Outcomes for Young Adults With Suicide Admitted to Adult Versus Pediatric Hospitals.

OBJECTIVES: To evaluate differences in care and outcomes for young adults admitted with suicide ideation (SI) or attempt (SA) to medical units of an adult (AH) versus pediatric hospital (PH). METHODS: Demographic and clinical characteristics were collected on patients aged 18 to 25 years admitted to either an AH or PH at an academic health system from September 2017 through June 2023 with a diagnosis of SI or SA. Outcomes measured were discharge location, length of stay (LOS), emergency department (ED) visit or hospital readmission, and inpatient consultations. Bivariate tests and multivariate regression were used to determine association of admission location and outcomes. RESULTS: Of 212 patients included, 54% were admitted to an AH and 46% to a PH. Admission to a PH compared with an AH was associated with shorter ED LOS (4.3 vs 7.3 hours, P < .01) and discharge to home (57% vs 42%, P = .028) on bivariate but not adjusted analysis. Admission location was not associated with hospital LOS, ED visit or medical readmission after discharge, or psychiatry consultation. Admission to a PH compared with an AH was associated with higher odds of psychology consultation (29 vs 3%, P < .01). CONCLUSIONS: Although young adults admitted to a PH for SI/SA had higher rates of psychology consultation, they otherwise had similar care and outcomes regardless of admission to an AH versus a PH. Further work is needed to determine if observed differences are generalizable and how they affect hospital throughput and long-term outcomes.

Gender Disparity in Teaching Evaluations of Pediatric Faculty by Residents.

OBJECTIVES: Despite their overrepresentation, female physicians continue to have lower rates of promotion compared with male physicians. Teaching evaluations play a role in physician advancement. Few studies have investigated gender disparity in resident evaluations of pediatric faculty. We hypothesized that gender disparities in resident evaluations of faculty exist and vary across subspecialties and primary work environments. METHODS: Pediatric faculty institution-specific evaluations completed by residents from January 1, 2015, to March 9, 2020, were obtained from a single academic center. Mean ratings of faculty performance were compared by gender using a Wilcoxon 2-sample test. RESULTS: Fifteen-thousand one-hundred and forty-two evaluations (5091 of male faculty and 10 051 of female faculty) were included. Female faculty were rated higher in overall teaching ability (female = 4.67 versus male = 4.65; P = .004). There was no statistical difference in the mean ratings of male and female faculty in the inpatient setting, whereas outpatient female faculty were rated higher in overall teaching ability (female = 4.79 versus male = 4.73; P = .005). For general pediatric faculty, females received higher ratings for overall teaching ability (female = 4.75 versus male = 4.70; P < .001). By contrast, there was no difference in ratings of subspecialty pediatric faculty. CONCLUSIONS: Pediatric female faculty were statistically rated higher than male faculty in overall teaching ability, although these findings may not be educationally significant. The difference was driven by evaluations in the outpatient setting and for general pediatricians. This study is one of the first in pediatrics adding to the continued investigation of gender disparities in academic medicine.

Management Practices for Standard-Risk and High-Risk Patients With Bronchiolitis.

OBJECTIVE: Management guidelines for bronchiolitis advocate for supportive care and exclude those with high-risk conditions. We aim to describe and compare the management of standard-risk and high-risk patients with bronchiolitis. METHODS: This retrospective study examined patients <2 years of age admitted to the general pediatric ward with an International Classification of Diseases, 10th Revision discharge diagnosis code of bronchiolitis or viral syndrome with evidence of lower respiratory tract involvement. Patients were defined as either standard- or high-risk on the basis of previously published criteria. The frequencies of diagnostic and therapeutic interventions were compared. RESULTS: We included 265 patients in this study (122 standard-risk [46.0%], 143 high-risk [54.0%]). Increased bronchodilator use was observed in the standard-risk group (any albuterol dosing, standard-risk 65.6%, high-risk 44.1%, P = .003). Increased steroid use was observed in the standard-risk group (any steroid dosing, standard-risk 19.7%, high-risk 14.7%, P = .018). Multiple logistic regression revealed >3 doses of albuterol, hypertonic saline, and chest physiotherapy use to be associated with rapid response team activation (odds ratio [OR] >3 doses albuterol: 8.36 [95% confidence interval (CI): 1.99-35.10], P = .048; OR >3 doses hypertonic saline: 13.94 [95% CI: 4.32-44.92], P = .001); OR percussion and postural drainage: 5.06 [95% CI: 1.88-13.63], P = .017). CONCLUSIONS: A varied approach to the management of bronchiolitis in both standard-risk and high-risk children occurred institutionally. Bronchodilators and steroids continue to be used frequently despite practice recommendations and regardless of risk status. More research is needed on management strategies in patients at high-risk for severe disease.

