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Rawcliffe N, Elder D, Dobinson H. Time to first dose of antibiotics in febrile neonates. J Paediatr Child Health 2023; 59:718-722. [PMID: 36999339 DOI: 10.1111/jpc.16375] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 04/01/2023]
Abstract
AIM To assess whether febrile neonates from the community received their first dose of intravenous antibiotics within 1 h from time of arrival, as per the regional paediatric sepsis pathway, at a tertiary combined adult/child emergency department in New Zealand. METHOD Retrospective data were collected from January 2018 to December 2019 with 28 patients included. RESULTS Mean time to first antibiotic dose for all neonates and those with serious bacterial infection was 3 h 20 min and 2 h 53 min respectively. No case used the paediatric sepsis pathway. A pathogen was identified in 19/28 (67%) neonates and 16/28 (57%) had clinical signs of shock. CONCLUSION This study adds to Australasian data on community neonatal sepsis. Antibiotic administration was delayed for neonates with serious bacterial infection, clinical signs of shock and raised lactate. The reasons for delay are examined, with a number of potential areas for improvement identified.
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Affiliation(s)
- Nicholas Rawcliffe
- Te Wao Nui Child Health, Capital Coast and Hutt Valley District Health, Wellington, New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Hazel Dobinson
- Te Wao Nui Child Health, Capital Coast and Hutt Valley District Health, Wellington, New Zealand
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2
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Elder D, Miller J, Douglas B, Stanley J, McDowall P, Campbell A. Children talking about their sleep: a cross-sectional survey of differences by ethnicity and socioeconomic status in Aotearoa New Zealand primary schools. J Clin Sleep Med 2023; 19:119-133. [PMID: 36591794 PMCID: PMC9806790 DOI: 10.5664/jcsm.10264] [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] [Received: 03/26/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES This study examined differences by ethnicity and socioeconomic status in attitudes to sleep and bedtime routine, as self-reported by children aged 7-9 years. METHODS Four groups of parent-child dyads were recruited: Māori participants from low- (n = 18) and high- (n = 17) decile schools and New Zealand European participants from low- (n = 18) and high- (n = 17) decile schools. Children completed a questionnaire about their sleep, a self-report of anxiety symptoms, and a semistructured interview. RESULTS Most (77%) children reported liking to go to sleep (Māori, 88% vs New Zealand European, 65%; P = .053) and 28% reported trouble sleeping. Māori children were less likely to report fear of the dark and fighting about going to bed. Liking going to sleep was associated with less fear of the dark and of sleeping alone. Children from low-decile schools more often reported waking with pain and feeling sleepy (P = .022) and taking naps (P = .018) during the day. They also had more symptoms of anxiety. New Zealand European children more frequently reported using "screen time" (P = .02) or "reading a book" (P = .05). Children attending high-decile schools were more likely to read at bedtime (P = .01), whereas children attending low-decile schools were more likely to have "play time" (P = .02). Children were able to articulate what was a good night and bad night sleep. CONCLUSIONS These findings suggest that more adverse differences in sleep habits and attitudes in children are most likely to be related to socioeconomic status than to ethnicity. CITATION Elder D, Miller J, Douglas B, Stanley J, McDowall P, Campbell A. Children talking about their sleep: a cross-sectional survey of differences by ethnicity and socioeconomic status in Aotearoa New Zealand primary schools. J Clin Sleep Med. 2023;19(1):119-133.
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Affiliation(s)
- Dawn Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - James Miller
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Bronte Douglas
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Dean’s Department, University of Otago, Wellington, New Zealand
| | - Philippa McDowall
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Angela Campbell
- Department of Medicine, University of Otago, Wellington, New Zealand
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3
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Elder D, Gandhi S, Campbell A. CPAP for paediatric patients in Aotearoa New Zealand: audit of a developing service at Capital and Coast DHB 2005-2020. N Z Med J 2022; 135:62-71. [PMID: 35728205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIMS To document the establishment of a Paediatric Continuous Positive Airway Pressure (CPAP) service within the Wellington Region, and review outcomes over the last 15 years. METHODS A retrospective audit of the Paediatric Sleep Service records including clinic letters and polysomnography (PSG) studies for all paediatric patients commenced on CPAP treatment, or for whom CPAP treatment was offered, from November 2005 to December 2020. Data were collected on demographics, medical diagnoses, indications for respiratory support, ENT involvement and surgery. Factors related to CPAP use were also recorded. RESULTS Seventy-four children were offered CPAP in the time frame, 52 (70%) male. The age range at onset of CPAP treatment was <1 year of age to 23 years with 12 cases ≥16 years of age. There were 3 (4%) cases presenting before 2006, 11 (15%) cases from 2006-2010, 16 (22%) cases from 2011-2015 and 44 (59%) cases between 2016-2020. Ethnicities included were, 32 (43%) NZ European, 18 (24%) Māori, 19 (26%) Pacific and 5 (7%) Indian/Asian. The most common primary diagnoses were Obesity 21 (28%), Down Syndrome 10 (14%) and Craniofacial abnormalities 8 (11%). One family declined a CPAP trial and there were eight failed CPAP trials. For the remaining 65 patients, compliance with treatment was good/usually good for 25, variable for 19, and poor for 21. Māori patients were less likely to have good/usually good compliance than NZ European and Pacific patients (25% versus 44% and 47% respectively). CONCLUSION Referrals for CPAP treatment in the paediatric age range are increasing and obesity is the commonest co-morbidity. Services need to be culturally appropriate to ensure the best outcomes.
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Affiliation(s)
- Dawn Elder
- Professor and HOD, Department of Paediatrics and Child Health, University of Otago, Wellington, Child Health Services, Capital and Coast DHB
| | - Sophie Gandhi
- Medical Student (at time study undertaken), Otago Medical School
| | - Angela Campbell
- Manager, WellSleep, Department of Medicine, University of Otago Wellington
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4
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Affiliation(s)
- Lucy Zwimpfer
- Paediatrics and Child Health University of Otago Wellington Wellington New Zealand
| | - Dawn Elder
- Paediatrics and Child Health University of Otago Wellington Wellington New Zealand
- Child Health, Capital and Coast District Health Board Wellington New Zealand
| | - John G. Lewis
- Steroid and Immunobiochemistry Laboratory Canterbury Health Laboratories Christchurch New Zealand
| | - James Stanley
- Dean’s Department Biostatistical Group University of Otago Wellington Wellington New Zealand
| | - Esko Wiltshire
- Paediatrics and Child Health University of Otago Wellington Wellington New Zealand
- Child Health, Capital and Coast District Health Board Wellington New Zealand
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5
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Marsters B, Shi B, Wheeler BJ, Boucher S, Macaulay G, Galland B, Elder D, Larsen P, Wiltshire E. Advanced ECG analysis of cardiac function in children and adolescents with type 1 diabetes-a pilot study. Acta Diabetol 2021; 58:1119-1122. [PMID: 33774731 DOI: 10.1007/s00592-021-01704-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Brooke Marsters
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Bhija Shi
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
- Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand
| | - Sara Boucher
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Grace Macaulay
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Barbara Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
- Child Health Service, Capital and Coast District Health Board, Wellington, New Zealand
| | - Peter Larsen
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Esko Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand.
- Child Health Service, Capital and Coast District Health Board, Wellington, New Zealand.
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6
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Elder D, McDowall P, Sim D, Campbell A. Sleep in New Zealand children aged 7-9: associations with ethnicity, socioeconomic status, and achievement in reading and mathematics. J Clin Sleep Med 2021; 16:847-854. [PMID: 32039752 DOI: 10.5664/jcsm.8342] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aims were (1) to investigate differences by ethnicity and socioeconomic status (SES) in objective measures of sleep in children aged 7-9 years and (2) determine whether measures of sleep predict child achievement in reading or mathematics after controlling for ethnicity and SES. METHODS Four groups of parent-child dyads were recruited: Māori, low-SES schools (n = 18); Māori, high-SES schools (n = 17); New Zealand European, low-SES schools (n = 18); New Zealand European, high-SES schools (n = 17). Child sleep was measured by actigraphy. Parents and teachers reported child daytime sleepiness and behavior, and children completed a self-report of anxiety symptoms. Teachers also reported on child achievement in reading and mathematics. RESULTS Children from low-SES schools went to bed later on school nights (F[1,68] = 12.150, P = .001) and woke later (F[1,68] = 15.978, P < .001) than children from high-SES schools but had similar sleep duration. There were no differences related to ethnicity. Children from low-SES schools were almost 3 times more likely to be below national standards for mathematics. Children not meeting academic standards in mathematics had a later sleep start time, lower sleep period efficiency, and a decreased total sleep time. However, when SES and sleep period efficiency were modeled together neither were found to significantly influence achievement in mathematics. CONCLUSIONS In this study, SES influenced sleep timing but not the quality and quantity of sleep in 7- to 9-year-old children, and a significant independent effect of sleep efficiency on learning could not be demonstrated.
