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Liu YA, Paton GR. Insights Into Pediatric Neuro-Ophthalmology Research: Exploring Frontiers and Overcoming Hurdles. J Neuroophthalmol 2024:00041327-990000000-00667. [PMID: 38913952 DOI: 10.1097/wno.0000000000002199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Affiliation(s)
- Yin Allison Liu
- Department of Ophthalmology (YAL), University of California, Davis, Davis, California; and Department of Ophthalmology (GRP), Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
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Hare MM, Walker CS, Sarver DE, Lim CS, Brown DC, Annett RD. Assessing attitudes towards pediatric research participation across diverse populations: Psychometric properties of a novel tool. Contemp Clin Trials 2023; 133:107321. [PMID: 37652358 PMCID: PMC10591922 DOI: 10.1016/j.cct.2023.107321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Clinical trials play a crucial role in advancing medical knowledge and improving health outcomes. However, there is a recognized need for greater representation of marginalized groups to ensure that research findings can be generalized and effectively applied to all individuals. While the Pediatric Research Participation Questionnaire (PRPQ) was developed to assist pediatric clinical trials research by identifying benefits and barriers to research participation among children with chronic medical conditions, there is still limited insight into the structure of the PRPQ when administered in diverse samples, including the general pediatric population. Therefore, the current study examined the factor structure of the PRPQ in a general pediatric population to investigate whether rural-urban differences exist in the PRPQ factor structure. METHODS Caregivers (N = 600) of children under age 18 completed the PRPQ in a population-based survey in Mississippi. Sampling was stratified to ensure equal representation in rural (n = 300) and urban areas (n = 300). Exploratory and confirmatory factor analyses were conducted to determine the factor structure of the PRPQ. RESULTS A five-factor structure was identified, compromising: social pressure, direct benefit, reasons for participation, mistrust in research/researchers, reasons against participation. While results were similar among urban participants, a three-factor structure emerged for rural participants. CONCLUSIONS This study contributes to the broader understanding of research participation among underrepresented groups. The findings suggest that clinical researchers should consider tailoring recruitment strategies to increase clinical trial participation among children in rural areas. Understanding factors that influence pediatric research participation, particularly among marginalized communities, is crucial for developing effective recruitment and retention strategies.
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Affiliation(s)
- Megan M Hare
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL 33199, USA
| | - Courtney S Walker
- Center for Advancement of Youth, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39110, USA; Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39110, USA
| | - Dustin E Sarver
- Center for Advancement of Youth, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39110, USA; Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39110, USA.
| | - Crystal S Lim
- Department of Health Psychology, University of Missouri, Columbia, MO 65211, USA
| | - Dustin C Brown
- Department of Sociology and Social Science Research Center, Mississippi State University, Mississippi State, MS 39762, USA
| | - Robert D Annett
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
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Carlson JC, Hardeman A, Hein N. Outcomes Research in Underrepresented Patients Is Needed to Verify Medication Effectiveness. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2914-2915. [PMID: 37684077 DOI: 10.1016/j.jaip.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 09/10/2023]
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Faro EZ, Sauder KA, Norman GS, Anderson A, Vélez-Vega C, Napp D, Huddleston KC. A mixed-methods analysis to understand the implementation of a multistakeholder research consortium: Environmental influences on child health outcomes (ECHO). J Clin Transl Sci 2023; 7:e198. [PMID: 37830008 PMCID: PMC10565193 DOI: 10.1017/cts.2023.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Large, transdisciplinary research consortia have increasingly been called upon to address complex and challenging health problems. The National Institutes of Health's (NIH) Environmental influences on Child Health Outcomes (ECHO) Program developed multisite collaboration strategies to promote impactful collaborative observational research on child health. Team science and implementation science offer theoretical and methodological structure to answer questions about the strategies that facilitate successful consortia. We sought to characterize the elements and conditions that influence the implementation of a complex, interdisciplinary longitudinal research program, ECHO. Methods Informed by the Practical, Robust, Implementation and Sustainability Model, our ethnographic research included semi-structured interviews with internal stakeholders and program evaluation metrics. We conducted template and matrix analysis and triangulated the qualitative and quantitative data to understand the implementation of ECHO. Results Between February and May 2022, we conducted 24 virtual interviews with representatives from ECHO components. The main cross-cutting topics that emerged from thematic analysis were collaboration and team science; communication and decision-making; data processes and harmonization; and diversity, equity, and inclusion. Both the qualitative and secondary quantitative evaluation data provided insights into the reach, adoption, implementation, and effectiveness of the program. Conclusion A large, multidisciplinary research consortium such as ECHO has produced conceptual, instrumental, capacity building, and connectivity impact for internal and external stakeholders. Facilitators included infrastructure that supported collaboration and learning, alignment of data processes, and harmonization. Opportunities for enhanced impact include multidisciplinary, multimethod communication strategies, and alignment of research priorities.
