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Delirium Screening in Critically Ill Children: secondary analysis of the multicenter PICU Up! pilot trial dataset, 2019–2020
(Wolters Kluwer, 2024) Azamfirei, Razvan; Behrens, Deanna; Padilla, Sofia; Madden, Kate; Goldberg, Sarah; Geno, Megan; Manning, Mary-Jeanne; Piole, Michelle; Madsen, Erik; Maue, Danielle; Abu-Sultaneh, Samer; Awojoodu, Ronke; Wang, Nae-Yuh; Needham, Dale M.; Neufeld, Karin; Kudchadkar, Sapna R.; Pediatrics, School of Medicine
Objectives: To determine the patient-level factors associated with performing daily delirium screening in PICUs with established delirium screening practices.
Design: A secondary analysis of 2019-2020 prospective data from the baseline phase of the PICU Up! pilot stepped-wedge multicenter trial (NCT03860168).
Setting: Six PICUs in the United States.
Patients: One thousand sixty-four patients who were admitted to a PICU for 3 or more days.
Interventions: None.
Measurements and main results: Of 1064 patients, 74% (95% CI, 71-76%) underwent delirium screening at least once during their PICU stay. On 57% of the 8965 eligible patient days, screening was conducted. The overall prevalence of delirium was 46% across all screened days, and 64% of screened patients experienced delirium at some point during their PICU stay. Factors associated with greater adjusted odds ratio (aOR) of increased daily delirium screening included PICU stay longer than 15 days compared with 1-3 days (aOR 3.36 [95% CI, 2.62-4.30]), invasive mechanical ventilation as opposed to room air (aOR 1.67 [95% CI, 1.32-2.12]), dexmedetomidine infusions (aOR 1.23 [95% CI, 1.04-1.44]) and propofol infusions (aOR 1.55 [95% CI, 1.08-2.23]). Conversely, decreased aOR of daily delirium screening was associated with female gender (aOR 0.78 [95% CI, 0.63-0.96]), and the administration of continuous infusions of opioids (aOR 0.75 [95% CI, 0.63-0.90]) or ketamine (aOR 0.48 [95% CI, 0.29-0.79]). Neither patient age, the presence of family or physical restraints, or benzodiazepine infusions were associated with daily delirium screening rates.
Conclusions: In the 2019-2020 PICU UP! cohort, across six PICUs, delirium screening occurred on only 57% of days, despite the presence of established practices. Female gender, patients in the early stages of their PICU stay, and patients not receiving mechanical ventilation were associated with lower odds of daily delirium screening. Our results highlight the need for structured quality improvement processes to both standardize and increase the frequency of delirium screening.
Editorial: Using the RE-AIM framework and other implementation theories, models, and frameworks to guide the implementation and evaluation of rural health innovations
(Frontiers Media, 2025-10-14) Schacht Reisinger, Heather; Damush, Teresa; Balkenende, Erin; Wong, Edwin; Arora, Kanika; Kenney, Rachael R.; Taylor, Laura D.; Matthieu, Monica; Medicine, School of Medicine
Health Services Use for SARS-CoV-2-Infected Children With Croup or Bronchiolitis
(American Academy of Pediatrics, 2024) Tyler, Amy; Bakel, Leigh Anne; Tucker, Joshua; Moss, Angela; Kille, Briana; Rifken, Katharine; Forrest, Christopher B.; Schroeder, Alan; Jhaveri, Ravi; Christakis, Dimitri; Muszynski, Jennifer; Khaitan, Alka; Morizono, Hiroki; Fitzgerald, Megan; Pajor, Nathan; Bunnell, Timothy; Bailey, L. Charles; Rao, Suchitra; Pediatrics, School of Medicine
Background and objectives: Croup and bronchiolitis are common reasons for hospitalization in children, and the role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on utilization outcomes for these conditions is not well understood. To compare health care utilization including the rates of hospitalization, readmission, length of stay, and ICU admission for croup and bronchiolitis in children with and without evidence of concurrent SARS-CoV-2 infection over the pandemic period.
