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1.
N Engl J Med ; 385(1): 11-22, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34133854

RESUMEN

BACKGROUND: Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. METHODS: We performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation. RESULTS: Data were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups. CONCLUSIONS: We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue. (Funded by the European Union's Horizon 2020 Program and others; BATS ISRCTN number, ISRCTN69546370.).


Asunto(s)
Tratamiento Farmacológico de COVID-19 , Glucocorticoides/uso terapéutico , Inmunoglobulinas Intravenosas/uso terapéutico , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Adolescente , Anticuerpos Antivirales , COVID-19/inmunología , COVID-19/mortalidad , COVID-19/terapia , Niño , Preescolar , Estudios de Cohortes , Intervalos de Confianza , Quimioterapia Combinada , Femenino , Hospitalización , Humanos , Inmunomodulación , Masculino , Puntaje de Propensión , Análisis de Regresión , Respiración Artificial , SARS-CoV-2/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/mortalidad , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Resultado del Tratamiento
2.
Clin Infect Dis ; 76(3): e518-e521, 2023 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-35788276

RESUMEN

Little is known about the risk of multisystem inflammatory syndrome in children (MIS-C) with different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. In southeast England, MIS-C rates per confirmed SARS-CoV-2 infections in children aged 0-16 years were 56% lower (rate ratio [RR], 0.34 [95% confidence interval {CI}, .23-.50]) during prevaccine Delta, 66% lower (RR, 0.44 [95% CI, .28-.69]) during postvaccine Delta, and 95% lower (RR, 0.05 [95% CI, .02-.10]) during the Omicron period.


Asunto(s)
COVID-19 , Enfermedades del Tejido Conjuntivo , Infecciones por Coronavirus , Neumonía Viral , Niño , Humanos , SARS-CoV-2 , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología
3.
J Neurophysiol ; 130(1): 23-42, 2023 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-37255214

RESUMEN

We routinely have physical interactions with others, whether it be handing someone a glass of water or jointly moving a heavy object together. These sensorimotor interactions between humans typically rely on visual feedback and haptic feedback. Recent single-participant studies have highlighted that the unique noise and time delays of each sense must be considered to estimate the state, such as the position and velocity, of one's own movement. However, we know little about how visual feedback and haptic feedback are used to estimate the state of another person. Here, we tested how humans utilize visual feedback and haptic feedback to estimate the state of their partner during a collaborative sensorimotor task. Across two experiments, we show that visual feedback dominated haptic feedback during collaboration. Specifically, we found that visual feedback led to comparatively lower task-relevant movement variability, smoother collaborative movements, and faster trial completion times. We also developed an optimal feedback controller that considered the noise and time delays of both visual feedback and haptic feedback to estimate the state of a partner. This model was able to capture both lower task-relevant movement variability and smoother collaborative movements. Taken together, our empirical and modeling results support the idea that visual accuracy is more important than haptic speed to perform state estimation of a partner during collaboration.NEW & NOTEWORTHY Physical collaboration between two or more individuals involves both visual and haptic feedback. Here, we investigated how visual and haptic feedback is used to estimate the movements of a partner during a collaboration task. Our experimental and computational modeling results parsimoniously support the notion that greater visual accuracy is more important than faster yet noisier haptic feedback when estimating the state of a partner.


Asunto(s)
Retroalimentación Sensorial , Tecnología Háptica , Humanos , Simulación por Computador , Mano , Movimiento
4.
Proc Biol Sci ; 290(2009): 20231475, 2023 10 25.
Artículo en Inglés | MEDLINE | ID: mdl-37848061

