Heterogeneity of Mycobacterium tuberculosis Strains Circulating in Panama's Western Region.

Tuberculosis remains a challenge in both rural and urban areas. Although a majority of countries display a higher burden in urban areas compared with rural areas, Panama continues to report the highest mortality rate in Central America. Urban areas, such as Panama City, report a high tuberculosis burden, whereas Panama's western region, including the provinces of Chiriquí, Bocas del Toro (both semiurban) and Ngäbe-Bugle (rural), show a lower burden. We aimed to identify highly transmitted Mycobacterium tuberculosis strains within rural and semiurban settings of Panama's western region during a 3-year period (2017, 2019, 2021). We randomly selected 87 M. tuberculosis isolates from a biobank from Panama's western region and analyzed them using allele-specific oligonucleotide polymerase chain reaction and 24-mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR). Our results show only 11.7% (10/85) of M. tuberculosis strains identified as prevalent A-Beijing, B-Haarlem, or C-LAM Strains. We found a low prevalence of A, B, and C M. tuberculosis strains in both rural and semirural settings compared with isolates collected from the Eastern Colon Province. MIRU-VNTR genotyping revealed a high degree of diversity with no clusters with single loci variation of ≥ 2 loci. These results support the notion that tuberculosis prevalence in the rural and semiurban western region of Panama are not due to previously described highly transmitted strains but is influenced instead by other health determinants, including poor health system access and a lack of systematic transmission chain monitoring. For remote rural and semiurban settings, we recommend allocating resources to reinforce efforts to prevent tuberculosis spread.

The nonlinearity of pupil diameter fluctuations in an insight task as criteria for detecting children who solve the problem from those who do not.

Insights, characterized by sudden discoveries following unsuccessful problem-solving attempts, are fascinating phenomena. Dynamic systems perspectives argue that insight arises from self-organizing perceptual and motor processes. Entropy and fractal scaling are potential markers for emerging new and effective solutions. This study investigated whether specific features associated with self-organization in dynamical systems can distinguish between individuals who succeed and those who fail in solving insight tasks. To achieve this, we analyzed pupillary diameter fluctuations of children aged 6 to 12 during the 8-coin task, a well-established insight task. The participants were divided into two groups: successful (n = 24) and unsuccessful (n = 43) task completion. Entropy, determinism, recurrence ratio, and the ß scaling exponent were estimated using Recurrence Quantification and Power Spectrum Density analyses. The results indicated that the solver group exhibited more significant uncertainty and lower predictability in pupillary diameter fluctuations before finding the solution. Recurrence Quantification Analysis revealed changes that went unnoticed by mean and standard deviation measures. However, the ß scaling exponent did not differentiate between the two groups. These findings suggest that entropy and determinism in pupillary diameter fluctuations can identify early differences in problem-solving success. Further research is needed to determine the exclusive role of perceptual and motor activity in generating insights and investigate these results' generalizability to other tasks and populations.

Parliamentary roll-call voting as a complex dynamical system: The case of Chile.

A method is proposed to study the temporal variability of legislative roll-call votes in a parliament from the perspective of complex dynamical systems. We studied the Chilean Chamber of Deputies' by analyzing the agreement ratio and the voting outcome of each vote over the last 19 years with a Recurrence Quantification Analysis and an entropy analysis (Sample Entropy). Two significant changes in the temporal variability were found: one in 2014, where the voting outcome became more recurrent and with less entropy, and another in 2018, where the agreement ratio became less recurrent and with higher entropy. These changes may be directly related to major changes in the Chilean electoral system and the composition of the Chamber of Deputies, given that these changes occurred just after the first parliamentary elections with non-compulsory voting (2013 elections) and the first elections with a proportional system in conjunction with an increase in the number of deputies (2017 elections) were held.

The effectiveness of a tablet-based video game that stimulates cognitive, emotional, and social skills in developing academic skills among preschoolers: study protocol for a randomized controlled trial.

