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Kushner LE, Ristagno EH, Dong SW, Konold VJL, Fatemi Y, Stillwell TL, Wohrley JD, Sattler MM, Kalu IC, Boguniewicz J. Laying the Groundwork for a Fulfilling Career in Pediatric Infectious Diseases: The Transition From Fellowship to Faculty. J Pediatric Infect Dis Soc 2023; 12:627-633. [PMID: 37815429 DOI: 10.1093/jpids/piad079] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023]
Abstract
There are limited resources for guidance on the transition from fellowship into a new faculty role in pediatric infectious diseases. This review aims to address this gap and provides a framework for a successful transition that is composed of four essential pillars-(1) stepping into your role, (2) finding your niche, (3) building your network, and (4) self-care-all of which are supported by strong mentorship/sponsorship and continual realignment with one's personal mission statement. In addition to providing general principles and guidance, this review also outlines specific steps that a junior faculty member can take to expand their influence and build a successful, fulfilling career in pediatric infectious diseases.
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Affiliation(s)
- Lauren E Kushner
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Elizabeth H Ristagno
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sara W Dong
- Department of Pediatrics, Division of Infectious Diseases, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Victoria J L Konold
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Yasaman Fatemi
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Terri L Stillwell
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julie D Wohrley
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Rush University Children's Hospital, Chicago, IL, USA
| | - Matthew M Sattler
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ibukunoluwa C Kalu
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Juri Boguniewicz
- Department of Pediatrics, Section of Infectious Diseases and Epidemiology, University of Colorado School of Medicine, Aurora, CO, USA
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Rajput C, Han M, Bentley JK, Lei J, Ishikawa T, Wu Q, Hinde JL, Callear AP, Stillwell TL, Jackson WT, Martin ET, Hershenson MB. Enterovirus D68 infection induces IL-17-dependent neutrophilic airway inflammation and hyperresponsiveness. JCI Insight 2018; 3:121882. [PMID: 30135310 PMCID: PMC6141171 DOI: 10.1172/jci.insight.121882] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/27/2018] [Accepted: 07/03/2018] [Indexed: 12/15/2022] Open
Abstract
Enterovirus D68 (EV-D68) shares biologic features with rhinovirus (RV). In 2014, a nationwide outbreak of EV-D68 was associated with severe asthma-like symptoms. We sought to develop a mouse model of EV-D68 infection and determine the mechanisms underlying airway disease. BALB/c mice were inoculated intranasally with EV-D68 (2014 isolate), RV-A1B, or sham, alone or in combination with anti-IL-17A or house dust mite (HDM) treatment. Like RV-A1B, lung EV-D68 viral RNA peaked 12 hours after infection. EV-D68 induced airway inflammation, expression of cytokines (TNF-α, IL-6, IL-12b, IL-17A, CXCL1, CXCL2, CXCL10, and CCL2), and airway hyperresponsiveness, which were suppressed by anti-IL-17A antibody. Neutrophilic inflammation and airway responsiveness were significantly higher after EV-D68 compared with RV-A1B infection. Flow cytometry showed increased lineage-, NKp46-, RORγt+ IL-17+ILC3s and γδ T cells in the lungs of EV-D68-treated mice compared with those in RV-treated mice. EV-D68 infection of HDM-exposed mice induced additive or synergistic increases in BAL neutrophils and eosinophils and expression of IL-17, CCL11, IL-5, and Muc5AC. Finally, patients from the 2014 epidemic period with EV-D68 showed significantly higher nasopharyngeal IL-17 mRNA levels compared with patients with RV-A infection. EV-D68 infection induces IL-17-dependent airway inflammation and hyperresponsiveness, which is greater than that generated by RV-A1B, consistent with the clinical picture of severe asthma-like symptoms.
