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Kumar S, King E, Binns HJ, Christison A, Cuda SE, Yee JK, Joseph M, Kirk S. Diabetes screening outcomes in youth presenting for paediatric weight management: A report of the Paediatric Obesity Weight Evaluation Registry. Pediatr Obes 2024; 19:e13102. [PMID: 38296252 DOI: 10.1111/ijpo.13102] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Rising prevalence of obesity has led to increased rates of prediabetes and diabetes mellitus (DM) in children. This study compares rates of prediabetes and diabetes using two recommended screening tests (fasting plasma glucose [FPG] and haemoglobin A1c [HbA1c]). STUDY DESIGN Data were collected prospectively from 37 multi-component paediatric weight management programs in POWER (Paediatric Obesity Weight Evaluation Registry). RESULTS For this study, 3962 children with obesity without a known diagnosis of DM at presentation and for whom concurrent measurement of FPG and HbA1c were available were evaluated (median age 12.0 years [interquartile range, IQR 9.8, 14.6]; 48% males; median body mass index 95th percentile [%BMIp95] 134% [IQR 120, 151]). Notably, 10.7% had prediabetes based on FPG criteria (100-125 mg/dL), 18.6% had prediabetes based on HbA1c criteria (5.7%-6.4%), 0.9% had DM by FPG abnormality (≥126 mg/dL) and 1.1% had DM by HbA1c abnormality (≥6.5%). Discordance between the tests was observed for youth in both age groups (10-18 years [n = 2915] and age 2-9 years [n = 1047]). CONCLUSION There is discordance between FPG and HbA1c for the diagnosis of prediabetes and DM in youth with obesity. Further studies are needed to understand the predictive capability of these tests for development of DM (in those diagnosed with prediabetes) and cardiometabolic risk.
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Affiliation(s)
- Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Helen J Binns
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Christison
- Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Suzanne E Cuda
- Alamo City Healthy Kids and Families, San Antonio, Texas, USA
| | - Jennifer K Yee
- Division of Pediatric Endocrinology, Harbor-UCLA Medical Center and The Lundquist Institute of Biomedical Innovation at Harbor-UCLA, Torrance, California, USA
| | - Madeline Joseph
- College of Medicine, University of Florida, Jacksonville, Florida, United States
| | - Shelley Kirk
- Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Maleyeff L, Newburger JW, Wypij D, Thomas NH, Anagnoustou E, Brueckner M, Chung WK, Cleveland J, Cunningham S, Gelb BD, Goldmuntz E, Hagler DJ, Huang H, King E, McQuillen P, Miller TA, Norris‐Brilliant A, Porter GA, Roberts AE, Grant PE, Im K, Morton SU. Association of genetic and sulcal traits with executive function in congenital heart disease. Ann Clin Transl Neurol 2024; 11:278-290. [PMID: 38009418 PMCID: PMC10863927 DOI: 10.1002/acn3.51950] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/06/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Persons with congenital heart disease (CHD) are at increased risk of neurodevelopmental disabilities, including impairments to executive function. Sulcal pattern features correlate with executive function in adolescents with single-ventricle heart disease and tetralogy of Fallot. However, the interaction of sulcal pattern features with genetic and participant factors in predicting executive dysfunction is unknown. METHODS We studied sulcal pattern features, participant factors, and genetic risk for executive function impairment in a cohort with multiple CHD types using stepwise linear regression and machine learning. RESULTS Genetic factors, including predicted damaging de novo or rare inherited variants in neurodevelopmental disabilities risk genes, apolipoprotein E genotype, and principal components of sulcal pattern features were associated with executive function measures after adjusting for age at testing, sex, mother's education, and biventricular versus single-ventricle CHD in a linear regression model. Using regression trees and bootstrap validation, younger participant age and larger alterations in sulcal pattern features were consistently identified as important predictors of decreased cognitive flexibility with left hemisphere graph topology often selected as the most important predictor. Inclusion of both sulcal pattern and genetic factors improved model fit compared to either alone. INTERPRETATION We conclude that sulcal measures remain important predictors of cognitive flexibility, and the model predicting executive outcomes is improved by inclusion of potential genetic sources of neurodevelopmental risk. If confirmed, measures of sulcal patterning may serve as early imaging biomarkers to identify those at heightened risk for future neurodevelopmental disabilities.
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Affiliation(s)
- Lara Maleyeff
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Jane W. Newburger
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Department of CardiologyBoston Children's HospitalBostonMassachusettsUSA
| | - David Wypij
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Department of CardiologyBoston Children's HospitalBostonMassachusettsUSA
| | - Nina H. Thomas
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and Center for Human Phenomic ScienceChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Evdokia Anagnoustou
- Department of PediatricsHolland Bloorview Kids Rehabilitation Hospital, University of TorontoTorontoOntarioCanada
| | - Martina Brueckner
- Department of GeneticsYale University School of MedicineNew HavenConnecticutUSA
- Department of PediatricsYale University School of MedicineNew HavenConnecticutUSA
| | - Wendy K. Chung
- Department of PediatricsColumbia University Medical CenterNew YorkNew YorkUSA
- Department of MedicineColumbia University Medical CenterNew YorkNew YorkUSA
| | - John Cleveland
- Department of Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sean Cunningham
- Division of General Pediatrics, Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Bruce D. Gelb
- Mindich Child Health and Development Institute and Department of PediatricsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of PediatricsChildren's Hospital of Philadelphia, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Donald J Hagler
- Center for Multimodal Imaging and GeneticsUniversity of California San DiegoSan DiegoCaliforniaUSA
- Department of Radiology, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Hao Huang
- Department of RadiologyChildren's Hospital of Philadelphia, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Eileen King
- Department of PediatricsUniversity of CincinnatiCincinnatiOhioUSA
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Patrick McQuillen
- Department of PediatricsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Thomas A. Miller
- Department of PediatricsPrimary Children's Hospital, University of UtahSalt Lake CityUtahUSA
- Division of Pediatric CardiologyMaine Medical CenterPortlandMaineUSA
| | - Ami Norris‐Brilliant
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - George A. Porter
- Department of PediatricsUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Amy E. Roberts
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Department of CardiologyBoston Children's HospitalBostonMassachusettsUSA
- Division of Genetics and GenomicsBoston Children's HospitalBostonMassachusettsUSA
| | - P. Ellen Grant
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Division of Newborn Medicine, Department of PediatricsBoston Children's HospitalBostonMassachusettsUSA
- Fetal Neonatal Neuroimaging and Developmental Science CenterBoston Children's HospitalBostonMassachusettsUSA
- Department of RadiologyBoston Children's HospitalBostonMassachusettsUSA
| | - Kiho Im
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Division of Newborn Medicine, Department of PediatricsBoston Children's HospitalBostonMassachusettsUSA
- Fetal Neonatal Neuroimaging and Developmental Science CenterBoston Children's HospitalBostonMassachusettsUSA
| | - Sarah U. Morton
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Division of Newborn Medicine, Department of PediatricsBoston Children's HospitalBostonMassachusettsUSA
- Fetal Neonatal Neuroimaging and Developmental Science CenterBoston Children's HospitalBostonMassachusettsUSA
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King E, Al‐Nahdi S, Ludwig N. Anaesthetic management of a parturient with an unrepaired coronary arteriovenous fistula for caesarean section. Anaesth Rep 2024; 12:e12276. [PMID: 38234877 PMCID: PMC10792593 DOI: 10.1002/anr3.12276] [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] [Accepted: 01/02/2024] [Indexed: 01/19/2024] Open
Abstract
Coronary arteriovenous fistulas are an abnormal conduit between a coronary artery and another cardiovascular lumen, without an intervening capillary bed. The reported prevalence is 0.002-0.3%. Physiologic consequences such as congestive heart failure, coronary steal phenomenon and fistula aneurysm formation and rupture are possible. There are limited reports of symptomatic coronary arteriovenous fistulas in association with pregnancy. We describe a 19-year-old woman with symptomatic left circumflex artery to coronary sinus fistula, terminating into a large exophytic varix in the right atrium, presenting for an elective caesarean section at 37 weeks gestational age. Our anaesthetic management strategy aimed to optimise myocardial perfusion, maintain euvolemia, avoid right ventricular obstruction from exophytic varix and avoid sympathetic stimulation or sudden increases in pulmonary vascular resistance. A slowly titrated epidural was used as the primary anaesthetic. Our patient tolerated the procedure well and was discharged home on postoperative day two. Understanding of the potential physiologic consequence of coronary arteriovenous fistulas, and interaction with the physiologic changes of pregnancy and delivery, are essential for the management of these cases.
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Affiliation(s)
- E. King
- Department of Anesthesiology and Perioperative MedicineWestern UniversityLondonONCanada
| | - S. Al‐Nahdi
- Department of Anesthesiology and Perioperative MedicineWestern UniversityLondonONCanada
| | - N. Ludwig
- Department of Anesthesiology and Perioperative MedicineWestern UniversityLondonONCanada
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Christison A, Tucker J, King E, Sweeney B, Cuda S, Frank M, Kirk S. Treating Children and Adolescents With Obesity: Characteristics of Success. Child Obes 2023. [PMID: 37971786 DOI: 10.1089/chi.2023.0083] [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] [Indexed: 11/19/2023]
Abstract
Background: Factors related to clinically meaningful outcomes for pediatric patients seeking care for severe obesity are not well known. Examining patient-level and program-level characteristics related to success may inform future care. Objectives: To determine factors associated with a clinically significant reduction in weight status measured by %BMIp95 after 6 months of treatment. Study Design: This is a retrospective study of youth 5-17 years of age seeking multicomponent weight management care to determine if patient characteristics, treatment recommendations, reported adherence, and additional program-affiliated class participation are associated with 6-month change in %BMIp95. Results: Among 170 children with obesity, higher reductions in %BMIp95 were seen in those with medium-high dietary adherence compared to low-none (-10.8 vs. -4.0, p = 0.002). Post hoc analysis showed higher dietary adherence among those with private insurance than public insurance (59% vs. 41%, respectively, p = 0.04). Conclusion: Children receiving multidisciplinary multicomponent weight management, who achieve clinically meaningful outcomes, are more likely to be adherent to dietary recommendations regardless of the type. Further study is needed of how best to address social determinants of health to improve dietary adherence. Clinical Trial Registration Number: NCT02121132.
