Showing papers by "James Taylor published in 2015"

The influence of provider communication behaviors on parental vaccine acceptance and visit experience

Abstract: Objectives. We investigated how provider vaccine communication behaviors influence parental vaccination acceptance and visit experience.Methods. In a cross-sectional observational study, we videotaped provider–parent vaccine discussions (n = 111). We coded visits for the format providers used for initiating the vaccine discussion (participatory vs presumptive), parental verbal resistance to vaccines after provider initiation (yes vs no), and provider pursuit of recommendations in the face of parental resistance (pursuit vs mitigated or no pursuit). Main outcomes were parental verbal acceptance of recommended vaccines at visit’s end (all vs ≥ 1 refusal) and parental visit experience (highly vs lower rated).Results. In multivariable models, participatory (vs presumptive) initiation formats were associated with decreased odds of accepting all vaccines at visit’s end (adjusted odds ratio [AOR] = 0.04; 95% confidence interval [CI] = 0.01, 0.15) and increased odds of a highly rated visit experience (AOR = 17.3;...

Communication Practices and Antibiotic Use for Acute Respiratory Tract Infections in Children

Abstract: PURPOSE This study examined relationships between provider communication practices, antibiotic prescribing, and parent care ratings during pediatric visits for acute respiratory tract infection (ARTI). METHODS A cross-sectional study was conducted of 1,285 pediatric visits moti- vated by ARTI symptoms. Children were seen by 1 of 28 pediatric providers rep- resenting 10 practices in Seattle, Washington, between December 2007 and April 2009. Providers completed post-visit surveys reporting on children's presenting symptoms, physical examination findings, assigned diagnoses, and treatments prescribed. Parents completed post-visit surveys reporting on provider communi- cation practices and care ratings for the visit. Multivariate analyses identified key predictors of prescribing antibiotics for ARTI and of parent visit ratings. RESULTS Suggesting actions parents could take to reduce their child's symptoms (providing positive treatment recommendations) was associated with decreased risk of antibiotic prescribing whether done alone or in combination with negative treat- ment recommendations (ruling out the need for antibiotics) (adjusted risk ratio (aRR) 0.48; 95% CI, 0.24-0.95; and aRR 0.15; 95% CI, 0.06-0.40, respectively). Parents receiving combined positive and negative treatment recommendations were more likely to give the highest possible visit rating (aRR 1.16; 95% CI, 1.01-1.34). CONCLUSION Combined use of positive and negative treatment recommenda- tions may reduce the risk of antibiotic prescribing for children with viral ARTIs and at the same time improve visit ratings. With the growing threat of antibiotic resistance at the community and individual level, these communication tech- niques may assist frontline providers in helping to address this pervasive public health problem.

Discrepancies Between Transcutaneous and Serum Bilirubin Measurements

Abstract: OBJECTIVE: To characterize discrepancies between transcutaneous bilirubin (TcB) measurements and total serum bilirubin (TSB) levels among newborns receiving care at multiple nursery sites across the United States. METHODS: Medical records were reviewed to obtain data on all TcB measurements collected during two 2-week periods on neonates admitted to participating newborn nurseries. Data on TSB levels obtained within 2 hours of a TcB measurement were also abstracted. TcB – TSB differences and correlations between the values were determined. Data on demographic information for individual newborns and TcB screening practices for each nursery were also collected. Multivariate regression analysis was used to identify characteristics independently associated with the TcB – TSB difference. RESULTS: Data on 8319 TcB measurements were collected at 27 nursery sites; 925 TSB levels were matched to a TcB value. The mean TcB – TSB difference was 0.84 ± 1.78 mg/dL, and the correlation between paired measurements was 0.78. In the multivariate analysis, TcB – TSB differences were 0.67 mg/dL higher in African-American newborns than in neonates of other races ( P CONCLUSIONS: During routine clinical care, TcB measurement provided a reasonable estimate of TSB levels in healthy newborns. Discrepancies between TcB and TSB levels were increased in African-American newborns and varied based on brand of meter used.

The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis.