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Affiliation(s)
- Dawn Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Philippa McDowall
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Dalice Sim
- Department of the Dean, University of Otago, Wellington, New Zealand
| | - Angela Campbell
- Department of Medicine, University of Otago, Wellington, New Zealand
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7
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Macaulay GC, Galland BC, Boucher SE, Wiltshire EJ, Haszard JJ, Campbell AJ, Black SM, Smith C, Elder D, Wheeler BJ. Impact of type 1 diabetes mellitus, glucose levels, and glycemic control on sleep in children and adolescents: a case-control study. Sleep 2021; 43:5580781. [PMID: 31583407 DOI: 10.1093/sleep/zsz226] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/04/2018] [Revised: 07/03/2019] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES To assess differences in habitual sleep patterns and sleep states between children and adolescents with type 1 diabetes mellitus (T1DM) and control subjects, and to explore the relationships between sleep, glucose levels, and glycemic control. METHODS Participants included 82 children (5-18 years); 41 with T1DM (cases), and 41 healthy control subjects group matched for age and sex. Sleep was measured by 7-day actigraphy and single-night home-based polysomnography (PSG) recordings. Hemoglobin A1c (HbA1c) and 7 days of continuous glucose monitoring (CGM) data were collected in cases. Regression analyses were used to model all within- and between-group comparisons adjusted for age, sex, and BMI z-scores. RESULTS There were no significant differences in sleep duration, efficiency, or awakenings as measured by actigraphy and PSG between cases and controls, nor sleep states measured by PSG. However, cases had significantly later sleep onset and offset than controls (both p < 0.05), partially moderated by age. Cases with suboptimal glycemic control (HbA1c ≥ 58 mmol/mol [≥7.5%]) had significantly shorter actigraphy-derived total sleep time (TST) (mean difference = -40 minutes; 95% confidence interval = -77, -3), with similar differences in TST measured by PSG. Cases with mean CGM glucose levels ≥10 mmol/L (≥180 mg/dL) on PSG night had significantly more stage N3 (%) sleep and less stage REM (%) sleep (both p < 0.05). CONCLUSIONS Short- and long-term suboptimal glycemic control in T1DM children appears to be associated with sleep alterations. Pediatric diabetes care teams should be aware of potential interrelationships between sleep and T1DM, including management and glycemic control.
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Affiliation(s)
- Grace C Macaulay
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Sara E Boucher
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Jillian J Haszard
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Angela J Campbell
- WellSleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand and
| | - Stephanie M Black
- WellSleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand and
| | - Claire Smith
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand
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8
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Doyle M, Watson D, Nguyen M, Wu J, Elder D, Ng M, Morton R, Keech A, Shah K, Harris J, Woldendorp K, Seco M. M19 Case Volume, Demographics and Surgical Risk Trends of Patients Undergoing Surgical and Transcatheter Aortic Valve Replacement. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.028] [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: 11/15/2022]
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9
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Shah K, Woldendorp K, Harris J, Keech A, Morton R, Ng M, Elder D, Seco M, Nguyen M, Turner L, Wu J, Watson D, Doyle M. R29 Hospital Resource Use and Costs of Isolated Aortic Valve Replacement Procedures in Patients with aortic stenosis, by STS risk scores in New South Wales, Australia. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.187] [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: 11/25/2022]
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10
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Neels A, Tuohy P, Elder D. Training and confidence in undertaking child protection work as reported by New Zealand paediatricians. J Paediatr Child Health 2020; 56:107-113. [PMID: 31140681 DOI: 10.1111/jpc.14504] [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: 12/13/2018] [Revised: 04/08/2019] [Accepted: 05/05/2019] [Indexed: 11/27/2022]
Abstract
AIM In New Zealand and rural Australia, general paediatricians undertake the majority of child protection (CP) medical assessments. This study aimed to document what New Zealand paediatricians think about their role in CP and their perceived preparedness for this work. METHODS A 43-item SurveyMonkey questionnaire was sent to paediatricians working in CP. Questions explored demographic detail, CP work undertaken clinically and with regard to teaching and paediatrician confidence and experience in areas of CP. A separate questionnaire documented organisational CP work. RESULTS A total of 79 paediatricians, 45 (57%) female, responded from 15 of 20 District Health Boards. For 73%, CP was less than 10% of their weekly workload, with 42% indicating they had been the lead paediatrician for fewer than five cases in the preceding 12 months. Paediatricians were more confident managing physical abuse than sexual abuse cases with regard to initial assessments, report writing and appearances in court. Just over a third reported at least once feeling personally threatened or unsafe while involved in a CP case. Only 29% were satisfied with their level of training, and 73% agreed they would like more CP training. CONCLUSIONS Paediatricians undertake a number of roles in CP but do not feel confident in all these roles. More attention needs to be given to training in CP in general paediatric physician training in New Zealand.
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Affiliation(s)
- Aimee Neels
- Child Youth and Health, Ministry of Health, Wellington, New Zealand
| | - Pat Tuohy
- Child Youth and Health, Ministry of Health, Wellington, New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
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11
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Shah K, Elder D, Nguyen M, Turner L, Doyle M, Woldendorp K, Seco M, Law C, Wilson M, Keech A, Ng M, Morton R. 628 Transcatheter Aortic Valve Implantation (TAVI) Versus Surgical Aortic Valve Replacement (SAVR) for Aortic Stenosis: A Cost-Comparison Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.635] [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: 11/28/2022]
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12
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Twiss J, Chawla J, Davey MJ, Edwards EA, Elder D, Francis A, Griffiths MA, Pamula Y, Suresh S, Verginis N, Nixon GM. Overnight oximetry for evaluating paediatric obstructive sleep apnoea: Technical specifications and interpretation guidelines. J Paediatr Child Health 2019; 55:1279. [PMID: 31629377 DOI: 10.1111/jpc.14586] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jacob Twiss
- Respiratory Department, Starship Children's Hospital, Auckland, New Zealand
| | - Jasneek Chawla
- Department of Respiratory and Sleep Medicine Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Queensland University, Brisbane, Queensland, Australia
| | - Margot J Davey
- Department of Paediatrics Monash University Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | | | - Dawn Elder
- Department of Paediatrics and Child Health, Otago University, Wellington, New Zealand
| | - Alana Francis
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Mandie A Griffiths
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Yvonne Pamula
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Sadasivam Suresh
- Department of Respiratory and Sleep Medicine Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Nicola Verginis
- Department of Paediatrics Monash University Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- Department of Paediatrics Monash University Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
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13
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Wellington G, Campbell A, Elder D. Intermittent hypoxia in preterm infants: Measurement using the desaturation index. Pediatr Pulmonol 2019; 54:865-872. [PMID: 30924319 DOI: 10.1002/ppul.24276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/16/2018] [Accepted: 01/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aims of this study were to: (i) Determine in preterm infants at neonatal discharge the prevalence of intermittent hypoxia (IH), as measured by the oxygen desaturation index (DSI) recorded by pulse oximetry and (ii) Determine the change in values for very preterm infants at 1-month post discharge. METHODS Preterm infants were recruited from the Wellington regional neonatal intensive care unit (NICU) and 24-h pulse oximetry recordings performed immediately before discharge. Infants born <32 weeks gestational age (GA) had repeat oximetry 1-month post discharge. Oxygenation measures included the 3% and 4% desaturation (DSI 3%, DSI 4%) indices. RESULTS At discharge from the neonatal unit the median and interquartile range (IQR) for DSI 4% was 51 (31-74) events per hour with normal mean SpO2 (median of 97.9% [97.2-98.8 IQR]). Episodes of IH 1 month post discharge decreased with improvements of between 42% and 57% seen for the three DSI measures. Infants <32 weeks GA had higher median DSI 3 and 4% values at discharge but differences when compared with late preterm infants were not significant. CONCLUSIONS Preterm infants have frequent episodes of IH as measured by the 3% and 4% DSI when deemed otherwise ready for discharge home. Further research in a larger cohort of very preterm infants and also in term infants is needed to determine the significance of this finding.