BACKGROUND: Evidence suggests that children from low-income families begin the preschool stage with less academic and non-academic skills development compared to higher-income families. There are several successful experiences of early stimulation of cognitive and social-emotional skills; however, there is scarce evidence of the effectiveness of a video game that incorporates the stimulation of these skills simultaneously. This study aims to evaluate the effectiveness of a video game in stimulating cognitive, emotional, and social competence skills in developing academic skills in socioeconomically disadvantaged preschool children. METHODS: A cluster-randomized controlled trial design will be used. A tablet-based video game that stimulates cognitive and socio-emotional skills to improve the development of academic skills is compared with a tablet-based game where students draw and paint with no explicit stimulation of cognitive and socio-emotional skills. Eighteen schools and 750 Chilean preschool students will be recruited. The effectiveness of the intervention will be assessed using a direct evaluation of children on literacy learning and pre-calculation skills at baseline, immediately after stimulation, and at 6, 12, 18, and 24 months post-intervention. The mediating effect of working memory, inhibitory control, emotion recognition, and prosocial behaviours will be assessed on the effectiveness of the intervention. DISCUSSION: The proposed study will be the first to test the effectiveness of a tablet-based video game stimulating cognitive and social-emotional skills to improve academic skills in socioeconomically disadvantaged preschool children in Chile, controlling for gender, age (in months), mental health, and baseline conditions of stimulated skills. TRIAL REGISTRATION: ClinicalTrials.gov NCT05224700. Registered on February 2022.

Choice of standards for sonographic fetal abdominal circumference percentile.

BACKGROUND: The diagnosis of abnormal fetal abdominal circumference is based on values >90th or <10th percentile. There are dozens of established norms that can be used to determine the percentile of a given abdominal circumference measurement, but there is no established method to determine which norms should be used. OBJECTIVE: This study aimed to evaluate the applicability of 5 established abdominal circumference norms to our measurements and to determine which, if any, should be used for the diagnosis of abnormal fetal abdominal circumference. STUDY DESIGN: Data were pooled from 6 maternal-fetal medicine practices to conduct a cross-sectional study. The inclusion criteria were a singleton fetus at 22.0 to 39.9 weeks of gestation with cardiac activity present, complete fetal biometry measured, and examination from 2019 or 2020. For patients with >1 eligible examination during the study period, a single examination was chosen at random for inclusion. Five norms of abdominal circumference were studied: the Hadlock formula, the World Health Organization Fetal Growth Curves, the International Fetal and Newborn Growth Consortium for the 21st-Century Project; and the National Institutes of Child Health and Human Development Fetal Growth Studies (fetuses of White patients and unified standard). Using formulas relating abdominal circumference to gestational age, we calculated the z scores of abdominal circumference (standard deviations from the mean), standard deviation of the z score, Kolmogorov-Smirnov D statistic, and relative mean squared error. The 5 norms were assessed for fit to our data based on 6 criteria: mean z score close to 0, standard deviation of the z score close to 1, low D statistic, low mean squared error, fraction of values >90th percentile close to 10%, and fraction of values <10th percentile close to 10%. RESULTS: The inclusion criteria were met in 40,684 ultrasound examinations in 15,042 patients. Considering the 6 evaluation criteria, observed abdominal circumferences had the best fit to the World Health Organization standard (mean z score of 0.11±1.05, D statistic of 0.041, mean squared error of 0.84±1.46, 13% of examinations >90th percentile, and 7% of examinations <10th percentile). The Hadlock reference had an anomaly in its assumption of a constant standard deviation, resulting in the underdiagnosis of abnormal values at early gestational ages and overdiagnosis at late gestational ages. The International Fetal and Newborn Growth Consortium for the 21st-Century Project standard had a mean circumference smaller than all the other norms, resulting in the underdiagnosis of small circumferences and the overdiagnosis of large circumferences. Similar results were observed when restricting the analyses to a low-risk subgroup of 5487 examinations without identified risk factors for large for gestational age or small for gestational age. CONCLUSION: The diagnosis of abnormal abdominal circumference depends on the norms used to define abdominal circumference percentiles. The World Health Organization standard had the best fit for our data.

Screening of Developmental Difficulties during the Transition to Primary School.

