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Case Presentation: An 8-month-old infant presented to a general emergency department with chief complaints of rhinorrhea, decreased activity, and fever. A point-of-care lung ultrasound (LUS) was performed at bedside with potential early findings of pneumonia. Based on these findings on LUS, a chest radiograph (CXR) was ordered and performed with no acute findings. He was discharged without antibiotics based on these findings; unfortunately, he returned two days later with worsening symptoms requiring chest tube placement, mechanical ventilation, and prolonged hospitalization for complicated bacterial pneumonia.Discussion: Pneumonia is a major cause of pediatric morbidity and mortality worldwide. Despite evidence supporting the utilization of LUS for the diagnosis of pediatric pneumonia, CXR remains the default imaging for clinical decision-making in most settings. In this case, earlier antibiotics and higher reliance on LUS for clinical decision-making may have prevented the morbidity associated with this hospitalization.

Case Presentation: An 8-month-old infant presented to a general emergency department with chief complaints of rhinorrhea, decreased activity, and fever. A point-of-care lung ultrasound (LUS) was performed at bedside with potential early findings of pneumonia. Based on these findings on LUS, a chest radiograph (CXR) was ordered and performed with no acute findings. He was discharged without antibiotics based on these findings; unfortunately, he returned two days later with worsening symptoms requiring chest tube placement, mechanical ventilation, and prolonged hospitalization for complicated bacterial pneumonia. Discussion: Pneumonia is a major cause of pediatric morbidity and mortality worldwide. Despite evidence supporting the utilization of LUS for the diagnosis of pediatric pneumonia, CXR remains the default imaging for clinical decision-making in most settings. In this case, earlier antibiotics and higher reliance on LUS for clinical decision-making may have prevented the morbidity associated with this hospitalization.

Background: The impact of body composition and sarcopenia in locally advanced rectal cancer (LARC) is still unclear, even several studies have been published on this issue. Our study aims to analyze the impact of sarcopenia on neoadjuvant chemoradiotherapy (nCRT) tolerance and survival outcomes. Methods: This is a retrospective, monocentric study where LARC patients treated between 2010 and 2020 were enrolled. A single slice, from the pre-therapy simulation computed tomography (CT) scan, was used to perform the body composition analysis with dedicated software. The primary endpoint was the impact of body composition on radiotherapy (RT) interruption secondarily on overall survival (OS), disease-free survival (DFS), and local control (LC). Results: The study included 628 LARC patients (40.9 % female, mean age 63.4 years): 24 % had low skeletal muscle index (SMI), 30 % had low muscle density (MD) and 17 (10.3 % of obese) were sarcopenic obese. Higher BMI (OR 2.38, 95 % CI 1.36–4.01) and lower SMI (0.73, 95 % CI 0.55–0.94) resulted as independent predictors of RT interruption. Sarcopenic obesity (HR 2.83, 95 % CI 1.24–6.45) was related to worse OS, while MD (0.96, 95 % CI 0.93–0.98), and higher SMI (0.97, 95 % CI 0.95–0.99) were related to better OS; a lower MD remained also associated even in adjusted multivariable analysis (0.96, 95 % CI0.93–0.98). Moreover, higher visceral adipose tissue (VAT) resulted associated with worse DFS (1.02, 95 % CI 1.01–1.03), while higher SMI was related to better Local Control (0.96, 95 % CI 0.93–0.99). Conclusions: Body composition analysis, particularly of muscle and fat masses, may be a useful tool for better management of LARC patients undergoing RT. Increased collaboration between radiation oncologists and clinical nutritionists is advisable, to enable early nutritional support of LARC.

Cell outer membranes contain glycosphingolipids and protein receptors, which are integrated into glycoprotein domains, known as lipid rafts, which are involved in a variety of cellular processes, including receptor-mediated signal transduction and cellular differentiation process. In this study, we analyzed the lipidic composition of human Dental Pulp-Derived Stem Cells (DPSCs), and the role of lipid rafts during the multilineage differentiation process. The relative quantification of lipid metabolites in the organic fraction of DPSCs, performed by Nuclear Magnetic Resonance (NMR) spectroscopy, showed that mono-unsaturated fatty acids (MUFAs) were the most representative species in the total pool of acyl chains, compared to polyunsatured fatty acids (PUFAs). In addition, the stimulation of DPSCs with different culture media induces a multilineage differentiation process, determining changes in the gangliosides pattern. To understand the functional role of lipid rafts during multilineage differentiation, DPSCs were pretreated with a typical lipid raft affecting agent (MβCD). Subsequently, DPSCs were inducted to differentiate into osteoblast, chondroblast and adipoblast cells with specific media. We observed that raft-affecting agent MβCD prevented AKT activation and the expression of lineage-specific mRNA such as OSX, PPARγ2, and SOX9 during multilineage differentiation. Moreover, this compound significantly prevented the tri-lineage differentiation induced by specific stimuli, indicating that lipid raft integrity is essential for DPSCs differentiation. These results suggest that lipid rafts alteration may affect the signaling pathway activated, preventing multilineage differentiation.

