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Jorgensen A, McManigal M, Post A, Werner D, Wichman C, Tao M, Wellsandt E. Reliability of an Instrumented Pressure Walkway for Measuring Walking and Running Characteristics in Young, Athletic Individuals. Int J Sports Phys Ther 2024; 19:429-439. [PMID: 38576831 PMCID: PMC10987304 DOI: 10.26603/001c.94606] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024] Open
Abstract
Background Spatiotemporal parameters of gait are useful for identifying pathological gait patterns and presence of impairments. Reliability of the pressure-sensitive ZenoTM Walkway has not been established in young, active individuals without impairments, and no studies to this point have included running. Purpose The purposes of this study were to 1) determine if up to two additional trials of walking and running on the ZenoTM Walkway are needed to produce consistent measurements of spatiotemporal variables, and 2) establish test-retest reliability and minimal detectable change (MDC) values for common spatiotemporal variables measured during walking and running. Study Design Cross-Sectional Laboratory Study. Methods Individuals (n=38) in this cross-sectional study walked and ran at self-selected comfortable speed on a pressure-sensitive ZenoTM Walkway. Twenty-one participants returned for follow-up testing between one and 14 days later. Intraclass correlation coefficients (ICCs) were used to assess reliability of spatiotemporal variable means using three, four, or five passes over the ZenoTM Walkway and to assess test-retest reliability of spatiotemporal variables across sessions. Results All variables showed excellent reliability (ICC > 0.995) for walking and running when measured using three, four, or five passes. Additionally, all variables demonstrated moderate to excellent test-retest reliability during walking (ICC: 0.732-0.982) and running (ICC: 0.679-0.985). Conclusion This study establishes a reliable measurement protocol of three one-way passes when using the ZenoTM Walkway for walking or running analysis. This is the first study to establish reliability of the ZenoTM Walkway during running and in young, active individuals without neuromusculoskeletal pathology. Level of Evidence 3b.
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Affiliation(s)
- Alyx Jorgensen
- Department of Health and Rehabilitation Sciences; Medical Sciences Interdepartmental Area Program University of Nebraska Medical Center
| | - Matthew McManigal
- Department of Health and Rehabilitation Sciences University of Nebraska Medical Center
| | - Austin Post
- College of Medicine University of Nebraska Medical Center
| | - David Werner
- Medical Sciences Interdepartmental Area Program; Department of Health and Rehabilitation Sciences University of Nebraska Medical Center
| | | | - Matthew Tao
- Department of Orthopaedic Surgery and Rehabilitation; Department of Health and Rehabilitation Sciences University of Nebraska Medical Center
| | - Elizabeth Wellsandt
- Department of Health and Rehabilitation Sciences; Department of Orthopaedic Surgery and Rehabilitation University of Nebraska Medical Center
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Bhatt VR, Wichman C, Koll TT, Fisher AL, Wildes TM, Berger A, Armitage JO, Holstein SA, Maness LJ, Gundabolu K. Longitudinal changes in cognitive and physical function and health-related quality of life in older adults with acute myeloid leukemia. J Geriatr Oncol 2024; 15:101676. [PMID: 38000343 PMCID: PMC11101205 DOI: 10.1016/j.jgo.2023.101676] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Many older adults with acute myeloid leukemia (AML) do not receive chemotherapy because of physicians' and patients' concern for toxicities and functional decline. This highlights the critical and urgent need to generate knowledge of functional changes following new treatments. MATERIALS AND METHODS As a part of a pragmatic single-center trial, 59 older adults ≥60 years with AML completed geriatric assessment and health-related quality of life measures before treatment and at one month and three months after chemotherapy initiation. Changes in scores of various geriatric assessment measures were computed by subtracting the baseline score from the one-month and three-month scores for each patient. Established cut-offs were used to determine a clinically meaningful change (improvement or worsening). This study provides results of descriptive exploratory analyses. RESULTS Patients experienced significant comorbidity burden and a high prevalence of functional impairments before treatment, with 56% of patients having ≥2 comorbid conditions, 69% having abnormal cognitive function (using Montreal Cognitive Assessment), 69% having impaired objective physical function (using Short Physical Performance Battery), and 64% having a positive depression screen (Patient Health Questionnaire-9). Patients (n = 53) received treatment with predominantly low-intensity chemotherapy; six patients received intensive chemotherapy. Among those who completed some or all of the three-month evaluation (N = 43), from baseline before treatment to three months later, cognitive function improved (38.7%) or remained stable (38.7%), objective physical function improved (51.6%) or remained stable (22.6%), and depression scores improved (9.4%) or remained stable (53.1%). Global health status score and role functioning moderately improved by a score of >16. DISCUSSION An exploratory analysis of our phase 2 trial demonstrated improvement or stabilization of cognitive and physical function and depression score at three months in a high proportion of older survivors of AML, despite a high prevalence of frailty and significant comorbidity burden at baseline. These results demonstrate success of treatment in improving cognitive and physical function and depression score, and, if confirmed in larger studies, should encourage oncologists to offer chemotherapy to older adults with AML. CLINICAL TRIAL REGISTRATION The study is registered in the ClinicalTrials.gov ID: NCT03226418.
