Readmissions have been identified as a priority area for pediatric inpatient quality measurement nationally. However, it is unknown whether readmission rates vary meaningfully across hospitals and how many hospitals would be identified as high- or low-performers.

Only a few hospitals that care for children are high- or low-performers when their condition-specific revisit rates are compared with average rates across hospitals. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. (Read the full article)

Stable health insurance coverage facilitates access to health care. Despite expanded coverage options for children, parents report barriers to accessing insurance programs for their children, including uncertainty about a child’s coverage status and eligibility.

Electronic health records can be used as an emerging data source for conducting health insurance surveillance to track trends in patients’ insurance coverage status, and to identify patients who may benefit from outreach and support to obtain and maintain coverage. (Read the full article)

The definition of hypertension in children is complex because of the age-, gender-, and height-specific blood pressure algorithm. Blood pressure to height ratio was reported to easily identify hypertension in Chinese children living in a local area (Hebei Province).

Blood pressure to height ratio index is simple and accurate for screening for prehypertension and hypertension in Chinese children aged 6 to 17 years and can be used for early screening or treating Chinese children with hypertension. (Read the full article)

Children born very preterm (VPT) are at high risk of educational delay. School readiness has been identified as a potentially useful clinical framework for early detection of those at greatest risk. However, evidence to support its predictive validity is limited.

VPT preschoolers are at risk of impairment across the 5 American Academy of Pediatrics school readiness domains. The number of domains affected predicted likelihood of later learning problems, supporting the utility of schoolreadiness frameworks for identifying children needing surveillance and/or support. (Read the full article)

In HIV-infected children, decisions to start antiretroviral therapy must weigh immunologic benefits against potential risks. Current guidelines recommend using CD4 percentage and age when deciding to start treatment. Population-level effects of these factors on immunologic recovery are unknown.

Starting antiretroviral therapy at higher CD4 percentages and younger ages maximizes potential for immunologic recovery. However, not all benefits are sustained, and viral failure may occur. Our results help clinicians better weigh immunologic benefits against viral failure risks. (Read the full article)

Cyber dating abuse victimization has been correlated with physical, sexual, and psychological adolescent relationship abuse.

This is the first clinic-based study of cyber dating abuse. Forty-one percent of youth reported cyber dating abuse victimization, female more than male respondents. Compared with nonexposed youth, abuse victims reported more sexual assault; female victims reported more contraceptive nonuse and reproductive coercion. (Read the full article)

Myxovirus resistance protein A (MxA) is a protein induced during viral infections. A few small-scale studies have suggested that MxA could be used as a marker of viral infection in clinical routine practice.

This study involves the largest patient population thus far and confirms the usefulness of MxA for diagnosing viral infections in children consulting the emergency department in a clinical routine setting. (Read the full article)

Clinical pain assessment methods in youth are vulnerable to underestimation bias and underrecognition. Facial expressions are sensitive, specific biomarkers of the presence and severity of pain. Computer vision–based pattern recognition enables measurement of pain-related facial expressions from video.

This study demonstrates initial validity for developing computer vision algorithms for automated pain assessment in children. The system developed and tested in this study could provide standardized, continuous, and valid patient monitoring that is potentially scalable. (Read the full article)

Discharge from the NICU requires coordination and may be delayed for nonmedical reasons. Predicting when patients will be medically ready for discharge can avoid these delays and result in cost savings for the hospital.

We developed a supervised machine learning approach using real-time patient data from the daily neonatology progress note to predict when patients will be medically ready for discharge. (Read the full article)

The American Academy of Pediatrics discourages providers from dismissing families who refuse vaccines for their children, yet some providers continue to do so.

We show that ~1 in 5 pediatricians dismiss families who refuse vaccines, and there is significant regional variation in the practice. Dismissing families for refusing vaccines was also associated with stricter state nonmedical exemption policies. (Read the full article)

The growing popularity of voice-activated technologies is forcing educators to think about the role such tools play in preparing students for the jobs of the future.

In this episode of the podcast, Tom chats with Tim Stuart about his new book, Personalized Learning in a PLC at Work: Student Agency Through the Four Critical Questions.

What should be included in a measure of school quality? If not by standardized test scores, how should we measure student achievement? Julian Vasquez Heilig and I each have some thoughts.

