Female scent accelerates growth of juvenile male mice.

Exposing female house mice (Mus musculus) to male urinary scent accelerates their sexual development (Vandenbergh effect). Here, we tested whether exposing juvenile male mice to females' urine similarly influences male growth and size of their sexual organs. We exposed three-week old male house mice to female urine or water (control) for ca. three months. We found that female-exposed males grew significantly faster and gained more body mass than controls, despite all males being reared on a controlled diet, but we detected no differences in males' muscle mass or sexual organs. In contrast, exposing juvenile males to male urine had no effect their growth. We tested whether the males' accelerated growth imposed functional trade-offs on males' immune resistance to an experimental infection. We challenged the same male subjects with an avirulent bacterial pathogen (Salmonella enterica), but found no evidence that faster growth impacted their bacterial clearance, body mass or survival during infection compared to controls. Our results provide the first evidence to our knowledge that juvenile male mice accelerate their growth when exposed to the urine of adult females, though we found no evidence that increased growth had negative trade-offs on immune resistance to infectious disease.

Implementation of indication-based antibiotic order sentences improves antibiotic use in emergency departments.

INTRODUCTION: Prior data have suggested that suboptimal antibiotic prescribing in the emergency department (ED) is common for uncomplicated lower respiratory tract infections (LRTI), urinary tract infections (UTI), and acute bacterial skin and skin structure infections (ABSSSI). The objective of this study was to measure the effect of indication-based antibiotic order sentences (AOS) on optimal antibiotic prescribing in the ED. METHODS: This was an IRB-approved quasi-experiment of adults prescribed antibiotics in EDs for uncomplicated LRTI, UTI, or ABSSSI from January to June 2019 (pre-implementation) and September to December 2021 (post-implementation). AOS implementation occurred in July 2021. AOS are lean process, electronic discharge prescriptions retrievable by name or indication within the discharge order field. The primary outcome was optimal prescribing, defined as correct antibiotic selection, dose, and duration per local and national guidelines. Descriptive and bivariate statistics were performed; multivariable logistic regression was used to determine variables associated with optimal prescribing. RESULTS: A total of 294 patients were included: 147 pre-group and 147 post-group. Overall optimal prescribing improved from 12 (8%) to 34 (23%) (P < 0.001). Individual components of optimal prescribing were optimal selection at 90 (61%) vs 117 (80%) (P < 0.001), optimal dose at 99 (67%) vs 115 (78%) (P = 0.036), and optimal duration at 38 (26%) vs 50 (34%) (P = 0.13) for pre- and post-group, respectively. AOS was independently associated with optimal prescribing after multivariable logistic regression analysis (adjOR, 3.6; 95%CI,1.7-7.2). A post-hoc analysis showed low uptake of AOS by ED prescribers. CONCLUSIONS: AOS are an efficient and promising strategy to enhance antimicrobial stewardship in the ED.

Characterization of ambient polychlorinated biphenyl background conditions in surface waters of the Pajarito Plateau, New Mexico.

This study presents the development of polychlorinated biphenyl (PCB) background threshold values (BTVs) that statistically characterize ambient background conditions for surface waters in undeveloped and developed landscapes of the Pajarito Plateau in the Rio Grande Basin of New Mexico. Between 2009 and 2018, surface water data were collected at 45 locations under a variety of flow conditions and regimes. A total of 163 samples were collected, with roughly 1/3 of samples and locations being in undeveloped areas (n = 53 from 17 locations), and the remainder being in developed areas (n = 110 from 28 locations). While there are areas on the Pajarito Plateau where PCB point sources are known or likely to have contributed to PCBs in soils, PCB BTVs calculated for undeveloped portions of watersheds (upstream of areas where PCB point sources are known or likely to have contributed to PCBs in soils, and therefore not affected by PCB sources within the watershed) are well above New Mexico's human health organism-only (HH-OO) water quality criterion (0.64 ng/L). Background threshold values are even higher in developed areas upstream of managed soil sites, suggesting that in developed areas, both diffuse ambient PCB sources (e.g., atmospheric deposition) and localized urban sources (e.g., building materials, paints, and electrical equipment) contribute to PCBs in those watersheds. These findings indicate that New Mexico's current HH-OO water quality criterion for PCBs cannot practicably be met due to ambient conditions. It is also impracticable to meet the US Environmental Protection Agency (EPA) criterion continuous concentration (CCC) of 14 ng/L in developed background areas, where the BTV is approximately 1.5 times the CCC. Integr Environ Assess Manag 2023;19:1307-1319. © 2022 SETAC.

