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.

Animal behaviour: Darwin's mischievous hat stealers are innovative problem solvers.

A new study shows a falcon species, the striated caracara, displays similar levels of behavioural innovation to tool-using parrots when solving a battery test in the wild.

A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Evaluating Transcranial Photobiomodulation as Treatment for Concussion.

INTRODUCTION: Literature indicating that transcranial photobiomodulation (tPBM) may enable the brain to recover normal function after concussion, resulting in symptoms reduction, and improved cognitive function after concussion is limited by small sample sizes and lack of controls. METHODS: We conducted a randomized, double-blind, placebo-controlled trial examining the effect of 6 wk of tPBM in patients 11 yr or older who received care for persistent postconcussion symptoms between September 2012 and December 2015. Our primary outcome measure was the mean difference in Postconcussion Symptom Scale total score and the raw Immediate Postconcussion Assessment and Cognitive Testing composite scores between study entry and treatment completion. Participants received two, 10-min sessions either with tPBM units or via two placebo units, three times per week. We screened for potential confounding variables using univariable analyses. We entered covariables that differed between the two groups on univariable screening into a regression analysis. We considered adjusted odds ratio that did not cross one statistically significant. RESULTS: Forty-eight participants completed the study. Most were female (63%), and a majority sustained their injury during sports or exercise (71%). Despite randomization, those that received tPBM therapy reported a greater number of previous concussions. After adjusting for the effect of previous concussions and multiple comparisons, there were no significant differences between tPBM and placebo groups at 3 or 6 wk of treatment. CONCLUSIONS: Despite showing promise in previous investigations, our study did not show benefit to tPBM over placebo therapy in patients experiencing persistent postconcussion symptoms. Further investigation is needed to determine if varying the dose or timing alters the efficacy of tPBM after concussion.

Social influences on delayed gratification in New Caledonian crows and Eurasian jays.

Self-control underlies goal-directed behaviour in humans and other animals. Delayed gratification - a measure of self-control - requires the ability to tolerate delays and/or invest more effort to obtain a reward of higher value over one of lower value, such as food or mates. Social context, in particular, the presence of competitors, may influence delayed gratification. We adapted the 'rotating-tray' paradigm, where subjects need to forgo an immediate, lower-quality (i.e. less preferred) reward for a delayed, higher-quality (i.e. more preferred) one, to test social influences on delayed gratification in two corvid species: New Caledonian crows and Eurasian jays. We compared choices for immediate vs. delayed rewards while alone, in the presence of a competitive conspecific and in the presence of a non-competitive conspecific. We predicted that, given the increased risk of losing a reward with a competitor present, both species would similarly, flexibly alter their choices in the presence of a conspecific compared to when alone. We found that species differed: jays were more likely to select the immediate, less preferred reward than the crows. We also found that jays were more likely to select the immediate, less preferred reward when a competitor or non-competitor was present than when alone, or when a competitor was present compared to a non-competitor, while the crows selected the delayed, highly preferred reward irrespective of social presence. We discuss our findings in relation to species differences in socio-ecological factors related to adult sociality and food-caching (storing). New Caledonian crows are more socially tolerant and moderate cachers, while Eurasian jays are highly territorial and intense cachers that may have evolved under the social context of cache pilfering and cache protection strategies. Therefore, flexibility (or inflexibility) in delay of gratification under different social contexts may relate to the species' social tolerance and related risk of competition.

Neurological and Psychological Sequelae Associated With Multisystem Inflammatory Syndrome in Children.

