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This study aimed to create a pediatric sedation scoring system independent of the American Society of Anesthesiology Physical Status (ASA-PS) classification that is predictive of adverse events, facilitates objective stratification, and resource allocation. Multivariable regression and machine learning algorithm analysis of 134,973 sedation encounters logged in to the Pediatric Sedation Research Consortium (PSRC) database between July 2007 and June 2011. Patient and procedure variables were correlated with adverse events with resultant β-regression coefficients used to assign point values to each variable. Point values were then summed to create a risk assessment score. Validation of the model was performed with the 2011 to 2013 PSRC database followed by calculation of ROC curves and positive predictive values. Factors identified and resultant point values are as follows: 1 point: age ≤ 6 months, cardiac diagnosis, asthma, weight less than 5th percentile or greater than 95th, and computed tomography (CT) scan; 2 points: magnetic resonance cholangiopancreatography (MRCP) and weight greater than 99th percentile; 4 points: magnetic resonance imaging (MRI); 5 points: trisomy 21 and esophagogastroduodenoscopy (EGD); 7 points: cough at the time of examination; and 18 points: bronchoscopy. Sum of patient and procedural values produced total risk assessment scores. Total risk assessment score of 5 had a sensitivity of 82.69% and a specificity of 26.22%, while risk assessment score of 11 had a sensitivity of 12.70% but a specificity of 95.29%. Inclusion of ASA-PS value did not improve model sensitivity or specificity and was thus excluded. Higher risk assessment scores predicted increased likelihood of adverse events during sedation. The score can be used to triage patients independent of ASA-PS with site-specific cut-off values used to determine appropriate sedation resource allocation.

Auxin, a plant growth-promoting hormone, is known to be produced by many if not all bacteria. Research has shown that bacteria produced auxin is associated with both positive and negative plant gro...

Friedreich ataxia (FRDA) is typically caused by homozygosity for an expanded GAA triplet-repeat in intron 1 of the FXN gene, which results in transcriptional deficiency via epigenetic silencing. Most patients are homozygous for alleles containing > 500 triplets, but a subset (~20%) have at least one expanded allele with 500 triplets, a significantly higher prevalence of unmethylated epialleles (median = 9.8%) was observed in patients with at least one allele containing 20%) and later onset (>15 years). The higher prevalence in mild FRDA of somatic FXN epialleles devoid of DNA methylation is consistent with variegated epigenetic silencing mediated by expanded triplet-repeats. The proportion of unsilenced somatic FXN genes is an unrecognized phenotypic determinant in FRDA and has implications for the deployment of effective therapies.

Switchgrass (Panicum virgatum L.) has gained wider attention due to its recognition and use as a model herbaceous crop species for bioenergy production. Genetic diversity information in lowland switchgrass cultivars can help to specify cultivars to be used in the breeding programs aiming for hybrid vigor. The objective of this research was to analyze genetic variation within and among five lowland switchgrass cultivars using amplified fragment length polymorphism (AFLP) markers. AFLP polymorphisms indicated the presence of high genetic variation within lowland switchgrass cultivars with ‘Alamo’ exhibiting the highest genetic variation and ‘Performer’ the lowest. The Nei’s genetic diversity parameters revealed the lowest genetic distance between cultivars ‘Alamo’ and ‘Cimarron’ and the highest value between cultivars ‘Alamo’ and ‘Kanlow’. ‘Alamo’ and ‘Cimarron’ were clustered together while ‘BoMaster’, ‘Kanlow’, and ‘Performer’ were grouped into the other cluster. In addition, there were clusters with mixed genotypes. The findings of this study can be used to select diverse lines as parents for heterosis and inbreeding studies.

BACKGROUND: Inhaled nitric oxide (iNO) is used in infants as a therapy for elevated pulmonary vascular resistance. When iNO is delivered at low tidal volumes, displayed inspiratory and expiratory volumes vary widely. We hypothesize that volume is removed by the sampling line during the ventilation cycle, and this results in a net volume loss at low tidal volumes. This study aimed to measure the volumes delivered and to assess the accuracy of displayed ventilator values using a test lung. METHODS: A test lung was connected to a ventilator and an iNO delivery system. All tests were performed with stable mode settings across volumes of 18, 30, 42, and 60 mL. Flow measured with a pneumotachometer attached between the test lung and the circuit assessed the percent error between inspiratory and expiratory volumes measured by the pneumotachometer measured and displayed on the ventilator under various iNO/sample line conditions to determine where and how much volume was being displaced. RESULTS: Displayed and measured inspiratory volumes had small variations between the iNO/sample line conditions and baseline. However, expiratory volumes, with the sample line connected, exhibited large percent error values that increased (−14, −20, −27, and −34) as tidal volume decreased (60, 42, 30, and 18 mL) and error was significantly larger compared to baseline in all tidal volumes (P CONCLUSIONS: We concluded that inspiratory volumes were not affected by iNO delivery, but additional removal of volume in the expiratory phase of the breath cycle by the sampling line results in a large error in the displayed expiratory volume.

In order to predict which newborns will require advanced resuscitation (ANR), we developed an ANR risk calculator (calculator.) using a bootstrap sample size of 52 973 from a case–control study of newborns ≥34 weeks gestation. Multivariable logistic regression coefficients were obtained for the 10 original risk factors and two interaction terms. The area under the receiving-operating characteristic curve predicting ANR was 0.9243. ANR prediction is improved by accounting for perinatal variables, beyond factors known prenatally. Prospective validation of this model is warranted in a clinical setting.

The objective of this study was to compare contamination rates in urine samples obtained by transurethral catheterization and clean-catch methods in preschool children aged 2 to 5 years.A retrospective, chart review was performed on patients evaluated in our emergency department over a 6-month period who had a urine culture obtained by either transurethral catheterization or clean-catch methods. The charts were reviewed for urine bacterial colony counts and divided into positive, negative, or contaminated cohorts. Demographic data were collected as well.Four hundred sixty patients met inclusion for this study. Of these patients, there were 120 samples collected by catheter (26.1%) and 340 samples collected by clean-catch method (73.9%).Female patients comprised 73% of the eligible samples (n = 336), and 27% were male (n = 124). Contamination rates significantly varied by collection method (P0.0001), with only 9 contaminated catheter samples (7.5%) and 125 contaminated clean-catch samples (36.76%). Contaminated samples were found in 122 of 336 female urine samples (36.3%), and 12 of 124 male urine samples (9.7%). There were no associations found between contamination rates and age within either sex.Our study demonstrated a higher urine culture contamination rate in preschool age children in the clean-catch method group compared with the transurethral catheterization group. This finding was particularly strong within the female subset, which could partially be accounted for by the small male sample size.

