Publications by authors named "Sarah Bauer"

50 Publications

Pediatric Respiratory Illness Hospitalizations Prior to COVID-19 and During the First Year of the COVID-19 Pandemic in Southeast Wisconsin.

WMJ 2022 Apr;121(1):54-57

Medical College of Wisconsin, Department of Pediatrics, Section of Hospital Medicine, Milwaukee, Wisconsin.

Background: Public health measures combatting the COVID-19 pandemic also led to a decrease in other pediatric respiratory illnesses. We describe the local pattern of pediatric respiratory hospitalizations in southeast Wisconsin prior to COVID-19 and during the first year of the pandemic.

Methods: We performed a cross-sectional examination of hospitalizations for asthma, bronchiolitis, and bacterial pneumonia at a single tertiary children's hospital prior to COVID-19 through the first year of the COVID-19 pandemic.

Results: We found a significant decrease in the average monthly hospitalization rates prior to and during COVID-19 for asthma, bronchiolitis, and bacterial pneumonia ( < 0.001), with average percent decrease of hospitalizations per month of 48%, 78%, and 47.7%, respectively.

Conclusions: The decrease in hospitalizations is likely multifactorial and related to public health measures, behavior changes, and other epidemiological factors.
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April 2022

An Opportunity in Cancer Prevention: Human Papillomavirus Vaccine Delivery in the Hospital.

Hosp Pediatr 2022 May;12(5):e157-e162

bMedical College of Wisconsin, Department of Pediatrics, Section of Hospital Medicine, Milwaukee, Wisconsin.

Objective: Pediatric hospitalizations are a missed opportunity for delivery of the human papilloma virus (HPV) vaccination. In this study, the authors' aim was to increase HPV vaccination rates among adolescents cared for by the pediatric hospital medicine (PHM) service at our academic children's hospital.

Methods: This quality improvement (QI) study included adolescents ≥13 years who were discharged from PHM. Interventions included: modification of discharge order sets to include vaccination status and provider training seminars regarding the delivery of the HPV vaccine. Follow-up materials were distributed to providers by e-mail. The primary outcome measure was adolescent HPV vaccination rates. Secondary outcome measures were adolescent meningococcal vaccination rates and accuracy of immunization status documentation. The balancing measure was length of stay (LOS). Data were collected via chart review. Statistical process control charts were used to analyze for special cause variation.

Results: From May 2019 through February 2020, 440 patients were included in this analysis. Throughout the study, HPV and meningococcal vaccination rates increased from a baseline median of 4.6% to 21.2% and 8.3% to 26.6%, respectively. HPV vaccination was not significantly associated with sex, HPV dose due, or admitting service. Accuracy of immunization status documentation and LOS remained unchanged.

Conclusions: Using QI methodology we were successful in increasing HPV and meningococcal vaccination rates among hospitalized adolescents. Considering the relationship of these 2 vaccines is a potential topic of future work. Discerning the correct immunization status at time of admission may be a potential opportunity for improvement in future work.
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http://dx.doi.org/10.1542/hpeds.2021-006302DOI Listing
May 2022

Growth and nutrition in children with established bronchopulmonary dysplasia: A review of the literature.

Nutr Clin Pract 2022 Apr 5;37(2):282-298. Epub 2022 Feb 5.

Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA.

Background: Bronchopulmonary dysplasia (BPD) remains the most common late morbidity of preterm birth. Clinical care and research have largely focused on the pathogenesis and prevention of BPD. Preterm infants who develop BPD have significant medical needs that persist throughout their hospital course and continue after discharge, including those associated with growth and nutrition. The objective of this study was to review the available literature on nutrition and growth in infants with established BPD and to identify the knowledge and research gaps to provide direction for future studies.

Methods: We conducted a literature search in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Ovid MEDLINE, CINAHL, and Embase. Titles, abstracts, and full texts were independently reviewed by the authors and selected based on predetermined inclusion/exclusion criteria. Results were summarized qualitatively.

Results: Excluding duplicates, 2315 articles were identified. Thirty articles were selected for inclusion. We identified the following key components of nutrition support and clinical care: energy expenditure, growth, and metabolism; body composition; enteral nutrition; supplements; parenteral nutrition; and respiratory outcomes.

Conclusions: Despite a large body of literature describing the role of growth and nutrition in the prevention of BPD, research is lacking with respect to interventions and management in the population with established BPD. Thus, organized approaches for clinical interventions and trials with respect to growth and nutrition in infants and young children with established BPD are needed. These studies should include multiple centers because of the small numbers of patients with BPD at each site.
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http://dx.doi.org/10.1002/ncp.10841DOI Listing
April 2022

Using Quality Improvement Methodology to Increase Communication of Discharge Criteria on Rounds.

Hosp Pediatr 2022 02;12(2):156-164

Medical College of Wisconsin, Wauwatosa, Wisconsin.

Objective: Clear communication about discharge criteria with families and the interprofessional team is essential for efficient transitions of care. Our aim was to increase the percentage of pediatric hospital medicine patient- and family-centered rounds (PFCR) that included discharge criteria discussion from a baseline mean of 32% to 75% over 1 year.

Methods: We used the Model for Improvement to conduct a quality improvement initiative at a tertiary pediatric academic medical center. Interventions tested included (1) rationale sharing, (2) PFCR checklist modification, (3) electronic discharge SmartForms, (4) data audit and feedback and (5) discharge criteria standardization. The outcome measure was the percentage of observed PFCR with discharge criteria discussed. Process measure was the percentage of PHM patients with criteria documented. Balancing measures were rounds length, length of stay, and readmission rates. Statistical process control charts assessed the impact of interventions.

