Identifying and Evaluating Patterns in Cardiorespiratory Physiology

SYNOPSIS. A major theme of many papers in this symposium isthe identification of broad physiological trends and patternsthat extend beyond the boundaries of data from individual studies.Recognizing patterns in everything from hypoxic ventilatorypatterns to regulation of blood gases not only helps the investigatorunderstand specific data sets, but also helps place those datain a broad context. Yet, recognizing physiological patternsis confounded by two factors: phylogenetic relationships andphysiological state. Fortunately, the last decade has seen infiltrationof sound evolutionary theory, including tools of cladisiticanalysis and population genetics, into more and more studiesof comparative physiology. However, even when an experimentercarefully accounts for phytogeny, differences in physiologicalstate in the experimental animals can still obscure physiologicalpatterns. Two informal categories of physiological state aredescribed, the first obvious and frequently controlled for,and the second less obvious and typically not controlled for.Examples of the latter, including seasons, rhythms, prandialeffects and sex of the animal, are developed to show how ignoringthese can lead to considerable misleading variation in cardiorespiratorydata sets. Considering physiological state is vital in producingreliable data that can be used meaningfully for delineatingbroad physiological patterns.     

Identifying Node Role in Social Network Based on Multiple Indicators

It is a classic topic of social network analysis to evaluate the importance of nodes and identify the node that takes on the role of core or bridge in a network. Because a single indicator is not sufficient to analyze multiple characteristics of a node, it is a natural solution to apply multiple indicators that should be selected carefully. An intuitive idea is to select some indicators with weak correlations to efficiently assess different characteristics of a node. However, this paper shows that it is much better to select the indicators with strong correlations. Because indicator correlation is based on the statistical analysis of a large number of nodes, the particularity of an important node will be outlined if its indicator relationship doesn''t comply with the statistical correlation. Therefore, the paper selects the multiple indicators including degree, ego-betweenness centrality and eigenvector centrality to evaluate the importance and the role of a node. The importance of a node is equal to the normalized sum of its three indicators. A candidate for core or bridge is selected from the great degree nodes or the nodes with great ego-betweenness centrality respectively. Then, the role of a candidate is determined according to the difference between its indicators'' relationship with the statistical correlation of the overall network. Based on 18 real networks and 3 kinds of model networks, the experimental results show that the proposed methods perform quite well in evaluating the importance of nodes and in identifying the node role.     

Efficacy and Safety of Praziquantel in Preschool-Aged Children in an Area Co-Endemic for Schistosoma mansoni and S. haematobium

Background

In sub-Saharan Africa the recommended strategy to control schistosomiasis is preventive chemotherapy. Emphasis is placed on school-aged children, but in high endemicity areas, preschool-aged children are also at risk, and hence might need treatment with praziquantel. Since a pediatric formulation (e.g., syrup) is not available outside of Egypt, crushed praziquantel tablets are used, but the efficacy and safety of this treatment regimen is insufficiently studied.

Methodology

We assessed the efficacy and safety of crushed praziquantel tablets among preschool-aged children (<6 years) in the Azaguié district, south Côte d''Ivoire, where Schistosoma mansoni and S. haematobium coexist. Using a cross-sectional design, children provided two stool and two urine samples before and 3 weeks after treatment. Crushed praziquantel tablets, mixed with water, were administered at a dose of 40 mg/kg. Adverse events were assessed and graded 4 and 24 hours posttreatment by interviewing mothers/guardians.

Principal Findings

Overall, 160 preschool-aged children had at least one stool and one urine sample examined with duplicate Kato-Katz thick smears and a point-of-care circulating cathodic antigen (POC-CCA) cassette for S. mansoni, and urine filtration for S. haematobium diagnosis before and 3 weeks after praziquantel administration. According to the Kato-Katz and urine filtration results, we found high efficacy against S. mansoni (cure rate (CR), 88.6%; egg reduction rate (ERR), 96.7%) and S. haematobium (CR, 88.9%; ERR, 98.0%). POC-CCA revealed considerably lower efficacy against S. mansoni (CR, 53.8%). Treatment was generally well tolerated, but moderately severe adverse events (i.e., body and face inflammation), were observed in four Schistosoma egg-negative children.