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Affiliation(s)
- Grace Wellington
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Angela Campbell
- Department of , Medicine, University of Otago, Wellington, New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
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14
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Shah K, Nguyen M, Seco M, Elder D, Turner L, Wu J, Doyle M, Watson D, Woldendorp K, Keech A, Ng M, Morton R. Comparing Hospital Costs Of Trans-Catheter Aortic Valve Replacement and Isolated Surgical Aortic Valve Replacement in Patients with Aortic Stenosis Treated in New South Wales, Australia. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.463] [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: 11/27/2022]
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15
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Elder D, Ng M, Morton R, Keech A, Seco M, Shah K, Turner L, Nguyen M, Woldendorp K, Doyle M, Wu J, Watson D. A Comparison of the Number and Demographics of Patients Undergoing Either Isolated Surgical or a Trans-Catheter Aortic Valve Replacement Following the Introduction of a TAVI Program. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.459] [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: 10/26/2022]
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16
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MacFarlane M, Thompson JMD, Zuccollo J, McDonald G, Elder D, Stewart AW, Lawton B, Percival T, Baker N, Schlaud M, Fleming P, Taylor B, Mitchell EA. Smoking in pregnancy is a key factor for sudden infant death among Māori. Acta Paediatr 2018; 107:1924-1931. [PMID: 29869345 DOI: 10.1111/apa.14431] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 11/27/2022]
Abstract
AIM To examine the sudden unexpected death in infancy (SUDI) disparity between Māori and non-Māori in New Zealand. METHODS A nationwide prospective case-control study ran from March 2012 to February 2015. Exposure to established SUDI risk factors was analysed to investigate the disparity experienced by Māori. Infant ethnicity was based on mother's ethnicity. Māori ethnicity was prioritised. Non-Māori includes Pacific, Asian, NZ European and Other. RESULTS There were 137 cases and 649 controls. The Māori SUDI rate was 1.41/1000 live births compared to 0.53/1000 for non-Māori. Parents/caregivers of 132 cases (96%) and 258 controls (40%) were interviewed. Smoking in pregnancy was associated with an equally increased SUDI risk for Māori (adjusted OR = 8.11, 95% CI = 2.64, 24.93) and non-Māori (aOR = 5.09, 95% CI = 1.79, 14.47), as was bed-sharing (aOR = 3.66, 95% CI = 1.49, 9.00 vs aOR = 11.20, 95% CI = 3.46, 36.29). Bed-sharing prevalence was similar; however, more Māori controls smoked during pregnancy (46.7%) than non-Māori (22.8%). The main contributor relating to increased SUDI risk for Māori/non-Māori infants is the combination of smoking in pregnancy and bed sharing. CONCLUSION The association between known SUDI risk factors, including bed sharing and/or smoking in pregnancy and SUDI risk, is the same regardless of ethnicity. Māori infants are exposed more frequently to both behaviours because of the higher Māori smoking rate.
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Affiliation(s)
- M MacFarlane
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - J M D Thompson
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - J Zuccollo
- University of Otago; Wellington New Zealand
| | - G McDonald
- University of Otago; Dunedin New Zealand
| | - D Elder
- University of Otago; Wellington New Zealand
| | - A W Stewart
- University of Auckland; Auckland New Zealand
| | - B Lawton
- Centre for Women's Health Research; Victoria University of Wellington; Wellington New Zealand
| | - T Percival
- University of Auckland; Auckland New Zealand
| | - N Baker
- Nelson Hospital; Nelson New Zealand
| | - M Schlaud
- Robert Koch University; Berlin Germany
| | | | - B Taylor
- University of Otago; Dunedin New Zealand
| | - E A Mitchell
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
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17
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Wellington G, Elder D, Campbell A. 24-hour oxygen saturation recordings in preterm infants: editing artefact. Acta Paediatr 2018; 107:1362-1369. [PMID: 29476622 DOI: 10.1111/apa.14293] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 11/28/2017] [Revised: 01/31/2018] [Accepted: 02/19/2018] [Indexed: 11/30/2022]
Abstract
AIM To create editing guidelines for artefact removal in preterm infant pulse oximetry recordings. METHODS 38 preterm infants ready for discharge home from the neonatal intensive care unit underwent 24-hour pulse oximetry recording using the Masimo® Rad-8 device. An expert panel determined editing rules based on clinical protocols. For each recording, three reports were generated, 'raw' no editing, 'auto' using the software editing feature and 'manual' reviewed and edited according to the rules. Primary outcome measures were desaturation indices including desaturation index 3% and 4%. Secondary measures included heart rate, mean oxygen saturation and time below 90%. RESULTS While all oximetry outcomes differed significantly between editing modes, the majority were not considered likely to influence clinical management. Use of the auto editing compared to no editing did alter by >5%: Time spent <90% oxygen saturation and Desaturation index 4% >10 seconds. The use of manual editing removed extremely low pulse values that were considered unphysiological in this group of otherwise healthy infants. CONCLUSION We recommend that oximetry recordings to determine cardiorespiratory stability in newborn infants ready for discharge from the neonatal unit have software editing features applied. This will remove artefact without consuming time in a busy unit.
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Affiliation(s)
- Grace Wellington
- Department of Paediatrics and Child Health; University of Otago Wellington; Wellington New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health; University of Otago Wellington; Wellington New Zealand
| | - Angela Campbell
- Department of Medicine; University of Otago Wellington; Wellington New Zealand
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Roberts T, Campbell A, Larsen P, Elder D. Preterm infants at discharge: nap polysomnography versus 24-hour oximetry. Acta Paediatr 2017; 106:1754-1759. [PMID: 28471526 DOI: 10.1111/apa.13900] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/08/2017] [Accepted: 04/28/2017] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to determine whether measures of intermittent hypoxia derived from 24-hour oximetry correlate with measures of apnoea derived from modified nap polysomnography undertaken for preterm infants before discharge. METHODS Infants born ≤32 weeks of gestation were recruited from the neonatal intensive care unit and had a modified polysomnography to assess their respiratory stability once they were ≥35 weeks of postmenstrual age. Infants were defined as unstable if they had more than 10 obstructive events per hour or any apnoea of >20 seconds in length. Infants also had a 24-hour oximetry performed during this period. The results of the 24-oximetry desaturation index (DSI) were compared to nap polysomnography results for central and obstructive apnoea indices and correlations tested. RESULTS Twenty-four infants completed the study. There were 15 (63%) infants defined as unstable by the modified polysomnography. The 3% DSI and 4% DSI from the 24-hour oximetry were significantly higher in the unstable infants, and values for all infants correlated with the obstructive index and the central apnoea index from the modified polysomnography. CONCLUSION The 3% DSI and 4% DSI values from a 24-hour oximetry study may provide noninvasive measures of respiratory stability in preterm infants ready for discharge.
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Affiliation(s)
- Tamsin Roberts
- Department of Paediatrics and Child Health; University of Otago; Wellington New Zealand
| | - Angela Campbell
- Department of Medicine; University of Otago; Wellington New Zealand
| | - Peter Larsen
- Department of Surgery and Anaesthesia; University of Otago; Wellington New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health; University of Otago; Wellington New Zealand
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Mitchell EA, Thompson JM, Zuccollo J, MacFarlane M, Taylor B, Elder D, Stewart AW, Percival T, Baker N, McDonald GK, Lawton B, Schlaud M, Fleming P. The combination of bed sharing and maternal smoking leads to a greatly increased risk of sudden unexpected death in infancy: the New Zealand SUDI Nationwide Case Control Study. N Z Med J 2017; 130:52-64. [PMID: 28571049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Despite a major reduction in overall infant mortality, sudden unexpected death in infancy (SUDI) continues to be of concern in New Zealand, as the rate is high by international standards, and is even higher in indigenous Māori. AIM To identify modifiable risk factors for SUDI. METHODS A three-year (1 March 2012-28 February 2015) nationwide case-control study was conducted in New Zealand. RESULTS There were 137 SUDI cases, giving a SUDI mortality rate of 0.76/1,000 live births. The rate for Māori was 1.41/1,000, Pacific 1.01/1,000 and non-Māori non-Pacific (predominantly European) 0.50/1,000. The parent(s) of 97% of the SUDI cases were interviewed. Six hundred and forty-nine controls were selected and 258 (40%) were interviewed. The two major risk factors for SUDI were: maternal smoking in pregnancy (adjusted OR=6.01, 95% CI=2.97, 12.15) and bed sharing (aOR=4.96, 95% CI=2.55, 9.64). There was a significant interaction (p=0.002) between bed sharing and antenatal maternal smoking. Infants exposed to both risk factors had a markedly increased risk of SUDI (aOR=32.8, 95% CI=11.2, 95.8) compared with infants not exposed to either risk factor. Infants not sharing the parental bedroom were also at increased risk of SUDI (aOR=2.77, 95% CI=1.45, 5.30). Just 21 cases over the three-year study were not exposed to smoking in pregnancy, bed sharing or front or side sleeping position. CONCLUSIONS This study has shown that many of the risk factors that were identified in the original New Zealand Cot Death Study (1987-1989) are still relevant today. The combination of maternal smoking in pregnancy and bed sharing is extremely hazardous for infants. Furthermore, our findings indicate that the SUDI prevention messages are still applicable today and should be reinforced. SUDI mortality could be reduced to just seven p.a. in New Zealand (approximately one in 10,000 live births).
