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Orkin S, Zhao X, Setchell KDR, Carr E, Arce-Clachar AC, Bramlage K, Huang R, Fei L, Beck AF, Fawaz R, Valentino PL, Xanthakos SA, Mouzaki M. Food Insecurity and Pediatric Nonalcoholic Fatty Liver Disease Severity. J Pediatr 2024; 265:113818. [PMID: 37931698 DOI: 10.1016/j.jpeds.2023.113818] [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: 06/13/2023] [Revised: 10/03/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To determine the association between food insecurity and pediatric nonalcoholic fatty liver disease (NAFLD). METHODS Cross-sectional study of patients < 21 years of age with histologically confirmed NAFLD. The Household Food Security Survey Module was administered to determine food insecurity status. Skin lipidomics were performed to explore pathophysiologic mechanisms. RESULTS Seventy-three patients with histologically confirmed NAFLD completed the Household Food Security Survey Module. Of these, the majority were male (81%) and non-Hispanic (53%), with a mean age at biopsy of 13 ± 3 years. Food insecurity was seen in 42% (n = 31). Comparison of features between food insecure and food secure subgroups revealed no differences in sex, ethnicity, BMI z-score, aminotransferases, or histologic severity. However, children experiencing food insecurity presented on average 2 years before their food secure counterparts (12.3 ± 3.0 vs 14.4 ± 3.6 years, P = .015). A subset of 31 patients provided skin samples. Skin lipidomics revealed that food insecurity was associated with down-regulated features from the lipoamino acid class of lipids, previously linked to inflammation and adipocyte differentiation. CONCLUSIONS Food insecurity is highly prevalent in children with NAFLD and is associated with earlier presentation. Lipidomic analyses suggest a possible pathophysiologic link that warrants further exploration.
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Affiliation(s)
- Sarah Orkin
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xueheng Zhao
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kenneth D R Setchell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Emily Carr
- Division of Pediatric Gastroenterology and Hepatology, Yale New Haven Children's Hospital, New Haven, CT
| | - Ana Catalina Arce-Clachar
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kristin Bramlage
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rong Huang
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lin Fei
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rima Fawaz
- Division of Pediatric Gastroenterology and Hepatology, Yale New Haven Children's Hospital, New Haven, CT; Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Pamela L Valentino
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Division of Pediatric Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Stavra A Xanthakos
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Marialena Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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Feldman AG, Beaty BL, Ferrolino JA, Maron G, Weidner HK, Ali SA, Bitterfeld L, Boulware MA, Campbell KM, Carr E, Chapman S, Chang YC, Cunningham R, Dallas RH, Dantuluri KL, Domenick BN, Ebel NH, Elisofon S, Fawaz R, Foca M, Gans HA, Gopalareddy VV, Gu C, Gupta NA, Harmann K, Hollenbeck J, Huppler AR, Jaramillo C, Kasi N, Kerkar N, Lerret S, Lobritto SJ, Lopez MJ, Marini E, Mavis A, Mehra S, Moats L, Mohandas S, Munoz FM, Mysore KR, Onsan C, Ovchinsky N, Perkins K, Postma S, Pratscher L, Rand EB, Rowe RK, Schultz D, Sear K, Sell ML, Sharma T, Stoll J, Vang M, Villarin D, Weaver C, Wood P, Woodford-Berry O, Yanni G, Danziger-Isakov LA. Safety and Immunogenicity of Live Viral Vaccines in a Multicenter Cohort of Pediatric Transplant Recipients. JAMA Netw Open 2023; 6:e2337602. [PMID: 37824141 PMCID: PMC10570873 DOI: 10.1001/jamanetworkopen.2023.37602] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/25/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Live vaccines (measles-mumps-rubella [MMR] and varicella-zoster virus [VZV]) have not been recommended after solid organ transplant due to concern for inciting vaccine strain infection in an immunocompromised host. However, the rates of measles, mumps, and varicella are rising nationally and internationally, leaving susceptible immunocompromised children at risk for life-threating conditions. Objective To determine the safety and immunogenicity of live vaccines in pediatric liver and kidney transplant recipients. Design, Setting, and Participants This cohort study included select pediatric liver and kidney transplant recipients who had not completed their primary MMR and VZV vaccine series and/or who displayed nonprotective serum antibody levels at enrollment between January 1, 2002, and February 28, 2023. Eligibility for live vaccine was determined by individual US pediatric solid organ transplant center protocols. Exposures Exposure was defined as receipt of a posttransplant live vaccine. Transplant recipients received 1 to 3 doses of MMR vaccine and/or 1 to 3 doses of VZV vaccine. Main Outcome and Measure Safety data were collected following each vaccination, and antibody levels were obtained at 0 to 3 months and 1 year following vaccination. Comparisons were performed using Mann-Whitney U test, and factors associated with development of postvaccination protective antibodies were explored using univariate analysis. Results The cohort included 281 children (270 [96%] liver, 9 [3%] kidney, 2 [1%] liver-kidney recipients) from 18 centers. The median time from transplant to enrollment was 6.3 years (IQR, 3.4-11.1 years). The median age at first posttransplant vaccine was 8.9 years (IQR, 4.7-13.8 years). A total of 202 of 275 (73%) children were receiving low-level monotherapy immunosuppression at the time of vaccination. The majority of children developed protective antibodies following vaccination (107 of 149 [72%] varicella, 130 of 152 [86%] measles, 100 of 120 [83%] mumps, and 124 of 125 [99%] rubella). One year post vaccination, the majority of children who initially mounted protective antibodies maintained this protection (34 of 44 [77%] varicella, 45 of 49 [92%] measles, 35 of 42 [83%] mumps, 51 of 54 [94%] rubella). Five children developed clinical varicella, all of which resolved within 1 week. There were no cases of measles or rubella and no episodes of graft rejection within 1 month of vaccination. There was no association between antibody response and immunosuppression level at the time of vaccination. Conclusions and Relevance The findings suggest that live vaccinations may be safe and immunogenic after solid organ transplant in select pediatric recipients and can offer protection against circulating measles, mumps, and varicella.
