Pediatric inpatient hospital resource use for congenital heart defects

Background: Congenital heart defects (CHDs) occur in approximately 8 per 1000 live births. Improvements in detection and treatment have increased survival. Few national estimates of the healthcare costs for infants, children and adolescents with CHDs are available. Methods: We estimated hospital costs for hospitalizations using pediatric (0–20 years) hospital discharge data from the 2009 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) for hospitalizations with CHD diagnoses. Estimates were up‐weighted to be nationally representative. Mean costs were compared by demographic factors and presence of critical CHDs (CCHDs). Results: Up‐weighting of the KID generated an estimated 4,461,615 pediatric hospitalizations nationwide, excluding normal newborn births. The 163,980 (3.7%) pediatric hospitalizations with CHDs accounted for approximately $5.6 billion in hospital costs, representing 15.1% of costs for all pediatric hospitalizations in 2009. Approximately 17% of CHD hospitalizations had a CCHD, but it varied by age: approximately 14% of hospitalizations of infants, 30% of hospitalizations of patients aged 1 to 10 years, and 25% of hospitalizations of patients aged 11 to 20 years. Mean costs of CHD hospitalizations were higher in infancy ($36,601) than at older ages and were higher for hospitalizations with a CCHD diagnosis ($52,899). Hospitalizations with CCHDs accounted for 26.7% of all costs for CHD hospitalizations, with hypoplastic left heart syndrome, coarctation of the aorta, and tetralogy of Fallot having the highest total costs. Conclusion: Hospitalizations for children with CHDs have disproportionately high hospital costs compared with other pediatric hospitalizations, and the 17% of hospitalizations with CCHD diagnoses accounted for 27% of CHD hospital costs. Birth Defects Research (Part A) 100:934–943, 2014. © 2014 Wiley Periodicals, Inc.     

Foodborne Transmission of Nipah Virus in Syrian Hamsters

Since 2001, outbreaks of Nipah virus have occurred almost every year in Bangladesh with high case-fatality rates. Epidemiological data suggest that in Bangladesh, Nipah virus is transmitted from the natural reservoir, fruit bats, to humans via consumption of date palm sap contaminated by bats, with subsequent human-to-human transmission. To experimentally investigate this epidemiological association between drinking of date palm sap and human cases of Nipah virus infection, we determined the viability of Nipah virus (strain Bangladesh/200401066) in artificial palm sap. At 22°C virus titers remained stable for at least 7 days, thus potentially allowing food-borne transmission. Next, we modeled food-borne Nipah virus infection by supplying Syrian hamsters with artificial palm sap containing Nipah virus. Drinking of 5×10⁸ TCID₅₀ of Nipah virus resulted in neurological disease in 5 out of 8 hamsters, indicating that food-borne transmission of Nipah virus can indeed occur. In comparison, intranasal (i.n.) inoculation with the same dose of Nipah virus resulted in lethal respiratory disease in all animals. In animals infected with Nipah virus via drinking, virus was detected in respiratory tissues rather than in the intestinal tract. Using fluorescently labeled Nipah virus particles, we showed that during drinking, a substantial amount of virus is deposited in the lungs, explaining the replication of Nipah virus in the respiratory tract of these hamsters. Besides the ability of Nipah virus to infect hamsters via the drinking route, Syrian hamsters infected via that route transmitted the virus through direct contact with naïve hamsters in 2 out of 24 transmission pairs. Although these findings do not directly prove that date palm sap contaminated with Nipah virus by bats is the origin of Nipah virus outbreaks in Bangladesh, they provide the first experimental support for this hypothesis. Understanding the Nipah virus transmission cycle is essential for preventing and mitigating future outbreaks.     

Analogues of 3-Hydroxyisoxazole-Containing Glutamate Receptor Ligands Based on the 3-Hydroxypyrazole-Moiety: Design,Synthesis and Pharmacological Characterization

A series of analogues of the glutamate receptor ligands (S)-2-amino-3-(3-hydroxy-5-methyl-isoxazol-4-yl)propionic acid (AMPA) and AMOA were synthesized in which the 3-hydroxyisoxazole moiety was exchanged for a 3-hydroxypyrazole moiety. This exchange enables further substitution at the additional nitrogen atom in the heterocyclic core. Several of the analogues have activity at AMPA receptors equipotent to the antagonist ATPO, demonstrating that additional substitution can be accommodated in the antagonist binding site. Modelling studies offer an explanation for the pharmacological pattern observed for the compounds and suggest that this scaffold may be developed further to obtain subtype selective antagonists.     

Selective lateral muscle activation in moderate medial knee osteoarthritis subjects does not unload medial knee condyle

There is some debate in the literature regarding the role of quadriceps-hamstrings co-contraction in the onset and progression of knee osteoarthritis. Does co-contraction during walking increase knee contact loads, thereby causing knee osteoarthritis, or might it be a compensatory mechanism to unload the medial tibial condyle? We used a detailed musculoskeletal model of the lower limb to test the hypothesis that selective activation of lateral hamstrings and quadriceps, in conjunction with inhibited medial gastrocnemius, can actually reduce the joint contact force on the medial compartment of the knee, independent of changes in kinematics or external forces. “Baseline” joint loads were computed for eight subjects with moderate medial knee osteoarthritis (OA) during level walking, using static optimization to resolve the system of muscle forces for each subject?s scaled model. Holding all external loads and kinematics constant, each subject?s model was then perturbed to represent non-optimal “OA-type” activation based on mean differences detected between electromyograms (EMG) of control and osteoarthritis subjects. Knee joint contact forces were greater for the “OA-type” than the “Baseline” distribution of muscle forces, particularly during early stance. The early-stance increase in medial contact load due to the “OA-type” perturbation could implicate this selective activation strategy as a cause of knee osteoarthritis. However, the largest increase in the contact load was found at the lateral condyle, and the “OA-type” lateral activation strategy did not increase the overall (greater of the first or second) medial peak contact load. While “OA-type” selective activation of lateral muscles does not appear to reduce the medial knee contact load, it could allow subjects to increase knee joint stiffness without any further increase to the peak medial contact load.     