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Affiliation(s)
- Amy Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Jared Tucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brooke Sweeney
- Department of General Academic Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, USA
- Children's Center for Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Suzanne Cuda
- Alamo City Healthy Kids & Families, San Antonio, TX, USA
| | - Michelle Frank
- The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Aertsen M, Melbourne A, Couck I, King E, Ourselin S, De Keyzer F, Dymarkowski S, Deprest J, Lewi L. Placental differences between uncomplicated and complicated monochorionic diamniotic pregnancies on diffusion and multicompartment Magnetic Resonance Imaging. Placenta 2023; 142:106-114. [PMID: 37683336 DOI: 10.1016/j.placenta.2023.09.001] [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: 03/27/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Twin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are common complications in monochorionic diamniotic (MCDA) pregnancies. The Diffusion-rElaxation Combined Imaging for Detailed Placental Evaluation (DECIDE) model, a placental-specific model, separates the T2 values of the fetal and maternal blood from the background tissue and estimates the fetal blood oxygen saturation. This study investigates diffusion and relaxation differences in uncomplicated MCDA pregnancies and MCDA pregnancies complicated by TTTS and sFGR in mid-pregnancy. METHODS This prospective monocentric cohort study included uncomplicated MCDA pregnancies and pregnancies complicated by TTTS and sFGR. We performed MRI with conventional diffusion-weighted imaging (DWI) and combined relaxometry - DWI-intravoxel incoherent motion. DECIDE analysis was used to quantify different parameters within the placenta related to the fetal, placental, and maternal compartments. RESULTS We included 99 pregnancies, of which 46 were uncomplicated, 12 were complicated by sFGR and 41 by TTTS. Conventional DWI did not find differences between or within cohorts. On DECIDE imaging, fetoplacental oxygen saturation was significantly lower in the smaller member of sFGR (p = 0.07) and in both members of TTTS (p = 0.01 and p = 0.004) compared to the uncomplicated pairs. Additionally, average T2 relaxation time was significantly lower in the smaller twin of the sFGR (p = 0.004) compared to the uncomplicated twins (p = 0.03). CONCLUSION Multicompartment functional MRI showed significant differences in several MRI parameters between the placenta of uncomplicated MCDA pregnancies and those complicated by sFGR and TTTS in mid-pregnancy.
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Affiliation(s)
- M Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium.
| | - A Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Medical Physics and Biomedical Engineering, University College London, UK
| | - I Couck
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - E King
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - S Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Medical Physics and Biomedical Engineering, University College London, UK
| | - F De Keyzer
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - S Dymarkowski
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - J Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium; Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St.Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - L Lewi
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
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Dick S, Kyle R, Wilson P, Aucott L, France E, King E, Malcolm C, Hoddinott P, Turner SW. Insights from and limitations of data linkage studies: analysis of short-stay urgent admission referral source from routinely collected Scottish data. Arch Dis Child 2023; 108:300-306. [PMID: 36719837 DOI: 10.1136/archdischild-2022-324171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/14/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION This study identified the referral source for urgent short-stay admissions (SSAs) and compared characteristics of children with SSA stratified by different referral sources. METHODS Routinely acquired data from urgent admissions to Scottish hospitals during 2015-2017 were linked to data held by the three referral sources: emergency department (ED), out-of-hours (OOH) service and general practice (GP). RESULTS There were 171 039 admissions including 92 229 (54%) SSAs. Only 171 (19%) of all of Scotland's GP practices contributed data. Among the subgroup of 10 588 SSAs where GP data were available (11% all SSA), there was contact with the following referral source on the day of admission: only ED, 1853 (18%); only GP, 3384 (32%); and only OOH, 823 (8%). Additionally, 2165 (20%) had contact with more than one referral source, and 1037 (10%) had contact with referral source(s) on the day before the admission. When all 92 229 SSAs were considered, those with an ED referrer were more likely to be for older children, of white ethnicity, living in more deprived communities and diagnosed with asthma, convulsions or croup. The odds ratio for an SSA for a given condition differed by referral source and ranged from 0.07 to 1.9 (with reference to ED referrals). CONCLUSION This study yielded insights and potential limitations regarding data linkage in a healthcare setting. Data coverage, particularly from primary care, needs to improve further. Evidence from data linkage studies can inform future intervention designed to provide safe integrated care pathways.
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Affiliation(s)
- Smita Dick
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Richard Kyle
- Academy of Nursing, University of Exeter, Exeter, UK
| | - Philip Wilson
- Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Emma France
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - E King
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Cari Malcolm
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Stephen W Turner
- Child Health, University of Aberdeen, Aberdeen, UK
- Women and Children Division, NHS Grampian, Aberdeen, UK
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Zhang N, Liu C, Steiner SJ, Colletti RB, Baldassano R, Chen S, Cohen S, Kappelman MD, Saeed S, Conklin LS, Strauss R, Volger S, King E, Lo KH. Using multiple imputation of real-world data to estimate clinical remission in pediatric inflammatory bowel disease. J Comp Eff Res 2023; 12:e220136. [PMID: 36799351 PMCID: PMC10402781 DOI: 10.57264/cer-2022-0136] [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: 07/27/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Aim: To evaluate the performance of the multiple imputation (MI) method for estimating clinical effectiveness in pediatric Crohn's disease in the ImproveCareNow registry; to address the analytical challenge of missing data. Materials & methods: Simulation studies were performed by creating missing datasets based on fully observed data from patients with moderate-to-severe Crohn's disease treated with non-ustekinumab biologics. MI was used to impute sPCDAI remission statuses in each simulated dataset. Results: The true remission rate (75.1% [95% CI: 72.6%, 77.5%]) was underestimated without imputation (72.6% [71.8%, 73.3%]). With MI, the estimate was 74.8% (74.4%, 75.2%). Conclusion: MI reduced nonresponse bias and improved the validity, reliability, and efficiency of real-world registry data to estimate remission rate in pediatric patients with Crohn's disease.
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Affiliation(s)
- Nanhua Zhang
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
- University of Cincinnati, Cincinnati, OH 45229, USA
| | - Chunyan Liu
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Steven J Steiner
- Riley Hospital for Children/Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Richard B Colletti
- University of Vermont College of Medicine, Department of Pediatrics, Burlington, VT 05405, USA
| | - Robert Baldassano
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Shiran Chen
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Stanley Cohen
- GI Care For Kids, Atlanta, GA 30342, USA
- Morehouse School of Medicine, Atlanta, GA 30310, USA
| | | | - Shehzad Saeed
- Dayton Children's Hospital/Wright State University, Dayton, OH 45404, USA
| | - Laurie S Conklin
- Janssen Research & Development, LLC, Spring House, PA 19477, USA
| | - Richard Strauss
- Janssen Research & Development, LLC, Spring House, PA 19477, USA
| | - Sheri Volger
- Janssen Research & Development, LLC, Spring House, PA 19477, USA
| | - Eileen King
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
- University of Cincinnati, Cincinnati, OH 45229, USA
| | - Kim Hung Lo
- Janssen Research & Development, LLC, Spring House, PA 19477, USA
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Lane TS, Sonderegger DL, Binns HJ, Kirk S, Christison AL, Novick M, Tucker J, King E, Wallace S, Brazendale K, Kharofa RY, Walka S, Heer H'DD. Seasonal variability in body mass index change among children enrolled in the Pediatric Obesity Weight Evaluation Registry: A step in the right direction. Pediatr Obes 2023; 18:e13012. [PMID: 36811325 PMCID: PMC10150645 DOI: 10.1111/ijpo.13012] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/09/2023] [Accepted: 01/25/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Research has shown children disproportionately gain excess weight over the summer months (vs. school months), with stronger effects for children with obesity. However, the question has not been investigated among children receiving care in paediatric weight management (PWM) programs. OBJECTIVE To test for seasonal variability in weight change among youth with obesity in PWM care enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). METHOD Longitudinal evaluation of a prospective cohort from 2014 to 2019 among youth in 31 PWM programs. Change in percentage of the 95th percentile for BMI (%BMIp95) was compared by quarter. RESULTS Participants (N = 6816) were primarily ages 6-11 (48%), female (54%), 40% non-Hispanic White, 26% Hispanic and 17% Black, and 73% had severe obesity. Children were enrolled on average 424.9 ± 401.5 days. Participants reduced their %BMIp95 every season, but compared with Quarter 3 (July-September), reductions were significantly greater in Q1 (Jan-March, b = -0.27, 95%CI -0.46, -0.09), Q2 (April-June, b = -0.21, CI -0.40, -0.03), and Q4 (October-December, b = -0.44, CI -0.63, -0.26). CONCLUSION AND RELEVANCE Across 31 clinics nationwide, children reduced their %BMIp95 every season, but reductions were significantly smaller during the summer quarter. While PWM successfully mitigated excess weight gain during every period, summer remains a high-priority time.
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Affiliation(s)
- Taylor S Lane
- Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Derek L Sonderegger
- Department of Math and Statistics, Northern Arizona University, Flagstaff, Arizona, USA
| | - Helen J Binns
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Shelley Kirk
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Better Health and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati, The Heart Institute, Milford, Ohio, USA
| | - Amy L Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Marsha Novick
- Department of Pediatrics and Family & Community Medicine, Healthy Weight Program for Children and Teens, Penn State Milton S. Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Jared Tucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, Michigan, USA
| | - Eileen King
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Stephenie Wallace
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Adolescent Medicine, Children's Alabama, Birmingham, Alabama, USA
| | - Keith Brazendale
- Department of Health Sciences, University of Central Florida, Orlando, Florida, USA
| | - Roohi Y Kharofa
- Department of Pediatrics and Family & Community Medicine, Healthy Weight Program for Children and Teens, Penn State Milton S. Hershey Children's Hospital, Hershey, Pennsylvania, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sherry Walka
- Northern Arizona Healthcare Inspire Program, Northern Arizona Healthcare, Flagstaff, Arizona, USA
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Morton SU, Norris-Brilliant A, Cunningham S, King E, Goldmuntz E, Brueckner M, Miller TA, Thomas NH, Liu C, Adams HR, Bellinger DC, Cleveland J, Cnota JF, Dale AM, Frommelt M, Gelb BD, Grant PE, Goldberg CS, Huang H, Kuperman JM, Li JS, McQuillen PS, Panigrahy A, Porter GA, Roberts AE, Russell MW, Seidman CE, Tivarus ME, Anagnoustou E, Hagler DJ, Chung WK, Newburger JW. Association of Potentially Damaging De Novo Gene Variants With Neurologic Outcomes in Congenital Heart Disease. JAMA Netw Open 2023; 6:e2253191. [PMID: 36701153 PMCID: PMC9880793 DOI: 10.1001/jamanetworkopen.2022.53191] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/01/2022] [Indexed: 01/27/2023] Open
Abstract
Importance Neurodevelopmental disabilities are commonly associated with congenital heart disease (CHD), but medical and sociodemographic factors explain only one-third of the variance in outcomes. Objective To examine whether potentially damaging de novo variants (dDNVs) in genes not previously linked to neurodevelopmental disability are associated with neurologic outcomes in CHD and, post hoc, whether some dDNVs or rare putative loss-of-function variants (pLOFs) in specific gene categories are associated with outcomes. Design, Setting, and Participants This cross-sectional study was conducted from September 2017 to June 2020 in 8 US centers. Inclusion criteria were CHD, age 8 years or older, and available exome sequencing data. Individuals with pathogenic gene variants in known CHD- or neurodevelopment-related genes were excluded. Cases and controls were frequency-matched for CHD class, age group, and sex. Exposures Heterozygous for (cases) or lacking (controls) dDNVs in genes not previously associated with neurodevelopmental disability. Participants were separately stratified as heterozygous or not heterozygous for dDNVs and/or pLOFs in 4 gene categories: chromatin modifying, constrained, high level of brain expression, and neurodevelopmental risk. Main Outcomes and Measures Main outcomes were neurodevelopmental assessments of academic achievement, intelligence, fine motor skills, executive function, attention, memory, social cognition, language, adaptive functioning, and anxiety and depression, as well as 7 structural, diffusion, and functional brain magnetic resonance imaging metrics. Results The study cohort included 221 participants in the post hoc analysis and 219 in the case-control analysis (109 cases [49.8%] and 110 controls [50.2%]). Of those 219 participants (median age, 15.0 years [IQR, 10.0-21.2 years]), 120 (54.8%) were male. Cases and controls had similar primary outcomes (reading composite, spelling, and math computation on the Wide Range Achievement Test, Fourth Edition) and secondary outcomes. dDNVs and/or pLOFs in chromatin-modifying genes were associated with lower mean (SD) verbal comprehension index scores (91.4 [20.4] vs 103.4 [17.8]; P = .01), Social Responsiveness Scale, Second Edition, scores (57.3 [17.2] vs 49.4 [11.2]; P = .03), and Wechsler Adult Intelligence Scale, Fourth Edition, working memory scores (73.8 [16.4] vs 97.2 [15.7]; P = .03), as well as higher likelihood of autism spectrum disorder (28.6% vs 5.2%; P = .01). dDNVs and/or pLOFs in constrained genes were associated with lower mean (SD) scores on the Wide Range Assessment of Memory and Learning, Second Edition (immediate story memory: 9.7 [3.7] vs 10.7 [3.0]; P = .03; immediate picture memory: 7.8 [3.1] vs 9.0 [2.9]; P = .008). Adults with dDNVs and/or pLOFs in genes with a high level of brain expression had greater Conners adult attention-deficit hyperactivity disorder rating scale scores (mean [SD], 55.5 [15.4] vs 46.6 [12.3]; P = .007). Conclusions and Relevance The study findings suggest neurodevelopmental outcomes are not associated with dDNVs as a group but may be worse in individuals with dDNVs and/or pLOFs in some gene sets, such as chromatin-modifying genes. Future studies should confirm the importance of specific gene variants to brain function and structure.