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Affiliation(s)
- Amy G. Feldman
- Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado and Children’s Hospital Colorado, Aurora
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado and Children’s Hospital Colorado, Aurora
| | - Brenda L. Beaty
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado and Children’s Hospital Colorado, Aurora
| | - Jose A. Ferrolino
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gabriela Maron
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Hillary K. Weidner
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Saira A. Ali
- Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | | | - Kathleen M. Campbell
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | - Shelley Chapman
- Children’s Wisconsin, Medical College of Wisconsin, Milwaukee
| | | | | | - Ronald H. Dallas
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | | | - Noelle H. Ebel
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, California
| | | | | | - Marc Foca
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York
| | - Hayley A. Gans
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, California
| | | | - Cindy Gu
- Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York
| | - Nitika A. Gupta
- Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Katherine Harmann
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, California
| | | | - Anna R. Huppler
- Children’s Wisconsin, Medical College of Wisconsin, Milwaukee
| | | | - Nagraj Kasi
- Medical University of South Carolina Shawn Jenkins Children’s Hospital, Charleston
| | - Nanda Kerkar
- Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York
| | - Stacee Lerret
- Children’s Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Steven J. Lobritto
- Children’s Hospital of New York, NewYork-Presbyterian Hospital, New York
| | | | | | - Alisha Mavis
- Levine Children’s Hospital at Atrium Health, Charlotte, North Carolina
| | - Sonia Mehra
- Intermountain Primary Children’s Hospital, Salt Lake City, Utah
| | | | | | - Flor M. Munoz
- Texan Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Krupa R. Mysore
- Texan Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Ceren Onsan
- C.S. Mott Children’s Hospital, Michigan Medicine, Ann Arbor
| | | | - Kerrigan Perkins
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Stacy Postma
- Washington University School of Medicine, St Louis, Missouri
| | - Lauren Pratscher
- Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado and Children’s Hospital Colorado, Aurora
| | | | - Regina K. Rowe
- Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York
| | | | - Katherine Sear
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, California
| | - Megan L. Sell
- Medical University of South Carolina Shawn Jenkins Children’s Hospital, Charleston
| | - Tanvi Sharma
- Boston Children’s Hospital, Boston, Massachusetts
| | - Janis Stoll
- Washington University School of Medicine, St Louis, Missouri
| | - Mychoua Vang
- Children’s Wisconsin, Medical College of Wisconsin, Milwaukee
| | | | - Carly Weaver
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Phoebe Wood
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - George Yanni
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Lara A. Danziger-Isakov
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
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3
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Matcham F, Carr E, White KM, Leightley D, Lamers F, Siddi S, Annas P, de Girolamo G, Haro JM, Horsfall M, Ivan A, Lavelle G, Li Q, Lombardini F, Mohr DC, Narayan VA, Penninx BWHJ, Oetzmann C, Coromina M, Simblett SK, Weyer J, Wykes T, Zorbas S, Brasen JC, Myin-Germeys I, Conde P, Dobson RJB, Folarin AA, Ranjan Y, Rashid Z, Cummins N, Dineley J, Vairavan S, Hotopf M. Predictors of engagement with remote sensing technologies for symptom measurement in Major Depressive Disorder. J Affect Disord 2022; 310:106-115. [PMID: 35525507 DOI: 10.1016/j.jad.2022.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Remote sensing for the measurement and management of long-term conditions such as Major Depressive Disorder (MDD) is becoming more prevalent. User-engagement is essential to yield any benefits. We tested three hypotheses examining associations between clinical characteristics, perceptions of remote sensing, and objective user engagement metrics. METHODS The Remote Assessment of Disease and Relapse - Major Depressive Disorder (RADAR-MDD) study is a multicentre longitudinal observational cohort study in people with recurrent MDD. Participants wore a FitBit and completed app-based assessments every two weeks for a median of 18 months. Multivariable random effects regression models pooling data across timepoints were used to examine associations between variables. RESULTS A total of 547 participants (87.8% of the total sample) were included in the current analysis. Higher levels of anxiety were associated with lower levels of perceived technology ease of use; increased functional disability was associated with small differences in perceptions of technology usefulness and usability. Participants who reported higher system ease of use, usefulness, and acceptability subsequently completed more app-based questionnaires and tended to wear their FitBit activity tracker for longer. All effect sizes were small and unlikely to be of practical significance. LIMITATIONS Symptoms of depression, anxiety, functional disability, and perceptions of system usability are measured at the same time. These therefore represent cross-sectional associations rather than predictions of future perceptions. CONCLUSIONS These findings suggest that perceived usability and actual use of remote measurement technologies in people with MDD are robust across differences in severity of depression, anxiety, and functional impairment.
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Affiliation(s)
- F Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - E Carr
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - K M White
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - D Leightley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - F Lamers
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - S Siddi
- Parc Sanitari Sant Joan de Déu, Fundació San Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - P Annas
- H. Lundbeck A/S, Valby, Denmark
| | - G de Girolamo
- IRCCS Instituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - J M Haro
- Parc Sanitari Sant Joan de Déu, Fundació San Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - M Horsfall
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - A Ivan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - G Lavelle
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Q Li
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | - F Lombardini
- Parc Sanitari Sant Joan de Déu, Fundació San Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - D C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventative Medicine, Northwestern University, Chicago, IL, USA
| | - V A Narayan
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | - B W H J Penninx
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - C Oetzmann
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - M Coromina
- Parc Sanitari Joan de Déu, Barcelona, Spain
| | - S K Simblett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - J Weyer
- RADAR-CNS Patient Advisory Board
| | - T Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - S Zorbas
- RADAR-CNS Patient Advisory Board
| | | | - I Myin-Germeys
- Department for Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - P Conde
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - R J B Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - A A Folarin
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Y Ranjan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Z Rashid
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - N Cummins
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - J Dineley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; EIHW - Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | - S Vairavan
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Powley N, Nesbitt A, Carr E, Hackett R, Baker P, Beatty M, Huddleston R, Danjoux G. Effect of digital health coaching on self-efficacy and lifestyle change. BJA Open 2022. [PMCID: PMC9617015 DOI: 10.1016/j.bjao.2022.100067] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- N. Powley
- South Tees NHS Hospitals, Celeveland, UK
| | - A. Nesbitt
- South Tees NHS Hospitals, Celeveland, UK
| | - E. Carr
- South Tees NHS Hospitals, Celeveland, UK
| | - R. Hackett
- South Tees NHS Hospitals, Celeveland, UK
| | - P. Baker
- South Tees NHS Hospitals, Celeveland, UK
| | | | | | - G. Danjoux
- South Tees NHS Hospitals, Celeveland, UK
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Almukhtar R, Carr E, Angra K, Lipp M, Boesn M, Goldman M. Single-Center, Prospective, Double-Blind, Evaluator-Blind, non-Randomized, Vehicle-Controlled Trial With a 1927 Nm Non-Ablative Fractionated Laser and Topical 0.05% Tretinoin Lotion for Facial Dyspigmentation and Photodamage. J Drugs Dermatol 2021; 20:1174-1179. [PMID: 34784124 DOI: 10.36849/jdd.6182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Dyspigmentation and photodamage are common concerns in patients who seek aesthetic consultation. A number of treatment modalities have been utilized to address this issue. 1927 nm thulium fiber laser is a fractionated non-ablative laser that has been shown to be safe and effective in treatment of photoaging. Topical retinoids have been used for over two decades for photoaging to promote epidermal hyperplasia and collagen synthesis and to decrease melanin production. There has been lack of data to support the combination of topical retinoids with laser treatments in the management of facial dyspigmentation and photodamage. OBJECTIVE The primary objective of this study is to evaluate the benefits and subject satisfaction resulting from use of a 1927 nm thulium fiber laser with and without 0.05% tretinoin lotion for facial dyspigmentation and photodamage. RESULTS Both groups showed a significant change in Investigator Assessed Overall Hyperpigmentation and Investigator Assessed Overall Photodamage over time (P<0.001). No statistically significant differences were seen between groups at any time point as measured by investigator reported and subject reported efficacy scales except for Subject Global Aesthetic Improvement Scale and Subject Satisfaction at 30 days after laser treatment, at which patients who received 0.05% tretinoin lotion reported a lower level of improvement (2.8 ± 0.86 in the treatment group vs 2 ± 0.85 in the vehicle group, P=0.009) and lower patient satisfaction when compared to the vehicle group (2.87 ± 1.55 in the treatment groups vs 1.53 ± 0.64 in the vehicle group, P=0.001). CONCLUSION In our study, patients tolerated the combination of 1927 nm thulium fiber laser and 0.05% tretinoin lotion well. Both groups resulted in significant reduction of hyperpigmentation and photodamage. Subject satisfaction and perceived improvement were temporarily lower at 30 days only when, combining 0.05% tretinoin lotion with 1927 nm thulium fiber laser. Future studies are needed to investigate the impact on efficacy when combining laser procedures with a longer duration of use or a higher concentration of topical tretinoin. J Drugs Dermatol. 2021;20(11):1174-1179. doi:10.36849/JDD.6182.