Conclusions/Significance

Crushed praziquantel administered to preschool-aged children at a dose of 40 mg/kg is efficacious against S. mansoni and S. haematobium in a co-endemic setting of Côte d''Ivoire. Further research is required with highly sensitive diagnostic tools and safety must be investigated in more depth.

Trial Registration

Controlled-Trials.com ISRCTN53172722     

Comparing the Ability of Anthropometric Indicators in Identifying Metabolic Syndrome in HIV Patients

Background

Highly active antiretroviral therapy (HAART) can cause side effects in HIV patients, as the metabolic syndrome. Early identification of risk for development of cardiovascular diseases using available reliable and practical methods is fundamental. On this basis, the aim of this study was to compare the effectiveness of anthropometric indicators to identify metabolic syndrome in HIV patients on HAART.

Methods

It is a cross-sectional study. A number of 280 stable HIV patients were studied. It measured weight, height, waist circumference (WC), hip circumference (HP), thigh circumference (TC) and calculated body mass index (BMI), body adiposity index (BAI), waist to hip ratio (WHR) and waist to thigh ratio (WTR). There was also a performance of biochemical tests of lipid profile and fasting glucose. Systemic blood pressure was measured. The criteria proposed by the National Cholesterol Education Program III (NCEP-ATP III) to metabolic syndrome classification was used. Individuals were divided in groups with or without metabolic alterations and their anthropometric indicators were compared. Receiver operating characteristic (ROC) curves were designed for each anthropometric indicator using the metabolic syndrome classification to identify sensitivity and specificity.

Results

WC was a good tool to identify each metabolic disorder separately: total cholesterol (only females, p<0.05), triglycerides (only males, p<0.001), HDL cholesterol (p<0.05), LDL cholesterol (p<005) and fasting glycemic (p<005). WC also showed the best performance to identify metabolic syndrome in both genders (areas under the curve (AUCs): 0.79 and 0.76 for male and female, respectively), while BAI proved to be an inadequate indicator (AUCs: 0.63 and 0.67 for males and females), respectively, in this population.

Conclusions

The central adiposity measure (WC) had the best performance to identify metabolic syndrome, and it is a convenient, cheap and reliable tool that can be used in clinical practice routinely to prevent cardiovascular complications in HIV patients.     

Evaluating outcomes in planning: Indicators and reference values for Swiss landscapes

Evaluation of achievement of set targets is a necessary step in landscape planning in order to learn from the past, reassess implemented measures and enhance trust in public managers and institutions. Though it is commonly accepted that indicators play a major role in such evaluations, so far no accepted framework for evaluating planning outcomes exists. Furthermore, the selection of appropriate indicators and reference values to effectively assess conditions of landscapes and determine whether observed developments can be considered positive or negative remains challenging. Our study contributes to much-needed research on this topic with a proposed evaluation framework built on goals, indicators and reference values. We analyzed the landscape section of eight Swiss cantonal comprehensive plans to specifically address (1) whether currently tracked indicators suffice to evaluate landscape-planning goals; (2) what a minimal set of landscape indicators for regional planning might look like; and (3) how the ratified value approach could be operationalized to develop reference values for landscape indicators. All eight plans have a similar hierarchical goal system with six major landscape goals, up to 18 themes and 21–33 subordinate goals. The studied cantons track from 29 to 84 indicators. We found a considerable imbalance in the ratio between subordinate goals and indicators, with comparatively few indicators being tracked to assess visual and recreational landscape quality. Our proposed minimal indicator set is well balanced since it lists 5–7 indicators for each theme. The general procedure for modeling reference values is based on the assumption that the protection status of a landscape is a proxy for high societal appreciation of a place. Consequently, indicator values for these areas would reflect reference values (ratified values). We illustrate the procedure with the exemplary indicator impervious surface. The proposed indicators and maps are powerful tools for outcome evaluation and also facilitate benchmarking, i.e. interregional comparisons of landscape qualities, which could be very useful for landscape planning in Europe.     

