Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Background: The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy. Methods: We analyzed surveillance data on inpatients younger than 21 years of age who had MIS-C and were admitted to 1 of 58 U.S. hospitals between March 15 and October 31, 2020. The effectiveness of initial immunomodulatory therapy (day 0, indicating the first day any such therapy for MIS-C was given) with intravenous immune globulin (IVIG) plus glucocorticoids, as compared with IVIG alone, was evaluated with propensity-score matching and inverse probability weighting, with adjustment for baseline MIS-C severity and demographic characteristics. The primary outcome was cardiovascular dysfunction (a composite of left ventricular dysfunction or shock resulting in the use of vasopressors) on or after day 2. Secondary outcomes included the components of the primary outcome, the receipt of adjunctive treatment (glucocorticoids in patients not already receiving glucocorticoids on day 0, a biologic, or a second dose of IVIG) on or after day 1, and persistent or recurrent fever on or after day 2. Results: A total of 518 patients with MIS-C (median age, 8.7 years) received at least one immunomodulatory therapy; 75% had been previously healthy, and 9 died. In the propensity-score-matched analysis, initial treatment with IVIG plus glucocorticoids (103 patients) was associated with a lower risk of cardiovascular dysfunction on or after day 2 than IVIG alone (103 patients) (17% vs. 31%; risk ratio, 0.56; 95% confidence interval [CI], 0.34 to 0.94). The risks of the components of the composite outcome were also lower among those who received IVIG plus glucocorticoids: left ventricular dysfunction occurred in 8% and 17% of the patients, respectively (risk ratio, 0.46; 95% CI, 0.19 to 1.15), and shock resulting in vasopressor use in 13% and 24% (risk ratio, 0.54; 95% CI, 0.29 to 1.00). The use of adjunctive therapy was lower among patients who received IVIG plus glucocorticoids than among those who received IVIG alone (34% vs. 70%; risk ratio, 0.49; 95% CI, 0.36 to 0.65), but the risk of fever was unaffected (31% and 40%, respectively; risk ratio, 0.78; 95% CI, 0.53 to 1.13). The inverse-probability-weighted analysis confirmed the results of the propensity-score-matched analysis. Conclusions: Among children and adolescents with MIS-C, initial treatment with IVIG plus glucocorticoids was associated with a lower risk of new or persistent cardiovascular dysfunction than IVIG alone. (Funded by the Centers for Disease Control and Prevention.)

Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Importance Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear. Objective To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19. Setting, Design, and Participants Case series of patients (age <21 years) hospitalized between March 15, 2020, and December 15, 2020, with positive severe acute respiratory syndrome coronavirus 2 test result (reverse transcriptase-polymerase chain reaction and/or antibody) at 61 US hospitals in the Overcoming COVID-19 public health registry, including 616 (36%) meeting criteria for multisystem inflammatory syndrome in children. Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening involvement was adjudicated by experts based on clinical and/or neuroradiologic features. Exposures Severe acute respiratory syndrome coronavirus 2. Main Outcomes and Measures Type and severity of neurologic involvement, laboratory and imaging data, and outcomes (death or survival with new neurologic deficits) at hospital discharge. Results Of 1695 patients (909 [54%] male; median [interquartile range] age, 9.1 [2.4-15.3] years), 365 (22%) from 52 sites had documented neurologic involvement. Patients with neurologic involvement were more likely to have underlying neurologic disorders (81 of 365 [22%]) compared with those without (113 of 1330 [8%]), but a similar number were previously healthy (195 [53%] vs 723 [54%]) and met criteria for multisystem inflammatory syndrome in children (126 [35%] vs 490 [37%]). Among those with neurologic involvement, 322 (88%) had transient symptoms and survived, and 43 (12%) developed life-threatening conditions clinically adjudicated to be associated with COVID-19, including severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), central nervous system infection/demyelination (n = 8), Guillain-Barré syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4). Compared with those without life-threatening conditions (n = 322), those with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios (median, 12.2 vs 4.4) and higher reported frequency of D-dimer greater than 3 μg/mL fibrinogen equivalent units (21 [49%] vs 72 [22%]). Of 43 patients who developed COVID-19–related life-threatening neurologic involvement, 17 survivors (40%) had new neurologic deficits at hospital discharge, and 11 patients (26%) died. Conclusions and Relevance In this study, many children and adolescents hospitalized for COVID-19 or multisystem inflammatory syndrome in children had neurologic involvement, mostly transient symptoms. A range of life-threatening and fatal neurologic conditions associated with COVID-19 infrequently occurred. Effects on long-term neurodevelopmental outcomes are unknown

