Influences of a remote monitoring program of home nasogastric tube feeds on transition from NICU to home.

OBJECTIVE: The transition from the neonatal intensive care unit (NICU) to the home is complex and multifaceted for families and infants, particularly those with ongoing medical needs. Our hospital utilizes a remote monitoring program called Growing @ Home (G@H) to support discharge from the NICU with continued nasogastric tube feeds. We aim to describe the experience of the transition from NICU to home for families enrolled in G@H. STUDY DESIGN: Using a semi-structured interviewing technique, parents of infants discharged on G@H were interviewed at NICU discharge, at 1-month, and at 6-months after NICU discharge. Interviews were recorded and transcribed into data analysis software. Conventional content analysis was used to analyze qualitative data. Codes were assigned to describe key elements of the interviews and used to identify major themes. RESULTS: Parents (n=11) identified three major themes when discussing the effect of G@H on the transition to home. The program provided a means of escape from the NICU, allowing families to stop living split lives between their homes and the NICU. It acted as a middle ground between the restrictive yet supportive NICU environment, and the normal yet isolated home environment. G@H served as a safety net for families, providing the continued connection to the NICU for their still fragile infants. CONCLUSION: G@H utilizes telehealth to positively support the complex transition from NICU to home for families and infants discharged with nasogastric tube feeds.

Growth of wood-inhabiting yeasts of the Faroe Islands in the presence of spent sulphite liquor.

In the microbial community of decaying wood, yeasts are important for the recycling of nutrients. Nevertheless, information on their biodiversity in this niche in the Northern hemisphere is limited. Wood-colonising yeasts encounter identical and similar growth-inhibitory compounds as those in spent sulphite liquor (SSL), an energy-rich, acid hydrolysate and waste product from the paper industry, which may render them well-suited for cultivation in SSL. In the present study, yeasts were isolated from decaying wood on the Faroe Islands and identified based on sequence homology of the ITS and D1/D2 regions. Among the yeasts isolated, Candida argentea, Cystofilobasidium infirmominiatum, Naganishia albidosimilis, Naganishia onofrii, Holtermanniella takashimae and Goffeauzyma gastrica were new to decaying wood in cold and temperate climates. C. argentea and Rhodotorula are rarely-isolated species, with no previous documentation from cold and maritime climates. The isolates were further tested for growth in a medium with increasing concentrations of softwood SSL. Most grew in the presence of 10% SSL. Isolates of Debaryomyces sp., C. argentea and Rhodotorula sp. were the most tolerant. Representatives of Debaryomyces and Rhodotorula have previously been found in decaying wood. In contrast, the least tolerant isolates belonged to species that are rarely reported from decaying wood. The relative importance of individual inhibitors to yeast growth is discussed. To our knowledge, none of the present yeast species have previously been cultivated in SSL medium. Decaying wood can be a useful future source of yeasts for valorisation of various hydrolysates to industrial chemicals and biofuels.

Botrytis cinerea differentially induces postharvest antioxidant responses in 'Braeburn' and 'Golden Delicious' apple fruit.

BACKGROUND: The fruit of two apple cultivars - 'Braeburn', which is susceptible to inoculation with Botrytis cinerea, and the less susceptible cv. 'Golden Delicious' - were investigated with respect to their response to inoculation with B. cinerea. Successful infection by B. cinerea leads to an oxidative burst and perturbation of plant redox homeostasis. To investigate the interaction between apple fruit and B. cinerea, antioxidant metabolism in fruit samples from sun-exposed and shaded sides of different tissue types was measured over time. RESULTS: The sun-exposed tissue of 'Braeburn' had higher initial levels of total vitamin C in the peel and phenolic compounds in the flesh than 'Golden Delicious', despite its greater susceptibility to gray mold. A substantial antioxidant response was recorded in diseased 'Braeburn' fruit 14 days after inoculation, which involved an elevated superoxide dismutase activity and ascorbate peroxidase activity, a progressive oxidation of total vitamin C, and a decrease in peroxidase activity and phenolic content. Disease development was slower on the sun-exposed sides than on the shaded sides. CONCLUSION: The two cultivars appeared to utilize different strategies to defend themselves against B. cinerea. 'Golden Delicious' almost entirely escaped infection. Preharvest exposure of apple fruit to high light / temperature stress appears to prepare them to better resist subsequent postharvest attack and disease. © 2019 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Familial Association of Granulocyte-Macrophage Colony-Stimulating Factor Autoantibodies in Inflammatory Bowel Disease.

