Single-Center Experience with Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy in Infants with <36 Weeks' Gestation.

OBJECTIVE: Hypoxic-ischemic encephalopathy (HIE) is a leading cause of morbidity and mortality in neonates. Therapeutic hypothermia (TH) has improved outcomes and mortality in infants with >36 weeks' gestational age (GA) with moderate-to-severe HIE. There are limited data on the safety and efficacy of TH in preterm infants with HIE. This study describes our experience and examines the safety of TH in neonates with <36 weeks' GA. STUDY DESIGN: A single-center, retrospective study of preterm neonates born at <36 weeks' GA with moderate-to-severe HIE and treated with TH, compared to a cohort of term neonates with HIE (≥37 weeks' GA), was conducted. The term cohort was matched for degree of background abnormality on electroencephalogram, sex, inborn versus outborn status, and birth year. Medical records were reviewed for pregnancy and delivery complications, need for transfusion, sedation and antiseizure medications, electroencephalography and imaging findings, and in-hospital mortality. RESULTS: Forty-two neonates born at <36 weeks' GA with HIE received TH between 2005 and 2022. Data from 42 term neonates were analyzed for comparison. The average GA of the preterm cohort was 34.6 weeks and 39.3 weeks for the term cohort. Apgar scores, degree of acidosis, and need for blood product transfusions were similar between groups. Preterm infants were more likely to require inotropic support (55 vs. 29%, p = 0.026) and hydrocortisone (36 vs. 12%, p = 0.019) for hypotension. The proportion of infants without evidence of injury on magnetic resonance imaging was similar in both groups: 43 versus 50% in preterm and term infants, respectively. No significant difference was found in mortality between groups. CONCLUSION: In this single-center cohort, TH in preterm infants appears to be as safe as in term infants, with no significant increase in intracranial bleeds or mortality. Preterm infants more frequently required inotropes and steroids for hypotension. Further research is needed to determine efficacy of TH in preterm infants. KEY POINTS: · TH is used off-protocol in preterm infants.. · Preterm and term infants have similar mortality.. · Preterm cohort required more inotropic support..

Dynamic winter weather moderates movement and resource selection of wild turkeys at high-latitude range limits.

For wide-ranging species in temperate environments, populations at high-latitude range limits are subject to more extreme conditions, colder temperatures, and greater snow accumulation compared with their core range. As climate change progresses, these bounding pressures may become more moderate on average, while extreme weather occurs more frequently. Individuals can mitigate temporarily extreme conditions by changing daily activity budgets and exhibiting plasticity in resource selection, both of which facilitate existence at and expansion of high-latitude range boundaries. However, relatively little work has explored how animals moderate movement and vary resource selection with changing weather, and a general framework for such investigations is lacking. We applied hidden Markov models and step selection functions to GPS data from wintering wild turkeys (Meleagris gallopavo) near their northern range limit to identify how weather influenced transition among discrete movement states, as well as state-specific resource selection. We found that turkeys were more likely to spend time in a stationary state as wind chill temperatures decreased and snow depth increased. Both stationary and roosting turkeys selected conifer forests and avoided land covers associated with foraging, such as agriculture and residential areas, while shifting their strength of selection for these features during poor weather. In contrast, mobile turkeys showed relatively weak resource selection, with less response in selection coefficients during poor weather. Our findings illustrate that behavioral plasticity in response to weather was context dependent, but movement behaviors most associated with poor weather were also those in which resource selection was most plastic. Given our results, the potential for wild turkey range expansion will partly be determined by the availability of habitat that allows them to withstand periodic inclement weather. Combining hidden Markov models with step selection functions is broadly applicable for evaluating plasticity in animal behavior and dynamic resource selection in response to changing weather. We studied turkeys at northern range limits, but this approach is applicable for any system expected to experience significant changes in the coming decade, and may be particularly relevant to populations existing at range peripheries.

Of Love and Death: Death Anxiety, Attachment, and Suicide as Experienced by College Students.

Drawing from the mental health crisis present on college campuses, we investigate the psychological processes associated with suicidal ideation among undergraduate students. Specifically, we used Terror Management Theory to investigate how individuals who have a history of suicidal ideation handle traditional death anxiety in coordination with Benjamin's theory underlying Interpersonal Reconstructive Therapy to explore specific attachment-based mechanisms that may allow for exceptions to the perceived meaning of death. Results show it was the fantasy of suicide itself, including its relevance in the lives of others, that was used to alleviate fear of death among the suicidal.

Occupational therapy's role in promoting the "Learn the Signs. Act Early." developmental monitoring program to public health employees.

