On alert for Ebola: public health risk assessment of travellers from Uganda to the U.S. during the 2022 outbreak.

BACKGROUND: On September 20, 2022, the Ugandan Ministry of Health declared an outbreak of Ebola disease caused by Sudan ebolavirus. METHODS: From October 6, 2022, through January 10, 2023, CDC staff conducted public health assessments at five U.S. ports of entry for travellers identified as having been in Uganda in the previous 21 days. CDC also recommended that state, local and territorial health departments ('health departments') conduct post-arrival monitoring of these travellers. CDC provided traveller contact information daily to 58 health departments and collected health department data regarding monitoring outcomes. RESULTS: Among 11 583 travellers screened, 132 (1%) required additional assessment due to potential exposures or symptoms of concern. Fifty-three (91%) health departments reported receiving traveller data from CDC for 10 114 (87%) travellers, of whom 8499 (84%) were contacted for monitoring, 1547 (15%) could not be contacted, and 68 (1%) had no reported outcomes. No travellers with high-risk exposures or Ebola disease were identified. CONCLUSIONS: Entry risk assessment and post-arrival monitoring of travellers are resource-intensive activities which had low demonstrated yield during this and previous outbreaks. The efficiency of future responses could be improved by incorporating an assessment of risk of importation of disease, accounting for individual travellers' potential for exposure, and expanded use of methods that reduce burden to federal agencies, health departments, and travellers.

COVID19 Diagnosis Using Chest X-rays and Transfer Learning.

A pandemic of respiratory illnesses from a novel coronavirus known as Sars-CoV-2 has swept across the globe since December of 2019. This is calling upon the research community including medical imaging to provide effective tools for use in combating this virus. Research in biomedical imaging of viral patients is already very active with machine learning models being created for diagnosing Sars-CoV-2 infections in patients using CT scans and chest x-rays. We aim to build upon this research. Here we used a transfer-learning approach to develop models capable of diagnosing COVID19 from chest x-ray. For this work we compiled a dataset of 112120 negative images from the Chest X-Ray 14 and 2725 positive images from public repositories. We tested multiple models, including logistic regression and random forest and XGBoost with and without principal components analysis, using five-fold cross-validation to evaluate recall, precision, and f1-score. These models were compared to a pre-trained deep-learning model for evaluating chest x-rays called COVID-Net. Our best model was XGBoost with principal components with a recall, precision, and f1-score of 0.692, 0.960, 0.804 respectively. This model greatly outperformed COVID-Net which scored 0.987, 0.025, 0.048. This model, with its high precision and reasonable sensitivity, would be most useful as "rule-in" test for COVID19. Though it outperforms some chemical assays in sensitivity, this model should be studied in patients who would not ordinarily receive a chest x-ray before being used for screening.

Twitter: More than Tweets for Undergraduate Student Researchers.

During the COVID-19 pandemic, biology educators were forced to think of ways to communicate with their students, engaging them in science and with the scientific community. For educators using course-based undergraduate research experiences (CUREs), the challenge to have students perform real science, analyze their work, and present their results to a larger scientific audience was difficult as the world moved online. Many instructors were able to adapt CUREs utilizing online data analysis and virtual meeting software for class discussions and synchronous learning. However, interaction with the larger scientific community, an integral component of making science relevant for students and allowing them to network with other young scientists and experts in their fields, was still missing. Even before COVID-19, a subset of students would travel to regional or national meetings to present their work, but most did not have these opportunities. With over 300 million active users, Twitter provided a unique platform for students to present their work to a large and varied audience. The Cell Biology Education Consortium hosted an innovative scientific poster session entirely on Twitter to engage undergraduate researchers with one another and with the much broader community. The format for posting on this popular social media platform challenged students to simplify their science and make their points using only a few words and slides. Nineteen institutions and over one hundred students participated in this event. Even though these practices emerged as a necessity during the COVID-19 pandemic, the Twitter presentation strategy shared in this paper can be used widely.

Ultrasonography and digital radiography findings in sheep with clinical disease associated with small ruminant lentivirus infection.