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Affiliation(s)
- Sarah U. Morton
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Genetics, Harvard Medical School, Boston, Massachusetts
| | - Ami Norris-Brilliant
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sean Cunningham
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City
| | - Eileen King
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children’s Hospital of Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Martina Brueckner
- Departments of Genetics and Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Thomas A. Miller
- Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City
- Division of Pediatric Cardiology, Maine Medical Center, Portland
| | - Nina H. Thomas
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and Center for Human Phenomic Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Heather R. Adams
- Departments of Neurology and Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - David C. Bellinger
- Departments of Neurology and Psychiatry, Boston Children’s Hospital, Boston, Massachusetts
- Departments of Neurology and Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - John Cleveland
- Departments of Surgery and Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
| | - James F. Cnota
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Anders M. Dale
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla
- Departments of Cognitive Science and Neuroscience, University of California San Diego, La Jolla
| | - Michele Frommelt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Bruce D. Gelb
- Mindich Child Health and Development Institute and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - P. Ellen Grant
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Caren S. Goldberg
- Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor
| | - Hao Huang
- Department of Radiology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia
| | - Joshua M. Kuperman
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla
- Departments of Cognitive Science and Neuroscience, University of California San Diego, La Jolla
| | - Jennifer S. Li
- Division of Pediatric Cardiology, Duke University, Durham, North Carolina
| | - Patrick S. McQuillen
- Departments of Pediatrics and Neurology, University of California, San Francisco
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - George A. Porter
- Departments of Neurology and Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Amy E. Roberts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts
| | - Mark W. Russell
- Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor
| | - Christine E. Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Madalina E. Tivarus
- Departments of Imaging Sciences and Neuroscience, University of Rochester Medical Center, Rochester, New York
| | - Evdokia Anagnoustou
- Department of Pediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Donald J. Hagler
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla
- Departments of Cognitive Science and Neuroscience, University of California San Diego, La Jolla
| | - Wendy K. Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, New York
| | - Jane W. Newburger
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
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Tabebordbar S, Lagerborg K, Ye S, Stanton A, King E, Tellez L, Krunnfusz A, Tavakoli S, Widrick J, Messemer K, Troiano E, Moghadaszadeh B, Peacker B, Leacock K, Horwitz N, Beggs A, Wagers A, Sabeti P. I.11 Directed evolution of a family of AAV capsid variants enabling potent muscle-directed gene delivery across species. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.225] [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: 11/05/2022]
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11
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Gist KM, Misfeldt A, Sahay RD, Gorga SM, Askenazi DJ, Bridges BC, Paden ML, Zappitelli M, Gien J, Basu RK, Jetton JG, Murphy HJ, King E, Fleming GM, Selewski DT, Cooper DS. Acute Kidney Injury and Fluid Overload in Pediatric Extracorporeal Cardio-Pulmonary Resuscitation: A Multicenter Retrospective Cohort Study. ASAIO J 2022; 68:956-963. [PMID: 34643574 DOI: 10.1097/mat.0000000000001601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acute kidney injury (AKI) and fluid overload (FO) are common complications of extracorporeal membrane oxygenation (ECMO). The purpose of this study was to characterize AKI and FO in children receiving extracorporeal cardiopulmonary resuscitation (eCPR). We performed a multicenter retrospective study of children who received eCPR. AKI was assessed during ECMO and FO defined as <10% [FO-] vs. ≥10% [FO+] evaluated at ECMO initiation and discontinuation. A composite exposure, defined by a four-group discrete phenotypic classification [FO-/AKI-, FO-/AKI+, FO+/AKI-, FO+/AKI+] was also evaluated. Primary outcome was mortality and hospital length of stay (LOS) among survivors. 131 patients (median age 29 days (IQR:9, 242 days); 51% men and 82% with underlying cardiac disease) were included. 45.8% survived hospital discharge. FO+ at ECMO discontinuation, but not AKI was associated with mortality [aOR=2.3; 95% CI: 1.07-4.91]. LOS for FO+ patients was twice as long as FO- patients, irrespective of AKI status [(FO+/AKI+ (60 days; IQR: 49-83) vs. FO-/AKI+ (30 days, IQR: 19-48 days); P = 0.01]. FO+ at ECMO initiation and discontinuation was associated with an adjusted 66% and 50% longer length of stay respectively. Prospective studies that target timing and strategy of fluid management, including its removal in children receiving ECPR are greatly needed.
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Affiliation(s)
- Katja M Gist
- From the Department of Pediatrics, Children's Hospital of Colorado University of Colorado Anschutz Medical Campus Aurora, Colorado
| | - Andrew Misfeldt
- Department of Pediatrics, University of Cincinnati College of Medicine, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rashmi D Sahay
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephen M Gorga
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - David J Askenazi
- Department of Pediatrics, University of Alabama Birmingham, Birmingham, Alabama
| | - Brian C Bridges
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Matthew L Paden
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Zappitelli
- Department of Pediatrics, Toronto Hospital for Sick Children, Toronto, Canada and McGill University Health Centre, Montreal, Canada
| | - Jason Gien
- From the Department of Pediatrics, Children's Hospital of Colorado University of Colorado Anschutz Medical Campus Aurora, Colorado
| | - Rajit K Basu
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer G Jetton
- Division of Nephrology, Dialysis and Transplantation, Stead Family Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Heidi J Murphy
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Geoffrey M Fleming
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
- Deceased
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David S Cooper
- Department of Pediatrics, University of Cincinnati College of Medicine, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Andrews R, Di Geronimo R, Virk H, Goldman R, Pillai R, Rao S, King E, Shah A, Vu C. Abstract No. 587 Morbidity and mortality conferencing as a quality assessment tool in interventional radiology: a survey of Society of Interventional Radiology members. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.569] [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] Open
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Key C, Di Geronimo R, Jenner Z, Nelson A, Kim P, Khan A, Liou F, King E, Shah A, Pillai R, Vu C, Andrews R, Rao S. Abstract No. 257 Financial analysis of outpatient evaluation and management billing by interventional radiologists in comparison to other specialties. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.338] [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: 11/26/2022] Open
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Kim P, Di Geronimo R, Vu C, Pillai R, Rao S, Shah A, King E, Khan A, Liou F, Key C, Nelson A, Andrews R. Abstract No. 313 Trends in percutaneous musculoskeletal procedure volume among Medicare patients from 2010-2018 by specialty. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.394] [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: 10/18/2022] Open
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Liou F, Di Geronimo R, Rao S, Shah A, King E, Pillai R, Andrews R, Vu C, Goldman R. Abstract No. 92 Effect on intra-procedural metrics of repeat imaging with CT arteriography prior to conventional angiography: analysis of trauma patients with active extravasation on initial portal venous phase imaging. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.173] [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: 11/17/2022] Open
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Khan A, Di Geronimo R, Liou F, Kim P, Key C, Nelson A, King E, Shah A, Vu C, Jenner Z, Yap P, Pillai R, Andrews R, Rao S. Abstract No. 132 Trends in percutaneous ablation procedures among Medicare patients from 2010-2018: an analysis of procedure volume, specialty involvement, and reimbursement rates. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.213] [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: 10/18/2022] Open
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17
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Safroneeva E, Pan Z, King E, Martin LJ, Collins MH, Yang GY, Capocelli KE, Arva NC, Abonia JP, Atkins D, Bonis PA, Dellon ES, Falk GW, Gonsalves N, Gupta SK, Hirano I, Leung J, Menard-Katcher PA, Mukkada VA, Schoepfer AM, Spergel JM, Wershil BK, Rothenberg ME, Aceves SS, Furuta GT. Long-Lasting Dissociation of Esophageal Eosinophilia and Symptoms After Dilation in Adults With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol 2022; 20:766-775.e4. [PMID: 34062314 PMCID: PMC8628021 DOI: 10.1016/j.cgh.2021.05.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 02/11/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Esophageal dilation improves dysphagia but not inflammation in eosinophilic esophagitis (EoE) patients. We investigated if dilation modifies the association between symptoms and peak esophageal eosinophils per high-power field (eos/hpf). METHODS Adults enrolled in a multisite prospective Consortium of Gastrointestinal Eosinophilic Disease Researchers Outcome Measures for Eosinophilic Gastrointestinal Diseases Across Ages observational study (NCT02523118) completed the symptom-based EoE activity index (EEsAI) patient-reported outcome instrument and underwent endoscopy with biopsy specimens. Patients were stratified based on dilation status as absent, performed 1 year or less before endoscopy, and performed more than 1 year before endoscopy. Assessments included Spearman correlations of the relationship between symptoms and eos/hpf and linear regression with EEsAI as the outcome, eos/hpf as predictor, and interaction for dilation and eos/hpf. RESULTS Among 100 patients (n = 61 males; median age, 37 y), 15 and 40 patients underwent dilation 1 year or less and more than 1 year before index endoscopy, respectively. In nondilated patients, the association between eos/hpf and symptoms was moderate (ρ = 0.49; P < .001); for a 10-eos/hpf increase, the predicted EEsAI increased by 2.69 (P = .002). In patients dilated 1 or less and more than 1 year before index endoscopy, this association was abolished (ρ = -0.38; P = .157 for ≤1 y and ρ = 0.02; P = .883 >1 y); for a 10-eos/hpf increase, the predicted EEsAI changed by -1.64 (P = .183) and 0.78 (P = .494), respectively. Dilation modified the association between symptoms and eos/hpf (P = .005 and P = .187 for interaction terms of eos/hpf and dilation 1 or less years before and more than 1 year before index endoscopy, respectively). CONCLUSIONS In nondilated EoE adults, eos/hpf correlate modestly with symptoms; this correlation was no longer appreciated in dilated patients, and the dilation effects lasted longer than 1 year. Dilation status should be considered in studies evaluating EoE treatment and for clinical follow-up evaluation.