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Affiliation(s)
- Edwin A Mitchell
- Professorial Research Fellow, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland
| | - John Md Thompson
- Epidemiologist/Statistician, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland
| | - Jane Zuccollo
- Perinatal Pathologist, Department of Obstetrics and Gynaecology, University of Otago, Wellington
| | | | - Barry Taylor
- Dean, Department of the Dean, Dunedin School of Medicine, University of Otago, Dunedin
| | - Dawn Elder
- Professor and HOD, Department of Paediatrics and Child Health, University of Otago, Wellington
| | - Alistair W Stewart
- Biostatistician, Section of Epidemiology & Biostatistics, School of Population Health, University of Auckland, Auckland
| | - Teuila Percival
- Senior Lecturer, Pacific Health Section, School of Population Health, University of Auckland, Auckland
| | | | - Gabrielle K McDonald
- Senior Lecturer, Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin
| | - Bev Lawton
- Senior Research Fellow, Department of Obstetrics and Gynaecology: Women's Health Research Centre, University of Otago, Wellington
| | - Martin Schlaud
- Professor of Epidemiology, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Peter Fleming
- Professor of Infant Health and Developmental Physiology, School of Social and Community Medicine, University of Bristol, Bristol, England
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Muller D, Signal L, Elder D, Gander P. Environmental and behavioural factors associated with school children's sleep in Aotearoa/New Zealand. J Paediatr Child Health 2017; 53:68-74. [PMID: 27586066 DOI: 10.1111/jpc.13268] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/27/2016] [Accepted: 05/17/2016] [Indexed: 11/29/2022]
Abstract
AIM To collect objective and subjective sleep data on 6- to 8-year-old children across the week and to identify factors within the family environment associated with sleep differences. METHODS Data were collected (n = 52) using actigraphy and diaries for 7 consecutive days and nights and a questionnaire incorporating the Children's Sleep Habits Questionnaire was completed by parents. RESULTS Children's actigraphic sleep periods averaged 10 h on school nights and 9.5 h on non-school nights and parents over-estimated children's sleep compared with actigraphy. One third (37%) of children had potential sleep problems. Children who shared a bedroom (31%) had shorter sleep onset latencies and those who consumed caffeinated drinks (33%) went to sleep and awoke later. Increased screen time was associated with later bedtimes on school nights and children with screens in bedrooms (12%) went to bed later and slept less on school nights, and had higher Children's Sleep Habits Questionnaire scores. Children living with a shift-working adult (27%) slept longer on non-school nights and had shorter sleep onset latencies on school nights. CONCLUSIONS It is important to consider children's sleep within the wider family context and to be aware that parents may over-estimate their children's sleep. Simple strategies to promote sleep health in clinical settings or education programmes include regular weekend bedtimes that align with those on school nights, removing technology from bedrooms and minimising caffeine consumption. An awareness of potential sleep differences associated with shift-working adults may ensure children are supported to have consistent sleep routines that promote adequate sleep.
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Affiliation(s)
- Diane Muller
- Sleep/Wake Research Centre, Massey University, Wellington, New Zealand
| | - Leigh Signal
- Sleep/Wake Research Centre, Massey University, Wellington, New Zealand
| | - Dawn Elder
- Department of Paediatrics, University of Otago, Wellington, New Zealand
| | - Philippa Gander
- Sleep/Wake Research Centre, Massey University, Wellington, New Zealand
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Affiliation(s)
- Amanda J D'Souza
- Health Promotion & Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Marie Russell
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | - Louise Signal
- Health Promotion & Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Dawn Elder
- Department of Paediatrics & Child Health, University of Otago, Wellington, New Zealand
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McBeth R, Elder D, Kesner A. SU-F-J-182: Investigation of Systems for Improved Accuracy in Clinical Y-90 Percent Delivered Calculations. Med Phys 2016. [DOI: 10.1118/1.4956090] [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: 11/07/2022] Open
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Galland B, Spruyt K, Dawes P, McDowall PS, Elder D, Schaughency E. Sleep Disordered Breathing and Academic Performance: A Meta-analysis. Pediatrics 2015; 136:e934-46. [PMID: 26347434 DOI: 10.1542/peds.2015-1677] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [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] [Accepted: 07/21/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Sleep-disordered breathing (SDB) in children is associated with daytime functioning decrements in cognitive performance and behavioral regulation. Studies addressing academic achievement are underrepresented. This study aimed to evaluate the strength of the relationships between SDB and achievement in core domains and general school performance. METHODS Data sources included PubMed, Web of Science, CINAHL, and PsycINFO. Studies of school-aged children investigating the relationships between SDB and academic achievement were selected for inclusion in a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extracted were converted into standardized mean differences; effect sizes (ES) and statistics were calculated by using random-effects models. Heterogeneity tests (I(2)) were conducted. RESULTS Of 488 studies, 16 met eligibility criteria. SDB was significantly associated with poorer academic performance for core academic domains related to language arts (ES -0.31; P < .001; I(2) = 74%), math (ES -0.33; P < .001; I(2) = 55%), and science (ES -0.29; P = .001; I(2) = 0%), and with unsatisfactory progress/learning problems (ES -0.23; P < .001; I(2) = 0%) but not general school performance. CONCLUSIONS Variable definitions of both academic performance and SDB likely contributed to the heterogeneity among published investigations. Clear links between SDB and poorer academic performance in school-age children are demonstrated. ES statistics were in the small to medium range, but nevertheless the findings serve to highlight to parents, teachers, and clinicians that SDB in children may contribute to academic difficulties some children face.
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Affiliation(s)
| | - Karen Spruyt
- Department of Developmental and Behavioral Pediatrics, Jiao Tong University School of Medicine, Shanghai, China; Faculty of Psychology, Vrije Universiteit Brussel and School for Mental Health and Neurosciences, Maastricht University, Maastricht, Netherlands
| | - Patrick Dawes
- Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Philippa S McDowall
- Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, New Zealand; and
| | - Dawn Elder
- Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, New Zealand; and
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Elder D. Reducing the risk of sudden infant death--a steady gain but still room for improvement. N Z Med J 2015; 128:13-14. [PMID: 25662374] [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: 06/04/2023]
Affiliation(s)
- Dawn Elder
- Department of Paediatrics and Child Health, University of Otago - Wellington, PO Box 7343, Wellington, New Zealand.
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Weimann C, Schindler PC, Palmer R, Wolf S, Bekele D, Korn D, Pfeifle J, Koeber S, Schmogrow R, Alloatti L, Elder D, Yu H, Bogaerts W, Dalton LR, Freude W, Leuthold J, Koos C. Silicon-organic hybrid (SOH) frequency comb sources for terabit/s data transmission. Opt Express 2014; 22:3629-3637. [PMID: 24663654 DOI: 10.1364/oe.22.003629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We demonstrate frequency comb sources based on silicon-organic hybrid (SOH) electro-optic modulators. Frequency combs with line spacings of 25 GHz and 40 GHz are generated, featuring flat-top spectra with less than 2 dB power variations over up to 7 lines. The combs are used for WDM data transmission at terabit/s data rates and distances of up to 300 km.
