Perspectives of Health Care Personnel on the Benefits of Bronchiolitis Interventions.

OBJECTIVES: Many interventions in bronchiolitis are low-value or poorly studied. Inpatient bronchiolitis management is multidisciplinary, with varying degrees of registered nurse (RN) and respiratory therapist (RT) autonomy. Understanding the perceived benefit of interventions for frontline health care personnel may facilitate deimplementation efforts. Our objective was to examine perceptions surrounding the benefit of common inpatient bronchiolitis interventions. METHODS: We conducted a cross-sectional survey of inpatient pediatric RNs, RTs, and physicians/licensed practitioners (P/LPs) (eg, advanced-practice practitioners) from May to December of 2021 at 9 university-affiliated and 2 community hospitals. A clinical vignette preceded a series of inpatient bronchiolitis management questions. RESULTS: A total of 331 surveys were analyzed with a completion rate of 71.9%: 76.5% for RNs, 57.4% for RTs, and 71.2% for P/LPs. Approximately 54% of RNs and 45% of RTs compared with 2% of P/LPs believe albuterol would be "extremely or somewhat likely" to improve work of breathing (P < .001). Similarly, 52% of RNs, 32% of RTs, and 23% of P/LPs thought initiating or escalating oxygen in the absence of hypoxemia was likely to improve work of breathing (P < .001). Similar differences in perceived benefit were observed for steroids, nebulized hypertonic saline, and deep suctioning, but not superficial nasal suctioning. Hospital type (community versus university-affiliated) did not impact the magnitude of these differences. CONCLUSIONS: Variation exists in the perceived benefit of several low-value or poorly studied bronchiolitis interventions among health care personnel, with RNs/RTs generally perceiving higher benefit. Deimplementation, educational, and quality improvement efforts should be designed with an interprofessional framework.

Characteristics of Hospitalized Children Positive for SARS-CoV-2: Experience of a Large Center.

OBJECTIVES: Define the spectrum of disease in pediatric inpatients with a positive SARS-CoV-2 test result in a manner relevant to pediatric hospital medicine. METHODS: Retrospective case series of all patients aged <22 years hospitalized at our institution with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction test result between May 1, 2020, and September 30, 2020. Demographic, clinical, and outcome data were collected and analyzed. RESULTS: Three distinct presentations were associated with acute SARS-CoV-2 positivity. Patients had incidental infection (40%), were potentially symptomatic (47%), or were significantly symptomatic (14%). The average length of stay differed between the significantly symptomatic group and the incidental and potentially symptomatic groups (P =.002). Average age differed among these groups, with significantly symptomatic patients older by >2 years. Fifty-five percent of incidental and 47% of potentially symptomatic patients had at least 1 identified comorbidity, whereas 90% of significantly symptomatic patients had at least 1 (P = .01). There was a significant relationship between obesity (P = .001) and asthma (P = .004) and severe disease. Additionally, there was a statistically significant difference between groups with respect to fever, hypoxia, supplemental oxygen use, duration of supplemental oxygen, and ICU admission, with a significantly higher percentage of patients in the significantly symptomatic group meeting each of these criteria (P < .001 for all categories). CONCLUSIONS: Pediatric patients hospitalized with SARS-CoV-2 fall into distinct categories, which are critical to understanding the true pathology of SARS-Cov-2 as it relates to hospitalized pediatric patients. Most hospitalized patients who test positive for SARS-CoV-2 are asymptomatic or have a reason for hospitalization other than coronavirus disease 2019.

Retraction Note: Losing control: Mostly incongruent lists postpone, but do not eliminate, the Stroop effect.

This article has been retracted at the request of all authors. In Experiments 3 and 4 an honest error in the experimental script pointed to the wrong stimulus file on 6.25% of trials, resulting in inaccurate output for each participant.

Losing control: Mostly incongruent lists postpone, but do not eliminate, the Stroop effect.