Importance: Acute neurological involvement occurs in some patients with multisystem inflammatory syndrome in children (MIS-C), but few data report neurological and psychological sequelae, and no investigations include direct assessments of cognitive function 6 to 12 months after discharge. Objective: To characterize neurological, psychological, and quality of life sequelae after MIS-C. Design, Setting, and Participants: This cross-sectional cohort study was conducted in the US and Canada. Participants included children with MIS-C diagnosed from November 2020 through November 2021, 6 to 12 months after hospital discharge, and their sibling or community controls, when available. Data analysis was performed from August 2022 to May 2023. Exposure: Diagnosis of MIS-C. Main Outcomes and Measures: A central study site remotely administered a onetime neurological examination and in-depth neuropsychological assessment including measures of cognition, behavior, quality of life, and daily function. Generalized estimating equations, accounting for matching, assessed for group differences. Results: Sixty-four patients with MIS-C (mean [SD] age, 11.5 [3.9] years; 20 girls [31%]) and 44 control participants (mean [SD] age, 12.6 [3.7] years; 20 girls [45%]) were enrolled. The MIS-C group exhibited abnormalities on neurological examination more frequently than controls (15 of 61 children [25%] vs 3 of 43 children [7%]; odds ratio, 4.7; 95% CI, 1.3-16.7). Although the 2 groups performed similarly on most cognitive measures, the MIS-C group scored lower on the National Institutes of Health Cognition Toolbox List Sort Working Memory Test, a measure of executive functioning (mean [SD] scores, 96.1 [14.3] vs 103.1 [10.5]). Parents reported worse psychological outcomes in cases compared with controls, particularly higher scores for depression symptoms (mean [SD] scores, 52.6 [13.1] vs 47.8 [9.4]) and somatization (mean [SD] scores, 55.5 [15.5] vs 47.0 [7.6]). Self-reported (mean [SD] scores, 79.6 [13.1] vs 85.5 [12.3]) and parent-reported (mean [SD] scores, 80.3 [15.5] vs 88.6 [13.0]) quality of life scores were also lower in cases than controls. Conclusions and Relevance: In this cohort study, compared with contemporaneous sibling or community controls, patients with MIS-C had more abnormal neurologic examinations, worse working memory scores, more somatization and depression symptoms, and lower quality of life 6 to 12 months after hospital discharge. Although these findings need to be confirmed in larger studies, enhanced monitoring may be warranted for early identification and treatment of neurological and psychological symptoms.

Global variability and controls on the accumulation of fallout radionuclides in cryoconite.

The accumulation of fallout radionuclides (FRNs) from nuclear weapons testing and nuclear accidents has been evaluated for over half a century in natural environments; however, until recently their distribution and abundance within glaciers have been poorly understood. Following a series of individual studies of FRNs, specifically 137Cs, 241Am and 210Pb, deposited on the surface of glaciers, we now understand that cryoconite, a material commonly found in the supraglacial environment, is a highly efficient accumulator of FRNs, both artificial and natural. However, the variability of FRN activity concentrations in cryoconite across the global cryosphere has never been assessed. This study thus aims to both synthesize current knowledge on FRNs in cryoconite and assess the controls on variability of activity concentrations. We present a global database of new and previously published data based on gamma spectrometry of cryoconite and proglacial sediments, and assess the extent to which a suite of environmental and physical factors can explain spatial variability in FRN activity concentrations in cryoconite. We show that FRNs are not only found in cryoconite on glaciers within close proximity to specific sources of radioactivity, but across the global cryosphere, and at activity concentrations up to three orders of magnitude higher than those found in soils and sediments in the surrounding environment. We also show that the organic content of cryoconite exerts a strong control on accumulation of FRNs, and that activity concentrations in cryoconite are some of the highest ever described in environmental matrices outside of nuclear exclusion zones, occasionally in excess of 10,000 Bq kg-1. These findings highlight a need for significant improvements in the understanding of the fate of legacy contaminants within glaciated catchments. Future interdisciplinary research is required on the mechanisms governing their accumulation, storage, and mobility, and their potential to create time-dependent impacts on downstream water quality and ecosystem sustainability.

Joyful by nature: approaches to investigate the evolution and function of joy in non-human animals.

The nature and evolution of positive emotion is a major question remaining unanswered in science and philosophy. The study of feelings and emotions in humans and animals is dominated by discussion of affective states that have negative valence. Given the clinical and social significance of negative affect, such as depression, it is unsurprising that these emotions have received more attention from scientists. Compared to negative emotions, such as fear that leads to fleeing or avoidance, positive emotions are less likely to result in specific, identifiable, behaviours being expressed by an animal. This makes it particularly challenging to quantify and study positive affect. However, bursts of intense positive emotion (joy) are more likely to be accompanied by externally visible markers, like vocalisations or movement patterns, which make it more amenable to scientific study and more resilient to concerns about anthropomorphism. We define joy as intense, brief, and event-driven (i.e. a response to something), which permits investigation into how animals react to a variety of situations that would provoke joy in humans. This means that behavioural correlates of joy are measurable, either through newly discovered 'laughter' vocalisations, increases in play behaviour, or reactions to cognitive bias tests that can be used across species. There are a range of potential situations that cause joy in humans that have not been studied in other animals, such as whether animals feel joy on sunny days, when they accomplish a difficult feat, or when they are reunited with a familiar companion after a prolonged absence. Observations of species-specific calls and play behaviour can be combined with biometric markers and reactions to ambiguous stimuli in order to enable comparisons of affect between phylogenetically distant taxonomic groups. Identifying positive affect is also important for animal welfare because knowledge of positive emotional states would allow us to monitor animal well-being better. Additionally, measuring if phylogenetically and ecologically distant animals play more, laugh more, or act more optimistically after certain kinds of experiences will also provide insight into the mechanisms underlying the evolution of joy and other positive emotions, and potentially even into the evolution of consciousness.

