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Hancock B, Miller EM, Parrott A, Weaver KN, Tretter JT, Pilipenko V, Shikany AR. Retrospective comparison of parent-reported genetics knowledge, empowerment, and familial uptake of cardiac screening between parents who received genetic counseling by a certified genetic counselor and those who did not: A single US academic medical center study. J Genet Couns 2022; 31:965-975. [PMID: 35261109 DOI: 10.1002/jgc4.1570] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart defect, which can cause severe cardiac complications. BAVs cluster in families and demonstrate high heritability. Cardiac screening for first-degree relatives of individuals with a BAV is recommended. This retrospective two-group study evaluated the impact of cardiovascular genetic counseling provided by a board-certified genetic counselor on parent-reported outcomes by comparing parental responses of those who received genetic counseling by a genetic counselor (GC group) for family history of BAV to those who did not (non-GC group). A retrospective chart review from May 2016 to June 2019 identified 133 pediatric patients with an isolated BAV. Parents of eligible probands were invited to complete an online survey assessing genetics knowledge, empowerment (Genomics Outcome Scale), and familial uptake of cardiac screening. Surveys were completed by 38/97 (39%) parents in the non-GC group and 20/36 (56%) parents in the GC group. The median genetics knowledge score was not significantly different between the two groups (GC group: 8, range 3-11 out of a maximum possible of 12; non-GC group: 7, range 2-11; p = .08). The mean empowerment score was not significantly different between the two groups (GC group: mean 24.6, SD 2.2; non-GC group: mean 23.2, SD 3.5; p = .06). The uptake of cardiac screening was significantly higher in the GC group with 39/59 (66%) total first-degree relatives reported as having been screened compared with 36/91 (40%) in the non-GC group (p = .002). Parent-reported outcomes in our study suggest that receiving genetic counseling by a board-certified genetic counselor significantly increased familial uptake of cardiac screening for first-degree relatives of pediatric patients with a BAV. Studies with larger sample sizes are needed to confirm the findings of this study; however, a referral to a genetic counselor should be considered for patients with a BAV.
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Affiliation(s)
- Bailey Hancock
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Erin M Miller
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashley Parrott
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Genome Medical, San Francisco, California, USA
| | - Kathryn Nicole Weaver
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Justin T Tretter
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Valentina Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Amy R Shikany
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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2
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Schneider K, Parrott A, Spar D, Knilans T, Czosek R, Miller E, Anderson J. A novel variant in KCNQ1 associated with short QT syndrome. HeartRhythm Case Rep 2021; 7:650-654. [PMID: 34712558 PMCID: PMC8530816 DOI: 10.1016/j.hrcr.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Kristin Schneider
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ashley Parrott
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Spar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Timothy Knilans
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Richard Czosek
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erin Miller
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey Anderson
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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3
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Ison HE, Griffin EL, Parrott A, Shikany AR, Meyers L, Thomas MJ, Syverson E, Demo EM, Fitzgerald KK, Fitzgerald-Butt S, Ziegler KL, Schartman AF, Stone KM, Helm BM. Genetic counseling for congenital heart disease - Practice resource of the national society of genetic counselors. J Genet Couns 2021; 31:9-33. [PMID: 34510635 DOI: 10.1002/jgc4.1498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 12/11/2022]
Abstract
Congenital heart disease (CHD) is an indication which spans multiple specialties across various genetic counseling practices. This practice resource aims to provide guidance on key considerations when approaching counseling for this particular indication while recognizing the rapidly changing landscape of knowledge within this domain. This resource was developed with consensus from a diverse group of certified genetic counselors utilizing literature relevant for CHD genetic counseling practice and is aimed at supporting genetic counselors who encounter this indication in their practice both pre- and postnatally.
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Affiliation(s)
- Hannah E Ison
- Stanford Center for Inherited Cardiovascular Disease, Stanford Health Care, Stanford, California, USA
| | - Emily L Griffin
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | | | - Amy R Shikany
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | | | - Matthew J Thomas
- Department of Pediatrics, Division of Genetics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Erin Syverson
- Department of Pediatrics, Division of Genetics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erin M Demo
- Sibley Heart Center Cardiology at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kristi K Fitzgerald
- Nemours Cardiac Center, Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Sara Fitzgerald-Butt
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Allison F Schartman
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Indiana University Health, Indianapolis, Indiana, USA
| | - Kristyne M Stone
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Indiana University Health, Indianapolis, Indiana, USA
| | - Benjamin M Helm
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
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Ahimaz P, Sabatello M, Qian M, Wang A, Miller EM, Parrott A, Lal AK, Chatfield KC, Rossano JW, Ware SM, Parent JJ, Kantor P, Yue L, Wynn J, Lee TM, Addonizio LJ, Appelbaum PS, Chung WK. Impact of Genetic Testing for Cardiomyopathy on Emotional Well-Being and Family Dynamics: A Study of Parents and Adolescents. Circ Genom Precis Med 2021; 14:e003189. [PMID: 34255550 DOI: 10.1161/circgen.120.003189] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genetic testing is indicated for children with a personal or family history of hereditary cardiomyopathy to determine appropriate management and inform risk stratification for family members. The implications of a positive genetic result for children can potentially impact emotional well-being. Given the nuances of cardiomyopathy genetic testing for minors, this study aimed to understand how parents involve their children in the testing process and investigate the impact of genetic results on family dynamics. METHODS A survey was distributed to participants recruited from the Children's Cardiomyopathy Foundation and 7 North American sites in the Pediatric Cardiomyopathy Registry. The survey explored adolescent and parent participants' emotions upon receiving their/their child's genetic results, parent-child result communication and its impact on family functionality, using the McMaster Family Assessment Device. RESULTS One hundred sixty-two parents of minors and 48 adolescents who were offered genetic testing for a personal or family history of cardiomyopathy completed the survey. Parents whose child had cardiomyopathy were more likely to disclose positive diagnostic genetic results to their child (P=0.014). Parents with unaffected children and positive predictive testing results were more likely to experience negative emotions about the result (P≤0.001) but also had better family functioning scores than those with negative predictive results (P=0.019). Most adolescents preferred results communicated directly to the child, but parents were divided about whether their child's result should first be released to them or their child. CONCLUSIONS These findings have important considerations for how providers structure genetic services for adolescents and facilitate discussion between parents and their children about results.
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Affiliation(s)
- Priyanka Ahimaz
- Division of Molecular Genetics, Department of Pediatrics (P.A., J.W., W.K.C.), Columbia University Irving Medical Center
| | - Maya Sabatello
- Center for Precision Medicine and Genomics, Division of Ethics, Departments of Medicine, Medical Humanities and Ethics (M.S.)
