Background Surfactant protein (SP) D has been proposed to be protective in allergic airway responses. Objective We aimed to determine the effect of SP-D deficiency on murine and human airway allergy. ...Methods Immunologic responses of SP-D gene–deficient mice ( Sftpd−/− ) at baseline and after 4 intranasal Aspergillus fumigatus exposures were assessed. In addition, the significance of a single nucleotide polymorphism (Met11 Thr) in the human SP-D gene (known to decrease SP-D function) was investigated. Results Macrophage and neutrophil bronchoalveolar lavage fluid levels and large airway mucus production were increased in naive Sftpd−/− mice in association with increased lung CCL17 levels and CD4+ T cell numbers. TH 2-associated antibody levels (IgG1 and IgE) were significantly lower in 4- to 5-week-old Sftpd−/− mice ( P < .05). Accordingly, naive Sftpd−/− splenocytes released significantly less IL-4 and IL-13 on anti-CD3/CD28 stimulation ( P < .01). After intranasal allergen exposures, a modest decrease in bronchoalveolar lavage fluid eosinophilia and IL-13 levels was observed in Sftpd−/− mice compared with values seen in wild-type mice in association with decreased airway resistance ( P < .01). A single nucleotide polymorphism in the SFTPD gene, affecting SP-D levels and pathogen binding, was associated with decreased atopy in black subjects and potentially lower asthma susceptibility in white subjects. Conclusion Sftpd−/− mice have an impaired systemic TH 2 response at baseline and reduced inflammation and airway responses after allergen exposure. Translational studies revealed that a polymorphism in the SFTPD gene was associated with lower atopy and possibly asthma susceptibility. Taken together, these results support the hypothesis that SP-D–dependent innate immunity influences atopy and asthma.
Previous studies have illustrated pediatric knowledge deficits among Emergency Medical Services (EMS) providers. The purpose of this study was to identify perspectives of a diverse group of EMS ...providers regarding pediatric prehospital care educational deficits and proposed methods of training improvements.
Purposive sampling was used to recruit EMS providers in diverse settings for study participation. Two separate focus groups of EMS providers (administrative and non-administrative personnel) were held in three locations (urban, suburban, and rural). A professional moderator facilitated focus group discussion using a guide developed by the study team. A grounded theory approach was used to analyze data.
Forty-two participants provided data. Four major themes were identified: (1) suboptimal previous pediatric training and training gaps in continuing pediatric education; (2) opportunities for improved interactions with emergency department (ED) staff, including case-based feedback on patient care; (3) barriers to optimal pediatric prehospital care; and (4) proposed pediatric training improvements.
Focus groups identified four themes surrounding preparation of EMS personnel for providing care to pediatric patients. These themes can guide future educational interventions for EMS to improve pediatric prehospital care. Brown SA , Hayden TC , Randell KA , Rappaport L , Stevenson MD , Kim IK . Improving pediatric education for Emergency Medical Services providers: a qualitative study. Prehosp Disaster Med. 2017;32(1):20-26.
The objective of this study was to identify factors that predict the presence of urolithiasis detected with unenhanced computed tomography (UCT) in children.
A retrospective study of all subjects <21 ...years of age who presented to the emergency department at Akron Children's Hospital and underwent UCT of the abdomen between January 2002 and December 2005 was performed. Demographic, clinical, diagnostic, treatment, and disposition data were abstracted by using a standardized form. Univariate and logistic regression analyses of factors associated with urolithiasis were performed.
A total of 339 eligible patients were identified, with 110 cases of urolithiasis detected with UCT for 95 individual patients. The mean age of the study patients was 14.4 years; 72 patients (66%) were female. In 17 cases (15%) of urolithiasis, initial urinalysis results were negative for blood. Fifty-seven stones (51.8%) were ureteral, 26 (23.6%) were renal, and 4 (3.6%) were in the bladder. Among children who did not have a stone identified through UCT, 23 cases (10%) of potentially significant, alternative diagnoses were identified. A history of urolithiasis, a history of nausea and vomiting, the presence of flank pain on examination, and >2 red blood cells per high-power field in urine microscopy were positively associated with urolithiasis. A history of fever or dysuria and costovertebral angle tenderness on physical examination were inversely associated with urolithiasis on UCT scans.
