Neonatal intensive care unit discharge of infants with cardiorespiratory events: Tri-country comparison of academic centers

OBJECTIVE

Compare how NICUs within academic centers in Canada, France, and the United States make discharge decisions regarding cardiorespiratory recordings and home use of apnea monitors, oximeters and caffeine.

STUDY DESIGN

An anonymous survey was sent to neonatologists through the member listserv of the American Academy of Pediatrics Section on Perinatal Pediatrics, the Canadian Fellowship Program Directory, and to Level 3 NICUs in France.

RESULTS

The response rates were 89% , 83% , and 79% for US, Canada and France respectively. In Canada, 45% perform pre-discharge recordings vs. 38% in France and 24% in the US. Apnea free days prior to discharge were required in 100% of centers in Canada, 96% in France, and 92% in the US. In Canada and France, 65% and 68% of units discharge patients on monitors vs. 99% in the US. 64% of the US centers sometimes use home caffeine compared to 40% in Canada and 34% in France. Over 60% of the centers in Canada and France wait until at least 40 weeks post menstrual age to discharge patients, whereas only about 33% of the US wait that late to discharge patients.

CONCLUSIONS

Discharge practices from NICUs are not well standardized across institutions or countries. Canada and France keep infants in the hospital longer and are less likely than the US to use home monitoring and home caffeine.

Remote focal scanning optical projection tomography with an electrically tunable lens

We describe a remote focal scanning technique for optical projection tomography (OPT) implemented with an electrically tunable lens (ETL) that removes the need to scan the specimen or objective lens. Using a 4× objective lens the average spatial resolution is improved by ∼46% and the light collection efficiency by a factor of ∼6.76, thereby enabling increased acquisition speed and reduced light dose. This convenient implementation is particularly appropriate for lower magnifications and larger sample diameters where axial objective scanning would encounter problems with speed and stability.

Association between liver transplant center performance evaluations and transplant volume

There has been increased oversight of transplant centers and stagnation in liver transplantation nationally in recent years. We hypothesized that centers that received low performance (LP) evaluations were more likely to alter protocols, resulting in reduced rates of transplants and patients placed on the waiting list. We evaluated the association of LP evaluations and transplant activity among liver transplant centers in the United States using national Scientific Registry of Transplant Recipients data (January 2007 to July 2012). We compared the average change in recipient and candidate volume and donor and patient characteristics based on whether the centers received LP evaluations. Of 92 eligible centers, 27 (29%) received at least one LP evaluation. Centers without an LP evaluation (n = 65) had an average increase of 9.3 transplants and 14.9 candidates while LP centers had an average decrease of 39.9 transplants (p < 0.01) and 67.3 candidates (p < 0.01). LP centers reduced the use of older donors, donations with longer cold ischemia, and donations after cardiac death (p-values < 0.01). There was no association between the change in transplant volume and measured performance (R(2)  = 0.002, p = 0.91). Findings indicate a strong association between performance evaluations and changes in candidate listings and transplants among liver transplant centers, with no measurable improvement in outcomes associated with reduction in transplant volume.

Rejection is less common in children undergoing liver transplantation for hepatoblastoma

To compare the incidence of acute histologically proven rejection in children who have had a liver transplant for hepatoblastoma with a control group of children transplanted for biliary atresia (EHBA). A retrospective case notes based study was performed. Twenty patients were identified with hepatoblastoma who were transplanted at a single unit between 1991 and 2008. These were matched as closely as possible for age, gender, year of transplant and type of immunosuppression used to the control group transplanted for biliary atresia (n = 60). There was a significant decrease in rate of acute rejection as assessed by the rejection activity index (RAI) in the hepatoblastoma group (75% vs. 50%, respectively, p < 0.04). Chronic rejection was rare in both groups, but twice as common in the biliary atresia group. Equal levels of immunosuppression were achieved in both groups. Renal function was noted to be reduced one yr post-transplant in both groups, as previously reported. A modified immunosuppression regimen could be considered in children with hepatoblastoma undergoing liver transplantation.

Biological activity of chemicals identified from extracts and volatiles of maleRhagoletis cerasi

Fractions obtained by chromatographic separation of extracts and volatiles from maleRhagoletis cerasi flies were tested for biological activity on females under laboratory conditions. During the bioassays, the number of incoming flies as well as the time spent by individual flies on the area of stimulus were taken under consideration. Two distinct types of female behavior were observed, i.e., attraction and arrestant behavior. GC-MS analysis of biologically active fractions resulted in tentative identification of 75 compounds. EAG screening for 27 of these compounds was performed, and subsequent laboratory bioassays resulted in the confirmation of arrestant activity for various mixtures of eight fatty acids (octadecanoic, nonadecanoic, eicosatetraenoic, eicosapenaenoic, eicosaenoic, heneicosanoic, docosahexenoic, and docosanoic). Following EAG tests and laboratory bioassays, a possible mode of chemical communication of this species with sex pheromones is proposed.

