Search

Your search keyword '"Nigrovic, P."' showing total 339 results
Start Over Author "Nigrovic, P."
339 results on '"Nigrovic, P."'

4. Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study.

Author

Florin, Todd, Ramilo, Octavio, Banks, Russell, Schnadower, David, Quayle, Kimberly, Powell, Elizabeth, Pickett, Michelle, Nigrovic, Lise, Mistry, Rakesh, Leetch, Aaron, Hickey, Robert, Glissmeyer, Eric, Dayan, Peter, Cruz, Andrea, Cohen, Daniel, Bogie, Amanda, Balamuth, Fran, Atabaki, Shireen, VanBuren, John, Mahajan, Prashant, and Kuppermann, Nathan

Subjects
emergency department, infections, pneumonia, respiratory, Infant, Humans, Child, Prospective Studies, Fever, Pneumonia, Procalcitonin, Emergency Service, Hospital, Respiratory Distress Syndrome
Abstract

OBJECTIVE: The lack of evidence-based criteria to guide chest radiograph (CXR) use in young febrile infants results in variation in its use with resultant suboptimal quality of care. We sought to describe the features associated with radiographic pneumonias in young febrile infants. STUDY DESIGN: Secondary analysis of a prospective cohort study in 18 emergency departments (EDs) in the Pediatric Emergency Care Applied Research Network from 2016 to 2019. Febrile (≥38°C) infants aged ≤60 days who received CXRs were included. CXR reports were categorised as no, possible or definite pneumonia. We compared demographics, clinical signs and laboratory tests among infants with and without pneumonias. RESULTS: Of 2612 infants, 568 (21.7%) had CXRs performed; 19 (3.3%) had definite and 34 (6%) had possible pneumonias. Patients with definite (4/19, 21.1%) or possible (11/34, 32.4%) pneumonias more frequently presented with respiratory distress compared with those without (77/515, 15.0%) pneumonias (adjusted OR 2.17; 95% CI 1.04 to 4.51). There were no differences in temperature or HR in infants with and without radiographic pneumonias. The median serum procalcitonin (PCT) level was higher in the definite (0.7 ng/mL (IQR 0.1, 1.5)) vs no pneumonia (0.1 ng/mL (IQR 0.1, 0.3)) groups, as was the median absolute neutrophil count (ANC) (definite, 5.8 K/mcL (IQR 3.9, 6.9) vs no pneumonia, 3.1 K/mcL (IQR 1.9, 5.3)). No infants with pneumonia had bacteraemia. Viral detection was frequent (no pneumonia (309/422, 73.2%), definite pneumonia (11/16, 68.8%), possible pneumonia (25/29, 86.2%)). Respiratory syncytial virus was the predominant pathogen in the pneumonia groups and rhinovirus in infants without pneumonias. CONCLUSIONS: Radiographic pneumonias were uncommon in febrile infants. Viral detection was common. Pneumonia was associated with respiratory distress, but few other factors. Although ANC and PCT levels were elevated in infants with definite pneumonias, further work is necessary to evaluate the role of blood biomarkers in infant pneumonias.

Published
2023

5. Rehydration Rates and Outcomes in Overweight Children With Diabetic Ketoacidosis.

Author

Brown, Kathleen, Glaser, Nicole, McManemy, Julie, DePiero, Andrew, Nigrovic, Lise, Quayle, Kimberly, Stoner, Michael, Schunk, Jeff, Trainor, Jennifer, Tzimenatos, Leah, Rewers, Arleta, Myers, Sage, Kwok, Maria, Ghetti, Simona, Casper, T, Olsen, Cody, and Kuppermann, Nathan

Subjects
Adolescent, Child, Humans, Diabetes Mellitus, Diabetic Ketoacidosis, Fluid Therapy, Infusions, Intravenous, Overweight, Pediatric Obesity, Clinical Trials as Topic
Abstract

BACKGROUND AND OBJECTIVES: The Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in Diabetic Ketoacidosis (DKA) (FLUID) Trial found that rapid fluid infusion does not increase the risk of cerebral injury. Concern persists, however, whether fluid rates should be adjusted for overweight or obese patients. We used the FLUID Trial database to evaluate associations between fluid infusion rate and outcomes in these patients. METHODS: We compared children and youth who were overweight, obese, or normal weight, in regard to protocol adherence, mental status changes, time to DKA resolution, and electrolyte abnormalities. We investigated associations between outcomes and the amount of fluid received in these groups. RESULTS: Obese children and youth were more likely to receive fluids at rates slower than dictated by protocol. Overweight and obese children and youth in the fast fluid arms, who received fluids per the study protocol based on their measured weight, had similar rates of mental status changes or clinically apparent cerebral injury as those with normal weights. Risk of hypophosphatemia was increased in those receiving larger initial bolus volumes and reduced in those receiving higher rehydration rates. No other metabolic outcomes were associated with rehydration. CONCLUSIONS: Protocol adherence data in the FLUID Trial suggest that physicians are uncomfortable using weight-based fluid calculations for overweight or obese children. However, higher rates of fluid infusion were not associated with increased risk of mental status changes or cerebral injury, suggesting that physicians should not limit fluid resuscitation in obese children and youth with DKA.

Published
2023

6. Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis.

Author

Trainor, Jennifer, Glaser, Nicole, Tzimenatos, Leah, Stoner, Michael, Brown, Kathleen, McManemy, Julie, Schunk, Jeffrey, Quayle, Kimberly, Nigrovic, Lise, Rewers, Arleta, Myers, Sage, Bennett, Jonathan, Kwok, Maria, Olsen, Cody, Casper, T, Ghetti, Simona, and Kuppermann, Nathan

Subjects
Child, Humans, Diabetic Ketoacidosis, Dehydration, Cohort Studies, Fluid Therapy, Hypertension, Retrospective Studies, Diabetes Mellitus
Abstract

STUDY OBJECTIVE: Our primary objective was to characterize the degree of dehydration in children with diabetic ketoacidosis (DKA) and identify physical examination and biochemical factors associated with dehydration severity. Secondary objectives included describing relationships between dehydration severity and other clinical outcomes. METHODS: In this cohort study, we analyzed data from 753 children with 811 episodes of DKA in the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation Study, a randomized clinical trial of fluid resuscitation protocols for children with DKA. We used multivariable regression analyses to identify physical examination and biochemical factors associated with dehydration severity, and we described associations between dehydration severity and DKA outcomes. RESULTS: Mean dehydration was 5.7% (SD 3.6%). Mild (0 to

Published
2023

9. Cognitive function following diabetic ketoacidosis in young children with type 1 diabetes

Author

Ghetti, Simona, Kuppermann, Nathan, Rewers, Arleta, Myers, Sage R, Schunk, Jeff E, Stoner, Michael J, Garro, Aris, Quayle, Kimberly S, Brown, Kathleen M, Trainor, Jennifer L, Tzimenatos, Leah, DePiero, Andrew D, McManemy, Julie K, Nigrovic, Lise E, Kwok, Maria Y, Olsen, Cody S, Casper, T Charles, Glaser, Nicole S, Lewis, Roger, Blumer, Jeffrey, Bremer, Andrew, Cook, Thomas, Slomine, Beth, Meert, Kathleen, Zimmerman, Jerry, and Hickey, Robert

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Trials and Supportive Activities, Diabetes, Prevention, Pediatric, Clinical Research, Autoimmune Disease, Pediatric Research Initiative, Metabolic and endocrine, Humans, Child, Preschool, Infant, Diabetes Mellitus, Type 1, Diabetic Ketoacidosis, Cognition, Cognitive Dysfunction, cognitive function, diabetic ketoacidosis, early childhood, intelligence, type 1 diabetes, Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group, Clinical sciences
Abstract

IntroductionYoung children with type 1 diabetes (T1D) may be at particularly high risk of cognitive decline following diabetic ketoacidosis (DKA). However, studies of cognitive functioning in T1D typically examine school-age children. The goal of this study was to examine whether a single experience of DKA is associated with lower cognitive functioning in young children. We found that recently diagnosed 3- to 5-year-olds who experienced one DKA episode, regardless of its severity, exhibited lower IQ scores than those with no DKA exposure.MethodsWe prospectively enrolled 46 3- to 5-year-old children, who presented with DKA at the onset of T1D, in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 22 children and mild in 24 children. Neurocognitive function was assessed once 2-6 months after the DKA episode. A comparison group of 27 children with T1D, but no DKA exposure, was also assessed. Patient groups were matched for age and T1D duration at the time of neurocognitive testing.ResultsChildren who experienced DKA, regardless of its severity, exhibited significantly lower IQ scores than children who did not experience DKA, F(2, 70) = 6.26, p = .003, partial η2  = .15. This effect persisted after accounting for socioeconomic status and ethnicity.ConclusionsA single DKA episode is associated with lower IQ scores soon after exposure to DKA in young children.

Published
2023

10. Relationships among biochemical measures in children with diabetic ketoacidosis

Author

Glaser, Nicole S, Stoner, Michael J, Kwok, Maria Y, Quayle, Kimberly S, Brown, Kathleen M, Schunk, Jeff E, Trainor, Jennifer L, McManemy, Julie K, Tzimenatos, Leah, Rewers, Arleta, Nigrovic, Lise E, Bennett, Jonathan E, Myers, Sage R, Smith, McKenna, Casper, T Charles, and Kuppermann, Nathan

Subjects
Diabetes, Pediatric, Humans, Child, Diabetic Ketoacidosis, Blood Glucose, Glucose, Glomerular Filtration Rate, Diabetes Mellitus, acid-base balance, diabetes, diabetic ketoacidosis, electrolytes, Paediatrics and Reproductive Medicine, Endocrinology & Metabolism
Abstract

ObjectivesInvestigating empirical relationships among laboratory measures in children with diabetic ketoacidosis (DKA) can provide insights into physiological alterations occurring during DKA. We determined whether alterations in laboratory measures during DKA conform to theoretical predictions.MethodsWe used Pearson correlation statistics and linear regression to investigate correlations between blood glucose, electrolytes, pH and PCO2 at emergency department presentation in 1,681 pediatric DKA episodes. Among children with repeat DKA episodes, we also assessed correlations between laboratory measures at the first vs. second episode.ResultspH and bicarbonate levels were strongly correlated (r=0.64), however, pH and PCO2 were only loosely correlated (r=0.17). Glucose levels were correlated with indicators of dehydration and kidney function (blood urea nitrogen (BUN), r=0.44; creatinine, r=0.42; glucose-corrected sodium, r=0.32). Among children with repeat DKA episodes, PCO2 levels tended to be similar at the first vs. second episode (r=0.34), although pH levels were only loosely correlated (r=0.19).ConclusionsElevated glucose levels at DKA presentation largely reflect alterations in glomerular filtration rate. pH and PCO2 are weakly correlated suggesting that respiratory responses to acidosis vary among individuals and may be influenced by pulmonary and central nervous system effects of DKA.

Published
2023

11. Impact of the COVID-19 pandemic on pediatric faculty: a report from nine academic institutions

Author

O’Connor, Teresia M., Guaman, Milenka Cuevas, Randell, Kimberly A., Keenan, Heather T., Snowden, Jessica, Mack, Jennifer W., Camp, Elizabeth A., Perez, Oriana, Chang, Michael L., Myers, Angela L., Nigrovic, Lise E., O’Toole, Jennifer, Reed, Jennifer L., Reese, Jennifer, Rosenberg, Abby R., Slater, Anne C., Wootton, Susan H., Ziniel, Sonja I., Yost, H. Joseph, Murray, Kristy O., Shekerdemian, Lara, and Chumpitazi, Corrie E.

Published
2024
Full Text
View/download PDF

13. Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results.

