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Uropathogen resistance, fluoroquinolone-resistance (FQR), and extended spectrum beta-lactamase (ESBL), has been observed to be emerging worldwide with prevalences above recommended thresholds for routine empirical treatment. The primary aim of our study was to determine the prevalence of FQR from a geographically diverse sample of United States emergency departments (EDs).We conducted a multi-center, observational cohort study using a network of 15 geographically diverse US EDs. All patients ≥18 years of age with the primary or secondary diagnosis of urinary tract infection (UTI) in the ED identified using International Classification of Diseases (ICD-10) diagnosis code of cystitis, pyelonephritis, or UTI from 2018 to 2020 were included. We calculated descriptive statistics for uropathogens and susceptibilities. Logistic regression analysis was used to identify antimicrobial resistance risk factors associated with FQR Escherichia coli.Among 3779 patients who met inclusion criteria, median age was 62.9 years (interquartile range [IQR]: 41-77.6) and 76.3% were female. The most common diagnoses were complicated (41.2%) and uncomplicated cystitis (40.3%). E. coli was the most common pathogen (63.2%), followed by Klebsiella pneumoniae (13.2%) and Enterococcus species (5.8%). Across all sites, overall E. coli FQ-resistance prevalence was 22.1%, ranging from 10.5 to 29.7% by site. The prevalence of ESBL-producing uropathogen was 7.4%, ranging from 3.6% to 11.6% by site. Previous IV or oral antimicrobial use in the past 90-days and history of a multi-drug resistant pathogen were associated with FQ-resistant E. coli (odds ratio [OR] 2.68, 95% confidence interval [CI]: 2.04-3.51, and OR 6.93, 95% CI: 4.95-9.70, respectively). Of the patients who had FQ-resistant E. coli or an ESBL-producing uropathogen isolated, 116 (37.1%) and 61 (36.7%) did not have any documented risk factors for resistance.FQ-resistant E. coli is widely prevalent across US sites highlighting the need for ongoing monitoring of antimicrobial resistance and, at some locations, modification of empirical treatments.

Holoprosencephaly ranges in severity based on the degree of anatomic abnormality. Middle interhemispheric variant of holoprosencephaly is a less common and often milder variant that has the characteristic sonographic findings of an absent cavum septum pellucidum and a single fused ventricle. This subtype may be associated with genetic conditions that have not been well-described in the literature. We present two cases of middle interhemispheric variant of holoprosencephaly diagnosed on fetal ultrasound.

Neurons in the pigeon nidopallium caudolaterale (NCL) are important for the maintenance of information across delays as long as 3 s. In the current study, we recorded neural activity from the avian NCL of 3 birds trained on a working memory task with three different delay lengths intermixed within a session. We found that when the birds are unable to predict the upcoming delay length there is no evidence that NCL cells engage in temporal coding. Furthermore, delay activity did not differ between correct and incorrect trials. Both findings have implications for the function of delay activity and its role in supporting working memory. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Introduction The high demand for psychiatric services has exceeded the capacity of available resources for behavioral health patients, forcing these patients to seek mental health care in the emergency department. Average lengths of stay for behavioral health boarders commonly extend over multiple days and prior-to-admission (PTA) medication administration may be delayed, which could lead to further deterioration and longer inpatient lengths of stay. Addition of a pharmacist-led medication reconciliation process and pharmacist integration into daily emergency department psychiatry rounds may decrease time to initiation of PTA medications and improve outcomes in this population. Methods This is a retrospective review of adult patients who required a psychiatric emergency evaluation in a large rural academic medical center emergency department. Objectives were to determine the number and type of medication discrepancies found with pharmacist intervention, and to compare time to initiation of PTA medications with a pharmacist versus a nonpharmacist completing medication reconciliation. Results A total of 139 patients were identified, 85 patients in August 2019 (no pharmacist [NP]) and 54 in October 2019 (pharmacist involvement [PI]). Among 484 medications reviewed in the PI group, 298 discrepancies were identified. The most common types of discrepancies were no longer taking (n = 99, 33%) and omission (n = 94, 32%). Time to administration of PTA medications was similar between NP and PI groups (median hours, interquartile range: NP: 10.8, 7.8-16.57; PI: 11.49, 6.16-16; P = .179). Discussion This study depicted one of the many values of pharmacists in the hospital setting, especially in the behavioral health patient population where continuation of accurate PTA medications may prevent further clinical deterioration.

