Using Video Ethnography and Stimulated Recall Interviews to Describe the Diagnostic Process in the Emergency Department.

Objectives: Understanding how physicians make diagnoses is challenging because cognitive processes are unobservable and partly unconscious, making it difficult for physicians to describe how they arrived at a diagnosis. Physicians who work in emergency departments (EDs) are especially vulnerable to making diagnostic errors because the ED is a fast-paced, dynamic setting where complex decision-making occurs under severe time, information, and resource constraints. The purpose of our study was to describe how the diagnostic process evolves for ED clinicians in both pediatric and adult ED settings.

Human iPSC-Derived Mononuclear Phagocytes Improve Cognition and Neural Health across Multiple Mouse Models of Aging and Alzheimer's Disease.

Young blood or plasma improves cognitive function in aged animals but has limited availability. The current study generates a subtype of young blood cells from easily expandable induced pluripotent stem cells and evaluates their effects on age- and Alzheimer's disease (AD)-associated cognitive and neural decline. In aging mice, intravenous delivery of induced mononuclear phagocytes (iMPs) improves performance in hippocampus-dependent cognitive tasks, increases neural health, and reduces neuroinflammation.

Identifying diagnostic errors in the emergency department using trigger-based strategies.

Importance: Diagnostic errors represent a major patient safety concern, with the potential to significantly impact patient outcomes. To address this, various trigger-based strategies have been developed to identify diagnostic errors, aiming to enhance clinical decision-making and improve patient safety.

Objective: To evaluate the performance of three pre-established triggers (T) in the emergency department (ED) setting and assess their effectiveness in detecting diagnostic errors.

Deciphering neutrophil dynamics in the focal lesion tumor microenvironment to overcome immunosuppression in multiple myeloma.

Understanding the roles of myeloid cells in the tumor microenvironment (TME) has emerged as a promising strategy to identify novel targets to counteract the immunosuppressive barriers protecting multiple myeloma (MM). Neutrophils are a new cancer research focus due to their potential to reduce the efficacy of immune-based therapies. This study aimed to deepen understanding of neutrophil function in MM by analyzing freshly isolated myeloid cells from paired focal lesions (FL) and bone marrow (BM) using single-cell RNA sequencing (scRNA-seq), immunofluorescence imaging, and functional assays.

Health outcomes following antimicrobial treatment of septic arthritis in Canadian feedlot calves.

Objective: To assess the clinical efficacy of treating septic arthritis (SA) with 3 different antimicrobials: oxytetracycline, florfenicol, and tulathromycin.

Animal: The study population comprised fall-placed steer and heifer calves at 4 commercial western Canadian feedlots. All calves received tulathromycin at induction for bovine respiratory disease (BRD).

Epidemiology of bacterial and fungal infections among level IV neonatal units in North America.

Background: Neonatal infections cause significant morbidity and mortality. A comprehensive analysis of bloodstream infections (BSI), urinary tract infections (UTI) and meningitis across level IV neonatal intensive care units (NICUs) is lacking.

Methods: This retrospective cohort study utilized data from the Children's Hospitals Neonatal Database (CHND) between January 2011 to December 2022.

Extracellular vesicle heterogeneity through the lens of multiomics.

Extracellular vesicles (EVs) are heterogeneous in size, biogenesis, content, and function. Aggressive cancer cells release a distinct, poorly characterized, and particularly large EV subtype, namely large oncosomes (LOs). This study employs an optimized method to improve LO yields and integrates mass spectrometry and RNA sequencing (RNA-seq) to profile their molecular cargo.

Artificial neural network risk prediction of COPD exacerbations using urine biomarkers.

Background: COPD exacerbations cause considerable morbidity and mortality. We sought to identify a panel of urine biomarkers that can distinguish between stable and exacerbation states and predict risk of future exacerbations.

Methods: A retrospective discovery study was done measuring 35 biomarkers implicated in COPD pathogenesis in paired urine samples from 55 COPD subjects during stable and exacerbation states.

