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Luccarelli J, Kalluri AS, Kalluri NS, McCoy TH. Pediatric Physical Restraint Coding in US Hospitals: A 2019 Kids Inpatient Database Study. Hosp Pediatr 2024; 14:337-347. [PMID: 38567417 DOI: 10.1542/hpeds.2023-007562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Reduction of physical restraint utilization is a goal of high-quality hospital care, but there is little nationally-representative data about physical restraint utilization in hospitalized children in the United States. This study reports the rate of physical restraint coding among hospitalizations for patients aged 1 to 18 years old in the United States and explores associated demographic and diagnostic factors. METHODS The Kids' Inpatient Database, an all-payors database of community hospital discharges in the United States, was queried for hospitalizations with a diagnosis of physical restraint status in 2019. Logistic regression using patient sociodemographic characteristics was used to characterize factors associated with physical restraint coding. RESULTS A coded diagnosis of physical restraint status was present for 8893 (95% confidence interval [CI]: 8227-9560) hospitalizations among individuals aged 1 to 18 years old, or 0.63% of hospitalizations. Diagnoses associated with physical restraint varied by age, with mental health diagnoses overall the most frequent in an adjusted model, male sex (adjusted odds ratio [aOR] 1.56; 95% CI: 1.47-1.65), Black race (aOR 1.43; 95% CI: 1.33-1.55), a primary mental health or substance diagnosis (aOR 7.13; 95% CI: 6.42-7.90), Medicare or Medicaid insurance (aOR 1.33; 95% CI: 1.24-1.43), and more severe illness (aOR 2.83; 95% CI: 2.73-2.94) were associated with higher odds of a hospitalization involving a physical restraint code. CONCLUSIONS Physical restraint coding varied by age, sex, race, region, and disease severity. These results highlight potential disparities in physical restraint utilization, which may have consequences for equity.
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Affiliation(s)
- James Luccarelli
- Departments of Psychiatry
- Harvard Medical School, Boston, Massachusetts
| | - Aditya S Kalluri
- Harvard Medical School, Boston, Massachusetts
- Boston Combined Residency Program in Pediatrics, Boston, Massachusetts; and
| | - Nikita S Kalluri
- Harvard Medical School, Boston, Massachusetts
- Department of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Thomas H McCoy
- Departments of Psychiatry
- Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Salazar-Martín AG, Kalluri AS, Villanueva MA, Hughes TK, Wadsworth MH, Dao TT, Balcells M, Nezami FR, Shalek AK, Edelman ER. Single-Cell RNA Sequencing Reveals That Adaptation of Human Aortic Endothelial Cells to Antiproliferative Therapies Is Modulated by Flow-Induced Shear Stress. Arterioscler Thromb Vasc Biol 2023; 43:2265-2281. [PMID: 37732484 PMCID: PMC10659257 DOI: 10.1161/atvbaha.123.319283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Endothelial cells (ECs) are capable of quickly responding in a coordinated manner to a wide array of stresses to maintain vascular homeostasis. Loss of EC cellular adaptation may be a potential marker for cardiovascular disease and a predictor of poor response to endovascular pharmacological interventions such as drug-eluting stents. Here, we report single-cell transcriptional profiling of ECs exposed to multiple stimulus classes to evaluate EC adaptation. METHODS Human aortic ECs were costimulated with both pathophysiological flows mimicking shear stress levels found in the human aorta (laminar and turbulent, ranging from 2.5 to 30 dynes/cm2) and clinically relevant antiproliferative drugs, namely paclitaxel and rapamycin. EC state in response to these stimuli was defined using single-cell RNA sequencing. RESULTS We identified differentially expressed genes and inferred the TF (transcription factor) landscape modulated by flow shear stress using single-cell RNA sequencing. These flow-sensitive markers differentiated previously identified spatially distinct subpopulations of ECs in the murine aorta. Moreover, distinct transcriptional modules defined flow- and drug-responsive EC adaptation singly and in combination. Flow shear stress was the dominant driver of EC state, altering their response to pharmacological therapies. CONCLUSIONS We showed that flow shear stress modulates the cellular capacity of ECs to respond to paclitaxel and rapamycin administration, suggesting that while responding to different flow patterns, ECs experience an impairment in their transcriptional adaptation to other stimuli.
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Affiliation(s)
- Antonio G. Salazar-Martín
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA (A.G.S.-M., M.A.V., T.T.D., A.K.S.)
| | - Aditya S. Kalluri
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
| | - Martin A. Villanueva
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA (A.G.S.-M., M.A.V., T.T.D., A.K.S.)