Effective navigation relies on knowledge of one’s environment. A challenge to\ud effective navigation is accounting for the time and energy costs of routes. Irregular terrain in\ud ecological environments poses a difficult navigational problem as organisms ought to avoid\ud effortful slopes to minimize travel costs. Route planning and navigation have previously been\ud shown to involve hippocampal place cells and their ability to encode and store information\ud about an organism’s environment. However, little is known about how place cells may\ud encode the slope of space and associated energy costs as experiments are traditionally carried\ud out in flat, horizontal environments. We set out to investigate how dorsal-CA1 place cells in\ud rats encode systematic changes to the slope of an environment by tilting a shuttle box from\ud flat to 15° and 25° while minimizing external cue change. Overall, place cell encoding of\ud tilted space was as robust as their encoding of flat ground as measured by traditional place\ud cell metrics such as firing rates, spatial information, coherence, and field size. A large\ud majority of place cells did, however, respond to slope by undergoing partial, complex\ud remapping when the environment was shifted from one tilt angle to another. The propensity\ud for place cells to remap did not, however, depend on the vertical distance the field shifted.\ud Changes in slope also altered the temporal coding of information as measured by the rate of\ud theta phase precession of place cell spikes, which decreased with increasing tilt angles.\ud Together these observations indicate that place cells are sensitive to relatively small changes\ud in terrain slope and that terrain slope may be an important source of information for\ud organizing place cell ensembles. The terrain slope information encoded by place cells could\ud be utilized by efferent regions to determine energetically advantageous routes to goal\ud locations.\ud

When performing tasks, animals must continually assess how much effort is being expended, and gauge this against ever-changing physiological states. As effort costs mount, persisting in the task may be unwise. The anterior cingulate cortex (ACC) and the anterior insular cortex are implicated in this process of cost-benefit decision-making, yet their precise contributions towards driving effortful persistence are not well understood. Here we investigated whether electrical stimulation of the ACC or insular cortex would alter effortful persistence in a novel weight-lifting task (WLT). In the WLT an animal is challenged to pull a rope 30 cm to trigger food reward dispensing. To make the action increasingly effortful, 45 g of weight is progressively added to the rope after every 10 successful pulls. The animal can quit the task at any point – with the rope weight at the time of quitting taken as the ‘break weight.’ Ten male Sprague-Dawley rats were implanted with stimulating electrodes in either the ACC (cingulate cortex area 1 (Cg1) in rodent) or anterior insula and then assessed in the WLT during stimulation. Low-frequency (10 Hz), high-frequency (130 Hz) and sham stimulations were performed. We predicted that low-frequency stimulation of Cg1 in particular would increase persistence in the WLT. Contrary to our predictions, low-frequency stimulation of Cg1 resulted in shorter session duration, lower break weights, and fewer attempts on the break weight. High-frequency stimulation of Cg1 led to an increase in time spent off-task. Low-frequency stimulation of the anterior insula was associated with a marginal increase in attempts on the break weight. Taken together our data suggest that stimulation of the rodent Cg1 during an effortful task alters certain aspects of effortful behavior, while insula stimulation has little effect.

