The effects of simulated gastroesophageal reflux on infant pig oropharyngeal feeding physiology.

The neural connectivity among the oral cavity, pharynx, and esophagus is a critical component of infant feeding physiology. Central integration of oral and pharyngeal afferents alters motor outputs to structures that power swallowing, but the potential effects of esophageal afferents on preesophageal feeding physiology are unclear. These effects may explain the prevalence of oropharyngeal dysphagia in infants suffering from gastroesophageal reflux (GER), though the mechanism underlying this relationship remains unknown. Here we use the validated infant pig model to assess the impacts of simulated GER on preesophageal feeding parameters. We used high-speed videofluoroscopy and electromyography to record bottle-feeding before and following the infusion of a capsaicin-containing solution into the lower esophagus. Sucking parameters were minimally affected by capsaicin exposure, such that genioglossus activity was unchanged and tongue kinematics were largely unaffected. Aspects of the pharyngeal swallow were altered with simulated GER, including increased thyrohyoid muscle activity, increased excursions of the hyoid and thyroid per swallow, decreased swallow frequency, and increased bolus sizes. These results suggest that esophageal afferents can elicit changes in pharyngeal swallowing. In addition, decreased swallowing frequency may be the mechanism by which esophageal pathologies induce oropharyngeal dysphagia. Although recent work indicates that oral or pharyngeal capsaicin may improve dysphagia symptoms, the decreased performance following esophageal capsaicin exposure highlights the importance of designing sensory interventions based upon neurophysiology and the mechanisms underlying disordered feeding. This mechanistic approach requires comprehensive data collection across the entirety of the feeding process, which can be achieved using models such as the infant pig.NEW & NOTEWORTHY Simulated gastroesophageal reflux (GER) in an infant pig model resulted in significant changes in pharyngeal swallowing, which suggests that esophageal afferents are centrally integrated to alter motor outputs to the pharynx. In addition, decreased swallow frequency and increased bolus sizes may be underlying mechanisms by which esophageal pathologies induce oropharyngeal dysphagia. The infant pig model used here allows for a mechanistic approach, which can facilitate the design of intervention strategies based on neurophysiology.

Antibiotic Use in Small Community Hospitals.

BACKGROUND: Antibiotic use and misuse is driving drug resistance. Much of US healthcare takes place in small community hospitals (SCHs); 70% of all US hospitals have <200 beds. Antibiotic use in SCHs is poorly described. We evaluated antibiotic use using data from the National Healthcare and Safety Network antimicrobial use option from the Centers for Disease Control and Prevention. METHODS: We used Intermountain Healthcare's monthly antibiotic use reports for 19 hospitals from 2011 to 2013. Hospital care units were categorized as intensive care, medical/surgical, pediatric, or miscellaneous. Antibiotics were categorized based on spectrum of coverage. Antibiotic use rates, expressed as days of therapy per 1000 patient-days (DOT/1000PD), were calculated for each SCH and compared with rates in large community hospitals (LCHs). Negative-binomial regression was used to relate antibiotic use to predictor variables. RESULTS: Total antibiotic use rates varied widely across the 15 SCHs (median, 436 DOT/1000PD; range, 134-671 DOT/1000PD) and were similar to rates in 4 LCHs (509 DOT/1000PD; 406-597 DOT/1000PD). The proportion of patient-days spent in the respective unit types varied substantially within SCHs and had a large impact on facility-level rates. Broad-spectrum antibiotics accounted for 26% of use in SCHs (range, 8%-36%), similar to the proportion in LCHs (32%; range, 26%-37%). Case mix index, proportion of patient-days in specific unit types, and season were significant predictors of antibiotic use. CONCLUSIONS: There is substantial variation in patterns of antibiotic use among SCHs. Overall usage in SCHs is similar to usage in LCHs. Small hospitals need to become a focus of stewardship efforts.

Notes on the data quality of bibliographic records from the MEDLINE database.

