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Congenital cytomegalovirus (CMV) infection is associated with a high rate of neurologic sequelae. In this study, intravenous CMV-specific hyperimmune globulin was given to 31 pregnant women who had evidence of recent primary CMV infection. Only one had an infant with symptomatic impairment, as compared with impairment in 7 of 14 infants born to women who did not receive hyperimmune globulin. Hyperimmune globulin was safe, and this nonrandomized study suggests that it may be effective in treating and preventing congenital CMV infections. In this study, intravenous CMV-specific hyperimmune globulin was given to 31 pregnant women who had evidence of recent primary CMV infection. This study suggests that it may be effective in treating and preventing congenital CMV infections. Cytomegalovirus (CMV) infection is a common and serious infection occurring in approximately 1 percent of all neonates. 1 – 3 Congenital CMV infection is symptomatic in about 10 percent of the infected neonates and is associated with clinically significant neurologic sequelae in almost half of them. In addition, neurologic defects will eventually develop in 8 to 13 percent of neonates with asymptomatic infection. 1 – 3 Among women with a primary infection during pregnancy, the rate of fetal infection is approximately 40 percent. 1 , 3 , 4 Although prenatal diagnosis of congenital infection is possible, no prenatal therapy is currently available. Following the favorable outcome of . . .

Clinicians frequently administer sedation to facilitate mechanical ventilation. The purpose of this study was to examine the relationship between sedation level and patient-ventilator asynchrony. Airway pressure and airflow were recorded for 15 minutes. Patient-ventilator asynchrony was assessed by determining the number of breaths demonstrating ineffective triggering, double triggering, short cycling, and prolonged cycling. Ineffective triggering index (ITI) was calculated by dividing the number of ineffectively triggered breaths by the total number of breaths (triggered and ineffectively triggered). Sedation level was assessed by the following 3 methods: Richmond Agitation-Sedation Scale (RASS), awake (yes or no), and delirium (Confusion Assessment Method for the intensive care unit [CAM-ICU]). Twenty medical ICU patients underwent 35 observations. Ineffective triggering was seen in 17 of 20 patients and was the most frequent asynchrony (88% of all asynchronous breaths), being observed in 9% ± 12% of breaths. Deeper levels of sedation were associated with increasing ITI (awake, yes 2% vs no 11%; P < .05; CAM-ICU, coma [15%] vs delirium [5%] vs no delirium [2%]; P < .05; RASS, 0, 0% vs −5, 15%; P < .05). Diagnosis of chronic obstructive pulmonary disease, sedative type or dose, mechanical ventilation mode, and trigger method had no effect on ITI. Asynchrony is common, and deeper sedation level is a predictor of ineffective triggering.

Introduction: Emergency department boarding has escalated to a crisis, impacting patient care, hospital finances, and physician burnout, and contributing to error. No prior studies have examined the effects of boarding hours on resident productivity. If boarding reduces productivity, it may have negative educational impacts. We investigated the effect of boarding on resident productivity as measured by patients per hour and hypothesized that increased boarding leads to decreased productivity. Methods: This was a retrospective study at a quaternary, urban, academic Level I trauma center from 2017–2021 with a three-year emergency medicine residency of 10–12 residents per year and annual volumes of 80,000–101,000. Boarding was defined as the time between an admission order and the patient leaving the ED. We created a multivariable mixed model with fixed covariates for year, month, day of week, resident experience, shift duration, total daily ED patients, and with residents as repeated measures. The effect of boarding was estimated after covarying out all other factors. Results: All variables included in the model were significantly associated with changes in productivity. Resident experience has the largest effect such that for each month of residency experience, a resident adds 0.012 patients per hour (95% confidence interval [CI] 0.010–0.014). Isolating the effect of boarding demonstrated that for every additional 100 hours of boarding, a resident’s productivity decreased by 0.022 patients per hour (95% CI 0.016–0.028). In the study, the median daily boarding was 261 hours; if this were eliminated (assuming a resident completes 100 10-hour shifts annually), a resident could be expected to see 56.9 more patients per year (95% CI 40.7–73.1). Conclusion: Hospital boarding significantly reduces resident productivity as measured by patients per hour. Further studies are warranted to determine the educational impact.

