Is Microdochium maydis Associated with Necrotic Lesions in the Tar Spot Disease Complex? A Culture-Based Survey of Maize in Mexico and the Midwestern United States.

Tar spot, caused by Phyllachora maydis, is an emerging disease of corn in the United States. Stromata of P. maydis are sometimes surrounded by necrotic lesions known as fisheyes and were previously reported to be caused by the fungus Microdochium maydis. The association of M. maydis with fisheye lesions has not been well documented outside of initial descriptions from the early 1980s. The objective of this work was to assess and identify Microdochium-like fungi associated with necrotic lesions surrounding P. maydis stromata using a culture-based method. In 2018, corn leaf samples with fisheye lesions associated with tar spot stromata were collected from 31 production fields across Mexico, Illinois, and Wisconsin. Cultures of pure isolates collected from Mexico believed to be M. maydis were included in the study. A total of 101 Microdochium/Fusarium-like isolates were obtained from the necrotic lesions, and 91% were identified as Fusarium spp., based on initial ITS sequence data. Multi-gene (ITS, TEF1-α, RPB1, and RPB2) phylogenies were constructed for a subset of 55 isolates; Microdochium, Cryptostroma, and Fusarium reference sequences were obtained from GenBank. All the necrotic lesion isolates clustered within Fusarium lineages and were phylogenetically distinct from the Microdochium clade. All Fusarium isolates from Mexico belonged to the F. incarnatum-equiseti species complex, whereas >85% of the U.S. isolates grouped within the F. sambucinum species complex. Our study suggests that initial reports of M. maydis were misidentifications of resident Fusarium spp. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

Multicenter Validation of the Neonatal Sequential Organ Failure Assessment Score for Prognosis in the Neonatal Intensive Care Unit.

Infants in the neonatal intensive care unit are at risk of life-threatening organ dysfunction, but few objective tools with utility exist. In a multicenter cohort of 20 152 infants, we show the neonatal sequential organ failure assessment score had good-to-excellent discrimination of mortality across centers, birth weights, and time points after admission.

2-Nonanone is a Critical Pheromone Component for Cerambycid Beetle Species Native to North and South America.

An increasing body of evidence indicates that cerambycid beetles native to different continents may share pheromone components, suggesting that these compounds arose as pheromone components early in the evolution of the family. Here, we describe the identification and field testing of the pheromone blends of two species in the subfamily Cerambycinae that share 2-nonanone as an important component of their male-produced aggregation-sex pheromones, the South American Stizocera consobrina Gounelle (tribe Elaphidiini) and the North American Heterachthes quadrimaculatus Haldeman (tribe Neoibidionini). Along with 2-nonanone, males of S. consobrina also produce 1-(1H-pyrrol-2-yl)-1,2-propanedione, whereas males of H. quadrimaculatus produce 10-methyldodecanol. Field bioassays conducted in Brazil (targeting S. consobrina) and Illinois (targeting H. quadrimaculatus) demonstrated that adults of both species were attracted only by the blends of both their pheromone components, and not to the individual components. The use of the pyrrole as a critical component for the former species is further evidence that this compound is a common pheromone structure among cerambycines in different biogeographical regions of the world.

Climate change and extreme events on drainage systems: numerical simulation of soil water in corn crops in Illinois (USA).

The influence of climate conditions in the agricultural environment is important in evapotranspiration, water availability for plants and roots, and other processes. This research focuses on two aspects: (1) the effects of climate change on the occurrence of extreme events that may affect agricultural processes in a region in Illinois (USA), and (2) the effects of climate change on the soil water dynamics in a corn crop. Different climate scenarios developed by the Institut Pierre Simon Laplace, using a climate model with medium resolution-IPSL(CM5MR), provided input to simulate soil water dynamics in two fields with different drainage system layouts. The Hydrus model simulated surface flux and runoff. Results indicate that the variation of precipitation and temperature in the future may increase extreme events, representing a risk for agriculture. Hydrus simulations indicate different results accordingly to the drainage layout, suggesting that it may be necessary to make adjustments in drainage systems in the future. In general, surface flux and runoff will increase over time, and these changes are more related to extreme events than average values. Extreme event indices show vulnerability in agriculture and will be reflected in changes in the soil water dynamics, and may increase the climatic risk of corn production.

Mealtime resistance: Hispanic mothers' perspectives on making healthy eating changes within the family.