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Brognaro E, Chang S, Cha J, Choi K, Choi C, DePetro J, Binding C, Blough M, Kelly J, Lawn S, Chan J, Weiss S, Cairncross G, Eisenbeis A, Goldbrunner R, Timmer M, Gabrusiewicz K, Cortes-Santiago N, Fan X, Hossain MB, Kaminska B, Heimberger A, Rao G, Yung WKA, Marini F, Fueyo J, Gomez-Manzano C, Halle B, Marcusson E, Aaberg-Jessen C, Jensen SS, Meyer M, Schulz MK, Andersen C, Bjarne, Kristensen W, Hashizume R, Ihara Y, Ozawa T, Parsa A, Clarke J, Butowski N, Prados M, Perry A, McDermott M, James D, Jensen R, Gillespie D, Martens T, Zamykal M, Westphal M, Lamszus K, Monsalves E, Jalali S, Tateno T, Ezzat S, Zadeh G, Nedergaard MK, Kristoffersen K, Poulsen HS, Stockhausen MT, Lassen U, Kjaer A, Ohka F, Natsume A, Zong H, Liu C, Hatanaka A, Katsushima K, Shinjo K, Wakabayashi T, Kondo Y, Picotte K, Li L, Westerhuis B, Zhao H, Plotkin S, James M, Kalamarides M, Zhao WN, Kim J, Stemmer-Rachamimov A, Haggarty S, Gusella J, Ramesh V, Nunes F, Rao G, Doucette T, Yang Y, Fuller G, Rao A, Schmidt NO, Humke N, Meissner H, Mueller FJ, Westphal M, Schnell O, Jaehnert I, Albrecht V, Fu P, Tonn JC, Schichor C, Shackleford G, Swanson K, Shi XH, D'Apuzzo M, Gonzalez-Gomez I, Sposto R, Seeger R, Erdreich-Epstein A, Moats R, Sirianni RW, Heffernan JM, Overstreet DJ, Sleire L, Skeie BS, Netland IA, Heggdal J, Pedersen PH, Enger PO, Stiles C, Sun Y, Mehta S, Taylor C, Alberta J, Sundstrom T, Wendelbo I, Daphu I, Hodneland E, Lundervold A, Immervoll H, Skaftnesmo KO, Babic M, Jendelova P, Sykova E, Lund-Johansen M, Bjerkvig R, Thorsen F, Synowitz M, Ku MC, Wolf SA, Respondek D, Matyash V, Pohlmann A, Waiczies S, Waiczies H, Niendorf T, Glass R, Kettenmann H, Thompson N, Elder D, Hopkins K, Iyer V, Cohen N, Tavare J, Thorsen F, Fite B, Mahakian LM, Seo JW, Qin S, Harrison V, Sundstrom T, Harter PN, Johnson S, Ingham E, Caskey C, Meade T, Skaftnesmo KO, Ferrara KW, Tschida BR, Lowy AR, Marek CA, Ringstrom T, Beadnell TJ, Wiesner SM, Largaespada DA, Wenger C, Miranda PC, Mekonnen A, Salvador R, Basser P, Yoon J, Shin H, Choi K, Choi C. TUMOR MODELS (IN VIVO/IN VITRO). Neuro Oncol 2013. [DOI: 10.1093/neuonc/not193] [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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Gibbs S, Wiltshire E, Elder D. Reply: To PMID 23102789. J Pediatr 2013; 163:307. [PMID: 23623532 DOI: 10.1016/j.jpeds.2013.03.046] [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: 10/26/2022]
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Gibbs S, Wiltshire E, Elder D. Nocturnal sleep measured by actigraphy in children with Prader-Willi syndrome. J Pediatr 2013; 162:765-9. [PMID: 23102789 DOI: 10.1016/j.jpeds.2012.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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] [Received: 03/18/2012] [Revised: 06/14/2012] [Accepted: 09/12/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess nocturnal sleep duration by actigraphy in children with Prader-Willi syndrome (PWS). STUDY DESIGN Baseline measurements including height, weight, and body mass index (BMI) were collected on 8 children with PWS (6 boys) with each subject age- and sex-matched to 2 control children. From 7 consecutive nights of actigraphy data, values for total sleep time (TST), sleep efficiency, sleep latency (SL), number of awakenings after sleep onset, and duration of awakenings after sleep onset (WASO) were extracted. Parents also completed a sleep diary and questionnaire during this period. RESULTS Subjects with PWS ranged from 4.2 to 15.4 years, and they had a lower height z score and higher BMI z score compared with controls. The PWS group had a shorter SL (P = .0007), longer WASO (P = .009), and higher daytime sleepiness score. TST, sleep efficiency, and number of awakenings after sleep onset were not significantly different between the groups, and subjects with PWS did not wake earlier than controls. There was no correlation between WASO and BMI or between WASO and sleepiness score. CONCLUSION Children with PWS appear to have a shorter SL but more time awake in the night than normal children and have similar TST and morning wake time compared with controls.
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Affiliation(s)
- Shiree Gibbs
- Department of Pediatrics and Child Health, University of Otago, Wellington, Wellington, New Zealand
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Birks S, Altinkaya M, Altinkaya A, Pilkington G, Kurian KM, Crosby C, Hopkins K, Williams M, Donovan L, Birks S, Eason A, Bosak V, Pilkington G, Birks S, Holliday J, Corbett I, Pilkington G, Keeling M, Bambrough J, Simpson J, Higgins S, Dogra H, Pilkington G, Kurian KM, Zhang Y, Bradley M, Schmidberger C, Hafizi S, Noorani I, Price S, Dubocq A, Jaunky T, Chatelain C, Evans L, Gaissmaier T, Pilkington GJ, An Q, Hurwitz V, Logan J, Bhangoo R, Ashkan K, Gullan A, Beaney R, Brazil L, Kokkinos S, Blake R, Singleton A, Shaw A, Iyer V, Kurian KM, Jeyapalan JN, Morley IC, Hill AA, Mumin MA, Tatevossian RG, Qaddoumi I, Ellison DW, Sheer D, Frary A, Price S, Jefferies S, Harris F, Burnet N, Jena R, Watts C, Haylock B, Leow-Dyke S, Rathi N, Wong H, Dunn J, Baborie A, Crooks D, Husband D, Shenoy A, Brodbelt A, Walker C, Bahl A, Larsen J, Craven I, Metherall P, McKevitt F, Romanowski C, Hoggard N, Jellinek DA, Bell S, Murray E, Muirhead R, James A, Hanzely Z, Jackson R, Stewart W, O'Brien A, Young A, Bell S, Hanzely Z, Stewart W, Shepherd S, Cavers D, Wallace L, Hacking B, Scott S, Bowyer D, Elmahdi A, Frary AJ, O'Donovan DG, Price SJ, Kia A, Przystal JM, Nianiaris N, Mazarakis ND, Mintz PJ, Hajitou A, Karakoula K, Phipps K, Harkness W, Hayward R, Thompson D, Jacques T, Harding B, Darling J, Warr T, Leow-Dyke S, Rathi N, Haylock B, Crooks D, Jenkinson M, Walker C, Brodbelt A, Zhou L, Ercolano E, Ammoun S, Schmid MC, Barczyk M, Hanemann CO, Rowther F, Dawson T, Ashton K, Darling J, Warr T, Maherally Z, Hatherell KE, Kroese K, Hafizi S, Pilkington GJ, Singh P, McQuaid S, Al-Rashid S, Prise K, Herron B, Healy E, Shoakazemi A, Donnelly M, McConnell R, Harney J, Conkey D, McGrath E, Lunsford L, Kondziolka D, Niranjan A, Kano H, Hamilton R, Flannery T, Majani Y, Smith S, Grundy R, Rahman R, Saini S, Hall G, Davis C, Rowther F, Lawson T, Ashton K, Potter N, Goessl E, Darling J, Warr T, Brodbelt A, Jenkinson M, Walker C, Leow-Dyke S, Haylock B, Dunn J, Wilkins S, Smith T, Petinou V, Nicholl I, Singh J, Lea R, Welsby P, Spiteri I, Sottoriva A, Marko N, Tavare S, Collins P, Price SJ, Watts C, Su Z, Gerhard A, Hinz R, Roncaroli F, Coope D, Thompson G, Karabatsou K, Sofat A, Leggate J, du Plessis D, Turkheimer F, Jackson A, Brodbelt A, Jenkinson M, Das K, Crooks D, Herholz K, Price SJ, Whittle IR, Ashkan K, Grundy P, Cruickshank G, Berry V, Elder D, Iyer V, Hopkins K, Cohen N, Tavare J, Zilidis G, Tibarewal P, Spinelli L, Leslie NR, Coope DJ, Karabatsou K, Green S, Wall G, Bambrough J, Brennan P, Baily J, Diaz M, Ironside J, Sansom O, Brunton V, Frame M, Young A, Thomas O, Mohsen L, Frary A, Lupson V, McLean M, Price S, Arora M, Shaw L, Lawrence C, Alder J, Dawson T, Hall G, Rada L, Chen K, Shivane A, Ammoun S, Parkinson D, Hanemann C, Pangeni RP, Warr TJ, Morris MR, Mackinnon M, Williamson A, James A, Chalmers A, Beckett V, Joannides A, Brock R, McCarthy K, Price S, Singh A, Karakoula K, Dawson T, Ashton K, Darling J, Warr T, Kardooni H, Morris M, Rowther F, Darling J, Warr T, Watts C, Syed N, Roncaroli F, Janczar K, Singh P, O'Neil K, Nigro CL, Lattanzio L, Coley H, Hatzimichael E, Bomalaski J, Szlosarek P, Crook T, Pullen NA, Anand M, Birks S, Van Meter T, Pullen NA, Anand M, Williams S, Boissinot M, Steele L, Williams S, Chiocca EA, Lawler S, Al Rashid ST, Mashal S, Taggart L, Clarke E, Flannery T, Prise KM. Abstracts from the 2012 BNOS Conference. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos198] [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: 11/13/2022] Open
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Abstract
AIM To review sudden unexpected infant deaths (SUDI) in the first 28 days of life referred to a Coronial Perinatal Forensic Pathology Service over a 10-year period from 2000 to 2009. METHODS Cases were collected from mortuary records, and a retrospective review of autopsy reports and other available infant records was undertaken. RESULTS Twenty-four neonatal SUDI were reviewed. For eight infants, a diagnosis was made at autopsy. For the remaining 16 infants, 14 (87.5%) were bedsharing at the time of death. Maori infants and those living in deprived neighbourhoods were over-represented. Only two infants were preterm, and four were growth-restricted. At post-mortem, white matter gliosis was found in 10 of the 16 (62.5%) unexplained SUDI cases. CONCLUSION Sudden unexpected infant deaths occur in the first month of life in association with bedsharing. Gliosis may be an important associated risk factor, and its presence indicates a previous insult of prenatal onset.