The endothelins and their receptors are best known for their regulation of the vascular system. Their widespread expression in epithelial cells and their overexpression in some tumors has prompted investigation into their ability to regulate cancer progression. In this study, we assessed the mRNA expression of the major endothelin B receptor gene (EDNRB) isoforms and found differences in both mRNA and protein expression in normal breast cells and breast cancer cell lines. Knocking down the EDNRB gene in breast cancer cells altered invasiveness toward endothelin 3 (ET3), and we observed EDNRB isoform-specific regulation of breast cancer cell invasion and cell signaling, as well as isoform- and subtype-specific differences in breast cancer patient survival. The results reported in this study emphasize the importance of the endothelin B receptor in breast cancer. To our knowledge, this study is the first to clarify the differential expression and roles of specific EDNRB isoforms in breast cancer.

Objectives To study the incidence, sequelae, follow up, and recovery rate of vocal fold motion impairment (VFMI) after complex aortic arch reconstruction in neonates. Study design Retrospective case control study. Methods We retrospectively evaluated 105 neonates who underwent complex aortic arch reconstruction from 2014 to 2016. We compared patients that did have VFMI compared to a control group of patients with normal vocal fold movement. Descriptive statistics were computed for all demographic and clinical variables by treatment group. Results 36% of patients were evaluated for VFMI (n = 38) by an otolaryngologist. The incidence of VFMI was 22% (n = 23). Females were more likely to have VFMI (p = 0.02). Aspiration was more common in patients with VFMI (p = 0.006). The difference in age, weight, incidence of pneumonia, nasogastric tube, gastrostomy, total length of stay, genetic anomaly, and reintubation was not significant between the VFMI group and control group (p > 0.05). Tracheostomy was not performed in any patients with unilateral paralysis. Only 61% of patients followed up in clinic (n = 14). 64% of patients showed improvement or resolution (n = 9). Average time to improvement was 4.8 months. Average time to complete resolution was 10.5 months. Conclusions VFMI after complex aortic arch reconstruction is relatively common. Despite increased aspiration in patients with VFMI, pneumonia did not occur at all in either group. Tracheostomy was not necessary in any patients with a unilateral paralysis. Most patients showed an improvement in the VFMI within 5 months of surgery. Our data support the need for otolaryngology follow-up after the diagnosis of VFMI.

OBJECTIVES To compare the modified Finnegan Scoring System (modified Finnegan) with an Adjusted Scoring System Criteria (adjusted Finnegan) for infants after cardiothoracic surgery with iatrogenic opioid abstinence syndrome (IOAS). METHODS This was a retrospective, observational pilot study. This study was conducted in a tertiary care academic hospital. Infants after cardiothoracic surgery with IOAS transferred between the pediatric intensive care unit and neonatal intensive care unit between January 1, 2014, and January 31, 2016, were included retrospectively. The main outcome variable was to compare the area under the curve for the mean modified Finnegan versus adjusted Finnegan. RESULTS Twenty-five patients were included in the study. Twenty patients with at least 30 scores were included in the final analysis. Overall, the modified Finnegan scores were at least 2 points higher than the adjusted Finnegan. The difference in area under the curve was 34.6 (p < 0.001). CONCLUSIONS Use of the modified Finnegan tool for older infants with IOAS could overestimate withdrawal, leading to unnecessary interventions.

Objective Simulation studies in adults and pediatrics demonstrate improvement in chest compression (CCs) quality as providers rotate every two minutes. There is paucity of studies in neonates on this matter. This study hypothesized that frequent rotation while performing CCs improves provider performance and decreases fatigue. Study design Prospective randomized, observational crossover study where 51 providers performed 3:1 compression-ventilation CPR as a pair on a term manikin. Participants performed CCs as part of 3 simulation models, rotating every 3, 5 and 10 minutes. Data on various CC metrics were collected. Participant vitals were recorded at multiple points during the simulation and participants reported their level of fatigue at completion of simulation. Results No statistically significant difference was seen in any of the compression metrics. However, differences in the providers’ fatigue scores were statistically significant. Conclusion CC performance metrics did not differ significantly, however, providers’ vital signs and self-reported fatigue scores significantly increased with longer CC durations.

The complex sphingolipids exhibit a diversity of ceramide acyl chain structures that influence their trafficking and intracellular distributions, but how the cell discerns among the different ceramides to affect such sorting remains unknown. To address mechanism, we synthesized a library of GM1 glycosphingolipids with naturally varied acyl chains and quantitatively assessed their sorting among different endocytic pathways. We found that a stretch of at least 14 saturated carbons extending from C1 at the water-bilayer interface dictated lysosomal sorting by exclusion from endosome sorting tubules. Sorting to the lysosome by the C14*-motif was cholesterol dependent. Perturbations of the C14*-motif by unsaturation enabled GM1 entry into endosomal sorting tubules of the recycling and retrograde pathways independently of cholesterol. Unsaturation occurring beyond the C14*-motif in very long acyl chains rescued lysosomal sorting. These results define a structural motif underlying membrane organization of sphingolipids and implicate cholesterol-sphingolipid nanodomain formation in sorting mechanisms.

Compound flooding, resulting from a combination of riverine and coastal processes, is a complex but important hazard to resolve along urbanized shorelines in the vicinity of river mouths. However, inland flooding models rarely consider oceanographic conditions, and vice versa for coastal flood models. Here, we describe the development of an operational, integrated coastal-watershed flooding model to address this issue of compound flooding in a highly urbanized estuarine environment, San Francisco Bay (CA, USA), where the surrounding communities are susceptible to flooding along the bay shoreline and inland rivers and creeks that drain to the bay. The integrated tributary-coastal forecast model (Hydro-Coastal Storm Modeling System, or Hydro-CoSMoS) was developed to provide water managers and other users with flood forecast information beyond what is currently available. Results presented here are focused on the interaction of the Napa River watershed and the San Pablo Bay at the northern end of San Francisco Bay. This paper describes the modeling setup, the scenario used in a tabletop exercise (TTE), and the assessment of the various flood forecast information products. Hydro-CoSMoS successfully demonstrated the capability to provide watershed and coastal flood information at scales and locations where no such information is currently available and was also successful in showing how tributary flows could be used to inform the coastal storm model during a flooding scenario. The TTE provided valuable feedback on how to guide continued model development and to inform what model outputs and formats are most useful to end-users.