Different Visual Preference Patterns in Response to Simple and Complex Dynamic Social Stimuli in Preschool-Aged Children with Autism Spectrum Disorders

Eye-tracking studies in young children with autism spectrum disorder (ASD) have shown a visual attention preference for geometric patterns when viewing paired dynamic social images (DSIs) and dynamic geometric images (DGIs). In the present study, eye-tracking of two different paired presentations of DSIs and DGIs was monitored in a group of 13 children aged 4 to 6 years with ASD and 20 chronologically age-matched typically developing children (TDC). The results indicated that compared with the control group, children with ASD attended significantly less to DSIs showing two or more children playing than to similar DSIs showing a single child. Visual attention preference in 4- to 6-year-old children with ASDs, therefore, appears to be modulated by the type of visual stimuli.     

Accuracy of Urine Circulating Cathodic Antigen Test for the Diagnosis of Schistosoma mansoni in Preschool-Aged Children before and after Treatment

Background

The Kato-Katz technique is widely used for the diagnosis of Schistosoma mansoni, but shows low sensitivity in light-intensity infections. We assessed the accuracy of a commercially available point-of-care circulating cathodic antigen (POC-CCA) cassette test for the diagnosis of S. mansoni in preschool-aged children before and after praziquantel administration.

Methodology

A 3-week longitudinal survey with a treatment intervention was conducted in Azaguié, south Côte d''Ivoire. Overall, 242 preschoolers (age range: 2 months to 5.5 years) submitted two stool and two urine samples before praziquantel administration, and 86 individuals were followed-up posttreatment. Stool samples were examined with duplicate Kato-Katz thick smears for S. mansoni. Urine samples were subjected to POC-CCA cassette test for S. mansoni, and a filtration method for S. haematobium diagnosis.

Principal Findings

Before treatment, the prevalence of S. mansoni, as determined by quadruplicate Kato-Katz, single CCA considering ‘trace’ as negative (t−), and single CCA with ‘trace’ as positive (t+), was 23.1%, 34.3% and 64.5%, respectively. Using the combined results (i.e., four Kato-Katz and duplicate CCA(t−)) as diagnostic ‘gold’ standard, the sensitivity of a single Kato-Katz, a single CCA(t−) or CCA(t+) was 28.3%, 69.7% and 89.1%, respectively. Three weeks posttreatment, the sensitivity of a single Kato-Katz, single CCA(t−) and CCA(t+) was 4.0%, 80.0% and 84.0%, respectively. The intensity of the POC-CCA test band reaction was correlated with S. mansoni egg burden (odds ratio = 1.2, p = 0.04).

Conclusions/Significance

A single POC-CCA cassette test appears to be more sensitive than multiple Kato-Katz thick smears for the diagnosis of S. mansoni in preschool-aged children before and after praziquantel administration. The POC-CCA cassette test can be recommended for the rapid identification of S. mansoni infections before treatment. Additional studies are warranted to determine the usefulness of POC-CCA for assessing drug efficacy and monitoring the impact of control interventions.     