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Affiliation(s)
- Elissa Z. Faro
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Katherine A. Sauder
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gwendolyn S. Norman
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Amber Anderson
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Carmen Vélez-Vega
- Social Sciences Department, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
| | - David Napp
- Practical Applications of Public Health, Durham, NC, USA
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Knapp EA, Kress AM, Parker CB, Page GP, McArthur K, Gachigi KK, Alshawabkeh AN, Aschner JL, Bastain TM, Breton CV, Bendixsen CG, Brennan PA, Bush NR, Buss C, Camargo, Jr. CA, Catellier D, Cordero JF, Croen L, Dabelea D, Deoni S, D’Sa V, Duarte CS, Dunlop AL, Elliott AJ, Farzan SF, Ferrara A, Ganiban JM, Gern JE, Giardino AP, Towe-Goodman NR, Gold DR, Habre R, Hamra GB, Hartert T, Herbstman JB, Hertz-Picciotto I, Hipwell AE, Karagas MR, Karr CJ, Keenan K, Kerver JM, Koinis-Mitchell D, Lau B, Lester BM, Leve LD, Leventhal B, LeWinn KZ, Lewis J, Litonjua AA, Lyall K, Madan JC, McEvoy CT, McGrath M, Meeker JD, Miller RL, Morello-Frosch R, Neiderhiser JM, O’Connor TG, Oken E, O’Shea M, Paneth N, Porucznik CA, Sathyanarayana S, Schantz SL, Spindel ER, Stanford JB, Stroustrup A, Teitelbaum SL, Trasande L, Volk H, Wadhwa PD, Weiss ST, Woodruff TJ, Wright RJ, Zhao Q, Jacobson LP, Influences on Child Health Outcomes ,OBOPCFE. The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort. Am J Epidemiol 2023; 192:1249-1263. [PMID: 36963379 PMCID: PMC10403303 DOI: 10.1093/aje/kwad071] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 03/26/2023] Open
Abstract
The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort Study (EWC), a collaborative research design comprising 69 cohorts in 31 consortia, was funded by the National Institutes of Health (NIH) in 2016 to improve children's health in the United States. The EWC harmonizes extant data and collects new data using a standardized protocol, the ECHO-Wide Cohort Data Collection Protocol (EWCP). EWCP visits occur at least once per life stage, but the frequency and timing of the visits vary across cohorts. As of March 4, 2022, the EWC cohorts contributed data from 60,553 children and consented 29,622 children for new EWCP data and biospecimen collection. The median (interquartile range) age of EWCP-enrolled children was 7.5 years (3.7-11.1). Surveys, interviews, standardized examinations, laboratory analyses, and medical record abstraction are used to obtain information in 5 main outcome areas: pre-, peri-, and postnatal outcomes; neurodevelopment; obesity; airways; and positive health. Exposures include factors at the level of place (e.g., air pollution, neighborhood socioeconomic status), family (e.g., parental mental health), and individuals (e.g., diet, genomics).
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Affiliation(s)
- Emily A Knapp
- Correspondence to Dr. Emily Knapp, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 700 E. Pratt Street, Suite 1000, Baltimore, Maryland 21202 (e-mail: )
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A capability framework to inform the fundamental requirements for clinical trial unit development, growth and long term success in outer metropolitan and rural areas. Contemp Clin Trials Commun 2023; 32:101072. [PMID: 36712185 PMCID: PMC9876817 DOI: 10.1016/j.conctc.2023.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/20/2022] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Background Participation in clinical trials is linked to improved patient outcomes. Despite this, most trial participants either reside in, or are treated in metropolitan areas. TrialHub developed hub-and-spoke models to support and grow clinical trial units in outer metropolitan and regional/rural centres in order to boost clinical trial engagement and reduce demands of trial participation on patients from outer metropolitan and regional/rural areas. The aim of this project was to establish a capability framework for clinical trial unit growth and development. Methods An integrative methods study design was used to inform the co-design and development of the capability framework based on data collected in Victoria during 2020-21. This included reviews of the literature and of existing local resources, infrastructure, and staffing; as well as education, mentoring and support, and a needs assessment through multidisciplinary working groups. Results We developed a capability framework based on the level of support required for outer metropolitan and regional/rural centres with diverse existing capabilities across Victoria. The framework applies a maturity model to assess resources, processes and practices which impact the capacity and capability of centres to conduct trials safely and sustainably. Each level of the model uses a consistent set of factors to describe the core elements required for safe clinical trial delivery. This benchmarking allows targeted investment to ensure safe and high-quality delivery of trials at newly establishing trial units. Conclusion The capability framework developed by TrialHub provides a basis for staged, planned and successful trial unit development and trial implementation. Further validation of the framework is required.