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Affiliation(s)
- Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| | - Zhaoxing Pan
- Pediatric Gastroenterology, Pediatric Allergy and Immunology, Aurora, Colorado
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati, Ohio
| | | | | | | | | | - Nicoleta C Arva
- Department of Pathology and Laboratory Medicine, Chicago, Illinois
| | - J Pablo Abonia
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati, Ohio
| | - Dan Atkins
- Section of Allergy, Immunology, Aurora, Colorado
| | - Peter A Bonis
- Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Gary W Falk
- Division of Gastroenterology, Philadelphia, Pennsylvania
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children/Indiana University School of Medicine, Indianapolis, Indiana
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - John Leung
- Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts
| | - Paul A Menard-Katcher
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Vincent A Mukkada
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alain M Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Jonathan M Spergel
- Department of Allergy and Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Barry K Wershil
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati, Ohio
| | - Seema S Aceves
- Division of Allergy Immunology, University of California, San Diego, Rady Children's Hospital, San Diego, California
| | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Gastrointestinal Eosinophilic Diseases Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Aurora, Colorado
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O'Mahony B, King E, Falvey E. Prevalence of Hip and Groin Pain Across Eras Amongst Former Elite Gaelic Footballers and Hurlers. Ir Med J 2022; 115:559. [PMID: 35532426] [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: 05/23/2023]
Abstract
Introduction Gaelic football and hurling are the most commonly played amateur sports in Ireland with elite level athletes participating at inter-county level. Over time, the intensity and frequency of inter-county training has approached levels of professional sports. Previous studies have not assessed differences in hip and groin injury between eras. We aimed to examine differences in hip and groin injury, incidence of surgery and Hip and Groin Outcome Scores between elite GAA players of different eras and duration of intercountry career. Methods Members of the squads from the 1976, 1986, 1996 and 2006 hurling and football All-Ireland Finals provided data on age starting intercounty career and previous hip and groin injury and surgery. 372 players were surveyed in total. The hip and groin outcome score (HAGOS), a validated questionnaire assessing hip and groin problems suffered was also assessed. Results There were significant differences in four of the six HAGOS categories between eras with lower scores in 2006 group and in those who were younger starting their intercounty career. In addition, those with younger start and those who played in more recent times had higher rates of groin surgery (23.9% of 2006 cohort, N = 17). As expected, older players had higher rates of total hip replacement (19.7% of the 1976 cohort, N = 12). Conclusion This study highlights the influence of early playing career at elite level on hip and groin injury and that those playing in more modern times had higher incidence of groin surgery and lower HAGOS scores.
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Affiliation(s)
- B O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
| | - E King
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Department of Life Sciences, Roehampton University, London, UK
| | - E Falvey
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
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Chan JSK, Lau DHH, King E, Shum YKL, Roever L, Liu T, Ng K, Dee EC, Ciobanu A, Bazoukis G, Mahmoudi E, Satti DI, Jeevaratnam K, Baranchuk A, Tse G. Virtual medical research mentoring and collaboration: breaking the bounds of nationality during the COVID-19 pandemic. Eur Heart J 2022. [PMCID: PMC9383365 DOI: 10.1093/eurheartj/ehab849.179] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. OnBehalf Cardioovascular Analytics Group Background Medical research is critical to professional advancement, and mentoring is an important means of early research engagement in medical training. In contrast to international research collaborations, research mentoring programs are often locally limited. With the COVID-19 pandemic causing drifts to virtual classes and conferences, virtual international medical research mentoring may be viable. We hereby describe our experience with a virtual, international mentorship group for cardiovascular research. Methods Our virtual international research mentorship group has been running since 2015. The group focuses on risk stratification and outcomes research in cardiovascular medicine and epidemiology. Mentees from any country or region in all stages of medical careers are welcomed. Considering the increasing emphasis of contemporary research on multidisciplinary healthcare and translational research, our team also includes allied healthcare professionals or students, and graduates from natural sciences (Figure 1). With our members’ diverse backgrounds, we firmly adhere to the principle that all members must be given equal opportunities and treatment, regardless of their age, gender, race, nationality, sexual orientation, family background, and institution of study or practice. We make use of virtual platforms and multi-level mentoring (both senior and peer mentoring), and emphasize active participation, early leadership, open culture, accessible research support, and a distributed research workflow (i.e. an accessible-distributed model). Results Since establishment, our group has expanded to include 63 active members from 14 countries (Figure 2), leading a total of 109 peer-reviewed original studies and reviews published. We observed no significant difficulty in communication between team members, nor conflicts due to differences in nationality or ethnicity. Most studies involve cross-country and ethnicity collaborations, and inter-disciplinary and inter-regional knowledge exchanges are frequent. Multi-level mentoring ensured mentoring quality without compromising bonding and communication. Conclusion An accessible-distributed model of virtual international medical research collaboration and multi-level mentoring is viable, efficient, and caters to the needs of contemporary healthcare. We hope that others will build similar models and improve medical research mentoring globally.
Abstract Figure 1
Abstract Figure 2 ![]()
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Affiliation(s)
- J S K Chan
- Cardiovascular Analytics Group, Hong Kong, Hong Kong
| | - D H H Lau
- Cardiovascular Analytics Group, Hong Kong, Hong Kong
| | - E King
- Cardiovascular Analytics Group, Hong Kong, Hong Kong
| | - Y K L Shum
- Cardiovascular Analytics Group, Hong Kong, Hong Kong
| | - L Roever
- Federal University of Uberlandia, Uberlandia, Brazil
| | - T Liu
- Tianjin Medical University, Tianjin, China
| | - K Ng
- University College London Hospitals, London, United Kingdom of Great Britain & Northern Ireland
| | - E C Dee
- Memorial Sloan Kettering Cancer Center, New York, United States of America
| | - A Ciobanu
- Carol Davila University Of Medicine And Pharm, Bucharest, Romania
| | | | - E Mahmoudi
- Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of)
| | - D I Satti
- Shifa College of Medicine, Islamabad, Pakistan
| | - K Jeevaratnam
- University of Surrey, Guildford, United Kingdom of Great Britain & Northern Ireland
| | | | - G Tse
- Kent and Medway Medical School, Canterbury, United Kingdom of Great Britain & Northern Ireland
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Carolan D, Richter C, Thorborg K, Franklyn-Miller A, O'Donovan J, Mc Donald C, King E. Hip and Groin Pain Prevalence and Prediction in Elite Gaelic Games: 2703 Male Athletes Across Two Seasons. Scand J Med Sci Sports 2022; 32:924-932. [PMID: 35108419 DOI: 10.1111/sms.14136] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/19/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hip and groin pain is highly prevalent in sub-elite Gaelic Athletic Association (GAA) athletes, but its prevalence at the elite level is unknown. The aims of this study were to report hip and groin pain prevalence in elite male athletes, to report changes in Copenhagen Hip and Groin Outcome Score (HAGOS) across two seasons and to assess if previous hip and groin pain or pre-season HAGOS could predict future hip and groin pain. METHODS During the 2017 and 2018 pre-season male Gaelic Players Association (GPA) playing members were invited to complete two questionnaires. The first questionnaire collected demographic information including age, GAA code played (Gaelic football or Hurling) and prevalence of hip and groin pain in the previous season. The second questionnaire was the HAGOS. Step-wise logistic regression models were fitted to HAGOS subscales, to examine if pre-season HAGOS subscale scores could predict future hip and groin pain. RESULTS The prevalence of hip and groin pain across the elite GAA cohort was 38%. Hip and groin pain in the previous season was the strongest predictor of future hip and groin pain (r2 =0.19, AUC=0.73, 95% CI 1.76-2.27) whereas pre-season HAGOS subscale scores had limited and no additional predictive ability (AUC 0.05-0.18). CONCLUSIONS Hip and groin pain prevalence is high in elite male GAA, with one in three athletes reporting pain. Previous season hip and groin pain is the strongest predictor of future hip and groin pain, while pre-season HAGOS scores have limited ability to predict future hip and groin pain.
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Affiliation(s)
- D Carolan
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland
| | - C Richter
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland
| | - K Thorborg
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark.,Department of Orthopedic Surgery and Physical Therapy, Physical Medicine & Amp; Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
| | - A Franklyn-Miller
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - J O'Donovan
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Gaelic Players Association Safety and Welfare Committee, Dublin, Ireland
| | - C Mc Donald
- Gaelic Players Association Safety and Welfare Committee, Dublin, Ireland
| | - E King
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Life Sciences, University of Roehampton, Roehampton, UK
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21
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Skinner AC, Xu H, Christison A, Neshteruk C, Cuda S, Santos M, Yee JK, Thomas L, King E, Kirk S. Patient Retention in Pediatric Weight Management Programs in the United States: Analyses of Data from the Pediatrics Obesity Weight Evaluation Registry. Child Obes 2022; 18:31-40. [PMID: 34415779 DOI: 10.1089/chi.2021.0092] [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] [Indexed: 11/13/2022]
Abstract
Objective: Meeting recommended provider contact hours in multicomponent pediatric weight management (PWM) programs is difficult when patient retention is low. Our objective was to examine associations between individual patient characteristics, program characteristics, and patient retention. Methods: Using the Pediatric Obesity Weight Evaluation Registry, a prospective longitudinal study of 32 PWM programs, we included children (≤18 years; n = 6502) enrolled for a full year. We examined associations between retention (any follow-up visit) and patient and program characteristics using multivariable models with site-clustering random effects. Results: Sixty-seven percent of children had at least one follow-up visit, whereas 12% had four or more visits. Compared with non-Hispanic white children, non-Hispanic black children were less likely to have a follow-up visit [adjusted odds ratio (aOR) = 0.79], whereas Hispanic children (any race) were more likely (aOR = 1.22). Children with Medicaid had similar retention to those with private insurance. Retention did not differ by age, gender, weight status, or comorbidities, nor by program characteristics. Conclusions: Few characteristics of PWM programs are clearly associated with retention, indicating that a variety of formats can support continued treatment and likely reflect the influence of unmeasured characteristics. Clearer ways to identify and overcome barriers for individual patients will be needed to improve retention in PWM.
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Affiliation(s)
- Asheley Cockrell Skinner
- Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Haolin Xu
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Amy Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Cody Neshteruk
- Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Suzanne Cuda
- Department of Pediatrics, Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Melissa Santos
- Pediatric Obesity Center, Connecticut Children's, Hartford, CT, USA
| | - Jennifer K Yee
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Laine Thomas
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shelley Kirk
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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22
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King E, Gustafson O, Judge T, Vollam S. A service evaluation exploring perceptions of relatives of ICU patients and multidisciplinary team on patients’ experience of games based therapy. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.005] [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: 10/19/2022]
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23
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King E, Loblova O. COVID-19 in Central and Eastern Europe. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.679] [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: 11/14/2022] Open
Abstract
Abstract
Issue
Countries of central and eastern Europe (CEE) are rarely accustomed to praise when compared to their western European neighbors. During the early months of the COVID-19 pandemic, however, as core European countries such as Italy, Spain, or the United Kingdom reported hundreds of confirmed cases and even deaths per day, all CEE countries managed to contain the disease with considerably lower rates of infection and deaths.