Objectives Placental expression of neuropilin‐1 (NRP1), a proangiogenic member of the vascular endothelial growth factor receptor family involved in sprouting angiogenesis, was recently discovered to be downregulated in pregnancies with fetal growth restriction (FGR) and abnormal umbilical artery (UA) Doppler. Soluble NRP1 (sNRP1) is an antagonist to NRP1; however, little is known about its role in normal and FGR pregnancies. This study tested the hypotheses that, first, sNRP1 would be detectable in maternal circulation and, second, its concentration would be upregulated in FGR pregnancies compared to those with normal fetal growth and this would correlate with the severity of the disease as assessed by UA Doppler. Methods This was a prospective case–control pilot study of 40 singleton pregnancies (20 FGR cases and 20 uncomplicated controls) between 24 + 0 and 40 + 0 weeks' gestation followed in an academic perinatal center from January 2015 to May 2017. FGR was defined as an ultrasound‐estimated fetal weight

When performing a physically demanding behavior, sometimes the optimal choice is to quit the behavior rather than persist in order to minimize energy expenditure for the benefits gained. The dorsomedial prefrontal cortex (dmPFC), consisting of the anterior cingulate cortex and secondary motor area, likely contributes towards such utility assessments. Here, we examined how male rat dmPFC single unit and ensemble level activity corresponded to changes in task utility and quitting in an effortful weight lifting task. Rats carried out two task paradigms: one that became progressively more physically demanding over time and a second fixed effort version. Rats could quit the task at any time. Dorsomedial PFC neurons were highly responsive to each behavioral stage of the task, consisting of rope pulling, reward retrieval, and reward area leaving. Activity was highest early in sessions, commensurate with the highest relative task utility, then decreased until the point of quitting. Neural ensembles consistently represented the sequential behavioral phases of the task. However, these representations were modified over time and became more distinct over the course of the session. These results suggest that dmPFC neurons represent behavioral states that are dynamically modified as behaviors lose their utility, culminating in task quitting.New & NoteworthyWhen carrying out a physically demanding task animals must continually assess whether to persist or quit. In this study we recorded neurons in the dorsomedial prefrontal cortex (dmPFC) of rats as they carried out a challenging weightlifting task, up to the point of quitting. We demonstrate that dmPFC neurons form a representation of the task that is modified, via a decrease in firing rate, by the decreasing utility of the task that may signal quitting.

Pigeons can successfully discriminate between sets of Picasso and Monet paintings. We recorded from three pallial brain areas: the nidopallium caudolaterale (NCL), an analogue of mammalian prefrontal cortex; the entopallium (ENTO), an intermediary visual area similar to primate extrastriate cortex; and the mesopallium ventrolaterale (MVL), a higher-order visual area similar to primate higher-order extrastriate cortex, while pigeons performed an S+/S− Picasso versus Monet discrimination task. In NCL, we found that activity reflected reward-driven categorisation, with a strong left-hemisphere dominance. In ENTO, we found that activity reflected stimulus-driven categorisation, also with a strong left-hemisphere dominance. Finally, in MVL, we found that activity reflected stimulus-driven categorisation, but no hemispheric differences were apparent. We argue that while NCL and ENTO primarily use reward and stimulus information, respectively, to discriminate Picasso and Monet paintings, both areas are also capable of integrating the other type of information during categorisation. We also argue that MVL functions similarly to ENTO in that it uses stimulus information to discriminate paintings, although not in an identical way. The current study adds some preliminary evidence to previous literature which emphasises visual lateralisation during discrimination learning in pigeons.

We recorded from single neurons in two areas of the pigeon brain while birds were required to peck a stimulus indicating either a high effort task or a low effort task would follow. Upon completion of the task the birds received the same reward. We found that activity in the nidopallium caudolaterale, an area equivalent to the mammalian prefrontal cortex, was modulated by the value of the reward that would be received based on how much effort was required to obtain it. Value coding was most prominent during the presentation of the stimulus indicating a high or low effort task, and in the delay period immediately prior to carrying out the effort task. In contrast, activity in the corticoidea dorsolateralis was not modulated by value, however, population firing patterns suggest that it may be involved in associating actions with outcomes. Our findings support the view that activity in the nidopallium caudolaterale reflects value of reward as a function of effort discounting and as such may serve functions similar to the mammalian anterior cingulate cortex.

