Epidemiology and treatment of invasive Bartonella spp. infections in the United States.

OBJECTIVES: Bartonella spp., renowned for cat-scratch disease, has limited reports of dissemination. Tissue and blood cultures have limitations in detecting this fastidious pathogen. Molecular testing (polymerase chain reaction, PCR) and cell-free DNA have provided an avenue for diagnoses. This retrospective observational multicenter study describes the incidence of disseminated Bartonella spp. and treatment-related outcomes. METHODS: Inclusion criteria were diagnosis of bartonellosis via diagnosis code, serology testing of blood, polymerase chain reaction (PCR) of blood, 16/18S tests of blood or tissue, cultures of blood or tissue, or cell-free DNA of blood or tissue from January 1, 2014, through September 1, 2021. Exclusions were patients who did not receive treatment, insufficient data on treatment course, absence of dissemination, or retinitis as dissemination. RESULTS: Patients were primarily male (n = 25, 61.0%), white (n = 28, 68.3%), with mean age of 50 years (SD 14.4), and mean Charlson comorbidity index of 3.5 (SD 2.1). Diagnosis was primarily by serology (n = 34, 82.9%), with Bartonella henselae (n = 40, 97.6%) as the causative pathogen. Treatment was principally doxycycline with rifampin (n = 17, 41.5%). Treatment failure occurred in 16 (39.0%) patients, due to escalation of therapy during treatment (n = 5, 31.3%) or discontinuation of therapy due to an adverse event or tolerability (n = 5, 31.3%). CONCLUSIONS: In conclusion, this is the largest United States-based cohort of disseminated Bartonella spp. infections to date with a reported 39% treatment failure. This adds to literature supporting obtaining multiple diagnostic tests when Bartonella is suspected and describes treatment options.

Young children spontaneously devise an optimal external solution to a cognitive problem.

Metacognition plays an essential role in adults' cognitive offloading decisions. Despite possessing basic metacognitive capacities, however, preschool-aged children often fail to offload effectively. Here, we introduced 3- to 5-year-olds to a novel search task in which they were unlikely to perform optimally across trials without setting external reminders about the location of a target. Children watched as an experimenter first hid a target in one of three identical opaque containers. The containers were then shuffled out of view before children had to guess where the target was hidden. In the test phase, children could perform perfectly by simply placing a marker in a transparent jar attached to the target container prior to shuffling, and then later selecting the marked container. Children of all ages used this external strategy above chance levels if they had seen it demonstrated to them, but only the 4- and 5-year-olds independently devised the strategy to improve their future performance. These results suggest that, when necessary for optimal performance, even 4- and 5-year-olds can use metacognitive knowledge about their own future uncertainty to deploy effective external solutions.

No Association Between Processing Speed and Risk of Sport-Related Concussion in Youth Soccer.

OBJECTIVE: To determine whether slow processing speed is associated with risk of sport-related concussion. DESIGN: We conducted a retrospective cohort study using computerized neurocognitive assessments (Immediate Post-concussion Assessment and Cognitive Testing [ImPACT]) from the Massachusetts Concussion Management Coalition. Slow processing speed was defined as 2 SD below the sample mean (n = 131) and fast processing speed as 2 SD above the sample mean (n = 259). We used a binary logistic regression model to determine the odds of sustaining a concussion with our main predictor being processing speed (high or low) adjusted for the effects of age, sex, and prior number of concussions. SETTING: Massachusetts Concussion Management Coalition, Institutional care. PARTICIPANTS: Three hundred ninety junior high soccer players ages 10 to 15 with a baseline score for ImPACT. INDEPENDENT VARIABLES: Processing Speed. MAIN OUTCOME MEASURES: Risk of sustaining a concussion. RESULTS: Those with slow processing speed had a visual motor composite score of ≤19.92, those with fast-processing speed had a score of ≥46.20. Athletes with slow processing speed were younger (13 vs 14 years; P < 0.001) and more likely to be male (57% vs 49%; P = 0.014). After adjusting for the effects of age, sex, and prior concussions, there was no significant difference in the odds of sustaining a concussion between groups (aOR 1.01; 95% CI, 0.99-1.04). CONCLUSIONS: Despite previous research showing that slow processing speed is a risk factor for musculoskeletal injuries during sports, our study suggests that processing speed is not associated with the risk of sustaining a concussion among junior high school soccer players.