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6
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Drissi M, Carr E, Housewright C. Sunscreen: a brief walk through history. Proc AMIA Symp 2021; 35:121-123. [PMID: 34970060 PMCID: PMC8682817 DOI: 10.1080/08998280.2021.1966602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022] Open
Abstract
The sunscreens we see today were paved by our ancestors' sun protection methods, followed by scientific discovery in the more recent era and the trials and errors of the sunscreen formulations that followed. This history highlights sun protection methods used over the centuries and the varying degrees of agreeable sensorial properties or comforts in these methods.
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Affiliation(s)
- Madeeha Drissi
- Department of Dermatology, Baylor Scott & White Health and Texas A&M Health Science Center, Temple, Texas
| | - Emily Carr
- Department of Dermatology, Baylor Scott & White Health and Texas A&M Health Science Center, Temple, Texas
| | - Chad Housewright
- Department of Dermatology, Baylor Scott & White Health and Texas A&M Health Science Center, Temple, Texas
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7
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Loyal J, Carr E, Almukhtar R, Goldman MP. Updates and Best Practices in the Management of Facial Erythema. Clin Cosmet Investig Dermatol 2021; 14:601-614. [PMID: 34135612 PMCID: PMC8197440 DOI: 10.2147/ccid.s267203] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022]
Abstract
Facial erythema is a common dermatologic complaint. There are many medical and procedure-based treatments to help reduce the appearance of unwanted facial redness. The authors review a variety of treatment options and techniques to reduce facial erythema and prominent facial veins including topical medical therapies, a variety of lasers, light- and energy-based devices as well as the use of neuromodulators and sclerotherapy. The benefits and potential pitfalls of each procedure modality are also highlighted.
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Affiliation(s)
- Jameson Loyal
- Department of Dermatology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Emily Carr
- Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA
| | - Rawaa Almukhtar
- Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA.,Department of Dermatology, University of California, San Diego, CA, USA
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8
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Carr E. Health inequalities in the north east of England and the COVID-19 pandemic: a student's reflection. ACTA ACUST UNITED AC 2021; 30:442-443. [PMID: 33830804 DOI: 10.12968/bjon.2021.30.7.442] [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: 11/11/2022]
Affiliation(s)
- Emily Carr
- Second-year Student Nurse, Northumbria University, Newcastle
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9
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Saadi JP, Carr E, Fleischmann M, Murray E, Head J, Steptoe A, Hackett RA, Xue B, Cadar D. The role of loneliness in the development of depressive symptoms among partnered dementia caregivers: Evidence from the English Longitudinal Study of Aging. Eur Psychiatry 2021; 64:e28. [PMID: 33766187 PMCID: PMC8080187 DOI: 10.1192/j.eurpsy.2021.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Depressive symptoms are highly prevalent among partnered dementia caregivers, but the mechanisms are unclear. This study examined the mediating role of loneliness in the association between dementia and other types of care on subsequent depressive symptoms. Methods Prospective data from partnered caregivers were drawn from the English Longitudinal Study of Aging. The sample consisted of 4,672 partnered adults aged 50–70 living in England and Wales, followed up between 2006–2007 and 2014–2015. Caregiving was assessed across waves 3 (2006–2007), 4 (2008–2009), and 5 (2010–2011), loneliness at wave 6 (2012–2013), and subsequent depressive symptoms at wave 7 (2014–15). Multivariable logistic regression models were used to assess the association between caregiving for dementia and depressive symptoms compared to caregiving for other illnesses (e.g., diabetes, coronary heart disease (CHD), cancer, and stroke). Binary mediation analysis was used to estimate the indirect effects of caregiving on depressive symptoms via loneliness. Results Care for a partner with dementia was associated with higher odds of depressive symptoms at follow-up compared to those not caring for a partner at all (odds ratio [OR] = 2.6, 95% confidence intervals [CI]: 1.4, 5.1). This association was partially mediated by loneliness (34%). Care for a partner with other conditions was also associated with higher odds of depressive symptoms compared to non-caregiving partners (OR = 1.7, 95% CI: 1.2, 2.5), but there was no evidence of an indirect pathway via loneliness. Conclusion Loneliness represents an important contributor to the relationship between dementia caregiving and subsequent depressive symptoms; therefore, interventions to reduce loneliness among partnered dementia caregivers should be considered.
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Affiliation(s)
- J P Saadi
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - E Carr
- Department of Epidemiology and Public Health, University College London, London, United Kingdom.,Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - M Fleischmann
- Faculty of Science, Methodology and Applied Biostatistics, University of Amsterdam, Amsterdam, The Netherlands
| | - E Murray
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - J Head
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - A Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - R A Hackett
- Department of Behavioural Science and Health, University College London, London, United Kingdom.,Department of Psychology, King's College London, London, United Kingdom
| | - B Xue
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - D Cadar
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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10
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Metrebian N, Carr E, Goldsmith K, Weaver T, Pilling S, Shearer J, Woolston-Thomas K, Tas B, Cooper C, Getty CA, van der Waal R, Kelleher M, Finch E, Bijral P, Taylor D, Scott J, Strang J. Mobile telephone delivered contingency management for encouraging adherence to supervised methadone consumption: feasibility study for an RCT of clinical and cost-effectiveness (TIES). Pilot Feasibility Stud 2021; 7:14. [PMID: 33407950 PMCID: PMC7789356 DOI: 10.1186/s40814-020-00761-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prescription methadone or buprenorphine enables people with opioid use disorder to stop heroin use safely while avoiding withdrawal. To ensure methadone is taken as prescribed and to prevent diversion onto the illicit market, people starting methadone take their daily dose under a pharmacist's supervision. Many patients miss their daily methadone dose risking withdrawal, craving for heroin and overdose due to loss of heroin tolerance. Contingency management (CM) can improve medication adherence, but remote delivery using technology may be resource-light and cost-effective. We developed an innovative way to deliver CM by mobile telephone. Software monitors patients' attendance and supervised methadone consumption through an internet self-login at the pharmacy and sends reinforcing text messages to patients' mobile telephones. A linked system sends medication adherence reports to prescribers and provides early warning alerts of missed doses. A pre-paid debit card system provides financial incentives. METHODS A cluster randomised controlled trial design was used to test the feasibility of conducting a future trial of mobile telephone CM to encourage adherence to supervised methadone in community pharmacies. Each cluster (drug service/3 allied pharmacies) was randomly allocated to provide patient's presenting for a new episode of opiate agonist treatment (OAT) with either (a) mobile telephone text message CM, (b) mobile telephone text message reminders, or (c) no text messages. We assessed acceptability of the interventions, recruitment, and follow-up procedures. RESULTS Four drug clinics were approached and three recruited. Thirty-three pharmacists were approached and 9 recruited. Over 3 months, 173 individuals were screened and 10 enrolled. Few patients presented for OAT and high numbers were excluded due to receiving buprenorphine or not attending participating pharmacies. There was 96% consistency in recording medication adherence by self-login vs. pharmacy records. In focus groups, CM participants were positive about using self-login, the text messages, and debit card. Prescribers found weekly reporting, time saving, and allowed closer monitoring of patients. Pharmacists reported that the tablet device was easy to host. CONCLUSION Mobile telephone CM worked well, but a planned future trial will use modified eligibility criteria (existing OAT patients who regularly miss their methadone/buprenorphine doses) and increase the number of participating pharmacies. TRIAL REGISTRATION The trial is retrospectively registered, ISRCTN 58958179 .
