Publications by authors named "Marie Wang"

Article Synopsis
  • Mild traumatic brain injury (mTBI), especially from blast exposure, is linked to a higher risk of developing neurodegenerative diseases like Alzheimer's and chronic traumatic encephalopathy, particularly in military personnel.
  • Research showed distinct changes in the expression of AQP4, a protein important for brain fluid dynamics, in the frontal cortex after blast exposure in both humans and a mouse model.
  • Veterans with blast mTBI exhibited MRI-visible changes that suggest disruption of brain fluid clearance, which may contribute to lasting symptoms and long-term brain health issues.
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Importance: There is a lack of randomized clinical trial (RCT) data to guide many routine decisions in the care of children hospitalized for common conditions. A first step in addressing the shortage of RCTs for this population is to identify the most pressing RCT questions for children hospitalized with common conditions.

Objective: To identify the most important and feasible RCT questions for children hospitalized with common conditions.

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Background: Nearly 25% of antibiotics prescribed to children are inappropriate or unnecessary, subjecting patients to avoidable adverse medication effects and cost.

Methods: We conducted a quality improvement initiative across 118 hospitals participating in the American Academy of Pediatrics Value in Inpatient Pediatrics Network 2020 to 2022. We aimed to increase the proportion of children receiving appropriate: (1) empirical, (2) definitive, and (3) duration of antibiotic therapy for community-acquired pneumonia, skin and soft tissue infections, and urinary tract infections to ≥85% by Jan 1, 2022.

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Importance: Urinary tract infection (UTI) is common in children, but the population incidence is largely unknown. Controversy surrounds the optimal diagnostic criteria and how to balance the risks of undertreatment and overtreatment. Changes in health care use during the COVID-19 pandemic created a natural experiment to examine health care use and UTI diagnosis and outcomes.

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Article Synopsis
  • Sleep disturbances are linked to dementia and cognitive decline, but the relationship between changing sleep patterns and cognitive impairment over time is not fully understood.
  • This study aimed to analyze how variations in sleep duration affect cognitive function in healthy older adults over several years.
  • By examining data from the Seattle Longitudinal Study, researchers assessed sleep duration and cognitive performance to evaluate potential connections between sleep patterns and cognitive health in older individuals.*
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Importance: Sleep disturbances and clinical sleep disorders are associated with all-cause dementia and neurodegenerative conditions. It remains unclear how longitudinal changes in sleep impact the incidence of cognitive impairment.

Objective: To evaluate how longitudinal sleep patterns contribute to age-related changes in cognitive function in healthy adults.

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Objective: To describe the clinical course of children with positive urine cultures without pyuria who were not given antibiotics initially, identify predictors of subsequent antibiotic treatment, and evaluate the association between subsequent treatment and urinary tract infection (UTI) within 30 days.

Methods: We conducted a multicenter retrospective cohort study of children 1 to 24 months old who had positive urine cultures without pyuria and who were not started on antibiotics upon presentation to 3 health care systems from 2010 to 2021. Outcomes included clinical status at the time urine cultures resulted, escalation of care (emergency department visit or hospitalization) and subsequent antibiotic treatment within 7 days, and subsequent UTI within 30 days of presentation.

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Importance: The prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis in febrile infants with SARS-CoV-2 is largely unknown. Knowledge of the prevalence of these bacterial infections among febrile infants with SARS-CoV-2 can inform clinical decision-making.

Objective: To describe the prevalence of UTI, bacteremia, and bacterial meningitis among febrile infants aged 8 to 60 days with SARS-CoV-2 vs without SARS-CoV-2.

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The goal of a diagnostic test is to provide information on the probability of disease. In this article, we review the principles of diagnostic test characteristics, including sensitivity, specificity, positive and negative predictive value, receiver operating characteristics curves, likelihood ratios, and interval likelihood ratios. We illustrate how interval likelihood ratios optimize the information that can be obtained from test results that can take on >2 values, how they are reflected in the slope of the receiver operating characteristics curve, and how they can be easily calculated from published data.

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The reduced clearance of amyloid-β (Aβ) is thought to contribute to the development of the pathology associated with Alzheimer's disease (AD), which is characterized by the deposition of Aβ plaques. Previous studies have shown that Aβ is cleared via the glymphatic system, a brain-wide network of perivascular pathways that supports the exchange between cerebrospinal fluid and interstitial fluid within the brain. Such exchange is dependent upon the water channel aquaporin-4 (AQP4), localized at astrocytic endfeet.