UCT plays an important role in the diagnostic evaluation of children with flank pain. Approximately 15% of children with urolithiasis do not have hematuria.
Objective Allergic sensitization is very prevalent and often precedes the development of allergic disease. This study examined the association of race with allergic sensitization among healthy ...children with no family history of atopy. Study design Two hundred seventy-five children, predominantly from lower socioeconomic strata, from Cincinnati, Ohio, ages 2 to 18 years without a family or personal history of allergic diseases, underwent skin prick testing to 11 allergen panels. The Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) was used to examine the impact of sensitization on quality of life. Results Thirty-nine percent of healthy children were sensitized to 1 or more allergen panels. Multivariate logistic regression showed increased risk among African-American children for any sensitization (OR, 2.17; 95% CI: 1.23, 3.84) and sensitization to any outdoor allergen (OR, 2.96 95% CI: 1.52, 5.74). Eighty-six percent of children had PADQLQ scores of 1 or less (0 to 6 scale). Conclusions Allergic sensitization is prevalent even among children who do not have a personal or family history of asthma, allergic rhinitis, or atopic dermatitis and who have no evidence of current, even subtle effects from this sensitization on allergic disease–related quality of life. African-American children are at greater risk for presence of sensitization, especially to outdoor allergens.
Objectives
While recent studies have demonstrated an overall increase in psychiatric visits in the emergency department (ED), none have focused on a nationally representative pediatric population. ...Understanding trends in pediatric psychiatric ED visits is important because of limited outpatient availability of pediatric specialists, as well as long wait times for psychiatric appointments. The study aim was to evaluate the trends in ED psychiatric visits for children between 2001 and 2010 with comparison by sociodemographic characteristics.
Methods
This was a retrospective, cross‐sectional analysis of ED psychiatric visits for children < 18 years of age using the National Hospital Ambulatory Medical Care Survey (NHAMCS). Visits were identified by International Classification of Diseases, Ninth Revision (ICD‐9), codes. Outcome measures included frequency of visits for children with psychiatric diagnosis codes and odds and adjusted odds of psychiatric visits controlling for temporal, demographic, and geographic factors.
Results
From 2001 to 2010, an average of 28.3 million pediatric visits to EDs occurred annually. Among those, an approximately 560,000 (2% of ED visits) were psychiatric visits each year. Pediatric psychiatric ED visits increased from an estimated 491,000 in 2001 to 619,000 in 2010 (p = 0.01). Teenagers (adjusted odds ratio AOR = 3.92, 95% confidence interval CI = 3.37 to 4.57) and publicly insured patient visits (AOR = 1.47, 95% CI = 1.25 to 1.74) had increased odds of psychiatric ED visits.
Conclusions
Pediatric ED psychiatric visits are increasing. Teenagers and children with public insurance appear to be at increased risk. Further investigation is needed to determine what the causative factors are.
Resumen
Objetivos
Estudios recientes han demostrado un incremento global en las visitas psiquiátricas al servicio de urgencias (SU), pero ninguno se ha centrado en una población pediátrica nacional representativa. El comprender las tendencias en las visitas pediátricas psiquiátricas al SU es importante por la disponibilidad ambulatoria limitada de especialistas pediátricos, así como por los tiempos de espera largos para las citas psiquiátricas. El objetivo del estudio fue evaluar la tendencia en las visitas de niños al SU por motivos psiquiátricos entre 2001 y 2010, y comparar las características sociodemográficas.
Metodología
Análisis transversal retrospectivo de las visitas psiquiátricas al SU de niños menores de 18 años mediante la National Hospital Ambulatory Medical Care Survey. Las visitas se identificaron mediante los códigos de la Clasificación Internacional de Enfermedades, novena versión (CIE‐9). Las medidas de resultado incluyeron frecuencia de visitas de niños con una codificación diagnóstica psiquiátrica, la razón de ventajas (OR) y la razón de ventajas ajustada (ORa) de visitas psiquiátricas controlada por factores geográficos, demográficos y temporales.