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James L, O'Sullivan BP, Majure M, Lang J, Ounpraseuth S, Hornik C, Baldner J, Garza M, Prior F, Lee JY, Snowden J. Protocol for the Vitamin D Oral Replacement in Asthma (VDORA) study. Contemp Clin Trials 2022; 120:106861. [PMID: 35907490 PMCID: PMC10411523 DOI: 10.1016/j.cct.2022.106861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/01/2022] [Accepted: 07/24/2022] [Indexed: 11/03/2022]
Abstract
Obesity and asthma are epidemic in the United States and obesity is an independent risk factor for asthma. Low vitamin D levels (i.e. serum 25-hydroxyvitamin D) have been reported in patients with reduced lung function, more frequent respiratory infections, and asthma exacerbations. Experts have proposed that serum levels > 40 ng/mL are required to offer the immunomodulatory benefits of vitamin D. Low vitamin D levels are common in both obesity and asthma, but it is not known whether supplementation with vitamin D improves asthma symptoms. Guidance for drug development stresses the importance of early phase studies to establish accurate population pharmacokinetics (PK) and drug dosing prior to larger phase 3 trials. The PK of this fat-soluble vitamin in children with increased adiposity are unknown; as are the doses need to reach proposed immunomodulatory levels. The objective of this study is to characterize the PK of vitamin D in children with obesity. Children ages 6--18 years who had physician diagnosed asthma and a body mass index (BMI) >85th percentile will be randomized to receive either standard daily dosing or loading doses followed by standard daily dosing. Blood samples will be obtained to characterize the PK of vitamin D. The results of this study will be used to identify a sufficient dose of vitamin D supplement to raise serum levels above a pre-specified value that may result in anti-inflammatory actions that could improve asthma symptoms.
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Affiliation(s)
- Laura James
- Arkansas Children's Research Institute and University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | | | - Mark Majure
- University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Jason Lang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
| | | | - Christoph Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
| | - Jamie Baldner
- Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Maryann Garza
- Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Fred Prior
- Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | | | - Jessica Snowden
- Arkansas Children's Research Institute and University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
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Conducting a pediatric randomized clinical trial during a pandemic: A shift to virtual procedures. J Clin Transl Sci 2022; 6:e115. [PMID: 36285019 PMCID: PMC9549582 DOI: 10.1017/cts.2022.453] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background/Objective Prior to the COVID-19 pandemic, our research group initiated a pediatric practice-based randomized trial for the treatment of childhood obesity in rural communities. Approximately 6 weeks into the originally planned 10-week enrollment period, the trial was forced to pause all study activity due to the COVID-19 pandemic. This pause necessitated a substantial revision in recruitment, enrollment, and other study methods in order to complete the trial using virtual procedures. This descriptive paper outlines methods used to recruit, enroll, and manage clinical trial participants with technology to obtain informed consent, obtain height and weight measurements by video, and maintain participant engagement throughout the duration of the trial. Methods The study team reviewed the IRB records, protocol team meeting minutes and records, and surveyed the site teams to document the impact of the COVID-19 shift to virtual procedures on the study. The IRB approved study changes allowed for flexibility between clinical sites given variations in site resources, which was key to success of the implementation. Results All study sites faced a variety of logistical challenges unique to their location yet successfully recruited the required number of patients for the trial. Ultimately, virtual procedures enhanced our ability to establish relationships with participants who were previously beyond our reach, but presented several challenges and required additional resources. Conclusion Lessons learned from this study can assist other study groups in navigating challenges, especially when recruiting and implementing studies with rural and underserved populations or during challenging events like the pandemic.
