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Top AI models unveiled in COVID-19 challenge to improve lung diagnostics
January 12, 2021 /in Infectious Disease, Infectious Disease News, Pulmonology and Sleep Medicine, Pulmonology and Sleep Medicine News /by Innovation District
The top 10 results have been unveiled in the first-of-its-kind COVID-19 Lung CT Lesion Segmentation Grand Challenge, a groundbreaking research competition focused on developing artificial intelligence (AI) models to help in the visualization and measurement of COVID specific lesions in the lungs of infected patients, potentially facilitating more timely and patient-specific medical interventions.
Attracting more than 1,000 global participants, the competition was presented by the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Hospital in collaboration with leading AI technology company NVIDIA and the National Institutes of Health (NIH). The competition's AI models utilized a multi-institutional, multi-national data set provided by public datasets from The Cancer Imaging Archive (National Cancer Institute), NIH and the University of Arkansas, that originated from patients of different ages, genders and with variable disease severity. NVIDIA provided GPUs to the top five winners as prizes, as well as supported the selection and judging process.
"Improving COVID-19 treatment starts with a clearer understanding of the patient's disease state. However, a prior lack of global data collaboration limited clinicians in their ability to quickly and effectively understand disease severity across both adult and pediatric patients," says Marius George Linguraru, D.Phil., M.A., M.Sc., principal investigator at the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National, who led the Grand Challenge initiative. "By harnessing the power of AI through quantitative imaging and machine learning, these discoveries are helping clinicians better understand COVID-19 disease severity and potentially stratify and triage into appropriate treatment protocols at different stages of the disease."
The top 10 AI algorithms were identified from a highly competitive field of participants who tested the data in November and December 2020. The results were unveiled on Jan. 11, 2021, in a virtual symposium, hosted by Children's National, that featured presentations from top teams, event organizers and clinicians.
Developers of the 10 top AI models from the COVID-19 Lung CT Lesion Segmentation Grand Challenge are:
Shishuai Hu, et al. Northwestern Polytechnical University, China. "Semi-supervised Method for COVID-19 Lung CT Lesion Segmentation"
Fabian Isensee, et al. German Cancer Research Center, Germany. "nnU-Net for Covid Segmentation"
Claire Tang, Lynbrook High School, USA. "Automated Ensemble Modeling for COVID-19 CT Lesion Segmentation"
Qinji Yu, et al. Shanghai JiaoTong University, China. "COVID-19-20 Lesion Segmentation Based on nnUNet"
Andreas Husch, et al. University of Luxembourg, Luxembourg. "Leveraging State-of-the-Art Architectures by Enriching Training Information – a case study"
Tong Zheng, et al. Nagoya University, Japan. "Fully-automated COVID-19-20 Segmentation"
Vitali Liauchuk. United Institute of Informatics Problems (UIIP), Belarus. "Semi-3D CNN with ImageNet Pretrain for Segmentation of COVID Lesions on CT"
Ziqi Zhou, et al. Shenzhen University, China. "Automated Chest CT Image Segmentation of COVID-19 with 3D Unet-based Framework"
Jan Hendrik Moltz, et al. Fraunhofer Institute for Digital Medicine MEVIS, Germany. "Segmentation of COVID-19 Lung Lesions in CT Using nnU-Net"
Bruno Oliveira, et al. 2Ai – Polytechnic Institute of Cávado and Ave, Portugal. "Automatic COVID-19 Detection and Segmentation from Lung Computed Tomography (CT) Images Using 3D Cascade U-net"
Linguraru added that, in addition to an award for the top five AI models, these winning algorithms are now available to partner with clinical institutions across the globe to further evaluate how these quantitative imaging and machine learning methods may potentially impact global public health.
"Quality annotations are a limiting factor in the development of useful AI models," said Mona Flores, M.D., global head of Medical AI, NVIDIA. "Using the NVIDIA COVID lesion segmentation model available on our NGC software hub, we were able to quickly label the NIH dataset, allowing radiologists to do precise annotations in record time."
"I applaud the computer science, data science and image processing global academic community for rapidly teaming up to combine multi-disciplinary expertise towards development of potential automated and multi-parametric tools to better study and address the myriad of unmet clinical needs created by the pandemic," said Bradford Wood, M.D., director, NIH Center for Interventional Oncology and chief, Interventional Radiology Section, NIH Clinical Center. "Thank you to each team for locking arms towards a common cause that unites the scientific community in these challenging times."
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Lee Beers, M.D., F.A.A.P, begins term as AAP president
January 4, 2021 /in Allergy and Immunology, Allergy and Immunology News, Anesthesiology, Perioperative and Pain, Anesthesiology, Perioperative and Pain News, Behavioral Sciences, Behavioral Sciences News, Cancer, Cancer News, Cardiology & Heart Surgery, Cardiology & Heart Surgery News, Colorectal, Colorectal News, Critical Medicine, Critical Medicine News, Diabetes & Endocrinology News, Diabetes and Endocrinology, Diagnostic Imaging and Radiology, Diagnostic Imaging and Radiology News, Discovery and Insights, Discovery and Insights Home Page, Emergency Medicine, Emergency Medicine News, Fetal Medicine, Fetal Medicine News, Gastroenterology & GI Surgery News, Gastroenterology and GI Surgery, Genetic Medicine, Genetics and Rare Diseases, Genetics and Rare Diseases News, Hematology, Immunotherapy, Immunotherapy News, Infectious Disease, Infectious Disease News, Neonatology, Neonatology News, Nephrology, Nephrology News, Neurology & Neurosurgery News, Neurology and Neurosurgery, Orthopaedic News, Orthopaedics, Public Health, Public Health News, Pulmonology and Sleep Medicine, Pulmonology and Sleep Medicine News, Surgical Innovation, Surgical Innovation News, Urology, Urology News /by Innovation District
"The past year has been a stark reminder about the importance of partnership and working together toward common goals," says Dr. Beers. "I am humbled and honored to be taking on this role at such a pivotal moment for the future health and safety of not only children, but the community at large."
Lee Savio Beers, M.D., F.A.A.P., medical director of Community Health and Advocacy at the Child Health Advocacy Institute (CHAI) at Children's National Hospital, has begun her term as president of the American Academy of Pediatrics (AAP). The AAP is an organization of 67,000 pediatricians committed to the optimal physical, mental and social health and well-being for all children – from infancy to adulthood.
Dr. Beers has pledged to continue AAP's advocacy and public policy efforts and to further enhance membership diversity and inclusion. Among her signature issues:
Partnering with patients, families, communities, mental health providers and pediatricians to co-design systems to bolster children's resiliency and to alleviate growing pediatric mental health concerns.
Continuing to support pediatricians during the COVID-19 pandemic with a focus on education, pediatric practice support, vaccine delivery systems and physician wellness.
Implementation of the AAP's Equity Agenda and Year 1 Equity Workplan.
Dr. Beers is looking forward to continuing her work bringing together the diverse voices of pediatricians, children and families as well as other organizations to support improving the health of all children.
"Dr. Beers has devoted her career to helping children," says Kurt Newman, M.D., president and chief executive officer of Children's National. "She has developed a national advocacy platform for children and will be of tremendous service to children within AAP national leadership."
Read more about Dr. Beer's career and appointment as president of the AAP.
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Causes, diagnosis and management of acute flaccid myelitis
December 23, 2020 /in Infectious Disease, Infectious Disease News /by Innovation District
Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. Children's National Hospital was part of a multi-center study focused on AFM and published in The Lancet.
Children's National authors include Elizabeth Wells, M.D., director of Inpatient Neurology; Jessica Carpenter, M.D., director of the Neonatal and Childhood Stroke Program and co-director of the Neurocritical Care Program; and Roberta DeBiasi, M.D., M.S., chief of the Division of Infectious Diseases.
This review describes the epidemiology, clinical features, course and outcomes of AFM to help to guide diagnosis, management and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral and immunological features of affected patients, host-virus interactions and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.
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COVID testing results highlight importance of understanding virus in children
December 21, 2020 /in Emergency Medicine, Emergency Medicine News, Infectious Disease, Infectious Disease News, Public Health, Public Health News /by Innovation District
A new study looking at the results of testing children for COVID-19 through a Children's National Hospital community-based testing site found that one in four patients had a positive test.
A new study looking at the results of testing children for COVID-19 through a Children's National Hospital community-based testing site found that one in four patients had a positive test. The findings, reported online Dec. 18 in The Journal of Pediatrics, reinforce that children and young adults are impacted by the virus more than originally believed, and that the continued understanding of their role in transmitting COVID-19 is essential to getting the virus under control.