Author

Cruz, Andrea, Vitale, Melissa, Powell, Elizabeth, Leetch, Aaron, Pickett, Michelle, Brayer, Anne, Nigrovic, Lise, Dayan, Peter, Atabaki, Shireen, Ruddy, Richard, Rogers, Alexander, Greenberg, Richard, Alpern, Elizabeth, Tunik, Michael, Saunders, Mary, Muenzer, Jared, Levine, Deborah, Hoyle, John, Lillis, Kathleen, Gattu, Rajender, Crain, Ellen, Borgialli, Dominic, Bonsu, Bema, Blumberg, Stephen, Anders, Jennifer, Roosevelt, Genie, Browne, Lorin, Cohen, Daniel, Linakis, James, Jaffe, David, Bennett, Jonathan, Schnadower, David, Park, Grace, Mistry, Rakesh, Glissmeyer, Eric, Cator, Allison, Bogie, Amanda, Quayle, Kimberly, Ellison, Angela, Balamuth, Fran, Richards, Rachel, Ramilo, Octavio, Mahajan, Prashant, VanBuren, John, Kuppermann, Nathan, and Tzimenatos, Leah

Subjects
Bacteremia, Bacterial Infections, Child, Fever, Humans, Infant, Meningitis, Bacterial, Procalcitonin, Urinalysis, Urinary Tract Infections
Abstract

UNLABELLED: It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require routine lumbar punctures for evaluation of bacterial meningitis. OBJECTIVE: To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. METHODS: Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. RESULTS: Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count

Published
2022

14. Interleukin (IL)-1/IL-6-Inhibitor–Associated Drug Reaction With Eosinophilia and Systemic Symptoms (DReSS) in Systemic Inflammatory Illnesses

Author

Aamir, R., Abulaban, K., Adams, A., Lapsia, C. Aguiar, Akinsete, A., Akoghlanian, S., Al Manaa, M., AlBijadi, A., Allenspach, E., Almutairi, A., Alperin, R., Amarilyo, G., Ambler, W., Amoruso, M., Angeles-Han, S., Ardoin, S., Armendariz, S., Asfaw, L., Aviran Dagan, N., Bacha, C., Balboni, I., Balevic, S., Ballinger, S., Baluta, S., Barillas-Arias, L., Basiaga, M., Baszis, K., Baxter, S., Becker, M., Begezda, A., Behrens, E., Beil, E., Benseler, S., Bermudez-Santiago, L., Bernal, W., Bigley, T., Bingham, C., Binstadt, B., Black, C., Blackmon, B., Blakley, M., Bohnsack, J., Boneparth, A., Bradfield, H., Bridges, J., Brooks, E., Brothers, M., Brunner, H., Buckley, L., Buckley, M., Bukulmez, H., Bullock, D., Canna, S., Cannon, L., Canny, S., Cartwright, V., Cassidy, E., Castro, D., Chalom, E., Chang, J., Chang, M., Chang-Hoftman, A., Chen, A., Chiraseveenuprapund, P., Ciaglia, K., Co, D., Cohen, E., Collinge, J., Conlon, H., Connor, R., Cook, K., Cooper, A., Cooper, J., Corbin, K., Correll, C., Cron, R., Curry, M., Dalrymple, A., Datyner, E., Davis, T., De Ranieri, D., Dean, J., DeCoste, C., Dedeoglu, F., DeGuzman, M., Delnay, N., DeSantis, E., Devine, R., Dhalla, M., Dhanrajani, A., Dissanayake, D., Dizon, B., Drapeau, N., Drew, J., Driest, K., Du, Q., Duncan, E., Dunnock, K., Durkee, D., Dvergsten, J., Eberhard, A., Ede, K., Edelheit, B., Edens, C., El Tal, T., Elder, M., Elzaki, Y., Fadrhonc, S., Failing, C., Fair, D., Favier, L., Feldman, B., Fennell, J., Ferguson, P., Ferguson, I., Figueroa, C., Flanagan, E., Fogel, L., Fox, E., Fox, M., Franklin, L., Fuhlbrigge, R., Fuller, J., Furey, M., Futch-West, T., Gagne, S., Gennaro, V., Gerstbacher, D., Gilbert, M., Gironella, A., Glaser, D., Goh, I., Goldsmith, D., Gorry, S., Goswami, N., Gottlieb, B., Graham, T., Grevich, S., Griffin, T., Grim, A., Grom, A., Guevara, M., Hahn, T., Halyabar, O., Hamda Natur, M., Hammelev, E., Hammond, T., Harel, L., Harris, J., Harry, O., Hausmann, J., Hay, A., Hays, K., Hayward, K., Henderson, L., Henrickson, M., Hersh, A., Hickey, K., Hiraki, L., Hiskey, M., Hobday, P., Hoffart, C., Holland, M., Hollander, M., Hong, S., Horton, D., Horwitz, M., Hsu, J., Huber, A., Huberts, A., Huggins, J., Huie, L., Hui-Yuen, J., Ibarra, M., Imlay, A., Imundo, L., Inman, C., Jackson, A., James, K., Janow, G., Jared, S., Jiang, Y., Johnson, L., Johnson, N., Jones, J., Kafisheh, D., Kahn, P., Kaidar, K., Kasinathan, S., Kaur, R., Kessler, E., Kienzle, B., Kim, S., Kimura, Y., Kingsbury, D., Kitcharoensakkul, M., Klausmeier, T., Klein, K., Klein-Gitelman, M., Knight, A., Kovalick, L., Kramer, S., Kremer, C., Kudas, O., LaFlam, T., Lang, B., Lapidus, S., Lapin, B., Lasky, A., Lawler, C., Lawson, E., Laxer, R., Lee, P., Lee, T., Lee, A., Leisinger, E., Lentini, L., Lerman, M., Levinsky, Y., Levy, D., Li, S., Lieberman, S., Lim, L., Limenis, E., Lin, C., Ling, N., Lionetti, G., Livny, R., Lloyd, M., Lo, M., Long, A., Lopez-Peña, M., Lovell, D., Luca, N., Lvovich, S., Lytch, A., Ma, M., Machado, A., MacMahon, J., Madison, J., Mannion, M., Manos, C., Mansfield, L., Marston, B., Mason, T., Matchett, D., McAllister, L., McBrearty, K., McColl, J., McCurdy, D., McDaniels, K., McDonald, J., Meidan, E., Mellins, E., Mian, Z., Miettunen, P., Miller, M., Milojevic, D., Mitacek, R., Modica, R., Mohan, S., Moore, T., Moore, K., Moorthy, L., Moreno, J., Morgan, E., Moyer, A., Murante, B., Murphy, A., Muscal, E., Mwizerwa, O., Najafi, A., Nanda, K., Nasah, N., Nassi, L., Nativ, S., Natter, M., Nearanz, K., Neely, J., Newhall, L., Nguyen, A., Nigrovic, P., Nocton, J., Nolan, B., Nowicki, K., Oakes, R., Oberle, E., Ogbonnaya-Whittesley, S., Ogbu, E., Oliver, M., Olveda, R., Onel, K., Orandi, A., Padam, J., Paller, A., Pan, N., Pandya, J., Panupattanapong, S., Toledano, A. Pappo, Parsons, A., Patel, J., Patel, P., Patrick, A., Patrizi, S., Paul, S., Perfetto, J., Perron, M., Peskin, M., Ponder, L., Pooni, R., Prahalad, S., Puplava, B., Quinlan-Waters, M., Rabinovich, C., Rafko, J., Rahimi, H., Rampone, K., Ramsey, S., Randell, R., Ray, L., Reed, A., Reid, H., Reiff, D., Richins, S., Riebschleger, M., Rife, E., Riordan, M., Riskalla, M., Robinson, A., Robinson, L., Rodgers, L., Rodriquez, M., Rogers, D., Ronis, T., Rosado, A., Rosenkranz, M., Rosenwasser, N., Rothermel, H., Rothman, D., Rothschild, E., Roth-Wojcicki, E., Rouster-Stevens, K., Rubinstein, T., Rupp, J., Ruth, N., Sabbagh, S., Sadun, R., Santiago, L., Saper, V., Sarkissian, A., Scalzi, L., Schahn, J., Schikler, K., Schlefman, A., Schmeling, H., Schmitt, E., Schneider, R., Schulert, G., Schultz, K., Schutt, C., Seper, C., Sheets, R., Shehab, A., Shenoi, S., Sherman, M., Shirley, J., Shishov, M., Siegel, D., Singer, N., Sivaraman, V., Sloan, E., Smith, C., Smith, J., Smitherman, E., Soep, J., Son, Mary B., Sosna, D., Spencer, C., Spiegel, L., Spitznagle, J., Srinivasalu, H., Stapp, H., Steigerwald, K., Stephens, A., Sterba Rakovchik, Y., Stern, S., Stevens, B., Stevenson, R., Stewart, K., Stewart, W., Stingl, C., Stoll, M., Stringer, E., Sule, S., Sullivan, J., Sundel, R., Sutter, M., Swaffar, C., Swayne, N., Syed, R., Symington, T., Syverson, G., Szymanski, A., Taber, S., Tal, R., Tambralli, A., Taneja, A., Tanner, T., Tarvin, S., Tate, L., Taxter, A., Taylor, J., Tesher, M., Thakurdeen, T., Theisen, A., Thomas, B., Thomas, L., Thomas, N., Ting, T., Todd, C., Toib, D., Torok, K., Tory, H., Toth, M., Tse, S., Tsin, C., Twachtman-Bassett, J., Twilt, M., Valcarcel, T., Valdovinos, R., Vallee, A., Van Mater, H., Vandenbergen, S., Vannoy, L., Varghese, C., Vasquez, N., Vega-Fernandez, P., Velez, J., Verbsky, J., Verstegen, R., von Scheven, E., Vora, S., Wagner-Weiner, L., Wahezi, D., Waite, H., Walker, B., Walters, H., Waterfield, M., Waters, A., Weiser, P., Weiss, P., Weiss, J., Wershba, E., Westheuser, V., White, A., Widrick, K., Williams, C., Wong, S., Woolnough, L., Wright, T., Wu, E., Yalcindag, A., Yasin, S., Yeung, R., Yomogida, K., Zeft, A., Zhang, Y., Zhao, Y., Zhu, A., Saper, Vivian E., Tian, Lu, Verstegen, Ruud H.J., Conrad, Carol K., Cidon, Michal, Hopper, Rachel K., Kuo, Christin S., Osoegawa, Kazutoyo, Baszis, Kevin, Bingham, Catherine A., Ferguson, Ian, Hahn, Timothy, Horne, Annacarin, Isupova, Eugenia A., Jones, Jordan T., Kasapcopur, Özgür, Klein-Gitelman, Marisa S., Kostik, Mikhail M., Ozen, Seza, Phadke, Omkar, Prahalad, Sampath, Randell, Rachel L., Sener, Seher, Stingl, Cory, Abdul-Aziz, Rabheh, Akoghlanian, Shoghik, Al Julandani, Dalila, Alvarez, Marcela B., Bader-Meunier, Brigitte, Balay-Dustrude, Erin E., Balboni, Imelda, Baxter, Sarah K., Berard, Roberta A., Bhattad, Sagar, Bolaria, Roxana, Boneparth, Alexis, Cassidy, Elaine A., Co, Dominic O., Collins, Kathleen P., Dancey, Paul, Dickinson, Aileen M., Edelheit, Barbara S., Espada, Graciela, Flanagan, Elaine R., Imundo, Lisa F., Jindal, Ankur K., Kim, Hyoun-Ah, Klaus, Günter, Lake, Carol, Lapin, W. Blaine, Lawson, Erica F., Marmor, Itay, Mombourquette, Joy, Ogunjimi, Benson, Olveda, Rebecca, Ombrello, Michael J., Onel, Karen, Poholek, Catherine, Ramanan, Athimalaipet V., Ravelli, Angelo, Reinhardt, Adam, Robinson, Amanda D., Rouster-Stevens, Kelly, Saad, Nadine, Schneider, Rayfel, Selmanovic, Velma, Sefic Pasic, Irmina, Shenoi, Susan, Shilo, Natalie R., Soep, Jennifer B., Sura, Angeli, Taber, Sarah F., Tesher, Melissa, Tibaldi, Jessica, Torok, Kathryn S., Tsin, Cathy Mei, Vasquez-Canizares, Natalia, Villacis Nunez, Diana S., Way, Emily E., Whitehead, Benjamin, Zemel, Lawrence S., Sharma, Surbhi, Fernández-Viña, Marcelo A., and Mellins, Elizabeth D.

Published
2024
Full Text
View/download PDF

17. Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis.

Author

Rewers, Arleta, Kuppermann, Nathan, Stoner, Michael J, Garro, Aris, Bennett, Jonathan E, Quayle, Kimberly S, Schunk, Jeffrey E, Myers, Sage R, McManemy, Julie K, Nigrovic, Lise E, Trainor, Jennifer L, Tzimenatos, Leah, Kwok, Maria Y, Brown, Kathleen M, Olsen, Cody S, Casper, T Charles, Ghetti, Simona, Glaser, Nicole S, and Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group

Subjects
Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group, Humans, Acidosis, Diabetic Ketoacidosis, Electrolytes, Sodium, Fluid Therapy, Adolescent, Child, Clinical Research, Pediatric, Clinical Trials and Supportive Activities, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Medical and Health Sciences, Endocrinology & Metabolism
Abstract

ObjectiveFluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment.Research design and methodsThe current analysis involved moderate or severe DKA episodes (n = 714) in children age

Published
2021

18. Genome editing to define the function of risk loci and variants in rheumatic disease

Author

Baglaenko, Yuriy, Macfarlane, Dana, Marson, Alexander, Nigrovic, Peter A, and Raychaudhuri, Soumya

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Arthritis, Biotechnology, Genetics, Autoimmune Disease, Human Genome, 2.1 Biological and endogenous factors, Generic health relevance, Inflammatory and immune system, Alleles, Animals, Gene Editing, Genetic Loci, Genetic Predisposition to Disease, Genetic Variation, Humans, Rheumatic Diseases, Risk Factors, Clinical sciences
Abstract

Discoveries in human genetic studies have revolutionized our understanding of complex rheumatic and autoimmune diseases, including the identification of hundreds of genetic loci and single nucleotide polymorphisms that potentially predispose individuals to disease. However, in most cases, the exact disease-causing variants and their mechanisms of action remain unresolved. Functional follow-up of these findings is most challenging for genomic variants that are in non-coding genomic regions, where the large majority of common disease-associated variants are located, and/or that probably affect disease progression via cell type-specific gene regulation. To deliver on the therapeutic promise of human genetic studies, defining the mechanisms of action of these alleles is essential. Genome editing technology, such as CRISPR-Cas, has created a vast toolbox for targeted genetic and epigenetic modifications that presents unprecedented opportunities to decipher disease-causing loci, genes and variants in autoimmunity. In this Review, we discuss the past 5-10 years of progress in resolving the mechanisms underlying rheumatic disease-associated alleles, with an emphasis on how genomic editing techniques can enable targeted dissection and mechanistic studies of causal autoimmune risk variants.