Methods: This retrospective cohort study used inpatient and outpatient electronic health record data from PEDSnet institutions to examine health services use for children aged 30 days to 14 years with SARS-CoV-2 infection and diagnosed with croup or bronchiolitis. The time frame (March 2020-May 2022) was divided into predelta, delta, and omicron variant periods. Multivariable mixed effects logistic and log gamma regression models were used to calculate adjusted odds ratios for factors linked to utilization outcomes for children with versus without SARS-CoV-2 infections. Disease burden was described by variant time period.
Results: Across all time periods, among subjects with croup and bronchiolitis, 9.65% of croup patients and 3.92% of bronchiolitis patients were SARS-CoV-2-positive. The omicron variant period had the highest number of SARS-CoV-2 cases for both croup and bronchiolitis. After controlling for patient-level variables and hospital variability, we found no statistically significant differences in utilization outcomes comparing children with and without SARS-CoV-2.
Conclusions: Pediatric patients with croup and bronchiolitis and positive SARS-CoV-2 polymerase chain reaction testing did not exhibit a significant increase in hospital and ICU admissions, which may have implications for future staffing models and public health recommendations.
State of Aging Report: Chapter 6 - Transportation
(Central Indiana Community Foundation, 2025-11-14) The Polis Center; SAVI Community Information System
Mechanisms of superior respiratory IgA responses against SARS-CoV-2 after mucosal vaccination
(bioRxiv, 2025-09-22) Tang, Jinyi; Chaudhuri, Arka Sen; Qu, Panke; Li, Pei; Liu, Yajie; Wu, Yue; Wavell, Kristin; Spano, MarthaJoy M.; Cheon, In Su; Li, Chaofan; Yu, Jane; Narasimhan, Harish; Arish, Mohd; Qian, Wei; Santos, Gislane de Almeida; Young, Samuel P.; Agarwal, Anika; Zhu, Fangming; Kobayashi, Takao; Velegraki, Maria; Kaplan, Mark H.; Taylor, Justin J.; Zhu, Guizhi; Hu, Haitao; Li, Zihai; Hu, Hui; Kita, Hirohito; Zhang, Nu; Liu, Shan-Lu; Teague, W. Gerald; Sun, Jie; Microbiology and Immunology, School of Medicine
Mucosal immunization and respiratory IgA offer significant promise in protecting against airborne pathogens, including SARS-CoV-2. However, the conditions and mechanisms that lead to the robust induction of respiratory IgA responses following mucosal vaccination remain poorly understood. It is also currently debatable whether mucosal vaccination is still warranted given that most individuals in developed countries have established a hybrid immunity from vaccination and infection. Here we characterized respiratory mucosal immune responses after SARS-CoV-2 infection, vaccination or both in humans. We found that hybrid immunity resulted in moderately increased respiratory IgA and neutralizing antibody responses compared to infection or vaccination alone. However, a direct comparison of hybrid immunity and a mucosal adenovirus-based booster vaccination in animal models revealed that respiratory booster immunization elicited markedly stronger and more durable respiratory IgA, T cell response, and protective immunity against SARS-CoV-2, supporting the promise of respiratory mucosal vaccination. Mechanistically, we found that mucosal booster immunization induced local IgA-secreting cells in the respiratory mucosa, aided by pulmonary CD4+ T cells in situ. Strikingly, local IL-21-producing Blimp-1+ Th1 effector cells were critical in mediating the CD4+ T cell help for respiratory IgA production. Furthermore, lung macrophages were important for this respiratory IgA response via the production of TGF-β. Consequently, we demonstrated delivery of adenoviral booster to the lower airway was necessary to generate robust upper and lower airway IgA responses. Collectively, our results uncover a local cellular network supporting enhanced respiratory IgA responses, with implications for the development of optimal mucosal immunization strategies against SARS-CoV-2 and other respiratory pathogens.