Results: We observed 700 PFCR (68 baseline PFCR from July to August 2019 and 632 intervention period PFCR from November 2019 to June 2021). At baseline, discharge was discussed during 32% of PFCR. After rationale sharing, checklist modification, and criteria standardization, this increased to 90%, indicating special cause variation. The improvement has been sustained for 10 months.At baseline, there was no centralized location to document discharge criteria. After development of the SmartForm, 21% of patients had criteria documented. After criteria standardization for common diagnoses, this increased to 71%. Rounds length, length of stay, and readmission rates remained unchanged.

Conclusion: Using quality improvement methodology, we successfully increased verbal discussions of discharge criteria during PFCR without prolonging rounds length.
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http://dx.doi.org/10.1542/hpeds.2021-006127DOI Listing
February 2022

Quality Initiative to Increase Delivery of Adolescent Hospital-Based Reproductive Health Care.

Hosp Pediatr 2022 01;12(1):53-61

Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.

Objectives: Hospitals are an important nontraditional setting in which to address adolescent reproductive health. However, opportunities for intervention are frequently missed, especially for boys and patients hospitalized for noningestion complaints. Our global aim was to increase delivery of reproductive health care to adolescents hospitalized through our children's hospital Pediatric Hospital Medicine service.

Methods: We performed 2 quality improvement intervention cycles: (1) provider education and monthly reminder e-mails and (2) an automated electronic health record (EHR) adolescent history and physical note template with social history prompts while discontinuing reminder e-mails. The primary outcome measure was sexual history documentation (SHD). Secondary measures were sexually transmitted infection (STI) testing and contraception provision. Statistical process control charts were used to analyze effectiveness of interventions.

Results: From July 2018 through June 2019, 528 Primary Hospital Medicine encounters were included in this study and compared with published baseline data on 150 encounters. Control charts revealed a special cause increase in SHD from 60% to 82% overall, along with 37% to 73% for boys and 57% to 80% for noningestion hospitalizations. Increased SHD correlated with cycle 1 and was maintained through cycle 2. Percent STI testing significantly increased but did not shift or trend toward special cause variation. Contraception provision, length of stay, and patient relations consultations were not affected.

Conclusions: The interventions were successful in increasing SHD, including among boys and noningestion hospitalizations. The EHR enhancement maintained these increases after reminder emails were discontinued. Future interventions should specifically address STI testing and provision of contraception.
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http://dx.doi.org/10.1542/hpeds.2021-006038DOI Listing
January 2022

Implications of Glycosaminoglycans on Viral Zoonotic Diseases.

Diseases 2021 Nov 17;9(4). Epub 2021 Nov 17.

Department of Chemistry and Chemical Biology, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA.

Zoonotic diseases are infectious diseases that pass from animals to humans. These include diseases caused by viruses, bacteria, fungi, and parasites and can be transmitted through close contact or through an intermediate insect vector. Many of the world's most problematic zoonotic diseases are viral diseases originating from animal spillovers. The Spanish influenza pandemic, Ebola outbreaks in Africa, and the current SARS-CoV-2 pandemic are thought to have started with humans interacting closely with infected animals. As the human population grows and encroaches on more and more natural habitats, these incidents will only increase in frequency. Because of this trend, new treatments and prevention strategies are being explored. Glycosaminoglycans (GAGs) are complex linear polysaccharides that are ubiquitously present on the surfaces of most human and animal cells. In many infectious diseases, the interactions between GAGs and zoonotic pathogens correspond to the first contact that results in the infection of host cells. In recent years, researchers have made progress in understanding the extraordinary roles of GAGs in the pathogenesis of zoonotic diseases, suggesting potential therapeutic avenues for using GAGs in the treatment of these diseases. This review examines the role of GAGs in the progression, prevention, and treatment of different zoonotic diseases caused by viruses.
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http://dx.doi.org/10.3390/diseases9040085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628766PMC
November 2021

Zinc status and growth in infants and young children with cystic fibrosis.

Pediatr Pulmonol 2021 12 17;56(12):3768-3776. Epub 2021 Sep 17.

Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Background: Zinc deficiency is associated with poor growth in children without cystic fibrosis (CF), but its impact on growth in children with CF is unknown.

Objective: To determine the prevalence of low serum Zn (sZn) and its relationship with growth in the first 3 years of life in children with CF.

Methods: We utilized data from infants with CF who were enrolled in a longitudinal study of nutrition and lung health and had sZn measured as part of clinical care. Cross-sectional correlations between sZn levels and growth z scores were assessed by Pearson's correlation coefficient. To identify factors associated with sZn status and its association to longitudinal growth patterns, multiple regression analysis with repeated measures were performed using generalized estimating equations.

Results: A total of 106 sZn measurements from 53 infants were identified. Seventeen infants (32%) had intermittent Zn insufficiency, defined as at least one sZn <70 mcg/dl in their first 3 years of life. There were no significant cross-sectional associations between sZn and growth z scores. However, analysis of longitudinal growth patterns revealed that weight- and length-for-age z scores in children with intermittent Zn insufficiency were lower during early infancy and their weight-for-length z scores at age 3 years were also lower compared to those who were always Zn sufficient.