The five-to-fifteen (FTF) questionnaire is a screening tool completed by parents that is able to distinguish developmental disorders in children aged 5 to 15 years old. The current study aimed to characterize the developmental difficulties by gender and school age (kindergarten and first grade) of children in their transition to primary school, using the Spanish-language version of the FTF questionnaire. The participants were 541 parents of typically developed children from kindergarten and first grade in public schools in Chile. Developmental difficulties were revealed, showing that boys displayed significantly more difficulties in their social skills when compared to girls, and that kindergartners displayed significantly more developmental difficulties than first graders. The children's developmental difficulties in executive functions, social skills, and emotional/behavioral problems exhibited interactions between gender and school age. The findings were discussed in terms of current conceptualizations of both executive functions and self-regulatory processes. These processes and functions are configured early in development, are gradually consolidated over the course of school age, and can be strengthened or weakened by conditions experienced in childhood. Early screening of developmental difficulties from the parents' perspective would facilitate early detection of problems, as early as in kindergarten, and considering the normal adaptable development of children.

Impact of adding abdominal circumference to the definition of fetal growth restriction.

BACKGROUND: Fetal growth restriction has traditionally been defined as fetuses with an estimated fetal weight <10th percentile for gestational age. In 2020, the Society for Maternal-Fetal Medicine recommended that the definition be expanded to include either an estimated fetal weight<10th percentile or a fetal abdominal circumference<10th percentile. OBJECTIVE: We sought to determine the impact of adding the criterion abdominal circumference<10th percentile on the rate of diagnosis of fetal growth restriction vs using the criterion estimated fetal weight<10th percentile alone. In addition, we evaluated the definition proposed by Copel and Bahtiyar, estimated fetal weight<10th percentile or abdominal circumference<5th percentile. STUDY DESIGN: This was a retrospective, descriptive study from 3 consultative maternal-fetal medicine practices. Biometry was compiled from ultrasound examinations from January 2019 to July 2020. The inclusion criteria were singleton pregnancy, gestational age of ≥24 weeks, presence of fetal cardiac activity, and presence of 4 standard fetal biometry parameters (biparietal diameter, head circumference, abdominal circumference, and femur length). We tabulated the indications for the examinations and the number of examinations meeting several criteria for the diagnosis of fetal growth restriction: Traditional criterion (estimated fetal weight<10th percentile), Copel-Bahtiyar criteria (estimated fetal weight<10th percentile or abdominal circumference<5th percentile), and Society for Maternal-Fetal Medicine criteria (estimated fetal weight<10th percentile or abdominal circumference<10th percentile). RESULTS: During the study period, 20,633 ultrasound examinations met the inclusion criteria. In 62% of examinations, there was ≥1 factor for fetal growth restriction, and in 51% of examinations, there was ≥1 factor for large for gestational age. The rate of estimated fetal weight<10th percentile was 9.7%. The rate of abdominal circumference<5th percentile was 5.7%, and the rate of abdominal circumference<10th percentile was 9.2%. The rate of fetal growth restriction was 9.7% using the traditional definition (estimated fetal weight<10th percentile only). The rate of fetal growth restriction was 10.2% using the Copel-Bahtiyar definition (estimated fetal weight<10th percentile or abdominal circumference<5th percentile), significantly higher than using the traditional definition (P<.001). The rate of fetal growth restriction was 11.6% using the Society for Maternal-Fetal Medicine definition (estimated fetal weight<10th percentile or abdominal circumference<10th percentile), significantly higher than using either the traditional or Copel-Bahtiyar definition (P<.001 for both). Among examinations with an abdominal circumference<10th percentile, 79% also had an estimated fetal weight<10th percentile and was considered fetal growth restriction even without considering abdominal circumference. CONCLUSION: Adding the criterion abdominal circumference<5th percentile or abdominal circumference<10th percentile to the definition of fetal growth restriction resulted in a statistically significant increase in the rate of diagnosis of fetal growth restriction. However, the absolute increase in the rate was small and was not expected to place a large burden on practice resources.

How Do Object Shape, Semantic Cues, and Apparent Velocity Affect the Attribution of Intentionality to Figures With Different Types of Movements?