Several perceived barriers to healthy eating within the family (e.g., cost, lack of time, energy, accessibility) are documented. However, few studies have assessed Hispanic mothers' perceived barriers and strategies in implementing healthy eating changes in the family's meals. The primary goal of this qualitative study was to investigate Mexican and Puerto Rican mothers' barriers and strategies to creating healthy eating changes within the family at home. A sample of 46 Mexican-American and Puerto Rican mothers in California, Illinois, and Texas participated in this study. An average of 5 mothers participated in a focus group session in Spanish and completed a demographic survey. Focus group thematic analysis revealed that major barriers to implementing healthy eating changes within the family include child and spouse resistance as well as meal preparation time. The resistance mothers reported encountering magnify their meal preparation workload. Mothers shared that they sometimes prepared multiple meals in a single mealtime to please family members. Several strategies to promote healthy eating at home, including serving as role models, providing easy access to healthy food items at home, and not purchasing, or hiding, unhealthy food at home, were also discussed. The current study expands the existing literature by emphasizing the need to empower parents to make healthy changes within their family and the importance of taking fathers and children into account in programming so that the whole family is involved in making healthy changes.

Acute Photobiomodulation Does Not Influence Specific High-Intensity and Intermittent Performance in Female Futsal Players.

The acute improvement of performance after photobiomodulation therapy (PBMT) has been reported in different types of exercise. However, the effect on high-intensity and intermittent exercises that are relevant for team sports is unknown. Thus, we evaluated the effect of prior acute application of PBMT on high-intensity and intermittent exercise performance, muscle oxygenation, and physiological/perceptual indicators in amateur female futsal players. Thirteen players (24.1 ± 3.7 years) performed a testing battery (countermovement jump (CMJ), Illinois agility and YoYo intermittent recovery test level 1 (YYIR1)) preceded by 15 min of PBMT (1 min 30 s each muscular point; five muscular points in each lower limbs) or 15 min of placebo (SHAM), in a counterbalanced randomized cross-over design (one-week in-between PBMT/SHAM). All test performance did not differ (p > 0.05) between PBMT and SHAM, as well as blood lactate, rating of perceived exertion, heart rate, and muscle oxygenation (via near infrared spectroscopy) responses. The acute application of PBMT prior to a physical testing battery does not influence high-intensity and intermittent exercises performance, neither physiological nor perceptual responses in amateur female futsal players.

Redescription and new records of Polymorphus trochus (Van Cleave, 1945) (Polymorphida: Polymorphidae), in Mexico.

Polymorphus trochus Van Cleave, 1945, is an acanthocephalan with limited distribution to the Americas and a common parasite of birds of the Rallidae family (Kinsella et al. 1973, McDonald 1988 and Amin 1992), mainly of the American coot Fulica americana Gmelin, 1789; however, despite existing records of this species, the knowledge and descriptions of its morphological characteristics are not sufficient. Therefore, the identification of this species can be confusing, particularly because it depends on the form of the proboscis of the female. Van Cleave (1945) provided a description and illustrations of this species based on 14 females and 2 males specimens collected in the intestine of F. americana from Lake Buckeye in Ohio, Lake Oneida in New York, and the Illinois River in Illinois; however, this description does not mention many traits that are taxonomically important. Years later, Nickol (1966, thesis not published) provided a description of P. trochus based on 36 mature specimens (14 females and 22 male) from Louisiana, but the author illustrated only the proboscis and included a schematic of the female. He described the shape and size of the proboscis in both sexes, provided measurements of the apical, middle and basal hooks of the proboscis armor, and measurements of the eggs. However, he did not mention the exact distribution of the hooks and spines of the trunk, the measurement of a complete row of hooks nor the shape of all the sexual organs, especially the female ones, which are important taxonomic characteristics in the polymorphids.

Population-Based Newborn Screening for Mucopolysaccharidosis Type II in Illinois: The First Year Experience.

OBJECTIVES: To assess the outcome of population-based newborn screening for mucopolysaccharidosis type II (MPS II) during the first year of screening in Illinois. STUDY DESIGN: Tandem mass spectrometry was used to measure iduronate-2-sulfatase (I2S) activity in dried blood spot specimens obtained from 162 000 infant samples sent to the Newborn Screening Laboratory of the Illinois Department of Public Health in Chicago. RESULTS: One case of MPS II and 14 infants with pseudodeficiency for I2S were identified. CONCLUSIONS: Newborn screening for MPS II by measurement of I2S enzyme activity was successfully integrated into the statewide newborn screening program in Illinois.

