental oxygen during admission. Telemetry was widely utilized (79%) yet arrhythmias were uncommon (14%) and were predominantly (90%) among patients with abnormal troponin levels or known cardiovascular disease. Ventricular tachycardia was rare (5%), nonsustained, and not associated with hydroxychloroquine/azithromycin treatment. Adverse events occurred in 62 patients (18%), including 22 deaths (6%), 48 ICU transfers (14%), and 49 patients with increased oxygen requirement (14%) and were independently associated with elevated C-reactive protein (odds ratio, 1.09 per 1 mg/dL; 95% CI, 1.01-1.18; P = .04) and lactate dehydrogenase (OR, 1.006 per 1U/L; 95% CI, 1.001-1.012; P = .03) in multivariable analysis. CONCLUSION: Among non–critically ill patients hospitalized within a nonepicenter health care system, overall survival was 94% with the development of more severe illness or death independently associated with higher levels of C-reactive protein and lactate dehydrogenase on admission. Clinical decompensation was largely respiratory-related, while serious cardiac arrhythmias were rare, which suggests that telemetry can be prioritized for high-risk patients.

Background/purpose The purpose of this study was to determine factors associated with patient and graft survival following orthotopic liver transplantation (OLT) in children and adolescents with primary hepatic malignancies. Methods The United Network for Organ Sharing (UNOS) database was queried for all patients n =544). Five-year patient and graft survival were determined using Kaplan–Meier methodology, and independent predictors of survival were determined using multivariate Cox proportional hazards model. Results The majority of patients were diagnosed with hepatoblastoma (HB) ( n =376, 70%) with 84 (15%) hepatocellular carcinoma (HCC) and 84 (15%) other. HCC patients were older, more often hospitalized at the time of transplant, and more likely to receive a cadaveric organ compared to HB patients. Five-year patient and graft survival for the entire cohort was 73% and 74%, respectively, with the majority of deaths owing to malignancy. On multivariate analysis, independent predictors of 5-year patient and graft survival included diagnosis, transplant era, and medical condition at transplant. Conclusions In recent years, there has been significant improvement in posttransplant patient and graft survival for children and adolescents with primary hepatic malignancies. However, patients with HCC continue to have worse outcomes than those with other cancer types. Type of study Case series with no comparison group. Level of evidence IV.

Trusting another person may depend on our level of generalised trust in others, as well as perceptions of that specific person’s trustworthiness. However, many studies measuring trust outcomes have not discussed generalised versus specific trust. To measure specific trust in others, we developed a novel behavioural task. Participants navigate a virtual maze and make a series of decisions about how to proceed. Before each decision, they may ask for advice from two virtual characters they have briefly interviewed earlier. We manipulated the virtual characters’ trustworthiness during the interview phase and measured how often participants approached and followed advice from each character. We also measured trust through ratings and an investment game. Across three studies, we found participants followed advice from a trustworthy character significantly more than an untrustworthy character, demonstrating the validity of the maze task. Behaviour in the virtual maze reflected specific trust rather than generalised trust, whereas the investment game picked up on generalised trust as well as specific trust. Our data suggest the virtual maze task may provide an alternative behavioural approach to measuring specific trust in future research, and we demonstrate how the task may be used in traditional laboratories.

The purpose of this study was to determine whether racial/ethnic disparities exist in disease presentation, treatment, and survival among children and adolescents with extremity sarcoma.The Surveillance, Epidemiology, and End Results (SEER) data were analyzed for patients20years old with soft-tissue extremity sarcomas from 1973 to 2013. Multivariate logistic regression was performed to determine the association between race/ethnicity and disease stage at presentation and likelihood of surgical resection. Overall survival (OS) was evaluated using hazard ratios with 95% confidence intervals.1261 cases were identified: 650 (52%) non-Hispanic whites (NHW), 313 (25%) Hispanics, 182 (14%) non-Hispanic blacks (NHB), and 116 (9%) other race/ethnicity. Logistic regression results showed that Hispanics and NHB were 51% and 44%, respectively, less likely to undergo surgical resection compared to NHW (OR=0.49, 95% CI: 0.30-0.80; OR=0.56, 95% CI: 0.32-0.98, respectively). Factors associated with failure to undergo surgical resection included histology, lower extremity site, tumor size, and distant metastases. OS based on race/ethnicity significantly differed using the log-rank test, with NHB having the worst survival (p0.05).We conclude that NHB, Hispanics, and other race/ethnicity were less likely to undergo surgical resection for extremity sarcoma. Further work is needed to better characterize and eliminate disparities in the management and outcomes of children with extremity sarcomas.Prognosis study.IV.

