We identified 174 315 observation encounters (44 422 LRU). Children <1 year (odds ratio [OR] 3.3; 95% confidence interval [CI] 3.1-3.4), without complex chronic conditions (OR 3.6; 95% CI 3.2-4.0), and those directly admitted (OR 4.2; 95% CI 4.1-4.4) had the greatest odds of experiencing an LRU encounter. Those children with the combination of direct admission, no medical complexity, and a respiratory diagnosis experienced an LRU stay 69.5% of the time. We observed variation in LRU encounters (1%-57% of observation encounters) across hospitals.
 
  LRU observation encounters are variable across children's hospitals. These stays may include a cohort of patients who could be treated outside of the hospital.
 LRU observation encounters are variable across children's hospitals. These stays may include a cohort of patients who could be treated outside of the hospital.Early sensory relay circuits in the vertebrate medulla often adopt a cerebellum-like organization specialized for comparing primary afferent inputs with central expectations. These circuits usually have a dual output, carried by center ON and center OFF neurons responding in opposite ways to the same stimulus at the center of their receptive fields. Here, we show in the electrosensory lateral line lobe of Gymnotiform weakly electric fish that basilar pyramidal neurons, representing 'ON' cells, and non-basilar pyramidal neurons, representing 'OFF' cells, have different intrinsic electrophysiological properties. We used classical anatomical techniques and electrophysiological in vitro recordings to compare these neurons. Basilar neurons are silent at rest, have a high threshold to intracellular stimulation, delayed responses to steady-state depolarization and low pass responsiveness to membrane voltage variations. They respond to low-intensity depolarizing stimuli with large, isolated spikes. As stimulus intensity increases, the spikes are followed by a depolarizing after-potential from which phase-locked spikes often arise. Non-basilar neurons show a pacemaker-like spiking activity, smoothly modulated in frequency by slow variations of stimulus intensity. Spike-frequency adaptation provides a memory of their recent firing, facilitating non-basilar response to stimulus transients. Considering anatomical and functional dimensions, we conclude that basilar and non-basilar pyramidal neurons are clear-cut, different anatomo-functional phenotypes. We propose that, in addition to their role in contrast processing, basilar pyramidal neurons encode sustained global stimuli such as those elicited by large or distant objects while non-basilar pyramidal neurons respond to transient stimuli due to movement of objects with a textured surface.Muscles consume metabolic energy for active movement, particularly when performing mechanical work or producing force. Less appreciated is the cost for activating muscle quickly, which adds considerably to the overall cost of cyclic force production. However, the cost magnitude relative to the cost of mechanical work, which features in many movements, is unknown. We therefore tested whether fast activation is costly compared with performing work or producing isometric force. We hypothesized that metabolic cost would increase with a proposed measure termed force rate (rate of increase in muscle force) in cyclic tasks, separate from mechanical work or average force level. We tested humans (N=9) producing cyclic knee extension torque against an isometric dynamometer (torque 22 N m, cyclic waveform frequencies 0.5-2.5 Hz), while also quantifying quadriceps muscle force and work against series elasticity (with ultrasonography), along with metabolic rate through respirometry. Net metabolic rate increased by more than four-fold (10.5 to 46.8 W) with waveform frequency. At high frequencies, the hypothesized force-rate cost accounted for nearly half (40%) of energy expenditure. This exceeded the cost for average force (17%) and was comparable to the cost for shortening work (43%). The force-rate cost is explained by additional active calcium transport necessary for producing forces at increasing waveform frequencies, owing to rate-limiting dynamics of force production. The force-rate cost could contribute substantially to the overall cost of movements that require cyclic muscle activation, such as locomotion.In pre-metamorphic tadpoles, the neural network generating lung ventilation is present but actively inhibited; the mechanisms leading to the onset of air breathing are not well understood. Orexin (ORX) is a hypothalamic neuropeptide that regulates several homeostatic functions, including breathing. While ORX has limited effects on breathing at rest, it potentiates reflexive responses to respiratory stimuli mainly via ORX receptor 1 (OX1Rs). Here, we tested the hypothesis that OXR1 facilitate the expression of the motor command associated with air breathing in pre-metamorphic bullfrog tadpoles (Lithobates catesbeianus). To do so, we used an isolated diencephalic-brainstem preparation to determine the contributions of OX1Rs to respiratory motor output during baseline breathing, hypercapnia, and hypoxia. A selective OX1R antagonist (SB-334867; 5 - 25 µM) or agonist (ORX-A; 200 nM-1 µM) was added to the superfusion media. Experiments were performed under basal conditions (media equilibrated with 98.2% O2+1.8% CO2), hypercapnia (5% CO2) or hypoxia (5-7% O2). Under resting conditions gill, but not lung, motor output was enhanced by the OX1R antagonist and ORX-A. Hypercapnia alone did not stimulate respiratory motor output, but its combination with SB-334867 increased lung burst frequency and amplitude, lung burst episodes, and the number of bursts/episode. Hypoxia alone increased lung burst frequency and its combination with SB-334867 enhanced this effect. Inactivation of OX1Rs during hypoxia also increased gill burst amplitude, but not frequency. In contrast with our initial hypothesis, we conclude that ORX neurons provide inhibitory modulation of the CO2 and O2 chemoreflexes in pre-metamorphic tadpoles.
  Coronavirus disease 2019 (COVID-19) pandemic recovery will require a broad and coordinated effort for infection testing, immunity determination, and vaccination. With the advent of several COVID-19 vaccines, the dissemination and delivery of COVID-19 immunization across the nation is of concern. Previous immunization delivery patterns may reveal important components of a comprehensive and sustainable effort to immunize everyone in the nation.
 
  The delivery of vaccinations were enumerated by provider type using 2017 Medicare Part B Fee-For-Service data and the 2013-2017 Medical Expenditure Panel Survey. The delivery of these services was examined at the service, physician, and visit level.
 
  In 2017 Medicare Part B Fee-For-Service, primary care physicians provided the largest share of services for vaccinations (46%), followed closely by mass immunizers (45%), then nurse practitioners/physician assistants (NP/PAs) (5%).  https://www.selleckchem.com/products/Carboplatin.html  The Medical Expenditure Panel Survey showed that primary care physicians provided most clinical visits for vaccination (54% of all visits).