RESUMEN

From a baby's babbling to a songbird practising a new tune, exploration is critical to motor learning. A hallmark of exploration is the emergence of random walk behaviour along solution manifolds, where successive motor actions are not independent but rather become serially dependent. Such exploratory random walk behaviour is ubiquitous across species' neural firing, gait patterns and reaching behaviour. The past work has suggested that exploratory random walk behaviour arises from an accumulation of movement variability and a lack of error-based corrections. Here, we test a fundamentally different idea-that reinforcement-based processes regulate random walk behaviour to promote continual motor exploration to maximize success. Across three human reaching experiments, we manipulated the size of both the visually displayed target and an unseen reward zone, as well as the probability of reinforcement feedback. Our empirical and modelling results parsimoniously support the notion that exploratory random walk behaviour emerges by utilizing knowledge of movement variability to update intended reach aim towards recently reinforced motor actions. This mechanism leads to active and continuous exploration of the solution manifold, currently thought by prominent theories to arise passively. The ability to continually explore muscle, joint and task redundant solution manifolds is beneficial while acting in uncertain environments, during motor development or when recovering from a neurological disorder to discover and learn new motor actions.


Asunto(s)
Aprendizaje , Refuerzo en Psicología , Humanos , Aprendizaje/fisiología , Recompensa , Movimiento/fisiología , Retroalimentación , Desempeño Psicomotor/fisiología
5.
J Neuroophthalmol ; 2023 Jul 13.
Artículo en Inglés | MEDLINE | ID: mdl-37440342

RESUMEN

BACKGROUND: We hypothesize that creation of a structured curriculum in neuro-ophthalmology principles might improve self-rated learner satisfaction and knowledge base of National Football League (NFL) game officials. Our initial objective is to create the said curriculum in coordination with game official experts and staff at the NFL to increase levels of understanding of neuro-ophthalmology principles. We reviewed the prior published literature on applicable neuro-ophthalmic principles in professional sports. Major neuro-ophthalmic principles reviewed include both the efferent (e.g., saccadic and pursuit eye movements and vestibulo-ocular reflex) and afferent (visual field, dynamic visual acuity during body movement, and selective attention deficits). METHODS: A 6-question survey pertaining to levels of understanding, future applicability, relevance, satisfaction, and interest in additional training was then given to 26 individuals before and after a lecture given by Dr. Andrew Lee in Plano, TX. The primary outcome measure was the creation of the curriculum followed by real-world testing for face and content validity and ending with a self-rated assessment. RESULTS: Twenty-one individuals completed the prelecture and postlecture survey out of 26 individuals who attended. Prelecture means for the level of understanding of oculomotor terms and the likelihood of using said terms were 3.4 and 3.2, respectively. Postlecture means were 8.9 and 8.8, respectively. The lecture was rated 9.2 of 10 for relevance to coaching and teaching officials, and individuals rated their interest in further content as 9.4 of 10. CONCLUSIONS: This study found that NFL game officials are interested in learning more about the science behind play-calling in terms of neuro-ophthalmology principles and practices. In addition, from our pilot survey, it is evident that even one lecture can improve participants' level of understanding and likelihood of learning more about neuro-ophthalmic principles.

6.
Pediatr Crit Care Med ; 22(11): e571-e581, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-33950888

RESUMEN

OBJECTIVES: Cardiopulmonary bypass surgery is complicated by metabolic acidosis, microvascular dysfunction, and capillary leak. The glycocalyx-a layer of proteins and sugars lining the vascular endothelium-is degraded during cardiopulmonary bypass. We aimed to describe the kinetics of glycocalyx degradation during and following cardiopulmonary bypass. We hypothesized that cleavage of negatively charged fragments of the glycocalyx would directly induce metabolic acidosis through changes in the strong ion gap (defined using Stewart's physicochemical approach to acid-base chemistry). We also investigated whether glycocalyx degradation was associated with failure of endothelial function and cardiovascular dysfunction. DESIGN: Single-center prospective cohort study. SETTING: Twenty-two bed surgical/medical PICU. PATIENTS: Twenty-seven term infants and children requiring cardiopulmonary bypass surgery for the correction/palliation of congenital heart disease. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We recruited 27 patients, 5 days to 57 months old. We prospectively sampled plasma prior to, during, and following cardiopulmonary bypass at predefined time points. We measured plasma concentrations of interleukin-6 (inflammatory marker), heparan sulfate (negatively charged glycocalyx glycosaminoglycan), and syndecan-1 (neutrally charged glycocalyx protein). We defined the following outcome measures: metabolic acidosis (strong ion gap), renal dysfunction (fold change in creatinine), capillary leak (fluid bolus volume), cardiovascular dysfunction (Vasoactive Inotropic Score), and length of ventilation. In linear regression models, maximum measured heparan sulfate concentration (negatively charged) was associated with metabolic acidosis (p = 0.016), renal dysfunction (p = 0.009), and length of ventilation (p = 0.047). In contrast, maximum measured syndecan-1 concentration (neutrally charged) was not associated with these clinical endpoints (p > 0.30 for all). CONCLUSIONS: Our data show that metabolic acidosis (increased strong ion gap) is associated with plasma concentration of heparan sulfate, a negatively charged glycosaminoglycan cleaved from the endothelial glycocalyx during cardiopulmonary bypass. In addition, cleavage of heparan sulfate was associated with renal dysfunction, capillary leak, and global markers of cardiovascular dysfunction. These data highlight the importance of designing translational therapies to protect the glycocalyx in cardiopulmonary bypass.