Diagnostic Stewardship of Blood Cultures in the Pediatric ICU Using Machine Learning.

Objective: The medical community recently experienced a severe shortage of blood culture media bottles. Rates of blood stream infection (BSI) among critically ill children are low. We sought to design a machine learning (ML) model able to identify children at low risk for BSI to improve blood culture diagnostic stewardship.

iDDN: determining trans-omics network structure and rewiring with integrative differential dependency networks.

Motivation: Mapping the gene networks that drive disease progression allows identifying molecules that rectify the network by normalizing pivotal regulatory elements. Upon mechanistic validation, these upstream normalizers represent attractive targets for developing therapeutic interventions to prevent the initiation or interrupt the pathways of disease progression. Differential network analysis aims to detect significant rewiring of regulatory network structures under different conditions.

"Everything is electronic health record-driven": the role of the electronic health record in the emergency department diagnostic process.

Objectives: There is limited knowledge on how providers and patients in the emergency department (ED) use electronic health records (EHRs) to facilitate the diagnostic process. While EHRs can support diagnostic decision-making, EHR features that are not user-centered may increase the likelihood of diagnostic error. We aimed to identify how EHRs facilitate or impede the diagnostic process in the ED and to identify opportunities to reduce diagnostic errors and improve care quality.

What's Old Is New Again: Measles.

Measles is resurging in the United States, fueled by decreasing vaccination rates and rising vaccine hesitancy. Clinicians are confronted with a highly infectious vaccine-preventable disease that is unfamiliar to them because, as a result of routine childhood vaccination with measles, mumps, and rubella vaccine, measles was declared nonendemic in the United States in 2000 and many pediatricians have never seen a case. In this article, we provide an update on measles presentation, clinical course, and outcomes by reviewing the literature and sharing the expertise of senior pediatric infectious disease physicians with experience in caring for children infected with measles.

Toward Real-Time Proteomics: Blood to Biomarker Quantitation in under One Hour.

Multistep multihour tryptic proteolysis has limited the utility of bottom-up proteomics for cases that require immediate quantitative information. The power of proteomics to quantify biomarkers of health status cannot practically assist in clinical care if the dynamics of disease outpaces the turnaround of analysis. The recently available hyperthermoacidic archaeal (HTA) protease "Krakatoa" digests samples in a single 5 to 30 min step at pH 3 and >80 °C in conditions that disrupt most cells and tissues, denature proteins, and block disulfide reformation thereby dramatically expediting and simplifying sample preparation.

Building a health systems science bridge between medical school and the clinical learning environment via a pilot faculty development cohort program.

Background: Clinical faculty development focused on Health Systems Science (HSS) is crucial for integrating HSS concepts into medical education. The 2021 HSSIP Faculty Development program was created to support faculty in effectively creating and incorporating comprehensive HSS content into the clerkship experience.

Methods: Nine clinical champions, selected for their diverse backgrounds and interest in HSS, participated from November 2021 through October 2022 in monthly day-long, in-person workshops, and bi-monthly self-directed sessions, covering both HSS domains and foundational learning in curriculum development.

Single Cell Proteomics Reveals Novel Cell Phenotypes in Marfan Mouse Aneurysm.

Background: Single-cell omics technology is a powerful tool in biomedical research. However, single cell proteomics has lagged due to an inability to amplify peptides in a similar fashion to nucleotide strings. Single cell proteomics is important because proteins are the main functional unit in cells, and they often poorly correlate with mRNA quantities.

Health system reform in the context of COVID-19: a policy brief outlining lessons from Ireland's journey towards the goal of universal healthcare.

The COVID-19 pandemic has presented unique challenges and opportunities for health system reform globally. In Ireland, this period coincided with the early stages of the Sláintecare reform plan, a core goal of which is to establish universal healthcare. This policy brief synthesises key research findings from 13 studies carried out under the Foundations research programme to harness key learnings from the pandemic response for health system change.

Selective removal of proteins and microvesicles ex vivo from blood of pancreatic cancer patients using bioengineered adsorption filters.

