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Gastrostomy tube (GT) placement is a common procedure in infants (≤1-year-old). There is variation in patient selection and a paucity of studies examining which patients require long term enteral access. The objective of this study was to assess demographic and clinical factors associated with persistent GT use (PGU) at 1-year after placement.We performed a single-institution retrospective review of patients ≤1-year-old who underwent GT placement from January 31, 2014, and January 31, 2020, using institutional NSQIP-P data supplemented with chart review. Multivariable logistic regression analysis was performed to identify factors associated with PGU. Clinical predictors were selected a priori, and a p-value less than 0.05 was used to detect a significant association.140 patients were included, and 118 had a 1-year follow-up. At 1-year following GT placement, 38 patients had weaned from their GT (32.2%). Failure to thrive (FTT), and inpatient admission prior to surgery are associated with increased odds of PGU at 1-year after surgery, OR: 5.19 and 6.02, respectively. There is an inverse association between the percentage of feeds taken by mouth at the time of surgery and the odds of PGU at 1-year (OR: 0.03).Patients who have FTT (documented prior to surgery) or an inpatient admission prior to GT had a higher odds of PGU at 1-year post-op. Additionally, the amount taken by mouth at the time of GT placement was inversely related to PGU. These factors are important in determining the need for a surgical gastrostomy tube.II.

The goals and approaches to fluid therapy vary through different stages of resuscitation. This pilot study was designed to test the safety and feasibility of a fluid therapy protocol for the second or optimisation stage of resuscitation in patients with predicted severe acute pancreatitis (SAP).Spontaneously breathing patients with predicted SAP were admitted after initial resuscitation and studied over a 24-h period in a tertiary hospital ward. Objective clinical assessment (OCA; heart rate, mean arterial pressure, urine output, and haematocrit) was done at 0, 4, 8, 12, 18-20, and 24 h. All patients had mini-fluid challenge (MFC; 250 ml intravenous normal saline within 10 min) at 0 h and repeated at 4 and 8 h if OCA score ≥2. Patients who were fluid responsive (10% change in stroke volume after MFC) received 5-10 ml/kg/h, otherwise 1-3 ml/kg/h until the next time point. Passive leg raising test (PLRT) was done at each time point and compared with OCA for assessing volume status and predicting fluid responsiveness.This fluid therapy protocol based on OCA, MFC, and PLRT and designed for the second stage of resuscitation was safe and feasible in spontaneously breathing predicted SAP patients. The PLRT was superior to OCA (at 0 and 8 h) for predicting fluid responsiveness and guiding fluid therapy.This pilot study found that a protocol for intravenous fluid therapy specifically for the second stage of resuscitation in patients with predicted SAP was safe, feasible, and warrants further investigation.

Key differences exist in pediatric and adult inflammatory bowel disease (IBD), and a multidisciplinary approach focused on meeting these needs should be implemented. In an emergency situation, surgical management of pediatric IBD should focus on patient stabilization with an eye toward future intestinal function.

Trichomonas vaginalis is not a notifiable disease in Australia in most states, resulting in limited Australian epidemiological studies. This study aimed to examine the positivity of T. vaginalis in women attending the Melbourne Sexual Health Centre (MSHC) and identify associated factors.All women 16 years or older who were tested for T. vaginalis at MSHC from 2006 to 2019 were included. The diagnostic method changed from culture to nucleic acid amplification test in August 2018. The annual positivity of T. vaginalis was calculated. Because of the data completeness, we performed a generalized estimating equations multivariable logistic regression using data from 2011 to 2019 to examine factors associated with T. vaginalis positivity.From 2006 to 2019, 69,739 tests for T. vaginalis were conducted, and 294 tested positive (0.42%; 95% confidence interval [CI], 0.37%-0.47%). Approximately 60% of women tested reported symptoms. After adjusting for potential confounders including the change in diagnostic method, there was a 21% (95% CI, 12%-31%) annual increase in T. vaginalis positivity between 2011 and 2019. Women with concurrent syphilis had the highest odds of testing positive for T. vaginalis (adjusted odds ratio [aOR], 21.55; 95% CI, 6.96-66.78), followed by women who had injected drugs in the last 12 months (aOR, 6.99; 95% CI, 4.11-11.87), were 35 years or older (aOR, 3.47; 95% CI, 2.26-5.35), or had concurrent chlamydia (aOR, 1.77; 95% CI, 1.05-2.99).The rising positivity of T. vaginalis at MSHC irrespective of change in diagnostic method suggests a concurrent community-wide rise in Melbourne. Given the rising positivity, testing informed by risk factors should be considered.