Abstract Background Antimicrobial stewardship programmes are needed in long-term care facilities (LTCFs) to tackle antimicrobial resistance. We aimed to identify factors associated with antibiotic use in LTCFs. Such information would be useful to guide antimicrobial stewardship programmes. Method We conducted a systematic review of studies retrieved from PubMed, Cochrane Library, Embase, APA PsycArticles, APA PsycINFO, APA PsycTherapy, ScienceDirect and Web of Science. We included quantitative studies that investigated factors associated with antibiotic use (i.e., antibiotic prescribing by health professionals, administration by LTCF staff, or use by residents). Participants were LTCF residents, their family, and/or carers. We performed a qualitative narrative synthesis of the findings. Results Of the 7,591 screened records, we included 57 articles. Most studies used a longitudinal design (n = 34/57), investigated resident-level (n = 29/57) and/or facility-level factors (n = 32/57), and fewer prescriber-level ones (n = 8/57). Studies included two types of outcome: overall volume of antibiotic prescriptions (n = 45/57), inappropriate antibiotic prescription (n = 10/57); two included both types. Resident-level factors associated with a higher volume of antibiotic prescriptions included comorbidities (5 out of 8 studies which investigated this factor found a statistically significant association), history of infection (n = 5/6), potential signs of infection (e.g., fever, n = 4/6), positive urine culture/dipstick results (n = 3/4), indwelling urinary catheter (n = 12/14), and resident/family request for antibiotics (n = 1/1). At the facility-level, the volume of antibiotic prescriptions was positively associated with staff turnover (n = 1/1) and prevalence of after-hours medical practitioner visits (n = 1/1), and negatively associated with LTCF hiring an on-site coordinating physician (n = 1/1). At the prescriber-level, higher antibiotic prescribing was associated with high prescription rate for antibiotics in the previous year (n = 1/1). Conclusions Improving infection prevention and control, and diagnostic practices as part of antimicrobial stewardship programmes remain critical steps to reduce antibiotic prescribing in LTCFs. Once results confirmed by further studies, implementing institutional changes to limit staff turnover, ensure the presence of a professional accountable for the antimicrobial stewardship activities, and improve collaboration between LTCFs and external prescribers may contribute to reduce antibiotic prescribing.

Background: This study evaluated the effect of a multifaceted antibiotic stewardship intervention on the overall prescription of systemic antibiotics in primary care. Secondary objectives evaluated the effect on the prescription of broad-spectrum antibiotics and the seasonal variation of both total antibiotic and quinolone prescriptions, as a proxy for unnecessary prescribing. Methods: This pragmatic, randomised, controlled, before-after intervention study was conducted among general practitioners (GPs) who over prescribe antibiotics in Lorraine, France (Intervention group, n = 109; Control group, n = 236; Before period, 01/10/2017–30/09/2018; After period, 01/10/2018–30/09/2019). The intervention included a public commitment charter, a patient information leaflet and a non-prescription pad. Health Insurance data was obtained to calculate overall and broad-spectrum prescription rate (defined daily doses/1000 consultations) and the seasonal variation of prescriptions (%), by period. The intervention effect was measured with general linear mixed models including three independent variables (group, period and group x period interaction). Results: Overall, compared to the Before period, GPs in both groups prescribed significantly fewer systemic antibiotics (p

Abstract Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self‐harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self‐harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home‐ and community‐based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on‐site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community‐ and home‐based services, pediatric‐receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.