Abstract: © 2015 Fleming et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Importance: Capillary refill time (CRT) is widely recommended as part of the routine assessment of unwell children. Objective: To determine the diagnostic value of capillary refill time for a range of serious outcomes in children. Methods: We searched Medline, Embase and CINAHL from inception to June 2014. We included studies that measured both capillary refill time and a relevant clinical outcome such as mortality, dehydration, meningitis, or other serious illnesses in children aged up to 18 years of age. We screened 1,265 references, of which 24 papers were included in this review. Where sufficient studies were available, we conducted meta-analysis and constructed hierarchical summary ROC curves. Results: Meta-analysis on the relationship between capillary refill time and mortality resulted in sensitivity of 34.6%(95% CI 23.9 to 47.1%), specificity 92.3% (88.6 to 94.8%), positive likelihood ratio 4.49 (3.06 to 6.57), and negative likelihood ratio 0.71 (0.60 to 0.84). Studies of children attending Emergency Departments with vomiting and diarrhea showed that capillary refill time had specificity of 89 to 94% for identifying 5% dehydration, but sensitivity ranged from 0 to 94%. This level of heterogeneity precluded formal meta-analysis of this outcome. Meta-analysis was not possible for other outcomes due to insufficient data, but we found consistently high specificity for a range of outcomes including meningitis, sepsis, admission to hospital, hypoxia, severity of illness and dengue. Conclusions: Our results show that capillary refill time is a specific sign, indicating that it can be used as a "red-flag": children with prolonged capillary refill time have a four-fold risk of dying compared to children with normal capillary refill time. The low sensitivity means that a normal capillary refill time should not reassure clinicians.

Validity and reliability of measurement of capillary refill time in children: a systematic review

Abstract: © 2015, BMJ Publishing Group. All rights reserved. Background: Most guidelines recommend the use of capillary refill time (CRT) as part of the routine assessment of unwell children, but there is little consensus on the optimum method of measurement and cut-off time. Methods: We searched Medline (from 1948), Embase (from 1980) and CINAHL (from 1991) to June 2014 to identify studies with information on the normal range of CRT in healthy children, the validity of CRT compared with reference standard measures of haemodynamic status, reliability and factors infl uencing measurement of CRT, such as body site, pressing time and temperature. Findings: We included 21 studies on 1915 children. Four studies provided information on the relationship between CRT and measures of cardiovascular status, 13 provided data on the normal range of CRT, 7 provided data on reliability and 10 assessed the effect of various confounding factors. In children over 7 days of age, the upper limit of normal CRT is approximately 2 s when measured on a finger, and 4 s when measured on the chest or foot, irrespective of whether the child is feverish or not. Longer pressing times and ambient temperature outside 20°C-25°C are associated with longer CRT. Evidence suggests that the use of stopwatches reduces variability between observers. Interpretation: We recommend use of the following standardised CRT method of measurement: press on the finger for 5 s using moderate pressure at an ambient temperature of 20°C-25°C. A capillary refill time of 3 s or more should be considered abnormal.

Fiber grating compression of giant-chirped nanosecond pulses from an ultra-long nanotube mode-locked fiber laser

Abstract: We demonstrate that the giant chirp of coherent, nanosecond pulses generated in an 846 m long, all-normal dispersion, nanotube mode-locked fiber laser can be compensated using a chirped fiber Bragg grating compressor. Linear compression to 11 ps is reported, corresponding to an extreme compression factor of ∼100. Experimental results are supported by numerical modeling, which is also used to probe the limits of this technique. Our results unequivocally conclude that ultra-long cavity fiber lasers can support stable dissipative soliton attractors and highlight the design simplicity for pulse-energy scaling through cavity elongation.