Of the 1,445 patients tested at the specimen collection site for SARS-CoV-2 virus between March 21 and May 16, 2020, the median age was 8 years old, and more than 34% of positive patients were Hispanic, followed by non-Hispanic Black and non-Hispanic white. The daily positivity rate increased over the study period, from 5.4% during the first week to a peak of 47.4% in May. Children and adolescents were referred to the testing site because of risk of exposure or mild symptoms.
"We knew that community-based testing sites were key in minimizing exposure risk to other patients and health care workers, preserving PPE, centralizing specimen collection services, mitigating acute care site overcrowding and informing our community of the burden caused by this disease," says Joelle Simpson, M.D., medical director of Emergency Preparedness at Children's National.
Drive-through/walk-up testing sites outside of a traditional acute care setting have emerged around the world to meet the need for testing mildly ill or asymptomatic individuals. In March, Children's National Hospital opened a drive-up/walk-up location — one of the first exclusively pediatric testing sites for the virus in the U.S. — where primary care doctors in the Washington, D.C., region could refer young patients for COVID-19 specimen collection and testing.
"At first, children were not the target of testing initiatives, but it is clear that making testing available to pediatric patients early was a very important part of the pandemic response," says Meghan Delaney, D.O., M.P.H., chief of Pathology and Laboratory Medicine at Children's National. "Not only can children get severe disease, they can be part of positive clusters with the adults they live with. The knowledge we have gained by testing many thousands of children over the pandemic has provided key information."
Compared with non-Hispanic white children and after adjustments for age, sex and distance of residence from specimen collection site, minority children had a higher likelihood of infection.
"We wanted to identify the features of children tested at this site who did not require acute medical care and be able to compare demographic and clinical differences between patients who tested positive and negative for COVID-19," says Dr. Simpson.
Patients with COVID-19 exposure and symptoms were more likely to have a positive test than patients without symptoms. This supports contact tracing for symptomatic cases and testing as an important tool in detecting and containing community spread, according to the study's findings. Although most patients were referred because they lived with a family member with high risk for exposure or infection, this was not associated with positive test results.
"The impact of this virus is broad and affects planning for children, especially as schools and childcare centers work to reopen," Dr. Simpson says. "In order to guide the development of measures to control the ongoing pandemic, we need better understand the transmission potential of these mildly symptomatic or well children and young adults."
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Single institution study finds high rates of cardiac complications in MIS-C
November 13, 2020 /in Cardiology & Heart Surgery, Cardiology & Heart Surgery News, Infectious Disease, Infectious Disease News, Meetings /by Innovation District
At this year's AHA Scientific Sessions, cardiologists from Children's National Hospital presented a poster about an interesting finding in children with MIS-C.
During the height of the pandemic, researchers at Children's National Hospital discovered that as many as one half of children diagnosed with multisystem inflammatory disease in children (MIS-C) at the hospital developed cardiac complications including coronary artery abnormalities, even when diagnosed and treated promptly.
The data was shared as part of a poster presentation at the American Heart Association Scientific Sessions in November 2020. Though analysis was limited to the data from one institution's confirmed MIS-C cases, the findings are significant enough to warrant further study.
Interestingly, the authors noted that the high rate of cardiac complications far exceeds the rate of similar issues in children with Kawasaki disease — another pediatric inflammatory syndrome that shares many common symptoms with MIS-C. The two are so similar that immunomodulation therapies successfully deployed in children with MIS-C were based on those developed to treat Kawasaki disease.
Knowledge of common cardiac complications in Kawasaki disease also flagged the need for routine echocardiograms in patients with MIS-C, which helped identify the higher rates of cardiac complications seen in the MIS-C patient population.
"This finding, however, is another data point that shows how MIS-C and Kawasaki disease have some specific differences needing further study," says Ashraf Harahsheh, M.D., a pediatric cardiologist at Children's National Hospital who studies Kawasaki disease and the first author on the new study.
"Previous clinical advancements made in Kawasaki disease set the stage for our response to MIS-C early on," he said. "Now we also need to understand MIS-C as its own syndrome so we can better address what we are seeing in this patient population," he says.
While most of the cardiac findings resolved during follow up, long-term studies are needed to determine if the cardiac abnormalities are associated with major cardiac events later.
"This work will help inform the community of the importance of diagnosing children with MIS-C promptly and following clinical guidelines for necessary tests and treatments once MIS-C is diagnosed," Harahsheh concludes.
Next, the research team plans to take a deep dive into patient demographics as well as findings from clinical, laboratory and electrocardiogram data for children who developed cardiac complications with MIS-C. The goal will be to refine treatment algorithms and potentially identify a subgroup of patients who may require different or more intense therapy to prevent cardiac complications.
American Heart Association Scientific Sessions 2020 Poster Session
Cardiac Complications of SARS CoV-2 Associated Multi-System Inflammatory Syndrome in Children (MIS-C)
Fri, Nov 13 (CST)
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Boeing gives $5 million to support Research & Innovation Campus
November 5, 2020 /in Allergy and Immunology, Allergy and Immunology News, Behavioral Sciences, Behavioral Sciences News, Cancer, Cancer News, Cardiology & Heart Surgery, Cardiology & Heart Surgery News, Colorectal, Colorectal News, Critical Medicine, Critical Medicine News, Diabetes & Endocrinology News, Diabetes and Endocrinology, Diagnostic Imaging and Radiology, Diagnostic Imaging and Radiology News, Discovery and Insights, Discovery and Insights Home Page, Emergency Medicine, Emergency Medicine News, Fetal Medicine, Fetal Medicine News, Gastroenterology & GI Surgery News, Gastroenterology and GI Surgery, Genetic Medicine, Genetics and Rare Diseases, Genetics and Rare Diseases News, Hematology, Immunotherapy, Immunotherapy News, In Brief, Infectious Disease, Infectious Disease News, Neonatology, Neonatology News, Nephrology, Nephrology News, Neurology & Neurosurgery News, Neurology and Neurosurgery, Orthopaedic News, Orthopaedics, Public Health, Public Health News, Pulmonology and Sleep Medicine, Pulmonology and Sleep Medicine News, Quality and Safety, Quality and Safety News, Surgical Innovation, Surgical Innovation News, Telehealth, Telehealth News, Urology News /by Innovation District
Children's National Hospital announced a $5 million gift from The Boeing Company that will help drive lifesaving pediatric discoveries at the new Children's National Research & Innovation Campus.
Children's National Hospital announced a $5 million gift from The Boeing Company that will help drive lifesaving pediatric discoveries at the new Children's National Research & Innovation Campus. The campus, now under construction, is being developed on nearly 12 acres of the former Walter Reed Army Medical Center. Children's National will name the main auditorium in recognition of Boeing's generosity.
"We are deeply grateful to Boeing for their support and commitment to improving the health and well-being of children in our community and around the globe," said Kurt Newman, M.D., president and CEO of Children's National "The Boeing Auditorium will help the Children's National Research & Innovation campus become the destination for discussion about how to best address the next big healthcare challenges facing children and families."
The one-of-a-kind pediatric hub will bring together public and private partners for unprecedented collaborations. It will accelerate the translation of breakthroughs into new treatments and technologies to benefit kids everywhere.
"Children's National Hospital's enduring mission of positively impacting the lives of our youngest community members is especially important today," said Boeing President and CEO David Calhoun. "We're honored to join other national and community partners to advance this work through the establishment of their Research & Innovation Campus."
Children's National Research & Innovation Campus partners currently include Johnson & Johnson Innovation – JLABS, Virginia Tech, the National Institutes of Health (NIH), Food & Drug Administration (FDA), U.S. Biomedical Advanced Research and Development Authority (BARDA), Cerner, Amazon Web Services, Microsoft, National Organization of Rare Diseases (NORD) and local government.
The 3,200 square-foot Boeing Auditorium will be the focal point of the state-of-the-art conference center on campus. Nationally renowned experts will convene with scientists, medical leaders and diplomats from around the world to foster collaborations that spur progress and disseminate findings.
Boeing's $5 million commitment deepens its longstanding partnership with Children's National. The company has donated nearly $2 million to support pediatric care and research at Children's National through Chance for Life and the hospital's annual Children's Ball. During the coronavirus pandemic, Boeing fabricated and donated 2,000 face shields to help keep patients and frontline care providers at Children's National safe.