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Affiliation(s)
- Vijaya R Bhatt
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Thuy T Koll
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Alfred L Fisher
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Tanya M Wildes
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Ann Berger
- College of Nursing - Omaha Division, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - James O Armitage
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Sarah A Holstein
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Lori J Maness
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Krishna Gundabolu
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States of America
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Gaffney KK, Medcalf S, Duysen E, Wichman C. Rural and Agricultural Natural Disaster Stress and Recovery: A Comparison. J Agromedicine 2023; 28:797-808. [PMID: 37394921 DOI: 10.1080/1059924x.2023.2230987] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
This study used a novel survey instrument to evaluate the hypothesis that U.S. agricultural producers have significantly different stress and recovery experiences following acute-onset natural disaster compared to their non-agricultural counterparts. Participants were recruited through local organizations and targeted email and social media in communities in Arkansas and Nebraska that had experienced violent tornadoes in 2014 and/or severe flooding in 2019. The survey instrument incorporated the Brief Resilience Scale, the Revised Impact of Event Scale referencing two time points, the Posttraumatic Growth Inventory-Short Form, and original questions. Demographic, exposure, stress, and recovery measures were analyzed in SAS with Chi-square tests, t-tests, Wilcoxon tests, and multiple linear regression modeling to test for differences between agricultural and non-agricultural groups in resilience, event exposure, stress symptoms in the week after the event, stress symptoms in the month before the survey, a calculated recovery ratio, and posttraumatic growth. Analysis sample (N = 159) contained 20.8% agricultural occupation, 71.1% female, and 49.1% over age 55. No significant differences were found between agricultural and non-agricultural participants when comparing resilience, stress, or recovery ratio measures. Unadjusted posttraumatic growth score was significantly lower in the agriculture group (P = .02), and an occupation group by sex interaction was significantly associated with posttraumatic growth score (P = .02) when controlled for number of initial posttraumatic stress symptoms in the adjusted model, with agricultural women showing lower growth. Overall, there was no evidence of significant difference in disaster stress and recovery between agricultural and rural, non-agricultural groups in this study. There was some evidence that women in agriculture may have lower levels of recovery. Data indicated that rural residents continue to experience posttraumatic-type symptoms up to 8 years beyond the acute-onset natural disaster events. Communities should include strategies to support mental and emotional health in their preparedness, response, and recovery plans with intentional inclusion of agricultural populations.
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Affiliation(s)
- Kristin K Gaffney
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sharon Medcalf
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ellen Duysen
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Weaver MS, Wichman C, Sharma S, Walter JK. Demand and Supply: Association between Pediatric Ethics Consultation Volume and Protected Time for Ethics Work. AJOB Empir Bioeth 2022; 14:135-142. [PMID: 36574230 DOI: 10.1080/23294515.2022.2160512] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Despite national increase in pediatric ethics consultation volume over the past decade, protected time and resources for healthcare ethics consultancy work has lagged. METHODS Correlation study investigating potential associations between ethics consult volume reported by recent national survey of consultants at children's hospitals and five programmatic domains. RESULTS 104 children's hospitals in 45 states plus Washington DC were included. There was not a statistically significant association between pediatric ethics consult volume and hospital size, rurality of patient population, or number of consultants. Academically-affiliated children's hospitals had fewer ethics consults compared to nonacademically affiliated. Association was found between full-time equivalent (FTE) hours and number of ethics consults (p < 0.0001). Spearman rank correlation between ethics consult volume and FTE was 0.5. CONCLUSIONS While the results of this study should be interpreted with caution, investment in protected time for ethics consultancy work may translate into increased volume of pediatric ethics consults.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, Pediatric Palliative Care, University of Nebraska Medical Center, Omaha, NE, USA
- Veterans Health Affairs, National Center for Ethics in Healthcare, Washington, DC, USA
| | - Christopher Wichman
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shiven Sharma
- Department of Medical Ethics and Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer K Walter
- Department of Medical Ethics and Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Gribben KC, Wyss AB, Poole JA, Farazi PA, Wichman C, Richards-Barber M, Beane Freeman LE, Henneberger PK, Umbach DM, London SJ, LeVan TD, Gribben KC. CC16 polymorphisms in asthma, asthma subtypes, and asthma control in adults from the Agricultural Lung Health Study. Respir Res 2022; 23:305. [PMID: 36352422 PMCID: PMC9644514 DOI: 10.1186/s12931-022-02211-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The club cell secretory protein (CC16) has anti-inflammatory and antioxidant effects and is a potential early biomarker of lung damage. The CC16 single nucleotide polymorphism (SNP) rs3741240 risk allele (A) has been inconsistently linked to asthma; other tagging SNPs in the gene have not been explored. The aim was to determine whether CC16 tagging polymorphisms are associated with adult asthma, asthma subtypes or asthma control in the Agricultural Lung Health Study (ALHS). METHODS The ALHS is an asthma case-control study nested in the Agricultural Health Study cohort. Asthma cases were individuals with current doctor diagnosed asthma, likely undiagnosed asthma, or asthma-COPD overlap defined by questionnaire. We also examined asthma subtypes and asthma control. Five CC16 tagging SNPs were imputed to 1000 Genomes Integrated phase 1 reference panel. Logistic regression was used to estimate associations between CC16 SNPs and asthma outcomes adjusted for covariates. RESULTS The sample included 1120 asthma cases and 1926 controls of European ancestry, with a mean age of 63 years. The frequency of the risk genotype (AA) for rs3741240 was 12.5% (n = 382). CC16 rs3741240 was not associated with adult asthma outcomes. A tagging SNP in the CC16 gene, rs12270961 was associated with uncontrolled asthma (n = 208, ORadj= 1.4, 95% CI 1.0, 1.9; p = 0.03). CONCLUSION This study, the largest study to investigate associations between CC16 tagging SNPs and asthma phenotypes in adults, did not confirm an association of rs3741240 with adult asthma. A tagging SNP in CC16 suggests a potential relationship with asthma control.