Group Well-Child Care for High-Risk Families

Abstract: OBJECTIVE To determine if participation in group sessions as part of health supervision visits for infants improves outcomes compared with individual visits in high-risk mothers. STUDY DESIGN Randomized controlled clinical trial. PARTICIPANTS Mothers of young infants who had at least 1 of the following risk factors: aged younger than 20 years at delivery, participation in Medicaid, less than a high school education, previous or ongoing substance abuse, or history of abuse as a child. SETTING Two urban university pediatric clinics in Seattle, Wash. INTERVENTIONS Mother-infant dyads were randomized to receive group well-child care (GWCC) or individual well-child care (IWCC) before the infant was 4 months old; the intervention continued until the child was 15 months old. Mothers completed the Sense of Competence and Social Isolation subscales from the Parenting Stress Index and Sarason's Social Support Questionnaire at enrollment and again on completion of the study. During the 11-month study period, 7 health supervision visits were scheduled for each mother-infant dyad. Social workers met periodically with mothers during the study and assessed the following functional outcomes: return to school, return to work, enrollment in a substance abuse treatment program, and becoming pregnant. In addition, data on study children were collected from Child Protective Services to assess referrals because of suspected abuse and/or neglect. RESULTS Data were collected on 213 mother-infant dyads, including 108 who received GWCC and 105 who received IWCC. At the conclusion of the study period, similar proportions of GWCC and IWCC mothers scored in the high-risk range on the Sense of Competence subscale, Social Isolation subscale, and the Social Support Questionnaire (P=.57, .32, and .59, respectively). For more than 50% of the mothers, scores on the Sense of Competence and Social Isolation subscales deteriorated during the study period from the not-high-risk range to the high-risk range, regardless of assignment to GWCC or IWCC. No differences were noted between GWCC and IWCC mothers for any functional outcome. During the study period, 8.8% of children receiving GWCC were referred to Child Protective Services vs 8.3% of those receiving IWCC (P=.85). CONCLUSION The format of well-child care may not be an important determinant of outcomes among high-risk mothers.

Effects of kaolin-based particle film and fruit zone netting on Cabernet Sauvignon grapevine physiology and fruit quality

Abstract: Aims: Long exposure to high temperatures or UV-radiation may induce negative effects on vine physiology and grape composition. Here, the effects of two methods to moderate radiation and temperature in the fruit zone of a Cabernet Sauvignon vineyard were evaluated against a control.Methods and results: The treatments assessed were: (a) periodical spraying of kaolin on leaves and bunches and (b) fruit zone netting with a Raschell’s type mesh. The kaolin-based treatment increased the reflectance of light and moderately reduced fruit temperature (~1oC below the control), whilst the shading net caused a significant reduction in radiation and temperature in the fruit zone (~7oC below the control). The Net treatment showed lower (more negative) stem water potential values than the control, but did not persist until the end of the trial. Also, none of the treatments led to significant changes in stomatal conductance, transpiration or CO2 assimilation throughout the season. However, the incidence and severity of fruit dehydration was significantly lower in the treated plants compared to the control. Finally, no differences in fruit chemical composition were observed between the treatments and the control.Conclusion: Under the conditions of this trial, both treatments tested were sufficient in moderating the negative effects of excess radiation or high temperature on grape berries.Significance and impact of the study: Kaolin-based particle spraying and fruit zone netting were proved to be feasible practical alternatives to lessen the negative effects of excess radiation or high temperature on grape berries, under hot climate.

Duration-tunable picosecond source at 560 nm with watt-level average power.

Abstract: A pulse source at 560 nm that is tunable in duration between 50 ps and 2.7 ns with >1 W of average power and near diffraction-limited beam quality is demonstrated. The source is based on efficient (up to 50%) second-harmonic generation in a periodically poled lithium tantalate crystal of a linearly polarized fiber-integrated Raman amplifier operating at 1120 nm. A duration-tunable ytterbium master-oscillator power-fiber amplifier is used to pulse-pump the Raman amplifier, which is seeded by a continuous-wave distributed-feedback laser diode at 1120 nm. The performance of the system using two different master oscillator schemes is compared. A pulse energy of up to 765 nJ is achieved with a conversion efficiency of 25% from the ytterbium fiber pump, demonstrating a compact and turn-key architecture for obtaining high peak-power radiation at 560 nm.

Fiber-integrated frequency-doubling of a picosecond Raman laser to 560 nm.

Abstract: We report the development of a fiber-integrated picosecond source at 560 nm by second harmonic generation of a Raman fiber laser. A picosecond ytterbium master oscillator power fiber amplifier is used to pulse-pump a Raman amplifier, which is seeded by a continuous wave distributed feedback laser diode operating at 1120 nm. The pulse train generated at 1120 nm is frequency-doubled in a fiber-coupled periodically-poled lithium niobate crystal module, producing 450 mW of average power at 560 nm with a pulse duration of 150 ps at a repetition rate of 47.5 MHz. The near diffraction-limited (M2 = 1.02) collimated output beam is ideal for super-resolution microscopy applications.