The US National Library of Medicine has created and maintained the PubMed® database, a collection of over 33.8 million records that contain citations and abstracts from the biomedical and life sciences literature. This database is an important resource for researchers and information service providers alike. As part of our work related to the creation of an author graph for coronaviruses, we encountered several data quality issues with records from a curated subset of the PubMed database called MEDLINE. We provide a data quality assessment for records selected from the MEDLINE database and report on several issues ranging from parsing issues (e.g. character encodings and schema definition weaknesses) to low scores for identifiers against several data quality metrics (e.g. completeness, validity and uniqueness). Database URL  https://pubmed.ncbi.nlm.nih.gov.

Exploring the interaction of viscosity and nipple design on feeding performance in an infant pig model.

Infant feeding behaviors are modulated via sensorimotor feedback, such that sensory perturbations can significantly impact performance. Properties of the nipple and milk (e.g., nipple hole size and viscosity) are critical sources of sensory information. However, the direct effects of varying milk and nipple properties on infant motor output and the subsequent changes in feeding performance are poorly understood. In this study, we use an infant pig model to explore the interaction between nipple hole size and milk viscosity. Using high-speed videofluoroscopy and electromyography, we measured key performance metrics including sucks per swallow and suck duration, then synchronized these data with the onset and offset of activity of jaw opening and closing muscles. The combination of a small nipple hole and thick milk resulted in negative effects on both suck and swallow performance, with reduced feeding efficiency compared to the other treatments. It also appears that this combination of viscosity and hole size disrupts the coordination between correlates of tongue and jaw movements. We did not see a difference in feeding efficiency between viscosities when infants fed on the large-hole nipple, which may be the result of non-Newtonian fluid mechanics. Our results emphasize the importance of considering both fluid and nipple properties when considering alterations to an infant's feeding system.

Testing the effects of body depth on fish maneuverability via robophysical models.

Fish show a wide diversity of body shapes which affect many aspects of their biology, including swimming and feeding performance, and defense from predators. Deep laterally compressed bodies are particularly common, and have evolved multiple times in different families. Functional hypotheses that explain these trends include predator defense and increased maneuverability. While there is strong evidence that increasing body depth helps fish avoid gape-limited predators, the evidence that body shape increases a fish's maneuverability is ambiguous. We used a two-pronged approach to explore the effects of body shape on the control of maneuvers using both live fish and a robotic model that allowed us to independently vary body shape. We captured ventral video of two tetra species (Gymnocorymbus ternetziandAphyocharax anisitsi) performing a wide range of maneuvers to confirm that both species of live fish utilize fundamentally similar body deformations to execute a turn, despite their different body depths. Both species use a propagating 'pulse' of midline curvature that is qualitatively similar to prior studies and displayed similar trends in the relationships between body kinematics and performance. We then tested the robotic model's maneuverability, defined as the total heading change and maximum centripetal acceleration generated during a single pulse, at a range of different input kinematics across three body shapes. We found that deepening bodies increase the robot's ability to change direction and centripetal acceleration, though centripetal acceleration exhibits diminishing returns beyond a certain body depth. By using a robotic model, we were able to isolate the effects of body shape on maneuverability and clarify this confounded relationship. Studying the functional morphology of complex traits such as body shape and their interaction with complex behavior like maneuverability benefits from both the broad view provided by comprehensive comparative studies, and the control of variables enabled by robophysical experiments.

Comparing the turn performance of different motor control schemes in multilink fish-inspired robots.

Fish robots have many possible applications in exploration, industry, research, and continue to increase in design complexity, control, and the behaviors they can complete. Maneuverability is an important metric of fish robot performance, with several strategies being implemented. By far the most common control scheme for fish robot maneuvers is an offset control scheme, wherein the robot's steady swimming is controlled by sinusoidal function and turns are generated biasing bending to one side or another. An early bio-inspired turn control scheme is based on the C-start escape response observed in live fish. We developed a control scheme that is based on the kinematics of routine maneuvers in live fish that we call the 'pulse', which is a pattern of increasing and decreasing curvature that propagates down the body. This pattern of curvature is consistent across a wide range of turn types and can be described with a limited number of variables. We compared the performance of turns using each of these three control schemes across a range of durations and bending amplitudes. We found that C-start and offset turns had the highest heading changes for a given set of inputs, whereas the bio-inspired pulse turns had the highest linear accelerations for a given set of inputs. However, pulses shift the conceptualization of swimming away from it being a continuous behavior towards it being an intermittent behavior that is built by combining individual bending events. Our bio-inspired pulse control scheme has the potential to increase the behavioral flexibility of bio-inspired robotic fish and solve some of the problems associated with integrating different swimming behaviors, despite lower maximal turning performance.