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Affiliation(s)
- N Metrebian
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK.
| | - E Carr
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - K Goldsmith
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - T Weaver
- Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, London, NW4 4BT, UK
| | - S Pilling
- Research Department of Clinical Health and Educational Psychology, University College London, London, WC1 7HB, UK
| | - J Shearer
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - K Woolston-Thomas
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - B Tas
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - C Cooper
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - C A Getty
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - R van der Waal
- Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, SE5 8RS, UK
| | - M Kelleher
- Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, SE5 8RS, UK
| | - E Finch
- Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, SE5 8RS, UK
| | - P Bijral
- Change, Grow, Live Charity, Management Offices, M4 1NA, Manchester, UK
| | - D Taylor
- Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, SE5 8RS, UK
| | - J Scott
- University of Bath, BAA2 7AY, Bath, UK
| | - J Strang
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK.,Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, SE5 8RS, UK
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11
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Figueiredo FC, Glanville JM, Arber M, Carr E, Rydevik G, Hogg J, Okonkwo A, Figueiredo G, Lako M, Whiter F, Wilson K. A systematic review of cellular therapies for the treatment of limbal stem cell deficiency affecting one or both eyes. Ocul Surf 2021; 20:48-61. [PMID: 33412337 DOI: 10.1016/j.jtos.2020.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE This systematic review (SR) assessed the efficacy, safety and cost-effectiveness of cell-based therapy to manage limbal stem cell deficiency (LSCD), a sight-threatening orphan condition most frequently associated with severe chemical or thermal burns. LSCD has historically been treated by transplanting limbal tissue. In 1997, a new treatment, cultured limbal epithelial autografts, was described for unilateral LSCD. In cases of bilateral disease cultured autologous oral mucosa stem cells have been used. The relative efficacy of different cultured tissue procedures is unknown. METHODS A protocol was registered with PROSPERO (CRD42017081117). Searches were conducted in 14 databases and 6 conference websites. Two reviewers independently selected studies, conducted data extraction and assessed risk of bias. One reviewer extracted individual patient data (IPD); a second checked extracted data. Data were assessed to determine the feasibility of statistical analysis, with Bayesian synthesis used to estimate improvement achieved by different treatments. RESULTS Fifty-two studies were eligible for inclusion (1113 eyes); 41 studies (716 eyes) reported IPD. No evidence was identified on cost-effectiveness. This SR was unable to confirm that any of the types of ex vivo cultured stem cell transplants identified for LSCD treatment were statistically superior when assessed against the outcomes of interest. CONCLUSIONS We believe this SR is the first to include IPD analysis of LSCD data. There is no evidence for the superiority of any method of limbal stem cell transplant. Confirmation of the safety and efficacy of this treatment modality is challenging due to heterogeneity within and between the studies identified. Therefore, recommendations for future research are proposed.
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Affiliation(s)
- F C Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary and University of Newcastle, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK.
| | - J M Glanville
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, YO10 5NQ, UK
| | - M Arber
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, YO10 5NQ, UK
| | - E Carr
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, YO10 5NQ, UK
| | - G Rydevik
- Quantics Biostatistics, West End House, 28 Drumsheugh Gardens, Edinburgh, EH3 7RN, UK
| | - J Hogg
- Department of Ophthalmology, Royal Victoria Infirmary and University of Newcastle, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK
| | - A Okonkwo
- Department of Ophthalmology, Royal Victoria Infirmary and University of Newcastle, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK
| | - G Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary and University of Newcastle, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK
| | - M Lako
- Biosciences Institute, Newcastle University, International Centre for Life, Newcastle, NE1 3BZ, UK
| | - F Whiter
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, YO10 5NQ, UK
| | - K Wilson
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, YO10 5NQ, UK
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12
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Harris MO, Carr E, Shah S, Housewright CD. 18082 Use of bilobed flaps on the proximal digit for repair after Mohs micrographic surgery. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.910] [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: 10/22/2022]
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13
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Plante J, Bruce C, Carr E, Ridley S, Bird K, Van Horn L. Medical Student and Resident Physician Perceptions on Including RDNs in Outpatient Practice. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Frizzell M, Carr E, Brust K. Omadacycline for treatment of Mycobacterium chelonae skin infection. Proc AMIA Symp 2020; 33:610-611. [PMID: 33100542 DOI: 10.1080/08998280.2020.1792748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Mycobacterium chelonae can be difficult to treat because of inherent resistance to many available antimicrobials. We present a case of a multidrug-resistant M. chelonae skin infection in a 52-year-old woman who presented with a 3- to 4-week history of painful, erythematous nodules on the bilateral lower extremities. She demonstrated dramatic improvement at her 4-week follow-up on omadacycline.
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Affiliation(s)
| | - Emily Carr
- Department of Dermatology, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Karen Brust
- Department of Infectious Diseases, Baylor Scott and White Medical Center - Temple, Temple, Texas
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15
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Viana M, Rizza V, Tobías A, Carr E, Corbett J, Sofiev M, Karanasiou A, Buonanno G, Fann N. Estimated health impacts from maritime transport in the Mediterranean region and benefits from the use of cleaner fuels. Environ Int 2020; 138:105670. [PMID: 32203802 PMCID: PMC8314305 DOI: 10.1016/j.envint.2020.105670] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 05/19/2023]
Abstract
Ship traffic emissions degrade air quality in coastal areas and contribute to climate impacts globally. The estimated health burden of exposure to shipping emissions in coastal areas may inform policy makers as they seek to reduce exposure and associated potential health impacts. This work estimates the PM2.5-attributable impacts in the form of premature mortality and cardiovascular and respiratory hospital admissions, from long-term exposure to shipping emissions. Health impact assessment (HIA) was performed in 8 Mediterranean coastal cities, using a baseline conditions from the literature and a policy case accounting for the MARPOL Annex VI rules requiring cleaner fuels in 2020. Input data were (a) shipping contributions to ambient PM2.5 concentrations based on receptor modelling studies found in the literature, (b) population and health incidence data from national statistical registries, and (c) geographically-relevant concentration-response functions from the literature. Long-term exposure to ship-sourced PM2.5 accounted for 430 (95% CI: 220-650) premature deaths per year, in the 8 cities, distributed between groups of cities: Barcelona and Athens, with >100 premature deaths/year, and Nicosia, Brindisi, Genoa, Venice, Msida and Melilla, with tens of premature deaths/year. The more stringent standards in 2020 would reduce the number of PM2.5-attributable premature deaths by 15% on average. HIA provided a comparative assessment of the health burden of shipping emissions across Mediterranean coastal cities, which may provide decision support for urban planning with a special focus on harbour areas, and in view of the reduction in sulphur content of marine fuels due to MARPOL Annex VI in 2020.
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Affiliation(s)
- M Viana
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Spain.
| | - V Rizza
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino (FR), Italy
| | - A Tobías
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Spain
| | - E Carr
- Energy and Environmental Research Associates, LLC, Pittsford, NY, United States
| | - J Corbett
- College of Earth, Ocean, and Environment, University of Delaware, Newark, DE, United States
| | - M Sofiev
- Finnish Meteorological Institute (FMI), Helsinki, Finland
| | - A Karanasiou
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Spain
| | - G Buonanno
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino (FR), Italy; Queensland University of Technology, Brisbane, Australia
| | - N Fann
- Office of Air Quality Planning and Standards, U.S. Environmental Protection Agency, Washington, DC, United States
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16
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Bergden J, Immekus J, Sawning S, Carr E, Brueckner-Collins J. Neurophobia: Anxiety and Self‐Efficacy Related to Learning Neuroanatomy in a Medical Student Population. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.05807] [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: 11/11/2022]
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17
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Corbett TK, Groarke A, Devane D, Carr E, Walsh JC, McGuire BE. The effectiveness of psychological interventions for fatigue in cancer survivors: systematic review of randomised controlled trials. Syst Rev 2019; 8:324. [PMID: 31836007 PMCID: PMC6911282 DOI: 10.1186/s13643-019-1230-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 11/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase. This systematic review evaluated the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors. METHODS We searched relevant online databases and sources of grey literature. Randomised controlled trials (RCTs) evaluating psychological interventions in adult cancer patients after the completion of treatment, with fatigue as an outcome measure, were included. Two review authors extracted data independently from the selected studies and assessed the methodological quality using the Cochrane Collaboration Risk of Bias Tool. RESULTS Thirty-three psychological interventions were identified. The sample size of the included studies varied between 28 and 409, with 4525 participants overall. Twenty-three of the included studies reported a significant effect of the interventions on reducing fatigue in cancer survivors. Most interventions focused on psychoeducation, mindfulness, cognitive or behaviour therapy-oriented strategies. However, studies differed widely in terms of measurement tools used to assess fatigue, mode, duration and frequency of the intervention delivery. CONCLUSIONS This review showed some tentative support for psychological interventions for fatigue after cancer treatment. However, as the RCTs were heterogeneous in nature and the number of high-quality studies was limited, definitive conclusions are not yet possible. With the growing need for stage-specific research in cancer, this review sought to inform current practice and to summarise the existing evidence base of randomised controlled trials in the area. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42014015219.