Change in Code Status Orders of Hospitalized Adults With COVID-19 Throughout the Pandemic: A Retrospective Cohort Study.

Aim: Our aim was to examine how code status orders for patients hospitalized with COVID-19 changed over time as the pandemic progressed and outcomes improved. Methods: This retrospective cohort study was performed at a single academic center in the United States. Adults admitted between March 1, 2020, and December 31, 2021, who tested positive for COVID-19, were included. The study period included four institutional hospitalization surges. Demographic and outcome data were collected and code status orders during admission were trended. Data were analyzed with multivariable analysis to identify predictors of code status. Results: A total of 3615 patients were included with full code (62.7%) being the most common final code status order followed by do-not-attempt-resuscitation (DNAR) (18.1%). Time of admission (per every six months) was an independent predictor of final full compared to DNAR/partial code status (p = 0.04). Limited resuscitation preference (DNAR or partial) decreased from over 20% in the first two surges to 10.8% and 15.6% of patients in the last two surges. Other independent predictors of final code status included body mass index (p < 0.05), Black versus White race (0.64, p = 0.01), time spent in the intensive care unit (4.28, p = <0.001), age (2.11, p = <0.001), and Charlson comorbidity index (1.05, p = <0.001). Conclusions: Over time, adults admitted to the hospital with COVID-19 were less likely to have a DNAR or partial code status order with persistent decrease occurring after March 2021. A trend toward decreased code status documentation as the pandemic progressed was observed.

The genome of the soybean gall midge (Resseliella maxima).

The cecidomyiid fly, soybean gall midge, Resseliella maxima Gagné, is a recently discovered insect that feeds on soybean plants in the Midwestern United States. R. maxima larvae feed on soybean stems that may induce plant death and can cause considerable yield losses, making it an important agricultural pest. From three pools of 50 adults each, we used long-read nanopore sequencing to assemble a R. maxima reference genome. The final genome assembly is 206 Mb with 64.88× coverage, consisting of 1,009 contigs with an N50 size of 714 kb. The assembly is high quality with a Benchmarking Universal Single-Copy Ortholog (BUSCO) score of 87.8%. Genome-wide GC level is 31.60%, and DNA methylation was measured at 1.07%. The R. maxima genome is comprised of 21.73% repetitive DNA, which is in line with other cecidomyiids. Protein prediction annotated 14,798 coding genes with 89.9% protein BUSCO score. Mitogenome analysis indicated that R. maxima assembly is a single circular contig of 15,301 bp and shares highest identity to the mitogenome of the Asian rice gall midge, Orseolia oryzae Wood-Mason. The R. maxima genome has one of the highest completeness levels for a cecidomyiid and will provide a resource for research focused on the biology, genetics, and evolution of cecidomyiids, as well as plant-insect interactions in this important agricultural pest.

The Genome of the Soybean Gall Midge ( Resseliella maxima ).

The cecidomyiid fly, soybean gall midge, Resseliella maxima Gagné, is a recently discovered insect that feeds on soybean plants in the Midwest US. Resseliella maxima larvae feed on soybean stems which may induce plant death and can cause considerable yield losses, making it an important agricultural pest. From three pools of 50 adults each, we used long-read nanopore sequencing to assemble a R. maxima reference genome. The final genome assembly is 206 Mb with 64.88X coverage, consisting of 1009 contigs with an N50 size of 714 kb. The assembly is high quality with a BUSCO score of 87.8%. Genome-wide GC level is 31.60% and DNA methylation was measured at 1.07%. The R. maxima genome is comprised of 21.73% repetitive DNA, which is in line with other cecidomyiids. Protein prediction annotated 14,798 coding genes with 89.9% protein BUSCO score. Mitogenome analysis indicated that R. maxima assembly is a single circular contig of 15,301 bp and shares highest identity to the mitogenome of the Asian rice gall midge, Orseolia oryzae (Wood-Mason). The R. maxima genome has one of the highest completeness levels for a cecidomyiid and will provide a resource for research focused on the biology, genetics, and evolution of cecidomyiids, as well as plant-insect interactions in this important agricultural pest.