With more women entering surgical training, it will become more commonplace to encounter pregnant surgeons. This paper discusses the evidence for work-related risk factors as well as outlining the rights of a pregnant doctor. There are, in fact, very few real risks to pregnancy encountered as a surgeon, with the main risks involving standing or sitting for long periods and fatigue, which can be managed with support from the department. It is important for women in surgery to know that it is possible to continue their training while pregnant so they do not feel pressured into changing to a less demanding specialty or even leaving medicine entirely. It is also important for other professionals to understand the risks and choices faced by pregnant surgeons so that they can better support them in the workplace.

Understanding other people have beliefs different from ours or different from reality is critical to social interaction. Previous studies suggest that healthy adults possess an implicit mentalising system, but alternative explanations for data from reaction time false belief tasks have also been given. In this study, we combined signal detection theory (SDT) with a false belief task. As application of SDT allows us to separate perceptual sensitivity from criteria, we are able to investigate how another person’s beliefs change the participant’s perception of near-threshold stimuli. Participants ( n = 55) watched four different videos in which an actor saw (or did not see) a Gabor cube hidden (or not hidden) behind an occluder. At the end of each video, the occluder vanished revealing a cube either with or without Gabor pattern, and participants needed to report whether they saw the Gabor pattern or not. A pre-registered analysis with classical statistics weakly suggests an effect of the actor’s belief on participant’s perceptions. An exploratory Bayesian analysis supports the idea that when the actor believed the cube was present, participants made slower and more liberal judgements. Although these data are not definitive, these current results indicate the value of new measures for understanding implicit false belief processing.

Reliable monitoring of the invasive Halyomorpha halys abundance, phenology and geographic distribution is critical for its management. Halyomorpha halys adult and nymphal captures on clear sticky traps and in black pyramid traps were compared in 18 states across the Great Lakes, Mid-Atlantic, Southeast, Pacific Northwest and Western regions of the United States. Traps were baited with commercial lures containing the H. halys pheromone and synergist, and deployed at field sites bordering agricultural or urban locations with H. halys host plants. Nymphal and adult captures in pyramid traps were greater than those on sticky traps, but captures were positively correlated between the two trap types within each region and during the early-, mid- and late season across all sites. Sites were further classified as having a low, moderate or high relative H. halys density and again showed positive correlations between captures for the two trap types for nymphs and adults. Among regions, the greatest adult captures were recorded in the Southeast and Mid-Atlantic on pyramid and sticky traps, respectively, with lowest captures recorded in the West. Nymphal captures, while lower than adult captures, were greatest in the Southeast and lowest in the West. Nymphal and adult captures were, generally, greatest during July-August and September-October, respectively. Trapping data were compared with available phenological models showing comparable population peaks at most locations. Results demonstrated that sticky traps offer a simpler alternative to pyramid traps, but both can be reliable tools to monitor H. halys in different geographical locations with varying population densities throughout the season. USDA-NIFA-SCRI [2016-51181-25409] We are tremendously grateful for the excellent technical assistance provided by the numerous technicians and student research assistants involved in this study. This research was supported by USDA-NIFA-SCRI 2016-51181-25409. Mention of trade names or commercial products in this publication is solely for the purpose of providing scientific information and does not constitute recommendation or endorsement by the United States Department of Agriculture. USDA is an equal opportunity provider and employer. Public domain – authored by a U.S. government employee

Whether pointing at a menu item or rifling through a clothes rack, when we choose we often move. We investigated whether people’s tendency to copy the movements of others could influence their choices. Participants saw pairs of pictures in private and indicated which one they preferred. They then entered a virtual art gallery and saw the same picture pairs in the presence of a virtual character. Having observed the virtual character point to indicate her preference with either a high or low movement trajectory, participants indicated their preference. There was either an anatomical (same movement, same choice) or spatial correspondence (same movement, different choice) between the participant’s pictures and those of the virtual character. We found that participants copied the movement made by the virtual character rather than her action goal (i.e., her choice of picture). This resulted in a shift towards the virtual character’s preferences in the anatomical condition but away from her preferences in the spatial condition. This effect was driven by the observation of the virtual character’s high pointing movements. In a further experiment, we did not find any significant differences in imitation behaviour in autism, although autistic participants were less consistent in their choices. Our findings demonstrate that we are not only influenced by other’s choices but also the types of movements others make to indicate those choices.