Creativity and flexibility in young children's use of external cognitive strategies.

A cardinal feature of adult cognition is the awareness of our own cognitive struggles and the capacity to draw upon this awareness to offload internal demand into the environment. In this preregistered study conducted in Australia, we investigated whether 3-8-year-olds (N = 72, 36 male, 36 female, mostly White) could self-initiate such an external metacognitive strategy and transfer it across contexts. Children watched as an experimenter demonstrated how to mark the location of a hidden prize, thus helping them successfully retrieve that prize in the future. Children were then given the opportunity to spontaneously adopt an external marking strategy across six test trials. Children who did so at least once were then introduced to a conceptually similar but structurally distinct transfer task. Although most 3-year-olds deployed the demonstrated strategy in the initial test phase, none of them modified that strategy to solve the transfer task. By contrast, many children aged 4 years and older spontaneously devised more than one previously unseen reminder-setting strategy across the six transfer trials, with this tendency increasing with age. From age 6, children deployed effective external strategies on most trials, with the number, combination, and order of unique strategies used varying widely both within and across the older age groups. These results demonstrate young children's remarkable flexibility in the transferral of external strategies across contexts and point to pronounced individual differences in the strategies children devise. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Clinical impact of a multiplex rapid diagnostic pneumonia panel in critically ill patients.

Objective: To evaluate the clinical impact of the BioFire FilmArray Pneumonia Panel (PNA panel) in critically ill patients. Design: Single-center, preintervention and postintervention retrospective cohort study. Setting: Tertiary-care academic medical center. Patients: Adult ICU patients. Methods: Patients with quantitative bacterial cultures obtained by bronchoalveolar lavage or tracheal aspirate either before (January-March 2021, preintervention period) or after (January-March 2022, postintervention period) implementation of the PNA panel were randomly screened until 25 patients per study month (75 in each cohort) who met the study criteria were included. Antibiotic use from the day of culture collection through day 5 was compared. Results: The primary outcome of median time to first antibiotic change based on microbiologic data was 50 hours before the intervention versus 21 hours after the intervention (P = .0006). Also, 56 postintervention regimens (75%) were eligible for change based on PNA panel results; actual change occurred in 30 regimens (54%). Median antibiotic days of therapy (DOTs) were 8 before the intervention versus 6 after the intervention (P = .07). For the patients with antibiotic changes made based on PNA panel results, the median time to first antibiotic change was 10 hours. For patients who were initially on inadequate therapy, time to adequate therapy was 67 hours before the intervention versus 37 hours after the intervention (P = .27). Conclusions: The PNA panel was associated with decreased time to first antibiotic change and fewer antibiotic DOTs. Its impact may have been larger if a higher percentage of potential antibiotic changes had been implemented. The PNA panel is a promising tool to enhance antibiotic stewardship.

Contrafreeloading in kea (Nestor notabilis) in comparison to Grey parrots (Psittacus erithacus).

Contrafreeloading-working to access food that could be freely obtained-is rarely exhibited and poorly understood. Based on data from Grey parrots (Psittacus erithacus), researchers proposed a correlation between contrafreeloading and play: that contrafreeloading is more likely when subjects view the task as play. We tested that hypothesis by subjecting a relatively more playful parrot species, the kea (Nestor notabilis), to the same experimental tasks. Experiment 1 presented eight kea with container pairs holding more- or less-preferred free or enclosed food items, and examined three types of contrafreeloading: calculated (working to access preferred food over less-preferred, freely available food); classic (working to access food identical to freely available food); and super (working to access less-preferred food over preferred, freely available food). At the group level, the kea behaved similarly to the Greys: They significantly preferred calculated contrafreeloading, performed classic contrafreeloading at chance, and significantly failed to super contrafreeload. However, overall kea engaged in more contrafreeloading than Greys. Experiment 2 examined a potentially more ecologically relevant task, a choice between shelled and unshelled walnuts. No kea contrafreeloaded for nuts, whereas two of five Greys significantly preferred nut contrafreeloading and one chose at chance. We examine proximate and adaptive explanations for the performances of these differentially playful parrot species to further elucidate the role of play in contrafreeloading.