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Affiliation(s)
- Charu Rajput
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mingyuan Han
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - J. Kelley Bentley
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jing Lei
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Tomoko Ishikawa
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Qian Wu
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joanna L. Hinde
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Amy P. Callear
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Terri L. Stillwell
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - William T. Jackson
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily T. Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Marc B. Hershenson
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Magdo HS, Stillwell TL, Greenhawt MJ, Stringer KA, Yu S, Fifer CG, Russell MW, Schumacher KR. Immune Abnormalities in Fontan Protein-Losing Enteropathy: A Case-Control Study. J Pediatr 2015; 167:331-7. [PMID: 26009017 DOI: 10.1016/j.jpeds.2015.04.061] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/10/2015] [Accepted: 04/22/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To comprehensively characterize the immunologic characteristics of patients with protein-losing enteropathy (PLE) post-Fontan and compare them with patients without PLE post-Fontan. STUDY DESIGN Patients with PLE post-Fontan and age-matched controls post-Fontan were prospectively studied with laboratory markers of immune function. Infectious history was obtained by interview and chart review. The groups' demographics, cardiac history, immune characteristics, and infection history were compared using appropriate 2-group statistics. RESULTS A total of 16 patients enrolled (8 patients with PLE and 8 controls). All patients with PLE had lymphopenia compared with 25% of controls (P = .01). All patients with PLE had markedly depressed CD4 T cell counts (median 58 cells/μL) compared with controls (median 450 cells/μL, P = .0002); CD4% was also low in the PLE group (12.3%) and normal in control (36.9%, P = .004). Both groups had mildly depressed CD8 T cells and normal to slightly elevated natural killer and B-cell subsets. A majority of patients with PLE (62.5%) had negative titers to measles, mumps, and rubella vaccination, compared with no control Fontan with a negative titer (P = .03). Despite profoundly low CD4 counts, the frequency of infection was not different between groups with no reported opportunistic infections. CONCLUSIONS Patients with Fontan-associated PLE have extensive quantitative immune abnormalities, particularly CD4 deficiency. These immune abnormalities are similar to those found in non-Fontan patients with PLE caused by intestinal lymphangiectasia.
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Affiliation(s)
- H Sonali Magdo
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI.
| | | | | | | | - Sunkyung Yu
- University of Michigan, Michigan Congenital Heart Outcomes Research and Discovery Ann Arbor, MI
| | - Carlen G Fifer
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Mark W Russell
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Kurt R Schumacher
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI
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Patrick SW, Davis MM, Sedman AB, Meddings JA, Hieber S, Lee GM, Stillwell TL, Chenoweth CE, Espinosa C, Schumacher RE. Accuracy of hospital administrative data in reporting central line-associated bloodstream infections in newborns. Pediatrics 2013; 131 Suppl 1:S75-80. [PMID: 23457153 DOI: 10.1542/peds.2012-1427i] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Central line-associated bloodstream infections (CLABSIs) are a significant source of morbidity and mortality in the NICU. In 2010, Medicaid was mandated not to pay hospitals for treatment of CLABSI; however, the source of CLABSI data for this policy was not specified. Our objective was to evaluate the accuracy of hospital administrative data compared with CLABSI confirmed by an infection control service. METHODS We evaluated hospital administrative and infection control data for newborns admitted consecutively from January 1, 2008, to December 31, 2010. Clinical and demographic data were collected through chart review. We compared cases of CLABSI identified by administrative data (International Classification of Diseases, Ninth Revision, Clinical Modification 999.31) with infection control data that use national criteria from the Centers for Disease Control and Prevention as the gold standard. To ascertain the nature possible deficiencies in the administrative data, each patient's medical record was searched to determine if clinical phrases that commonly refer to CLABSI appeared. RESULTS Of 2920 infants admitted to the NICU during our study period, 52 were identified as having a CLABSI: 42 by infection control data only, 7 through hospital administrative data only, and 3 appearing in both. Against the gold standard, hospital administrative data were 6.7% sensitive and 99.7% specific, with a positive predictive value of 30.0% and a negative predictive value of 98.6%. Only 48% of medical records indicated a CLABSI. CONCLUSIONS Our findings from a major children's hospital NICU indicate that International Classification of Diseases, Ninth Revision, Clinical Modification code 993.31 is presently not accurate and cannot be used reliably to compare CLABSI rates in NICUs.
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Affiliation(s)
- Stephen W Patrick
- Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan, USA.
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