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Children's National joins international AI COVID-19 initiative
October 28, 2020 /in Critical Medicine, Critical Medicine News, Emergency Medicine, Emergency Medicine News, Infectious Disease, Infectious Disease News, Public Health, Public Health News /by Innovation District
Children's National Hospital is the first pediatric partner to join an international initiative led by leading technology firm NVIDIA and Massachusetts General Brigham Hospital, focused on creating solutions through machine and deep learning to benefit COVID-19 healthcare outcomes.
Children's National Hospital is the first pediatric partner to join an international initiative led by leading technology firm NVIDIA and Massachusetts General Brigham Hospital, focused on creating solutions through machine and deep learning to benefit COVID-19 healthcare outcomes. The initiative, known as EXAM (EMR CXR AI Model) is the largest and most diverse federated learning enterprise, comprised of 20 leading hospitals from around the globe.
Marius George Linguraru, D.Phil., M.A., M.Sc., principal investigator at the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Hospital, noted that one of the core goals of the initiative is to create a platform which brings resources together, from a variety of leading institutions, to advance the care of COVID-19 patients across the board, including children.
"Children's National Hospital is proud to be the first pediatric partner joining the world's leading healthcare institutions in this collaboration to advance global health," says Linguraru. "We are currently living in a time where rapid access to this kind of global data has never been more important — we need solutions that work fast and are effective. That is not possible without this degree of collaboration and we look forward to continuing this important work with our partners to address one of the most significant healthcare challenges in our lifetime."
A recent systematic review and meta-analysis from Children's National Hospital became another core contribution to understanding how children are impacted by COVID-19. Led by Linguraru and accepted to be published in Pediatric Pulmonology, it offers the first comprehensive summary of the findings of various studies published thus far that describe COVID-19 lung imaging data across the pediatric population.
The review examined articles based on chest CT imaging in 1,026 pediatric patients diagnosed with COVID-19, and concluded that chest CT manifestations in those patients could potentially be used to prompt intervention across the pediatric population.
"Children's National Hospital is proud to be the first pediatric partner joining the world's leading healthcare institutions in this collaboration to advance global health," says Marius George Linguraru, D.Phil., M.A., M.Sc.
"Until this point, pediatric COVID-19 studies have largely been restricted to case reports and small case series, which have prevented the identification of any specific pediatric lung disease patterns in COVID-19 patients," says Linguraru. "Not only did this review help identify the common patterns in the lungs of pediatric patients presenting COVID-19 symptoms, which are distinct from the signs of other viral respiratory infections in children, it also provided insight into the differences between children and adults with COVID-19."
Earlier this month, NVIDIA announced the EXAM initiative had – in just 20 days – developed an artificial intelligence (AI) model to determine whether a patient demonstrating COVID-19 symptoms in an emergency room would require supplemental oxygen hours – even days – after the initial exam. This data ultimately aids physicians in determining the proper level of care for patients, including potential ICU placement.
The EXAM initiative achieved a machine learning model offering precise prediction for the level of oxygen incoming patients would require.
In addition to Children's National Hospital, other participants included Mass Gen Brigham and its affiliated hospitals in Boston; NIHR Cambridge Biomedical Research Centre; The Self-Defense Forces Central Hospital in Tokyo; National Taiwan University MeDA Lab and MAHC and Taiwan National Health Insurance Administration; Tri-Service General Hospital in Taiwan; Kyungpook National University Hospital in South Korea; Faculty of Medicine, Chulalongkorn University in Thailand; Diagnosticos da America SA in Brazil; University of California, San Francisco; VA San Diego; University of Toronto; National Institutes of Health in Bethesda, Maryland; University of Wisconsin-Madison School of Medicine and Public Health; Memorial Sloan Kettering Cancer Center in New York; and Mount Sinai Health System in New York.
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COVID-19: First comprehensive review of pediatric lung imaging features
October 19, 2020 /in Infectious Disease, Infectious Disease News, Pulmonology and Sleep Medicine, Pulmonology and Sleep Medicine News, Uncategorized /by Innovation District
A systematic review and meta-analysis by Children's National Hospital researchers, published in Pediatric Pulmonology, provides the first comprehensive review of the findings of published studies describing COVID-19 lung imaging data in children.
The number COVID-19 studies focused on children have been small and with limited data. This has prevented the identification of specific pediatric lung disease patterns in COVID-19. Although children make up around 9.5% of COVID-19 infections, less than 2% of the literature on the virus, its symptoms and effects, have focused on kids.
A systematic review and meta-analysis by Children's National Hospital researchers, published in Pediatric Pulmonology, provides the first comprehensive review of the findings of published studies describing COVID-19 lung imaging data in children. The analysis concludes that chest CT manifestations in children with COVID‐19 could potentially prompt intervention in the pediatric population.
Marius George Linguraru, D.Phil., M.A., M.Sc., principal investigator in the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National, discusses the importance of this work.
Q: What findings stand out to you?
A: We found that more than a third of children with COVID-19 had normal imaging. The lung imaging findings in these children were overall less frequent and less severe than in adult patients, but they were also more heterogeneous than in adults. Importantly, children with COVID-19 were three times more likely to have a normal exam than adults.
Several common lung imaging findings reported in adults were extremely rare or not found in the pediatric studies. These discoveries, and other recent reports in this space, support the fact that children's symptoms may be less obvious than adults or even absent, but they still carry the virus and may be at risk for serious and life-threatening illness.
Marius George Linguraru, D.Phil., M.A., M.Sc., principal investigator in the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National.
Q: How will the findings of this study benefit pediatric care?
A: In our study, we showed how the health of the lungs of these children is impacted. Our results from data from 1,026 children (from newborns to 18 year old) with COVID-19 present chest manifestations that could potentially prompt informed intervention and better recovery.
Another conclusion of our study is that the abnormalities reported on the chest scans of children infected with COVID-19 are distinct from the typical lung images seen during other viral respiratory infections in the pediatric population. This is important for preparing for the cold and flu season.
Q: Why was this review important to our understanding of how COVID-19 impacts children?
A: This is the first systematic review and meta-analysis focused on the manifestation of the COVID-19 infection in the lungs of children. Our study, and others from colleagues at Children's National, helps lead the efforts on elucidating how the pandemic affects the health of children.
Though children were initially thought to be less susceptible to infection, the data has made it clear that many children are at high risk for hospitalization and severe health complications. Although there are similarities between how children and adults are affected by the pandemic, there are also critical differences.
Given the limited knowledge in the manifestation of COVID-19 in children, with children susceptible to infection and hospitalization, and with children returning to school, continued efforts to understand the impact of COVID-19 on young patients is critically important. Understanding how children fare through the pandemic is the foundation of discovering better ways to take care of young patients and their health.
You can find the full study published in Pediatric Pulmonology. Learn more about the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National.
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October 2, 2020 /in Critical Medicine, Critical Medicine News, Emergency Medicine, Emergency Medicine News, Infectious Disease, Infectious Disease News, Meetings, Public Health, Public Health News /by Innovation District
The CN-NIAID Virtual Symposium highlighted work being done to fight the COVID-19 pandemic globally.
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Telehealth team shares its pandemic response and discusses the future of telehealth
October 2, 2020 /in Infectious Disease, Infectious Disease News, Telehealth, Telehealth News /by Innovation District
The telehealth team at Children's National Hospital is featured in DataBank IMX's latest Tech Talk podcast. They discuss how the organization scaled up and managed the telehealth program through the early and mid phases of the COVID-19 pandemic, as well as the future of telehealth.
Featured in the discussion are clinical, operational and revenue cycle leaders from Children's National:
Mary Daymont, M.S.N., R.N., CCM, Vice President, Revenue Cycle & Care Management
Clarence Williams, MHA, MBA, Director, Telehealth Program
Alejandro Lopez-Magallon, M.D., Medical Director, Telehealth Program, Cardiac Critical Care Specialist
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Clinical features of COVID-19 versus influenza
September 24, 2020 /in Infectious Disease, Infectious Disease News, Public Health, Public Health News /by Innovation District
In a cohort retrospective study comparing clinical features of COVID-19 and seasonal flu, researchers found surprisingly little difference in the rates of hospitalization, admission to the intensive care unit and mechanical ventilator use between the two groups.
As the fall approaches, pediatric hospitals will start seeing children with seasonal influenza A and B. At the same time, COVID-19 will be co-circulating in communities with the flu and other respiratory viruses, making it more difficult to identify and prevent the novel coronavirus.