The recent Ktunaxa Nation decision of the Supreme Court of Canada provides an opportunity to discuss the fundamental legal presumptions that underlie the Crown’s duty to consult and accommodate Aboriginal peoples. The jurisprudence in this area has been based on a “thick” conception of Crown sovereignty as including legislative power and underlying title in relation to Aboriginal lands. This, in the Supreme Court’s view, justifies the possibility of the unilateral infringement of Aboriginal rights. This framework assumes that the relationship between the Crown and Aboriginal peoples is a sovereign-to-subjects one. This assumption, however, lacks a legal and factual basis. Conversely, Aboriginal peoples articulate their claims in the language of inherent jurisdiction within a nation-to nation relationship. If the Supreme Court acknowledged that the relationship between the parties is indeed nation-to-nation, the appropriate doctrine would no longer be a duty to consult and accommodate. Following the approach to a similar relationship outlined by the Supreme Court in the Secession Reference, the appropriate model would be a generative duty to negotiate. This article sets a path to a model that preserves the useful components of the duty to consult while providing a remedy to the distributional inequity in bargaining power created under the current framework, thereby opening avenues for effective conflict resolution.

During our daily lives, we often learn about the similarity of the traits and preferences of others to our own and use that information during our social interactions. However, it is unclear how the brain represents similarity between the self and others. One possible mechanism is to track similarity to oneself regardless of the identity of the other (Similarity account); an alternative is to track each other person in terms of consistency of their choice similarity with respect to the choices they have made before (consistency account). Our study combined functional Magnetic Resonance Imaging (fMRI) and computational modelling of reinforcement learning (RL) to investigate the neural processes that underlie learning about preference similarity. Participants chose which of two pieces of artwork they preferred and saw the choices of one agent who usually shared their preference and another agent who usually did not. We modelled neural activation with RL models based on the similarity and consistency accounts. Our results showed that activity in brain areas linked to reward and social cognition followed the consistency account. Our findings suggest that impressions of other people can be calculated in a person-specific manner, which assumes that each individual behaves consistently with their past choices.

Background Ambulating medical inpatients may improve outcomes, but this practice is often overlooked by nurses who have competing clinical duties. Objective This study aimed to assess the feasibility and effectiveness of dedicated mobility technician-assisted ambulation in older inpatients. Design This study was a single-blind randomized controlled trial. Setting Patients aged ≥60 years and admitted as medical inpatients to a tertiary care center were recruited. Intervention Patients were randomized into two groups to participate in the ambulation protocol administered by a dedicated mobility technician. Usual care patients were not seen by the mobility technician but were not otherwise restricted in their opportunity to ambulate. Measurements Primary outcomes were length of stay and discharge disposition. Secondary outcomes included change in mobility measured by six-clicks score, daily steps measured by Fitbit, and 30-day readmission. Results Control (n = 52) and intervention (n = 50) groups were not significantly different at baseline. Of patients randomized to the intervention group, 74% participated at least once. Although the intervention did not affect the primary outcomes, the intervention group took nearly 50% more steps than the control group (P = .04). In the per protocol analysis, the six-clicks score significantly increased (P = .04). Patients achieving ≥400 steps were more likely to go home (71% vs 46%, P = .01). Conclusions Attempted ambulation three times daily overseen by a dedicated mobility technician was feasible and increased the number of steps taken. A threshold of 400 steps was predictive of home discharge. Further studies are needed to establish the appropriate step goal and the effect of assisted ambulation on hospital outcomes.

The tendency to imitate the actions of others appears to be a fundamental aspect of human social interaction. Emotional expressions are a particularly salient form of social stimuli (Vuilleumier & Schwartz, 2001) but their relationship to imitative behaviour is currently unclear. In this paper we report the results of five studies which investigated the effect of a target's dynamic emotional stimuli on participants' tendency to respond compatibly to the target's actions. Experiment one examined the effect of dynamic emotional expressions on the automatic imitation of opening and closing hand movements. Experiment two used the same basic paradigm but added gaze direction as an additional factor. Experiment three investigated the effect of dynamic emotional expressions on compatibility responses to handshakes. Experiment four investigated whether dynamic emotional expressions modulated response to valenced social gestures. Finally, experiment five compared the effects of dynamic and static emotional expressions on participants' automatic imitation of finger lifting. Across all five studies we reliably elicited a compatibility effect however, none of the studies found a significant modulating effect of emotional expression. This null effect was also supported by a random effects meta-analysis and a series of Bayesian t-tests. Nevertheless, these results must be caveated by the fact that our studies had limited power to detect effect sizes below d = 0.4. We conclude by situating our findings within the literature, suggesting that the effect of emotional expressions on automatic imitation is, at best, minimal., Highlights • The effect of emotional expressions on automatic imitation is currently unclear. • We used dynamic expressions to investigate this effect across five experiments. • We found that the expressions did not affect the imitation of response to gestures. • This was the case even when the gestures had affective or social meaning.