Neurocysticercosis is associated with epilepsy in pig-raising communities with poor sanitation. Current internationally recognized diagnostic guidelines for neurocysticercosis rely on brain imaging, a technology that is frequently not available or not accessible in areas endemic for neurocysticercosis. Minimally invasive and low-cost aids for diagnosing neurocysticercosis epilepsy could improve treatment of neurocysticercosis. The goal of this study was to test the extent to which patients with neurocysticercosis epilepsy, epilepsy of unknown etiology, idiopathic headaches and among different types of neurocysticercosis lesions could be distinguished from each other based on serum mass profiling. For this, we collected sera from patients with neurocysticercosis-associated epilepsy, epilepsy of unknown etiology, recovered neurocysticercosis, and idiopathic headaches then performed binary group comparisons among them using electrospray ionization mass spectrometry. A leave one [serum sample] out cross validation procedure was employed to analyze spectral data. Sera from neurocysticercosis patients was distinguished from epilepsy of unknown etiology patients with a p -value of 10 −28 . This distinction was lost when samples were randomized to either group ( p -value = 0.22). Similarly, binary comparisons of patients with neurocysticercosis who has different types of lesions showed that different forms of this disease were also distinguishable from one another. These results suggest neurocysticercosis epilepsy can be distinguished from epilepsy of unknown etiology based on biomolecular differences in sera detected by mass profiling.

To evaluate vitamin D inadequacy among extremely low-birth-weight (ELBW, 1000 g) infants and the association between circulating vitamin D concentrations and perinatal-neonatal outcomes.Prospective cohort study of ELBW infants in the neonatal ICU. Blood was collected within the first 3 days after birth after obtaining informed consent. Circulating 25-hydroxyvitamin D concentrations (25(OH)D) were quantified using liquid chromatography-tandem mass spectroscopy and classified as vitamin D deficient, insufficient, or adequate ( 20, 20-30, or 30 ng/mL, respectively). Associations between 25(OH)D and perinatal-neonatal outcomes were determined by multivariable regression, adjusted for covariates that differ in the bivariate analysis.Of the 60 ELBW infants enrolled, 13 (22%) were vitamin D deficient, 15 (25%) were insufficient, and 32 (53%) were adequate. 25(OH)D levels were positively associated with fetal growth restriction and prolonged rupture of the membranes.Vitamin D inadequacy was frequent among ELBW infants. Circulating vitamin D concentrations were significantly associated with perinatal outcomes in this contemporary cohort.

Waterpipe (WP) tobacco smoking delivers many of the same harmful toxicants as cigarette smoking and is on the rise in the US. This study evaluated the feasibility and efficacy of a brief personalized feedback intervention in affecting changes in WP smoking among current WP smokers.Participants (N=109) were recruited as they entered WP lounges and completed a questionnaire and exhaled carbon monoxide (eCO) testing before entering the WP lounge. Participants were cluster-randomized to assessment-only control (AOC) or intervention conditions. The intervention condition received health risk information and personalized feedback on pre- and post-WP session eCO levels. Participants completed a survey at the end of the WP session and at 3-month follow-up.Compared to control, the intervention was effective in increasing knowledge of WP-related harms, correcting risk perceptions, increasing importance of quitting WP smoking, and increasing confidence in ability to quit WP smoking at post-WP session (p0.05). Differences were maintained for knowledge of WP-related harms, risk perceptions, and commitment to quitting WP at 3-month follow-up; however, no significant difference (p0.05) was observed in WP smoking (i.e., days smoked and number of WPs smoked) at 3-month follow-up between the intervention (M=3.97days, SD=9.83; M=6.45 bowls, SD=19.60) and control conditions (M=3.32days, SD=5.24; M=3.49 bowls, SD=5.10).The current research supports the use of personalized feedback as a useful intervention method to increase commitment to quit WP, but suggests more intensive interventions may be necessary to achieve WP cessation.

Objective: To determine the safety of ibuprofen used for postoperative pain control following palatoplasty in pediatric patients. Design: Retrospective chart review. Setting: Tertiary care, pediatric hospital. Participants: Patients who received ibuprofen for postoperative pain control after palatoplasty. Main Outcome Measures: Number of doses of ibuprofen given during hospitalization and the presence of postoperative primary or secondary bleeding following palatoplasty. Detection of postoperative hemorrhage was obtained from (1) chart review from inpatient hospitalization after palatoplasty, (2) chart review of each patient’s 3-week postoperative clinic visit, and (3) phone call to caretakers from primary author. Results: Thirty-two patients underwent palatoplasty who received ibuprofen for control of postoperative pain. Mean number of inpatient doses given was 4.8 (range: 1-17). None (0%) experienced hemorrhage in the hospital before discharge. Thirty-two (100%) patients were seen at a 3-week follow-up and no (0%) episodes of postoperative hemorrhage were noted. Seventeen (53%) caretakers of patients responded to contact by phone and confirmed no subsequent bleeding. Conclusions: Ibuprofen may not increase postoperative hemorrhage after palatoplasty. Further studies will be needed to evaluate safety on a larger scale.

In 2016, the neonatal resuscitation guidelines suggested electronic cardiac (ECG) monitoring to assess heart rate for an infant receiving positive pressure ventilation immediately after birth. Our aim was to study the impact of ECG monitoring on delivery room resuscitation interventions and neonatal outcomes.Observational cohort study compared maternal, perinatal and infant characteristics, before (retrospective cohort, calendar year 2015) and after (prospective cohort, calendar year 2017) implementation of ECG monitoring in the delivery room. Association of ECG monitoring with delivery room resuscitation practice interventions and neonatal outcomes was assessed using unadjusted and adjusted multivariable regression analyses.Of 632 newly born infants who received positive pressure ventilation in the delivery room, ECG monitoring was performed in 369 (the prospective cohort) compared with no ECG monitoring in 263 (the retrospective cohort). Compared to neonates in the retrospective cohort, neonates with ECG monitoring had a significantly lower endotracheal intubation rate (36% vs 48%, P .005) in the delivery room and higher 5-min Apgar scores (7 [5-8] vs 6 [5-8], P .05). There was no difference in mortality (31 [8%] vs 23 [9%]), but infants who received ECG monitoring had increased odds of receiving chest compressions with an adjusted odds ratio of 3.6 (95% confidence interval: 1.4-9.5).Introduction of ECG monitoring in the delivery room was associated with fewer endotracheal intubations, and an increase use of chest compressions with no difference in mortality.

OBJECTIVES The primary aim was to compare attainment of goal serum amikacin concentrations using two dosage regimens in patients admitted to a neonatal intensive care unit. Secondary objectives included comparison of percentages of supratherapeutic trough concentrations, and subtherapeutic and supratherapeutic peak concentrations. METHODS This was an Institutional Review Board–approved, retrospective study of neonates receiving amikacin during January–December 2013 (group 1) and January–December 2014 (group 2). Group 1 received amikacin dosage consistent with published recommendations, whereas group 2 was dosed using a modified protocol that was based on postmenstrual and postnatal age. Goal serum amikacin peak concentration was defined as 20 to 35 mg/L; hence, subtherapeutic and supratherapeutic peak concentrations were defined as 35 mg/L, respectively. Supratherapeutic trough concentrations were >8 mg/L. Between-group analysis was performed using Wilcoxon-Mann-Whitney test, Student t-test or χ2, or Fisher exact analysis as appropriate with a p value RESULTS A total of 278 neonates were included (group 1: n = 144; group 2: n = 134). Most patients were male (60%) and were admitted for prematurity or respiratory distress (77%). The median gestational age in group 1 was 34.4 weeks (range, 30.0–37.9 weeks) versus group 2 at 36.9 weeks (range, 31.4–38.9 weeks), whereas the postnatal age was similar between both groups at 4 days. There was a significant increase in attaining goal peak amikacin concentrations between groups 1 and 2, 34% versus 84%, p < 0.001, and decrease in supratherapeutic peak concentrations, 65% versus 12%, p < 0.001. There was no significant difference in subtherapeutic peak or supratherapeutic trough concentrations. CONCLUSIONS A modified neonatal amikacin dosage protocol resulted in increased peak amikacin serum concentration compared with published dosage recommendations. Future research should focus on determination of the optimal dosage regimen in neonates.