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health (M.Q., A.W.)
| | - Aijin Wang
- Department of Biostatistics, Mailman School of Public Health (M.Q., A.W.)
| | - Erin M Miller
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Heart Institute Cincinnati, OH (E.M.M.)
| | - Ashley Parrott
- The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (A.P.)
| | - Ashwin K Lal
- Primary Children's Hospital, University of Utah, Salt Lake City (A.K.L.)
| | - Kathryn C Chatfield
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (K.C.C.)
| | | | - Stephanie M Ware
- Departments of Pediatrics and Medical and Molecular Genetics (S.M.W.), Indiana University School of Medicine, Indianapolis
| | - John J Parent
- Department of Pediatrics (J.J.P.), Indiana University School of Medicine, Indianapolis
| | - Paul Kantor
- Stollery Children's Hospital, Edmonton, Alberta, Canada (P.K.)
| | - Lisa Yue
- Children's Cardiomyopathy Foundation (L.Y.), Columbia University Irving Medical Center
| | - Julia Wynn
- Division of Molecular Genetics, Department of Pediatrics (P.A., J.W., W.K.C.), Columbia University Irving Medical Center
| | - Teresa M Lee
- Division of Cardiology, Department of Pediatrics (T.M.L., L.J.A.), Columbia University Irving Medical Center
| | - Linda J Addonizio
- Division of Cardiology, Department of Pediatrics (T.M.L., L.J.A.), Columbia University Irving Medical Center
| | - Paul S Appelbaum
- Center for Research on Ethical, Legal and Social Implications of Psychiatric, Neurologic and Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY (P.S.A.)
| | - Wendy K Chung
- Division of Molecular Genetics, Department of Pediatrics (P.A., J.W., W.K.C.), Columbia University Irving Medical Center.,Department of Medicine (W.K.C.), Columbia University Irving Medical Center
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Shikany AR, Landis BJ, Parrott A, Miller EM, Coyan A, Walters L, Hinton RB, Goldenberg P, Ware SM. A Comprehensive Clinical Genetics Approach to Critical Congenital Heart Disease in Infancy. J Pediatr 2020; 227:231-238.e14. [PMID: 32717230 PMCID: PMC8424561 DOI: 10.1016/j.jpeds.2020.07.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the frequency of genetic diagnoses among infants with critical congenital heart disease (CHD) using a comprehensive cardiovascular genetics approach and to identify genotype-phenotype correlations. STUDY DESIGN A retrospective chart review of patients evaluated by cardiovascular genetics in a pediatric cardiac intensive care unit from 2010 to 2015 was performed. Infants with CHD who were <1 month of age were included. CHD was classified using structured phenotype definitions. Cardiac and noncardiac phenotypes were tested for associations with abnormal genetic testing using χ1 and Fisher exact tests. RESULTS Genetic evaluation was completed in 293 infants with CHD, of whom 213 had isolated congenital heart disease (iCHD) and 80 had multiple congenital anomalies. Overall, the yield of abnormal genetic testing was 26%. The multiple congenital anomalies cohort had a greater yield of genetic testing (39%) than the iCHD cohort (20%) (OR 2.7). Using a non-hierarchical CHD classification and excluding 22q11.2 deletion and common aneuploidies, right ventricular obstructive defects were associated with abnormal genetic testing (P = .0005). Extracardiac features associated with abnormal genetic testing included ear, nose, and throat (P = .003) and brain (P = .0001) abnormalities. A diagnosis of small for gestational age or intrauterine growth retardation also was associated with abnormal genetic testing (P = .0061), as was presence of dysmorphic features (P = .0033, OR 3.5). Infants without dysmorphia with iCHD or multiple congenital anomalies had similar frequencies of abnormal genetic testing. CONCLUSIONS The present study provides evidence to support a comprehensive cardiovascular genetics approach in evaluating infants with critical CHD while also identifying important genotype-phenotype considerations.
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Affiliation(s)
- Amy R Shikany
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Benjamin J Landis
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | | | - Erin M Miller
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alyxis Coyan
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Robert B Hinton
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Paula Goldenberg
- Massachusetts General Hospital, Medical Genetics, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Stephanie M Ware
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Raseta M, Bazarova A, Wright H, Parrott A, Nayak S. A novel toolkit for the prediction of clinical outcomes following mechanical thrombectomy. Clin Radiol 2020; 75:795.e15-795.e21. [PMID: 32718742 DOI: 10.1016/j.crad.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/18/2020] [Indexed: 11/16/2022]
Abstract
AIM To develop a robust toolkit to aid decision-making for mechanical thrombectomy (MT) based on readily available patient variables that could accurately predict functional outcome following MT. MATERIALS AND METHODS Data from patients with anterior circulation stroke who underwent MT between October 2009 and January 2018 (n=239) were identified from our MT database. Patient explanatory variables were age, sex, National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS), collateral score, and Glasgow Coma Scale. Five models were developed from the data to predict five outcomes of interest: model 1: prediction of survival: modified Rankin Scale (mRS) of 0-5 (alive) or 6 (dead); model 2: prediction of good/poor outcome: mRS of 0-3 (good), or 4-6 (poor); model 3: prediction of good/poor outcome: mRS of 0-2 (good), or 3-6 (poor); model 4: prediction of mRS category: mRS of 0-2 (no disability), 3 (minor disability), 4-5 (severe disability) or 6 (dead); model 5: prediction of the exact mRs score (mRs as a continuous variable). The accuracy and discriminative power of each predictive model were tested. RESULTS Prediction of survival was 87% accurate (area under the curve [AUC] 0.89). Prediction of good/poor outcome was 91% accurate (AUC 0.94) for Model 2 and 95% accurate (AUC 0.98) for Model 3. Prediction of mRS category was 76% accurate, and increased to 98% using the "one-score-out rule". Prediction of the exact mRS value was accurate to an error of 0.89. CONCLUSIONS This novel toolkit provided accurate estimations of outcome for MT.
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Affiliation(s)
- M Raseta
- Institute for Applied Clinical Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - A Bazarova
- Institute of Cancer and Genomic Sciences, Centre for Computational Biology, University of Birmingham, 6 Mindelsohn Way, Birmingham, B15 2SY, UK
| | - H Wright
- University Hospital of North Midlands NHS Trust, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK
| | - A Parrott
- Keele University School of Medicine, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK
| | - S Nayak
- University Hospital of North Midlands NHS Trust, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK.