Background. CLSI and EUCAST susceptibility breakpoints for voriconazole and C. albicans differ by one dilution (≤0.125 and ≤0.06 mg/l, respectively) whereas the epidemiological cutoff values (ECOFF/ECV) with both methodologies are the same (0.03 mg/L). We therefore determined the pharmacokinetic-pharmacodynamic (PK/PD) breakpoints of voriconazole against C. albicans for both methodologies with an in vitro PK/PD model, which was validated using existing animal PK/PD data.

Methods. Four clinical wild-type and non-wild-type C. albicans isolates (voriconazole MICs 0.008-0.125 mg/l) were tested in an in vitro PK/PD model. For validation purposes, mouse PK were simulated and in vitro PD were compared with in vivo outcome. Human PK were simulated and the exposure-effect relationship fAUC_0-24/MIC was described for EUCAST and CLSI24/48h methods. PK/PD breakpoints were determined using the fAUC_0-24/MIC associated with half-maximal activity (EI₅₀) and Monte Carlo simulation analysis.

Results. The in vitro 24h-PD EI₅₀ of voriconazole against C. albicans were 2.5-5 (1.5-17) fAUC/MIC. However, the 72h-PD were higher, 133 (51-347) fAUC/MIC for EUCAST and 94 (35-252) fAUC/MIC for CLSI. The mean (95% confidence interval) probability of target attainment (PTA) was 100(95-100)%, 97(72-100)%, 83(35-99)%, and 49(8-91)% and 100(97-100)%, 99(85-100)%, 91(52-100)% and 68(17-96)% for EUCAST and CLSI MICs 0.03, 0.06, 0.125, and 0.25 mg/L, respectively. Significantly, >95% PTAs were found for EUCAST/CLSI MICs ≤0.03 mg/ll. For MICs 0.06-0.125 mg/l trough levels 1-4 mg/ll would be required.

Conclusion. A PK/PD breakpoint of C. albicans voriconazole at the ECOFF/ECV of 0.03 mg/L was determined for both EUCAST/CLSI methods, indicating the need for breakpoint harmonization for the reference methodologies.

Omadacycline is a novel aminomethylcycline with activity against Gram-positive and -negative organisms, including Haemophilus influenzae, which is one of the leading causes of community-acquired bacterial pneumonia (CABP). The evaluation of antimicrobial agents against H. influenzae using standard murine infection models is challenging due to the low pathogenicity of this species in mice. Therefore, 24-hour dose-ranging studies using a one-compartment in vitro infection model were undertaken with the goal of characterizing the magnitude of the ratio of the area under the concentration-time curve (AUC) to the MIC (AUC/MIC ratio) associated with efficacy for a panel of five clinical H. influenzae isolates. These five isolates, which had MIC values of 1 or 2 mg/L, were exposed to omadacycline total-drug epithelial lining fluid (ELF) concentration-time profiles based on those observed in healthy volunteers following intravenous omadacycline administration. Relationships between change in log₁₀ colony forming units (CFU) from baseline at 24 hours and total-drug ELF AUC/MIC ratio for each isolate and the isolates pooled together were evaluated using Hill-type models and non-linear least squares regression. As evidenced by the high coefficient of determination (r²) of 0.88 to 0.98, total-drug ELF AUC/MIC ratio described the data well for each isolate and the isolates pooled together. The median total-drug ELF AUC/MIC ratio associated with net bacterial stasis and 1- and 2-log₁₀ CFU/mL reductions from baseline at 24 hours was 6.91, 8.91, and 11.1, respectively. These data were useful to support the omadacycline dosing regimens selected for the treatment of patients with CABP, as well as susceptibility breakpoints for H. influenzae.

Omadacycline, a novel aminomethylcycline antibiotic with activity against Gram-positive and -negative organisms, including tetracycline-resistant pathogens, received FDA approval in October, 2018 for the treatment of patients with acute bacterial skin and skin structure infections (ABSSSI) and community-acquired bacterial pneumonia (CABP). A previously-developed population pharmacokinetic (PK) model based on Phase 1 intravenous and oral PK data was refined using data from infected patients. Data from 10 Phase 1 studies used to develop the previous model were pooled with data from three additional Phase 1 studies, a Phase 1b uncomplicated urinary tract infection study, one Phase 3 CABP study, and two Phase 3 ABSSSI studies. The final population PK model was a three-compartment model with first-order absorption using transit compartments to account for absorption delay following oral dosing and first-order elimination. Epithelial lining fluid (ELF) concentrations were modeled as a sub-compartment of the first peripheral compartment. A food effect on oral bioavailability was included in the model. Sex was the only significant covariate identified, with 15.6% lower clearance for females relative to males. Goodness-of-fit diagnostics indicated a precise and unbiased fit to the data. The final model, which was robust in its ability to predict plasma and ELF exposures following omadacycline administration, was also able to predict the central tendency and variability in concentration-time profiles using an external Phase 3 ABSSSI dataset. A population PK model, which described omadacycline PK in healthy subjects and infected patients, was developed and subsequently used to support pharmacokinetic-pharmacodynamic (PK-PD) and PK-PD target attainment assessments.