With little published data directly comparing the clinical features of children with COVID-19 to those with seasonal flu, researchers at Children's National Hospital decided to conduct a retrospective cohort study of patients in the two groups. Their findings — published September 8 in JAMA Network Open — surprised them.
The study — detailed in the article "Comparison of Clinical Features of US Children With COVID-19 vs Seasonal Influenza A and B" — showed no statistically significant differences in the rates of hospitalization, admission to the intensive care unit and mechanical ventilator use between the two groups.
The other unexpected finding was that more patients with COVID-19 than those with seasonal influenza reported fever, cough, diarrhea or vomiting, headache, body ache or chest pain at the time of diagnosis, says Xiaoyan Song, Ph.D., M.Sc., M.B., the study's principal investigator.
"I didn't see this coming when I was thinking about doing the study," says Dr. Song, director of Infection Control and Epidemiology at Children's National since 2007 and a professor of pediatrics at the George Washington University School of Medicine and Health Sciences. "It took several rounds of thinking and combing through the data to convince myself that this was the conclusion."
Given that much remains unknown about COVID-19, the researchers' discovery that children with the disease present with more symptoms at the time of diagnosis is a valuable one.
"It's a good cue from a prevention and planning perspective," says Dr. Song. "We always emphasize early recognition and early isolation with COVID. Having a clinical picture in mind will assist clinicians as they diagnose patients with symptoms of the coronavirus."
The study included 315 children who were diagnosed with a laboratory-confirmed COVID-19 between March 25, 2020, and May 15, 2020, and 1,402 children who were diagnosed with a laboratory-confirmed seasonal influenza between Oct. 1, 2019, and June 6, 2020, at Children's National. Asymptomatic patients who tested positive for COVID-19 during pre-admission or pre-procedural screening were excluded from the study.
Of the 315 patients who tested positive for COVID-19, 52% were male, with a median age of 8.4 years. Of these patients, 54 (17.1 %) were hospitalized, including 18 (5.7%) who were admitted to the intensive care unit (ICU) and 10 (3.2%) who received mechanical ventilator treatment.
Among the 1,402 patients who tested positive for influenza A or B, 52% were male, with a median age of 3.9 years, and 291 (21.2%) were hospitalized, including 143 for influenza A and 148 for influenza B. Ninety-eight patients (7.0%) were admitted to the ICU, and 27 (1.9%) received mechanical ventilator support.
The study showed a slight difference in the age of children hospitalized with COVID-19 compared to those hospitalized with seasonal influenza. Patients hospitalized with COVID-19 had a median age of 9.7 years vs. those hospitalized with seasonal influenza who had a median age of 4.2 years.
In both groups, fever was the most often reported symptom at the time of diagnosis followed by cough. A greater proportion of patients hospitalized with COVID-19 than those hospitalized with seasonal influenza reported fever (76% vs. 55%), cough (48% vs. 31%), diarrhea or vomiting (26% vs. 12%), headache (11% vs. 3%), body ache/myalgia (22% vs. 7%), and chest pain (11% vs. 3%).
More patients hospitalized with COVID-19 than those with seasonal influenza reported sore throat or congestion (22% vs. 20%) and shortness of breath (30% vs. 20%), but the differences were not statistically significant.
During the study period, the researchers noticed an abrupt decline of influenza cases at Children's National after local schools closed in mid-March and stay-at-home orders were implemented about two weeks later to combat the community spread of COVID-19. Dr. Song says the impact of school closures on the spread of COVID-19 among children is the next area of study for her research team.
"We want to assess the quantitative impact of school closures so we can determine at what point the cost of closing schools and staying at home outweighs the benefit of reducing transmission of COVID-19 and burdens on the health care system," she says.
Dr. Song urges members of the community "first and foremost to stay calm and be strong. We're learning new and valuable things about this virus each day, which in turn improves care. The collision of the flu and COVID-19 this fall could mean an increase in pediatric hospitalizations. That's why it's important to get your flu shot, because it can help take at least one respiratory virus out of circulation."
Other researchers who contributed to this study include Meghan Delaney, D.O.; Rahul K. Shah, M.D.; Joseph M. Campos, Ph.D.; David L. Wessel, M.D.; and Roberta L. DeBiasi, M.D.
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Study provides important insight into spread of COVID-19 in children
September 15, 2020 /in Critical Medicine, Critical Medicine News, Infectious Disease, Infectious Disease News, Public Health, Public Health News /by Innovation District
New research suggests that children can shed SARS-CoV-2, the virus that causes COVID-19, even if they never develop symptoms or for long after symptoms have cleared. But many questions remain about the significance of the pediatric population as vectors for this sometimes deadly disease.
New research suggests that children can shed SARS-CoV-2, the virus that causes COVID-19, even if they never develop symptoms or for long after symptoms have cleared. But many questions remain about the significance of the pediatric population as vectors for this sometimes deadly disease, according to an invited commentary by Children's National Hospital doctors that accompanies this new study published online Aug. 28, 2020 in JAMA Pediatrics. The commissioned editorial, written by Roberta L. DeBiasi, M.D., M.S., chief of the Division of Infectious Diseases, and Meghan Delaney, D.O., M.P.H., chief of the Division of Pathology and Lab Medicine, provides important insight on the role children might play in the spread of COVID-19 as communities continue to develop public health strategies to reign in this disease.
The study that sparked this commentary focused on 91 pediatric patients followed at 22 hospitals throughout South Korea. "Unlike in the American health system, those who test positive for COVID-19 in South Korea stay at the hospital until they clear their infections even if they aren't symptomatic," explains Dr. DeBiasi.
The patients here were identified for testing through contact tracing or developing symptoms. About 22% never developed symptoms, 20% were initially asymptomatic but developed symptoms later, and 58% were symptomatic at their initial test. Over the course of the study, the hospitals where these children stayed continued to test them every three days on average, providing a picture of how long viral shedding continues over time.
The study's findings show that the duration of symptoms varied widely, from three days to nearly three weeks. There was also a significant spread in how long children continued to shed virus and could be potentially infectious. While the virus was detectable for an average of about two-and-a-half weeks in the entire group, a significant portion of the children — about a fifth of the asymptomatic patients and about half of the symptomatic ones — were still shedding virus at the three week mark.
Drs. DeBiasi and Delaney write in their commentary that the study makes several important points that add to the knowledge base about COVID-19 in children. One of these is the large number of asymptomatic patients — about a fifth of the group followed in this study. Another is that children, a group widely thought to develop mostly mild disease that quickly passes, can retain symptoms for weeks. A third and important point, they say, is the duration of viral shedding. Even asymptomatic children continued to shed virus for a long time after initial testing, making them potential key vectors.
However, the commentary authors say, despite these important findings, the study raises several questions. One concerns the link between testing and transmission. A qualitative "positive" or "negative" on testing platforms may not necessarily reflect infectivity, with some positives reflecting bits of genetic material that may not be able to make someone sick or negatives reflecting low levels of virus that may still be infectious.
Testing reliability may be further limited by the testers themselves, with sampling along different portions of the respiratory tract or even by different staff members leading to different laboratory results. It's also unknown whether asymptomatic individuals are shedding different quantities of virus than those with symptoms, a drawback of the qualitative testing performed by most labs. Further, testing only for active virus instead of antibodies ignores the vast number of individuals who may have had and cleared an asymptomatic or mild infection, an important factor for understanding herd immunity.
Lastly, Drs. DeBiasi and Delaney point out, the study only tested for viral shedding from the respiratory tract even though multiple studies have detected the virus in other bodily fluids, including stool. It's unknown what role these other sources might play in the spread of this disease.
Drs. DeBiasi and Delaney note that each of these findings and additional questions could affect public health efforts continually being developed and refined to bring COVID-19 under control in the U.S. and around the world. Children's National has added their own research to these efforts, with ongoing studies to assess how SARS-CoV-2 infections proceed in children, including how antibodies develop both at the individual and population level.
"Each of these pieces of information that we, our collaborators and other scientists around the world are working to gather," says Dr. DeBiasi, "is critical for developing policies that will slow the rate of viral transmission in our community."
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Higher COVID-19 rates seen in minority socioeconomically disadvantaged children
Minority and socioeconomically disadvantaged children have significantly higher rates of COVID-19 infection, a new study led by Children's National Hospital researchers shows.
Minority and socioeconomically disadvantaged children have significantly higher rates of COVID-19 infection, a new study led by Children's National Hospital researchers shows. These findings, reported online August 5 in Pediatrics, parallel similar health disparities for the novel coronavirus that have been found in adults, the authors state.