Description
This changed in late summer and fall of 2020, when many CEE countries overtook western Europe in the number of new COVID-19 cases, as well as deaths, per population, but for a few months the region could enjoy its unusual accomplishment. A number of hypotheses have been suggested to explain the surprising containment success in the spring, including the widespread prevalence of the bacille Calmette-Guérin tuberculosis vaccine, lower population density and exposure to tourism, lack of trust in the healthcare system and government in general, low testing numbers (which may have led to underreporting of cases), and an autocratic advantage leaders of imperfect democracies, such as in CEE, enjoy when imposing lockdowns and other restrictive policies.
Results
In the spring, CEE governments implemented strict measures to protect public health at a time when their countries had few COVID-19 cases and deaths at most in the single digits.
Lessons
The Russian approach to addressing COVID-19 reflects the messiness of classifying “regime type.” Some of the responses used were more authoritarian in their approach. A greater flow of information and more transparency in the data would allow a more complete assessment of Russia's response to COVID-19.
Main messages
Creating a “virus of silence,” short- cutting global standards for vaccine clinical trials, and not providing disaggregated and timely data make it difficult to evaluate the reasons for Russia's relatively low case count and low fatality rate.
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Affiliation(s)
- E King
- School of Public Health, University of Michigan, Michigan, USA
| | - O Loblova
- School of Public Health, University of Michigan, Michigan, USA
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24
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Bento MHL, Lewis EA, Ramírez de Arellano I, Millán C, King E, Scott-Baird E, McGuire P, Richardson K. Establishing the tolerability to broiler chickens and laying hens of nonanoic acid at practical levels of use as a feed flavouring. Br Poult Sci 2021; 63:218-225. [PMID: 34404304 DOI: 10.1080/00071668.2021.1966752] [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: 10/20/2022]
Abstract
1. The following experiments were conducted to evaluate the effects of nonanoic acid (NA) in broilers and laying hens, at practical levels as a flavouring in complete feed.2. In the first experiment, 1100, one-day-old Ross 308 chicks, half male and female, were randomly assigned to 50 floor pens containing 22 chicks each. Chicks were fed one of five treatment diets containing either 0 (control), 100, 300, 500 or 1,000 mg NA/kg complete feed for 42 days.3. The NA treatment had no effect on ADFI, but there was a linear relationship with ADG and FCR. No differences were observed in blood parameters or tissue pathology among treatment groups.4. In a second study, 150 Hyline hens aged 24 weeks old were randomly assigned to 50 pens containing three birds each. Laying hens were fed one of five treatment diets containing 0 (control), 100, 300, 500 or 1,000 mg NA/kg complete feed for 56 days.5. Treatment with NA has no effect on live weight, ADFI or egg production in laying hens, and there were no observed changes in tissue pathology.6. The results supported the toleration of NA in broilers or layers at dietary levels of up to 1,000 mg/kg.
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Affiliation(s)
- M H L Bento
- NutraSteward, Bridge Innovation Center, Pembroke Dock, UK
| | - E A Lewis
- NutraSteward, Bridge Innovation Center, Pembroke Dock, UK
| | | | - C Millán
- IMASDE Agroalimentaria, Madrid, Spain
| | - E King
- Drayton Animal Health, Stratford-upon-Avon, UK
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25
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Kaufman D, Woodle ES, Shields A, Leone J, Matas A, Wiseman A, West-Thielke P, Sa T, King E, Alloway R. Belatacept for Simultaneous Calcineurin Inhibitor and Chronic Corticosteroid Immunosuppression Avoidance. Clin J Am Soc Nephrol 2021; 16:1387-1397. [PMID: 34233921 PMCID: PMC8729588 DOI: 10.2215/cjn.13100820] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 06/23/2021] [Indexed: 11/23/2022]
Abstract
Immunosuppressive therapy in kidney transplantation is associated with numerous toxicities. CD28-mediated T cell costimulation blockade using belatacept may reduce long-term nephrotoxicity, compared with calcineurin inhibitor-based immunosuppression. The efficacy and safety of simultaneous calcineurin inhibitor avoidance and rapid steroid withdrawal were tested in a randomized, prospective, multi-center study. Methods All kidney transplants were performed using rapid steroid withdrawal immunosuppression. Recipients were randomized to 1:1:1 to receive belatacept with alemtuzumab induction, belatacept with rabbit antithymocyte globulin (rATG) induction, or tacrolimus with rATG induction. The composite endpoint consisted of death, kidney allograft loss, or an MDRD calculated eGFR of <45 ml/min/1.73m2 at 2 years. Results The composite endpoint was observed for 11/107 (10%) participants assigned to belatacept/alemtuzumab, 13/104 (13%) assigned to belatacept /rATG, and 21/105 (21%) assigned to tacrolimus/rATG (belatacept/alemtuzumab vs tacrolimus/rATG p = 0.99: belatacept/rATG vs tacrolimus/rATG p = 0.66). Patient and graft survival rates were similar between all groups. eGFR <45 ml/min/1.73m2 was observed for 9/107 (8%) participants assigned to belatacept/alemtuzuab, 8/104 (8%) participants assigned to belatacept/rATG, and 20/105 (19%) participants assigned to tacrolimus/rATG (p<0.05 for each belatacept group vs tacrolimus/rATG). Biopsy-proven acute rejection was observed for 20/107 (19%) participants assigned to belatacept/alemtuzuab, 26/104 (25%) participants assigned to belatacept/rATG, and 7/105 (7%) participants assigned to tacrolimus/rATG (belatacept/alemtuzumab vs tacrolimus/rATG p = 0.006: belatacept/rATG vs tacrolimus/rATG p < 0.001). Gastrointestinal and neurologic adverse events were less frequent with belatacept versus calcineurin based immunosuppression. Conclusions Overall two-year outcomes were similar comparing maintenance immunosuppression based on belatacept versus tacrolimus, each protocol with rapid steroid withdrawal. The incidence of eGFR <45 ml/min/1.73m2 was significantly lower but the incidence of biopsy proven acute rejection significantly higher with belatacept compared with tacrolimus.
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Affiliation(s)
- Dixon Kaufman
- D Kaufman, University of Wisconsin-Madison, Madison, United States
| | - E Steve Woodle
- E Woodle, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Adele Shields
- A Shields, University of Cincinnati College of Medicine, Cincinnati, United States
| | - John Leone
- J Leone, Tampa General Hospital, Tampa, United States
| | - Arthur Matas
- A Matas, University of Minnesota, Minneapolis, United States
| | | | | | - Ting Sa
- T Sa, Biostastics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Eileen King
- E King, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Rita Alloway
- R Alloway, University of Cincinnati College of Medicine, Cincinnati, United States
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Yap S, Liou F, Khan A, Pillai R, Vu C, Andrews R, King E, Shah A, Goldman R. Abstract No. 472 Alternate venous access sites for ported catheters: experience at a single quaternary care institution. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.281] [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] Open
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27
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Di Geronimo R, Kim P, Andrews R, King E, Shah A, Vu C, Pillai R, Goldman R. Abstract No. 568 Interpretation of diagnostic vascular imaging studies for Medicare patients by interventional radiologists: a comparison to other specialties and implications for interventional radiology. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.378] [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: 10/21/2022] Open
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28
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Murphy HJ, Gien J, Sahay R, King E, Selewski DT, Bridges BC, Cooper DS, Fleming GM, Paden ML, Zappitelli M, Gist KM, Basu RK, Jetton JG, Askenazi D. Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately. Blood Purif 2021; 50:808-817. [PMID: 33461205 DOI: 10.1159/000512538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/12/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to characterize acute kidney injury (AKI), fluid overload (FO), and renal replacement therapy (RRT) utilization by diagnostic categories and examine associations between these complications and mortality by category. METHODS To test our hypotheses, we conducted a retrospective multicenter, cohort study including 446 neonates (categories: 209 with cardiac disease, 114 with congenital diaphragmatic hernia [CDH], 123 with respiratory disease) requiring extracorporeal membrane oxygenation (ECMO) between January 1, 2007, and December 31, 2011. RESULTS AKI, FO, and RRT each varied by diagnostic category. AKI and RRT receipt were most common in those neonates with cardiac disease. Subjects with CDH had highest peak %FO (51% vs. 28% cardiac vs. 32% respiratory; p < 0.01). Hospital survival was 55% and varied by diagnostic category (45% cardiac vs. 48% CDH vs. 79% respiratory; p < 0.001). A significant interaction suggested risk of mortality differed by diagnostic category in the presence or absence of AKI. In its absence, diagnosis of CDH (vs. respiratory disease) (OR 3.04, 95% CL 1.14-8.11) independently predicted mortality. In all categories, peak %FO (OR 1.20, 95% CL 1.11-1.30) and RRT receipt (OR 2.12, 95% CL 1.20-3.73) were independently associated with mortality. DISCUSSION/CONCLUSIONS Physiologically distinct ECMO diagnoses warrant individualized treatment strategies given variable incidence and effects of AKI, FO, and RRT by category on mortality.
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Affiliation(s)
- Heidi J Murphy
- Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA,
| | - Jason Gien
- Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Rashmi Sahay
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Eileen King
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David T Selewski
- Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian C Bridges
- Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - David S Cooper
- Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Geoffrey M Fleming
- Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Michael Zappitelli
- Pediatrics, Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Katja M Gist
- Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Rajit K Basu
- Pediatrics, Emory University, Atlanta, Georgia, USA
| | | | - David Askenazi
- Pediatrics, University of Alabama Birmingham, Birmingham, Alabama, USA
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29
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Borzutzky C, King E, Fox CK, Stratbucker W, Tucker J, Yee JK, Kumar S, Cuda S, Sweeney B, Kirk S, On Behalf Of The Power Work Group. Trends in prescribing anti-obesity pharmacotherapy for paediatric weight management: Data from the POWER Work Group. Pediatr Obes 2021; 16:e12701. [PMID: 32877010 DOI: 10.1111/ijpo.12701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/11/2020] [Accepted: 06/20/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION To better inform the field of obesity medicine, we set out to describe the current use of pharmacotherapy meant to improve patient weight status among a group of clinicians connected through the Paediatric Obesity Weight Evaluation Registry (POWER), as well as reasons behind clinicians' use or non-use of the medications. METHODS Paediatric weight management (PWM) programs participating in POWER were asked to complete a program profile survey in 2014 (n = 30) and 2017 (n = 33); questions about pharmacotherapy use were included. Descriptive statistics were used to identify: (a) the proportion of PWM programs offering obesity pharmacotherapy; (b) the medications most commonly prescribed; and (c) reasons among non-prescribers for not offering pharmacotherapy. RESULTS The 2014 and 2017 surveys were completed by 29 PWM programs (97%) and 30 PWM programs (91%), respectively. Twenty-one programs completed both surveys. In 2014, 10 (34%) programs reported offering pharmacologic agents specifically for weight control, whereas in 2017, 16 (53%) reported offering pharmacotherapy for a primary indication of weight loss. Metformin was reported as the most commonly used agent in 2014, and topiramate in 2017. Largest reported increases in use over time were for topiramate and phentermine. DISCUSSION Our survey results demonstrate that a majority of this group of PWM programs offered pharmacotherapy to promote weight loss in patients with complications or associated medical conditions. There was a trend indicating increasing use over time, despite the significant gap regarding pharmacotherapy use in the literature. CONCLUSIONS These data suggest the need for (a) additional robust paediatric drug trials to further develop the evidence base guiding use or non-use of pharmacotherapy in paediatric weight management, and (b) increased understanding of both facilitators and barriers to prescribing anti-obesity pharmacotherapy for youth with obesity.