OBJECTIVES: Elevated granulocyte-macrophage colony-stimulating factor auto-antibodies (GM-CSF Ab) are associated with increased intestinal permeability and stricturing behavior in Crohn disease (CD). We tested for familial association of serum GM-CSF Ab level in CD and ulcerative colitis (UC) families. METHODS: Serum GM-CSF Ab concentration was determined in 230 pediatric CD probands and 404 of their unaffected parents and siblings, and 45 UC probands and 71 of their unaffected parents and siblings. A linear mixed effects model was used to test for familial association. The intra-class correlation coefficient (ICC) was used to determine the degree of association of the serum GM-CSF Ab level within families in comparison with the degree of association among families. RESULTS: The median (IQR) serum GM-CSF Ab concentration was higher in CD probands than in UC probands (1.5 [0.5,5.4] µg/mL vs 0.7 [0.3, 1.6] µg/mL, P = 0.0002). The frequency of elevated serum GM-CSF Ab concentration ≥1.6 µg/mL was increased in unaffected siblings of CD probands with elevated GM-CSF Ab, compared with unaffected siblings of CD probands without elevated GM-CSF Ab (33% vs 13%, respectively, P = 0.04). A similar result was observed within UC families. In families of CD patients, the mean (95th CI) ICC was equal to 0.153 (0.036, 0.275), P = 0.001, whereas in families of UC patients, the mean (95th CI) ICC was equal to 0.27 (0.24, 0.31), P = 0.047. CONCLUSIONS: These data confirmed familial association of serum GM-CSF Ab levels. This could be accounted for by either genetic or environmental factors shared within the family.

Isotopic Labeling Studies Reveal the Patulin Detoxification Pathway by the Biocontrol Yeast Rhodotorula kratochvilovae LS11.

Patulin (1) is a mycotoxin contaminant in fruit and vegetable products worldwide. Biocontrol agents, such as the yeast Rhodotorula kratochvilovae strain LS11, can reduce patulin (1) contamination in food. R. kratochvilovae LS11 converts patulin (1) into desoxypatulinic acid (DPA) (5), which is less cytotoxic than the mycotoxin (1) to in vitro human lymphocytes. In the present study, we report our investigations into the pathway of degradation of patulin (1) to DPA (5) by R. kratochvilovae. Isotopic labeling experiments revealed that 5 derives from patulin (1) through the hydrolysis of the γ-lactone ring and subsequent enzymatic modifications. The ability of patulin (1) and DPA (5) to cause genetic damage was also investigated by the cytokinesis-block micronucleus cytome assay on in vitro human lymphocytes. Patulin (1) was demonstrated to cause much higher chromosomal damage than DPA (5).

Implementation of an Evidence-Based and Content Validated Standardized Ostomy Algorithm Tool in Home Care: A Quality Improvement Project.

Many nurses have limited experience with ostomy management. We sought to provide a standardized approach to ostomy education and management to support nurses in early identification of stomal and peristomal complications, pouching problems, and provide standardized solutions for managing ostomy care in general while improving utilization of formulary products. This article describes development and testing of an ostomy algorithm tool.

Challenges to breastfeeding infants with phenylketonuria.

Breastfeeding duration for infants with phenylketonuria (PKU) is less than other full-term infants. However, no study has examined the challenges encountered by mothers' breastfeeding infants with PKU. In 75 mothers of a child with PKU, three categories of breastfeeding challenges were identified: common breastfeeding issues, breastfeeding and PKU, and no challenges. The common breastfeeding issues can be identified in the literature but for these mothers, the issues are heightened due to frequent phenylalanine (Phe) monitoring. Even so, many mothers adapt breastfeeding to maintain desired Phe levels. A few mothers had no issues and were the exception, not the norm.