Conclusion: Low sZn occurs in one-third of children with CF in the first 3 years of life. Cross-sectional and longitudinal analyses revealed discrepant associations between sZn and growth. Therefore, prospective studies are needed to understand the role of Zn in growth in CF.
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http://dx.doi.org/10.1002/ppul.25666DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629965PMC
December 2021

RISC in Entamoeba histolytica: Identification of a Protein-Protein Interaction Network for the RNA Interference Pathway in a Deep-Branching Eukaryote.

mBio 2021 10 7;12(5):e0154021. Epub 2021 Sep 7.

Division of Infectious Diseases, Department of Internal Medicine, Stanford Universitygrid.168010.e School of Medicine, Stanford, California, USA.

Entamoeba histolytica is a protozoan parasite that causes amebiasis in humans and is a major health concern in developing countries. Our previous work revealed a functional RNA interference (RNAi) pathway in . Several unusual features encompass the RNAi pathway in the parasite, including small RNAs (sRNAs) with a 5'-polyphosphate structure (identified to date only in and nematodes) and the conspicuous absence of a canonical Dicer enzyme. Currently, little is known about the RNA-induced silencing complex (RISC), which is critical in understanding how RNAi is achieved in the parasite. In this study, we examined the RISC of Ago2-2, the most highly expressed Argonaute protein in . We identified 43 protein components of Ago2-2 RISC with a broad range of functional activities. Two proteins with nucleosome assembly protein (NAP) domains, not previously observed in other RNAi systems, were identified as novel core members of amebic RISC. We further demonstrated the interaction of these NAPs with Ago using an recombinant system. Finally, we characterized the interaction network of five RISC components identified in this study to further elucidate the interactions of these RNAi pathway proteins. Our data suggest the presence of closely interacting protein groups within RISC and allowed us to build a map of protein-protein interactions in relation to Ago. Our work is the first to elucidate RISC components in and expands the current knowledge of RISC to a deep-branching single-celled eukaryote. Entamoeba histolytica is a leading parasitic cause of death in developing countries, and our efforts are focused on defining the molecular basis of RNA interference (RNAi) gene regulation in this parasite. The RNAi pathway effectively silences a subset of endogenous genes and has also been harnessed as a gene silencing tool to study gene function in this organism. However, little is known about the components of the RNA-induced silencing complex (RISC), which is critical in understanding how gene silencing is achieved in the parasite. This study characterizes, for the first time, the RISC components in and provides new insights in understanding the molecular regulatory mechanisms of RNAi in this parasite, including the demonstration of novel Ago protein-interacting partners. From an evolutionary point of view, our findings expand the current knowledge of RISC to a deep-branching single-celled eukaryote.
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http://dx.doi.org/10.1128/mBio.01540-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546589PMC
October 2021

Nutrition and growth in infants with established bronchopulmonary dysplasia.

Pediatr Pulmonol 2021 11 2;56(11):3557-3562. Epub 2021 Sep 2.

Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA.

Bronchopulmonary dysplasia (BPD) remains the most common late morbidity of preterm birth. Ongoing clinical care and research have largely focused on the pathogenesis and prevention of BPD in preterm infants. However, preterm infants who develop BPD have significant medical needs that persist throughout their neonatal intensive care unit course and continue post-discharge, including those associated with growth and nutrition. The objective of this manuscript was to provide a review on nutrition and growth in infants with established BPD after discharge from the hospital and to identify the knowledge and research gaps to provide direction for future studies.
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http://dx.doi.org/10.1002/ppul.25638DOI Listing
November 2021

Using Electronic Health Record Tools to Decrease Antibiotic Exposure in Infant Sepsis Evaluation.

Hosp Pediatr 2021 09 13;11(9):936-943. Epub 2021 Aug 13.

Children's Wisconsin, Milwaukee, Wisconsin.

Background: Our internal infant sepsis evaluation clinical practice guideline recommends infants with negative culture results who are undergoing sepsis evaluation receive antibiotics until culture results are negative for a maximum of 36 hours. The aims of our project were to decrease the percentage of patients who received >30 hours of administered antibiotic doses (recognizing effective concentrations last until hour 36) and increase 36-hour phrase documentation by using clinical decision support tools.

Methods: We used quality improvement methodology to study infants aged ≤60 days with negative culture results. The outcome measures were the percentage of patients who received >30 hours of administered antibiotic doses, the percentage of history and physical (H&P) notes that included a statement of the anticipated 36-hour antibiotic discontinuation time (36-hour phrase), and length of stay. The process measure was the use of an illness-specific H&P template or an influencer smartphrase. Balancing measures were readmissions for positive culture results. Interventions included education, an illness-specific H&P template, a criteria-based rule to default to this H&P template, and editing influencer smartphrases.

Results: Over 33 months, 311 patients were included. Percentage of patients who received >30 hours of administered antibiotic doses decreased from 75.6% to 62%. Percentage of H&P notes documenting the 36-hour phrase increased from 4.9% to 75.6%. Illness-specific H&P template and influencer smartphrase usage increased to a mean of 51.5%; length of stay did not change. No readmissions for positive culture results were reported.

Conclusions: Clinical decision support techniques and educational interventions popularized the "36-hour phrase" and were associated with a reduction in the antibiotic exposure in infants with negative culture results hospitalized for sepsis evaluation.
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http://dx.doi.org/10.1542/hpeds.2021-005883DOI Listing
September 2021

Recovery-oriented acute inpatient mental health care: Operationalization and measurement.

Psychiatr Rehabil J 2021 Dec 29;44(4):318-326. Epub 2021 Jul 29.

Department of Psychology.