Leveraging Existing Birth Defects Surveillance Infrastructure to Build Neonatal Abstinence Syndrome Surveillance Systems - Illinois, New Mexico, and Vermont, 2015-2016.

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome that can occur following prenatal exposure to opioids (1). NAS surveillance in the United States is based largely on diagnosis codes in hospital discharge data, without validation of these codes or case confirmation. During 2004-2014, reported NAS incidence increased from 1.5 to 8.0 per 1,000 U.S. hospital births (2), based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes identified in hospital discharge data, without case confirmation. However, little is known about how well these codes identify NAS or how the October 1, 2015, transition from ICD-9-CM to the tenth revision of ICD-CM (ICD-10-CM) codes affected estimated NAS incidence. This report describes a pilot project in Illinois, New Mexico, and Vermont to use birth defects surveillance infrastructure to obtain state-level, population-based estimates of NAS incidence among births in 2015 (all three states) and 2016 (Illinois) using hospital discharge records and other sources (varied by state) with case confirmation, and to evaluate the validity of NAS diagnosis codes used by each state. Wide variation in NAS incidence was observed across the three states. In 2015, NAS incidence for Illinois, New Mexico, and Vermont was 3.0, 7.5, and 30.8 per 1,000 births, respectively. Among evaluated diagnosis codes, those with the highest positive predictive values (PPVs) for identifying confirmed cases of NAS, based on a uniform case definition, were drug withdrawal syndrome in a newborn (ICD-9-CM code 779.5; state range = 58.6%-80.2%) and drug withdrawal, infant of dependent mother (ICD-10-CM code P96.1; state range = 58.5%-80.2%). The methods used to assess NAS incidence in this pilot project might help inform other states' NAS surveillance efforts.

Racial Differences in Rates of Change of Childhood Body Mass Index and Blood Pressure Percentiles.

OBJECTIVE: To assess whether racial differences in rates of change in body mass index (BMI) and blood pressure (BP) percentiles emerge during distinct periods of childhood. STUDY DESIGN: In this retrospective cohort study, we included children aged 5-20 years who received regular outpatient care at a large academic medical center between January 1996 and April 2016. BMI was expressed as age- and sex-specific percentiles and BP as age-, sex-, and height-specific percentiles. Linear mixed models incorporating linear spline functions with 2 breakpoints at 9 and 12 years of age were used to estimate the changes in BMI and BP percentiles over time during age periods: <9, 9-<12, and >12 years of age. RESULTS: Among 5703 children (24.8% black, 10.1% Hispanic), Hispanic females had an increased rate of change in BMI percentile per year relative to white females during ages 5-9 years (+2.94%; 95% CI, 0.24-5.64; P = .033). Black and Hispanic males also had an increased rate of change in BMI percentile per year relative to white males that occurred from ages 5-9 (+2.35% [95% CI, 0.76-3.94; P = .004]; +2.63% [95% CI, 0.31-4.95; P = .026], respectively). There were no significant racial differences in the rate of change of BP percentiles, although black females had higher hypertension rates compared with white females (10.0% vs 5.7%; P < .001). CONCLUSIONS: Childhood patterns in BMI percentiles differ by race. Racial differences in rates of change in BMI percentile emerge early in childhood. Further study of early patterns could help to identify critical periods during childhood where disparities begin to emerge.

Serum Lipid Concentrations and FADS Genetic Variants in Young Mexican College Students: The UP-AMIGOS Cohort Study.

BACKGROUND: Recent genome-wide association studies in the Mexican population have identified several genetic loci associated with blood lipid levels in adults. However, studies focusing on the fatty acid desaturase (FADS) gene cluster have been understudied in this population, even though it seems associated with lipid profiles in other ethnicities. The aim of this study was to test associations between single nucleotide polymorphisms (SNPs) in the FADS cluster (rs174546, rs1535, rs174548, rs174550, rs174450, and rs174618) and serum lipid profiles in young Mexicans. METHODS: Anthropometrics, serum lipid profiles, and FADS SNPs were measured in 998 subjects in the UP-AMIGOS cohort study. Genotype-phenotype (total cholesterol [TC], triglyceride [TG], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], and very-low-density lipoprotein [VLDL]) associations were assessed using PLINK adjusted for sex, age, and body mass index (BMI). RESULTS: Among 6 FADS SNPs, we found that carriers of the C-allele of the FADS1-rs174546 showed a significant association with lower TG concentrations (ß = -12.6 mg/dL, p = 0.009) and lower VLDL concentrations (ß = -2.52 mg/dL, p = 0.005). We found that rs174546, rs1535, and rs174550 were in high linkage disequilibrium (r2 > 0.80). There were no significant associations between rs174550, rs174548, and rs174618 and lipid profiles. CONCLUSION: A genetic variant in the FADS1 (rs174546) gene is a major contributor of plasma TG and VLDL concentrations in healthy young Mexicans.