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA (M.A.V., T.K.H., M.H.W., T.T.D., A.K.S.)
- Departments of Biology (M.A.V.), Massachusetts Institute of Technology, Cambridge
| | - Travis K. Hughes
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Koch Institute for Integrative Cancer Research (T.K.H., M.H.W., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA (M.A.V., T.K.H., M.H.W., T.T.D., A.K.S.)
- Department of Immunology, Harvard Medical School, Boston, MA (T.K.H., M.H.W., A.K.S.)
| | - Marc H. Wadsworth
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Koch Institute for Integrative Cancer Research (T.K.H., M.H.W., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA (M.A.V., T.K.H., M.H.W., T.T.D., A.K.S.)
- Department of Immunology, Harvard Medical School, Boston, MA (T.K.H., M.H.W., A.K.S.)
| | - Tyler T. Dao
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA (A.G.S.-M., M.A.V., T.T.D., A.K.S.)
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA (M.A.V., T.K.H., M.H.W., T.T.D., A.K.S.)
- Biological Engineering (T.T.D.), Massachusetts Institute of Technology, Cambridge
| | - Mercedes Balcells
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
| | - Farhad R. Nezami
- Division of Cardiac Surgery (F.R.N.), Brigham and Women’s Hospital, Boston, MA
| | - Alex K. Shalek
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Koch Institute for Integrative Cancer Research (T.K.H., M.H.W., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA (A.G.S.-M., M.A.V., T.T.D., A.K.S.)
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA (M.A.V., T.K.H., M.H.W., T.T.D., A.K.S.)
- Chemistry (A.K.S.), Massachusetts Institute of Technology, Cambridge
- Department of Immunology, Harvard Medical School, Boston, MA (T.K.H., M.H.W., A.K.S.)
| | - Elazer R. Edelman
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Koch Institute for Integrative Cancer Research (T.K.H., M.H.W., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Division of Cardiovascular Medicine, Department of Medicine (E.R.E.), Brigham and Women’s Hospital, Boston, MA
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Luccarelli J, Kalluri AS, Thom RP, Hazen EP, Pinsky E, McCoy TH. The occurrence of delirium diagnosis among youth hospitalizations in the United States: A Kids' Inpatient Database analysis. Acta Psychiatr Scand 2023; 147:481-492. [PMID: 35794791 PMCID: PMC9816352 DOI: 10.1111/acps.13473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Delirium is an acute neuropsychiatric condition associated with increased morbidity and mortality. There is increasing recognition of delirium as a substantial health burden in younger patients, although few studies have characterized its occurrence. This study analyzes the occurrence of delirium diagnosis, its comorbidities, and cost among youth hospitalized in the United States. METHODS The Kids' Inpatient Database, a national all-payers sample of pediatric hospitalizations in general hospitals, was examined for the year 2019. Hospitalizations with a discharge diagnosis of delirium among patients aged 1-20 years were included in the analysis. RESULTS Delirium was diagnosed in 43,138 hospitalizations (95% CI: 41,170-45,106), or 2.3% of studied hospitalizations. Delirium was diagnosed in a broad range of illnesses, with suicide and self-inflicted injury as the most common primary discharge diagnosis among patients with delirium. In-hospital mortality was seven times greater in hospitalizations caring a delirium diagnosis. The diagnosis of delirium was associated with an adjusted increased hospital cost of $8648 per hospitalization, or $373 million in aggregate cost. CONCLUSIONS Based on a large national claims database, delirium was diagnosed in youth at a lower rate than expected based on prospective studies. The relative absence of delirium diagnosis in claims data may reflect underdiagnosis, a failure to code, and/or a lower rate of delirium in general hospitals compared with other settings. Further research is needed to better characterize the incidence and prevalence of delirium in young people in the hospital setting.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114
- Department of Psychiatry, McLean Hospital, Belmont, MA 02478
- Harvard Medical School, Boston, MA 02115
| | - Aditya S. Kalluri
- Harvard Medical School, Boston, MA 02115
- Boston Combined Residency Program in Pediatrics, Boston, MA 02115
| | - Robyn P. Thom
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