Seeds of Discomfort: An Unusual Case of Pediatric Abdominal Pain.

This case describes a seven-year-old healthy boy who presented with seven days of abdominal pain, small-volume liquid stools, tenesmus, fevers, and dehydration after consuming an unknown amount of shelled watermelon seeds. He was ultimately found to have a large rectal seed bezoar that caused irritation, resulting in stercoral colitis with rectal inflammation. He was additionally found to have sigmoid volvulus during one of his disimpactions, which was also likely secondary to his rectal seed bezoar. This case uniquely highlights the importance of maintaining an index of suspicion for rectal seed bezoars, discusses previously unreported pediatric complications of rectal seed bezoars, including stercoral colitis and sigmoid volvulus, and addresses the management of this rare presentation.

Microbiome network traits in the rumen predict average daily gain in beef cattle under different backgrounding systems.

BACKGROUND: Backgrounding (BKG), the stage between weaning and finishing, significantly impacts feedlot performance in beef cattle; however, the contributions of the rumen microbiome to this growth stage remain unexplored. A longitudinal study was designed to assess how BKG affects rumen bacterial communities and average daily gain (ADG) in beef cattle. At weaning, 38 calves were randomly assigned to three BKG systems for 55 days (d): a high roughage diet within a dry lot (DL, n = 13); annual cover crop within a strip plot (CC, n = 13); and perennial pasture vegetation within rotational paddocks (PP, n = 12), as before weaning. After BKG, all calves were placed in a feedlot for 142 d and finished with a high energy ration. Calves were weighed periodically from weaning to finishing to determine ADG. Rumen bacterial communities were profiled by collecting fluid samples via oral probe and sequencing the V4 region of the 16S rRNA bacterial gene, at weaning, during BKG and finishing. RESULTS: Rumen bacterial communities diverged drastically among calves once they were placed in each BKG system, including sharp decreases in alpha diversity for CC and DL calves only (P < 0.001). During BKG, DL calves showed a substantial increase of Proteobacteria (Succinivibrionaceae family) (P < 0.001), which also corresponded with greater ADG (P < 0.05). At the finishing stage, Proteobacteria bloomed for all calves, with no previous alpha or beta diversity differences being retained between groups. However, at finishing, PP calves showed a compensatory ADG, particularly greater than that in calves coming from DL BKG (P = 0.02). Microbiome network traits such as lower average shortest path length, and increased neighbor connectivity, degree, number and strength of bacterial interactions between rumen bacteria better predicted ADG during BKG and finishing than variation in specific taxonomic profiles. CONCLUSIONS: Bacterial co-abundance interactions, as measured by network theory approaches, better predicted growth performance in beef cattle during BKG and finishing, than the abundance of specific taxa. These findings underscore the importance of early post weaning stages as potential targets for feeding interventions that can enhance metabolic interactions between rumen bacteria, to increase productive performance in beef cattle.

If Your Heart Were to Stop: Characterization and Comparison of Code Status Orders in Adult Patients Admitted with COVID-19.

Aim: Our aim is to characterize code status documentation for patients hospitalized with novel coronavirus 2019 (COVID-19) during the first peak of the pandemic, when prognosis, resource availability, and provider safety were uncertain. Methods: This retrospective cohort study was performed at a single tertiary academic medical center. Adult patients admitted between March 1, 2020 and October 31, 2020 who tested positive for COVID-19 were included. Demographic and hospital outcome data were collected. Code status orders during this admission and prior admissions were trended. Data were analyzed with multivariable analysis to identify predictors of code status choice. Results: A total of 720 patients were included. The majority (70%) were full code and 12% were in do-not-attempt resuscitation (DNAR) status on admission; by discharge, 20% were DNAR. Age (p < 0.001), time in the intensive care unit (ICU) (p < 0.001), and having Medicaid (p = 0.04) compared to private insurance were predictors of DNAR. Fourteen percent had no code status order. Older age (p < 0.001), time in the ICU (p = 0.01), and admission to a teaching service (p < 0.001) were associated with having an order. Of patients with a prior admission (n = 227), 33.5% previously had no code status order and 44.5% had a different code status for their COVID-19 admission. Of those with a change, most transitioned to less aggressive resuscitation preferences. Conclusions: Most patients hospitalized with COVID-19 in our study elected to be full code. Almost half of patients with prepandemic admissions had a different code status during their COVID-19 admission, with a trend toward less aggressive resuscitation preference.