Trypanosoma cruzi strain TcIV infects raccoons from Illinois.

BACKGROUND: The northern limits of Trypanosoma cruzi across the territory of the United States remain unknown. The known vectors Triatoma sanguisuga and T. lecticularia find their northernmost limits in Illinois; yet, earlier screenings of those insects did not reveal the presence of the pathogen, which has not been reported in vectors or reservoir hosts in this state. OBJECTIVES: Five species of medium-sized mammals were screened for the presence of T. cruzi. METHODS: Genomic DNA was isolated from heart, spleen and skeletal muscle of bobcats (Lynx rufus, n = 60), raccoons (Procyon lotor, n = 37), nine-banded armadillos (Dasypus novemcinctus, n = 5), Virginia opossums (Didelphis virginiana, n = 3), and a red fox (Vulpes vulpes). Infections were detected targeting DNA from the kinetoplast DNA minicircle (kDNA) and satellite DNA (satDNA). The discrete typing unit (DTU) was determined by amplifying two gene regions: the Spliced Leader Intergenic Region (SL), via a multiplex polymerase chain reaction, and the 24Sα ribosomal DNA via a heminested reaction. Resulting sequences were used to calculate their genetic distance against reference DTUs. FINDINGS: 18.9% of raccoons were positive for strain TcIV; the rest of mammals tested negative. MAIN CONCLUSIONS: These results confirm for the first time the presence of T. cruzi in wildlife from Illinois, suggesting that a sylvatic life cycle is likely to occur in the region. The analyses of sequences of SL suggest that amplicons resulting from a commonly used multiplex reaction may yield non-homologous fragments.

Newborn Screening for Lysosomal Storage Disorders in Illinois: The Initial 15-Month Experience.

OBJECTIVES: To assess the outcomes of newborn screening for 5 lysosomal storage disorders (LSDs) in the first cohort of infants tested in the state of Illinois. STUDY DESIGN: Tandem mass spectrometry was used to assay for the 5 LSD-associated enzymes in dried blood spot specimens obtained from 219 973 newborn samples sent to the Newborn Screening Laboratory of the Illinois Department of Public Health in Chicago. RESULTS: The total number of cases with a positive diagnosis and the incidence for each disorder were as follows: Fabry disease, n = 26 (1 in 8454, including the p.A143T variant); Pompe disease, n = 10 (1 in 21 979); Gaucher disease, n = 5 (1 in 43 959); mucopolysaccharidosis (MPS) type 1, n = 1 (1 in 219 793); and Niemann-Pick disease type A/B, n = 2 (1 in 109 897). Twenty-two infants had a positive screen for 1 of the 5 disorders but could not be classified as either affected or unaffected after follow-up testing, including genotyping. Pseudodeficiencies for alpha-L-iduronidase and alpha-glucosidase were detected more often than true deficiencies. CONCLUSIONS: The incidences of Fabry disease and Pompe disease were significantly higher than published estimates, although most cases detected were predicted to be late onset. The incidences of Gaucher disease, MPS I, and Niemann-Pick disease were comparable with previously published estimates. A total of 16 infants could not be positively identified as either affected or unaffected. To validate the true risks and benefits of newborn screening for LSD, long term follow-up in these infants and those detected with later-onset disorders will be essential.

Legal Aspects of Concussion: The Ever-Evolving Standard of Care.

Today, when an athlete is catastrophically injured while playing a sport, litigation often follows. The likelihood of litigation is even greater in the event of a head injury, especially when the athlete can allege that a prior concussion somehow contributed to the current injury. Whether the potential defendants in these lawsuits, such as schools, coaches, athletic trainers, and other health care professionals, actually face legal liability depends on whether they are deemed to have conformed to the standard of care. The standard of care is a legal term, defined as acting as a reasonable professional in that position or industry would have under the circumstances based on then-existing knowledge. In this article, we examine the standard of care with regard to concussion management and treatment in the context of some of the most notable lawsuits in recent years.