Published
2021

19. The Pediatric Emergency Research Network

Author

Klassen, Terry, Dalziel, Stuart R, Babl, Franz E, Benito, Javier, Bressan, Silvia, Chamberlain, James, Chang, Todd P, Freedman, Stephen B, Kohn-Loncarica, Guillermo, Lyttle, Mark D, Mintegi, Santiago, Mistry, Rakesh D, Nigrovic, Lise E, Oostenbrink, Rianne, Plint, Amy C, Rino, Pedro, Roland, Damian, Van De Mosselaer, Gregory, and Kuppermann, Nathan

Subjects
Clinical Trials and Supportive Activities, Clinical Research, Pediatric, Infectious Diseases, Generic health relevance, Child, Emergency Medical Services, Emergency Medicine, Health Promotion, Health Services Research, Humans, International Cooperation, Pediatrics, multicenter randomized controlled trials, implementation, health care disparities, health equity, Paediatrics and Reproductive Medicine, Emergency & Critical Care Medicine
Abstract

ObjectivesThe Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent for existing national and regional research networks in pediatric emergency care to organize globally for the conduct of collaborative research across networks.MethodsThe Pediatric Emergency Research Network has grown from 5- to 8-member networks over the past decade. With an executive committee comprising representatives from all member networks, PERN plays a supportive and collaborative rather than governing role. The full impact of PERN's facilitation of international collaborative research, although somewhat difficult to quantify empirically, can be measured indirectly by the observed growth of the field, the nature of the increasingly challenging research questions now being addressed, and the collective capacity to generate and implement new knowledge in treating acutely ill and injured children.ResultsBeginning as a pandemic response with a high-quality retrospective case-controlled study of H1N1 influenza risk factors, PERN research has progressed to multiple observational studies and ongoing global randomized controlled trials. As a recent example, PERN has developed sufficient network infrastructure to enable the rapid initiation of a prospective observational study in response to the current coronavirus disease 2019 pandemic. In light of the ongoing need for translation of research knowledge into equitable clinical practice and to promote health equity, PERN is committed to a coordinated international effort to increase the uptake of evidence-based management of common and treatable acute conditions in all emergency department settings.ConclusionsThe Pediatric Emergency Research Network's successes with global research, measured by prospective observational and interventional studies, mean that the network can now move to improve its ability to promote the implementation of scientific advances into everyday clinical practice. Achieving this goal will involve focus in 4 areas: (1) expanding the capacity for global randomized controlled trials; (2) deepening the focus on implementation science; (3) increasing attention to healthcare disparities and their origins, with growing momentum toward equity; and (4) expanding PERN's global reach through addition of sites and networks from resource-restricted regions. Through these actions, PERN will be able to build on successes to face the challenges ahead and meet the needs of acutely ill and injured children throughout the world.

Published
2021

20. Cognitive Function Following Diabetic Ketoacidosis in Children With New-Onset or Previously Diagnosed Type 1 Diabetes.

Author

Ghetti, Simona, Kuppermann, Nathan, Rewers, Arleta, Myers, Sage R, Schunk, Jeff E, Stoner, Michael J, Garro, Aris, Quayle, Kimberly S, Brown, Kathleen M, Trainor, Jennifer L, Tzimenatos, Leah, DePiero, Andrew D, McManemy, Julie K, Nigrovic, Lise E, Kwok, Maria Y, Perry, Clinton S, Olsen, Cody S, Casper, T Charles, Glaser, Nicole S, and Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group

Subjects
Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group, Humans, Diabetic Ketoacidosis, Diabetes Mellitus, Type 1, Hyperglycemia, Hypoglycemia, Fluid Therapy, Severity of Illness Index, Cognition, Memory, Adolescent, Child, Female, Male, Mental Status and Dementia Tests, Glycemic Control, Clinical Trials and Supportive Activities, Diabetes, Clinical Research, Pediatric, Prevention, Metabolic and endocrine, Medical and Health Sciences, Endocrinology & Metabolism
Abstract

ObjectiveThis study assessed whether a single diabetic ketoacidosis (DKA) episode is associated with cognitive declines in children with newly diagnosed type 1 diabetes and whether the same is true in children who had previously been diagnosed after accounting for variations in glycemic control and other relevant factors.Research design and methodsWe prospectively enrolled 758 children, 6-18 years old, who presented with DKA in a randomized multisite clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 430 children and mild in 328 children. A total of 392 children with DKA had new onset of type 1 diabetes, and the rest were previously diagnosed. Neurocognitive assessment occurred 2-6 months after the DKA episode. A comparison group of 376 children with type 1 diabetes, but no DKA exposure, was also enrolled.ResultsAmong all patients, moderate/severe DKA was associated with lower intelligence quotient (IQ) (β = -0.12, P < 0.001), item-color recall (β = -0.08, P = 0.010), and forward digit span (β = -0.06, P = 0.04). Among newly diagnosed patients, moderate/severe DKA was associated with lower item-color recall (β = -0.08, P = 0.04). Among previously diagnosed patients, repeated DKA exposure and higher HbA1c were independently associated with lower IQ (β = -0.10 and β = -0.09, respectively, P < 0.01) and higher HbA1c was associated with lower item-color recall (β = -0.10, P = 0.007) after hypoglycemia, diabetes duration, and socioeconomic status were accounted for.ConclusionsA single DKA episode is associated with subtle memory declines soon after type 1 diabetes diagnosis. Sizable IQ declines are detectable in children with known diabetes, suggesting that DKA effects may be exacerbated in children with chronic exposure to hyperglycemia.

Published
2020

21. Time to Positive Blood and Cerebrospinal Fluid Cultures in Febrile Infants ≤60 Days of Age

Author

Alpern, Elizabeth R, Kuppermann, Nathan, Blumberg, Stephen, Roosevelt, Genie, Cruz, Andrea T, Nigrovic, Lise E, Browne, Lorin R, VanBuren, John M, Ramilo, Octavio, and Mahajan, Prashant

Subjects
Health Services and Systems, Health Sciences, Infectious Diseases, Pediatric, Clinical Research, Infection, Anti-Bacterial Agents, Blood Culture, Cohort Studies, Fever, Humans, Infant, Retrospective Studies, PEDIATRIC EMERGENCY CARE APPLIED RESEARCH NETWORK, Clinical Sciences, Public Health and Health Services, Health services and systems
Abstract

ObjectivesTo determine the time to positivity for bacterial pathogens and contaminants in blood and cerebrospinal fluid (CSF) cultures in a cohort of febrile infants ≤60 days of age.MethodsThis was a secondary analysis of prospective observational multicenter study of noncritically ill infants ≤60 days of age with temperatures ≥38°C and blood cultures (December 2008 to May 2013). The main outcome was time to positivity for bacterial pathogens and contaminants.ResultsA total of 256 of 303 (84.49%) patients with positive blood cultures, and 73 of 88 (82.95%) with positive CSF cultures met inclusion criteria. Median time (interquartile range [IQR]) to positivity for blood cultures was 16.6 hours (IQR 12.6-21.9) for bacterial pathogens (n = 74) and 25.1 hours (IQR 19.8-33.0) for contaminants (n = 182); P < .001. Time to bacterial pathogen positivity was similar in infants 0 to 28 days of age (15.8 hours [IQR 12.6-21.0]) and 29 to 60 days of age (17.2 [IQR 12.9-24.3]; P = .328). Median time to positivity for CSF was 14.0 hours (IQR 1.5-21.0) for bacterial pathogens (n = 22) and 40.5 hours (IQR 21.2-62.6) for contaminants (n = 51); P < .001. A total of 82.4% (95% confidence interval, 71.8-90.3) and 81.8% (95% confidence interval, 59.7%-94.8%) of blood and CSF cultures showed bacterial pathogen positivity within 24 hours.ConclusionsAmong febrile infants ≤60 days of age, time to blood and CSF positivity was significantly shorter for bacterial pathogens than contaminants. Most blood and CSF cultures for bacterial pathogens were positive within 24 hours. With our findings, there is potential to reduce duration of hospitalization and avoid unnecessary antibiotics.

Published
2020

22. Hypertension during Diabetic Ketoacidosis in Children

Author

DePiero, Andrew, Kuppermann, Nathan, Brown, Kathleen M, Schunk, Jeff E, McManemy, Julie K, Rewers, Arleta, Stoner, Michael J, Tzimenatos, Leah, Garro, Aris, Myers, Sage R, Quayle, Kimberly S, Trainor, Jennifer L, Kwok, Maria Y, Nigrovic, Lise E, Olsen, Cody S, Casper, T Charles, Ghetti, Simona, Glaser, Nicole S, and Group, for the Pediatric Emergency Care Applied Research Network DKA FLUID Study

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Hypertension, Cardiovascular, Pediatric, Clinical Research, Blood Pressure, Child, Diabetic Ketoacidosis, Emergencies, Emergency Service, Hospital, Female, Fluid Therapy, Humans, Male, Prognosis, Risk Factors, Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group, Human Movement and Sports Sciences, Paediatrics and Reproductive Medicine, Pediatrics, Paediatrics
Abstract

ObjectivesTo characterize hemodynamic alterations occurring during diabetic ketoacidosis (DKA) in a large cohort of children and to identify clinical and biochemical factors associated with hypertension.Study designThis was a planned secondary analysis of data from the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in DKA Study, a randomized clinical trial of fluid resuscitation protocols for children in DKA. Hemodynamic data (heart rate, blood pressure) from children with DKA were assessed in comparison with normal values for age and sex. Multivariable statistical modeling was used to explore clinical and laboratory predictors of hypertension.ResultsAmong 1258 DKA episodes, hypertension was documented at presentation in 154 (12.2%) and developed during DKA treatment in an additional 196 (15.6%), resulting in a total of 350 DKA episodes (27.8%) in which hypertension occurred at some time. Factors associated with hypertension at presentation included more severe acidosis, (lower pH and lower pCO2), and stage 2 or 3 acute kidney injury. More severe acidosis and lower Glasgow Coma Scale scores were associated with hypertension occurring at any time during DKA treatment.ConclusionsDespite dehydration, hypertension occurs in a substantial number of children with DKA. Factors associated with hypertension include greater severity of acidosis, lower pCO2, and lower Glasgow Coma Scale scores during DKA treatment, suggesting that hypertension might be centrally mediated.

Published
2020

23. Provider-Level and Hospital-Level Factors and Process Measures of Quality Care Delivered in Pediatric Emergency Departments.

Author

Marcin, James P, Romano, Patrick S, Dayal, Parul, Dharmar, Madan, Chamberlain, James M, Dudley, Nanette, Macias, Charles G, Nigrovic, Lise E, Powell, Elizabeth C, Rogers, Alexander J, Sonnett, Meridith, Tzimenatos, Leah, Alpern, Elizabeth R, Andrews-Dickert, Rebecca, Borgialli, Dominic A, Sidney, Erika, Casper, T Charles, Kuppermann, Nathan, and Pediatric Emergency Care Applied Research Network

Subjects
Pediatric Emergency Care Applied Research Network, Humans, Adolescent, Child, Emergency Service, Hospital, Hospitals, Pediatric, Emergency Medical Services, Quality of Health Care, Process Assessment, Health Care, emergency care, pediatrics, quality of care, Pediatric, Emergency Care, Health Services, Clinical Research, Health and social care services research, 8.1 Organisation and delivery of services, Generic health relevance, Paediatrics and Reproductive Medicine, Pediatrics
Abstract

ObjectiveDifferences in the quality of emergency department (ED) care are often attributed to nonclinical factors such as variations in the structure, systems, and processes of care. Few studies have examined these associations among children. We aimed to determine whether process measures of quality of care delivered to patients receiving care in children's hospital EDs were associated with physician-level or hospital-level factors.MethodsWe included children (

Published
2020

24. What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial

Author

Skains, Rachel M, Kuppermann, Nathan, Homme, James L, Kharbanda, Anupam B, Tzimenatos, Leah, Louie, Jeffrey P, Cohen, Daniel M, Nigrovic, Lise E, Westphal, Jessica J, Shah, Nilay D, Inselman, Jonathan, Ferrara, Michael J, Herrin, Jeph, Montori, Victor M, and Hess, Erik P

Subjects
Health Services and Systems, Health Sciences, Behavioral and Social Science, Clinical Trials and Supportive Activities, Patient Safety, Clinical Research, Adolescent, Brain Injuries, Traumatic, Child, Child, Preschool, Decision Support Techniques, Ethnicity, Female, Head, Health Literacy, Humans, Infant, Infant, Newborn, Male, Parents, Patient Participation, Risk Factors, Tomography, X-Ray Computed, Trust, Vulnerable Populations, decision aid, head trauma, paediatrics, shared decision making, Nursing, Public Health and Health Services, Psychology, Public Health, Health services and systems, Public health
Abstract

ObjectiveTo test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust.MethodsThis was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy-two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site.ResultsThe decision aid did not increase knowledge more in parents with high numeracy (P for interaction [Pint ] = 0.14) or physician trust more in parents with low health literacy (Pint  = 0.34). The decision aid decreased decisional conflict more in non-white parents (decisional conflict scale, -8.14, 95% CI: -12.33 to -3.95; Pint  = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35-14.83; Pint  = 0.04).ConclusionsUse of the Head CT Choice decision aid resulted in less decisional conflict in non-white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents.