Evaluating Network Analysis Indicators of Ecosystem Status in the Gulf of Alaska

This is the first study on the emergent properties for empirical ecosystem models that have been validated by time series information. Ecosystem models of the western and central Aleutian Islands and Southeast Alaska were used to examine indices of ecosystem status generated from network analysis and incorporated into Ecopath with Ecosim. Dynamic simulations of the two ecosystems over the past 40 years were employed to examine if these indices reflect the dissimilar changes that occurred in the ecosystems. The results showed that the total systems throughput (TST) and ascendancy (A) followed the climate change signature (Pacific decadal oscillation, PDO) in both ecosystems, whereas the redundancy (R) followed the inverse trend. The different trajectories for important species such as Steller sea lions (Eumetopias jubatus), Atka mackerel (Pleurogrammus monopterygius), pollock (Theragra chalcograma), herring (Clupea pallasii), Pacific cod (Gadus macrocephalus) and halibut (Hippoglossus stenolepis) were noticeable in the Finn cycling index (FCI), entropy (H) and average mutual information (AMI): not showing large change during the time that the Stellers sea lions, herring, Pacific cod, halibut and arrowtooth flounder (Atheresthes stomias) increased in Southeast Alaska, but showing large declines during the decline of Steller sea lions, sharks, Atka mackerel and arrowtooth flounder in the Aleutians. On the whole, there was a change in the emergent properties of the Aleutians around 1976 that was not seen in Southeast Alaska. Conversely, the emergent properties of both systems showed a change around 1988, which indicated that both systems were unstable after 1988.     

Evaluating pedigree data. II. Identifying the cause of error in families with inconsistencies

Pedigree data can be evaluated, and subsequently corrected, by analysis of the distribution of genetic markers, taking account of the possibility of mistyping . Using a model of pedigree error developed previously, we obtained the maximum likelihood estimates of error parameters in pedigree data from Tokelau. Posterior probabilities for the possible true relationships in each family are conditional on the putative relationships and the marker data are calculated using the parameter estimates. These probabilities are used as a basis for discriminating between pedigree error and genetic marker errors in families where inconsistencies have been observed. When applied to the Tokelau data and compared with the results of retyping inconsistent families, these statistical procedures are able to discriminate between pedigree and marker error, with approximately 90% accuracy, for families with two or more offspring. The large proportion of inconsistencies inferred to be due to marker error (61%) indicates the importance of discriminating between error sources when judging the reliability of putative relationship data. Application of our model of pedigree error has proved to be an efficient way of determining and subsequently correcting sources of error in extensive pedigree data collected in large surveys.     

Clinical Indicators for Bacterial Co-Infection in Ghanaian Children with P. falciparum Infection

Differentiation of infectious causes in severely ill children is essential but challenging in sub- Saharan Africa. The aim of the study was to determine clinical indicators that are able to identify bacterial co-infections in P. falciparum infected children in rural Ghana. In total, 1,915 severely ill children below the age of 15 years were recruited at Agogo Presbyterian Hospital in Ghana between May 2007 and February 2011. In 771 (40%) of the children malaria parasites were detected. This group was analyzed for indicators of bacterial co-infections using bivariate and multivariate regression analyses with 24 socio-economic variables, 16 terms describing medical history and anthropometrical information and 68 variables describing clinical symptoms. The variables were tested for sensitivity, specificity, positive predictive value and negative predictive value. In 46 (6.0%) of the children with malaria infection, bacterial co-infection was detected. The most frequent pathogens were non-typhoid salmonellae (45.7%), followed by Streptococcus spp. (13.0%). Coughing, dehydration, splenomegaly, severe anemia and leukocytosis were positively associated with bacteremia. Domestic hygiene and exclusive breastfeeding is negatively associated with bacteremia. In cases of high parasitemia (>10,000/μl), a significant association with bacteremia was found for splenomegaly (OR 8.8; CI 1.6–48.9), dehydration (OR 18.2; CI 2.0–166.0) and coughing (OR 9.0; CI 0.7–118.6). In children with low parasitemia, associations with bacteremia were found for vomiting (OR 4.7; CI 1.4–15.8), severe anemia (OR 3.3; CI 1.0–11.1) and leukocytosis (OR 6.8 CI 1.9–24.2). Clinical signs of impaired microcirculation were negatively associated with bacteremia. Ceftriaxone achieved best coverage of isolated pathogens. The results demonstrate the limitation of clinical symptoms to determine bacterial co-infections in P. falciparum infected children. Best clinical indicators are dependent on the parasitemia level. Even with a moderate sensitivity of >60%, only low positive predictive values can be obtained due to low prevalence of bacteremia. Rapid testing for distinguishing parasitemia and bacteremia is essential.     