The Impact of Low-Level Lead Toxicity on School Performance among Hispanic Subgroups in the Chicago Public Schools.

BACKGROUND: Environmental lead exposure detrimentally affects children's educational performance, even at very low blood lead levels (BLLs). Among children in Chicago Public Schools (CPS), the severity of the effects of BLL on reading and math vary by racial subgroup (White vs. Hispanic vs. non-Hispanic Black). We investigated the impact of BLL on standardized test performance by Hispanic subgroup (Mexican, Puerto Rican, and Other Hispanic). METHODS: We examined 12,319 Hispanic children born in Chicago between 1994 and 1998 who were tested for BLL between birth and 2006 and enrolled in the 3rd grade at a CPS school between 2003 and 2006. We linked the Chicago birth registry, the Chicago Blood Lead Registry, and 3rd grade Illinois Standard Achievement Test (ISAT) scores to examine associations between BLL and school performance. Primary analyses were restricted to children with BLL below 10 µg/dL (0.483 µmol/L). RESULTS: BLLs below 10 µg/dL (0.483 µmol/L) were inversely associated with reading and math scores in all Hispanic subgroups. Adjusted Relative Risks (RRadj) and 95% confidence intervals (CI) for reading and math failure were 1.34 (95% CI = 1.25, 1.63) and 1.53 (95% CI = 1.32, 1.78), respectively, per each additional 5 µg/dL of lead exposure for Hispanic children; RRadj did not differ across subgroups. We estimate that 7.0% (95% CI = 1.8, 11.9) of reading and 13.6% (95% CI = 7.7, 19.2) of math failure among Hispanic children can be attributed to exposure to BLLs of 5-9 µg/dL (0.242 to 0.435 µmol/L) vs. 0-4 µg/dL (0-0.193 µmol/L). The RRadj of math failure for each 5 µg/dL (0.242 µmol/L) increase in BLL was notably (p = 0.074) stronger among black Puerto Rican children (RRadj = 5.14; 95% CI = 1.65-15.94) compared to white Puerto Rican children (RRadj = 1.50; 95% CI = 1.12-2.02). CONCLUSIONS: Early childhood lead exposure is associated with poorer achievement on standardized reading and math tests in the 3rd grade for Mexican, Puerto Rican, and Other Hispanic children enrolled in Chicago Public Schools. While we did not see interactions between BLL and ISAT performance by Hispanic subgroup, the stronger association between BLL and math failure for Black Puerto Rican children is intriguing and warrants further study.

Indirect Standardization Matching: Assessing Specific Advantage and Risk Synergy.

OBJECTIVE: To develop a method to allow a hospital to compare its performance using its entire patient population to the outcomes of very similar patients treated elsewhere. DATA SOURCES/SETTING: Medicare claims in orthopedics and common general, gynecologic, and urologic surgery from Illinois, New York, and Texas from 2004 to 2006. STUDY DESIGN: Using two example "focal" hospitals, each hospital's patients were matched to 10 very similar patients selected from 619 other hospitals. DATA COLLECTION/EXTRACTION METHODS: All patients were used at each focal hospital, and we found the 10 closest matched patients from control hospitals with exactly the same principal procedure as each focal patient. PRINCIPAL FINDINGS: We achieved exact matches on all procedures and very close matches for other patient characteristics for both hospitals. There were few to no differences between each hospital's patients and their matched control patients on most patient characteristics, yet large and significant differences were observed for mortality, failure-to-rescue, and cost. CONCLUSION: Indirect standardization matching can produce fair audits of quality and cost, allowing for a comprehensive, transparent, and relevant assessment of all patients at a focal hospital. With this approach, hospitals will be better able to benchmark their performance and determine where quality improvement is most needed.

MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort.