Aggregation of the bean flower thrips, Megalurothrips sjostedti (Trybom) (Thysanoptera: Thripidae), has been observed on cowpea, Vigna unguiculata (L.) Walp. To understand the mechanism underpinning this behavior, we studied the responses of M. sjostedti to headspace volatiles from conspecifics in a four-arm olfactometer. Both male and female M. sjostedti were attracted to male, but not to female odor. Gas chromatography/mass spectrometry (GC/MS) analyses revealed the presence of two distinct compounds in male M. sjostedti headspace, namely (R)-lavandulyl 3-methylbutanoate (major compound) and (R)-lavandulol (minor compound); by contrast, both compounds were only present in trace amounts in female headspace collections. A behavioral assay using synthetic compounds showed that male M. sjostedti was attracted to both (R)-lavandulyl 3-methylbutanoate and (R)-lavandulol, while females responded only to (R)-lavandulyl 3-methylbutanoate. This is the first report of a male-produced aggregation pheromone in the genus Megalurothrips. The bean flower thrips is the primary pest of cowpea, which is widely grown in sub-Saharan Africa. The attraction of male and female M. sjostedti to these compounds offers an opportunity to develop ecologically sustainable management methods for M. sjostedti in Africa.

When someone is watching you, you may change your behaviour in various ways: this is called the ‘audience effect’. Social behaviours such as acting prosocially or changing gaze patterns may be used as signals of reputation and thus may be particularly prone to audience effects. The present paper aims to test the relationship between prosocial choices, gaze patterns and the feeling of being watched within a novel ecologically valid paradigm, where participants communicate with a video-clip of a confederate and believe she is (or is not) a live feed of a confederate who can see them back. Results show that when participants believe they are watched, they tend to make more prosocial choices and they gaze less to the confederate. We also find that the increase in prosocial behaviour when being watched correlates with social anxiety traits. Moreover, we show for the first time that prosocial choices influence subsequent gaze patterns of participants, although this is true for both live and pre-recorded interactions. Overall, these findings suggest that the opportunity to signal a good reputation to other people is a key modulator of prosocial decisions and eye gaze in live communicative contexts. They further indicate that gaze should be considered as an interactive and dynamic signal.

Human social interaction is part of what defines us. Here I present an overview of recent studies of imitation, a subdomain of social interaction that can be dissected and examined in a scientific fashion. I use these studies to test two core claims: (a) that there is more than one copying mechanism in the human brain and (b) that mimicry (a form of copying) is particularly relevant for understanding social behaviour. Evidence in favour of the first claim comes from neuroimaging studies that show distinct brain systems for understanding action kinematics, action goals, and irrational actions. Further studies of participants with autism show abnormal copying of irrational actions. Evidence in favour of the second claim comes from behavioural studies of the social cues that prime mimicry and from neuroimaging studies of the pathways involved in this priming. These studies suggest that medial prefrontal cortex has a core role in controlling mimicry responses and support the STORM (social top-down response modulation) model. Future work should determine what organizing principles govern the control of social responses and how these critical mechanisms for interpersonal connection differ in autism.

The invasive stink bug species, Halyomorpha halys (Stal) (Hemiptera; Pentatomidae), severely damages multiple agricultural commodities, resulting in the disruption of established IPM programs. Several semiochemicals have been identified to attract H. halys to traps and monitor their presence, abundance, and seasonal activity. In particular, the two-component aggregation pheromone of H. halys, (3S,6S,7R,10S)-10,11-epoxy-1-bisabolen-3-ol and (3R,6S,7R,10S)-10,11-epoxy-1-bisabolen-3-ol (PHER), in combination with the pheromone synergist, methyl (2E,4E,6Z)-decatrienoate (MDT), were found to be attractive. Here, we report that an analogous trienoate, ethyl (2E,4E,6Z)-decatrienoate (EDT), enhances H. halys captures when combined with PHER. In trials conducted in Eastern and Western regions of the United States, we observed that when traps were baited with the H. halys PHER + EDT, captures were significantly greater than when traps were baited with PHER alone. Traps baited with EDT alone were not attractive. Thus, the addition of EDT to lures for attracting H. halys to traps may further improve monitoring efficiency and management strategies for this invasive species.