COVID-19, an infection caused by the novel coronavirus SARS-CoV-2 that emerged in late 2019, has infected more than 4.5 million Americans, including tens of thousands of children. Early in the pandemic, studies highlighted significant disparities in the rates of infection in the U.S., with minorities and socioeconomically disadvantaged adults bearing much higher burdens of infection. However, says Monika Goyal, M.D., M.S.C.E, a pediatric emergency medicine specialist and associate division chief in the Division of Emergency Medicine at Children's National whose research focuses on health disparities, it's been unclear whether these disproportionate rates of infection also extend to youth.
To investigate this question, she and her colleagues looked to data collected between March 21, 2020, and April 28, 2020, from a drive-through/walk-up COVID-19 testing site affiliated with Children's National — one of the first exclusively pediatric testing sites for the virus in the U.S. To access this free testing site, funded by philanthropic support, patients between the ages of 0 and 22 years needed to meet specific criteria: mild symptoms and either known exposure, high-risk status, family member with high-risk status or required testing for work. Physicians referred patients through an online portal that collected basic demographic information, reported symptoms and the reason for referral.
When Dr. Goyal and her colleagues analyzed the data from the first 1,000 patients tested at this site, they found that infection rates differed dramatically among different racial and ethnic groups. While about 7% of non-Hispanic white children were positive for COVID-19, about 30% of non-Hispanic Black and 46% of Hispanic children were positive.
"You're going from about one in 10 non-Hispanic white children to one in three non-Hispanic Black children and one in two Hispanic children. It's striking," says Dr. Goyal.
Using data from the American Families Survey, which uses five-year census estimates derived from home address to estimate median family income, the researchers separated the group of 1,000 patients into estimated family income quartiles. They found marked disparities in COVID-19 positivity rates by income levels: while those in the highest quartile had infection rates of about 9%, about 38% of those in the lowest quartile were infected.
There were additional disparities in exposure status, Dr. Goyal adds. Of the 10% of patients who reported known exposure to COVID-19, about 11% of these were non-Hispanic white. However, non-Hispanic Black children were triple this number.
Although these numbers show clear disparities in COVID-19 infection rates, the authors are now trying to understand why these disparities occur and how they can be mitigated.
"Some possible reasons may be socioeconomic factors that increase exposure, differences in access to health care and resources, as well as structural racism," says Dr. Goyal.
She adds that Children's National is working to address those factors that might increase risk for COVID-19 infection and poor outcomes by helping to identify unmet needs — such as food and/or housing insecurity — and steer patients toward resources when patients receive their test results.
"As clinicians and researchers at Children's National, we pride ourselves on not only being a top-tier research institution that provides cutting-edge care to children, but by being a hospital that cares about the community we serve," says Denice Cora-Bramble, M.D., M.B.A., chief medical officer of Ambulatory and Community Health Services at Children's National and the research study's senior author. "There's still so much work to be done to achieve health equity for children."
Other Children's National researchers who contributed to this study include Joelle N. Simpson, M.D.; Meleah D. Boyle, M.P.H, Gia M. Badolato, M.P.H; Meghan Delaney, D.O,. M.P.H.; and Robert McCarter Jr., Sc.D.
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Dr. Youssef Kousa awarded Pediatric Epilepsy Research Grant
August 31, 2020 /in Fetal Medicine, Fetal Medicine News, Genetics and Rare Diseases, Genetics and Rare Diseases News, Infectious Disease, Infectious Disease News, Neurology & Neurosurgery News, Neurology and Neurosurgery /by Innovation District
The Child Neurology Foundation has awarded Youssef A. Kousa, M.S., D.O., Ph.D., the 2020 Pediatric Epilepsy Research Foundation Shields Research Grant. The funds will support his work on identifying genetic risk factors in congenital Zika syndrome.
The Child Neurology Foundation has awarded Youssef A. Kousa, M.S., D.O., Ph.D., physician-scientist within the Division of Neurology at Children's National Hospital, and founder and director of the Zika Genetics Consortium, the 2020 Pediatric Epilepsy Research Foundation Shields Research Grant. The funds will support his work on identifying genetic risk factors in congenital Zika syndrome.
This prestigious grant provides $100,000 of research funding to help identify treatments and cures for pediatric neurologic diseases. It will allow Dr. Kousa to test the hypothesis that rare genetic variants in individuals contributed to being affected with congenital Zika syndrome and the severity of the phenotype for those who were affected.
"Despite decades of research, identifying those at greatest risk of congenital infection or being severely affected remains an elusive goal," says Dr. Kousa. "This research is important because identifying genetic risk or protective factors for developmental brain malformations can help teach us how the brain develops."
In 2015, Dr. Kousa established the Zika Genetic Consortium to investigate whether maternal and fetal genetic factors can modify the risk of brain injury from congenital infections.
Dr. Kousa adds that this work will provide key insights into maternal and fetal genetic factors that can contribute to brain malformations. The hope is that these insights may one day translate into targeted prevention efforts.
"Dr. Kousa's project is very creative and has a fantastic opportunity to look at factors of Zika on brain development," says William D. Gaillard, M.D., division chief of both Epilepsy and Neurophysiology, and Neurology at Children's National. "This is a very competitive award. It's a tremendous achievement that few accomplish."
Children's National is the leading site for this international research study.
In 2015, Dr. Kousa established the Zika Genetic Consortium to investigate whether maternal and fetal genetic factors can modify the risk of brain injury from congenital infections. Dr. Kousa is the principal investigator of the consortium, which includes 19 co-investigators representing 13 different institutions.
The consortium is bringing together cohorts of 12,000 mother-infant participants retrospectively and prospectively. These cohorts come from 15 international health centers in seven countries in collaboration with partners at the National Institutes of Health, and the Centers for Disease Control and Prevention.
"This support gives us the opportunity to test our hypothesis," says Dr. Kousa. "We also hope what we continue to learn about Zika can play a role in helping us understand other congenital infections and neurodevelopment diseases."
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We can do better: Lessons learned on COVID-19 data sharing can inform future outbreak preparedness
August 25, 2020 /in Genetics and Rare Diseases, Genetics and Rare Diseases News, Infectious Disease, Infectious Disease News, Public Health, Public Health News, Quality and Safety, Quality and Safety News, Uncategorized /by Innovation District
Since COVID-19 emerged late last year, there's been an enormous amount of research produced on this novel coronavirus disease. But the content publicly available for this data and the format in which it's presented lack consistency across different countries' national public health institutes, greatly limiting its usefulness, Children's National Hospital scientists report in a new study. Their findings and suggestions, published online August 19 in Science & Diplomacy, could eventually help countries optimize their COVID-19-related data — and data for future outbreaks of other diseases — to help further new research, clinical decisions and policy-making around the world.
Recently, explains study senior author Emmanuèle Délot, Ph.D., research faculty at Children's National Research Institute, she and her colleagues sought data on sex differences between COVID-19 patients around the world for a new study. However, she says, when they checked the information available about different countries, they found a startling lack of consistency, not only for sex-disaggregated data, but also for any type of clinical or demographic information.
"The prospects of finding the same types of formats that would allow us to aggregate information, or even the same types of information across different sites, was pretty dismal," says Dr. Délot.
To determine how deep this problem ran, she and colleagues at Children's National, including Eric Vilain, M.D., Ph.D., the James A. Clark Distinguished Professor of Molecular Genetics and the director of the Center for Genetic Medicine Research at Children's National, and Jonathan LoTempio, a doctoral candidate in a joint program with Children's National and George Washington University, surveyed and analyzed the data on COVID-19.
The research spanned data reported by public health agencies from highly COVID-19 burdened countries, viral genome sequence data sharing efforts, and data presented in publications and preprints.
Publications with the term "coronavirus" archived in PubMed over time.
At the time of study, the 15 countries with the highest COVID-19 burden at the time included the US, Spain, Italy, France, Germany, the United Kingdom, Turkey, Iran, China, Russia, Brazil, Belgium, Canada, the Netherlands and Switzerland. Together, these countries represented more than 75% of the reported global cases. The research team combed through COVID-19 data presented on each country's public health institute website, looking first at the dashboards many provided for a quick glimpse into key data, then did a deeper dive into other data on this disease presented in other ways.