Published
2020

25. PD-1hi CXCR5- T peripheral helper cells promote B cells responses in lupus via MAF and IL-21

Author

Bocharnikov, Alexandra V, Keegan, Joshua, Wacleche, Vanessa S, Cao, Ye, Fonseka, Chamith Y, Wang, Guoxing, Muise, Eric S, Zhang, Kelvin X, Arazi, Arnon, Keras, Gregory, Li, Zhihan J, Qu, Yujie, Gurish, Michael F, Petri, Michelle, Buyon, Jill P, Putterman, Chaim, Wofsy, David, James, Judith A, Guthridge, Joel M, Diamond, Betty, Anolik, Jennifer H, Mackey, Matthew F, Alves, Stephen E, Nigrovic, Peter A, Costenbader, Karen H, Brenner, Michael B, Lederer, James A, and Rao, Deepak A

Subjects
Lupus, Kidney Disease, Autoimmune Disease, Clinical Research, Aetiology, 2.1 Biological and endogenous factors, Inflammatory and immune system, Adult, Aged, B-Lymphocytes, CD11c Antigen, CRISPR-Cas Systems, Case-Control Studies, Cell Communication, Cell Culture Techniques, Cell Separation, Cells, Cultured, Coculture Techniques, Female, Flow Cytometry, Gene Knockout Techniques, Humans, Interleukins, Lupus Erythematosus, Systemic, Lymphocyte Activation, Male, Middle Aged, Programmed Cell Death 1 Receptor, Proto-Oncogene Proteins c-maf, RNA-Seq, Receptors, CXCR5, T-Lymphocytes, Helper-Inducer, Accelerating Medicines Partnership (AMP) RA/SLE Network, Adaptive immunity, Autoimmunity, Immunology, T cells
Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by pathologic T cell-B cell interactions and autoantibody production. Defining the T cell populations that drive B cell responses in SLE may enable design of therapies that specifically target pathologic cell subsets. Here, we evaluated the phenotypes of CD4+ T cells in the circulation of 52 SLE patients drawn from multiple cohorts and identified a highly expanded PD-1hiCXCR5-CD4+ T cell population. Cytometric, transcriptomic, and functional assays demonstrated that PD-1hiCXCR5-CD4+ T cells from SLE patients are T peripheral helper (Tph) cells, a CXCR5- T cell population that stimulates B cell responses via IL-21. The frequency of Tph cells, but not T follicular helper (Tfh) cells, correlated with both clinical disease activity and the frequency of CD11c+ B cells in SLE patients. PD-1hiCD4+ T cells were found within lupus nephritis kidneys and correlated with B cell numbers in the kidney. Both IL-21 neutralization and CRISPR-mediated deletion of MAF abrogated the ability of Tph cells to induce memory B cell differentiation into plasmablasts in vitro. These findings identify Tph cells as a highly expanded T cell population in SLE and suggest a key role for Tph cells in stimulating pathologic B cell responses.

Published
2019

26. Early progression to active tuberculosis is a highly heritable trait driven by 3q23 in Peruvians

Author

Luo, Yang, Suliman, Sara, Asgari, Samira, Amariuta, Tiffany, Baglaenko, Yuriy, Martínez-Bonet, Marta, Ishigaki, Kazuyoshi, Gutierrez-Arcelus, Maria, Calderon, Roger, Lecca, Leonid, León, Segundo R, Jimenez, Judith, Yataco, Rosa, Contreras, Carmen, Galea, Jerome T, Becerra, Mercedes, Nejentsev, Sergey, Nigrovic, Peter A, Moody, D Branch, Murray, Megan B, and Raychaudhuri, Soumya

Subjects
Biological Sciences, Genetics, Prevention, Orphan Drug, Lung, Infectious Diseases, Rare Diseases, Tuberculosis, Vaccine Related, Human Genome, Aetiology, 2.1 Biological and endogenous factors, Infection, Good Health and Well Being, Adult, Disease Progression, Female, Gene Expression, Genetic Loci, Genome-Wide Association Study, Genotype, Humans, Male, Monocytes, Mycobacterium tuberculosis, Peru, Sodium-Potassium-Exchanging ATPase
Abstract

Of the 1.8 billion people worldwide infected with Mycobacterium tuberculosis, 5-15% will develop active tuberculosis (TB). Approximately half will progress to active TB within the first 18 months after infection, presumably because they fail to mount an effective initial immune response. Here, in a genome-wide genetic study of early TB progression, we genotype 4002 active TB cases and their household contacts in Peru. We quantify genetic heritability ([Formula: see text]) of early TB progression to be 21.2% (standard error 0.08). This suggests TB progression has a strong genetic basis, and is comparable to traits with well-established genetic bases. We identify a novel association between early TB progression and variants located in a putative enhancer region on chromosome 3q23 (rs73226617, OR = 1.18; P = 3.93 × 10-8). With in silico and in vitro analyses we identify rs73226617 or rs148722713 as the likely functional variant and ATP1B3 as a potential causal target gene with monocyte specific function.

Published
2019

27. Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis

Author

Aronson, Paul L, Cruz, Andrea T, Freedman, Stephen B, Balamuth, Fran, Grether‐Jones, Kendra L, Lyons, Todd W, Fleming, Alesia H, Louie, Jeffrey, Mistry, Rakesh D, Garro, Aris C, Shah, Samir S, Nigrovic, Lise E, and Group, Pediatric Emergency Medicine Clinical Research Network Herpes Simplex Virus Study

Subjects
Sexually Transmitted Infections, Perinatal Period - Conditions Originating in Perinatal Period, Brain Disorders, Clinical Research, Infectious Diseases, Neurosciences, Pediatric, Prevention, Infection, Emergency Service, Hospital, Female, Herpes Simplex, Hospitals, Humans, Infant, Infant, Newborn, Length of Stay, Male, Meningitis, Polymerase Chain Reaction, Pregnancy Complications, Infectious, Retrospective Studies, Simplexvirus, Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group, Clinical Sciences, General & Internal Medicine
Abstract

Although neonatal herpes simplex virus (HSV) causes significant morbidity, utilization of the cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) test remains variable. Our objective was to examine the association of CSF HSV PCR testing with length of stay (LOS) in a 20-center retrospective cohort of hospitalized infants aged ≤60 days undergoing evaluation for meningitis after adjustment for patient-level factors and clustering by center. Of 20,496 eligible infants, 7,399 (36.1%) had a CSF HSV PCR test performed, and 46 (0.6% of those tested) had a positive test. Infants who had a CSF HSV PCR test performed had a 23% longer hospital LOS (incident rate ratio 1.23; 95% CI: 1.14-1.33). Targeted CSF HSV PCR testing may mitigate the impact on LOS for low-risk infants.

Published
2019

28. Health Equity Implications of Missing Data Among Youths With Childhood‐Onset Systemic Lupus Erythematosus: A Proof‐of‐Concept Study in the Childhood Arthritis and Rheumatology Research Alliance Registry

Author

Woo, Jennifer M. P., Simmonds, Faith, Dennos, Anne, Son, Mary Beth F., Lewandowski, Laura B., Rubinstein, Tamar B., Abel, N., Abulaban, K., Adams, A., Adams, M., Agbayani, R., Aiello, J., Akoghlanian, S., Alejandro, C., Allenspach, E., Alperin, R., Alpizar, M., Amarilyo, G., Ambler, W., Anderson, E., Ardoin, S., Armendariz, S., Baker, E., Balboni, I., Balevic, S., Ballenger, L., Ballinger, S., Balmuri, N., Barbar‐Smiley, F., Barillas‐Arias, L., Basiaga, M., Baszis, K., Becker, M., Bell‐Brunson, H., Beltz, E., Benham, H., Benseler, S., Bernal, W., Beukelman, T., Bigley, T., Binstadt, B., Black, C., Blakley, M., Bohnsack, J., Boland, J., Boneparth, A., Bowman, S., Bracaglia, C., Brooks, E., Brothers, M., Brown, A., Brunner, H., Buckley, M., Buckley, M., Bukulmez, H., Bullock, D., Cameron, B., Canna, S., Cannon, L., Carper, P., Cartwright, V., Cassidy, E., Cerracchio, L., Chalom, E., Chang, J., Chang‐Hoftman, A., Chauhan, V., Chira, P., Chinn, T., Chundru, K., Clairman, H., Co, D., Confair, A., Conlon, H., Connor, R., Cooper, A., Cooper, J., Cooper, S., Correll, C., Corvalan, R., Costanzo, D., Cron, R., Curiel‐Duran, L., Curington, T., Curry, M., Dalrymple, A., Davis, A., Davis, C., Davis, C., Davis, T., De Benedetti, F., De Ranieri, D., Dean, J., Dedeoglu, F., DeGuzman, M., Delnay, N., Dempsey, V., DeSantis, E., Dickson, T., Dingle, J., Donaldson, B., Dorsey, E., Dover, S., Dowling, J., Drew, J., Driest, K., Du, Q., Duarte, K., Durkee, D., Duverger, E., Dvergsten, J., Eberhard, A., Eckert, M., Ede, K., Edelheit, B., Edens, C., Edens, C., Edgerly, Y., Elder, M., Ervin, B., Fadrhonc, S., Failing, C., Fair, D., Falcon, M., Favier, L., Federici, S., Feldman, B., Fennell, J., Ferguson, I., Ferguson, P., Ferreira, B., Ferrucho, R., Fields, K., Finkel, T., Fitzgerald, M., Fleming, C., Flynn, O., Fogel, L., Fox, E., Fox, M., Franco, L., Freeman, M., Fritz, K., Froese, S., Fuhlbrigge, R., Fuller, J., George, N., Gerhold, K., Gerstbacher, D., Gilbert, M., Gillispie‐Taylor, M., Giverc, E., Godiwala, C., Goh, I., Goheer, H., Goldsmith, D., Gotschlich, E., Gotte, A., Gottlieb, B., Gracia, C., Graham, T., Grevich, S., Griffin, T., Griswold, J., Grom, A., Guevara, M., Guittar, P., Guzman, M., Hager, M., Hahn, T., Halyabar, O., Hammelev, E., Hance, M., Hanson, A., Harel, L., Haro, S., Harris, J., Harry, O., Hartigan, E., Hausmann, J., Hay, A., Hayward, K., Heiart, J., Hekl, K., Henderson, L., Henrickson, M., Hersh, A., Hickey, K., Hill, P., Hillyer, S., Hiraki, L., Hiskey, M., Hobday, P., Hoffart, C., Holland, M., Hollander, M., Hong, S., Horwitz, M., Hsu, J., Huber, A., Huggins, J., Hui‐Yuen, J., Hung, C., Huntington, J., Huttenlocher, A., Ibarra, M., Imundo, L., Inman, C., Insalaco, A., Jackson, A., Jackson, S., James, K., Janow, G., Jaquith, J., Jared, S., Johnson, N., Jones, J., Jones, J., Jones, J., Jones, K., Jones, S., Joshi, S., Jung, L., Justice, C., Justiniano, A., Karan, N., Kaufman, K., Kemp, A., Kessler, E., Khalsa, U., Kienzle, B., Kim, S., Kimura, Y., Kingsbury, D., Kitcharoensakkul, M., Klausmeier, T., Klein, K., Klein‐Gitelman, M., Kompelien, B., Kosikowski, A., Kovalick, L., Kracker, J., Kramer, S., Kremer, C., Lai, J., Lam, J., Lang, B., Lapidus, S., Lapin, B., Lasky, A., Latham, D., Lawson, E., Laxer, R., Lee, P., Lee, P., Lee, T., Lentini, L., Lerman, M., Levy, D., Li, S., Lieberman, S., Lim, L., Lin, C., Ling, N., Lingis, M., Lo, M., Lovell, D., Lowman, D., Luca, N., Lvovich, S., Madison, C., Madison, J., Manzoni, S. Magni, Malla, B., Maller, J., Malloy, M., Mannion, M., Manos, C., Marques, L., Martyniuk, A., Mason, T., Mathus, S., McAllister, L., McCarthy, K., McConnell, K., McCormick, E., McCurdy, D., Stokes, P. McCurdy, McGuire, S., McHale, I., McMonagle, A., McMullen‐Jackson, C., Meidan, E., Mellins, E., Mendoza, E., Mercado, R., Merritt, A., Michalowski, L., Miettunen, P., Miller, M., Milojevic, D., Mirizio, E., Misajon, E., Mitchell, M., Modica, R., Mohan, S., Moore, K., Moorthy, L., Morgan, S., Dewitt, E. Morgan, Moss, C., Moussa, T., Mruk, V., Murphy, A., Muscal, E., Nadler, R., Nahal, B., Nanda, K., Nasah, N., Nassi, L., Nativ, S., Natter, M., Neely, J., Nelson, B., Newhall, L., Ng, L., Nicholas, J., Nicolai, R., Nigrovic, P., Nocton, J., Nolan, B., Oberle, E., Obispo, B., OʼBrien, B., OʼBrien, T., Okeke, O., Oliver, M., Olson, J., OʼNeil, K., Onel, K., Orandi, A., Orlando, M., Osei‐Onomah, S., Oz, R., Pagano, E., Paller, A., Pan, N., Panupattanapong, S., Pardeo, M., Paredes, J., Parsons, A., Patel, J., Pentakota, K., Pepmueller, P., Pfeiffer, T., Phillippi, K., Phillippi, K., Marafon, D. Pires, Ponder, L., Pooni, R., Prahalad, S., Pratt, S., Protopapas, S., Puplava, B., Quach, J., Quinlan‐Waters, M., Rabinovich, C., Radhakrishna, S., Rafko, J., Raisian, J., Rakestraw, A., Ramirez, C., Ramsay, E., Ramsey, S., Randell, R., Reed, A., Reed, A., Reed, A., Reid, H., Remmel, K., Repp, A., Reyes, A., Richmond, A., Riebschleger, M., Ringold, S., Riordan, M., Riskalla, M., Ritter, M., Rivas‐Chacon, R., Robinson, A., Rodela, E., Rodriquez, M., Rojas, K., Ronis, T., Rosenkranz, M., Rosolowski, B., Rothermel, H., Rothman, D., Roth‐Wojcicki, E., Rouster‐Stevens, K., Rubinstein, T., Ruth, N., Saad, N., Sabbagh, S., Sacco, E., Sadun, R., Sandborg, C., Sanni, A., Santiago, L., Sarkissian, A., Savani, S., Scalzi, L., Schanberg, L., Scharnhorst, S., Schikler, K., Schlefman, A., Schmeling, H., Schmidt, K., Schmitt, E., Schneider, R., Schollaert‐Fitch, K., Schulert, G., Seay, T., Seper, C., Shalen, J., Sheets, R., Shelly, A., Shenoi, S., Shergill, K., Shirley, J., Shishov, M., Shivers, C., Silverman, E., Singer, N., Sivaraman, V., Sletten, J., Smith, A., Smith, C., Smith, J., Smith, J., Smitherman, E., Soep, J., Son, M., Spence, S., Spiegel, L., Spitznagle, J., Sran, R., Srinivasalu, H., Stapp, H., Steigerwald, K., Rakovchik, Y. Sterba, Stern, S., Stevens, A., Stevens, B., Stevenson, R., Stewart, K., Stingl, C., Stokes, J., Stoll, M., Stringer, E., Sule, S., Sumner, J., Sundel, R., Sutter, M., Syed, R., Syverson, G., Szymanski, A., Taber, S., Tal, R., Tambralli, A., Taneja, A., Tanner, T., Tapani, S., Tarshish, G., Tarvin, S., Tate, L., Taxter, A., Taylor, J., Terry, M., Tesher, M., Thatayatikom, A., Thomas, B., Tiffany, K., Ting, T., Tipp, A., Toib, D., Torok, K., Toruner, C., Tory, H., Toth, M., Tse, S., Tubwell, V., Twilt, M., Uriguen, S., Valcarcel, T., Van Mater, H., Vannoy, L., Varghese, C., Vasquez, N., Vazzana, K., Vehe, R., Veiga, K., Velez, J., Verbsky, J., Vilar, G., Volpe, N., von Scheven, E., Vora, S., Wagner, J., Wagner‐Weiner, L., Wahezi, D., Waite, H., Walker, J., Walters, H., Muskardin, T. Wampler, Waqar, L., Waterfield, M., Watson, M., Watts, A., Weiser, P., Weiss, J., Weiss, P., Wershba, E., White, A., Williams, C., Wise, A., Woo, J., Woolnough, L., Wright, T., Wu, E., Yalcindag, A., Yee, M., Yen, E., Yeung, R., Yomogida, K., Yu, Q., Zapata, R., Zartoshti, A., Zeft, A., Zeft, R., Zhang, Y., Zhao, Y., Zhu, A., and Zic, C.