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Affiliation(s)
- May Chiu
- Medical Student, University of Otago, Wellington, New Zealand
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Wagner SN, Somasundaram R, Pinc A, Van Belle PA, Wagner C, Hoermann M, Karanikas G, Stingl G, Elder D, Herlyn M. CD20-immunotargeting of malignant melanoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8565] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
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Hannaford-Turner K, Elder D, Sim MR, Abramson MJ, Johnson AR, Yates DH. Surveillance of Australian workplace Based Respiratory Events (SABRE) in New South Wales. Occup Med (Lond) 2010; 60:376-82. [PMID: 20308261 DOI: 10.1093/occmed/kqq011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Surveillance of Australian workplace Based Respiratory Events (SABRE) New South Wales (NSW) scheme is a voluntary notification scheme established to determine the incidence of occupational lung diseases in NSW Australia. AIMS Data presented in this paper summarize the last 7 years of reporting to SABRE (June 2001 to December 2008). METHODS Every 2 months, participating occupational physicians, respiratory physicians and general practitioners (accredited by the NSW WorkCover Authority) reported new cases of occupational lung disease seen in their practices. Data collected include gender, age, causal agent and the occupations and industries believed responsible. Estimated incidence was calculated for each disease. RESULTS Three thousand six hundred and fifty-four cases were notified to the scheme, consisting of 3856 diagnoses. Most of the cases were males (76%). Pleural plaques [1218 (28%)] were the most frequently reported condition, followed by mesothelioma [919 (24%)]. Silicosis [90 (2%)] and occupational asthma [OA; 89 (2%)] were the most frequently reported non-asbestos-related diseases. Estimated rates for mesothelioma, diffuse pleural thickening (DPT) and OA were 83, 83 and 5 cases per million employed males per year, respectively. Trades such as carpenters and electricians associated with the building industry, electricity supply and asbestos product manufacture were the most common occupations and industries reported. CONCLUSIONS Asbestos-related diseases are the most frequently reported conditions to SABRE NSW. The very low incidence of OA for NSW most likely reflects under-diagnosis as well as under-reporting. Occupational lung disease is still occurring in NSW despite current preventative strategies. The SABRE scheme currently provides the only available information in this area.
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Affiliation(s)
- K Hannaford-Turner
- Workers' Compensation (Dust Diseases) Board Education & Research Unit, Sydney, New South Wales, Australia
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Yun S, Gimotty P, Hwang W, Dawson P, VanBelle P, Elder D, Elenitsas R, Guerry D, Schuchter L, Xu X. The biology and prognostic value of lymphatic vessel density (LD) and lymphatic invasion (LI) in regression in melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9017] [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] [Indexed: 11/20/2022] Open
Abstract
9017 Background: Regression in melanoma is characterized by increased vascularity, lymphocytic infiltrate and fibroplasia in the papillary dermis, accompanied by the absence (complete regression, CoR) or presence (partial regression, PaR) of melanoma cells in the epidermis. The prognostic value of regression is controversial. We noticed that LD and LI were increased in the areas of regression (AR) or areas with brisk lymphocytic infiltration (AB). Our goal was to clarify the prognostic value of regression in melanoma. Methods: Dual immunohistochemical staining was done using antibodies to podoplanin (lymphatic vessels) and S100 (melanoma cells) on paraffin tissues from 321 patients with vertical growth phase (VGP) primary melanomas who had 10 years or more of follow-up. LD in AR (both CoR and PaR) was compared with that of normal dermis adjacent and distant, as well as LD in the AB. LI in these areas was also scored. Unadjusted and adjusted hazard rates were obtained from univariate and multivariate Cox models for time to melanoma-specific death using established melanoma prognostic factors. Results: 116 patients (36%) had regression: 75 CoR (23%) and 41 PaR (13%). LD significantly decreased stepwise from CoR (mean ± se, 23.7 ± 2.7) to PaR (15.5 ± 1.1), adjacent normal dermis (7.3 ± 0.28) and distant normal dermis (5.4±0.31) and it was significantly elevated in the AB (18.5±0.78). Melanomas with CoR had the highest percentage of LI in both AR and AB. In addition, the percentage of LI in AB was highest for men and for those with VGP tumor infiltrating lymphocytes (TILs). Both high LD in AR and more LI in AB were associated with poor prognosis (p=0.004 and p=0.002, respectively). Six factors were significant in the final multivariate model: LI in AB (HR=2.3), LD in AR (HR=1.04), thickness (HR=1.44), axial (HR=7.7), ulceration (HR=2.5) and no VGP TILs (HR=2.8). Conclusions: AR and AB were associated with increased LD and higher incidence of LI in primary melanomas. LD and LI in AR or AB are independent prognostic factors. Our data suggest that the effects of regression on prognosis are mediated at least in part through lymphangiogenesis and LI. No significant financial relationships to disclose.
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Affiliation(s)
- S. Yun
- University of Pennsylvania, Philadelphia, PA
| | - P. Gimotty
- University of Pennsylvania, Philadelphia, PA
| | - W. Hwang
- University of Pennsylvania, Philadelphia, PA
| | - P. Dawson
- University of Pennsylvania, Philadelphia, PA
| | - P. VanBelle
- University of Pennsylvania, Philadelphia, PA
| | - D. Elder
- University of Pennsylvania, Philadelphia, PA
| | | | - D. Guerry
- University of Pennsylvania, Philadelphia, PA
| | | | - X. Xu
- University of Pennsylvania, Philadelphia, PA
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Gimotty P, Guerry D, VanBelle P, Montone K, Guerra M, Hwang W, Schuchter L, Xu X, Elder D. Ki67 as a prognostic biomarker for patients with vertical growth phase (VGP) melanomas. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9043] [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] [Indexed: 11/20/2022] Open
Abstract
9043 Background: In VGP melanomas proliferation is reflected in dermal mitotic figures (“mitogenic” VGP) and/or tumor cell nests larger than any epidermal nest. An alternative to mitotic rate (MR) to characterize cell proliferation is the expression of Ki67 protein. Since Ki67 is expressed in all phases of the cell cycle except G0, it is potentially a more robust biomarker for proliferation and prognosis than mitoses. Methods: To test the hypothesis that Ki67 would replace MR as a prognostic factor, we did a retrospective cohort study of 432 patients with Stage I/II primary VGP melanomas who had at least 10 years of follow up. Tissue sections were stained using the monoclonal antibody MIB-1 to Ki67 and the % of positive melanoma cells were evaluated by two readers. ROC curves for Ki67 and MR were computed. Predicted probabilities (PP) of 10-year melanoma-specific death were computed from 3 multivariate logistic regression models, one for each biomarker (Models 1 and 2) and one with both (Model 3), controlling for established melanoma prognostic factors (thickness, gender, anatomic site, ulceration, regression and tumor infiltrating lymphocytes), and compared. Cross-validation was used to assess differences between using Ki67 and using MR including the differences in PP, Brier scores and the misclassification rates. A decision curve analysis was done to assess the clinical net benefit of the two. Results: The areas under the ROC curve (AUCs) for Ki67 and MR, both continuous factors, were 0.69 and 0.79, respectively. In the multivariate analysis, Ki67 expression was significant in Model 1 (OR=1.03, 95% CI: 1.01–1.05), mitotic rate was not significant in Model 2 (1.05, 0.99–1.1), and only Ki67 was significant in Model 3 (1.03, 1.01–1.05). The AUCs for the three models were 0.84, 0.84, and 0.85, respectively. Based on cross-validation, there was no difference between the two biomarkers in PP, Brier scores, or misclassification rates. The decision cost analysis demonstrated the same net benefit for the two. Conclusions: A prospective study needs to be conducted to confirm that Ki67 and MR are equivalent. No significant financial relationships to disclose.