Stable isotopes in fossil hominin tooth enamel suggest a fundamental dietary shift in the Pliocene

Accumulating isotopic evidence from fossil hominin tooth enamel has provided unexpected insights into early hominin dietary ecology. Among the South African australopiths, these data demonstrate significant contributions to the diet of carbon originally fixed by C₄ photosynthesis, consisting of C₄ tropical/savannah grasses and certain sedges, and/or animals eating C₄ foods. Moreover, high-resolution analysis of tooth enamel reveals strong intra-tooth variability in many cases, suggesting seasonal-scale dietary shifts. This pattern is quite unlike that seen in any great apes, even ‘savannah’ chimpanzees. The overall proportions of C₄ input persisted for well over a million years, even while environments shifted from relatively closed (ca 3 Ma) to open conditions after ca 1.8 Ma. Data from East Africa suggest a more extreme scenario, where results for Paranthropus boisei indicate a diet dominated (approx. 80%) by C₄ plants, in spite of indications from their powerful ‘nutcracker’ morphology for diets of hard objects. We argue that such evidence for engagement with C₄ food resources may mark a fundamental transition in the evolution of hominin lineages, and that the pattern had antecedents prior to the emergence of Australopithecus africanus. Since new isotopic evidence from Aramis suggests that it was not present in Ardipithecus ramidus at 4.4 Ma, we suggest that the origins lie in the period between 3 and 4 Myr ago.     

Characterization of an anti-lymphocyte function-associated antigen-1 antibody in a simian immunodeficiency virus-pig-tailed macaque (Macaca nemestrina) model

The simian immunodeficiency virus (SIV)/pig-tailed macaque (Macaca nemestrina) model of acquired immune deficiency syndrome (AIDS) is a powerful system in which to study cell adhesion molecules and retroviral pathogenesis in vivo. Preliminary experiments were conducted to examine the role of lymphocyte function-associated antigen 1 (LFA-1) in early SIV infection in vivo by using an LFA-1 monoclonal antibody (MHM.23) specific to human LFA-1. In vitro studies revealed that at concentrations of > or = 20 microg/ml, MHM.23 blocked LFA-1-mediated adhesion and T-cell activation (>90%) of pig-tailed macaque peripheral blood mononuclear cells (PBMCs). In addition, SIVmac239 infection of macaque cells was inhibited in a dose-dependant manner by MHM.23. Administration of MHM.23 to pig-tailed macaques inhibited LFA-1-ICAM-1-mediated activity in vivo and maintained binding on macaque cells for < or = 4 d. Our in vitro studies indicated that at an MHM.23 concentration of 20 microg/ml, macaque PBMCs were completely saturated. Our in vivo studies determined that 5 mg/kg MHM.23 intravenously every 24 h was required to maintain saturating levels and inhibit LFA-1-ICAM-1 function in pig-tailed macaques.     

A cranial base of Australopithecus robustus from the hanging remnant of Swartkrans, South Africa

SKW 18, a partial hominin cranium recovered from the site of Swartkrans, South Africa, in 1968 is described. It is derived from ex situ breccia of the Hanging Remnant of Member 1, dated to approximately 1.5-1.8 Mya. Although partially encased in breccia, it was refit to the facial fragment SK 52 (Clarke 1977 The Cranium of the Swartkrans Hominid SK 847 and Its Relevance to Human Origins, Ph.D. dissertation, University of the Witwatersrand, Johannesburg), producing the composite cranium SKW 18/SK 52. Subsequent preparation revealed the most complete cranial base attributable to the species Australopithecus robustus. SKW 18 suffered weathering and slight postdepositional distortion, but retains considerable anatomical detail. The composite cranium most likely represents a large, subadult male, based on the incomplete fusion of the spheno-occipital synchondrosis; unerupted third molar; pronounced development of muscular insertions; and large teeth. Cranial base measures of SKW 18 expand the range of values previously recorded for A. robustus. SKW 18 provides information on anatomical features not previously visible in this taxon, and expands our knowledge of morphological variability recognizable in the cranial base. Morphological heterogeneity in the development of the prevertebral and nuchal muscular insertions is likely the result of sexual dimorphism in A. robustus, while differences in cranial base angles and the development of the occipital/marginal sinus drainage system cannot be attributed to size dimorphism.     

Using computed muscle control to generate forward dynamic simulations of human walking from experimental data

The objective of this study was to develop an efficient methodology for generating muscle-actuated simulations of human walking that closely reproduce experimental measures of kinematics and ground reaction forces. We first introduce a residual elimination algorithm (REA) to compute pelvis and low back kinematic trajectories that ensure consistency between whole-body dynamics and measured ground reactions. We then use a computed muscle control (CMC) algorithm to vary muscle excitations to track experimental joint kinematics within a forward dynamic simulation. CMC explicitly accounts for delays in muscle force production resulting from activation and contraction dynamics while using a general static optimization framework to resolve muscle redundancy. CMC was used to compute muscle excitation patterns that drove a 21-degrees-of-freedom, 92 muscle model to track experimental gait data of 10 healthy young adults. Simulated joint kinematics closely tracked experimental quantities (mean root-mean-squared errors generally less than 1 degrees), and the time histories of muscle activations were similar to electromyographic recordings. A simulation of a half-cycle of gait could be generated using approximately 30 min of computer processing time. The speed and accuracy of REA and CMC make it practical to generate subject-specific simulations of gait.