Digital radiography and ultrasonographic images were used in this case series to evaluate 4 ewes from a single flock for chronic weight loss and ill-thrift. On examination, all displayed tachypnea, dyspnea, coughing, and normothermia with abnormal thoracic auscultations. Three of the 4 animals were diagnosed with chronic respiratory disease associated with Maedi-visna (MV) infection confirmed via serologic testing. Diagnostic thoracic imaging identified characteristics consistent with pathological lesions associated with interstitial pneumonia in the 3 MV affected animals; these findings were absent in the animal that tested negative for MV. Key clinical message: Diagnostic imaging may be useful to clinicians looking to obtain further visualization of lung pathologies and as a reliable means of detecting thoracic lesions indicative of interstitial pneumonia on-farm. These results can be used to aid the practitioner in determining appropriate further diagnostic testing and treatment strategies while awaiting confirmatory test results for diagnosis of MV.

Résultats de l'échographie et de la radiographie numérique chez des ovins atteints d'une maladie clinique associée à une infection à lentivirus des petits ruminants. La radiographie numérique et les images échographiques ont été utilisées dans cette série de cas pour évaluer quatre brebis d'un seul troupeau présentant une perte de poids chronique et un retard de croissance. À l'examen, tous les animaux présentaient une tachypnée, une dyspnée, une toux et étaient normothermiques avec des auscultations thoraciques anormales. Trois des quatre animaux ont été diagnostiqués avec une maladie respiratoire chronique associée à une infection Maedi-visna (MV) confirmée via des tests sérologiques. L'imagerie thoracique diagnostique a identifié des caractéristiques compatibles avec des lésions pathologiques associées à une pneumonie interstitielle chez les trois animaux atteints de MV; ces résultats étaient absents chez l'animal qui a été testé négatif pour MV.Message clinique clé :L'imagerie diagnostique peut être utile aux cliniciens qui cherchent à obtenir une visualisation plus poussée des pathologies pulmonaires et comme un moyen fiable de détecter les lésions thoraciques indiquant une pneumonie interstitielle à la ferme. Ces résultats peuvent être utilisés pour aider le praticien à déterminer d'autres tests de diagnostic appropriés et des stratégies de traitement en attendant les résultats des tests de confirmation pour le diagnostic de MV.(Traduit par Dr Serge Messier).

An Ensemble of U-Net Models for Kidney Tumor Segmentation With CT Images.

We present here the Arkansas AI-Campus solution method for the 2019 Kidney Tumor Segmentation Challenge (KiTS19). Our Arkansas AI-Campus team participated the KiTS19 Challenge for four months, from March to July of 2019. This paper provides a summary of our methods, training, testing and validation results for this grand challenge in biomedical imaging analysis. Our deep learning model is an ensemble of U-Net models developed after testing many model variations. Our model has consistent performance on the local test dataset and the final competition independent test dataset. The model achieved local test Dice scores of 0.949 for kidney and tumor segmentation, and 0.601 for tumor segmentation, and the final competition test earned Dice scores 0.9470 and 0.6099 respectively. The Arkansas AI-Campus team solution with a composite DICE score of 0.7784 has achieved a final ranking of top fifty worldwide, and top five among the United States teams in the KiTS19 Competition.

Integration of social media with targeted emails and in-person outreach for exception from informed consent community consultation.

BACKGROUND: Exception from informed consent (EFIC) enables the enrollment of research subjects with emergent conditions to clinical trials without prior consent. EFIC study approval requires community consultation and public disclosure. We hypothesized that the integration of social media with targeted emails and in-person outreach is an effective community consultation strategy. METHODS: We utilized social media with targeted emails and in-person outreach for the community consultation of the ACCESS cardiac arrest trial. Study advertisements were disseminated using Facebook and Instagram, and targeted emails were sent to emergency medicine, prehospital, and cardiology providers. We also interviewed at-risk individuals with cardiac conditions, their caretakers, and patient advocacy groups. Participants were asked to complete a survey about their opinions about the study. RESULTS: We collected 559 surveys over an 8-week period, and 70.5% of the surveys were obtained using social media. The median (IQR) age of survey respondents was 44 (33-57) years; 89.9% were White and 60.1% were women. A total of 91.3% believed ACCESS was an important study. Compared to the in-person group, more from social media (81.8% vs. 63.3%, p < 0.05) and targeted email (77.4% vs. 63.3%, p < 0.05) groups said they would include their loved ones in the study. More from the in-person group believed that their opinion would be considered seriously compared to the social media (75.9% vs. 62.6%, p < 0.05) and targeted email (75.9% vs. 54.5%, p < 0.05) groups. The incorporation of social media and targeted emails for community consultation reduced the cost per survey by fourfold compared to an in-person-only strategy. CONCLUSIONS: The integration of social media with targeted emails and in-person outreach was a feasible and cost-saving approach for EFIC community consultation. Future work is necessary to determine the perception and best utilization of social media for community consultation.