Mitochondrial dysfunction has been implicated in pregnancy-induced hypertension (PIH). The role of mitochondrial gene dysregulation in PIH, and consequences for maternal-fetal interactions, remain elusive. Here, we investigated mitochondrial gene expression and dysregulation in maternal and placental tissues from pregnancies with and without PIH; further, we measured circulating mitochondrial DNA (mtDNA) mutational load, an index of mtDNA integrity. Differential gene expression analysis followed by Time Course Gene Set Analysis (TcGSA) were conducted in publicly available high throughput sequencing transcriptomic datasets. Mutational load analysis was carried out on peripheral mononuclear blood cells from healthy pregnant individuals and individuals with preeclampsia. Thirty mitochondrial differentially expressed genes (mtDEGs) were detected in the maternal cell-free circulating transcriptome, while 9 were detected in placental transcriptome from pregnancies with PIH. In PIH pregnancies, maternal mitochondrial dysregulation was associated with pathways involved in inflammation, cell death/survival, and placental development, while fetal mitochondrial dysregulation was associated with increased production of extracellular vesicles (EVs) at term. Mothers with preeclampsia did not exhibit a significantly different degree of mtDNA mutational load. Our findings support the involvement of maternal mitochondrial dysregulation in the pathophysiology of PIH and suggest that mitochondria may mediate maternal-fetal interactions during healthy pregnancy.

Lungs are a prototypical trait of most tetrapods, but some amphibians have become secondarily lungless over evolutionary time. Anuran (frog) tadpoles offer an opportunity to examine lung loss from an evolutionary perspective, because there are many independent instances where lungs are not inflated until adulthood, and so are functionally lost. Lung loss is typically associated with living in fast-flowing streams, and so we examined larval lung development in the stream specialist family Heleophrynidae. We find that one genus, Hadromophryne Van Dijk, 2008, has large lungs as tadpole, while the other genus, Heleophryne Sclater, 1898, has much smaller, stunted lung buds. We further speculate how this information changes our understanding of how the specialised torrent form has evolved in this specialised group.

ObjectivesAssess the validity of the Chinese version of the Dominic Interactive (DI), a 91-item, video-based diagnostic screening instrument for children that assesses four internalized disorders (phobias, separation anxiety disorder, generalized anxiety disorder, and major depressive disorder) and three externalized disorders (attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder).Methods(1) Compare DI-generated “probable” or “possible” diagnoses to diagnoses based on the Development and Well-Being Assessment (DAWBA) instrument in 113 psychiatric outpatients and 20 community controls. (2) Administer DI to 1,479 children from elementary schools in Tianjin.ResultsIn the validation sample, DI with DAWBA concordance was much greater for internalized disorders (mean Kappa = 0.56) than for externalized disorders (mean kappa = 0.11). The positive predictive value of DI diagnoses ranged from 0.96 (generalized anxiety disorder) to 25% (oppositional defiant disorder) and negative from 0.81 to 0.96. Using “probable” cuts provides better results. In the survey, prevalence of probable DI disorders ranged from 1.0% (conduct disorder) to 13.1% (phobias). Internal consistency of all DI items was excellent (Cronbach alpha = 0.93) and that of the seven subscales ranged from 0.64 (phobias) to 0.87 (major depressive disorder). In multilevel SEM analyses, SRMR (Standardized root mean square residual) or each of the seven diagnoses was below 0.08 and each coefficient of determination was below 0.60.ConclusionThe Chinese DI is a convenient method of screening common mental disorders in Chinese children mainly for internalized disorders, which are the most prevalent diagnoses in that population. However its high negative predictive values for externalized could be used for screening.

Femtosecond lasers with high repetition rates are attractive for spectroscopic applications with high sampling rates, high power per comb line, and resolvable lines. However, at long wavelengths beyond 2 µm, current laser sources are either limited to low output power or repetition rates below 1 GHz. Here we present an ultrafast laser oscillator operating with high output power at multi-GHz repetition rate. The laser produces transform-limited 155-fs pulses at a repetition rate of 2 GHz, and an average power of 0.8 W, reaching up to 0.7 mW per comb line at the center wavelength of 2.38 µm. We have achieved this milestone via a Cr2+-doped ZnS solid-state laser modelocked with an InGaSb/GaSb SESAM. The laser is stable over several hours of operation. The integrated relative intensity noise is 0.15% rms for [10 Hz, 100 MHz], and the laser becomes shot noise limited (-160 dBc/Hz) at frequencies above 10 MHz. Our timing jitter measurements reveal contributions from pump laser noise and relaxation oscillations, with a timing jitter of 100 fs integrated over [3 kHz, 100 MHz]. These results open up a path towards fast and sensitive spectroscopy directly above 2 µm.