Previous studies have demonstrated that mean activity levels in the hippocampus oscillate on a circadian timescale, both at the single neuron and EEG level. This oscillation is also entrained by the availability of food, suggesting that the circadian modulation of hippocampal activity might comprise part of the recently discovered food-entrainable circadian oscillator (FEO). In order to determine whether the circadian oscillation in hippocampal activity is linked to activity in other brain regions, we recorded field-potential EEG from hippocampus and two cortical regions known to connect to hippocampus; the anterior cingulate cortex and the agranular insular cortex. These latter regions are involved in executive control (cingulate) and gustatory feedback (insula) and so are in a position where they could usefully contribute to, or benefit from, hippocampal memorial information in order to undertake task-related processing. We recorded EEG from these three regions for 20 m every hour for 58 consecutive hours in one continuous exposure to the recording environment. We found that there are regular and distinct increases in magnitude coherence between hippocampus and both cortical regions for EEG in both theta (6–12 Hz) and gamma (30–48 Hz) bands. These periods of increased coherence are spaced approximately one solar day apart, appear not to be specifically light-entrained, and are most apparent for gamma frequency activity. The gamma association between the two cortical regions shows the same temporal pattern of coherence peaks as the hippocampal-cortical coherences. We propose that these peaks in coherence represent the transient synchronization of temporally tagged memorial information between the hippocampus and other brain regions for which this information may be relevant. These findings suggest that the FEO involves coordinated activity across a number of brain regions and may underlie a mechanism via which an organism can store and recall salient gustatory events on a circadian timescale. Keywords: Hippocampus, Cingulate, Insula, Theta, Gamma, Coherence, Circadian

Here we present a novel effort-based task for laboratory rats: the weight lifting task (WLT). Studies of effort expenditure in rodents have typically involved climbing barriers within T-mazes or operant lever pressing paradigms. These task designs have been successful for neuropharmacological and neurophysiological investigations, but both tasks involve simple action patterns prone to automatization. Furthermore, high climbing barriers present risk of injury to animals and/or tethered recording equipment. In the WLT, a rat is placed in a large rectangular arena and tasked with pulling a rope 30 cm to trigger food delivery at a nearby spout; weights can be added to the rope in 45 g increments to increase the intensity of effort. As compared to lever pressing and barrier jumping, 30 cm of rope pulling is a multi-step action sequence requiring sustained effort. The actions are carried out on the single plane of the arena floor, making it safer for the animal and more suitable for tethered equipment and video tracking. A microcontroller and associated sensors enable precise timestamping of specific behaviors to synchronize with electrophysiological recordings. The rope and reward spout are spatially segregated to allow for spatial discrimination of the effort zone and the reward zone. We validated the task across five cohorts of rats (total n=35) and report consistent behavioral metrics. The WLT is well-suited for neuropharmacological and/or in vivo neurophysiological investigations surrounding effortful behaviors, particularly when wanting to probe different aspects of effort expenditure (intensity vs. duration).

Serial-order behaviour is the ability to complete a sequence of responses in order to obtain a reward. Serial-order tasks can be thought of as either externally-ordered (EO) such that the order of responses is predetermined, or internally-ordered (IO) such that the subject determines the order of responses from trial to trial. Ordinal knowledge (representation of first, second, or third etc.) is a key component of successful serial-order behaviour, and is considered a higher-order cognitive function. The nidopallium caudolaterale (NCL) is the avian equivalent to the prefrontal cortex, an area of the primate brain important for serial-order behaviour. The importance of the NCL for serial-order behaviour, however, is still unknown. In the current study, we trained pigeons to complete either three-item EO or IO tasks and recorded single-neuron activity from the NCL to determine whether neurons in the NCL code ordinal knowledge. Our results support the view that the NCL is involved in serial-order behaviour by coding ordinal position, at least with respect to the IO task. The absence of any ordinal coding during the EO task could be explained by the different strategies that birds adopt between the EO and IO tasks.