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7
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Monteil DC, Shikany A, Aljeaid D, Parrott A, Tretter JT, James J, Martin LJ, Weaver KN. Comparison of Evolution of Aortic Root Dilation and Ghent Criteria in Preadolescents and Adolescents with and without Marfan Syndrome. J Pediatr 2020; 221:188-195.e1. [PMID: 32446479 DOI: 10.1016/j.jpeds.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/28/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether the Ghent Criteria (2010) can be reliably used in evaluating preadolescents and adolescents for Marfan syndrome by comparing aortic growth, systemic scores, and anthropometric features in individuals with and without Marfan syndrome. STUDY DESIGN A retrospective chart review was completed for patients less than 15 years of age referred for Marfan syndrome. Comparisons were made between the first and last visit. Paired t tests were used to compare Ghent systemic scores. Wilcoxon rank-sum test were used to compare age, aortic root z scores, height z scores, and body mass index z scores. Recursive partitioning was used to identify combinations of factors to distinguish Marfan syndrome. RESULTS In total, 53 individuals met inclusion criteria (29 Marfan syndrome and 24 non-Marfan syndrome). Ghent systemic score increased in the Marfan syndrome group and declined in the non-Marfan syndrome. The non-Marfan syndrome group did not develop progressive aortic root dilation with age. Individuals with Marfan syndrome had higher median height z scores than non-Marfan syndrome, with no difference in median body mass index z score between groups. A combination of aortic root z score above 0.95 and Ghent systemic score above 3 was highly indicative of a Marfan syndrome diagnosis in children less than 15 years of age. CONCLUSION The Ghent criteria (2010) can be used to reliably exclude a diagnosis of Marfan syndrome in individuals less than 15 years of age. Genetic testing should be used as an aide in confirming or excluding the diagnosis of Marfan syndrome in individuals with an aortic root z score above 0.95 in combination with a Ghent systemic score above 3 at initial visit.
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Affiliation(s)
- Danielle C Monteil
- Department of Pediatrics, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Amy Shikany
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Deema Aljeaid
- Department of Genetics Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ashley Parrott
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jeanne James
- Section of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Lisa J Martin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - K Nicole Weaver
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati Cincinnati College of Medicine, Cincinnati, OH.
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8
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Parrott A, Lombardo R, Brown N, Tretter JT, Riley L, Weaver KN. Cantu syndrome: A longitudinal review of vascular findings in three individuals. Am J Med Genet A 2020; 182:1243-1248. [PMID: 32065455 DOI: 10.1002/ajmg.a.61521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 11/10/2022]
Abstract
Cantu syndrome is a rare autosomal dominant disorder caused by missense variants in ABCC9 and KCNJ8. It is characterized by hypertrichosis, neonatal macrosomia, coarse facial features, and skeletal anomalies. Reported cardiovascular anomalies include cardiomegaly, structural defects, collateral vessels, and rare report of arteriovenous malformation (AVM). Arterial dilation is reported in a few individuals including one with surgical intervention for a thoracic aortic aneurysm. The natural history of this aortopathy including the rate of progression or risk for dissection is unknown and longitudinal patient data is unavailable. We present data from vascular imaging in three individuals with genetically confirmed Cantu syndrome over 3 to 14 years of follow-up. All patients had generally stable aortic dilation, which did not reach the surgical threshold, including one individual followed closely through pregnancy. In adulthood, one individual had a maximum ascending aortic measurement of 4.2 cm. Two pediatric patients had aortic root or ascending z-scores of approximately +3. A large asymptomatic pelvic AVM was identified in one individual on head-pelvis MRI. While the data reported in these individuals is reassuring regarding the risk for progressive disease, further data from additional individuals with Cantu syndrome is needed to best inform screening recommendations, improve understanding of dissection risk, and guide management.
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Affiliation(s)
- Ashley Parrott
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rachel Lombardo
- Department of Medical Genetics, UT Southwestern Medical Center, Dallas, Texas
| | - Nicole Brown
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Justin T Tretter
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Laura Riley
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathryn Nicole Weaver
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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9
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Parrott A, Khoury PR, Shikany AR, Lorts A, Villa CR, Miller EM. Investigation of de novo variation in pediatric cardiomyopathy. Am J Med Genet C Semin Med Genet 2020; 184:116-123. [PMID: 31912959 DOI: 10.1002/ajmg.c.31764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 12/20/2022]
Abstract
Pediatric cardiomyopathies can be caused by variants in genes encoding the sarcomere and cytoskeleton in cardiomyocytes. Variants are typically inherited in an autosomal dominant manner with variable expressivity. De novo variants have been reported, however their overall frequency is largely unknown. We sought to determine the rate of de novo, pathogenic and likely pathogenic (P/LP) variants in children with a diagnosis of hypertrophic, dilated, or restrictive cardiomyopathy (HCM, DCM, or RCM), and to compare disease outcomes between individuals with and without a de novo variant. A retrospective record review identified 126 individuals with HCM (55%), DCM (37%), or RCM (8%) ≤18 years of age who had genetic testing. Overall, 50 (40%) had positive genetic testing and 18% of P/LP variants occurred de novo. The rate of de novo variation in those with RCM (80%) was higher than in those with HCM (9%) or DCM (20%). There was evidence of germline mosaicism in one family with RCM. Individuals with de novo variants were more likely than those without to have a history of arrhythmia (p = .049), sudden cardiac arrest (p = .024), hospitalization (p = .041), and cardiac transplantation (p = .030). The likelihood of de novo variation and impact on family risk and screening should be integrated into genetic counseling.
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Affiliation(s)
- Ashley Parrott
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Philip R Khoury
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Amy R Shikany
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Chet R Villa
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erin M Miller
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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10
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Shikany AR, Parrott A, James J, Madueme P, Nicole Weaver K, Cassidy C, Khoury PR, Miller EM. Left ventricular outflow tract obstruction: Uptake of familial cardiac screening and parental knowledge from a single tertiary care center. J Genet Couns 2019; 28:779-789. [PMID: 30907979 DOI: 10.1002/jgc4.1117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/06/2022]
Abstract
Left ventricular outflow tract obstruction (LVOTO) malformations exhibit higher heritability than other cardiac lesions and cardiac screening is encouraged for first-degree relatives. This study sought to determine the uptake of familial cardiac screening in families with an infant with an LVOTO and assess parental knowledge regarding genetics and heritability of LVOTO. A chart review of the period 2010-2015 identified 69 families who received genetic counseling regarding a diagnosis of LVOTO in an infant. Surveys assessing familial cardiac screening and parental knowledge were completed by a parent in 24 families (completion rate of 35%). Forty percent (36/89) of all at-risk first-degree family members completed cardiac screening. The presence of additional congenital malformations in the affected infant was the only significant factor reducing the uptake of familial cardiac screening (p = 0.003). The reported uptake of screening for subsequent at-risk pregnancies was 11/12 (92%) compared to 25/77 (32%) of living at-risk relatives. Survey respondents answered seven knowledge questions with an average score of 5.2 and all correctly identified that LVOTO can run in families. Uptake of familial cardiac screening is occurring in less than half of at-risk individuals, despite parents demonstrating basic knowledge and receiving genetic counseling. Follow-up counseling in the outpatient setting to review familial screening recommendations should be considered to increase uptake and optimize outcomes.
