Patterns of Use of β-2 Agonists, Steroids, and Mucoactive Medications to Treat Bronchiolitis in the PICU: U.S. Pediatric Health Information System 2009-2022 Database Study.

Objectives: Describe β2-agonists, steroids, hypertonic saline (HTS), n-acetylcysteine (NAC), and dornase alfa (DA) use to treat bronchiolitis, factors associated with use, and associations between use and PICU length of stay (LOS).

Design: Retrospective, multicenter cohort study.

Setting: PICUs in the Pediatric Health Information System database.

Targeted Temperature Management After Pediatric Cardiac Arrest: A Quality Improvement Program With Multidisciplinary Implementation in the PICU.

Objectives: We aimed to implement a post-cardiac arrest targeted temperature management (TTM) bundle to reduce the percent of time with a fever from 7% to 3.5%.

Design: A prospective, quality improvement (QI) initiative utilizing the Method for Improvement.

A mediation analysis evaluating change in self-stigma on diabetes outcomes among people with depression in urban India: A secondary analysis from the INDEPENDENT trial of the collaborative care model.

Self-stigma-the internalization of negative community attitudes and beliefs about a disease or condition-represents an important barrier to improving patient care outcomes for people living with common mental disorders and diabetes. Integrated behavioral healthcare interventions are recognized as evidence-based approaches to improve access to behavioral healthcare and for improving patient outcomes, including for those with comorbid diabetes, yet their impact on addressing self-stigma remains unclear. Using secondary data from the Integrating Depression and Diabetes Treatment (INDEPENDENT) study-a trial that aimed to improve diabetes outcomes for people with undertreated and comorbid depression in four urban Indian cities via the Collaborative Care Model-we longitudinally analyzed self-stigma scores and evaluated whether change in total self-stigma scores on diabetes outcomes is mediated by depressive symptom severity.

Probabilistic Linkage Creates a Novel Database to Study Bronchiolitis Care in the PICU.

Objectives: Lack of a comprehensive database containing diagnosis, patient and clinical characteristics, diagnostics, treatments, and outcomes limits needed comparative effectiveness research (CER) to improve care in the PICU. Combined, the Pediatric Hospital Information System (PHIS) and Virtual Pediatric Systems (VPS) databases contain the needed data for CER, but limits on the use of patient identifiers have thus far prevented linkage of these databases with traditional linkage methods. Focusing on the subgroup of patients with bronchiolitis, we aim to show that probabilistic linkage methods accurately link data from PHIS and VPS without the need for patient identifiers to create the database needed for CER.

Implementation Science Research in Pediatric Critical Care Medicine.

Objectives: Delay or failure to consistently adopt evidence-based or consensus-based best practices into routine clinical care is common, including for patients in the PICU. PICU patients can fail to receive potentially beneficial diagnostic or therapeutic interventions, worsening the burden of illness and injury during critical illness. Implementation science (IS) has emerged to systematically address this problem, but its use of in the PICU has been limited to date.

Grieving Children' Death in an Intensive Care Unit: Implementation of a Standardized Process.

The grief that accompanies witnessing the death of a child puts health care professionals at risk of secondary trauma, burnout, and turnover when left unaddressed. Support staff well-being and promote resiliency. Descriptive implementation of a structured, peer-to-peer bereavement support program for intensive care unit (ICU) staff at a tertiary children's hospital.

Fomepizole Therapy for Acetaminophen-Induced Liver Failure in an Infant.

Acetaminophen overdose is common in the pediatric population. N-acetylcysteine (NAC) is effective at preventing liver injury in most patients when started shortly after the overdose. Delays to therapy increase risk of hepatotoxicity and liver failure that may necessitate organ transplant.

What does non-standard employment look like in the United States? An empirical typology of employment quality.

Despite significant interest in the changing nature of employment as a critical social and economic challenge facing society-especially the decline in the so-called Standard Employment Relationship (SER) and rise in more insecure, precarious forms of employment-scholars have struggled to operationalize the multifaceted and heterogeneous nature of contemporary worker-employer relationships within empirical analyses. Here we investigate the character and distribution of employment relationships in the U.S.

Development of a tool to assess HIV prevention readiness of adolescent girls and young women in HPTN 082 study.

Background: African adolescent girls and young women (AGYW) represent a large proportion of new HIV infections, a priority population for pre-exposure prophylaxis (PrEP), but adherence remains a challenge. A reliable, valid readiness tool would help identify AGYW motivated to take PrEP who need adherence support.

Methods: In the HPTN 082 open-label PrEP study (2016-2019), South African and Zimbabwean women ages 16-25 were administered an HIV prevention readiness measure (HPRM).

Extracorporeal membrane oxygenation and paediatric palliative care in an ICU.

Objectives: Compare rates, clinical characteristics, and outcomes of paediatric palliative care consultation in children supported on extracorporeal membrane oxygenation admitted to a single-centre 16-bed cardiac or a 28-bed paediatric ICU.

Methods: Retrospective review of clinical characteristics and outcomes of children (aged 0-21 years) supported on extracorporeal membrane oxygenation between January, 2017 and December, 2019 compared by palliative care consultation.

Measurements And Results: One hundred children (N = 100) were supported with extracorporeal membrane oxygenation; 19% received a palliative care consult.

A framework for characterizing heterogeneity in neurodevelopmental data using latent profile analysis in a sample of children with ADHD.