The control of routine fish maneuvers: Connecting midline kinematics to turn outcomes.

Maneuverability is an important factor in determining an animal's ability to navigate its environment and succeed in predator-prey interactions. Although fish are capable of a wide range of maneuvers, most of the literature has focused on escape maneuvers while less attention has been paid to routine maneuvers, such as those used for habitat navigation. The quantitative relationships between body deformations and maneuver outcomes (displacement of the center of mass and change in trajectory) are fundamental to understanding how fish control their maneuvers, yet remain unknown in routine maneuvers. We recorded high-speed video of eight giant danios (Devario aquepinnatus) performing routine and escape maneuvers and quantified the deformation of the midline, the heading of the anterior body, and the kinematics of the centroid (a proxy for center of mass). We found that both routine and escape behaviors used qualitatively similar independent body bending events, which we curvature pulses, that propagate from head to tail but show quantitative differences in midline kinematics and turn outcomes. In routine maneuvers, the direction change and acceleration of the fish are influenced by both the magnitude of the bending pulse and by the duration of the pulse, whereas in escape maneuvers, only pulse duration influenced direction change and turn acceleration. The bending pulse appears to be the smallest functional unit of a turn, and can function independently or in combination, enabling a fish to achieve a wide range of complex maneuvers.

Adaptive differentiation of quantitative traits in the globally distributed weed, wild radish (Raphanus raphanistrum).

Weedy species with wide geographical distributions may face strong selection to adapt to new environments, which can lead to adaptive genetic differentiation among populations. However, genetic drift, particularly due to founder effects, will also commonly result in differentiation in colonizing species. To test whether selection has contributed to trait divergence, we compared differentiation at eight microsatellite loci (measured as F(ST)) to differentiation of quantitative floral and phenological traits (measured as Q(ST)) of wild radish (Raphanus raphanistrum) across populations from three continents. We sampled eight populations: seven naturalized populations and one from its native range. By comparing estimates of Q(ST) and F(ST), we found that petal size was the only floral trait that may have diverged more than expected due to drift alone, but inflorescence height, flowering time, and rosette formation have greatly diverged between the native and nonnative populations. Our results suggest the loss of a rosette and the evolution of early flowering time may have been the key adaptations enabling wild radish to become a major agricultural weed. Floral adaptation to different pollinators does not seem to have been as necessary for the success of wild radish in new environments.

Parallel behavioral and morphological divergence in fence lizards on two college campuses.

The spread of urban development has dramatically altered natural habitats, modifying community relationships, abiotic factors, and structural features. Animal populations living in these areas must perish, emigrate, or find ways to adjust to a suite of new selective pressures. Those that successfully inhabit the urban environment may make behavioral, physiological, and/or morphological adjustments that represent either evolutionary change and/or phenotypic plasticity. We tested for effects of urbanization on antipredator behavior and associated morphology across an urban-wild gradient in the western fence lizard (Sceloporus occidentalis) in two California counties, Santa Barbara and San Luis Obispo. We compared college campuses in both counties with adjacent rural habitats, conducting field trials that allowed us to characterize antipredator behavior in response to the acute stress of capture. We found notable divergence between campus and rural behavior, with campus lizards more frequently exhibiting diminished escape behavior, including tonic immobility, and lower sprint speeds. Furthermore, campus females had significantly shorter limbs, and while this did not explain variation in sprint speed, those with shorter limbs were more likely to show tonic immobility. We hypothesize that these parallel behavioral and morphological changes on both campuses reflect adjustment to a novel environment involving changes in predation and human presence.