Published
2023
Full Text
View/download PDF

29. Childhood‐Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short‐Term Kidney Status and Variation in Care

Author

Smitherman, Emily A., Chahine, Rouba A., Beukelman, Timothy, Lewandowski, Laura B., Rahman, A. K. M. Fazlur, Wenderfer, Scott E., Curtis, Jeffrey R., Hersh, Aimee O., Abel, N., Abulaban, K., Adams, A., Adams, M., Agbayani, R., Aiello, J., Akoghlanian, S., Alejandro, C., Allenspach, E., Alperin, R., Alpizar, M., Amarilyo, G., Ambler, W., Anderson, E., Ardoin, S., Armendariz, S., Baker, E., Balboni, I., Balevic, S., Ballenger, L., Ballinger, S., Balmuri, N., Barbar‐Smiley, F., Barillas‐Arias, L., Basiaga, M., Baszis, K., Becker, M., Bell‐Brunson, H., Beltz, E., Benham, H., Benseler, S., Bernal, W., Beukelman, T., Bigley, T., Binstadt, B., Black, C., Blakley, M., Bohnsack, J., Boland, J., Boneparth, A., Bowman, S., Bracaglia, C., Brooks, E., Brothers, M., Brown, A., Brunner, H., Buckley, M., Buckley, M., Bukulmez, H., Bullock, D., Cameron, B., Canna, S., Cannon, L., Carper, P., Cartwright, V., Cassidy, E., Cerracchio, L., Chalom, E., Chang, J., Chang‐Hoftman, A., Chauhan, V., Chira, P., Chinn, T., Chundru, K., Clairman, H., Co, D., Confair, A., Conlon, H., Connor, R., Cooper, A., Cooper, J., Cooper, S., Correll, C., Corvalan, R., Costanzo, D., Cron, R., Curiel‐Duran, L., Curington, T., Curry, M., Dalrymple, A., Davis, A., Davis, C., Davis, C., Davis, T., De Benedetti, F., De Ranieri, D., Dean, J., Dedeoglu, F., DeGuzman, M., Delnay, N., Dempsey, V., DeSantis, E., Dickson, T., Dingle, J., Donaldson, B., Dorsey, E., Dover, S., Dowling, J., Drew, J., Driest, K., Du, Q., Duarte, K., Durkee, D., Duverger, E., Dvergsten, J., Eberhard, A., Eckert, M., Ede, K., Edelheit, B., Edens, C., Edens, C., Edgerly, Y., Elder, M., Ervin, B., Fadrhonc, S., Failing, C., Fair, D., Falcon, M., Favier, L., Federici, S., Feldman, B., Fennell, J., Ferguson, I., Ferguson, P., Ferreira, B., Ferrucho, R., Fields, K., Finkel, T., Fitzgerald, M., Fleming, C., Flynn, O., Fogel, L., Fox, E., Fox, M., Franco, L., Freeman, M., Fritz, K., Froese, S., Fuhlbrigge, R., Fuller, J., George, N., Gerhold, K., Gerstbacher, D., Gilbert, M., Gillispie‐Taylor, M., Giverc, E., Godiwala, C., Goh, I., Goheer, H., Goldsmith, D., Gotschlich, E., Gotte, A., Gottlieb, B., Gracia, C., Graham, T., Grevich, S., Griffin, T., Griswold, J., Grom, A., Guevara, M., Guittar, P., Guzman, M., Hager, M., Hahn, T., Halyabar, O., Hammelev, E., Hance, M., Hanson, A., Harel, L., Haro, S., Harris, J., Harry, O., Hartigan, E., Hausmann, J., Hay, A., Hayward, K., Heiart, J., Hekl, K., Henderson, L., Henrickson, M., Hersh, A., Hickey, K., Hill, P., Hillyer, S., Hiraki, L., Hiskey, M., Hobday, P., Hoffart, C., Holland, M., Hollander, M., Hong, S., Horwitz, M., Hsu, J., Huber, A., Huggins, J., Hui‐Yuen, J., Hung, C., Huntington, J., Huttenlocher, A., Ibarra, M., Imundo, L., Inman, C., Insalaco, A., Jackson, A., Jackson, S., James, K., Janow, G., Jaquith, J., Jared, S., Johnson, N., Jones, J., Jones, J., Jones, J., Jones, K., Jones, S., Joshi, S., Jung, L., Justice, C., Justiniano, A., Karan, N., Kaufman, K., Kemp, A., Kessler, E., Khalsa, U., Kienzle, B., Kim, S., Kimura, Y., Kingsbury, D., Kitcharoensakkul, M., Klausmeier, T., Klein, K., Klein‐Gitelman, M., Kompelien, B., Kosikowski, A., Kovalick, L., Kracker, J., Kramer, S., Kremer, C., Lai, J., Lam, J., Lang, B., Lapidus, S., Lapin, B., Lasky, A., Latham, D., Lawson, E., Laxer, R., Lee, P., Lee, P., Lee, T., Lentini, L., Lerman, M., Levy, D., Li, S., Lieberman, S., Lim, L., Lin, C., Ling, N., Lingis, M., Lo, M., Lovell, D., Lowman, D., Luca, N., Lvovich, S., Madison, C., Madison, J., Manzoni, S. Magni, Malla, B., Maller, J., Malloy, M., Mannion, M., Manos, C., Marques, L., Martyniuk, A., Mason, T., Mathus, S., McAllister, L., McCarthy, K., McConnell, K., McCormick, E., McCurdy, D., Stokes, P. McCurdy, McGuire, S., McHale, I., McMonagle, A., McMullen‐Jackson, C., Meidan, E., Mellins, E., Mendoza, E., Mercado, R., Merritt, A., Michalowski, L., Miettunen, P., Miller, M., Milojevic, D., Mirizio, E., Misajon, E., Mitchell, M., Modica, R., Mohan, S., Moore, K., Moorthy, L., Morgan, S., Dewitt, E. Morgan, Moss, C., Moussa, T., Mruk, V., Murphy, A., Muscal, E., Nadler, R., Nahal, B., Nanda, K., Nasah, N., Nassi, L., Nativ, S., Natter, M., Neely, J., Nelson, B., Newhall, L., Ng, L., Nicholas, J., Nicolai, R., Nigrovic, P., Nocton, J., Nolan, B., Oberle, E., Obispo, B., OʼBrien, B., OʼBrien, T., Okeke, O., Oliver, M., Olson, J., OʼNeil, K., Onel, K., Orandi, A., Orlando, M., Osei‐Onomah, S., Oz, R., Pagano, E., Paller, A., Pan, N., Panupattanapong, S., Pardeo, M., Paredes, J., Parsons, A., Patel, J., Pentakota, K., Pepmueller, P., Pfeiffer, T., Phillippi, K., Marafon, D. Pires, Phillippi, K., Ponder, L., Pooni, R., Prahalad, S., Pratt, S., Protopapas, S., Puplava, B., Quach, J., Quinlan‐Waters, M., Rabinovich, C., Radhakrishna, S., Rafko, J., Raisian, J., Rakestraw, A., Ramirez, C., Ramsay, E., Ramsey, S., Randell, R., Reed, A., Reed, A., Reed, A., Reid, H., Remmel, K., Repp, A., Reyes, A., Richmond, A., Riebschleger, M., Ringold, S., Riordan, M., Riskalla, M., Ritter, M., Rivas‐Chacon, R., Robinson, A., Rodela, E., Rodriquez, M., Rojas, K., Ronis, T., Rosenkranz, M., Rosolowski, B., Rothermel, H., Rothman, D., Roth‐Wojcicki, E., Rouster – Stevens, K., Rubinstein, T., Ruth, N., Saad, N., Sabbagh, S., Sacco, E., Sadun, R., Sandborg, C., Sanni, A., Santiago, L., Sarkissian, A., Savani, S., Scalzi, L., Schanberg, L., Scharnhorst, S., Schikler, K., Schlefman, A., Schmeling, H., Schmidt, K., Schmitt, E., Schneider, R., Schollaert‐Fitch, K., Schulert, G., Seay, T., Seper, C., Shalen, J., Sheets, R., Shelly, A., Shenoi, S., Shergill, K., Shirley, J., Shishov, M., Shivers, C., Silverman, E., Singer, N., Sivaraman, V., Sletten, J., Smith, A., Smith, C., Smith, J., Smith, J., Smitherman, E., Soep, J., Son, M., Spence, S., Spiegel, L., Spitznagle, J., Sran, R., Srinivasalu, H., Stapp, H., Steigerwald, K., Rakovchik, Y. Sterba, Stern, S., Stevens, A., Stevens, B., Stevenson, R., Stewart, K., Stingl, C., Stokes, J., Stoll, M., Stringer, E., Sule, S., Sumner, J., Sundel, R., Sutter, M., Syed, R., Syverson, G., Szymanski, A., Taber, S., Tal, R., Tambralli, A., Taneja, A., Tanner, T., Tapani, S., Tarshish, G., Tarvin, S., Tate, L., Taxter, A., Taylor, J., Terry, M., Tesher, M., Thatayatikom, A., Thomas, B., Tiffany, K., Ting, T., Tipp, A., Toib, D., Torok, K., Toruner, C., Tory, H., Toth, M., Tse, S., Tubwell, V., Twilt, M., Uriguen, S., Valcarcel, T., Van Mater, H., Vannoy, L., Varghese, C., Vasquez, N., Vazzana, K., Vehe, R., Veiga, K., Velez, J., Verbsky, J., Vilar, G., Volpe, N., von Scheven, E., Vora, S., Wagner, J., Wagner‐Weiner, L., Wahezi, D., Waite, H., Walker, J., Walters, H., Muskardin, T. Wampler, Waqar, L., Waterfield, M., Watson, M., Watts, A., Weiser, P., Weiss, J., Weiss, P., Wershba, E., White, A., Williams, C., Wise, A., Woo, J., Woolnough, L., Wright, T., Wu, E., Yalcindag, A., Yee, M., Yen, E., Yeung, R., Yomogida, K., Yu, Q., Zapata, R., Zartoshti, A., Zeft, A., Zeft, R., Zhang, Y., Zhao, Y., Zhu, A., and Zic, C.