A series of experiments show that attribution of intentionality to figures depends on the interaction between the type of movement -Theory of Mind (ToM), Goal-Directed (GD), Random (R)- with the presence of human attributes, the way these figures are labeled, and their apparent velocity. In addition, the effect of these conditions or their interaction varies when the use of human nouns -present in the participant's responses- is statistically controlled. In Experiment 1, one group of participants observed triangular figures (n = 46) and another observed humanized figures, called Stickman figures (n = 38). In ToM movements, participants attributed more intentionality to triangular figures than to Stickman figures. However, in R movements, the opposite trend was observed. In Experiment 2 (n = 42), triangular figures were presented as if they were people and compared to triangular figures presented in Experiment 1. Here, when the figures were labeled as people the attribution of intentionality only increased in R and GD movements, but not in ToM movements. Finally, in Experiment 3, Stickman figures (n = 45) move at a higher (unnatural) speed with higher frames per second (fps) than the Stickman figures of Experiment 1. This manipulation decreased the attribution of intentionality in R and GD movements but not in ToM movements. In general terms, it was found that the human attributes and labels promote the use of human nouns in participants' responses, while a high apparent speed reduces their use. The use of human nouns was associated to intentionality scores significantly in R movements, but at a lesser extent in GD and ToM movements. We conclude that, although the type of movement is the most important cue in this sort of task, the tendency to attribute intentionality to figures is affected by the interaction between perceptual and semantic cues (figure shape, label, and apparent speed).

Neoaltar: An interactive multimedia day of the dead experience.

Technology has permeated many aspects of human life, from everyday events, entertainment, learning environments, festivities, even solemn ceremonies; such is the case of the century-old Mexican tradition of Day of the Dead. Altars or offerings as they are sometimes called, are a central part of this celebration; whether they are small homemade shrines or big public installations, they are a narrative medium to tell the life-story and honor the memory of a beloved or important individual. This paper presents the creation of a traditional and technologically enhanced offering dubbed Neoaltar, from the identification and classification of narrative elements found in traditional altars, the proposal of an interactive multimedia interface based on a user experience model, and the construction, installation, live demonstration and evaluation of the altar. The exhibition of the offering was done during the most important and publicly open Day of the Dead event in the Mexican city of Juárez; as part of this study a survey was created, and information gathered from 120 users is analyzed and presented. The Neoaltar strives to tell the life story of the departed by introducing a non-linear interactive multimedia narrative while keeping with tradition by using a non-invasive approach to technology inclusion.

Conductas sexuales en adolescentes de una escuela secundaria en Mérida, Yucatán, México / Sexual behavior in a group of yucatecan adolescents

Resumen Introducción La conducta sexual ha sido ampliamente estudiada en sujetos mayores de 18 años. La edad de inicio de vida sexual ha ido disminuyendo, sin embargo, estudiar la conducta sexual en adolescentes es un reto, y la información es escasa. En este trabajo se realiza un análisis descriptivo de la conducta sexual de un grupo de adolescentes yucatecos. Material y Método Se realizó un estudio prospectivo, transversal y descriptivo que incluyó a 245 adolescentes de 11 a 16 años. La recolección de datos se llevó a cabo con un instrumento autoaplicable y los resultados se analizaron con estadística descriptiva. Resultados El 5.71% (14/245) de la población estudiada refirió ser sexualmente activa; (8.26%, (10/121) de los varones y 3.22% (4/124) de las mujeres), declarándose todos heterosexuales. Las caricias y/o besos en genitales fueron las prácticas sexuales más comunes 78.57% (11/14); la masturbación a la pareja, el sexo oral y el sexo con penetración anal o vaginal se reportaron con la misma frecuencia 28.57% (4/14). El 21.4% (3/14) utilizaron condón en su primera relación sexual y 7.14% (1/14) ha tenido relaciones sexuales en los últimos 6 meses bajo el efecto del alcohol o drogas. El 2.04% (5/245) de la población estudiada practica cibersexo. Conclusión Es baja la frecuencia de adolescentes que han iniciado su vida sexual, sin embargo, la protección es prácticamente inexistente lo que los hace vulnerables a contraer infecciones de transmisión sexual y tener embarazos no deseados.