Outcomes of clinical decision support for outpatient management of Clostridioides difficile infection.

OBJECTIVE: To determine the impact of clinical decision support on guideline-concordant Clostridioides difficile infection (CDI) treatment. DESIGN: Quasi-experimental study in >50 ambulatory clinics. SETTING: Primary, specialty, and urgent-care clinics. PATIENTS: Adult patients were eligible for inclusion if they were diagnosed with and treated for a first episode of symptomatic CDI at an ambulatory clinic between November 1, 2019, and November 30, 2020. INTERVENTIONS: An outpatient best practice advisory (BPA) was implemented to notify prescribers that "vancomycin or fidaxomicin are preferred over metronidazole for C.difficile infection" when metronidazole was prescribed to a patient with CDI. RESULTS: In total, 189 patients were included in the study: 92 before the BPA and 97 after the BPA. Their median age was 59 years; 31% were male; 75% were white; 30% had CDI-related comorbidities; 35% had healthcare exposure; 65% had antibiotic exposure; 44% had gastric acid suppression therapy within 90 days of CDI diagnosis. The BPA was accepted 23 of 26 times and was used to optimize the therapy of 16 patients in 6 months. Guideline-concordant therapy increased after implementation of the BPA (72% vs 91%; P = .001). Vancomycin prescribing increased and metronidazole prescribing decreased after the BPA. There was no difference in clinical response or unplanned encounter within 14 days after treatment initiation. Fewer patients after the BPA had CDI recurrence within 14-56 days of the initial episode (27% vs 7%; P < .001). CONCLUSIONS: Clinical decision support increased prescribing of guideline-concordant CDI therapy in the outpatient setting. A targeted BPA is an effective stewardship intervention and may be especially useful in settings with limited antimicrobial stewardship resources.

Parents' Perceptions and Use of School-Based Body Mass Index Report Cards.

BACKGROUND: Obesity in children and adolescents has become one of the most critical public health problems in the United States. Schools may play an important role in raising awareness and possibly slowing the obesity epidemic. METHODS: The purpose of this study was to gather information on parents' perception and use of body mass index (BMI) report cards provided by public schools through the administration of a questionnaire. The questionnaire was developed with the assistance of physical educators, pediatricians, and exercise scientists. The questionnaires were backpacked home with 1127 students in 6 Arkansas public schools. Parents completed and returned 404 questionnaires. RESULTS: Findings indicate that parents are supportive of schools reporting BMI and providing information on healthier lifestyles. However, most parents reported not making any adjustment to their child's diet and physical activity habits based on the BMI reports. Approximately half of parents (55%) thought the BMI report accurately reflected their child's health status. Approximately half of the parents reported their child's BMI report led them to think about their family's health habits. CONCLUSIONS: Although parents do support receiving BMI information from schools, many did not indicate using the data to initiate changes such as increased physical activity or healthy eating.

Recommendations for the derivation and use of biota-sediment bioaccumulation models for carcinogenic polycyclic aromatic hydrocarbons.