UNLABELLED: BACKGROUND AND RATIONALE FOR THE STUDY: The Model for End Stage Liver Disease (MELD) score has not been derived and validated for the emergent transjugular intrahepatic portosystemic shunt (TIPS) population. We sought to identify predictive factors for survival among emergent TIPS patients, and to substantiate MELD for outcomes prognostication in this population. RESULTS: 101 patients with acute life threatening variceal hemorrhage underwent emergent TIPS (defined by failed endoscopic therapy for active bleeding, acute hemoglobin drop, ≥ 2-unit transfusion requirement, and/or vasopressor need) at between 1998-2013. Demographic, clinical, laboratory, and procedure parameters were analyzed for correlation with mortality using Cox proportional hazards regression to derive the prognostic value of MELD constituents. Area under receiver operator characteristic (AUROC) curves was used to assess the capability of MELD prediction of mortality. TIPS were created 119 ± 167 h after initial bleeding events. Hemodynamic success was achieved in 90%. Median final portosystemic pressure gradient was 8 mmHg. Variceal rebleeding incidence was 21%. The four original MELD components showed significant correlation with mortality on multivariate Cox regression: baseline bilirubin (regression coefficient 0.366), creatinine (0.621), international normalized ratio (1.111), and liver disease etiology (0.808), validating the MELD system for emergent cases. No other significant predictive parameters were identified. MELD was an excellent predictor of 90-day mortality in the emergent TIPS population (AUROC = 0.842, 95% CI 0.755-0.928). CONCLUSIONS: Based on independent derivation of prognostic constituents and confirmation of predictive accuracy, MELD is a valid and reliable metric for risk stratification and survival projection after emergent TIPS.

A hospital-specific template for benchmarking its cost and quality.

OBJECTIVE: Develop an improved method for auditing hospital cost and quality tailored to a specific hospital's patient population. DATA SOURCES/SETTING: Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, New York, and Texas between 2004 and 2006. STUDY DESIGN: A template of 300 representative patients from a single index hospital was constructed and used to match 300 patients at 43 hospitals that had a minimum of 500 patients over a 3-year study period. DATA COLLECTION/EXTRACTION METHODS: From each of 43 hospitals we chose 300 patients most resembling the template using multivariate matching. PRINCIPAL FINDINGS: We found close matches on procedures and patient characteristics, far more balanced than would be expected in a randomized trial. There were little to no differences between the index hospital's template and the 43 hospitals on most patient characteristics yet large and significant differences in mortality, failure-to-rescue, and cost. CONCLUSION: Matching can produce fair, directly standardized audits. From the perspective of the index hospital, "hospital-specific" template matching provides the fairness of direct standardization with the specific institutional relevance of indirect standardization. Using this approach, hospitals will be better able to examine their performance, and better determine why they are achieving the results they observe.

Template matching for auditing hospital cost and quality.

OBJECTIVE: Develop an improved method for auditing hospital cost and quality. DATA SOURCES/SETTING: Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, Texas, and New York between 2004 and 2006. STUDY DESIGN: A template of 300 representative patients was constructed and then used to match 300 patients at hospitals that had a minimum of 500 patients over a 3-year study period. DATA COLLECTION/EXTRACTION METHODS: From each of 217 hospitals we chose 300 patients most resembling the template using multivariate matching. PRINCIPAL FINDINGS: The matching algorithm found close matches on procedures and patient characteristics, far more balanced than measured covariates would be in a randomized clinical trial. These matched samples displayed little to no differences across hospitals in common patient characteristics yet found large and statistically significant hospital variation in mortality, complications, failure-to-rescue, readmissions, length of stay, ICU days, cost, and surgical procedure length. Similar patients at different hospitals had substantially different outcomes. CONCLUSION: The template-matched sample can produce fair, directly standardized audits that evaluate hospitals on patients with similar characteristics, thereby making benchmarking more believable. Through examining matched samples of individual patients, administrators can better detect poor performance at their hospitals and better understand why these problems are occurring.

Nausea predicts delayed gastric emptying in children.

OBJECTIVES: To assess whether the gastroparesis cardinal symptom index (GCSI), or any individual symptom, is associated with delayed gastric emptying in children, and to assess understanding of symptoms associated with delayed gastric emptying. STUDY DESIGN: Fifty children (36 F), 5-18 years of age, undergoing gastric emptying scintigraphy (GES) at Lurie Children's Hospital in Chicago, Illinois, completed Likert-type GCSI and symptom comprehension questionnaires. Correlation of GES results (normal or abnormal) with questionnaire results using the Wilcoxon rank sum test. RESULTS: Seventy percent of subjects had a normal GES. Children reported understanding most terms of GCSI (average score 2.59, range 0-3). The GCSI was not associated with delayed gastric emptying. Nausea was associated with delayed gastric emptying only (numerical P = .04, word P = .02). Results were not altered when poorly understood terms were excluded. CONCLUSIONS: The GCSI is not associated with delayed gastric emptying in children. Lack of association does not seem to be related to lack of understanding. Nausea alone was the only symptom that showed an association with delayed gastric emptying on GES.