Collaboration between doctors and nurses in children's cancer care: insights from a European project

PURPOSE

It has long been recognised that effective cancer care is not possible without multi-professional team working. Collaboration and multi-professional working however are known to be less than straightforward. This project aimed to use a collaborative approach to explore and facilitate professional groups to work together more effectively in the field of children's cancer care.

METHOD

Based on an earlier project in Italy, a three-year seminar series was organised involving both a doctor and nurse from 15 paediatric haematology/oncology units across Europe. Participants had to be able to speak English and commit to participate in annual seminars as well as the development and implementation of a local project to enhance doctor-nurse collaboration in their own unit. Appreciative Inquiry was the methodological approach used to address organisational as well as interpersonal change.

RESULTS

Fifteen doctor-nurse teams were initially selected from a range of different countries, and 10 completed the project. Key outcomes reported include implementation and successful completion of projects, publication of the results achieved, participant satisfaction with improvements in collaboration. Feedback from participants would suggest that change had been implemented and possibly sustained.

CONCLUSIONS

Active involvement and group support were required for success. More formal relationships needed to be activated with participating centres to guarantee support for those involved in implementing lasting change. A web-based resource to allow other programmes and centres to use the resources developed has been made available. The same approach, we believe, could be used to improve multi-professional working in the care of other childhood illnesses.

Prevalence of clinical hip abnormalities in haemophilia A and B: an analysis of the UDC database

Clinical hip abnormalities, secondary to recurrent joint and/or muscle bleeding in persons with haemophilia, have not been well characterized and have the potential for significant morbidity. We aimed to examine the prevalence of clinical hip abnormalities in the US haemophilia population and to explore associations between these findings and putative risk factors. We conducted a study of hip abnormalities of 8192 subjects aged 2-69 years with haemophilia A and haemophilia B (54% of haemophilia A and haemophilia B are severe) currently enrolled in the Universal Data Collection (UDC) database. Associations between hip abnormality and type/severity of haemophilia A/B, current age, history of high-titre (≥ 5 BU) inhibitor (HTinh), concomitant ankle (AA) and knee arthropathy (KA), overweight and obesity and prophylaxis were examined using logistic regression. Overall prevalence of hip abnormality at the last recorded UDC visit for all subjects was 16.7%. Haemophilia A (aOR = 1.3, 1.0-1.4), severe haemophilia (aOR = 1.3, 1.0-1.5), a history of HTinh (aOR = 1.4, 1.1-1.7), and concomitant AA (aOR = 1.7, 1.4-1.9) were each independently associated with hip abnormality. Older age (45-69 years) was significantly associated with hip abnormality prevalence only in subjects with KA (aOR = 3.4, 1.9-5.9). The presence of overweight (aOR = 1.4, 1.1-1.8) and obesity (aOR = 2.1, 1.6-2.8) was associated with hip abnormality only among subjects without KA. Hip abnormality prevalence was not influenced by prophylaxis (aOR = 0.9, 0.8-1.1). These data suggest that hip abnormalities in US patients with haemophilia are associated with haemophilia severity and type, HTinh, concomitant AA and, depending on the presence or absence of KA, advancing age and obesity.

The reproductive biology of the New Zealand flora

New Zealand's long isolation from other elements of Gondwanaland, oceanic climate, the unusual combination of ancient Gondwanic, tropical and more recently arrived elements in its flora, and its relatively depauperate pollinator and disperser fauna have set the stage for the evolution of a subtle, complex and distinctive reproductive biology. This contrasts markedly with the neighbouring continent of Australia where the fauna is diverse and the flowers vivid. Recent advances in understanding New Zealand's floral biology include evidence that the ancestor to the anthophytes was cosexual, with insect pollinators receiving stigmatic nectar rewards; the discovery of ground-level bat pollination in an obligate root parasite; the finding that the greater resource sensitivity of fruit set in males than in females may account for sex ratio variation in gynodioecious species; and, evidence for much more pronounced mast seeding at higher altitudes even in the absence of mammalian seed predators.

THE CESSATION OF DIALYSIS IN PATIENTS WITH END-STAGE RENAL DISEASE: DEVELOPING AN APPROPRIATE EVIDENCE BASE FOR PRACTICE

Recently there has been a growing awareness that not all patients with Established Renal Failure will benefit from dialysis treatment, and it has been recognised that this patient population requires an enhanced approach to assessment and control of symptoms, as well as supportive management, including effective and high-quality palliative care. This overview of the literature examines supportive care for the patient with Established Renal Failure and how conscious decision-making in this group of patients can be best facilitated. It highlights recommendations, which have been produced to assist in the decision-making process regarding withholding and withdrawing dialysis, and is a starting point prior to establishing supportive care programmes for the renal population. Patients who decide to abstain from dialysis or for whom such a decision is made should be offered appropriate supportive and palliative care.