Carcinogenic polycyclic aromatic hydrocarbons (cPAHs) are important sediment contaminants that can pose health risks to people who eat shellfish from contaminated sites. Biota-sediment accumulation factors (BSAFs) are quotients of colocated lipid-normalized tissue concentrations and organic carbon (OC)-normalized sediment concentrations, whereas biota-sediment accumulation regressions (BSARs) are models describing the relationships between these tissue and sediment concentrations. BSAR/Fs (BSARs and/or BSAFs) are commonly used to back-calculate sediment preliminary remediation goals (PRGs) from target tissue concentrations; the PRGs are then used to set target action levels (i.e., sediment concentrations above which remedial actions will be prescribed). The cPAH BSAR/Fs reported across sites and species are highly variable due to both site- and species-specific differences and inconsistent BSAR/F calculation methods and assumptions. We reviewed past studies, identified best practices for developing BSAR/Fs, and compiled publicly available colocated tissue and sediment data for 7 cPAHs from 13 sites across the United States. Of the 249 unique cPAH data sets compiled for various species, only 17 yielded acceptable BSAR/Fs, 16 of which were for clams. The influence of BSAR/Fs on sediment remedial action decisions and costs can be disproportionate to the quality of the statistical models from which they are derived. Therefore, it is important to establish and follow best practices for deriving BSAR/Fs and for deciding whether and how BSAR/Fs should be used. Based on our review and analysis, we highlight the advantages of relying on BSARs and propose a consistent method for deriving and judging the reliability of these relationships. We also offer guidance for evaluating the ramifications of BSAR uncertainty on remedial decision making at contaminated sediment sites, and we discuss alternative ways to make risk management decisions in the absence of a reliable site-specific BSAR. Integr Environ Assess Manag 2017;13:1060-1071. © 2017 SETAC.

Development of biotic ligand model-based freshwater aquatic life criteria for lead following us environmental protection agency guidelines.

The US Environmental Protection Agency's (USEPA's) current ambient water quality criteria (AWQC) for lead (Pb) in freshwater were developed in 1984. The criteria are adjusted for hardness, but more recent studies have demonstrated that other parameters, especially dissolved organic carbon (DOC) and pH, have a much stronger influence on Pb bioavailability. These recent studies have been used to support development of a biotic ligand model (BLM) for Pb in freshwater, such that acute and chronic Pb toxicity can be predicted over a wide range of water chemistry conditions. Following USEPA guidelines for AWQC development and using a methodology consistent with that used by the USEPA in developing its recommended BLM-based criteria for copper in 2007, we propose acute and chronic BLM-based AWQC for Pb in freshwater. In addition to the application of the BLM approach that can better account for site-specific Pb bioavailability, the toxicity data sets presented are much more robust than in 1984, and there are now sufficient chronic Pb toxicity data available that use of an acute-to-chronic ratio is no longer necessary. Over a range of North American surface waters with representative water chemistry conditions, proposed acute BLM-based Pb criteria ranged from approximately 20 to 1000 µg/L and chronic BLM-based Pb criteria ranged from approximately 0.3 to 40 µg/L. The lowest criteria were for water with low DOC (1.2 mg/L), pH (6.7), and hardness (4.3 mg/L as CaCO3), whereas the highest criteria were for water with high DOC (9.8 mg/L), pH (8.2), and hardness (288 mg/L as CaCO3 ). Environ Toxicol Chem 2017;36:2965-2973. © 2017 SETAC.

Updated species sensitivity distribution evaluations for acute and chronic lead toxicity to saltwater aquatic life.

