IntroductionAlthough dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy.ObjectiveTo assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children.MethodsA prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having “some dehydration” with weight change 3–9% or “severe dehydration” with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity.Results850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60), sensitivity (67%), and specificity (49%), for predicting severe dehydration were all poor.ConclusionsPoint-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

In 4 experiments, the authors examined the use of the hands in simple arithmetic tasks. Experiments 1 and 2 demonstrated that pointing increases both accuracy and speed in counting arrays of items, whether those items are identical or distinctive. Experiment 3 demonstrated that individuals tend to nod their heads when not allowed to point and that nodding is associated with greater accuracy, suggesting that pointing is functional for reasons other than simply providing additional visual information. Experiment 4 examined changes in speech when adding arrays of digits, depending on whether participants were allowed to use their hands to manipulate the tokens on which the digits were presented. Taken together, the results of these experiments are consistent with recent research suggesting that gesture can serve cognitive functions and that the hands can support the binding of representational elements to their functional roles by providing phase markers for cyclic cognitive processes.

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