Analysis of Different Prognostic Indicators for Malnutrition and Shigella flexneri Infection Among the Children in Bangladesh

The present study investigates into some socio-economic, demographic, and nutritional features that can predispose Bangladeshi children to malnutrition and Shigella flexneri infection. Significant prognostic indicators associated with malnutrition were mother’s illiteracy (unadjusted odds ratio, OR = 2.580; 95% confidence interval, CI = 1.134–5.867 and adjusted odds ratio, ORa, 3.814; 95% CI = 1.124–12.943), low birth weight (OR = 3.143; 95% CI = 1.2–8.232 and ORa = 2.404; 95% CI = 0.870–6.644) and poor socioeconomic status (OR = 2.549; 95% CI = 1.382–4.701 and ORa = 1.808; 95% CI = 0.852–3.838). Age was the strongest predictor for the acquisition of S. flexneri infection in the studied population (OR = 5.472; 95% CI = 2.583–11.592 and ORa = 5.808; 95% CI = 2.420–13.942). The severity of malnutrition was significantly (P = 0.033) related to seroprevalence of S. flexneri infection. To reduce malnutrition emphasis should be given on controlling the incidence of low birth weight, improving the literacy status especially of mothers and narrowing the gap between different socio-economic levels. Malnourished children should be examined for severity and direct intervention therapy should be given when necessary.     

Evaluating the Impact of Breastfeeding on Rotavirus Antigenemia and Disease Severity in Indian Children

Objectives

To evaluate the contribution of breastfeeding to Rotavirus (RV)-induced antigenemia and/or RNAemia and disease severity in Indian children (<2 yrs age).

Methods

Paired stool and serum samples were collected from (a) hospitalized infants with diarrhea (n = 145) and (b) healthy control infants without diarrhea (n = 28). Stool RV-antigen was screened in both groups by commercial rapid-test and enzyme immunoassay. The disease severity was scored and real-time-PCR was used for viral-load estimation. Serum was evaluated for RV-antigenemia by EIA and RV-RNAemia by RT-PCR. Data was stratified by age-group and breastfeeding status and compared.

Results

Presence of RV-antigenemia and RV-RNAemia was positively related with presence of RV in stool. Disease severity and stool viral-load was significantly associated with RV-antigenemia[(r = 0.74; CI:0.66 to 0.84; P<0.0001,R² = 0.59) and (r = -0.55; CI:-0.68 to -0.39; P<0.0001,R² = 0.31) respectively], but not with RV-RNAemia. There was significant reduction in RV-antigenemiarate in the breast-fed group compared to non-breastfed infants, especially in 0–6 month age group (P<0.001). Non-breastfed infants were at risk for RV-antigenemia with severe disease manifestations in form of high Vesikari scores correlating with high fever, more vomiting episodes and dehydration.

Conclusion

RV-antigenemia was common in nonbreastfed children with severe RV-diarrhea and correlated with stool RV-load and disease severity.     

Field Tests for Evaluating the Aerobic Work Capacity of Firefighters

Working as a firefighter is physically strenuous, and a high level of physical fitness increases a firefighter’s ability to cope with the physical stress of their profession. Direct measurements of aerobic capacity, however, are often complicated, time consuming, and expensive. The first aim of the present study was to evaluate the correlations between direct (laboratory) and indirect (field) aerobic capacity tests with common and physically demanding firefighting tasks. The second aim was to give recommendations as to which field tests may be the most useful for evaluating firefighters’ aerobic work capacity. A total of 38 subjects (26 men and 12 women) were included. Two aerobic capacity tests, six field tests, and seven firefighting tasks were performed. Lactate threshold and onset of blood lactate accumulation were found to be correlated to the performance of one work task (r_s = −0.65 and −0.63, p<0.01, respectively). Absolute (mL·min⁻¹) and relative (mL·kg⁻¹·min⁻¹) maximal aerobic capacity was correlated to all but one of the work tasks (r_s = −0.79 to 0.55 and −0.74 to 0.47, p<0.01, respectively). Aerobic capacity is important for firefighters’ work performance, and we have concluded that the time to row 500 m, the time to run 3000 m relative to body weight (s·kg⁻¹), and the percent of maximal heart rate achieved during treadmill walking are the most valid field tests for evaluating a firefighter’s aerobic work capacity.     

