Despite advances in the medical and surgical management of cardiovascular disease, greater than 350,000 patients experience out-of-hospital cardiac arrest in the United States annually, with only a ...12% neurologically favorable survival rate. Of these patients, 23% have an initial shockable rhythm of ventricular fibrillation/pulseless ventricular tachycardia (VF/VT), a marker of high probability of acute coronary ischemia (80%) as the precipitating factor. However, few patients (22%) will experience return of spontaneous circulation and sufficient hemodynamic stability to undergo cardiac catheterization and revascularization. Previous case series and observational studies have demonstrated the successful application of intra-arrest extracorporeal life support, including to out-of-hospital cardiac arrest victims, with a neurologically favorable survival rate of up to 53%. For patients with refractory cardiac arrest, strategies are needed to bridge them from out-of-hospital cardiac arrest to the catheterization laboratory and revascularization. To address this gap, we expanded our ICU and perioperative extracorporeal membrane oxygenation (ECMO) program to the emergency department (ED) to reach this cohort of patients to improve survival. In this report, we illustrate our process and initial experience of developing a multidisciplinary team for rapid deployment of ED ECMO as a template for institutions interested in building their own ED ECMO programs.
A major goal of current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine efforts is to elicit antibody responses that confer protection. Mapping the epitope targets of the ...SARS-CoV-2 antibody response is critical for vaccine design, diagnostics, and development of therapeutics. Here, we develop a pan-coronavirus phage display library to map antibody binding sites at high resolution within the complete viral proteomes of all known human-infecting coronaviruses in patients with mild or moderate/severe coronavirus disease 2019 (COVID-19). We find that the majority of immune responses to SARS-CoV-2 are targeted to the spike protein, nucleocapsid, and ORF1ab and include sites of mutation in current variants of concern. Some epitopes are identified in the majority of samples, while others are rare, and we find variation in the number of epitopes targeted between individuals. We find low levels of SARS-CoV-2 cross-reactivity in individuals with no exposure to the virus and significant cross-reactivity with endemic human coronaviruses (CoVs) in convalescent sera from patients with COVID-19.
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•Pan-coronavirus phage display library maps epitopes in patients with COVID-19•Most immune responses target SARS-CoV-2 S, N, and ORF1ab sequences•Certain epitopes include sites of mutation in SARS-CoV-2 variants of concern•Evidence for cross-reactivity between SARS-CoV-2 and endemic human CoVs
Stoddard et al. map common and rare coronavirus epitopes in individuals with mild or moderate/severe COVID-19 and healthy, pre-pandemic individuals. They find a subset of epitopes with residues that are mutated in SARS-CoV-2 variants of concern and show evidence for cross-reactivity between SARS-CoV-2 and commonly circulating human coronaviruses.
•Pediatric burn recovery assessment metrics need to account for child growth.•Computer adaptive tests (CAT) allow more efficient survey administration.•Items were culled and developed to track burn ...recovery in children 1–5 years of age.•Co-production was used to refine and optimize this large item pool.•This item pool will serve as a foundation for a new preschool burn outcomes CAT.
Modern, reliable, and valid outcome measures are essential to understanding the health needs of young children with burn injuries. Burn-specific and age-appropriate legacy assessment tools exist for this population but are hindered by the limitations of existing paper-based instruments. The purpose of this study was to develop item pools comprised of questions appropriate for children aged 1–5 with burn injuries. Item development was based on a framework provided by previous work to develop the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Conceptual Model. The Preschool LIBRE Conceptual Model work established four sub-domains of functioning for children with burns aged 1–5. Item development involved a systematic literature review, a qualitative item review process with clinical experts, and parent cognitive interviews. Four item pools were established: (1) communication and language development; (2) physical functioning; (3) psychological functioning and (4) social functioning for preschool-aged children with burn injuries. We selected and refined candidate items, recall periods, survey instructions, and response option choices through clinical and parental feedback during the qualitative review and cognitive interview processes. Item pools are currently being field-tested as part of the process to calibrate and validate the Preschool1–5 LIBRE Computer Adaptive Test (CAT) Profile.
