The Role of Parental Concerns in the Recognition of Sepsis in Children: A Literature Review

Background: Sepsis is a time critical disease and outcomes strongly depend on time to initiation of appropriate treatment in hospital. A range of studies have assessed sepsis recognition in hospital settings, whereas little is known about sepsis recognition in the community. The decision-making of parents in seeking medical care may substantially impact survival of children with sepsis. An improved understanding of the parental perspective in recognizing sepsis is urgently needed to inform the design of education campaigns and consideration of using parental concerns as a trigger in sepsis screening tools.Aim: To review the literature on parental concerns in the diagnosis of sepsis in children.Methods: A literature review on parental concerns in pediatric sepsis was performed accessing publications in PubMed, CINAHL and Medline published between 1990 and 2018. In addition, we compared guidelines and online institutional sepsis recognition tools and assessed whether parental concerns were used for screening.Results: Out of 188 articles reviewed, 11 met the criteria. One article was found prospectively assessing the diagnostic performance of parental concern in children evaluated for infection, indicating high positive (16.4) and negative likelihood ratio (0.23) for sepsis/meningitis in presence of parental concerns. The role of parental concern was listed as a sign assisting recognition of sepsis in four studies reporting original data, and six reviews commented on parental concern listed as a factor upon diagnosis of sepsis. When comparing selected examples of institutional sepsis pathways available online, parental concern was variably listed as a criterion to prompt evaluation for sepsis.Conclusions: Despite some guidelines emphasizing the role of parental concern in recognizing sepsis, there is a paucity of data in the field. An improved understanding of whether parental concerns adds diagnostic value to sepsis recognition at acceptable sensitivity and specificity is urgently needed. Future prospective studies should assess whether including parental concerns in sepsis screening tools benefits the assessment resulting in early diagnosis and treatment of children with sepsis

Patient and economic impact of implementing a paediatric sepsis pathway in emergency departments in Queensland, Australia.

We examined systems-level costs before and after the implementation of an emergency department paediatric sepsis screening, recognition and treatment pathway. Aggregated hospital admissions for all children aged < 18y with a diagnosis code of sepsis upon admission in Queensland, Australia were compared for 16 participating and 32 non-participating hospitals before and after pathway implementation. Monte Carlo simulation was used to generate uncertainty intervals. Policy impacts were estimated using difference-in-difference analysis comparing observed and expected results. We compared 1055 patient episodes before (77.6% in-pathway) and 1504 after (80.5% in-pathway) implementation. Reductions were likely for non-intensive length of stay (- 20.8 h [- 36.1, - 8.0]) but not intensive care (-9.4 h [- 24.4, 5.0]). Non-pathway utilisation was likely unchanged for interhospital transfers (+ 3.2% [- 5.0%, 11.4%]), non-intensive (- 4.5 h [- 19.0, 9.8]) and intensive (+ 7.7 h, [- 20.9, 37.7]) care length of stay. After difference-in-difference adjustment, estimated savings were 596 [277, 942] non-intensive and 172 [148, 222] intensive care days. The program was cost-saving in 63.4% of simulations, with a mean value of $97,019 [-$857,273, $1,654,925] over 24 months. A paediatric sepsis pathway in Queensland emergency departments was associated with potential reductions in hospital utilisation and costs

The Grizzly, October 10, 2013

Annual Ursinus College Crime Report Released • Homecoming 2013 Preview • Religious Faith on Campus • Student Affairs\u27 New Mission Statement • Student Retention • Ursinus\u27 Grizzly Gala Returns • CSCG Features Speaker • Opinion: Ursinus Curates its Web Presence Poorly; We All Need the Stress Management Course • Carty Balances Football and Pre-Law • Golf Prepares for Spring During Fall Season • Football Sits at 5-0, Men\u27s Soccer Takes a Losshttps://digitalcommons.ursinus.edu/grizzlynews/1889/thumbnail.jp