Background To determine whether there are racial/ethnic disparities in disease presentation, treatment and survival outcomes among children and young adults with chest wall sarcomas. Methods The Surveillance, Epidemiology and End Results (SEER) database was analyzed for patients 21 years old and younger with chest wall sarcoma. We performed multivariate logistic regression to investigate the association of race/ethnicity with advanced stage of disease at presentation and likelihood of undergoing surgical resection. Overall survival (OS) was evaluated using Cox regression modeling to calculate hazard ratios with 95% confidence intervals. Results A total of 669 patients were identified: 393 non-Hispanic whites (NHW) (59%), 151 Hispanics (23%), 64 non-Hispanic blacks (NHB) (11%), and 64 other race/ethnicity (9%). The 5- and 10-year OS rates for the entire cohort were 69% and 64%, respectively. NHB had significantly worse 5-year and 10-year OS compared to NHW based on the log rank test (61% versus 70%, 52% versus 66%, respectively; p = 0.037).). Most patients (80%) underwent surgical resection. However, NHB were less likely than NHW to undergo surgical resection by multivariate analysis (OR 0.43, 95% CI 0.22–0.82). Conclusions NHB children and young adults with chest wall sarcoma have decreased overall survival. In addition, NHB are less likely to undergo surgical resection which may contribute to survival disparities. It is paramount that health care providers work to close the treatment gap between racial/ethnic groups to improve survival in children and young adults with chest wall sarcoma. Level of evidence Level III Treatment Study.

Purpose: To compare the effectiveness of the Zero Gravity Suit (CFI Medical Solutions) in reducing the annual dose received by one physician in the Cardiac Catheterization Lab. Methods: A physician with a history of receiving high annual dose equivalents was purchased a Zero Gravity Suit. Film badges (Landauer) were worn at the collar and waist and monitored monthly. Previous dose history was acquired via the Landauer Exposure Report Archive. Annual values for Deep Dose Equivalent (DDE), Eye Dose Equivalent (LDE), and Shallow Dose Equivalent (SDE) were compared for the first full year of the Zero Gravity Suit (2011) to the previous four years (2007–2010). Readings for 2009 and 2007 were corrected for improper wear of the film badges. Results: The reduction in dose equivalent for DDE ranged from 70%–87%. The reduction in dose equivalent for LDE ranged from 16%–60%. The reduction in dose equivalent for SDE ranged from 16%–60%. Conclusions: : It was determined that the Zero Gravity Suit is effective at reducing the exposure of a physician with a history of high annual dose equivalents in our facilities Cardiac Catheterization Lab. While the suit did reduce the LDE and SDE it was more effective at reducing the DDE. During 2010 the suit was acquired midyear. The dose equivalent values would likely be similar to 2011 if the suit was introduced at the beginning of the year. In 2009 the physician was pregnant and attempting a reduced workload. The physician only uses the suit if a procedure is expected to take longer than fifteen minutes. The accuracy of the study is dependent upon the physician wearing the badges consistently and correctly and the physician using the Zero Gravity Suit consistently.

The neural and cognitive mechanisms by which primed constructs can impact on social behavior are poorly understood. In the present study, we used functional magnetic resonance imaging (fMRI) to explore how scrambled sentence priming can impact on mimicry behavior. Sentences involving pro/ antisocial events from a first/third-person point of view were presented in short blocks, followed by a reaction-time assessment of mimicry. Behavioral results showed that both prosociality and viewpoint impact on mimicry, and fMRI analysis showed this effect is implemented by anterior medial prefrontal cortex (amPFC). We suggest that social primes may subtly modulate processing in amPFC in a manner linked to the later behavior, and that this same region also implements the top-down control of mimicry responses. This priming may be linked to processing of self-schemas in amPFC. Our findings demonstrate how social priming can be studied with fMRI, and have important implications for our understanding of the underlying mechanisms of prime-to-behavior effects as well as for current theories in social psychology.