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Affiliation(s)
- T K Corbett
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - A Groarke
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - D Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - E Carr
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - J C Walsh
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - B E McGuire
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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18
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Carr E, Joudeh L. A Young Woman With A History of Stroke and Recurrent Migraine Headaches. Mayo Clin Proc 2019; 94:1033-1034. [PMID: 31171115 DOI: 10.1016/j.mayocp.2019.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/31/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Emily Carr
- Department of Dermatology, Baylor Scott & White Health, Temple, TX; Texas A&M Health Science Center College of Medicine, Temple.
| | - Lana Joudeh
- Texas A&M Health Science Center College of Medicine, Temple
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19
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Ruseckaite R, Pekin N, King S, Carr E, Ahern S, Oldroyd J, Earnest A, Sims G, Wainwright C, Armstrong D. EPS5.07 Evaluating the impact of 2006 clinical practice guidelines for nutrition in children with cystic fibrosis in Australia. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Head J, Carr E, Stafford M, Kivimaki M, Stansfeld S. MIDLIFE PSYCHOSOCIAL WORKING CONDITIONS AND MENTAL HEALTH AS PREDICTORS OF EXIT FROM PAID WORK. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3418] [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: 11/14/2022] Open
Affiliation(s)
- J. Head
- University College London, London, United Kingdom,
| | - E. Carr
- University College London, London, United Kingdom,
| | - M. Stafford
- University College London, London, United Kingdom,
| | - M. Kivimaki
- University College London, London, United Kingdom,
| | - S. Stansfeld
- Queen Mary University of London, London, United Kingdom
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21
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Clark C, Smuk M, Lain D, Stansfeld SA, Carr E, Head J, Vickerstaff S. Impact of childhood and adulthood psychological health on labour force participation and exit in later life. Psychol Med 2017; 47:1597-1608. [PMID: 28196554 DOI: 10.1017/s0033291717000010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adulthood psychological health predicts labour force activity but few studies have examined childhood psychological health. We hypothesized that childhood psychological ill-health would be associated with labour force exit at 55 years. METHOD Data were from the 55-year follow-up of the National Child Development Study (n = 9137). Labour force participation and exit (unemployment, retirement, permanent sickness, homemaking/other) were self-reported at 55 years. Internalizing and externalizing problems in childhood (7, 11 and 16 years) and malaise in adulthood (23, 33, 42, 50 years) were assessed. Education, social class, periods of unemployment, partnership separations, number of children, and homemaking activity were measured throughout adulthood. RESULTS Childhood internalizing and externalizing problems were associated with unemployment, permanent sickness and homemaking/other at 55 years, after adjustment for adulthood psychological health and education: one or two reports of internalizing was associated with increased risk for unemployment [relative risk (RR) 1.59, 95% confidence interval (CI) 1.12-2.25; RR 2.37, 95% CI 1.48-3.79] and permanent sickness (RR 1.32, 95% CI 1.00-1.74; RR, 1.48, 95% CI 1.00-2.17); three reports of externalizing was associated with increased risk for unemployment (RR 2.26, 95% CI 1.01-5.04), permanent sickness (RR 2.63, 95% CI 1.46-4.73) and homemaking/other (RR 1.95, 95% CI 1.00-3.78). CONCLUSIONS Psychological ill-health across the lifecourse, including during childhood, reduces the likelihood of working in older age. Support for those with mental health problems at different life stages and for those with limited connections to the labour market, including homemakers, is an essential dimension of attempts to extend working lives.
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Affiliation(s)
- C Clark
- Barts & the London School of Medicine, Queen Mary University of London,London,UK
| | - M Smuk
- Barts & the London School of Medicine, Queen Mary University of London,London,UK
| | - D Lain
- Brighton Business School, University of Brighton,Brighton,UK
| | - S A Stansfeld
- Barts & the London School of Medicine, Queen Mary University of London,London,UK
| | - E Carr
- Department of Epidemiology and Public Health,University College London,London,UK
| | - J Head
- Department of Epidemiology and Public Health,University College London,London,UK
| | - S Vickerstaff
- School of Social Policy, Sociology and Social Research, University of Kent,Canterbury,UK
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22
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Reidy P, Wurie A, Barnes W, Carr E, Kamau D, Marsden D, Mundell K, Watson L, Paveley M, Sithole BL, Sekikongo TM, Johnston AM, Fletcher TE. Knowledge, attitudes and practice for Ebola virus disease in the national rapidly deployable isolation and treatment facility in Sierra Leone. J Infect 2017; 74:618-620. [PMID: 28347706 DOI: 10.1016/j.jinf.2017.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | - Alie Wurie
- Ministry of Health and Sanitation, Sierra Leone
| | | | - Emily Carr
- UK MoD Short Term Training Team, Sierra Leone
| | - David Kamau
- UK MoD Short Term Training Team, Sierra Leone
| | | | | | - Lisa Watson
- UK MoD Short Term Training Team, Sierra Leone
| | | | | | | | | | - Tom E Fletcher
- UK MoD Short Term Training Team, Sierra Leone; Liverpool School of Tropical Medicine, Liverpool, UK.