Silicic volcanic eruptions commonly begin with the explosive ejection of pyroclastic material, before transitioning to gentler effusion-dominated activity. Well-exposed dissected silicic systems are scarce and poorly studied, hindering the advances in our understanding of the explosive–effusive transition needed to improve interpretations of volcanic unrest and hazard forecasting. The Mule Creek vent (New Mexico, USA) is a dissected silicic conduit that records the processes controlling conduit formation and evolution, and the role tuffisites (fractures filled with variably welded pyroclasts) play in conduit dynamics. Here, we use decimeter-scale photo-mapping of lithostratigraphic units and thin section analysis to differentiate and interpret three dominant emplacement styles during vent evolution. First, there was repeated deposition and erosion of pyroclastic material at the conduit walls, recorded by erosive surfaces in pyroclastic breccia and agglomerates at the conduit margins. Second, sub-vertical domains of dense melt-dominated magma were emplaced and preserved as glass-dominated vitrophyre and brecciated vitrophyre, with the textural hallmarks of assembly from welding of pyroclasts. Finally, the sub-horizontal fracturing of previously deposited lithologies produced laterally cross-cutting tuffisites. The vent deposits track the widening and then narrowing of the conduit through time and reflect progressive insulation and generally higher temperatures towards the conduit center as pyroclasts accumulate. Welding of pyroclastic fill and the formation of dense vitrophyres towards the conduit center lowers deposit porosity and effective wall permeability. This drives localized gas pressure increases and results in gas-driven fracturing, generating tuffisites, which act as transient outgassing pathways. The structure of the Mule Creek vent records an explosive–effusive transition, constraining the processes controlling conduit evolution and aiding our interpretation of volcanic unrest.

Liposomal bupivacaine (LB) has emerged as a superior form of local anesthetic across numerous surgical subspecialties. The purpose of this study is to evaluate the ex-vivo antimicrobial effects of LB in comparison with traditional local anesthetics.A standardized inoculum of bacteria commonly associated with surgical site infection was inoculated into a suspension of 1% lidocaine, 0.25% bupivacaine, Exparel (proprietary liposomally packaged 1.3% bupivacaine), and normal saline as a growth control.In all five bacteria tested, the medium inoculated with traditional local anesthetics reduced growth to a greater degree than LB-inoculated plates. Both conventional local anesthetics reduced the growth of all bacteria when compared with the control with the exception of methicillin-susceptible Staphylococcus aureus growth in bupivacaine. LB-inoculated plates had equivalent growth to the control in all plates with the exception of Escherichia coli plates which demonstrated superior growth.The results of this simple ex-vivo model suggest that the liposomal packaging of bupivacaine may decrease this local anesthetic's innate antibacterial properties.

Multidimensional progressive declines in the absence of standard biomarkers for neurodegeneration are observed commonly in the development of schizophrenia, and are accepted as consistent with neurodevelopmental etiological hypotheses to explain the origins of the disorder. Far less accepted is the possibility that neurodegenerative processes are involved as well, or even that key dimensions of function, such as cognition and aspects of biological integrity, such as white matter function, decline in chronic schizophrenia beyond levels associated with normal aging. We propose that recent research germane to these issues warrants a current look at the question of neurodegeneration. We propose the view that a neurodegenerative hypothesis provides a better explanation of some features of chronic schizophrenia, including accelerated aging, than is provided by neurodevelopmental hypotheses. Moreover, we suggest that neurodevelopmental influences in early life, including those that may extend to later life, do not preclude the development of neurodegenerative processes in later life, including some declines in cognitive and biological integrity. We evaluate these views by integrating recent findings in representative domains such as cognition and white and gray matter integrity with results from studies on accelerated aging, together with functional implications of neurodegeneration for our understanding of chronic schizophrenia.

Purpose Burn outcome data in infants is lacking from sub-Saharan Africa. We, therefore, sought to assess the characteristics and predictors of in-hospital burn mortality in a resource-limited setting. Methods We performed a retrospective study of the prospectively collected Burn Injury Surveillance database from June 2011 to December 2019. We performed bivariate analysis and Poisson regression to assess risk factors for mortality in our infant burn population. Results 115 (7.3%) infants met inclusion criteria. The median age of 8 months (IQR: 6–10) and primarily male (n = 67, 58.8%). Most burns were from scald (n = 62, 53.9%). Infant burn mortality was 12.2%. Poisson multivariable regression to determine burn mortality risk in infants showed that increased %TBSA burns (RR 1.04, 95% CI 1.01–1.07) and flame burns (RR 3.08, 95%CI 1.16–8.16) had a higher risk of mortality. Having surgery reduced the relative risk of death for infants with burns. Conclusion We show that factors that increase infant burn mortality risk include percent total body surface area burn, flame burn mechanism, and lack of operative intervention. Increasing burn operative capability, particularly for infants and other children, is imperative.