Hippocampal spatial mapping and the acquisition of competing responses.

Response reversal learning is facilitated in many species, including humans, when competing responses occur in separate contexts. This suggests hippocampal maps may facilitate the acquisition of competing responses and is consistent with the hypothesis that contextual encoding permits rapid acquisition of new behaviors in similar environments. To test this hypothesis, the pattern of Arc expression was examined after rats completed a series of left/right response reversals in a T-maze. This reversal training occurred in the same room, two different rooms, or within a single room but with the maze enclosed in wall-length curtains of different configurations (i.e., black/white square or circle). Across CA1 and CA3, successive T-maze exposures in the same room recruited the same cells to repeatedly transcribe Arc, while a unique population of cells transcribed Arc in response to each of two different rooms as well as to the two unique curtain configurations in the same room. The interference from original learning that was evident on the first reversal in animals without a context switch was absent in groups that experienced changes in room or curtain configuration. However, only the use of unique rooms, and not changes in the curtained enclosure, facilitated learning across response reversals relative to the groups exposed to only one room. Thus, separate hippocampal maps appear to provide protection from the original learning interference but do not support improved reversals over trials. The present data suggest changes in heading direction input, rather than remapping, are the source of facilitation of reversal learning.

Branching Path Simulation for Pediatric Nurse Practitioner Students to Promote Critical Thinking: A Quasi-Experimental Study.

INTRODUCTION: Branching path simulation (BPS) is an active learning pedagogy incorporating gaming principles in a low-stakes, safe environment. No study has explored the use of BPS in advanced practice nursing education. This study measured pediatric nurse practitioner students' perception of the integration of BPS in one graduate-level course. METHOD: This study used a one group, post-test only quasi-experimental design with a convenience sample of 22 pediatric nurse practitioner students over 2 years enrolled in a university in the Pacific Northwest United States. RESULTS: Responses to BPS were positive: design (M = 4.8; SD ± 0.4), usability (M = 4.3; SD ± 1.0), self-confidence (M = 4.2; SD ± 0.8) and satisfaction (M = 4.8; SD ± 0.4). DISCUSSION: BPS was well received by learners. It not only provides immediate feedback and encourages students to identify their clinical management weaknesses and strengths but it also can be customized to needs in a course at a significant cost saving.

Breast-feeding success among infants with phenylketonuria.

Breast milk is the nutrition of choice for human infants (American Academy of Pediatrics, 2005; American Association of Family Physicians, 2008; Association of Women's Health Obstetric and Neonatal Nurses, 2005; Canadian Paediatric Society, 2005; U.S. Preventive Services Task Force, 2008; World Health Organization, 2009). In comparison to standard commercial formula, human breast milk has a lower concentration of protein and a lower content of the amino acid phenylalanine (Phe). For infants with phenylketonuria (PKU), these attributes of human breast milk make it ideal as a base source of nutrition. The purpose of this study was to compare the incidence and duration of breast-feeding and corresponding Phe levels of breast-fed and formula-fed infants with PKU in the caseload of a pediatric metabolic clinic at an urban tertiary-care medical center. Charts were reviewed for infants diagnosed with PKU beginning with 2005 and ending with 1980, the year no further breast-feeding cases were identified in the PKU population. During the first year of life, most of the infants, whether breast-fed or formula-fed, had similar mean Phe levels. However, the frequency distributions revealed that more breast-fed infants with PKU had Phe levels within the normal range (120-360 µmol/L) and were less likely to have low Phe levels (<120 µmol/L) than formula-fed infants with PKU. Further research is needed to understand how mothers manage breast-feeding in the context of PKU.

Development of resources for the analysis of gene function in Pucciniomycotina red yeasts.