The proportion of sonographers who scan in pain is increasing, in spite of recommendations and guidelines for proper body mechanics and for the use of ergonomic equipment in the workplace. No study has examined in detail the type of equipment that is available to sonographers in the workplace and whether sonographers who have access to ergonomic equipment are scanning in pain. This study evaluated the proportions of sonographers who had access to various types of ergonomic equipment and compared the results with the prevalence of scanning-related pain. Most sonographers had access to ergonomic features manufactured into ultrasound machines but had less access to equipment provided by employers, such as scanning chairs and cable braces. Sonographers who had access to machines that had swiveling keyboards reported less pain and injury than those who did not.

Summary Standard false discovery rate (FDR) procedures can provide misleading inference when testing multiple null hypotheses with heterogeneous multinomial data. For example, in the motivating study the goal is to identify species of bacteria near the roots of wheat plants (rhizobacteria) that are moderately or strongly associated with productivity. However, standard procedures discover the most abundant species even when their association is weak and fail to discover many moderate and strong associations when the species are not abundant. This article provides a new FDR-controlling method based on a finite mixture of multinomial distributions and shows that it tends to discover more moderate and strong associations and fewer weak associations when the data are heterogeneous across tests. The new method is applied to the rhizobacteria data and performs favorably over competing methods.

The article responds to the issue article "Making Change Happen: The New Mission and Location of Language Departments" by Rogelio Minana. Topics include the author's experience in a U.S. university's English-as-a-second-language (ESL) department, the possible role of multilingualism in universities, and the siloing of academic departments.

Failure to account for misclassification error accruing from imperfect case-finding instruments can produce biased estimates of suspected major depression disorder (MDD) risk factor associations. The objective of this study was to estimate the impact of misclassification error on the magnitude of measures of association between suspected risk factors and MDD assessed using the Center of Epidemiological Studies on Depression-Short Form during the prenatal and postnatal periods. Baseline data were collected from 520 mothers participating in two home visitation studies in Oklahoma City between 2010 and 2014. A Bayesian binomial latent class model was used to compare the prevalence proportion ratio (PPR) between suspected risk factors and MDD with and without adjustment for misclassification error and confounding by period of MDD symptom on-set. Adjustment for misclassification error and confounding by period of MDD on-set (prenatal vs postnatal) showed that the association between suspected risk factors and MDD is underestimated (-) and overestimated (+) differentially in different source populations of low-income mothers. The median bias in the magnitude of PPR estimates ranged between -.47 (95% Bayesian Credible Intervals [BCI]: -10.67, 1.90) for intimate partner violence to +.06 (95%BCI: -0.37, 0.47) for race/ethnicity among native-born US residents. Among recent Hispanic immigrants, bias ranged from -.77 (95%BCI: -15.31, 0.96) for history of childhood maltreatment to +.10 (95%BCI: -0.17, 0.39) for adequacy of family resources. Overall, the extent of bias on measures of association between maternal MDD and suspected risk factors is considerable without adjustment for misclassification error and is even higher for confounding by period of MDD assessment. Consideration of these biases in MDD prevention research is warranted.

Background: Factors surrounding pediatricians’ parenting advice and training on parenting during residency have not been well studied. The Resident Parenting Questionnaire was developed to assess a) the relationship between pediatric residents’ upbringing and their parenting advice style and b) factors associated with confidence and resource use when delivering parenting advice. Methods: 301 pediatric residents from 15 United States residency programs completed the Resident Parenting Questionnaire with upbringing and advice responses categorized using Baumrind’s parenting model (authoritative, authoritarian, permissive). Chi-square/Fisher’s exact tests, Bowker’s test of symmetry, and regression analyses assessed associations between residents’ upbringing, parenting advice style/content, and confidence in providing parenting advice. Results: Most participants indicated being raised authoritatively (68%) and giving authoritative parenting advice (83%), but advice differed based on how they perceived their upbringing (p

OBJECTIVES To evaluate the success of a sedation protocol of fentanyl and midazolam infusions for infants undergoing laser photocoagulation for retinopathy of prematurity. METHODS This retrospective study included infants receiving a sedation protocol for laser photocoagulation during a 4-year period. The primary objective was protocol success, defined as completion without interruption, absence of protocol dose deviations, and absence of interventions. Secondary objectives compared outcomes between those with and without opioid/benzodiazepine exposure. A logistic regression was used to assess the effect of prior opioid/benzodiazepine exposure on requirement for fentanyl infusion increases. RESULTS Twenty-six infants were included. Seven (26.9%) had protocol success. Sixteen (61.5%) had protocol success, excluding dose deviations. Seventeen (65.4%) experienced ≥1 cardiopulmonary adverse events. Photocoagulation was completed in all cases. CONCLUSIONS Most achieved protocol success, when eliminating dosing deviations. These data indicate that flexibility is needed in fentanyl and midazolam infusion titration, based on clinical response.

Optimal dialysate sodium (dNa) is unknown, with both higher and lower values suggested in adult studies to improve outcomes. Similar studies in pediatric hemodialysis (HD) population are missing. This is the first report of the effect of two constant dNa concentrations in pediatric patients on chronic HD. 480 standard HD sessions and interdialytic periods were studied in 5 patients (age 4-17 years, weight 20.8-66 kg) during a period of 6-11 months per patient. dNa was 140 mEq/L during the first half, and 138 mEq/L during the second half of the study period for each patient. Lowering dNa was associated with improved preHD hypertension, decreased interdialytic weight gain, decreased need for ultrafiltration, lower sodium gradient and was well tolerated despite lack of concordance with predialysis sNa, that was variable. Further studies are needed to verify our findings and to investigate if an even lower dNa may be more beneficial in the pediatric HD population.