Objective: The current article describes efforts to develop and test a measure of recovery-oriented inpatient care.

Method: The Recovery-oriented Acute INpatient (RAIN) scale was based on prior literature and current Veterans Health Administration (VHA) policy and resources and further revised based on data collection from 34 VHA acute inpatient units.

Results: A final scale of 23, behaviorally anchored items demonstrated a four-factor structure including the following factors: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. While several items require additional revision to address psychometric concerns, the scale demonstrated adequate model fit and was consistent with prior literature on recovery-oriented inpatient care. Conclusions and Implementations for Practice: The RAIN scale represents an important tool for future implementation and empirical study of recovery-oriented inpatient care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/prj0000494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664980PMC
December 2021

Pediatric COVID-19 Delirium: Case Report of 2 Adolescents.

WMJ 2021 Jul;120(2):131-136

Medical College of Wisconsin, Department of Pediatrics, Section of Infectious Diseases, Milwaukee, Wisconsin.

Introduction: Neurological complications of COVID-19, including delirium, are emerging in the adult population but have not been well described in pediatrics.

Case Presentation: We report the cases of 2 adolescent males, ages 16 and 17, who presented with delirium secondary to an acute COVID-19 infection in the fall of 2020 at Children's Wisconsin in Milwaukee, Wisconsin. The foundation of our treatment strategy was the triad of alpha-2 agonists (clonidine, dexmedetomidine, guanfacine), antipsychotic agents (quetiapine, haloperidol, olanzapine), and melatonin. Discharge planning required involvement from inpatient psychiatry, case management, social work, and the family. Both patients showed improvement after several weeks.

Discussion: We believe these are the first reported cases of COVID-19-associated delirium in children outside of multisystem inflammatory syndrome in children (MIS-C).

Conclusion: Pediatric COVID-19 delirium is a new manifestation of the COVID-19 disease. Treatment guidelines are emerging and lessons regarding therapies and discharge considerations are described in these 2 unique cases.
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July 2021

DDX3X Links NLRP11 to the Regulation of Type I Interferon Responses and NLRP3 Inflammasome Activation.

Front Immunol 2021 13;12:653883. Epub 2021 May 13.

Department of Immunology, Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.

Tight regulation of inflammatory cytokine and interferon (IFN) production in innate immunity is pivotal for optimal control of pathogens and avoidance of immunopathology. The human Nod-like receptor (NLR) NLRP11 has been shown to regulate type I IFN and pro-inflammatory cytokine responses. Here, we identified the ATP-dependent RNA helicase DDX3X as a novel binding partner of NLRP11, using co-immunoprecipitation and LC-MS/MS. DDX3X is known to enhance type I IFN responses and NLRP3 inflammasome activation. We demonstrate that NLRP11 can abolish IKKϵ-mediated phosphorylation of DDX3X, resulting in lower type I IFN induction upon viral infection. These effects were dependent on the LRR domain of NLRP11 that we mapped as the interaction domain for DDX3X. In addition, NLRP11 also suppressed NLRP3-mediated caspase-1 activation in an LRR domain-dependent manner, suggesting that NLRP11 might sequester DDX3X and prevent it from promoting NLRP3-induced inflammasome activation. Taken together, our data revealed DDX3X as a central target of NLRP11, which can mediate the effects of NLRP11 on type I IFN induction as well as NLRP3 inflammasome activation. This expands our knowledge of the molecular mechanisms underlying NLRP11 function in innate immunity and suggests that both NLRP11 and DDX3X might be promising targets for modulation of innate immune responses.
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http://dx.doi.org/10.3389/fimmu.2021.653883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158815PMC
September 2021

One Call Away: Addressing a Safety Gap for Urgent Issues Post Discharge.

Hosp Pediatr 2021 06;11(6):632-635

Children's Wisconsin, Milwaukee, Wisconsin.

Objectives: The transition period from hospitalization to outpatient care can be high risk for pediatric patients. Our aim was to profile the use of a "safety net" for families through provision of specific inpatient provider contact information for urgent issues post discharge.

Methods: In this prospective study, we implemented an updated after-visit summary that directed families to call the hospital operator and specifically ask for the pediatric hospital medicine attending on call if they were unable to reach their primary care provider (PCP) with an urgent postdischarge concern. Education for nursing staff, operators, and pediatric hospital medicine providers was completed, and contact information was automatically populated into the after-visit summary. Information collected included the number of calls, the topic, time spent, whether the family contacted the PCP first, and the time of day. Descriptive statistics and Fisher's exact test were used to summarize findings.

Results: Over a 13-month period, of 5145 discharges, there were 47 postdischarge phone calls, which averaged to 3.6 calls per month. The average length of time spent on a call was 21 minutes. For 30% of calls, families had tried contacting their PCPs first, and 55% of calls occurred at night. Topics of calls included requesting advice about symptoms, time line for reevaluation, and assistance with medications.

Conclusions: This safety net provided families with real-time problem-solving for an urgent need post discharge, which included triaging patient symptoms at home, counseling on medication questions, information about the time line of illness recovery, and provision of additional resources.
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http://dx.doi.org/10.1542/hpeds.2020-003418DOI Listing
June 2021

Letting Residents Lead: Implementing Resident Admission Triage Call Curriculum and Practice.

Hosp Pediatr 2021 06 17;11(6):579-586. Epub 2021 May 17.

Section of Pediatric Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin.