Abstract Introduction Outcome measures are critical to assess interventions, establish evidence based practice guidelines, and ultimately support the needs of teenage burn survivors’ integration into ...the community. Only one condition- and age-specific instrument exists to monitor burn recovery. A more granular instrument with advanced technological capability (i.e., computer adaptive test (CAT)) is needed. The current study developed a preliminary conceptual framework and item pools as first steps to create a new instrument for teen burn survivors. Methods The International Classification of Functioning, Disability, and Health Child and Youth Version informed the conceptual framework. Initial candidate items were reviewed qualitatively through binning and winnowing. A team of experts reviewed sets of items in four rounds from March through June 2023, such that each set was reviewed twice. Experts rated each item as “keep, omit, modify, or revisit”. To identify outcomes important in assessment of recovery, focus groups of clinicians, teenagers, and parents were conducted until thematic saturation was reached. Each transcript was analyzed using deductive and inductive approaches to identify and categorize content. Findings were used to validate the framework and ensure adequate domain coverage. Results Initial candidate items (n=5,472) from 178 generic and burn-specific assessments previously published were grouped into two domains of the conceptual framework – activity and participation. At the end of round four, experts had modified item content for 29.8% of items. Activity item pools (n=128) included mobility, physical self-care, general tasks, experience of self, and learning and applying knowledge. Participation item pools (n=73) included major life areas, interpersonal relationships, and engagement. The recall period was set to “currently”. A five-point Likert scale format for responses was assigned based on the item measurement of agreement (n=124), difficulty (n=23), or frequency (n=54) of behavior. Eighteen participants completed the study. Clinicians mean age was 48.4 years with 90% female and 80% White; teens mean age was 13.8 years with 63% female and 75% white. Burn size ranged from 0.25 to 60% TBSA. Examples of themes included body image, self-esteem, and social relationships. Conclusions The preliminary item pool (n=201) was developed containing domains of activity and participation. The next step is to conduct cognitive interviews and refine item content prior to field-testing for the calibration and validation of the CAT. Applicability of Research to Practice Clinical and research use of the Teen-Aged12-19 LIBRE (Life Impact Burn Recovery Evaluation) will facilitate optimization of interventions, allow for more efficient allocation of resources and care for teenagers with burn injuries.
Abstract
Due to the rapid developmental growth in preschool-aged children, more precise measurement of the effects of burns on child health outcomes is needed. Expanding upon the Shriners Hospitals ...for Children/American Burn Association Burn Outcome Questionnaire 0 to 5 (BOQ0–5), we developed a conceptual framework describing domains important in assessing recovery from burn injury among preschool-aged children (1–5 years). We developed a working conceptual framework based on the BOQ0–5, the National Research Council and Institute of Medicine’s Model of Child Health, and the World Health Organization’s International Classification of Functioning, Disability, and Health for Children and Youth. We iteratively refined our framework based on a literature review, focus groups, interviews, and expert consensus meetings. Data were qualitatively analyzed using methods informed by grounded theory. We reviewed 95 pediatric assessments, conducted two clinician focus groups and six parent interviews, and consulted with 23 clinician experts. Three child health outcome domains emerged from our analysis: symptoms, functioning, and family. The symptoms domain describes parents’ perceptions of their child’s pain, skin-related discomfort, and fatigue. The functioning domain describes children’s physical functioning (gross and fine motor function), psychological functioning (internalizing, externalizing, and dysregulation behavior; trauma; toileting; resilience), communication and language development (receiving and producing meaning), and social functioning (connecting with family/peers, friendships, and play). The family domain describes family psychological and routine functioning outcomes.
To assess the psychometric properties of the Child Stress Disorders Checklist (CSDC), a 36-item observer-report instrument that measures acute stress and posttraumatic symptoms in children.