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.

The signature-testing approach to mapping biological and artificial intelligences.

Making inferences from behaviour to cognition is problematic due to a many-to-one mapping problem, in which any one behaviour can be generated by multiple possible cognitive processes. Attempts to cross this inferential gap when comparing human intelligence to that of animals or machines can generate great debate. Here, we discuss the challenges of making comparisons using 'success-testing' approaches and call attention to an alternate experimental framework, the 'signature-testing' approach. Signature testing places the search for information-processing errors, biases, and other patterns centre stage, rather than focussing predominantly on problem-solving success. We highlight current research on both biological and artificial intelligence that fits within this framework and is creating proactive research programs that make strong inferences about the similarities and differences between the content of human, animal, and machine minds.

Retrospective evaluation of a delirium order set utilizing nonpharmacologic and pharmacologic interventions for the treatment of delirium in medical intensive care unit patients.

PURPOSE: To describe the use of a medical intensive care unit (MICU) delirium order set pilot and its associated impact on utilization of nonpharmacologic and pharmacologic interventions, pharmacologic continuation at transitions of care, and resolution of ICU delirium. METHODS: This was a retrospective cohort analysis of MICU patients who received delirium management using an order set pilot compared to standard care. Patients 18 years of age or older admitted to the MICU between May 2019 and January 2020 who received an antipsychotic or valproic acid for the treatment of delirium were included. RESULTS: Pharmacologic treatment continuation past ICU discharge occurred in 30% of patients in the pilot cohort (n = 50) compared to 54% of patients receiving standard care (n = 50; P = 0.027). On treatment days 1 through 7, utilization of deliriogenic medications was significantly lower in the pilot cohort (78% vs 96%, P = 0.007). No differences were observed between the groups in delirium resolution, delirium recurrence, hospital and ICU length of stay, or mortality. CONCLUSION: A MICU order set prioritizing nonpharmacologic management and limiting the duration of pharmacologic agents for delirium may aid providers in the management of ICU delirium and reduce exposure to pharmacologic interventions.

Jumping spiders do not seem fooled by texture gradient illusions.

Jumping spiders (Salticidae) use exceptional vision, largely mediated by their forward-facing anterior lateral (AL) and anterior medial (AM) eyes, to pounce on prey from a distance. We evaluated depth perception through the use of 'texture density' (depth estimation through surface texture comparisons, with greater distances having higher textural density) in the salticid Trite planiceps. In visual cliff experiments, spiders tended to choose an area with a false 'low drop' over a false 'high drop' with the same texture densities, but showed no preference for either area when presented with substrates with different texture densities at a constant height. This was corroborated when T. planiceps did not avoid jumping over an illusion resembling a trench compared to a no-illusion control pattern. We then selectively occluded both AL and 1 AM eye (monocular treatment), both AL eyes (ALE-occluded binocular treatment) or no eyes (control), and induced spiders to jump across a gap at different heights. Neither control spiders, spiders with binocular cues from the AM eyes or monocular treatment spiders exhibited a height preference. These results suggest that while T. planiceps accurately perceives depth, it does not appear to rely on texture gradients as a depth cue.

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.

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.

Self-care tooling innovation in a disabled kea (Nestor notabilis).

Tooling is associated with complex cognitive abilities, occurring most regularly in large-brained mammals and birds. Among birds, self-care tooling is seemingly rare in the wild, despite several anecdotal reports of this behaviour in captive parrots. Here, we show that Bruce, a disabled parrot lacking his top mandible, deliberately uses pebbles to preen himself. Evidence for this behaviour comes from five lines of evidence: (i) in over 90% of instances where Bruce picked up a pebble, he then used it to preen; (ii) in 95% of instances where Bruce dropped a pebble, he retrieved this pebble, or replaced it, in order to resume preening; (iii) Bruce selected pebbles of a specific size for preening rather than randomly sampling available pebbles in his environment; (iv) no other kea in his environment used pebbles for preening; and (v) when other individuals did interact with stones, they used stones of different sizes to those Bruce preened with. Our study provides novel and empirical evidence for deliberate self-care tooling in a bird species where tooling is not a species-specific behaviour. It also supports claims that tooling can be innovated based on ecological necessity by species with sufficiently domain-general cognition.