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Affiliation(s)
- Claudia Borzutzky
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - William Stratbucker
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Jared Tucker
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Jennifer K Yee
- Division of Endocrinology, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA.,The Lundquist Institute for Biomedical Innovation at Harbor-UCLA, Torrance, California, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzanne Cuda
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - Brooke Sweeney
- General Academic Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.,University of Missouri Kansas City, Kansas City, Missouri, USA.,Children's Center for Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Cooper DS, Thiagarajan R, Henry BM, Byrnes JW, Misfeldt A, Frischer J, King E, Gao Z, Rycus P, Marino BS. Outcomes of Multiple Runs of Extracorporeal Membrane Oxygenation: An analysis of the Extracorporeal Life Support Registry. J Intensive Care Med 2020; 37:195-201. [PMID: 33349100 DOI: 10.1177/0885066620981903] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE When patients deteriorate after decannulation from extracorporeal membrane oxygenation (ECMO), a second run of extracorporeal support may be considered. However, repeat cannulation can be difficult and poor outcomes associated with multiple ECMO runs are a concern. The aim of this study was to evaluate outcomes and identify factors associated with survival and mortality in cases of multiple runs of extracorporeal membrane oxygenation. DESIGN Retrospective cohort analysis of the Extracorporeal Life Support Organization Registry. SETTING The Extracorporeal Life Support Organization's registry was queried for neonates, children, and adults receiving 2 or more runs of ECMO during the same hospitalization, for any indication, from 1998 to 2015. PATIENTS 1,818 patients from the Extracorporeal Life Support Organization Registry. RESULTS Of the 1,818 patients, 1,648 underwent 2 runs and 170 underwent 3 or more runs of ECMO. The survival to discharge rate was 36.7% for 2 runs and 29.4% for 3 or more runs. No significant differences in survival were detected in analysis by decade of ECMO run (p = 0.21). Pediatric patients had less mortality than adults (OR: 0.45, 95%CI: 0.24-0.82). Cardiac support on the first run portrayed worse mortality than pulmonary support regardless of final run indication (OR:1.38, 95%CI: 1.09-1.75). Across all age groups, patients receiving pulmonary support on the last run tended to have higher survival rates regardless of support type on the first run. The only first run complication independently predictive of mortality on the final run was renal complications (OR: 1.60, 95%CI: 1.28-1.99). CONCLUSIONS Though the use of multiple runs of ECMO is growing, outcomes remain poor for most cohorts. Survival decreases with each additional run. Patients requiring additional runs for a pulmonary indication should be considered prime candidates. Renal complications on the first run significantly increases the risk of mortality on subsequent runs, and as such, careful consideration should be applied in these cases.
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Affiliation(s)
- David S Cooper
- Department of Pediatrics, The Heart Institute, 2518Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ravi Thiagarajan
- Department of Cardiology, 1862Boston Children's Hospital, Boston, MA, USA
| | - Brandon Michael Henry
- Department of Pediatrics, The Heart Institute, 2518Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan W Byrnes
- Department of Pediatrics, The Heart Institute, 2518Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew Misfeldt
- Department of Pediatrics, The Heart Institute, 2518Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jason Frischer
- Division of Pediatric General and Thoracic Surgery, 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Zhiqian Gao
- Division of Biostatistics and Epidemiology, 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Peter Rycus
- Extracorporeal Life Support Organization, Ann Arbor, MI, USA
| | - Bradley S Marino
- Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Gore S, Franklyn-Miller A, Richter C, King E, Falvey EC, Moran K. Corrigendum to "The effects of rehabilitation on the biomechanics of patients with athletic groin pain" [J. Biomech. 99 (2020) 109474]. J Biomech 2020; 115:110128. [PMID: 33303213 DOI: 10.1016/j.jbiomech.2020.110128] [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: 11/28/2022]
Affiliation(s)
- S Gore
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland; School of Health and Human Performance, Dublin City University, Dublin, Ireland; INSIGHT Centre for Data Analytics, Dublin City University, Dublin, Ireland.
| | - A Franklyn-Miller
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Australia
| | - C Richter
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
| | - E King
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland; Department of Life Sciences, Roehampton University, UK
| | - E C Falvey
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland; Department of Medicine, University College Cork, Ireland
| | - K Moran
- School of Health and Human Performance, Dublin City University, Dublin, Ireland; INSIGHT Centre for Data Analytics, Dublin City University, Dublin, Ireland
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Gupta N, Liu C, King E, Sylvester F, Lee D, Boyle B, Trauernicht A, Chen S, Colletti R, Ali SA, Al-Nimr A, Ayers TD, Baron HI, Beasley GL, Benkov KJ, Cabrera JM, Cho-Dorado ME, Dancel LD, Di Palma JS, Dorsey JM, Gulati AS, Hellmann JA, Higuchi LM, Hoffenberg E, Israel EJ, Jester TW, Kiparissi F, Konikoff MR, Leibowitz I, Maheshwari A, Moulton DE, Moses J, Ogunmola NA, Palmadottir JG, Pandey A, Pappa HM, Pashankar DS, Pasternak BA, Patel AS, Quiros JA, Rountree CB, Samson CM, Sandberg KC, Schoen B, Steiner SJ, Stephens MC, Sudel B, Sullivan JS, Suskind DL, Tomer G, Tung J, Verstraete SG. Continued Statural Growth in Older Adolescents and Young Adults With Crohn's Disease and Ulcerative Colitis Beyond the Time of Expected Growth Plate Closure. Inflamm Bowel Dis 2020; 26:1880-1889. [PMID: 31968095 DOI: 10.1093/ibd/izz334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 08/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cessation of statural growth occurs with radiographic closure of the growth plates, radiographically defined as bone age (BA) 15 years in females and 17 in males. METHODS We determined the frequency of continued growth and compared the total height gain beyond the time of expected growth plate closure and the chronological age at achievement of final adult height in Crohn's disease (CD) vs ulcerative colitis (UC) and described height velocity curves in inflammatory bowel disease (IBD) compared with children in the National Health and Nutrition Examination Survey (NHANES). We identified all females older than chronological age (CA) 15 years and males older than CA 17 years with CD or UC in the ImproveCareNow registry who had height documented at ≥3 visits ≥6 months apart. RESULTS Three thousand seven patients (48% female; 76% CD) qualified. Of these patients, 80% manifested continued growth, more commonly in CD (81%) than UC (75%; P = 0.0002) and in females with CD (83%) than males with CD (79%; P = 0.012). Median height gain was greater in males with CD (1.6 cm) than in males with UC (1.3 cm; P = 0.0004), and in females with CD (1.8 cm) than in females with UC (1.5 cm; P = 0.025). Height velocity curves were shifted to the right in patients with IBD vs NHANES. CONCLUSIONS Pediatric patients with IBD frequently continue to grow beyond the time of expected growth plate closure. Unexpectedly, a high proportion of patients with UC exhibited continued growth, indicating delayed BA is also common in UC. Growth, a dynamic marker of disease status, requires continued monitoring even after patients transition from pediatric to adult care.
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Affiliation(s)
- Neera Gupta
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eileen King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francisco Sylvester
- Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dale Lee
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Brendan Boyle
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anna Trauernicht
- Division of Pediatric Gastroenterology, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Shiran Chen
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Richard Colletti
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT, USA
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Stojanovski K, King E, Amico KR, Eisenberg M, Geronimus A, Schmidt A. Stigmatizing policies’ influence on HIV risk through their effect on internalized homonegativity and health behaviors among men who have sex with men in Europe. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.733] [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: 11/13/2022] Open
Abstract
Abstract
Background
Men who have sex with men (MSM) in Europe are most affected by HIV disparities. Complex systems theory proposes that many health behaviors and risks arise from numerous cascading and interacting processes. Our aim was to explore how stigmatizing policies at the European country-level create pathways to HIV risk and disparities among MSM in Europe.
Methods
We used data from the 2017 European Men Who Have Sex with Men Internet Survey (EMIS-2017). The anonymous online survey recruited 126,090 European MSM. We assessed condom use with steady & non-steady partners as the outcome. Condom use was categorized from zero to 10 (10 or more partners). Abuse was scored zero to three and internalized homonegativity from zero to six. We used the International Gay and Lesbian Association's Rainbow Index as the main predictor, which ranks European countries' laws and policies regarding LGBTQ+ legal protections from zero (worst) to 100 (best). We used structural equation and multi-level modeling for analyses.
Results
The mean Rainbow Index score was 50.8 with a range from 6 to 88. The Rainbow Index scores were the highest in Western European (mean=62.5), then Central European (mean=45.9), then Eastern Europe (mean=21.4) (p < 0.000). Unadjusted regression models suggested that for every one-unit improvement in the Rainbow Index the number of condomless sexual acts with steady sexual partners was reduced [β=-0.0012, 95% CI (-0.0016, -0.0009)]. The unadjusted structural equation model showed that the relationship between the Rainbow Index and condom use with steady partners was mediated by 30% because of internalized homonegativity (p < 0.000).
Conclusions
The policy context influences HIV risk, especially through the policies' effects on condom use. HIV research and prevention efforts must recognize that structural determinants can shape people's risk for HIV and that the best individual and local efforts may be undermined by structural factors such as policies.
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Affiliation(s)
- K Stojanovski
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, USA
| | - E King
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, USA
| | - K R Amico
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, USA
| | - M Eisenberg
- Department of Epidemiology, University of Michigan, Ann Arbor, USA
| | - A Geronimus
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, USA
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Abstract
While it is hard to predict what will have happened by the time of the conference, this round table will be tightly templated and coordinated. Each speaker will briefly address the challenges experienced by that country and the actions taken, and focus on explaining why those actions happened in order to draw comparative lessons about public health politics and governance.
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Affiliation(s)
- E King
- School of Public Health, University of Michigan, Ann Arbor, USA
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King E, Alexandrova O, Batluk J, Shaboltas A. Women who inject drugs in Russia: stigma as a barrier in access to HIV and drug treatment services. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.735] [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: 11/14/2022] Open
Abstract
Abstract
Background
There are over one million people living with HIV in Russia. People who inject drugs experience major disparities in their susceptibility to the virus and in their access to HIV services. Women who inject drugs (WWID) have been shown to be at heightened susceptibility to HIV, through both unsafe drug use and unprotected sex. Less is known about the social determinants of engagement in care specifically among WWID.
Methods
We conducted a qualitative research study in St. Petersburg in order to assess what factors influence engagement in HIV-related and drug rehabilitation services. We conducted in-depth interviews with 20 service providers and 30 WWID from June-November 2018. We recruited providers to represent a range of services, including government clinics, non-governmental organizations, and family services. We recruited WWID through community outreach services. We used thematic analysis and a team-based approach to coding data.
Results
A major theme across our data was the stigma and discrimination that WWID experience in their everyday lives and in their interactions with the healthcare system. WWID are subjected to stigmatization related to gender norms about drug use, the capacity to fulfill their roles as mothers, (for some) engagement in sex work, and (for some) HIV-positive serostatus. WWID are often reluctant to seek HIV-related services, including testing and treatment, out of fear of being treated poorly because of their drug use. The omnipresent societal stigma manifests into self-stigmatization and many WWID questioned their deserving of and abilities to seek healthcare services, including drug rehabilitation and HIV-related care.
Conclusions
Interventions are needed to address the stigma and discrimination that WWID in Russia experience in families, communities, and health institutions. Additionally, psychosocial interventions may help to address the self-stigmatization that sometimes influences WWID's self-efficacy to seek services.