Published
2023
Full Text
View/download PDF

31. Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections

Author

Mahajan, Prashant, Browne, Lorin R, Levine, Deborah A, Cohen, Daniel M, Gattu, Rajender, Linakis, James G, Anders, Jennifer, Borgialli, Dominic, Vitale, Melissa, Dayan, Peter S, Casper, T Charles, Ramilo, Octavio, Kuppermann, Nathan, Network, Febrile Infant Working Group of the Pediatric Emergency Care Applied Research, Powell, Elizabeth C, Tunik, Michael G, Nigrovic, Lise E, Roosevelt, Genie, Alpern, Elizabeth R, Browne, Lorin, Saunders, Mary, Atabaki, Shireen M, Ruddy, Richard M, Hoyle, John D, Blumberg, Stephen, Crain, Ellen F, Bonsu, Bema, Bennett, Jonathan E, Greenberg, Richard, Jaffe, David M, Muenzer, Jared, Cruz, Andrea T, Macias, Charles, Tzimenatos, Leah, Rogers, Alexander J, Brayer, Anne, and Lillis, Kathleen

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Hematology, Infectious Diseases, Prevention, Pediatric, Sepsis, Clinical Research, 2.2 Factors relating to the physical environment, Aetiology, Infection, Bacteremia, Coinfection, Emergency Service, Hospital, Female, Fever, Humans, Infant, Infant, Newborn, Male, Meningitis, Bacterial, Prospective Studies, Risk Assessment, Sampling Studies, Urinary Tract Infections, Virus Diseases, Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network, coinfection, febrile infant, serious bacterial infection, viral infection, Human Movement and Sports Sciences, Paediatrics and Reproductive Medicine, Pediatrics, Paediatrics
Abstract

ObjectiveTo determine the risk of serious bacterial infections (SBIs) in young febrile infants with and without viral infections.Study designPlanned secondary analyses of a prospective observational study of febrile infants 60 days of age or younger evaluated at 1 of 26 emergency departments who did not have clinical sepsis or an identifiable site of bacterial infection. We compared patient demographics, clinical, and laboratory findings, and prevalence of SBIs between virus-positive and virus-negative infants.ResultsOf the 4778 enrolled infants, 2945 (61.6%) had viral testing performed, of whom 1200 (48.1%) were virus positive; 44 of the 1200 had SBIs (3.7%; 95% CI, 2.7%-4.9%). Of the 1745 virus-negative infants, 222 had SBIs (12.7%; 95% CI, 11.2%-14.4%). Rates of specific SBIs in the virus-positive group vs the virus-negative group were: UTIs (33 of 1200 [2.8%; 95% CI, 1.9%-3.8%] vs 186 of 1745 [10.7%; 95% CI, 9.2%-12.2%]) and bacteremia (9 of 1199 [0.8%; 95% CI, 0.3%-1.4%] vs 50 of 1743 [2.9%; 95% CI, 2.1%-3.8%]). The rate of bacterial meningitis tended to be lower in the virus-positive group (0.4%) than in the viral-negative group (0.8%); the difference was not statistically significant. Negative viral status (aOR, 3.2; 95% CI, 2.3-4.6), was significantly associated with SBI in multivariable analysis.ConclusionsFebrile infants ≤60 days of age with viral infections are at significantly lower, but non-negligible risk for SBIs, including bacteremia and bacterial meningitis.

Published
2018

32. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis

Author

Kuppermann, Nathan, Ghetti, Simona, Schunk, Jeff E, Stoner, Michael J, Rewers, Arleta, McManemy, Julie K, Myers, Sage R, Nigrovic, Lise E, Garro, Aris, Brown, Kathleen M, Quayle, Kimberly S, Trainor, Jennifer L, Tzimenatos, Leah, Bennett, Jonathan E, DePiero, Andrew D, Kwok, Maria Y, Perry, Clinton S, Olsen, Cody S, Casper, T Charles, Dean, J Michael, and Glaser, Nicole S

Subjects
Neurosciences, Diabetes, Clinical Research, Prevention, Brain Disorders, Pediatric, Mental health, Good Health and Well Being, Adolescent, Brain Edema, Brain Injuries, Child, Child, Preschool, Diabetic Ketoacidosis, Drug Administration Schedule, Female, Fluid Therapy, Glasgow Coma Scale, Humans, Infant, Infusions, Intravenous, Male, Prospective Studies, Rehydration Solutions, Sodium Chloride, PECARN DKA FLUID Study Group, Medical and Health Sciences, General & Internal Medicine
Abstract

BACKGROUND:Diabetic ketoacidosis in children may cause brain injuries ranging from mild to severe. Whether intravenous fluids contribute to these injuries has been debated for decades. METHODS:We conducted a 13-center, randomized, controlled trial that examined the effects of the rate of administration and the sodium chloride content of intravenous fluids on neurologic outcomes in children with diabetic ketoacidosis. Children were randomly assigned to one of four treatment groups in a 2-by-2 factorial design (0.9% or 0.45% sodium chloride content and rapid or slow rate of administration). The primary outcome was a decline in mental status (two consecutive Glasgow Coma Scale scores of

Published
2018

33. Implicit Review Instrument to Evaluate Quality of Care Delivered by Physicians to Children in Emergency Departments

Author

Marcin, James P, Romano, Patrick S, Dharmar, Madan, Chamberlain, James M, Dudley, Nanette, Macias, Charles G, Nigrovic, Lise E, Powell, Elizabeth C, Rogers, Alexander J, Sonnett, Meridith, Tzimenatos, Leah, Alpern, Elizabeth R, Andrews‐Dickert, Rebecca, Borgialli, Dominic A, Sidney, Erika, Casper, Charlie, Dean, Jonathan Michael, Kuppermann, Nathan, and Network, the Pediatric Emergency Care Applied Research

Subjects
Health Services and Systems, Health Sciences, Emergency Care, Pediatric, Clinical Research, Health Services, Generic health relevance, Acute Disease, Adolescent, Child, Child Health, Child, Preschool, Electronic Health Records, Emergency Service, Hospital, Female, Humans, Infant, Infant, Newborn, Male, Outcome and Process Assessment, Health Care, Pediatrics, Quality Indicators, Health Care, Quality of Health Care, Reproducibility of Results, Retrospective Studies, Socioeconomic Factors, Wounds and Injuries, quality, emergency department, Pediatric Emergency Care Applied Research Network, Public Health and Health Services, Policy and Administration, Health Policy & Services, Health services and systems, Policy and administration
Abstract

ObjectiveTo evaluate the consistency, reliability, and validity of an implicit review instrument that measures the quality of care provided to children in the emergency department (ED).Data sources/study settingMedical records of randomly selected children from 12 EDs in the Pediatric Emergency Care Applied Research Network (PECARN).Study designEight pediatric emergency medicine physicians applied the instrument to 620 medical records.Data collection/extraction methodsWe determined internal consistency using Cronbach's alpha and inter-rater reliability using the intraclass correlation coefficient (ICC). We evaluated the validity of the instrument by correlating scores with four condition-specific explicit review instruments.Principal findingsIndividual reviewers' Cronbach's alpha had a mean of 0.85 with a range of 0.76-0.97; overall Cronbach's alpha was 0.90. The ICC was 0.49 for the summary score with a range from 0.40 to 0.46. Correlations between the quality of care score and the four condition-specific explicit review scores ranged from 0.24 to 0.38.ConclusionsThe quality of care instrument demonstrated good internal consistency, moderate inter-rater reliability, high inter-rater agreement, and evidence supporting validity. The instrument could be useful for systems' assessment and research in evaluating the care delivered to children in the ED.

Published
2018

34. Patient‐level Factors and the Quality of Care Delivered in Pediatric Emergency Departments

Author

Marcin, James P, Romano, Patrick S, Dayal, Parul, Dharmar, Madan, Chamberlain, James M, Dudley, Nanette, Macias, Charles G, Nigrovic, Lise E, Powell, Elizabeth C, Rogers, Alexander J, Sonnett, Meridith, Tzimenatos, Leah, Alpern, Elizabeth R, Andrews‐Dickert, Rebecca, Borgialli, Dominic A, Sidney, Erika, Casper, T Charles, Dean, J Michael, Kuppermann, Nathan, and Network, for the Pediatric Emergency Care Applied Research

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Pediatric, Prevention, Infectious Diseases, Emergency Care, Clinical Research, Health Services, 8.1 Organisation and delivery of services, Health and social care services research, 7.3 Management and decision making, Management of diseases and conditions, Adolescent, Child, Child, Preschool, Emergency Service, Hospital, Female, Humans, Infant, Infant, Newborn, Insurance Coverage, Linear Models, Male, Outcome Assessment, Health Care, Quality of Health Care, Retrospective Studies, Severity of Illness Index, Pediatric Emergency Care Applied Research Network, Public Health and Health Services, Emergency & Critical Care Medicine, Clinical sciences
Abstract

ObjectiveQuality of care delivered to adult patients in the emergency department (ED) is often associated with demographic and clinical factors such as a patient's race/ethnicity and insurance status. We sought to determine whether the quality of care delivered to children in the ED was associated with a variety of patient-level factors.MethodsThis was a retrospective, observational cohort study. Pediatric patients (

Published
2018

35. mTORC1 links pathology in experimental models of Still’s disease and macrophage activation syndrome

Author

Huang, Zhengping, You, Xiaomeng, Chen, Liang, Du, Yan, Brodeur, Kailey, Jee, Hyuk, Wang, Qiang, Linder, Grace, Darbousset, Roxane, Cunin, Pierre, Chang, Margaret H., Wactor, Alexandra, Wauford, Brian M., Todd, Marc J. C., Wei, Kevin, Li, Ying, Levescot, Anais, Iwakura, Yoichiro, Pascual, Virginia, Baldwin, Nicole E., Quartier, Pierre, Li, Tianwang, Gianatasio, Maria T., Hasserjian, Robert P., Henderson, Lauren A., Sykes, David B., Mellins, Elizabeth D., Canna, Scott W., Charles, Julia F., Nigrovic, Peter A., and Lee, Pui Y.

Published
2022
Full Text
View/download PDF

37. Proteomics based markers of clinical pain severity in juvenile idiopathic arthritis

Author

Van Der Heijden, Hanne, Fatou, Benoit, Sibai, Diana, Hoyt, Kacie, Taylor, Maria, Cheung, Kin, Lemme, Jordan, Cay, Mariesa, Goodlett, Benjamin, Lo, Jeffery, Hazen, Melissa M., Halyabar, Olha, Meidan, Esra, Schreiber, Rudy, Jaimes, Camilo, Ecklund, Kirsten, Henderson, Lauren A., Chang, Margaret H., Nigrovic, Peter A., Sundel, Robert P., Steen, Hanno, and Upadhyay, Jaymin

Published
2022
Full Text
View/download PDF

39. Herpes Simplex Virus Infection in Infants Undergoing Meningitis Evaluation

Author

Cruz, Andrea T, Freedman, Stephen B, Kulik, Dina M, Okada, Pamela J, Fleming, Alesia H, Mistry, Rakesh D, Thomson, Joanna E, Schnadower, David, Arms, Joseph L, Mahajan, Prashant, Garro, Aris C, Pruitt, Christopher M, Balamuth, Fran, Uspal, Neil G, Aronson, Paul L, Lyons, Todd W, Thompson, Amy D, Curtis, Sarah J, Ishimine, Paul T, Schmidt, Suzanne M, Bradin, Stuart A, Grether-Jones, Kendra L, Miller, Aaron S, Louie, Jeffrey, Shah, Samir S, and Nigrovic, Lise E

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Sexually Transmitted Infections, Infectious Diseases, Pediatric, Neurosciences, Brain Disorders, Clinical Research, 2.2 Factors relating to the physical environment, Aetiology, Infection, Cerebrospinal Fluid, Cross-Sectional Studies, Female, Herpes Simplex, Humans, Infant, Infant, Newborn, Male, Meningitis, Odds Ratio, Retrospective Studies, Simplexvirus, HSV Study Group of the Pediatric Emergency Medicine Collaborative Research Committee, Medical and Health Sciences, Psychology and Cognitive Sciences, Pediatrics, Biomedical and clinical sciences, Health sciences, Psychology
Abstract

BACKGROUND:Although neonatal herpes simplex virus (HSV) is a potentially devastating infection requiring prompt evaluation and treatment, large-scale assessments of the frequency in potentially infected infants have not been performed. METHODS:We performed a retrospective cross-sectional study of infants ≤60 days old who had cerebrospinal fluid culture testing performed in 1 of 23 participating North American emergency departments. HSV infection was defined by a positive HSV polymerase chain reaction or viral culture. The primary outcome was the proportion of encounters in which HSV infection was identified. Secondary outcomes included frequency of central nervous system (CNS) and disseminated HSV, and HSV testing and treatment patterns. RESULTS:Of 26 533 eligible encounters, 112 infants had HSV identified (0.42%, 95% confidence interval [CI]: 0.35%-0.51%). Of these, 90 (80.4%) occurred in weeks 1 to 4, 10 (8.9%) in weeks 5 to 6, and 12 (10.7%) in weeks 7 to 9. The median age of HSV-infected infants was 14 days (interquartile range: 9-24 days). HSV infection was more common in 0 to 28-day-old infants compared with 29- to 60-day-old infants (odds ratio 3.9; 95% CI: 2.4-6.2). Sixty-eight (0.26%, 95% CI: 0.21%-0.33%) had CNS or disseminated HSV. The proportion of infants tested for HSV (35%; range 14%-72%) and to whom acyclovir was administered (23%; range 4%-53%) varied widely across sites. CONCLUSIONS:An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.