The data content they found, says LoTempio, was extremely heterogeneous. For example, while most countries kept running totals on confirmed cases and deaths, the availability of other types of data — such as the number of tests run, clinical aspects of the disease such as comorbidities, symptoms, or admission to intensive care, or demographic information on patients, such as age or sex — differed widely among countries.
Similarly, the format in which data was presented lacked any consistency among these institutes. Among the 15 countries, data was presented in plain text, HTML or PDF. Eleven offered an interactive web-based data dashboard, and seven had comma-separated data available for download. These formats aren't compatible with each other, LoTempio explains, and there was little to no documentation about where the data that supplies some formats — such as continually updated web-based dashboards — was archived.
Graphic representation of the science-policy interface.
Dr. Vilain says that a robust system is already in place to allow uniform sharing of data on flu genomes — the World Health Organization's (WHO) Global Initiative on Sharing All Influenza Data (GISAID) — which has been readily adapted for the virus that causes COVID-19 and has already helped advance some types of research. However, he says, countries need to work together to develop a similar system for harmonized sharing other types of data for COVID-19. The study authors recommend that COVID-19 data should be shared among countries using a standardized format and standardized content, informed by the success of GISAID and under the backing of the WHO.
In addition, the authors say, the explosion of research on COVID-19 should be curated by experts who can wade through the thousands of papers published on this disease since the pandemic began to identify research of merit and help merge clinical and basic science.
"Identifying the most useful science and sharing it in a way that's usable to most researchers, clinicians and policymakers, will not only help us emerge from COVID-19 but could help us prepare for the next pandemic," Dr. Vilain says.
Other researchers who contributed to this study include D'Andre Spencer, MPH, Rebecca Yarvitz, BA, and Arthur Delot-Vilain.
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Connections between Kawasaki disease and MIS-C
August 4, 2020 /in Cardiology & Heart Surgery, Cardiology & Heart Surgery News, Critical Medicine, Critical Medicine News, Genetics and Rare Diseases, Genetics and Rare Diseases News, Immunotherapy, Immunotherapy News, Infectious Disease, Infectious Disease News /by Innovation District
A new review article enumerates some key similarities and differences between MIS-C and Kawasaki disease.
Since May 2020, there has been some attention in the general public and the news media to a specific constellation of symptoms seen in children with COVID-19 or who have been exposed to COVID-19. For a time, headlines even called it a "Kawasaki-like" disease. At first glance, both the symptoms and the effective treatments are remarkably similar. However, a new review published in Trends in Cardiovascular Medicine finds that under closer scrutiny, the two conditions have some interesting differences as well.
"At the beginning of this journey, we thought we might be missing actual cases of Kawasaki disease because we identified a few patients who presented late and developed coronary artery abnormalities," says Ashraf Harahsheh, M.D., senior author of the review article, "Multisystem inflammatory syndrome in children: Is there a linkage to Kawasaki disease?" and a cardiologist at Children's National Hospital. "But as time passed, children exposed to COVID-19 started to present with a particular constellation of symptoms that actually had some important similarities and distinctions from Kawasaki."
Similarities between Kawasaki disease and MIS-C
Both disease patterns seem to have a common trigger that provokes the inflammatory cascade reaction in genetically susceptible children, the authors write. However, there is also early evidence that children with each disease have different genetic markers, meaning different populations are genetically susceptible to each disease.
Additionally, the authors found that the massive activation of pro-inflammatory cytokines seen in MIS-C, also known as a "cytokine storm," overlaps with a similar occurrence seen in Kawasaki disease, adult COVID-19 patients, toxic shock syndrome and some other viral infections.
Primary differences between Kawasaki disease and MIS-C
Overall, when compared to Kawasaki disease, children with MIS-C tend to:
Present at an older age
Have a more profound form of inflammation
Have more gastrointestinal manifestation
Show different laboratory findings
Have greater risk of left ventricle dysfunction and shock
Further study of both Kawasaki and MIS-C needed
Despite noted differences, the authors are also careful to credit the documented similarities between Kawasaki disease and MIS-C as a key to the quick identification of the new syndrome in children. The study of Kawasaki disease also gave clinicians a valid basis to begin developing diagnostic recommendations and treatment protocols.
The review's first author Yue-Hin Loke, M.D., who is also a cardiologist at Children's National, says, "The quick recognition of MIS-C is only possible because of meticulous research conducted by Dr. Tomisaku Kawasaki, who recently passed away on June 5th, 2020. Even though some aspects of both are still shrouded in mystery, the previous research and clinical advancements made in Kawasaki disease set the stage for our immediate response to MIS-C."
"Previous research provided key information for cardiologists facing this new syndrome, including the necessity of routine echocardiograms to watch for coronary artery abnormalities (CAAs) and for use of intravenous immunoglobulin (IVIG) to mitigate the development of CAAs," says Charles Berul, M.D., chief of Cardiology at Children's National and a co-author. "Both of these factors have played a key role in reducing the mortality of MIS-C to almost zero."
The authors note that more research is needed to understand both Kawasaki disease and the specifics of MIS-C, but that what is learned about the mechanisms of one can and should inform study and treatment of the other. And in the meantime, caution and continued surveillance of these patients, especially with respect to coronary artery and myocardial function, will continue to improve the long-term outcomes for both syndromes.
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"COVID-19-edition" of pediatric medical device competition announces winners
July 23, 2020 /in Infectious Disease, Infectious Disease News, Neonatology, Neonatology News, Public Health, Public Health News, Surgical Innovation, Surgical Innovation News /by Innovation District
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"COVID-19-edition" of pediatric medical device competition announces finalists
July 15, 2020 /in Infectious Disease, Infectious Disease News, Public Health, Public Health News /by Innovation District
Sixteen finalists have been selected in the "Make Your Medical Device Pitch for Kids!" special COVID-19 edition competition presented by the National Capital Consortium for Pediatric Device Innovation (NCC-PDI). Representing innovations in COVID-19-related pediatric medical devices, the finalists will compete in a virtual pitch event held on July 20,2020 where up to $250,000 in awards will be given. Winners will receive grant funding of up to $50,000.
The competition is led by NCC-PDI co-founders the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Hospital and the A. James Clark School of Engineering at the University of Maryland and powered by nonprofit accelerator and NCC-PDI member, MedTech Innovator.
This competition focuses on pediatric medical devices that support home health monitoring and telehealth, and improve sustainability, resiliency and readiness in diagnosing and treating children during a pandemic.
"As COVID -19 continues to threaten the health of families and children across the nation, we must continue to seek new and better ways to deliver quality care during a pandemic and offer technology solutions to reopen more safely," says Kolaleh Eskandanian, Ph.D., MBA, PMP, vice president and chief innovation officer at Children's National Hospital and principal investigator of NCC-PDI. "Competitions like this are vital to get ahead of the healthcare challenge that COVID-19 presents in the world of pediatrics. By supporting innovation, we provide critical breakthroughs that can positively impact the lives of the children and families we serve."
Along with grant funding, one company from the competition will be selected by Johnson & Johnson Innovation – JLABS to receive a one-year residency at JLABS @ Washington, DC, which will be located on the new Children's National Research & Innovation Campus currently under construction. In addition to the 2021 JLABS residency, the awardee will have access to the JLABS community and expert mentoring by the Johnson & Johnson family of companies.
The 16 pediatric device innovations that judges selected for the final competition include:
Adipomics – simple and fast, one-step COVID-19 diagnostic kit for home or school use
Bloom Standard (Kaaria) – wearable, AI-driven ultrasound for infant cardiac and pulmonary screening and diagnostics
CereVu Medical – remote COVID-19 sensor, monitor and centralized data hub that measures blood oxygen saturation, muscle aches, temperature and trouble breathing
Children's Hospital of Philadelphia – a transparent reusable DIY origami facemask that reveals facial expressions & improves communication
Children's National Hospital – Lab-on-a-chip device for high-throughput combination drug screening
Hopscotch – gamified cognitive behavioral therapy-based computer exercises to encourage kids to stay engaged and complete treatment programs
Medichain – cost effective, accurate COVID-19 test with results in minutes and can detect the virus in the early stage
Medipines – monitor device that displays critical respiratory parameters analyzed from a patient's breathing sample
OtoPhoto – a smart otoscope that quickly and accurately aids diagnosis of ear infections for home telehealth use
OxiWear – continuous wear oxygen-monitoring device used to reduce patient insecurity
REALTROMINS – real time, continuously updated predictive analytics to identify impending mortality in children
SurgiPals – digital assistant and urine biochemical sensor to aid in outpatient care of children with COVID-19
TGV-Dx – a novel, phenotype-based test system for rapid selection of effective antibiotic regimen
VitaScope – quick, accurate infant vital signs to facilitate high-quality virtual care
Vitls – wearable platform for remote patient monitoring of the vitals clinicians require to assess a patient
X-Biomedical – rugged, portable smart ICU ventilator for pediatric and adult patients
Funding for the competition is made possible by a grant from the Food and Drug Administration (FDA) and a philanthropic gift from Mei Xu, founder of e-commerce platform Yes She May, a site dedicated to women-owned brands.