- Lurie Center for Autism, Lexington, MA 02421
| | - Eric P. Hazen
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
| | - Elizabeth Pinsky
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
| | - Thomas H. McCoy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
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Kalluri AS, Vellarikkal SK, Edelman ER, Nguyen L, Subramanian A, Ellinor PT, Regev A, Kathiresan S, Gupta RM. Single-Cell Analysis of the Normal Mouse Aorta Reveals Functionally Distinct Endothelial Cell Populations. Circulation 2019; 140:147-163. [PMID: 31146585 DOI: 10.1161/circulationaha.118.038362] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The cells that form the arterial wall contribute to multiple vascular diseases. The extent of cellular heterogeneity within these populations has not been fully characterized. Recent advances in single-cell RNA-sequencing make it possible to identify and characterize cellular subpopulations. METHODS We validate a method for generating a droplet-based single-cell atlas of gene expression in a normal blood vessel. Enzymatic dissociation of 4 whole mouse aortas was followed by single-cell sequencing of >10 000 cells. RESULTS Clustering analysis of gene expression from aortic cells identified 10 populations of cells representing each of the main arterial cell types: fibroblasts, vascular smooth muscle cells, endothelial cells (ECs), and immune cells, including monocytes, macrophages, and lymphocytes. The most significant cellular heterogeneity was seen in the 3 distinct EC populations. Gene set enrichment analysis of these EC subpopulations identified a lymphatic EC cluster and 2 other populations more specialized in lipoprotein handling, angiogenesis, and extracellular matrix production. These subpopulations persist and exhibit similar changes in gene expression in response to a Western diet. Immunofluorescence for Vcam1 and Cd36 demonstrates regional heterogeneity in EC populations throughout the aorta. CONCLUSIONS We present a comprehensive single-cell atlas of all cells in the aorta. By integrating expression from >1900 genes per cell, we are better able to characterize cellular heterogeneity compared with conventional approaches. Gene expression signatures identify cell subpopulations with vascular disease-relevant functions.
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Affiliation(s)
- Aditya S Kalluri
- Broad Institute of MIT and Harvard University, Cambridge, MA (A.S.K., S.K.V., L.N., A.S., P.T.E., A.R., S.K., R.M.G.).,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (A.S.K., E.R.E.)
| | - Shamsudheen K Vellarikkal
- Broad Institute of MIT and Harvard University, Cambridge, MA (A.S.K., S.K.V., L.N., A.S., P.T.E., A.R., S.K., R.M.G.).,Center for Genomic Medicine (S.K.V., S.K., R.M.G.), Massachusetts General Hospital, Boston
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (A.S.K., E.R.E.).,Division of Cardiovascular Medicine, Department of Medicine (E.R.E., R.M.G.), Brigham and Women's Hospital, Boston MA
| | - Lan Nguyen
- Broad Institute of MIT and Harvard University, Cambridge, MA (A.S.K., S.K.V., L.N., A.S., P.T.E., A.R., S.K., R.M.G.)
| | - Ayshwarya Subramanian
- Broad Institute of MIT and Harvard University, Cambridge, MA (A.S.K., S.K.V., L.N., A.S., P.T.E., A.R., S.K., R.M.G.)
| | - Patrick T Ellinor
- Broad Institute of MIT and Harvard University, Cambridge, MA (A.S.K., S.K.V., L.N., A.S., P.T.E., A.R., S.K., R.M.G.).,Cardiology Division, Department of Medicine (P.T.E., S.K.), Massachusetts General Hospital, Boston
| | - Aviv Regev
- Broad Institute of MIT and Harvard University, Cambridge, MA (A.S.K., S.K.V., L.N., A.S., P.T.E., A.R., S.K., R.M.G.)
| | - Sekar Kathiresan
- Broad Institute of MIT and Harvard University, Cambridge, MA (A.S.K., S.K.V., L.N., A.S., P.T.E., A.R., S.K., R.M.G.).,Cardiology Division, Department of Medicine (P.T.E., S.K.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K.V., S.K., R.M.G.), Massachusetts General Hospital, Boston
| | - Rajat M Gupta
- Broad Institute of MIT and Harvard University, Cambridge, MA (A.S.K., S.K.V., L.N., A.S., P.T.E., A.R., S.K., R.M.G.).,Division of Cardiovascular Medicine, Department of Medicine (E.R.E., R.M.G.), Brigham and Women's Hospital, Boston MA.,Division of Genetics (R.M.G.), Brigham and Women's Hospital, Boston MA.,Center for Genomic Medicine (S.K.V., S.K., R.M.G.), Massachusetts General Hospital, Boston
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