The Pucciniomycotina is an important subphylum of basidiomycete fungi but with limited tools to analyze gene functions. Transformation protocols were established for a Sporobolomyces species (strain IAM 13481), the first Pucciniomycotina species with a completed draft genome sequence, to enable assessment of gene function through phenotypic characterization of mutant strains. Transformation markers were the URA3 and URA5 genes that enable selection and counter-selection based on uracil auxotrophy and resistance to 5-fluoroorotic acid. The wild type copies of these genes were cloned into plasmids that were used for transformation of Sporobolomyces sp. by both biolistic and Agrobacterium-mediated approaches. These resources have been deposited to be available from the Fungal Genetics Stock Center. To show that these techniques could be used to elucidate gene functions, the LEU1 gene was targeted for specific homologous replacement, and also demonstrating that this gene is required for the biosynthesis of leucine in basidiomycete fungi. T-DNA insertional mutants were isolated and further characterized, revealing insertions in genes that encode the homologs of Chs7, Erg3, Kre6, Kex1, Pik1, Sad1, Ssu1 and Tlg1. Phenotypic analysis of these mutants reveals both conserved and divergent functions compared with other fungi. Some of these strains exhibit reduced resistance to detergents, the antifungal agent fluconazole or sodium sulfite, or lower recovery from heat stress. While there are current experimental limitations for Sporobolomyces sp. such as the lack of Mendelian genetics for conventional mating, these findings demonstrate the facile nature of at least one Pucciniomycotina species for genetic manipulation and the potential to develop these organisms into new models for understanding gene function and evolution in the fungi.

Genetic diversity and pathogenic potential of Shiga toxin-producing Escherichia coli (STEC) derived from German flour.

Shiga toxin-producing Escherichia coli (STEC) can cause severe human illness, which are frequently linked to the consumption of contaminated beef or dairy products. However, recent outbreaks associated with contaminated flour and undercooked dough in the United States and Canada, highlight the potential of plant based food as transmission routes for STEC. In Germany STEC has been isolated from flour, but no cases of illness have been linked to flour. In this study, we characterized 123 STEC strains isolated from flour and flour products collected between 2015 and 2019 across Germany. In addition to determination of serotype and Shiga toxin subtype, whole genome sequencing (WGS) was used for isolates collected in 2018 to determine phylogenetic relationships, sequence type (ST), and virulence-associated genes (VAGs). We found a high diversity of serotypes including those frequently associated with human illness and outbreaks, such as O157:H7 (stx2c/d, eae), O145:H28 (stx2a, eae), O146:H28 (stx2b), and O103:H2 (stx1a, eae). Serotypes O187:H28 (ST200, stx2g) and O154:H31 (ST1892, stx1d) were most prevalent, but are rarely linked to human cases. However, WGS analysis revealed that these strains, as well as, O156:H25 (ST300, stx1a) harbour high numbers of VAGs, including eae, nleB and est1a/sta1. Although STEC-contaminated flour products have yet not been epidemiologically linked to human clinical cases in Germany, this study revealed that flour can serve as a vector for STEC strains with a high pathogenic potential. Further investigation is needed to determine the sources of STEC contamination in flour and flour products particularly in regards to these rare serotypes.

Differences in methylation at GATC sites in genomic DNA of Campylobacter coli from turkeys and swine.

A significant fraction (46/108, 43%) of swine isolates of Campylobacter coli but none of 81 isolates of C. coli from turkeys had genomic DNA that was resistant to digestion by MboI, suggesting methylation of adenines at GATC sites. No consistent association was noted between antimicrobial resistance and MboI resistance. Seven swine-associated multilocus sequence typing-based sequence types (STs) were detected among multiple isolates with MboI-resistant DNA. The data suggest host-associated DNA modification system(s) specific for adenine at GATC sites in C. coli from swine.

Further Study of the Effects of Treatment Intensity on Outcomes of Sound Production Treatment for Acquired Apraxia of Speech: Does Dose Frequency Matter?