A Novel Non-Acoustic Voiced Speech Sensor: Experimental Results and Characterization

Recovering clean speech from an audio signal with additive noise is a problem that has plagued the signal processing community for decades. One promising technique currently being utilized in speech-coding applications is a multi-sensor approach, in which a microphone is used in conjunction with optical, mechanical, and electrical non-acoustic speech sensors to provide greater versatility in signal processing algorithms. One such non-acoustic glottal waveform sensor is the Tuned Electromagnetic Resonator Collar (TERC) sensor, first developed in [BLP+02]. The sensor is based on Magnetic Resonance Imaging (MRI) concepts, and is designed to detect small changes in capacitance caused by changes to the state of the vocal cords - the glottal waveform. Although preliminary simulations in [BLP+02] have validated the basic theory governing the TERC sensor's operation, results from human subject testing are necessary to accurately characterize the sensor's performance in practice. To this end, a system was designed and developed to provide real-time audio recordings from the sensor while attached to a human test subject. From these recordings, executed in a variety of acoustic noise environments, the practical functionality of the TERC sensor was demonstrated. The sensor in its current evolution is able to detect a periodic waveform during voiced speech, with two clear harmonics and a fundamental frequency equal to that of the speech it is detecting. This waveform is representative of the glottal waveform, with little or no articulation as initially hypothesized. Though statistically significant conclusions about the sensor's immunity to environmental noise are difficult to draw, the results suggest that the TERC sensor is considerably more resistant to the effects of noise than typical acoustic sensors, making it a valuable addition to the multi-sensor speech processing approach

Performance evaluation solutions -- improving service quality at a telephone solicitation service.

Information Service 113 is concerned with the quality of service it provides to its customers. ING. Katia Arana Puente, Director of Information Service 113, commissioned our group to evaluate and criticize the Service's recent performance. Our research resulted in a system of rating for the Service and its operators, as well as a system for the replication of these results. Along with the new system of evaluation and recommendations developed in the project, the effectiveness of the Service's evaluation procedures was improved without sacrificing the quality of service currently provided

It Is Not Always Sepsis: Fatal Tachypnea in a Newborn

Coarctation of the aorta (CoA) is a congenital cardiac malformation that is well understood. Despite being well characterized, CoA is a commonly missed congenital heart disease (CHD) during the newborn period. We report a full-term nine-day-old male who presented to the pediatric emergency department (ED) with isolated tachypnea. After an initial sepsis workup, subsequent investigations revealed critical CoA. Because the primary workup focused on sepsis, there was a significant delay in prostaglandin E1 (PGE1) initiation. This case illustrates the importance of early CoA recognition and timely initiation of PGE1 in newborns who present with suspected sepsis along with tachypnea

Remote surveillance system over GSM network

Internet Control Solutions was interested in determining the feasibility of a commercial remote surveillance system over the European GSM network utilising their existing Telemetry Box technology. This project successfully created a working prototype that met the predetermined system specifications, effectively proving the feasibility of developing it as a commercial product

Robert Duncan’s Legacies: a Centennial Celebration

2019 marked the 100th anniversary of the birth of Californian poet Robert Duncan (January 7, 1919 – February 3, 1988), whose work and influence have drawn ever-growing scholarly attention. All of the papers gathered together in this issue began as presentations at “Passages”: The Robert Duncan Centennial Conference in Paris held in June 2019 at Sorbonne Université. Organized by Hélène Aji, Stephen Collis, Xavier Kalck, James Maynard, and Clément Oudart, and co-sponsored by Simon Fraser University, the University at Buffalo Libraries Poetry Collection, Université Paris Nanterre and Sorbonne Université, the three-day conference included three keynote addresses, three plenary panels, ten workshops, a roundtable discussion, and two poetry readings, featuring over 50 presenters and a high number of attendees from around the world. We are pleased to present here eighteen of those presentations, comprising thirteen formal essays along with five more personal testimonies that serve as the coda to each section, and to take this opportunity to reflect briefly on the history of Duncan studies before considering more specifically his modernist, formal, poetic, social, and queer legacies at the century