First Report of Leaf Spot of Kentucky Bluegrass (Poa pratensis) Caused by Nigrospora oryzae in Ontario

Kentucky bluegrass (Poa pratensis L.) is an important cool-season perennial grass in Ontario. It is native to Europe and can form an attractive and durable turf. In late September 2011, distinct leaf spots were observed on a Kentucky bluegrass lawn in Guelph, ON. Symptoms ranged from small lesions that were chocolate brown and oval or circular up to withered leaves. On potato dextrose agar (PDA) amended with streptomycin and tetracycline, a fungus was consistently recovered from symptomatic leaf samples after surface sterilization for 1 min in 1% sodium hypochlorite. On PDA, cultures were gray with an irregularly distributed, wool-like, fastgrowing aerial mycelium, showing a dark back side as the colony changed to darker brown after 7 days at 25°C. On diseased leaves, conidia were observed after moist incubation, borne on a hyaline vesicle at the tip of each conidiophore. Conidia were single celled, black, smooth, spherical, and 11.2 to 15.5 μm (average 13.8 μm) in diameter. The pathogen was identified as Nigrospora oryzae based on previous descriptions (1,2). Genomic DNA was extracted from a representative isolate, 11201, and the internal transcribed spacer (ITS) region of the ribosomal DNA was amplified by the primers ITS1 and ITS4 (4). The ITS sequence showed 99.8% similarity in the overlapping 508-bp portion with N. oryzae (GenBank No. GQ328855). Pathogenicity tests were performed in the laboratory with the isolate on 3-week-old, sand-based, Magenta box-grown plants of three cool-season turfgrass species, P. pratensis, Agrostis stolonifera, and Lolium perenne, by inoculating with fungal plugs. A 5-mm-diameter plug from 5-day-old PDA cultures was directly placed onto leaves in each of four replicate boxes per species, and then removed after 48 h of incubation. Plants treated with sterile agar plugs served as controls. Magenta boxes containing treated turf were covered loosely with their plastic lids and incubated at 23°C. Three days after inoculation and 1 day after inoculum removal, typical chocolate brown spots were observed on inoculated leaves from all three turfgrass species, but no symptoms were seen on agar plug-treated control plants. Koch's postulates were fulfilled by reisolation of N. oryzae from diseased leaves. The pathogenicity tests were carried out twice with the same results. This is an indication that N. oryzae causing leaf spot of Kentucky bluegrass in Ontario was not hostspecific, and could potentially affect other cool-season turfgrass species. Review of the literature revealed that N. oryzae is known as a pathogen on maize, rice, sorghum, cotton, weeds, and several other hosts, but has not been reported on any species of turfgrass (3). To our knowledge, this is the first report of N. oryzae infecting Kentucky bluegrass in Ontario or worldwide. References: (1) M. B. Ellis. Dematiaceous Hyphomycetes, CAB, Kew, Surrey, England, 1971. (2) H. J. Hudson. Trans. Brit. Mycol. Soc. 46:355, 1963. (3) R. W. Smiley et al. Compendium of Turfgrass Diseases. 3rd ed. APS Press, St Paul, MN, 2005. (4) T. J. White et al. PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

Expression of heparan sulfate proteoglycans in murine models of experimental colitis

BACKGROUND

Heparan sulfate proteoglycans (HSPGs) are considered important in maintaining physiological homeostasis in many systems. Their expression is altered greatly in several pathophysiological conditions. Herein, we assess the expression and cellular localization of HSPGs in two murine models of human inflammatory bowel disease (IBD).

METHODS

Expression and localization of HSPGs, syndecans, and HS epitopes were examined in the colon of 129SvEv interleukin 10 knockout (IL10(-/-)), C3Bir IL10(-/-), and their genetic control (IL10(+/+)) counterparts (129SvEv; C3H/HeJ). mRNA expression of syndecans and heparan sulfate biosynthesis enzymes were evaluated by real-time polymerase chain reaction (PCR). Localization of HSPGs was determined by immunofluorescence.

RESULTS

mRNA for all syndecans was detected and expression in colonic tissues altered in IL10(-/-) mice. Syndecan-1 protein was expressed in the intestinal epithelium and on lamina propria cells of IL10(-/-) and control mice but was significantly reduced on the intestinal epithelial cells of IL10(-/-), mice particularly with severe colitis. Syndecan-2 was not detected, whereas syndecan-3 immunoreactivity was localized in the lamina propria but did not differ between control and IL10(-/-) mice. Syndecan-4 was present on epithelial cells of all mice but was significantly reduced in IL10(-/-) mice. Differences in the expression of HS epitopes between control and IL10(-/-) mice were also confirmed.

CONCLUSIONS

The study has revealed altered expression of syndecan-1 and -4 and HS epitopes in the gut of mice with an IBD-like gut disorder. The IL10(-/-) mouse is a useful model for further study of the functional role of HSPGs in chronic inflammation and in maintaining healthy gut barrier.