Health Services Research Commons^™

Sumoylation Regulates Functional Properties Of The Oocyte Transcription Factors Sohlh1 And Nobox, Bethany K Patton, Surabhi Madadi, Shawn M Briley, Avery A Ahmed, Stephanie A Pangas

Faculty, Staff and Students Publications

SOHLH1 and NOBOX are oocyte-expressed transcription factors with critical roles in ovary development and fertility. In mice, Sohlh1 and Nobox are essential for fertility through their regulation of the oocyte transcriptional network and cross-talk to somatic cells. Sumoylation is a posttranslational modification that regulates transcription factor function, and we previously showed that mouse oocytes deficient for sumoylation had an altered transcriptional landscape that included significant changes in NOBOX target genes. Here, we show that mouse SOHLH1 is modified by SUMO2/3 at lysine 345 and mutation of this residue alters SOHLH1 nuclear to cytoplasmic localization. In NOBOX, we identify a non-consensus …

Anxiety Sensitivity And Cigarette Use On Cannabis Use Problems, Perceived Barriers For Cannabis Cessation, And Self-Efficacy For Quitting Among Adults With Cannabis Use Disorder, Michael F Orr, Luke F Heggeness, Nirvi Mehta, Jacob Moya, Kara Manning, Lorra Garey, Julianna Hogan, Marcel De Dios, Michael J Zvolensky

Faculty, Staff and Students Publications

Many individuals diagnosed with cannabis use disorder (CUD) report a desire to quit using cannabis due to problems associated with use. Yet, successful abstinence is difficult for a large subset of this population. Thus, the present study sought to elucidate potential risk factors for cannabis use problems, perceived barriers for quitting, and diminished self-efficacy for remaining abstinent. Specifically, this investigation examined cigarette user status, anxiety sensitivity, and the interplay between these individual difference factors in terms of cannabis-related problems, perceived barriers for cannabis cessation, and self-efficacy for quitting cannabis use. The sample consisted of 132 adult cannabis users who met …

Comparison Of Postoperative Outcomes Of Laparoscopic Vs Open Inguinal Hernia Repair, Jennie Meier, Audrey Stevens, Miles Berger, Konstantinos I Makris, Athanasios Bramos, Joan Reisch, C Munro Cullum, Simon C Lee, Celette Sugg Skinner, Herbert Zeh, Cynthia J Brown, Courtney J Balentine

Faculty, Staff and Students Publications

Importance: Advocates of laparoscopic surgery argue that all inguinal hernias, including initial and unilateral ones, should be repaired laparoscopically. Prior work suggests outcomes of open repair are improved by using local rather than general anesthesia, but no prior studies have compared laparoscopic surgery with open repair under local anesthesia.

Objective: To evaluate postoperative outcomes of open inguinal hernia repair under general or local anesthesia compared with laparoscopic repair.

Design, setting, and participants: This retrospective cohort study identified 107 073 patients in the Veterans Affairs Surgical Quality Improvement Program database who underwent unilateral initial inguinal hernia repair from 1998 to 2019. …

Dynamic Errors In Pulse Oximetry Preclude Use Of Correction Factor, Ashraf Fawzy, Valeria S M Valbuena, Christopher F Chesley, Tianshi David Wu, Theodore J Iwashyna

Faculty, Staff and Students Publications

No abstract provided.

Using Cognitive Interviews To Improve A Measure Of Organizational Readiness For Implementation, Maria Mcclam, Lauren Workman, Emanuelle M Dias, Timothy J Walker, Heather M Brandt, Derek W Craig, Robert Gibson, Andrea Lamont, Bryan J Weiner, Abraham Wandersman, Maria E Fernandez

Faculty, Staff and Student Publications

BACKGROUND: Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC

METHODS: We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using "think aloud" and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked …

Nudging Health Care Providers' Adoption Of Clinical Decision Support: Protocol For The User-Centered Development Of A Behavioral Economics-Inspired Electronic Health Record Tool, Safiya Richardson, Katherine Dauber-Decker, Jeffrey Solomon, Sundas Khan, Douglas Barnaby, John Chelico, Michael Qiu, Yan Liu, Devin Mann, Renee Pekmezaris, Thomas Mcginn, Michael Diefenbach

Faculty, Staff and Students Publications

BACKGROUND: The improvements in care resulting from clinical decision support (CDS) have been significantly limited by consistently low health care provider adoption. Health care provider attitudes toward CDS, specifically psychological and behavioral barriers, are not typically addressed during any stage of CDS development, although they represent an important barrier to adoption. Emerging evidence has shown the surprising power of using insights from the field of behavioral economics to address psychological and behavioral barriers. Nudges are formal applications of behavioral economics, defined as positive reinforcement and indirect suggestions that have a nonforced effect on decision-making.