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Affiliation(s)
- E King
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, USA
| | - O Alexandrova
- Department of Psychology, St. Petersburg State University, St. Petersburg, Russia
| | - J Batluk
- Department of Psychology, St. Petersburg State University, St. Petersburg, Russia
| | - A Shaboltas
- Department of Psychology, St. Petersburg State University, St. Petersburg, Russia
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Gorga SM, Sahay RD, Askenazi DJ, Bridges BC, Cooper DS, Paden ML, Zappitelli M, Gist KM, Gien J, Basu RK, Jetton JG, Murphy HJ, King E, Fleming GM, Selewski DT. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy: a multicenter retrospective cohort study. Pediatr Nephrol 2020; 35:871-882. [PMID: 31953749 PMCID: PMC7517652 DOI: 10.1007/s00467-019-04468-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/09/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to characterize continuous renal replacement therapy (CRRT) utilization on extracorporeal membrane oxygenation (ECMO) and to determine the association of both fluid overload (FO) at CRRT initiation and fluid removal during CRRT with mortality in a large multicenter cohort. METHODS Retrospective chart review of all children < 18 years of age concurrently treated with ECMO and CRRT from January 1, 2007, to December 31, 2011, at six tertiary care children's hospital. Children treated with hemodialysis or peritoneal dialysis were excluded from the FO analysis. MEASUREMENTS AND MAIN RESULTS A total of 756 of the 1009 children supported with ECMO during the study period had complete FO data. Of these, 357 (47.2%) received either CRRT or were treated with an in-line filter and thus entered into the final analysis. Survival to ECMO decannulation was 66.4% and survival to hospital discharge was 44.3%. CRRT initiation occurred at median of 1 day (IQR 0, 2) after ECMO initiation. Median FO at CRRT initiation was 20.1% (IQR 5, 40) and was significantly lower in ECMO survivors vs. non-survivors (15.3% vs. 30.5% p = 0.005) and in hospital survivors vs. non-survivors (13.5% vs. 25.9%, p = 0.004). Median FO at CRRT discontinuation was significantly lower in ECMO survivors (23% vs. 37.6% p = 0.002) and hospital survivors vs. non-survivors (22.6% vs. 36.1%, p = 0.002). In ECMO survivors, after adjusting for pH at CRRT initiation, non-renal complications, ECMO mode, support type, center, patient age and AKI, FO at CRRT initiation (p = 0.01), and FO at CRRT discontinuation (p = 0.0002) were independently associated with duration of ECMO. In a similar multivariable analysis, FO at CRRT initiation (adjusted adds ratio [aOR] 1.09, 95% CI 1.00-1.18, p = 0.045) and at CRRT discontinuation (aOR 1.11, 95% CI 1.03-1.19, p = 0.01) were independently associated with hospital mortality. CONCLUSIONS In a multicenter pediatric ECMO cohort, this study demonstrates that severe FO was very common at CRRT initiation. We found an independent association between the degree of FO at CRRT initiation with adverse outcomes including mortality and increased duration of ECMO support. The results suggest that intervening prior to the development of significant FO may be a clinical therapeutic target and warrants further evaluation.
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Affiliation(s)
- Stephen M Gorga
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rashmi D Sahay
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David J Askenazi
- Department of Pediatrics, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Brian C Bridges
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David S Cooper
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Matthew L Paden
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Zappitelli
- Department of Pediatrics, Toronto Hospital for Sick Children, Toronto, Canada and McGill University Health Centre, Montreal, Canada
| | - Katja M Gist
- Department of Pediatrics, Children's Hospital of Colorado University of Colorado Anschutz Medical Campus Aurora, Aurora, CO, USA
| | - Jason Gien
- Department of Pediatrics, Children's Hospital of Colorado University of Colorado Anschutz Medical Campus Aurora, Aurora, CO, USA
| | - Rajit K Basu
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer G Jetton
- Division of Nephrology, Dialysis and Transplantation, Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA, USA
| | - Heidi J Murphy
- Department of Pediatric, Medical University of South Carolina, Charleston, SC, USA
| | - Eileen King
- Department of Pediatrics, University of Alabama Birmingham, Birmingham, Alabama, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Geoffrey M Fleming
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David T Selewski
- Department of Pediatric, Medical University of South Carolina, Charleston, SC, USA.
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Areia C, Vollam S, Ede J, Young L, Piper P, King E, Watkinson P. Regulatory challenges of designing and testing continuous ambulatory vital signs monitoring in ward environments: lessons learned from the vHDU project. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.185] [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: 10/24/2022]
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Dean HF, King E, Gane D, Hocking D, Rogers J, Pullyblank A. Introduction of a care bundle effectively and sustainably reduces patient-reported surgical site infection in patients undergoing colorectal surgery. J Hosp Infect 2020; 105:156-161. [PMID: 32289384 DOI: 10.1016/j.jhin.2020.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/06/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common healthcare-associated infections and is particularly prevalent following colorectal surgery. It is associated with an increase in patient morbidity and healthcare costs. SSI is difficult to monitor as it frequently presents after discharge from hospital, especially if enhanced recovery programmes are in place. AIM To develop an effective method for measuring patient-reported 30-day SSI in patients undergoing colorectal resection. To implement a new care bundle capable of delivering a sustainable reduction in SSI. METHODS The Public Health England SSI surveillance questionnaire was used. Several data collection methods were tested including postal and telephone-based systems. A new SSI bundle was introduced in our centre incorporating four evidence-based interventions: 2% chlorhexidine skin preparation; repeat-dose antibiotics after 4 h; dual-ring wound protectors; and triclosan-coated sutures for wound closure. System changes were introduced to ensure that the change was sustainable. FINDINGS The most reliable method of measuring patient-reported SSI was found to be postal questionnaire with telephone calls made to non-responders. Response rates to the SSI surveillance questionnaire were consistently >75%. Introduction of the new care bundle produced a significant reduction in SSI from 20% to 10% (P ≤ 0.0001) which has been sustained for six years. CONCLUSION This is a reliable method for measuring 30-day patient-reported SSI rates. The introduction of this new care bundle has halved the rate of SSI from 20% to 10%.
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Affiliation(s)
- H F Dean
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK.
| | - E King
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
| | - D Gane
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
| | - D Hocking
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
| | - J Rogers
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
| | - A Pullyblank
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
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Nommsen-Rivers L, King E, Wagner E, Riddle S, Ward L, Thompson A. Reply to Letter to the Editor by Frank Nice. J Hum Lact 2020; 36:196. [PMID: 31596640 DOI: 10.1177/0890334419879116] [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] [Indexed: 11/17/2022]
Affiliation(s)
| | - Eileen King
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Erin Wagner
- University of Cincinnati, Cincinnati, OH, USA
| | | | - Laura Ward
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Clarke P, Henning J, King E, Coleman G, Schull D. What makes a great clinical team? Stakeholder perspectives on the attributes of effective veterinary health care teams in Australia. Aust Vet J 2020; 97:424-432. [PMID: 31651999 DOI: 10.1111/avj.12855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 05/26/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
Extensive research in the business and organisational literature links teamwork to enhanced productivity and employee job satisfaction. Good teamwork capability is also a highly regarded graduate attribute linked to employability. This study explored desirable teamwork attributes for veterinary technology graduates in Australia, by surveying veterinarians, veterinary technology graduates, veterinary nurses, clients and academics. Respondents highlighted the importance of seven attributes sourced from the cross-disciplinary teamwork literature-'flexibility' (in approach to work), 'agreeableness', being 'cooperative', 'socially sensitive and perceptive', 'conscientiousness', being 'accepting of others' and 'sharing professional values'. The majority in each stakeholder group viewed all attributes important for teamwork concurring with findings in other fields. Few differences were found between and within groups with veterinarians and academics rating 'conscientiousness' higher than others and female clients placing more importance on relational attributes compared to male clients. Thematic analysis of an open-ended item asking the veterinary health care groups, and veterinary academics, to define teamwork generated nine themes centred on: collaboration, goals and outcomes, sharing values, relationships, diversity, communication, task-orientation, personal attributes, and workplace culture. This study illuminates an interprofessional perspective on veterinary teamwork. Results will be useful for veterinary technology, veterinary nursing and veterinary educators when developing a curriculum for interprofessional teamwork to enhance team performance, employability and, ultimately, the quality of veterinary services.
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Affiliation(s)
- P Clarke
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - J Henning
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - E King
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - G Coleman
- Faculty of Health, Engineering & Sciences, University of Southern Queensland, Toowoomba, Australia
| | - D Schull
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
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Gore S, Franklyn-Miller A, Richter C, King E, Falvey E, Moran K. The effects of rehabilitation on the biomechanics of patients with athletic groin pain. J Biomech 2020; 99:109474. [DOI: 10.1016/j.jbiomech.2019.109474] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/12/2019] [Accepted: 10/26/2019] [Indexed: 01/29/2023]
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King E, Turner JE, Ali S, Wilkinson I. 4THE INTRODUCTION OF AN ORTHOPAEDIC CLERKING PRO-FORMA FOR PATIENTS OVER 60 YEARS OF AGE TO IDENTIFY PATIENTS WITH A HIGH CLINICAL FRAILTY SCORE REQUIRING AN ORTHOGERIATRIC INTERVENTION. Age Ageing 2019. [DOI: 10.1093/ageing/afz055.04] [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: 11/12/2022] Open
Affiliation(s)
- E King
- East Surrey Hospital, Redhill
| | | | - S Ali
- East Surrey Hospital, Redhill
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Nommsen-Rivers L, Thompson A, Riddle S, Ward L, Wagner E, King E. Feasibility and Acceptability of Metformin to Augment Low Milk Supply: A Pilot Randomized Controlled Trial. J Hum Lact 2019; 35:261-271. [PMID: 30629889 PMCID: PMC8992687 DOI: 10.1177/0890334418819465] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Metformin improves insulin action, but feasibility in treating low milk supply is unknown. RESEARCH AIM To determine the feasibility of a metformin- versus-placebo definitive randomized clinical trial in women with low milk production and signs of insulin resistance. METHODS Pilot trial criteria included: Mother 1-8 weeks postpartum (ideally 1-2 weeks), low milk production, and ≥1 insulin resistance sign; and singleton, healthy, term infant. Eligible mothers were randomly assigned 2:1 (metformin:placebo) and instructed in frequent milk removal for 28 days with option to stop at 14 days. RESULTS From 02/2015 through 06/2016, we screened 114 women, completed baseline assessments on 46, and trialed 15 (median, 36 days postpartum). Comparing metformin-assigned ( n = 10) to placebo ( n = 5), 70% versus 80% continued to day 28; peak median change in milk output was +8 versus -58 mL/24 hr ( p = .31) and 80% peaked at Day 14 for both groups; 0% versus 20% desired to continue assigned drug after study completion; 44% versus 0% reported nausea/vomiting. Post-hoc, median peak change in milk output was +22 (metformin completers, n = 8) versus -58 mL/24 hr (placebo + non-completers, n = 7, p = .07). At baseline assessment, median milk production was significantly lower in those with ( n = 31), versus those without ( n = 15) signs of insulin resistance ( p = .002). CONCLUSIONS Although results trend toward hypothesized direction, trial feasibility concerns include late enrollment and only 20% of metformin-assigned participants sustaining improved milk output to Day 28, with none perceiving metformin worthwhile. Better tools are needed to identify and treat metabolically-driven low milk production. Registered at ClinicalTrials.gov (NCT02179788) on 02/JUL/2014.