The CSDC ...was administered to parents of 43 children with acute burns and 41 children who had experienced a traffic crash. This instrument was also administered to the burned children's primary nurse to estimate interrater reliability. The CSDC was completed again by parents of burned children, 2 days and 3 months later. Convergent validity was determined by correlating scores on the CSDC with scores on instruments of known validity for assessing posttraumatic stress disorder (PTSD) in children. Concurrent validity was determined through an examination of the relationship between CSDC scores and an index of trauma severity (percentage of body surface area burned). Discriminant validity was assessed by administering the Child Behavior Checklist (CBCL): it was hypothesized that PTSD symptoms would be more closely related to the PTSD scale of the CBCL than the Thought Problems scale of the CBCL.
The CSDC has reliable and valid psychometric properties.
The CSDC, an observer-report instrument of ASD and PTSD in children, has important utility in clinical and research settings.
Modern, reliable, and valid outcome measures are essential to understanding the health needs of young children with burn injuries. Burn-specific and age-appropriate legacy assessment tools exist for ...this population but are hindered by the limitations of existing paper-based instruments. The purpose of this study was to develop item pools comprised of questions appropriate for children aged 1-5 with burn injuries. Item development was based on a framework provided by previous work to develop the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Conceptual Model. The Preschool LIBRE Conceptual Model work established four sub-domains of functioning for children with burns aged 1-5. Item development involved a systematic literature review, a qualitative item review process with clinical experts, and parent cognitive interviews. Four item pools were established: (1) communication and language development; (2) physical functioning; (3) psychological functioning and (4) social functioning for preschool-aged children with burn injuries. We selected and refined candidate items, recall periods, survey instructions, and response option choices through clinical and parental feedback during the qualitative review and cognitive interview processes. Item pools are currently being field-tested as part of the process to calibrate and validate the Preschool
LIBRE Computer Adaptive Test (CAT) Profile.
Recent medical and surgical advances allow many severely burned patients to survive who formally would have died. Assessment of psychiatric outcomes with these patients may provide ways of measuring ...effects of acute burn care methods on later quality of life, specify more accurately their emotional needs during rehabilitation, and stimulate further research. Thirty children, aged 7 to 19, with severe burns are compared with 30 nonburned subjects matched for age, sex, SES, and parents' marital status according to DSM-III criteria. The burned children had significantly higher levels of overanxious disorder, phobias, and enuresis, but they had the same rates of present depressive disorders.
To allow genetic analysis of starch quality in wheat and its relatives, it was necessary to develop techniques suitable for use on endosperm halves of seeds, leaving the embryo half to be grown for ...the next generation. Seeds were split and the endosperm end was crushed and soaked in 0.5 M NaCl overnight. The solids were ground three times in 0.5 M NaCl, the supernatant starch slurries were pooled and washed through a series of 4 M NaCl, 6 M NaCl/50 %, sucrose, 2 % sodium dodecyl sulphate solution, and acetone before being dried over silica gel. Subsamples of 1 mg of starch were dispersed in ethanol in preweighed microfuge tubes, gelatinised in NaOH solution, diluted to constant concentration, and aliquots were neutralised with citric acid, stained with iodine, diluted with water, and evaluated in an ELISA plate reader at 620 nm. The overall method provided cleaner starch than earlier methods, as shown by higher apparent amylose values, and was highly repeatable. The method was used to demonstrate the variation in amylose content within single heads of an inbred tetraploid wheat. No consistent patterns of variation due to seed location were detected but the overall breadth of variation around the median value of 27 % was ± 5 %.
Biochemical and electrophysiological factors were studied longitudinally in a rapidly cycling manic-depressive patient. Slow changes in mood, motor activity, sleep, and urinary norepinephrine levels ...during the course of each depressed and manic episode are reported, as well as rapid alterations in many variables at the time of mood switch. Urinary concentrations of norepinephrine and its metabolite, 3-methoxy-4-hydroxyphenyl glycol (MHPG) were significantly lower in depression than in mania; norepinephrine but not MHPG excretion increased prior to the switch. We postulate that the slow behavioral and biological changes preceding switches in this patient are an important manifestation of the cyclic process in manic-depressive illness.
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