Hypothesis We hypothesize that patients with a positive tangent sign will have rotator cuff tears that are not able to be repaired primarily. Methods We performed a retrospective review of the charts of patients who had undergone surgery for repair of a rotator cuff tear. The operative note was reviewed to determine whether the cuff tear was primarily repaired. The magnetic resonance imaging study of each patient was reviewed to assess for a positive or negative tangent sign. The reviewer was blinded to the result of each measurement. Results Eighty-one patients met the inclusion criteria. Of the 79 included in our analyses, 17 had a positive tangent sign and 62 had a negative tangent sign. There was only 1 patient with a negative tangent sign who had an irreparable rotator cuff tear. There were 3 patients with a positive tangent sign who had a repairable rotator cuff. With a pretest prevalence of irreparable tears of 18.9%, a positive finding suggested a post-test probability of 82.3% with a positive tangent sign and a post-test probability of only 1.6% when the tangent sign was negative. Conclusion Our results showed decision-making value in both a negative tangent sign and a positive tangent sign. The tangent sign is an easily performed and reproducible tool with good intraobserver and interobserver reliability that is a powerful predictor of whether a rotator cuff tear will be repairable.

Our understanding of the pathogenesis of idiopathic thrombotic thrombocytopenic purpura (TTP) has increased, but remains incomplete, particularly with respect to cases of suspected TTP that are either unresponsive to therapeutic plasma exchange (TPE) or have normal ADAMTS13 (a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13) activity. A 53-year-old woman presented with severe anemia (hemoglobin 1.8 g/dL) and clinical and laboratory findings consistent with TTP in conjunction with acute cocaine use. The patient was treated with TPE until the pre-treatment ADAMTS13 activity was reported as normal without evidence of an inhibitor. TPE was stopped and the patient continued to improve without treatment. This patient's microangiopathic hemolytic anemia (MAHA) appeared to be secondary to cocaine use. The proposed pathogenesis is likely a combination of cocaine-induced vasoconstriction, vascular damage, platelet activation, and procoagulation. This is the fifth published report of cocaine-induced MAHA and to our knowledge the first with ADAMTS13 testing.

Monitoring the distribution and abundance of an invasive species is challenging, especially during the initial years of spread when population densities are low and basic biology and monitoring methods are being investigated. Brown marmorated stink bug (Halyomorpha halys (Stal)) is an invasive agricultural and urban pest that was first detected in the United States in the late 1990s. At the time of its detection, no method was available to effectively track H. halys populations, which are highly mobile and polyphagous. One possible solution was the utilization of black light traps, which are nonspecific traps attractive to night flying insects. To determine if black light traps are a reliable monitoring tool for H. halys, a state-wide network of 40-75 traps located on New Jersey farms were monitored from 2004 to 2011 for H. halys. This proved to be a highly effective method of monitoring H. halys populations and their spread at the landscape level. The total number of brown marmorated stink bug caught in New Jersey increased exponentially during this period at a rate of 75% per year. Logistic regression estimates that 2.84 new farms are invaded each year by H. halys. The results indicate that black light traps are attractive to early season populations as well as at low population densities. Weekly trap catch data are being used to generate state-wide population distribution maps made available to farmers in weekly newsletters and online. While no economic threshold currently exists for brown marmorated stink bug, the maps provide farmers with a tool to forecast pest pressure and plan management.

Background Aedes (Stegomyia) albopictus (Skuse) is an important disease vector and biting nuisance. During the 2009 active season, six ∼1000-parcel sites were studied, three in urban and three in suburban areas of New Jersey, United States, to examine the efficacy of standard integrated urban mosquito control strategies applied area wide. Active source reduction, larviciding, adulticiding and public education (source reduction through education) were implemented in one site in each county, an education-only approach was developed in a second site and a third site was used as an untreated experimental control. Populations were surveyed weekly with BG-Sentinel traps and ovitraps. Results A substantial reduction in Ae. albopictus populations was achieved in urban sites, but only modest reductions in suburban sites. Education alone achieved significant reductions in urban adult Ae. albopictus. Egg catches echoed adult catches only in suburban sites. Conclusions There are significant socioeconomic and climatic differences between urban and suburban sites that impact upon Ae. albopictus populations and the efficacy of the control methods tested. An integrated pest management approach can affect abundances, but labor-intensive, costly source reduction was not enough to maintain Ae. albopictus counts below a nuisance threshold. Nighttime adult population suppression using truck-mounted adulticides can be effective. Area-wide cost-effective strategies are necessary. Published 2013. This article is a U.S. Government work and is in the public domain in the USA

