Children's Hospital of Philadelphia

When stable performance misleads: A formal model of compensation-dependent systems

Background. Reliable performance in sociotechnical systems depends on continuous human adaptation. Resilience engineering and Safety-II established adaptation as the mechanism through which systems remain safe, yet governance monitors its products — accidents, mortality, delays,...

Validation of AACN’s Healthy Work Environment Assessment Tool–Team

Background In 2024, the American Association of Critical-Care Nurses (AACN) updated the Healthy Work Environment Assessment Tool (HWEAT), renamed HWEAT-Team. Objective Validating HWEAT-Team for interprofessional use. Methods This was a multisite, descriptive, nonexperimental corr...

Anatomical white matter tracts span the cortical hierarchy to support cognitive diversity

Long-range white matter (WM) tracts support cognition by enabling communication between distant cortical regions, which are organized along a hierarchy defined by the sensorimotor-to-association (S-A) axis. However, it remains unknown how WM tracts are positioned within the corti...

The PMADS project: a longitudinal multimodal cohort study to understand risk for perinatal mood and anxiety disorders

Abstract Background Perinatal mood and anxiety disorders (PMADs) are among the most common and consequential complications of pregnancy. The perinatal period is also characterized by profound hormonal fluctuations and large-scale brain plasticity. However, the mechanisms linking...

Deciphering the development of synovial joints in the limbs: Recent discoveries and clinical implications

Abstract The synovial joints are essential for skeletal function and dexterity and do so by virtue of their components and structure. The capsule protects and insulates the joint from the surrounding environment, articular cartilage provides mechanical resilience and endurance, t...

Kinematics-based assessment of reaching and grasping movements in LRN ablated animals identifies a role for the LRN in endpoint stabilization and reach timing

The lateral reticular nucleus (LRN) is positioned to relay motor-related information to cerebellar circuits, but its direct contribution to skilled reaching and grasping remains unclear. Here, we examined skilled forelimb behavior in intact adult female Long-Evans rats after bila...

Tisa-cel and axi-cel CAR structure influences the development of resistance to CD19-CAR-T therapy

CD19-CAR-T cells are a major therapy for relapsed/refractory B-cell malignancies, yet ~50% of patients relapse after infusion. Clinical data suggest that tisa-cel treatment is associated with higher rates of CD19 mutation than axi-cel, though direct comparisons have been lacking....

Patient Portal Use and Care Utilization Among Hospitalized Children

OBJECTIVE: Patient portals allow patients and caregivers to better engage with health care. Disparities in portal use among high-risk populations, like hospitalized children, could limit their benefits. Additionally, little is known about the association between pediatric portal...

SGLT2 inhibitors activate pantothenate kinase in the human heart

Abstract Inhibitors of sodium glucose cotransporter-2 (SGLT2i) demonstrate strong symptomatic and mortality benefits in the treatment of heart failure but appear to do so independently of SGLT2. The relevant pharmacologic target of SGLT2i remains unclear. We show here that SGLT2i...

Maxillary Distraction Osteogenesis as both Bridge to and Replacement for Orthognathic Surgery in Patients with Cleft Lip and Palate

Background: Although maxillary distraction osteogenesis (MaxDO) has demonstrated superior bone healing in patients with cleft lip and palate (CLP), its clinical use is relatively unreported. Questions persist regarding its effectiveness in treating severe maxillary retrusion, its...

A Mammalian High-Throughput Screen for AI-Designed Peptide-Guided Protein Degraders

Targeted protein degradation (TPD) offers a route to eliminate disease-driving proteins that remain inaccessible to conventional inhibitors. However, degrader discovery remains low-throughput, labor-intensive, and dependent on randomized libraries or non-human display systems, li...

Videographic Assessment of Preintubation Checklist Use in Pediatric Emergency Departments: A NEAR4PEM Checklist Feasibility Study

OBJECTIVES: Cognitive aids are widely used in pediatric emergency departments (PEDs), yet real-world use is difficult to assess via self-report or the medical record. We used video review to assess whether (adoption) and how (fidelity) the NEAR4PEM Preintubation Checklist was use...

Correlation of polygenic risk score and clinical phenotype in patients with genetic generalized epilepsy

Abstract Objective The polygenic risk score (PRS) for individuals with genetic generalized epilepsy (GGE) quantifies the common risk variants in genes identified in genome‐wide association studies. We hypothesized that the phenotype of GGE patients differs based on their GGE PRS....

Empiric MRSA Coverage for Children with Osteoarticular Infections: 2015 to 2024

BACKGROUND AND OBJECTIVES Staphylococcus aureus is the most common causative pathogen for children with acute hematogenous osteomyelitis (AHO) and acute bacterial arthritis (ABA). National guidelines recommend empiric coverage for methicillin-resistant S. aureus (MRSA) at hospita...

Two-Year-Old Girl With Chronic Cough and Lymphadenopathy

A 27-month-old previously healthy girl presented with 3 months of cough and 1 day of fever and rhinorrhea. Her parents had immigrated from Africa, but our patient had been born in the United States and had no notable environmental exposures. An alarming chest radiograph suggested...

Corticolimbic structure-function coupling is sensitive to childhood adversity and buffers adversity-related symptoms during development

Abstract Childhood adversity is a potent predictor of mental health problems across the lifespan, and a rich cross-species literature implicates stress-sensitive corticolimbic circuits in adversity-related psychopathology. Structure-function coupling (SFC) is a promising multimod...

Hemodynamic Effects of Topical Oxymetazoline During Pediatric Flexible Bronchoscopy

BACKGROUND: Bleeding is a well-recognized complication in flexible bronchoscopy, especially with advanced procedures. Oxymetazoline is a topical vasoconstrictor often used to reduce or treat bleeding in the nares and airways. METHODS: A retrospective cohort study was conducted on...

Variation in In-Hospital Emergency Transfer Rates Across Pediatric Hospitals

BACKGROUND: Clinical deterioration with late escalation, termed emergency transfer (ET), is a key safety metric. However, national benchmarking is limited by variable definitions. We sought to estimate pooled ET rates and assess variation across pediatric hospitals. METHODS: We p...

Early life exposures association with later diagnosis of spondyloarthritis: A population-based case-control study

Objective To assess whether early-life antibiotics are associated with spondyloarthritis (SpA) diagnosed by age 21. Methods In this population-based, matched case–control study, we used Danish live births (1997-2023) restricted to those reaching minimum relevant ages by December...

Homicide at home: setting the agenda for an international collaboration to improve support for children bereaved due to family violence

Background: Bereavement due to fatal family violence (e.g. intimate partner homicide, filicide, parricide, siblicide) is a profoundly disruptive experience for children, with lifelong psychosocial consequences. Although the need for fatal family violence prevention is increasingl...