Published
2018

40. Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger

Author

Powell, Elizabeth C, Mahajan, Prashant V, Roosevelt, Genie, Hoyle, John D, Gattu, Rajender, Cruz, Andrea T, Rogers, Alexander J, Atabaki, Shireen M, Jaffe, David M, Casper, T Charles, Ramilo, Octavio, Kuppermann, Nathan, Network, Febrile Infant Working Group of the Pediatric Emergency Care Applied Research, Levine, Deborah A, Tunik, Michael G, Nigrovic, Lise E, Mahajan, Prashant, Alpern, Elizabeth R, Vitale, Melissa, Browne, Lorin, Saunders, Mary, Ruddy, Richard M, Linakis, James G, Borgialli, Dominic, Blumberg, Stephen, Crain, Ellen F, Anders, Jennifer, Bonsu, Bema, Cohen, Daniel M, Bennett, Jonathan E, Dayan, Peter S, Greenberg, Richard, Muenzer, Jared, Macias, Charles, Tzimenatos, Leah, Brayer, Anne, and Lillis, Kathleen

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Pediatric, Hematology, Clinical Research, Infectious Diseases, Sepsis, Infection, Bacteremia, Escherichia coli, Escherichia coli Infections, Humans, Infant, Infant, Newborn, Meningitis, Bacterial, Prospective Studies, Streptococcal Infections, Urinary Tract Infections, Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network, Emergency & Critical Care Medicine, Clinical sciences
Abstract

Study objectiveTo describe the current epidemiology of bacteremia in febrile infants 60 days of age and younger in the Pediatric Emergency Care Applied Research Network (PECARN).MethodsWe conducted a planned secondary analysis of a prospective observational study of febrile infants 60 days of age and younger presenting to any of 26 PECARN emergency departments (2008 to 2013) who had blood cultures obtained. We excluded infants with significant comorbidities or critically ill appearance. The primary outcome was prevalence of bacteremia.ResultsOf 7,335 screened infants, 4,778 (65.1%) had blood cultures and were enrolled. Of these patients, 84 had bacteremia (1.8%; 95% confidence interval [CI] 1.4% to 2.2%). The prevalence of bacteremia in infants aged 28 days or younger (47/1,515) was 3.1% (95% CI 2.3% to 4.1%); in infants aged 29 to 60 days (37/3,246), 1.1% (95% CI 0.8% to 1.6%). Prevalence differed by week of age for infants 28 days of age and younger (0 to 7 days: 4/156, 2.6%; 8 to 14 days: 19/356, 5.3%; 15 to 21 days: 15/449, 3.3%; and 22 to 28 days: 9/554, 1.6%). The most common pathogens were Escherichia coli (39.3%; 95% CI 29.5% to 50.0%) and group B streptococcus (23.8%; 95% CI 16.0% to 33.9%). Bacterial meningitis occurred in 19 of 1,515 infants 28 days of age and younger (1.3%; 95% CI 0.8% to 2.0%) and 5 of 3,246 infants aged 29 to 60 days (0.2%; 95% CI 0.1% to 0.4%). Of 84 infants with bacteremia, 36 (42.9%; 95% CI 32.8% to 53.5%) had urinary tract infections (E coli 83%); 11 (13.1%; 95% CI 7.5% to 21.9%) had bacterial meningitis.ConclusionThe prevalence of bacteremia and meningitis among febrile infants 28 days of age and younger is high and exceeds that observed in infants aged 29 to 60 days. E coli and group B streptococcus are the most common bacterial pathogens.

Published
2018

41. A Brush with Danger

Author

Hirsch, Alexander W., Popovsky, Erica Y., Nigrovic, Lise E., and Burns, Michele M.

Published
2018

42. Racial Disparities and Achievement of the Low Lupus Disease Activity State: A CARRARegistry Study

Author

Soulsby, William Daniel, Olveda, Rebecca, He, Jie, Berbert, Laura, Weller, Edie, Barbour, Kamil E., Greenlund, Kurt J., Schanberg, Laura E., von Scheven, Emily, Hersh, Aimee, Son, Mary Beth F., Chang, Joyce, Knight, Andrea, Aamir, R., Abulaban, K., Adams, A., Aguiar Lapsia, C., Akinsete, A., Akoghlanian, S., Al Manaa, M., AlBijadi, A., Allenspach, E., Almutairi, A., Alperin, R., Amarilyo, G., Ambler, W., Amoruso, M., Angeles‐Han, S., Ardoin, S., Armendariz, S., Asfaw, L., Aviran Dagan, N., Bacha, C., Balboni, I., Balevic, S., Ballinger, S., Baluta, S., Barillas‐Arias, L., Basiaga, M., Baszis, K., Baxter, S., Becker, M., Begezda, A., Behrens, E., Beil, E., Benseler, S., Bermudez‐Santiago, L., Bernal, W., Bigley, T., Bingham, C., Binstadt, B., Black, C., Blackmon, B., Blakley, M., Bohnsack, J., Boneparth, A., Bradfield, H., Bridges, J., Brooks, E., Brothers, M., Brunner, H., Buckley, L., Buckley, M., Buckley, M., Bukulmez, H., Bullock, D., Canna, S., Cannon, L., Canny, S., Cartwright, V., Cassidy, E., Castro, D., Chalom, E., Chang, J., Chang, M., Chang, J., Chang‐Hoftman, A., Chen, A., Chiraseveenuprapund, P., Ciaglia, K., Co, D., Cohen, E., Collinge, J., Conlon, H., Connor, R., Cook, K., Cooper, A., Cooper, J., Corbin, K., Correll, C., Cron, R., Curry, M., Dalrymple, A., Datyner, E., Davis, T., De Ranieri, D., Dean, J., DeCoste, C., Dedeoglu, F., DeGuzman, M., Delnay, N., DeSantis, E., Devine, R., Dhalla, M., Dhanrajani, A., Dissanayake, D., Dizon, B., Drapeau, N., Drew, J., Driest, K., Du, Q., Duncan, E., Dunnock, K., Durkee, D., Dvergsten, J., Eberhard, A., Ede, K., Edelheit, B., Edens, C., El Tal, T., Elder, M., Elzaki, Y., Fadrhonc, S., Failing, C., Fair, D., Favier, L., Feldman, B., Fennell, J., Ferguson, P., Ferguson, I., Figueroa, C., Flanagan, E., Fogel, L., Fox, E., Fox, M., Franklin, L., Fuhlbrigge, R., Fuller, J., Furey, M., Futch‐West, T., Gagne, S., Gennaro, V., Gerstbacher, D., Gilbert, M., Gironella, A., Glaser, D., Goh, I., Goldsmith, D., Gorry, S., Goswami, N., Gottlieb, B., Graham, T., Grevich, S., Griffin, T., Grim, A., Grom, A., Guevara, M., Hahn, T., Halyabar, O., Hamda Natur, M., Hammelev, E., Hammond, T., Harel, L., Harris, J., Harry, O., Hausmann, J., Hay, A., Hays, K., Hayward, K., Henderson, L., Henrickson, M., Hersh, A., Hickey, K., Hiraki, L., Hiskey, M., Hobday, P., Hoffart, C., Holland, M., Hollander, M., Hong, S., Horton, D., Horwitz, M., Hsu, J., Huber, A., Huberts, A., Huggins, J., Huie, L., Hui‐Yuen, J., Ibarra, M., Imlay, A., Imundo, L., Inman, C., Jackson, A., James, K., Janow, G., Jared, S., Jiang, Y., Johnson, L., Johnson, N., Jones, J., Kafisheh, D., Kahn, P., Kaidar, K., Kasinathan, S., Kaur, R., Kessler, E., Kienzle, B., Kim, S., Kimura, Y., Kingsbury, D., Kitcharoensakkul, M., Klausmeier, T., Klein, K., Klein‐Gitelman, M., Knight, A., Kovalick, L., Kramer, S., Kremer, C., Kudas, O., LaFlam, T., Lang, B., Lapidus, S., Lapin, B., Lasky, A., Lawler, C., Lawson, E., Laxer, R., Lee, P., Lee, P., Lee, T., Lee, A., Leisinger, E., Lentini, L., Lerman, M., Levinsky, Y., Levy, D., Li, S., Lieberman, S., Lim, L., Limenis, E., Lin, C., Ling, N., Lionetti, G., Livny, R., Lloyd, M., Lo, M., Long, A., Lopez‐Peña, M., Lovell, D., Luca, N., Lvovich, S., Lytch, A., Ma, M., Machado, A., MacMahon, J., Madison, J., Mannion, M., Manos, C., Mansfield, L., Marston, B., Mason, T., Matchett, D., McAllister, L., McBrearty, K., McColl, J., McCurdy, D., McDaniels, K., McDonald, J., Meidan, E., Mellins, E., Mian, Z., Miettunen, P., Miller, M., Milojevic, D., Mitacek, R., Modica, R., Mohan, S., Moore, T., Moore, K., Moorthy, L., Moreno, J., Morgan, E., Moyer, A., Murante, B., Murphy, A., Muscal, E., Mwizerwa, O., Najafi, A., Nanda, K., Nasah, N., Nassi, L., Nativ, S., Natter, M., Nearanz, K., Neely, J., Newhall, L., Nguyen, A., Nigrovic, P., Nocton, J., Nolan, B., Nowicki, K., Oakes, R., Oberle, E., Ogbonnaya‐Whittesley, S., Ogbu, E., Oliver, M., Olveda, R., Onel, K., Orandi, A., Padam, J., Paller, A., Pan, N., Pandya, J., Panupattanapong, S., Pappo Toledano, A., Parsons, A., Patel, J., Patel, P., Patrick, A., Patrizi, S., Paul, S., Perfetto, J., Perron, M., Peskin, M., Ponder, L., Pooni, R., Prahalad, S., Puplava, B., Quinlan‐Waters, M., Rabinovich, C., Rafko, J., Rahimi, H., Rampone, K., Ramsey, S., Randell, R., Ray, L., Reed, A., Reed, A., Reid, H., Reiff, D., Richins, S., Riebschleger, M., Rife, E., Riordan, M., Riskalla, M., Robinson, A., Robinson, L., Rodgers, L., Rodriquez, M., Rogers, D., Ronis, T., Rosado, A., Rosenkranz, M., Rosenwasser, N., Rothermel, H., Rothman, D., Rothschild, E., Roth‐Wojcicki, E., Rouster‐Stevens, K., Rubinstein, T., Rupp, J., Ruth, N., Sabbagh, S., Sadun, R., Santiago, L., Saper, V., Sarkissian, A., Scalzi, L., Schahn, J., Schikler, K., Schlefman, A., Schmeling, H., Schmitt, E., Schneider, R., Schulert, G., Schultz, K., Schutt, C., Seper, C., Sheets, R., Shehab, A., Shenoi, S., Sherman, M., Shirley, J., Shishov, M., Siegel, D., Singer, N., Sivaraman, V., Sloan, E., Smith, C., Smith, J., Smitherman, E., Soep, J., Son, Mary B., Sosna, D., Spencer, C., Spiegel, L., Spitznagle, J., Srinivasalu, H., Stapp, H., Steigerwald, K., Stephens, A., Sterba Rakovchik, Y., Stern, S., Stevens, B., Stevenson, R., Stewart, K., Stewart, W., Stingl, C., Stoll, M., Stringer, E., Sule, S., Sullivan, J., Sundel, R., Sutter, M., Swaffar, C., Swayne, N., Syed, R., Symington, T., Syverson, G., Szymanski, A., Taber, S., Tal, R., Tambralli, A., Taneja, A., Tanner, T., Tarvin, S., Tate, L., Taxter, A., Taylor, J., Tesher, M., Thakurdeen, T., Theisen, A., Thomas, B., Thomas, L., Thomas, N., Ting, T., Todd, C., Toib, D., Toib, D., Torok, K., Tory, H., Toth, M., Tse, S., Tsin, C., Twachtman‐Bassett, J., Twilt, M., Valcarcel, T., Valdovinos, R., Vallee, A., Van Mater, H., Vandenbergen, S., Vannoy, L., Varghese, C., Vasquez, N., Vega‐Fernandez, P., Velez, J., Verbsky, J., Verstegen, R., Scheven, E., Vora, S., Wagner‐Weiner, L., Wahezi, D., Waite, H., Walker, B., Walters, H., Waterfield, M., Waters, A., Weiser, P., Weiss, P., Weiss, J., Wershba, E., Westheuser, V., White, A., Widrick, K., Williams, C., Wong, S., Woolnough, L., Wright, T., Wu, E., Yalcindag, A., Yasin, S., Yeung, R., Yomogida, K., Zeft, A., Zhang, Y., Zhao, Y., and Zhu, A.

Abstract

Differential disease control may contribute to racial disparities in outcomes of childhood‐onset systemic lupus erythematosus (cSLE). We evaluated associations of race and individual‐ or neighborhood‐level social determinants of health (SDoH) with achievement of low lupus disease activity state (LLDAS), a clinically relevant treatment target. In this cSLE cohort study using the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, the primary exposure was self‐reported race and ethnicity, and collected SDoH included insurance status and area deprivation index (ADI). Outcomes included LLDAS, disease activity, and time‐averaged prednisone exposure. Associations among race and ethnicity, SDoH, and disease activity were estimated with multivariable regression models, adjusting for disease‐related and demographic factors. Among 540 children with cSLE, 27% identified as Black, 25% identified as White, 23% identified as Latino/a, 11% identified as Asian, 9% identified as more than one race, and 5% identified as other. More Black children (41%) lived in neighborhoods of highest ADI compared to White children (16%). Black race was associated with lower LLDAS achievement (adjusted odds ratio 0.56, 95% confidence interval [CI] 0.38–0.82) and higher disease activity (adjusted β 0.94, 95% CI 0.11–1.78). The highest ADI was not associated with lower LLDAS achievement on adjustment for renal disease and insurance. However, renal disease was found to be a significant mediator (P= 0.04) of the association between ADI and prednisone exposure. Children with cSLE who identified as Black are less likely to achieve LLDAS and have a higher disease activity. Living in areas of higher ADI may relate to renal disease and subsequent prednisone exposure. Strategies to address root causes will be important to design interventions mitigating cSLE racial disparities.