The brown marmorated stink bug, Halyomorpha halys (Stal), is an invasive stink bug (Hemiptera: Pentatomidae) introduced into the United States in the mid-1990s. Since its initial establishment, it has spread throughout the east coast as far south as Georgia, and as far north as New Hampshire. While information is available regarding H. halys behavior and life history in some crops, relatively little information is available for vegetables such as peppers. Key questions include understanding when H. halys enters pepper fields to feed and how best to predict infestations, what population levels create economic damage, and if peppers that vary in capsaicin levels also vary in susceptibility to attack. To answer these questions, replicated plots were set up across four mid-Atlantic states using three types of peppers: sweet bell, sweet banana, and hot chili. We found that there was no difference in the overall abundance of all life stages of H. halys on all pepper varieties tested. However, there were differences in bug density by site, but these differences did not translate to differences in the proportion of damaged fruit. The presence of adult H. halys is a better predictor of damage in banana peppers, whereas nymphs are a better predictor in bell pepper. In addition, across all sites, the presence of egg masses was low in pepper crops and densities of both adults and immatures tend to peak on pepper plants in early August. Altogether, this information can be used to help develop a pest management program in peppers that will reduce crop losses to this new devastating pest, while reducing the reliance on insecticides to manage this pest at the same time.

OBJECTIVE Health disparities in access to care, early detection, and survival exist among adult patients with cancer. However, there have been few reports assessing how health disparities impact pediatric patients with malignancies. The objective in this study was to examine the impact of racial/ethnic and social factors on disease presentation and outcome for children with primary CNS solid tumors. METHODS The authors examined all children (age ≤ 18 years) in whom CNS solid tumors were diagnosed and who were enrolled in the Texas Cancer Registry between 1995 and 2009 (n = 2421). Geocoded information was used to calculate the driving distance between a patient's home and the nearest pediatric cancer treatment center. Socioeconomic status (SES) was determined using the Agency for Healthcare Research and Quality formula and 2007–2011 US Census block group data. Logistic regression was used to determine factors associated with advanced-stage disease. Survival probability and hazard ratios were calculated using life table methods and Cox regression. RESULTS Children with advanced-stage CNS solid tumors were more likely to be < 1 year old, Hispanic, and in the lowest SES quartile (all p < 0.05). The adjusted odds ratios of presenting with advanced-stage disease were higher in children < 1 year old compared with children > 10 years old (OR 1.71, 95% CI 1.06–2.75), and in Hispanic patients compared with non-Hispanic white patients (OR 1.56, 95% CI 1.19–2.04). Distance to treatment and SES did not impact disease stage at presentation in the adjusted analysis. Furthermore, 1- and 5-year survival probability were worst in children 1–10 years old, Hispanic patients, non-Hispanic black patients, and those in the lowest SES quartile (p < 0.05). In the adjusted survival model, only advanced disease and malignant behavior were predictive of mortality. CONCLUSIONS Racial/ethnic disparities are associated with advanced-stage disease presentation for children with CNS solid tumors. Disease stage at presentation and tumor behavior are the most important predictors of survival.

The purpose of this study was to evaluate the impact of hospital specialization on survival in pediatric melanoma.We reviewed all patients under 18years old with cutaneous melanoma evaluated at MD Anderson Cancer Center, a National Cancer Institute (NCI)-designated center, from 2000 to 2014. We compared overall survival (OS) and disease-free survival (DFS) between patients who underwent all treatments at MDACC (Group A, n=146) and those who underwent initial surgical treatment at a non-NCI center (Group B, n=58). Kaplan-Meier survival curves were compared using the log-rank test.Group A patients had significantly better OS and DFS (both p0.001). Five-year OS was 97% (95% CI 92%-99%) in Group A versus 88% (95% CI 74%-94%) in Group B. Group survival differences were most notable in Stage 3 and 4 patients. Group A patients presenting with stage III or IV disease had a 5-year OS rate of 91.2% (95% CI 75.1%-97.1%) compared to 80.8% (95% CI 59.8%-91.5%) in Group B. The DFS rate was 94.4% (95% CI 88.5%-97.3%) in Group A versus 77.2% (95% CI 62.5%-86.7%) in Group B.Surgical treatment at a comprehensive cancer center may improve outcomes for pediatric melanoma especially for patients presenting with later stage disease.Case-control study: Level III.