The US Environmental Protection Agency's (USEPA's) ambient water quality criteria (AWQC) for lead (Pb) in salt water were developed in 1984. The acute and chronic criteria are 210 and 8.1 µg/L dissolved Pb, respectively. Because data were limited in 1984, the chronic criterion was derived using an acute-to-chronic ratio, but there are now sufficient toxicity data such that an acute-to-chronic ratio is no longer needed. Based on the data now available, the proposed updated acute and chronic salt water Pb AWQC (following USEPA methods) are 100 and 10 µg/L, respectively. In the European Union, a chronic salt water predicted no-effect concentration based on the median 5th percentile hazardous concentration (HC5-50) was developed in 2008 for the Registration, Evaluation, Authorisation, and Restriction of Chemicals program, which forms the basis for deriving chronic environmental quality standards for Pb in European marine waters. The salt water HC5-50 previously derived for Pb was 6.1 µg/L, whereas the proposed, updated chronic salt water HC5-50 derived following European Union methods is 11.0 µg/L. Thus, despite differences in derivation methodologies, the proposed AWQC and HC5-50 values are very consistent. Studies evaluating the effect of water quality factors on bioavailability and toxicity of Pb in salt water are limited; the effect of water quality on Pb toxicity in salt water should be considered in future studies. Environ Toxicol Chem 2017;36:2974-2980. © 2017 SETAC.

Hypertonic salt solution for peri-operative fluid management.

BACKGROUND: Fluid excess may place people undergoing surgery at risk for various complications. Hypertonic salt solution (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium. This review was published in 2010 and updated in 2016. OBJECTIVES: To determine the benefits and harms of HS versus IS solutions administered for fluid resuscitation to people undergoing surgery. SEARCH METHODS: In this updated review we have searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2016); MEDLINE (January 1966 to April 2016); EMBASE (January 1980 to April 2016); LILACS (January 1982 to April 2016) and CINAHL (January 1982 to April 2016) without language restrictions. We conducted the original search on April 30th, 2007, and reran it on April 8th, 2016. SELECTION CRITERIA: We have included randomized clinical trials (RCTs) comparing HS to IS in people undergoing surgery, irrespective of blinding, language, and publication status. DATA COLLECTION AND ANALYSIS: Two independent review authors read studies that met our selection criteria. We collected study information and data using a data collection sheet with predefined parameters. We have assessed the impact of HS administration on mortality, organ failure, fluid balance, serum sodium, serum osmolarity, diuresis and physiologic measures of cardiovascular function. We have pooled the data using the mean difference (MD) for continuous outcomes. We evaluated heterogeneity between studies by I² percentage. We consider studies with an I² of 0% to 30% to have no or little heterogeneity, 30% to 60% as having moderate heterogeneity, and more than 60% as having high heterogeneity. In studies with low heterogeneity we have used a fixed-effect model, and a random-effects model for studies with moderate to high heterogeneity. MAIN RESULTS: We have included 18 studies with 1087 participants of whom 545 received HS compared to 542 who received IS. All participants were over 18 years of age and all trials excluded high-risk patients (ASA IV). All trials assessed haematological parameters peri-operatively and up to three days post-operatively.There were three (< 1%) deaths reported in the IS group and four (< 1%) in the HS group, as assessed at 90 days in one study. There were no reports of serious adverse events. Most participants were in a positive fluid balance postoperatively (4.4 L IS and 2.5 L HS), with the excess significantly less in HS participants (MD -1.92 L, 95% confidence interval (CI) -2.61 to -1.22 L; P < 0.00001). IS participants received a mean volume of 2.4 L and HS participants received 1.49 L, significantly less fluid than IS-treated participants (MD -0.91 L, 95% CI -1.24 to -0.59 L; P < 0.00001). The maximum average serum sodium ranged between 138.5 and 159 in HS groups compared to between 136 and 143 meq/L in the IS groups. The maximum serum sodium was significantly higher in HS participants (MD 7.73, 95% CI 5.84 to 9.62; P < 0.00001), although the level remained within normal limits (136 to 146 meq/L).A high degree of heterogeneity appeared to be related to considerable differences in the dose of HS between studies. The quality of the evidence for the outcomes reported ranged from high to very low. The risk of bias for many of the studies could not be determined for performance and detection bias, criteria that we assess as likely to impact the study outcomes. AUTHORS' CONCLUSIONS: HS reduces the volume of intravenous fluid required to maintain people undergoing surgery but transiently increases serum sodium. It is not known if HS affects survival and morbidity, but this should be examined in randomized controlled trials that are designed and powered to test these outcomes.