Study COVID-19 Severity of Patients Admitted to Emergency Room (ER) with Chest X-ray Images.

We have conducted a study of the COVID-19 severity with the chest x-ray images, a private dataset collected from our collaborator St Bernards Medical Center. The dataset is comprised of chest x-ray images from 1,550 patients who were admitted to emergency room (ER) and were all tested positive for COVID-19. Our study is focused on the following two questions: (1) To predict patients hospital staying duration, based on the chest x-ray image which was taken when the patient was admitted to the ER. The length of stay ranged from zero hours to 95 days in the hospital and followed a power law distribution. Based on our testing results, it is hard for the prediction models to detect strong signal from the chest x-ray images. No model was able to perform better than a trivial most-frequent classifier. However, each model was able to outperform the most-frequent classifier when the data was split evenly into four categories. This would suggest that there is signal in the images, and the performance may be further improved by the addition of clinical features as well as increasing the training set. (2) To predict if a patient is COVID-19 positive or not with the chest x-ray image. We also tested the generalizability of training a prediction model on chest x-ray images from one hospital and then testing the model on images captures from other sites. With our private dataset and the COVIDx dataset, the prediction model can achieve a high accuracy of 95.9%. However, for our hold-one-out study of the generalizability of the models trained on chest x-rays, we found that the model performance suffers due to a significant reduction in training samples of any class.

Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest (EROCA): Results of a Randomized Feasibility Trial of Expedited Out-of-Hospital Transport.

STUDY OBJECTIVE: Outcomes of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest depend on time to therapy initiation. We hypothesize that it would be feasible to select refractory out-of-hospital cardiac arrest patients for expedited transport based on real-time estimates of the 911 call to the emergency department (ED) arrival interval, and for emergency physicians to rapidly initiate ECPR in eligible patients. METHODS: In a 2-tiered emergency medical service with an ECPR-capable primary destination hospital, adults with refractory shockable or witnessed out-of-hospital cardiac arrest were randomized 4:1 to expedited transport or standard care if the predicted 911 call to ED arrival interval was less than or equal to 30 minutes. The primary outcomes were the proportion of subjects with 911 call to ED arrival less than or equal to 30 minutes and ED arrival to ECPR flow less than or equal to 30 minutes. RESULTS: Of 151 out-of-hospital cardiac arrest 911 calls, 15 subjects (10%) were enrolled. Five of 12 subjects randomized to expedited transport had an ED arrival time of less than or equal to 30 minutes (overall mean 32.5 minutes [SD 7.1]), and 5 were eligible for and treated with ECPR. Three of 5 ECPR-treated subjects had flow initiated in less than or equal to 30 minutes of ED arrival (overall mean 32.4 minutes [SD 10.9]). No subject in either group survived with a good neurologic outcome. CONCLUSION: The Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest trial did not meet predefined feasibility outcomes for selecting out-of-hospital cardiac arrest patients for expedited transport and initiating ECPR in the ED. Additional research is needed to improve the accuracy of predicting the 911 call to ED arrival interval, optimize patient selection, and reduce the ED arrival to ECPR flow interval.

Utility of point-of-care lung ultrasound for monitoring cardiogenic pulmonary edema in dogs.