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Affiliation(s)
- KC Gribben
- grid.266813.80000 0001 0666 4105Department of Epidemiology, University of Nebraska Medical Center, 68198 Omaha, NE USA
| | - AB Wyss
- grid.94365.3d0000 0001 2297 5165Epidemiology Branch, National Institute of Environmental Health Sciences, Department of Health and Human Services, National Institutes of Health, Research Triangle Park, NC USA
| | - JA Poole
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, Division of Allergy and Immunology, University of Nebraska Medical Center, 68198 Omaha, NE USA
| | - PA Farazi
- grid.266813.80000 0001 0666 4105Department of Epidemiology, University of Nebraska Medical Center, 68198 Omaha, NE USA
| | - C Wichman
- grid.266813.80000 0001 0666 4105Department of Biostatistics, University of Nebraska Medical Center, 68198 Omaha, NE USA
| | | | - LE Beane Freeman
- grid.48336.3a0000 0004 1936 8075Occupational and Environmental Epidemiology Branch, National Cancer Institute, Bethesda, MD USA
| | - PK Henneberger
- grid.416738.f0000 0001 2163 0069Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV USA
| | - DM Umbach
- grid.94365.3d0000 0001 2297 5165Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Department of Health and Human Services, National Institutes of Health, Research Triangle Park, NC USA
| | - SJ London
- grid.94365.3d0000 0001 2297 5165Epidemiology Branch, National Institute of Environmental Health Sciences, Department of Health and Human Services, National Institutes of Health, Research Triangle Park, NC USA
| | - TD LeVan
- grid.266813.80000 0001 0666 4105Department of Epidemiology, University of Nebraska Medical Center, 68198 Omaha, NE USA ,grid.266813.80000 0001 0666 4105Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep, University of Nebraska Medical Center, 68198 Omaha, NE USA
| | - Kelli C. Gribben
- grid.266813.80000 0001 0666 4105Department of Epidemiology, University of Nebraska Medical Center, 68198 Omaha, NE USA
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Flores LE, Mack L, Wichman C, Weaver AA, Kothari V, Bilek LD. Protocol for a pilot randomised controlled trial of zoledronic acid to prevent bone loss following sleeve gastrectomy surgery. BMJ Open 2021; 11:e057483. [PMID: 34887285 PMCID: PMC8663101 DOI: 10.1136/bmjopen-2021-057483] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is an increasingly used and effective treatment for obesity; however, the rapid weight loss associated with SG adversely affects bone metabolism predisposing patients to skeletal fragility. Bisphosphonate medications have been evaluated for safety and efficacy in combating bone loss in patients with osteoporosis, but their use in SG-induced bone loss is limited. The goal of this study is to investigate how a one-time infusion of zoledronic acid compares to placebo, in its ability to combat SG-associated bone loss. METHODS AND ANALYSIS This research protocol is a 9-month, pilot randomized controlled trial (RCT) involving 30 adult SG patients randomised to receive an infusion of either 5 mg of zoledronic acid or placebo, 6 weeks following surgery. To be included participants must be <350 lbs/158.8 kg, free of bone-impacting pathologies or medications, and must have adequate serum calcium and vitamin D levels at baseline. The primary outcome is change in areal bone mineral density (aBMD) at the total hip. Secondary outcomes include change in aBMD of the femoral neck, and lumbar spine, and change in volumetric BMD at the lumbar spine. The primary aim will be tested using a linear mixed model fit with total hip aBMD at 9 months as the outcome. Treatment, participant sex and menopausal status will be considered in analysis. Groups will be compared using contrast statements at 9 months, with change over 9 months being the primary comparison. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of the University of Nebraska Medical Center (IRB820-19). Written consent will be obtained from participants at enrolment by trained staff. Careful and thorough explanation are used in obtainment of consent and voluntariness is emphasised throughout the trial. The findings of this study will be presented locally, nationally, and published in peer-reviewed journals. Additional details will be reported on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT04279392.
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Affiliation(s)
- Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lynn Mack
- Diabetes, Endocrinology, & Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ashley A Weaver
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vishal Kothari
- Department of Minimally Invasive Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Laura D Bilek
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Thompson CM, Cannon A, West S, Ghersi D, Atri P, Bhatia R, Smith L, Rachagani S, Wichman C, Kumar S, Batra SK. Mucin Expression and Splicing Determine Novel Subtypes and Patient Mortality in Pancreatic Ductal Adenocarcinoma. Clin Cancer Res 2021; 27:6787-6799. [PMID: 34615717 DOI: 10.1158/1078-0432.ccr-21-1591] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/15/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy demonstrating aberrant and progressive expression of mucins. The contribution of individual mucins has been extensively investigated in PDAC; however, comprehensive mucin profiling including splice variants in PDAC tumors has not been reported. EXPERIMENTAL DESIGN Using publicly available RNA sequencing (RNA-seq) datasets, we assess the expression of mucin family members and their splice variants (SV) in PDAC tumor samples for the first time. Mucin SVs that are correlated with PDAC patient survival are validated in a cohort of patient tumor samples. Further, we use computational methods to derive novel pancreatic tumor subtypes using mucin expression signatures and their associated activated pathways. RESULTS Principal component analysis identified four novel mucin-based PDAC subtypes. Pathway analysis implicated specific biological signatures for each subtype, labeled (i) immune activated, (ii) progressive, (iii) pancreatitis-initiated, and (iv) anti-inflammatory/PanIN-initiated. Assessing mucin SVs, significantly longer survival is observed with higher expression of 4 MUC1 and 1 MUC13 SVs, whereas patients expressing 2 MUC4 and 1 MUC16 SVs had shorter survival. Using a whole-transcriptome correlation, a three-gene panel, including ESRP2, PTK6, and MAGEH1, is designated to assess PDAC tumor sample cellularity by PCR. One MUC4 SV and one MUC13 SV are quantified in a separate PDAC patient cohort, and their effects on survival are experimentally validated. CONCLUSIONS Altogether, we demonstrate the unique expression pattern of mucins, four mucin-based PDAC subtypes, and the contribution of MUC1, MUC4, and MUC16 SVs in PDAC patient survival.