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Affiliation(s)
- Amy R Shikany
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ashley Parrott
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeanne James
- Division of Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Peace Madueme
- Nemours Cardiac Center, Nemours Children's Hospital, Orlando, Florida
| | - Kathryn Nicole Weaver
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine Cassidy
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Philip R Khoury
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erin M Miller
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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11
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Anderson K, Cnota J, James J, Miller EM, Parrott A, Pilipenko V, Weaver KN, Shikany A. Prevalence of Noonan spectrum disorders in a pediatric population with valvar pulmonary stenosis. CONGENIT HEART DIS 2018; 14:264-273. [PMID: 30556322 DOI: 10.1111/chd.12721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/09/2018] [Accepted: 10/25/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the prevalence of Noonan spectrum disorders (NSD) in a pediatric population with valvar pulmonary stenosis (vPS) and identify the clinical characteristics that differentiate those with NSD from those without NSD. DESIGN A retrospective chart review of 204 patients diagnosed with vPS between 9/1/2012 and 12/1/2016 at a pediatric medical center was performed. The quantitative features of vPS, genetic diagnosis information, and phenotypic characteristics of Noonan syndrome were collected. Chi-square test, Fisher's exact test, t test, Wilcoxon rank-sum test, and ANOVA were used for comparisons among the groups. Logistic regression was used to test for the association between the clinical characteristics and the presence of NSD. RESULTS Syndromic diagnoses were made in 10% of the children with vPS, with NSD accounting for 6%. Hypertrophic cardiomyopathy (P < .0001), short stature (P < .0001), developmental delay (P < .0001), ophthalmological abnormalities (P < .0001), pectus carinatum/excavatum (P = .01), neurological abnormalities (P = .022), and aortic stenosis (P = .031) were present more often in individuals with NSD compared to nonsyndromic vPS. A logistic regression analysis showed a 4.8-fold increase in odds for NSD for each additional characteristic (P < .0001). CONCLUSIONS At least 6% of the children with vPS have an underlying NSD. Individuals with vPS and NSD were significantly more likely to have additional features known to be associated with NSD than those with vPS without NSD. We conclude that vPS in the presence of one or more significant characteristics should prompt referral for genetic evaluation as a guide to ascertain patients at risk for NSD while optimizing the use of clinical genetics evaluation and potential genetic testing.
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Affiliation(s)
- Kailyn Anderson
- Department of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James Cnota
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeanne James
- Department of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Erin M Miller
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ashley Parrott
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Valentina Pilipenko
- Department of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kathryn Nicole Weaver
- Department of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy Shikany
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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12
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Newman R, Jefferies JL, Chin C, He H, Shikany A, Miller EM, Parrott A. Hypertrophic Cardiomyopathy Genotype Prediction Models in a Pediatric Population. Pediatr Cardiol 2018; 39:709-717. [PMID: 29362845 DOI: 10.1007/s00246-018-1810-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/04/2018] [Indexed: 01/16/2023]
Abstract
The Toronto Hypertrophic Cardiomyopathy (HCM) Genotype Score and Mayo HCM Genotype Predictor are risk assessment models developed to estimate a patient's likelihood of testing positive for a pathogenic variant causative of HCM. These models were developed from adult populations with HCM based on factors that have been associated with a positive genotype and have not been validated in external populations. The purpose of this study was to evaluate the overall predictive abilities of these models in a clinical pediatric HCM setting. A retrospective medical record review of 77 pediatric patients with gene panel testing for HCM between September 2005 and June 2015 was performed. Clinical and echocardiographic variables used in the developed models were collected and used to calculate scores for each patient. To evaluate model performance, the ability to discriminate between a carrier and non-carrier was assessed by area under the ROC curve (AUC) and overall calibration was evaluated by the Hosmer-Lemeshow goodness-of-fit statistic. Discrimination assessed by AUC was 0.72 (P < 0.001) for the Toronto model and 0.67 (P = 0.004) for the Mayo model. The Toronto model and the Mayo model showed P values of 0.36 and 0.82, respectively, for model calibration. Our findings suggest that these models are useful in predicting a positive genetic test result in a pediatric HCM setting. They may be used to aid healthcare providers in communicating risk and enhance patient decision-making regarding pursuit of genetic testing.
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Affiliation(s)
- Randa Newman
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, USA.
| | - John Lynn Jefferies
- The Heart Institute at CCHMC, Cincinnati, USA.,University of Cincinnati, Cincinnati, USA
| | - Clifford Chin
- The Heart Institute at CCHMC, Cincinnati, USA.,University of Cincinnati, Cincinnati, USA
| | - Hua He
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, USA
| | - Amy Shikany
- The Heart Institute at CCHMC, Cincinnati, USA
| | - Erin M Miller
- The Heart Institute at CCHMC, Cincinnati, USA.,University of Cincinnati, Cincinnati, USA
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13
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Miller EM, Hinton RB, Czosek R, Lorts A, Parrott A, Shikany AR, Ittenbach RF, Ware SM. Genetic Testing in Pediatric Left Ventricular Noncompaction. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.117.001735. [DOI: 10.1161/circgenetics.117.001735] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Erin M. Miller
- From the Division of Cardiology (E.M.M., R.B.H., R.C., A.L., A.P., A.R.S.) and Division of Biostatistics and Epidemiology (R.F.I.), Cincinnati Children’s Hospital Medical Center, OH; and Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis (S.M.W.)
| | - Robert B. Hinton
- From the Division of Cardiology (E.M.M., R.B.H., R.C., A.L., A.P., A.R.S.) and Division of Biostatistics and Epidemiology (R.F.I.), Cincinnati Children’s Hospital Medical Center, OH; and Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis (S.M.W.)
| | - Richard Czosek
- From the Division of Cardiology (E.M.M., R.B.H., R.C., A.L., A.P., A.R.S.) and Division of Biostatistics and Epidemiology (R.F.I.), Cincinnati Children’s Hospital Medical Center, OH; and Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis (S.M.W.)
| | - Angela Lorts
- From the Division of Cardiology (E.M.M., R.B.H., R.C., A.L., A.P., A.R.S.) and Division of Biostatistics and Epidemiology (R.F.I.), Cincinnati Children’s Hospital Medical Center, OH; and Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis (S.M.W.)
| | - Ashley Parrott
- From the Division of Cardiology (E.M.M., R.B.H., R.C., A.L., A.P., A.R.S.) and Division of Biostatistics and Epidemiology (R.F.I.), Cincinnati Children’s Hospital Medical Center, OH; and Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis (S.M.W.)
| | - Amy R. Shikany
- From the Division of Cardiology (E.M.M., R.B.H., R.C., A.L., A.P., A.R.S.) and Division of Biostatistics and Epidemiology (R.F.I.), Cincinnati Children’s Hospital Medical Center, OH; and Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis (S.M.W.)
| | - Richard F. Ittenbach
- From the Division of Cardiology (E.M.M., R.B.H., R.C., A.L., A.P., A.R.S.) and Division of Biostatistics and Epidemiology (R.F.I.), Cincinnati Children’s Hospital Medical Center, OH; and Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis (S.M.W.)
| | - Stephanie M. Ware
- From the Division of Cardiology (E.M.M., R.B.H., R.C., A.L., A.P., A.R.S.) and Division of Biostatistics and Epidemiology (R.F.I.), Cincinnati Children’s Hospital Medical Center, OH; and Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis (S.M.W.)