BACKGROUND: Point-of-care lung ultrasound (LUS) is an effective tool to diagnose left-sided congestive heart failure (L-CHF) in dogs via detection of ultrasound artifacts (B-lines) caused by increased lung water. HYPOTHESIS/OBJECTIVES: To determine whether LUS can be used to monitor resolution of cardiogenic pulmonary edema in dogs, and to compare LUS to other indicators of L-CHF control. ANIMALS: Twenty-five client-owned dogs hospitalized for treatment of first-onset L-CHF. METHODS: Protocolized LUS, thoracic radiographs (TXR), and plasma N-terminal pro-B-type natriuretic peptide were performed at hospital admission, hospital discharge, and recheck examinations. Lung ultrasound findings were compared between timepoints and to other clinical measures of L-CHF. RESULTS: From time of hospital admission to discharge (mean 19.6 hours), median number of LUS sites strongly positive for B-lines (>3 B-lines per site) decreased from 5 (range, 1-8) to 1 (range, 0-5; P < .001), and median total B-line score decreased from 37 (range, 6-74) to 5 (range, 0-32; P = .002). Lung ultrasound indices remained improved at first recheck (P < .001). Number of strong positive sites correlated positively with respiratory rate (r = 0.52, P = .008) and TXR edema score (r = 0.51, P = .009) at hospital admission. Patterns of edema resolution differed between LUS and TXR, with cranial quadrants showing more significant reduction in B-lines compared to TXR edema score (80% vs 29% reduction, respectively; P = .003). CONCLUSIONS AND CLINICAL IMPORTANCE: Lung ultrasound could be a useful tool for monitoring resolution of pulmonary edema in dogs with L-CHF.

Transfer learning with chest X-rays for ER patient classification.

One of the challenges with urgent evaluation of patients with acute respiratory distress syndrome (ARDS) in the emergency room (ER) is distinguishing between cardiac vs infectious etiologies for their pulmonary findings. We conducted a retrospective study with the collected data of 171 ER patients. ER patient classification for cardiac and infection causes was evaluated with clinical data and chest X-ray image data. We show that a deep-learning model trained with an external image data set can be used to extract image features and improve the classification accuracy of a data set that does not contain enough image data to train a deep-learning model. An analysis of clinical feature importance was performed to identify the most important clinical features for ER patient classification. The current model is publicly available with an interface at the web link: http://nbttranslationalresearch.org/ .

Binaural Pitch Fusion in Children With Normal Hearing, Hearing Aids, and Cochlear Implants.

OBJECTIVES: Binaural pitch fusion is the perceptual integration of stimuli that evoke different pitches between the ears into a single auditory image. Adults who use hearing aids (HAs) or cochlear implants (CIs) often experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3 to 4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The main goal of this study was to measure binaural pitch fusion in children with different hearing device combinations and compare results across groups and with adults. A second goal was to examine the relationship of binaural pitch fusion to interaural pitch differences or pitch match range, a measure of sequential pitch discriminability. DESIGN: Binaural pitch fusion was measured in children between the ages of 6.1 and 11.1 years with bilateral HAs (n = 9), bimodal CI (n = 10), bilateral CIs (n = 17), as well as normal-hearing (NH) children (n = 21). Depending on device combination, stimuli were pure tones or electric pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. Interaural pitch match functions were measured using sequential presentation of reference and comparison stimuli, and varying the comparison stimulus to find the pitch match center and range. RESULTS: Children with bilateral HAs had significantly broader binaural pitch fusion than children with NH, bimodal CI, or bilateral CIs. Children with NH and bilateral HAs, but not children with bimodal or bilateral CIs, had significantly broader fusion than adults with the same hearing status and device configuration. In children with bilateral CIs, fusion range was correlated with several variables that were also correlated with each other: pure-tone average in the second implanted ear before CI, and duration of prior bilateral HA, bimodal CI, or bilateral CI experience. No relationship was observed between fusion range and pitch match differences or range. CONCLUSIONS: The findings suggest that binaural pitch fusion is still developing in this age range and depends on hearing device combination but not on interaural pitch differences or discriminability.

Detection of stratospheric gravity waves induced by the total solar eclipse of July 2, 2019.

Atmospheric gravity waves generated by an eclipse were first proposed in 1970. Despite numerous efforts since, there has been no definitive evidence for eclipse generated gravity waves in the lower to middle atmosphere. Measuring wave characteristics produced by a definite forcing event such as an eclipse provides crucial knowledge for developing more accurate physical descriptions of gravity waves. These waves are fundamental to the transport of energy and momentum throughout the atmosphere and their parameterization or simulation in numerical models provides increased accuracy to forecasts. Here, we present the findings from a radiosonde field campaign carried out during the total solar eclipse of July 2, 2019 aimed at detecting eclipse-driven gravity waves in the stratosphere. This eclipse was the source of three stratospheric gravity waves. The first wave (eclipse wave #1) was detected 156 min after totality and the other two waves were detected 53 and 62 min after totality (eclipse waves #2 and #3 respectively) using balloon-borne radiosondes. Our results demonstrate both the importance of field campaign design and the limitations of currently accepted balloon-borne analysis techniques for the detection of stratospheric gravity waves.