Chagas disease, caused by the protozoan Trypanosoma cruzi, is one of the main causes of death due to cardiomyopathy and heart failure in Latin American countries. The treatment of Chagas disease is directed at eliminating the parasite, decreasing the probability of cardiomyopathy, and disrupting the disease transmission cycle. Benznidazole (BZ) and nifurtimox (NFX) are recognized as effective drugs for the treatment of Chagas disease by the World Health Organization, but both have high toxicity and limited efficacy, especially in the chronic disease phase. At low doses, aspirin (ASA) has been reported to protect against T. cruzi infection. We evaluated the effectiveness of BZ in combination with ASA at low doses during the acute disease phase and evaluated cardiovascular aspects and cardiac lesions in the chronic phase. ASA treatment prevented the cardiovascular dysfunction (hypertension and tachycardia) and typical cardiac lesions. Moreover, BZ+ASA-treated mice had a smaller cardiac fibrotic area than that in BZ-treated mice. These results were associated with an increase in the number of eosinophils and reticulocytes and level of nitric oxide in the plasma and cardiac tissue of ASA-treated mice relative to respective controls. These effects of ASA and BZ+ASA in chronically infected mice were inhibited by pretreatment with the LXA₄ receptor antagonist, Boc-2, indicating that the protective effects of ASA are mediated by ASA-triggered lipoxin. These results emphasize the importance of exploring new drug combinations for treatments of acute phase of Chagas disease that are beneficial for chronic patients.

Methicillin-resistant Staphylococcus aureus (MRSA) has grown to become a major burden on healthcare systems. The cumulation of limited therapeutic options and worsened patient outcomes with persistent MRSA bacteremia has driven research in optimizing its initial management. The guidelines published by the Infectious Disease of America currently recommend combination therapy for refractory MRSA bacteremia, but the utility of combining antibiotics from the start of therapy is under investigation. The alternative strategy of early use of a β-lactam antibiotics in combination with vancomycin upon initial MRSA bacteremia detection has shown promise. While this concept has gained international attention, providers should give this strategy serious consideration prior to implementation. The objective of this review is to examine retrospective and prospective evidence for early combination with vancomycin and β-lactam antibiotics, as well as explore potential consequences of combination therapy.

For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas.

For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas.

Penn State Abington faculty are using the current situation as an opportunity to enrich students academically and support them personally during this period of remote learning. "What may be most inspiring of all is the deep-seated concern for our students that faculty efforts expose,” said Friederike Baer, division head for Arts and Humanities.

As a student in Penn State's College of Information Sciences and Technology, Steve Ney learned critical skills, from coding to data design and architecture. Today, he applies that foundation in his "dream job" as a healthcare data analyst for Geisinger Health, where he uses those skills to help produce visual outputs for doctors and staff to utilize in caring for patients.

Penn State Fayette, The Eberly Campus has introduced a new phone-based resource for area veterans.

A multi-disciplinary collaborative relationship, developed between Penn State EMS Energy Institute researchers and a Pittsburgh-based start-up company, may hold the answer to reducing global greenhouse gas (GHG) emissions while also paving the way to disrupt the chemical and material industries.

For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas.

A soundwave is saved from a voice recording, converted into a circular pattern, and then used for the indentations on 3D-printed wheel nuts and keys.

For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas.

For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas.

A Korean Transit Challenge team member shares the gospel by using face painting to overcome the language barrier in France.

Math teachers are more likely to be using highly-rated curricula than English-language arts teachers, according to a new analysis from the RAND Corporation.

Nebraska's education department released an interactive instructional materials map last week, showing what curricula districts have adopted for English-language arts, math, and K-8 science.

As a U.S. senator and vice president, Biden focused on preschool, gun-free school zones, and the Obama administration's response to the Newtown, Conn. school shooting in 2012.

For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas.

For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas.

Bloomberg says People's Liberation Army operatives added tiny, nefarious microchips to server motherboards made by Super Micro and used by Apple and Amazon, among others. All three companies pushed back hard on the story.