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Affiliation(s)
- Christopher M Thompson
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Andrew Cannon
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sean West
- School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska, Omaha, Nebraska
| | - Dario Ghersi
- School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska, Omaha, Nebraska
| | - Pranita Atri
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Rakesh Bhatia
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Lynette Smith
- Department of Biostatistics, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Satyayanarayana Rachagani
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Christopher Wichman
- Department of Biostatistics, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sushil Kumar
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska. .,The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
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Hill JL, Heelan KA, Bartee RT, Wichman C, Michaud T, Abbey BM, Porter G, Golden C, Estabrooks PA. A Type III Hybrid Effectiveness-Implementation Pilot Trial Testing Dissemination and Implementation Strategies for a Pediatric Weight Management Intervention: The Nebraska Childhood Obesity Research Demonstration Project. Child Obes 2021; 17:S70-S78. [PMID: 34569848 DOI: 10.1089/chi.2021.0170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/13/2022]
Abstract
Background: Several family-based efficacious pediatric weight management interventions (PWMIs) have been developed to reduce child weight status. These programs are typically based in larger cities delivered by an interdisciplinary team in a hospital or medical center. The degree to which these efficacious PWMIs have been translated to, and are feasible in, rural or micropolitan areas is unclear. This study protocol describes a pilot Type III hybrid effectiveness-implementation (T3HEI) trial testing a multilevel strategy that focuses on the adoption, implementation, and sustainability of a PWMI online training program and resource package designed for implementation in micropolitan and rural areas. Methods: The trial design employed the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate outcomes and the Promoting Action on Research Implementation in Health Services framework to specify potential mechanisms of adoption, implementation, and sustainability. The study will test the feasibility of a fund and contract dissemination strategy in the adoption of a PWMI in four to eight rural communities, compare a learning collaborative implementation strategy including embedded training and sustainability action planning with communities who receive the PWMI online program and resources alone, and determine whether the PWMI reach, effectiveness, and maintenance are of magnitude similar to previous effectiveness trials. The dissemination and implementation process focused on an integrated research-practice partnership process model that includes a systems-based approach with multiple sectors and vertical decision-making representation. Conclusions: Our pilot T3HEI study has the potential to inform how best to move and sustain evidence-based PWMIs into practice. The findings will inform larger scale dissemination, implementation, and sustainability efforts in medically underserved areas across the country. Trial registration: This protocol is registered with clinicaltrials.gov (NCT04719442).
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Affiliation(s)
- Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kate A Heelan
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - R T Bartee
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tzeyu Michaud
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bryce M Abbey
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - Gwenndolyn Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Caitlin Golden
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
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Lobl MB, Clarey D, Schmidt C, Wichman C, Wysong A. Analysis of mutations in cutaneous squamous cell carcinoma reveals novel genes and mutations associated with patient-specific characteristics and metastasis: a systematic review. Arch Dermatol Res 2021; 314:711-718. [PMID: 33735396 DOI: 10.1007/s00403-021-02213-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/11/2020] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
Abstract
Cutaneous squamous cell carcinoma (SCC) causes approximately 1,000,000 cases and 9000 deaths each year in the United States. While individual tumor sequencing studies have discovered driver mutations in SCC, there has yet to be a review and subsequent analysis synthesizing current studies. To conduct a comprehensive synthesis and analysis of SCC sequencing studies with individual patient-level data, a comprehensive literature search was performed. Statistical analyses were performed to identify trends. Studies meeting inclusion criteria included a total of 279 patients (189 localized SCCs, 90 metastatic SCCs). Several mutations were correlated with demographic characteristics (TP53, MLL4, BRCA2, COL4A1). TP53, TERT, SPEN, MLL3, and NOTCH2 mutations were significantly more likely to be found in metastatic versus localized SCCs even after the Bonferroni correction for multiple comparisons. Silent mutations were found more in localized SCCs than metastatic SCCs, and nonsense mutations were found more in metastatic SCCs than localized SCCs (p = 0.0003 and p = 0.04, respectively). Additional mutations were identified that have not yet been explored in SCC including AHNAK2, LRP1B, TRIO, MDN1, COL4A2, SVIL, VPS13C, DST, DMD, and DYSF. Overall, novel mutations were identified and differences between mutation patterns in localized and metastatic SCCs were found. These findings may have clinical applications.