Fecal Occult Blood and Fecal Calprotectin as Point-of-Care Markers of Intestinal Morbidity in Ugandan Children with Schistosoma mansoni Infection

Background

Calprotectin is a calcium-binding cytoplasmic protein found in neutrophils and increasingly used as a marker of bowel inflammation. Fecal occult blood (FOB) is also a dependable indicator of bowel morbidity. The objective of our study was to determine the applicability of these tests as surrogate markers of Schistosoma mansoni intestinal morbidity before and after treatment with praziquantel (PZQ).

Methods

216 children (ages 3–9 years old) from Buliisa District in Lake Albert, Uganda were examined and treated with PZQ at baseline in October 2012 with 211 of them re-examined 24 days later for S. mansoni and other soil transmitted helminths (STH). POC calprotectin and FOB assays were performed at both time points on a subset of children. Associations between the test results and infection were analysed by logistic regression.

Results

Fecal calprotectin concentrations of 150–300 µg/g were associated with S. mansoni egg patent infection both at baseline and follow up (OR: 12.5 P = 0.05; OR: 6.8 P = 0.02). FOB had a very strong association with baseline anemia (OR: 9.2 P = 0.03) and medium and high egg intensity schistosomiasis at follow up (OR: 6.6 P = 0.03; OR: 51.3 P = 0.003). Both tests were strongly associated with heavy intensity S. mansoni infections. There was a significant decrease in FOB and calprotectin test positivity after PZQ treatment in those children who had egg patent schistosomiasis at baseline.

Conclusions

Both FOB and calprotectin rapid assays were found to correlate positively and strongly with egg patent S. mansoni infection with a positive ameloriation response after PZQ treatment indicative of short term reversion of morbidity. Both tests were appropriate for use in the field with excellent operational performance and reliability. Due to its lower-cost which makes its scale-up of use affordable, FOB could be immediately adopted as a monitoring tool for PC campaigns for efficacy evaluation before and after treatment.     

Drowning Mortality and Morbidity Rates in Children and Adolescents 0-19yrs: A Population-Based Study in Queensland,Australia

ObjectiveTo redress the lack of Queensland population incidence mortality and morbidity data associated with drowning in those aged 0-19yrs, and to understand survival and patient care.ResultsDrowning death to survival ratio was 1:10, and two out of three of those who survived were admitted to hospital. Incidence rates for fatal and non-fatal drowning increased over time, primarily due to an increase in non-fatal drowning. There were non-significant reductions in fatal and admission rates. Rates for non-fatal drowning that did not result in hospitalisation more than doubled over the seven years. Children aged 5-9yrs and 10-14yrs incurred the lowest incidence rates 6.38 and 4.62 (expressed as per 100,000), and the highest rates were among children aged 0-4yrs (all drowning events 43.90; fatal 4.04; non-fatal 39.85–comprising admission 26.69 and non-admission 13.16). Males were over-represented in all age groups except 10-14yrs. Total male drowning events increased 44% over the seven years (P<0.001).ConclusionThis state-wide data collection has revealed previously unknown incidence and survival ratios. Increased trends in drowning survival rates may be viewed as both positive and challenging for drowning prevention and the health system. Males are over-represented, and although infants and toddlers did not have increased fatality rates, they had the greatest drowning burden demonstrating the need for continued drowning prevention efforts.     