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Hamza AV, Nikroo A, Alger E, Antipa N, Atherton LJ, Barker D, Baxamusa S, Bhandarkar S, Biesiada T, Buice E, Carr E, Castro C, Choate C, Conder A, Crippen J, Dylla-Spears R, Dzenitis E, Eddinger S, Emerich M, Fair J, Farrell M, Felker S, Florio J, Forsman A, Giraldez E, Hein N, Hoover D, Horner J, Huang H, Kozioziemski B, Kroll J, Lawson B, Letts SA, Lord D, Mapoles E, Mauldin M, Miller P, Montesanti R, Moreno K, Parham T, Nathan B, Reynolds J, Sater J, Segraves K, Seugling R, Stadermann M, Strauser R, Stephens R, Suratwala TI, Swisher M, Taylor JS, Wallace R, Wegner P, Wilkens H, Yoxalla B. Target Development for the National Ignition Campaign. Fusion Science and Technology 2017. [DOI: 10.13182/fst15-163] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. V. Hamza
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - A. Nikroo
- General Atomics, La Jolla, California 92121
| | - E. Alger
- General Atomics, La Jolla, California 92121
| | - N. Antipa
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - L. J. Atherton
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - D. Barker
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - S. Baxamusa
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - S. Bhandarkar
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - T. Biesiada
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - E. Buice
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - E. Carr
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - C. Castro
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - C. Choate
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - A. Conder
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. Crippen
- General Atomics, La Jolla, California 92121
| | - R. Dylla-Spears
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - E. Dzenitis
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | | | - M. Emerich
- General Atomics, La Jolla, California 92121
| | - J. Fair
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - M. Farrell
- General Atomics, La Jolla, California 92121
| | - S. Felker
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. Florio
- General Atomics, La Jolla, California 92121
| | - A. Forsman
- General Atomics, La Jolla, California 92121
| | | | - N. Hein
- General Atomics, La Jolla, California 92121
| | - D. Hoover
- General Atomics, La Jolla, California 92121
| | - J. Horner
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - H. Huang
- General Atomics, La Jolla, California 92121
| | - B. Kozioziemski
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. Kroll
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - B. Lawson
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - S. A. Letts
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - D. Lord
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - E. Mapoles
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - M. Mauldin
- General Atomics, La Jolla, California 92121
| | - P. Miller
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - R. Montesanti
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - K. Moreno
- General Atomics, La Jolla, California 92121
| | - T. Parham
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - B. Nathan
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. Reynolds
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. Sater
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - K. Segraves
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - R. Seugling
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - M. Stadermann
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | | | | | - T. I. Suratwala
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - M. Swisher
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. S. Taylor
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - R. Wallace
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - P. Wegner
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - H. Wilkens
- General Atomics, La Jolla, California 92121
| | - B. Yoxalla
- Lawrence Livermore National Laboratory, Livermore, California 94550
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Carr E, Vahtera J, Goldberg M, Zins M, Head J. Occupational and educational inequalities in health-related exits from employment at older ages. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Carr E, Vahtera J, Goldberg M, Zins M, Head J. Occupational and educational inequalities in health-related exits from employment at older ages: evidence from 6 prospective cohorts. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw168.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Head J, Carr E, Stafford M, Kivimäki M, Stansfeld S. Mid-life psychosocial working conditions and mental health as predictors of transitions out of paid employment: a 20-year follow-up of the Whitehall II study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw168.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Youngstrom DW, Dishowitz MI, Bales CB, Carr E, Mutyaba PL, Kozloff KM, Shitaye H, Hankenson KD, Loomes KM. Jagged1 expression by osteoblast-lineage cells regulates trabecular bone mass and periosteal expansion in mice. Bone 2016; 91:64-74. [PMID: 27416809 PMCID: PMC5578473 DOI: 10.1016/j.bone.2016.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 07/05/2016] [Accepted: 07/09/2016] [Indexed: 01/20/2023]
Abstract
Loss-of-function mutations in the Notch ligand, Jagged1 (Jag1), result in multi-system developmental pathologies associated with Alagille syndrome (ALGS). ALGS patients present with skeletal manifestations including hemi-vertebrae, reduced bone mass, increased fracture incidence and poor bone healing. However, it is not known whether the increased fracture risk is due to altered bone homeostasis (primary) or nutritional malabsorption due to chronic liver disease (secondary). To determine the significance of Jag1 loss in bone, we characterized the skeletal phenotype of two Jag1-floxed conditional knockout mouse models: Prx1-Cre;Jag1(f/f) to target osteoprogenitor cells and their progeny, and Col2.3-Cre;Jag1(f/f) to target mid-stage osteoblasts and their progeny. Knockout phenotypes were compared to wild-type (WT) controls using quantitative micro-computed tomography, gene expression profiling and mechanical testing. Expression of Jag1 and the Notch target genes Hes1 and Hey1 was downregulated in all Jag1 knockout mice. Osteoblast differentiation genes were downregulated in whole bone of both groups, but unchanged in Prx1-Cre;Jag1(f/f) cortical bone. Both knockout lines exhibited changes in femoral trabecular morphology including decreased bone volume fraction and increased trabecular spacing, with males presenting a more severe trabecular osteopenic phenotype. Prx1-Cre;Jag1(f/f) mice showed an increase in marrow mesenchymal progenitor cell number and, counterintuitively, developed increased cortical thickness resulting from periosteal expansion, translating to greater mechanical stiffness and strength. Similar alterations in femoral morphology were observed in mice with canonical Notch signaling disrupted using Prx1-Cre-regulatable dominant-negative mastermind like-protein (dnMAML). Taken together, we report that 1) Jag1 negatively regulates the marrow osteochondral progenitor pool, 2) Jag1 is required for normal trabecular bone formation and 3) Notch signaling through homotypic Jag1 signaling in osteochondral progenitors, but not mature osteoblasts, inhibits periosteal expansion. Therefore, Jag1 signaling within the osteoblast lineage regulates bone metabolism in a compartment-dependent manner. Moreover, loss of Jag1 function in osteoblast lineage cells may contribute to the skeletal phenotype associated with ALGS.
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Affiliation(s)
- D W Youngstrom
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI, United States; Department of Physiology, Michigan State University, East Lansing, MI, United States
| | - M I Dishowitz
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - C B Bales
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - E Carr
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - P L Mutyaba
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - K M Kozloff
- Department of Orthopaedic Surgery, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - H Shitaye
- Medical Scientist Training Program, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - K D Hankenson
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI, United States; Department of Physiology, Michigan State University, East Lansing, MI, United States
| | - K M Loomes
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
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Gallagher NA, Clarke P, Carr E. Physical activity in older adults in a combined functional circuit and walking program. Geriatr Nurs 2016; 37:353-359. [PMID: 27344216 DOI: 10.1016/j.gerinurse.2016.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/16/2016] [Accepted: 04/25/2016] [Indexed: 11/18/2022]
Abstract
Our study examined the impact of a 16-week functional circuit/walking program on physical activity (PA) in older adults in independent-living facilities. Exploratory goals included examination of associations among self-efficacy, neighborhood and mobility. Participants (N = 13) were female (M = 77.8, SD = 7.44, range = 65-85 years). One third were African-American; the remainder Caucasian; 1/3 used assistive devices. PA increased from 70 min/week (SD = 35.51) at baseline to 81.31 min/week (SD = 34.21) at 16 weeks. PA was associated with self-efficacy for overcoming neighborhood and facility barriers to walking at all measurement points (baseline r = .73, p < .05 and r = .68, p < .05, respectively). At eight weeks, PA was associated with self-efficacy for walking duration (r = .58, p < .05), self-efficacy for individual (r = .66, p < .05), facility (r = .58, p < .05) and neighborhood (r = .70, p < .05) barriers. At sixteen weeks, physical activity was associated with balance confidence (r = .72, p < .05), and self-efficacy for individual (r = .76, p < .05), facility (r = .71, p < .05), and neighborhood (r = .80, p < .01) barriers. Functional circuit/walking interventions can increase PA in older adults. Further examination of self-efficacy, mobility, neighborhoods and PA is needed.
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Affiliation(s)
- Nancy Ambrose Gallagher
- University of Michigan School of Nursing, 400 North Ingalls, Room 3341, Ann Arbor, MI 48109, USA.
| | - Philippa Clarke
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA
| | - Emily Carr
- University of Michigan-Flint Department of Physical Therapy, Flint, MI, USA
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Memon MA, Shmalberg J, Adair HS, Allweiler S, Bryan JN, Cantwell S, Carr E, Chrisman C, Egger CM, Greene S, Haussler KK, Hershey B, Holyoak GR, Johnson M, Jeune SL, Looney A, McConnico RS, Medina C, Morton AJ, Munsterman A, Nie GJ, Park N, Parsons-Doherty M, Perdrizet JA, Peyton JL, Raditic D, Ramirez HP, Saik J, Robertson S, Sleeper M, Dyke JV, Wakshlag J. Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges. Open Vet J 2016; 6:44-56. [PMID: 27200270 PMCID: PMC4824037 DOI: 10.4314/ovj.v6i1.7] [Citation(s) in RCA: 14] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/04/2016] [Indexed: 12/13/2022] Open
Abstract
Integrative veterinary medicine (IVM) describes the combination of complementary and
alternative therapies with conventional care and is guided by the best available
evidence. Veterinarians frequently encounter questions about complementary and
alternative veterinary medicine (CAVM) in practice, and the general public has
demonstrated increased interest in these areas for both human and animal health.