Published
2025
Full Text
View/download PDF

43. The ‘Tregparadox’ in inflammatory arthritis

Author

Schnell, Julia T., Briviesca, Raquel Laza, Kim, Taehyeung, Charbonnier, Louis-Marie, Henderson, Lauren A., van Wijk, Femke, and Nigrovic, Peter A.

Abstract

Classic regulatory T (Treg) cells expressing CD4 and the hallmark transcription factor FOXP3 are integral to the prevention of multi-system autoimmunity. However, immune-mediated arthritis is often associated with increased numbers of Tregcells in the inflamed joints. To understand these seemingly conflicting observations, which we collectively describe as ‘the Tregparadox’, we provide an overview of Tregcell biology with a focus on Tregcell heterogeneity, function and dysfunction in arthritis. We discuss how the inflamed environment constrains the immunosuppressive activity of Tregcells while also promoting the differentiation of TH17-like Tregcell, exTregcell (effector T cells that were formerly Tregcells), and osteoclastogenic Tregcell subsets that mediate tissue injury. We present a new framework to understand Tregcells in joint inflammation and define potential strategies for Tregcell-directed interventions in human inflammatory arthritis.

Published
2025
Full Text
View/download PDF

44. Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

Author

Aronson, Paul L, Lyons, Todd W, Cruz, Andrea T, Freedman, Stephen B, Okada, Pamela J, Fleming, Alesia H, Arms, Joseph L, Thompson, Amy D, Schmidt, Suzanne M, Louie, Jeffrey, Alfonzo, Michael J, Monuteaux, Michael C, Nigrovic, Lise E, Group, Pediatric Emergency Medicine Clinical Research Network Herpes Simplex Virus Study, Alpern, Elizabeth R, Balamuth, Fran, Bradin, Stuart A, Curtis, Sarah J, Garro, Aris C, Grether-Jones, Kendra L, Ishimine, Paul T, Kulik, Dina, Mahajan, Prashant, Miller, Aaron S, Mistry, Rakesh D, Pruitt, Christopher M, Schnadower, David, Shah, Samir S, Thomson, Joanna E, and Uspal, Neil G

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Neurosciences, Clinical Research, Pediatric, Infection, Cerebrospinal Fluid, Cohort Studies, Enterovirus, Enterovirus Infections, Female, Humans, Infant, Length of Stay, Male, Meningitis, Viral, Polymerase Chain Reaction, Retrospective Studies, Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group, enterovirus, meningitis, neonate, young infant, Human Movement and Sports Sciences, Paediatrics and Reproductive Medicine, Pediatrics, Paediatrics
Abstract

ObjectiveTo determine the impact of a cerebrospinal fluid enterovirus polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection.Study designWe performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a cerebrospinal fluid culture obtained at 1 of 18 participating centers (2005-2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an enterovirus PCR test performed vs not performed and among those tested, for infants with a positive vs negative test result.ResultsOf 19 953 hospitalized infants, 4444 (22.3%) had an enterovirus PCR test performed and 945 (21.3% of tested infants) had positive test results. Hospital LOS was similar for infants who had an enterovirus PCR test performed compared with infants who did not (incident rate ratio 0.98 hours; 95% CI 0.89-1.06). However, infants PCR positive for enterovirus had a 38% shorter LOS than infants PCR negative for enterovirus (incident rate ratio 0.62 hours; 95% CI 0.57-0.68). No infant with a positive enterovirus PCR test had bacterial meningitis (0%; 95% CI 0-0.4).ConclusionsAlthough enterovirus PCR testing was not associated with a reduction in LOS, infants with a positive enterovirus PCR test had a one-third shorter LOS compared with infants with a negative enterovirus PCR test. Focused enterovirus PCR test use could increase the impact on LOS for infants undergoing cerebrospinal fluid evaluation.

Published
2017

45. The Yale Observation Scale Score and the Risk of Serious Bacterial Infections in Febrile Infants

Author

Nigrovic, Lise E, Mahajan, Prashant V, Blumberg, Stephen M, Browne, Lorin R, Linakis, James G, Ruddy, Richard M, Bennett, Jonathan E, Rogers, Alexander J, Tzimenatos, Leah, Powell, Elizabeth C, Alpern, Elizabeth R, Casper, T Charles, Ramilo, Octavio, and Kuppermann, Nathan

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Pediatric, Clinical Research, Infant Mortality, Infectious Diseases, Infection, Bacterial Infections, Cross-Sectional Studies, Female, Fever, Humans, Infant, Infant, Newborn, Male, Prospective Studies, Risk Assessment, Severity of Illness Index, Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network, Medical and Health Sciences, Psychology and Cognitive Sciences, Pediatrics, Biomedical and clinical sciences, Health sciences, Psychology
Abstract

To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs). We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ≤60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network. We defined SBIs as urinary tract infections, bacteremia, or bacterial meningitis, with the latter 2 considered invasive bacterial infections. Emergency department clinicians applied the YOS (range: 6-30; normal score: ≤10) and estimated the risk of SBI using unstructured clinician suspicion (50%). Of the 4591 eligible infants, 444 (9.7%) had SBIs and 97 (2.1%) had invasive bacterial infections. Of the 4058 infants with YOS scores of ≤10, 388 (9.6%) had SBIs (sensitivity: 51/439 [11.6%]; 95% confidence interval [CI]: 8.8%-15.0%; negative predictive value: 3670/4058 [90.4%]; 95% CI: 89.5%-91.3%) and 72 (1.8%) had invasive bacterial infections (sensitivity 23/95 [24.2%], 95% CI: 16.0%-34.1%; negative predictive value: 3983/4055 [98.2%], 95% CI: 97.8%-98.6%). Of the infants with clinician suspicion of

Published
2017

47. Repression of CTSG, ELANE and PRTN3-mediated histone H3 proteolytic cleavage promotes monocyte-to-macrophage differentiation

Author

Cheung, Peggie, Schaffert, Steven, Chang, Sarah E., Dvorak, Mai, Donato, Michele, Macaubas, Claudia, Foecke, Mariko H., Li, Tie-Mei, Zhang, Lichao, Coan, John P., Schulert, Grant S., Grom, Alexei A., Henderson, Lauren A., Nigrovic, Peter A., Elias, Joshua E., Gozani, Or, Mellins, Elizabeth D., Khatri, Purvesh, Utz, Paul J., and Kuo, Alex J.

Published
2021
Full Text
View/download PDF

49. Association of RNA Biosignatures With Bacterial Infections in Febrile Infants Aged 60 Days or Younger

Author

Mahajan, Prashant, Kuppermann, Nathan, Mejias, Asuncion, Suarez, Nicolas, Chaussabel, Damien, Casper, T Charles, Smith, Bennett, Alpern, Elizabeth R, Anders, Jennifer, Atabaki, Shireen M, Bennett, Jonathan E, Blumberg, Stephen, Bonsu, Bema, Borgialli, Dominic, Brayer, Anne, Browne, Lorin, Cohen, Daniel M, Crain, Ellen F, Cruz, Andrea T, Dayan, Peter S, Gattu, Rajender, Greenberg, Richard, Hoyle, John D, Jaffe, David M, Levine, Deborah A, Lillis, Kathleen, Linakis, James G, Muenzer, Jared, Nigrovic, Lise E, Powell, Elizabeth C, Rogers, Alexander J, Roosevelt, Genie, Ruddy, Richard M, Saunders, Mary, Tunik, Michael G, Tzimenatos, Leah, Vitale, Melissa, Dean, J Michael, and Ramilo, Octavio

Subjects
Genetics, Infectious Diseases, Pediatric, Clinical Research, Infant Mortality, Infection, Bacteremia, Bacterial Infections, Biomarkers, Case-Control Studies, Diagnostic Tests, Routine, Emergency Service, Hospital, Female, Fever, Genetic Markers, Humans, Infant, Infant, Newborn, Male, Meningitis, Bacterial, Microarray Analysis, Prospective Studies, RNA, Statistics, Nonparametric, Urinary Tract Infections, Pediatric Emergency Care Applied Research Network, Medical and Health Sciences, General & Internal Medicine
Abstract

ImportanceYoung febrile infants are at substantial risk of serious bacterial infections; however, the current culture-based diagnosis has limitations. Analysis of host expression patterns ("RNA biosignatures") in response to infections may provide an alternative diagnostic approach.ObjectiveTo assess whether RNA biosignatures can distinguish febrile infants aged 60 days or younger with and without serious bacterial infections.Design, setting, and participantsProspective observational study involving a convenience sample of febrile infants 60 days or younger evaluated for fever (temperature >38° C) in 22 emergency departments from December 2008 to December 2010 who underwent laboratory evaluations including blood cultures. A random sample of infants with and without bacterial infections was selected for RNA biosignature analysis. Afebrile healthy infants served as controls. Blood samples were collected for cultures and RNA biosignatures. Bioinformatics tools were applied to define RNA biosignatures to classify febrile infants by infection type.ExposureRNA biosignatures compared with cultures for discriminating febrile infants with and without bacterial infections and infants with bacteremia from those without bacterial infections.Main outcomes and measuresBacterial infection confirmed by culture. Performance of RNA biosignatures was compared with routine laboratory screening tests and Yale Observation Scale (YOS) scores.ResultsOf 1883 febrile infants (median age, 37 days; 55.7% boys), RNA biosignatures were measured in 279 randomly selected infants (89 with bacterial infections-including 32 with bacteremia and 15 with urinary tract infections-and 190 without bacterial infections), and 19 afebrile healthy infants. Sixty-six classifier genes were identified that distinguished infants with and without bacterial infections in the test set with 87% (95% CI, 73%-95%) sensitivity and 89% (95% CI, 81%-93%) specificity. Ten classifier genes distinguished infants with bacteremia from those without bacterial infections in the test set with 94% (95% CI, 70%-100%) sensitivity and 95% (95% CI, 88%-98%) specificity. The incremental C statistic for the RNA biosignatures over the YOS score was 0.37 (95% CI, 0.30-0.43).Conclusions and relevanceIn this preliminary study, RNA biosignatures were defined to distinguish febrile infants aged 60 days or younger with vs without bacterial infections. Further research with larger populations is needed to refine and validate the estimates of test accuracy and to assess the clinical utility of RNA biosignatures in practice.

Published
2016

50. Proceedings of the 2016 Childhood Arthritis and Rheumatology Research Alliance (CARRA) Scientific Meeting : Toronto, Canada. 14-17 April 2016.

Author

Fotis, Lampros, Shaikh, Nur, Baszis, Kevin, French, Anthony, Tarr, Phillip, Grevich, Sriharsha, Lee, Peggy, Ringold, Sarah, Leroux, Brian, Leahey, Hannah, Yuasa, Megan, Foster, Jessica, Sokolove, Jeremy, Lahey, Lauren, Robinson, William, Newsom, Joshua, Stevens, Anne, Karasawa, Rie, Tamaki, Mayumi, Tanaka, Megumi, Sato, Toshiko, Yudoh, Kazuo, Jarvis, James N, Moncrieffe, Halima, Bennett, Mark F, Tsoras, Monica, Luyrink, Lorie, Xu, Huan, Prahalad, Sampath, Morris, Paula, Dare, Jason, Nigrovic, Peter A, Rosenkranz, Margalit, Becker, Mara, O’Neil, Kathleen M, Griffin, Thomas, Lovell, Daniel J, Grom, Alexei A, Medvedovic, Mario, Thompson, Susan D, Zhu, Lisha, Jiang, Kaiyu, Wong, Laiping, Buck, Michael J, Chen, Yanmin, Brungs, Laura, Liu, Tao, Wang, Ting, Alsaeid, Khaled, Alfailakawi, Jasim, Alenezi, Hamid, Alsaeed, Hazim, Beukelman, Tim, Natter, Marc, Ilowite, Norm, Mieszkalski, Kelly, Burrell, Grendel, Best, Brian, Bristow, Helen, Carr, Shannon, Dennos, Anne, Kaufmann, Rachel, Kimura, Yukiko, Schanberg, Laura, Blier, Peter R, Boneparth, Alexis, Wenderfer, Scott E, Moorthy, L Nandini, Radhakrishna, Suhas M, Sagcal-Gironella, Anna Carmela P, von Scheven, Emily, Gedik, Kader Cetin, Siddique, Salma, Aguiar, Cassyanne L, Erkan, Doruk, Cohen, Ezra, Lee, Yvonne, Dossett, Michelle, Mehta, Darshan, Davis, Roger, Gilbert, Mileka, Goilav, Beatrice, Meidan, Esra, Hsu, Joyce, Chua, Anabelle, Ardoin, Stacy, Von Scheven, Emily, Ruth, Natasha M, Hui-Yuen, Joyce, Bermudez, Liza, Cook, Ashlea, Imundo, Lisa, Starr, Amy, Eichenfield, Andrew, and Askanase, Anca

Subjects
Arthritis & Rheumatology, Clinical Sciences, Paediatrics and Reproductive Medicine
Published
2016

Catalog

Books, media, physical & digital resources
See catalog results