The Grizzly, February 20, 2014

Student Senate Assembled After Reimert Party Ban • Ursinus to Hold First Musical Combining Three Departments • Professors Determine Class Cancellations • More Than 300 Students Attend Job Fair This Year • Professors Return to Campus Life • Heavy Snowfall no Match for Facilities; Ursinus Remains Open • Student Response Counts When Hiring Faculty • Opinion: Supply Chain is Our Biggest Food Risk; Michael Sam Shouldn\u27t Need a Press Conference • Record-Breaking Career for UC Swimmer • Large Freshman Class Will Help Baseball Bounce Back • Winter Sports End Regular Season on High Notehttps://digitalcommons.ursinus.edu/grizzlynews/1898/thumbnail.jp

The Grizzly, September 26, 2013

Courtyard Pilot Program Extended • Much Ado About UC Drama • Extern Program • Marks Discusses Online Education • Live Music at Reimert • Community Yard Sale This Weekend • New Film Professor Joins the Campus • Enactus Prepares for a New Year • Opinion: Make the Most of Your Ursinus Years; School Spirit Should Extend Beyond Campus • Senior Spotlight: Jenna Stover • Topic of Injuries Overshadowing Football Season • Family Day Rounduphttps://digitalcommons.ursinus.edu/grizzlynews/1887/thumbnail.jp

Automated, high-accuracy classification of textured microstructures using a convolutional neural network

Crystallographic texture is an important descriptor of material properties but requires time-intensive electron backscatter diffraction (EBSD) for identifying grain orientations. While some metrics such as grain size or grain aspect ratio can distinguish textured microstructures from untextured microstructures after significant grain growth, such morphological differences are not always visually observable. This paper explores the use of deep learning to classify experimentally measured textured microstructures without knowledge of crystallographic orientation. A deep convolutional neural network is used to extract high-order morphological features from binary images to distinguish textured microstructures from untextured microstructures. The convolutional neural network results are compared with a statistical Kolmogorov–Smirnov tests with traditional morphological metrics for describing microstructures. Results show that the convolutional neural network achieves a significantly improved classification accuracy, particularly at early stages of grain growth, highlighting the capability of deep learning to identify the subtle morphological patterns resulting from texture. The results demonstrate the potential of a convolutional neural network as a tool for reliable and automated microstructure classification with minimal preprocessing

Effects of IRF5 Lupus Risk Haplotype on Pathways Predicted to Influence B Cell Functions

Both genetic and environmental interactions affect systemic lupus erythematosus (SLE) development and pathogenesis. One known genetic factor associated with lupus is a haplotype of the interferon regulatory factor 5 (IRF5) gene. Analysis of global gene expression microarray data using gene set enrichment analysis identified multiple interferon- and inflammation-related gene sets significantly overrepresented in cells with the risk haplotype. Pathway analysis using expressed genes from the significant gene sets impacted by the IRF5 risk haplotype confirmed significant correlation with the interferon pathway, Toll-like receptor pathway, and the B-cell receptor pathway. SLE patients with the IRF5 risk haplotype have a heightened interferon signature, even in an unstimulated state (P = 0.011), while patients with the IRF5 protective haplotype have a B cell interferon signature similar to that of controls. These results identify multiple genes in functionally significant pathways which are affected by IRF5 genotype. They also establish the IRF5 risk haplotype as a key determinant of not only the interferon response, but also other B-cell pathways involved in SLE

The Grizzly, March 1, 1994

Up \u27Til Noone to Play at The Trappe • Last Semester\u27s Blood Drive a Success • Kane Encourages Support for Blood Drive • CIA Officer and his Wife Accused of Spying • Professor Profile: Keith Brand • Broughton Exhibit to Open in Berman • Senior Profile: Alan McCabe • The Snow Closing Debates, Continued • Letter to the Editor • To All Administrators, Faculty, Staff, and Other Interested Parties • Women\u27s Hoops Have Best Season Everhttps://digitalcommons.ursinus.edu/grizzlynews/1332/thumbnail.jp