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Newborn screening efforts focusing on the quantification of T cell receptor excision circles (TRECs), as a biomarker for abnormal thymic production of T cells, have allowed for the identification and definitive treatment of severe combined immunodeficiency (SCID) in asymptomatic neonates. With the adoption of TREC quantification in Guthrie cards across the USA and abroad, typical, and atypical SCID constitutes only ~ 10% of cases identified with abnormal TRECs associated with T cell lymphopenia. Several other non-SCID-related conditions may be identified by newborn screening in a term infant. Thus, it is important for physicians to recognize that other factors, such as prematurity, are often associated with low TRECs initially, but often improve with age. This paper focuses on a challenge that immunologists face: the diagnostic evaluation and management of cases in which abnormal TRECs are associated with variants of T cell lymphopenia in the absence of a genetically defined form of typical or atypical SCID. Various syndromes associated with T cell impairment, secondary forms of T cell lymphopenia, and idiopathic T cell lymphopenia are identified using this screening approach. Yet there is no consensus or guidelines to assist in the evaluation and management of these newborns, despite representing 90% of the patients identified, resulting in significant work for the clinical teams until a diagnosis is made. Using a case-based approach, we review pearls relevant to the evaluation of these newborns, as well as the management dilemmas for the families and team related to the resolution of genetic ambiguities.

BackgroundEosinophilic esophagitis (EoE) is a chronic and increasingly prevalent antigen-driven disease. There is a paucity of information on long-term course in children.ObjectiveWe sought to understand the longitudinal trajectory of pediatric EoE during routine clinical care.MethodsWe prospectively enrolled children into an EoE database and reviewed their medical and pathologic records over 13 years.ResultsFrom 2011 to 2015, 146 children with EoE seen for their first visit at our center had 2 or more years of follow-up and 3 or more endoscopies over an average follow-up period of 5.13 years (range, 2-13 years). Longitudinal eosinophilic inflammation during treatment demonstrated 3 patterns over time. Children with less than 15 eosinophils/high-power field (hpf) for greater than 75% of their follow-up period were termed continuous responders (CRs). Children with waxing and waning inflammation of less than 15 eosinophils/hpf for less than 75% but 25% or more of the follow-up period were termed intermittent responders (IRs). Nonresponders (NRs) were defined as having less than 15 eosinophils/hpf for less than 25% of their follow-up. Fifty-nine (40%) of 146 patients were CRs, 65 (45%) of 146 were IRs, and 22 (15%) of 146 were NRs. CRs differed from IRs and NRs on the parameter of male/female ratio (1:1 in CRs, 4:1 in IRs, and 6:1 in NRs; P

Purpose: There is a growing number of youth and their parents seeking assistance from care providers related to gender dysphoria and transitional care for transgender and gender‐nonconforming (TGNC) youth. The purpose of this study was to determine pediatric nurse practitioners' (PNP) attitudes/beliefs and knowledge/competence in caring for TGNC youth. Design and Methods: This cross‐sectional descriptive study surveyed PNPs (N = 93) from eight states using two survey instruments to measure attitudes and beliefs and knowledge and perceived competence related to caring for TGNC youth. Results: Eighty‐one percent of PNPs reported caring for TGNC youth in their practice. Despite this, only 15% of the PNPs received education related to transgender patients during their advanced practice education. Results showed that attending continuing education offerings related to caring for TGNC patients increases PNP perceived competence as well as knowledge. Attitudes and behaviors towards the transgender population were also more positive if the PNP had attended continuing nursing education offerings. Three themes emerged from a qualitative portion of the survey, asking the participant to share thoughts related to caring for transgender youth: lack of education for healthcare providers, the need to refer patients to comprehensive gender services, and the need for support for transgender patients and their families. Practice Implications: Education plays an important part in nurses' attitudes, beliefs, and perceived competence in caring for transgender patients. Because the PNP is likely to be exposed to patients with TGNC, it is imperative they seek out opportunities to learn about transgender issues and caring for transgender patients. [ABSTRACT FROM AUTHOR]

In this study, we illustrate, for the first time, that preexisting low-avidity neutralizing measles maternal antibodies do not interfere with the development of high concentrations of high-avidity measles antibodies in children immunized at age 12 months. This suggests that the quality of measles maternal antibodies, rather than the quantity, impacts immunogenicity of primary measles immunization. [ABSTRACT FROM AUTHOR]

OBJECTIVE(S): The purpose of the study was to describe definitions of health in Hispanic and African American elders. METHOD(S): This study employed a qualitative framework conducted through a doctoral-level multicultural nursing course. Quasi-statistics and a semi-structured interview format tabulated a frequency in themes in the sample. Hispanic and African American clients at senior citizen centers comprised the convenience sample. Data collection occurred concurrently and the raw data was then shared throughout the class, which led to the study's major limitation. RESULT(S): Eight reoccurring themes were identified: spirituality, without pain/feeling good, positive attitude with good mentality, high priority, independent/active, health promotion/maintenance, socialization and helping others. CONCLUSION(S): Consistency was found between the existing literature and the results of the study. Differences were discovered between the groups, however more similarities were identified. The study results serve as a reminder to the importance in avoiding stereotypes when caring for individuals from any cultural background. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of the study was to describe definitions of health in Hispanic and African American elders. METHODS: This study employed a qualitative framework conducted through a doctoral level multicultural nursing course. Quasi-statistics and a semi-structured interview format tabulated a frequency in themes in the sample. Hispanic and African American clients at senior citizen centers comprised the convenience sample. Data collection occurred concurrently and the raw data was then shared throughout the class, which led to the stud\;'s major limitation. RESULTS: Eight reoccurring themes were Identified: spirituality, without pain/feeling good, positive attitude with good mentality, high priority, independent/active, health promotion/maintenance, socialization, and helping others. CONCLUSIONS: Consistency was found between the existing literature and the results of the study. Differences were discovered between the groups, however more similarities were identified. The study results serve as a reminder to the importance in avoiding stereotypes when caring for individuals from any cultural background. [ABSTRACT FROM AUTHOR]