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14
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Francis N, Rose T, Parrott A, Birtles P, Archer J, Alexander H. 4DOES A WEEKLY COMMUNITY GERIATRIC CLINIC IN PEACEHAVEN REDUCE HOSPITAL ATTENDANCES? Age Ageing 2017. [DOI: 10.1093/ageing/afx115.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Goldenberg P, Shikany A, Parrott A, Ware SM, Hinton RB. Persistent Left Superior Vena Cava: An Overlooked Feature of CHARGE Syndrome? Cardiogenetics 2015. [DOI: 10.4081/cardiogenetics.2015.5511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
CHARGE is a well-characterized syndrome (OMIM 2148400) associated with multiple congenital anomalies including cardiovascular malformations. Mutations in CHD7 are the most common cause of CHARGE syndrome. Persistent left superior vena cava (LSVC) has been described in patients with CHARGE syndrome in one study of LSVC associations. A retrospective chart review was conducted for all patients with CHARGE syndrome, diagnosed by Blake criterion features and/or the presence of a pathogenic CHD7 mutation. Echocardio - grams were performed on a clinical basis for all patients and were systematically reviewed and classified. Persistent LSVC was present in 50% of patients with CHARGE syndrome (4/8) and was seen in 3 out of 33 patients seen by cardiovascular genetics with 22q11.2 deletion syndrome. Persistent LSVC is a common finding in patients with CHARGE syndrome and its presence may increase the index of suspicion in patients with other characteristic congenital anomalies.
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16
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Parrott A. The Adverse Psychiatric Consequences of Recreational Stimulant Drugs Such as Methamphetamine, Cocaine, Ecstasy/mdma, and Mephedrone: a Unified Psychobiological Explanation. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Parrott A, James J, Goldenberg P, Hinton RB, Miller E, Shikany A, Aylsworth AS, Kaiser-Rogers K, Ferns SJ, Lalani SR, Ware SM. Aortopathy in the 7q11.23 microduplication syndrome. Am J Med Genet A 2014; 167A:363-70. [DOI: 10.1002/ajmg.a.36859] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ashley Parrott
- Department of Pediatrics; Cincinnati Children's Hospital Medical Center; Heart Institute; Cincinnati Ohio
| | - Jeanne James
- Department of Pediatrics; Cincinnati Children's Hospital Medical Center; Heart Institute; Cincinnati Ohio
| | - Paula Goldenberg
- Department of Pediatrics; Cincinnati Children's Hospital Medical Center; Heart Institute; Cincinnati Ohio
| | - Robert B. Hinton
- Department of Pediatrics; Cincinnati Children's Hospital Medical Center; Heart Institute; Cincinnati Ohio
| | - Erin Miller
- Department of Pediatrics; Cincinnati Children's Hospital Medical Center; Heart Institute; Cincinnati Ohio
| | - Amy Shikany
- Department of Pediatrics; Cincinnati Children's Hospital Medical Center; Heart Institute; Cincinnati Ohio
| | - Arthur S. Aylsworth
- Department of Pediatrics; University of North Carolina; Chapel Hill North Carolina
- Department of Genetics; University of North Carolina; Chapel Hill North Carolina
| | - Kathleen Kaiser-Rogers
- Department of Pediatrics; University of North Carolina; Chapel Hill North Carolina
- Department of Genetics; University of North Carolina; Chapel Hill North Carolina
- Department of Pathology and Laboratory Medicine; University of North Carolina; Chapel Hill North Carolina
| | - Sunita J. Ferns
- Department of Pediatrics; University of North Carolina; Chapel Hill North Carolina
| | - Seema R. Lalani
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston Texas
| | - Stephanie M. Ware
- Department of Pediatrics and Medical and Molecular Genetics; Indiana University School of Medicine; Indianapolis Indiana
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18
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19
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Mekap D, Macko T, Brüll R, Cong R, deGroot AW, Parrott A, Yau W. One-Step Method for Separation and Identification of n-Alkanes/Oligomers in HDPE Using High-Temperature High-Performance Liquid Chromatography. Macromolecules 2013. [DOI: 10.1021/ma401146a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. Mekap
- Division Plastics, Group Material
Analytics, Fraunhofer Institute for Structural Durability and System Reliability, Schlossgartenstrasse 6, 64289
Darmstadt, Germany
| | - T. Macko
- Division Plastics, Group Material
Analytics, Fraunhofer Institute for Structural Durability and System Reliability, Schlossgartenstrasse 6, 64289
Darmstadt, Germany
| | - R. Brüll
- Division Plastics, Group Material
Analytics, Fraunhofer Institute for Structural Durability and System Reliability, Schlossgartenstrasse 6, 64289
Darmstadt, Germany
| | - R. Cong
- Performance
Plastics Characterization, The Dow Chemical Company, 2301 Brazosport Blvd., Freeport,
Texas 77541, United States
| | - A. W. deGroot
- Performance
Plastics Characterization, The Dow Chemical Company, 2301 Brazosport Blvd., Freeport,
Texas 77541, United States
| | - A. Parrott
- Performance
Plastics Characterization, The Dow Chemical Company, 2301 Brazosport Blvd., Freeport,
Texas 77541, United States
| | - W. Yau
- Performance
Plastics Characterization, The Dow Chemical Company, 2301 Brazosport Blvd., Freeport,
Texas 77541, United States
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20
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Abstract
There is a growing population of adults with congenital heart disease due to the advancements in surgical repair and medical management. At the same time, the understanding of the genetic basis of both syndromic and isolated congenital heart disease has grown tremendously and is being rapidly translated into changes in clinical care, resulting in an increasing need for incorporation of genetic expertise into the care of adult congenital heart disease patients. Here we review the importance of delivery of genetic information to the adult congenital heart disease population and highlight the shared and distinct roles of clinical geneticists and genetic counselors in provision of services. The adult congenital heart disease patient population has unique needs and clinical geneticists and genetic counselors can play an important role in the diagnostic evaluation and assessment of these patients to provide an accurate etiologic diagnosis and to counsel regarding genetic testing, recurrence risk, family screening, and prenatal diagnosis.