OBJECTIVE: Our goal is to employ …

Generation Of A Tree Shrew Breast Cancer Model Using Lentivirus Expressing Pik3ca-H1047r, Li Zeng, Hong-Yan Zhang, Chuan-Yu Yang, Zhuo Cheng, Qiu-Yun Jiang, Yao Luo, Yi Li, Fu-Bing Li, Ce-Shi Chen

Faculty, Staff and Students Publications

No abstract provided.

Shifting Perspectives: A Qualitative Study To Understand Family Expectations At The Time Of Their Child’S Admission, Rosamarie Maiorella, Avital Fischer, Sumeet L. Banker

Journal of Patient-Centered Research and Reviews

Purpose: Patient-centered approaches to health care acknowledge the important role that families have in patients’ lives. Shared expectations between families and providers have the potential to improve patient and family experience, hospital care, and outcomes. We aimed to understand families’ expectations for their child’s admission from the vantage point of the start of a hospital stay.

Methods: This qualitative research studied families of hospitalized children at a large pediatric tertiary care center. Family members were approached if their child was admitted to the general pediatrics team, was under 18 years of age, had a length of stay less than 5 …

Understanding Quality Of Life In Patients With Acute Leukemia, A Global Survey, Zack Pemberton-Whiteley, Samantha Nier, Jan Geissler, Sophie Wintrich, Bregje Verhoeven, Rita O. Christensen, Sam Salek, Esther Natalie Oliva, Tatyana Ionova, Jennie Bradley

Journal of Patient-Centered Research and Reviews

Purpose: The Acute Leukemia Advocates Network (ALAN) sought to determine which factors are most associated with poor quality of life (QoL) in patients with acute leukemia and to determine key issues and unmet needs through administration of an online survey distributed worldwide via partner patient organizations.

Methods: ALAN developed a questionnaire informed by literature review and based extensively on the hematological malignancy-specific patient-reported outcomes (HM-PRO) measure to assess the impact of acute leukemia on QoL and its relationships with patients’ demographics, disease state, disease impact, and support from health care professionals. Univariate and multivariable statistical analysis was used to investigate …

Neighborhood Condition Prevalence Rates Correlate With Covid-19 Mortality In Milwaukee County, Wisconsin, George L. Morris Iii

Journal of Patient-Centered Research and Reviews

Purpose: We sought to determine if census tract-level (ie, neighborhood) COVID-19 death rates in Milwaukee County correlated with the census tract-level condition prevalence rates (CPRs) for individual COVID-19 mortality risk.

Methods: This study used Milwaukee County-reported COVID-19 death rates per 100,000 lives for the 296 census tracts within the county to perform a linear regression with individual COVID-19 mortality risk CPR, mean age, racial composition of census tract (by percentage of non-White residents), and poverty (by percentage within census tract), followed by multiple regression with all 7 CPRs as well as the 7 CPRs combined with the additional demographic variables. …

Progressive Interstitial Lung Disease In Relatives Of Patients With Pulmonary Fibrosis, Jonathan A Rose, Maria A Planchart Ferretto, Anthony H Maeda, Maria F Perez Garcia, Nikkola E Carmichael, Swati Gulati, Mary B Rice, Hilary J Goldberg, Rachel K Putman, Hiroto Hatabu, Benjamin A Raby, Ivan O Rosas, Gary M Hunninghake

Faculty, Staff and Students Publications

No abstract provided.