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Affiliation(s)
- Marissa B Lobl
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Dillon Clarey
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Cynthia Schmidt
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
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Weaver MS, Jenkins R, Wichman C, Robinson JE, Potthoff MR, Menicucci T, Vail CA. Sowing Across a State: Development and Delivery of a Grassroots Pediatric Palliative Care Nursing Curriculum. J Palliat Care 2019; 36:22-28. [PMID: 31771423 DOI: 10.1177/0825859719889700] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rural pediatricians and adult-trained hospice teams report feeling ill-prepared to care for children at end of life, resulting in geographies in which children are not able to access home-based services. OBJECTIVES To develop a pediatric palliative care curriculum for inpatient nurses and adult-trained hospice teams caring for children in a rural region. METHODS Curriculum design and delivery was informed by local culture through an interdisciplinary, iterative development approach with confidence, intention, and support measured pre-, post-, and 4 months after delivery. A needs assessment was completed by pediatric nurses caring for children receiving palliative or end-of-life care to inform curricular content (phase 1). A curriculum was designed by an interdisciplinary pediatric palliative care team and piloted with nursing cohorts annually through educational conferences with monthly discussion series for 3 consecutive years (phase 2). Curricular content was then provided for 31 rural hospice team members (phase 3). RESULTS Self-reported confidence in caring for children increased by 1.1/10 points for adult-trained hospice team members. Mean score for intention to care for children increased by 5.2 points (sustained 5.1 points above baseline at 4 months). Perception of support in caring for children increased by 5 points (mean sustained 5.4 points above baseline at 4 months). Family needs, care goals, and symptom management were prioritized learning topics. Rural hospices previously unwilling to accept children enrolled pediatric patients in the 4 months following the conference. CONCLUSION Grassroots curricular initiatives and ongoing educational mentorship can grow pediatric palliative and hospice services in rural regions.
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Affiliation(s)
- Meaghann S Weaver
- Division of Pediatric Palliative Care, Department of Pediatrics, 20635Children's Hospital and Medical Center, Omaha, NE, USA
| | - Rebecca Jenkins
- Department of Pediatrics, 20635Children's Hospital and Medical Center, Omaha, NE, USA
| | - Christopher Wichman
- Division of Biostatistics, Department of Public Health, 14720University of Nebraska Medical Center, Omaha, NE, USA
| | - Jacob E Robinson
- Division of Pediatric Palliative Care, Department of Pediatrics, 20635Children's Hospital and Medical Center, Omaha, NE, USA
| | | | - Traci Menicucci
- Department of Pediatrics, 20635Children's Hospital and Medical Center, Omaha, NE, USA
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11
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Palacios GS, Zimmerman M, Mathai S, Wichman C, Wichman T. SUPEROXIDE IS INCREASED IN PATIENTS WITH PULMONARY HYPERTENSION. Chest 2019. [DOI: 10.1016/j.chest.2019.08.354] [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: 11/30/2022] Open
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12
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Varman M, Sharlin C, Fernandez C, Vasudevan J, Wichman C. Human Papilloma Virus Vaccination Among Adolescents in a Community Clinic Before and After Intervention. J Community Health 2019; 43:455-458. [PMID: 29368102 DOI: 10.1007/s10900-018-0467-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Human Papilloma Virus (HPV) is the most common sexually transmitted disease with over 14 million infections in 2008. Certain HPV types have been identified in up to 70% of cases of cervical and anal cancers. Despite being safe and effective, HPV vaccination rates remain low. Vaccination and demographic data was collected pre-and post-intervention. Among 13 thru 17-year-old cohort females were significantly more likely to be fully vaccinated. Assessment also found that patients insured by Medicaid were significantly more likely to be fully vaccinated than patients insured privately. Post-intervention vaccination rate is similar to baseline rates. There was non-significant improvement in HPV vaccination coverage after intervention. Male and privately insured patients of Creighton's Pediatric Clinic have lower HPV vaccination coverage than their counterparts. More direct efforts are needed in vaccination process and policy in the clinic to improve immunization against HPV among children and adolescents.
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Affiliation(s)
- M Varman
- Creighton University School of Medicine, Omaha, NE, USA. .,Department of Pediatrics, Creighton University, Omaha, NE, USA.
| | - C Sharlin
- Creighton University School of Medicine, Omaha, NE, USA
| | - C Fernandez
- Creighton University School of Medicine, Omaha, NE, USA.,Department of Pediatrics, Creighton University, Omaha, NE, USA
| | - J Vasudevan
- Creighton University School of Medicine, Omaha, NE, USA.,Department of Pediatrics, Creighton University, Omaha, NE, USA
| | - C Wichman
- Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
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13
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Nguyen MN, Watanabe-Galloway S, Hill JL, Siahpush M, Tibbits MK, Wichman C. Ecological model of school engagement and attention-deficit/hyperactivity disorder in school-aged children. Eur Child Adolesc Psychiatry 2019; 28:795-805. [PMID: 30390147 DOI: 10.1007/s00787-018-1248-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/18/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
Abstract
School engagement protects against negative mental health outcomes; however, few studies examined the relationship between school engagement and attention-deficit hyperactivity disorder (ADHD) using an ecological framework. The aims were to examine: (1) whether school engagement has an independent protective association against the risk of ADHD in children, and (2) whether environmental factors have an association with ADHD either directly or indirectly via their association with school engagement. This cross-sectional study used data from the 2011-2012 National Survey of Children's Health, which collected information about children's mental health, family life, school, and community. The sample contained 65,680 children aged 6-17 years. Structural equation modeling was used to estimate the direct association of school engagement and ADHD and indirect associations of latent environmental variables (e.g., family socioeconomic status (SES), adverse childhood experiences (ACEs), environmental safety, and neighborhood amenities) and ADHD. School engagement had a direct and inverse relationship with ADHD (β = - 0.35, p < 0.001) such that an increase in school engagement corresponds with a decrease in ADHD diagnosis. In addition, family SES (β = - 0.03, p = 0.002), ACEs (β = 0.10, p < 0.001), environment safety (β = - 0.10, p < 0.001), and neighborhood amenities (β = - 0.01, p = 0.025) all had an indirect association with ADHD via school engagement. In conclusion, school engagement had a direct association with ADHD. Furthermore, environmental correlates showed indirect associations with ADHD via school engagement. School programs targeted at reducing ADHD should consider family and community factors in their interventions.