Advanced biomaterials and sophisticated processing technologies aim at fabricating tissue-engineering scaffolds that can predictably interact within a biological environment at the cellular level. Sterilization of such scaffolds is at the core of patient safety and is an important regulatory issue that needs to be addressed before clinical translation. In addition, it is crucial that meticulously engineered micro- and nano- structures are preserved after sterilization. Conventional sterilization methods involving heat, steam, and radiation are not compatible with engineered polymeric systems because of scaffold degradation and loss of architecture. Using electrospun scaffolds made from polycaprolactone, a low melting polymer, and employing spores of Bacillus atrophaeus as biological indicators, we compared ethylene oxide, autoclaving and 80% ethanol to a known chemical sterilant, peracetic acid (PAA), for their ability to sterilize as well as their effects on scaffold properties. PAA diluted in 20% ethanol to 1000 ppm or above sterilized electrospun scaffolds in 15 min at room temperature while maintaining nano-architecture and mechanical properties. Scaffolds treated with PAA at 5000 ppm were rendered hydrophilic, with contact angles reduced to 0°. Therefore, PAA can provide economical, rapid, and effective sterilization of heat-sensitive polymeric electrospun scaffolds that are used in tissue engineering.

Background. Serological testing for primary maternal cytomegalovirus (CMV) infection during pregnancy is not routine, but ultrasound studies are routine. Therefore, we evaluated placental thickening in women with primary CMV infection during pregnancy. Methods. The study included 92 women with primary CMV infection during pregnancy and 73 CMV-seropositive pregnant women without primary CMV infection. Neonatal CMV transmission was determined by CMV culture of urine samples. Thirty-two women were treated with CMV hyperimmune globulin to either prevent or treat intrauterine CMV infection. Maximal placental thickness was measured by longitudinal (nonoblique) scanning with the ultrasound beam perpendicular to the chorial dish. Programmed placental ultrasound evaluations were performed from 16 to 36 weeks of gestation. Results. At each measurement between 16 and 36 weeks of gestation, women with primary CMV infection who had a fetus or newborn with CMV disease had placentas that were significantly thicker than those of women with primary CMV infection who did not have a diseased fetus or newborn (P <.0001); the latter group, in turn, had placentas that were significantly thicker than those of seropositive control subjects (P <.0001). For both women with and women without diseased fetuses or newborns, receipt of hyperimmune globulin after primary CMV infection was associated with statistically significant reductions in placental thickness (P <.001). Placental vertical thickness values, which are predictive of primary maternal infection, were observed at each measurement from 16 to 36 weeks of gestation, and cutoff values ranged from 22 mm to 35 mm, with the best sensitivity and specificity at 28 and 32 weeks of gestation. Conclusions. Primary maternal CMV infection and fetal or neonatal disease are associated with sonographically thickened placentas, which respond to administration of hyperimmune globulin. These observations suggest that many of the manifestations of fetal and neonatal disease are caused by placental insufficiency.

Improved diagnostics remains a fundamental goal of biomedical research. This study was designed to assess cytokine biomarkers that could predict bone loss (BL) in localized aggressive periodontitis. 2,058 adolescents were screened. Two groups of 50 periodontally healthy adolescents were enrolled in the longitudinal study. One group had Aggregatibacter actinomycetemcomitans (Aa), the putative pathogen, while the matched cohort did not. Cytokine levels were assessed in saliva and gingival crevicular fluid (GCF). Participants were sampled, examined, and radiographed every 6 months for 2-3 years. Disease was defined as radiographic evidence of BL. Saliva and GCF was collected at each visit, frozen, and then tested retrospectively after detection of BL. Sixteen subjects with Aa developed BL. Saliva from Aa-positive and Aa-negative healthy subjects was compared to subjects who developed BL. GCF was collected from 16 subjects with BL and from another 38 subjects who remained healthy. GCF from BL sites in the 16 subjects was compared to healthy sites in these same subjects and to healthy sites in subjects who remained healthy. Results showed that cytokines in saliva associated with acute inflammation were elevated in subjects who developed BL (i.e., MIP-1α MIP-1β IL-α, IL-1β and IL-8; p<0.01). MIP-1α was elevated 13-fold, 6 months prior to BL. When MIP-1α levels were set at 40 pg/ml, 98% of healthy sites were below that level (Specificity); whereas, 93% of sites with BL were higher (Sensitivity), with comparable Predictive Values of 98%; p<0.0001; 95% C.I. = 42.5-52.7). MIP-1α consistently showed elevated levels as a biomarker for BL in both saliva and GCF, 6 months prior to BL. MIP-1α continues to demonstrate its strong candidacy as a diagnostic biomarker for both subject and site vulnerability to BL.