Dogs Mentally Represent Jealousy-Inducing Social Interactions.

Jealousy may have evolved to protect valuable social bonds from interlopers, but some researchers have suggested that it is linked to self-awareness and theory of mind, leading to claims that it is unique to humans. We presented dogs (N = 18; 11 females; age: M = 4.6 years, SD = 1.9) with situations in which they could observe an out-of-sight social interaction between their owner and a fake dog or between their owner and a fleece cylinder. We found evidence for three signatures of jealous behavior in dogs: (a) Jealousy emerged only when the dog's owner interacted with a perceived social rival, (b) it occurred as a consequence of that interaction and not because of the mere presence of a conspecific, and (c) it emerged even for an out-of-sight interaction between the dog's owner and a social rival. These results support claims that dogs display jealous behavior, and they provide the first evidence that dogs can mentally represent jealousy-inducing social interactions.

Are parrots naive realists? Kea behave as if the real and virtual worlds are continuous.

Human psychology and animal cognition have increasingly used virtual stimuli to test cognitive abilities, with the expectation that participants are 'naive realists', that is, that they perceive virtual environments as both equivalent and continuous with real-life equivalents. However, there have been no attempts to investigate whether nonhuman subjects in fact behave as if physical processes in the virtual and real worlds are continuous. As kea parrots have previously shown the ability to transfer knowledge between real stimuli and both images on paper and images on touchscreens, here we test whether kea behave as naive realists and so expect physical processes to be continuous between the physical and virtual worlds. We find that, unlike infants, kea do not discriminate between these two contexts, and that they do not exhibit a preference for either. Our findings therefore validate the use of virtual stimuli as a powerful tool for testing the cognition of nonhuman animal species.

A Provider-Focused Intervention to Promote Optimal Care of Pediatric Patients With Suspected Elbow Fracture.

OBJECTIVE: Emergency department (ED) and urgent care (UC) physicians' accurate assessment of the neurovascular and musculoskeletal (NV/MSK) examination in pediatric patients with suspected elbow fracture is crucial to the early recognition of neurovascular compromise. Our objective was to determine the impact of computer-based simulation (CBS) and computerized clinical decision support systems (CCDSS) on ED and UC physicians' assessment of the NV/MSK examination of pediatric patients with elbow fracture as noted in their documentation. METHODS: All ED UC physician participants received CBS training about management of pediatric patients with suspected elbow fracture. Participants were then randomized to receive CCDSS (intervention arm) when an eligible patient was seen or no further intervention (comparison arm.) Participants received feedback on the proportion of patients with discharge diagnosis of elbow fracturewith proper examination elements documented. RESULTS: Twenty-eight ED and UC physicians were enrolled - 14 in each arm. Over the span of 16 weeks, 50 patients with a discharge diagnosis of elbow fracture were seen - 25 in each arm. Twenty-two of 25 (88%) patients seen by intervention arm participants had a complete NV/MSK examination documented. Six of 25 (24%) patients seen by comparison arm participants had a complete NV/MSK examination documented. Elements most commonly missed in the comparison arm included documentation of ulnar pulse as well as radial, median, and ulnar nerve motor functions. CONCLUSIONS: Compared with single CBS training alone, repeated exposure to CCDSS after CBS training resulted in improved documentation of the NV/MSK status of pediatric patients with elbow fracture.

Contagious yawning is not a signal of empathy: no evidence of familiarity, gender or prosociality biases in dogs.

Contagious yawning has been suggested to be a potential signal of empathy in non-human animals. However, few studies have been able to robustly test this claim. Here, we ran a Bayesian multilevel reanalysis of six studies of contagious yawning in dogs. This provided robust support for claims that contagious yawning is present in dogs, but found no evidence that dogs display either a familiarity or gender bias in contagious yawning, two predictions made by the contagious yawning-empathy hypothesis. Furthermore, in an experiment testing the prosociality bias, a novel prediction of the contagious yawning-empathy hypothesis, dogs did not yawn more in response to a prosocial demonstrator than to an antisocial demonstrator. As such, these strands of evidence suggest that contagious yawning, although present in dogs, is not mediated by empathetic mechanisms. This calls into question claims that contagious yawning is a signal of empathy in mammals.