OBJECTIVE: To compare new mental health diagnoses (NMHD) in children after a firearm injury versus following a motor vehicle collision (MVC). BACKGROUND: A knowledge gap exists regarding childhood mental health diagnoses following firearm injuries, notably in comparison to other forms of traumatic injury. METHODS: We utilized Medicaid MarketScan claims (2010-2016) to conduct a matched case-control study of children ages 3 to 17 years. Children with firearm injuries were matched with up to 3 children with MVC injuries. Severity was determined by injury severity score and emergency department disposition. We used multivariable logistic regression to measure the association of acquiring a NMHD diagnosis in the year postinjury after firearm and MVC mechanisms. RESULTS: We matched 1450 children with firearm injuries to 3691 children with MVC injuries. Compared to MVC injuries, children with firearm injuries were more likely to be black, have higher injury severity score, and receive hospital admission from the emergency department ( P

Abstract Commercial laying hens have high frequency of damage to the keel bone (KB), which causes negative effects on health and welfare. KB damage may consist in fractures (KBF) and deviations (KBD). The aim of the present study was to compare the KB shape, by means of Geometric Morphometric, and the occurrence of fractures in different chicken genotypes reared either free-range (FR) or in enriched cages. Moreover, the relationship between KB shape, genotype and rearing system was analysed. Sixty birds/genotype (2 Italian local breeds, Bionda Piemontese and Robusta Maculata, their crossbreeds with Sasso and Lohmann Brown) were used. All the hens fed the same commercial feed throughout the trial. Body weight, egg production, feed intake and mortality were recorded from 25 to 66 weeks of age. Ca intake (IN) and output (OUT) were estimated and Ca OUT/IN was calculated. FR affected the occurrence of KB deviations but not the shape, whereas the fractures were mainly affected by genotype. Local breeds had a lower prevalence of KBF with similar level of KBD but with different shapes. Crossbreeds seemed to be a suitable compromise between egg deposition rate and occurrence of KB damages.

Purpose: The main objective of this research was to develop a questionnaire for the subjective evaluation of the quantity and magnitude of impacts experienced by rugby players. Methods: Thirty-six male rugby union players (mean ± SD, age; 23.5 ± 3.6 years, height; 179 ± 10.0 cm, body mass; 89.58 ± 13.6 kg) participated in this study, comprising eighteen forwards and fourteen backs. Participants were tasked with completing self-reported questionnaires assessing their perception of the quantity and magnitude of impacts after thirteen consecutive matches. Objective data were concurrently collected using Micro-Electrical Mechanical Systems (MEMS) integrated with a GPS device (WIMU, Realtrack Systems, Almeria, Spain). Results: The statistical analysis revealed that 49.7% of players overestimated and 39.8% underestimated the number of impacts above 8G, with a mean team error of 0.017 impacts. Bayesian methods indicated a 95% high-density interval for the mean error between −0.46 and 0.45, with 95.8% within the region of practical equivalence, signifying negligible bias at the team level. Positional variations were notable, with Halfbacks overestimating and Fullbacks and Second Row underestimating impacts. The errors and number of impacts displayed a non-linear relationship, better described by an exponential model. Additionally, the study identified significant correlations between the number of impacts players estimated and the actual impacts received, further underlined by position-specific trends, suggesting that players’ estimation abilities are influenced by the actual exposure to impacts and their playing positions. Conclusions: The utilization of a subjective impact questionnaire is a valid tool to assess rugby players level of impacts during a match. This approach proves particularly valuable in situations where technology is unavailable, showcasing its adaptability as a practical tool in diverse sporting contexts.

Visual imagery has been proposed to be one of eight mechanisms by which music induces emotion in listeners. Initial research into aphantasia, a condition referring to individuals who do not (or only minimally) form visual imagery in their mind's eye, suggests that aphantasics may experience reduced emotional experiences in response to imagined stimuli. In this two-part online investigation, we sought to explore the emotional experiences of aphantasics within the context of music listening. In Survey 1, we compared 51 aphantasics to 51 control individuals in terms of their experiences of visual imagery, liking, and felt emotional intensity when listening to three film music excerpts. We found significant group differences in terms of visual imagery and felt emotional intensity, but not liking. In Survey 2, we examined aphantasics’ ability to recognize emotions conveyed by music, and their patterns of experience of, and engagement with, music in everyday life by comparing the responses of 29 aphantasics with 29 matched controls. We found no differences in terms of emotion discrimination ability. However, aphantasics generally experienced less Reminiscence (dimension from the Adaptive Functions of Music Listening scale) to music, as well as fewer Episodic Memories (dimension from the MecScale). Aphantasics and control listeners did not exhibit differences in terms of sensitivity to musical reward (measured using the BMRQ) or in terms of musical sophistication (measured using the Gold-MSI). Finally, our findings suggest nuanced differences between controls and those with pure and minimal aphantasia. In all, we reveal the influence that aphantasia can have on emotional responses to music and thus provide further evidence for the relationship between visual imagery and music-induced emotion.