Asunto(s)
Acidosis , Glicocálix , Acidosis/etiología , Puente Cardiopulmonar/efectos adversos , Niño , Heparitina Sulfato , Humanos , Lactante , Estudios Prospectivos
7.
Cardiol Young ; 31(6): 1043-1047, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33504377

RESUMEN

Coronary artery aneurysms in children were observed as a rare complication associated with coronavirus disease 2019 (COVID-19). This case report describes the severe end of the spectrum of the new multisystem inflammatory syndrome in a 12-year-old child with coronary aneurysms, myocardial dysfunction, and shock, managed successfully with extracorporeal membrane oxygenation support and immunomodulation therapy. This report also highlights the additional benefits of cardiac CT in the diagnosis and follow-up of coronary aneurysms.


Asunto(s)
COVID-19 , Aneurisma Coronario , Oxigenación por Membrana Extracorpórea , Niño , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/etiología , Humanos , Inmunomodulación , SARS-CoV-2 , Síndrome de Respuesta Inflamatoria Sistémica , Tomografía Computarizada por Rayos X
9.
BMC Pediatr ; 18(1): 109, 2018 03 13.
Artículo en Inglés | MEDLINE | ID: mdl-29534694

RESUMEN

BACKGROUND: Dengue fever is a re-emerging viral disease commonly occurring in tropical and subtropical areas. The clinical features and abnormal laboratory test results of dengue infection are similar to those of other febrile illnesses; hence, its accurate and timely diagnosis for providing appropriate treatment is difficult. Delayed diagnosis may be associated with inappropriate treatment and higher risk of death. Early and correct diagnosis can help improve case management and optimise the use of resources such as hospital staff, beds, and intensive care equipment. The goal of this study was to develop a predictive model to characterise dengue severity based on early clinical and laboratory indicators using data mining and statistical tools. METHODS: We retrieved data from a study of febrile illness in children at Angkor Hospital for Children, Cambodia. Of 1225 febrile episodes recorded, 198 patients were confirmed to have dengue. A classification and regression tree (CART) was used to construct a predictive decision tree for severe dengue, while logistic regression analysis was used to independently quantify the significance of each parameter in the decision tree. RESULTS: A decision tree algorithm using haematocrit, Glasgow Coma Score, urine protein, creatinine, and platelet count predicted severe dengue with a sensitivity, specificity, and accuracy of 60.5%, 65% and 64.1%, respectively. CONCLUSIONS: The decision tree we describe, using five simple clinical and laboratory indicators, can be used to predict severe cases of dengue among paediatric patients on admission. This algorithm is potentially useful for guiding a patient-monitoring plan and outpatient management of fever in resource-poor settings.


