Quality Improvement Initiative Enhances Outpatient Pediatric Pulmonology Follow-up for Premature Infants with Bronchopulmonary Dysplasia.

Introduction: Bronchopulmonary dysplasia (BPD) is a chronic lung disorder affecting many premature infants. Infants with BPD have higher hospital readmission rates due to respiratory-related morbidity. We aimed to increase the rates of outpatient pulmonary follow-up and attendance of premature babies with moderate and severe BPD to above 85% within 6 months. Methods: We conducted a quality improvement project at Yale New Haven Children's Hospital. Key interventions included developing a BPD clinical pathway integrated into the electronic medical record to assist providers in correctly classifying BPD severity, assigning the appropriate International Classification of Diseases, 10th Revision code (P27.1), and providing standardized treatment options. The outcome measures included correct diagnosis and classification of BPD, the percentage of patients with BPD scheduled for pediatric pulmonology appointments within 45 days, and the percentage attending those appointments. Results: There were 226 patients in our study, including 85 in the baseline period. Correct diagnosis of BPD increased from 49% to 95%, the percentage of scheduled appointments increased from 71.9% to 100%, and the percentage of appointments attended increased from 55.6% to 87.1%. Conclusions: Our quality improvement initiative improved the accuracy of diagnosis, severity classification, and outpatient pulmonary follow-up of children with moderate and severe BPD.

Emergency Department Pain Management in Pediatric Patients With Fracture or Dislocation in a Bi-Ethnic Population.

STUDY OBJECTIVE: We determine whether ethnicity in a bi-ethnic population of northern Israel is associated with disparities in pediatric emergency department (ED) opioid analgesia in patients with fracture or dislocation. METHODS: A retrospective cohort study was conducted. All records of patients aged 3 to 15 years and receiving a diagnosis of a limb fracture or dislocation were extracted. Data on demographics, including ethnicity, nurse ethnicity, pain level, and pain medication, were collected. Medications were administered according to a nurse-driven pain protocol. RESULTS: During the nearly 4-year study period, 3,782 children with fractures visited the ED, 1,245 Arabs and 2,537 Jews. Of these, 315 Arabic patients and 543 Jewish patients had a pain score of 7 to 10. The proportion of Arabic and Jewish children who received opioid therapy was 312 of 315 (99.05%) and 538 of 543 (99.08%), respectively (difference 0.03%; 95% confidence interval -0.13% to 0.19%). Of the 315 Arabic children, 99 were approached by Arabic nurses (31.4%), and 98 of those received opioids (98.9%); 216 were approached by Jewish nurses (68.6%), and 214 of those received opioids (99%). Of the 543 Jewish children, 351 were approached by Jewish nurses (64.6%), and 348 of those received opioids (98.9%); 192 were approached by Arab nurses (35.4%), and 190 of those received opioids (98.9%). During the 2014 11-week Israeli-Palestinian armed conflict, 232 children with fractures visited the ED, 87 Arabs and 145 Jews, of whom 16 and 27 had pain scores of 7 to 10. The proportion of Arabic and Jewish children who received opioid medication was 16 of 16 (100%) and 26 of 27 (96%), respectively (difference 4%; 95% confidence interval -16% to 18%). CONCLUSION: Findings suggest that ethnic differences, including during periods of conflicts, have no effect on opioid analgesia in this ED.

Inhibition of exocytosis or endocytosis blocks activity-dependent redistribution of synapsin.

The synaptic vesicle cycle encompasses the pre-synaptic events that drive neurotransmission. Influx of calcium leads to the fusion of synaptic vesicles with the plasma membrane and the release of neurotransmitter, closely followed by endocytosis. Vacated release sites are repopulated with vesicles which are then primed for release. When activity is intense, reserve vesicles may be mobilized to counteract an eventual decline in transmission. Recently, interplay between endocytosis and repopulation of the readily releasable pool of vesicles has been identified. In this study, we show that exo-endocytosis is necessary to enable detachment of synapsin from reserve pool vesicles during synaptic activity. We report that blockage of exocytosis in cultured mouse hippocampal neurons, either by tetanus toxin or by the deletion of munc13, inhibits the activity-dependent redistribution of synapsin from the pre-synaptic terminal into the axon. Likewise, perturbation of endocytosis with dynasore or by a dynamin dominant-negative mutant fully prevents synapsin redistribution. Such inhibition of synapsin redistribution occurred despite the efficient phosphorylation of synapsin at its protein kinase A/CaMKI site, indicating that disengagement of synapsin from the vesicles requires exocytosis and endocytosis in addition to phosphorylation. Our results therefore reveal hitherto unidentified feedback within the synaptic vesicle cycle involving the synapsin-managed reserve pool.

SpRET: highly sensitive and reliable spectral measurement of absolute FRET efficiency.

Contemporary research aims to understand biological processes not only by identifying participating proteins, but also by characterizing the dynamics of their interactions. Because Förster's Resonance Energy Transfer (FRET) is invaluable for the latter undertaking, its usage is steadily increasing. However, FRET measurements are notoriously error-prone, especially when its inherent efficiency is low, a not uncommon situation. Furthermore, many FRET methods are either difficult to implement, are not appropriate for observation of cellular dynamics, or report instrument-specific indices that hamper communication of results within the scientific community. We present here a novel comprehensive spectral methodology, SpRET, which substantially increases both the reliability and sensitivity of FRET microscopy, even under unfavorable conditions such as weak fluorescence or the presence of noise. While SpRET overcomes common pitfalls such as interchannel crosstalk and direct excitation of the acceptor, it also excels in removal of autofluorescence or background contaminations and in correcting chromatic aberrations, often overlooked factors that severely undermine FRET experiments. Finally, SpRET quantitatively reports absolute rather than relative FRET efficiency values, as well as the acceptor-to-donor molar ratio, which is critical for full and proper interpretation of FRET experiments. Thus, SpRET serves as an advanced, improved, and powerful tool in the cell biologist's toolbox.