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Challenges and opportunities for improving access to approved neonatal drugs and devices. J Perinatol 2022; 42:825-828. [PMID: 35132149 PMCID: PMC8819193 DOI: 10.1038/s41372-021-01304-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/02/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
Neonatal drug and device development has lagged behind other patient populations. Oftentimes, providers are using drugs and devices without adequate study of safety and efficacy. Neonates deserve dedicated drug and device development programs, which will require novel approaches and unique collaborations between multiple key stakeholders. Legislative efforts, infrastructure, clinical trial methodology, and international collaborations have all contributed to improvements in neonatal drug and device development, but more work is still needed. Leadership from neonatologists, clinical care providers, and parents is essential to implement needed changes.
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Annett RD, Bickel S, Carlson JC, Cowan K, Cox S, Fisher MJ, Jarvis JD, Kong AS, Kosut JS, Kulbeth KR, Laptook A, McElfish PA, McNally MM, Pachter LM, Pahud BA, Pyles LA, Shaw J, Simonsen K, Snowden J, Turley CB, Atz AM. Capacity Building for a New Multicenter Network Within the ECHO IDeA States Pediatric Clinical Trials Network. Front Pediatr 2021; 9:679516. [PMID: 34336738 PMCID: PMC8316720 DOI: 10.3389/fped.2021.679516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/10/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Research capacity building is a critical component of professional development for pediatrician scientists, yet this process has been elusive in the literature. The ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) seeks to implement pediatric trials across medically underserved and rural populations. A key component of achieving this objective is building pediatric research capacity, including enhancement of infrastructure and faculty development. This article presents findings from a site assessment inventory completed during the initial year of the ISPCTN. Methods: An assessment inventory was developed for surveying ISPCTN sites. The inventory captured site-level activities designed to increase clinical trial research capacity for pediatrician scientists and team members. The inventory findings were utilized by the ISPCTN Data Coordinating and Operations Center to construct training modules covering 3 broad domains: Faculty/coordinator development; Infrastructure; Trials/Research concept development. Results: Key lessons learned reveal substantial participation in the training modules, the importance of an inventory to guide the development of trainings, and recognizing local barriers to clinical trials research. Conclusions: Research networks that seek to implement successfully completed trials need to build capacity across and within the sites engaged. Our findings indicate that building research capacity is a multi-faceted endeavor, but likely necessary for sustainability of a unique network addressing high impact pediatric health problems. The ISPCTN emphasis on building and enhancing site capacity, including pediatrician scientists and team members, is critical to successful trial implementation/completion and the production of findings that enhance the lives of children and families.
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Affiliation(s)
- Robert D Annett
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Scott Bickel
- Department of Pediatrics, University of Louisville School of Medicine and Norton Children's Hospital, Louisville, KY, United States
| | - John C Carlson
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, United States
| | - Kelly Cowan
- Department of Pediatrics, University of Vermont, Burlington, VT, United States
| | - Sara Cox
- Department of Community and Public Health Sciences, University of Montana, Missoula, MT, United States
| | - Mark J Fisher
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - J Dean Jarvis
- Dartmouth-Hitchcock Clinic: Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Alberta S Kong
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Jessica S Kosut
- Department of Pediatrics, Division of Hospitalist Medicine, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, United States
| | - Kurtis R Kulbeth
- ECHO IDeA States Pediatric Clinical Trials Network Data Coordinating and Operations Center, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Abbot Laptook
- Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, United States
| | - Mary M McNally
- Dartmouth-Hitchcock Clinic: Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Lee M Pachter
- Institute for Research on Equity and Community Health, Thomas Jefferson University, Newark, DE, United States
| | - Barbara A Pahud
- Children's Mercy Hospital - Kansas City Department of Infectious Diseases, Kansas University Medical Center, University of Missouri Kansas City, Kansas City, MO, United States
| | - Lee A Pyles
- Department of Pediatrics, West Virginia University, Morgantown, WV, United States
| | - Jennifer Shaw
- Division of Organizational Development and Innovation, Southcentral Foundation, Anchorage, AK, United States
| | - Kari Simonsen
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jessica Snowden
- Department of Pediatric Infectious Disease, ECHO IDeA States Pediatric Clinical Trials Network Data Coordinating and Operations Center, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Christine B Turley
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Andrew M Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
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