Nicole Irgens-Moller

All Publications

• Quality of Care and Opportunities for Improvement in Prehospital Care of Critically Ill Pediatric Patients: An Observational, Simulation-Based Study. Prehospital emergency care Cicero, M. X., Schissler, K., Baird, J., Brown, L., Auerbach, M., Irgens-Moller, N., Pavlinetz, N., Adelgais, K. 2025: 1-32

  Abstract

  Emergency medical services (EMS) clinicians infrequently care for infants or children. Simulation allows assessment of EMS at the individual, team, and agency level. Standardized tools to evaluate EMS team performance provides educators and EMS clinicians information on the quality of clinical skills performed in pediatric prehospital scenarios, providing opportunities for reinforcement or relearning. This study utilizes skills checklists to describe EMS team performance during three pediatric emergencies and describes skill performance within each simulation. As secondary objectives we evaluated performance differences among three states, and for teams whose agency had a pediatric emergency care coordinator (PECC) compared to those that did not.This was a prospective cohort study of EMS clinician team performance, across three standardized pediatrics simulations: Respiratory (child asthma/respiratory arrest), Cardiac (infant cardiopulmonary arrest, and Neurological (sepsis/seizure). Simulations were conducted with 11 EMS agencies in three states, video-recorded and evaluated using standardized tools. Video recordings were evaluated if they included the complete simulation and the audio was intelligible. The primary outcome was mean percent of actions performed correctly in each simulation. Using a series of ANOVAs, comparisons were made among the three simulation types, states, and, whether there was an EMS PECC in participating agencies.There were 166 simulations conducted over 30 months of which 140/163 (84.3%) were evaluated. The mean percent of actions performed correctly by teams in the Respiratory simulation was higher than for Cardiac and Neurological simulations (Respiratory =60.9%, SD = 8.9, range = 40-78.6%; Cardiac 58.7% (SD = 11.8, range = 26.0.1-81.0%); Neurological =54.9%, SD = 9.9, range = 34.1-72.3%; p = 0.02), and no significant difference between Cardiac and Neurological simulation performance. There were differences by participating states in the Respiratory simulation performance (p = 0.04) and Neurological simulations (p = 0.03). The study was underpowered to determine if PECC presence was associated with improved performance.In high acuity pediatric simulations, EMS teams demonstrated better resuscitation performance for children with child asthma/respiratory arrest than for infants with cardiopulmonary arrest or sepsis/seizure. The gaps noted in EMS quality of care can be used to guide educational and quality of care improvement interventions.

  View details for DOI 10.1080/10903127.2025.2500715

  View details for PubMedID 40353808

• Complications of Long-Acting Reversible Contraceptive Modalities. Pediatric emergency care Irgens-Moller, N., Baum, C. R. 2023; 39 (6): 443-449

  Abstract

  Long-acting reversible contraception has risen in popularity in recent decades and is becoming one of the more common modalities of contraception in the United States, with a growing adolescent population among its users. The 2 modalities of long-acting reversible contraception-intrauterine devices and subcutaneous hormonal implants/etonogestrel implants (referred to as Nexplanon in the US)-are beneficial for their excellent effectiveness, ease of use, and safety profile. This article reviews the pharmacology of these modalities, common complications and their presentations, and the initial evaluation and management in the pediatric emergency department setting. Where applicable, attention will be paid to problems unique to the adolescent population.

  View details for DOI 10.1097/PEC.0000000000002970

  View details for PubMedID 37256282

• MARCH1 protects the lipid raft and tetraspanin web from MHCII proteotoxicity in dendritic cells. The Journal of cell biology Oh, J., Perry, J. S., Pua, H., Irgens-Möller, N., Ishido, S., Hsieh, C. S., Shin, J. S. 2018; 217 (4): 1395-1410

  Abstract

  Dendritic cells (DCs) produce major histocompatibility complex II (MHCII) in large amounts to function as professional antigen presenting cells. Paradoxically, DCs also ubiquitinate and degrade MHCII in a constitutive manner. Mice deficient in the MHCII-ubiquitinating enzyme membrane-anchored RING-CH1, or the ubiquitin-acceptor lysine of MHCII, exhibit a substantial reduction in the number of regulatory T (Treg) cells, but the underlying mechanism was unclear. Here we report that ubiquitin-dependent MHCII turnover is critical to maintain homeostasis of lipid rafts and the tetraspanin web in DCs. Lack of MHCII ubiquitination results in the accumulation of excessive quantities of MHCII in the plasma membrane, and the resulting disruption to lipid rafts and the tetraspanin web leads to significant impairment in the ability of DCs to engage and activate thymocytes for Treg cell differentiation. Thus, ubiquitin-dependent MHCII turnover represents a novel quality-control mechanism by which DCs maintain homeostasis of membrane domains that support DC's Treg cell-selecting function.

  View details for DOI 10.1083/jcb.201611141

  View details for PubMedID 29371232

  View details for PubMedCentralID PMC5881489