Watcher Initiative Associated With Decrease in Failure to Rescue Events in Pediatric Population.

BACKGROUND AND OBJECTIVES: Improved situation awareness may prevent unplanned ICU transfers. Transfers with serious safety issues may be classified as unrecognized situation awareness failure events (UNSAFE) and are associated with intubation, vasopressors, or >3 fluid boluses within 1 hour before or after ICU arrival. Our aim was to decrease the proportion of unplanned ICU transfers that met UNSAFE criteria by 50% in 1 year. METHODS: We adapted a previously described huddle-based intervention. In May 2015, we started a daily safety brief with hospital-wide representation; concurrently, nurses and residents separately identified watcher patients (ie, patients at risk for UNSAFE transfers) to be reported in the daily safety brief. Watcher patients frequently differed between the groups, so in July 2015, we started twice-daily watcher huddles on a pilot floor. During these huddles, nurses and residents jointly identified watcher patients on the basis of defined criteria and deployed mitigation plans. By March 2016, we implemented these huddles hospital-wide. We reviewed the electronic medical record to categorize all unplanned ICU transfers as safe or UNSAFE. Our outcome was the proportion of unplanned ICU transfers that met UNSAFE criteria. RESULTS: In the 16-month pre-intervention period, 49 of the 322 unplanned ICU transfers were UNSAFE (median 15.5%); in the 12-month post-intervention period, 13 of the 329 unplanned ICU transfers were UNSAFE (median 3%). These findings represent an 81% reduction in the proportion of UNSAFE transfers. CONCLUSIONS: Watcher huddles incorporated into the daily inpatient routine can significantly decrease UNSAFE transfers.

Association analysis of resistance to cereal cyst nematodes (Heterodera avenae) and root lesion nematodes (Pratylenchus neglectus and P. thornei) in CIMMYT advanced spring wheat lines for semi-arid conditions.

To identify loci linked to nematode resistance genes, a total of 126 of CIMMYT advanced spring wheat lines adapted to semi-arid conditions were screened for resistance to Heterodera avenae, Pratylenchus neglectus, and P. thornei, of which 107 lines were genotyped with 1,310 DArT. Association of DArT markers with nematode response was analyzed using the general linear model. Results showed that 11 markers were associated with resistance to H. avenae (pathotype Ha21), 25 markers with resistance to P. neglectus, and 9 significant markers were identified to be linked with resistance to P. thornei. In this work we confirmed that chromosome 4A (~90-105 cM) can be a source of resistance to P. thornei as has been recently reported. Other significant markers were also identified on chromosomal regions where no resistant genes have been reported for both nematodes species. These novel QTL were mapped to chromosomes 5A, 6A, and 7A for H. avenae; on chromosomes 1A, 1B, 3A, 3B, 6B, 7AS, and 7D for P. neglectus; and on chromosomes 1D, 2A, and 5B for P. thornei and represent potentially new loci linked to resistance that may be useful for selecting parents and deploying resistance into elite germplasm adapted to regions where nematodes are causing problem.

Fitness of three Fusarium pathogens of wheat.

Crown rot and head blight of wheat are caused by the same Fusarium species. To better understand their biology, this study has compared 30 isolates of the three dominant species using 13 pathogenic and saprophytic fitness measures including aggressiveness for the two diseases, saprophytic growth and fecundity and deoxynivalenol (DON) production from saprophytic colonization of grain and straw. Pathogenic fitness was generally linked to DON production in infected tissue. The superior crown rot fitness of Fusarium pseudograminearum was linked to high DON production in the stem base tissue, while Fusarium culmorum and Fusarium graminearum had superior head blight fitness with high DON production in grains. Within each species, some isolates had similar aggressiveness for both diseases but differed in DON production in infected tissue to indicate that more than one mechanism controlled aggressiveness. All three species produced more DON when infecting living host tissue compared with saprophytic colonization of grain or straw, but there were significant links between these saprophytic fitness components and aggressiveness. As necrotrophic pathogens spend a part of their life cycle on dead organic matter, saprophytic fitness is an important component of their overall fitness. Any management strategy must target weaknesses in both pathogenic fitness and saprophytic fitness.