Outcomes Of Patients Treated For Hepatoblastoma With Low Alpha-Fetoprotein And/Or Small Cell Undifferentiated Histology: A Report From The Children's Hepatic Tumors International Collaboration (Chic), Angela D Trobaugh-Lotrario, Rudolf Maibach, Daniel C Aronson, Arun Rangaswami, Beate Häberle, Allison F O'Neill, Irene Schmid, Marc Ansari, Tomoro Hishiki, Sarangarajan Ranganathan, Rita Alaggio, Ronald R De Krijger, Yukichi Tanaka, Soo-Jin Cho, Christian Vokuhl, Rebecca Maxwell, Mark Krailo, Eiso Hiyama, Piotr Czauderna, Milton Finegold, James H Feusner, Marcio H Malogolowkin, Rebecka L Meyers, Dolores Lopez-Terrada

Faculty, Staff and Students Publications

Small cell undifferentiated (SCU) histology and alpha-fetoprotein (AFP) levels below 100 ng/mL have been reported as poor prognostic factors in hepatoblastoma (HB); subsequent studies reported SMARCB1 mutations in some SCU HBs confirming the diagnosis of rhabdoid tumor. The Children's Hepatic tumors International Collaboration (CHIC) database was queried for patients with HB who had AFP levels less than 100 ng/mL at diagnosis or were historically diagnosed as SCU HBs. Seventy-three of 1605 patients in the CHIC database were originally identified as SCU HB, HB with SCU component, or HB with low AFP levels. Upon retrospective review, they were re-classified as rhabdoid …

Feasibility Of Group-Based Implementation Facilitation For Video Telemental Health, Anthony H Ecker, Giselle Day, Amber B Amspoker, Jennifer L Bryan, Stephanie C Day, Miryam Wassef, Kendra Weaver, Jan Lindsay

Faculty, Staff and Students Publications

Video telehealth experienced rapid growth throughout the COVID-19 pandemic in many healthcare sectors, including mental health. The Veterans Health Administration’s video telehealth platform, VA Video Connect, has been widely used to reach veterans who may have experienced difficulty accessing care, such as those living in rural areas or other barriers (e.g., transportation). Implementing VVC requires a multifaceted approach, including training providers on technical skills, increasing access to equipment for providers and veterans, and integrating VVC within the culture and processes of the clinic unit. Prior successful VVC implementation efforts in rural areas have focused on simultaneous one-on-one provider and leadership …

Agreement Between Patient’S Description Of Abdominal Symptoms Of Possible Upper Gastrointestinal Cancer And General Practitioner Consultation Notes: A Qualitative Analysis Of Video-Recorded Uk Primary Care Consultation Data, Victoria Hardy, Juliet Usher-Smith, Stephanie Archer, Rebecca Barnes, John Lancaster, Margaret Johnson, Matthew Thompson, Jon Emery, Hardeep Singh, Fiona M Walter

Faculty, Staff and Students Publications

Introduction: Abdominal symptoms are common in primary care but infrequently might be due to an upper gastrointestinal (UGI) cancer. Patients' descriptions may differ from medical terminology used by general practitioners (GPs). This may affect how information about abdominal symptoms possibly due to an UGI cancer are documented, creating potential missed opportunities for timely investigation.

Objectives: To explore how abdominal symptoms are communicated during primary care consultations, and identify characteristics of patients' descriptions that underpin variation in the accuracy and completeness with which they are documented in medical records.

Methods and analysis: Primary care consultation video recordings, transcripts and medical records …

Epidemiological/Disease And Economic Burdens Of Cervical Cancer In 2010–2014: Are Younger Women At Risk?, Chuhao Xi, Jay J. Shen, Betty Burston, Soumya Upadhyay, Shoujun Zhou

Healthcare Administration and Policy Faculty Research

Objective: Cervical cancer is an important factor threatening women’s health in China. This study examined the epidemiological and economic burden of cervical cancer among the medically insured population, which could provide data support for government departments to formulate policies. Methods: All new cases of cervical cancer under the Urban Employee Basic Medical Insurance (UEBMI) plan in a provincial capital city in eastern China from 2010 to 2014 were collected. The Cox proportional hazard model was used to analyze the factors affecting the survival rates for cervical cancer. Outpatient and hospitalization expenses were used to assess the direct economic burden, and …

Gaps In Behavioral Health Care In Rural Primary Care Clinics And The Promise Of Vbhi: Perspectives From Clinic Staff, Monique Gill

Articles, Abstracts, and Reports

No abstract provided.