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Affiliation(s)
- Ashley Parrott
- The Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 240 Albert Sabin Way, MLC 7020, Cincinnati, OH 45229-3039, USA
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21
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Lynch J, Parrott A, Hopkin RJ, Myers M. Media coverage of direct-to-consumer genetic testing. J Genet Couns 2011; 20:486-94. [PMID: 21638197 DOI: 10.1007/s10897-011-9374-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
Abstract
Media coverage of Direct-to-Consumer (DTC) genetic testing shapes public perception of such testing. The purpose of this study was to determine and assess the themes presented by U.S. news media regarding DTC genetic testing. We performed a Lexis-Nexis search with the keywords "Direct-to-Consumer" and "genetic test" for news stories published from 2006-2009. The sample was coded on themes of genetic determinism, privacy, discrimination, validity, regulation, the Genetic Information Nondiscrimination Act (GINA), utility, and cost. Ninety-two news stories were included. Stories displayed moderate genetic determinism and were neutral about validity and utility. Stories indicated that insurance and employers were the most likely sources of discrimination, yet identified the physicians and DTC companies as groups most likely to violate privacy. Stories claimed lack of regulation would harm consumers, but most post-GINA stories did not discuss the law. The costs of tests were frequently included. The results of this study show a broad range of views toward DTC genetic testing and its potential impacts. The genetics community should be aware that the public has been exposed to multiple views of DTC genetic testing when discussing these tests.
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Affiliation(s)
- John Lynch
- Department of Communication, University of Cincinnati, Cincinnati, OH 45221-0184, USA.
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22
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Brown LE, Mitchell G, Holden J, Folkard A, Wright N, Beharry-Borg N, Berry G, Brierley B, Chapman P, Clarke SJ, Cotton L, Dobson M, Dollar E, Fletcher M, Foster J, Hanlon A, Hildon S, Hiley P, Hillis P, Hoseason J, Johnston K, Kay P, McDonald A, Parrott A, Powell A, Slack RJ, Sleigh A, Spray C, Tapley K, Underhill R, Woulds C. Priority water research questions as determined by UK practitioners and policy makers. Sci Total Environ 2010; 409:256-266. [PMID: 21035169 DOI: 10.1016/j.scitotenv.2010.09.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/17/2010] [Accepted: 09/22/2010] [Indexed: 05/30/2023]
Abstract
Several recent studies have emphasised the need for a more integrated process in which researchers, policy makers and practitioners interact to identify research priorities. This paper discusses such a process with respect to the UK water sector, detailing how questions were developed through inter-disciplinary collaboration using online questionnaires and a stakeholder workshop. The paper details the 94 key questions arising, and provides commentary on their scale and scope. Prioritization voting divided the nine research themes into three categories: (1) extreme events (primarily flooding), valuing freshwater services, and water supply, treatment and distribution [each >150/1109 votes]; (2) freshwater pollution and integrated catchment management [100-150 votes] and; (3) freshwater biodiversity, water industry governance, understanding and managing demand and communicating water research [50-100 votes]. The biggest demand was for research to improve understanding of intervention impacts in the water environment, while a need for improved understanding of basic processes was also clearly expressed, particularly with respect to impacts of pollution and aquatic ecosystems. Questions that addressed aspects of appraisal, particularly incorporation of ecological service values into decision making, were also strongly represented. The findings revealed that sustainability has entered the lexicon of the UK water sector, but much remains to be done to embed the concept operationally, with key sustainability issues such as resilience and interaction with related key sectors, such as energy and agriculture, relatively poorly addressed. However, the exercise also revealed that a necessary condition for sustainable development, effective communication between scientists, practitioners and policy makers, already appears to be relatively well established in the UK water sector.
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Affiliation(s)
- L E Brown
- School of Geography, University of Leeds, Leeds, LS2 9JT, UK.
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23
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Parrott A. S38-02 - Recreational MDMA ‘Ecstasy’: psychiatric aspects and the diathesis stress model. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Ecstasy [3,4-methylenedioxymethamphetamine (MDMA)] use has been associated with a number of psychopathological problems. However, research suggests that reported symptoms might be associated more with heavy polydrug use in general rather than ecstasy per se. The current study aimed to determine the role of other drug use in reports of long-term effects by some ecstasy-polydrug users. Problematic ecstasy users (n = 53), reporting problems which they attributed to ecstasy use, were compared with non-problematic ecstasy users (n = 62), polydrug (n = 62) and alcohol/nicotine using controls (n = 111). Drug use was recorded, and positive and negative life changes were assessed along with which previous drug use, if any, they attributed these changes too. Both ecstasy groups reported higher drug use compared with polydrug controls. Polydrug and ecstasy users more often reported life changes compared with non-drug users, and ecstasy users appeared to experience more life changes than polydrug users, with problematic ecstasy users experiencing most alterations. Ecstasy users reported changes more to a combination of drugs than to one specific drug, suggesting that polydrug use in these groups has an impact on their life experiences. These findings emphasise that research into the psychological effects of ecstasy should not underestimate the role of other polydrug use.
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Affiliation(s)
- K Soar
- Department of Psychology, University of East London, London, UK.
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26
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Sykes LM, Nelson JT, Parrott A, Skews BW. An investigation into digital colour recipe prediction for use in dentistry. SADJ 2006; 61:102, 104-6, 108. [PMID: 16796200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- L M Sykes
- Department of Stomatological Studies, University of the Limpopo
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Rodgers J, Buchanan T, Scholey AB, Heffernan TM, Ling J, Parrott A. Differential effects of Ecstasy and cannabis on self-reports of memory ability: a web-based study. Hum Psychopharmacol 2001; 16:619-625. [PMID: 12404542 DOI: 10.1002/hup.345] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [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: 11/11/2022]
Abstract
Given the legal status of MDMA (3,4-methylenedioxymethamphetamine), or Ecstasy, face-to-face access to participants is sometimes difficult. The number of participants in studies of cognitive performance amongst Ecstasy users is variable, with the average being around 30. Access to a larger number of participants is clearly desirable. The present investigation accessed a larger sample size using a web-based design. A website was developed and used for data collection. Prospective memory ability was assessed using the Prospective Memory Questionnaire. Self-report of day-to-day memory performance was investigated using the Everyday Memory Questionnaire. The Drug Questionnaire assessed the use of other substances as well as Ecstasy, allowing a regression design to isolate the contribution of each substance to any variance on the cognitive measures. Preliminary findings (N = 488) indicate that there is a clear double dissociation between the impact of Ecstasy and cannabis. We found that cannabis was associated with reports of 'here-and-now' cognitive problems in short-term and internally cued prospective memory. In contrast, Ecstasy was associated with reports of long-term memory problems, which were more related to storage and retrieval difficulties. Copyright 2001 John Wiley & Sons, Ltd.