Root and Crown Rot Fungi Associated with Spring, Facultative, and Winter Wheat in Turkey.

The objective of this study was to determine the distribution frequency of the fungi associated with wheat (Triticum aestivum) crowns and roots in cereal producing areas of Turkey through a targeted survey of 518 commercial fields over a 2-year period. More than 26% of the fields had one or more of the fungal species commonly reported as part of the dryland root rot complex, Fusarium culmorum (14%) > Bipolaris sorokiniana (10%) > F. pseudograminearum (2%). The fungi considered to be part of the high rainfall root rot complex were found at very low frequencies: 2% for Gaeumannomyces graminis and 3% for Pythium spp. Species of Rhizoctonia were found in 22% of the fields. Several Fusarium species considered to be less or nonpathogenic to cereals were also found in high frequencies at 11% (F. oxysporum, F. chlamydosporum), 10% (F. sporotrichioides), and 8% (F. avenaceum and F. solani). The mostly random distribution of cereal root-rotting species across the survey area suggests the fungi are not distributed in any distinct agroecological relationship. As a result, the relative economic importance of a given species on wheat will be determined by a number of factors, such as their fungal pathogenicity, host susceptibility/tolerance, and the seasonal conditions. Results from this study suggest that there are a wide range of fungal species associated with root and crown tissues of wheat.

Identification of common root-lesion nematode (Pratylenchus thornei Sher et Allen) loci in bread wheat.

Plant parasitic nematodes are a major biotic cause of wheat-yield loss in temperate wheat-growing regions. A major strategy to develop resistance to root-lesion nematodes (RLNs) in wheat is to assess and then exploit their natural genetic variation. This study examines RLN (Pratylenchus thornei) resistance in 1 Middle Eastern landrace (AUS4930 7.2) and 1 synthetic hexaploid wheat, CROC_1/AE. SQUARROSA (224)//OPATA (CROC), using F2 and F9 populations generated by crossing AUS4930 7.2 and CROC with the susceptible cultivar Pastor, and inoculating these crosses with P. thornei in greenhouse trials. Wheat microsatellite markers linked to previously identified quantitative trait loci (QTLs) for resistance to P. thornei and P. neglectus were used to screen both populations. In the AUS4930 7.2 x Pastor population, resistance loci on chromosomes 1B, 2B, and 6D were detected. Similarly, in the CROC x Pastor population, 2 resistance loci, located on chromosomes 1B and 3B, were identified. Interestingly, a resistance locus located on chromosome 6D was not detected. More detailed mapping is required in these 2 populations, developed using new RLN resistance sources, to determine whether the QTLs identified on these chromosomes are the same, are allelic, or are linked to different resistance loci from those previously identified, and to determine whether these 2 sources contain other novel resistance loci.

Evaluation of carotid artery stenosis: contrast-enhanced magnetic resonance angiography compared with conventional digital subtraction angiography.

OBJECTIVE: To compare retrospectively high-resolution contrast-enhanced magnetic resonance angiography with centric k-space filling and digital subtraction angiography in the assessment of degree of carotid artery stenosis. METHODS: Two neuroradiologists independently evaluated 14 carotid arteries (in 7 patients), and the degree of carotid stenosis determined was compared to calculate interobserver reliability. Thirty-six carotid arteries (in 18 patients) were then assessed with both contrast-enhanced magnetic resonance angiography and digital subtraction angiography. The degree of stenosis was determined by consensus, and the findings of the 2 modalities were compared. RESULTS: Close interobserver agreement was found with an intraclass correlation coefficient of 0.98 (95% confidence interval 0.95-0.99). Sensitivity of 86% and specificity of 91% were found for contrast-enhanced magnetic resonance angiography detection of surgically significant carotid stenosis compared with digital subtraction angiography. The Spearman rank correlation test also found a significant correlation (R(s) = 0.90, p < 0.001) in the comparison of the classifications of degree of carotid artery stenosis. CONCLUSION: Contrast-enhanced magnetic resonance angiography shows excellent correlation with digital subtraction angiography for the evaluation of carotid artery disease and has the potential to replace it in the assessment of degree of carotid artery stenosis.