In addition to this COVID-19 special edition event, NCC-PDI recently revealed the ten finalists in its prestigious 8th annual "Make Your Medical Device Pitch for Kids!" competition. Cardiovascular, NICU, and orthopaedic and spine device innovations are the focus of the fall competition, taking place October 7, 2020 as part of the 8th Annual Symposium on Pediatric Device Innovation, presented by Children's National and co-located with The MedTech Conference powered by AdvaMed.
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Airway microbial diversity in children with Cystic Fibrosis
June 18, 2020 /in Genetics and Rare Diseases, Genetics and Rare Diseases News, Infectious Disease, Infectious Disease News, Pulmonology and Sleep Medicine, Pulmonology and Sleep Medicine News /by Innovation District
Despite having less overall microbial richness, children with Cystic Fibrosis displayed a greater presence of Staphylococcus species.
Cystic Fibrosis (CF) is a disease that mainly affects the lungs and arises from mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene that encodes for the CFTR membrane protein located on certain secretory cells. CFTR dysfunction leads to complications such as the production of abnormally viscous mucus which causes chronic suppurative lung infections that require antibiotics to treat. New drugs called CFTR modulators can help improve CFTR protein function and some are even FDA-approved for use in children. In addition to CFTR protein function, the lung's resident microbiota and its richness of diversity, plays an important role in both health and disease, including CF.
In a new study published in Heliyon, scientists from Children's National Hospital examined the difference in the upper airway microbiome between children with CF and healthy controls. Age-related differences among children with CF and the impact of CFTR modulators on microbial diversity were also assessed. Seventy-five children between 0-6 years of age participated in the study, including 25 children with CF and 50 healthy controls. For CF participants, oropharyngeal swabs and clinical data were obtained from the biorepository, while data for controls were obtained during a single clinical visit.
Analysis revealed that CF patients had less microbial diversity and different composition of the upper airway microbiome compared to age similar controls, a finding that is consistent with research on the lower airways. Despite having less overall microbial richness, children with CF displayed a greater presence of Staphylococcus species, (a main driver of the pulmonary exacerbations characteristic of CF), three Rothia operational taxonomic units (OTUs) and two Streptococcus OTUs. CF patients received a significantly higher number of antibiotics courses within the previous year compared to healthy controls, and further investigation will be necessary to understand the impact of antibiotics on the upper airway microbiome of infants and children with CF.
Longitudinal comparisons to study effects of age and CFTR modulation on the microbiome of children with CF were also undertaken. Younger CF patients (those 0 to <3 years of age at study enrollment), were more likely to have culturally-normal respiratory flora and more stable microbial composition over time than older CF patients (those ≥ 3–6 years of age at study enrollment), with no significant differences in alpha or beta diversity. Older CF patients were significantly more likely to be receiving a CFTR modulator than younger patients. CF patients receiving CFTR modulators had higher microbial diversity measures than those not receiving CFTR modulators and were closer (but still significantly lower) in microbial richness to healthy controls. No significant differences in beta diversity were found between the three groups.
This study adds to the growing body of evidentiary support for the use of CFTR modulators in improving airway microbial diversity in CF patients. Future studies with a larger cohort and greater focus on the impact on early initiation of CFTR modulators on microbial diversity and clinical outcomes is necessary.
The study, "Airway microbial diversity is decreased in young children with cystic fibrosis compared to healthy controls but improved with CFTR modulation," was recently published in Heliyon. The lead author is Andrea Hahn, M.D., M.S., an investigator at the Children's National Research Institute. Notable authors include Aszia Burrell; Emily Ansusinha; Hollis Chaney, M.D.; Iman Sami, M.D.; Geovanny F. Perez, M.D.; Anastassios C. Koumbourlis, M.D., M.P.H.; Robert McCarter, Sc.D.; and Robert J. Freishtat, M.D., M.P.H..
https://innovationdistrict.childrensnational.org/wp-content/uploads/2018/05/Staphylococcus.jpg 300 400 Innovation District https://innovationdistrict.childrensnational.org/wp-content/uploads/2018/11/idlogo1-tagline-Advances-in-Medicine.gif Innovation District2020-06-18 16:44:072020-10-27 14:53:13Airway microbial diversity in children with Cystic Fibrosis


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Messenger Plus!, a prominent software development company, created Messenger Plus! Live, a free add-on for Windows Live Messenger that enhances the popular chatting application's functionality. Mr. Shamash contributes to the continuing success of Messenger Plus! Live by applying his skills to develop new scripts, products, and sites that will ultimately benefit the user. Thanks in large part to the creativity and innovation Mr. Shamash brings to software development, more than 60 million people around the world use Messenger Plus! Live. An invaluable and multitalented member of the Messenger Plus! team, Alex Shamash also acts as an intermediary between the company and multiple outside agencies, building lasting professional relationships and promoting products through effective public relations.
Alex Shamash and his team incorporated myriad user-friendly features into Messenger Plus! Live, including tabbed chats, which allow users to compile multiple chats into a single chat window; quick texts that eliminate the need to retype frequently used phrases; and account polygamy, which enables users to sign in to multiple Windows Live Messenger accounts simultaneously. Intimately familiar with the diverse needs of users, Mr. Shamash also focused on creating customizable features such as formatted text; personalized status messages; and custom emotion sounds, which give users the option of sending customized, prerecorded sounds during chat conversations. In addition to creating fun and useful features to enhance the Windows Live Messenger experience, Alex Shamash and his team build new tools to safeguard children from the various dangers associated with online chatting.
Alex Shamash attended the prestigious University of Manchester in the United Kingdom and earned a combined degree in Media Studies and Business Administration. Alex Shamash enjoys several outdoor activities, including sailing and bicycling.


Change in nanocomposite structure in rapidly solidified Fe86Nd9B5 alloy during electron irradiation was investigated. Nanocrystalline structure composed of α-Fe, Fe3B, Nd2Fe14B and Nd2Fe23B3 crystalline phases was formed by rapid solidification. Electron irradiation can introduce amorphization of intermetallic compounds and crystallization of an amorphous phase, resulting in the formation of a novel nanocomposite structure in which α-Fe and Nd2Fe14B nanocrystals are embedded in the amorphous matrix. The mechanism of nanocomposite structure formation was discussed based on the phase stability of amorphous and crystalline phases under electron irradiation.


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Red Sox promote Roenicke to interim manager
Boston – still awaiting a ruling on MLB's investigation into sign-stealing allegations – promotes bench coach Ron Roenicke and plans to remove the interim tag he is cleared in MLB's probe.
By JIMMY GOLENAssociated Press
Ron Roenicke, right, speaks as Red Sox Chief Baseball Officer Chaim Bloom looks on after Roenicke was named the interim manager of the Boston Red Sox on Tuesday in Fort Myers, Florida. John Bazemore/Associated Press
FORT MYERS, Fla. — It took Ron Roenicke almost five years to get another chance as a major league manager.
He'll need to wait at least until next week for "permanency."
The Red Sox made Roenicke their interim manager Tuesday, promoting the former Brewers skipper to replace Alex Cora on the day Boston's pitchers and catchers reported for the start of spring training.
Although there is no expiration date on Roenicke's tenure, the interim tag will stay until Major League Baseball completes its investigation into whether the Red Sox engaged in illegal sign-stealing during their 2018 World Series championship season. If the probe clears Roenicke, who has denied being part of any rules violations, he is expected to stay.
"We felt that naming Ron our interim manager was the best way to respect the investigation that's ongoing into our 2018 club. But we feel very strongly about Ron's ability to lead this group and how well-suited he is for this task," Chief Baseball Officer Chaim Bloom said in a news conference on the eve of the team's first formal workout.
"We have no reason to think that there is anything that would cause an adverse result for Ron in this investigation," Bloom said. "We're going to respect the ongoing investigation and we'll address permanency once it's complete."