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Affiliation(s)
- Minh N Nguyen
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Jennie L Hill
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Mohammad Siahpush
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Melissa K Tibbits
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Christopher Wichman
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
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14
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Luzarraga J, Wichman C, Shirk R, Jarosz C, Weaver MS. Using a Mindfulness-Based Intervention to Support the Resiliency of In-Patient Pediatric Respiratory Therapists. Respir Care 2019; 64:550-554. [DOI: 10.4187/respcare.06483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Merickel J, High R, Smith L, Wichman C, Frankel E, Smits K, Drincic A, Desouza C, Gunaratne P, Ebe K, Rizzo M. Driving Safety and Real-Time Glucose Monitoring in Insulin-Dependent Diabetes. ACTA ACUST UNITED AC 2019; 10:34-40. [PMID: 34306907 DOI: 10.20485/jsaeijae.10.1_34] [Citation(s) in RCA: 9] [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] [Indexed: 11/03/2022]
Abstract
Our goal is to address the need for driver-state detection using wearable and in-vehicle sensor measurements of driver physiology and health. To address this goal, we deployed in-vehicle systems, wearable sensors, and procedures capable of quantifying real-world driving behavior and performance in at-risk drivers with insulin-dependent type 1 diabetes mellitus (DM). We applied these methodologies over 4 weeks of continuous observation to quantify differences in real-world driver behavior profiles associated with physiologic changes in drivers with DM (N=19) and without DM (N=14). Results showed that DM driver behavior changed as a function of glycemic state, particularly hypoglycemia. DM drivers often drive during at-risk physiologic states, possibly due to unawareness of impairment, which in turn may relate to blunted physiologic responses (measurable heart rate) to hypoglycemia after repeated episodes of hypoglycemia. We found that this DM driver cohort has an elevated risk of crashes and citations, which our results suggest is linked to the DM driver's own momentary physiology. Overall, our findings demonstrate a clear link between at-risk driver physiology and real-world driving. By discovering key relationships between naturalistic driving and parameters of contemporaneous physiologic changes, like glucose control, this study directly advances the goal of driver-state detection through wearable physiologic sensors as well as efforts to develop "gold standard" metrics of driver safety and an individualized approach to driver health and wellness.
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Affiliation(s)
- Jennifer Merickel
- University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences 988440 Nebraska Medical Center, Omaha, NE, 68198
| | - Robin High
- University of Nebraska Medical Center, College of Public Health, Biostatistics 984355 Nebraska Medical Center, Omaha, NE, 68198
| | - Lynette Smith
- University of Nebraska Medical Center, College of Public Health, Biostatistics 984355 Nebraska Medical Center, Omaha, NE, 68198
| | - Christopher Wichman
- University of Nebraska Medical Center, College of Public Health, Biostatistics 984355 Nebraska Medical Center, Omaha, NE, 68198
| | - Emily Frankel
- University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences 988440 Nebraska Medical Center, Omaha, NE, 68198
| | - Kaitlin Smits
- University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences 988440 Nebraska Medical Center, Omaha, NE, 68198
| | - Andjela Drincic
- University of Nebraska Medical Center, Department of Internal Medicine, Division of Diabetes, Endocrinology & Metabolism 984130 Nebraska Medical Center, Omaha, NE, 68198
| | - Cyrus Desouza
- University of Nebraska Medical Center, Department of Internal Medicine, Division of Diabetes, Endocrinology & Metabolism 984130 Nebraska Medical Center, Omaha, NE, 68198
| | - Pujitha Gunaratne
- Toyota Motor Engineering & Manufacturing North America Inc., Collaborative Safety Research Center 1555 Woodridge Avenue, Ann Arbor, MI, 48105
| | - Kazutoshi Ebe
- Toyota Motor Engineering & Manufacturing North America Inc., Collaborative Safety Research Center 1555 Woodridge Avenue, Ann Arbor, MI, 48105
| | - Matthew Rizzo
- University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences 988440 Nebraska Medical Center, Omaha, NE, 68198
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16
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Weaver MS, Pawliuk C, Wichman C. Use of an Electronic Journal Club to Increase Access to and Acceptance of Palliative Care Literature across General Pediatricians and Pediatric Subspecialties. J Palliat Med 2019; 22:50-53. [DOI: 10.1089/jpm.2018.0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Meaghann S. Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha, Omaha, Nebraska
| | - Colleen Pawliuk
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
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17
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Weekly T, Riley B, Wichman C, Tibbits M, Weaver M. Impact of a Massage Therapy Intervention for Pediatric Palliative Care Patients and Their Family Caregivers. J Palliat Care 2018; 34:164-167. [DOI: 10.1177/0825859718810727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Taelyr Weekly
- Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Beverly Riley
- Division of Pediatric Palliative Care, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Christopher Wichman
- Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Melissa Tibbits
- Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Meaghann Weaver
- Division of Pediatric Palliative Care, Children’s Hospital and Medical Center, Omaha, NE, USA
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18
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Nordgren TM, Heires AJ, Zempleni J, Swanson BJ, Wichman C, Romberger DJ. Bovine milk-derived extracellular vesicles enhance inflammation and promote M1 polarization following agricultural dust exposure in mice. J Nutr Biochem 2018; 64:110-120. [PMID: 30476878 DOI: 10.1016/j.jnutbio.2018.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 12/21/2022]
Abstract
Occupational agricultural dust exposure can cause severe lung injury, including COPD and asthma exacerbations. Cell-derived extracellular vesicles can mediate inflammatory responses and immune activation, but the contribution of diet-derived extracellular vesicles to these processes is poorly understood. We investigated whether bovine milk-derived extracellular vesicles modulate inflammatory responses to agricultural dust exposures in a murine model. C57BL/6 mice were fed either an extracellular vesicle-enriched modification of the AIN-93G diet with lyophilized bovine milk (EV) or a control diet wherein the milk was presonicated, disrupting the milk extracellular vesicles and thereby leading to RNA degradation (DEV). Mice were maintained on the diets for 5-7 weeks and challenged with a single (acute) intranasal instillation of a 12.5% organic dust extract (DE) or with 15 instillations over 3 weeks (repetitive exposure model). Through these investigations, we identified significant interactions between diet and DE when considering numerous inflammatory outcomes, including lavage inflammatory cytokine levels and cellular infiltration into the lung airways. DE-treated peritoneal macrophages also demonstrated altered polarization, with EV-fed mouse macrophages exhibiting an M1 shift compared to an M2 phenotype in DEV-fed mice (IL-6, TNF, IL-12/23 all significantly elevated, and IL-10 and arginase decreased in EV macrophages, ex vivo). In complementary in vitro studies, mouse macrophages treated with purified milk-derived EV were found to express similar polarization phenotypes upon DE stimulation. These results suggest a role for dietary extracellular vesicles in the modulation of lung inflammation in response to organic dust which may involve macrophage phenotype polarization.