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Objectives: Our objective was to describe the prevalence of urinary tract infection (UTI) and invasive bacterial infection (IBI) in febrile infants during the coronavirus disease 2019 pandemic.

Methods: We conducted a multicenter cross-sectional study that included 97 hospitals in the United States and Canada. We included full-term, well-appearing infants 8 to 60 days old with a temperature of ≥38°C and an emergency department visit or hospitalization at a participating site between November 1, 2020 and March 31, 2022.

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Article Synopsis
  • Healthcare utilization among children significantly decreased during the first year of the COVID-19 pandemic, with urgent care visits dropping 76.9% and overall hospitalizations reducing by 43%.
  • The study analyzed national claims data from before and during the pandemic, showing that while well visits returned to pre-pandemic levels by mid-pandemic, mental health-related hospitalizations rose significantly.
  • These findings highlight a shift in healthcare trends among children, which is crucial for developing strategies for future healthcare responses and identifying areas needing attention in pediatric training.
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Background And Objectives: Recommendations for parenteral antibiotic therapy duration in bacterial meningitis in young infants are based predominantly on expert consensus. Prolonged durations are generally provided for proven and suspected meningitis and are associated with considerable costs and risks. The objective of the study was to review the literature on the duration of parenteral antibiotic therapy and outcomes of bacterial meningitis in infants <3 months old.

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Background: Temperature measurement plays a central role in determining pediatric patients' disease risk and management. However, current pediatric temperature thresholds may be outdated and not applicable to children.

Objective: To characterize pediatric temperature norms and variation by patient characteristics, time of measurement, and thermometer route.

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Clinical practice guideline by the Pediatric Infectious Diseases Society and the Infectious Disease Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Children RELEASE DATE: August 5, 2021 PRIOR VERSION(S): n/a DEVELOPER: Pediatric Infectious Diseases Society (PIDS) and Infectious Disease Society of America (IDSA) FUNDING SOURCE: PIDS and IDSA TARGET POPULATION: Children with suspected or confirmed acute hematogenous osteomyelitis.

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Background: Slowed clearance of amyloid β (Aβ) is believed to underlie the development of Aβ plaques that characterize Alzheimer's disease (AD). Aβ is cleared in part by the glymphatic system, a brain-wide network of perivascular pathways that supports the exchange of cerebrospinal and brain interstitial fluid. Glymphatic clearance, or perivascular CSF-interstitial fluid exchange, is dependent on the astroglial water channel aquaporin-4 (AQP4) as deletion of Aqp4 in mice slows perivascular exchange, impairs Aβ clearance, and promotes Aβ plaque formation.

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Background And Objectives: Inconsistencies in the timing and process of family-centered rounds can contribute to inefficiencies in patient care, inconsistent nursing participation, and variable end times. Through the implementation of schedule-based rounds, our aims were to (1) start 90% of rounds encounters within 30 minutes of the scheduled time, (2) increase nursing presence from 79% to >90%, and (3) increase the percentage of rounds completed by 11:20 am from 0% to 80% within 1 year.

Methods: We used quality improvement methods to implement and evaluate a scheduled rounds process on a pediatric hospital medicine service at a university-affiliated children's hospital.

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Background: Alzheimer's disease (AD) is a multifactorial process that takes years to manifest clinically. We propose that brain-derived indicators of cerebrovascular dysfunction and inflammation would inform on AD-related pathological processes early in, and perhaps prior to neurodegenerative disease development.

Objective: Define the relationship between cerebrospinal fluid (CSF) markers of cerebrovascular dysfunction and neuroinflammation with AD CSF biomarkers in cognitively normal individuals.

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We conducted a national survey of pediatric infectious diseases (ID) clinicians on outpatient parenteral antibiotic therapy (OPAT) practices and post-discharge ID follow-up. Only 15% of sites required ID consultation for all OPAT. ID division resources for post-discharge care varied.

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Objectives: To determine the (1) frequency and visit characteristics of routine temperature measurement and (2) rates of interventions by temperature measurement practice and the probability of incidental fever detection.

Methods: In this retrospective cohort study, we analyzed well-child visits between 2014-2019. We performed multivariable regression to characterize visits associated with routine temperature measurement and conducted generalized estimating equations regression to determine adjusted rates of interventions (antibiotic prescription, and diagnostic testing) and vaccine deferral by temperature measurement and fever status, clustered by clinic and patient.

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