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Affiliation(s)
- J. Rodgers
- Doctorate in Clinical Psychology, University of Newcastle, Newcastle upon Tyne, UK
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29
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Field CJ, Thomson CA, Van Aerde JE, Parrott A, Euler A, Lien E, Clandinin MT. Lower proportion of CD45R0+ cells and deficient interleukin-10 production by formula-fed infants, compared with human-fed, is corrected with supplementation of long-chain polyunsaturated fatty acids. J Pediatr Gastroenterol Nutr 2000; 31:291-9. [PMID: 10997375 DOI: 10.1097/00005176-200009000-00017] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The immune consequences of adding 20:4n-6 and 22:6n-3 fatty acids to preterm infant formula are not known. METHODS The effect of feeding preterm infants (14-42 days of age) human milk (Human Milk group), infant formula (Formula group), or formula with added long-chain polyunsaturated fatty acids 20:4n-6 and 22:6n-3 (Formula + LCP group) on isolated peripheral blood lymphocytes (by flow cytometry) and lipid composition (by gas-liquid chromatography) was determined. Lymphocytes were stimulated in vitro with phytohemagglutinin to measure soluble interleukin (sIL)-2R and IL-10 production (by enzyme-linked immunosorbent assay). RESULTS With age, the percentage of CD3+ CD4+ T cells and the percentage of CD20+ cells increased in the Human Milk and Formula + LCP groups (P < 0.05), but not in the unsupplemented Formula group. Compared with the Formula group, CD4+ cells from the Formula + LCP and Human Milk groups expressed more CD45R0 (antigen mature) and less CD45RA (antigen naive) at 42 days of age (P < 0.05). At 42 days, IL-10 production was lower (P < 0.05) in cells of the Formula group than in cells of the Human Milk group. Production of IL-10 by the cells of the Formula + LCP group was not different from that produced by the Human Milk group cells. An age-related decrease (P < 0.05) in sIL-2R production by Formula + LCP lymphocytes was observed, but sIL-2R production at 42 days in the Formula + LCP group did not differ significantly from that in the Human Milk group. Compared with Formula alone, adding LCP to formula resulted in a lower C18:2n-6 and higher C20:4n-6 content in lymphocyte phospholipids (P < 0.05). CONCLUSIONS Adding LCP to a preterm infant formula resulted in lymphocyte populations, phospholipid composition, cytokine production, and antigen maturity that are more consistent with that in human milk-fed infants. This may affect the ability of the infant to respond to immune challenges.
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Affiliation(s)
- C J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada
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30
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Parrott A. Smoking and adverse childhood experiences. JAMA 2000; 283:1959; author reply 1959-60. [PMID: 10789658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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31
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Clandinin MT, Van Aerde JE, Parrott A, Field CJ, Euler AR, Lien E. Assessment of feeding different amounts of arachidonic and docosahexaenoic acids in preterm infant formulas on the fatty acid content of lipoprotein lipids. Acta Paediatr 1999; 88:890-6. [PMID: 10503691 DOI: 10.1080/08035259950168847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
This study evaluated preterm infants of less than 2.3 kg birth weight fed commercial formula (Preemie SMA) devoid of arachidonic acid (AA) and docosahexaenoic acid (DHA) and compared this control group with similar infant groups fed one of three formulas containing a range of 0.32-1.1% AA and 0.24-0.75% DHA in the fat component of the formula. An analogous group of infants fed on their mothers' breast milk and a breast milk fortifier was also studied. Individual lipoprotein fractions were isolated from blood samples collected at 12 d of age and after a further 4 wk of feeding. The fatty acid content of individual lipid components, isolated from each lipoprotein fraction was quantitatively determined in order to identify change in marker pools of essential fatty acid. The high density lipoproteins (HDL) and low density lipoproteins (LDL) phospholipid and cholesterol ester fractions contain most of the AA and DHA found in the lipoprotein fractions (total of 0.49% and 0.35%, respectively). Infants fed a formula without AA and DHA showed a reduction in AA level in the phospholipid fraction of all lipoproteins and in the HDL and LDL cholesterol ester fraction. A reduced level of DHA was also observed primarily in the lipoprotein phospholipid fraction in comparison with infants fed breast milk or infant formula containing AA and DHA. Supplementing infant formula with increasing levels of AA and DHA produced a clear dose response in the level of AA found in the HDL and LDL phospholipid fraction. From comparison of the fatty acid levels present in the lipoproteins it appears that a formula level of 0.49% AA and 0.35% DHA provides sufficient levels of these fatty acids to achieve a similar fatty acid content to that of infants fed breast milk for the major lipoprotein fractions examined.
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Affiliation(s)
- M T Clandinin
- Nutrition and Metabolism Research Group, University of Alberta, Edmonton, Canada.
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Murgraff V, Parrott A, Bennett P. Risky single-occasion drinking amongst young people--definition, correlates, policy, and intervention: a broad overview of research findings. Alcohol Alcohol 1999; 34:3-14. [PMID: 10075396 DOI: 10.1093/alcalc/34.1.3] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Risky single-occasion drinking (RSOD) has dire consequences upon health and well-being including unplanned pregnancies, sexually transmitted diseases such as HIV/AIDS, crime, and car accidents. The prevalence of RSOD among young people is alarming. Despite this, as yet, a review of existing literature on RSOD amongst young people is lacking. This article will provide an overview of this area of research focusing on the definition of RSOD, its prevalence among young people, health and behavioural effects of RSOD, the perceived risk of RSOD among young people, and interventions to reduce RSOD in young people. In addition, recommendations are made for health educators interested in reducing the incidence of RSOD in young people.
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Affiliation(s)
- V Murgraff
- Department of Psychology, University of East London, UK
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Clandinin MT, Van Aerde JE, Parrott A, Field CJ, Euler AR, Lien EL. Assessment of the efficacious dose of arachidonic and docosahexaenoic acids in preterm infant formulas: fatty acid composition of erythrocyte membrane lipids. Pediatr Res 1997; 42:819-25. [PMID: 9396564 DOI: 10.1203/00006450-199712000-00017] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The nutritional requirements of preterm infants for the long chain polyunsaturated essential fatty acids, arachidonic acid (AA) and docosahexaenoic acid (DHA), have not been clearly defined. The present study evaluated preterm infants of less than 2.3 kg birth weight fed a commercial formula (Preemie SMA) devoid of AA and DHA and compared this control group with similar infant groups fed one of three formulas containing a range of 0.32 to 1.1% AA and 0.24 to 0.76% DHA. An analogous group of infants fed their mothers' breast milk and a breast milk fortifier (when indicated) was also studied. Erythrocyte membrane phospholipids were isolated from blood samples collected at 12 d of age and after a further 4 wk of feeding. Infants fed the formula without AA and DHA showed a reduction in AA level in erythrocyte phosphatidylcholine, and a reduced level of DHA in phosphatidylethanolamine in comparison with infants fed breast milk or infant formula containing AA and DHA. Supplementing infant formula with increasing levels of AA and DHA produced a clear dose response in the levels of AA and DHA found in erythrocyte membrane phospholipids. From comparison of membrane phospholipid fatty acid composition it appears that a formula level of 0.32-1.1% AA and 0.24-0.76% DHA provides sufficient levels of these fatty acids to achieve a similar fatty acid composition to that of infants fed human milk for most of the lipid fractions examined.