Background: Occupational therapists can play a key role in early identification of delay at the population health level by providing education to public health employees on how to implement developmental monitoring with caregivers of children birth to age 5. Methods: A pretest posttest design was utilized to assess the online education and training that was provided to Department of Public Health employees (N = 339), including Head Start, Special Supplemental Nutrition Program for Women, Infants and Children, Home Visiting, and Early Intervention. Results: Analysis of pretest-posttest survey data showed significant results for all 12 key learning outcomes. Six out of 12 outcomes were found to have a large effect size (d > 0.8), 4 outcomes indicated a medium effect size (d > 0.5), and 2 outcomes had a small effect size (d > 0.2). Participants gained knowledge of the "Learn the Signs. Act Early." (LTSAE) developmental monitoring program, the difference between developmental monitoring and screening, the state's referral system and age-appropriate parental engagement activities through knowledge of child development. Conclusions: Occupational therapists are child development specialists who can provide education on developmental monitoring and activities for parental engagement. The online course proved to be an effective platform to promote LTSAE within state agencies.

PATHOGEN SURVEY AND PREDICTORS OF LYMPHOPROLIFERATIVE DISEASE VIRUS INFECTION IN WILD TURKEYS (MELEAGRIS GALLOPAVO).

Growing populations of Wild Turkeys (Meleagris gallopavo) may result in increased disease transmission among wildlife and spillover to poultry. Lymphoproliferative disease virus (LPDV) is an avian retrovirus that is widespread in Wild Turkeys of eastern North America, and infections may influence mortality and parasite co-infections. We aimed to identify individual and spatial risk factors of LPDV in Maine's Wild Turkeys. We also surveyed for co-infections between LPDV and reticuloendotheliosis virus (REV), Mycoplasma gallisepticum, and Salmonella pullorum to estimate trends in prevalence and examine covariance with LPDV. From 2017 to 2020, we sampled tissues from hunter-harvested (n=72) and live-captured (n=627) Wild Turkeys, in spring and winter, respectively, for molecular detection of LPDV and REV. In a subset of captured individuals (n=235), we estimated seroprevalence of the bacteria M. gallisepticum and S. pullorum using a plate agglutination test. Infection rates for LPDV and REV were 59% and 16% respectively, with a co-infection rate of 10%. Seroprevalence for M. gallisepticum and S. pullorum were 74% and 3.4%, with LPDV co-infection rates of 51% and 2.6%, respectively. Infection with LPDV and seroprevalence of M. gallisepticum and S. pullorum decreased, whereas REV infection increased, between 2018 and 2020. Females (64%), adults (72%), and individuals sampled in spring (76%) had higher risks of LPDV infection than males (47%), juveniles (39%), and individuals sampled in winter (57%). Furthermore, LPDV infection increased with percent forested cover (ß=0.014±0.007) and decreased with percent agriculture cover for juveniles (ß=-0.061±0.018) sampled in winter. These data enhance our understanding of individual and spatial predictors of LPDV infection in Wild Turkeys and aid in assessing the associated risk to Wild Turkey populations and poultry operations.

Including a spatial predictive process in band recovery models improves inference for Lincoln estimates of animal abundance.

Abundance estimation is a critical component of conservation planning, particularly for exploited species where managers set regulations to restrict harvest based on current population size. An increasingly common approach for abundance estimation is through integrated population modeling (IPM), which uses multiple data sources in a joint likelihood to estimate abundance and additional demographic parameters. Lincoln estimators are one commonly used IPM component for harvested species, which combine information on the rate and total number of individuals harvested within an integrated band-recovery framework to estimate abundance at large scales. A major assumption of the Lincoln estimator is that banding and recoveries are representative of the whole population, which may be violated if major sources of spatial heterogeneity in survival or harvest rates are not incorporated into the model. We developed an approach to account for spatial variation in harvest rates using a spatial predictive process, which we incorporated into a Lincoln estimator IPM. We simulated data under different configurations of sample sizes, harvest rates, and sources of spatial heterogeneity in harvest rate to assess potential model bias in parameter estimates. We then applied the model to data collected from a field study of wild turkeys (Meleagris gallapavo) to estimate local and statewide abundance in Maine, USA. We found that the band recovery model that incorporated a spatial predictive process consistently provided estimates of adult and juvenile abundance with low bias across a variety of spatial configurations of harvest rate and sampling intensities. When applied to data collected on wild turkeys, a model that did not incorporate spatial heterogeneity underestimated the harvest rate in some subregions. Consistent with simulation results, this led to overestimation of both local and statewide abundance. Our work demonstrates that a spatial predictive process is a viable mechanism to account for spatial variation in harvest rates and limit bias in abundance estimates. This approach could be extended to large-scale band recovery data sets and has applicability for the estimation of population parameters in other ecological models as well.

National utilization of rib fracture fixation in the geriatric population in the United States.