Asunto(s)
Toma de Decisiones Clínicas/métodos , Árboles de Decisión , Dengue/diagnóstico , Índice de Severidad de la Enfermedad , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad , Dengue Grave/diagnóstico
10.
Psychol Res ; 82(3): 496-506, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-28243728

RESUMEN

A distinct learning advantage has been shown when participants control their knowledge of results (KR) scheduling during practice compared to when the same KR schedule is imposed on the learner without choice (i.e., yoked schedules). Although the learning advantages of self-controlled KR schedules are well-documented, the brain regions contributing to these advantages remain unknown. Identifying key brain regions would not only advance our theoretical understanding of the mechanisms underlying self-controlled learning advantages, but would also highlight regions that could be targeted in more applied settings to boost the already beneficial effects of self-controlled KR schedules. Here, we investigated whether applying anodal transcranial direct current stimulation (tDCS) to the primary motor cortex (M1) would enhance the typically found benefits of learning a novel motor skill with a self-controlled KR schedule. Participants practiced a spatiotemporal task in one of four groups using a factorial combination of KR schedule (self-controlled vs. yoked) and tDCS (anodal vs. sham). Testing occurred on two consecutive days with spatial and temporal accuracy measured on both days and learning was assessed using 24-h retention and transfer tests without KR. All groups improved their performance in practice and a significant effect for practicing with a self-controlled KR schedule compared to a yoked schedule was found for temporal accuracy in transfer, but a similar advantage was not evident in retention. There were no significant differences as a function of KR schedule or tDCS for spatial accuracy in retention or transfer. The lack of a significant tDCS effect suggests that M1 may not strongly contribute to self-controlled KR learning advantages; however, caution is advised with this interpretation as typical self-controlled learning benefits were not strongly replicated in the present experiment.


Asunto(s)
Retroalimentación Psicológica/fisiología , Conocimiento Psicológico de los Resultados , Aprendizaje/fisiología , Corteza Motora/fisiología , Destreza Motora/fisiología , Estimulación Transcraneal de Corriente Directa/métodos , Adulto , Femenino , Humanos , Masculino , Transferencia de Experiencia en Psicología/fisiología , Adulto Joven
11.
Dev Biol ; 409(2): 451-8, 2016 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-26610632

RESUMEN

Frontonasal dysplasia (FND) can have severe presentations that are medically and socially debilitating. Several genes are implicated in FND conditions, including Aristaless-Like Homeobox 1 (ALX1), which is associated with FND3. Breeds of cats are selected and bred for extremes in craniofacial morphologies. In particular, a lineage of Burmese cats with severe brachycephyla is extremely popular and is termed Contemporary Burmese. Genetic studies demonstrated that the brachycephyla of the Contemporary Burmese is a simple co-dominant trait, however, the homozygous cats have a severe craniofacial defect that is incompatible with life. The craniofacial defect of the Burmese was genetically analyzed over a 20 year period, using various genetic analysis techniques. Family-based linkage analysis localized the trait to cat chromosome B4. Genome-wide association studies and other genetic analyses of SNP data refined a critical region. Sequence analysis identified a 12bp in frame deletion in ALX1, c.496delCTCTCAGGACTG, which is 100% concordant with the craniofacial defect and not found in cats not related to the Contemporary Burmese.


Asunto(s)
Anomalías Craneofaciales/genética , Cara/anomalías , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Proteínas de Homeodominio/genética , Polimorfismo de Nucleótido Simple/genética , Animales , Cruzamiento , Gatos , Ligamiento Genético , Estudio de Asociación del Genoma Completo , Técnicas de Genotipaje
12.
J Neurophysiol ; 118(3): 1720-1731, 2017 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-28659461