This research examines whether using a reference tool alters the monitoring of the mechanical index (MI) and thermal index (TI) during obstetric (OB) sonograms. A presurvey regarding users’ behavior patterns of monitoring MI/TI indices was emailed to sonographers who were registered in a clinical database affiliated with an accredited sonography program. The presurvey included a reference tool which respondents were asked to print and use when performing OB sonograms. A postsurvey was sent to the same respondents to determine if behavior patterns regarding MI/TI monitoring improved after using the reference tool. There were no significant changes in how often sonographers monitored MI/TI from the pre- to the postsurvey.

OBJECTIVE: To assess patient opinion on the Patient Protection and Affordable Care Act (PPACA) in an Otolaryngology practice and the factors that influence those opinions. STUDY DESIGN: Observational study. METHODS: An anonymous survey assessing patient opinion on the PPACA, demographic information, political affiliation, medical diagnosis, and insurance status was distributed to patients in three separate Otolaryngology clinics (General, cancer, and Low-income/Indigent) from April to June 2014. A total of 300 surveys were distributed and 207 were used for final analysis. The primary study outcome measures were patient opinion of the PPACA and statistically significant variables affecting that opinion. The association of Support for the PPACA and variables were tested using the Chi-square test. RESULTS: The only variables that showed a significant association with support for the PPACA were Political Party (p0.0001) and Ethnicity (p=0.0050). Specifically, a higher proportion of Democrats support the PPACA than Republicans and a higher proportion of African Americans and Hispanic/Latinos support the PPACA than Whites and Native Americans. CONCLUSION: Our survey of current Otolaryngology patients mirrors national findings of the division between Republicans and Democrats in their attitudes towards the Affordable Care Act. Political party appears to be the most significant factor in shaping patient opinion on this controversial subject regardless of insurance status or cancer diagnosis and a higher proportion of African Americans and Hispanic/Latinos support the PPACA than Whites and Native Americans. LEVEL OF EVIDENCE: IV.

Aim To determine the effect of childhood obesity and insulin resistance on bone health. Methods We conducted a cross sectional study in pubertal adolescents and young adults 13-20 years old who were either overweight/obese or normal weight. Participants were Tanner 3 or above for pubertal stage, and had fasting blood work done to measure glucose, insulin, C-reactive protein and lipid levels. Homeostatic model of insulin resistance (HOMA-IR) was calculated using the formula (Fasting Blood Glucose *Insulin/405). Body composition and bone mineral density were measured using dual energy X-ray absorptiometry (DXA; Hologic QDR 4500, Waltham, MA, United Kingdom). Results Percent trunk fat was associated inversely with whole body bone mineral content (BMC), whereas HOMA-IR was associated positively with whole body BMC. Conclusion Our results suggest that abdominal adiposity may have an adverse effect on whole body bone parameters and that this effect is not mediated by insulin resistance.

Background In various types of pulmonary research, pulmonary function testing (PFT) is performed to quantify the severity of lung disease. Induction of apnea and positive pressure ventilation are required for accurate PFT measurements in non-cooperative subjects. We compared two methods of apnea induction in infant olive baboons (Papio anubis). Methods Pulmonary function testing results were compared during apnea induced by hyperventilation (CO2 washout) vs. intravenous propofol (1 dose 10 mg/kg). PFT was evaluated using a hot-wire pneumotachometer incorporated within an Avea ventilator in nine 1-month-old baboons. Results Propofol induced apnea faster and more reliably. In both groups, PFT values passed the statistical equivalence test and were not significantly different (Student's t-test). There was a trend toward less data variability after propofol administration. Conclusions Intravenous propofol was non-inferior to CO2 washout for apnea induction in infant olive baboons. Propofol induced apnea faster and more reliably and yielded less variable PFT results.

Switchgrass (Panicum virgatum L.) is a naturally allogamous species. Recent studies indicated conditional self-compatibility exists in the species and can be used to produce inbreds for the exploitation of heterosis in biomass production. However, efficient and reliable bagging methods are unavailable for development of inbreeding. This study was designed to determine the efficacy of a polyester bagging method in blocking extraneous pollen such that switchgrass may self more efficiently. In this experiment four northern lowland (NL) inbreds, four NL non-inbreds, two southern lowland (SL) non-inbreds and 16 upland-lowland (interecotypic) F1 hybrids were self-pollinated by enclosing their inflorescences in polyester bags in the field; bags were also placed on 14 F1 interecotypic hybrid plants potted in a greenhouse. The reliability of the bags was determined using eight to ten simple sequence repeat (SSR) markers that distinguished the genetic parentage of the pollen. Contaminants were identified in two groups: outcrossing contaminants (OCs) and physical contaminants (PCs) based on the amplified alleles of their progeny and their seed parents. Of 39 polyester bags field tested in 2012, 35 bags showed 100 % selfed progeny, four showed PCs; no OCs were identified. Similarly, of 61 bags tested in 2013 in two field plots, 50 bags produced 100 % selfed progeny, while four bags produced OCs, five produced PCs and the other two produced both OCs and PCs. No contaminants were identified from the progeny of 18 bags used in the greenhouse, suggesting that high wind speed, physical damage or handling errors may have resulted in the contaminations of bagged progeny in the field. The result of this experiment establishes the increased reliability of the polyester bagging method over previously tested methods for selfing switchgrass under field and greenhouse conditions. Additionally, the S1, S2 and S3 inbreds produced in this study will contribute to developing completely or near completely homozygous inbred lines in the future.

Objective Friedreich ataxia (FRDA) is caused by an expanded GAA triplet-repeat (GAA-TR) mutation in the FXN gene. Patients are typically homozygous for expanded alleles containing 100 to 1,300 triplets, and phenotypic severity is significantly correlated with the length of the shorter of the 2 expanded alleles. Patients have a severe deficiency of FXN transcript, which is predominantly caused by epigenetic silencing of the FXN promoter. We sought to determine whether the severity of FXN promoter silencing is related to the length of the expanded GAA-TR mutation in FRDA. Methods Patient-derived lymphoblastoid cell lines bearing a range of expanded alleles (200–1,122 triplets) were evaluated for FXN transcript levels by quantitative reverse transcriptase polymerase chain reaction. FXN promoter function was directly measured by quantitative analysis of transcriptional initiation via metabolic labeling of newly synthesized transcripts in living cells. Results FXN transcriptional deficiency was significantly correlated with the length of the shorter of the 2 expanded alleles, which was noted both upstream (R2 = 0.84, p = 0.014) and downstream (R2 = 0.89, p = 0.002) of the expanded GAA-TR mutation, suggesting that FXN promoter silencing in FRDA is related to repeat length. A bilinear regression model revealed that length dependence was strongest when the shorter of the 2 expanded alleles contained 400 triplets in the shorter of the 2 expanded alleles revealed a significantly greater deficiency in individuals with longer GAA-TR alleles (p