As previously described by several authors, dental pulp stem cells (DPSCs), when adequately stimulated, may acquire a neuronal-like phenotype acting as a favorable source of stem cells in the generation of nerves. Besides, it is known that hypoxia conditioning is capable of stimulating cell differentiation as well as survival and self-renewal, and that multiple growth factors, including Epidermal Growth factor (EGF) and basic fibroblast growth factor (bFGF), are often involved in the induction of the neuronal differentiation of progenitor cells. In this work, we investigated the role of hypoxia in the commitment of DPSCs into a neuronal phenotype. These cells were conditioned with hypoxia (O2 1%) for 5 and 16 days; subsequently, we analyzed the proliferation rate and morphology, and tested the cells for neural and stem markers. Moreover, we verified the possible autocrine/paracrine role of DPSCs in the induction of neural differentiation by comparing the secretome profile of the hypoxic and normoxic conditioned media (CM). Our results showed that the hypoxia-mediated DPSC differentiation was time dependent. Moreover, conditioned media (CM derived from DPSCs stimulated by hypoxia were able, in turn, to induce the neural differentiation of SH-SY5Y neuroblastoma cells and undifferentiated DPSCs. In conclusion, under the herein-mentioned conditions, hypoxia seems to favor the differentiation of DPSCs into neuron-like cells. In this way, we confirm the potential clinical utility of differentiated neuronal DPSCs, and we also suggest the even greater potential of CM-derived-hypoxic DPSCs that could more readily be used in regenerative therapies.

BackgroundDuring the COVID-19 pandemic, federal and state governments removed the scope of practice restrictions on nurse practitioners (NPs), allowing them to deliver care to patients without restrictions.PurposeTo support policy makers' efforts to grant full practice authority to NPs beyond the COVID-19 pandemic, this manuscript summarizes the existing evidence on the benefits of permanently removing state-level scope of practice barriers and outline recommendations for policy, practice, and research.MethodsWe have conducted a thorough review of the existing literature.FindingsNP full scope of practice improves access and quality of care and leads to better patient outcomes. It also has the potential to reduce health care cost.DiscussionThe changes to support full practice authority enacted to address COVID-19 are temporary. NP full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure.

In a recent paper, under the auspices of an unorthodox variety of bilateralism, we introduced a new kind of proof-theoretic semantics for the base modal logic \(\mathbf{K}\), whose values lie in the closed interval \([0,1]\) of rational numbers [14]. In this paper, after clarifying our conception of bilateralism – dubbed “soft bilateralism” – we generalize the fractional method to encompass extensions and weakenings of \(\mathbf{K}\). Specifically, we introduce well-behaved hypersequent calculi for the deontic logic \(\mathbf{D}\) and the non-normal modal logics \(\mathbf{E}\) and \(\mathbf{M}\) and thoroughly investigate their structural properties.

Abstract In this study, 144 red swamp crayfish (Procambarus clarkii, initial mean weight 3.9 ± 0.3 g) juveniles were fed diets containing graded levels of purslane (Portulaca oleracea), with a decreasing percentage of proteins (from 17.3% to 1.0%) for 10 weeks. Six diets were administered: four fishmeal diets containing 5%, 15%, 25%, and 50% purslane, a diet with 100% purslane, and a commercial diet. Growth performance and the amounts of fatty acids and carotenoids were measured. Crayfish fed 25% and 50% purslane diets showed optimal contents in fatty acids (FAs) and astaxanthin, and their growth was comparable to that of the control group. Significant differences in FA content of the crayfish groups were observed for saturated FAs, monounsaturated FAs (MUFAs), and polyunsaturated FAs (PUFAs). The highest levels of n − 3 α‐linolenic acid (ALA) and n − 6 linoleic acid (LA) were found in the groups fed 25%, 50%, and 100% purslane diets. This study shows that the best purslane content to be included in the crayfish diet should range between 25% and 50%. Although the nutritional value of purslane is low, its inclusion at up to 50% in crayfish diets seems to improve the carotenoid content and FA quality, while reducing the daily intake of animal protein, without affecting growth performance, thus contributing to the goal of more sustainable crustacean aquaculture.

Abstract Background Primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care. Objective To develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance—Primary Care Antibiotic Audit and Feedback Network. Methods We used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement. Results The final set of guidelines include 13 best practice statements in four categories: general considerations (n = 3), selecting feedback recipients (n = 1), data and indicator selection (n = 4), and feedback delivery (n = 5). Conclusion We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care.