RESUMEN

During continuous bimanual coordination, in-phase (IP; 0° relative phase) and anti-phase (AP; 180° relative phase) patterns can be stably performed without practice. Paradigms in which participants are required to intentionally switch between these coordination patterns have been used to investigate the interaction between the performer's intentions and intrinsic dynamics of the body's preferred patterns. The current study examined the processes associated with switching preparation and execution through the use of a startling acoustic stimulus (SAS) as the switch stimulus. A SAS is known to involuntarily trigger preprogrammed responses at a shortened latency and, thus, can be used to probe advance preparation. Participants performed cyclical IP and AP bimanual elbow extension-flexion movements in which they were required to switch patterns in response to an auditory switch cue, which was either nonstartling (80 dB) or a SAS (120 dB). Results indicated that reaction time to the switch stimulus (i.e., switch onset) was significantly reduced on startle trials, indicative of advance preparation of the switch response. Similarly, switching time was reduced on startle trials, which was attributed to increased neural activation caused by the SAS. Switching time was also shorter for AP to IP trials, but only when the switching stimulus occurred at either the midpoint or reversal locations within the movement cycle, suggesting that the switch location may affect the intrinsic dynamics of the system.NEW & NOTEWORTHY The current study provides novel information regarding preparation and execution of intentional switching between in-phase and anti-phase bimanual coordination patterns. Using a startling acoustic stimulus, we provide strong evidence that the switching response is prepared before the switch stimulus, and switch execution is accelerated by the startling stimulus. In addition, the time required to switch between patterns and relative limb contribution is dependent upon where in the movement cycle the switch stimulus occurred.


Asunto(s)
Mano/fisiología , Movimiento , Desempeño Psicomotor , Adulto , Retroalimentación Sensorial , Femenino , Humanos , Masculino
13.
Psychol Res ; 81(2): 399-406, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26892773

RESUMEN

The learning advantages of self-controlled knowledge-of-results (KR) schedules compared to yoked schedules have been linked to the optimization of the informational value of the KR received for the enhancement of one's error-detection capabilities. This suggests that information-processing activities that occur after motor execution, but prior to receiving KR (i.e., the KR-delay interval) may underlie self-controlled KR learning advantages. The present experiment investigated whether self-controlled KR learning benefits would be eliminated if an interpolated activity was performed during the KR-delay interval. Participants practiced a waveform matching task that required two rapid elbow extension-flexion reversals in one of four groups using a factorial combination of choice (self-controlled, yoked) and KR-delay interval (empty, interpolated). The waveform had specific spatial and temporal constraints, and an overall movement time goal. The results indicated that the self-controlled + empty group had superior retention and transfer scores compared to all other groups. Moreover, the self-controlled + interpolated and yoked + interpolated groups did not differ significantly in retention and transfer; thus, the interpolated activity eliminated the typically found learning benefits of self-controlled KR. No significant differences were found between the two yoked groups. We suggest the interpolated activity interfered with information-processing activities specific to self-controlled KR conditions that occur during the KR-delay interval and that these activities are vital for reaping the associated learning benefits. These findings add to the growing evidence that challenge the motivational account of self-controlled KR learning advantages and instead highlights informational factors associated with the KR-delay interval as an important variable for motor learning under self-controlled KR schedules.


Asunto(s)
Retroalimentación Psicológica , Conocimiento Psicológico de los Resultados , Práctica Psicológica , Adulto , Femenino , Humanos , Individualidad , Masculino , Destreza Motora , Desempeño Psicomotor , Factores de Tiempo , Adulto Joven
14.
J Sports Sci ; 34(17): 1650-6, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26707002

RESUMEN

Research has shown learning advantages for self-controlled practice contexts relative to yoked (i.e., experimenter-imposed) contexts; yet, explanations for this phenomenon remain relatively untested. We examined, via path analysis, whether self-efficacy and intrinsic motivation are important constructs for explaining self-controlled learning benefits. The path model was created using theory-based and empirically supported relationships to examine causal links between these psychological constructs and physical performance. We hypothesised that self-efficacy and intrinsic motivation would have greater predictive power for learning under self-controlled compared to yoked conditions. Participants learned double-mini trampoline progressions, and measures of physical performance, self-efficacy and intrinsic motivation were collected over two practice days and a delayed retention day. The self-controlled group (M = 2.04, SD = .98) completed significantly more skill progressions in retention than their yoked counterparts (M = 1.3, SD = .65). The path model displayed adequate fit, and similar significant path coefficients were found for both groups wherein each variable was predominantly predicted by its preceding time point (e.g., self-efficacy time 1 predicts self-efficacy time 2). Interestingly, the model was not moderated by group; thus, failing to support the hypothesis that self-efficacy and intrinsic motivation have greater predictive power for learning under self-controlled relative to yoked conditions.