The purpose of this study was to evaluate the association of insurance status on the probability of transfer of pediatric trauma patients to level I/II centers after initial evaluation at lower level centers.A retrospective review of all pediatric trauma patients (age16years) registered in the 2007-2012 National Trauma Data Bank was performed. Multiple regression techniques controlling for clustering at the hospital level were used to determine the impact of insurance status on the probability of transfer to level I/II trauma centers.Of 38,205 patients, 33% of patients (12,432) were transferred from lower level centers to level I/II trauma centers. Adjusting for demographics and injury characteristics, children with no insurance had a higher likelihood of transfer than children with private insurance. Children with public or unknown insurance status were no more likely to be transferred than privately insured children. There were no variable interactions with insurance status.Among pediatric trauma patients, lack of insurance is an independent predictor for transfer to a major trauma center. While burns, severely injured, and younger patients remain the most likely to be transferred, these findings suggest a triage bias influenced by insurance status. Additional policies may be needed to avoid unnecessary transfer of uninsured pediatric trauma patients.Case-control study, level III.

A pediatric computed tomography (CT) radiation dose reduction program was implemented throughout our children's associated hospital system in 2010. We hypothesized that the CT dose received for evaluation of appendicitis in children would be significantly higher among the 40 referral, nonmember hospitals (NMH) than the 9 member hospitals (MH).Preoperative CTs of pediatric (18years) appendectomy patients between April 2012 and April 2015 were reviewed. Size specific dose estimate (SSDE), an approximation of absorbed dose incorporating patient diameter, and Effective Dose (ED) were calculated for each scan.1128 (65%) of 1736 appendectomy patients underwent preoperative CT. 936 patients seen at and 102 children evaluated at NMH had dosing and patient diameter data for analysis. SSDE and ED were significantly higher with greater variance at NMH across all ages (all p0.05, Figure). NMH's SSDE and ED also exceeded reference levels.Radiation exposure in CT scans for evaluation of pediatric appendicitis is significantly higher and more variable in NMH. A proactive approach to reduce dose, in addition to frequency, of CT scans in pediatric patients is essential.Level III.

Importance Telemetry alarms involving traditional on-site monitoring rarely alter management and often miss serious events, sometimes resulting in death. Poor patient selection contributes to a high alarm volume with low clinical yield. Objective To evaluate outcomes associated with an off-site central monitoring unit (CMU) applying standardized cardiac telemetry indications using electronic order entry. Design, Setting, and Participants All non–intensive care unit (ICU) patients at Cleveland Clinic and 3 regional hospitals over 13 months between March 4, 2014, and April 4, 2015. Exposures An off-site CMU applied standardized cardiac telemetry when ordered for standard indications, such as for known or suspected tachyarrhythmias or bradyarrhythmias. Main Outcomes and Measures CMU detection and notification of rhythm/rate alarms occurring 1 hour or less prior to emergency response team (ERT) activation, direct CMU-to-ERT notification outcomes, total telemetry census, and cardiopulmonary arrests in comparison with the previous 13 months. Results The CMU received electronic telemetry orders for 99 048 patients (main campus, 72 199 [73%]) and provided 410 534 notifications (48% arrhythmia/hemodynamic) among 61 nursing units. ERT activation occurred among 3243 patients, including 979 patients (30%) with rhythm/rate changes occurring 1 hour or less prior to the ERT activation. The CMU detected and provided accurate notification for 772 (79%) of those events. In addition, the CMU provided discretionary direct ERT notification for 105 patients (ventricular tachycardia, n = 44; pause/asystole, n = 36; polymorphic ventricular tachycardia/ventricular fibrillation, n = 14; other, n = 11), including advance warning of 27 cardiopulmonary arrest events (26%) for which return of circulation was achieved in 25 patients (93%). Telemetry standardization was associated with a mean 15.5% weekly census reduction in the number of non-ICU monitored patients per week when compared with the prior 13-month period (580 vs 670 patients; mean difference, −90 patients [95% CI, −82 to −99]; P Conclusions and Relevance Among non–critically ill patients, use of standardized cardiac telemetry with an off-site central monitoring unit was associated with detection and notification of cardiac rhythm and rate changes within 1 hour prior to the majority of ERT activations, and also with a reduction in the census of monitored patients, without an increase in cardiopulmonary arrest events.