Abstract Introduction Sexual behavior has been widely studied in subjects older than 18 years despite the increasing evidence that the age of onset of sexual life has been decreasing. Studying adolescent population is a challenge because of the ethical implications it entails, making information on this issue scarce. The objective of this work is to perform descriptive analysis on the sexual behavior in a group of yucatecan adolescents. Material and methods A prospective, cross-sectional and descriptive study was conducted, including 245 adolescents, 11 to 16 years old. The data collection was carried out with a self-applicable instrument, and the results were analyzed with descriptive statistics. Results The 5.71% (14/245) of the population reported having already started their sexual life; (8.26%, (10/121), of males and 3.22% (4/124); of females) declaring themselves as being heterosexual. Genital kissing and touching were the most common sexual practices 78.57% (11/14); masturbation to the couple, oral sex, and anal/vaginal intercourse were reported with the same frequency 28.57% (4/14). In addition, 21.4% (3/14) used condom in their first sexual relationship, and 7.14% (1/14) reported sexual activity in the last 6 months while being under the effects of alcohol or drugs. The 2.04% (5/245) of the studied sample reported practicing cybersex. Conclusion The frequency of adolescents who have begun their sexual life is low, however, protection is practically non-existent which makes them vulnerable to contract sexually transmitted infections and having unintended pregnancies.

Oral health-related quality of life and masticatory function after conventional prosthetic treatment: A cohort follow-up study.

STATEMENT OF PROBLEM: The impact of conventional prosthetic treatment on both the objective and subjective assessments of mastication as well as on well-being is unclear. PURPOSE: The purpose of this clinical study was to compare the impact on oral health-related quality of life and masticatory function in participants treated with conventional dental prostheses. MATERIAL AND METHODS: A total of 72 patients requiring prosthetic rehabilitation were enrolled by referral from the Faculty of Dentistry at the University of Granada, Spain. At baseline, demographic, behavioral, and clinical (prosthetic status, occlusal units) data were collected. In addition, the scores for quality of life, oral satisfaction, masticatory ability (Leake index), and masticatory performance (after 5, 10, and 15 cycles of bicolored chewing gum) were obtained. These records were obtained again at 6 to 8 weeks after insertion of the prostheses. RESULTS: The findings revealed that patients treated with fixed prostheses had better quality of life and better masticatory function than patients treated with removable prostheses. This result was even more pronounced for those treated with complete dentures. For all items, most of the treated patients improved the quality of life (average, 8.6 of the 4 items), although only between 5% and 15% of patients, especially those with a removable prosthesis, commented on functional impact after receiving treatment. Generally, masticatory performance was improved between 7% and 18% and was highly correlated not only with the number of natural teeth (r=0.61) and occlusal units (r=0.51) but also with subjective variables such as mastication satisfaction (r=0.31), impact on quality of life (r=0.30), or masticatory ability (r=0.30). CONCLUSIONS: Treatment with fixed prostheses achieved better results regarding quality of life, oral satisfaction, and masticatory function than treatment with removable prostheses. A moderate but significant correlation exists between the objective and subjective assessments of the masticatory functions.

Hands-on experience can lead to systematic mistakes: A study on adults' understanding of sinking objects.

In line with theories of embodied cognition, hands-on experience is typically assumed to support learning. In the current paper, we explored this issue within the science domain of sinking objects. Adults had to make a guess about which of two objects in a pair would sink faster. The crucial manipulation was whether participants were handed real-life objects (real-objects condition) or were shown static images of objects (static-images condition). Results of Experiment 1 revealed more systematic mistakes in the real-objects than the static-images condition. Experiment 2 investigated this result further, namely by having adults make predictions about sinking objects after an initial training. Again, we found that adults made more mistakes in the real-objects than the static-images condition. Experiment 3 showed that the negative effect of hands-on experiences did not influence later performance. Thus, the negative effects of hands-on experiences were short-lived. Even so, our results call into question an undifferentiated use of manipulatives to convey science concepts. Based on our findings, we suggest that a nuanced theory of embodied cognition is needed, especially as it applies to science learning.

Beliefs as Self-Sustaining Networks: Drawing Parallels Between Networks of Ecosystems and Adults' Predictions.