Delayed gratification in New Caledonian crows and young children: influence of reward type and visibility.

Self-control underlies cognitive abilities such as decision making and future planning. Delay of gratification is a measure of self-control and involves obtaining a more valuable outcome in the future by tolerating a delay or investing a greater effort in the present. Contextual issues, such as reward visibility and type, may influence delayed gratification performance, although there has been limited comparative investigation between humans and other animals, particularly non-primate species. Here, we adapted an automated 'rotating tray' paradigm used previously with capuchin monkeys to test for delay of gratification ability that requires little pre-test training, where the subject must forgo an immediate, less preferred reward for a delayed, more preferred one. We tested New Caledonian crows and 3-5-year-old human children. We manipulated reward types to differ in quality or quantity (Experiments 1 and 2) as well as visibility (Experiment 2). In Experiments 1 and 2, both species performed better when the rewards varied in quality as opposed to quantity, though performed above chance in both conditions. In Experiment 1, both crows and children were able to delay gratification when both rewards were visible. In Experiment 2, 5-year-old children outperformed 3- and 4-year olds, though overall children still performed well, while the crows struggled when reward visibility was manipulated, a result which may relate to difficulties in tracking the experimenters' hands during baiting. We discuss these findings in relation to the role of contextual issues on self-control when making species comparisons and investigating the mechanisms of self-control.

The crow in the room: New Caledonian crows offer insight into the necessary and sufficient conditions for cumulative cultural evolution.

New Caledonian (NC) crow populations have developed complex tools that show suggestive evidence of cumulative change. These tool designs, therefore, appear to be the product of cumulative technological culture (CTC). We suggest that tool-using NC crows offer highly useful data for current debates over the necessary and sufficient conditions for the emergence of CTC.

New Caledonian crows infer the weight of objects from observing their movements in a breeze.

Humans use a variety of cues to infer an object's weight, including how easily objects can be moved. For example, if we observe an object being blown down the street by the wind, we can infer that it is light. Here, we tested whether New Caledonian crows make this type of inference. After training that only one type of object (either light or heavy) was rewarded when dropped into a food dispenser, birds observed pairs of novel objects (one light and one heavy) suspended from strings in front of an electric fan. The fan was either on-creating a breeze which buffeted the light, but not the heavy, object-or off, leaving both objects stationary. In subsequent test trials, birds could drop one, or both, of the novel objects into the food dispenser. Despite having no opportunity to handle these objects prior to testing, birds touched the correct object (light or heavy) first in 73% of experimental trials, and were at chance in control trials. Our results suggest that birds used pre-existing knowledge about the behaviour exhibited by differently weighted objects in the wind to infer their weight, using this information to guide their choices.

Lycophyte plastid genomics: extreme variation in GC, gene and intron content and multiple inversions between a direct and inverted orientation of the rRNA repeat.

Lycophytes are a key group for understanding vascular plant evolution. Lycophyte plastomes are highly distinct, indicating a dynamic evolutionary history, but detailed evaluation is hindered by the limited availability of sequences. Eight diverse plastomes were sequenced to assess variation in structure and functional content across lycophytes. Lycopodiaceae plastomes have remained largely unchanged compared with the common ancestor of land plants, whereas plastome evolution in Isoetes and especially Selaginella is highly dynamic. Selaginella plastomes have the highest GC content and fewest genes and introns of any photosynthetic land plant. Uniquely, the canonical inverted repeat was converted into a direct repeat (DR) via large-scale inversion in some Selaginella species. Ancestral reconstruction identified additional putative transitions between an inverted and DR orientation in Selaginella and Isoetes plastomes. A DR orientation does not disrupt the activity of copy-dependent repair to suppress substitution rates within repeats. Lycophyte plastomes include the most archaic examples among vascular plants and the most reconfigured among land plants. These evolutionary trends correlate with the mitochondrial genome, suggesting shared underlying mechanisms. Copy-dependent repair for DR-localized genes indicates that recombination and gene conversion are not inhibited by the DR orientation. Gene relocation in lycophyte plastomes occurs via overlapping inversions rather than transposase/recombinase-mediated processes.