Alternative Pharmacology: Exploring Ketamine Use For Treatment Resistant Mental Health Disorders, Kiersten L. Ash

Soaring: A Journal of Undergraduate Research

No abstract provided.

Fostering A High-Functioning Team In Cancer Care Using The 4r Oncology Model: Assessment In A Large Health System And A Blueprint For Other Institutions, Raymond Liu, Christine B Weldon, Elizabeth Linehan, Nancy Gordon, Thea Abbe, Marti Hennings, Henie James, Jed Katzel, Chun Ng, Megumi Tomita, Jeffrey B Velotta, Stephanie Ossowski, Lori C Sakoda, Sharon Likely Sprague, Anna Dowling, Kimberly Beringer, Arliene Ravelo, Elaine Yu, Julia R Trosman

Faculty, Staff and Student Publications

PURPOSE: Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation, which threatens care quality, affects patient outcomes, and strains the oncology workforce. We assessed whether the 4R Oncology model for team-based interdependent care delivery and patient self-management affected team functioning in a large community-based health system.

METHODS: 4R was deployed at four locations in breast and lung cancers and assessed along four characteristics of high-functioning teams: recognition as a team internally and externally; commitment to an explicit shared goal; enablement of interdependent work to achieve the goal; and engagement in regular reflection to adapt objectives and processes. …

Containment Measures During The Covid Pandemic: The Role Of Non-Pharmaceutical Health Policies, Michael Funke, Tai-Kuang Ho, Andrew Tsang

Faculty, Staff and Student Publications

Many countries have imposed a set of non-pharmaceutical health policy interventions in an effort to slow the spread of the COVID-19 pandemic. The objective of this paper is to examine the effects of the interventions, drawing on evidence from the OECD countries. A special feature here is the mechanism that underlies the impact of the containment policies. To this end, a causal mediation analysis decomposing the total effect into a direct and an indirect effect is conducted. The key finding is a dual cause-effect channel. On the one hand, there is a direct effect of the non-pharmaceutical interventions on the …

Association Between Surgical Technical Skills And Clinical Outcomes: A Systematic Literature Review And Meta-Analysis, Michael S Woods, Joshua N Liberman, Pinyao Rui, Emily Wiggins, Joan White, Bruce Ramshaw, Jonah J Stulberg

Faculty, Staff and Student Publications

BACKGROUND: A systematic literature review and meta-analysis was conducted to assess the association between intraoperative surgical skill and clinical outcomes.

METHODS: Peer-reviewed, original research articles published through August 31, 2021 were identified from PubMed and Embase. From the 1,513 potential articles, seven met eligibility requirements, reporting on 151 surgeons and 17,932 procedures. All included retrospective assessment of operative videos. Associations between surgical skill and outcomes were assessed by pooling odds ratios (OR) using random-effects models with the inverse variance method. Eligible studies included pancreaticoduodenectomy, gastric bypass, laparoscopic gastrectomy, prostatectomy, colorectal, and hemicolectomy procedures.

RESULTS: Meta-analytic pooling identified significant associations between …

Radiographic Response To Neoadjuvant Therapy In Pleural Mesothelioma Should Serve As A Guide For Patient Selection For Cytoreductive Operations, Nathaniel Deboever, Nicolas Zhou, Daniel J Mcgrail, Katarzyna Tomczak, Jacqueline L Oliva, Hope A Feldman, Edwin Parra, Jianjun Zhang, Percy P Lee, Mara B Antonoff, Wayne L Hofstetter, Reza J Mehran, Ravi Rajaram, David C Rice, Jack A Roth, Stephen S Swisher, Ara A Vaporciyan, Mehmet Altan, Annikka Weissferdt, Anne S Tsao, Cara L Haymaker, Boris Sepesi

Faculty, Staff and Student Publications

BACKGROUND: Malignant pleural mesothelioma (MPM) is associated with poor prognosis despite advances in multimodal therapeutic strategies. While patients with resectable disease may benefit from added survival with oncologic resection, patient selection for mesothelioma operations often relies on both objective and subjective evaluation metrics. We sought to evaluate factors associated with improved overall survival (OS) in patients with mesothelioma who underwent macroscopic complete resection (MCR).