Ridgeline plots are useful for visualizing changes in the shapes of distribution over multiple groups or time periods. Let us look at an example of how we can create this plot using the SGPLOT procedure that is part of the ODS Graphics Procedures. For this example, we will plot the [...]

The post Ridgeline Plots using SGPLOT appeared first on Graphically Speaking.

As we continue to process and understand the ongoing effects of the novel coronavirus, many of us have grown used to viewing COVID-19 dashboards and visualizations, including this popular coronavirus dashboard from SAS. If you are more accustomed to building graphs and visualizations using the SGPLOT and SGPANEL procedures, this [...]

The post Visualizing COVID-19 data using SGPLOT and SGPANEL appeared first on Graphically Speaking.

Delaware State Housing Authority (DSHA) along with Governor Markell and their partners today held the 2012 Governor’s Conference on Housing. The event brought together over 400 housing professionals and residents from throughout Delaware and surrounding states to discuss important issues in housing ranging from homeownership, affordable rental housing, special needs populations and other hot topics. Attendees had the opportunity to discuss regional, state and local perspectives on today’s affordable housing climate, and the event provided strategies to address current and future housing needs.

Delaware awarded $5.1 million to create and sustain 170 units of affordable housing over five years for persons with disabilities through the Section 811 Project Rental Assistance Demonstration Program.

Three former shelter residents today have a home to call their own thanks to the efforts of the Delaware State Housing Authority (DSHA) and Dover Interfaith Mission for Housing (DIMH) which together celebrated the milestone of the 500th home assisted through the Neighborhood Stabilization Program (NSP) by opening DIMH’s first permanent supportive housing residence in Dover. This previously foreclosed and vacant home will provide stable housing for employed, income-qualified residents formerly housed at DIMH’s shelter.

The Delaware State Housing Authority (DSHA), in partnership with The Money School and the Delaware Federation of Housing Counselors, held its annual Homebuyer Fair on Saturday, April 5, 2014, at the Chase Center on the Riverfront in Wilmington, Delaware. The Fair – geared toward providing prospective homebuyers with the opportunity to learn about the steps in purchasing a home – was a great success for the fourth year in a row.

The Delaware State Housing Authority (DSHA) honored students in the DSHA housing community for achieving academic excellence by making the honor roll and having perfect attendance, with a luncheon and awards ceremony at Polytech High School in Woodside, Delaware.

Governor Jack Markell today joined Delaware State Housing Authority (DSHA) for the release of the Delaware Housing Needs Assessment 2015-2020. The report, prepared by GCR Incorporated of New Orleans, Louisiana and The Reinvestment Fund (TRF) of Philadelphia, Pennsylvania, will drive planning for housing resources at DSHA and in communities around the State. With this new analysis of housing needs and market conditions in the state for years 2015-2020, DSHA will be identifying priorities for the next five years and evaluating its programs and strategies.

This morning, Congressman John Carney (D-DE) visited Liberty Court Apartments in Dover to announce new legislation to improve affordable housing options. The Housing Assistance Reform Act would increase housing options for low-income Americans and help housing authorities raise capital for affordable housing projects. The legislation would expand access to the Department of Housing and Urban Development’s Moving to Work program from 39 local housing authorities to 60, and eliminate the current unit cap for the Rental Assistance Demonstration program, allowing any eligible housing authority to participate.

DOVER — Nonprofit organizations wanting to develop permanent supportive housing for the homeless or persons with disabilities can now apply for $1 million in federal funding through the Delaware State Housing Authority, DSHA Director Anas Ben Addi announced today. The projects, which may include new construction or rehabilitation, should serve people who are homeless; who […]

State Rental Assistance Program has housed 1,200 clients on 5th anniversary of collaboration NEW CASTLE, Del. – Governor John Carney celebrated Monday the fifth anniversary of the State Rental Assistance Program, which has provided housing for 1,200 Delawareans through a unique collaboration supporting those in special need of help. The anniversary event took place at […]

Seven affordable housing projects statewide will receive a total of $1 million from Delaware’s Housing Development Fund (HDF), Governor John Carney announced today joined by Delaware State Housing Authority (DSHA) Director Anas Ben Addi, New Castle County Executive Matt Meyer, elected officials and community leaders from across Delaware.

How Massachusetts students are demonstrating their global collaborative projects.

Bank Audi proposed using government assets as collateral to offset the losses of the Central Bank and commercial banks that were the result of lending to the state.