Background: Heterogeneity in neurodevelopmental disorders, and attention deficit hyperactivity disorder (ADHD) in particular, is increasingly identified as a barrier to identifying biomarkers and developing standards for clinical care. Clustering analytic methods have previously been used across a variety of data types with the goal of identifying meaningful subgroups of individuals with ADHD. However, these analyses have often relied on algorithmic approaches which assume no error in group membership and have not made associations between patterns of behavioral, neurocognitive, and genetic indicators.

Improving Knowledge of Active Safety and QI Projects Amongst Practitioners in a Pediatric ICU.

Introduction: The success of quality improvement (QI) projects depends on many factors, with communication and knowledge of project-specific practice change being fundamental. This project aimed to improve the knowledge of active safety and QI projects.

Methods: Two interventions were trialed to improve knowledge: paired email and meeting announcements followed by a daily huddle to review ongoing projects.

Systems analysis and improvement approach to optimize outpatient mental health treatment cascades in Mozambique (SAIA-MH): study protocol for a cluster randomized trial.

Background: Significant investments are being made to close the mental health (MH) treatment gap, which often exceeds 90% in many low- and middle-income countries (LMICs). However, limited attention has been paid to patient quality of care in nascent and evolving LMIC MH systems. In system assessments across sub-Saharan Africa, MH loss-to-follow-up often exceeds 50% and sub-optimal medication adherence often exceeds 60%.

Validity and reliability of the Neilands sexual stigma scale among Kenyan gay, bisexual, and other men who have sex with men.

Background: We evaluated the validity and reliability of the Neilands sexual stigma scale administered to 871 gay, bisexual, and other men who have sex with men (GBMSM) at two research locations in Kenya.

Methods: Using cross-validation, exploratory factor analysis (EFA) was performed on a randomly selected subset of participants and validated using confirmatory factor analysis (CFA) on the remaining participants. Associations of the initial and final stigma scale factors with depressive symptoms, alcohol use, and other substance use were examined for the entire dataset.

An Automatic Pediatric Palliative Care Consultation for Children Supported on Extracorporeal Membrane Oxygenation: A Survey of Perceived Benefits and Barriers.

Pediatric palliative care (PPC) consultation is infrequent among children on extracorporeal membrane oxygenation (ECMO). Investigate intensive care unit (ICU) team members' perceptions of automatic PPC consultation for children on ECMO in an ICU in the United States. Cross-sectional survey assessing benefits, barriers to PPC, and consultation processes.

Heritability and Clinical Characteristics of Neuropsychological Profiles in Youth With and Without Elevated ADHD Symptoms.

Objective: In the last decade, there has been an increase in research that aims to parse heterogeneity in attention deficit hyperactivity disorder (ADHD). The current study tests heritability of latent class neuropsychological subtypes.

Method: Latent class analysis was used to derive subtypes in a sample of school-age twins ( = 2,564) enriched for elevated ADHD symptoms.

Parent Preferences for Transparency of Their Child's Hospitalization Costs.

Importance: Health care in the US is often expensive for families; however, there is little transparency in the cost of medical services. The extent to which parents want cost transparency in their children's care is not well characterized.

Objective: To explore the preferences and experiences of parents of hospitalized children regarding the discussion and consideration of health care costs in the inpatient care of their children.

Many classes, restricted measurement (MACREM) models for improved measurement of activities of daily living.

Scientists use latent class (LC) models to identify subgroups in heterogeneous data. LC models reduce an item set to a latent variable and estimate measurement error. Researchers typically use unrestricted LC models, which have many measurement estimates, yet scientific interest primarily concerns the classes.

Modeling Behavior as Dynamic Sequential States: Introduction to the Special Issue.

This special issue of focuses on applications and extensions of latent transition analysis (LTA), a longitudinal parameterization of the latent class (LC) model. LTA is a model of discrete or qualitative change over time among potentially complex states (e.g.

Using discrete choice experiments to design interventions for heterogeneous preferences: protocol for a pragmatic randomised controlled trial of a preference-informed, heterogeneity-focused, HIV testing offer for high-risk populations.

Introduction: Approximately one million undiagnosed persons living with HIV in Southern and Eastern Africa need to test for HIV. Novel approaches are necessary to identify HIV testing options that match the heterogeneous testing preferences of high-risk populations. This pragmatic randomised controlled trial (PRCT) will evaluate the efficacy of a preference-informed, heterogeneity-focused HIV counselling and testing (HCT) offer, for improving rates of HIV testing in two high-risk populations.

Financial Difficulties in Families of Hospitalized Children.

Background: High costs of hospitalization may contribute to financial difficulties for some families.

Objective: To examine the prevalence of financial distress and medical financial burden in families of hospitalized children and identify factors that can predict financial difficulties.

Design, Setting, And Participants: Cross-sectional survey of parents of hospitalized children at six children's hospitals between October 2017 and November 2018.

Characteristics of pediatric patients with traumatic epidural hematomas who can be safely observed: a clinical validation study.

Objective: The study aimed to validate admission clinical and radiographic features of pediatric patients with traumatic epidural hematoma (EDH) that lead to safe observation.

Methods: A Level I trauma center radiology and electronic medical record databases were retrospectively queried for pediatric patients with EDH on CT scan between 1/1/2016 and 10/1/2016. Patient imaging, treatment and outcome variables were abstracted.