Consequently, veterinary students should receive adequate exposure to the principles,
theories, and current knowledge supporting or refuting such techniques. A proposed
curriculum guideline would broadly introduce students to the objective evaluation of
new veterinary treatments while increasing their preparation for responding to
questions about IVM in clinical practice. Such a course should be evidence-based,
unbiased, and unaffiliated with any particular CAVM advocacy or training group. All
IVM courses require routine updating as new information becomes available.
Controversies regarding IVM and CAVM must be addressed within the course and
throughout the entire curriculum. Instructional honesty regarding the uncertainties
in this emerging field is critical. Increased training of future veterinary
professionals in IVM may produce an openness to new ideas that characterizes the
scientific method and a willingness to pursue and incorporate evidence-based medicine
in clinical practice with all therapies, including those presently regarded as
integrative, complementary, or alternative.
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Affiliation(s)
- M A Memon
- Department of Clinical Science, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | - J Shmalberg
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - H S Adair
- Department of Small Animal Clinical Sciences (Egger) and Department of Large Animal Clinical Sciences (Adair), College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - S Allweiler
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - J N Bryan
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - S Cantwell
- Medicine Wheel Veterinary Services, Ocala, FL, USA
| | - E Carr
- Department of Small Animal Clinical Sciences (Robertson) and Department of Large Animal Clinical Sciences (Carr), College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - C Chrisman
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - C M Egger
- Department of Small Animal Clinical Sciences (Egger) and Department of Large Animal Clinical Sciences (Adair), College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - S Greene
- Department of Clinical Science, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | - K K Haussler
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - B Hershey
- Integrative Veterinary Oncology, Phoenix, AZ, USA
| | - G R Holyoak
- Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
| | - M Johnson
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - S Le Jeune
- Veterinary Medical Teaching Hospital (Peyton) and Department of Surgical and Radiological Sciences (Le Jeune), School of Veterinary Medicine, University of California, Davis, CA, USA
| | | | - R S McConnico
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - C Medina
- Coral Springs Animal Hospital, Coral Springs, FL, USA
| | - A J Morton
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - A Munsterman
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - G J Nie
- Angel Animal Hospital, Springfield, MO, USA
| | - N Park
- Integrative Ophthalmology for Pets, Los Angeles, CA, USA
| | | | | | - J L Peyton
- Veterinary Medical Teaching Hospital (Peyton) and Department of Surgical and Radiological Sciences (Le Jeune), School of Veterinary Medicine, University of California, Davis, CA, USA
| | | | - H P Ramirez
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - J Saik
- Winterville Animal Clinic, Winterville, GA, USA
| | - S Robertson
- Department of Small Animal Clinical Sciences (Robertson) and Department of Large Animal Clinical Sciences (Carr), College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - M Sleeper
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - J Van Dyke
- Canine Rehabilitation Institute, Wellington, FL, USA
| | - J Wakshlag
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain. Health Services and Delivery Research 2013. [DOI: 10.3310/hsdr01120] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing. One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved. However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain. A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain. Specifically, it would help us understand peoples' experience of health care with the aim of improving it.AimThe aim of this study was to increase our understanding of patients’ experience of chronic non-malignant MSK pain; utilise existing research knowledge to improve understanding and, thus, best practice in patient care; and contribute to the development of methods for qualitative research synthesis.MethodsWe used the methods of meta-ethnography, which aim to develop concepts that help us to understand a particular experience, by synthesising research findings. We searched six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012. We also hand-searched particular journals known to report qualitative studies and searched reference lists of all relevant qualitative studies for further potential studies. We appraised each study to decide whether or not to include it. The full texts of 321 potentially relevant studies were screened, of which 77 qualitative studies that explored adults’ experience of chronic non-malignant MSK pain were included. Twenty-eight of these studies explored the experience of fibromyalgia.ResultsOur findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain. This included the struggle to affirm self and construct self over time; find an explanation for pain; negotiate the health-care system while feeling compelled to stay in it; be valued and believed; and find the right balance between sick/well and hiding/showing pain. In spite of this struggle, our model showed that some people were able to move forward alongside their pain by listening to their body rather than fighting it; letting go of the old self and finding a new self; becoming part of a community and not feeling like the only one; telling others about pain and redefining relationships; realising that pain is here to stay rather than focusing on diagnosis and cure; and becoming the expert and making choices. We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.ConclusionOur model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain. This study opens up possibilities for therapies that aim to help a person to move forward alongside pain. Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure. Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain. Not feeling believed can have an impact on a person’s participation in everyday life. The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice. Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain. Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it. Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience. Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain. Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- F Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Warwick, UK
| | - N Allcock
- Faculty of Medicine and Health Sciences, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK
| | - M Briggs
- Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
| | - E Carr
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | - J Andrews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Carr E, Birchall J. Suction aural snare. Clin Otolaryngol 2013; 38:360. [PMID: 23957552 DOI: 10.1111/coa.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/28/2022]
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. A meta-ethnography of patients' experience of chronic non-malignant musculoskeletal pain. Osteoarthritis Cartilage 2013. [DOI: 10.1016/j.joca.2013.02.539] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Bowes MJ, Palmer-Felgate EJ, Jarvie HP, Loewenthal M, Wickham HD, Harman SA, Carr E. High-frequency phosphorus monitoring of the River Kennet, UK: are ecological problems due to intermittent sewage treatment works failures? ACTA ACUST UNITED AC 2012; 14:3137-45. [DOI: 10.1039/c2em30705g] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
BACKGROUND Equid herpesvirus-1 (EHV-1) reactivation and shedding can occur in latently infected, asymptomatic animals. Risk factors for reactivation include stress and illness. The risk of asymptomatic shedding in hospitalized, critically ill horses with acute abdominal disease is unknown. This information is important to assess the need for additional biosecurity protocols to prevent spread of EHV-1 in hospitalized critically ill horses with acute abdominal disorders. OBJECTIVES To determine the frequency of reactivation and nasal shedding of EHV-1 in hospitalized critically ill horses. ANIMALS One hundred twenty-four client-owned horses admitted to the Veterinary Teaching Hospital with acute abdominal disorders were included in the study. METHODS Cross-sectional study examining the risk of reactivation of EHV-1 in horses admitted with acute, severe, gastrointestinal disease. Whole blood and nasal secretions were collected throughout hospitalization. In addition, mandibular lymph nodes were collected from 9 study horses and 26 other Michigan horses. All samples were tested for the presence of EHV-1 nucleic acid by real-time PCR assays targeting the glycoprotein B gene and the polymerase (ORF 30) gene. RESULTS One hundred and twenty-four horses met the inclusion criteria. None of the samples were positive for EHV-1 DNA. CONCLUSION AND CLINICAL IMPORTANCE These results suggest that nasal shedding and viremia of EHV-1 in hospitalized critically ill horses with acute abdominal disorder is extremely rare. Implementation of additional biosecurity protocols to limit aerosol spread of EHV-1 among horses with acute abdominal disease and other hospitalized horses is not necessary.
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Affiliation(s)
- E Carr
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA.