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Affiliation(s)
| | | | - Sarah Riddle
- 1 University of Cincinnati, Cincinnati, OH, USA.,2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura Ward
- 1 University of Cincinnati, Cincinnati, OH, USA.,2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Erin Wagner
- 1 University of Cincinnati, Cincinnati, OH, USA
| | - Eileen King
- 1 University of Cincinnati, Cincinnati, OH, USA.,2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Lichvar A, Tremblay S, Naik D, Lipscomb J, King E, Vinks AA, Christians U, Alloway RR. Evaluation of Clinical and Safety Outcomes Following Uncontrolled Tacrolimus Conversion in Adult Transplant Recipients. Pharmacotherapy 2019; 39:564-575. [PMID: 30892704 DOI: 10.1002/phar.2260] [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: 11/08/2022]
Abstract
PURPOSE To compare clinical and safety outcomes of transplant recipients converted between different tacrolimus formulations to those patients who remained on a single formulation in an outpatient environment. METHODOLOGY This was a single-center, retrospective cohort study at a large tertiary care medical center with an associated institutional outpatient pharmacy system. Adult transplant recipients with institutional pharmacy refill from August 1, 2009, to May 31, 2016, were assessed. Patients were allocated into four separate groups: Group (A) innovator tacrolimus (no conversion), Group (B) generic tacrolimus (no conversion), Group (C) single conversion (from innovator to single generic or from generic to innovator tacrolimus), and Group (D) multiple conversions. Index date was either the date of first tacrolimus product conversion (Groups C and D) or a pre-specified post-transplant time (Groups A and B). RESULTS Overall, 100 patients were included in the analysis, 63% were male, 62% were Caucasian, and 59% were renal transplant recipients. When compared between groups, linear trends in dose-normalized tacrolimus levels were similar in the pre-index date period (p=0.52) and in the post-index date period (p=0.08). When groups were compared individually, linear trends in dose-normalized tacrolimus levels were significantly different pre- versus post-index date for Group B (p=0.008). There were no differences in the linear trends of dose-normalized tacrolimus levels across the other groups (p>0.05 for all). After the index date, 43% of patients across all groups required tacrolimus dose modification with no differences by group (p=0.32). Allograft function and hospitalizations were similar across all groups. CONCLUSIONS Conversion between tacrolimus generic formulations has been suggested to be unsafe. This study demonstrates that switching tacrolimus products in post-transplant recipients does not alter dose-normalized tacrolimus trough concentrations, renal or hepatic function, pathology, or hospitalizations.
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Affiliation(s)
- Alicia Lichvar
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Simon Tremblay
- Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, OH.,Department of Environmental Health, Division of Epidemiology, University of Cincinnati, Cincinnati, OH
| | - Devanshi Naik
- University of Cincinnati, James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Jessi Lipscomb
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alexander A Vinks
- Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Uwe Christians
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Denver, Colorado
| | - Rita R Alloway
- Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, OH
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King E, King E, King E. Abstract No. 549 Sample adequacy and safety outcomes of small-bore needles for ultrasound-guided percutaneous biopsy of the native kidney. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.630] [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: 10/27/2022] Open
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Stojanovski K, King E, Bondikjova V, Brooks D, Mihajlov A. Avenues to address the needs of SGM in post-socialist countries: findings from Macedonia. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.150] [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)
| | - E King
- University of Michigann, Ann Arbor, USA
| | | | - D Brooks
- University of Michigann, Ann Arbor, USA
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Alsaied T, Tseng S, King E, Hahn E, Divanovic A, Habli M, Cnota J. Effect of fetal hemodynamics on growth in fetuses with single ventricle or transposition of the great arteries. Ultrasound Obstet Gynecol 2018; 52:479-487. [PMID: 29057564 DOI: 10.1002/uog.18936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/19/2017] [Accepted: 09/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES As birth weight is a critical predictor of outcome in neonates with congenital heart defect (CHD), the common problem of poor fetal growth in this population is clinically important. However, it is not well understood and the impact of fetal hemodynamics on fetal growth and birth weight in those with CHD has not been assessed. In this study, we sought to evaluate the association between combined cardiac output (CCO) and fetal middle cerebral artery (MCA) and umbilical artery (UA) pulsatility indices (PIs) and fetal growth in different subgroups of CHD, and to study the effects of fetal hemodynamics on late gestational weight gain. We hypothesized that fetuses with CHD will have lower CCO and be smaller at birth. METHODS This was a retrospective review of fetal echocardiograms from 67 fetuses diagnosed with hypoplastic left heart syndrome (HLHS, n = 30), non-HLHS single ventricle (SV) (n = 20) or dextrotransposition of the great arteries (d-TGA, n = 17), compared with normal controls (n = 42). CCO was calculated using valvar area, velocity-time integral and heart rate and indexed to estimated fetal weight. MCA- and UA-PI were calculated using systolic, diastolic and mean velocities. Fetal biometry was recorded. Regression models were used to study trends in CCO, MCA- and UA-PI and fetal biometry over gestational age. To evaluate fetal weight gain in late gestation, Z-scores of estimated fetal weight at 30 weeks and birth weight were compared. Regression analysis was used to determine the associations of CCO, indexed CCO and MCA- and UA-PI at 30 weeks with birth weight, length and head circumference Z-scores, in addition to weight gain late in gestation. The gestational age of 30 weeks was chosen based on previous studies that found evidence of poor weight gain in fetuses with CHD in late gestation, starting at around that time. RESULTS CCO increased with gestation in all four groups but the rate was slower in fetuses with HLHS and in those with SV. MCA-PI was lower in fetuses with HLHS compared with in those with non-HLHS-SV throughout gestation, suggesting different cerebral blood distribution. At the end of gestation, rate of fetal weight gain slowed in those with HLHS and in those with SV (similar to CCO curves), and head circumference growth rate slowed in all groups but controls. CCO, indexed CCO and MCA- and UA-PI did not correlate with any of the birth measurements or with weight gain late in gestation in fetuses with CHD. CONCLUSIONS We found no associations of CCO or MCA- and UA-PI with late gestational weight gain or biometry at birth in fetuses with CHD. This does not support fetal hemodynamics as the primary driver of suboptimal fetal growth in fetuses with SV. Future research could further explain genetic and placental abnormalities that may affect fetal growth in those with CHD. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T Alsaied
- Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - S Tseng
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - E King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - E Hahn
- Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - A Divanovic
- Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M Habli
- Division of Maternal Fetal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Cnota
- Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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King E, Wengreen H. Associations Between Level of Interest In Nutrition, Knowledge of Nutrition, and Prevalence of Orthorexia Traits. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.129] [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: 10/28/2022]
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Kurowski BG, Stancin T, Taylor HG, McNally KA, Kirkwood MW, Cassedy A, King E, Sklut M, Narad ME, Wade SL. Comparative effectiveness of family problem-solving therapy (F-PST) for adolescents after traumatic brain injury: Protocol for a randomized, multicenter, clinical trial. Contemp Clin Trials Commun 2018; 10:111-120. [PMID: 30023445 PMCID: PMC6046511 DOI: 10.1016/j.conctc.2018.04.001] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction The objective of this manuscript is to describe the methodology that will be used to test the comparative effectiveness, feasibility, and acceptability of three formats of family problem solving therapy (F-PST) for improving functional outcomes of complicated mild to severe adolescent TBI. Methods Three-arm comparative effectiveness, randomized clinical trial (RCT) design. We describe the protocol of a three-arm RCT comparing the effectiveness of three modalities of F-PST to reduce executive dysfunction and behavior problems following TBI in adolescence. The RCT will compare the relative effectiveness among face-to-face; online and self-directed; and therapist-supported online modes of treatment. Ethics and dissemination It is anticipated that findings from this work will inform future clinical care practices, with implications for treatment of other patient populations of youth with psychological symptoms arising from neurological conditions. Institutional review board approval will be obtained from all sites prior to commencement of the study.
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Affiliation(s)
- Brad G. Kurowski
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Corresponding author. Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 4009, Cincinnati, OH, 45229-3039, USA.
| | - Terry Stancin
- Case Western Reserve University and MetroHealth Medical Center, Cleveland Medical Center, Cleveland, OH, USA
| | - H. Gerry Taylor
- Biobehavioral Health Center, Nationwide Children's Hospital Research Institute, The Ohio State University, Columbus, OH, USA
- Case Western Reserve University, Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kelly A. McNally
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Michael W. Kirkwood
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eileen King
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - McKenna Sklut
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Megan E. Narad
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shari L. Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Nadarajan J, Benson EE, Xaba P, Harding K, Lindstrom A, Donaldson J, Seal CE, Kamoga D, Agoo EMG, Li N, King E, Pritchard HW. Comparative Biology of Cycad Pollen, Seed and Tissue - A Plant Conservation Perspective. Bot Rev 2018; 84:295-314. [PMID: 30174336 PMCID: PMC6105234 DOI: 10.1007/s12229-018-9203-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Cycads are the most endangered of plant groups based on IUCN Red List assessments; all are in Appendix I or II of CITES, about 40% are within biodiversity 'hotspots,' and the call for action to improve their protection is long-standing. We contend that progress in this direction will not be made until there is better understanding of cycad pollen, seed and tissue biology, which at the moment is limited to relatively few (<10%) species. We review what is known about germplasm (seed and pollen) storage and germination, together with recent developments in the application of contemporary technologies to tissues, such as isotype labelling, biomolecular markers and tissue culture. Whilst progress is being made, we conclude that an acceleration of comparative studies is needed to facilitate the integration of in situ and ex situ conservation programmes to better safeguard endangered cycads.
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Affiliation(s)
- J. Nadarajan
- Royal Botanic Gardens, Kew, Wakehurst Place, Ardingly, West Sussex RH17 6TN UK
- Present Address: The New Zealand Institute for Plant & Food Research Ltd, Private Bag 11600, Palmerston North, 4442 New Zealand
| | - E. E. Benson
- Damar Research Scientists, Damar, Cuparmuir, Fife, KY15 5RJ UK
| | - P. Xaba
- South African National Biodiversity Institute, Kirstenbosch National Botanical Garden, Cape Town, Republic of South Africa
| | - K. Harding
- Damar Research Scientists, Damar, Cuparmuir, Fife, KY15 5RJ UK
| | - A. Lindstrom
- Nong Nooch Tropical Botanical Garden, Chonburi, 20250 Thailand
| | - J. Donaldson
- South African National Biodiversity Institute, Kirstenbosch National Botanical Garden, Cape Town, Republic of South Africa
| | - C. E. Seal
- Royal Botanic Gardens, Kew, Wakehurst Place, Ardingly, West Sussex RH17 6TN UK
| | - D. Kamoga
- Joint Ethnobotanical Research Advocacy, P.O.Box 27901, Kampala, Uganda
| | | | - N. Li
- Fairy Lake Botanic Garden, Shenzhen, Guangdong People’s Republic of China
| | - E. King
- UNEP-World Conservation Monitoring Centre, Cambridge, UK
| | - H. W. Pritchard
- Royal Botanic Gardens, Kew, Wakehurst Place, Ardingly, West Sussex RH17 6TN UK
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