Purpose The aim of this study was to examine the effects of dose frequency, an aspect of treatment intensity, on articulation outcomes of sound production treatment (SPT). Method Twelve speakers with apraxia of speech and aphasia received SPT administered with an intense dose frequency and a nonintense/traditional dose frequency (SPT-T). Each participant received both treatment intensities in the context of multiple baseline designs across behaviors. SPT-Intense was provided for 3 hourly sessions per day/3 days per week; and SPT-T for 1 hour-long session per day/3 days per week. Twenty-seven treatment sessions were completed with each phase of treatment. Articulation accuracy was measured in probes of production of treated and untreated words. Results All participants achieved improved articulation of treated words with both intensities; there were no notable differences in magnitude of improvement associated with dose frequency. Positive response generalization to untrained words was found in 21 of 24 treatment applications; the cases of negligible response generalization occurred with SPT-T words. Conclusions Dose frequency (and corresponding total intervention duration) did not appear to impact treatment response for treated items. Disparate response generalization findings for 3 participants in the current study may relate to participant characteristics such as apraxia of speech severity and/or stimuli factors.

Antimicrobial susceptibility profiles and strain type diversity of Campylobacter jejuni isolates from turkeys in eastern North Carolina.

Campylobacter jejuni is one of the most common bacterial causes of human gastroenteritis, and recent findings suggest that turkeys are an important reservoir for this organism. In this study, 80 C. jejuni isolates from eastern North Carolina were characterized for resistance to nine antimicrobials, and strain types were determined by fla typing, pulsed-field gel electrophoresis (PFGE) with SmaI and KpnI, and (for 41 isolates) multilocus sequence typing (MLST). PFGE analysis suggested that many of the isolates (37/40 [ca. 93%]) in a major genomic cluster had DNA that was partially methylated at SmaI sites. Furthermore, 12/40 (30%) of the isolates in this cluster were completely resistant to digestion by KpnI, suggesting methylation at KpnI sites. MLST of 41 isolates identified 10 sequence types (STs), of which 4 were new. Three STs (ST-1839, ST-2132 and the new ST-2934) were predominant and were detected among isolates from different farms. The majority of the isolates (74%) were resistant to three or more antimicrobials, and resistance to ciprofloxacin was common (64%), whereas resistance to the other drug of choice for treatment of human campylobacteriosis, erythromycin, was never encountered. Most (33/34) of the kanamycin-resistant isolates were also resistant to tetracycline; however, only ca. 50% of the tetracycline-resistant isolates were also kanamycin resistant. Isolates with certain antimicrobial resistance profiles had identical or closely related strain types. Overall, the findings suggest dissemination of certain clonal groups of C. jejuni isolates in the turkey production industry of this region.

The contribution of spatial cues to memory: direction, but not cue, changes support response reversal learning.

In four experiments, rats were trained on a response problem followed by three reversals. Rats that changed rooms between acquisition and reversals learned the reversals in fewer trials than rats that remained in the same room, even when distal visual cues were limited. Changes in orientation, even in the same room, also facilitated response reversal learning. The advantage observed with changes in orientation across reversals does not appear to be due to differences in local views or to different start positions. Direction changes, but not cue changes, may support response reversal learning by taking advantage of the natural interaction between responses and direction when one map is used.

Language Changes Following Combined Aphasia and Apraxia of Speech Treatment.

Purpose: Combined Aphasia and Apraxia of Speech Treatment (CAAST) is a newly developed treatment shown to increase production of accurate content in narrative discourse for persons with aphasia and apraxia of speech. The purpose of this post hoc study was to further describe lexical and morphosyntactic changes associated with changes in content production. Method: Existing probe data from 8 persons with aphasia who had completed CAAST were used to complete analyses of morphosyntactic production, lexical diversity, and novelty of content. Language analyses were completed using discourse samples obtained at numerous pretreatment and posttreatment intervals. Results: All participants demonstrated gains in morphosyntactic language output for treated items, which extended to untreated sets for 7 participants. All 8 increased in production of novel content. Lexical diversity increases were evident for most participants. Although there were some similarities in language changes, there was substantial variability across response profiles. Conclusion: CAAST, previously associated with positive treatment effects for production of accurate content, also appears to facilitate acquisition and generalization of morphosyntactic complexity, lexical diversity, and novelty of content for individuals with nonfluent aphasia. Further investigation is needed to determine causality and appropriate clinical application. Supplemental Material: https://doi.org/10.23641/asha.5912530.