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Affiliation(s)
- P. Gimotty
- University of Pennsylvania, Philadelphia, PA
| | - D. Guerry
- University of Pennsylvania, Philadelphia, PA
| | - P. VanBelle
- University of Pennsylvania, Philadelphia, PA
| | - K. Montone
- University of Pennsylvania, Philadelphia, PA
| | - M. Guerra
- University of Pennsylvania, Philadelphia, PA
| | - W. Hwang
- University of Pennsylvania, Philadelphia, PA
| | | | - X. Xu
- University of Pennsylvania, Philadelphia, PA
| | - D. Elder
- University of Pennsylvania, Philadelphia, PA
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Xu X, Chen L, Hwang W, Dawson P, Guerry D, VanBelle P, Elder D, Schuchter L, Gimotty P. The prognostic significance of lymphatic invasion in primary melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9050] [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] [Indexed: 11/20/2022] Open
Abstract
9050 Background: Lymphatic invasion (LI) is an under-observed phenomenon in primary malignancies that can be better detected by immunostaining and that may associate with prognosis. In this study we sought to test the hypothesis that LI was associated with melanoma-specific survival (MSS) and was an independent prognostic factor. Methods: This study included 277 patients with stage I/II melanomas in vertical growth phase (VGP) who had at least 10 years of follow up. The log-rank test was used to test the study hypothesis - 72 melanoma-specific deaths were needed for 80% power to detect an odds ratio of 2.1. Paraffin sections were stained with antibodies to podoplanin (lymphatic vessels) and S-100 (melanoma cells) to identify LI. Univariate and multivariate Cox models were used to evaluate the prognostic significance of LI. An independent cohort of 106 similar patients was used for validation of the 10-year MSS rates. Results: LI was observed in 44.5% (95% CI: 38.6% - 50.4%) of the melanomas and its presence was significantly associated with thickness, mitotic rate, gender, age, and ulceration (U). The Kaplan-Meier survival curves for those with and without LI were significantly different (log-rank test p=0.022). The final multivariate model for time to MSD identified 4 independent prognostic factors: thickness (HR=1.5, p<0.001), U (HR=2.2 p=0.013), site (HR=3.9, p<0.001) and LI (HR=1.9, p=0.015). These factors were used to define a prognostic tree with 5 risk groups defined by melanomas that were thin (≤1.0mm) with no LI or U; thin with LI but no U; 1–3mm with no U; 1–3mm with U; and >3mm. Respectively, MSS rates were 100%, 88.6%, 77%, 48% and 42%. In the validation set, observed 10-year MSS rates in each risk group were not significantly different from those predicted from the survival curves for the tree-based risk groups. Conclusions: LI is an independent prognostic factor for MSS. Among patients with thin melanomas without U the 10-year MSS was lower for those patients with LI (89%, 95% CI=78% - 99%; n=41) compared to those without (100%, n=78). LI is an important prognostic factor that needs further validation in a population of patients from the sentinel node biopsy era. No significant financial relationships to disclose.
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Affiliation(s)
- X. Xu
- University of Pennsylvania, Philadelphia, PA
| | - L. Chen
- University of Pennsylvania, Philadelphia, PA
| | - W. Hwang
- University of Pennsylvania, Philadelphia, PA
| | - P. Dawson
- University of Pennsylvania, Philadelphia, PA
| | - D. Guerry
- University of Pennsylvania, Philadelphia, PA
| | - P. VanBelle
- University of Pennsylvania, Philadelphia, PA
| | - D. Elder
- University of Pennsylvania, Philadelphia, PA
| | | | - P. Gimotty
- University of Pennsylvania, Philadelphia, PA
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Newton Bishop JA, Beswick S, Randerson-Moor J, Chang Y, Affleck P, Elliott F, Elder D, Barrett J, Bishop T. Serum vitamin D levels, VDR, and survival from melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9016] [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] [Indexed: 11/20/2022] Open
Abstract
9016 Background: Vitamin D has pleiotropic effects, which may moderate the interaction between patients and their tumors. Two studies were carried out to test the hypothesis that higher vitamin D levels reduce the risk of relapse from melanoma. Methods: A pilot retrospective case-control study in 271 melanoma patients suggested that vitamin D may protect against recurrence of melanoma. We then tested these findings in a survival analysis in a cohort of 872 cases recruited to the Leeds Melanoma Cohort (median follow up of 4.7 years). Results: Pilot study Results suggested that taking vitamin D reduced the risk of relapse from melanoma (OR 0.6, 95% CI: 0.4, 1.1). Non-relapsers had higher mean 25-dihydroxyvitamin D3 levels than relapsers (49 nmol/L compared with 46, p=0.3). Cohort study Higher 25-dihydroxyvitamin D3 levels were associated with lower Breslow thickness at diagnosis and were independently protective of relapse and death: hazard ratio (HR) for relapse free survival (RFS) 0.76, 95% CI: (0.64, 0.96), for a 20nmol/L increase in serum level. There was evidence of interaction between the vitamin D receptor (VDR) BsmI genotype and serum 25-dihydroxyvitamin D3 levels on RFS. Conclusions: The pilot study provided preliminary evidence for a role for vitamin D in outcome from melanoma. The cohort study provided further evidence that higher 25-dihydroxyvitamin D3 levels, at diagnosis, were associated both with thinner tumors and better survival, independent of Breslow thickness, from melanoma. Melanoma patients should avoid vitamin D deficiency. Further studies are needed to establish optimal serum levels for melanoma patients. No significant financial relationships to disclose.
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Affiliation(s)
- J. A. Newton Bishop
- University of Leeds, Leeds, United Kingdom; University of Pensylvania, Philadelphia, PA
| | - S. Beswick
- University of Leeds, Leeds, United Kingdom; University of Pensylvania, Philadelphia, PA
| | - J. Randerson-Moor
- University of Leeds, Leeds, United Kingdom; University of Pensylvania, Philadelphia, PA
| | - Y. Chang
- University of Leeds, Leeds, United Kingdom; University of Pensylvania, Philadelphia, PA
| | - P. Affleck
- University of Leeds, Leeds, United Kingdom; University of Pensylvania, Philadelphia, PA
| | - F. Elliott
- University of Leeds, Leeds, United Kingdom; University of Pensylvania, Philadelphia, PA
| | - D. Elder
- University of Leeds, Leeds, United Kingdom; University of Pensylvania, Philadelphia, PA
| | - J. Barrett
- University of Leeds, Leeds, United Kingdom; University of Pensylvania, Philadelphia, PA
| | - T. Bishop
- University of Leeds, Leeds, United Kingdom; University of Pensylvania, Philadelphia, PA
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Kalra P, Pauriah M, Elder D, Lang CC. Going for gold, from Beijing to Munich, highlights from the ESC 2008 Congress: BEAUTIFUL, GISSI-HF, and potential new therapies for acute decompensated heart failure. Cardiovasc Ther 2008; 26:235-7. [PMID: 19035873 DOI: 10.1111/j.1755-5922.2008.00061.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wong A, Elder D, Zuccollo J. Changes in cause of neonatal death over a decade. N Z Med J 2008; 121:39-46. [PMID: 18677329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIMS To classify neonatal deaths at Wellington Hospital (Wellington, New Zealand) over a 10-year period and assess changes in cause of death over time. METHODS Retrospective audit from 1995-2004 of live-born infants > or = 20 weeks gestation dying before 28 days of age. Deaths were classified according to the PSANZ-NDC Classification guideline. The years 1995-1999 and 2000-2004 were compared to analyse for changes in cause of death. RESULTS There were 219 neonatal deaths: 67(31%) of these were term infants and 154 preterm; 109 infants from 1995-1999 and 110 from 2000-2004. The autopsy rate was 62% and highest in term infants (76%). Deaths due to congenital anomaly and extreme prematurity decreased over time and deaths due to infection increased. CONCLUSIONS Use of the PSANZ-NDC death classification system enables an accurate cause of death to be established for most neonatal deaths and allows monitoring of mortality rates over time.