BackgroundEmergency pediatric care curriculum (EPCC) was developed to address the need for pediatric rapid assessment and resuscitation skills among out-of-hospital emergency providers in Armenia. This study was designed to evaluate the effectiveness of EPCC in increasing physicians’ knowledge when instruction transitioned to local instructors. We hypothesize that (1) EPCC will have a positive impact on post-test knowledge, (2) this effect will be maintained when local trainers teach the course, and (3) curriculum will satisfy participants.MethodsThis is a quasi-experimental, pre-test/post-test study over a 4-year period from October 2014‑November 2017. Train-the-trainer model was used. Primary outcomes are immediate knowledge acquisition each year and comparison of knowledge acquisition between two cohorts based on North American vs local instructors. Descriptive statistics was used to summarize results. Pre-post change and differences across years were analyzed using repeated measures mixed models.ResultsTest scores improved from pretest mean of 51% (95% CI 49.6 to 53.0%) to post-test mean of 78% (95% CI 77.0 to 79.6%, p < 0.001). Average increase from pre- to post-test each year was 27% (95% CI 25.3 to 28.7%). Improvement was sustained when local instructors taught the course (p = 0.74). There was no difference in improvement when experience in critical care, EMS, and other specialties were compared (p = 0.23). Participants reported satisfaction and wanted the course repeated. In 2017, EPCC was integrated within the Emergency Medicine residency program in Armenia.DiscussionThis program was effective at impacting immediate knowledge as well as participant satisfaction and intentions to change practice. This knowledge acquisition and reported satisfaction remained constant even when the instruction was transitioned to the local instructors after 2 years. Through a partnership between the USA and Armenia, we provided OH-EPs in Armenia with an intensive educational experience to attain knowledge and skills necessary to manage acutely ill or injured children in the out-of-hospital setting.ConclusionsEPCC resulted in significant improvement in knowledge and was well received by participants. This is a viable and sustainable model to train providers who have otherwise not had formal education in this field.

Synthetic polymers offer control over composition, architecture, mechanical properties and degradation kinetics. Predictable sterilization of synthetic polymeric scaffolds made from low temperature melting polymers, remains a challenge to clinical translation. We previously demonstrated successful room temperature sterilization of electrospun polycaprolactone scaffolds (ePCL) using peracetic acid (PA). The current paper investigates the effects of PA sterilization on two different scaffolds types—ePCL and commercially available porous polystyrene (Alvetex®) scaffolds using mouse calvarial osteoblasts cell line (MC3T3) and Live-Dead Assay. We report cytotoxicity in PA-treated ePCL scaffolds (PA-ePCL), while control scaffolds strongly supported cell survival. Treatment of PA-ePCL scaffolds with known methods of PA residual elimination (sodium thiosulfate, catalase, washing and aeration) had minimal effect on MC3T3 survival. However, incubation in 80% ethanol for 30 min successfully eliminated the toxic PA residuals and restored scaffold cytocompatibility. On the other hand, PA treatment of Alvetex® scaffolds induced diametrically opposite effects: cell survival and proliferation was enhanced after PA exposure and these responses were reversed following ethanol wash. These results suggest that PA treatment can induce different biological effects based on polymer chemistry and scaffold architecture and presents interesting opportunities to modulate biological properties of tissue engineering scaffolds.

Many children of incarcerated parents exhibit positive behavior and adjustment (Nesmith & Ruhland, 2008), and we need to know more about the processes that facilitate such resilience. We propose that children's prosocial teasing, prosocial behavior with peers, and avoidance of bullying result, in part, from children's ability to regulate their emotions. Thus, a child's emotion regulation may serve as a protective factor against engaging in bullying behavior. In this study, we sought to find how bullying behavior in children of incarcerated mothers was predicted by dual aspects (i.e., both the positive and the negative sides) of teasing, peer interaction, and emotion regulation. Exhibiting resilience is both difficult and critical for children whose families are affected by incarceration (Nesmith & Ruhland, 2008). A child's capacity to regulate emotions--and to manage bullying and teasing--may relate to their overall competence, potentially facilitating resilience (Shields & Cicchetti, 2001).