Resultados
Desde 2001 a 2010, hubo una media anual de 28,3 millones de visitas pediátricas a los SU. Entre ellas, aproximadamente 560.000 (1,98% de las visitas al SU) fueron visitas psiquiátricas. Las visitas psiquiátricas pediátricas al SU se incrementaron de una estimación de 491.000 en 2001 a 619.000 en 2010 (p = 0,01). Las visitas de pacientes con seguro público (ORa 1,47, IC 95% = 1,25 a 1,74) y los adolescentes (ORa 3,92, IC 95%= 3,37 a 4,57) han aumentado la razón de ventajas de las visitas psiquiátricas al SU.
Conclusiones
Las visitas pediátricas por motivos psiquiátricos al SU están incrementándose. Los adolescentes y los niños con seguro público tienen un mayor riesgo. Son necesarias futuras investigaciones para determinar cuáles son los factores causales.
Objectives
Patients with chronic diseases are often forced to seek emergency care for exacerbations. In the face of large predicted increases in the prevalence of chronic diseases, there is increased ...pressure to avoid hospitalizing these patients at the end of the ED visit, if they can obtain the care they need in the outpatient setting. We performed this scoping study to provide a broad overview of the published literature on the transition of care between ED and primary care following ED discharge.
Methods
We performed a MEDLINE search of English‐language articles published between 1990 and March 2015. We created a data‐charting form a priori of the search. Papers were organized into themes, with new themes created when none of the existing themes matched the paper. Papers with multiple themes were assigned preferentially to the theme that was consistent with their primary objectives. We created a descriptive numerical summary of the included studies.
Results
Of 1,138 titles, there were 252 potentially relevant s, and among those 122 met criteria for full paper review. An additional 11 papers were acquired from reference review. From the 133 papers, 85 were included in the study. The papers were categorized into seven themes. These included Follow‐up compliance and its predictors (38 studies), Telephone calls to discharged ED patients (15 studies), ED navigators (14 studies), The current system (nine studies), Ways to alert primary care providers (PCPs) of the ED visit (seven studies), and Patient views and PCP information requirements (one each). In the Follow‐up compliance and predictors theme, the two most frequently identified significant predictors for increasing the frequency of follow‐up care were the provision of a follow‐up appointment time prior to ED departure and the presence of health insurance. Follow‐up telephone calls to patients resulted in better follow‐up rates, but increased ED return visits in some studies. In the current system patients themselves are the conduit, and the barriers to follow‐up care can be high. E‐mail and/or electronic medical record alerts to the PCP are relatively new, and no studies limited the alerts to patients who had a defined need for follow‐up care.
Conclusions
A plethora of work has been published on the transition of care from ED to primary care. To decrease hospitalizations among the upcoming wave of patients with chronic diseases, it appears that the two most efficient areas to target are a primary care follow‐up appointment system and health insurance. Further research is needed in particular to identify the patients who actually need follow‐up care and to develop information technology solutions that can be effectively implemented within the current emergency healthcare system.