METHODS: Patients with MPM who received neoadjuvant therapy and underwent MCR were identified in a prospectively maintained departmental database. Clinicopathologic, blood-based, and radiographic variables were collected and included in a Cox regression analysis (CRA). Response to …

Addressing Breast Health Disparities Among Recent, Established African-Born Immigrant Women And Second-Generation Americans In Prince George County, Maryland, Omolola Okunromade

College of Graduate Studies: Theses & Dissertations

Background: Breast health disparities and underutilization of screening methods are major concerns in the United States (US), particularly affecting Black women who experience lower survival rates and advanced diagnoses. Despite the rapid growth of the African-born immigrant population, breast health among this group in the US is notably under-examined. This study aims to investigate the breast health knowledge and practices of first-generation African-born immigrants and second-generation immigrant women of African descent, aiming to understand the distinctive attributes of this group and the impact of acculturation on this public health issue.

Methods: Interviews were conducted among First Generation African immigrants and …

Perspective: Developing Future Veterans Affairs Scientists Through A Diversity, Equity, And Inclusion Program, Darius B Dawson, Valerie Lewis, Terri L Fletcher, Robert Hal Scofield

Faculty, Staff and Students Publications

For >95 years, the Department of Veterans Affairs Office of Research and Development (ORD) has been improving the lives of Veterans and all Americans through health care discovery and innovation. Scientists and trainees from diverse backgrounds and life experiences bring different perspectives and creativity to address complex health-related problems, which helps to foster scientific innovation, improve quality of research, and advance the likelihood that underserved populations participate in and benefit from clinical and health services research. In this study, we will discuss our experiences in developing future scientists through mentored research supplements supported by ORD.

Astrocytic-Based Controller Shifts Epileptic Activity To The Chaotic State, Mojde Nahtani, Mehdi Siahi, Javad Razjouyan

Faculty, Staff and Students Publications

Introduction: Investigating an effective controller to shift hippocampal epileptic periodicity to normal chaotic behavior will be new hope for epilepsy treatment. Astrocytes nourish and protect neurons and maintain synaptic transmission and network activity. Therefore, this study explored the ameliorating effect of the astrocyte computational model on epileptic periodicity.

Methods: Modified Morris-Lecar equations were used to model the hippocampal CA3 network. Network inhibitory parameters were employed to generate oscillation-induced epileptiform periodicity. The astrocyte controller was based on a functional dynamic mathematical model of brain astrocytic cells.

Results: Results demonstrated that the synchronization of two neural networks shifted the brain's chaotic state …

Toward More Rigorous And Informative Nutritional Epidemiology: The Rational Space Between Dismissal And Defense Of The Status Quo, Andrew W Brown, Stella Aslibekyan, Dennis Bier, Rafael Ferreira Da Silva, Adam Hoover, David M Klurfeld, Eric Loken, Evan Mayo-Wilson, Nir Menachemi, Greg Pavela, Patrick D Quinn, Dale Schoeller, Carmen Tekwe, Danny Valdez, Colby J Vorland, Leah D Whigham, David B Allison

Faculty, Staff and Students Publications

To date, nutritional epidemiology has relied heavily on relatively weak methods including simple observational designs and substandard measurements. Despite low internal validity and other sources of bias, claims of causality are made commonly in this literature. Nutritional epidemiology investigations can be improved through greater scientific rigor and adherence to scientific reporting commensurate with research methods used. Some commentators advocate jettisoning nutritional epidemiology entirely, perhaps believing improvements are impossible. Still others support only normative refinements. But neither abolition nor minor tweaks are appropriate. Nutritional epidemiology, in its present state, offers utility, yet also needs marked, reformational renovation. Changing the status quo …

Assessment Of The Cytolytic Potential Of A Multivirus-Targeted T Cell Therapy Using A Vital Dye-Based, Flow Cytometric Assay, Kiriakos Koukoulias, Penelope G Papayanni, Julia Jones, Manik Kuvalekar, Ayumi Watanabe, Yovana Velazquez, Sarah Gilmore, Anastasia Papadopoulou, Ann M Leen, Spyridoula Vasileiou