Asunto(s)
Aprendizaje/fisiología , Motivación , Destreza Motora/fisiología , Autoeficacia , Adolescente , Niño , Femenino , Humanos , Masculino , Retención en Psicología
15.
JAMA ; 316(8): 835-45, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27552617

RESUMEN

IMPORTANCE: Because clinical features do not reliably distinguish bacterial from viral infection, many children worldwide receive unnecessary antibiotic treatment, while bacterial infection is missed in others. OBJECTIVE: To identify a blood RNA expression signature that distinguishes bacterial from viral infection in febrile children. DESIGN, SETTING, AND PARTICIPANTS: Febrile children presenting to participating hospitals in the United Kingdom, Spain, the Netherlands, and the United States between 2009-2013 were prospectively recruited, comprising a discovery group and validation group. Each group was classified after microbiological investigation as having definite bacterial infection, definite viral infection, or indeterminate infection. RNA expression signatures distinguishing definite bacterial from viral infection were identified in the discovery group and diagnostic performance assessed in the validation group. Additional validation was undertaken in separate studies of children with meningococcal disease (n = 24) and inflammatory diseases (n = 48) and on published gene expression datasets. EXPOSURES: A 2-transcript RNA expression signature distinguishing bacterial infection from viral infection was evaluated against clinical and microbiological diagnosis. MAIN OUTCOMES AND MEASURES: Definite bacterial and viral infection was confirmed by culture or molecular detection of the pathogens. Performance of the RNA signature was evaluated in the definite bacterial and viral group and in the indeterminate infection group. RESULTS: The discovery group of 240 children (median age, 19 months; 62% male) included 52 with definite bacterial infection, of whom 36 (69%) required intensive care, and 92 with definite viral infection, of whom 32 (35%) required intensive care. Ninety-six children had indeterminate infection. Analysis of RNA expression data identified a 38-transcript signature distinguishing bacterial from viral infection. A smaller (2-transcript) signature (FAM89A and IFI44L) was identified by removing highly correlated transcripts. When this 2-transcript signature was implemented as a disease risk score in the validation group (130 children, with 23 definite bacterial, 28 definite viral, and 79 indeterminate infections; median age, 17 months; 57% male), all 23 patients with microbiologically confirmed definite bacterial infection were classified as bacterial (sensitivity, 100% [95% CI, 100%-100%]) and 27 of 28 patients with definite viral infection were classified as viral (specificity, 96.4% [95% CI, 89.3%-100%]). When applied to additional validation datasets from patients with meningococcal and inflammatory diseases, bacterial infection was identified with a sensitivity of 91.7% (95% CI, 79.2%-100%) and 90.0% (95% CI, 70.0%-100%), respectively, and with specificity of 96.0% (95% CI, 88.0%-100%) and 95.8% (95% CI, 89.6%-100%). Of the children in the indeterminate groups, 46.3% (63/136) were classified as having bacterial infection, although 94.9% (129/136) received antibiotic treatment. CONCLUSIONS AND RELEVANCE: This study provides preliminary data regarding test accuracy of a 2-transcript host RNA signature discriminating bacterial from viral infection in febrile children. Further studies are needed in diverse groups of patients to assess accuracy and clinical utility of this test in different clinical settings.


Asunto(s)
Antígenos/sangre , Infecciones Bacterianas/diagnóstico , Proteínas del Citoesqueleto/sangre , Fiebre/microbiología , Fiebre/virología , ARN/sangre , Virosis/diagnóstico , Antibacterianos/administración & dosificación , Antígenos/genética , Área Bajo la Curva , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/genética , Biomarcadores/sangre , Preescolar , Coinfección/diagnóstico , Coinfección/microbiología , Coinfección/virología , Proteínas del Citoesqueleto/genética , Diagnóstico Diferencial , Femenino , Fiebre/sangre , Perfilación de la Expresión Génica , Marcadores Genéticos , Humanos , Lactante , Modelos Logísticos , Masculino , Estudios Prospectivos , ARN/análisis , ARN/genética , Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Virosis/complicaciones , Virosis/genética
16.
J Neurophysiol ; 113(3): 780-5, 2015 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-25376785