Utilization profile of the trauma intensive care unit at the Role 3 Multinational Medical Unit at Kandahar Airfield between May 1 and Oct. 15, 2009.

BACKGROUND: In the war against the Taliban, Canada was the lead North Atlantic Treaty Organization (NATO) nation to provide medical and surgical care to NATO soldiers, Afghanistan National Army soldiers, Afghanistan Nation Police, civilians working in and outside Kandahar Airfield and Afghanistan civilians at the Role 3 Multinational Medical Unit (R3MMU) from February 2006 to October 2009. METHODS: We obtained data from the Joint Theatre Trauma Registry between May 1 and Oct. 15, 2009; 188 patients were admitted to the R3MMU intensive care unit (ICU). We analyzed the ICU data according to types and causes of trauma, mechanical ventilation prevalence, ICU medical and surgical complications, blood products utilization, length of stay in the ICU and mortality. RESULTS: The admitting services were general surgery (35%), neurosurgery (29%), orthopedic surgery (18%) and internal medicine (3%). Improvised explosive devices (46%) and gunshot wounds (26%) were the main causes of ICU admissions. The mean injury severity score for all patients admitted to the ICU was 37, and 81% of ICU patients required mechanical ventilation for a mean duration of 3 days. The main ICU complications were coagulopathy (6.4%), aspiration pneumonia (4.3%), pneumothorax (3.7%) and wound infection (2.7%). The following blood products were most used: packed red blood cells (55%), fresh frozen plasma (54%), platelets (29%) and cryoprecipitate (23%). The average length of stay in the ICU was 4.3 days, and the survival rate was 93%. CONCLUSION: The high survival rate suggests that ICU care is a necessary and vital resource for a trauma hospital in a war zone.

Hypertonic saline for peri-operative fluid management.

BACKGROUND: Fluid excess may place patients undergoing surgery at risk for various complications. Hypertonic saline (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium. OBJECTIVES: To determine the benefits and harms of HS versus IS solutions administered to patients undergoing surgery. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library) Issue 1, 2009; MEDLINE (1966 to 2009); EMBASE (1980 to 2009); LILACS (to August 2009) and CINAHL (1982 to 2009) without language restrictions. SELECTION CRITERIA: We included randomized clinical trials where HS was compared to IS in patients undergoing surgery, irrespective of blinding, language, and publication status. DATA COLLECTION AND ANALYSIS: We assessed the impact of HS administration on mortality, organ failure, fluid balance, serum sodium, serum osmolarity, diuresis and physiologic measures of cardiovascular function. We pooled data using odds ratio or mean difference (MD) for binary and continuous outcomes, respectively, using random-effects models. MAIN RESULTS: We included 15 studies with 614 participants. One death in each group and no other serious adverse events were reported. While all patients were in a positive fluid balance postoperatively, the excess was significantly less in HS patients (standardized mean difference (SMD) -1.43L, 95% confidence interval (CI) 0.8 to 2.1 L less; P < 0.00001). Patients treated with HS received significantly less fluid than IS-treated patients (MD -2.4L 95% (CI) 1.5 to 3.2 L less; P < 0.00001) without differences in diuresis between the groups. Maximum intraoperative cardiac index was significantly increased with HS (SMD 0.6 L/min/M2 higher, 95% CI 0.1 to 1.0, P = 0.02) but Intraoperative pulmonary artery wedge pressure remained unchanged. While the maximum serum sodium and the serum sodium at the end of the study were significantly higher in HS patients, the level remained within normal limits (136 to 146 meq/L). AUTHORS' CONCLUSIONS: HS reduces the volume of intravenous fluid required to maintain patients undergoing surgery but transiently increases serum sodium. It is not known if HS effects patient survival and morbidity but it should be tested in randomized clinical trials that are designed and powered to test these outcomes.