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Affiliation(s)
- Tara M Nordgren
- Pulmonary, Critical Care, Sleep and Allergy Division, University of Nebraska Medical Center, Omaha, NE, 68198; Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, 92521.
| | - Art J Heires
- Pulmonary, Critical Care, Sleep and Allergy Division, University of Nebraska Medical Center, Omaha, NE, 68198.
| | - Janos Zempleni
- Nebraska Center for the Prevention of Obesity Diseases, Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE, 68588.
| | - Benjamin J Swanson
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, 68198.
| | - Christopher Wichman
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198.
| | - Debra J Romberger
- Pulmonary, Critical Care, Sleep and Allergy Division, University of Nebraska Medical Center, Omaha, NE, 68198; VA Nebraska-Western Iowa Health Care System, Omaha, NE, 68105.
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19
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Weaver MS, Wolfe A, Walker N, Wichman C. Personalize the Patient Initiative: A Demedicalized Medical Chart Cover Page for Children Receiving Palliative Care. J Palliat Med 2018; 21:583-584. [DOI: 10.1089/jpm.2017.0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meaghann S. Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha, Omaha, Nebraska
| | - Abby Wolfe
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha, Omaha, Nebraska
| | - Nikki Walker
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha, Omaha, Nebraska
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
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20
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Grindstaff TL, Chaput M, Farmer B, Anderson K, Lanier AS, Lanier AS, Knarr BA, Wichman C, Turman KA. Decreased Gait Variability Following Anterior Cruciate Ligament Reconstruction Negatively Impacts Patient Function. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535117.61829.06] [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: 11/21/2022]
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21
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Weaver M, Wichman C, Darnall C, Bace S, Vail C, MacFadyen A. Proxy-Reported Quality of Life and Family Impact for Children Followed Longitudinally by a Pediatric Palliative Care Team. J Palliat Med 2017; 21:241-244. [PMID: 28956672 DOI: 10.1089/jpm.2017.0092] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND One goal of pediatric palliative care is to maintain quality of life for children and their families. Quality-of-life investigations may be enhanced by considering clinically important metrics in addition to statistical significance. OBJECTIVE The purpose of this study was to longitudinally evaluate the effect of time on quality of life and family impact for pediatric palliative care patients across all diagnoses and ages. DESIGN This prospective quality-of-life study included administration of a 23-item PedsQL™ Measurement Model to evaluate for physical, emotional, social, and cognitive dimensions of the child's quality of life and a 36-item PedsQL Family Impact Module to assess for the familial impact at time of initial palliative care consultation, Month 6, and Month 12. SETTING/SUBJECTS All pediatric patients who received a palliative care consultation in our Midwestern free-standing children's hospital over a five-year period were included in the longitudinal study (n = 87). MEASUREMENTS Repeated measures ANOVA was used to investigate how proxy-reported quality of life and family impact changed with time with attentiveness to also follow trends in minimal clinically important difference (MCID) metrics. RESULTS The emotional domain showed a statistically significant positive trend over the first six months of palliative care involvement (p = 0.049), while the physical domain (p = 0.028) and daily activity (p = 0.039) showed a positive improvement for the full year. In using a standard of MCID, the physical, emotional, and cognitive domains improved in the quality-of-life scale and the communication, worry, and daily activity domains improved in the family impact scale over 12 months. CONCLUSIONS In considering quality-of-life analyses for pediatric palliative care programmatic improvements, providers may consider analyzing not only for statistical significance in collective data sets but also for clinically important difference over time.