Visual information is processed hierarchically along a ventral ('what') pathway that terminates with categorical representation of biologically relevant visual percepts (such as faces) in the mammalian extrastriate visual cortex. How birds solve face and object representation without a neocortex is a long-standing problem in evolutionary neuroscience, though multiple lines of evidence suggest that these abilities arise from circuitry fundamentally similar to the extrastriate visual cortex. The aim of the present experiment was to determine whether birds also exhibit a categorical representation of the avian face-region in four visual forebrain structures of the tectofugal visual pathway: entopallium (ENTO), mesopallium ventrolaterale (MVL), nidopallium frontolaterale (NFL), and area temporo-parieto-occipitalis (TPO). We performed electrophysiological recordings from the right and left hemispheres of 13 pigeons while they performed a Go/No-Go task that required them to discriminate between two sets of stimuli that included images of pigeon faces. No neurons fired selectively to only faces in either ENTO, NFL, MVL, or TPO. Birds' predisposition to attend to the local-features of stimuli may influence the perception of faces as a global combination of features, and explain our observed absence of face-selective neurons. The implementation of naturalistic viewing paradigms in conjunction with electrophysiological and fMRI techniques has the potential to promote and uncover the global processing of visual objects to determine whether birds exhibit category-selective patches in the tectofugal visual forebrain.

An animal’s ability to assess the value of their behaviors to minimize energy use while maximizing goal achievement is critical to its survival. The anterior cingulate cortex (ACC) has been previously shown to play a critical role in this behavioral optimization process, especially when animals are faced with effortful behaviors. In the present study, we designed a novel task to investigate the role of the ACC in evaluating behaviors that varied in effort but all resulted in the same outcome. We recorded single unit activity from the ACC as rats ran back and forth in a shuttle box that could be tilted to different tilt angles (0, 15, and 25°) to manipulate effort. Overall, a majority of ACC neurons showed selective firing to specific effort conditions. During effort expenditure, ACC units showed a consistent firing rate bias toward the downhill route compared with the more difficult uphill route, regardless of the tilt angle of the apparatus. Once rats completed a run and received their fixed reward, ACC units also showed a clear firing rate preference for the single condition with the highest relative value (25° downhill). To assess effort preferences, we used a choice version of our task and confirmed that rats prefer downhill routes to uphill routes when given the choice. Overall, these results help to elucidate the functional role of the ACC in monitoring and evaluating effortful behaviors that may then bias decision-making toward behaviors with the highest utility. NEW & NOTEWORTHY We developed a novel effort paradigm to investigate how the anterior cingulate cortex (ACC) responds to behaviors with varied degrees of physical effort and how changes in effort influence the ACC’s evaluation of behavioral outcomes. Our results provide evidence for a wider role of the ACC in its ability to motivate effortful behaviors and evaluate the outcome of multiple behaviors within an environment.

As animals carry out behaviors, particularly costly ones, they must constantly assess whether or not to persist in the behavior or quit. The anterior cingulate cortex (ACC) has been shown to assess the value of behaviors and to be especially sensitive to physical effort costs. Complimentary to these functions, the insula is thought to represent the internal state of the animal including factors such as hunger, thirst, and fatigue. Utilizing a novel weight lifting task for rats, we characterized the local field potential (LFP) activity of the ACC and anterior insula (AI) during effort expenditure. In the task male rats are challenged to work for sucrose reward, which costs progressively more effort over time to obtain. Rats are able to quit the task at any point. We found modest shifts in LFP theta (7-9 Hz) activity as the task got progressively more difficult in terms of absolute effort expenditure. However, when the LFP data were analyzed based on the rat’s relative progress towards quitting the task, or performance state, substantial shifts in LFP power in the theta and gamma (55-100 Hz) frequency bands were observed in ACC and AI. Both ACC and AI theta power decreased as the rats got closer to quitting, while ACC and AI gamma power increased. Furthermore, coherency between ACC and AI in the delta (2-4 Hz) range shifted alongside the rat’s performance state. Overall we show that ACC and AI LFP activity changes correlate to the rats’ relative performance state in an effort-based task.Significance StatementAnimals need to assess whether or not a behavior is worth pursuing based on their internal states (e.g., hunger, fatigue) and the costs and benefits of the behavior. However, internal states often change as behaviors are carried out, such as becoming fatigued, necessitating constant reassessment as to whether to continue the behavior or quit. We characterized brain activity in the anterior cingulate cortex and insula, brain regions involved in cost-benefit decision making and internal state representations, respectively, as rats carried out a challenging physical-effort task. Both brain regions showed significant shifts in activity as the rats approached their quitting point. Our study provides one of the first characterizations of neural activity as an animal decides to quit an effortful task.