Background And Objectives: Graduating residents are expected to be competent in triaging patients to appropriate resources. Before 2017, pediatric residents were not involved in admission triage decisions. In 2017, after implementing an admission triage curriculum (ATC), residents had opportunities to be involved in overnight admission calls with the emergency department (ED), which were initially supervised (joint calls), and as skills progressed, residents conducted calls and admitted patients independently. We implemented and evaluated the impact of a graduated ATC intervention bundle on pediatric resident opportunities to participate in admission triage, while monitoring resident confidence, the ED experience, and patient safety.

Methods: We evaluated the impact of our ATC using quality improvement methodology. The primary outcome was the frequency of resident participation in joint and independent triage calls. Other measures included resident confidence, the ED clinician experience, and patient safety. Resident confidence and the ED clinician experience were rated via surveys. Safety was monitored with daytime hospitalist morning assessments and postadmission complications documented in the medical record.

Results: The percent of joint calls with the hospitalist increased from 7% to 88%, and 125 patients were admitted independently. Residents reported significant increases in adequacy of triage training and confidence in 3 triage skills ( < .001) after ATC. There were no complications or safety concerns on patients admitted by residents. ED clinicians reported increased admitting process efficiency and satisfaction.

Conclusions: Our ATC intervention bundle increased the number of admission decision opportunities for pediatric residents, while increasing resident triage confidence, maintaining safety, and improving ED clinician experience.
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http://dx.doi.org/10.1542/hpeds.2020-005199DOI Listing
June 2021

The Application of Seaweed Polysaccharides and Their Derived Products with Potential for the Treatment of Alzheimer's Disease.

Mar Drugs 2021 Feb 4;19(2). Epub 2021 Feb 4.

Center for Biotechnology and Interdisciplinary Studies, Department of Chemistry and Chemical Biology, Rensselaer Polytechnic Institute, Troy, NY 12180, USA.

Neurodegenerative diseases are among the most widespread diseases affecting humans, and the number of patients is only rising. Seaweed polysaccharide extracts show significant neuroprotective and reparative activities. Seaweed polysaccharides might provide the next big breakthrough in neurodegenerative disease treatment. This paper reviews the applications of seaweed polysaccharides as potential treatments of neurodegenerative diseases. The particular focus is on fucoidan, ulvan, and their derivatives as potential agents to treat Alzheimer's disease. This review provides a critical update on the progress in this important research area.
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http://dx.doi.org/10.3390/md19020089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913876PMC
February 2021

Outcomes of repeat sweat testing in cystic fibrosis newborn screen positive infants.

Pediatr Pulmonol 2021 06 9;56(6):1521-1526. Epub 2021 Feb 9.

Division of Pediatrics, Indiana University, Indianapolis, Indiana, USA.

Background: Infants with a positive cystic fibrosis (CF) newborn screen, only one identified CFTR mutation (NBS+/1 mut), and an initial intermediate sweat chloride (30-59 mmol/L) should have repeat sweat chloride testing (SCT). However, the outcome of repeat SCT and the relationship between initial sweat Cl and subsequent CF diagnosis have not been reported.

Objective: The objective of this study was to analyze the outcomes of repeat SCT and subsequent CF diagnosis in NBS+/1 mut infants based on their initial sweat chloride concentration.

Methods: We retrospectively identified all infants born in Indiana from 2007 to 2017 with NBS+/1 mut and initial SCT in the intermediate range. For each infant, we recorded the initial and repeat SCT results and/or a final CF diagnosis.

Results: From 2007 through 2017 there were 2822 NBS+/1 mut infants of which 2613 (82%) had at least one SCT result. No infants with an initial SCT of 30-39 mmol/L were subsequently diagnosed with CF. Of the 31 infants with an initial SCT of 40-49 mmol/L, only 1 was subsequently diagnosed with CF. In contrast, 61% of those with SCTs of 50-59 mmol/L were later diagnosed with CF.

Conclusion: These results suggest that infants with a positive NBS for CF and one CFTR mutationwhose initial sweat chloride concentration is 50-59 mmol/L need to be monitored more closely forCF with strong consideration for earlier repeat SCTs and immediate genotyping.
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http://dx.doi.org/10.1002/ppul.25296DOI Listing
June 2021

Identifying characteristics and outcomes in youth with obesity and developmental disabilities.

Disabil Health J 2021 04 10;14(2):100988. Epub 2020 Sep 10.

Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. Electronic address:

Background: Youth with developmental disability are at increased risk of obesity; literature focusing on the two is rare.

Objective: To identify characteristics and outcomes of youth presenting for obesity care having a disability as compared to without.

Methods: A medical record review of youth aged 2-18 years initiating obesity care 2013-2015 at a tertiary care obesity management program. Youth were grouped by disability status to identify differences in presenting characteristics and factors associated with a reduction in body mass index (BMI) percent of the 95th BMI percentile (BMIp95) over 12 months. Logistic regression (LR) models examined associations with BMIp95 drop (<5-points versus ≥5-points) for each disability group.

Results: Of 887 subjects, 253 (28.5%) had a disability. At presentation, youth with disability were more often (p < 0.01) male (58.5% versus 47.9%), had birth weight <2500 g (14.1% versus 8.4%), had a father who was not obese (61.6% versus 47.4%), and were on weight influencing medications. Overall, 182 subjects (20.5%) completed 12-month follow-up. At follow-up, the with disability group (n = 63) had mean -2.3 (SD 10.7) BMIp95 change (p = 0.679); youth having a motor disability less often had ≥5-point BMIp95 drop (odds ratio 0.15, 95% confidence interval 0.04-0.59). At follow-up, the no disability group (n = 119) had mean -2.9 (SD 8.5) BMIp95 change; youth identified as having initial severe obesity status and not having a parent with diabetes more often had ≥5-point BMIp95 drop.