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Affiliation(s)
- Meaghann Weaver
- 1 Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska
| | - Christopher Wichman
- 2 Department of Biostatistics, University of Nebraska Medical Center , Omaha, Nebraska
| | - Cheryl Darnall
- 1 Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska
| | - Sue Bace
- 1 Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska
| | - Catherine Vail
- 1 Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska
| | - Andrew MacFadyen
- 1 Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska.,3 Division of Pediatric Critical Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska
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22
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Weaver MS, Darnall C, Bace S, Vail C, MacFadyen A, Wichman C. Trending Longitudinal Agreement between Parent and Child Perceptions of Quality of Life for Pediatric Palliative Care Patients. Children (Basel) 2017; 4:children4080065. [PMID: 28763047 PMCID: PMC5575587 DOI: 10.3390/children4080065] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/01/2017] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Abstract
Pediatric palliative care studies often rely on proxy-reported instead of direct child-reported quality of life metrics. The purpose of this study was to longitudinally evaluate quality of life for pediatric patients receiving palliative care consultations and to compare patient-reported quality of life with parent perception of the child’s quality of life across wellness domains. The 23-item PedsQL™ V4.0 Measurement Model was utilized for ten child and parent dyads at time of initial palliative care consultation, Month 6, and Month 12 to assess for physical, emotional, social, and cognitive dimensions of quality of life as reported independently by the child and by the parent for the child. Findings were analyzed using Bland–Altman plots to compare observed differences to limits of agreement. This study revealed overall consistency between parent- and child-reported quality of life across domains. Physical health was noted to be in closest agreement. At the time of initial palliative care consult, children collectively scored their social quality of life higher than parental perception of the child’s social quality of life; whereas, emotional and cognitive quality of life domains were scored lower by children than by the parental report. At the one year survey time point, the physical, emotional, and social domains trended toward more positive patient perception than proxy perception with congruence between quality of life scores for the cognitive domain. Findings reveal the importance of eliciting a child report in addition to a parent report when measuring and longitudinally trending perceptions on quality of life.
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Affiliation(s)
- Meaghann S Weaver
- Children's Hospital and Medical Center Omaha, Division of Palliative Care, 8200 Dodge Street, Omaha, NE 68114, USA.
| | - Cheryl Darnall
- Children's Hospital and Medical Center Omaha, Division of Palliative Care, 8200 Dodge Street, Omaha, NE 68114, USA.
| | - Sue Bace
- Children's Hospital and Medical Center Omaha, Division of Palliative Care, 8200 Dodge Street, Omaha, NE 68114, USA.
| | - Catherine Vail
- Children's Hospital and Medical Center Omaha, Division of Palliative Care, 8200 Dodge Street, Omaha, NE 68114, USA.
| | - Andrew MacFadyen
- Children's Hospital and Medical Center Omaha, Division of Palliative Care, 8200 Dodge Street, Omaha, NE 68114, USA.
| | - Christopher Wichman
- University of Nebraska Medical Center, Department of Biostatistics, Omaha, NE 68198, USA.
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23
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Weaver M, Schroeder D, Wichman C, Bace S, Vail C, Macfadyen A. Pediatric Palliative Care Needs Assessments: From Paper Forms to Actionable Patient Care. J Palliat Med 2017; 20:216-217. [PMID: 28103131 DOI: 10.1089/jpm.2016.0507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Meaghann Weaver
- 1 Hand in Hand/Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska
| | - Denice Schroeder
- 1 Hand in Hand/Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska
| | - Christopher Wichman
- 2 Department of Biostatistics, University of Nebraska Medical Center , Omaha, Nebraska
| | - Sue Bace
- 1 Hand in Hand/Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska
| | - Catherine Vail
- 1 Hand in Hand/Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska
| | - Andrew Macfadyen
- 1 Hand in Hand/Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska.,3 Division of Pediatric Critical Care, Children's Hospital and Medical Center Omaha , Omaha, Nebraska
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Vallabhajosyula S, Sundaragiri P, Ahmed A, Rayes H, Mahfood Haddad T, Buaisha H, Khan A, Pershwitz G, Nawaz MS, McCann D, Wichman C, Holmberg M, Morrow L. Influence of Comorbid Risk Factors and Prehospital Medications on Patients With Heart Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Chest 2015. [DOI: 10.1378/chest.2259459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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25
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Vallabhajosyula S, Kanmanthareddy A, Sundaragiri P, Ahmed A, Mahfood Haddad T, Rayes H, Khan A, Buaisha H, Pershwitz G, Nawaz MS, McCann D, Wichman C, Holmberg M, Morrow L. Left Ventricular Hypertrophy as a Predictor of B-Type Natriuretic Peptide Levels and In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Five-Year Retrospective Analysis. Chest 2015. [DOI: 10.1378/chest.2260308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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26
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Au T, Malesker M, Hilleman D, Walters R, Wichman C, Morrow L. A Retrospective Analysis of Dexmedetomidine Use for Alcohol Withdrawal Syndrome in Critical Care Patients. Chest 2014. [DOI: 10.1378/chest.1991617] [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: 11/01/2022] Open
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27
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Wagner M, Vonk J, Wichman C, Hegde A, Oliveto J. Calculated radiation exposure for trauma patients is lower when using the New Injury Severity Score versus the Injury Severity Score to calculate injury severity. Crit Care 2014. [PMCID: PMC4068211 DOI: 10.1186/cc13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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28
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Culic DD, Battaglia MC, Wichman C, Schmid FR. Efficacy of compression gloves in rheumatoid arthritis. Am J Phys Med 1979; 58:278-84. [PMID: 517640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Twenty-three patients with rheumatoid arthritis whose disease had become stabilized while receiving non-steroidal, anti-inflammatory drugs and/or gold salt injections entered an 8 week crossover study in which the effect of a compression glove worn during sleep was compared to a loosely fitting glove made of the same material. Improvement in hand symptoms was greater with the compression glove than with the control glove as regards morning stiffness, pain, night time throbbing, numbness or heaviness and a subjective assessment of swelling (p = 0.01). In addition, swelling of the proximal interphalangeal joints was slightly reduced (p = 0.05). These data suggest that the night time use of compression gloves in patients with rheumatoid arthritis can improve hand symptoms and exert a mild, transiently beneficial effect upon the degree of hand swelling.
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