Purpose: The use of surgical stabilization of rib fractures (SSRF) has steadily increased over the past decade. Recent literature suggests that a larger population may benefit from SSRF, and that the geriatric population-as the highest-risk population-may receive the greatest improvement from these interventions. We sought to determine the overall utilization of SSRF in the United States. Methods: The National Trauma Database was analyzed between 2016 and 2017. The inclusion criteria were all patients ≥65 years old with rib fractures. We further stratified these patients according to age (65-79 vs. ≥80 years old), the presence of coding for flail chest, three or more rib fractures, and intervention (surgical vs. nonoperative management). The main outcomes were surgical interventions, mortality, pneumonia, length of stay, intensive care unit length of stay, ventilator use, and tracheostomy. Results: Overall, 93,638 patients were identified. SSRF was performed in 992 patients. Patients who underwent SSRF had improved mortality in the 65 to 79 age group, regardless of the number of ribs fractured. We identified 92,637 patients in the age group of 65 to 79 years old who did not undergo SSRF. This represents an additional 20,000 patients annually who may benefit from SSRF. Conclusions: By conservative standards and the well-established Eastern Association for the Surgery of Trauma clinical practice guidelines, SSRF is underutilized. Our data suggest that SSRF may be very beneficial for the geriatric population, specifically those aged 65 to 79 years with any rib fractures. We hypothesize that roughly 20,000 additional cases will meet the inclusion criteria for SSRF each year. It is therefore imperative that we train acute care surgeons in this skill set.

Arsenic, cadmium, chromium, lead, manganese, mercury, and selenium in feathers of Black-legged Kittiwake (Rissa tridactyla) and Black Oystercatcher (Haematopus bachmani) from Prince William Sound, Alaska.

Arsenic, cadmium, chromium, lead, manganese, mercury and selenium were analyzed in the feathers of Black-legged Kittiwakes (Rissa tridactyla) from Shoup Bay in Prince William Sound, Alaska to determine if there were age-related differences in metal levels, and in Black Oystercatchers (Haematopus bachmani)) from the same region to determine if there were differences in oiled and unoiled birds. Except for mercury, there were no age-related differences in metals levels in the feathers of kittiwakes. Kittiwakes over 13 years of age had the highest levels of mercury. There were no differences in levels of metals in the feathers of oystercatchers from oiled and unoiled regions of Prince William Sound. Except for mercury, the feathers of oystercatchers had significantly higher levels of all metals than those of kittiwakes. Levels of mercury in kittiwake feathers (mean of 2910 ng/g [ppb]) were within the range of many species of seabirds reported for other studies, and were generally below adverse effects levels.

Mercury in wintering American black ducks (Anas rubripes) downstream from a point-source on the lower Penobscot River, Maine, USA.

Waterfowl wintering along the lower Penobscot River, Maine continue to be exposed to elevated Hg concentrations from the HoltraChem chlor-alkali plant that operated along the river between 1967 and 2000. In American black ducks (Anas rubripes) total Hg in duck breast muscle increased with residence time on contaminated marshes, reaching means of 0.82±0.21µg/g ww (wet weight) by the end of the fall hunting season, and prompting Maine to issue a human consumption advisory on duck breast muscle. Methyl Hg comprised over 99% of the total Hg in breast muscle. The ratio of Hg concentrations in blood and muscle were strongly correlated and approached 1:1 after extended residence times. Primary feather (P1) total Hg concentrations averaged 2.2±1.3µg/g fw (fresh weight), verifying low Hg exposure during feather growth on distant breeding grounds the preceding summer. Mercury concentrations in black ducks, following winter residence along the lower Penobscot exceeded levels associated with reproductive toxicity. Carry-over of Hg to summer breeding grounds may limit the subsequent reproductive success of black ducks.

Mercury, arsenic, cadmium, chromium lead, and selenium in feathers of pigeon guillemots (Cepphus columba) from Prince William Sound and the Aleutian Islands of Alaska.

Arsenic, cadmium, chromium, lead, manganese, mercury and selenium were analyzed in the feathers of pigeon guillemots (Cepphus columba) from breeding colonies in Prince William Sound and in the Aleutian Islands (Amchitka, Kiska) to test the null hypothesis that there were no differences in metal levels as a function of location, gender, or whether the birds were from oiled or unoiled areas in Prince William Sound. Birds from locations with oil from the Exxon Valdez Oil Spill in the environment had higher levels of cadmium and lead than those from unoiled places in Prince William Sound, but otherwise there were no differences in metal levels in feathers. The feathers of pigeon guillemots from Prince William Sound had significantly higher levels of cadmium and manganese, but significantly lower levels of mercury than those from Amchitka or Kiska in the Aleutians. Amchitka had the lowest levels of chromium, and Kiska had the highest levels of selenium. There were few gender-related differences, although females had higher levels of mercury and selenium in their feathers than did males. The levels of most metals are below the known effects levels, except for mercury and selenium, which are high enough to potentially pose a risk to pigeon guillemots and to their predators.