In this paper, we argue that beliefs share common properties with the self-sustaining networks of complex systems. Matching experiences are said to couple with each other into a mutually reinforcing network. The goal of the current paper is to spell out and develop these ideas, using our understanding of ecosystems as a guide. In Part 1 of the paper, we provide theoretical considerations relevant to this new conceptualization of beliefs, including the theoretical overlap between energy and meaning. In Part 2, we discuss the implications of this new conceptualization on our understanding of belief emergence and belief change. Finally, in Part 3, we provide an analytical mapping between beliefs and the self-sustaining networks of ecosystems, namely by applying to behavioral data a measure developed for ecosystem networks. Specifically, average accuracies were subjected to analyses of uncertainty (H) and average mutual information. The ratio between these two values yields degree of order, a measure of how organized the self-sustained network is. Degree of order was tracked over time and compared to the amount of explained variance returned by a categorical non-linear principal components analysis. Finding high correspondence between the two measures of order, together with the theoretical groundwork discussed in Parts 1 and 2, lends preliminary validity to our theory that beliefs have important similarities to the structural characteristics of self-sustaining networks.

Procesamiento semántico de palabras epistémicas y metafísicas en niños y adolescentes con trastorno de espectro autista (TEA) y con desarrollo típico (DT) / Semantic processing of epistemic and metaphysical words in children and adolescents with autism spectrum disorder (ASD) and typically developing (TD)

La capacidad para entender palabras abstractas se relaciona con la inteligencia y procesos de orden superior. Sin embargo, un creciente número de investigaciones sugiere que las palabras abstractas, aun cuando tienen bajos niveles de concreción e imaginabilidad, son procesadas de una manera diferente. Este artículo proporciona evidencia experimental, donde el procesamiento de palabras abstractas-epistémicas (v.g. imaginación, certeza) es diferente al procesamiento de palabras abstractas-metafísicas (v.g. libertad, criterio). Se llevó a cabo un experimento en el que 16 niños y adolescentes con Trastorno del Espectro Autista (ASD) y un grupo pareado con Desarrollo Típico (DT) completaron nueve sentencias incompletas graduadas por dificultad. Los sujetos con TEA fueron menos precisos y lentos con palabras epistémicas-abstractas, y lentos con palabras abstractas-metafísicas que los sujetos con DT. Los resultados se discuten en términos de los procesos cognitivos y sociales para detectar y entender los estados mentales, una habilidad llamada teoría de la mente (ToM).

The ability to understand abstract words is related to intelligence and higher order processes. However, a growing corpus of research suggests that abstracts words, while having lower level of concreteness and imaginability, are processed in different manners. This article provides experimental evidence that the processing of epistemic-abstract words (eg. Imagination, certainty) is different from the processing of metaphysical-abstract words (eg. Freedom, criteria). We carried out an experiment in which 16 children and adolescents with Autism Spectrum Disorder (ASD) and a typically developing matched group (TD) completed nine sentences graded by difficulty. Subjects with ASD were less accurate and slower with abstract-epistemic words; and slower with abstract-metaphysical words, than subjects with TD. The findings are discussed in terms of the social and cognitive processes to detect and understand the mental states, an ability named theory of mind (ToM).

Long-range correlations and patterns of recurrence in children and adults' attention to hierarchical displays.

In order to make sense of a scene, a person must pay attention to several levels of nested order, ranging from the most differentiated details of the display to the integrated whole. In adults, research shows that the processes of integration and differentiation have the signature of self-organization. Does the same hold for children? The current study addresses this question with children between 6 and 9 years of age, using two tasks that require attention to hierarchical displays. A group of adults were tested as well, for control purposes. To get at the question of self-organization, reaction times were submitted to a detrended fluctuation analysis and a recurrence quantification analysis. H exponents show a long-range correlations (1/f noise), and recurrence measures (percent determinism, maximum line, entropy, and trend), show a deterministic structure of variability being characteristic of self-organizing systems. Findings are discussed in terms of organism-environment coupling that gives rise to fluid attention to hierarchical displays.

Fractal coordination in adults' attention to hierarchical visual patterns.