Conclusion: Youth with developmental disabilities were as successful in obesity care as those without disabilities. Predictors of success differed between the groups.
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http://dx.doi.org/10.1016/j.dhjo.2020.100988DOI Listing
April 2021

Head and neck surgical oncology in the time of a pandemic: Subsite-specific triage guidelines during the COVID-19 pandemic.

Head Neck 2020 06;42(6):1194-1201

Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Background: COVID-19 pandemic has strained human and material resources around the world. Practices in surgical oncology had to change in response to these resource limitations, triaging based on acuity, expected oncologic outcomes, availability of supportive resources, and safety of health care personnel.

Methods: The MD Anderson Head and Neck Surgery Treatment Guidelines Consortium devised the following to provide guidance on triaging head and neck cancer (HNC) surgeries based on multidisciplinary consensus. HNC subsites considered included aerodigestive tract mucosa, sinonasal, salivary, endocrine, cutaneous, and ocular.

Recommendations: Each subsite is presented separately with disease-specific recommendations. Options for alternative treatment modalities are provided if surgical treatment needs to be deferred.

Conclusion: These guidelines are intended to help clinicians caring for patients with HNC appropriately allocate resources during a health care crisis, such as the COVID-19 pandemic. We continue to advocate for individual consideration of cases in a multidisciplinary fashion based on individual patient circumstances and resource availability.
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http://dx.doi.org/10.1002/hed.26206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267348PMC
June 2020

Factors Associated with Neurodevelopmental Impairment in Bronchopulmonary Dysplasia.

J Pediatr 2020 03 8;218:22-27.e2. Epub 2020 Jan 8.

Department of Pediatrics, The Ohio State University, Columbus, OH; Center for Perinatal Research, Research Institute at Nationwide Children's Hospital, Columbus, OH; Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH. Electronic address:

Objective: To identify factors associated with neurodevelopmental impairment (NDI) in patients with bronchopulmonary dysplasia (BPD).

Study Design: We identified 151 patients with moderate to severe BPD from 2010 to 2014 with complete Bayley Scales of Infant Development (BSID) scores at 24 months corrected age. We defined NDI as any diagnosis of cerebral palsy or ≥1 BSID composite scores of <80.

Results: The mean corrected age at BSID was 23 ± 1 months; 18% had a cognitive score of <80, 37% had a communication score of <80, and 26% had a motor score of <80. Cerebral palsy was diagnosed in 22 patients (15%); 84 (56%) patients did not have NDI. Patients with NDI had lower birth weight, but there was no difference in gestational age at birth, severe intraventricular hemorrhage (IVH), necrotizing enterocolitis, or patent ductus arteriosus ligation compared with patients with no NDI. Ventilator days were greater in patients with NDI than in patients without NDI. More patients with NDI received furosemide and systemic corticosteroids and the hospital length of stay was longer than in patients with no NDI. Logistic regression modeling demonstrated that for every additional 100 g of birth weight the odds of NDI decreased by 35% and for every additional hospital day the odds of NDI increased by 1.3%.

Conclusions: In our cohort of patients with moderate to severe BPD, the majority had no NDI, and low birth weight and length of hospital stay were associated with increased risk of developing NDI. This finding suggests that there are potentially modifiable factors associated with better neurodevelopmental outcomes in patients with BPD that deserve further study.
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http://dx.doi.org/10.1016/j.jpeds.2019.11.016DOI Listing
March 2020

Effects of Shambhavi Mahamudra Kriya, a Multicomponent Breath-Based Yogic Practice ( Pranayama), on Perceived Stress and General Well-Being.

J Evid Based Complementary Altern Med 2017 Oct 22;22(4):788-797. Epub 2017 Sep 22.

5 Indiana University School of Medicine, Indianapolis, IN, USA.

Stress-induced disorders such as anxiety represent the leading causes of adult disability worldwide. Previous studies indicate that yoga and other contemplative practices such as pranayama, or controlled yogic breathing techniques, may be effective in the treatment of mood disorders and stress. In this study, 142 individuals (mean age = 43 years; SD = 13.90) participated in a 3-day retreat program during which they learned Shambhavi Mahamudra kriya, which is a yogic practice that includes both deep breathing and meditation techniques. Participants were instructed to practice the kriya each day for 21 minutes. After 6 weeks of daily practice, participants reported subjectively lower levels of perceived stress (Perceived Stress Scale) and higher levels of general well-being (General Well-Being Scale) compared to baseline. These results support the notion that Shambhavi Mahamudra kriya may represent a natural treatment for stress reduction.
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http://dx.doi.org/10.1177/2156587217730934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871312PMC
October 2017

Glycosome biogenesis in trypanosomes and the de novo dilemma.

PLoS Negl Trop Dis 2017 04 20;11(4):e0005333. Epub 2017 Apr 20.

Eukaryotic Pathogens Innovation Center, Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina, United States of America.