Identifying the color (e.g., red) of a color word that is incongruent (e.g., "BLUE") can be remarkably difficult. The Stroop effect is a measure of the interference between activity from word and color pathways. The efficacy of these pathways is thought to be highly contingent on the frequency of incongruent trials within a block. A block of trials with mostly incongruent (MI) trials typically results in a smaller Stroop effect than a block with mostly congruent (MC) trials. This reduction of the Stroop effect has been largely attributed to the strategic list-wide control of the word pathway. Here, the time course of the Stroop effect was explored using speed-accuracy tradeoff functions (SATfs) in tasks with 50 % congruent, MC, and MI trials. In the MC and 50 % congruent condition, color-word congruency affected the rate parameter of the SATf. In the MI condition, however, congruency affected the asymptote. This evidence is consistent with the idea that the strategic control of the word pathway is an effortful, temporary phenomenon, prone to buckle if responding is held in check.

Expect the unexpected: a paradoxical effect of cue validity on the orienting of attention.

Predictive central cues generate location-based expectancies, voluntary shifts of attention, and facilitate target processing. Often, location-based expectancies and voluntary attention are confounded in cueing tasks. Here we vary the predictability of central cues to determine whether they can evoke the inhibition of target processing in three go/no-go experiments. In the first experiment, the central cue was uninformative and did not predict the target's location. Importantly, these cues did not seem to affect target processing. In the second experiment, the central cue indicated the most or the least likely location of the target. Surprisingly, both types of cues facilitated target processing at the cued location. In the third experiment, the central cue predicted the most likely location of a no-go target, but it did not provide relevant information pertaining to the location of the go target. Again, the central cue facilitated processing of the go target. These results suggest that efforts to strategically allocate inhibition may be thwarted by the paradoxical monitoring of the cued location. The current findings highlight the need to further explore the relationship between location-based expectancies and spatial attention in cueing tasks.

Identification and functional analysis of candidate genes regulating mesenchymal stem cell self-renewal and multipotency.

Adult human mesenchymal stem cells (hMSCs) possess multilineage differentiation potential, and differentiated hMSCs have recently been shown to have the ability to transdifferentiate into other lineages. However, the molecular signature of hMSCs is not well-known, and the mechanisms regulating their self-renewal, differentiation, and transdifferentiation are not completely understood. In this study, we demonstrate that fully differentiated hMSCs could dedifferentiate, a likely critical step for transdifferentiation. By comparing the global gene expression profiles of undifferentiated, differentiated, and dedifferentiation cells in three mesenchymal lineages (osteogenesis, chondrogenesis, and adipogenesis), we identified a number of "stemness" and "differentiation" genes that might be essential to maintain adult stem cell multipotency as well as to drive lineage-specific commitment. These genes include those that encode cell surface molecules, as well as components of signaling pathways. These genes may be valuable for developing methods to isolate, enrich, and purify homogeneous population of hMSCs and/or maintain and propagate hMSCs as well as guide or regulate their differentiation for gene and cell-based therapy. Using small interfering RNA gene inactivation, we demonstrate that five genes (actin filament-associated protein, frizzled 7, dickkopf 3, protein tyrosine phosphatase receptor F, and RAB3B) promote cell survival without altering cell proliferation, as well as exhibiting different effects on the commitment of hMSCs into multiple mesenchymal lineages.

Origin and characterization of multipotential mesenchymal stem cells derived from adult human trabecular bone.

Much of the knowledge regarding the regulatory pathways for adult stem cell self-renewal and differentiation has been obtained from the results of in vitro cultures. However, it is unclear if adult stem cells are controlled in the same way under physiological conditions. We examined this issue with respect to the migration of stem cells to tissue injury and how switch from a migratory state to one of proliferation wherein they participate in development. Building on our previous identification of multipotent stem cells in trabecular bone, we have examined the in vitro behavior of these cells within the bone milieu. We found that cell proliferation is inhibited within the trabecular bone niche as cells migrate out of the trabecular bone prior to proliferation. Additionally, multiple cell types were detected in adult trabecular bone, including osteoblasts, osteoclasts, endothelial cells, and Stro-1-positive mesenchymal stem cells. Furthermore, we demonstrated that Stro-1-positive cells migrated out of their native bone niche to generate multipotential stem and progenitor cells during in vitro culture. We conclude that self-renewal and differentiation of adult stem cells in connective tissues are tightly controlled and separately orchestrated processes. A regulatory network of extrinsic factors and intrinsic signals acts to stimulate the exit of stem cells from their niche so that they can localize to sites of wound healing, where they participate in development after functional differentiation.