Aim High arterial carbon dioxide (PaCO2) and cerebral reperfusion are associated with peri/intraventricular haemorrhage. Our aim was to study the relationship between PaCO2 and cerebral blood flow (CBF) in preterm infants during postnatal transition. Methods We prospectively studied ≤30 weeks' gestation haemodynamically stable preterm infants during the first three postnatal days (n = 21; gestational age 25.8 ± 1.4 weeks). We measured middle cerebral artery mean flow velocity (MCA-MV) as a surrogate for CBF at the time of blood gas analysis. Results We obtained 78 PaCO2–MCA-MV data pairs. The expected positive linear relationship between PaCO2 and MCA-MV was absent on the first postnatal day, equivocal on the second and present on the third. Using piecewise bilinear regression models, we identified PaCO2 breakpoints at 52.7 and 51.0 mmHg for postnatal days two and three, respectively. Conclusion In haemodynamically stable preterm neonates, the expected positive linear relationship between PaCO2 and CBF may be absent on postnatal day one. On postnatal day three, and possibly day two, a PaCO2 threshold exists for this relationship, above which CBF becomes reactive to PaCO2. We speculate that the enhanced CBF response to PaCO2 above the threshold contributes to the reperfusion injury and partly explains the association between hypercapnia and peri/intraventricular haemorrhage.

Social networking creates easy opportunities to violate HIPAA (Health Insurance Portability and Accountability Act). The purpose of this study is to determine if students who frequently update their Facebook statuses have the ability to identify certain Facebook postings as HIPAA violations. An anonymous survey was distributed to students on a university campus of a health sciences center, containing questions related to how often Facebook was used or accessed, how often students updated their Facebook statuses, and whether they could identify if specific online postings constituted HIPAA violations. Students’ HIPAA scenario responses were compared to their frequency of Facebook status updates, and students who frequently updated their information were more likely to incorrectly identify a HIPAA violation—namely, photos of patients posted to Facebook, even those devoid of identifying information. No other HIPAA violation scenarios demonstrated an association with frequencies of use or status updates. Further research needs to be conducted to see what traits or behaviors put students at risk for violating HIPAA through social networking sites.

To determine whether medical student intubation proficiency with a neonatal mannequin differs according to weekly or consecutive day practice sessions during a six-week pediatric clerkship.From July 2010 through June 2011, the authors prospectively randomized 110 third-year medical students into three neonatal intubation practice groups: standard (control; no practice sessions), weekly (practice once/week for four consecutive weeks), or consecutive day (practice once/day for four consecutive days). At baseline, students performed intubation during individual sessions using a neonatal mannequin (SimNewB). Two reviewers, blinded to practice group, viewed videotapes of intubations and independently scored students on equipment selection, procedural skill steps, length of intubation attempts (in seconds), and the number of attempts (up to three) needed for a successful intubation. Videotaped individual final assessment intubation sessions during week six were evaluated in the same manner.Students in the weekly and consecutive day practice groups performed better at the final assessment on all variables than students in the standard group (P.001), but over six weeks, the authors detected no differences between the two distributed practice formats for any outcomes of interest.Practice improved all aspects of neonatal intubation performance, including choosing the correct equipment, properly performing the skill steps, length of time to successful intubation, and success rate, for novice health care providers in a simulation setting. Over six weeks, neither practice format proved superior, but it remains unclear whether one format is superior for learning and skill retention over the long term or in actual practice.

Background: Sickle cell disease (SCD) and its complications are associated with frequent hospital visits and treatment often requires venous access for administration of fluids, medications and blood transfusions. Due to frequent use, peripheral venous access can become difficult over time because of venous scarring. Moreover, certain interventions such as chronic simple or exchange transfusions require reliable venous access for prolonged periods of time. Implantable central venous devices such as ports offer definitive access and mitigate the need for frequent peripheral access attempts. However, existing knowledge on the use of these devices in pediatric patients with SCD is limited. Due to possible increased risks of thrombosis and mechanical occlusion from hypercoagulable state, risk of infectious complications and need for surgical placement, ports are often not used routinely. We review the indications and complications associated with placement of ports in the pediatric cohort of patients with SCD - to better define the scope of port placement in this group. Methods: We performed an IRB-approved, retrospective chart review to assess the indications, complications and risk factors associated with port placement in children and adolescents with SCD at the University of Oklahoma Health Sciences Center (OUHSC). The study period analyzed was 17.5 years from January 1st, 2000 to July 30th, 2018 and included patients from birth to 21 years of age, diagnosed with SCD who had homozygous sickle cell disease (HbSS) or compound heterozygous SCD - either sickle cell-β0-thalassemia, sickle cell-β+-thalassemia or sickle cell-hemoglobin C (HbSC) disease, and had ports in place for more than 7 days. Patients were identified systematically by querying the OUHSC Clinical Data Warehouse using diagnostic codes followed by chart review. Results: Thirty-two patients with SCD and ports were identified during the study period, out of which 31 patients had HbSS and one patient had HbSC disease. The median age at first port insertion was 8 years (range 1-20 years). A total of 63 ports were placed for a total of 99,272 port days with a median port life span of 1340 days. The two main indications for port placement were - either chronic transfusions for which 48 ports were placed for a total of 80,238 port days, or poor venous access (PVA) for which 15 ports were placed for a total of 19,034 port days. Out of the 48 ports placed for chronic transfusions, 6 ports were for transfusions for primary stroke prophylaxis, 22 ports were for transfusions for secondary stroke prophylaxis, 17 ports were for transfusions for recurrent vaso-occlusive episodes (VOE) and 3 ports were for transfusions after multi-organ failure. A total of 54 port complications occurred (malfunction=29, infection=20, thrombosis=3, difficult port access=1, and intractable pain over port site=1). From the data available, more ports were placed in the left subclavian vein (LSV=20) than right subclavian vein (RSV=4) and right internal jugular (RIJ=2), however rate of overall complications were similar between LSV and RSV - 0.57 complications/1,000 catheter days in LSV and 0.58 complications/1,000 catheter days in RSV. The rate of port associated infection, defined as a positive blood culture drawn from the port, was 0.2 per 1,000 port days. A total of 20 infections identified mostly gram-positive organisms (n=15) predominantly Staphylococcus, compared to gram-negatives (n=3), fungus with Candida albicans (n=1) and a rare acid-fast bacilli infection with Mycobacterium mucogenicum (n=1). The rate of thrombosis, identified radiologically using vascular doppler ultrasound, was 0.03 per 1,000 port days. The rate of premature port removal arising from complications was 0.36 per 1,000 port days. Ports placed for chronic transfusions had a lower rate of removal (0.31 per 1,000 port days) compared to ports placed for poor venous access (0.58 per 1,000 port days) with a ratio of 0.54 which approached statistical significance (p=0.09; CI 0.26-1.21). Conclusion: Ports in pediatric patients with SCD are associated with low rates of thrombosis, infection and malfunction. Ports may be a reasonable alternative for vascular access in patients with SCD - especially in patients who require chronic simple or exchange transfusions and have difficult access. Larger prospective studies will be needed to further assess the scope of use of ports in this population. Disclosures No relevant conflicts of interest to declare.