Evaluation of a multipump air pistol as a method for euthanizing young dairy goat kids.

OBJECTIVE: To assess the extent of damage to the skull and brain of cadaveric dairy goat kids caused by a .22-caliber, 16-g pellet fired from a multipump air pistol at various power levels. SAMPLE: Cadavers of 8 male and 7 female dairy goat kids ≤ 5 days old. PROCEDURES: Each cadaver was positioned in sternal recumbency with the head and neck extended on a straw bale. A multipump air pistol was held with the barrel perpendicular to and 2.5 cm from the head at the intersection of 2 imaginary lines that extended from the lateral canthus of each eye to the middle of the contralateral ear base and fired at half (5 pumps; n = 2), intermediate (7 pumps; 2), or full (10 pumps; 11) power. The head and neck were removed from the carcass for CT imaging and gross sectioning to determine the location of the pellet and extent of damage caused to the skull and brain. RESULTS: The pellet successfully penetrated the skull of all 13 heads shot at full or intermediate power and 1 of the 2 heads shot at half power. The pellet did not fragment after entering the skull of any cadaver and penetrated the brainstem (necessary for instantaneous death) in only 7 cadavers. CONCLUSIONS AND CLINICAL RELEVANCE: The described technique was insufficient for use as a stand-alone method for euthanizing young dairy goat kids. Modification of the technique warrants further research to determine whether air pistols can be used to effectively euthanize young goat kids.

Cautery Disbudding Iron Application Time and Brain Injury in Goat Kids: A Pilot Study.

Cautery disbudding is a painful procedure performed on goat kids to prevent horn growth that may result in brain injury. Thermal damage to the cerebral cortex of the brain and subsequent neurologic disease is a primary concern. Cautery iron application time may affect transmission of heat to the brain; however, research in this area is scarce. Therefore, the objective of this pilot study was to evaluate the effect of iron application time on brain injury of goat kids. A total of six buck and doe kids <9 days of age were obtained from a commercial dairy and transported to an Iowa State University research facility. Kids received a different randomly assigned application time (5, 10, 15, or 20s) on each horn bud. Kids were disbudded using an electric cautery iron (under isoflurane general anesthesia). After a 5-day observation period, the kids were euthanized, and magnetic resonance (MR) images were acquired to evaluate brain injury. Additionally, four of the six kids were presented for gross examination and two kids were selected for histopathologic examination. From the MR images, white matter edema was observed subjacent to four treated areas, representing application times of 5 s (one horn bud), 15 s (one horn bud), and 20 s (two horn buds). With the exception of the horn bud that received 5 s, which had white matter edema restricted to a single gyrus, the remaining three groups had a branching region of edema. No bone abnormalities were identified on any kids. Gross evidence of discoloration and hemorrhage on the cerebral hemispheres was observed on two horn buds that received 20 s, two horn buds that received 15 s, and one horn bud that received 10 s. Microscopic lesions consisting of leptomeningeal and cerebrocortical necrosis were observed in sections of brain from all groups. Lesions were most severe with 20 s. In conclusion, all application times used in this study resulted in some level of brain injury; however, using 15 s or more resulted in more severe and consistent brain injury. These results indicate that extended iron application time may increase the risk of brain injury in cautery disbudded kids.

Improved Use of Human Milk, Growth, and Central Line Utilization With Standard Feeding Roadmap in an Academic NICU.