Just one year after winning the World Series in his first season in Boston, Cora was let go when Commissioner Rob Manfred named him as a ringleader behind the Astros' 2017 illegal sign-stealing. The Red Sox have maintained that there was no similar scheme after Cora took over in Boston the next year.
Manfred said last week that he hoped to have the Red Sox investigation completed before the start of spring training. But a person with knowledge of the probe said Tuesday the investigation will continue at least into next week. The person spoke on the condition of anonymity because there was no formal announcement.
Red Sox pitchers and catchers reported Tuesday and have their first workout Wednesday. Rather than open spring training without a manager, the team gave the job to Roenicke – for now.
General Manager Brian O'Halloran said the team heard from people inside and outside the organization who spoke highly of Roenicke.
"I know you did a lot of background check on me," Roenicke said. "I'm glad it turned out well."
Roenicke, 63, takes over a team that is dealing with the fallout not only from the cheating investigation but also the salary dump of onetime AL MVP Mookie Betts and Cy Young winner David Price.
"You don't replace Mookie Betts, who is one of the best players in the game. David Price … you don't replace him. But you move forward," Roenicke said. "This team, they're focused on what they can do and showing people wrong.
"This is a really good ballclub. There are some tremendous athletes on this team," he said. "And you hope that the guys you replace them with become great players. And whether it's this year, whether it's a few years. You just keep moving on."
After winning a franchise-record 108 regular-season games and the World Series in 2018, Cora's first year, the Red Sox followed that up by missing the playoffs for the first time since 2015.
"We're very disappointed – as all these players are – in what happened last year," Roenicke said. "And our focus is to try to get back in the playoffs, and seeing what happens after that."
Roenicke spent five years as the Brewers manager from 2010-15, winning 96 games and the NL Central title in his first season and finishing as runner-up for NL manager of the year. In all, he led Milwaukee to a 342-331 record in five seasons.
"Right away, I thought I would" get another chance, Roenicke said. "But then as years go by you, you kind of wonder about it."
Roenicke batted .238 with 17 homers and 113 RBI as an outfielder and pinch hitter with six teams from 1981-88. The younger brother of major-leaguer Gary Roenicke, he went on to coach in the Dodgers and Angels systems before taking over the Brewers in the 2011 season.
"Whether it's a good season, which I had my first year, or whether it's a poor season, which we had my last year there, you're still learning things. And all the time I'm thinking about, 'What could I have done better?'" he said. "I want to do this job better."
Red Sox notebook: Players support Betts and Price, but are ready 'to move forward'
Red Sox officially complete trade with Dodgers

redpajama_set_name: RedPajamaCommonCrawl


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Submitted by Judith James (@judithjames808) 1 year ago
What environmental and genetic factors influence the development of osteoarthritis?
Osteoarthritis (OA) is the most common cause of disability in the United States, and there are no available biomarkers or disease-modifying therapies for OA. Currently, we are unable to identify rapidly progressive OA patients at diagnosis. All of Us offers a unique opportunity to obtain clinical data and biospecimens, along with diet and exercise information, which associate with rapidly progressive OA to help foster ...more »
Submitted by Andrea Baccarelli (@abaccarelli) 1 year ago
Does the human epigenome reflect exposure to environmental chemicals?
The human epigenome is altered by environmental pollutants, including particulate air pollution, bisphenol A, phthalates, metals, pesticides, dioxin-like compounds, and persistent organic pollutants. All of us will be uniquely positioned to link exposure to environmental chemicals with alterations in the human epigenome. This will require refined measures of environmental exposure that—if measured in All of us—will cause ...more »
AoU's sample/measures uniquely allow for modeling high-burden disease pathways specified by the biopsychosocial ecological model
Biological, psychological & social domains interact at multiple levels (genes, human & environment microbiomes, stress, behavior, broad SES & environment) outlined by the biopsychosocial ecological model (BPSEM). The BPSEM specifies pathways aligned with the AoU pillars of biology, lifestyle, & environment. Simultaneous examination of the interacting domains and levels of the BPSEM is now computationally possible and ...more »
Submitted by Lisa Signorello (@lisa.signorello) 1 year ago
To what extent are adverse childhood experiences (ACE) or trauma related to a wide range of adult diseases or premature death?
Adverse childhood experiences (ACE) can be retrospectively assessed in adults, ideally before the onset of the diseases under study. There are existing ACE instruments, or attempts to refine these instruments could be undertaken within All of Us.
To develop or optimize a non-invasive BIOMARKER that can be used to measure the experience of stress in children and adults.
The impact of psychosocial stress on child and adult health risk is increasingly appreciated. The measurement of this exposure is currently poor, and All of Us has the opportunity to develop or refine biomarkers that could help push this field of research forward in a valid way for the future. Such biomarkers could be a part of individual studies of stress and disease, and could also be used as a gold standard to develop ...more »
To develop or optimize a non-invasive TECHNOLOGY that can be used to measure the experience of stress in children and adults.
The impact of psychosocial stress on child and adult health risk is increasingly appreciated. The measurement of this exposure is currently poor, and All of Us has the opportunity to develop or refine wearable technologies that could help push this field of research forward in a valid way for the future. Such technology could be a part of individual studies of stress and disease, and could also be used as a gold standard ...more »
Do genomic, epigenetic, and metabolomic characteristics explain the excess risk of type 2 diabetes (T2D) in Asian-Americans?
California data shows T2D prevalence is higher among Pacific Islanders, Filipinos and South Asians, compared to Latinos, African-Americans, and Native Americans; further, Chinese, Japanese, and Koreans in California have a 50% higher risk of T2D compared to Whites. High throughput technologies, including metabolomics and genomics could provide valuable insight regarding the etiology of T2D disease mechanisms, and novel ...more »
Submitted by Sarah Vogelstein (@svogelstein) 1 year ago
What etiology factors contribute to the onset of seizures in late adulthood?
The incidence of seizures increases after the age of 50 years. With the increased life expectancy, seizures in older adults represents an emerging and important public health concern. Although cerebrovascular disease contributes to some cases, the etiology of these seizures in most patients is large known. Metabolic factors are likely to contribute to risk in some patients as diet changes can reduce the frequency of seizures ...more »
Submitted by Renaissance Bio (@renaissance) 1 year ago
How reliably do epigenetic aging clocks predict disease onset and mortality? Can they be slowed or reversed?
An annual blood test with analysis of methylation sites from key epigenetic aging clocks (e.g. Horvath). Epigenetic aging clocks have already been shown to reliably predict age, time-to-death, all cause mortality, cog. function, immune function, CV disease, cancer, and more. They may also become a key tool to demonstrate the reversibility of disease risk through dietary and therapeutic regimens, as epigenetic states are ...more »


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Kaitlyn Responds to Hate On 'Bachelorette'
By Nicole Pomarico
When you sign up to be The Bachelorette, you should expect a certain amount of hate, especially since Bachelor Nation shows are so live tweet-able. But what Kaitlyn Bristowe has had to deal with this season? It definitely surpasses what anyone in the public eye should have to deal with. All season long — especially after she slept with Nick Viall — Kaitlyn was constantly bashed, and not just on Monday nights. And while she tried to keep a good sense of humor about it, it still royally sucks that there are so many mean people in the world. On Monday night's Men Tell All, Kaitlyn responded to the Bachelorette hate she's gotten this season, and it's heartbreaking to hear what she's gone through.
After sitting down with Chris Harrison, Kaitlyn talked about how she doesn't regret any of the choices she's made, but having to deal with the backlash from those who try to judge her? It's a lot to deal with. She explained it this way:
You know, I really like to think of myself as a tough person, and I think I'm so fine with people disagreeing with me or having their opinions. That's OK. But speaking hate the way people have been is not OK, and I don't know. I'm almost in shock. And the hardest part for me is that it affects my family... I can handle it, it doesn't feel good, but I can handle it, but it's my family. They call me to see if I'm okay.... it's really hard. It's hurtful. I like to think that it doesn't matter what people think about me an45d I try to preach that. I'm gonna be who I am no matter what, but when it's thousands and thousands of comments after comments pouring in of people hating? I get death threats. That hurts.
Then, Chris read just a few of the messages that Kaitlyn has received, and they were horrifying and surprising to hear. The audience was shocked, and so were the guys from her season — and they should be. It's terrible to think that anyone should have to be subjected to messages like that, especially someone as sweet as Kaitlyn.
For the record, if I was in charge of this segment, I totally wouldn't have blurred out those names. Maybe this will be a lesson in cyberbullying for us all?
Image: Rick Rowell/ABC