Biotransformation of vanillin into vanillyl alcohol by a novel strain of Cystobasidium laryngis isolated from decaying wood.

Vanillin is an aromatic aldehyde found as a component of lignocellulosic material, and in the cured pods of orchidaceae plants. Like other phenolic substances, vanillin has antimicrobial activity and can be extracted from lignin either by a thermo-chemical process or through microbial degradation. Vanillin, can serve as a model monomer in biodegradation studies of lignin. In the present study, a yeast isolated from decaying wood on the Faroe Islands, was identified as Cystobasidium laryngis strain FMYD002, based on internal transcribed spacer sequence analysis. It demonstrated the ability to convert vanillin to vanillyl alcohol, as detected by ultra-high performance liquid chromatography-quadrupole-time-of-flight. Structural analysis of vanillyl alcohol was carried out by using gas chromatography-mass spectrometry and 1H NMR spectroscopy, and further verified by synthesis. The reduction of vanillin to vanillyl alcohol has been documented for only a few species of fungi. However, to our knowledge, this biotransformation has not yet been reported for basidiomycetous yeast species, nor for any representative of the subphylum Pucciniomycotina. The biotransformation capability of the present strain might prove useful in the industrial utilisation of lignocellulosic residues.

Combined aphasia and apraxia of speech treatment (CAAST): Systematic replications in the development of a novel treatment.

PURPOSE: The purpose of this investigation was to examine the effects of a modified version of a newly developed therapy for aphasia and acquired apraxia of speech (AOS), Combined Aphasia and Apraxia of Speech Treatment (CAAST). METHOD: Four speakers with chronic AOS and aphasia received CAAST in the context of multiple baseline designs. Dependent variables included language measures (i.e. production of correct information units (CIUs)) and speech production measures (i.e. speech intelligibility and percent correct consonants (PCC) in sentence repetition). RESULT: Three of the participants demonstrated improved CIU production with treated picture sets and two also demonstrated generalization to untreated sets. All participants achieved substantially increased CIU production in an untrained discourse context. Speech intelligibility increased for three of the participants and increases in PCC were observed for all of the participants at two weeks post-treatment. However, PCC improvements were maintained for only two of the speakers at six weeks post-treatment. CONCLUSION: The revised CAAST protocol was associated with improved changes in speech and generalization across contexts in comparison to the previous iteration of CAAST. However, focus on sentence production in generalization practice may have been detrimental to CIU production for one participant.

Effects of Treatment Intensity on Outcomes in Acquired Apraxia of Speech.

Purpose: This investigation was designed to examine the effects of treatment intensity (i.e., dose frequency) on the outcomes of Sound Production Treatment (SPT) for acquired apraxia of speech. Method: Five men with chronic apraxia of speech and aphasia received both intense SPT (3 hr per day/3 days per week) and nonintense/traditional SPT (SPT-T; 1 hr per day/3 days per week) in the context of single-case experimental designs. Each treatment was applied separately to a designated set of experimental words with 1 treatment applied at a time. Twenty-seven treatment sessions were conducted with each phase of treatment. Accuracy of articulation of target sounds within treated and untreated experimental words was measured during the course of the investigation. Results: All participants demonstrated improved articulation with both treatment intensities. Better maintenance of gains for treated items was found with SPT-T for 2 participants as measured at an 8-week posttreatment retention probe. Superior maintenance of increased accuracy of production of untreated items was also observed with SPT-T for all participants. Conclusion: A less intense (distributed) application of SPT facilitated better maintenance of improved articulatory accuracy for untreated items, and in some cases treated items, than intense SPT. Supplemental Materials: https://doi.org/10.23641/asha.5734053.