Faculty, Staff and Students Publications

Reliable and sensitive characterization assays are important determinants of the successful clinical translation of immunotherapies. For the assessment of cytolytic potential, the chromium 51 (51Cr) release assay has long been considered the gold standard for testing effector cells. However, attaining the approvals to access and use radioactive isotopes is becoming increasingly complex, while technical aspects [i.e. sensitivity, short (4-6 hours) assay duration] may lead to suboptimal performance. This has been the case with our ex vivo expanded, polyclonal (CD4+ and CD8+) multivirus-specific T cell (multiVST) lines, which recognize 5 difficult-to-treat viruses [Adenovirus (AdV), BK virus (BKV), cytomegalovirus (CMV), Epstein Barr …

The Small Intestinal Microbiome: Vibing With Intestinal Stem Cells, Victoria Poplaski, Faith Sawyer, Sarah E Blutt

Faculty, Staff and Students Publications

The epithelial lining of the small intestine mediates its absorptive and secretory function and thus is a critical component of human health. Regeneration and renewal of the epithelium is the result of proliferation of intestinal stem cells (ISCs). Many cell types and molecular factors are known to regulate the ability of ISCs to proliferate, including adjacent neighboring epithelial cells and the underlying, supportive stromal cells. The microbiome resides in the lumen of the small intestine and is in close contact with the epithelium. Due to its proximity to ISCs, it has been hypothesized that species within the microbiome have the …

Expanding Access To Evidence-Based Psychotherapy In Va Settings: Implementation Of The Brief Cognitive Behavioral Therapy For Depression Program, Joseph Mignogna, Derrecka Boykin, Raquel D Gonzalez, Andrew Robinson, Darrell Zeno, Shubhada Sansgiry, Jennifer Broderick-Mcdaniel, Richard B Roberson, Kristen Sorocco, Jeffrey A Cully

Faculty, Staff and Students Publications

Introduction: Evidence-based psychotherapies (EBPs) are effective for mental health conditions, but access to these services remains limited and rural Veterans are particularly underserved. Specialized implementation and dissemination programs are needed to improve access to known EBPs.

Methods: The current project sought to improve access to a known EBP-brief Cognitive Behavioral Therapy for depression (Brief CBT). Diverse Veterans and those from rural settings were a focus of this work. Aligned with the RE-AIM framework, a multifaceted implementation program was used to train and support VHA providers in their use of Brief CBT in VHA mental health settings, with specific outreach efforts …

Effectiveness Of Elbasvir/Grazoprevir Plus Ribavirin For Hepatitis C Virus Genotype 1a Infection And Baseline Ns5a Resistance, Deanna D Hill, Jennifer R Kramer, Kassie R Chaffin, T Christopher Mast, Michael N Robertson, Fasiha Kanwal, Barbara A Haber

Faculty, Staff and Students Publications

Introduction and objectives: In clinical trials, patients with hepatitis C virus (HCV) genotype (GT)1a infection and baseline resistance-associated substitutions (RASs) at amino acid positions 28, 30, 31, or 93 receiving elbasvir/grazoprevir for 12 weeks achieved lower rates of sustained virologic response (SVR) than those without baseline RASs. SVR rates in patients with RASs were improved when elbasvir/grazoprevir treatment duration was extended from 12 to 16 weeks and administered concomitantly with ribavirin.

Materials and methods: This was a retrospective, observational analysis using electronic health record abstraction. Patients with HCV GT1a infection and RASs at positions 28, 30, 31, or 93 who …

Innate Immune Cell Dysfunction And Systemic Inflammation In Children With Chronic Liver Diseases Undergoing Transplantation, Krupa R Mysore, Sunil Kannanganat, Jeremy M Schraw, Philip J Lupo, John A Goss, Kenneth D R Setchell, Farrah Kheradmand, Xian C Li, Benjamin L Shneider

Faculty, Staff and Students Publications

Advanced liver diseases (ALD) can affect immune function and compromise host defense against infections. In this study, we examined the phenotypic and functional alterations in circulating monocyte and dendritic cells (DCs) in children with ALD undergoing liver transplantation (LT). Children were stratified into 2 clusters, C1 (mild) and C2 (severe), on the basis of laboratory parameters of ALD and compared with healthy pediatric controls. Children in C2 had a significant reduction in frequencies of nonclassical monocytes and myeloid DCs. Children in C2 displayed monocyte and DC dysfunction, characterized by lower human leucocyte antigen DR expression and reduced interleukin 12 production, …