BACKGROUND: Before the initiation of a standardized feeding roadmap in our regional, level IV academic neonatal intensive care unit, utilization of central lines was high, and initiation of enteral feeds delayed in the very low-birth-weight population (<1500 g). Given our review of the literature, it appeared that the standardization of feeding advancement would likely result in improved performance in both issues. METHODS: This was a retrospective cohort comparison of very low-birth-weight patients before initiation of any feeding roadmap with a second cohort following completion of the final roadmap. Infants were examined retrospectively in 2 historical cohorts: Phase 1, infants fed before roadmap development and rollout, October 1, 2012-March 31, 2013; and Phase 2, following promulgation of the final feeding roadmap, January 1, 2017-June 30, 2017. RESULTS: During Phase 2, we observed a significant reduction in median (interquartile range) days to first feed (3 [1] vs 1 [1] [P < 0.0001]) and utilization of a second central line (35% vs 12% [P < 0.01]). Weight gain was significantly improved from before roadmap implementation to final, mean (SD) (g/d, 21 [5] vs 24 [4]; [P < .0001]). Percentage of first enteral feedings that were human milk also increased significantly from 71% to 91% (P = 0.0007). CONCLUSION: Implementation of a standardized feeding roadmap was associated with a reduction in days to first enteral feeds, an increase in the primary use of human milk for initiation of enteral feeds, and a decrease in the utilization of central lines while improving weight gain in very low-birth-weight infants.

Assessing Cyberbiosecurity Vulnerabilities and Infrastructure Resilience.

The convergence of advances in biotechnology with laboratory automation, access to data, and computational biology has democratized biotechnology and accelerated the development of new therapeutics. However, increased access to biotechnology in the digital age has also introduced additional security concerns and ultimately, spawned the new discipline of cyberbiosecurity, which encompasses cybersecurity, cyber-physical security, and biosecurity considerations. With the emergence of this new discipline comes the need for a logical, repeatable, and shared approach for evaluating facility and system vulnerabilities to cyberbiosecurity threats. In this paper, we outline the foundation of an assessment framework for cyberbiosecurity, accounting for both security and resilience factors in the physical and cyber domains. This is a unique problem set, but despite the complexity of the cyberbiosecurity field in terms of operations and governance, previous experience developing and implementing physical and cyber assessments applicable to a wide spectrum of critical infrastructure sectors provides a validated point of departure for a cyberbiosecurity assessment framework. This approach proposes to integrate existing capabilities and proven methodologies from the infrastructure assessment realm (e.g., decision science, physical security, infrastructure resilience, cybersecurity) with new expertise and requirements in the cyberbiosecurity space (e.g., biotechnology, biomanufacturing, genomics) in order to forge a flexible and defensible approach to identifying and mitigating vulnerabilities. Determining where vulnerabilities reside within cyberbiosecurity business processes can help public and private sector partners create an assessment framework to identify mitigation options for consideration that are both economically and practically viable and ultimately, allow them to manage risk more effectively.

Promoting Outdoor Physical Activity for People and Pets: Opportunities for Veterinarians to Engage in Public Health.

Regular physical activity (PA) is a health promoting behavior that transcends species. The collective evidence of a positive relationship between PA and health in both people and animals suggests that implementation of outdoor, dog-associated activities to increase PA may synergistically enhance both human and dog health. A systematic literature review was performed to identify research investigating objective, quantitative health outcomes in both dogs and people exercising together. Within the confines of the search, only 2 studies fulfilled the criteria for complete review. One study was administered through a veterinary clinic and another through a human health care provider. Both studies focused on obesity treatment, either for the dog or for both the dog and the owner. Collectively this work demonstrates the feasibility of simultaneously promoting health in both groups through PA; however there are limitations to the generalizability of the findings. Additional research is needed to further investigate the feasibility and effectiveness of PA promotion in primary care veterinary clinics as well as the use of animal-assisted PA promotion as a preventative, not just therapeutic, tool. As diseases that can be prevented, at least in part, by regular PA are now the leading causes of morbidity and mortality in developed countries, veterinarians have the potential to significantly impact not only the health of their patients, but also that of the public.

Binaural Pitch Fusion in Bilateral Cochlear Implant Users.

OBJECTIVES: Binaural pitch fusion is the fusion of stimuli that evoke different pitches between the ears into a single auditory image. Individuals who use hearing aids or bimodal cochlear implants (CIs) experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3-4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The goal of this study was to determine if adult bilateral CI users also experience broad binaural pitch fusion. DESIGN: Stimuli were pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. RESULTS: Bilateral CI listeners had binaural pitch fusion ranges varying from 0 to 12 mm (average 6.1 ± 3.9 mm), where 12 mm indicates fusion over all electrodes in the array. No significant correlations of fusion range were observed with any subject factors related to age, hearing loss history, or hearing device history, or with any electrode factors including interaural electrode pitch mismatch, pitch match bandwidth, or within-ear electrode discrimination abilities. CONCLUSIONS: Bilateral CI listeners have abnormally broad fusion, similar to hearing aid and bimodal CI listeners. This broad fusion may explain the variability of binaural benefits for speech perception in quiet and in noise in bilateral CI users.