Systems, devices, and methods for estimating bilirubin levels

Abstract: Systems, methods, and devices are provided for estimating bilirubin levels. In one aspect, a method for estimating the level of bilirubin in a patient includes receiving image data for at least one image including a region of the patient's skin and a color calibration target. Color-balanced image data for the skin region is generated based on a subset of the image data corresponding to the color calibration target and the skin region. The bilirubin level in the patient is estimated based on the color-balanced image data for the skin region.

Sizing tool for rapid optimisation of pack configuration at early-stage automotive product development

Abstract: The specifications that define an automotive development project are established at an early point in the process and define the direction of such a development, and changing these decisions becomes more costly the further the project progresses. Tools to enable better consideration of choice can help prevent this. The tool presented is designed to aid with the decisions needed when embarking on the development of a vehicle that incorporates electric-vehicle technologies and the important choices made regarding the battery pack required by such a vehicle. The tool incorporates a sizing model for determining the number of cells and the configuration required to meet a specified battery requirement. The tool then uses a 1-d model to determine some of the basic thermal and power characteristics that can then be used to inform other parts of the design specification. When attached to a database containing cell information, the tool can pre-select candidate cells to meet the requirement, and rapid execution time of the tool means that it can be used to quickly compare between cell choices, at a level understandable by all stakeholders in the decision making process.

Categorizing Weight Loss in Breastfed Infants: A Good First Step

Abstract: One of the most gratifying public health trends over the past 50 years in the United States has been the increasing rate of breastfeeding among newborn infants. In 1965, it was estimated that <30% of neonates born in the United States were breastfed; by 2011, the percentage of infants who were at least partially breastfed had risen to 79%.1,2 A major focus of contemporary care during the birth hospitalization is the management of breastfed infants. Although much effort is centered on the provision of optimal instruction and support to mothers initiating breastfeeding, an equally important goal is to appropriately diagnose and manage newborns with breastfeeding difficulties. The results of the study by Flaherman et al in this issue of Pediatrics provide much needed data for both of these efforts.3 Using a large database and an elegant methodology, Dr Flaherman and her colleagues have constructed nomograms that describe weight loss in breastfed infants during the first few days of life. With the nomograms, clinicians can plot the percent weight loss for a neonate at a specific age and determine, with precision, whether this percentage is normal for a … Address correspondence to James A. Taylor, MD, University of Washington, Box 354920, Seattle, WA 98195. E-mail: uncjat{at}uw.edu

Study of the within-plant spatial variability of stomatal conductance on a young 'Arbequina' olive orchard under drip-irrigated and semi-arid conditions

Abstract: Para olivos regados por goteo, el monitoreo del estado hidrico de la planta es una herramienta fundamental para la gestion del riego, ya que influencia directamente el rendimiento final de fruta y de aceite. Sin embargo, el monitoreo del estado hidrico de la planta utilizando mediciones fisiologicas tales como el potencial hidrico y la conductancia estomatica (gs), implican un desafio tecnico importante en la seleccion del sitio de medicion dentro del dosel, el cual debe ser representativo de toda la planta. Por lo tanto, el objetivo de la presente investigacion fue estudiar la variabilidad espacial de la conductancia estomatica dentro de la planta, en un huerto joven de olivos regados por goteo creciendo en condiciones semi-aridas. Se realizo un ensayo de campo en un huerto comercial joven de olivos (Olea europea L. 'Arbequina') regado por goteo, ubicado en el valle de Pencahue, Region del Maule, Chile (35° 23' S; 71° 44' O; WGS 84; 96 m.s.n.m.). Las mediciones de gs se realizaron en cuatro fechas utilizando un analizador infrarrojo de gases (LI-COR, LI-6400, EE.UU.) durante la temporada de crecimiento 2011-2012. Los resultados mostraron que en condiciones de restriccion hidrica de leve a moderada (-1,5 a -2,2 MPa), la variabilidad intraplanta de la conductancia estomatica fue alta, permitiendo identificar dos zonas distintas dentro del follaje, las cuales fueron observadas en ambos niveles de expresion vegetativa. Por el contrario, en condiciones de restriccion hidrica de moderada a fuerte (< -2,2 a -3,5 MPa), la variabilidad intraplanta de la conductancia estomatica fue baja para ambos niveles de expresion vegetativa, sin detectar sectores distintos al interior de la planta. Los resultados anteriores son relevante para la seleccion del sitio mas apropiado de muestreo dentro del dosel de la planta para las mediciones de potencial hidrico y/o intercambio gaseoso.