Many existing studies lack a comprehensive picture of the social exclusion statuses and health outcomes of empty nesters and those empty nesters living alone or with a spouse only. Cross-sectional analysis was conducted on representative national data from the 2014 China Longitudinal Aging Social Survey, focusing on respondents aged 60 and above (N = 7,923). Four dimensions of social exclusion (social relationships, subjective feeling of being excluded, social activities and financial products) and three health outcomes (self-reported health (SRH), activities of daily living (ADLs) and depression), were considered. Results show that ‘empty nest’ older people were more likely to be excluded from social relationships and to experience subjective feelings of being excluded, and were less likely to participate in social activities than non-empty nesters. Empty nesters were significantly less likely to report fair SRH and ADL difficulties than non-empty nesters, but they were more likely to report having depression than non-empty nesters. Among ‘empty nest’ older people, empty nesters who were living alone were associated with higher levels of being excluded from social relationships and to experience subjective feelings of being excluded than those who were living with a spouse only. Future research could focus on the development of age-friendly communities which act as health interventions to address relevant situations of social exclusion and depression among empty nesters.

RATIONALE: Recreational and medical use of stimulants is increasing, and their use may increase susceptibility to aging and promote neurobehavioral impairments. The long-term consequences of these psychostimulants and how they interact with age have not been fully studied. OBJECTIVES: Our study investigated whether chronic exposure to the prototypical psychostimulant, methamphetamine (METH), at doses designed to emulate human therapeutic dosing, would confer a pro-oxidizing redox shift promoting long-lasting neurobehavioral impairments. METHODS: Groups of 4-month-old male and female C57BL/6J mice were administered non-contingent intraperitoneal injections of either saline or METH (1.4 mg/kg) twice a day for 4 weeks. Mice were randomly assigned to one experimental group: (i) short-term cognitive assessments (at 5 months), (ii) long-term cognitive assessments (at 9.5 months), and (ii) longitudinal motor assessments (at 5, 7 and 9 months). Brain regions were assessed for oxidative stress and markers of neurotoxicity after behavior testing. RESULTS: Chronic METH exposure induced short-term effects on associative memory, gait speed, dopamine (DA) signaling, astrogliosis in females and spatial learning and memory, balance, DA signaling, and excitotoxicity in males. There were no long-term effects of chronic METH on cognition, however, it decreased markers of excitotoxicity in the striatum and exacerbated age-associated motor impairments in males. CONCLUSION: In conclusion, cognitive and motor function were differentially and sex-dependently affected by METH exposure, and oxidative stress did not seem to play a role in the observed behavioral outcomes. Future studies are necessary to continue exploring the long-term neurobehavioral consequences of drug use in both sexes and the relationship between aging and drugs.

Background There have been limited studies of group sex among heterosexual individuals. This study aimed to explore the factors associated with group sex among heterosexual males and females to improve risk assessment guidelines and inform sexually transmitted infection (STI) screening requirements. Methods A cross-sectional survey was conducted among heterosexual males and females aged ≥16 years attending the Melbourne Sexual Health Centre between March and April 2019. The survey asked about group sex participation, methods used to meet sexual partners, number of casual and/or regular partners, and injection drug use (IDU) in the previous 3 months. HIV and STI (chlamydia, gonorrhoea, syphilis) diagnoses were extracted. A multivariable logistic regression was conducted to identify the factors associated with group sex participation. Results A total of 698 participants (325 males, 373 females) were included and 4.7% (33/698) had participated in group sex in the previous 3 months. The proportion who participated in group sex increased with age (2.1% in 16–24 years, 5.5% in 25–34 years, 7.8% in ≥35 years, ptrend = 0.010). Meeting partners at sex venues (e.g. brothels) was associated with the highest odds of participating in group sex (aOR = 5.74, 95% CI: 1.20–27.44), followed by dating apps (aOR = 2.99, 95% CI: 1.36–6.58), friends/family (aOR = 2.99, 95% CI: 1.34–6.69) and social venues (e.g. bar) (aOR = 2.73, 95% CI: 1.18–6.30). Group sex was strongly associated with STI positivity (aOR = 6.24, 95% CI: 2.41–16.13). There was no association between group sex and sex, casual and/or regular partners, HIV positivity or IDU. Conclusion Heterosexual individuals participating in group sex had a six-fold risk of testing positive for STIs. Including group sex in a sexual history is useful to determine STI risk and inform testing practices. Safe sex messages on group sex that are delivered through multiple methods (e.g. at sex venues, social venues and dating apps simultaneously) would be beneficial.