IMPORTANCE: Apnea is a rare, life-threatening complication of bronchiolitis, the leading cause of infant hospitalization in the United States. Currently, no objective method exists for identifying ...which infants will become apneic. OBJECTIVE: To investigate whether serum albumin levels are associated with apnea in infants with severe bronchiolitis. DESIGN, SETTING, AND PARTICIPANTS: A secondary data analysis of the 35th Multicenter Airway Research Collaboration, an ongoing multicenter cohort study of infants hospitalized for bronchiolitis, was conducted from December 11, 2018, to May 30, 2019. Seventeen hospitals across the United States enrolled infants (n = 1016) during 3 consecutive bronchiolitis seasons (November 1 to April 30) between 2011 and 2014. Infants with heart-lung disease or a gestational age less than 32 weeks were excluded. EXPOSURES: Serum albumin level was categorized as low (<3.8 g/dL) or normal (≥3.8 g/dL). MAIN OUTCOMES AND MEASURES: Apnea during the hospitalization. RESULTS: Of the 1016 infants hospitalized for bronchiolitis, the median (interquartile range IQR) age was 3 (2-6) months, 610 (60.0%) were male, and 186 (18.3%) were born preterm (32-37 weeks’ gestation). Among the 25 infants (2.5%) with apnea while hospitalized, the median (IQR) serum albumin level was 3.5 (3.1-3.6) g/dL, and 22 (88.0%) had low serum albumin levels. The prevalence of apnea was 5.7% among all infants with low albumin levels, compared with 0.5% prevalence in infants with normal serum albumin levels. In unadjusted analyses, apnea was associated with younger age, preterm birth, weight-for-age z score, and low albumin (odds ratio OR, 12.69; 95% CI, 3.23-49.82). After adjustment for age, preterm birth, and weight-for-age z score, low serum albumin levels remained statistically significantly associated with apnea (OR, 4.42; 95% CI, 1.21-16.18). CONCLUSIONS AND RELEVANCE: Low serum albumin levels appeared to be associated with increased risk of apnea after adjustment for known apnea risk factors. This finding provides a path to potentially identifying apnea, a life-threatening complication of bronchiolitis.
The adhesive properties, as measured by bulk tack analysis, are found to decrease in blends of isomerically pure Sc3N@Ih-C80 metallic nitride fullerene (MNF) and ...polystyrene-block-polyisoprene-block-polystyrene (SIS) copolymer pressure-sensitive adhesive under white light irradiation in air. The reduction of tack is attributed to the in situ generation of 1O2 and subsequent photooxidative cross-linking of the adhesive film. Comparisons are drawn to classical fullerenes C60 and C70 for this process. This work represents the first demonstration of 1O2 generating ability in the general class of MNFs (M3N@C80). Additional support is provided for the sensitizing ability of Sc3N@Ih-C80 through the successful photooxygenation of 2-methyl-2-butene to its allylic hydroperoxides in benzene-d 6 under irradiation at 420 nm, a process that occurs at a rate comparable to that of C60. Photooxygenation of 2-methyl-2-butene is found to be influenced by the fullerene sensitizer concentration and O2 flow rate. Molar extinction coefficients are reported for Sc3N@Ih-C80 at 420 and 536 nm. Evaluation of the potential antimicrobial activity of films prepared in this study stemming from the in situ generation of 1O2 led to an observed 1 log kill for select Gram-positive and Gram-negative bacteria.
It remains unclear whether hyponatremia independently predicts a higher severity of bronchiolitis in children. The objective of this study was to investigate the association between hyponatremia and ...bronchiolitis severity in children hospitalized in the ICU for bronchiolitis.
We conducted a 16-center, prospective cohort study of hospitalized children aged <2 years with bronchiolitis during the winters of 2007 through 2010. Patients were classified into 2 groups (normonatremic 135-145 mEq/L and hyponatremic <135 mEq/L) based on the first-measured serum sodium concentration on the day of hospitalization. Outcomes were use of mechanical ventilation and ICU length of stay (LOS). To examine the association of sodium status with outcomes, we fit logistic and linear regression models with propensity score adjustment.
Of 231 children hospitalized in the ICU for bronchiolitis, 193 (84%) were categorized into the normonatremic group and 38 (16%) into the hyponatremic group. Compared with children with normonatremia, those with hyponatremia had higher risks of mechanical ventilation use (40% vs 58%; P = .04) and longer ICU LOS (median, 3 vs 6 days; P = .007). Likewise, in the adjusted analyses, children with hyponatremia had significantly higher risks of mechanical ventilation use (odds ratio, 2.14 95% confidence interval, 1.03-4.48; P = .04) and longer ICU LOS (β-coefficient, 2.21 days 95% confidence interval, 0.68-3.73; P = .005).
In this prospective, multicenter study of children hospitalized for bronchiolitis, hyponatremia on the day of hospitalization was associated with a higher severity of disease. Our data support hyponatremia as a prognostic factor that might improve the ability of clinicians to predict the disease course of children with severe bronchiolitis.
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