Fiber-integrated second harmonic generation modules for visible and near-visible picosecond pulse generation

Abstract: Second harmonic generation (SHG) is a ubiquitous technique for extending the spectral coverage of laser sources into regions that would otherwise be technologically challenging to access. SHG schemes typically rely on the use of bulk optical components, resulting in systems with large footprints requiring precise optical alignment. Integration of the SHG components into a single unit facilitates the implementation of compact, robust and turn-key sources, suitable for applications in biophotonic imaging, amongst others. We report on the development of fiber-coupled frequency doubling modules and their application to novel fiberintegrated picosecond pulse sources in the visible and near-visible. The modules employ a simple, single-pass configuration using a periodically-poled lithium niobate (PPLN) crystal as the nonlinear conversion medium. They are readily adaptable for different fiber pump laser configurations and are configurable with either fiber-coupled or collimated free-space outputs. Two sources using the modules are presented, operating at 780 nm and 560 nm. The 780 nm source utilizes an erbium master oscillator power fiber amplifier (MOPFA) scheme. SHG was performed in a 35 mm long crystal, generating 3.5 W of 780 nm radiation with a pulse duration of 410 ps at 50 MHz and conversion efficiencies exceeding 20%. Results of this source being used for parametric wavelength conversion in photonic crystal fiber are discussed. The 560 nm source was based on SHG of a Raman amplified CW diode pumped by a pulsed ytterbium-fiber MOPFA. This source generated 450 mW of average power with conversion efficiencies greater than 20%.

Study of the within-plant spatial variability of stomatal conductance on a young 'Arbequina' olive orchard under drip-irrigated and semi-arid conditions Estudio de la variabilidad espacial intraplanta de la conductancia estomática en un huerto joven de olivos cultivar 'Arbequina' regado por goteo creciendo bajo condiciones semiáridas

Abstract: For drip-irrigated olive orchards, plant water status monitoring is an important tool for irrigation management practices, as it determines final fruit and oil yield. However, plant water status monitoring using plant physiological measurements, such as plant water potential and stomatal conductance (g s ) imposes a challenge because the selection of the measurement site inside the canopy must be representative of the whole plant trend. Therefore, the objective of the present work was to study the spatial variability of stomatal conductance at the within-plant scale on a young drip-irrigated olive orchard under semi-arid growing conditions. A field study was carried out on a commercial drip-irrigated olive orchard ( Olea europea L. ‘Arbequina’) located in Pencahue valley, Maule Region, Chile (35o 23’ S; 71o 44’ W; WGS 84; 96 m.a.s.l.). Measurements of g s were done at four dates using an infrared gas analyzer (LI-COR, LI-6400, USA) during the 2011-2012 growing season. The results show that under mild to moderate water restriction (−1.5 to −2.2 MPa), intracanopy stomatal conductance variability was high and two sectors were identified, independent of the level of vegetative expression. In contrast, under moderate to strong water restriction (< −2.2 to −3.5 MPa), intra-canopy stomatal conductance variability was low for both high and low vegetative expression, with no sector detected. These considera-tions are relevant to select the more appropriate site within the canopy for plant water status and/or gas exchange measurements.