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Yamada NA, Rector LS, Tsang P, Carr E, Scheffer A, Sederberg MC, Aston ME, Ach RA, Tsalenko A, Sampas N, Peter B, Bruhn L, Brothman AR. Visualization of fine-scale genomic structure by oligonucleotide-based high-resolution FISH. Cytogenet Genome Res 2010; 132:248-54. [PMID: 21178330 DOI: 10.1159/000322717] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2010] [Indexed: 01/28/2023] Open
Abstract
The discovery of complex structural variations that exist within individual genomes has prompted a need to visualize chromosomes at a higher resolution than previously possible. To address this concern, we established a robust, high-resolution fluorescence in situ hybridization (FISH) method that utilizes probes derived from high complexity libraries of long oligonucleotides (>150 mers) synthesized in massively parallel reactions. In silico selected oligonucleotides, targeted to only the most informative elements in 18 genomic regions of interest, eliminated the need for suppressive hybridization reagents. Because of the inherent flexibility in our probe design methods, we readily visualized regions as small as 6.7 kb with high specificity on human metaphase chromosomes, resulting in an overall success rate of 94%. Two-color FISH over a 479-kb duplication, initially reported as being identical in 2 individuals, revealed distinct 2-color patterns representing direct and inverted duplicons, demonstrating that visualization by high-resolution FISH provides further insight in the fine-scale complexity of genomic structures. The ability to design FISH probes for any sequenced genome along with the ease, reproducibility, and high level of accuracy of this technique suggests that it will be powerful for routine analysis of previously difficult genomic regions and structures.
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Affiliation(s)
- N A Yamada
- Agilent Laboratories, Agilent Technologies, Santa Clara, Calif., USA.
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Abstract
Inpatient magnetic resonance imaging for evaluation of new-onset afebrile seizures can extend hospital stay, can add cost, and may not affect acute management. The study was to assess cost and impact on acute management of inpatient brain magnetic resonance imagings performed as part of new-onset seizure evaluation. Retrospective chart review of brain magnetic resonance imagings on pediatric inpatients admitted for new-onset afebrile seizure has been carried out. Seventy-five patients were identified. Seventy-one of the patients (95%) stayed an additional day for the magnetic resonance imaging. Thirteen had abnormal results. No patient had treatment changes based upon the magnetic resonance imaging results. If these magnetic resonance imagings had been done as an outpatient, the savings to the hospital could have been $215,575. Thus, obtaining an inpatient brain magnetic resonance imaging for evaluation of new-onset seizures did not lead to acute changes in management and added to facility costs and length of stay. Scheduling a magnetic resonance imaging as an outpatient could achieve cost savings without compromising care.
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Affiliation(s)
- Daniel A Rauch
- Department of Pediatrics New York University School of Medicine, New York, NY 10016, USA.
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Fahey T, Jeyaseelan S, McCowan C, Carr E, Goudie BM, Pringle SD, Donnan PT, Sullivan FM, Struthers AD. Diagnosis of left ventricular systolic dysfunction (LVSD): development and validation of a clinical prediction rule in primary care. Fam Pract 2007; 24:628-35. [PMID: 17827466 DOI: 10.1093/fampra/cmm055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Diagnosing suspected left ventricular systolic dysfunction (LVSD) in the community is a challenge for GPs. We developed and validated a clinical prediction rule (CPR) for LVSD based on history, examination and electrocardiogram (ECG). METHODS Prospective cohort studies of 458 symptomatic patients (derivation cohort) and 535 patients (validation cohort) in 26 general practices in Tayside and Fife, Scotland. All patients underwent a structured clinical examination and ECG and the 'reference standard' investigation of echocardiography to establish the presence of LVSD. RESULTS Four elements from the clinical history and examination were all independently associated with LVSD--male sex [adjusted odds ratio (OR) 2.5; 95% CI 1.1, 5.0], presence of orthopnoea (OR 5.4; 1.9, 13.8) history of myocardial infarction (OR 5.6; 2.3, 13.6) and elevated jugular venous pulsations (OR 15.1; 4.6, 49.3). Addition of ECG (OR 20.6; 2.7, 158.6) provides important diagnostic information in terms of probability of LVSD. A CPR based on the presence or absence of these five elements will generate probabilities ranging from 1% to 97% for LVSD when applied to an individual patient. In the validation cohort, the model under-predicted the probability of LVSD, particularly at lower levels of expected risk, reflecting differences in the risk-factor profiles of the derivation and validation cohorts. CONCLUSIONS The derived CPR provides quantitative estimates of post-test probability for LVSD. This rule requires further validation in other populations and settings because of the difficulties encountered in the validation cohort.
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Affiliation(s)
- T Fahey
- Division of Community Health Sciences, University of Dundee, Mackenzie Building, Dundee DD2 4BF, UK.
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Carr E, Obholzer R, Caulfield H. A prospective study to determine the incidence of atopy in children undergoing adenotonsillectomy for obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2007; 71:19-22. [PMID: 16979762 DOI: 10.1016/j.ijporl.2006.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2005] [Revised: 08/10/2006] [Accepted: 08/16/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate the relationship between adenotonsillar hypertrophy seen in pediatric obstructive sleep apnea and upper airway allergy to airborne allergens. METHODS A prospective study of Radioallergosorbent (RAST) tests to common airborne allergens in children (<16 years old) undergoing adenotonsillectomy for obstructive sleep apnea in a London Teaching Hospital. RESULTS 20.9% of patients had a positive RAST result to house dust mite, 2.8% to cat hair, 0% to mixed feather, 7.8% to mixed grass pollen and 3.8% to dog hair. CONCLUSIONS This study does not support the hypothesis that the adenotonsillar hypertrophy seen in pediatric patients with obstructive sleep apnea is contributed to by allergy to airborne allergens. It is possible that there is a localized allergic reaction in the upper respiratory tract mucosa which is not apparent on an assay of systemic IgE.
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Affiliation(s)
- E Carr
- Department of Ear, Nose & Throat Surgery, Royal Free Hospital, London, United Kingdom.
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Carr E, Jayabose S, Stringel G, Slim M, Ozkaynak MF, Tugal O, Sandoval C. The safety of central line placement prior to treatment of pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer 2006; 47:886-8. [PMID: 16200633 DOI: 10.1002/pbc.20629] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Central venous lines are placed in children with acute lymphoblastic leukemia at diagnosis, despite significant cytopenias, to facilitate the administration of chemotherapy and blood sampling. The present study aimed to determine the safety of central line placement in these patients. METHODS We reviewed the charts of 115 consecutive patients treated during a 10-year period. Data abstracted comprised age, gender, presenting and preoperative blood counts, type of central line, blood products transfused preoperatively, duration of neutropenia (absolute neutrophil count [ANC], <500/microl), treatment, and central line-associated complications. RESULTS There were 66 male and 49 female patients with a median age of 4 years. Seventy-one patients were classified as standard-risk and 44 as high-risk. Respective median blood counts at diagnosis and prior to surgery were white cell count (microl), 4,200 and 5,550; hemoglobin (g/dl), 7.7 and 9.4; platelet count (microl), 63,000 and 72,000; and ANC (microl), 3,950 and 4,900. The median duration of neutropenia was 15 days in the standard-risk group and 18 days in the high-risk group. Thirty-eight patients were not transfused preoperatively. There were no episodes of bacteremia. Seven patients (7%) with life-ports experienced a complication: in four blood could not be aspirated, two ports needed realignment, and one a wound infection developed without dehiscence. Four patients (27%) with external lines had a complication: one each with line occlusion, accidental removal by patient, line rupture, and line leakage at insertion site. The complication rate between ports and external lines was different (P = 0.045). CONCLUSIONS Central line placement prior to anti-leukemia treatment is safe. Most complications are mechanical and not due to leukemia, chemotherapy, or cytopenias.
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Affiliation(s)
- Emily Carr
- Department of Pediatrics, New York Medical College, Valhalla, New York 10595, USA
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