Trypanosomatid parasites, including Trypanosoma and Leishmania, are the causative agents of lethal diseases threatening millions of people around the world. These organisms compartmentalize glycolysis in essential, specialized peroxisomes called glycosomes. Peroxisome proliferation can occur through growth and division of existing organelles and de novo biogenesis from the endoplasmic reticulum. The level that each pathway contributes is debated. Current evidence supports the concerted contribution of both mechanisms in an equilibrium that can vary depending on environmental conditions and metabolic requirements of the cell. Homologs of a number of peroxins, the proteins involved in peroxisome biogenesis and matrix protein import, have been identified in T. brucei. Based on these findings, it is widely accepted that glycosomes proliferate through growth and division of existing organelles; however, to our knowledge, a de novo mechanism of biogenesis has not been directly demonstrated. Here, we review recent findings that provide support for the existence of an endoplasmic reticulum (ER)-derived de novo pathway of glycosome biogenesis in T. brucei. Two studies recently identified PEX13.1, a peroxin involved in matrix protein import, in the ER of procyclic form T. brucei. In other eukaryotes, peroxins including PEX13 have been found in the ER of cells undergoing de novo biogenesis of peroxisomes. In addition, PEX16 and PEX19 have been characterized in T. brucei, both of which are important for de novo biogenesis in other eukaryotes. Because glycosomes are rapidly remodeled via autophagy during life cycle differentiation, de novo biogenesis could provide a method of restoring glycosome populations following turnover. Together, the findings we summarize provide support for the hypothesis that glycosome proliferation occurs through growth and division of pre-existing organelles and de novo biogenesis of new organelles from the ER and that the level each mechanism contributes is influenced by glucose availability.
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http://dx.doi.org/10.1371/journal.pntd.0005333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398534PMC
April 2017

Integrating Self-Determination and Job Demands-Resources Theory in Predicting Mental Health Provider Burnout.

Adm Policy Ment Health 2018 01;45(1):121-130

Department of Psychology, Indiana University-Purdue University, Indianapolis (IUPUI), 402 N. Blackford St., LD 120A, Indianapolis, IN, 46202, USA.

Limited progress has been made in reducing burnout in mental health professionals. Accordingly, we identified factors that might protect against burnout and could be productive focal areas for future interventions. Guided by self-determination theory, we examined whether supervisor autonomy support, self-efficacy, and staff cohesion predict provider burnout. 358 staff from 13 agencies completed surveys. Higher levels of supervisor autonomy support, self-efficacy, and staff cohesion were predictive of lower burnout, even after accounting for job demands. Although administrators may be limited in their ability to reduce job demands, our findings suggest that increasing core job resources may be a viable alternative.
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http://dx.doi.org/10.1007/s10488-016-0772-zDOI Listing
January 2018

Veterans' pain management goals: Changes during the course of a peer-led pain self-management program.

Patient Educ Couns 2016 12 4;99(12):2080-2086. Epub 2016 Aug 4.

VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, INC., Indianapolis, IN, USA; Department of Communications Studies, Indiana University-Purdue University, Indianapolis, IN, USA.

Objective: Goal setting is a common element of self-management support programs; however, little is known about the nature of patients' goals or how goals change during pain self-management. The purpose of the current study is to explore how patients' goals and views of goal setting change over the course of a peer-led pain self-management program.

Methods: Veterans (n=16) completing a 4-month peer-led pain self-management program completed semi-structured interviews at baseline and follow-up regarding their goals for their pain. Interviews were analyzed using immersion/crystallization.

Results: Analyses revealed six themes: motivation to do something for their pain, more goal-oriented, actually setting goals, clarity of goal importance, more specific/measurable goal criteria, and more specific/measurable strategies.

Conclusion: The current analyses illustrate how participants' goals can evolve over the course of a peer-led pain self-management program. Specifically, increased motivation, more openness to using goals, greater clarity of goal importance, more specific and measurable goals and strategies, and the influence of the peer coach relationship were described by participants.

Practice Implications: Pain self-management interventions should emphasize goal setting, and development of specific, measurable goals and plans. Trainings for providers should address the potential for the provider-patient relationship, particularly peer providers, to facilitate motivation and goal setting.
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http://dx.doi.org/10.1016/j.pec.2016.07.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571443PMC
December 2016

Illness management and recovery in community practice.

Psychiatr Rehabil J 2016 12 8;39(4):343-351. Epub 2016 Aug 8.

Health Services Research, Regenstreif Institute.

Objective: To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence.

Method: IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR Treatment Integrity Scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation).

Results: Average IMR competence scores were in the "needs improvement" range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review.

Conclusions And Implications For Practice: IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed. (PsycINFO Database Record
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http://dx.doi.org/10.1037/prj0000200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125841PMC
December 2016

Reevaluation of the global warming impacts of algae-derived biofuels to account for possible contributions of nitrous oxide.

Bioresour Technol 2016 Oct 18;218:196-201. Epub 2016 Jun 18.

Department of Civil and Environmental Engineering, University of Virginia, 351 McCormick Road, P.O. Box 400742, Charlottesville, VA 22904, United States. Electronic address:

The environmental impacts of algae biofuels have been evaluated by life-cycle assessment (LCA); however, these analyses have overlooked nitrous oxide (N2O), a potent greenhouse gas. A literature analysis was performed to estimate algal N2O emissions and assess the impacts of growth conditions on flux magnitudes. Nitrogen source and dissolved oxygen concentration were identified as possible key contributors; therefore, their individual and combined impacts were evaluated using bench-scale experiments. It was observed that maximum N2O emissions (77.5μg/galgae/day) occur under anoxic conditions with nitrite. Conversely, minimum emissions (6.25μg/galgae/day) occur under oxic conditions with nitrate. Aggregated N2O flux estimates were then incorporated into a LCA framework for algae biodiesel. Accounting for "low" N2O emissions mediated no significant increase (<1%) compared to existing GWP estimates; however, "high" N2O emissions mediate an increase of roughly 25%, potentially jeopardizing the anticipated economic and environmental performances of algae biofuels.
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http://dx.doi.org/10.1016/j.biortech.2016.06.058DOI Listing
October 2016

Localization of a Trypanosome Peroxin to the Endoplasmic Reticulum.