Regional and Local-Scale Variation in Benthic Megafauna from the LTER Observatory HAUSGARTEN in the Arctic

Abstract: The LTER (Long-Term Ecological Research) observatory HAUSGARTEN, in the eastern Fram Strait, provides us the unique ability to study the composition of benthic megafaunal communities through the analysis of seafloor photographs. This, in combination with extensive annual sampling campaigns, which have yielded a unique data set on faunal, bacterial, biogeochemical and geological properties, as well as on hydrography and sedimentation patterns, allows us to address the question of why variations in megafaunal community structure and species distribution exist within regional (60-110 km) and local (<4 km) scales. Here, we present first results from the latitudinal HAUSGARTEN transect, consisting of three different stations (N3, HG-IV, S3) between 78°30’N and 79°45’N (2500m depth), obtained via the analysis of images acquired by a towed camera (Ocean Floor Observation System) in 2011. We assess variability in megafaunal densities, species composition and diversity as well as biotic and abiotic factors, which may cause the patterns observed. While there were significant differences in megafaunal composition and densities between all stations (N3 = 26.74 ±0.63; HG-IV = 11.21 ±0.25; S3 = 18.34 ±0.39 individuals/m2), significant local differences were only found at HG-IV. We discuss our results in the context of sea ice coverage in the area and biogeochemical sediment parameters indicating food availability on the deep seafloor. These parameters were measured in parallel to the photographic transects, to develop the understanding of external factors that affect species distribution patterns amongst arctic benthic megafauna. Finally, we focus on specific individual species, such as the sea cucumber Kolga hyalina and the amphipod Neohela lamia, that display particularly significant and varied distribution patterns across the latitudinal transect, as well as within each transect, in 2011 and other years. The results will be discussed in the context of diminishing sea ice coverage with projections of completely ice free areas within 30 years.

A closer inspection of tedizolid

Abstract: I read the Article by Gregory Moran and colleagues, who used intention to treat (ITT) analysis of a noninferiority trial, with great interest. ITT is widely accepted as the appropriate analysis for randomised controlled trials. However, this recognition is based on assumptions of trial design. Superiority trials (ie, the attempt to prove treatment A is superior to treatment B) use ITT as it both avoids attrition bias and is inherently conservative by ensuring that high dropout rates reduce the chance of obtaining a positive result. This outcome can be noted in the extreme case of 100% dropout in a trial, in which no diff erence will occur. In the counterintuitive world of non-inferiority trials, with ITT this conservatism is lost and dropouts contribute to confirmation of a positive result. The hypothetical trial with 100% dropouts would show noninferiority between the treatments. This result would be the case no matter what the real diff erence between the treatments was. Increase of dropout rates does not just reduce the power of the study (as in a superiority study), it also reduces the diff erence between the two treatments and therefore might falsely lead to non-inferiority being declared. For these reasons, non-inferiority trials reporting only ITT analysis cannot be considered complete. A per-protocol (PP) analysis should be done on the same primary endpoint, preferably as a coprimary outcome with a positive result being declared only if both analyses show noninferiority. Indeed, in a utopian perfect trial, ITT and PP results would be equal. The diff erence between these results could even be routinely used as a quality marker of a study’s conduct. Unfortunately, to do a PP analysis from the data available in Moran and colleagues’ study or their electronic appendix is not possible. A PP analysis should be done to confi rm their findings, as without this the fi ndings cannot be considered fi rm. Moran and colleagues’ tipping point analysis does not seem, from their description, to provide this reassurance. I note that the US Food and Drug Administration (FDA) only needs an ITT analysis. This requirement is an insuffi cient basis to accept a non-inferiority trial, in view of the inherent methodological and statistical problems they conceal. We should not be swayed by the apparent similarity to familiar superiority trials. Finally, this trial of a condition “frequently encountered in clinical practice” needed 58 centres and more than a year’s recruitment to fi nd 666 patients, which questions the external validity of this evidence.

Watt-level, Duration-tunable Picosecond Source at 560 nm by Second-harmonic Generation of a Raman Fiber Laser

Abstract: High peak-power sources at 560 nm with excellent beam quality are in high demand for a diverse range of applications, including fluorescence microscopy, biochemical analysis and semiconductor characterization [1]. Direct generation of this strategic wavelength is possible with gain-switched laser diodes, but these suffer from limited average power and poor beam quality at fixed pulse durations. Nonlinear conversion techniques such as fiber-based supercontinuum sources or bulk parametric conversion of ultrafast oscillators typically produce limited pulse energies. In this contribution, we present a novel fiber architecture for generating narrow-linewidth, duration-tunable picosecond radiation at 1120 nm. Second-harmonic generation (SHG) in a bulk periodically-poled (PP) crystal of this source results in > 1 W of 560 nm with a conversion efficiency of > 45%.