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Affiliation(s)
- Annie Wong
- University of Otago, Wellington, New Zealand
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Fecher LA, Nathanson K, Flaherty KT, Amaravadi R, Giles L, McGettigan S, Carberry M, Elder D, Schuchter L. Phase I/II trial of imatinib and temozolomide in advanced unresectable melanoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Banu N, Buda A, Chell S, Elder D, Moorghen M, Paraskeva C, Qualtrough D, Pignatelli M. Inhibition of COX-2 with NS-398 decreases colon cancer cell motility through blocking epidermal growth factor receptor transactivation: possibilities for combination therapy. Cell Prolif 2007; 40:768-79. [PMID: 17877615 PMCID: PMC6496834 DOI: 10.1111/j.1365-2184.2007.00459.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 12/21/2022] Open
Abstract
UNLABELLED The use of non-steroidal anti-inflammatory drugs has proved of great interest in the prevention and treatment of colorectal cancer, although their precise mechanisms of action remain unclear. Overexpression of cyclooxygenase-2 (COX-2) and subsequent prostaglandin production promote metastasis and have been shown to increase cell motility in vitro. OBJECTIVE We have aimed to elucidate whether specific inhibition of COX-2 with NS-398 (NS-398 is a selective inhibitor of COX-2) would be able to inhibit motility of colorectal cancer cells and whether this was modulated through epidermal growth factor receptor (EGFR) transactivation. MATERIALS AND METHODS A transwell filter assay was used to study cell motility. Expression of COX-2, EGFR phosphorylation and prostaglandin E(2) (PGE(2)) receptors were assessed by Western blot analysis and reverse transcriptase-polymerase chain reaction. PGE(2) concentrations after NS-398 treatment were estimated by enzyme immunoassay. RESULTS Treatment with NS-398 significantly reduced PGE(2) levels and reduced cell migration in the HT29 and HCA7 colorectal carcinoma cell lines and this effect was rescued by addition of PGE(2). Furthermore, specific inhibition of COX-2 with NS-398 reduced EGFR phosphorylation in colorectal cancer cells. Direct inhibition of EGFR activity with AG1478 reduced PGE(2)-stimulated motility, clearly demonstrating that PGE(2 )acts via the EGFR-signalling pathway. The novel combination of NS-398 and AG1478 dramatically reduced migration of colorectal cancer cells. CONCLUSION The data presented indicate that the use of NS-398 in chemoprevention and adjuvant therapy for colorectal cancer may work in part, through the inhibition of cell motility. Furthermore, our data suggest that the combined use of non-steroidal anti-inflammatory drugs with EGFR antagonists could be explored further for future use in the clinic.
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Affiliation(s)
- N Banu
- Division of Histopathology, Department of Cellular and Molecular Medicine, School of Medical Sciences and Bristol Royal Infirmary, University of Bristol, Bristol, UK
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Elder D. Inflicted Ano-Genital Injuries in Children: Physical Abuse or Sexual Abuse? Forensic Sci Med Pathol 2006; 2:25-8. [DOI: 10.1385/fsmp:2:1:25] [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] [Accepted: 11/09/2005] [Indexed: 11/11/2022]
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Kruper L, Botbyl J, Czerniecki B, Elder D, Fraker D, Ming M, Schuchter L, Spitz F, Guerry D, Gimotty P. Predicting sentinel lymph node status in stage I/II melanoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- L. Kruper
- Univ of Pennsylvania, Philadelphia, PA
| | - J. Botbyl
- Univ of Pennsylvania, Philadelphia, PA
| | | | - D. Elder
- Univ of Pennsylvania, Philadelphia, PA
| | - D. Fraker
- Univ of Pennsylvania, Philadelphia, PA
| | - M. Ming
- Univ of Pennsylvania, Philadelphia, PA
| | | | - F. Spitz
- Univ of Pennsylvania, Philadelphia, PA
| | - D. Guerry
- Univ of Pennsylvania, Philadelphia, PA
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Abstract
Model organisms like Drosophila melanogaster or Caenorhabditis elegans have revealed genes that influence senescence and the evolvability of senescence. We are interested instead in evaluating why and how senescence evolves in natural populations. To do so, we are taking the ecological geneticist's perspective of comparing natural populations that differ in factors that are predicted to influence the evolution of senescence and are evaluating whether senescence has evolved in the predicted fashion. We are also manipulating the environment to evaluate more directly the evolution of senescence. Guppies (Poecilia reticulata) are found in streams throughout the Northern Range mountains of Trinidad. Natural populations experience large differences in mortality rate as a consequence of the predators with which they co-occur. We have already shown, both with comparative studies and manipulations of the distribution of guppies and their predators, that the early life history evolves very rapidly in response to these differences in mortality. For example, high adult mortality rates select for individuals that develop more rapidly, produce their first litter of young at an earlier age, and devote more of their available resources to reproduction for the remainder of their lives. These changes were predicted by independently derived theory. Aspects of this same theory also predict how the late life history and senescence should evolve. Specifically, theory predicts that the populations that experience low mortality rates should also experience delayed senescence and longer life spans relative to those that experience high mortality rates. We are currently evaluating these predictions with representatives from two high-predation and two low-predation environments. Our presentation will focus on our pilot study, which evaluated life span, lifetime reproduction, and the patterns of aging in our laboratory populations. We will also report on the progress in our ongoing comparative studies of senescence in natural populations.
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Affiliation(s)
- D Reznick
- Department of Biology, University of California, Riverside, CA 92521, USA.
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Halsted S, Elder D. Delays in the investigation of allegations of child sexual abuse in the Wellington city district 1995-1996: a retrospective study. N Z Med J 2001; 114:33-5. [PMID: 11277473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
AIMS To determine the duration of the statutory investigation process after referral of alleged chid sexual abuse and to assess which components of this process are most prone to delay. METHODS Retrospective review of police, Child Youth and Family (CYF) and medical records for 123 young persons <17 years old for whom a referral regarding alleged sexual abuse was made to the Wellington Serious Abuse Team from January 1995 to December 1996. RESULTS There were 82 (66.7%) females and 41 (33.3%) males referred. Maori and Pacific Island children were over-represented in the sample. The median time from referral to evidential interview or diagnostic interview was 47 days. This period was longer for children <5 years of age (66 days) compared with children > or =5 years of age (45.5 days), although this difference was not statistically significant. Although 53.3% of children alleged genital contact, only 26% were referred for a medical assessment. The time from initiation of investigation to completion was a median of 141 days. Reasons for delay were difficult to delineate but appeared to relate to inadequate staffing. CONCLUSIONS There is an unreasonable delay in the investigation of alleged child sexual abuse. This is particularly concerning in younger children.
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Affiliation(s)
- S Halsted
- Department of Paediatrics, Wellington School of Medicine, Otago University
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Li J, Pereira S, Van Belle P, Tsui P, Elder D, Speicher D, Deen K, Linnenbach A, Somasundaram R, Swoboda R, Herlyn D. Isolation of the melanoma-associated antigen p23 using antibody phage display. J Immunol 2001; 166:432-8. [PMID: 11123321 DOI: 10.4049/jimmunol.166.1.432] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The general responsiveness of human melanoma to immunotherapy has been well established, but active immunotherapy of melanoma has been hampered by insufficient information on the immunogenicity of melanoma-associated Ags in patients. In this study, we isolated a recombinant phage-Fab clone (A10-5) from a phage-Fab library derived from the B cells of a melanoma patient in remission after immunotherapy. Purified A10-5 Fab bound at high levels to cultured melanoma cell lines and to tissue sections of metastatic and vertical growth phase primary melanoma, but not to radial growth phase primary melanoma, nevi, or normal skin. A10-5 Fab bound to both the surface and the cytoplasm of cultured melanoma cells, but only to the cytoplasm of cultured fibroblasts. Western blot analysis revealed A10-5 Fab reactivity with a 33- and a 23-kDa glycoprotein under nonreducing conditions, and with a 23-kDa protein only under reducing conditions. A cDNA with an open reading frame predicted to encode a 23-kDa protein was cloned by screening a melanoma cell cDNA library with A10-5 Fab. This protein (p23) is the human homologue of the murine tumor transplantation Ag P198 that interacts with the cytoplasmic domain of ErbB-3 expressed by melanoma cells. Thus, the Ab phage display method has identified a novel, stage-specific melanoma-associated Ag that may have therapeutic and diagnostic value.
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Affiliation(s)
- J Li
- The Wistar Institute, Philadelphia, PA 19104
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Abstract
The introns-early view has been challenged for several genes; prominent instances are triose phosphate isomerase (TPI), aldolase, pyruvate kinase (PK), alcohol dehydrogenase (ADH), glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and myosin heavy chain. While some of their introns appear to be phylogenetically ancient and/or to delineate exons corresponding to protein modules, a considerable number seemingly do not. But it is argued here that many of these anomalous introns are periodic, that is, relics of internal sequence repetitions within the ancestral gene. Some of these periodic-intron patterns are shared between related genes, as in the alphabeta -barrels of TPI, aldolase and PK, or the Rossmann nucleotide-binding domain common to PK, ADH and GAPDH. This is further evidence for the ancestral status of these introns. The myosin heavy chain C-terminal rod region is paradoxical in that its sequence is clearly periodic but its intron placements are not; however, they exhibit a remarkable coherence of intron translational phases, suggesting that these introns may also have originally had a periodic arrangement now obscured by intron slipping.
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Affiliation(s)
- D Elder
- School of Pharmacy, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
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Tuthill D, Elder D, Pringle K, Richardson V, Selby R, Robinson R. Posterior urethral valves: failure of antenatal diagnosis. N Z Med J 2000; 113:333-4. [PMID: 11008610] [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: 02/17/2023]
Affiliation(s)
- D Tuthill
- Department of Paediatrics, University Hospital of Wales, Cardiff
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