Evaluating the Persistence of DNA from Decomposing Transgenic Watermelon Tissues in the Field

To analyze the persistence of the 35S promoter, nos terminator, and hpt, we buried the leaves and rootstocks of transgenic watermelons (Citrullus lanatus (Thunb.) Matsum. & Nakai) in 10 cm of soil. Qualitative and quantitative PCR analyses showed that the amount of transgenes in leaf samples was greatly decreased, by 70%, after 1 month, and only 2.5% remained after 2 months. No transgenes were detected in the leaves after 3 months. For buried rootstock samples, transgenes also degraded quickly, but a very small amount was still detectable up to 3 months later. In our investigation of possible gene transfer from decomposing transgenic watermelon to soil bacteria, only the 35S promoter was detected. However, further examination using colony dot hybridization tests indicated that such a transfer did not occur.     

Identifying Areas of the Visual Field Important for Quality of Life in Patients with Glaucoma

PurposeThe purpose of this study was to create a vision-related quality of life (VRQoL) prediction system to identify visual field (VF) test points associated with decreased VRQoL in patients with glaucoma.MethodVRQoL score was surveyed in 164 patients with glaucoma using the ‘Sumi questionnaire’. A binocular VF was created from monocular VFs by using the integrated VF (IVF) method. VRQoL score was predicted using the ‘Random Forest’ method, based on visual acuity (VA) of better and worse eyes (better-eye and worse-eye VA) and total deviation (TD) values from the IVF. For comparison, VRQoL scores were regressed (linear regression) against: (i) mean of TD (IVF MD); (ii) better-eye VA; (iii) worse-eye VA; and (iv) IVF MD and better- and worse-eye VAs. The rank of importance of IVF test points was identified using the Random Forest method.ResultsThe root mean of squared prediction error associated with the Random Forest method (0.30 to 1.97) was significantly smaller than those with linear regression models (0.34 to 3.38, p<0.05, ten-fold cross validation test). Worse-eye VA was the most important variable in all VRQoL tasks. In general, important VF test points were concentrated along the horizontal meridian. Particular areas of the IVF were important for different tasks: peripheral superior and inferior areas in the left hemifield for the ‘letters and sentences’ task, peripheral, mid-peripheral and para-central inferior regions for the ‘walking’ task, the peripheral superior region for the ‘going out’ task, and a broad scattered area across the IVF for the ‘dining’ task.ConclusionThe VRQoL prediction model with the Random Forest method enables clinicians to better understand patients’ VRQoL based on standard clinical measurements of VA and VF.     

Evaluating the Use of Blood Cultures in the Management of Children Hospitalized for Community-Acquired Pneumonia

BackgroundBlood cultures are often recommended for the evaluation of community-acquired pneumonia (CAP). However, institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children.ObjectiveTo identify clinical factors associated with obtaining blood cultures in children hospitalized with CAP, and to estimate the association between blood culture obtainment and hospital length of stay (LOS).MethodsWe performed a multicenter retrospective cohort study of children admitted with a diagnosis of CAP to any of four pediatric hospitals in the United States from January 1, 2011-December 31, 2012. Demographics, medical history, diagnostic testing, and clinical outcomes were abstracted via manual chart review. Multivariable logistic regression evaluated patient and clinical factors for associations with obtaining blood cultures. Propensity score-matched Kaplan-Meier analysis compared patients with and without blood cultures for hospital LOS.ResultsSix hundred fourteen charts met inclusion criteria; 390 children had blood cultures obtained. Of children with blood cultures, six (1.5%) were positive for a pathogen and nine (2.3%) grew a contaminant. Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome (OR 1.78, 95% CI 1.10–2.89), receiving intravenous hydration (OR 3.94, 95% CI 3.22–4.83), receiving antibiotics before admission (OR 1.49, 95% CI 1.17–1.89), hospital admission from the ED (OR 1.65, 95% CI 1.05–2.60), and having health insurance (OR 0.42, 95% CI 0.30–0.60). In propensity score-matched analysis, patients with blood cultures had median 0.8 days longer LOS (2.0 vs 1.2 days, P < .0001) without increased odds of readmission (OR 0.94, 95% CI 0.45–1.97) or death (P = .25).ConclusionsObtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased LOS. Our results highlight the need to refine the role of obtaining blood cultures in children hospitalized with CAP.