Challenges of Using Probabilistic Linkage Methodology to Characterize Post-Cardiac Arrest Care in Michigan.

BACKGROUND: To improve survival of patients resuscitated from out of hospital cardiac arrest (OCHA), data is needed to assess and improve inpatient post-resuscitation care. Our objective was to apply probabilistic linkage methodology to link EMS and inpatient databases and evaluate whether it may be used to describe post-arrest care in Michigan. METHODS: We performed a retrospective study to describe post-cardiac arrest care in adult OHCA patients who were transported to Michigan hospitals from July 1, 2010, to June 30, 2013. Using probabilistic linkage methodology we linked two databases, the Michigan EMS Information System (MI_EMSIS) and the Michigan Inpatient Database (MIDB), which describes inpatient care and outcome of all admissions. Rates of case incidence and survival were compared to published literature. We compared the linked dataset to existing cardiac arrest databases from three counties to evaluate the quality of this linkage. RESULTS: Multiple iterations of match strategies were used to create a linked EMS-inpatient dataset. There were 12,838 MI_EMSIS cardiac arrest records of which 1,977 were matched with MIDB records, identifying them as surviving to hospital admission. Of these 590 (30.0%) survived to hospital discharge. The annual survival incidence/100,000 population to admission was 6.93/100,000 and survival incidence to discharge was 2.1/100,000. The matched dataset was compared to county databases identified a limited sensitivity [48.2%, 95% CI 42.1%-55.3%)] and positive predictive value [64.4%, 95% CI 56.8%-71.3%)]. CONCLUSION: Use of the MI_EMSISEMS database and the Michigan Inpatient database was feasible and produced rates of cardiac arrest admission and survival rates similar to published literature. This process yielded a limited match compared to existing county cardiac arrest databases. We conclude that such a linked dataset is useful for descriptive purposes but not as a population based dataset to evaluate statewide post-cardiac arrest care.

Comparison of Thoracic Radiography and Computed Tomography in Calves with Naturally Occurring Respiratory Disease.

OBJECTIVE: To evaluate the severity and extent of lung disease using thoracic computed radiography (CR) compared to contrast-enhanced multi-detector computed tomography (MDCT) of the thorax in calves with naturally occurring respiratory disease and to evaluate the feasibility and safety of performing contrast-enhanced thoracic multi-detector MDCT examinations in sedated calves. Furthermore, to evaluate if combining CR or MDCT with respiratory scoring factors will improve prediction of the chronicity of pulmonary disease in calves. ANIMALS: Thirty Jersey heifer calves ranging in age between 25 and 89 days with naturally occurring respiratory disease. PROCEDURES: All calves were evaluated via thoracic CR and contrast-enhanced MDCT. All calves were euthanized immediately following thoracic MDCT and submitted for necropsy. Imaging and histopathology results were compared with each other. RESULTS: Thoracic MDCT was superior for evaluation of pneumonia in calves due to the lack of summation in all areas of the lungs. Intravenously administered sedation provided an adequate plane of sedation for acquiring MDCT images of diagnostic quality, without the need for re-scanning. A diagnosis of pneumonia was made with equal rate on both thoracic CR and MDCT. Although mild differences in classification of lung pattern and extent of lung disease were seen when comparing an experienced and a less experienced evaluator, the overall differences were not statistically significant. The best intra- and inter-observer agreement was noted when evaluating the cranioventral aspects of the lungs in either modality. Clinical respiratory scoring is inadequate for diagnosing chronicity of pneumonia in calves with naturally occurring pneumonia. CONCLUSION AND CLINICAL IMPORTANCE: Both imaging modalities allowed diagnosis of pneumonia in calves. The cranial ventral aspects of the lungs were most commonly affected. Thoracic CR and MDCT provided similar diagnostic effectiveness in diagnosing pneumonia. However, MDCT provided better assessment of subtle details, which may be otherwise obscured due to summation artifact.