RESUMEN

Coordinated bimanual oscillatory movements often involve one of two intrinsically stable phasing relationships characterized as in-phase (symmetrical) or antiphase (asymmetrical). The in-phase mode is typically more stable than antiphase, and if movement frequency is increasing during antiphase movements, a spontaneous transition to the in-phase pattern occurs. There is converging neurophysiological evidence that the supplementary motor area (SMA) plays a critical role in the successful performance of these patterns, especially during antiphase movements. We investigated whether modulating the excitability of the SMA via offline transcranial direct current stimulation (tDCS) would delay the onset of anti-to-in-phase transitions. Participants completed two sessions (separated by ∼48 h), each consisting of a pre- and post-tDCS block in which they performed metronome-paced trials of rhythmic in- and antiphase bimanual supination-pronation movements as target oscillation frequency was systematically increased. Anodal or cathodal tDCS was applied over the SMA between the pre- and post-tDCS blocks in each session. Following anodal tDCS, participants performed the antiphase pattern with increased accuracy and stability and were able to maintain the coordination pattern at a higher oscillation frequency. Antiphase performance was unchanged following cathodal tDCS, and neither tDCS polarity affected the in-phase mode. Our findings suggest increased SMA excitability induced by anodal tDCS can improve antiphase performance and adds to the accumulating evidence of the pivotal role of the SMA in interlimb coordination.


Asunto(s)
Estimulación Encefálica Profunda , Corteza Motora/fisiología , Pronación , Supinación , Adulto , Electrodos , Femenino , Humanos , Masculino , Tiempo de Reacción
17.
Trop Med Int Health ; 20(1): 24-8, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25324202

RESUMEN

OBJECTIVE: Antibiotic resistance is a prominent public and global health concern. We investigated antibiotic use in children by determining the proportion of unselected children with antibacterial activity in their urine attending a paediatric outpatient department in Siem Reap, Cambodia. METHODS: Caregiver reports of medication history and presence of possible infection symptoms were collected in addition to urine samples. Urine antibiotic activity was estimated by exposing bacteria to urine specimens, including assessment against multiresistant bacteria previously isolated from patients in the hospital (a methicillin-resistant Staphylococcus aureus (MRSA), a multiresistant Salmonella typhi and an extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli isolate). RESULTS: Medication information and urine were collected from 775 children. Caregivers reported medication use in 69.0% of children in the preceding 48 h. 31.7% samples showed antibacterial activity; 16.3% showed activity against a local multiresistant organism. No specimens demonstrated activity against an ESBL-producing E. coli. CONCLUSIONS: Antibiotics are widely used in the community setting in Cambodia. Parents are often ill-informed about drugs given to treat their children. Increasing the regulation and training of private pharmacies in Cambodia may be necessary. Regional surveillance of antibiotic use and resistance is also essential in devising preventive strategies against further development of antibiotic resistance, which would have both local and global consequences.


Asunto(s)
Antibacterianos/orina , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Orina/química , Antibacterianos/farmacología , Cambodia , Niño , Preescolar , Escherichia coli/efectos de los fármacos , Femenino , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Pacientes Ambulatorios , Salmonella typhi/efectos de los fármacos , beta-Lactamasas/efectos de los fármacos
18.
Exp Brain Res ; 233(9): 2673-83, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26026810

RESUMEN

Previous studies have used a secondary probe reaction time (RT) task to assess attentional demands of a primary task. The current study used a startling acoustic stimulus (SAS) in a probe RT paradigm to test the hypothesis that attentional resources would be directly related to limitations in response preparation. Participants performed an easy or difficult version of a continuous primary task that was either primarily motor in nature (pursuit tracking) or cognitive (counting backward). Concurrently, participants responded to an auditory cue as fast as possible by performing a wrist extension secondary movement. On selected trials, the auditory cue was replaced with a SAS (120 dB), which is thought to involuntarily trigger a prepared response and thus bypass any response initiation bottleneck that may be present when trying to perform two movements. Although startle trials were performed at a shorter latency, both non-startle and startle probe trials resulted in a delayed RT, as compared to single-task trials, consistent with reduced preparation of the secondary task. In addition, analysis of SAS trial RT when a startle indicator was present versus absent provided evidence that the secondary task was at a lowered state of preparation when engaged in the cognitive primary task as compared to a motor primary task, suggesting a facilitative effect on preparatory activation when both the primary and secondary tasks are motoric in nature.