J Eukaryot Microbiol 2017 01 18;64(1):97-105. Epub 2016 Jul 18.

Department of Genetics and Biochemistry, Eukaryotic Pathogens Innovation Center, Clemson University, Clemson, South Carolina, 29634.

Trypanosoma brucei is the causative agent of diseases that affect 30,000-50,000 people annually. Trypanosoma brucei harbors unique organelles named glycosomes that are essential to parasite survival, which requires growth under fluctuating environmental conditions. The mechanisms that govern the biogenesis of these organelles are poorly understood. Glycosomes are evolutionarily related to peroxisomes, which can proliferate de novo from the endoplasmic reticulum or through the growth and division of existing organelles depending on the organism and environmental conditions. The effect of environment on glycosome biogenesis is unknown. Here, we demonstrate that the glycosome membrane protein, TbPex13.1, is localized to glycosomes when cells are cultured under high glucose conditions and to the endoplasmic reticulum in low glucose conditions. This localization in low glucose was dependent on the presence of a C-terminal tripeptide sequence. Our findings suggest that glycosome biogenesis is influenced by extracellular glucose levels and adds to the growing body of evidence that de novo glycosome biogenesis occurs in trypanosomes. Because the movement of peroxisomal membrane proteins is a hallmark of ER-dependent peroxisome biogenesis, TbPex13.1 may be a useful marker for the study such processes in trypanosomes.
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http://dx.doi.org/10.1111/jeu.12343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215699PMC
January 2017

Primary Care-Based Interventions to Promote Positive Parenting Behaviors: A Meta-analysis.

Pediatrics 2016 05 19;137(5). Epub 2016 Apr 19.

Departments of Pediatrics and Medical Education, College of Medicine, and.

Context: Utilization of primary care settings offers a promising approach to enhance parenting practices that are critical for promoting early childhood development. Determining the impact of existing primary care interventions on key parenting behaviors will aid providers and policy makers as they seek strategies to improve early child outcomes.

Objective: To evaluate the efficacy of primary care-based interventions on parenting practices that promote early child development among children younger than 36 months.

Data Sources: PubMed, Excerpta Medica dataBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases were searched electronically.

Study Selection: English-language articles that were quasi-randomized or randomized controlled trials, included parents of children <36 months of age, and reported outcomes related to parenting behaviors that promote early child development.

Data Extraction: Two reviewers independently extracted data regarding participants, interventions, and outcomes. Quantitative meta-analyses were conducted with random effects for study and fitted with restricted maximum likelihood methods.

Results: The review included 13 studies reporting parenting outcomes in 2 categories: participation in cognitively stimulating activities and positive parent-child interactions. We found a statistically significant positive effect of primary care-delivered interventions and parent-child interactions (summary standardized mean difference 0.29, 95% confidence interval [CI] 0.06-0.52, P < .0001) and participation in cognitively stimulating activities (summary standardized mean difference 0.34, 95% CI 0.03-0.54; summary odds ratio 0.13, 95% CI 0.01-0.25, P < .0001).

Limitations: Limitations included heterogeneity in measures used, outcomes, and timing of assessments.

Conclusions: Primary care-based interventions modestly affect positive parenting behaviors important for early childhood development. Randomized controlled trials with comparable outcome measures using standardized assessments are needed to assess further beneficial impacts.
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http://dx.doi.org/10.1542/peds.2015-3393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845871PMC
May 2016

Disability and physical and communication-related barriers to health care related services among Florida residents: A brief report.

Disabil Health J 2016 07 24;9(3):552-6. Epub 2016 Mar 24.

Florida Department of Health, Disability and Health Program, USA.

Background: Research has not fully characterized barriers to health care faced by persons with disabilities (PWD) which constitutes a critical gap given the increased risk of chronic illness faced by PWD.

Objective: To understand the current barriers to seeking health care-related services for PWD in Florida.

Methods: The study was based on a random-digit-dial telephone interview survey of respondents aged 18 and over (n = 1429). Multivariable logistic regression assessed the relationship between disability and physical and communication barriers.

Results: One thousand four hundred and twenty-nine Florida residents participated in the survey. Thirty-three percent of respondents (n = 471) reported having a disability. PWD were significantly older (mean age 68 vs. 61) and had lower levels of income and education than persons without disabilities (PWOD) (p < 0.05). In adjusted analyses, PWD had significantly higher odds of encountering a physical environment barrier (Odds Ratio [OR] = 16.6 95% CI: 7.9, 34.9), a clinical experience barrier (OR = 13.9 95% CI: 6.9, 27.9) a communication and knowledge barrier (OR = 6.7 95% CI: 4.0, 11.3) and a barrier coordinating care (OR = 5.7 95% CI: 3.4, 9.6) compared to persons without disabilities (PWOD).

Conclusions: PWD disproportionately face health care access difficulties that can impede the receipt of high quality care within and between provider visits. Efforts to reduce physical barriers and improve communication between providers and PWD may improve functional status and quality of life for these patients.
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http://dx.doi.org/10.1016/j.dhjo.2016.03.001DOI Listing
July 2016
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