This study assesses potential changes in runoff of California&rsquo, s eight major Central Valley water supply watersheds in the 21st century. The study employs the latest operative climate projections from 10 general circulation models (GCMs) of the Coupled Model Intercomparison Project Phase 5 (CMIP5) under two emission scenarios (RCP 4.5 and RCP 8.5) to drive a hydrologic model (VIC) in generating runoff projections through 2099. Changes in peak runoff, peak timing, seasonal (major water supply season April&ndash, July) runoff, and annual runoff during two future periods, mid-century and late-century, relative to a historical baseline period are examined. Trends in seasonal and annual runoff projections are also investigated. The results indicate that watershed characteristics impact runoff responses to climate change. Specifically, for rain-dominated watersheds, runoff is generally projected to peak earlier with higher peak volumes on average. For snow-dominated watersheds, however, runoff is largely projected to peak within the same month as historical runoff has, with little changes in peak volume during mid-century but pronounced decreases during late-century under the higher emission scenario. The study also identifies changes that are common to all study watersheds. Specifically, the temporal distribution of annual runoff is projected to change in terms of shifting more volume to the wet season, though there is no significant changing trend in the total annual runoff. Additionally, the snowmelt portion of the total annual runoff (represented by April&ndash, July runoff divided by total annual runoff) is projected to decline consistently under both emission scenarios, indicative of a shrinking snowpack across the study watersheds. Collectively, these changes imply higher flood risk and lower water supply reliability in the future that are expected to pose stress to California&rsquo, s water system. Those findings can inform water management adaptation practices (e.g., watershed restoration, re-operation of the current water system, investing in additional water storage) to cope with the stress.

OBJECTIVE Transfusion Associated Necrotizing Enterocolitis (TANEC) is defined as the onset of necrotizing enterocolitis (NEC) within 48 hours of receiving a blood transfusion in preterm neonates. We wanted to determine if hematocrit changes following blood transfusions were associated with disease development. PATIENTS AND METHODS This is a case-control analysis of inborn neonates ≤32 weeks' gestational age, from January 1, 2007 and December 31, 2010, who were diagnosed with Bell stage II or greater NEC. Those meeting TANEC criteria were identified and an analysis completed to determine if beginning or ending hematocrit values were associated with an increased risk for disease development. RESULTS Nineteen of forty-nine (39%) infants with NEC met the criteria for TANEC. We found no differences in gestational age at birth or birth weight in our experimental groups. The degree of illness including PDA, IVH, central line use, and respiratory support 48 hours prior to disease onset was also similar between groups. Those with TANEC had higher modified Bell staging of NEC and were more likely to be receiving full enteric feeds at the time of NEC onset. No statistically significant differences were found in hematocrit levels prior to or following the blood transfusion closest to NEC onset in the TANEC group, as compared to classic NEC (CNEC) or control infants. CONCLUSION The onset of NEC following transfusion occurs with a frequency that invites investigation regarding causation. Our data indicates no association between the beginning and ending hematocrit values and TANEC in our patient population.

Background: Opioids are commonly used in the neonatal intensive care unit (NICU). Negative neurodevelopmental effects in the short-term setting have been associated with opioids ; however, long-term studies have been limited. Objective: The primary objective was to determine if there is a dose relationship between fentanyl and neurodevelopmental outcomes, as measured by Bayley Scales of Infant and Toddler Development (Bayley-III) composite scores for language, cognition, and motor skills. Secondary objectives included comparison of Bayley-III scores and neurodevelopmental impairment classification based on fentanyl exposure. Methods: A retrospective evaluation of 147 very-low-birth-weight infants with Bayley-III scores obtained at a chronological age of 6 months to 2 years at clinic follow-up was conducted. Univariate and multivariable linear regression analyses were used to determine if there was a dose-related association between fentanyl and neurodevelopmental outcomes. To evaluate secondary outcomes, patients were divided based on cumulative fentanyl dose (“high-dose” versus “low/no-dose”). Results: The univariate analysis found a statistically significant decrease in cognition ( P = .034) and motor skills scores ( P = .006). No association was found in the multi-variable regression between fentanyl cumulative dose and Bayley-III scores. There was a significant decrease in the motor skills score between the high-dose versus low/no-dose group, 94 ± 20 versus 102 ± 15, respectively ( P = .026); however, no statistical differences were noted for language or cognition scores or neurological impairment classification. Conclusions: When controlling for other variables, the cumulative fentanyl dose did not correlate with neurodevelopmental outcomes. Further evaluation of benefits and risks of opioids in premature infants are needed.

Middle-molecules (MM) are not monitored in children on hemodialysis (HD), but are accumulated and increase the risk of cardiovascular disease and mortality. Molecular properties of Cystatin C (CyC), 13 kDa, potentially make it a preferred MM marker over Beta-2-Microglobulin (B2M), 12 kDa. We compared CyC and B2M kinetics to investigate if CyC can be used as preferred MM marker. CyC (mg/L) and B2M (μg/mL) were measured in 21 low-flux HD sessions in seven children. Blood samples were taken at HD start (pre), 1 and 2 hours into HD and at end of HD (post) for all sessions and 60 minutes after the first HD (Eq). PreCyC (9.85 ± 2.15) did not differ (P > 0.05) from postCyC (10.04 ± 2.83). PostB2M (38.87 ± 7.12) was higher (P 0.05), while EqB2M was lower than postB2M (36.48 ± 7.68 vs. 41.09 ± 8.99, P < 0.05). MMs as represented by B2M and CyC are elevated in children on standard HD. Intensified HD modalities would be needed for their removal. B2M is affected by the dialytic process with a rise during HD independent of ultrafiltration and decrease 1 hour after, while CyC remains unchanged. We suggest that CyC be used as preferred marker of MM removal and as a marker of adequacy of intensified HD regimens.