Metastatic pancreatic ductal adenocarcinoma (PDAC) is a deadly disease with limited efficacious therapeutic options. Recent investigations have provided proof of concept that circulating tumor cells (CTCs) are reduced by purification of PDAC patient blood samples through ExThera Seraph100™ adsorption filters. Whether additional tumorigenic factors are also removed remains inadequately studied.

Opportunities for collaboration: the synergy between antimicrobial and diagnostic stewardship in pediatrics.

Advancement of antimicrobial stewardship (AS) programs requires partnership with clinicians, quality assurance teams, and laboratorians. Inevitably, AS programs also practice diagnostic stewardship (DS), as stewards are aptly placed to connect key stakeholders and help steer processes toward higher value care for pediatric patients. In this review, we illustrate five moments of collaboration between stakeholders in the interplay between AS and DS in pediatrics.

Exploring the effect of play on heart rate variability as a measure of positive emotional states in pigs.

Play behaviour has been suggested to be inherently rewarding for animals, inducing positive emotional states. The psychophysiological effect of emotions can be assessed through heart rate variability (HRV), serving as a proxy measure of sympathovagal balance. This study investigated how the performance of play influences heart rate (HR) and HRV parameters (RMSSD, SDNN) in pigs.

Examining universal access to acute hospital care in Ireland during the first three months of COVID-19: Lessons from the policy process.

Background: The onset of the COVID-19 pandemic prompted the Irish state to address unprecedented challenges by prioritising public health and equitable access to care. Confronted with the threat of overwhelmed capacity in acute public hospitals, Ireland, initiated a historic Safety Net Agreement (SNA) with 19 private hospitals in March 2020, marking the inaugural establishment of universal single-tier access to hospital care in Ireland. This research aimed to comprehensively examine the policy process underlying the agreement, deriving insights for the implementation of Universal Healthcare.

The surgical time-out: the relationship between perceptions of a safety-task anchor and surgical team workflow.

Background: The surgical time-out is a critical safety measure used in the operating room (OR). We examined the mediating relationship of the length of the time-out between team perceived usefulness of the time-out, and the rate at which the circulating nurse left the OR to retrieve instruments.

Methods: 60 cardiac surgical teams were observed performing their work.

Cell Storage Conditions Impact Single-Cell Proteomic Landscapes.

Single cell transcriptomics (SCT) has revolutionized our understanding of cellular heterogeneity, yet the emergence of single cell proteomics (SCP) promises a more functional view of cellular dynamics. A challenge is that not all mass spectrometry facilities can perform SCP, and not all laboratories have access to cell sorting equipment required for SCP, which together motivate an interest in sending bulk cell samples through the mail for sorting and SCP analysis. Shipping requires cell storage, which has an unknown effect on SCP results.

Epidemiology of diagnostic errors in pediatric emergency departments using electronic triggers.

Objectives: We applied three electronic triggers to study frequency and contributory factors of missed opportunities for improving diagnosis (MOIDs) in pediatric emergency departments (EDs): return visits within 10 days resulting in admission (Trigger 1), care escalation within 24 h of ED presentation (Trigger 2), and death within 24 h of ED visit (Trigger 3).

Methods: We created an electronic query and reporting template for the triggers and applied them to electronic health record systems of five pediatric EDs for visits from 2019. Clinician reviewers manually screened identified charts and initially categorized them as "unlikely for MOIDs" or "unable to rule out MOIDs" without a detailed chart review.

An exploratory analysis of differences in serum protein expression by sex in patients with systemic sclerosis associated interstitial lung disease.

Background: Systemic sclerosis (SSc) is a rare connective tissue disease, frequently affecting the skin, lungs, and pulmonary vasculature. Approximately 30-50% of SSc patients develop interstitial lung disease (SSc-ILD), with 30-35% of related deaths attributed to it. Even though men are less likely to develop systemic sclerosis, they have a higher incidence of SSc-ILD than women, and they tend to develop it at a younger age with a higher mortality rate.