The mycelium of the Trametes versicolor (Turkey tail) mushroom and its fermented substrate each show potent and complementary immune activating properties in vitro.

BACKGROUND: The medicinal mushroom Trametes versicolor (Tv, Turkey Tail) is often prepared for consumption as a powder from the fungal mycelium and the fermented substrate on which it grew. The goal for this study was to evaluate the immune-modulating properties of the mycelium versus the fermented substrate, to document whether an important part of the immune-activating effects resides in the metabolically fermented substrate. METHODS: Tv mycelium was cultured on rice flour. The mycelium and the fermented substrate were mechanically separated, dried, and milled. The initial substrate served as a control. Aqueous fractions were extracted and passed through 0.22-µm filters. The remaining solids were passed through homogenization spin columns without filtration. The aqueous and solid fractions of the initial substrate (IS), the fermented substrate (FS), and the Trametes versicolor mycelium (TvM) were tested for immune-activating and modulating activities on human peripheral blood mononuclear cell cultures, to examine expression of the CD69 activation marker on lymphocytes versus monocytes, and on the T, NKT, and NK lymphocyte subsets. Culture supernatants were tested for cytokines using Luminex arrays. RESULTS: Both aqueous and solid fractions of TvM triggered robust induction of CD69 on lymphocytes and monocytes, whereas FS only triggered minor induction of CD69, and IS had no activating effect. The aqueous extract of TvM had stronger activating effects than the solid fraction. In contrast, the solid fraction of IS triggered a reduction in CD69, below levels on untreated cells. Both aqueous and solid fractions of FS triggered large and dose-dependent increases in immune-activating pro-inflammatory cytokines (IL-2, IL-6), anti-inflammatory cytokines Interleukin-1 receptor antagonist (IL-1ra) and Interleukin-10 (IL-10), anti-viral cytokines interferon-gamma (IFN-γ) and Macrophage Inflammatory Protein-alpha (MIP-1α), as well as Granulocyte-Colony Stimulating Factor (G-CSF) and Interleukin-8 (IL-8). TvM triggered more modest cytokine increases. The aqueous extract of IS showed no effects, whereas the solid fraction showed modest effects on induction of cytokines and growth factors. CONCLUSION: The results demonstrated that the immune-activating bioactivity of a mycelial-based medicinal mushroom preparation is a combination of the mycelium itself (including insoluble beta-glucans, and also water-soluble components), and the highly bioactive, metabolically fermented substrate, not present in the initial substrate.

How New Caledonian crows solve novel foraging problems and what it means for cumulative culture.

New Caledonian crows make and use tools, and tool types vary over geographic landscapes. Social learning may explain the variation in tool design, but it is unknown to what degree social learning accounts for the maintenance of these designs. Indeed, little is known about the mechanisms these crows use to obtain information from others, despite the question's importance in understanding whether tool behavior is transmitted via social, genetic, or environmental means. For social transmission to account for tool-type variation, copying must utilize a mechanism that is action specific (e.g., pushing left vs. right) as well as context specific (e.g., pushing a particular object vs. any object). To determine whether crows can copy a demonstrator's actions as well as the contexts in which they occur, we conducted a diffusion experiment using a novel foraging task. We used a nontool task to eliminate any confounds introduced by individual differences in their prior tool experience. Two groups had demonstrators (trained in isolation on different options of a four-option task, including a two-action option) and one group did not. We found that crows socially learn about context: After observers see a demonstrator interact with the task, they are more likely to interact with the same parts of the task. In contrast, observers did not copy the demonstrator's specific actions. Our results suggest it is unlikely that observing tool-making behavior transmits tool types. We suggest it is possible that tool types are transmitted when crows copy the physical form of the tools they encounter.

White Sharks Exploit the Sun during Predatory Approaches.