The primary objective of this study was to determine if children with abnormal body mass index (BMI) percentiles for age were admitted to the hospital from the emergency room at greater frequency than normal-weight children. This study also sought to evaluate what specific diagnoses both underweight and overweight children were being admitted with, and if a discrepancy exists.A prospective observational chart review was conducted of children evaluated in the emergency department of the Children's Hospital at the University of Oklahoma during the month of October 2011 (n = 1747). One thousand nine hundred thirteen patient charts were reviewed, but 166 were excluded because of inability to obtain a height or weight within a 3-month period of the child being seen in the emergency department.Thirty-five (24.5%) of underweight patients, 82 (14.6%) of overweight or obese, and 173 (16.6%) of the normal-weight patients were admitted to the hospital from the emergency department. The underweight patients were admitted more frequently than the normal-weight (P = 0.0206) and overweight or obese patients (P = 0.0046). In addition, underweight patients were admitted more frequently with respiratory infections than normal-weight (P = 0.0279) and overweight or obese (P = 0.0509) patients. In addition, underweight patients were admitted more than overweight or obese patients with fractures (P = 0.0278). There was no statistical difference between overweight or obese and normal-weight admissions within any of the diagnostic categories.Underweight children (BMI ≤5%) have an increased risk of hospitalization from the emergency department, even when adjusted for age and sex. In particular, hospitalization among underweight patients was increased for those patients with respiratory infections and fractures. No difference was seen between admission rates of overweight (BMI ≥85%) or obese (BMI ≥95%) patients from those of normal-weight patients. This warrants the need to counsel patients and their families on the dangers not only of obesity, but also of being underweight. Emphasis should be placed on healthy lifestyles that include well-balanced meals and exercise.

Published in Agron. J. 105:463–470 (2013) doi:10.2134/agronj2012.0286 Available freely online through the author-supported open access option. Copyright © 2013 by the American Society of Agronomy, 5585 Guilford Road, Madison, WI 53711. All rights reserved. No part of this periodical may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. S is a warm-season perennial grass native to North America. It is considered a leading candidate for deployment as a cellulosic biomass feedstock crop for bioenergy production (U.S. Department of Energy, 2011). Th e species has high potential to be cultivated as a renewable biofuels feedstock source on marginal land unsuited for traditional cultivated grain and forage crops (Parrish and Fike, 2005). Switchgrass is comprised of two major ecotypes designated “lowland” and “upland” based on edaphic adaptation and plant morphology. Native stands of the lowland ecotype occur on alluvial soils while native stands of the upland ecotype are typically found on drier and less fertile nonalluvial soils. Th e lowland ecotype is naturally distributed in the south-central and southeastern United States to about 40° N latitude while the upland ecotype is distributed throughout the expanse of U.S. switchgrass adaptation. Plants of the lowland ecotype are typically much larger than those of the upland ecotype, thereby having greater biomass production potential in suitable growth environments. Deployment of switchgrass as a bioenergy feedstock crop in the south-central and southeastern United States would likely heavily use lowland cultivars because of their greater biomass production potential compared to upland cultivars. Harvest timing is an important consideration in switchgrass production management as it aff ects biomass yield, chemical composition, harvesting cost, and stand persistence. Sanderson et al. (1999) reported that maximum biomass yield of lowland switchgrass was achieved in Texas with one seasonal autumn harvest completed by mid-September. Th ey further noted total yield was reduced by 12 to 19% depending on locations when the one seasonal harvest was taken in November compared with September. However, delaying the harvest past October in a onecut system can help maximize switchgrass biomass production the next year (Sanderson et al., 1999). Casler and Boe (2003) measured the eff ects of a single seasonal harvest of six upland switchgrass cultivars in Wisconsin and South Dakota during August, September, and October. Th ey reported that an August harvest produced the largest biomass yield in the fi rst year, but proved detrimental to biomass yield and stand persistence by the third year of the study. Th ey further indicated that an October harvest produced the greatest biomass yields over a 4-yr period. Parrish et al. (1997) reported decreased biomass yields associated with delaying autumn harvest of lowland switchgrass in Virginia. Th e decrease in biomass yield associated with delayed autumn harvest has been attributed partially to the remobilization and translocation of C and N reserve compounds from aboveground biomass to regenerative crown structures and underground roots (Parrish et al., 1997; Sanderson et al., 1999). Leaf loss near and aft er the end of the growing season is also thought to contribute to biomass yield reduction (Parrish et al., 1997; Sanderson et al., 1999). Although early fall harvest is recommended (Sanderson et al., 1999), a wider window extending harvest into or through winter months would alleviate potential problems associated with the much shorter early ABSTRACT Th e maximum biomass yield of switchgrass (Panicum virgatum L.) usually is achieved with one seasonal autumn harvest. However, information is limited on the infl uences of winter harvesting on annual biomass yield and on quality parameters impacting conversion into bioethanol. Accordingly, the objectives of this study were to assess: (i) yield of standing fi eld cured biomass at monthly intervals through winter, (ii) year-round elemental composition of biomass, and (iii) associated year-round soil nutrient status. An unfertilized 'Kanlow' switchgrass planting established in 1998 was used for this study conducted from November 2007 to October 2010. Th e experimental treatment was monthly harvest from November to the following March and year-round monthly sampling of biomass (except April) and soil for chemical analyses. Th e 3-yr mean dry matter yield of winter harvests was 5.94Mg ha–1, ranging from 3.88 Mg ha–1 in the winter of 2007–2008 to 7.55 Mg ha–1 in 2009–2010. Monthly biomass yield diff erences were signifi cant in Years 1 and 3 but not in Year 2. Concentrations of biomass elements and soil nutrients changed with various degrees over the 3 yr. Concentrations of ash, cell wall components, and mineral nutrients, except P, K, and S, did not change appreciably across winter months. Early winter harvests resulted in less yield loss compared to late winter harvests. Th ese fi ndings will be valuable in harvest management for switchgrass biomass production.

Background Young children should consume a variety of nutrient-dense foods to support growth, while limiting added fat and sugar. A majority of children between the ages of 3 and 5 years attend child care in the United States, which makes this environment and the child-care staff influential at meals. Objective The aim was to determine the association between best-practice food-related behaviors and young children's tastes of fruit, vegetable, low-fat dairy, and high-fat/high-sugar foods at child care. Design This was a cross-sectional study. Participants A community-based study with 201 children ages 3 to 5 years from 25 early care and education centers, including 11 tribally affiliated centers and two Head Start programs across Oklahoma. Data collection occurred from fall 2011 to spring 2014. Main outcome measures Classroom observations used the Environmental Policy Assessment Observation tool to measure the staff behaviors and environment. Staff behavior was compared at three different levels: the composite score of staff nutrition behavior, each constituent staff behavior, and staff behaviors grouped into broader feeding behaviors. Tasted food was measured through the Dietary Observation in Child Care method. The children's meals were categorized into the following food groups: fruit, vegetable, low-fat dairy, fried vegetable, fried meat, high-fat meat, and high-fat/high-sugar food. Statistical analysis performed Descriptive statistics were calculated for relevant variables. Relationships between the constituent staff behaviors and food groups that children tasted were compared using multilevel mixed-model analysis. Results The mean number of tasted fruit or vegetable items was higher and the mean number of tasted high-fat/high-sugar food items was lower when staff: 1) determined fullness before plate removal when less than half of food was eaten, 2) ate with the children, 3) and talked about healthy food. Conclusions The utilization of the three staff behaviors and their association with higher mean tastes of nutrient-dense items and lower mean tastes of high-fat/high-sugar food items among exposed children demonstrated support for the use of the best practices in early care and education centers.