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Affiliation(s)
- M T Clandinin
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada
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Parrott A. Psychoactive drugs of use and abuse: wobble, rave, inhale or crave? Symposium organised by the Psychobiology Section, at the British Psychological Society Annual Conference, University of Warwick, UK; 2nd April 1995: Convenors: Dr Andy Parrott, Department of Psychology, University of East London, London E15 4LZ Dr Martin Yeomans, Department of Experimental Psychology, University of Sussex, Sussex BN1 9DG. J Psychopharmacol 1995; 9:390-1. [PMID: 22298407 DOI: 10.1177/026988119500900416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A Parrott
- Reader in Psychology University of East London, London
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Borzotta AP, Pennings J, Papasadero B, Paxton J, Mardesic S, Borzotta R, Parrott A, Bledsoe F. Enteral versus parenteral nutrition after severe closed head injury. J Trauma 1994; 37:459-68. [PMID: 8083910 DOI: 10.1097/00005373-199409000-00022] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We measured energy expenditure (MREE) and nitrogen excretion (UUN) in patients with severe head injury randomized to early parenteral (TPN, n = 21) or jejunal (ENT, n = 27) feeding with identical formulations. The MREE rose to 2400 +/- 531 kcal/day in both groups and remained at 135% +/- 26% to 146% +/- 42% of predicted energy expenditure over 4 weeks. Nitrogen excretion peaked the second week at 33.4 +/- 10 (TPN) and 31.2 +/- 7.5 (ENT) g N/day. Both routes were equally effective at meeting nutritional goals (1.2 x MREE, 2.5 g protein/kg/day intake, stabilized albumin and transferrin levels). Infections were equally frequent: 1.86 episodes/TPN patient versus 1.89 episodes/ENT patient. While patient charges were much greater for TPN, the hospital costs were similar for TPN and ENT support regimens. These findings show that patients with head injuries are hypermetabolic for weeks, that only 27% are capable of spontaneously eating nutritional requirements by discharge, and that either TPN or ENT support is equally effective when prescribed according to individual measurements of MREE and nitrogen excretion.
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Affiliation(s)
- A P Borzotta
- Trauma Services, Legacy Emanuel Hospital, Portland, OR 97227
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Affiliation(s)
- A Parrott
- Department of Psychology, University of East London, UK
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Clandinin MT, Parrott A, Van Aerde JE, Hervada AR, Lien E. Feeding preterm infants a formula containing C20 and C22 fatty acids simulates plasma phospholipid fatty acid composition of infants fed human milk. Early Hum Dev 1992; 31:41-51. [PMID: 1486817 DOI: 10.1016/0378-3782(92)90013-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Thirty-four premature infants weighing less than 1500 grams at birth were fed preterm formula (formula), preterm infant formula manufactured to contain a balance of C20 and C22 omega 6 and omega 3 fatty acids within the range characteristic of human milk (LCPE-formula) or their mothers' expressed breast milk (EBM). Blood samples were obtained during the first week of life and after 28 days of feeding to determine the effect of feeding C20 and C22 omega 6 and omega 3 fatty acids on plasma lipids. Fatty acid analyses of red blood cell phospholipids indicated few differences between dietary treatment and age. Fatty acid content of plasma cholesterol esters indicated a high plasma cholesterol linoleate level for infants fed formula and a reduced content of C20 and C22 omega 6 and omega 3 fatty acids. For infants fed the modified formula (LCPE-formula) the levels of 20:4 omega 6, 20:5 omega 3 and 22:6 omega 3 were higher than observed for the formula group and similar to those observed for infants fed EBM. By the fifth week of life, feeding the modified formula resulted in plasma phospholipid levels of C20 and C22 omega 6 and omega 3 fatty acids similar to levels of C20 and C22 omega 6 and omega 3 fatty acids found in infants fed EBM and significantly higher than levels characteristic of infants fed formula. It is concluded that infants fed LCPE-formula illustrate an overall balance between C20 and C22 omega 6 to omega 3 fatty acids in the plasma similar to that characteristic of infants fed human milk.
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Affiliation(s)
- M T Clandinin
- Nutrition and Metabolism Research Group, University of Alberta, Edmonton, Canada
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Clandinin MT, Garg ML, Parrott A, Van Aerde J, Hervada A, Lien E. Addition of long-chain polyunsaturated fatty acids to formula for very low birth weight infants. Lipids 1992; 27:896-900. [PMID: 1491607 DOI: 10.1007/bf02535869] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Thirty-four premature infants who were appropriate for gestational age and weighing less than 1500 g at birth were fed "preemie" SMA-24 formula, "preemie" SMA-24 formula manufactured to contain C20 and C22 omega 6 and omega 3 fatty acids (LCPE-SMA), or expressed milk (EBM). Blood samples were drawn from a small arm vein during the first week of life and after 28 days of feeding. The fatty acid content of plasma phospholipids was determined. Infants fed SMA-24 had a high content of 18:2 omega 6 in plasma phospholipids. Feeding LCPE-SMA normalized plasma phospholipid levels of C20 and C22 omega 6 and omega 3 fatty acids to be similar to levels of C20 and C22 omega 6 and omega 3 fatty acids found in infants fed EBM, and significantly higher than characteristic levels for infants fed SMA-24. Feeding LCPE-SMA or EBM results in a balanced incorporation of C20 and C22 omega 6 and omega 3 fatty acids into phospholipids derived from the liver or perhaps the small intestine.
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Affiliation(s)
- M T Clandinin
- Department of Foods and Nutrition, University of Alberta, Edmonton, Canada
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Abstract
Ten females in the midcycle phase of the menstrual cycle, 10 females in the premenstrual phase of the menstrual cycle, and 10 males agreed to try and stop smoking for two consecutive days. The Smoking Motivation Questionnaire and Profile of Mood States Questionnaire (POMS) were completed by all subjects beforehand. On each "no smoking" day, the POMS and a Smoking Withdrawal Questionnaire were completed. Males and midcycle females achieved significantly greater smoking reduction than premenstrual females during the "no smoking" days. Premenstrual females reported becoming significantly more tired, confused, depressed, anxious, and irritable than midcycle females. Midcycle females reported only slight changes in feeling state during cigarette withdrawal. The position of the males was broadly intermediate between the two female groups.
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Affiliation(s)
- D Craig
- Department of Psychology, Polytechnic of East London, Great Britain
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Abstract
This symposium of the British Psychological Society Annual Conference was convened by Dr Andy Parrott (Department of Psychology, University of East London) and Dr Ian Deary (Department of Psychology, University of Edinburgh). The conference was held in Scarborough at the International Spa Complex in April 1992.
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Affiliation(s)
- A Parrott
- Department of Psychology University of East London
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Parrott A. Teaching mouth care. Nurs Times 1991; 87:48-9. [PMID: 1896369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Parrott A, Ponte J, Purves MJ, Stephenson T. Changes in carbon dioxide and pH in pulmonary post-capillary blood in cats [proceedings]. J Physiol 1979; 296:23P-24P. [PMID: 43389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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