The avian Wulst is the pallial (analogous to mammalian cortex) termination point of the thalamofugal pathway, one of two main visual pathways in birds, and is considered to be equivalent to primate striate cortex. We recorded neuronal activity from the Wulst in pigeons during two versions of a delayed matching-to-sample procedure. Two birds were trained on a common outcomes (CO) procedure, in which correct responses following both the skateboarder and the flower stimuli were associated with reward. Two other birds were trained on a differential outcomes (DO) procedure in which correct responses following only the skateboarder stimulus were associated with reward, while correct responses following the flower stimulus were not rewarded. In line with previous studies, under CO conditions, and for both excitatory and inhibitory neurons, delay activity in the Wulst was significantly different from baseline activity following both sample stimuli, which may indicate that Wulst delay activity is a neural correlate of working memory for the sample stimulus. On the other hand, under DO conditions, Wulst delay activity appeared to be a neural correlate of the upcoming reward. We argue that Wulst neurons display flexibility in their encoding in that they can encode both sample and reward information, but may default to one type of coding over the other based on the demands of the task. The current study provides the first evidence that delay activity in the Wulst represents both a neural correlate for sample information as well as reward information.

We recorded from neurons in the nidopallium caudolaterale, the avian equivalent of the mammalian prefrontal cortex, in four birds. The birds were required to peck a stimulus that indicated the amount of reward they would receive (small or large) after a certain delay (short or long). We found that the activity of neurons in the nidopallium caudolaterale was modulated by the value of the reward that would be received based on the reward amount and the delay to reward. We found that value coding was most prominent during the presentation of the sample period, and less so during the delay period and during the presentation of the reward itself. Our findings support the view that activity in nidopallium caudolaterale reflects the encoding of the value of reward based on a combination of reward amount and delay to a reward.

Objective: Pregnancy serves as an opportune time for “teachable moments” to elicit positive behavior change. We evaluated change in exercise perception, behavior and gestational weight gain in participants engaged in a one-hour educational experience. Methods: Women between 28 0/7 to 36 6/7 weeks with no prior yoga experience carrying a non-anomalous singleton fetus participated in a randomized controlled trial on prenatal yoga. The yoga group engaged in a one-hour yoga class; the attention control educational group, in a one-hour presentation on exercise, nutrition and obesity in pregnancy. Maternal perception of yoga, exercise effects and current health status was conducted before and after the intervention. Gestational weight gain (GWG) and body mass index (BMI) were assessed. A postpartum survey was performed to determine self-reported behavioral changes during and after pregnancy. Results: Over 6 months, 52 women were randomized and 46 (88%) completed the study. Women reported a more positive attitude towards exercise and yoga after the yoga intervention. Total GWG was similar (yoga 32.9 versus education 32.8 pounds, p = 0.98). Stratified by pre-pregnancy BMI, 13% gained within and 61% gained above the Institute of Medicine guidelines in each group. Of 29 inactive women prior to the intervention, 60% of the yoga group and 75% of the education group began prenatal exercises after the intervention and 50% of each group continued to exercise after delivery. There were no significant differences between groups. Conclusion: A one-time, one-hour intervention teaching a new exercise or educating women during pregnancy can positively impact pregnancy behaviors and perception with the potential to improve maternal and neonatal outcomes. Clinical Trial Registration: Clinicaltrials.gov, www.clinicaltrials.gov, NCT02063711.