Use of a Proven Framework for Computer Decision Support within the Intermountain Healthcare Network.

Hospitalized patients in the U.S. do not always receive optimal care. In light of this, Computerized Decision Support (CDS) has been recommended to for the improvement of patient care. A number of methodologies, standards, and frameworks have been developed to facilitate the development and interoperability of computerized clinical guidelines and CDS logic. In addition, Health Information Exchange using Service-Oriented Architecture holds some promise to help realize that goal. We have used a framework at Intermountain Healthcare that employs familiar programming languages and technology to develop over 40 CDS applications during the past 13 years, which clinicians are dependent on each day. This paper describes the framework, technology, and CDS application development methods, while providing three distinct examples of applications that illustrate the need and use of the framework for patient care improvement. The main limitation of this framework is its dependence on point-to-point interfaces to access patient data. We look forward to the use of validated and accessible Service-Oriented Architecture to facilitate patient data access across diverse databases.

Automated detection of physiologic deterioration in hospitalized patients.

OBJECTIVE: Develop and evaluate an automated case detection and response triggering system to monitor patients every 5 min and identify early signs of physiologic deterioration. MATERIALS AND METHODS: A 2-year prospective, observational study at a large level 1 trauma center. All patients admitted to a 33-bed medical and oncology floor (A) and a 33-bed non-intensive care unit (ICU) surgical trauma floor (B) were monitored. During the intervention year, pager alerts of early physiologic deterioration were automatically sent to charge nurses along with access to a graphical point-of-care web page to facilitate patient evaluation. RESULTS: Nurses reported the positive predictive value of alerts was 91-100% depending on erroneous data presence. Unit A patients were significantly older and had significantly more comorbidities than unit B patients. During the intervention year, unit A patients had a significant increase in length of stay, more transfers to ICU (p = 0.23), and significantly more medical emergency team (MET) calls (p = 0.0008), and significantly fewer died (p = 0.044) compared to the pre-intervention year. No significant differences were found on unit B. CONCLUSIONS: We monitored patients every 5 min and provided automated pages of early physiologic deterioration. This before-after study found a significant increase in MET calls and a significant decrease in mortality only in the unit with older patients with multiple comorbidities, and thus further study is warranted to detect potential confounding. Moreover, nurses reported the graphical alerts provided information needed to quickly evaluate patients, and they felt more confident about their assessment and more comfortable requesting help.

Application of classification-tree methods to identify nitrate sources in ground water.

A study was conducted to determine if nitrate sources in ground water (fertilizer on crops, fertilizer on golf courses, irrigation spray from hog (Sus scrofa) wastes, and leachate from poultry litter and septic systems) could be classified with 80% or greater success. Two statistical classification-tree models were devised from 48 water samples containing nitrate from five source categories. Model 1 was constructed by evaluating 32 variables and selecting four primary predictor variables (delta 15N, nitrate to ammonia ratio, sodium to potassium ratio, and zinc) to identify nitrate sources. A delta 15N value of nitrate plus potassium > 18.2 indicated animal sources; a value < 18.2 indicated inorganic or soil organic N. A nitrate to ammonia ratio > 575 indicated inorganic fertilizer on agricultural crops; a ratio < 575 indicated nitrate from golf courses. A sodium to potassium ratio > 3.2 indicated septic-system wastes; a ratio < 3.2 indicated spray or poultry wastes. A value for zinc > 2.8 indicated spray wastes from hog lagoons; a value < 2.8 indicated poultry wastes. Model 2 was devised by using all variables except delta 15N. This model also included four variables (sodium plus potassium, nitrate to ammonia ratio, calcium to magnesium ratio, and sodium to potassium ratio) to distinguish categories. Both models were able to distinguish all five source categories with better than 80% overall success and with 71 to 100% success in individual categories using the learning samples. Seventeen water samples that were not used in model development were tested using Model 2 for three categories, and all were correctly classified. Classification-tree models show great potential in identifying sources of contamination and variables important in the source-identification process.