Background Individuals who have both opposite- and same-sex partners have the potential to pass sexually transmitted infections (STIs) between high- and low-risk populations. Our aim was to examine assortative sexual mixing in terms of same-sex activity among male–female partnerships. Methods This was a retrospective repeated cross-sectional study of male–female partnerships attending the Melbourne Sexual Health Centre (MSHC) from 2015 to 2019. Sex of sexual partners was collected via computer-assisted self-interview. We calculated the proportion of partnerships where at least one individual reported same-sex partners in the previous 12 months and the degree of assortativity by bisexuality. Results A total of 2112 male–female partnerships (i.e. 4224 individuals) were included, with a median age of 27 years (IQR 23–31). Overall, 89.3% (1885/2112) of male–female partnerships did not report any other same-sex partners; however, in 9.5% (201/2112) of partnerships, same-sex partners were reported by one individual and in 1.2% (26/2112) of partnerships, both individuals reported same-sex partners. Bisexuality appeared to be slightly assortative in male–female partnerships (r = 0.163, 95% CI: 0.150–0.176; P

Background Kissing may be a risk factor for gonorrhoea. Past studies have focused on male kissing partners among men who have sex with men (MSM). This study aimed to examine the kissing practices of MSM who kiss male and female partners. Methods We conducted a cross-sectional survey at the Melbourne Sexual Health Centre (MSHC) between March and April 2019. Men attending the MSHC, aged ≥16 years who reported any sexual contact with another man in the previous 12 months were invited to participate in the survey. Data about the number of kissing-only (kissing without sex), kissing-with-sex, and sex-only (having sex without kissing) partners in the previous 3 months were collected. Men were asked to report the number of male and female partners separately. Results There were 357 MSM included in the survey. Most men (97.2%, n = 347) had kissed or had sex with another man, whereas 16.0% (n = 57) had kissed or had sex with a female partner in the previous 3 months. Of the 57 men, 26.3% (n = 15) had only kissed a female partner without having sex. The mean number of male partners for kissing-only was 5.5 (s.d. = 6.6), kissing-with-sex was 5.0 (s.d. = 6.6) and sex-only was 3.9 (s.d. = 4.3). The mean number of female partners for kissing-only was 4.2 (s.d. = 6.9), kissing-with-sex was 3.8 (s.d. = 4.9) and sex-only was 3.2 (s.d. = 3.4). Conclusion MSM not only kiss men in the absence of sex, but also kiss women in the absence of sex. Gonorrhoea could be transmitted between MSM and women via kissing in the absence of sex.

Timing of inguinal hernia repair (IHR) in premature infants is variable and influenced by surgeon preference and complication profile. The purpose of this study was to evaluate factors related to early IHR, defined as hernia repair during initial neonatal admission, in premature infants.Neonatal hospitalizations of premature infants (gestational age at birth 37 weeks and ≤ 28 days old at admission), with a diagnosis of inguinal hernia from 2010 to 2017 in HCUP National Inpatient Sample and Kid's Inpatient Sample databases were evaluated. Multivariable Cox proportional hazard models was used to estimate associations between demographics, additional procedures, hospital characteristics, and early IHR.Overall, 30,298 neonatal hospitalizations of premature infants with inguinal hernia were identified; 13,228 (43.3%) underwent early IHR. Early IHR was more likely with older gestational age at birth (35-36 weeks vs 24 weeks, HR 6.05, 95% CI 4.17, 8.79), female sex (HR 1.20, 95% CI 1.07, 1.34), and undergoing concomitant gastrostomy (HR 2.51, 95% CI 1.72, 3.66). Non-Hispanic Black infants (HR 0.84, 95% CI 0.75, 0.95), infants at urban non-teaching hospitals (HR 0.15, 95% CI 0.07, 0.33), and infants at rural hospitals (HR 0.81, 95% CI 0.70, 0.97) were less likely to undergo early IHR.Using a nationally representative database, early IHR in premature neonates was more commonly performed in non-Hispanic White, female neonates and at urban teaching hospitals. Patient race and hospital type were determinants of early IHR in premature neonates. There is a need to further evaluate the impact of race and socioeconomic factors on outcomes of common pediatric operations like inguinal hernia repairs.Level III.