SummaryRecent evidence suggests that the hippocampus may integrate overlapping memories into relational representations, or schemas, that link indirectly related events and support flexible memory expression. Here we explored the nature of hippocampal neural population representations for multiple features of events and the locations and contexts in which they occurred. Hippocampal networks developed hierarchical organizations of associated elements of related but separately acquired memories within a context, and distinct organizations for memories where the contexts differentiated object-reward associations. These findings reveal neural mechanisms for the development and organization of relational representations.Video Abstract

Nicotinamide phosphoribosyltransferase (NAMPT) was first reported in 1994 and has been explored in various human disease processes. However, until recently, very little has been done to define the role of NAMPT in pregnancy. NAMPT is a 52 kDa protein that has diverse functions in the human body, acting as a growth factor, cytokine, an enzyme, and an insulinomimetic agent. Initial studies examined NAMPT expression in fetal membranes and its effects on the amnion. Later research in nonpregnant studies showed an insulinomimetic effect, and attention focused on its role in gestational diabetes. In addition, as studies revealed NAMPT's function as an inflammatory cytokine, studies examined NAMPT in preeclampsia and fetal growth restriction. Several studies have confirmed that NAMPT is a marker of systemic infectious processes such as pyelonephritis and intrauterine infection. In this review, we present the current understanding of NAMPT's role in various pregnancy-related conditions as well as possible directions for future research.

Hippocampal oscillations are dynamic, with unique oscillatory frequencies present during different behavioral states. To examine the extent to which these oscillations reflect neuron engagement in distinct local circuit processes that are important for memory, we recorded single cell and local field potential activity from the CA1 region of the hippocampus as rats performed a context-guided odor-reward association task. We found that theta (4–12 Hz), beta (15–35 Hz), low gamma (35–55 Hz), and high gamma (65–90 Hz) frequencies exhibited dynamic amplitude profiles as rats sampled odor cues. Interneurons and principal cells exhibited unique engagement in each of the four rhythmic circuits in a manner that related to successful performance of the task. Moreover, principal cells coherent to each rhythm differentially represented task dimensions. These results demonstrate that distinct processing states arise from the engagement of rhythmically identifiable circuits, which have unique roles in organizing task-relevant processing in the hippocampus. DOI: http://dx.doi.org/10.7554/eLife.09849.001, eLife digest Electrodes placed on the surface of the scalp can reveal rhythmic patterns of electrical activity within the brain. These rhythms reflect the coordinated firing of large numbers of neurons that are connected together within a network in order to process information. A single network can show rhythms with various different frequencies depending on its local connections and the pattern of input that it receives at any given time. One region that exhibits striking changes in these rhythmic patterns is the hippocampus: a brain area that plays a key role in memory. The hippocampus contains many cell types, including interneurons (which form connections with nearby cells) and principal cells (which connect with cells outside of this region). Though both participate in rhythmic circuits, little is known about the different extents to which these distinct cell types are engaged in rhythmic processing, or how rhythmic processing might support memory. Rangel, Rueckemann, Rivière et al. have now addressed these questions by using electrodes to record from the hippocampus as rats learned to associate specific odors in different environments with a reward. As the rats sniffed the odors, their brains showed four different hippocampal rhythms: from a low frequency called “theta”, through “beta” and “low gamma” up to “high gamma” frequencies. Each of these hippocampal rhythms varied in strength over time, indicating that rhythmic processing is dynamic during the task. Rangel, Rueckemann, Rivière et al. found that neurons fired rhythmically during trials in which the rat chose the correct odor-environment combination. In these correct trials, individual principal cells were more likely to fire in synchrony with only one of the rhythms. In contrast, interneurons were more likely to fire in synchrony to each of the four rhythms at some point during a correct choice. Among the four rhythms, coordinated principal cell and interneuron firing with respect to the beta rhythm was most tightly linked with a correct choice. These findings reveal that investigation of rhythmic dynamics in the hippocampus can provide insight into how the timing of cell activity is coordinated to support memory. DOI: http://dx.doi.org/10.7554/eLife.09849.002

This chapter provides a review of the three major areas of the use of Doppler ultrasound imaging for fetal and maternal risk assessment in early pregnancy. Ductus venosus and tricuspid flow assessments have now become an essential part of prenatal diagnostic workup in the first trimester. Uterine artery Doppler offers early prediction of preeclampsia and other pregnancy complications that can lead to prevention of some of these disorders through prophylactic therapeutics such as low-dose aspirin. Further research in this field holds exciting opportunities for improving perinatal care and outcome.