There is no conclusive evidence of any nonhuman animal using the sun as part of its predation strategy. Here, we show that the world's largest predatory fish-the white shark (Carcharodon carcharias)-exploits the sun when approaching baits by positioning the sun directly behind them. On sunny days, sharks reversed their direction of approach along an east-west axis from morning to afternoon but had uniformly distributed approach directions during overcast conditions. These results show that white sharks have sufficient behavioral flexibility to exploit fluctuating environmental features when predating. This sun-tracking predation strategy has a number of potential functional roles, including improvement of prey detection, avoidance of retinal overstimulation, and predator concealment.

Trends in Ambulatory Care for Children with Concussion and Minor Head Injury from Eastern Massachusetts between 2007 and 2013.

OBJECTIVE: To characterize trends in health care utilization and costs for children diagnosed with concussion or minor head injury within a large pediatric primary-care association. STUDY DESIGN: We conducted a retrospective cohort analysis from 2007 through 2013 examining all outpatient medical claims related to concussion and minor head injury from 4 commercial insurance companies for children 6-21 years of age who were patients within a large pediatric independent practice association located throughout eastern Massachusetts. RESULTS: Health care visits for concussion and minor head injury increased more than 4-fold during the study period, with primary-care and specialty clinics experiencing the greatest increases in the rate of visits while emergency department visits increased comparatively less. These increases were accounted for by both the proportion of children diagnosed with concussion or minor head injury (1.3% of all children in 2007 vs 3.3% in 2013) and the number of encounters per diagnosed patient (1.0 encounters per patient in 2007 vs 1.7 in 2013). Although the overall population costs devoted to care for concussion or minor head injury increased 34%, the cost per individual diagnosed child decreased 31%. CONCLUSIONS: Over the past 7 years, health care encounters for children diagnosed with concussion or minor head injury increased substantially in eastern Massachusetts. Care for these injuries increasingly shifted from the emergency department to primary-care and specialty providers.

Audio-video recording of health care encounters for pediatric chronic conditions: observational reactivity and its correlates.

OBJECTIVES: Audio-video recording of pediatric clinic visits could generate observational reactivity, affecting measures of communication among patients, parents, and clinicians. METHODS: We measured observational reactivity in a direct observation study of communication during 155 pediatric visits for any of 5 chronic conditions by coding camcorder awareness behaviors and self-report questionnaires. We analyzed associations between observational reactivity and measures of communication behavior and visit quality. RESULTS: Directly observed camcorder awareness behaviors (634 events) comprised 0.59% of all coded events (n = 107,668). Younger children displayed these behaviors more often than did older children (F = 6.47; p < .0001). Clinicians' camcorder awareness declined significantly over successive study visits (t = -2.096; p = .043). Associations of camcorder awareness with objectively scored communication behaviors or self-reported visit quality were negligible. CONCLUSIONS: Most recordings included slight evidence of participant camcorder awareness. But there was negligible evidence that camcorder awareness influenced clinic visit communication.

New Caledonian crows reason about hidden causal agents.

The ability to make inferences about hidden causal mechanisms underpins scientific and religious thought. It also facilitates the understanding of social interactions and the production of sophisticated tool-using behaviors. However, although animals can reason about the outcomes of accidental interventions, only humans have been shown to make inferences about hidden causal mechanisms. Here, we show that tool-making New Caledonian crows react differently to an observable event when it is caused by a hidden causal agent. Eight crows watched two series of events in which a stick moved. In the first set of events, the crows observed a human enter a hide, a stick move, and the human then leave the hide. In the second, the stick moved without a human entering or exiting the hide. The crows inspected the hide and abandoned probing with a tool for food more often after the second, unexplained series of events. This difference shows that the crows can reason about a hidden causal agent. Comparative studies with the methodology outlined here could aid in elucidating the selective pressures that led to the evolution of this cognitive ability.

Of babies and birds: complex tool behaviours are not sufficient for the evolution of the ability to create a novel causal intervention.

Humans are capable of simply observing a correlation between cause and effect, and then producing a novel behavioural pattern in order to recreate the same outcome. However, it is unclear how the ability to create such causal interventions evolved. Here, we show that while 24-month-old children can produce an effective, novel action after observing a correlation, tool-making New Caledonian crows cannot. These results suggest that complex tool behaviours are not sufficient for the evolution of this ability, and that causal interventions can be cognitively and evolutionarily disassociated from other types of causal understanding.