Asunto(s)
Movimiento/fisiología , Músculo Esquelético/fisiología , Desempeño Psicomotor/fisiología , Reflejo de Sobresalto/fisiología , Estimulación Acústica , Adolescente , Adulto , Análisis de Varianza , Electromiografía , Femenino , Humanos , Masculino , Psicoacústica , Tiempo de Reacción/fisiología , Adulto Joven
19.
Conserv Biol ; 28(6): 1699-709, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24976050

RESUMEN

Understanding spatial and temporal variability in the distribution of species is fundamental to the conservation of marine and terrestrial ecosystems. To support strategic decision making aimed at sustainable management of the oceans, such as the establishment of protected areas for marine wildlife, we identified areas predicted to support multispecies seabird aggregations in the Timor Sea. We developed species distribution models for 21 seabird species based on at-sea survey observations from 2000-2013 and oceanographic variables (e.g., bathymetry). We applied 4 statistical modeling techniques and combined the results into an ensemble model with robust performance. The ensemble model predicted the probability of seabird occurrence in areas where few or no surveys had been conducted and demonstrated 3 areas of high seabird richness that varied little between seasons. These were located within 150 km of Adele Island, Ashmore Reef, and the Lacepede Islands, 3 of the largest aggregations of breeding seabirds in Australia. Although these breeding islands were foci for high species richness, model performance was greatest for 3 nonbreeding migratory species that would have been overlooked had regional monitoring been restricted to islands. Our results indicate many seabird hotspots in the Timor Sea occur outside existing reserves (e.g., Ashmore Reef Marine Reserve), where shipping, fisheries, and offshore development likely pose a threat to resident and migratory populations. Our results highlight the need to expand marine spatial planning efforts to ensure biodiversity assets are appropriately represented in marine reserves. Correspondingly, our results support the designation of at least 4 new important bird areas, for example, surrounding Adele Island and Ashmore Reef.


Asunto(s)
Distribución Animal , Aves/fisiología , Conservación de los Recursos Naturales , Animales , Océano Índico , Modelos Biológicos , Australia Occidental
20.
Adv Mater ; : e2312087, 2024 Feb 28.
Artículo en Ro | MEDLINE | ID: mdl-38419481

RESUMEN

Lightweight, low-cost metasurfaces and reflectarrays that are easy to stow and deploy are desirable for many terrestrial and space-based communications and sensing applications. This work demonstrates a lightweight, flexible metasurface platform based on flat-knit textiles operating in the cm-wave spectral range. By using a colorwork knitting approach called float-jacquard knitting to directly integrate an array of resonant metallic antennas into a textile, two textile reflectarray devices, a metasurface lens (metalens), and a vortex-beam generator are realized. Operating as a receiving antenna, the metalens focuses a collimated normal-incidence beam to a diffraction-limited, off-broadside focal spot. Operating as a transmitting antenna, the metalens converts the divergent emission from a horn antenna into a collimated beam with peak measured directivity, gain, and efficiency of 21.30, 15.30, and -6.00 dB (25.12%), respectively. The vortex-beam generating metasurface produces a focused vortex beam with a topological charge of m = 1 over a wide frequency range of 4.1-5.8 GHz. Strong specular reflection is observed for the textile reflectarrays, caused by wavy yarn floats on the backside of the float-jacquard textiles. This work demonstrates a novel approach for the scalable production of flexible metasurfaces by leveraging commercially available yarns and well-established knitting machinery and techniques.

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