A display that contains hierarchically nested levels of order requires the perceiver to selectively attend to one of the levels. We investigate the degree to which such selective attention is sustained by a soft-assembled emergent coordinative process, one that does not require designated executive control. In the case of emergent soft-assembly, performance from one trial to the next should show characteristic interdependence, visible in the fractal structure of reaction time. To test this hypothesis, we asked participants across three experiments to decide whether two displays matched in a certain way (e.g., in a local element). In order to gauge this coordinative process, task constraints were experimentally manipulated (e.g., familiarity, predictability, and task instruction). Obtained reaction-time data were subjected to a spectral analysis to measure the degree of interdependence among trials. As predicted, results show correlated structure across trials, significantly different from what would be predicted by an independent-process view of selective attention. Results also show that the obtained spectral scaling exponents track the degree of coupling in the task as a function of the degree of task constraints. Findings are discussed in terms of the relative organism-environment coupling to sustain an adaptive behavior.

Reducing blood testing in pediatric patients after heart surgery: a quality improvement project.

OBJECTIVES: To safely optimize blood testing and costs for pediatric cardiac surgical patients without adversely impacting patient outcomes. DESIGN: This is a quality improvement cohort project with pre- and postintervention groups. SETTING: University-affiliated pediatric cardiac ICU in a tertiary care children's hospital. PATIENTS: All patients were surgical patients for whom Risk Adjustment for Congenital Heart Surgery categories allowed for stratification by complexity. The preintervention group was treated in 2010 and the postintervention group in 2011. INTERVENTIONS: Laboratory ordering processes were analyzed, and practice changed to limit standing blood test orders and requires individualized ordering. MEASUREMENTS AND MAIN RESULTS: Three hundred nineteen patients were studied in 2010 and 345 in 2011. Groups were similar in median age, weight, length of stay (ICU length of stay), and Risk Adjustment for Congenital Heart Surgery category. There was a reduction in the total blood tests per patient (24 vs 38; p < 0.0001) and length of stay adjusted tests per patient-day (10.4 vs 14.4; p = 0.0001) in the postintervention group. The largest test reductions were blood gases and single electrolytes. Adverse outcomes, such as extubation failure (6.4% vs 5.6%), central catheter-associated bloodstream infection (2.2 vs 1.5), and hospital mortality (0.6% vs 0.6%), were not significantly different between the groups. Cost analysis demonstrated an overall laboratory cost savings of 32%. In addition, the volume of packed RBC transfusions was also significantly decreased in the postintervention group among the most complex patients (Risk Adjustment for Congenital Heart Surgery, 6). CONCLUSIONS: Blood testing rates were safely decreased in postoperative pediatric cardiac patients by changing laboratory ordering practices. In addition, packed RBC transfusion was decreased among the most complex patients.

The impact of human rhinovirus infection in pediatric patients undergoing heart surgery.

Human rhinovirus (HRV), the most common cause of upper respiratory infection in children, can present as bronchiolitis, pneumonia, or asthma exacerbations. The impact of HRV in infants and toddlers with congenital heart disease is poorly defined. A case-control study was performed to compare the clinical course for 19 young children with respiratory symptoms who tested positive for rhinovirus after heart surgery with that of 56 matched control subjects. The control subjects were matched by surgical repair, age, weight, and time of the year. Patients with known HRVs before surgery and control subjects with respiratory symptoms or positive test results for viruses were excluded from the study. Human rhinovirus infection was associated with more than a tenfold increase in the odds of noninvasive ventilation after extubation (odds ratio [OR] 11.45; 95 % confidence interval [CI] 3.97-38.67), a 12-fold increase in the probability of extubation failure (OR 12.84; 95 % CI 2.93-56.29), and increased use of pulmonary medications including bronchodilator and nitric oxide (p < 0.001). As a result, the hospital length of stay (HLOS) was two times longer than for the control subjects (p < 0.001), and the cardiac intensive care unit (CICU) length of stay (CICU LOS) was three times longer (p < 0.0001). The intubation time was significantly longer (p < 0.001), and the CICU respiratory charges were significantly greater (p = 0.001) for the infected patients. Human rhinovirus increases resource use and prolongs postoperative recovery after pediatric heart surgery. Surgery timing should be delayed for patients with rhinovirus if possible.