Background: Identifying patients at high risk for multidrug-resistant urinary tract infections (UTIs) is important for guiding empirical antimicrobial therapy. Clinical risk factors associated with antimicrobial-resistant urinary pathogens and the derivation of a simple clinical decision rule could help define health care–associated UTI. Objective: To derive a simple clinical decision rule to identify clinical risk factors associated with antimicrobial-resistant urinary pathogens. Methods: This was a retrospective case-control study of all emergency department (ED) patients from July 1, 2011, to July 1, 2012, who presented to the ED with UTI and a positive urine culture. Candidate risk factors were collected retrospectively from medical record review. We compared differences in patient characteristics stratified by the presence of an antimicrobial-resistant urinary pathogen. Results: A total of 360 patients with UTI had a positive, noncontaminated urine culture during the study period. About 6.7% of patients (n = 24) had a multidrug-resistant (MDR) urinary infection. Logistic regression modeling identified 3 clinical factors associated with the identification of a MDR pathogen: male sex, chronic hemodialysis, and nursing home residence. A scoring system was created to identify patients with MDR pathogens. Test characteristics were calculated using bootstrapping for internal validation, with a sensitivity of 74.7% (95% CI = 55.1%-91.3%) and specificity of 85.1% (95% CI = 77.8%-86.2%), positive likelihood ratio of 4.3, and a negative likelihood ratio of 0.3. Conclusions: Clinical factors can be used to identify UTI patients at high risk of MDR urinary pathogens.

Introduction: The emergency department (ED) plays a critical role in the management of life-threatening infection. Prior data suggest that ED vancomycin dosing is frequently inappropriate.The objective is to assess the impact of an electronic medical record (EMR) intervention designed to improve vancomycin dosing accuracy, on vancomycin dosing and clinical outcomes in critically ill ED patients. Methods: Retrospective before-after cohort study of all patients (n=278) treated with vancomycin in a 60,000-visit Midwestern academic ED (March 2008 and April 2011) and admitted to an intensive care unit. The primary outcome was the proportion of vancomycin doses defined as “appropriate” based on recorded actual body weight. We also evaluated secondary outcomes of mortality and length of stay. Results: The EMR dose calculation tool was associated with an increase in mean vancomycin dose ([14.1±5.0] vs. [16.5±5.7] mg/kg, p

Objective The aim of the study is to examine the relationship between sickle cell trait (Hb AS) and other sickle hemoglobinopathies and the risk of thromboembolism during pregnancy or the puerperium. Study Design Retrospective cohort study of African American women receiving prenatal care from 1991 to 2006. Sickle cell status was ascertained by routine hemoglobin electrophoresis. Venous thromboembolism (VTE) was defined as one or more episodes of deep venous and/or pulmonary thromboembolism during pregnancy or the puerperium according to discharge diagnoses based on International Classification of Diseases, Ninth Revision codes. Results Among 22,140 women with hemoglobin (Hb) AA status, 20 women (0.09%) experienced pregnancy-related VTE compared with 3 women (0.15%) of 2,037 women with Hb AS; relative risk (RR) for the association with AS status = 1.6; 95% confidence interval (CI) 0.5 to 5.5. Of 103 women, 3 women (2.9%) with sickle cell disease conditions (Hb SS, Hb SC, or Hb S,beta-thalassemia) experienced thromboembolism. Compared with women with Hb AA status, the RR = 32.2, 95% CI 9.7 to 107. Conclusion Sickle cell trait may be associated with a modest increase in VTE in the setting of pregnancy; sickle cell disease conditions are strongly associated with this rare but potentially fatal outcome.